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1.
Clin Kidney J ; 17(9): sfae250, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39258261

RESUMEN

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are multipurpose agents effective in improving glycemic control in patients with type 2 diabetes while also achieving weight loss and risk reduction of major cardiovascular (CV) events and chronic kidney disease progression. With their increased utility in diabetes, obesity, CV health and renal protection, the use of GLP-1RAs has increased. However, with this increased use, there have also been increased reports of associated kidney adverse events, including case reports of acute interstitial nephritis (AIN) associated with GLP-1RA use. We report the data from the Food and Drug Administration adverse event reporting system (FAERS) in relation to GLP-1RA use and adverse kidney events, with acute kidney injury being the most common. In addition, we report two cases of semaglutide-associated biopsy-proven AIN and one with associated podocytopathy. To our knowledge, this is the first case of biopsy-proven AIN with podocytopathy associated with semaglutide use. Both patients experienced complete remission shortly after discontinuing semaglutide and undergoing immunosuppressive therapy. Further analysis of the FAERS database revealed 17 cases of proteinuria and 1 case of glomerulonephritis associated with semaglutide in the FAERS database, however no further information was available. While further research is needed to establish causality, this case series adds to the growing body of literature that semaglutide is associated with AIN and adds a new association, semaglutide with AIN and podocytopathies. While the overall clinical and mortality benefits of GLP-1RAs may outweigh the rarer risks, prescribers need to be aware of these associations, particularly as the use of GLP-1RAs continues to expand.

2.
Cureus ; 16(8): e67127, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39290922

RESUMEN

Severe preeclampsia is a disorder of pregnancy, characterized by increased blood pressure (>140/90 mmHg) and proteinuria (≥ 300 mg/24 hours) at later than 20 weeks of gestation. Particularly in underdeveloped nations, severe preeclampsia and eclampsia have a significant negative impact on the health of expectant mothers, fetuses, and newborns. The HELLP (hemolysis, increased liver enzymes, low platelets) syndrome is thought to be a subset of preeclampsia, a group of hypertensive disorders of pregnancy that also includes eclampsia. Compared to preeclampsia alone, maternal and fetal problems are more severe in HELLP. There can be a diagnostic dilemma that arises when attempting to differentiate HELLP from its numerous imitators to determine the appropriate course of treatment. Here, we present a rare case of a pregnant woman presenting with preeclampsia complicated by manifestations and investigations suggestive of HELLP syndrome with acute kidney injury (AKI), retinal detachment, and symptoms of DIC (disseminated intravascular coagulation), which can be grievous to the mother as well as the fetus.

3.
Vet Parasitol Reg Stud Reports ; 53: 101062, 2024 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-39025546

RESUMEN

BACKGROUND: Ticks are hematophagous arthropods acting as important vectors for several microorganisms. Ticks have an important role in the epidemiology of numerous diseases from a public health standpoint. In Algeria, knowledge of tick-borne associated microorganisms is limited. This paper aimed to investigate the presence of microorganisms in Ixodes ticks in Ain Kerma El Tarf region. MATERIALS AND METHODS: Ticks were collected from the environment using the flagging method in El Hannachir, Ain kerma (El Tarf province), conserved in 70% ethanol, and morphologically identified. DNA was individually isolated from the ticks and screened for the presence of Piroplasmids and Hepatozoon spp., Borrelia spp., Spotted fever group Rickettsia, Bartonella spp., Mycoplasma spp., Anaplasmataceae, Anaplasma phagocytophilum, Francisella tularensis. RESULTS: Adult ticks of the genus Ixodes (n = 51) were collected. Due to their pronounced morphological resemblance, the sampled ticks are referenced as: I. ricinus/ I.inopinatus (n = 51, 26 males, 25 females). The following pathogens were identified in the tested ticks: Borrelia lusitaniae (n = 17; 33.33%), Rickettsia monacensis (n = 10; 19.60%), and R. helvetica (n = 5; 9.80%). In addition, five ticks (9.80%) were found to be coinfected with Borrelia lusitaniae and R. monacensis/ heletica. All ticks were negative for Piroplasmids and Hepatozoon spp., Bartonella spp., Mycoplasma spp., Anaplasmataceae, Anaplasma phagocytophilum and Francisella tularensis. CONCLUSION: Questing Ixodes ticks from Algeria are carriers of various pathogens, with Borrelia lusitaniae posing a potential risk in the country.


