scholarly journals POS0140 URATE-LOWERING THERAPY REDUCES NON-EPISODIC FOOT PAIN IN PATIENTS WHO FAIL TO MEET ACR/EULAR 2015 GOUT CLASSIFICATION CRITERIA: AN EFFECT PREDICTED BY ULTRASOUND

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 282.1-282
Author(s):  
R. Flood ◽  
C. Kirby ◽  
Y. Alammari ◽  
D. Kane ◽  
R. Mullan
Keyword(s):  
Early Stage ◽  
Serum Urate ◽  
Classification Criteria ◽  
Disease Classification ◽  
Foot Pain ◽  
Cross Sectional ◽  
Baseline Serum ◽  
First Metatarsophalangeal Joint ◽  
Lowering Therapy ◽  
Significant Difference

Background:Emerging evidence that the joints of asymptomatic hyperuricaemic individuals contain monosodium urate (MSU) deposits and that alternative presentations of foot pain occur in hyperuricaemia suggests that preclinical phases may occur prior to a first episodic gout attack. (1) This case–control study evaluates urate deposition in hyperuricaemic individuals not fulfilling the current gout classification criteria, as well as a potential therapeutic role for urate lowering therapy (ULT).Objectives:To investigate whether ULT reduces non-episodic foot pain in patients who fail to meet ACR/EULAR 2015 gout classification criteria.Methods:Following informed consent, hyperuricaemic individuals with persistent, non-episodic foot pain (n=53) not fulfilling ACR/EULAR 2015 gout classification criteria, were compared with asymptomatic hyperuricaemic controls (n=18). Ultrasound (US) of bilateral first metatarsophalangeal (MTP) joints and features of MSU deposition including double contour (DC) sign, tophus and juxta-articular erosion were recorded. Cases only were treated with febuxostat or allopurinol daily for 6 months. Serum urate, 24-hour and 7-day visual analogue score (VAS) 0–100 mm pain scales and the Manchester Foot Pain and Disability Index (MFPDI) were recorded before treatment and after 3 and 6 months. MTP Ultrasound was repeated after a minimum of 6 months on treatment.Results:53 hyperuricaemic individuals with persistent, non-episodic foot pain not meeting the ACR/EULAR 2015 gout classification criteria were recruited. At baseline MTP US DC sign, erosion and tophus occurred in 62.5%, 20.8% and 49% of cases, respectively. No US features of gout occurred in controls. No significant difference was seen in baseline serum urate between cases (481±14 mg/dL) versus controls (437±14; p=NS). Serum urate in cases fell at 3 months (325±25; p<0.01) and 6 months (248±19; p<0.01). For cases, baseline 24-hour pain VAS (46±3.9) reduced at 3 months (32±4.1; p<0.05) and 6 months (21±5.2; p<0.05) of ULT. The 7-day pain VAS (59±3.9) decreased at 3 months (35±4.5; p<0.05) and 6 months (30±5.3; P<0.05). MFPDI (17±1.4) decreased at 3 month (13±1.8; p=<0.05) and 6 months (11±2.2; p=<0.05). When cases were grouped according to the presence (N=33) or absence (N=18) of DC sign on baseline US, no differences were observed for baseline pain scores. Following ULT however, 24-hour pain VAS were significantly lower in DC positive patients at 3 months (22±4.48 DC positive vs 42±6.14 DC negative; p<0.05) and 6 months (12.±5.4 vs 33±8.4; p<0.05). The 7-day pain VAS were significantly lower in DC positive patients at 3 months (23±4.6 vs 47±6.6; p<0.05) and MFDPI were significantly lower in DC positive patients at 3 months (10±1.9 DC positive vs 19±2.9 DC negative; p<0.05).Conclusion:These findings indicate that persistent, non-episodic foot pain in hyperuricaemia is both associated with US features of MSU deposition and is responsive to ULT. Symptomatic hyperuricaemia occurring prior to episodic gout therefore represents an earlier or alternative disease presentation. Changes to the ACR/ EULAR classification criteria to include non-episodic foot pain in the presence of US features of gout may increase the sensitivity of disease classification at an early stage, leading to improved future treatment strategies and long-term outcomes.References:[1]Stewart S, Dalbeth N, Vandal AC, Rome K. Characteristics of the first metatarsophalangeal joint in gout and asymptomatic hyperuricaemia: A cross-sectional observational study. J Foot Ankle Res. 2015;8(1):1–8.Disclosure of Interests:None declared

