scholarly journals AB0378 UPGRADING THERAPY STRATEGY IMPROVES PREGNANCY OUTCOME IN ANTIPHOSPHOLIPID SYNDROME: A COHORT MANAGEMENT STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1489.1-1489
Author(s):  
A. Hoxha ◽  
M. Favaro ◽  
A. Calligaro ◽  
T. Del Ross ◽  
A. T. Ruffatti ◽  
...  
Keyword(s):  
Pregnancy Complications ◽  
Treatment Strategies ◽  
Evidence Based ◽  
Efficacy And Safety ◽  
Live Births ◽  
Pregnancy Morbidity ◽  
Group I ◽  
History Of ◽  
Group Ii ◽  
Evidence Based Guidelines

Background:While it is generally agreed that pregnant APS patients should receive personalized treatment, evidence-based guidelines for these patients continue to be lacking.Objectives:The current study was designed as a management cohort study aiming to evaluate the efficacy and safety of different treatment strategies for pregnant APS patients in the attempt to provide some practical suggestions for attending physicians.Methods:One-hundred-twenty-seven consecutive pregnancies were assessed; 87 (68.5%) with a history of pregnancy morbidity alone were treated with prophylactic low molecular weight heparin (LMWH)+low-dose aspirin (LDA, 100 mg) [Group I] and 40 (31.5%) with a history of thrombosis and/or severe pregnancy complications with therapeutic LMWH+LDA [Group II]. LMWH doses were increased throughout the pregnancies depending on the patients’ weight gain, and treatment was switched to a more intensive one at the first sign of maternal/fetal complications. The study’s primary outcome was live births.Results:There were no significant differences in live birth rate between Group I (95.4%) and Group II (87.5%). Even, fetal complication rate was similar in the two groups; the Group II nevertheless had a higher prevalence of maternal and neonatal complications (p=0.0005 and p=0.01, respectively) and registered a significantly lower gestational age at delivery and birth weight (p=0.0001 and p=0.0005, respectively). Two patients in Group I switched to Group II therapy, six patients in Group II switched to a more intensive treatment strategy (weekly plasma exchange+ fortnightly intravenous immunoglobulins in addition to therapeutic LMWH+LDA). Comparison of the clinical and laboratory characteristics between patients who had shifted to a more intensive therapy and those who did not showed a significant prevalence of history of thrombosis ± pregnancy morbidity (p=0.02, OR 5.96, 95% CI 1.33-26.62) previous pregnancy complications (p=0.02, OR 8.32, 95% CI 1.67-41.3), triple aPL positivity (p <0.0001, OR 97.13, 95% CI 10.6-890) and pregnancy complications (p<0.0001, OR 197,7, 95% CI 10.57-3699) in upgrading group, instead single aPL positivity significantly prevailed (p=0.003, OR 0.06, 95% CI 0.008-0.58) in non-upgrading group. Logistic regression analysis demonstrated that triple aPL positivity was an independent factor for switching to a more effective therapy protocol (p <0.0001, OR 98, 95% CI 10.7-897.54). All eight switched patients achieved a live birth.Conclusion:Using adjusted LMWH doses and upgrading therapy at the first signs of pregnancy complications led to a high rate of live births in a relatively large group of APS patients. The study outlines the criteria for prescribing appropriate therapy for various subsets of these patients and for switching/upgrading the treatment protocol when it is no longer sufficient. Unfortunately, for the moment there are no evidence-based guidelines on the ideal additional treatment in refractory to conventional therapy APS patients. The present results will hopefully help point the direction of future clinical trials investigating the efficacy and safety of the different therapies on large numbers of APS pregnant patients in order to identify the benefits and limits of different treatment strategies administered from the beginning of pregnancy.Disclosure of Interests:Ariela Hoxha Speakers bureau: Celgene, UCB, Novartis, Sanofi, Werfen, Maria Favaro: None declared, Antonia Calligaro: None declared, Teresa Del Ross: None declared, Alessandra Teresa Ruffatti: None declared, Chiara Infantolino: None declared, Marta Tonello: None declared, Elena Mattia: None declared, Amelia Ruffatti: None declared

scholarly journals Upgrading Therapy Strategy Improves Pregnancy Outcome in Antiphospholipid Syndrome: A Cohort Management Study

