scholarly journals Efficacy of Extended Valganciclovir Prophylaxis in Preventing Cytomegalovirus Infection in Pediatric Kidney Transplantation

2014 ◽  
Vol 7 (1) ◽  
pp. 152-157
Author(s):  
Hashim Faris ◽  
A. Gregg Jon ◽  
R. Dharnidharka Vikas
Keyword(s):  
Late Onset ◽  
Cmv Infection ◽  
University Of Florida ◽  
Pediatric Kidney Transplantation ◽  
Final Study ◽  
Significant Difference ◽  
Infection Resistance ◽  
The University ◽  
Cmv Disease

Cytomegalovirus (CMV) is one of the most frequent opportunistic infection in renal transplant (RTx) recipients. Valganciclovir (VGC) has been showed to be safe and highly effective in prophylaxis of CMV infection in RTx recipients. Recently, an increase in delayed onset CMV disease has been noted with some arguing that longer prophylaxis may decrease the late-onset disease. We retrospectively tested the hypothesis that extended term prophylaxis (ETP) of VGC for 12 months is more effective than short term prophylaxis (STP) of 6 months in preventing CMV infection and disease in pediatric RTx performed at the University of Florida from July 2003 to December 2010. In this period, all recipients underwent prospective CMV PCR (Polymerase Chain Reaction) monitoring and were maintained on similar immunosuppression. Eighty six patients received RTx during that period. All eligible subjects had to have at least 12 months of graft survival and 18 months of follow up, leaving 73 eligible subjects in final study group. CMV infection or disease occurred in 6/29 (20%) in the STP group vs 6/44 (14%) in the ETP group with no statistical significant difference (P= 0.42). Donor positive/recipients negative CMV serology status (D+/R-) were associated with a higher risk of CMV infection in both univariate and multivariate analysis (P=0.01). Anemia and Leucopenia directly associated with VGC were similar in both groups (P=0.58 and P=0.2 respectively). Biopsy-proven acute rejection was also non-significant in both groups (P=0.39). Although ETP for CMV from 6 months to 12 months is safe and has minimal adverse effect, it did not reduce CMV infection or disease. Further controlled studies in pediatrics age group are considered to compare longer versus shorter periods of prophylaxis and their impact on prevention of CMV infection, resistance, cost, and toxicity.

Socioeconomic patient benefits of a pediatric neurosurgery telemedicine clinic

2020 ◽  
Vol 25 (2) ◽  
pp. 204-208 ◽  
Author(s):  
Kelsey Hayward ◽  
Sabrina H. Han ◽  
Alexander Simko ◽  
Hector E. James ◽  
Philipp R. Aldana
Keyword(s):  
Travel Time ◽  
Cost Savings ◽  
Transportation Cost ◽  
Pediatric Neurosurgery ◽  
University Of Florida ◽  
Remote Location ◽  
Socioeconomic Data ◽  
The University ◽  
Time Away

OBJECTIVEThe objective of this study was to examine the socioeconomic benefits to the patients and families attending a regional pediatric neurosurgery telemedicine clinic (PNTMC).METHODSA PNTMC was organized by the Division of Pediatric Neurosurgery of the University of Florida College of Medicine–Jacksonville based at Wolfson Children’s Hospital and by the Children’s Medical Services (CMS) to service the Southeast Georgia Health District. Monthly clinics are held with the CMS nursing personnel at the remote location. A retrospective review of the clinic population was performed, socioeconomic data were extracted, and cost savings were calculated.RESULTSClinic visits from August 2011 through January 2017 were reviewed. Fifty-five patients were seen in a total of 268 initial and follow-up PNTMC appointments. The average round-trip distance for a family from home to the University of Florida Pediatric Neurosurgery (Jacksonville) clinic location versus the PNTMC remote location was 190 versus 56 miles, respectively. The families saved an average of 2.5 hours of travel time and 134 miles of travel distance per visit. The average transportation cost savings for all visits per family and for all families was $180 and $9711, respectively. The average lost work cost savings for all visits per family and for all families was $43 and $2337, respectively. The combined transportation and work cost savings for all visits totaled $223 per family and $12,048 for all families. Average savings of $0.68/mile and $48.50/visit in utilizing the PNTMC were calculated.CONCLUSIONSManaging pediatric neurosurgery patients and their families via telemedicine is feasible and saves families substantial travel time, travel cost, and time away from work.

Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

2019 ◽  
Vol 128 (10) ◽  
pp. 693-698
Author(s):  
Sabine Dillenberger ◽  
Detlef K. Bartsch ◽  
Elisabeth Maurer ◽  
Peter Herbert Kann
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multiple Endocrine Neoplasia ◽  
University Hospital ◽  
Primary Surgery ◽  
Endocrine Neoplasia ◽  
Single Centre Experience ◽  
Significant Difference ◽  
History Of ◽  
The University

Abstract Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

Plication versus Resection in Horizontal Strabismus Surgery

2019 ◽  
Vol 236 (04) ◽  
pp. 442-445 ◽  
Author(s):  
Jill Kühne ◽  
Anja Palmowski-Wolfe
Keyword(s):  
Strabismus Surgery ◽  
Dose Effect ◽  
P Value ◽  
Separate Analysis ◽  
Resection Group ◽  
Simultaneous Surgery ◽  
Age At Surgery ◽  
Significant Difference ◽  
The University

Abstract Background To compare two commonly used strengthening procedures in strabismus surgery: plication and resection of the extraocular muscle (EOM). Patients and Methods From an anonymous databank of strabismus surgeries, performed at the University Eye Hospital Basel, patients with a horizontal strabismus surgery, consisting of a recession combined with either plication or resection of the antagonist and a follow-up of at least 3 months, were included. Exclusion criteria were previous eye surgeries, binocular surgeries, and simultaneous surgery of oblique or vertical EOM. Pre- and postoperative angles were measured using the alternating prism cover test during fixation at distance. Results Fifty-nine patients met the criteria and were matched according to the angle at baseline in the recession/plication group, resulting in 12 resection/recession and 12 plication/recession patients. There was no significant difference in the number of eso- and exodeviations, age at surgery, or gender between the groups. Mean difference between plication and resection was 1.2 PD at 1 week (p = 0.72) and 1.7 PD at 3 months (p = 0.61). A separate analysis for eso- and exodeviations showed no significant difference between recession/plication and recession/resection at 1 week or 3 months (p value side effect = 0.59; resection vs. plication at 1 week p = 0.68; resection vs. plication at 3 months: p = 0.57). The overall dose effect (SD) was 2.13 PD (0.88)/mm in the recession/plication group and 2.51 PD (0.81)/mm in the recession/resection group after 1 week (p = 0.331). After 3 months, the mean dose effect was 1.85 PD (1.06)/mm in the recession/plication group and 2.09 PD (1.12)/mm in the recession/resection group (p = 0.611). Discussion Our findings show that recession/plication is a valid alternative to recession/resection in horizontal strabismus without the need to cut the muscle, as we saw no difference in surgical effectiveness in either eso- or exodeviations at 1 week or at 3 months.

Changing treatment paradigms in the era of targeted therapies.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 518-518
Author(s):  
Philipp Marius Papavassilis ◽  
Edwin Herrmann ◽  
Laura-Maria Krabbe ◽  
Lothar Hertle ◽  
Martin Boegemann ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Rank Test ◽  
P Value ◽  
Line Treatment ◽  
New Agents ◽  
Exact Test ◽  
Significant Survival ◽  
Significant Difference ◽  
The University

518 Background: Our goal was to describe the change of treatment paradigms for metastatic renal cell carcinoma (mRCC) since targeted therapy became available in 2006. Methods: In this cohort population study we retrospectively investigated all mRCC patients who were treated with targeted therapy between 06/2006 and 06/2012 in the Department of Urology of the University of Münster. To distinguish nominal variables Fisher's exact test was used, in other respects Pearson's χ² test. For metrical variables the Mann-Whitney-U-Test was used. The log-rank test was chosen to derive differences between two or more groups with regard to survival. A p value <0,05 was considered statistically significant. Results: 50/158 (31.6%) patients with a median follow-up of 362 days were initially treated with immunotherapy. The most often used second line treatment after immunotherapy was sorafenib (29 patients, 58.0%). As first line treatment sunitinib was chosen most frequently (68 patients, 63.0%). There was no statistically significant difference in survival between the patients who were treated with immunotherapy and those who were not (572 vs. 554 days, p=0,745). 134 (84.4%) patients received cytoreductive nephrectomy before systemic treatment start. Comparing the survival curves there was a significant survival benefit in favor of nephrectomized patients (632 vs. 169 days, p<0,0001). Conclusions: After introduction of the new agents treatment paradigms have changed substantially. Immunotherapy is used only rarely. Cytoreductve nephrectomy should continue to be regarded as standard treatment.

scholarly journals High incidence of cytomegalovirus infection after nonmyeloablative stem cell transplantation: potential role of Campath-1H in delaying immune reconstitution

Blood ◽  
2002 ◽  
Vol 99 (12) ◽  
pp. 4357-4363 ◽  
Author(s):  
Suparno Chakrabarti ◽  
Stephen Mackinnon ◽  
Raj Chopra ◽  
Panagiotis D. Kottaridis ◽  
Karl Peggs ◽  
...  
Keyword(s):  
Immune Reconstitution ◽  
De Novo ◽  
Unrelated Donor ◽  
Cmv Infection ◽  
Nonmyeloablative Stem Cell Transplantation ◽  
Wide Range ◽  
Significant Difference ◽  
High Incidence ◽  
Cmv Disease