scholarly journals A single-centre experience of febuxostat as a second-line urate-lowering therapy

2021 ◽  
Vol 16 (1) ◽  
pp. 50-55
Author(s):  
Swee Gaik Ong ◽  
Hui Jen Ding
Keyword(s):  
Serum Creatinine ◽  
Significant Proportion ◽  
Serum Urate ◽  
Oxidase Inhibitor ◽  
Equal Proportion ◽  
Second Line ◽  
Cross Sectional ◽  
Xanthine Oxidase Inhibitor ◽  
Lowering Therapy ◽  
Significant Difference

Introduction: The purpose of this study was to describe the local experience in terms of drug efficacy and safety using a new xanthine oxidase inhibitor, febuxostat, as a second-line urate lowering therapy (ULT) in gout patients with normal renal function and chronic kidney disease. Methods: This cross-sectional study included all gout patients who attended the rheumatology clinic from January 2013 to June 2018 and had received febuxostat as a second-line ULT. Analysis focused on the proportion of gout patients who achieved target serum urate (sUA) of <360 μmol/L, duration taken to achieve target sUA, and febuxostat dosage at achievement of target sUA. Safety assessments included comparison of serum creatinine, estimated glomerular filtration rate (eGFR), and serum alanine aminotransferase (ALT) at baseline, at achievement of target sUA, and at 12-monthly intervals. Results: Majority (90.9%) of patients achieved target sUA. Median duration required to achieve target sUA was 5.5 months with IQR (interquartile range) of 8.5. Five (22.7%) patients achieved target sUA within one month of therapy with febuxostat 40 mg per day. Eleven (55%) patients achieved target sUA within six months and 16 (80%) by 12 months. Equal proportion of patients achieved target sUA with febuxostat 40 mg per day and 80 mg per day, respectively. There was no significant difference in the changes in serum creatinine level, eGFR and ALT from baseline and at achievement of target sUA, nor at 12-monthly intervals throughout the duration of febuxostat therapy. Apart from three patients who developed hypersensitivity reactions to febuxostat, no other adverse events were reported. Conclusion: A significant proportion of gout patients with CKD managed to achieve target sUA with a lower dose of febuxostat at 40 mg per day and it is reasonable to maintain this dose for up to six months before considering dose escalation.

scholarly journals Phosphatase Regenerating Liver3 and ECadherin Expression in Epithelial Ovarian Cancer

2017 ◽  
pp. 170-175
Author(s):  
Risma Maharani ◽  
Syahrul Rauf ◽  
Rina Masadah
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Early Stage ◽  
Cross Sectional Study ◽  
Teaching Hospitals ◽  
Advanced Stage ◽  
Cross Sectional ◽  
Exact Test ◽  
Significant Difference ◽  
E Cadherin

