Time Of Last Visit Research Articles

Dental Attendance Among the Elderly in Benin-city, Edo state

Background: Despite the increase in the elderly population globally, it appears that several studies focused on dental clinic attendance by other age groups and with sparse data on the elderly.
 Aim: This study therefore, aimed to determine the rate of dental clinic attendance among the elderly in Benin-city.
 Materials and methods: This was a half year multi-center, prospective cross-sectional study. This study conducted among dental patients at the outpatient departments two tertiary health facilities in Benin-city. A three-sectioned questionnaire was used to collect data. The data collected were sex, age, and level of educational, marital status, occupational level, religion, and ethnicity. Other collected data were co-morbidities, previous visit to dental clinic, time of last visit, reason for last visit, intention to visit the clinic again, presenting complaints and barriers to dental attendant. Both descriptive and inferential statistics were analyzed.
 Results: a total number of patients seen were 1450. The prevalence of the elderly patients was 27.7 %. Mean age was 70.4 ± 5.7 years with age range of 65- 97 years. The female elderly were more (52.9%) than their male counterparts. More than half (53.6%) had hypertensions. Less than half (30.2%) rate their dental health as good. More than half (56.9%) have never visited the dental clinic. Of all the presenting complained asked of the respondents, highest (18.5%) proportion was for toothache. Majority (71.3%) of the respondents affirmed that cost of transportation and long distance was the barrier for attending dental clinic. The rate of attendance (χ = 8.9; p = 0.03) and time of last visit (T =2.84; p = 0.01) was affected by the age of the respondents
 Conclusions: There was poor attendance to dental clinic by elderly in Benin City mainly due to cost of transportation and long distance. Age was related to poor attendance and time of visitation for attendance.
 Key words: Dental clinic, attendance, elderly

Post-Hoc Analysis of the Final, Three-Year Follow-up Results of a Phase I/II Study on Tirabrutinib (ONO-4059) in Patients with Relapsed or Refractory Primary Central Nervous System Lymphoma

[Background] Tirabrutinib (TIR; ONO-4059) is a second-generation inhibitor of Bruton's tyrosine kinase with high kinase selectivity. Based on the results of study ONO-4059-02 in patients with relapsed or refractory (r/r) primary central nervous system lymphoma (PCNSL) (Phase I/II study, jRCT: 2080223590), TIR was approved in Japan, Korea, and Taiwan. We have reported the results of 3-year follow-up (median follow-up: 37.1 months) of study ONO-4059-02, in which the overall response rate (ORR), the primary endpoint, was 63.6% and median duration of response was 9.2 months. The 3-year PFS and OS rates were 13.9% and 56.7%, respectively (Asai et al. ASCO 2023, Abstract 7548). Several clinical questions still remained to be addressed, including the proportion of patients who received subsequent treatment after discontinuation of TIR, and their treatment types; the characteristics of patients with higher efficacy of TIR; and the impact of long-term TIR treatment on Karnofsky Performance Status (KPS) and the Quality of Life (QoL). Here, we report the results of post-hoc analyses of the 37-month follow-up data of study ONO-4059-02. [Methods] In study ONO-4059-02, 44 patients with r/r PCNSL, age ≥20, and KPS≥70 were treated with TIR once daily at doses of 320 mg (n=20), 480 mg (n=7), or 480 mg (n=17) under a fasted condition. TIR was administered in 28-day cycles, and treatment was continued until disease progression or clinically unacceptable toxicity was observed. We assessed the number of patients who received subsequent treatment after discontinuation of TIR and their treatment types. ORR was assessed in patient subgroups according to their characteristics. In addition, patient characteristics associated with 12-month PFS rates were identified using univariate/multivariate logistic regression analysis. The time course of KPS and QoL during the TIR treatment was also assessed. QoL was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, EORTC QLQ-BN20, and EuroQol 5 dimensions. [Results] Of the 44 patients, 6 patients were treated for 3 years. At the time of last visit, 2 patients (4.5%) continued the TIR treatment, 10 (22.7%) discontinued the TIR treatment but had not received subsequent treatment, and 32 (72.7%) received subsequent treatment after discontinuation of TIR. The subsequent treatments included systemic therapy, radiotherapy, hematopoietic stem cell transplantation, and surgery. Major subsequent treatments were MTX-based therapy (n=18) and radiotherapy (n=10) with the 3-year OS rate of 61.1% and 40.0%, respectively. The subgroup analyses of ORR by patient characteristics showed that response to TIR was observed in all patient subgroups; ORR was low in those refractory to the treatment just before TIR (33.3%), those receiving ≥ 4 previous treatments (33.3%), those receiving hematopoietic stem cell transplantation (28.6%), those with high tumor burden (42.9%), and those having mutations in CD79B and MYD88 (40.0%). The univariate/multivariate analyses for the 12-month PFS rate identified that baseline KPS 90-100 was significantly associated with long-term response (odds ratio 5.99, P=0.0289). The median baseline KPS was 80.0 (range: 70~100) and was maintained during the TIR treatment (max: 49 cycles). QoL scores were generally maintained. [Conclusion] The majority of patients were able to receive subsequent treatment, including MTX, after TIR. TIR responses were observed in all patient subpopulations, and the baseline KPS was suggested to be associated with long-term response. KPS and QoL were generally maintained during the long-term observation period.

