Prolonged Adrenal Insufficiency After the Discontinuation of Mitotane Therapy

2020 ◽  
Vol 20 (3) ◽  
pp. 485-487 ◽  
Author(s):  
Leonardo Muratori ◽  
Anna Pia ◽  
Giuseppe Reimondo ◽  
Chiara Pisano ◽  
Anna La Salvia ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Radical Resection ◽  
Severe Allergic Reaction ◽  
Retrospective Case ◽  
Free Survival ◽  
Long Time ◽  
Almost All ◽  
Control Study

Introduction:: Adrenocortical carcinoma (ACC) is a rare neoplasm characterized by a high risk of recurrence after radical resection. The role of adjuvant systemic therapy in radically resected patients is unclear. Mitotane, a steroidogenesis inhibitor, is the only drug approved for the systemic treatment of advanced ACC. In 2007, a retrospective case-control study provided the evidence that mitotane, administered for two years after successful surgery, could prolong recurrence-free survival. Adrenal insufficiency (AI), which occurs in almost all patients during the first 12 months of treatment, is an expected side effect of mitotane and requires steroid replacement therapy. Due to its long halflife, mitotane-induced AI persists several months after treatment discontinuation and is managed by cautious tapering of glucocorticoid replacement therapy. Results:: We report a case of symptomatic AI diagnosed after a severe allergic reaction occurring three years after the discontinuation of adjuvant mitotane therapy. Conclusions:: The case suggests that mitotane-induced AI should be monitored for a long time to asses full recovery of adrenal function, in order to prevent adrenal crises.

scholarly journals Do we really ponder about necessity of intravenous hydration in acute bronchiolitis?

2016 ◽  
pp. 21-24
Author(s):  
Şule Yıldırım ◽  
Nazan Kaymaz ◽  
Naci Topaloğlu ◽  
Fatih Köksal Binnetoğlu ◽  
Mustafa Tekin ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Bronchiolitis ◽  
Retrospective Case ◽  
Short Acting ◽  
Severity Scores ◽  
Significant Difference ◽  
Intravenous Hydration ◽  
Β2 Agonist ◽  
Control Study

Objective: The goal was to establish the role of intravenous hydration therapy on mild bronchiolitis. Methods: This was a retrospective case control study. Infants between 1 month and 2 years of age admitted to our general pediatrics ward between June 2012 and June 2013 with a diagnosis of uncomplicated acute bronchiolitis were enrolled to the study. Hospital medical files were reviewed to get information about children personal history, symptoms of the disease, disease severity scores and their management. Patients were classified into 4 groups according to the management; nebulized short-acting β2-agonist (salbutamol) +hydration; nebulized short-acting β2-agonist (salbutamol); hydration and neither bronchodilator nor hydration. We examined length of stay in the hospital as an outcome measure. Results: A total of 94 infants were studied. There was no significant difference between groups in terms of length of stay in hospital. Conclusions: IV hydration is not effective on length of stay in hospital in mild acute bronchiolitis patients.

P–142 Comparison of the IVF outcome in the course of ICSI vs PICSI treatment continuation in exactly the same group of HBA abnormal patients

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Rusin ◽  
W Szecel ◽  
M Jagiello ◽  
J Liss ◽  
K Lukaszuk
Keyword(s):  
Binding Sites ◽  
Poor Response ◽  
Cumulus Cells ◽  
Fertilization Rate ◽  
Retrospective Case ◽  
Plasmatic Membrane ◽  
Registration Number ◽  
Main Component ◽  
Control Study

