History Of Medical Treatment Research Articles

Prediction of incident chronic kidney disease in a population with normal renal function and normo-proteinuria.

Regarding the irreversible clinical course of chronic kidney disease, identifying high-risk subjects susceptible to Chronic Kidney Disease (CKD) has an important clinical implication. Previous studies have developed risk prediction models identifying high-risk individuals within a group, including those who may have experienced minor renal damage, to provide an opportunity for initiating therapies or interventions at earlier stages of CKD. To date, there were no other studies developed a prediction model with quantitative risk factors to detect the earliest stage of CKD that individuals with normal renal function in the general population may experience. We derived 11,495,668 individuals with an estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m2 and normo-proteinuria, who underwent health screening ≥2 times between 2009 and 2016 from the prospective nationwide registry cohort. The primary outcome was the incident CKD, defined by an eGFR <60 mL/min/1.73 m2. Sex-specific multivariate Cox regression models predicting the 8-year incident CKD risk were developed. The performance of developed models was assessed using Harrell's C and the area under the receiver operating characteristics curve (AUROC) with 10-fold cross-validation. Both men and women, who met the definition of incident CKD, were older and had more medical treatment history in hypertension and diabetes. Harrell's C and AUROC of the developed prediction models were 0.82 and 0.83 for men and 0.79 and 0.80 for women. This study developed sex-specific prediction equations with reasonable performance in a population with normal renal function.

MP16-13 CYSTINURIA AND PREGNANCY: CLINICAL COURSE AND OUTCOMES FROM 2000-2020

You have accessJournal of UrologyCME1 Apr 2023MP16-13 CYSTINURIA AND PREGNANCY: CLINICAL COURSE AND OUTCOMES FROM 2000-2020 Amy Reed and Nicole Miller Amy ReedAmy Reed More articles by this author and Nicole MillerNicole Miller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cystinuria is a rare disease which limits the understanding of its impact on pregnancy. We sought to characterize stone disease and management of patients with cystinuria during pregnancy at a single institution. METHODS: We completed a retrospective chart review of cystinuria patients at a single institution from 2000-2022. Patients were identified by ICD-10 codes (E72.01) and then included for childbearing potential. Charts were reviewed for urologic history as well as baseline medical and surgical treatment history. We evaluated imaging studies, stone episodes, stone surgeries and complications during pregnancy. This was then compared to the reported historic incidence of renal colic, stone diagnosis and surgical intervention during pregnancy. RESULTS: 44 female patients with cystinuria were identified and 40 were included based on child bearing potential. Patient age ranged from 16-68 years. Nine patients had a total of 27 pregnancies and 20 successful live births. Patients were treated with Thiola (3), urinary alkalinization (4) or fluid alone (5) and all medications were discontinued during pregnancy. Patients had an average of 6 stone surgeries prior to pregnancy. Comorbidities included chronic pain (2), chronic kidney disease (1) and multiple sclerosis (1). Renal colic occurred in 27% of pregnancies requiring an average of 1 renal ultrasound in addition to routine prenatal assessment. Of these, only one patient had confirmed stone events in 2 out of her 4 pregnancies (8.3% of symptomatic patients) which required a total of six surgeries (stent placement, ureteroscopy). The remaining 8 patients did not have any confirmed stone events. Comparatively, the reported incidence of renal colic in all pregnancies is 0.12% with 71% of these patients having confirmed stone events and 28% of them undergoing surgical intervention. Comparing pre- and post-partum imaging, 4 patients had radiographic evidence of stone growth during pregnancy. Pregnancies were complicated by 4 (15%) spontaneous abortions in the first trimester and one patient developed a ureteral stricture after ureteroscopy during pregnancy that required delayed reconstruction. CONCLUSIONS: Patients with cystinuria are at an increased risk of renal colic episodes during pregnancy but these symptomatic patients do not have a higher rate of stone diagnosis or surgical intervention. Cystinuria patients do not seem to increased complications during pregnancy. However, given a high rate of new stone formation, close follow up of these patients in the post-partum period is necessary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e207 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amy Reed More articles by this author Nicole Miller More articles by this author Expand All Advertisement PDF downloadLoading ...