87 Not Normal but not MCI: Course of Memory over time

Objective:A diagnosis of mild cognitive impairment (MCI) requires memory complaint and objective memory impairment. However, some individuals report subjective memory complaints (SMC) despite having intact memory performance, while others demonstrate subtle impairment on memory testing but have no memory complaints; neither case would meet criteria for MCI. This study aimed to compare memory performances over time in individuals who do not meet traditional MCI criteria to those with normal cognition and those who converted to MCI.Participants and Methods:Diagnoses for a longitudinal sample from the Texas Alzheimer’s Research and Care Consortium were reviewed by a consensus panel of neuropsychologists and neurologists and reclassified at time of last visit. Diagnostic categories included SMC (i.e., memory complaint but no impairment on testing), objective cognitive impairment but no complaint (Impaired but not MCI), normal control (NC), MCI, and dementia. In this study, 827 participants were divided into 4 groups: 1) NC over 5 visits (n=511, 71% female; 42% Latinx/Hispanic), 2) baseline NC to amnestic MCI (n=62; 63% female; 57% Latinx/Hispanic), 3) SMC at last visit (n=133; 58% female; 70% Latinx/Hispanic), and 4) impaired but not MCI at last visit (n=121; 71% female; 60% Latinx/Hispanic). A memory composite (z-score) was created from the CERAD list-learning task (immediate, delayed, and recognition-discrimination) and Wechsler Memory Scale (Immediate and Delayed Logical Memory and Visual Reproduction) to evaluate memory performance over time. A linear mixed-model adjusting for age, education, sex, ethnicity, and number of APOE e4 alleles evaluated memory performance across 5 visits for the groups. To assess if depression followed a similar course, a linear mixed-model evaluated Geriatric Depression Scale (GDS) scores over time.Results:At baseline, groups differed by age (F=22.82; p<.001), education (F=8.60; p<.001), MMSE scores (F=9.38; p<.001), GDS-30 scores (F=3.56; p=.015), and memory composites (F=24.29; p<.001). A significant group X time interaction was observed (F=4.83, p<.001). Memory performance improved in both the SMC and the NC groups, remained stable in the impaired but not MCI group, and declined (as expected) in those who converted to amnestic MCI. Depression scores also showed a significant group X time interaction (F=2.43; p=.004), in which the NC to MCI group endorsed slightly more depression symptoms over time, while other groups declined or remained stable.Conclusions:Memory trajectories in this diverse sample differed across groups. Individuals with SMC but without objective memory impairment and normal controls showed some improvement in memory over time, presumably due to practice effects. Those with subtle memory impairments but no complaint (i.e., did not meet MCI criteria) remained stable and those who converted to amnestic MCI had worse memory across time. The stability of memory performances in the impaired not MCI group suggests these subtle memory inefficiencies may be longstanding or unperceived. However, because our sample achieved retrospective diagnoses of SMC and impaired not MCI, it will be important for future studies to prospectively follow these groups to determine which risk factors may predict progression to MCI and what impact ethnicity may have on these trajectories.

MM-326: Visceral Leishmaniasis Mimicking Multiple Myeloma

Context Western parts of the Republic of North Macedonia are considered endemic regions for leishmaniasis. Due to the broad spectrum of hematologic manifestations of visceral leishmaniasis (VL), this anthropozoonosis may be occasionally misdiagnosed as a hematological disease. Objective We present here a patient with VL whose initial clinical and laboratory findings mimicked multiple myeloma and led us to series of diagnostic procedures for plasma cell dyscrasia. Patient Case Report A 66-year-old woman presented at our institution with a history of back pain radiating down the legs. Physical examination revealed massive splenomegaly crossing the abdominal midline. Laboratory data showed pancytopenia (Hb 91 g/L; WBC 1.8 x 109/L; PLT 26 x 109/L), and the peripheral blood smear did not show any specific findings. What led us to suspect multiple myeloma was hyperproteinemia (96 g/L) due to hypergammaglobulinemia with IgG monoclonal components (IgG 71.5 g/L). Bone marrow biopsy with bone marrow aspiration was performed, and clusters of atypical plasma cells up to 20% infiltration were noted, further confirming the initial diagnosis. Still, we noted on M-Grunwald-Giemsa-stained bone marrow aspirate smears intra- and extracellular inclusions, resembling leishmaniasis. Additionally, PCR for B-cell gene rearrangement was negative. The diagnosis of VL was reached by a positive leishmania immunofluorescence antibody test. The patient was treated with amphotericin for 10 days with protracted resolution of the symptoms. The complete recovery of the blood counts was noted within three months. Still, monoclonal IgG, although decreased, remained high at the time of last visit (IgG 55 g/L), which is within three months of treatment. Conclusions Although endemic in our country, VL is rarely included in the differential diagnosis for clinicians, especially in cases with atypical clinical presentation. This case underlies the need for hematologists to consider this condition in patients presenting with uncertain yet common hematological abnormalities.