Abstract Study question Does the PICSI have a beneficial effect for men with abnormal HBA on the fertilization rate, blastocysts number and clinical pregnancies in the next attempt? Summary answer Patients with HBA <80% choosing to undergo PICSI after ICSI failure see an increase in blastocyst and pregnancy rates. What is known already Hyaluronic acid (HA) is a main component of cervical mucus and the extracellular matrix of cumulus cells. The formation of HA-binding sites in sperm cell membranes is one of the markers of sperm maturation indicating completion the spermatogenic process of remodelling the plasmatic membrane, cytoplasmic extrusion and nuclear maturity. Spermatozoa selected by the HA-binding technique (the physiologically selected intracytoplasmic sperm injection – PICSI) have a potentially reduced risk of chromosomal aneuploidy or DNA fragmentation. Recent evidence do not show significant benefits in using PICSI. However, it has not been analysed in the course of treatment continuation in the same patients. Study design, size, duration This was a retrospective case-control study. It included exactly the same 58 patients with abnormal HBA, who underwent IVF treatment with ICSI initially and later with PICSI, between January 2014 and October 2020 at INVICTA Fertility Centre, Poland. Median female partner age in PICSI group was 36,2±5,34, without PICSI 35,8 ±5,28. Participants/materials, setting, methods 275 cycles (130 ICSI and 145 PICSI) resulted in 793 and 897 MII respectively. Patients were also divided into two groups <80% and ≥80% depending on the obtained HBA score expressed as the percentage of sperm bound with hyaluronan. The analysis covered the fertilization rate (FR), TQ and total blastocyst rate on day 5 and clinical pregnancy rate. Patients with poor response to stimulation were excluded from the study. Main results and the role of chance FR in ICSI and PICSI groups was not significantly difference (57.00%±31.2 vs 59.87%±30.8) even when taking into account the division of patients according to the obtained HBA score. In the <80% group the FR was 57.04%±29.3 vs 59.54%±30.8 in ICSI vs PICSI group respectively. There were no significant differences when comparing the under HBA ≥80% subgroups for all analysed outcomes. Fertilization rate ​​was 56.88% in the ICSI group vs 61.03% in the PICSI group. The percentage of blastocysts was 28.61% vs 34.45% and the percentage of TQ blastocysts on day 5 was 15.32% vs 16.81% with ICSI and PICSI respectively, in the group consisting of the same patients. In the HBA <80% group significant differences were observed in the percentage of obtained blastocysts 37.81% vs 47.61% by comparing the ICSI and PICSI approaches (p < 0.05). Also, percentage of TQ blastocyst on day 5 also was higher in patients with <80% HBA score after PICSI and was statistically significant (17.07% ICSI vs 23.92% PICSI, p < 0.05). We saw statistically significant (p < 0.01) increase in percentage of clinical pregnancies from 29.03% without PICSI to 69.44% in patient’s subsequent procedures involving PICSI. Limitations, reasons for caution More data is required to confirm that improved results of PICSI procedure are consistent and possible to reproduce in a larger group – and as a result could be included as part of the standard treatment process. Wider implications of the findings: The presented results show that in patients with normal HBA score, PICSI does not bring a measurable benefit and this may be important factor to consider in decision-making for couples seeking assistance. Trial registration number Not applicable

scholarly journals The Lebanese COVID-19 Cohort; A Challenge for the ABO Blood Group System

2020 ◽  
Vol 7 ◽  
Author(s):  
Athar Khalil ◽  
Rita Feghali ◽  
Mahmoud Hassoun
Keyword(s):  
Blood Group ◽  
Severe Form ◽  
Abo Blood Group ◽  
Blood Group System ◽  
Retrospective Case ◽  
Genetic Characteristics ◽  
Group System ◽  
Different Populations ◽  
Control Study

A sudden outbreak of pneumonia caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has rapidly spread all over the world facilitating the declaration of the resultant disease as a pandemic on March 2020. Predisposing factors for acquiring COVID-19 and for developing a severe form of this disease were postulated to be related to the epidemiological, clinical, and genetic characteristics of the patients. Biological markers such as the ABO blood group system were amongst these factors that were proposed to be linked to the variability in the disease course and/or the prevalence of the infection among different groups. Herein, we conducted the first retrospective case-control study from the Middle East and North Africa that tackles the association between the blood group types and the susceptibility to, as well as the severity of, SARS-CoV-2 infection. Contrary to the most acknowledged hypothesis, our results challenged the significance of this association and questioned the role of the ABO blood group system in dictating the severity of this disease. For future similar studies, we endorsed analyzing larger cohorts among different populations and we encouraged implementing more rigorous approaches to diminish the potential confounding effect of some underlying comorbidities and genetic variants that are known to be associated with the ABO blood group system.

The role of obinutuzumab in the management of follicular lymphoma

2019 ◽  
Vol 15 (31) ◽  
pp. 3565-3578 ◽  
Author(s):  
Jenny O’Nions ◽  
William Townsend
Keyword(s):  
Clinical Trials ◽  
Follicular Lymphoma ◽  
Progression Free Survival ◽  
Free Survival ◽  
Cd20 Antibody ◽  
Anti Cd20 ◽  
Almost All ◽  
Cd20 Antibodies

The outcomes for follicular lymphoma (FL) have improved significantly in recent years. This has been driven by an improved understanding of the pathobiology of FL and the development of therapeutic anti-CD20 antibodies. Combining rituximab with chemotherapy, coupled with its use as maintenance therapy, has contributed to significant improvements in disease control and progression-free survival. However, FL remains incurable and almost all patients invariably relapse. Therefore, there remains a need to develop novel therapeutic options and optimize existing regimens. Obinutuzumab (a first-in-class, glycoengineered, humanized type 2 anti-CD20 antibody) has been evaluated in a number of clinical trials. In this review, we will summarize the evaluable results of clinical trials investigating the efficacy of obinutuzumab in the treatment of FL.