Asunto(s)
Borrelia , Ixodes , Animales , Argelia/epidemiología , Ixodes/microbiología , Ixodes/parasitología , Borrelia/aislamiento & purificación , Borrelia/genética , Femenino , Masculino
4.
Cureus ; 16(6): e62423, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-39011199

RESUMEN

We report the case of a patient who sustained a right proximal radial shaft fracture. He experienced isolated flexor pollicis longus weakness as a result of a partial anterior interosseous nerve (AIN) injury. The incidence of AIN injury is recognized as an exceptional postoperative complication for this particular type of fracture. It might be helpful to do electrodiagnostic investigations to confirm the diagnosis. A complete clinical recovery of the nerve occurred 16 weeks following the surgical operation.

5.
Eur J Haematol ; 2024 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-39031658

RESUMEN

Evans syndrome (ES) is rare and mostly treated on a "case-by-case" basis and no guidelines are available. With the aim of assessing disease awareness and current management of adult ES, a structured survey was administered to 64 clinicians from 50 Italian participating centers. Clinicians had to be involved in the management of autoimmune cytopenias and were enrolled into the ITP-NET initiative. The survey included domains on epidemiology, diagnosis, and therapy of ES and was designed to capture current practice and suggested work-up and management. Thirty clinicians who had followed a median of 5 patients (1-45)/15 years responded. The combination of AIHA plus ITP was more common than the ITP/AIHA with neutropenia (p < .001) and 25% of patients had an associated condition, including lymphoproliferative syndromes, autoimmune diseases, or primary immunodeficiencies. The agreement of clinicians for each diagnostic test is depicted (i.e., 100% for blood count and DAT; only 40% for anti-platelets and anti-neutrophils; 77% for bone marrow evaluation). Most clinicians reported that ES requires a specific approach compared to isolated autoimmune cytopenias, due to either a more complex pathogenesis and a higher risk of relapse and thrombotic and infectious complications. The heterogeneity of treatment choices among different physicians suggests the need for broader harmonization.

6.
BMC Musculoskelet Disord ; 25(1): 566, 2024 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-39033290

RESUMEN

BACKGROUND: High ulnar nerve injuries is known to have unfavorable motor outcomes compared to other peripheral nerve injuries in the upper extremity. Functional muscle recovery after peripheral nerve injury depends on the time to motor end plate reinnervation and the number of motor axons that successfully reach the target muscle. The purpose of this study is to assess the functional recovery, and complications following performing supercharge end-to-side (SETS) anastomosis for proximal ulnar nerve injuries. Our study focuses on the role of SETS in the recovery process of high ulnar nerve injury. PATIENT AND METHODS: This study is a prospective, single-arm, open-label, case series. The original proximal nerve pathology was dealt with according to the cause of injury, then SETS was performed distally. The follow-up period was 18 months. We compared the neurological findings before and after the procedure. A new test was used to show the effect of SETS on recovery by performing a Lidocaine proximal ulnar nerve block test. RESULTS: Recovery of the motor function of the ulnar nerve was evident in 33 (86.8%) patients. The mean time to intrinsic muscle recovery was 6.85 months ± 1.3, only 11.14% of patients restored protective sensation to the palm and finger and 86.8% showed sensory level at the wrist level at the end of the follow-up period. Lidocaine block test was performed on 35 recovered patients and showed no change in intrinsic hand function in 31 patients. CONCLUSION: SETS exhibit a remarkable role in the treatment of high ulnar nerve damage. SETS transfer can act as a nerve transfer that can supply intrinsic muscles by its fibers and allows for proximal nerve regeneration. We believe that this technique improves recovery of hand motor function and allows recovery of sensory fibers when combined with treating the proximal lesion. TRIAL REGISTRATION: Approved by Research Ethics Committee of Faculty of Medicine- Cairo University on 01/09/2021 with code number: MD-215-2021.