Relationship between fluoride exposure and count of Streptococcus mutans in supragingival biofilm of mexican scholar children

Background/purposeThe use of fluoride is known to reduce the risk of dental caries. There is limited information on the relationship between Streptococcus mutans (S. mutans) and fluoride exposure. This study investigated the association between the count of S. mutans on supragingival biofilm and fluoride exposure of scholar children.Materials and methodsIn this cross-sectional study, 56 children from 9 to 11 years of age were selected. Fluoride concentration in drinking water, urine and saliva of each participant were assessed. The count of S. mutans was estimated by calculating the DNA copy number through a quantitative real time polymerase chain reaction (qPCR) assay. Also, sociodemographic data, oral and general health information and variables related to caries risk were evaluated. A stepwise multiple linear regression was performed in all caries related predictor variables with the count of S. mutans as the dependent variable.ResultsThe multiple linear regression analysis showed that the concentration of fluoride in saliva (β = −3.029, p < 0.001) and urine (β = −2.057, p = 0.017), time of last visit to the dentist (β = 1.968, p = 0.001), plaque index (β = 1.637, p = 0.006) and number of surfaces with codes 3–6 (D3-6MFS) of ICDAS II criteria (β = 0.283, p = 0.076) were significantly associated with the count of S. mutans (Adjusted R square = 0.427, p < 0.001).ConclusionFluoride levels in urine and saliva were negatively associated with the count of S. mutans in supragingival biofilm. Plaque index, D3-6MFS and time of last visit to the dentist showed a positive association.

Quality of life and associated factors in non-institutionalized elderly: a cross-section study

The aim this study was to analyze the quality of life (QoL) and its the association with sociodemographic and oral health data in non-institutionalized elderly individuals. This is a cross-sectional study with a sample of 225 elderly individuals aged 60 years or older from a city in Southern Brazil. For data collection, we used the quality of life scale (WHOQOL-OLD), the Geriatric Oral Health Assessment Index (GOHAI), as well as questions about sociodemographic and oral health conditions. QoL presented a mean of 62.73. Sociodemographic variables were tested in a linear regression model, and those that remained associated in the final adjusted model were: age (β = -0.25; 95% confidence interval, CI: -0.40; -0.14), daily independence (β = -0.32; 95% CI: -7.71; -3.57), and participation in social activities (β = -0.12; 95% CI: -4.31; -0.21). The elderly individuals’ oral characteristics were compared, and the following remained associated in the adjusted model: time of last visit to the dentist (β = -0.34; 95% CI: -9.50; -4.65) and oral self-perception (β = 0.30; 95% CI: 0.53; 1.18).The findings of this study showed that, being older, being dependent in life and non-participating in social activities, as well as no visiting the dentist last year were predictors of a worst QoL for the elderly, however, good self-perception of oral health was a predictor of better QoL.

Delineating the clinical spectrum of isolated methylmalonic acidurias: cblA and mut.

Long-term outcome is postulated to be different in isolated methylmalonic aciduria caused by mutations in the MMAA gene (cblA type) compared with methylmalonyl-CoA mutase deficiency (mut), but case definition was previously difficult. Cross-sectional analysis of data from the European Registry and Network for Intoxication type Metabolic Diseases (Chafea no. December 1, 2010). Data from 28 cblA and 95 mut patients in most cases confirmed by mutation analysis (including 4 new mutations for cblA and 19 new mutations for mut). Metabolic crisis is the predominant symptom leading to diagnosis in both groups. Biochemical disturbances during the first crisis were similar in both groups, as well as the age at diagnosis. Z scores of body height and body weight were similar in both groups at birth, but were significantly lower in the mut group at the time of last visit. Glomerular filtration rate was significantly higher in cblA; and as a consequence, chronic renal failure and related complications were significantly less frequent and renal function could be preserved even in older patients. Neurological complications were predominantly found in the mut subgroup. Methylmalonic acidemia (MMA) levels in urine and plasma were significantly lower in cblA. 27/28 cblA patients were reported to be responsive to cobalamin, only 86% of cblA patients were treated with i.m. hydroxocobalamin. In total, 73% of cblA and 98% of mut patients followed a calculated diet with amino acid supplements in 27% (cblA) and 69% (mut). During the study interval, six patients from the mut group died, while all cblA patients survived. Although similar at first, cblA patients respond to hydroxocobalamin treatment, subsequently show significantly lower levels of MMA and a milder course than mut patients.

Individual and contextual factors associated with traumatic dental injuries in a population of Brazilian adolescents.