Successful Ultrasound-Guided Methotrexate Intervention in the Treatment of Heterotopic Interstitial Pregnancy: A Case Report and Literature Review

This study aims to share the experience of minimally invasive ultrasound-guided methotrexate intervention in the treatment of heterotopic interstitial pregnancy (HIP) with good pregnancy outcomes, and to review the treatment, pregnancy outcomes, and impact on the future fertility of HIP patients. The paper describes the medical history, clinical manifestations, treatment history, and clinical prognosis of a 31-year-old woman with HIP, and reviews cases of HIP from 1992 to 2021 published in the PubMed database. The patient was diagnosed with HIP by transvaginal ultrasound (TVUS) at 8 weeks after assisted reproductive technology. The interstitial gestational sac was inactivated by ultrasound-guided methotrexate injection. The intrauterine pregnancy was successfully delivered at 38 weeks of gestation. Twenty-five HIP cases in 24 studies published on PubMed from 1992 to 2021 were reviewed. Combined with our case, there were 26 cases in total. According to these studies, 84.6% (22/26) of these cases were conceived by in vitro fertilization embryo transfer, 57.7% (15/26) had tubal disorders, and 23.1% (6/26) had a history of ectopic pregnancy; 53.8% (14/26) of the patients presented with abdominal pain and 19.2% (5/26) had vaginal bleeding. All cases were confirmed by TVUS. In total, 76.9% (20/26) of intrauterine pregnancies had a good prognosis (surgery vs. ultrasound interventional therapy 1:1). All fetuses were born without abnormalities. The diagnosis and treatment of HIP remain challenging. Diagnosis mainly relies on TVUS. Interventional ultrasound therapy and surgery are equally safe and effective. Early treatment of concomitant heterotopic pregnancy is associated with high survival of the intrauterine pregnancy.

Methods for Analyzing Medical-Order Sequence Variants in Sequential Pattern Mining for Electronic Medical Record Systems

Electronic medical record systems have been adopted by many large hospitals worldwide, enabling the recorded data to be analyzed by various computer-based techniques to gain a better understanding of hospital-based disease treatments. Among such techniques, sequential pattern mining, already widely used for data mining and knowledge discovery in other application domains, has shown great potential for discovering frequent patterns in sequences of disease treatments. However, studies have yet to evaluate the use of medical-order sequence variants , where a “frequent pattern” can include some limited variations to the pattern, or have considered the factors that lead to these variants. Such a study would be meaningful for medical tasks such as improving the quality of a particular treatment method, comparing treatments with multiple hospitals, recommending the best-suited treatment for each patient, and optimizing the running costs in hospitals. This article proposes methods for evaluating medical-order sequence variants and understanding variant factors based on a statistical approach. We consider the safety and efficiency of sequences and related information about the variants, such as gender, age, and test results from hospitals. Our proposal has been demonstrated as effective by experimentally evaluating an electronic medical record system’s real dataset and obtaining feedback from medical workers. The experimental results indicate that the medical treatment history and specimen test results after hospitalization are significant in identifying the factors that lead to variants.

PENERAPAN CAESAR CHIPER DAN LEAST SIGNIFICANT BIT UNTUK MENGAMANKAN DATA REKAM MEDIS

Technological developments in data security systems in maintaining information security have grown rapidly. Medical record is a document that contains personal data and medical history and medical treatment history of a patient at a hospital. Medical records are sensitive and confidential so that not just anyone can read the information in the patient's medical record. This study aims to secure patient medical record information by encrypting it with caesar cipher cryptography, the name of the patient's disease, then from the results of the encryption, the process of inserting the encrypted information into a digital image uses the least significant bit (LSB) steganography, namely replacing 1 digit behind the binary number in every 1 bit. The results of the study show that the application created is capable of encrypting and encoding patient medical record data information and embedding this information into digital images.

Selective Myectomy and Myotomy In Situ for the Management of Refractory Blepharospasm in Meige Syndrome.

