scholarly journals Efficacy and Tolerability of Methotrexate and Methylprednisolone in a Comparative Assessment of the Primary and Long-Term Outcomes in Patients with Pulmonary Sarcoidosis

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1289
Author(s):  
Volodymyr Gavrysyuk ◽  
Ievgenia Merenkova ◽  
Yaroslav Dziublyk ◽  
Nataliia Morska ◽  
Nataliia Pendalchuk ◽  
...  
Keyword(s):  
Side Effects ◽  
Relapse Rate ◽  
Total Duration ◽  
Treatment Resistance ◽  
Pulmonary Sarcoidosis ◽  
Long Term Outcomes ◽  
High Resolution Computed Tomography ◽  
Chi Square ◽  
Ct Data

Background: There is insufficient information in the literature on the comparative efficacy and tolerability of methotrexate (MTX) and methylprednisolone (MP) in patients with pulmonary sarcoidosis in assessing primary outcomes and the relapse rate. Purpose: The aim of our study was to evaluate primary and long-term outcomes of using MTX and MP in patients with pulmonary sarcoidosis. Methods: A total of 143 patients with newly diagnosed pulmonary sarcoidosis, verified by high-resolution computed tomography (CT) data, were examined. Corticosteroid (CS) therapy was used in 97 patients using MP at a dose of 0.4 mg/kg body weight for 4 weeks, followed by a dose reduction to 0.1 mg/kg by the end of the sixth month. The total duration of CS therapy was 12 months on average. Forty-six patients were treated with MTX at a dose of 10 mg/week (28) and 15 mg/week (18) per os for 6 to 12 months. The study of the relapse rate was conducted within 12 months after the CT data normalization in 60 patients after CS therapy and in 24 after MTX treatment. Results: MP treatment was successfully completed in 68 (70.1%), and MTX in 29 (60.4%) patients. In five MP patients (5.2%) and in five (10.9%) MTX, treatment was discontinued due to serious side effects. In seven (7.2%) MP patients and ten (21.7%) MTX patients, treatment required additional therapy due to the lack of efficacy. Progression with MP treatment (17–17.5%) was more common than with MTX (2–4.3%; Chi square = 4.703, p = 0.031). Relapses after MP therapy were observed in 26 (43.3%) patients, and after MTX therapy in 2 (8.3%; Chi square = 9.450, p = 0.003). Conclusion: In patients with pulmonary sarcoidosis, MTX monotherapy does not differ significantly from MP monotherapy in terms of the level of efficacy and the rate of serious side effects. Increasing the MTX dose from 10 to 15 mg/week accelerates the rate of regression of sarcoidosis, improves treatment efficacy, and does not affect the rate of serious side effects. When using MTX, there is a significant decrease in the incidence of treatment resistance and the relapse rate.

scholarly journals Comparative Effectiveness of Conservative Management Compared to Cryotherapy in Localized Prostate Cancer Patients

2018 ◽  
Vol 12 (5) ◽  
pp. 1681-1691 ◽  
Author(s):  
Surbhi Shah ◽  
Henry N. Young ◽  
Ewan K. Cobran
Keyword(s):  
Prostate Cancer ◽  
Side Effects ◽  
Conservative Management ◽  
Comparative Effectiveness ◽  
Urinary Tract Obstruction ◽  
Localized Prostate Cancer ◽  
Long Term Outcomes ◽  
Lower Urinary Tract Obstruction

The high frequency of treatment-related side effects for men with localized prostate cancer creates uncertainty for treatment outcomes. This study assessed the comparative effectiveness of treatment-related side effects associated with conservative management and cryotherapy in patients with localized prostate cancer. A retrospective longitudinal cohort study was conducted, using the linked data of the Surveillance, Epidemiology, and End Results and Medicare, which included patients diagnosed from 2000 through year 2013, and their Medicare claims information from 2000 through 2014. To compare the differences in baseline characteristics and treatment-related side effects between the study cohorts, χ2 tests were conducted. Multivariate logistic regression was used to assess the association between treatment selection and side effects. There were 7,998 and 3,051 patients in the conservative management and cryotherapy cohort, respectively. The likelihood of erectile dysfunction, lower urinary tract obstruction, urinary fistula, urinary incontinence, and hydronephrosis was reported to be significantly lower (53%, 35%, 69%, 65%, and 36%, respectively) in the conservative management cohort. Conservative management had a lower likelihood of treatment-related side effects compared to cryotherapy. However, further research is needed to compare other significant long-term outcomes such as costs associated with these treatment choices and quality of life.