Nonmyeloablative conditioning is increasingly used for transplantation in a wide range of diseases, but little is known about its impact on the incidence of infections and immune reconstitution. We examined the pattern and outcome of cytomegalovirus (CMV) infections monitored by polymerase chain reaction–based assays and treated preemptively in 101 patients following nonmyeloablative conditioning containing in vivo Campath-1H. Fifty-one patients (50%) had a CMV infection at a median of 27 days after transplantation with a probability of 84.8% in patients at risk of CMV infection. The probability of recurrence of CMV infection before and after 100 days was 53.6% and 46.6%, respectively, and was more common in unrelated donor transplant recipients. All 3 patients who developed CMV disease died of this complication. The 2 patients with late CMV disease had grade III to IV graft-versus-host-disease (GVHD), which occurred de novo in only 4% of patients and in another 10% following donor lymphocyte infusions. The median time to CD4+ T-cell count more than 200/μL was 9 months in the 48 patients studied. The probabilities of overall survival and nonrelapse mortality at 18 months were 65% and 27.8%, respectively, with no significant difference in survival between CMV-infected and -uninfected patients. The use of Campath-1H appeared to be associated with a low incidence of GVHD but a high incidence of CMV infections and prolonged immune paresis.

scholarly journals Self-Efficacy of the University Students’ Toefl Performance: Differences in the Test Skill and English Skills in Toefl

2020 ◽  
Vol 8 (3) ◽  
pp. 497
Author(s):  
Marisa Yoestara ◽  
Zaiyana Putri
Keyword(s):  
University Students ◽  
Self Efficacy ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Total Sample ◽  
P Value ◽  
Significant Difference ◽  
The University ◽  
One Way Anova

This study aimed at reporting differences in terms of the university students’ TOEFL self-efficacy in the test skill and the English skills tested in TOEFL namely listening, structure, and reading. In conducting the study, the explanatory sequential mixed method was used as the study design, where the quantitative data from the survey was conducted first followed by the follow-up interview as the qualitative data. To collect the data in this study, a specifically designed self-efficacy questionnaire of TOEFL was distributed to the total sample of 200 university students across different disciplines from Syiah Kuala University and the University of Serambi Mekkah. The interview was then conducted with 3 selected students to have a deeper understanding of the study result. In terms of the data analysis, one-way ANOVA and t-test were used to describe the quantitative data, while the qualitative data was described and elaborated in words with detailed explanations. The result showed that there was a significant difference among the test skill and the English skills in TOEFL, where F= 13.61 (3, 796), p<0.05. The result also revealed that within the gender, only reading skill had a significant difference, where t198= -2.003, p <. 005, and within the language course participation, all the test skills and TOEFL skills were significantly different as the p-value of each skill was smaller than .005 (p< .005).

scholarly journals Use of ganciclovir for cytomegalovirus infection.

1992 ◽  
Vol 2 (12) ◽  
pp. S270
Author(s):  
T E Nevins ◽  
D L Dunn
Keyword(s):  
Graft Loss ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
University Of Minnesota ◽  
Cmv Infection ◽  
Seronegative Patient ◽  
Patient Morbidity ◽  
Infected Cells ◽  
The University ◽  
Cmv Disease

Ganciclovir (9-(1,3-dihydroxy-2-propoxymethyl) guanine, DHPG) is an acyclovir analog with excellent antiviral activity against human cytomegalovirus (CMV). Clinically, CMV infection occurs in from 60 to 90% of all renal transplant recipients and it is responsible for significant patient morbidity and graft loss. The likelihood of infection is closely related to the CMV status of both donor and recipient, with the greatest risk arising in the combination of a seronegative patient receiving a seropositive organ. Intracellularly, DHPG is converted to DHPG-triphosphate, which competitively inhibits DNA polymerase. This conversion is accelerated up to 10-fold in virally infected cells, providing some selectivity of action. Uncontrolled studies demonstrated DHPG efficacy in CMV disease, but experience in children remains limited. Although bone marrow suppression is a major immediate toxicity, long-term concerns about carcinogenesis and infertility mandate careful patient selection. Recently at the University of Minnesota, 93 solid organ recipients (45 renal transplants) including some children have been treated for tissue-invasive CMV with DHPG. All had a characteristic clinical picture and either a positive CMV culture or a biopsy with CMV inclusions. The patients received i.v. DHPG (10 mg/kg/day) with appropriate adjustments for renal function. In renal allograft recipients, 89% recovered within 30 days, although 21% had to be retreated with DHPG. Although no patient died, allograft survival was significantly reduced (P = 0.02). An additional subgroup of patients (N = 18) who had both biopsy-proven rejection and invasive CMV disease were simultaneously treated for both processes. All of these patients recovered from their CMV infection, but two grafts were lost to rejection.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Ulcerative Colitis and Cytomegalovirus Infection: From A to Z