Meige syndrome is characterized by involuntary blepharospasm and varied subphenotypes of oromandibular tonic-clonic muscle contraction. Despite botulinum toxin (BTx) being the mainstay of treatment for Meige syndrome, a small subset of patients remain refractory to its effects because the disease is a form of functional blindness. An integrative surgical procedure combining selective myectomy and myotomy in situ of eyelid protractors, blepharoptosis correction, and tightening of the lower eyelid laxity was first applied to treat refractory blepharospasm in patients with Meige syndrome. This study is a retrospective review conducted on 24 patients with refractory Meige syndrome between 2013 and 2020. Besides selective myectomy and myotomy in situ of eyelid protractors, levator plication and lateral tarsoplasty or canthopexy was performed for blepharoptosis correction and lower eyelid tightening, respectively. Patient demographics, associated diseases, medical treatment history, associated surgical procedures, final aesthetic outcomes, and therapeutic effects as reflected by changes in function disability score and Botox (BTx) treatment were thoroughly recorded and analyzed. The mean age of the patients was 65.2 ± 8.9 years. Twenty-one patients (87.5%) received blepharoptosis correction by levator plication with an average of 11.2 ± 2.9 mm in length. Lateral tarsoplasty was performed in 16 patients (66.7%) by pentagonal tarsal resection with an average of 3.9 ± 0.8 mm in width. Five patients (20.8%) received lateral canthopexy. Among the total of 96 operated eyelids, scar revision with fat graft was performed in 3 eyelids (3.1%). The average amount of BTx treatment decreased from 49.2 ± 12.8 U once every 2.7 ± 0.8 months before surgery to 35.4 ± 7.8 U once every 3.8 ± 0.7 months after surgery. Function disability score improved from 76.7 ± 17.5% preoperatively to 15.6 ± 9.9% postoperatively ( P < 0.001). Only 3 upper eyelids (3.1%) received scar revision and fat grafting due to minor postoperative contour depression. All patients expressed high satisfaction with both functional and aesthetic outcomes (Likert scale 4.5 ± 0.5). Selective myectomy and myotomy in situ of eyelid protractors combining blepharoplasty correction and lower eyelid tightening can produce long-lasting functional and aesthetic results with minimal complication in patients with refractory Meige syndrome.

Psychiatric Characteristics of Students Who Make Threats Toward Others at School

While studies have focused on identifying potential school shooters, little is known about the mental health and other characteristics of students who make threats. This study aimed to describe these students and factors prompting psychiatric interventions and treatment recommendations. Child and adolescent psychiatry threat assessment evaluations of 157 consecutive school-referred youths in grades K-12 between 1998 and 2019 were reviewed for demographics, reasons for referral, nature of threat, psychiatric diagnosis, and psychiatric and educational recommendations. Predictors of recommendations for psychiatric interventions were modeled using multivariable logistic regression as a function of above-mentioned covariates. Mean (SD) age of referred students was 13.37 (2.79) years; 88.5% were male; 79.7%, White; 11.6%, Hispanic; 10.1%, Black; 2.5%, Asian. Of students, 51.6% were receiving special education services. Verbal threat was made by 80%, and 29.3% brought a weapon to school. History included being bullied in 43.4%, traumatic family events in 52.2%, physical abuse in 5.1%, sexual abuse in 5.7%, and verbal abuse in 36.3%. Frequently encountered psychiatric diagnoses were attention-deficit/hyperactivity, learning, depressive, anxiety, and autism spectrum disorders, usually in combinations. History of medication treatment was reported in 79 (50.3%) and psychotherapeutic interventions in 57 (36.3%). Recommendations to return the student to their prior schools were made for 63.1%. Recommendations for psychotherapy were made for 79.9%, medication for 88.5%, and both for 70.1%. Therapeutic school setting or psychiatric hospitalization was more likely recommended (with statistical significance) with a prior threat history (odds ratio [OR] 5.47, 95% CI 1.91-15.70), paranoid symptoms (OR 5.72, 95% CI 1.55-21.14, p= .009), autism spectrum disorders (OR 3.45, 95% CI 1.32-9.00), mood disorder (OR 5.71, 95% CI 1.36-23.96), personality disorder (OR 9.47, 95% CI 1.78-50.55), or with psychotherapy recommendation (OR 4.84, 95% CI 1.08-21.75). Students who make threats have diverse psychiatric profiles and warrant treatments. A trauma and/or abuse history is common. Evaluations of youths who make threats need to go beyond simply assessing the threat itself and should include identifying underlying psychiatric problems. Psychiatric evaluation of students who issue threats of any type can lead to revelations about psychiatric diagnoses and crucial treatment and educational recommendations. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Long-term mortality after transcatheter aortic valve implantation for aortic stenosis in immunosuppression-treated patients: a propensity-matched multicentre retrospective registry-based analysis.