Asunto(s)
Transferencia de Nervios , Recuperación de la Función , Nervio Cubital , Humanos , Estudios Prospectivos , Nervio Cubital/lesiones , Nervio Cubital/cirugía , Adulto , Masculino , Femenino , Transferencia de Nervios/métodos , Persona de Mediana Edad , Adulto Joven , Traumatismos de los Nervios Periféricos/cirugía , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/fisiopatología , Resultado del Tratamiento , Estudios de Seguimiento , Regeneración Nerviosa/fisiología , Adolescente
7.
Pediatr Nephrol ; 39(11): 3213-3215, 2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-38801453

RESUMEN

We present a case of lamotrigine-triggered DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome with acute kidney injury stage 3. A 17-year-old girl with known epilepsy treated with lamotrigine presented with acute kidney injury as well as skin eruption, fever, and apathy. Extended diagnostics, considering infectious and autoimmune diseases, remained unremarkable. Lamotrigine blood levels were within the target range. Kidney biopsy showed acute interstitial nephritis with tubular necrosis. Methylprednisolone pulse therapy led to an improvement in kidney function; skin eruption and neurological symptoms resolved. During the hospital stay, the girl admitted to inconsistent and variable intake of lamotrigine, occasionally resulting in notable overdosing. This report demonstrates that acute kidney injury in lamotrigine-induced DRESS syndrome is an acute interstitial nephritis with tubular necrosis, an aspect that has not been deeply characterized so far. Additionally, we aim to elevate awareness towards non-adherence as cause of disease, especially among the adolescent population.


Asunto(s)
Lesión Renal Aguda , Anticonvulsivantes , Síndrome de Hipersensibilidad a Medicamentos , Lamotrigina , Triazinas , Humanos , Lamotrigina/efectos adversos , Lamotrigina/uso terapéutico , Femenino , Adolescente , Síndrome de Hipersensibilidad a Medicamentos/etiología , Síndrome de Hipersensibilidad a Medicamentos/diagnóstico , Síndrome de Hipersensibilidad a Medicamentos/tratamiento farmacológico , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/diagnóstico , Triazinas/efectos adversos , Anticonvulsivantes/efectos adversos , Metilprednisolona/uso terapéutico , Metilprednisolona/administración & dosificación , Epilepsia/tratamiento farmacológico , Nefritis Intersticial/inducido químicamente , Nefritis Intersticial/diagnóstico , Biopsia
8.
Surg Clin North Am ; 104(3): 517-527, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38677817

RESUMEN

Anal intraepithelial neoplasia (AIN) are precancerous lesions and are sequela of human papilloma virus (HPV) infection. AIN is classified as low-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion. Screening with anal cytology and anoscopy should be considered for high-risk populations. Diagnosis is made through high resolution anaoscopy and biopsy. Options for treatment include ablation and several topical therapies; however, recurrence rates are high for all treatment options, and an ongoing surveillance is necessary to prevent progression to anal squamous cell carcinoma. HPV vaccination is recommended to prevent disease.


Asunto(s)
Neoplasias del Ano , Condiloma Acuminado , Infecciones por Papillomavirus , Humanos , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/terapia , Neoplasias del Ano/patología , Neoplasias del Ano/virología , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/terapia , Carcinoma in Situ/patología , Carcinoma in Situ/virología , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/terapia , Condiloma Acuminado/virología , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/diagnóstico , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/patología , Lesiones Precancerosas/terapia , Lesiones Precancerosas/virología , Lesiones Intraepiteliales Escamosas/diagnóstico , Lesiones Intraepiteliales Escamosas/patología , Lesiones Intraepiteliales Escamosas/virología
9.
Toxicol Res (Camb) ; 13(2): tfae053, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38585338