2019 ◽  
Vol 120 (01) ◽  
pp. 036-043 ◽  
Author(s):  
Ariela Hoxha ◽  
Maria Favaro ◽  
Antonia Calligaro ◽  
Teresa Del Ross ◽  
Alessandra Teresa Ruffatti ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Live Birth ◽  
Pregnancy Complications ◽  
Intensive Therapy ◽  
Live Births ◽  
Therapy Strategy ◽  
Group I ◽  
Study Results ◽  
History Of ◽  
Group Ii

AbstractThe current study evaluates the efficacy and safety of different treatment strategies for pregnant patients with antiphospholipid syndrome. One hundred twenty-seven consecutive pregnancies were assessed; 87 (68.5%) with a history of pregnancy morbidity alone were treated with prophylactic low molecular weight heparin (LMWH) + low-dose aspirin (LDA, 100 mg) (group I) and 40 (31.5%) with a history of thrombosis and/or severe pregnancy complications with therapeutic LMWH + LDA (group II). LMWH doses were increased throughout the pregnancies depending on the patients' weight gain, and treatment was switched to a more intensive one at the first sign of maternal/fetal complications. The study's primary outcome was live births. There were no significant differences in live birth rate between group I (95.4%) and group II (87.5%). Even fetal complication rate was similar in the two groups; group II nevertheless had a higher prevalence of maternal and neonatal complications (p = 0.0005 and p = 0.01, respectively) and registered a significantly lower gestational age at delivery and birth weight (p = 0.0001 and p = 0.0005, respectively). Two patients in group I switched to group II therapy, six patients in group II switched to a more intensive treatment strategy (weekly plasma exchange + fortnightly intravenous immunoglobulins in addition to therapeutic LMWH + LDA). The multivariate analysis uncovered that triple antiphospholipid antibodies positivity was an independent factor leading to a more intensive therapy. All eight switched patients achieved a live birth. Study results revealed that adjusted LMWH doses and switching therapy at first signs of severe pregnancy complications led to a high rate of live births in antiphospholipid syndrome patients.

scholarly journals TO STUDY THE ONSET AND PROGRESSION OF AIRWAY ABNORMALITY IN TERMS OF ALTERATION IN PFT IN ASYMPTOMATIC SMOKERS.

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Hitesh Kumar Solanki ◽  
Dr. Omnath P Yadav ◽  
Dr. Anita J Gojiya
Keyword(s):  
Lung Function ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Group I ◽  
Significant Difference ◽  
History Of ◽  
Young Smokers ◽  
The Mean ◽  
Group Ii

The study was conducted in department of physiology, B J Medical College, Ahmedabad from Mar. 2012 to Feb. 2013. This was a cross-sectional study to evaluate the effect of smoking on lung   function and serum lipids in asymptomatic smokers   and comparable non   smokers. The mean of the various spirometric parameters were calculated of the subjects for both the groups. The mean FVC in group I and group II was 2.60 ± 0.62 L and 4.10 ± 0.64L respectively. The mean FEV1 in group I was 1.91 ± 0.57L and     3.19 ± 0.77L in group II Group I had mean FEF25% - 75% and PEFR of 1.98 ± 0.67L/sec and 4.50 ± 1.57L/sec respectively. Group II had mean FEF25 – 75% of 4.22 ± 1.23L/sec and a mean PEFR of 7.22 ± 1.42L/sec. In young smokers and asymptomatic, still the spirometric values were significantly deranged as compared to controls. Even smokers with history of less pack years of smoking also had significant abnormalities of lung function. All he spirometric values in the two groups had statistically highly significant difference and were higher in non-smokers as compared to smokers. The spirometric values were reduced in smokers with history of smoking for as low as two pack years. Keywords: Progression, PFT, Asymptomatic & Smokers