Data regarding patients with a previous medical record of immunosuppression treatment who have undergone transcatheter aortic valve implantation (TAVI) are limited and extremely inconclusive. Available studies are mostly short term observations; thus there is a lack of evidence on efficacy and safety of TAVI in this specific group of patients. To compare the in-hospital and long-term outcomes between patients with or without a medical history of immunosuppressive treatment undergoing TAVI for aortic valve stenosis (AS). We conducted a retrospective registry-based analysis including patients undergoing TAVI for AS at 5 centres between January 2009 and August 2017. The primary endpoint was long-term all-cause mortality. Secondary endpoints comprised major vascular complications, life-threatening or disabling bleeding, stroke and new pacemaker implantation. Of 1451 consecutive patients who underwent TAVI, two propensity-matched groups including 25 patients with a history of immunosuppression and 75 patients without it were analysed. No differences between groups in all-cause mortality were found in a median follow-up time of 2.7 years following TAVI (p = 0.465; HR = 0.73; 95% CI: 0.30-1.77). The rate of major vascular complications (4.0% vs. 5.3%) was similar in the two groups (p = 1.000). There were no statistically significant differences in the composite endpoint combining life-threatening or disabling bleeding, major vascular complications, stroke and new pacemaker implantation (40.0% vs. 20.0%, p = 0.218). Patients who had undergone TAVI for AS had similar long-term mortality regardless of whether they had a previous medical record of immunosuppression. Procedural complication rates were comparable between the groups.

Abstract P043: A precision medicine gap: limited recognition of colorectal patients eligible for germline testing in molecular residual disease testing setting

Abstract Background: Germline testing for hereditary colorectal cancer (CRC) has traditionally been offered to patients with strong cancer family histories, whose colon tumors revealed mismatch repair deficiency (dMMR), and/or individuals diagnosed with CRC under age 50. Underdiagnosis of hereditary cancer syndromes is often attributed to the complexity or unawareness of family history or phenotypic criteria.1,2 The National Comprehensive Cancer Network (NCCN) guidelines for CRC were recently updated (v. 1.2022) to consider germline multigene panel testing (MGPT) evaluation for all individuals with CRC.3,4 Our goal was to evaluate documentation of MGPT in CRC patients referred for molecular residual disease (MRD) testing. Methods: This retrospective cohort study reviewed clinical data submitted to a commercial laboratory for consecutive CRC patients referred from non-academic medical facilities for MRD testing during a two-month study period. Medical diagnoses, treatment history, family history and germline genetic evaluation status were obtained from the test requisition form and pathology reports. Clinical notes were reviewed in 77/80 cases. Results: Of the 80 patients who met criteria for inclusion, 65/80 (81%) had documented MMR testing of their colorectal tumor. Whereas five had abnormal immunohistochemistry, only two (40%) had documented germline results. 19/80 (24%) met NCCN criteria solely based on a personal CRC diagnosis &amp;lt;50 years, but only 1/19 (5.3%) had documented MGPT. Only 5/80 (6%) of all CRC patients had documented MGPT. Conclusion: Our real-world data from the community oncology precision medicine setting suggests that a majority of CRC patients who received MRD testing and met the prior NCCN criteria for MGPT may not have received evaluation beyond routine MMR status. Process and educational improvements are needed in community health settings to increase access and uptake of germline testing in CRC patients regardless of age at diagnosis or MMR status. Citation Format: Suzanne Schrock-Kelley, Vivienne Souter, Michael Hall, Jeffrey N. Weitzel. A precision medicine gap: limited recognition of colorectal patients eligible for germline testing in molecular residual disease testing setting. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P043.

Cancer Disease-Oriented-Drug Development Examples

The history of cancer medical treatments goes up to 1908 with the use of arsenic in this disease. An intermediate milestone was the discovery, in 1943, of an amazing tumor response using nitrogen mustard in a patient with a radio-resistant lymphoma. Chemotherapy really born with this achievement, and a plethora of antitumor agent’s came to age after 1948 till nowadays. Here, some examples of recent disease-oriented drug development approaches are presented and analyzed, as well as present limitations and challenges raised by each one

Historical Study of Returning to Life: Review of the History of Life and Medical Treatment in the Song Dynasty

Historical Study of Returning to Life: Review of the History of Life and Medical Treatment in the Song Dynasty

Ambulatory Hysteroscopy in Abnormal Uterine Bleeding: A Tertiary Care Hospital Perspective