Abstract P101: Short and Long-Term Outcomes in Aspirin Treated PCI Patients Using NSAIDs

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Rizwan Alimohammad ◽  
Sayed Tariq ◽  
Ali Elkharbotly ◽  
Ed Timm ◽  
Mikhail Torosoff
Keyword(s):  
Myocardial Infarction ◽  
Rank Test ◽  
Long Term Outcomes ◽  
Chi Square ◽  
Low Dose Aspirin ◽  
History Of ◽  
Short And Long Term ◽  
Mortality Table ◽  
Prolonged Hospital

Background: NSAIDs may exert direct deleterious effects on CV system, while non-selective (NS) -NSAIDs may also diminish cardio-protective effect of low-dose aspirin. On another hand, NSAIDs may decrease CRP levels and ameliorate systemic inflammation. We have investigated short and long-term outcomes associated with NSAIDs use in post-PCI patients. Methods and Material: NSAID utilization, hospital and long-term outcomes of 2933 percutaneous coronary revascularizations (PCI) were collected and analyzed. Patients not on aspirin, or treated with rofecoxib and valdecoxib were excluded. ANOVA, Chi-square, Kaplan-Meyer analysis with log-rank test, and logistic regression were utilized. The study was approved by the Institutional IRB. Results: Patients treated with NS-NSAIDs, but not celecoxib, experienced longer length of stay, higher incidence of peri-procedural myocardial infarction, and mildly increased post-PCI mortality (Table). These effects were unchanged after adjustment for age (p=0.001), ejection fraction (p<0.001), and history of previous MI (p<0.001). There was a trend towards lower long-term (50+/-15 months) mortality in NS-NSAIDs (9%) and celecoxib (6.7%) treated patients, when compared to the rest of the cohort (11.3%, Table). Conclusion: Non-selective NSAIDs, but not Celecoxib, are associated with prolonged hospital stay and increased peri-procedural myocardial infarction in PCI patients. Long-term mortality does not appear to be affected by the NSAIDs use at the time of PCI. Randomized studies of this important clinical question are needed.

scholarly journals Prognostic Factors of Long-Term Outcomes in Endodontic Microsurgery: A Retrospective Cohort Study over Five Years

2020 ◽  
Vol 9 (7) ◽  
pp. 2210
Author(s):  
Yeon-Jee Yoo ◽  
Dong-Won Kim ◽  
Hiran Perinpanayagam ◽  
Seung-Ho Baek ◽  
Qiang Zhu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Prognostic Factors ◽  
Periodontal Disease ◽  
Maxillary Sinus ◽  
Long Term Outcomes ◽  
Chi Square ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Endodontic Microsurgery

The aim of this study was to analyze the long-term outcomes of endodontic microsurgeries in a cohort and identify their association with prognostic factors. A cohort of endodontic microsurgeries followed up periodically with complete clinical and radiographic records for at least 5 years were reviewed retrospectively. Their survival and healing status and profile characteristics were analyzed by Pearson chi-square test and logistic regression (α = 0.05) to identify prognostic factors that influenced outcomes. Of 652 cases in the cohort, 225 (34.5%) were included. The mean follow-up period was 90.4 months (range, 60–168 months). The long-term success rate was 80.5%, and the 5-year survival rate was 83.5%. Logistic regression showed higher success in anteriors compared to molars (OR = 5.405, (95% CI, 1.663–17.571; p = 0.005)) and in teeth with crown restorations (OR = 10.232, (95% CI, 3.374–31.024; p < 0.001)). Conversely, lower success was found in teeth with periodontal disease (OR = 0.170, (95% CI, 0.032–0.900; p = 0.037)) and maxillary sinus involvement (OR = 0.187, (95% CI, 0.035–0.994; p = 0.049)). Endodontic microsurgery has a highly favorable long-term outcome. Tooth position, crown restoration, periodontal disease, and maxillary sinus involvement were identified as main prognostic factors.

scholarly journals Neosuture formation after endoscope-assisted craniosynostosis repair

2016 ◽  
Vol 18 (2) ◽  
pp. 196-200 ◽  
Author(s):  
Afshin Salehi ◽  
Katherine Ott ◽  
Gary B. Skolnick ◽  
Dennis C. Nguyen ◽  
Sybill D. Naidoo ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Head Width ◽  
Long Term Outcomes ◽  
Sagittal Synostosis ◽  
Helmet Therapy ◽  
Age At Surgery ◽  
Significant Difference ◽  
Ct Data ◽  
Strip Craniectomy