RESUMEN

BACKGROUND: Poisoning-induced shock is a serious medical emergency with a high mortality rate. Hospitalized poisoned individuals experience multiple adverse cardiovascular events that could progress to cardiac arrest. This study was designed to compare the prognostic role of the admission shock index and plasma copeptin level in shocked poisoned patients and to evaluate their associations with initial patients' characteristics and outcomes. METHODS: We conducted a prospective study on acutely poisoned adult patients. RESULTS: A total of 41 patients were enrolled in the study. The mean age of all patients was 27.05 ± 10.99 years and most of the patients were females (n = 27, 66%). Pesticides were the most common type of poisoning (n = 18, 44%), followed by cardiovascular drugs (n = 12, 29.3%). Eleven (26.8%) patients died during the hospital stay length. The initial serum copeptin level and shock index could predict organ dysfunction indexed by sequential organ assessment score (SOFA) with area under the curve (AUCs) of 0.862 and 0.755, respectively. Initial serum copeptin and lactate levels, SOFA score, and their combination can strongly differentiate between survivors and non-survivors with an AUC of 0.944, 0.885, and 0.959, and 0.994, respectively. CONCLUSION: We concluded that the shock index, serum lactate level, and SOFA score may help in risk stratifying patients and predicting outcomes in critically ill patients with poisoning-induced shock. Copeptin is superior to the shock index in predicting mortality among the studied patients. However, a combination of SOFA score, serum copeptin level, and serum lactate level can develop a more predominant prediction for overall clinical outcomes in these patients.

10.
BMC Pulm Med ; 24(1): 190, 2024 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-38641775

RESUMEN

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has robustly affected the global healthcare and economic systems and it was caused by coronavirus-2 (SARS-CoV-2). The clinical presentation of the disease ranges from a flu-like illness to severe pneumonia and death. Till September 2022, the cumulative number of cases exceeded 600 million worldwide and deaths were more than 6 million. Colchicine is an alkaloid drug that is used in many autoinflammatory conditions e.g., gout, familial Mediterranean fever, and Behçet's syndrome. Colchicine inhibits the production of superoxide and the release of interleukins that stimulate the inflammatory cascade. Colchicine decreases the differentiation of myofibroblast and the release of fibrotic mediators including transforming growth factor (TGF-ß1) that are related to the fibrosis. Moreover, colchicine has been used to traet viral myocarditis caused by CMV or EBV, interstitial pneumonia, and pericarditis resulting from influenza B infection. Additionally, colchicine is considered safe and affordable with wide availability. OBJECTIVE: The aim of the current study was to assess the evidence of colchicine effectiveness in COVID-19 treatment. METHODS: A comprehensive review of the literature was done till May 2022 and yielded 814 articles after ranking the articles according to authors and year of publication. Only 8 clinical trials and cohort studies fulfilling the inclusion criteria were included for further steps of data collection, analysis, and reporting. RESULTS: This meta-analysis involved 16,488 patients; 8146 patients in the treatment group and 8342 patients in the control group. The results showed that colchicine resulted in a significant reduction in the mortality rate among patients received colchicine in comparison with placebo or standard care (RR 0.35, 95%CI: 0.15-0.79). Colchicine resulted in a significant decrease in the need for O2 therapy in patients with COVID-19 (RR 0.07, 95%CI 0.02-0.27, P = 0.000024). However, colchicine had no significant effect on the following outcomes among COVID-19 patients: the need for hospitalization, ICU admission, artificial ventilation, and hospital discharge rate. Among the PCR confirmed COVID-19 patients, colchicine decreased the hospitalization rate (RR 0.75, 95%CI 0.57-0.99, P = 0.042). However, colchicine had no effect on mortality and the need for mechanical ventilation among this subgroup. CONCLUSION: Colchicine caused a significant clinical improvement among COVID-19 patients as compared with the standard care or placebo, in terms of the need for O2, and mortality. This beneficial effect could play a role in the management of COVID-19 especially severe cases to decrease need for oxygen and to decrease mortality among these patients.