Traumatic dental injuries (TDIs) stand out as one of the major public health problems worldwide, characterized by a high prevalence in children and adolescents. However, their association with the 15-19years age group has not been fully described. The aim of this study was to evaluate TDIs in a population of Brazilian adolescents. An association study was performed with 5558 adolescents attending the São Paulo State Oral Health Survey (SBSP-15). Individual predisposing variables (gender, age, schooling, ethnic, overjet, and molar relationship); contextual predisposing (city size and Municipal Human Development Index); individual enabling (per capita income and type of service used); contextual enabling (number of dentists, family health team coverage, and family median income); individual need (satisfaction and perception regarding treatment) and contextual needs (average supervised brushing, number of visits, and dental extractions per city), as well as health behaviors were analyzed. Andersen's behavioral model was used for the data analysis. A multilevel logistic regression with fixed effects was performed to calculate the odds ratio (OR), with 95% confidence interval (CI). The prevalence of TDIs in adolescents was 1.42% (95% CI: 0.94-2.13). Individual and contextual factors of need, predisposing factors, facilitators, and health behaviors were associated with TDIs. In the adjusted analysis, gender (OR = 0.32, 95% CI: 0.18-0.53), mean family income (OR=2.52, 95% CI: 1.35-4.69), number of dental visits (OR=0.40, 95% CI: 0.19-0.84), and time of last visit (OR=2.64, 95% CI: 1.46-4.77) remained significant concerning trauma. At least one variable of the individual and contextual predisposing, enabling, and need factors (except for individual enabling variables) were associated with dental trauma in Brazilian adolescents aged 15-19years. This information may help with the planning of preventive actions and dental treatment, especially in mid-sized and large cities.

Characteristics and cardiovascular complications of a large cohort of adults diagnosed with type 2 diabetes\xa0

BackgroundThe aim was to evaluate the characteristics and cardiovascular complications of a large Belgian cohort of adults diagnosed with type 2 diabetes (T2DM) <45 years.MethodsRetrospective analysis of 886 patients diagnosed with T2DM <45 years and 933 T2DM patients diagnosed at the age between 60 and 70 years. To compare variables between groups, the independent t test or paired t test was used for normally distributed continuous variables, the Mann–Whitney’s U-test for non-normally distributed continuous variables and the Chi squared test or McNemar test for categorical variables. Multivariable logistic regression was used to adjust for confounders.ResultsIn the young-onset T2DM cohort, the age at diagnosis was 37.3 ± 6.4 years, 44.1% of patients were female and 12.1% were from an ethnic minority (EM) background. At last visit, age of patients was 57.3 ± 12.5 years with a diabetes duration of 20.5 ± 11.8 years and a mean HbA1c of 7.3% ± 1.3 (56 mmol/mol ± 14). Of all patients, 56.8% were obese, 49.9% were hypertensive, 34.1% did not reach the LDL cholesterol target and 20.1% had a cardiac event by time of last visit. Compared to women, men had a higher HbA1c [7.3% ± 1.4 (56 mmol/mol ± 15) vs. 7.1% ± 1.2 (54 mmol/mol ± 13), p = 0.021] and a significantly higher rate of cardiac events, even after adjustment for confounders (24.3 vs. 14.8%, p = 0.010). Compared to Caucasians, EM patients were younger at diagnosis (35.4 ± 6.8 years vs. 37.6 ± 6.2 years, p = 0.001) and were less often obese (43.3 vs. 55.6%, p = 0.007). Compared to the first visit, glycemic control improved [7.3% ± 1.3 (56 mmol/mol ± 14) vs. 7.9% ± 1.7 (62 mmol/mol ± 19), p < 0.0001] by the time of the last visit. Compared to the older-onset T2DM cohort, young-onset T2DM patients showed a higher HbA1c [7.3 ± 1.3% (56 mmol/mol ± 14) vs. 6.9 ± 1.0% (51 mmol/mol ± 11), p = <0.0001] and a higher BMI (31.2 ± 5.8 vs. 29.6 ± 5.5 kg/m2, p = <0.0001) at last contact. When adjusted for age, diabetes duration, HbA1c and cardiovascular risk factors, there was no difference in cardiovascular events between the two cohorts.ConclusionsA diagnosis of T2DM <45 years has an important impact on patients’ lives. Prevention measures are essential, but also specific attention to this high-risk group is needed for them to better achieve their therapeutic targets.

Oral health conditions and activities of daily living in an elderly population in Brazil

Abstract Objective: To analyze the relationship between the oral health status and functional capacity in performing basic activities of daily living of a population of elderly persons. Method: A cross-sectional population-based study with 441 individuals aged 60 years or over both genders was performed in the municipality of Macaíba, Rio Grande do Norte. From intraoral epidemiological examination, the degree of caries attacks (CPO-D index), periodontal condition (CPI and PIP indexes), the use and need for dental prosthesis and the presence of oral lesions were evaluated. Independence in Activities of Daily Living was used to evaluate functional capacity. Socioeconomic and demographic characteristics were surveyed using a structured questionnaire. Results: Oral health variables were subjected to factor analysis, which resulted in four indicators. There was no association between these indicators and the functional capacity of the elderly. Gender, age, presence of caregiver, dominant area of residence, time of last visit to the dentist, type of care sought during such visit and self-perception regarding prosthesis replacement were significantly associated with oral health indicators. Conclusion: Given the non-identification of the effect of functional capacity on the oral health of the elderly, the time of measurement of the events investigated should be considered. It is suggested that dependency among the elderly occurs at different times from when the consequences of oral problems are observed, considering the cumulative effects of a previous history of invasive dental care.

Natalizumab in the pediatric MS population: results of the Italian registry.

