MO301RITUXIMAB FOR RELAPSING MEMBRANOUS NEPHROPATHY: A SPANISH HOSPITAL EXPERIENCE

Abstract Background and Aims B cell targeting agent Rituximab has been proven to be effective and safe for the treatment of idiopathic membranous nephropathy (iMN) in previous studies with nearly 75% achievement of partial or complete remission of nephrotic syndrome. The aim of this study was to evaluate this treatment in a cohort of patients at Complejo Hospitalario de Navarra with relapsing disease. Method This is a retrospective, cross sectional study including 12 patients with membranous nephropathy diagnosed by means of a kidney biopsy. All of them were treated before with different immunosuppressive regimens and had a relapse at the time of the inclusion. All of them were treated with two iv infusions of Rituximab. In this study we report patient clinical and immunological baseline characteristics and treatment response at 12 months of follow up. Results Between 2015-20 a total of 12 patients (41,6% women and 58,3% men) were treated with two iv infusions of Rituximab with a total mean dose of 2gr. All of them diagnosed previously of iMN, and 10/12 were PLA2r positive. Baseline laboratory data showed serum creatinine levels 1,3±0,9 mg/dl, serum albumin 29±9 g/L, 24 hour- urinary protein excretion of 6,8±3,2 and serum PLA2R levels of 50,54±63,2 RU/ml. Either complete or partial response (CR and PR) were achieved in 83,3% of the cases, however only 3/12 (25%) patients had a complete response at 12 months follow up. All patients who responded had also a significative decrease PLA2r antibodies. Three of the patients who did a PR were treated with an incomplete dose of iv Rituximab (two infusions of 500mg). Conclusion Rituximab was effective in our cohort of patients with iMN with achievement of 83,3% response at 12 months of follow up, however only 25% of patients had complete response maybe due to incomplete dosing. Immunological response was seen in all patients. Still, a longer follow up of these patients is needed in order to evaluate Rituximab response.

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Epidemiology Data of Ovarian Cancer in Dr. Cipto Mangunkusumo Hospital, Jakarta

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v4i2.84 ◽

2016 ◽

pp. 101

Author(s):

Fransisca Noela ◽

Kartiwa H Nuryanto

Keyword(s):

Ovarian Cancer ◽

Survival Rate ◽

Adjuvant Chemotherapy ◽

Neoadjuvant Chemotherapy ◽

Complete Response ◽

Cross Sectional Study ◽

Cross Sectional ◽

Epidemiology Data ◽

Gynecology Oncology

Objective: To describe the incidence of ovarian cancer and its characteristic in Dr. Cipto Mangunkusumo Hospital in the last 5 years. Method: This was cross sectional study design. The data was collected from Gynecology Oncology Division Cancer Registry and Dr. Cipto Mangunkusumo Hospital medical record from January 2009 to December 2013; follow up was performed to know the 4-years survival rate. Result: There were 98 subjects in this study. The majority incidence of ovarian cancer was 45-54 years old (33.6%); the incidence of ovarian cancer decreased with the increased number of parity; the majority histotype was epithelial (76.5%); and most of them were diagnosed on advanced stage (55.1%). The 4-year survival rate for epithelial type was 77%; germinal type was 83.3%; and stromal type was 100%. Based on therapy, the 4-year survival rate was 84.1% for surgical only; 83.3% in adjuvant chemotherapy group; and 68.4% in neoadjuvant chemotherapy. In the group of adjuvant chemotherapy, there was 63% patients with complete response and 41.2% patients with complete response in neoadjuvant chemotherapy. Conclusion: The highest incidence of ovarian cancer in Dr. Cipto Mangunkusumo Hospital belongs to the age of reproductive women (≤ 55 years old) with the highest incidence occurs in nulliparity women. Most of the ovarian cancer cases are diagnosed in advanced stage (stage III-IV). [Indones J Obstet Gynecol 2016; 4-2: 101-106] Keywords: age, histotype, ovarian cancer, parity, response, stage, survival, treatment

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Hearing Outcome of Stapes Surgery in NIENT, Bangladesh

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v26i1.47950 ◽

2020 ◽

Vol 26 (1) ◽

pp. 31-36

Author(s):

Md Zakaria Sarkar ◽

AHM Ferdows Nur ◽

Utpal Kumar Dutta ◽

Muhammad Rafiqul Islam ◽

Debabrota Roy ◽

...

