ANALYSIS OF HIGH DOSE AND LONG-TERM PREDNISONE THERAPY ON OSTEOCALCIN LEVELS IN CHILDREN WITH NEPHROTIC SYNDROME (STUDY AT PEDIATRIC DEPARTMENT NEPHROLOGY DIVISION OF DR. SOETOMO TEACHING HOSPITAL SURABAYA)

Objective: The objective of the study to analyze osteocalcin levels in induction and alternate phase, associated with clinical manifestation. Methods: We conducted a prospective longitudinal study. This study was subject to approval by the Ethics Committee of Dr. Soetomo Teaching Hospital Surabaya. Osteocalcin levels were measured before and after induction phases and 4 weeks after the alternate phase. Samples were collected in the morning at 08.00-09.00 am. Results: A total of 15 patients were included in this study. The suppression of osteocalcin levels in the induction phase was 53.33%. After the alternate phase, osteocalcin levels increased 175.82%. Clinical manifestation as bone pain/cramps only appeared 33% in the induction phase and 20% in the alternate phase. The mean suppression of osteocalcin levels in the group with induction phase duration therapy ≥28 days and without calcium supplementation was higher than 21-27 days and with calcium supplementation. Osteocalcin levels increased in the alternate phase also in patients with and without calcium supplementation. The result of analysis showed there was no significant difference among all groups (p>0.05). Conclusion: Suppression of osteocalcin levels was reversible after the alternate phase. It shows that tapering off regimen is important. Clinical sign as pain bone/cramps almost showed no manifest in all of these patients.

Download Full-text

Safety and Security in International Humanitarian Missions – Assessing the Stress Level of Responders in Critical Situations during a Realistic Full-Scale Training

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19005016 ◽

2019 ◽

Vol 34 (6) ◽

pp. 575-579

Author(s):

Andreas Spall ◽

Marcel Van der Auwera ◽

Jessica Gerstner ◽

Yasmeen M. Taalab ◽

Robert Wunderlich

Keyword(s):

Border Crossing ◽

Peace Operations ◽

Hostile Environment ◽

Short Term ◽

Prospective Longitudinal Study ◽

After Care ◽

Significant Difference ◽

Before And After ◽

Disaster Aid ◽

Prospective Longitudinal

AbstractIntroduction:Crises, wars, and disasters are remarkably increasing across the world. Responders are frequently tackled with an ever-greater number of challenges, and undoubtedly, they are physically and mentally affected during and after their missions, during which posttraumatic stress disorder (PTSD) is considered high-risk. To the authors’ knowledge, no studies have addressed which type of incident has the greatest influence to trigger stress, and consequently, to cause PTSD for the responders after their missions.Methods:A prospective longitudinal study was conducted with 69 participants of the “Safety and Security” course at the Federal Office for Civil Protection and Disaster Aid of the Federal Ministry of Interior Affairs (Berlin, Germany). The course is certified by the Hostile Environment Awareness Training (HEAT) guidelines of Europe’s New Training Initiative for Civilian Crisis Management (ENTRi; Center for International Peace Operations; Berlin, Germany). Four incidents were evaluated: hostage-taking, carjacking, evacuation, and border-crossing. The participants completed the Positive and Negative Affect Schedule (PANAS) before and after each incident. For each incident, the delta of the PANAS scores was calculated. The differences between the described incidents, as well as the differences between novice and experienced responders, were evaluated.Results:The hostage-taking incident had the greatest influence on the participants’ temper, followed by carjacking and evacuation. Ultimately, the border-crossing event had the least effect on the responders. Novices were more affected by hostage-taking than experienced responders; however, no significant difference had been demonstrated between novices and experienced responders for the other evaluated incidents.Conclusion:Different incidents have big psychological impacts on humanitarian responders, in which consequences vary from short-term effects to PTSD. Therefore, humanitarian responders should be selected very carefully. They should also have more specific preparation for their missions. Mental after-care should be obligatory. Further studies are needed to understand and avoid reasons for the development of PTSD or other potential problems of responders.