Background: To avoid delays in outpatient facilities for managing benign gynecological conditions like abnormal uterine bleeding (AUB), there is a need to evaluate the usage of unconventional methods like outpatient hysteroscopy. Objectives: To evaluate the usage of outpatient diagnostic hysteroscopy in women with abnormal uterine bleeding. Methods: An observational study was conducted at the Obstetrics and Gynecology Department of Combined Military Hospital, Kharian. The study included 56 women having AUB with or without a history of failed medical treatment. The study participants underwent outpatient diagnostic hysteroscopy. Diagnostic hysteroscopy was done under the local para-cervical block in the Outpatient department. Procedure indications, outcome and biopsy findings were recorded on predesigned proformas. Results: Median age of the study participants was 44 years. The most common indications for diagnostic hysteroscopy were postmenopausal bleeding (34%) and heavy menstrual bleeding (28%). Hysteroscopy outcomes included endometrial biopsy (34%), discharge with no biopsy (25%), further test and evaluations required (21%), and admission due to failed outpatient procedures (20%). Sixty-two percent of the study participants had normal biopsy findings while other biopsy findings included polyps (20%), fibroids (14%) and endometrial hyperplasia (4%). Nine percent had unsuccessful hysteroscopy due to patient refusal to proceed. Conclusion: Outpatient hysteroscopy can be helpful in the early and rapid diagnosis of women with abnormal uterine bleeding.

Enterocytozoon bieneusi in fecal samples from calves and cows in Austria

Enterocytozoon bieneusi is an obligate intracellular pathogen that infects livestock, companion animals, and wildlife and has the potential to cause severe diarrhea especially in immunocompromised humans. In the underlying study, fecal samples from 177 calves with diarrhea and 174 adult cows originating from 70 and 18 farms, respectively, in Austria were examined for the presence of E. bieneusi by polymerase chain reaction targeting the Internal Transcribed Spacer 1 (ITS1) region. All positive samples were further sequenced for genotype determination. Overall, sixteen of the 351 (4.6%) samples were positive for E. bieneusi, two of the 174 samples from cows (1.2%) and 14 of the 177 samples from calves (7.9%). In total, four genotypes, J (n = 2), I (n = 12), BEB4 (n = 3), and BEB8 (n = 1), were identified. The uncorrected p-distance between the four ITS1 lineages (344 bp) ranges from 0.3% to 2.9%. The lineages differ by 1 bp (I and J), 2 bp (J and BEB4), and 3 bp (I and BEB4), respectively, and BEB8 differs by 7 to 10 bp from the latter three lineages. Two of the E. bieneusi-positive calves showed an infection with two different genotypes. E. bieneusi occurred significantly more often in calves > 3 weeks (8/59) than in calves ≤ 3 weeks (6/118), respectively (p = 0.049). Calves with a known history of antimicrobial treatment (50 of 177 calves) shed E. bieneusi significantly more often than untreated calves (p = 0.012). There was no statistically significant difference in E. bieneusi shedding in calves with or without a medical history of antiparasitic treatment (p = 0.881). Calves showing a co-infection with Eimeria spp. shed E. bieneusi significantly more often than uninfected calves (p = 0.003). To our knowledge, this is the first report of E. bieneusi in cattle in Austria. Cattle should be considered as a reservoir for human infection since potentially zoonotic E. bieneusi genotypes were detected.

Characterization of Real-World Chronic Graft-Versus-Host-Disease Patients Receiving Belumosudil