Objective: To determine the expression of Phosphatase Regenerating Liver-3 (PRL-3) and E-Cadherin in the epithelial ovarian cancer on various stages and differentiation grades. Method: This was a cross-sectional study design conducted at Obstetrics and Gynecology Department of several teaching hospitals, Faculty of Medicine Universitas Hasanuddin from January to June 2015. The expression of PRL-3 and E-cadherin was assessed immunohistochemically in 40 patients with epithelial ovarian cancer including 15 patients in early stage and 25 patients in advanced stage. We used the Fisher’s exact test with the significance of p0.05). The significant difference was found in the expression of E-cadherin whereas the high expression was shown at early stage than advanced stage (p0.05). This study also pointed out no correlation between the expression of PRL-3 and E-cadherin in epithelial ovarian cancer (p>0.05). Conclusion: PRL-3 overexpression does not decrease E-cadherin expression in epithelial ovarian cancer. Keywords: E-cadherin, epithelial ovarian cancer, PRL-3

scholarly journals The Effect of Side Effects Tuberculosis Treatment in the Early Stage Towards Compliance with Tuberculosis Patients

2021 ◽  
Vol 5 (01) ◽  
pp. 29-32
Author(s):  
Joko Sapto Pramono ◽  
Nilam Noorma ◽  
Andi Lis Arming Gandini ◽  
Sopia Fitriani
Keyword(s):  
Side Effects ◽  
Pulmonary Tuberculosis ◽  
Health Workers ◽  
Early Stage ◽  
Treatment Compliance ◽  
Tuberculosis Treatment ◽  
Cross Sectional ◽  
Tuberculosis Patients ◽  
Early Stages ◽  
Significant Difference

Pulmonary tuberculosis treatment causes various side effects including nausea and vomiting, itching, vision problems, and anemia. Drug side effects in the early stages are one of the causes of non-adherence to complete treatment. The purpose of this study was to analyze the effect of the side effects Tuberculosis treatment in the early stages on treatment compliance for tuberculosis patients. This study used a cross sectional design. Samples were taken as many as 71 respondents, the instruments used were side effects of early-stage tuberculosis treatment and compliance with tuberculosis treatment in tuberculosis patients from the Morisky Medication Adherence Scale (MMAS). The results of the study found 97.7% adherent and 2.3% non-adherent, 39.5% mild side effects and 60.5% severe side effects. Chi-square test showed that no significant difference between the side effects of TB treatment in the early stages of tuberculosis treatment compliance in patients p = 0.669 at significant level of 95% (α = 0.05). There was no effect between the side effects of Tuberculosis treatment in the early stages of treatment compliance for Tuberculosis patients. It was recommended that health workers continue to monitor the side effects of tuberculosis treatment and provide motivation to carry out treatment completely. Keywords: side effects; early stage; treatment; pulmonary tuberculosis; compliance

scholarly journals A Study to Determine the Frequency Rate of Scoliosis Disorder and Compare the Anthropometric Characteristics of Normal versus the Scoliosis Diagnosed Students

2016 ◽  
Vol 8 (9) ◽  
pp. 288
Author(s):  
Gholamreza Khosravi ◽  
Mohammad Reza Sharif ◽  
Erfan Khosravi ◽  
Fatemeh Kardan ◽  
Hamed Haddad Kashani ◽  
...  
Keyword(s):  
Early Stage ◽  
Cross Sectional Study ◽  
Bending Test ◽  
School Students ◽  
Cross Sectional ◽  
Significant Difference ◽  
Anthropometric Characteristics ◽  
Spss Software ◽  
The City ◽  
Test Result

<p><strong>INTRODUCTION: </strong>Postural deformities are commonly acquired disorders that occur throughout the life. The purpose of this research was to determine and compare the frequency of scoliosis disorder and anthropometric characteristics of normal versus the disordered Students.</p><p><strong>MATERIALS AND METHODS:</strong> This was a cross-sectional study that was performed on 1416 girls and boys of elementary school students in the city of Kashan in education year 2010-2011. Adams bending test was employed to examine 1416 students to identify the disorder. Seca scale was employed to measure weight and inflexible tape was used to measure the height of students. SPSS software was employed to analyze the data. </p><p><strong>RESULTS: </strong>The result of analysis showed that 63.8 percent of students were boys and 36.2 percent were girls. The frequency of scoliosis in boys and girls was 29.8 and 24.2 percent, respectively. Independent t-test result showed that there was a significant difference between the height and weight of normal versus the scoliosis identified boys and girls student (P=0.004, 0.031; 0.0001, 0.041).</p><p><strong>CONCLUSION:</strong> These types of studies are conducted regularly to identify poor postural cases at an early stage. The identification of acquired deformities at an early stage is important since it provides the opportunity to take the appropriate measures to correct them.  Early identification of scoliosis is vital to maximize effectiveness of treatment.</p>