scholarly journals Vitamin D Deficiency in Non-Autoimmune Hypothyroidism: A case-control study

2020 ◽  
Author(s):  
Salma Ahi ◽  
Mohammad Reza Dehdar ◽  
Naser Hatami
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Case Control Study ◽  
Inverse Correlation ◽  
Case Control ◽  
Control Group ◽  
Retrospective Case ◽  
Autoimmune Hypothyroidism ◽  
Control Study

Abstract Objectives: Although in many studies, the relationship between autoimmune hypothyroidism (Hashimoto) and Vitamin D deficiency was shown, no research has been performed on the role of vitamin D in non-autoimmune hypothyroidism. Design: This was a Retrospective case–control study in Endocrinology clinic of Jahrom (south of Iran). The patients with Hashimoto (n=633) and non-Hashimoto hypothyroidism (n=305), along with a control group (n=200) were evaluated. 25(OH)D level, T3 and T4 levels were studied and Anti TPO and Anti TG tests were performed. The results of vitamin D level were analyzed and interpreted using SPSS in terms of the cause of hypothyroidism (immune and non-immune). Results: The results of the study showed a significantly lower level of vitamin D in both immune and non-immune Hashimoto’s thyroiditis (HT) in comparison to healthy controls (P<0.05). We observed a significant inverse correlation between the vitamin D and TGAb level (p=0.001, r=-0.261) and a direct correlation of vitamin D with TSH level (p=0.008, r=0.108) in HT patients. Conclusion: Finally, the results indicated that non-autoimmune hypothyroidism, as well as HT, is associated with vitamin D deficiency. The role of vitamin D deficiency in HT was thought to be in the association of higher autoantibody (TGAb) level; while, there should be further studies determining vitamin D deficiency's role in non-immune hypothyroidism.

PROREPAIR-A: Clinical and molecular characterization study of prostate cancer (PC) patients with and without previously known germline BRCA1/2 mutations.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 5511-5511
Author(s):  
Rebeca Lozano ◽  
Elena Castro ◽  
Isabel Aragon ◽  
Heather Thorne ◽  
Fernando López-Campos ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Prognostic Value ◽  
Cox Regression ◽  
Castration Resistance ◽  
Free Survival ◽  
Kaplan Meier ◽  
Characterization Study ◽  
Control Study ◽  
Cause Specific Survival

5511 Background: Germline BRCA1/2 (g BRCA1/2) mutations are associated with poor clinical outcomes in PC. Previous studies showed that g BRCA2 carriers present more CNV in several genes associated with more aggressive disease. These aberrations may explain the poor clinical outcomes of these patients, but larger studies are needed to confirm these findings. Methods: PROREPAIR-A is a multicenter case-control study in which g BRCA2 carriers with available diagnostic timor-tissue were matched 1:2 by Gleason and stage at diagnosis (M0 vs M1) with known non-carriers (NC). A minimum of 120 controls-60 cases were required to prove a 5yr Cause Specific Survival (CSS)-rate of 85% vs 60%. The primary endpoint was to confirm the independent prognostic value of g BRCA2 in PC CSS. In addition, we explored the prognostic role of g BRCA1 and somatic events in BRCA2, RB1, MYC, PTEN and TMPRSS2-ERG by FISH. Χ2, Kaplan-Meier, log-rank and cox-regression models were carried out to identify associations with baseline characteristics and outcomes: Metastases Free Survival (MFS), Time to Castration-Resistance (TTCR) and CSS. Results: A total of 80:160 matched cases-controls were initially included, but tumor tissue and clinical data were only available in 73 g BRCA2 and 127 NC. 14 g BRCA1 were also included. At diagnosis, g BRCA2 were younger (median 62.6 vs 64.5, p = 0.02) and had cT3-4 disease more often than NC (31.5% vs 9.4%, p < 0.01), but no other significant differences were found. Somatic BRCA2-RB1 codeletion (40.8% vs 11.8%, p < 0.01) and MYC amplification (51.4% vs 22.8%, p < 0.01) were more frequent in g BRCA2 compared to NC, but no significant differences in PTEN and TMPRSS2-ERG were observed. g BRCA2 mutations as well as somatic BRCA2-RB1 codel and MYC amplif were significantly associated with shorter CSS, MFS and TTCR (Table). MVA model confirmed the independent prognostic value of g BRCA2 (HR 1.94, p = 0.03), BRCA2-RB1 codel (HR 3.16, p < 0.01), MYC amplif (HR 2.36, p < 0.01), Gleason ≥8 (p < 0.01) and M1 at diagnosis (p < 0.01) for CSS. Conclusions: PROREPAIR-A confirmed the independent prognostic value of g BRCA2 for CSS. Somatic BRCA2, RB1 and MYC aberrations were more frequent in g BRCA2 carriers. Those alterations are associated with shorter CSS, MFS and TTCR, and may contribute to poor clinical outcomes in g BRCA2 and NC. [Table: see text]