BackgroundNatalizumab is a promising option for pediatric multiple sclerosis (MS) patients with active evolution and a poor response to Interferon-beta or Glatiramer Acetate. However, no data are available in large cohorts of patients and after a long-term follow up. Our study was planned to shed lights on this topic.MethodsA registry was established in 2007 in Italy to collect MS cases treated with Natalizumab (NA) before 18 years of age.Results101 patients were included (69 females), mean age of MS onset 12.9 ± 2.7 years, mean age at NA initiation 14.7 ± 2.4 years. Mean treatment duration was 34.2 ± 18.3 months.During NA treatment, a total of 15 relapses were recorded in 9 patients, annualized relapse rate was 2.3 ± 1.0 in the year prior to NA and decreased to 0.1 ± 0.3 (p < 0.001) at last NA infusion.Mean Expanded Disability Status Scale (EDSS) decreased from 2.6 ± 1.3 at initiation of NA to 1.8 ± 1.2 at the time of last visit (p < 0.001). At brain MRI, new T2 or Gd enhancing lesions were observed in 10/91 patients after 6 months, 6/87 after 12 months, 2/61 after 18 months, 2/68 after 24 months, 3/62 after 30 months, and 5/43 at longer follow up. At the time of last observation, 58 % of patients were free from clinical (relapses/increased EDSS) and/or MRI activity (new T2 or gadolinium-enhancing lesions). No relevant adverse events were recorded.DiscussionNA was safe, well tolerated and very efficacious in the large majority of patients. Our data support the use of this medication in subjects with pediatric MS and an aggressive course.ConclusionsA relevant reduction of relapse rate and EDSS was observed during NA treatment, compared to pre-treatment period. No evidence of disease activity (NEDA) occurred in 58 % of cases.

When Is the Optimal Timing of the Surgical Treatment for Secondary Spontaneous Pneumothorax?

Objectives The definition of spontaneous pneumothorax is accumulation of air in the pleural space, resulting in dyspnea or chest pain. Unlike primary spontaneous pneumothorax, secondary pneumothorax can be a life-threatening condition and spontaneous healing rate is uncommon. Although surgery is the most effective treatment modality for pneumothorax, surgical management and timing is difficult where there is underlying lung disease and/or medical comorbidities. Prolonged air leakage increases the morbidity and mortality in thoracic surgery. We hypothesized that duration of air leakage before operation may lead to increase in complications. Methods This study is a retrospective review of 155 consecutive patients with air leakage who underwent bullectomy for secondary spontaneous pneumothorax from January 2005 to July 2013. The patients were divided according to the duration of preoperative air leakage. The patients were followed-up until the time of last visit or death. Postoperative morbidity and mortality were assessed and the risk factors for complications were analyzed. Results The median age was 65 years (range, 52-88) with male predominance (96.13%). The median duration of preoperative air leakage was 6 days (range, 1-30). The median surgery time was 90 minutes (range, 25-300) and median hospital stay after operation was 7 days (range, 3-75). Postoperative complications occurred in 38 patients (24.52%) and postoperative recurrence was shown to have occurred in 8 patients (5.16%). With multivariate analysis, risk factors for postoperative complications were: underlying interstitial lung disease and air leakage > 5 days before operation. Conclusion Persistent air leakage was a major surgical indication for pneumothorax. Early surgical treatment reduced postoperative complications for secondary spontaneous pneumothorax.

Long-term survival and liver-related events after pegylated interferon/ribavirin therapy in HIV-infected patients with chronic hepatitis C.

Sustained HCV clearance after hepatitis C therapy is associated with reduced liver-related complications and death. It is unknown if treatment may provide any clinical benefit in patients that fail therapy. This could be particularly relevant in HIV-HCV-coinfected patients, in whom liver disease progresses more rapidly. This was a retrospective study of clinical end points in a large cohort of HIV-HCV-coinfected patients with compensated liver disease followed since 2004. Patients were stratified into three groups: treated and cured, treatment failures and non-treated. Follow-up ended at the time of last visit, first liver decompensation event or death. A total of 527 HIV-HCV-coinfected patients were examined, of whom 339 (64.3%) had been treated with pegylated interferon/ribavirin. During a mean follow-up of 70.5 months, hepatic decompensation events or liver-related deaths occurred less frequently in cured patients (4/138; 2.9%) than in treatment failures (28/201; 13.9%) or untreated (25/188; 13.3%) patients (P<0.001). Interestingly, in the subset of patients with baseline advanced liver fibrosis (Metavir F3-F4), those with treatment failure experienced less hepatic decompensation events or deaths than untreated patients (19% versus 42%; P=0.005) and this finding was more pronounced in patients harbouring IL28B-CC alleles (15.8% versus 47.4%; P=0.02). Sustained HCV clearance following pegylated interferon/ribavirin therapy is associated with a reduced incidence of liver complications and death in HIV-HCV-coinfected patients. In the subset of patients with baseline advanced liver fibrosis, treatment provides clinical benefit despite lack of sustained virological response. The transient antiviral and/or anti-inflammatory effect of interferon, more recognizable in IL28B-CC carriers, could explain this finding.