Asunto(s)
COVID-19 , Virosis , Humanos , SARS-CoV-2 , Colchicina/uso terapéutico , Tratamiento Farmacológico de COVID-19
11.
J Egypt Public Health Assoc ; 99(1): 4, 2024 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-38326578

RESUMEN

BACKGROUND: Cognitive decline is one of the aging health problems that strongly affects daily functioning and quality of life of older adults and threatens their independence. The aim of this study was to assess the prevalence and pattern of cognitive impairment (CI) among community-dwelling elderly in Egypt and the contribution of socioeconomic status to inequality in cognitive impairment. METHODS: A cross-sectional study involved 470 community-dwelling elderly aged 60 years or older living in Kafr El-Sheikh Governorate, Egypt. Subjects were recruited from home visits, geriatric clubs, and outpatient clinics. The Montreal Cognitive Assessment tools (MoCA & MoCA-B) were used to assess the prevalence of cognitive impairment, Hachinski ischemic score (HIS) to investigate the type of cognitive impairment, Ain Shams Cognitive Assessment (ASCA) tool to assess the pattern of specific cognitive domain affection, and an Egyptian socioeconomic status (SES) scale to classify the SES of the study participants. RESULTS: The prevalence of cognitive impairment was 50.2% distributed as 37.7% for mild cognitive impairment (MCI) and 12.5% for dementia. The most common type of cognitive impairment was the degenerative type (47.9%). Pattern of specific domain affection among cognitively impaired subjects ranged from 94% for visuospatial function to 12.7% for abstraction. Cognitive impairment was significantly higher with increasing age, female sex, marital status (single or widow), low education, higher number of comorbidities, and positive family history of cognitive impairment (p < 0.001). Also, cognitive impairment was concentrated mainly among participants with low socioeconomic score (p < 0.001). CONCLUSION: In Egypt, cognitive impairment is significantly prevalent and concentrated among those who are in low socioeconomic status. Patients with mild CI were more than those with dementia, and the most common type of CI was the degenerative type. Increasing educational level of low SES population and improving their access to healthcare services are highly recommended to improve the inequity of cognitive impairment.

12.
Basic & Clinical Medicine ; (12): 270-275, 2024.
Artículo en Chino | WPRIM (Pacífico Occidental) | ID: wpr-1018608

RESUMEN

Objective To investigate the current status and training requirements of pain medicine among non-anes-thetic residents rotating in the Department of Anesthesiology at a tertiary hospital in Beijing.Methods A self-de-signed questionnaire of"pain medicine education requirements of rotating residents"was administered to each resi-dent on their first day of rotation,and voluntary responses were collected.Results A total of 108 questionnaires were collected(87.1%response rate),comprising 45 from surgical residents,42 from internal medicine resi-dents,and 21 from emergency and intensive care residents.The results showed that surgical residents encountered a higher prevalence of surgery-related pain as compared to internal medicine residents or emergency and intensive care residents(P<0.001).Internal medicine residents experienced a greater incidence of inflamma-tory pain than surgical residents(P<0.05)or emergency and intensive care residents(P<0.01).All residents expressed continuing education requirements on pain management.Regarding training modalities,surgical residents favored medical course(86.7%);internal medicine residents preferred outpatient clinic rotation(88.1%);and emergency and intensive care residents preferred interventional treatment rotations(90.5%).Conclusions There are a wide need for continuing medical education on pain management.The training should be tailored diversely based on the specific clinical needs of each department to improve the overall quality of continuing medical educa-tion and accelerate the development of integrative pain management.

13.
Cureus ; 15(9): e45261, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37720126

RESUMEN

Acute kidney injury (AKI) involves a rapid decline in kidney function, classified into prerenal, intrarenal, and postrenal causes. Drug-induced AKI's complex pathophysiology includes altered hemodynamics, inflammation, crystal deposition, hemolysis, and rhabdomyolysis. This report details a 42-year-old female with hypertension and diabetes who, following a dog bite, exhibited reduced kidney function (GFR: 16 ​​mL/min/1.73m2; BUN/Cr: 23/3.23 mg/dL). A renal ultrasound revealed no stones or masses, and the recent use of tirzepatide was identified. Discontinuation of the drug, IV fluid maintenance, and close monitoring led to swift kidney function improvement. This case underscores the importance of recognizing drug-induced AKI, even in unrelated complaints, and highlights the need for vigilance and research into the adverse effects of medications such as glucagon-like peptide 1 (GLP-1) receptor agonists.