Keyword(s):

Hearing Loss ◽

Cross Sectional Study ◽

Surgical Trauma ◽

Group 14 ◽

Progressive Hearing Loss ◽

Cross Sectional ◽

Hearing Gain ◽

Hearing Outcome

Objective: The aim of this study was to evaluate hearing outcome after stapedotomy in patients with Otosclerosis. Methods: This cross sectional study was carried out from July 2017 to January 2019 in National Institute of ENT, Unit V. About 22 patients with Otosclerosis were included in this study. Diagnosis of Otosclerosis was based on the history, medical status with Otoscopy, Tuning fork tests and Audiometric tests. We compiled data on the pre and post operative air-bone gap (ABG) at 0.5, 1, 2 KHZ. The ABG was Calculated using AC and BC thresholds on the same audiogram. Post operative hearing gain was then Calculated from the ABG before the operation minus the ABG of the last follow up examination Results: In this study most of the cases were age group 14-30 years (72.7%), female (54.5%). Most common symptoms was progressive hearing loss, tinnitus (77.8%).The average preoperative hearing loss in this study was (AC) was 48.31±7.68. The average post opt. hearing (AC) at follow up was 28.95±10.30 with an average hearing gain of 15.40±8.53 dB which was significant. The average pre-operative ABG was 28.99 dB ± 8.10. The average post opt. ABG was analyzed at 1 follow up showed ABG 13.18±8.09 dB which was found to be significant. Conclusion: Stapedotomy is an effective surgical procedure for the treatment of otosclerosis which leads to improvement in patient’s quality of life. A favorable hearing outcome can be obtained by the combination of experienced hands with minimal surgical trauma and appropriate surgical technique. Bangladesh J Otorhinolaryngol; April 2020; 26(1): 31-36

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EFFICACY OF TREATMENT OF H.PYLORI EARDICATION WITH STANDARD TRIPLE THERAPY IN PEPTIC ULCER PATIENTS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.3.17 ◽

2011 ◽

pp. 122-129

Author(s):

Quang Di Bui ◽

Phuoc Lam Nguyen

Keyword(s):

Peptic Ulcer ◽

Adverse Effects ◽

Triple Therapy ◽

Cross Sectional Study ◽

Cross Sectional ◽

Duodenal Ulcers ◽

Ulcer Disease ◽

Intention To Treat ◽

Standard Triple Therapy

Objectives: The aim of study is to evaluate the efficacy, tolerability and adverse effects of a standard triple therapy including Rabeprazole, Clarithromycin and Amoxicilline at Sai gon Hoan My hospital in order to consider treatment H.pylori for patients who have not yet eradicated before or need to be undertaked by alternative regimens. Methods: By descriptive cross-sectional study, the authors have examined 116 patients sufferring from peptic ulcer received 10-day therapy including Rabe (20mg b.d) plus Clari(500mg b.d) plus Amoxi(1g b.d). Eradication is confirmed with endoscopy after 4 weeks from completing of treatment. Results and Discussion: 100% of patients were initially included and noboby was dropped out of the follow-up satges. The mean age was 49 in which 62% was male, 73(62,9%) presented duodenal ulcer, 28(24,1%) gastric ulcer and 15(13%) simultaneous gastric and duodenal ulcers. All patients took medications correctly. Per-protocol and intention to treat eradication rates were both 75%(95% CI=73,4-78,3). Additionally, 62(53,4%) patients had at least one risky factor for peptic ulcer disease, smoking being the most common one 44(37,9%).The adverse effects were reported overall in 67% of the patients, mainly including changed taste, very bitter, tired 49%, trouble sleeping 12% and diarrhea 5%. Conclusion: this ten-day standard triple therapy used in this study is ineffective with high adverse effects.The first line eradication with new regimens should be alternative.