English

BACKGROUND: Acne vulgaris is an almost universal problem of adolescence characterized by inflammation in and around sebaceous gland. Effective treatment is essential to prevent physical and psychological scarring. Antibiotic requires frequent administration and associated with side effects contributing to reduced compliance . Isotretinoin was a major therapeutic advanced which revolutionized the treatment of acne. Thus it is important to analyze its risk- benefit ratio at lower dosages. Hence the present study carried out with the objective of oral Isotretinoin in patients of moderate to severe grade acne vulgaris. METHODOLOGY: The present prospective study carried out among the acne vulgaris cases attending the out-patient department of dermatology at a tertiary care Centre during January 2007 to December 2007. Oral is otretinoin was started at a dose of 0.5 mg/kg/day for a total duration of 20 weeks. Patients were scheduled for 3 visits i.e. at the end of 1st, 2nd & 5th month after start of treatment. All collected data entered and analyzed using SPSS for efficacy of drug on different lesions. RESULTS: 38 (95%) patients completed the study and same were evaluated for efficacy and safety. 50% decrease in comedons at the end of 2 month from the initiation of treatment. The efficacy of oral isotretinoin on inflammatory lesions shows decreased from baseline 36.13 to 4.87 at the time of last visit at 5 month. This was statistically significant (0.0001). Side effects observed an 11% case includes dryness, palmoplantar peeling, exfoliative dermatitis, photosensitivity, facial dermatitis. CONCLUSION: The oral is otretino in is effective and safe as well as showing early response especially for inflammatory lesions.

The UCH bladder manikin

s 115 Review of posterior urethral valve in UCH Ibadan B. Abiola 1,∗, A.O. Takure 1, O.B. Shittu 1,2,3, L.I. Okeke 1,2,3, E.O. Olapade-Olaopa 1,2,3 1 University College Hospital, Ibadan, Nigeria 2 College of Medicine, University of Ibadan, Nigeria 3 Ibadan PUITA Center, Department of Surgery, University College Hospital, Ibadan, Nigeria ∗Corresponding author at: Department of Surgery, University College Hospital, Nigeria. E-mail address: tundexxl@yahoo.com (B. Abiola) Introduction: Posterior urethral valve is a well recognized cause of obstructive uropathy in infancy and childhood with long term implication on renal function in later life. It is commonly diagnosed in utero and immediately after birth. Objectives: To describe the clinical presentation, treatment, and eventual outcome of patients with posterior urethral valves to our service. Methods: A retrospective analysis of patients with posterior urethral valve over a period between 2006 and 2013 was done. Case notes were retrieved and data on patients age, clinical and radiological features, treatment modality, outcome, duration of follow up and condition as at last follow up were extracted. Results: Forty patients were managed during this period and 31 (77.5%) patients had available data. No patient was identified pre-natally. The median age at presentation was 5 years 7 months (range 2 weeks-25 years). Twentythree patients (92%) had back pressure changes on ultrasound. MCUG was confirmatory in all the patients. Twenty patients (64.5%) had Mohan’s valvotomy done while 9 (29%) were treated with endoscopic valve ablation. One patient (3.2%) had closed suprapubic cystostomy. Sixty-percent of patients had follow-up outpatient visits, 40%defaulted. The median follow up postoperation was 8 months (range 1 week–6 years). All patients seen after surgery had normal renal function at the time of last visit. Conclusion: Majority of our patients presented late with features of back pressure changes. Though surgery was successful, and renal function preserved, a large number of patients defaulted from follow up. http://dx.doi.org/10.1016/j.afju.2014.03.015 The UCH bladder manikin I.N. Chibuzo 1,∗, S.A. Adebayo 1,3, E.O. Olapade-Olaopa 1,2,3, A. Takure 1,3, L.I. Okeke 1,2,3, O.B. Shittu 1,2,3 1 Department of Surgery, University College Hospital Ibadan, Nigeria 2 College of Medicine, University of Ibadan, Nigeria 3 Ibadan PIUTA Centre, Department of Surgery, University College Hospital Ibadan, Nigeria ∗Corresponding author at: Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria. E-mail address: ijeomanc2002@yahoo.com (I.N. Chibuzo) Introduction and objectives: Emergency suprapubic catheterisation (ESPC) is an indispensable skill for medical practice. It may be done via open or closed techniques. In Nigeria, majority of the general medical practitioners and non-urological residents have no formal training in suprapubic catheterisation. A low-cost manikin was designed locally for the purpose of training doctors in ESPC. This paper describes the development of the manikin and assesses its usefulness in teaching ESPC. Methods: A foundation of urology workshop was organised by the Ibadan PIUTA Centre, in March 2013, at which general medical practitioners and non-urological residents were given instruction in suprapubic catheterisation using the locally manufactured manikin. At the end, questionnaires were administered to evaluate the effectiveness of the manikin in SPC training. Six months later, questionnaires were administered to the surgical residents to evaluate the impact of the training on their practice. Results: There were twenty-five medical practitioners in attendance, which included eighteen non-urological surgical residents. The others were family physicians and gynaecologists. All were taught the open and closed techniques using the manikin. At the end of the workshop, 100% of the participants stated that the manikin was an effective teaching aid. Six months later, 67% of the surgical residents had independently performed successful ESPCs. The closed technique was used by 83%, while 17% used both open and closed methods. Conclusion: The UCH bladder manikin is an effective, low-cost and easily manufactured aid for teaching doctors emergency suprapubic catheterisation. We recommend its use by other centers in low resource countries. http://dx.doi.org/10.1016/j.afju.2014.03.016 Endourology/Robotics The emergence of Da Vinci Robotic surgery in urologic oncology-Kokilaben Dhirubhai Ambani Hospital Experience