14.
AIDS Patient Care STDS ; 37(9): 436-446, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37713286

RESUMEN

People living with human immunodeficiency virus (HIV) are at high risk for anal cancer. Anal cancer screenings are recommended annually for US veterans with HIV. Screenings can identify treatable precursor lesions and prevent cancer development. In a previous study, we found screening rate to be only 15%. Semistructured interviews were conducted with Veterans Affairs (VA) providers who treat veterans living with HIV. Participants described their experiences with anal cancer screenings. Researchers developed a codebook based on Theoretical Domains Framework (TDF) and coded data using thematic analysis to identify barriers to anal cancer screenings. Twenty-three interviews were conducted with VA providers representing 10 regions. Barriers identified corresponded with five targetable TDF domains: Knowledge, Skills, Environmental Context/Resources, Professional Roles/Identities, and Social Influence. Many providers lacked knowledge of screening protocols. Knowledgeable providers often lacked needed resources, including swabs, clinic space, reliable pathology, access to high-resolution anoscopy, or leadership support to implement a screening program. Providers mentioned competing priorities in the care of veterans with HIV infection and lack of skilled/trained personnel to perform the tests. It was often unclear which provider specialty should "own" screening responsibilities. Additional factors included patient discomfort with screening exams. Anal cancer screening protocols are recommended but not widely adopted in VA. There is a critical need to address barriers to anal cancer screenings in veterans. The TDF domains identified align with five intervention domains to target, including education, training, resource/environment, delineation of provider roles, and improved counseling efforts. Targeting these barriers may help improve the uptake of anal cancer screenings within VA.


Asunto(s)
Neoplasias del Ano , Infecciones por VIH , Veteranos , Humanos , Detección Precoz del Cáncer , VIH , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/epidemiología
15.
EClinicalMedicine ; 62: 102128, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37588624

RESUMEN

Background: Anal cancer prevention has two critical points: the incidence rate is several fold higher for some groups, such as people living with human immunodeficiency virus (HIV) and men who have sex with men (MSM), and there is not a well-defined guideline for its screening. This systematic review evaluates the accuracy of DNA HRHPV (high-risk human papillomavirus), mRNA HPV, DNA HPV16 isolated and p16 staining biomarkers in anal canal smears for identifying anal intraepithelial neoplasia (AIN) 2 or 3, summarised as anal high-grade squamous intraepithelial lesions (aHSIL), and cancer. Methods: We searched the MEDLINE, Cochrane Library and Embase electronic databases as well as Grey literature to identify eligible papers published up to 31st July 2022. This systematic review and meta-analysis included observational studies comparing biomarker tests to histopathology after HRA (High-resolution Anoscopy) as a reference standard. We (ACM, TF) analysed studies in which patients of both sexes were screened for anal cancer using DNA HRHPV, mRNA HPV, DNA HPV16 and/or p16 biomarkers. The analysis was performed in pairs, for instance AIN2 or worse (AIN2+) vs. AIN1, HPV infection and normal (AIN1-). PROSPERO CRD42015024201. Findings: We included 21 studies with 7445 patients. DNA HR HPV showed a higher sensitivity 92.4% (95% CI 84.2-96.5), specificity 41.7% (95% CI 33.9-44.9) and AUC 0.67, followed by the mRNA HPV test, with a sensitivity 77.3% (95% CI 73.2%-80.9%), specificity 61.9% (95% CI 56.6-66.9) and AUC 0.78. DNA HPV16 showed higher specificity 71.7% (95% CI 55.3-83.8), followed by p16 test, 64.1% (95% CI 51.0-75.4); Sensitivity of DNA HPV16 was 53.3% (95% CI 35.4-70.3) and AUC 0.69, while p16 had a sensitivity of 68.8% (95% CI 47.9-84.1) and AUC 0.74. Subgroup analysis of MSM with HIV, with 13 studies and 5123 patients, showed similar accuracy, with a bit higher sensitivities and lower specificities. Considering the measure of the total between-study variability, mRNA HPV tests showed the smallest area of the 95% prediction ellipse, 6.0%, influenced by the low logit sensitivity, 0.011. All other groups of tests exceed 50% prediction ellipse area, which represent a high heterogeneity. Interpretation: Our findings suggested that DNA HR HPV can be a useful tool for screening for aHSIL and anal cancer if followed by biomarker with a higher specificity. As an isolated test, mRNA HPV had better performance. Funding: There was no funding source for this study.