Incidence of Post-Thrombotic Syndrome Following Asymptomatic Thrombosis in Survivors of Childhood Acute Lymphoblastic Leukemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1631-1631
Author(s):  
Stefan Kuhle ◽  
Maria Spavour ◽  
Jacqueline Halton ◽  
Patricia Massicotte ◽  
Irene Cherrick ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Group I ◽  
Arm Circumference ◽  
History Of ◽  
Group Ii

Abstract BACKGROUND: Asymptomatic deep venous thrombosis (DVT) are well-known complications of treatment of acute lymphoblastic leukemia (ALL) in children. However, the clinical significance of radiographically detected, asymptomatic DVT is unclear and controversial, as there are no studies on long-term outcome of asymptomatic DVT in children available. There are two likely reasons for the studies not being done in this area. First, there is a lack of defined cohorts of pediatric patients screened for DVT and secondly, there is a great deal of difficulty in following patients over many years. The study, Prophylaxis with Antithrombin Replacement in Kids with ALL treated with L-Asparaginase (PARKAA) was a multicentre randomized controlled trial in which children with ALL were screened for DVT. As survivors of childhood cancer, the PARKAA cohort continues to be followed in their respective centers. Therefore, establishment of the PARKAA cohort (1997–99) and the ability to locate these patients provided a unique opportunity to study the long-term outcome of asymptomatic DVT. OBJECTIVE: To assess the incidence of PTS in children with ALL who previously had an asymptomatic DVT. The objective were approached in two ways. Firstly, to assess the outcome of asymptomatic DVT by determining the prevalence of PTS in children with a history of ALL with radiographically diagnosed DVT (PARKAA cohort); secondly, to corroborate the findings by determining the prevalence of PTS in an unselected group of survivors of childhood ALL. METHODS: Cross-sectional study in two separate populations: Group I comprised of children enrolled in the PARKAA multicentre study who had been screened for, and diagnosed with, DVT in the upper venous system. Group II consisted of non-selected patients &lt; 21 years with a history of ALL followed at Stollery Children’s Hospital, Edmonton. Patients were invited for a follow-up at their treatment centre (Group I) or were assessed for PTS childhood cancer survivor clinic (Group II). PTS was assessed by two of the investigators (Group I) or by the attending oncologist (Group II), respectively, using a standardized scoring sheet. RESULTS: Group I: 13 PARKAA patients with a history of ALL and objectively diagnosed DVT were assessed for PTS (4 males; median age 11.9 years; median age at diagnosis of ALL 4.4 years). 7/13 patients had PTS (54%, 95%CI 25;81). All patients with PTS had collaterals on examination, 3 also had increased arm circumference. Group II: 41 patients with a history of ALL were enrolled (61% males; median age at diagnosis 3.0 years; 28% high-risk, 67% standard risk). Mean length of follow-up since diagnosis was 9.5 years. PTS was diagnosed in 10/41 (24%; 95%CI 11–38) patients. All patients with PTS had collaterals on examination, 5 (50%) also had increased arm circumference. CONCLUSIONS: There is a clinically significant prevalence of PTS in children with a history of ALL and radiographically diagnosed DVT. A significant proportion of survivors of ALL develop PTS, indicating previously undiagnosed DVT in this population.

scholarly journals Evolutionary History of the GH3 Family Based on 48 Sequenced Plants and Identification of Jasmonic Acid-Relate GH3 Genes in Solanum tuberosum

2018 ◽  
Author(s):  
Chao Zhang ◽  
Leilei Zhang ◽  
Dongdong Wang ◽  
Haoli Ma ◽  
Bailin Liu ◽  
...  
Keyword(s):  
Solanum Tuberosum ◽  
Evolutionary History ◽  
Group Iii ◽  
Biotic Stresses ◽  
Conserved Sequence ◽  
Group I ◽  
Meja Treatment ◽  
History Of ◽  
Group Ii ◽  
Family Based

