Renal Toxicity of Long-Term Therapy With Tenofovir in HIV-Infected Patients

2012 ◽  
Vol 25 (5) ◽  
pp. 552-559 ◽  
Author(s):  
Maricelle O. Monteagudo-Chu ◽  
Mei H. Chang ◽  
Horatio B. Fung ◽  
Norbert Bräu
Keyword(s):  
Renal Toxicity ◽  
Care Center ◽  
Tertiary Care ◽  
Term Therapy ◽  
Kaplan Meier ◽  
Ckd Stage ◽  
Advanced Stages ◽  
Long Term Therapy

Data are sparse on long-term renal toxicity of tenofovir as measured by estimated glomerular filtration rate (eGFR) and progression to advanced stages of chronic kidney disease (CKD). The objective of the study is to determine the incidence of renal impairment associated with the use of tenofovir in HIV-infected patients, using abacavir as a control. In a single tertiary care center, all HIV-infected patients with baseline CKD stage 0 or 1 (CKD-1), who were started on either tenofovir or abacavir from 1998 to 2008 and had at least 1 follow-up eGFR measure on therapy, were included in this retrospective analysis. Progression to CKD stages 2 to 5 was compared using Kaplan-Meier analysis. Progression to CKD-2 and CKD-3 occurred more frequently in patients who received tenofovir than those receiving abacavir (CKD-2, 2-year actuarial frequency, 48.8% vs 23.7%; P < .001, log rank; CKD-3, 5.8% vs 0.0%; P = .028). Only 1 patient in the tenofovir group progressed to CKD-4 and none to CKD-5. Treatment with tenofovir was the only independent factor associated with progression to CKD-2 (hazard ratio [HR], 2.12; 95% confidence interval [CI]: 1.41-3.18; P < .001) and to CKD-3 (HR, 4.91; 95% CI, 1.02-23.7; P = .048). In HIV-infected patients, long-term therapy with tenofovir is associated with mild-to-moderate nephrotoxicity which is significantly higher than in abacavir-treated patients.

scholarly journals Adverse drug reaction monitoring in patients of hypertension at a tertiary care hospital, Aurangabad, Maharashtra, India

2021 ◽  
Vol 10 (6) ◽  
pp. 720
Author(s):  
Shruti Chandra ◽  
Sukhmeen Kaur ◽  
Deepali Jayabhaye ◽  
Amol Ubale
Keyword(s):  
Antihypertensive Drugs ◽  
Patient Adherence ◽  
Tertiary Care ◽  
Term Therapy ◽  
Care Hospital ◽  
Cross Sectional ◽  
Hypertensive Patients ◽  
Long Term Therapy

Background: Hypertension is one of the highest prevailing diseases worldwide. Due to long term therapy antihypertensive drugs are commonly associated with adverse drug reactions (ADRs). Therefore, the study was conducted with the objective to examine the incidence of different types of ADRs in drug treated hypertensive patients.Methods: Present study was a prospective cross sectional observational study carried out in the outpatient of department of medicine of MGM hospital, a tertiary care teaching hospital, in Aurangabad. 320 diagnosed hypertensive patients were studied. Questionnaire was asked and their prescription were analysed and follow up was done.Results: Among 320 patient’s 75 patients were reported ADR. Males accounted for higher percent of ADRs 46 (61%) than females 29 (38.6%). Most of the patients 147 (55.9%) were on mono therapy. Calcium channel blocker was the frequently used class of drug, showed maximum number of ADR (30.6%) followed by ACE inhibitor (28%) and ARB (21.3%). As per WHO-UMC scale, type of reactions and their percentage were as certain (9.3%), Probable/ Likely (64%), possible (22.6%), and unlikely (4%). According to Naranjo scale most of the reactions were possible (64%). severity assessment is done by Hartwig and Siegel scale. No lethal ADR were reported. 4% reactions were severe, 32% were of moderate category and 64% were mild reactions.Conclusions: Such type of studies are helpful in selection of appropriate medicines for hypertensive patients, enhancing patient adherence with the therapy by selecting medicines of lesser ADR profile, reducing unnecessary economic burden to the patients due to unwanted effects of the therapy.