Introduction Chronic graft-versus-host-disease (cGVHD) is a common complication of hematopoietic stem cell transplant (HSCT). cGVHD is characterized by inflammation and fibrosis that negatively impact multiple organ systems, resulting in substantial morbidity and mortality. While many systemic therapies are available to treat cGVHD, these therapies are associated with adverse events that may limit treatment adherence or lead to discontinuation. In July 2021, the Rho-associated coiled-coil kinase 2 (ROCK2) inhibitor belumosudil was approved by the United States Food and Drug Administration for the treatment of cGVHD for patients 12 years and older after failure of at least two prior lines of systemic therapy based on the efficacy observed in a randomized, open-label, multicenter trial (NCT03640481). Characteristics of patients being treated with belumosudil outside of a clinical trial have not been described previously. The objective of this study is to understand the real-world, non-clinical trial use of belumosudil for patients with cGVHD. Methods This retrospective study describes cGVHD patients recorded in the Komodo closed claims dataset between January 2016 and March 2022. The final cohort of interest included patients who were diagnosed with cGVHD (≥1 medical claim with the International Classifications of Disease Version 10 [ICD-10] diagnosis code D89.811), received belumosudil (≥1 claims with National Drug Code 79802020030), and were 12 years of age or older in the year of belumosudil initiation. Patients were required to have at least 36 months of continuous medical and pharmacy enrollment prior to their initial belumosudil prescription to ensure a complete medical diagnosis, treatment, and healthcare utilization history. Results A total of 151 patients were identified [median (interquartile range) age of 53 (40-62) years old; 54% female]. Sixty percent (92/151) of the patients had an HSCT within the 36-month observation period, and 73% (67/92) of the patients with an observable HSCT also had a diagnosis for a hematologic cancer in the 3 months prior to their HSCT. The median times from HSCT (in those with a recorded event) and cGVHD diagnoses (in all patients available) to belumosudil initiation were 3.2 (1.7-4.0) and 1.5 (0.5-3.1) years, respectively. During the 36 months pre-belumosudil treatment, common diagnoses included dyspnea (81%, 123/151), cytopenia (79%, 119/151; includes anemia, neutropenia, and thrombocytopenia), and "complications of stem cell transplant" (76%, 115/151; ICD-10 code T86.5). In the 12 months immediately prior to belumosudil initiation, the mean (standard deviation) Charlson Comorbidity Index score was 3.6 (2.2); a median of 9 (4-20) cGVHD-related healthcare encounters occurred; and nearly half of all patients had a hospitalization (all-cause 48%, 73/151; cGVHD-related, 27%, 41/151), with the most frequent primary diagnoses for admission attributed to respiratory illnesses and transplant complications. The majority of patients had received ≥3 lines of cGVHD treatment (85%, 128/151) in the 36 months pre-belumosudil, with a median of 5 (4-6) systemic therapies. Combination therapies containing either calcineurin inhibitors (17%; 25/151) or ruxolitinib (15% 23/151) were the most common lines of therapy immediately prior to belumosudil prescription. Use of strong Cytochrome P450 Family 3 Subfamily A (CYP3A) inducers was not observed during the observation period. In the 12 months prior to belumosudil initiation, 55% (83/151) patients were prescribed proton pump inhibitors. For the first belumosudil prescription that a patient received, 74% (111/151) of patients received once-daily dosing, and 26% (40/151) of patients received twice-daily dosing. Conclusions In this real-world data, prior to receiving belumosudil, patients received a median of 5 lines of systemic therapies at a median of 1.5 years from cGVHD diagnosis. Patients displayed multiple comorbidities and frequent hospitalizations that could complicate clinical management with existing cGVHD therapies. There is an unmet need for safe and effective treatment for cGVHD patients. Further research is needed to describe outcomes for patients being treated with belumosudil.

Clinical and Radiological Correlation of Low Flow Vascular Malformation Treated With Percutaneous Sclerotherapy.

Objective: To retrospectively correlate imaging findings post-sclerotherapy of low-flow vascular malformations with clinical outcome. Materials and Methods: We retrospectively evaluated 81 pediatric patients who had sclerotherapy in our department over a 14-year period. Patients with a diagnosis of low-flow vascular malformation, pre and post-treatment ultrasound (US) and clinical follow-up evaluation were included in the study. Exclusion criteria were coexisting high-flow vascular malformations, history of additional surgical or medical treatment to their malformation and large infiltrative lesions difficult to measure on US. Pre and post-treatment sonographic volumes of the malformation were assessed. Changes in volume were categorized into 6- increased volume, stable and volume decrease of 1-25%/26-50%/51-75%/75-100%. Clinical outcomes were categorized into 4 - worse, no change, improved and symptom free. In cases where pre-treatment MRI was available, the estimated malformation volumes in both modalities were correlated using Spearman's rank correlation. The change in sonographic volume was correlated with clinical outcome using Spearman's rank correlation. P-values < .05 were considered significant. Results: Twenty-nine patients were included in the study; 13 with venous malformation (VM), and 16 with lymphatic malformation (LM). Nineteen patients had both pre-treatment US and MRI, showing correlation in volume between the 2 modalities (P < .001). Post-treatment change in volume correlated with clinical outcome for combined venous and LMs (rho = .44, P = .02). No correlation was found when venous (rho = .48, P = .09) and lymphatic (rho = .33, P = .21) malformations were considered separately. Conclusion: Ultrasound can potentially be used as an objective tool in evaluating sclerotherapy treatment response of low-flow vascular malformations in the pediatric population.