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Etiologies, Clinical Manifestations, and Factors Associated with Severe Symptomatic Hyponatremia among Hospitalized Hyponatremia Patients

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.05.10937 ◽

2020 ◽

Vol 103 (5) ◽

pp. 465-471

Keyword(s):

Clinical Manifestations ◽

Cross Sectional Study ◽

Hospitalized Patients ◽

Sectional Study ◽

Close Attention ◽

Cross Sectional ◽

Factors Associated ◽

Present Cross Sectional Study ◽

Important Health ◽

Baseline Characteristics

Background: Hyponatremia is associated with unfavorable outcomes in many cases. The mainstay of hyponatremia treatment depends on its symptoms and etiology. However, etiologies, clinical manifestations, and factors associated with severe symptomatic hyponatremia have been rarely reported. Objective: To analyze and report etiologies, clinical manifestations, and factors associated with severe symptomatic hyponatremia. Materials and Methods: In the present cross-sectional study, the authors enrolled hospitalized patients with hyponatremia who had consulted a nephrologist between October 1, 2017, and October 31, 2018. Their baseline characteristics and clinical manifestations were recorded. Etiologies were confirmed by the attending nephrology staff. Factors associated with severe symptomatic hyponatremia were evaluated using logistic regression analysis. Results: One hundred patients were included in this study. The syndrome of inappropriate antidiuresis (SIAD), hypovolemia, and hydrochlorothiazide use were the leading hyponatremia etiologies. Hyponatremia etiologies differed between patients with community-acquired hyponatremia (n=50) and those with hospital-associated hyponatremia (n=50). Patients with communityacquired hyponatremia were older, presented with a higher frequency of severe symptomatic hyponatremia, and showed lower SNa-levels. Low SNa-levels were significantly associated with severe symptomatic hyponatremia (p=0.014). Conclusion: Hyponatremia remains an important health problem. SIAD, hypovolemia, and hydrochlorothiazide use are among the leading etiologies of hyponatremia. Low SNa-levels are associated with severe symptomatic hyponatremia; thus, physicians should pay close attention to low SNa-levels in hospitalized patients. Keywords: Hyponatremia, Symptomatic Hyponatremia, Community-acquired hyponatremia, Hospital-associated hyponatremia

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Predictors of loss to follow-up in art experienced patients in Nigeria: a 13 year review (2004–2017)

AIDS Research and Therapy ◽

10.1186/s12981-019-0241-3 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

Ahmad Aliyu ◽

Babatunde Adelekan ◽

Nifarta Andrew ◽

Eunice Ekong ◽

Stephen Dapiap ◽

...

Keyword(s):

Patient Adherence ◽

Cross Sectional Study ◽

Emergency Plan ◽

Cross Sectional ◽

Loss To Follow Up ◽

Viral Loads ◽

Review Period ◽

Lost To Follow Up ◽

Differentiated Care

Abstract Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.

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The causes of infertility in women presenting to gynaecology clinics in Harare, Zimbabwe; a cross sectional study

Fertility Research and Practice ◽

10.1186/s40738-020-00093-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Mugove G. Madziyire ◽

Thulani L. Magwali ◽

Vasco Chikwasha ◽

Tinovimba Mhlanga

Keyword(s):

Assisted Reproduction ◽

Cross Sectional Study ◽

Male Factor ◽

Cross Sectional ◽

Unprotected Sexual Intercourse ◽

Assisted Reproduction Techniques ◽

Public Facilities ◽

Tubal Blockage ◽

Private And Public

Abstract Background Infertility affects 48.5 million couples globally. It is defined clinically as failure to conceive after 12 months or more of regular unprotected sexual intercourse. The contribution of various aetiological factors to infertility differs per population. The causes of infertility have not been assessed in Zimbabwe. Our objectives were to determine the reproductive characteristics, causes and outcomes of women presenting for infertility care. Methods A retrospective and prospective study of women who had not conceived within a year of having unprotected intercourse presenting in private and public facilities in Harare was done. A diagnosis was made based on the history, examination and results whenever these were deemed sufficient. Data was analysed using STATA SE/15. A total of 216 women were recruited. Results Of the 216 women recruited, two thirds (144) of them had primary infertility. The overall period of infertility ranged from 1 to 21 years with an average of 5.6 ± 4.7 years whilst 98 (45.4%) of the couples had experienced 2–4 years of infertility and 94 (43.5%) had experience 5 or more years of infertility. About 1 in 5 of the women had irregular menstrual cycles with 10 of them having experienced amenorrhoea of at least 1 year. Almost half of the participants (49%) were overweight or obese. The most common cause for infertility was ‘unexplained’ in 22% of the women followed by tubal blockage in 20%, male factor in 19% and anovulation in 16%. Of the 49 (22.7%) women who conceived 21(9.7%) had a live birth while 23 (10.7%) had an ongoing pregnancy at the end of follow up. Thirty-seven (17.1%) had Assisted Reproduction Techniques (ART) in the form of Invitro-fertilisation/Intracytoplasmic Sperm Injection (IVF/ICSI) or Intra-Uterine Insemination (IUI). Assisted Reproduction was significantly associated with conception. Conclusion Most women present when chances of natural spontaneous conception are considerably reduced. This study shows an almost equal contribution between tubal blockage, male factor and unexplained infertility. Almost half of the causes are female factors constituted by tubal blockage, anovulation and a mixture of the two. Improved access to ART will result in improved pregnancy rates. Programs should target comprehensive assessment of both partners and offer ART.