Nephrocalcinosis, Renal Dysfunction, and Calculi in Patients With Primary Hypoparathyroidism on Long-Term Conventional Therapy

2020 ◽  
Vol 105 (4) ◽  
pp. e1215-e1224 ◽  
Author(s):  
Soma Saha ◽  
Devasenathipathy Kandasamy ◽  
Raju Sharma ◽  
Chandrasekhar Bal ◽  
Vishnubhatla Sreenivas ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Conventional Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Fractional Excretion ◽  
Renal Calculi ◽  
Serum Total Calcium ◽  
Calcium Phosphorus

Abstract Context There are concerns about the long-term safety of conventional therapy on renal health in patients with hypoparathyroidism. Careful audit of these would help comparisons with upcoming parathyroid hormone therapy. Objective We investigated nephrocalcinosis, renal dysfunction, and calculi, their predictors and progression over long-term follow-up in patients with primary hypoparathyroidism (PH). Design and Setting An observational study at a tertiary care center was conducted. Participants and Methods A total of 165 PH patients receiving conventional therapy were evaluated by radiographs, ultrasonography, and computed tomography. Their glomerular filtration rate (GFR) was measured by Tc-99m-diethylenetriamine penta-acetic acid clearance. Clinical characteristics, serum total calcium, phosphorus, creatinine, hypercalciuria, and fractional excretion of phosphorus (FEPh) at presentation and during follow-up were analyzed as possible predictors of renal complications. Controls were 165 apparently healthy individuals. Results Nephrocalcinosis was present in 6.7% of PH patients but not in controls. Patients younger than 15 years at presentation and with higher serum calcium-phosphorus product were at higher risk. Nephrocalcinosis showed no significant association with cataract and intracranial calcification. Prevalence of renal calculi was comparable between hypoparathyroid patients and controls (5% vs 3.6%, P = .58). Fourteen percent of patients had a GFR less than 60 mL/min/1.73 m2. Increased FEPh during follow-up was the significant predictor of low GFR. Nephrocalcinosis developed in 9% of patients over 10 years of conventional therapy. Conclusion A total of 6.7% of PH patients had nephrocalcinosis, and 14% showed renal dysfunction. Prevalence of renal calculi was similar in patients and controls. Nine percent of patients developed nephrocalcinosis over 10 years of conventional therapy.

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses

2019 ◽  
Vol 161 (1) ◽  
pp. 123-129 ◽  
Author(s):  
C. Burton Wood ◽  
Robert Yawn ◽  
Anne Sun Lowery ◽  
Brendan P. O’Connell ◽  
David Haynes ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Ossicular Chain ◽  
Tertiary Care Center ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Hearing Outcomes

Objective(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort.Study DesignCase series with chart review.SettingTertiary care center.Subject and MethodsThis study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years.ResultsIn total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant ( P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%).ConclusionTitanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

Follow-up of patients with prolactinomas after discontinuation of long-term therapy with bromocriptine

1983 ◽  
Vol 104 (2) ◽  
pp. 139-142 ◽  
Author(s):  
Arturo Zárate ◽  
Elías S. Canales ◽  
Carlos Cano ◽  
Carlos J. Pilonieta
Keyword(s):  
Sella Turcica ◽  
Ct Scanning ◽  
Serum Levels ◽  
Primary Treatment ◽  
Term Therapy ◽  
History Of ◽  
Permanent Cure ◽  
Long Term Therapy

Abstract. The effects of bromocriptine discontinuation after a 2 year course of therapy on prolactin (Prl) serum levels and the radiological size of the sella turcica were investigated in 16 women with amenorrhoea-galactorrhoea due to prolactinoma. During therapy, all but 2 patients had normalized serum Prl levels, and 4 women with macroprolactinomas exhibited a reduction in the size of the tumour as documented by CT-scanning and tomography of the sellae. After bromocriptine withdrawal and follow-up during 2 additional years, Prl levels remained normal in 6 patients, 2 of them with microprolactinomas and 4 with macroprolactinoma. The remaining 10 women developed hyperprolactinaemia associated with amenorrhoea and galactorrhoea within 3 months after discontinuation of therapy. No tumour expansion was observed in any case during the 4 year observation period. In the present study bromocriptine treatment seemed to result in permanent cure in 6 out of 16 cases of prolactinomas; nevertheless it is difficult to justify an indefinite medical treatment since the natural history of prolactinoma remains unknown. We presently feel that bromocriptine is more appropriate than neurosurgical transsphenoidal exploration for the primary treatment of prolactinomas. Further investigation is needed before a more definitive conclusion regarding the management of prolactinomas can be reached.