scholarly journals COMPARISON OF CURRENT SARCOPENIA CLASSIFICATION CRITERIA IN OLDER NEW ENGLAND WOMEN

2017 ◽  
pp. 1-5
Author(s):  
S.G. Slezak ◽  
K.B Mahoney ◽  
E.N. Renna ◽  
I.E. Lofgren ◽  
F. Xu ◽  
...  
Keyword(s):  
Working Group ◽  
Bioelectrical Impedance ◽  
Impedance Analysis ◽  
Classification Criteria ◽  
Community Dwelling ◽  
Self Report ◽  
Cross Sectional ◽  
European Working ◽  
Significant Difference ◽  
Distribution Frequency

Objectives: To evaluate the prevalence of sarcopenia in a sample of older, sedentary women using criteria from the European Working Group on Sarcopenia in Older People (EWGSOP), the International Working Group (IWG), and the Foundation for the National Institutes of Health Sarcopenia Project (FNIHSP). Design: Cross-sectional analysis. Setting and Participants: Community-dwelling women (n = 61) aged 71.9 ± 4.6 years (mean±SD) with a BMI 27.3 ± 6.0 kg/m2 who by self-report were healthy and did not exercise were recruited and evaluated for sarcopenia. Measurements: Height, weight, grip strength, gait speed, and appendicular lean mass (via segmental multi-frequency bioelectrical impedance analysis: SMF-BIA) were measured. Prevalence was reported using descriptive statistics and a Fisher’s exact test was used to analyze the distribution frequency of sarcopenia classification by different criteria. Results: In this sample 14.8% met EWGSOP criteria, 6.6% met FNIHSP criteria, and 3.3% met IWG criteria. There was a borderline significant difference in distribution frequency between EWGSOP and IWG classification criteria (p=0.053). Conclusion: The variation in sarcopenia prevalence depending on the diagnostic criteria used is consistent with previous research and there are borderline significant differences between classification criteria in this population. These data suggest the need for additional examination to determine current cut points for ALM measured by SMF-BIA, as well as which established definition of sarcopenia is appropriate for this population.

scholarly journals Variation in serum urate levels in the absence of gout and urate lowering therapy

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Andrew Shaffer ◽  
Elizabeth Rahn ◽  
Kenneth Saag ◽  
Amy Mudano ◽  
Angelo Gaffo
Keyword(s):  
Coefficient Of Variation ◽  
Study Participant ◽  
Serum Urate ◽  
Control Group ◽  
Single Measurement ◽  
Link Type ◽  
Lowering Therapy ◽  
Significant Difference ◽  
Data Points ◽  
Single Data