Download Full-text

Effect of Myopic Femtosecond Laser-Assisted LASIK on Anterior Chamber Inflammation (Flare Values) and Corneal Endothelium: A Prospective before and after Study

Journal of Ophthalmology ◽

10.1155/2021/2395028 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Kemal Turgay Özbilen ◽

Emre Altinkurt ◽

Nihan Aksu Ceylan ◽

Gizem Sayar Bilgin ◽

Nilüfer Gözüm

Keyword(s):

Endothelial Cells ◽

Femtosecond Laser ◽

Cell Count ◽

Anterior Chamber ◽

Morphological Changes ◽

Specular Microscopy ◽

Prospective Longitudinal Study ◽

Significant Difference ◽

Before And After ◽

Prospective Longitudinal

Purpose. This study aimed to investigate whether femtosecond laser-assisted LASIK (FS-LASIK) surgery causes inflammation in the anterior chamber and to analyze its effect on endothelial cells. Methods. This prospective, longitudinal study included left eyes of 30 patients (19 females) who had undergone FS-LASIK surgery due to myopia and myopic astigmatism. Endothelial cell density (ECD) and morphological measurements were performed using a specular microscopy, and laser flare photometry was used to measure the anterior chamber flare values on the day of surgery. iFS™ Advanced FS and VISX STAR S4-IR Wavescan Excimer Laser platforms were used. Flare measurements were repeated on the postoperative 1st day and 7th day and the 1st and 3rd months. The endothelial measurements were repeated in the 3rd month. Results. Preoperatively, the mean flare was 5.59 ± 1.24 photons/ms; it was 6.49 ± 2.42 on the postoperative 1st day, 5.87 ± 2.27 on the 7th day, 5.68 ± 1.66 on the 1st month, and 5.35 ± 1.24 on the 3rd month. A significant difference was observed only between the preoperative and postoperative 1st day flare values ( p = 0.047 ). The decrease in the ECD was clinically insignificant but statistically significant, with an average of 97.0 ± 209.9 cell count/mm2 (3.3%, p = 0.017 ). However, there was no significant change in the coefficient of variation ( p = 0.448 ) and hexagonality ( p = 0.096 ). No significant correlation was found between the increase in the flare value on the postoperative 1st day and variables. A significant correlation was found between the decrease in ECD and the preoperative ECD (r = 0.356, p = 0.027 ). Conclusion. FS-LASIK caused minimal inflammation in the anterior chamber on only the 1st postoperative day; additionally, a minimal decrease of cell count with no morphological changes were noted in the endothelial cells on postoperative 3rd month. This trial is registered with NCT04899258.

Download Full-text

Evaluation of the Effect of Myopic Femtosecond Laser Assisted-LASIK on Anterior Chamber Flare Values and Corneal Endothelial Cells: A Prospective Before-and-After Study

10.21203/rs.3.rs-498066/v1 ◽

2021 ◽

Author(s):

Kemal Turgay Özbilen ◽

Emre Altınkurt ◽

Nihan Aksu Ceylan ◽

Gizem Sayar Bilgin ◽

Nilüfer Gözüm

Keyword(s):