OBJECTIVE The goal of this study was to identify the rate of neosuture formation in patients with craniosynostosis treated with endoscope-assisted strip craniectomy and investigate whether neosuture formation in sagittal craniosynostosis has an effect on postoperative calvarial shape. METHODS The authors retrospectively reviewed 166 cases of nonsyndromic craniosynostosis that underwent endoscope-assisted repair between 2006 and 2014. Preoperative and 1-year postoperative head CT scans were evaluated, and the rate of neosuture formation was calculated. Three-dimensional reconstructions of the CT data were used to measure cephalic index (CI) (ratio of head width and length) of patients with sagittal synostosis. Regression analysis was used to calculate significant differences between patients with and without neosuture accounting for age at surgery and preoperative CI. RESULTS Review of 96 patients revealed that some degree of neosuture development occurred in 23 patients (23.9%): 16 sagittal, 2 bilateral coronal, 4 unilateral coronal, and 1 lambdoid synostosis. Complete neosuture formation was seen in 14 of those 23 patients (9 of 16 sagittal, 1 of 2 bilateral coronal, 3 of 4 unilateral coronal, and 1 of 1 lambdoid). Mean pre- and postoperative CI in the complete sagittal neosuture group was 67.4% and 75.5%, respectively, and in the non-neosuture group was 69.8% and 74.4%, respectively. There was no statistically significant difference in the CI between the neosuture and fused suture groups preoperatively or 17 months postoperatively in patients with sagittal synostosis. CONCLUSIONS Neosuture development can occur after endoscope-assisted strip craniectomy and molding helmet therapy for patients with craniosynostosis. Although the authors did not detect a significant difference in calvarial shape postoperatively in the group with sagittal synostosis, the relevance of neosuture formation remains to be determined. Further studies are required to discover long-term outcomes comparing patients with and without neosuture formation.

Combination of Prednisolone and Azathioprine for Steroid-Responsive Meningitis-Arteritis Treatment in Dogs

2020 ◽  
Vol 57 (1) ◽  
pp. 1-7
Author(s):  
Lucile Giraud ◽  
Maud Girod ◽  
Laurent Cauzinille
Keyword(s):  
Side Effects ◽  
Relapse Rate ◽  
Primary Treatment ◽  
Immunosuppressive Drug ◽  
Duration Of Treatment ◽  
Glucocorticoid Treatment ◽  
Immune Mediated

ABSTRACT Treatment with high corticosteroid dosages for steroid-responsive meningitis-arteritis (SRMA) is correlated with severe adverse effects and worse quality of life. In order to improve immunosuppression and decrease dosage and duration of glucocorticoid treatment, a second immunosuppressive drug is commonly used in most of the immune-mediated diseases. The objective of this retrospective study was to evaluate the efficacy, tolerability, and occurrence of relapse for the combination of prednisolone and azathioprine. All dogs received azathioprine 2 mg/kg q 24 hr for 1 mo and then 2 mg/kg every other day for 2 mo; prednisolone was started at an immunosuppressive dosage and tapered off gradually during a mean of 3 mo. Twenty-six dogs met inclusion criteria. Twenty-one dogs (81%) were in clinical remission with no relapse observed within the 2 yr follow-up period. Treatment was well tolerated in all dogs and side effects were most of the time mild and self-limiting. The relapse rate (19%) was lower than most published rates. A prednisolone and azathioprine combination appeared to be effective for primary treatment of dogs with SRMA and allows a quicker tapering in prednisolone dosage, a decrease in long-term side effects of steroids, a shorter duration of treatment, and a low relapse rate.

scholarly journals Non-Adherence to Anti-Hypertensive Treatment

2020 ◽  
Vol 32 (1) ◽  
pp. 126-129
Author(s):  
Shalini . ◽  
Manish Kumar Goel
Keyword(s):  
Side Effects ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Developed Countries ◽  
New Delhi ◽  
Care Hospital ◽  
Chi Square ◽  
Cross Sectional

Background: In developed countries, adherence among patients suffering from chronic diseases averages only 50%; in developing countries it is assumed to be much lower. Aims & objectives: To find out the prevalence of non-adherence to antihypertensive treatment among individuals seeking anti-hypertensive treatment from tertiary care hospital in New Delhi & to find out the factors related to non-adherence to the anti-hypertensive treatment among study subjects. Material and Methods: A cross-sectional hospital-based study was conducted from June to October 2018 among 150 diagnosed cases of hypertension. The drug adherence was assessed by using standard Brief Medication Questionnaire I (BMQ I) and to know the determinants of non-adherence a semi-structured (self-designed and pre tested) questionnaire was used. The association of different factors with adherence was analyzed by applying chi square (χ2) test. Results: Among total of 150 participants 44% were males and 56% were females. The magnitude of non-adherence to anti-hypertensive drugs was 35.3%. Side effects of anti-hypertensive drugs was significant risk factor for non-adherence to anti-hypertensive drugs and common reasons for non-adherence were unwanted side effects (64.2%) followed by worry about long term side effects (62.3%). Conclusion: Prevalence of non-adherence to anti-hypertensive drugs was quite high, most common reason for non-adherence to anti-hypertensive medication was unwanted side effects and worry about long term side effects.