Abstract Background Previous studies have noted significant variation in serum urate (sUA) levels, and it is unknown how this influences the accuracy of hyperuricemia classification based on single data points. Despite this known variability, hyperuricemic patients are often used as a control group in gout studies. Our objective was to determine the accuracy of hyperuricemia classifications based on single data points versus multiple data points given the degree of variability observed with serial measurements of sUA. Methods Data was analyzed from a cross-over clinical trial of urate-lowering therapy in young adults without a gout diagnosis. In the control phase, sUA levels used for this analysis were collected at 2–4 week intervals. Mean coefficient of variation for sUA was determined, as were rates of conversion between normouricemia (sUA ≤6.8 mg/dL) and hyperuricemia (sUA > 6.8 mg/dL). Results Mean study participant (n = 85) age was 27.8 ± 7.0 years, with 39% female participants and 41% African-American participants. Mean sUA coefficient of variation was 8.5% ± 4.9% (1 to 23%). There was no significant difference in variation between men and women, or between participants initially normouricemic and those who were initially hyperuricemic. Among those initially normouricemic (n = 72), 21% converted to hyperuricemia during at least one subsequent measurement. The subgroup with initial sUA < 6.0 (n = 54) was much less likely to have future values in the range of hyperuricemia compared to the group with screening sUA values between 6.0–6.8 (n = 18) (7% vs 39%, p = 0.0037). Of the participants initially hyperuricemic (n = 13), 46% were later normouricemic during at least one measurement. Conclusion Single sUA measurements were unreliable in hyperuricemia classification due to spontaneous variation. Knowing this, if a single measurement must be used in classification, it is worth noting that those with an sUA of < 6.0 mg/dL were less likely to demonstrate future hyperuricemic measurements and this could be considered a safer threshold to rule out intermittent hyperuricemia based on a single measurement point. Trial registration Data from parent study ClinicalTrials.gov Identifier: NCT02038179.

scholarly journals Variation in Serum Urate Levels in the Absence of Gout and Urate Lowering Therapy: An Analysis Using Data from a Randomized Controlled Trial

2020 ◽  
Author(s):  
Andrew Shaffer ◽  
Elizabeth Rahn ◽  
Kenneth Saag ◽  
Amy Mudano ◽  
Angelo Gaffo
Keyword(s):  
Coefficient Of Variation ◽  
Controlled Trial ◽  
Study Participant ◽  
Serum Urate ◽  
Control Group ◽  
Lowering Therapy ◽  
Significant Difference ◽  
Data Points ◽  
Single Data ◽  
Using Data

Abstract Background: Previous studies have noted significant variation in serum urate (sUA) levels, and it is unknown how this influences the accuracy of hyperuricemia classification based on single data points. Despite this known variability, hyperuricemic patients are often used as a control group in gout studies. Our objective was to determine the accuracy of hyperuricemia classifications based on single data points versus multiple data points given the degree of variability observed with serial measurements of sUA.Methods: Data was analyzed from a cross-over clinical trial of urate-lowering therapy in young adults without a gout diagnosis. In the control phase, sUA levels used for this analysis were collected at 2-4 week intervals. Mean coefficient of variation for sUA was determined, as were rates of conversion between normouricemia (sUA ≤6.8 mg/dL) and hyperuricemia (sUA >6.8 mg/dL). Results: Mean study participant (n = 85) age was 27.8 ± 7.0 years, with 39% female participants and 41% African-American participants. Mean sUA coefficient of variation was 8.5% ± 4.9% (1% to 23%). There was no significant difference in variation between men and women, or between participants initially normouricemic and those who were initially hyperuricemic.Among those initially normouricemic (n=72), 15% converted to hyperuricemia during at least one subsequent measurement. The subgroup with initial sUA <6.0 (n=54) was much less likely to have future values in the range of hyperuricemia compared to the group with screening sUA values between 6.0-6.8 (n=18) (7% vs 39%, p = 0.0037).Of the participants initially hyperuricemic (n=13), 46% were later normouricemic during at least one measurement.Conclusion: Single sUA measurements were unreliable in hyperuricemia classification due to spontaneous variation. Those with an sUA of <6.0 mg/dL were less likely to demonstrate future hyperuricemic measurements and this could be considered a safer threshold to rule out intermittent hyperuricemia based on a single measurement point.Trial registration: Data from parent study ClinicalTrials.gov Identifier: NCT02038179

scholarly journals Role of urinary podocalyxin in early diagnosis of diabetic nephropathy