Endothelial Cells ◽

Femtosecond Laser ◽

Anterior Chamber ◽

Morphological Changes ◽

Specular Microscopy ◽

Prospective Longitudinal Study ◽

Significant Difference ◽

Before And After ◽

Prospective Longitudinal ◽

Anterior Chamber Flare

Abstract Purpose This study aimed to investigate whether femtosecond laser-assisted LASIK (FS-LASIK) surgery causes inflammation in the anterior chamber and to analyze its effect on endothelial cells.Methods This prospective, longitudinal study included 60 eyes of 30 patients (19 females) who had undergone FS-LASIK surgery due to myopia and myopic astigmatism. Endothelial cell density (ECD) and morphological measurements were performed using a specular microscopy, and laser flare photometry was used to measure the anterior chamber flare values on the day of surgery. iFS™ Advanced FS and VISX STAR S4-IR Wavescan Excimer Laser platforms were used. Flare measurements were repeated on the postoperative 1st day and 7th day and the 1st and 3rd months. The endothelial measurements were repeated in the 3rd month.Results Preoperatively, the mean flare was 5.34 ± 1.13 photons/ms; it was 6.02 ± 2.0 on the postoperative 1st day, 5.78 ± 1.98 on the 7th day, 5.77 ± 3.16 in the 1st month, and 5.45 ± 1.13 in the 3rd month. A significant difference was observed between the preoperative values and the postoperative 1st day values (p = 0.010). The decrease in the ECD was statistically significant, with an average of 120.3 ± 260 cell-count/mm2 (p = 0.001) and a minimal change in the coefficient of variation (p = 0.043). A significant correlation was found between the increase in the flare value on the postoperative 1st day and the preoperative flare value (r = -0.281, p = 0.015). A significant correlation was found between the decrease in ECD and the preoperative ECD (r = 0.434, p < 0.001)Conclusion FS-LASIK only causes minimal inflammation in the anterior chamber on the 1st preoperative day; additionally, a statistically significant decrease of 4.2% and minimal morphological changes were noted in the endothelial cells.

Download Full-text

Functional lung rejuvenation in obese patients after bariatric surgery

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.02.157 ◽

2016 ◽

Vol 62 (2) ◽

pp. 157-161 ◽

Cited By ~ 1

Author(s):

Saulo Maia Davila Melo ◽

Pedro Alves Argentino ◽

Murilo Matos de Santana Oliveira ◽

Gabriela Nabuco Chaves Melo ◽

Gildo Lima Souza Neto

Keyword(s):

Bariatric Surgery ◽

The Body ◽

Morbidly Obese ◽

Obese Patients ◽

Obese People ◽

Prospective Longitudinal Study ◽

Significant Difference ◽

Before And After ◽

The Difference ◽

Prospective Longitudinal

Summary Objective: To determine the lung age (LA) in obese people before and after bariatric surgery, compare the LA with the chronological age (CA) before and after the peration, and verify whether there was a functional pulmonary rejuvenation after it. Methods: A prospective longitudinal study including 43 morbidly obese patients who underwent bariatric surgery. The patients underwent clinical and spirometric evaluation in two stages, before and after the surgery. In both stages, LA, CA and spirometric variables were measured. Results: A significant improvement in the spirometric variables (FVC; FEV1; and FEV1/FVC ratio) was found after the operation (p≤ 0.0001). Comparing the LA before (50.93±13.36 years) and after the surgery (39.02±12.95 years), there was an important reduction of 11.90±9.12 years (95CI:9.10-14.71; p≤0.0001) in LA after surgery. The difference between LA and CA before surgery was 12.20± 11.71 years (95CI:8.60-15.81) with significant difference (p≤0.0001), and the difference between LA and CA after surgery was -1.95±11.83 years (95CI: -5.59-1.69) with no significant difference (p≤0.28). Regarding LA, we observed a pulmonary aging of 12.20±11.71 years before the surgery and a pulmonary rejuvenation of 11.90±9.12 years after it. Conclusion: Morbid obesity is responsible for early damage and functional accelerated pulmonary aging. After the correction of the body weight by surgery, there is a functional pulmonary rejuvenation demonstrated by the normalization of LA in relation to CA.