The Association Between Subclinical Thyroid Dysfunction and Recurrence of Atrial Fibrillation After Catheter Ablation.

ObjectiveThe aim of this study was to evaluate the association between subclinical thyroid dysfunction and the recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA).MethodsWe examined the association between subclinical thyroid dysfunction and the recurrence of AF at a large university-affiliated cardiac arrhythmia center in China. Data were collected from consecutive patients who underwent RFCA for AF, excluding those with a history of hypothyroidism, hyperthyroidism, or ongoing medical treatment for hypothyroidism or hyperthyroidism, biochemically defined overt thyroid disease, and long-term use of amiodarone before admission. The primary end point was the recurrence of AF in a time-to-event analysis. We compared outcomes in patients who had subclinical hyperthyroidism or hypothyroidism with those who had euthyroid state, using a multivariable Cox model with inverse probability weighting and propensity score matching.ResultsIn all, 93 patients were excluded from 435 consecutive patients who underwent RFCA for AF. Of the remaining 342 patients for the analysis, the prevalence of subclinical hyperthyroidism and subclinical hypothyroidism were 26 (7.6%) and 41 (12.0%), respectively; during a median follow-up of 489 days, 91 patients (26.6%) developed a primary end point event. In the main analysis of the multivariable Cox model, only subclinical hyperthyroidism [hazard ratio: 3.07, 95% confidence interval (CI): 1.54–6.14] was associated with an increased risk of end point event after adjusting for potential confounders. However, the association between subclinical hypothyroidism and the end point event was not significant (hazard ratio: 0.66, 95% CI: 0.31–1.43). Results were consistent either in multiple sensitivity analyses or across all subgroups of analysis. Compared with individuals with free triiodothyronine (fT3) in the lowest quintile, those with fT3 in the highest quintile had an HR of 2.23 (95% CI: 1.16–4.28) for recurrence of AF. With the increase of thyroid-stimulating hormone (TSH), a reduction in the risk of recurrence of AF was detected in the adjusted model, and the hazard ratio (HR) per standard deviation (SD) increase was 0.82 (95% CI: 0.68–0.98).ConclusionIn this retrospective cohort study involving patients who underwent RFCA for AF, patients with subclinical hyperthyroidism were associated with a markedly higher prevalence of recurrence of AF, whereas patients with subclinical hypothyroidism had a similar recurrence rate of AF compared to those with the euthyroid state.

MO876: B Lymphocyte Subpopulations in End-Stage Renal Disease Patients Undergoing Renal Replacement Therapy: Does the Method Affect the Phenotype?

Abstract BACKGROUND AND AIMS End-stage renal disease (ESRD) patients are considered as immunocompromised, and infections contribute greatly to their morbidity and mortality. This study focuses on the changes of B lymphocyte subpopulations in pre- and post- renal replacement therapy ESRD patients and the potential differences between haemodialysis and peritoneal dialysis. METHOD Using flow cytometry, B cells (CD19+) and their subsets B1a (CD19 + CD5+), naive (CD19 + CD27−), memory (CD19 + CD27+), (CD19 + BAFF-R+) and (CD19 + IgM+), were quantified in the peripheral blood of 40 pre-dialysis patients. IgG, IgA and IgM serum levels and apoptotic lymphocytes and b lymphocytes were also measured, and the measurements were repeated 6 months after the initiation of renal replacement therapy. The patients were allocated to haemodialysis (22patients, M/F 10/12, age 64,1 ± 9,8) and peritoneal dialysis (18 patients, M/F 11/11, age 56,4 ± 15,6). Exclusion criteria were age &amp;lt; 18 or &amp;gt;75 years, active autoimmune or chronic inflammatory disease, medical history of malignancy, corticosteroids or immunosuppresive treatment for the last 12 months. RESULTS There were no statistically significant difference between the two groups concerning the aforementioned variants pre dialysis. Collectively, ESRD patients showed no statistically significant alterations after the initiation of dialysis concerning the B cells phenotype, lymphocyte apoptosis and Immunoglobin serum levels, with the notable exception of B1a cells, which presented a decrease (3.6 ± 4.9 μ/L versus 1.6 ± 2.5 μ/L, P = 0.022). There seem to be no particular differences between the two methods either, with the exception of WBC count (6574 ± 1519 μ/L versus 8325 ± 2541 μ/L, P = 0.014) and apoptotic B lymphocytes (2 ± 2.4 μ/L versus 4.5 ± 3.9 μ/L, P = 0.02), which were lower in the peritoneal dialysis patients. Lastly there seemed to be no differentiation between the two methods concerning the percentage change of B lymphocytes subpopulations, lymphocyte apoptosis and IgG, IgM and IgA serum levels. CONCLUSION The changes that the uremic milieu causes in ESRD patients concerning their humoral Immunity do not reverse with the initiation of renal replacement therapy. Furthermore, with the exception of B cells apoptosis and WBC count, there is no significant difference between haemodialysis and peritoneal dialysis.