2020 ◽  
Vol 58 (4) ◽  
pp. 233-241
Author(s):  
Irena Kostovska ◽  
Katerina Tosheska Trajkovska ◽  
Svetlana Cekovska ◽  
Sonja Topuzovska ◽  
Julijana Brezovska Kavrakova ◽  
...  
Keyword(s):  
Early Detection ◽  
Early Stage ◽  
Venous Blood ◽  
Cross Sectional Study ◽  
Control Group ◽  
Specific Marker ◽  
Cross Sectional ◽  
Podocyte Injury ◽  
Significant Difference ◽  
Biochemical Analyses

AbstractIntroduction. Podocyte injury has been reported as an early feature of DN therefore, the assessment of podocyte injury can be accomplished by estimation of podocalyxin in urine. This study aimed to estimate the urinary podocalyxin levels and to determine the sensitivity and specificity of this biomarker for early detection of DN.Materials and methods. A total of 90 patients with type 2 diabetes mellitus (T2DM) were included in this cross-sectional study. Sixty of them were without diagnosed DN, and 30 with diagnosed DN. A control group consisted of 30 healthy subjects. All patients with T2DM were divided into three subgroups according to urinary microalbumin/creatinine ratio (UM/CR): normoalbuminuric, microalbuminuric and macroalbuminuric patients. Urine samples, were used for measurement of podocalyxin by ELISA, creatinine and microalbumin. Fasting venous blood samples was collected for biochemical analyses.Results. The levels of urinary podocalyxin (u-PDX) were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied subgroups regarding u-PDX was found (p < 0.05). Levels of u-PDX are increasing gradually with the degree of DN (p < 0.029). u-PDX levels were positively correlated with UM/CR (r = 0.227, p = 0.002). A cut-off level of 43.8 ng/ml u-PDX showed 73.3% sensitivity and 93.3% specificity to detect DN in early stage. A cut-off level of 30 mg/g UM/CR showed 41.5% sensitivity and 90% specificity in predicting DN. u-PDX was elevated in 48,2% of normoalbuminuric patients.Conclusion. Urinary podocalyxin be useful and more sensitive and specific marker in early detection of DN than microalbuminuria.

scholarly journals Role of Serum Chromogranin A in Early Diagnosis of Diabetic Nephropathy

2021 ◽  
Author(s):  
Hui Yu ◽  
Hong-Ping Wang ◽  
Xue Su ◽  
Ai-Li Cao ◽  
Xing-Mei Yao ◽  
...  
Keyword(s):  
Diabetic Nephropathy ◽  
Early Diagnosis ◽  
Chromogranin A ◽  
Early Stage ◽  
Moderate Intensity ◽  
Control Group ◽  
Cross Sectional ◽  
Main Site ◽  
Significant Difference

Abstract Background: Kidney is the main site for the removal of Chromogranin A (CgA). Previous studies have found that patients with renal impairment displayed elevated concentrations of CgA in plasma and the CgA concentrations reflect deterioration of renal function. In this study, we aimed to estimate the serum CgA levels and to evaluate the role of serum CgA in early diagnosis of diabetic nephropathy (DN).Methods: A total of 219 patients with type 2 diabetes mellitus (T2DM) were included in this cross-sectional study. They were classified into normoalbuminuria (n = 121), microalbuminuria (n = 73), or macroalbuminuria (n = 25) groups based on their urine albumin to creatinine ratios (UACR). A control group consisted of 45 healthy subjects. The serum CgA levels were measured by ELISA and other key parameters were assayed.Results: The serum CgA levels were higher in patients with T2DM compared to control subjects and a statistically significant difference among studied subgroups regarding CgA was found (P<0.05). Levels of serum CgA were increasing gradually with the degree of DN (P<0.001). Serum CgA levels were moderate intensity positively correlated with UACR (P<0.001). A cut-off level of 3.46 ng/ml CgA showed 69.86% sensitivity and 66.12% specificity to detect DN in early stage.Conclusions: Levels of serum CgA increased gradually with the degree of DN, and can be used as a biomarker in early detection of DN.

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