Download Full-text

Longitudinal electrophysiological study of auditory pathway in small for gestational age infants

CoDAS ◽

10.1590/2317-1782/201420140042 ◽

2014 ◽

Vol 26 (4) ◽

pp. 294-301 ◽

Cited By ~ 2

Author(s):

Rosanna Giaffredo Angrisani ◽

Edna Maria Albuquerque Diniz ◽

Ruth Guinsburg ◽

Alexandre Archanjo Ferraro ◽

Marisa Frasson de Azevedo ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Neonatal Period ◽

Electrophysiological Study ◽

Auditory Pathway ◽

Prospective Longitudinal Study ◽

The Third ◽

Significant Difference ◽

Brainstem Response ◽

Prospective Longitudinal

PURPOSE: To follow the maturation of the auditory pathway of infants born small for gestational age term, by studying absolute and interpeak latencies of Auditory Brainstem Response (ABR) in the first six months of life.METHODS: Multicentric prospective longitudinal study. The ABR was carried out in the neonatal period in 96 newborn infants, 49 small for gestational age (SGA) and 47 appropriate for gestational age (AGA). Of these, 77 infants (39 SGA and 38 AGA) returned for a second evaluation. In the third evaluation, 70 infants (35 SGA and 35 AGA) returned.RESULTS: SGA and AGA did not present significant differences in the neonatal period and at three months of life. However, at six months, there was statistical significant difference between SGA and AGA groups for the latencies of wave III and interpeak I-III. Latencies of ABR waves decreased more rapidly in the first three months than the third to the sixth month of life for the SGA. AGA group showed progressive decrease in latency of ABR waves during the six months.CONCLUSION: The findings suggest that, for SGA infants, the maturational process of the auditory pathway occurs in different rate when compared to AGA infants. The SGA infants have faster maturation especially at the first three months of life, while in infants AGA, this process occurred in a constant and gradual way throughout the six months studied.

Download Full-text

A Five Year Longitudinal Study of the Educational Environment in a Newly Integrated Medical Curriculum

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2019.19.04.009 ◽

2019 ◽

Vol 19 (4) ◽

pp. 335

Author(s):

Syed I. Shehnaz

Keyword(s):

Longitudinal Study ◽

United Arab Emirates ◽

Medical Curriculum ◽

Educational Environment ◽

Traditional Curriculum ◽

Prospective Longitudinal Study ◽

Significant Difference ◽

The Mean ◽

Prospective Longitudinal ◽

Course Of Study

Objectives: The College of Medicine at Gulf Medical University (GMU), Ajman, United Arab Emirates, was subjected to a curricular reform, which shifted the institution from a traditional curriculum to a hybrid, studentcentred, integrated curriculum. There are no previous studies analysing the consequences of such a curricular modification on the educational environment (EE). Therefore, this study aimed to analyse the EE of a pioneer cohort of the innovative curriculum over their five-year course of study. Methods: This prospective longitudinal study was conducted between September 2009 and September 2013 at the College of Medicine. The Dundee Ready Education Environment Measure questionnaire was completed by a pioneer cohort of students at the start of each academic session for five consecutive years. The mean overall, subscale and individual statement scores were evaluated using the Kruskal-Wallis and Wilcoxon-rank sum tests. Results: A total of 178 responses were collected (response rate: 90.4%). The mean overall score throughout the five years of study was 130/200. A significant difference in the scores (P <0.05) was observed as the students proceeded through the course. The overall and subscale scores were significantly higher in the first and final years of study. Analysis of the statements recognised the medical knowledge of the teachers’ and students’ awareness of empathy and social interactions as persistent strengths of the college over the entire course of study. A curricular overload, a want for support systems for stressed students, students’ waning interest levels and assessment strategies emerged as areas that warranted further attention. Conclusion: The pioneer cohort of the new curriculum rated their EE as positive throughout their five years of study at GMU. An examination of individual statements revealed the programme’s strengths and areas for improvement for the institution.Keywords: Curriculum; Environment; Longitudinal Study; Medical Students; Perception; Undergraduate Medical Education; United Arab Emirates.

Download Full-text

Follicle-Stimulating Hormone Treatment and Male Idiopathic Infertility: Effects on Sperm Parameters and Oxidative Stress Indices according to FSHR c. 2039 A/G and c. -29 G/A Genotypes

Journal of Clinical Medicine ◽

10.3390/jcm9061690 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1690

Author(s):

Laura M. Mongioì ◽

Rosita A. Condorelli ◽

Angela Alamo ◽

Rossella Cannarella ◽

Nicolò Musso ◽

...