Glycoside Hydrolase 3 (GH3) is a phytohormone-responsive family of genes that has been found in many plant species. It is implicated in the biological activity of indolacetic (IAA) and jasmonic acids (JA), and also affects plant growth and developmental processes and some stresses. In this study, GH3 genes were identified in 48 plants, which belong to algae, moss, fern, gymnosperm and angiosperm. No GH3 representative gene has been found in algae, and our research identified 4 genes in mosses, 19 in ferns, 7 in gymnosperms, and numerous in Angiosperms. The results showed that GH3 genes mainly occur in seed plants. Phylogenetic analysis of all GH3 genes showed three separate clades. Group I was related to JA adenylation, group II was related to IAA adenylation, and group III was separated from group II but the function was not clear. The structure of GH3 protein indicated highly conserved sequence in the plant kingdom. The analysis of JA-adenylation related to gene expression of GH3 in potato (Solanum tuberosum) showed that StGH3.12 highly responded to Methyl Jasmonate (MeJA) treatment. Expression levels of StGH3.1, StGH3.11, and StGH3.12 were high in flower and StGH3.11 expression was also high in stolon. Our research revealed the evolution of the GH3 family, which is useful for studying the precise function about JA-adenylation GH3 genes in S. tuberosum under development and biotic stresses.

scholarly journals Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding

2008 ◽  
Vol 45 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Severino Marcos Borba de Arruda ◽  
Victorino Spinelli Toscano Barreto ◽  
Fernando José do Amaral
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Variceal Bleeding ◽  
Collateral Circulation ◽  
Past History ◽  
Duplex Sonography ◽  
Group I ◽  
History Of ◽  
Group Ii ◽  
Upper Gastrointestinal

BACKGROUND: Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson’s schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. AIMS: To evaluate duplex sonography findings in patients with hepatosplenic Manson’s schistosomiasis with and without upper gastrointestinal variceal hemorrhage. METHODS: A cross-sectional study was performed whereby 27 consecutive patients with hepatosplenic Manson’s schistosomiasis were divided into two groups: group I (six men and six women; mean age 48.7 years) with a past history of bleeding and group II (four men and eight women; mean age 44.7 years) without a past history of upper gastrointestinal bleeding, underwent duplex sonography examination. All patients underwent the same upper gastrointestinal endoscopy and laboratory examinations. Those with signs of mixed chronic liver disease or portal vein thrombosis (three cases) were excluded. RESULTS: Group I showed significantly higher mean portal vein flow velocity than group II (26.36 cm/s vs 17.15 cm/sec). Although, as a whole it was not significant in all forms of collateral vessels (83% vs 100%), there was a significantly higher frequency of splenorenal collateral circulation type in group II compared with group I (17% vs 67%). The congestion index of the portal vein was significantly lower in group I than in group II (0.057 cm vs 0.073 cm/sec). CONCLUSION: Our duplex sonography findings in hepatosplenic Manson’s schistosomiasis support the idea that schistosomotic portal hypertension is strongly influenced by overflow status, and that collateral circulation seems to play an important role in hemodynamic behavior.

scholarly journals Renal Sympathetic Denervation by Image-Guided Percutaneous Ethanol Injection – Histopathologic Characteristics, Efficacy and Safety

2020 ◽  
Vol 192 (06) ◽  
pp. 549-560
Author(s):  
Patrick Freyhardt ◽  
Patrick Haage ◽  
Anna Walter ◽  
Birgit Aufmesser-Freyhardt ◽  
Rolf W. Guenther ◽  
...  
Keyword(s):  
Renal Denervation ◽  
Percutaneous Ethanol Injection ◽  
Renal Tissue ◽  
Renal Sympathetic Denervation ◽  
Efficacy And Safety ◽  
Ethanol Injection ◽  
Contralateral Kidney ◽  
Image Guided ◽  
Group I ◽  
Group Ii