Retrospective evaluation of resected ampulla of vater adenocarcinoma (AOVA): Clinicopathologic variables and long-term outcomes—REAL study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14612-e14612
Author(s):  
Neelam Vijay Desai ◽  
Tania Zuluaga Toro ◽  
Lizette Vila Duckworth ◽  
Alex Sommerfeld ◽  
Ahmad Alkhasawneh ◽  
...  
Keyword(s):  
Survival Data ◽  
Ampulla Of Vater ◽  
Long Term Outcomes ◽  
Chi Square ◽  
Molecular Subgroup ◽  
Curative Intent ◽  
Substantial Impact ◽  
Impact On Survival ◽  
Chi Square Test

e14612 Background: AOVA accounts for about 1% of GI cancers. 30% of patients receive curative intent resection with 5-year survival between 20-50%. Limited data are available concerning the value of adjuvant therapy. AOVA may be intestinal or biliary based on histology with each associated with a different natural history and prognosis. This study aims to characterize clinicopathologic features of this disease and associate these with outcomes. Methods: An IRB-approved retrospective review of all patients at the University of Florida between 2000-2011 was undertaken to identify patients with resected AOVA. Periampullary tumors were excluded. Independent histologic review to define intestinal versus biliary subtype and molecular phenotype (including CK 7, 19, 20, SMAD4, CDX2 and MUC1) was undertaken. Chi-square test was used to determine significance between variables. Results: 68 total patients were identified and analyzed. Clinical variables, relapse and survival data are presented (Table). For patients <70 years old, median OS was 69 months vs 13 months for patients >70 years (P=0.0115). Histologic and molecular subgroup analysis is ongoing. Conclusions: AOVA long-term outcomes are consistent with previous publications with 5-year survival of 32%. Age and stage appear to have a substantial impact on survival. Histologic and molecular analysis may further define patient subsets and will be reported. [Table: see text]

Comparison of endovascular and microsurgical management of 208 basilar apex aneurysms

2017 ◽  
Vol 127 (6) ◽  
pp. 1342-1352 ◽  
Author(s):  
Bradley N. Bohnstedt ◽  
Mary Ziemba-Davis ◽  
Rishabh Sethia ◽  
Troy D. Payner ◽  
Andrew DeNardo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Endovascular Management ◽  
Long Term Outcomes ◽  
Chi Square ◽  
Treatment Groups ◽  
Microsurgical Treatment ◽  
Select Group ◽  
Discharge Status ◽  
Perforating Arteries

OBJECTIVEThe deep and difficult-to-reach location of basilar apex aneurysms, along with their location near critical adjacent perforating arteries, has rendered the perception that microsurgical treatment of these aneurysms is risky. As a result, these aneurysms are considered more suitable for treatment by endovascular intervention. The authors attempt to compare the immediate and long-term outcomes of microsurgery versus endovascular therapy for this aneurysm subtype.METHODSA prospectively maintained database of 208 consecutive patients treated for basilar apex aneurysms between 2000 and 2012 was reviewed. In this group, 161 patients underwent endovascular treatment and 47 were managed microsurgically. The corresponding records were analyzed for presenting characteristics, postoperative complications, discharge status, and Glasgow Outcome Scale (GOS) scores up to 1 year after treatment and compared using chi-square and Student t-tests.RESULTSAmong these 208 aneurysms, 116 (56%) were ruptured, including 92 (57%) and 24 (51%) of the endovascularly and microsurgically managed aneurysms, respectively. The average Hunt and Hess grade was 2.4 (2.4 in the endovascular group and 2.2 in the microsurgical group; p = 0.472). Postoperative complications of cranial nerve deficits and hemiparesis were more common in patients treated microsurgically than endovascularly (55.3% vs 16.2%, p < 0.05; and 27.7% vs 10.6%, p < 0.05, respectively). However, aneurysm remnants and need for retreatment were more common in the endovascular than the microsurgical group (41.3% vs 2.3%, p < 0.05; and 10.6% vs 0.0%, p < 0.05, respectively). Stent placement significantly reduced the need for retreatment. Rehemorrhage rates and average GOS score at discharge and 1 year after treatment were not statistically different between the two treatment groups.CONCLUSIONSPatients with basilar apex aneurysms were significantly more likely to be treated via endovascular management, but compared with those treated microsurgically, they had higher rates of recurrence and need for retreatment. The current study did not detect an overall difference in outcomes at discharge and 1 year after either treatment modality. Therefore, in a select group of patients, microsurgical treatment continues to play an important role.

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