Review of posterior urethral valve in UCH Ibadan

s 115 Review of posterior urethral valve in UCH Ibadan B. Abiola 1,∗, A.O. Takure 1, O.B. Shittu 1,2,3, L.I. Okeke 1,2,3, E.O. Olapade-Olaopa 1,2,3 1 University College Hospital, Ibadan, Nigeria 2 College of Medicine, University of Ibadan, Nigeria 3 Ibadan PUITA Center, Department of Surgery, University College Hospital, Ibadan, Nigeria ∗Corresponding author at: Department of Surgery, University College Hospital, Nigeria. E-mail address: tundexxl@yahoo.com (B. Abiola) Introduction: Posterior urethral valve is a well recognized cause of obstructive uropathy in infancy and childhood with long term implication on renal function in later life. It is commonly diagnosed in utero and immediately after birth. Objectives: To describe the clinical presentation, treatment, and eventual outcome of patients with posterior urethral valves to our service. Methods: A retrospective analysis of patients with posterior urethral valve over a period between 2006 and 2013 was done. Case notes were retrieved and data on patients age, clinical and radiological features, treatment modality, outcome, duration of follow up and condition as at last follow up were extracted. Results: Forty patients were managed during this period and 31 (77.5%) patients had available data. No patient was identified pre-natally. The median age at presentation was 5 years 7 months (range 2 weeks-25 years). Twentythree patients (92%) had back pressure changes on ultrasound. MCUG was confirmatory in all the patients. Twenty patients (64.5%) had Mohan’s valvotomy done while 9 (29%) were treated with endoscopic valve ablation. One patient (3.2%) had closed suprapubic cystostomy. Sixty-percent of patients had follow-up outpatient visits, 40%defaulted. The median follow up postoperation was 8 months (range 1 week–6 years). All patients seen after surgery had normal renal function at the time of last visit. Conclusion: Majority of our patients presented late with features of back pressure changes. Though surgery was successful, and renal function preserved, a large number of patients defaulted from follow up. http://dx.doi.org/10.1016/j.afju.2014.03.015 The UCH bladder manikin I.N. Chibuzo 1,∗, S.A. Adebayo 1,3, E.O. Olapade-Olaopa 1,2,3, A. Takure 1,3, L.I. Okeke 1,2,3, O.B. Shittu 1,2,3 1 Department of Surgery, University College Hospital Ibadan, Nigeria 2 College of Medicine, University of Ibadan, Nigeria 3 Ibadan PIUTA Centre, Department of Surgery, University College Hospital Ibadan, Nigeria ∗Corresponding author at: Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria. E-mail address: ijeomanc2002@yahoo.com (I.N. Chibuzo) Introduction and objectives: Emergency suprapubic catheterisation (ESPC) is an indispensable skill for medical practice. It may be done via open or closed techniques. In Nigeria, majority of the general medical practitioners and non-urological residents have no formal training in suprapubic catheterisation. A low-cost manikin was designed locally for the purpose of training doctors in ESPC. This paper describes the development of the manikin and assesses its usefulness in teaching ESPC. Methods: A foundation of urology workshop was organised by the Ibadan PIUTA Centre, in March 2013, at which general medical practitioners and non-urological residents were given instruction in suprapubic catheterisation using the locally manufactured manikin. At the end, questionnaires were administered to evaluate the effectiveness of the manikin in SPC training. Six months later, questionnaires were administered to the surgical residents to evaluate the impact of the training on their practice. Results: There were twenty-five medical practitioners in attendance, which included eighteen non-urological surgical residents. The others were family physicians and gynaecologists. All were taught the open and closed techniques using the manikin. At the end of the workshop, 100% of the participants stated that the manikin was an effective teaching aid. Six months later, 67% of the surgical residents had independently performed successful ESPCs. The closed technique was used by 83%, while 17% used both open and closed methods. Conclusion: The UCH bladder manikin is an effective, low-cost and easily manufactured aid for teaching doctors emergency suprapubic catheterisation. We recommend its use by other centers in low resource countries. http://dx.doi.org/10.1016/j.afju.2014.03.016 Endourology/Robotics The emergence of Da Vinci Robotic surgery in urologic oncology-Kokilaben Dhirubhai Ambani Hospital Experience

FRI0178 A comparative study of clinical composite measures (DAS28, SDAI, CDAI, BOOLEAN) using patients with rheumatoid arthritis treated with anti-TNF agents

BackgroundIn addition to familiar DAS28, SDAI and CDAI have been routinely used in the clinical studies or in clinical setting. New remission criteria have been also developed. These new movement...