Purpose Evaluation of the efficacy and safety of chemical renal denervation by image-guided periarterial ethanol injection in pigs with emphasis on histopathological characteristics. Materials and Methods Unilateral renal periarterial ethanol injection under general anesthesia was performed in 16 animals with the contralateral kidney serving as the control. All interventions were performed in an open MRI system under real-time multiplanar guidance. In 10 pigs an ethanol-carbostesin contrast agent mixture was injected with amounts of 5 ml (6 animals, group I) and 10 ml (4 animals, group II). 6 pigs (group III) were treated with 10 ml of an ethanol-polyacrylic (2 %) mixture. Four weeks after treatment, all animals underwent MRI including MRA. After euthanasia, macroscopic and histologic examination of the kidneys, renal arteries and periarterial tissue was performed to assess nerve injury and potential side effects. Furthermore, the norepinephrine concentration (RTNEC) in the renal tissue was determined as a surrogate parameter of efficacy. Results Histologic signs of nerval degeneration with various degrees of severity and circumferential distribution were found in all groups. Injury depths ranged up to 7.6 mm. In groups II and III the nerve count was significantly lower on the treated side. Renal artery stenosis was not observed in any pig. In all pigs of group II treatment resulted in neural degeneration with a mean RTNEC reduction of 53 % (p < 0.02). In groups I and III significant changes in RTNEC were not observed. Conclusion Image-guided percutaneous periarterial ethanol injection was efficient and safe for renal denervation. The detected variations in histologic outcome underlined the importance of the preclinical optimization of the technique in order to maximize treatment effects in humans. Key Points: Citation Format

Efficacy and safety of sofosbuvir plus daclatasvir with or without ribavirin in treatment of Egyptian patients infected with chronic HCV (Single Centre Study)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Shaker ◽  
Heba Abdella ◽  
Zeinab hefny
Keyword(s):  
General Hospital ◽  
Cross Sectional Study ◽  
World Health ◽  
Combination Regimen ◽  
Efficacy And Safety ◽  
Cross Sectional ◽  
Group I ◽  
Egyptian Patients ◽  
Group Ii ◽  
Chronic Hcv

Abstract Background and aim As indicated by the World Health Organization (WHO), Egypt is positioned as the country with the world’s highest prevalence of Hepatitis C virus (HCV). The current study was designed to describe the efficacy and safety of Sofosbuvir plus Daclatasvir with or without Ribavirin in treatment of chronic HCV in a cohort of Egyptian patients who were referred to the viral hepatitis unit in El -Fayoum general hospital. Methods This is a prospective descriptive cross sectional study that describes the effect of 12 weeks of daily Sofosbuvir (SOF) 400 mg plus Daclatasvir (DCV) 60 mg with or without ribavirin (RBV) with dose adjustment if indicated. It included 200 patients that fulfilled the inclusion and exclusion criteria and treated in El -Fayoum general hospital, El-Fayoum, Egypt. Results In the current study, concerning viral response, SVR12 rate was achieved by 92.5% in the overall patients (185/200); by 98% (98/100) in group I, and by 87% (87/100) in group II. Concerning safety and tolerability, The main adverse effects recorded during and after 12 weeks of treatments were fatigue (46%), (66%); headache (24%), (40%); gastrointestinal upset (15%), (43%); and nausea (10%), (15%) in group 1 and group 2, respectively. Only one female patient in group II developed HCC. All patients completed treatment till the end of course. Conclusion The current study suggested that treatment of SOF plus DCV with/without RBV for chronic HCV patients in Egypt was generally safe, well tolerated, and of high efficacy, reflecting the antiviral potency and high resistance barrier of the combination regimen.