Carcinoids of the ampulla: Long-term follow-up after endoscopic resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 430-430
Author(s):  
George Nyasha Baison ◽  
Nadav Sahar ◽  
Morgan M Bonds ◽  
Janelle F Rekman ◽  
Flavio G. Rocha ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Care Center ◽  
Benign Lesion ◽  
Tertiary Care ◽  
Case Series ◽  
World Health ◽  
Long Term Follow Up ◽  
Well Differentiated

430 Background: Neuroendocrine tumors (NET) or carcinoids of the ampulla are exceedingly rare in comparison to duodenal NET. Surgical management is widely accepted as the treatment of choice, but for patients that refuse surgery or are poor operative candidates, endoscopic resection may be option. We present a consecutive case series at a tertiary care center describing our experience with endoscopic resection of ampullary NET. Methods: This is a restrospective review with a long-term follow-up of patients with ampullary NET that were endoscopically resected. Outcomes were analyzed based on the histopathologic classification system proposed by the World Health Organization in 2000. Results: Twelve patients (9 male, 3 female), ranging in age from 41 to 86 (mean 59) underwent endoscopic ampullectomy for ampullary NET, with a mean follow-up time of 5 years. Patients had refused surgery or were poor surgical candidates. All, but one incidentally found case, were symptomatic on presentation, with gastrointestinal bleeding being the main symptom. No patients had a hormonal syndrome. The mean size of the lesions was 21 mm (6 mm to 35 cm). Six (50%) patients had a well-differentiated, benign lesion, 6 (50%) patients had a well-differentiated NET with unknown malignant potential (gangliocytic paragangliomas). Eight (67%) were completely excised during the initial endoscopy with 4 requiring re-excision. Only 2 patients developed recurrence, after 2.5 and 10 years and this necessitated a pancreaticoduodenectomy. Five patients had complications (2 for bleeding and 3 for post-ERCP pancreatitis), with zero deaths. Conclusions: Unlike duodenal carcinoids, ampullary NET are rare. Pancreaticoduodenectomy can be offered to fit patients except for gangliocytic paragangliomas that do not require an aggressive operation. However, for those that refuse surgery or are poor candidates, endoscopic ampullectomy can be an option with acceptable short and long-term outcomes.

Long-term follow-up of jaw osteomyelitis associated with bisphosphonate use in a tertiary-care center

2014 ◽  
Vol 32 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Carlos Pigrau-Serrallach ◽  
Evelyn Cabral-Galeano ◽  
Benito Almirante-Gragera ◽  
Roger Sordé-Masip ◽  
Dolors Rodriguez-Pardo ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Long Term Follow Up

scholarly journals Long-term therapy with non-steroidal anti-inflammatory drugs for axial spondyloarthritis: focus on changes in liver function

2021 ◽  
pp. 152-157
Author(s):  
A. P. Rebrov ◽  
A. V. Aparkina ◽  
E. V. Kchondkaryan
Keyword(s):  
Liver Function ◽  
Liver Enzymes ◽  
Genetically Engineered ◽  
Term Therapy ◽  
Acute Liver Damage ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Long Term Therapy

The purpose of the study is to analyze the state of liver function in patients with spondyloarthritis taking non-steroidal anti-inflammatory drugs continuously for 24 months. Materials and methods of the study include 198 patients with spondyloarthritis. The prospective study involved 36 patients with spondyloarthritis who took non-steroidal anti-inflammatory drugs (NSAIDs) prescribed by a physician in the community for 24 months. The level of liver enzymes in blood serum at admission and in dynamics was studied. The increase of liver enzymes was detected in 12 (6.06%) of 198 patients with spondyloarthritis. Among them 6 (50%) patients took methotrexate, 1 (8.33%) - genetically engineered drug, 2 (16.67%) patients-sulfasalazine and 3 (25%) - nonsteroidal anti - inflammatory drugs. 19.4% of patients were registered with a periodic increase of transaminase levels on the background of NSAIDs for the last 24 months. At the same time, no cases of acute liver damage or progressive deterioration of liver function requiring discontinuation of therapy were recorded during the entire follow-up period.

Sustained Antihypertensive Response with Minizide: Long-Term Follow-Up in a Multicentre Study

1981 ◽  
Vol 9 (5) ◽  
pp. 309-314 ◽  
Author(s):  
A E Woeltjen ◽  
A J Gordon
Keyword(s):  
Treatment Compliance ◽  
Term Therapy ◽  
Once Daily ◽  
Long Term Follow Up ◽  
Antihypertensive Response ◽  
Laboratory Changes ◽  
Long Term Therapy ◽  
Toxic Potential