2020 ◽  
Vol 14 (8) ◽  
pp. 1162-1171 ◽  
Author(s):  
Fadi H Mourad ◽  
Jana G Hashash ◽  
Viraj C Kariyawasam ◽  
Rupert W Leong
Keyword(s):  
Ulcerative Colitis ◽  
Inclusion Bodies ◽  
Antiviral Treatment ◽  
Low Grade ◽  
High Grade ◽  
Cmv Infection ◽  
Significant Difference ◽  
Cmv Colitis ◽  
Cmv Disease ◽  
Severe Colitis

Abstract Despite multiple studies, the role of cytomegalovirus [CMV] infection in exacerbating the severity of inflammation in ulcerative colitis [UC], and its response to treatment, remain debatable. Additionally, the optimal diagnostic tests for CMV infection in the setting of UC relapse, and timing of antiviral treatment initiation, remain unclear. The challenge faced by gastroenterologists is to differentiate between an acute UC flare and true CMV colitis. It seems that the presence of CMV colitis, as defined by the presence of intranuclear or intracellular inclusion bodies on haematoxylin and eosin [H&E] staining and/or positive immunohistochemistry [IHC] assay on histology, is associated with more severe colitis. Patients with CMV infection and acute severe colitis are more resistant to treatment with corticosteroids than non-infected patients. This refractoriness to steroids is related to colonic tissue CMV viral load and number of inclusion bodies [high-grade CMV infection] which may have a pronounced effect on clinical outcomes and colectomy rates. Whereas many studies showed no effect for antiviral treatment on colectomy rates in CMV-infected UC patients, there was a significant difference in colectomy rates of patients with high-grade infection who received anti-viral therapy compared with those who did not receive treatment. It was therefore proposed that high-grade CMV disease indicates that the virus is acting as a pathogen, whereas in those with low-grade CMV disease, the severity of IBD itself is more likely to influence outcome. The different algorithms that have been put forward for the management of patients with UC and concomitant CMV infection are discussed.

Disorganization of Retinal Inner Layers in Retinal Vein Occlusions: New Insights From Anti-VEGF Treatment

2019 ◽  
Vol 3 (5) ◽  
pp. 309-316 ◽  
Author(s):  
Minh T. Nguyen ◽  
Aline L.B. Martins ◽  
Mia A. Heiligenstein ◽  
Barbara A. Blodi ◽  
Mihai Mititelu
Keyword(s):  
Retinal Vein Occlusion ◽  
Study Visit ◽  
University Of Wisconsin ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Significant Difference ◽  
The University ◽  
Endothelial Growth Factor ◽  
Retinal Vein Occlusions

Purpose: The purpose of this study is to determine the significance of disorganization of the retinal inner layers (DRIL) in patients with retinal vein occlusions (RVOs) and whether this is influenced by the choice of antivascular endothelial growth factor (anti-VEGF) agent used. Methods: A retrospective chart study was conducted on patients with RVO and center-involved macular edema (ME) presenting to the University of Wisconsin with a minimum follow-up time of 12 months. Medical records were reviewed for demographics, vision, and imaging at baseline and 2 study visits over the course of 1 year. Two masked graders evaluated spectral-domain optical coherence tomography scans for DRIL and other features within the 1-mm-wide area centered on the foveal depression. Results: Twenty-two eyes had DRIL at baseline. DRIL resolved in 10 eyes at the first study visit, and in 2 more eyes at the second study visit. Although we could not establish an association between visual acuity (VA) and DRIL at baseline, we found a more robust correlation between DRIL extent and VA at baseline in eyes with central retinal vein occlusion/hemicentral vein occlusion compared to eyes with branch retinal vein occlusion. There was an association between DRIL improvement at the first study visit and VA improvement at the second study visit ( P = .049). However, this effect was smaller than the effect of initial VA improvement on final VA improvement. No significant difference in DRIL change was observed between the 3 anti-VEGF treatment algorithms: bevacizumab only, aflibercept only, and bevacizumab followed by aflibercept. Additionally, there was no significant correlation between RVO risk factors and change in DRIL over time. Conclusions: In our study, DRIL was not associated with VA in RVO-ME, but its resolution was predictive of VA improvement in response to anti-VEGF therapy. The choice of anti-VEGF agent (bevacizumab, aflibercept or a combination of the 2) did not affect the magnitude of DRIL resolution in RVO.

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