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The association between clinical laboratory data and chest CT findings explains disease severity in a large Italian cohort of COVID-19 patients

BMC Infectious Diseases ◽

10.1186/s12879-021-05855-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Simone Canovi ◽

◽

Giulia Besutti ◽

Efrem Bonelli ◽

Valentina Iotti ◽

...

Keyword(s):

Clinical Laboratory ◽

Laboratory Data ◽

Organ Damage ◽

Cross Sectional Study ◽

Chest Ct ◽

Arterial Oxygen ◽

Emergency Rooms ◽

Cross Sectional ◽

Ct Findings ◽

Patient Prognosis

Abstract Background Laboratory data and computed tomography (CT) have been used during the COVID-19 pandemic, mainly to determine patient prognosis and guide clinical management. The aim of this study was to evaluate the association between CT findings and laboratory data in a cohort of COVID-19 patients. Methods This was an observational cross-sectional study including consecutive patients presenting to the Reggio Emilia (Italy) province emergency rooms for suspected COVID-19 for one month during the outbreak peak, who underwent chest CT scan and laboratory testing at presentation and resulted positive for SARS-CoV-2. Results Included were 866 patients. Total leukocytes, neutrophils, C-reactive protein (CRP), creatinine, AST, ALT and LDH increase with worsening parenchymal involvement; an increase in platelets was appreciable with the highest burden of lung involvement. A decrease in lymphocyte counts paralleled worsening parenchymal extension, along with reduced arterial oxygen partial pressure and saturation. After correcting for parenchymal extension, ground-glass opacities were associated with reduced platelets and increased procalcitonin, consolidation with increased CRP and reduced oxygen saturation. Conclusions Pulmonary lesions induced by SARS-CoV-2 infection were associated with raised inflammatory response, impaired gas exchange and end-organ damage. These data suggest that lung lesions probably exert a central role in COVID-19 pathogenesis and clinical presentation.

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Association of breastfeeding and risk of metabolic syndrome and its components in postmenopausal parous women: Korea national health and nutrition examination survey (2010 ~ 2016)

Archives of Public Health ◽

10.1186/s13690-021-00607-2 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Jusuk Lee ◽

Taehong Kim

Keyword(s):

Metabolic Syndrome ◽

Laboratory Data ◽

Multivariate Logistic Regression Analysis ◽

Density Lipoprotein ◽

Cross Sectional Study ◽

Korean Women ◽

Cross Sectional ◽

Increased Risk ◽

Nationally Representative ◽

Study Participants

Abstract Background Understanding the relationship between breastfeeding (BF) and metabolic syndrome (Mets) is important for maternal long-term health benefits and disease prevention. This study aimed to examine the association between BF and Mets and its components among postmenopausal parous Korean women. Methods This cross-sectional study on 10,356 Korean women used nationally representative data from the KNHANES from 2010 to 2016. Anthropometric, laboratory data and manual BP were measured. A multivariate logistic regression analysis was conducted to examine the association of BF with Mets and its components after adjusting for potential confounding variables. A p-value < 0.05 was to be considered statistically significant. Results Mets was present in 42% of the study participants. The BF group had low household income and education level. The prevalence of Mets in the BF group was higher than that in the non-BF group (42.69% vs. 34.76%, p < 0.001). BF was associated with increased risk of Mets (odds ratio [OR]: 1.4, 95% confidence interval [CI]: 1.18–1.65, p < 0.001). The BF group was at higher risks for diabetes (OR: 1.5, 95%CI: 1.14–1.98), hypertension (OR: 1.32, 95%CI: 1.03–1.68), hypertriglyceridemia (OR: 1.42, 95%CI: 1.02–1.99) and low high-density lipoprotein cholesterol (OR: 1.32, 95%CI: 1.06–1.65). Conclusion In this study, BF did not affect decreasing the prevalence of Mets and its components.