Keyword(s):

Oxidative Stress ◽

Follicle Stimulating Hormone ◽

Sperm Concentration ◽

Sperm Parameters ◽

Prospective Longitudinal Study ◽

Stress Indices ◽

Idiopathic Infertility ◽

Before And After ◽

Prospective Longitudinal ◽

Stimulating Hormone

Scientific evidence shows that the administration of follicle-stimulating hormone (FSH) to infertile patients with normal serum FSH concentrations improves sperm parameters in oligozoospermic men. The aim of this study was to evaluate the effects of highly purified urofollitropin (hpFSH) on conventional and bio-functional sperm parameters and on oxidative stress indices in patients with idiopathic infertility. We also evaluated the response to hpFSH on these parameters in relationship to FSHR c. 2039 A/G and FSHR c. -29 G/A genotypes. A prospective longitudinal study was conducted on 42 patients with idiopathic male infertility, 23 of whom underwent to FSHR c. 2039 A/G and FSHR c. -29 G/A genotyping. Each patient was asked to collect two semen samples before and after administration of 150 IU hpFSH three times a week for 16 weeks. Patients were divided into responders or non-responders based on whether their total sperm count had at least doubled or was less than double at the end of treatment, respectively. Responders showed a significantly higher semen volume, sperm concentration, spermatids, and leukocytes. Non-responders had a significant decrease of the percentage of spermatozoa in early apoptosis after hpFSH administration. Oxidative stress indexes did not differ significantly after FSH administration in both groups. Conventional and bio-functional sperm parameters did not differ in patients with FSHR c. 2039 GG and AA genotypes, and FSHR c. -29 GG genotype both before and after FSH administration. The FSHR c. 2039 and FSHR -29 G/A genotypes and allelic distribution did not differ between responders and non-responders. FSH showed to be capable of ameliorating sperm parameters in about half patients treated, therefore it may be helpful in patients with idiopathic infertility.

Download Full-text

Effect of glucocorticoid therapy on adrenal function in children with acute lymphoblastic leukemia

Paediatrica Indonesiana ◽

10.14238/pi54.1.2014.15-21 ◽

2014 ◽

Vol 54 (1) ◽

pp. 15

Author(s):

Gita Widyapuri ◽

Djajadiman Gatot ◽

Aman Bakti Pulungan ◽

Badriul Hegar

Keyword(s):

Hpa Axis ◽

Standard Dose ◽

Lymphoblastic Leukemia ◽

Adrenal Function ◽

High Dose ◽

Induction Phase ◽

Acth Test ◽

Before And After ◽

Response To Stress ◽

Cortisol Levels

BackgroundGlucocorticoids play an important role in thetreatment ofacute lymphoblastic leukemia (ALL), but can causeside effects such as suppression of the hypothalamic-pituitaryadrenal (HPA) axis. Suppression of the HPA axis causes adrenal insufficiency, disturbs the cortisol response to stress, and may be a cause of morbidity and mortality in children with ALL.ObjectiveTo evaluate adrenal function in children with ALL afterinduction chemotherapy with high dose glucocorticoids.MethodsThe adrenal function of 20 children with ALL wasevaluated using a standard dose (250 μ g) adrenocorticotropinhormone (ACTH) test performed before and after a 6 week oftreatment with glucocorticoids induction phase chemotherapy,which was followed by a week period tapering off. Adrenalinsuffien cy was defined as blood cortisol level of < 18 μg/dLResultsAdrenal insufficiency was found in 14/20 subjects afterthe induction phase followed by a week period of tapering off.Median cortisol levels pre- and post-stimulation before inductionphase were 14.72 (range 2.0 1- 46. 1) μg/dL and 29.29 (range 21.65 - 55 .15) μg/dL, respectively. Median cortisol levels pre- and poststimulation after induction phase were 5.87 (range 0.2 - 20.53)μg/dL and 10.49 (range 0.33 - 28.69) μg/dL, respectively. Clinicalsigns and symptoms did not differ between those with and withoutadrenal insufficiency.ConclusionOf 20 children with ALL, 14 develop adrenalinsufficiency after a 6-week induction therapy with glucocorticoidsand followed by a week period of tapering off. No specific clinicalsigns and symptoms are identified to be related to the adrenalinsufficiency.