The safety and effectiveness of prazosin hydrochloride combined with polythiazide for the treatment of hypertension was studied in four European countries by ten investigators. One-hundred and seventy-seven adult male and female patients, 91% with essential hypertension, were treated for an average of 7 months. Reductions from placebo-controlled baseline blood pressure exceeded 15% over the 8-week short-term phase of the study with further reductions of up to 22% observed at the end of the study. Ninety-six per cent of all patients completed therapy with a diastolic blood presssure of 90 mm Hg or less. Most patients were adequately controlled on 2 tablets or less once daily. Each tablet contained 0.5 mg prazosin hydrochloride and 0.25 mg polythiazide. Long-term toleration was excellent. Side-effects were typical of those expected with antihypertensive medication and nearly all were reported during the first 8 weeks of treatment with no interruption or discontinuation of drug. Nearly all patients were followed throughout for laboratory changes. There were minimal changes consistent with the therapy and there was no pattern indicative of toxic potential. It is concluded that the drug combination, Minizide, is effective and well tolerated as initial and long-term therapy in hypertension and that the convenient dosage regimen will lead to enhanced treatment compliance for this chronic condition.

Biopsy forceps disruption paired with bougie dilation of esophageal strictures lengthens time to repeat intervention

2020 ◽  
Author(s):  
Tricia Hengehold ◽  
Benjamin D Rogers ◽  
Farhan Quader ◽  
C Prakash Gyawali
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Balloon Dilation ◽  
Biopsy Forceps ◽  
Kaplan Meier ◽  
Esophageal Strictures ◽  
Foregut Surgery

Summary Esophageal strictures commonly cause dysphagia and require treatment with endoscopic dilation using balloons or bougies. We aimed to determine whether biopsy forceps disruption of strictures at time of dilation increases time to repeat intervention or duration of intervention-free follow-up. We performed a retrospective analysis of 289 adults (age 61.0 ± 0.8 years, 66.4% female) who underwent dilation of an esophageal stricture at our tertiary care center between 2014 and 2016. Exclusions consisted of endoscopic intervention within the preceding 6 months, prior foregut neoplasia, achalasia, radiofrequency ablation, endoscopic mucosal resection, endoscopic submucosal dissection, or foregut surgery. Demographics, clinical presentation, dilation technique, and follow-up were abstracted from electronic medical records. We compared time to repeat dilation and duration of intervention-free follow-up between treatment subgroups. Balloon dilation was performed more often than bougie dilation (76.8 vs. 17.6%); biopsy forceps disruption was performed in 23.2%. Over a median follow-up of 52.9 months, 135 patients (46.7%) underwent repeat dilation. Age, body mass index, gender, and use of antisecretory medications did not influence need for repeat dilation (P = ns for each). Bougie dilation with biopsy forceps disruption prolonged time to repeat dilation in all patients (P ≤ 0.02), particularly in those with gastroesophageal reflux disease (P ≤ 0.03), compared with bougie dilation alone and balloon dilation with or without disruption. On Kaplan–Meier analysis, bougie dilation with biopsy forceps resulted in longer intervention-free follow-up compared with dilation alone (P = 0.03). We conclude that stricture disruption with biopsy forceps increases time to repeat intervention with bougie but not balloon dilation.

scholarly journals Clinical management of maxillary osteonecrosis associated with antiresorptive medication (MRONJ): Presentation of clinical cases

2020 ◽  
Vol 1 ◽  
pp. 63-67
Author(s):  
Eduardo A Rey ◽  
Sergio A. Rodriguez Genta ◽  
Silvana Noemi Picardo
Keyword(s):  
Monoclonal Antibodies ◽  
Osteoblastic Differentiation ◽  
Pathological Process ◽  
Term Therapy ◽  
Non Invasive ◽  
Nuclear Activation ◽  
Antiresorptive Drugs ◽  
Long Term Therapy

Antiresorptive drugs: Bisphosphonates (BPs) and Monoclonal Antibodies: Denosumab (DS) are known to suppress osteoclastic activity, affecting the expression of the RANKL (Kappa β Nuclear Activation Receptor), which corresponds to an osteoblastic differentiation factor and which is secreted by said cells, being responsible for inducing reabsorption by osteoclasts. Under certain circumstances, those medications may induce the development of Maxillary Osteonecrosis (MRONJ).The paper is aimed to share our experience of MRONJ treatment using minimally invasive therapies (including washes and antibiotics) that does not expand the necrotic bed volumetrically and provide non-recurrent resolution of the lesion. The patients we described were on long-term therapy either with BPs or DS.Conclusion: Interaction between health professional is essential for MRONJ prevention. The therapeutics consolidated in non-invasive maneuvers, and the manipulation of bone tissue with close follow up allows to avoid spread to deep planes. The pathological process could be successfully treated, and it is not necessary to suspend antiresorptive medications.

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