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The Nature of Affect
Published in A. O. Mahendran, Moments of Rupture: The Importance of Affect in Medical Education and Surgical Training, 2019
I pick out a small glass dish containing a wonderfully aromatic crème brûlée, the vanilla and cinnamon are heavenly. I think back to three months ago when Julian Martino walked onto this same ward: disbelief, trepidation, wonder at the prospect of an impending liver transplant. Since then, one complication after another has weakened him and made his ‘new’ liver a hostile implant. He is presently in a state of acute organ rejection. For the second time in 12 weeks. The effects are florid and pernicious. A strong cocktail of anti-rejection drugs has eaten away at his tissues and destroyed his innate defences against disease. I perch on the edge of his bed, teetering on a precipice holding only dessert.
Pharmacotherapeutic considerations in solid organ transplant patients with COVID-19
Published in Expert Opinion on Pharmacotherapy, 2020
Simin Dashti-Khavidaki, Keyhan Mohammadi, Hossein Khalili, Azin Abdollahi
Prophylactic administration of antiviral agents or prophylactic reduction of immunosuppressive therapy to prevent COVID-19 in SOT patients is not suggested. Continuing immunosuppressive drugs with the lowest effective dose/therapeutic blood levels is suggested in patients with mild to moderate COVID-19. In SOT patients with moderate to severe COVID-19 such as those with hypoxemia, a respiratory rate more than 30 breaths per minute, the presence of pulmonary infiltrates on chest imaging or sepsis, the discontinuation of antimetabolites (mycophenolate or azathioprine) and perhaps mTOR inhibitors is suggested. In these patients, CNIs with the lowest therapeutic concentration can be continued. Due to the risk of adrenal insufficiency, steroids are suggested to be continued in SOT recipients who had been taking steroids in their maintenance immunosuppression regimen. In SOT patients with moderate to severe COVID-19 who are at high risk for acute organ rejection and who were planning to hold antiproliferative agents, switching from mTOR inhibitors to CNIs may be considered. SARS-CoV-2 can be associated with respiratory distress syndrome, acute kidney injury, acute heart failure, or elevated liver enzymes. It may be hard to differentiate COVID-19 associated organ failure and allograft rejection without tissue biopsy. In these situations, intravenous immunoglobulins may be the safest treatment for both COVID-19 and allograft rejection.
Novel strategies for the diagnosis and treatment of scleritis
Published in Expert Review of Ophthalmology, 2021
Melis Kabaalioğlu Güner, Ankur Mehra, Wendy M. Smith
Daclizumab is a humanized IGG monoclonal antibody that specifically binds CD25 of the human interleukin-2 (IL-2) receptor that is expressed on activated T lymphocytes. It was FDA approved for prophylaxis of acute organ rejection in patients receiving renal transplants. A study reported that one of two patients with scleritis had improvement in inflammation with DAC and no adverse effects were recorded [165]. In 2018, the worldwide marketing and distribution of DAC was voluntarily discontinued due to safety concerns. Basiliximab, another IL-2 receptor antagonist approved for prophylaxis of solid organ rejection, is still commercially available, but there are no studies of its efficacy in ocular inflammatory disease.