Corneal Ulcer, What Should We Do as a General Practitioner?

Introduction : Corneal ulcer with hypopyon is a serious corneal infection and a common potential cause of vision loss. It is profoundly predominant and also the common cause of visual impairment and preventable ocular morbidity around the world. Management of corneal ulcers with hypopyon requires a referral and multimodal treatment including pharmacological intervention. Case Report : A case of a 56-year-old male patient who presented with a chief complaint of blurry vision, red, and pain in the right eye since 3 weeks prior. There was a history of the right eye scratched by coconut husk. He complains of a whitish plaque 2 weeks earlier. Previous medical treatment history was denied. Visual acuity of the right eye was 1/300 and the left eye was 20/20. Eye examination revealed a corneal ulcer with a 2mm hypopyon, conjunctival and ciliary injection. This patient was diagnosed with a corneal ulcer with hypopyon. Treatment begins with oral antifungal, eyedrop, and oral antibiotics. The patient was planned to be referred to the ophthalmologist, but the patient refused. Conclusion: Corneal ulcer with a hypopyon could lead to sight-threatening complications such as perforation and endophthalmitis. General practitioners should be aware to early diagnose and give initial treatment to the patient. Appropriate referral and education given to the patients are necessary to avoid complications or prevent severe cases.

The Natural History of Initial Antipsychotic Treatment Among Men Admitted to a State Prison.

This study examined the natural history of antipsychotic medication treatment for men with a psychotic disorder who entered the North Carolina prison system in 2016-2017. The authors used prison records to identify individuals with a psychotic illness who were prescribed an index antipsychotic medication on prison entry (N=245). Data were analyzed to determine persistence of antipsychotic therapy and potential associations with treatment discontinuation. About 28% of the patients had stopped their antipsychotic medication by day 50; the median time until stopping was 248 days (95% confidence interval=147-355). Younger patients and those not continuing a preincarceration medication regimen discontinued treatment sooner than their respective counterparts. The early weeks of incarceration are a period of increased risk for antipsychotic discontinuation, particularly among younger individuals and those prescribed a new medication. These findings may help guide prison systems in implementing interventions that reduce antipsychotic treatment interruptions.

Assessment of risk factors and molecular biomarkers in children with supernumerary teeth: a single-center study

BackgroundSupernumerary teeth are considered one of the commonly observed dental anomalies in children. Several theories have been proposed to explain the presence of supernumerary teeth, including environmental and genetic factors. This study aimed to identify the different risk factors and molecular biomarkers in patients presented with supernumerary teeth.MethodsThis case–control study included 240 children, 6 to 12-year-old. They were divided into a test group (n = 120 children presented with supernumerary teeth) and a control group (n = 120 children with no supernumerary teeth). Questionnaires were distributed to assess demographics and exposure to several environmental factors. Ten extracted supernumerary teeth from the test group were processed for histopathological analysis.ResultsMale gender, dental history of severe oral infection or medical history of chemotherapy treatment, previous history of taking medication or illness during pregnancy, family history of neoplastic disorders, use of electronic devices, and living beside agricultural fields or industrial areas were found to be statistically significant associated with the risk of supernumerary teeth development. Immunohistochemistry panel revealed that supernumerary teeth showed enhanced expression of wingless (Wnt) and sonic hedgehog (SHH) proteins as well as a reduced expression of adenomatous polyposis coli (APC) protein, denoting molecular derangement in a group of pathways classically believed to be involved in its pathogenesis.ConclusionsMales were more frequently affected by supernumerary teeth than females. Several risk factors were notably correlated with the existence of supernumerary teeth. Additionally, molecular biomarkers assessment demonstrated a high expression level of pro-tumorigenic proteins such as Wnt and SHH in patients with supernumerary teeth.