Download Full-text

Efficacy and Tolerability of Aripiprazole Intramuscular as Maintenance Treatment in Patients with Paranoid Schizophrenia

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.125 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S280-S280

Author(s):

B. Serván ◽

A. Montes ◽

M. Machín ◽

P. Gómez ◽

J. García-Albea ◽

...

Keyword(s):

Relapse Rate ◽

Negative Symptoms ◽

Rating Scale ◽

Paranoid Schizophrenia ◽

Tolerability Profile ◽

Prospective Longitudinal Study ◽

Therapeutic Adherence ◽

Significant Difference ◽

Previously Treated ◽

Prospective Longitudinal

IntroductionPatients suffering from paranoid schizophrenia, require long-term anti-psychotic treatment, which provide, in addition to adequate efficacy both positive and negative symptoms, a good safety and tolerability profile that would ensure adequate adherence to prevent relapse.ObjectivesTo analyze the efficacy, tolerability and therapeutic adherence over a year after the introduction of aripiprazole depot in patients diagnosed with paranoid schizophrenia previously treated with other oral or depot anti-psychotics [1,2,3].MethodsOne-year prospective longitudinal study with a sample size of 23 patients diagnosed with schizophrenia in outpatient treatment. Study variables (baseline, 6 and 12 months): Brief Psychiatric Rating Scale (BPRS), clinical global impression (CGI), mean dose of aripiprazole depot, previous treatments, adherence, relapse rate, prolactin levels, sexual dysfunction, BMIs.ResultsTwenty-three patients (71% men, 29% women) diagnosed with paranoid schizophrenia were identified. Improvement was obtained in the different study variables with statistically significant difference (P ≤ 0.05).ConclusionsFollowing the introduction of aripiprazole depot in patients diagnosed with schizophrenia previously treated with other oral or depot anti-psychotics in our study, we conclude that maintaining therapeutic efficacy a better tolerability and safety profile, better therapeutic adherence and consequently lower relapse rate were achieved.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Influence of changes in arterial pCO2 on cerebral blood flow and metabolism during high-dose barbiturate therapy in dogs

Journal of Neurosurgery ◽

10.3171/jns.1981.54.5.0615 ◽

1981 ◽

Vol 54 (5) ◽

pp. 615-619 ◽

Cited By ~ 15

Author(s):

Neal F. Kassell ◽

Patrick W. Hitchon ◽

Mary K. Gerk ◽

Martin D. Sokoll ◽

Todd R. Hill

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

High Dose ◽

Sodium Thiopental ◽

Arterial Pco2 ◽

Content Type ◽

Cerebral Vasoconstriction ◽

Significant Difference ◽

Before And After ◽

High Doses

✓ In 13 dogs the response of the cerebral circulation to changes in PaCO2 ranging from 20 to 60 torr was studied before and after administration of high doses of sodium thiopental. Infusion of sufficient barbiturate to produce 30- to 60-second burst suppression in the electroencephalogram was associated with a profound degree of cerebral vasoconstriction, equivalent to that produced by hypocapnia with PaCO2 = 20 torr. Furthermore, once sodium thiopental was administered, no significant difference in cerebral blood flow (CBF) or vascular resistance (CVR) was noted between PaCO2 of 30 and 20 torr. However, changes of approximately 15% in CBF and 30% in CVR were noted between PaCO2 at 40 and 20 torr. These data suggest that hyperventilation of PaCO2 of less than 30 torr may not effectively increase the degree of cerebral vasoconstriction in these circumstances.

Download Full-text