Laminar Necrosis of Placental Membranes: A Histologic Sign of Uteroplacental Hypoxia

2005 ◽  
Vol 8 (1) ◽  
pp. 34-42 ◽  
Author(s):  
Jerzy Stanek ◽  
Hikmat A. Al-Ahmadie
Keyword(s):  
Oxidative Stress ◽  
Caspase 3 ◽  
Retrospective Case ◽  
Ki 67 ◽  
Laminar Necrosis ◽  
Histologic Lesion ◽  
Probable Role ◽  
Placental Membranes ◽  
Control Study

Laminar necrosis of placental membranes (LN), a band of coagulative necrosis at the choriodecidual interphase, is a histologic lesion of unclear pathogenesis that has been reported in placentas from preeclampsia, preterm premature rupture of membranes, and preterm abruption. To better explore other possible correlations of LN, we performed a retrospective case-control study in which data on pregnancy risks and outcomes, neonate conditions, and placental gross, routine microscopic, and selected immunohistochemistry examinations in 52 consecutive cases of LN were compared with 52 gestational age-matched control cases without LN. Maternal hypertensive disorders and combinations of 2 or more maternal, fetal, neonatal, or placental conditions known to be potentially associated with uteroplacental hypoxia were more prevalent in patients with LN than in control patients. By immunohistochemistry, LN areas were positive for complement 9 (marker of necrosis) and negative for active caspase 3 (marker of irreversible apoptosis), nitrotyrosine residues (marker of oxidative stress), and Ki-67 (proliferation marker), thus confirming their necrotic rather than apoptotic nature. However, LN areas were flanked by caspase 3 positivity, and the positivity for nitrotyrosine residues was more pronounced in the decidua and mesenchyme in the same membrane rolls as LN, which indicates a probable role of apoptosis and oxidative stress in the development of LN. Based on these immunohistochemical results and clinicopathologic correlations, we believe LN should be recognized and reported as a hypoxic placental lesion.

scholarly journals Adrenal Insufficiency at the Time of COVID-19: A Retrospective Study in Patients Referring to a Tertiary Center

2020 ◽  
Author(s):  
Giulia Carosi ◽  
Valentina Morelli ◽  
Giulia Del Sindaco ◽  
Andreea Liliana Serban ◽  
Arianna Cremaschi ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Case Control Study ◽  
Infection Risk ◽  
Adrenal Crisis ◽  
Retrospective Case ◽  
Tertiary Center ◽  
Severe Impairment ◽  
Positive Results ◽  
Control Study

Abstract Context Coronavirus disease 2019 (COVID-19) represents a global health emergency, and infected patients with chronic diseases often present with a severe impairment. Adrenal insufficiency (AI) is supposed to be associated with an increased infection risk, which could trigger an adrenal crisis. Objective Our primary aim was to evaluate the incidence of COVID-19 symptoms and complications in AI patients. Design and Setting We conducted a retrospective case-control study. All patients were on active follow-up and lived in Lombardy, Italy, one of the most affected areas. Patients We enrolled 279 patients with primary and secondary AI and 112 controls (patients with benign pituitary lesions without hormonal alterations). All AI patients had been previously trained to modify their replacement therapy on stress doses. Intervention By administering a standardized questionnaire by phone, we collected data on COVID-19 suggestive symptoms and consequences. Results In February through April 2020, the prevalence of symptomatic patients (complaining at least 1 symptom of viral infection) was similar between the 2 groups (24% in AI and 22.3% in controls, P = 0.79). Highly suggestive COVID-19 symptoms (at least 2 including fever and/or cough) also occurred equally in AI and controls (12.5% in both groups). No patient required hospitalization and no adrenal crisis was reported. Few nasopharyngeal swabs were performed (n = 12), as indicated by sanitary regulations, limiting conclusions on the exact infection rate (2 positive results in AI and none in controls, P = 0.52). Conclusions AI patients who are adequately treated and trained seem to display the same incidence of COVID-19-suggestive symptoms and disease severity as controls.

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