Abstract 14995: Family History of Coronary Artery Disease in Patients With Vasospastic Angina: What Does it Mean Clinically?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hiroki Teragawa ◽  
Chikage Oshita ◽  
Yuichi Orita
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Stenosis ◽  
Coronary Risk Factors ◽  
Coronary Risk ◽  
Chemical Parameters ◽  
Group I ◽  
History Of ◽  
Group Ii ◽  
Artery Disease

Introduction: It has been reported that a family history of coronary artery disease (FH-CAD) is one of the coronary risk factors for CAD with organic coronary stenosis (o-CAD). Hypothesis: However, the indication for FH-CAD in patients with vasospastic angina (VSA) is yet to be fully elucidated. Therefore, we investigated the frequency of FH-CAD in patients with VSA and examined the clinical characteristics of patients with VSA with FH-CAD. Methods: A total of 78 patients with VSA diagnosed by coronary angiography and spasm provocation test (SPT) were included. Patients with cardiomyopathies, long QT syndrome, or Brugada syndrome, were excluded. On SPT, VSA was defined as >90% narrowing of coronary artery in response to acetylcholine accompanied with chest symptoms and/or ST- T changes on ECG. Each patient was interviewed about their FH-CAD, and its presence was defined as having known CAD and sudden cardiac death affecting first-degree relatives. According to the presence of FH-CAD, patients with VSA were classified into the two groups: Group I, with FH-CAD; and Group II, without FH-CAD. Conventional risk factors, blood chemical parameters, vascular function, including flow-mediated dilation (FMD) and nitroglycerin-induced dilation (NID), duration of angina, were checked. Furthermore, the frequency of FH-CAD was checked in 161 patients with o-CAD (≥50% coronary stenosis) and 69 patients without o-CAD or VSA (non-CAD) . Results: Group I and Group II comprised 17 (21%) and 61 patients (79%), respectively. The frequency of FH-CAD in patients with VSA was not significantly different between o-CAD and non-CAD groups (17% vs. 16%). The conventional coronary risk factors, blood chemical parameters, and FMD (3.2 ± 3.1%, vs. 3.4 ± 3.8%) were not significantly different between Group I and Group II. In contrast, NID and duration of angina were significantly higher in Group I than in Group II, (18.2 ± 9.1% vs. 14.0 ± 5.2%; 52 ± 15 months vs. 16 ± 7 months, respectively; both p < 0.05). Conclusions: These findings suggest that the FH-CAD is associated with the duration of angina and abnormal vascular smooth muscle function. Thus, FH-CAD may provide clinically important information regarding the activity and the possible mechanism, even in patients with VSA.

scholarly journals A COMPARATIVE STUDY OF EFFICACY AND SAFETY AMONG METFORMIN WITH SITAGLIPTIN, METFORMIN WITH VOGLIBOSE, AND METFORMIN WITH GLIMEPIRIDE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

2017 ◽  
Vol 10 (12) ◽  
pp. 313
Author(s):  
Kala P ◽  
Jamuna Rani R ◽  
Kumar Js
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Plasma Glucose ◽  
P Value ◽  
Efficacy And Safety ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Objective: Type 2 diabetes mellitus (DM) is a most common metabolic disorder. The present study aimed to compare the efficacy and safety among metformin with sitagliptin, metformin with voglibose, and metformin with glimepiride in patients with type 2 DM. Methods: This study was a prospective, randomized clinical trial study, conducted in patients attending the diabetology outpatient department of SRM Medical College Hospital and Research Center, Potheri, Kancheepuram, Tamil Nadu, from January 2013 to January 2014. The patients were randomized into three groups with 40 patients in each group. Fasting plasma glucose (FPG), 2 hrs postprandial plasma glucose (PPG), and hemoglobin A1c (HbA1c) level were assessed in all the patients before starting the treatment. In Group I, patients were prescribed metformin 500 mg with sitagliptin 50 mg, in Group II, patients were given metformin 500 mg with voglibose 0.2 mg, and in Group III, patients were put on metformin 500 mg with glimepiride 1 mg in the fixed combination. The outcome of the therapy was based on the level of improvement in the blood parameters. Results: There was a significant reduction of FPG level seen in all three groups (p value - Group I <0.0001, Group II < 0.005, and Group III <0.0001). Group I and III showed significant reduction of PPG with p value <0.0001. There was a significant reduction of HbA1c seen in all the three groups (p<0.0001). Conclusion: From the results of this study, it could be concluded that all the three groups were comparable in their efficacy.

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