Hepatocellular carcinoma with portal vein thrombosis treated with yttrium-90 microsphere radioembolization results on 22 consecutive patients.

e14573 Background: Portal vein tumoral thrombosis is a pejorative and a frequent complication of hepatoculluar carcinoma (HCC). PVT shows as the primary tumour, an arterial hypervascularization; his main characteristic is the rationale of this study which aim to assess the safety and the efficacy of a Yttrium-90 microsphere (90Y- microS) treatment with TheraSphere in this advanced situation. Methods: Since 2008 we have treated 22 patients with unresectable HCC and PVT; 24 treatments were done as described by Salem and col (J Vasc Interv Radiol 2006;17:1251-78.). Patients were evaluated at 3, 6 and then every 3 months for response (EASL criterias), survival and toxicity (CTCAEv3.0 criterias). Patients characteristics were as follow : Sex (M/F; n) 17/5; Mean age+/-SD (y) 65.3 +/-7.1. Previous treatment: 19 Etiology of cirrhosis VHC 5–Alcohol 12–Iron overload 3– Dysmetabolic syndrom 2; Child–Pugh grade: A/B/C : 15/7/0, Mean largest diameter +/- SD (cm) 8.3-3.5; Patent portal vein thrombosis: right/left/both: 8/3/11; a-fetoprotein (ng/mL) 849+/-19400- normal in 5 cases. CLIP score (2/3/4): 11/6/3; BCLC score C (n=22). Toxicity, response, and survival analyses were censored at time of last visit or death. Results: Median follow up was 11 months (1-34). Responses were: complete 2 (9%), partial 14 (63%), stable disease 3 (13%), progression 4 (18%), 3 patients were refered to surgery and one to transplantation. Median time to progression and overall survival were respectively 7.2 (95%CI, 3.9-10.5) and 9.0 (95%CI, 5.5-12.5) months. 4 cases of liver disfunction (Child B patients with right and left PVT) were observed, all were grade 2. Conclusions: The safety and efficacy results of in this monocentric cohort of 22 patients challenged those obtained with sorafenib in this indication and are in accordance with previous published data (Gastroenterology, 2010;138: 52-64; J Vasc Interv Radio. 2010; 8:1205-12.). Further clinical trials are waranted to confirm these results and to compare 90Y-microS with or without sorafenib to sorafenib alone, taking into account not only the overall survival but also the possibility of secondary surgery after downstaging.

Remitting seronegative symmetrical synovitis with pitting edema (RS 3PE) syndrome in a tertiary care hospital: A retrospective analysis

Remitting seronegative symmetrical synovitis with pitting edema (RS 3 PE) affects mainly elderly males, characterized by acute onset pitting edema of hands, negative rheumatoid factor and excellent result with short course of low dose corticosteroid therapy. To re-evaluate the clinical, laboratory features, management, and ultimate disease progression of RS 3 PE cases in rheumatology clinic in tertiary care hospital and compare results with previous literature. We selected the patients of RS 3 PE in the Rheumatology clinic, Medical College, Kolkata, between 1 January 2002 and 1 January 2010 and followed them up. Among the cases reviewed 23 were female patients and 12 were male patients with mean (SD) age of 54.74 (3.03) and 58.33 (5.33) years, respectively. Oral Hydroxychloroquine was started in all, giving a satisfactory result in 21 patients; rest of the 14 patients needed additional corticosteroid, to alleviate musculoskeletal symptoms. Baseline mean (SD) C-reactive protein and erythrocyte sedimentation rate were 21.63 (2.08) mg/L and 81.34 (9.29) mm/hr, respectively, and reduced to 3.23 (0.95) mg/L and 17.43 (5.55) mm/hr, respectively, following therapy. During follow-up, musculoskeletal symptoms relapsed in 17 patients, seven (20%) of them were found to be associated with malignancy. At the time of last visit during the follow-up period, only four patients developed definite arthropathy (one seronegative rheumatoid arthritis, three undifferentiated spondyloarthropathy), rest of the 31 cases were remitted. Regarding RS 3 PE, results of our study showed similarity with previous reports excepting the gender. Hydroxychloroquine has been proved as a good steroid-sparing agent in RS 3 PE. This study supported the association of RS 3 PE with malignancy in the previous literatures.

Factors influencing cardiovascular risk following termination of glucocorticoid therapy for nephrotic syndrome

This study attempted to identify the cardiovascular risk factors associated with retention of excess weight following termination of glucocorticoid therapy in children with nephrotic syndrome. We performed a retrospective study of 30 Japanese children (18 males, 12 females, aged 1-14years) who had been treated with glucocorticoids for steroid-sensitive nephrotic syndrome and 32 control children (17 males, 15 females, aged 1-15years). The subjects receiving glucocorticoid therapy were divided into a retention group (n=14) or a reduction group (n=16) on the basis of the presence or absence of a maintained body mass index (BMI) following glucocorticoid termination. BMI z-scores, age, gender, blood pressure, serum total cholesterol levels (T-cho), and the dose and duration of glucocorticoid exposure were evaluated in each group during the study period. The retention group had a significantly (P<0.05) increased dose and duration of glucocorticoid exposure, and of T-cho at the time of last visit compared with the control or reduction group. Moreover, logistic regression analysis showed that the adjusted odds ratio for T-cho at the time of last visit in the retention group was significantly higher (P<0.05) relative to the reduction group. Retention of excess weight during the period of remission from nephrotic syndrome following cessation of glucocorticoid therapy was related to the dose and duration of glucocorticoid exposure and was associated with hyperlipidemia, which might enhance cardiovascular risk.