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Vitamin D and Hospital Admission in Older Adults: A Prospective Association

Nutrients ◽

10.3390/nu13020616 ◽

2021 ◽

Vol 13 (2) ◽

pp. 616

Author(s):

Avril Beirne ◽

Kevin McCarroll ◽

James Bernard Walsh ◽

Miriam Casey ◽

Eamon Laird ◽

...

Keyword(s):

Older Adults ◽

Vitamin D ◽

Hospital Admission ◽

Cross Sectional Study ◽

Vitamin D Supplementation ◽

Inverse Association ◽

Cross Sectional ◽

Prospective Association ◽

Randomised Controlled

The health effects of vitamin D are well documented, with increasing evidence of its roles beyond bone. There is, however, little evidence of the effects of vitamin D on hospitalisation among older adults. This study aimed to prospectively determine the relationship of vitamin D status in older adults with hospital admission and emergency department (ED) attendance. Trinity University of Ulster Department of Agriculture (TUDA) is a large cross-sectional study of older adults with a community population from three disease-defined cohorts (cognitive dysfunction, hypertension, and osteoporosis). Participants included in this analysis were recruited between 2008 and 2012. ED and hospital admission data were gathered from the date of TUDA participation until June 2013, with a mean follow up of 3.6 years. Of the 3093 participants, 1577 (50.9%) attended the ED during the period of follow-up. Attendees had lower mean serum 25(OH)D concentrations than non-attendees (59.1 vs. 70.6 nmol/L). Fully adjusted models showed an inverse association between vitamin D and ED attendance (Hazard Ratio (HR) 0.996; 95% Confidence Interval (CI) 0.995–0.998; p < 0.001). A total of 1269 participants (41%) were admitted to hospital during the follow-up. Those admitted had lower mean vitamin D concentrations (58.4 vs. 69.3 nmol/L, p < 0.001). In fully adjusted models, higher vitamin D was inversely associated with hospital admission (HR 0.996; 95% CI 0.994–0.998; p < 0.001) and length of stay (LOS) (β = −0.95, p = 0.006). This study showed independent prospective associations between vitamin D deficiency and increased hospitalisation by older adults. The need for further evaluation of current recommendations in relation to vitamin D supplementation, with consideration beyond bone health, is warranted and should focus on randomised controlled trials.

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Chemotherapy-induced peripheral neuropathy: longitudinal analysis of predictors for postural control

Scientific Reports ◽

10.1038/s41598-021-81902-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jana Müller ◽

Charlotte Kreutz ◽

Steffen Ringhof ◽

Maximilian Koeppel ◽

Nikolaus Kleindienst ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Peripheral Nerve ◽

Postural Control ◽

Action Potentials ◽

Exercise Intervention ◽

Cross Sectional Study ◽

Nerve Function ◽

Cross Sectional ◽

Peripheral Nerve Function

AbstractImpaired postural control is often observed in response to neurotoxic chemotherapy. However, potential explanatory factors other than chemotherapy-induced peripheral neuropathy (CIPN) have not been adequately considered to date due to primarily cross-sectional study designs. Our objective was to comprehensively analyze postural control during and after neurotoxic chemotherapy, and to identify potential CIPN-independent predictors for its impairment. Postural control and CIPN symptoms (EORTC QLQ-CIPN20) were longitudinally assessed before, during and three weeks after neurotoxic chemotherapy, and in three and six months follow-up examinations (N = 54). The influence of peripheral nerve function as determined by nerve conduction studies (NCS: compound motor action potentials (CMAP) and sensory action potentials (SNAP)), physical activity, and muscle strength on the change in postural control during and after chemotherapy was analyzed by multiple linear regression adjusted for age and body mass index. Postural control, CIPN signs/symptoms, and CMAP/SNAP amplitudes significantly deteriorated during chemotherapy (p < .01). During follow-up, patients recovered from postural instabilities (p < .01), whereas CIPN signs/symptoms and pathologic NCS findings persisted compared to baseline (p < .001). The regression model showed that low CMAP and high SNAP amplitudes at baseline predicted impairment of postural control during but not after chemotherapy. Hence, pre-therapeutically disturbed somatosensory inputs may induce adaptive processes that have compensatory effects and allow recovery of postural control while CIPN signs/symptoms and pathologic peripheral nerve function persist. Baseline NCS findings in cancer patients who receive neurotoxic chemotherapy thus might assist in delineating individual CIPN risk profiles more precisely to which specific exercise intervention programs could be tailor-made.

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