16.
Hand (N Y) ; : 15589447231174482, 2023 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-37341212

RESUMEN

BACKGROUND: The anterior interosseus nerve (AIN) to ulnar motor nerve transfer has been popularized as an adjunct to surgical decompression in patients with severe cubital tunnel syndrome (CuTS) and high ulnar nerve injuries. The factors influencing its implementation in Canada have yet to be described. METHODS: An electronic survey was distributed to all members of the Canadian Society of Plastic Surgery (CSPS) using REDCap software. The survey examined 4 themes: previous training/experience, practice volume of nerve pathologies, experience with nerve transfers, and approach to the treatment of CuTS and high ulnar nerve injuries. RESULTS: A total of 49 responses were collected (12% response rate). Of all, 62% of surgeons would use an AIN to ulnar motor supercharge end-to-side (SETS) transfer for a high ulnar nerve injury. For patients with CuTS and signs of intrinsic atrophy, 75% of surgeons would add an AIN-SETS transfer to a cubital tunnel decompression. Sixty-five percent would also release Guyon's canal, and the majority (56%) use a perineurial window for their end-to-side repair. Eighteen percent of surgeons did not believe the transfer would improve outcomes, 3% cited lack of training, and 3% would preferentially use tendon transfers. Surgeons with hand fellowship training and those less than 30 years in practice were more likely to use nerve transfers in the treatment of CuTS (P < .05). CONCLUSIONS: Most CSPS members would use an AIN-SETS transfer in the treatment of both a high ulnar nerve injury and severe CuTS with intrinsic atrophy.

17.
Front Immunol ; 14: 1140677, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37180131

RESUMEN

Background: The advent of immune checkpoint inhibitors (ICIs) has powerfully broadened the scope of treatment options for malignancies with an ongoing increase of indications, but immune-related adverse events (irAEs) represent a serious threat to treatment success. Agents directed against programmed cell death protein 1 (PD-1) or its ligand 1 (PD-L1) are known to cause renal complications with an incidence of 3%. In contrast, subclinical renal involvement is estimated to be much higher, up to 29%. We recently reported about urinary flow cytometry-based detection of urinary PD-L1-positive (PD-L1+) kidney cells correlating with tubular PD-L1-positivity that reflected susceptibility to develop ICI-related nephrotoxicity as an irAE attending ICI treatment. Therefore, we designed a study protocol to evaluate urinary detection of PD-L1+ kidney cells as a tool for non-invasive biomonitoring of renal complications in cancer patients treated with ICIs. Methods: A prospective, controlled, non-interventional, longitudinal, single-center observational study will be conducted at the Department of Nephrology and Rheumatology of the University Medical Center Göttingen, Germany. We intend to enroll approximately 200 patients treated with immunotherapy from the Departments of Urology, Dermatology, and Hematology and Medical Oncology of the University Medical Center Göttingen, Germany. First, we will assess clinical, laboratory, histopathological, and urinary parameters in addition to urinary cell collection. Then, we will perform a correlative analysis between urinary flow cytometry of different PD-L1+ cell of renal origin with the onset of ICI-related nephrotoxicity. Discussion: Because of growing ICI-treatment applicability with an expectable incidence of renal complications, providing cost-efficient and easily performable diagnostic tools for treatment-attendant and non-invasive biomonitoring becomes vital to improve both renal and overall survival rates in cancer patients receiving immunotherapy. Trial registration: https://www.drks.de, DRKS-ID DRKS00030999.


Asunto(s)
Antineoplásicos Inmunológicos , Neoplasias , Humanos , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Antígeno B7-H1/metabolismo , Estudios Prospectivos , Monitoreo Biológico , Antineoplásicos Inmunológicos/uso terapéutico , Riñón/metabolismo , Estudios Observacionales como Asunto
18.
J Plast Reconstr Aesthet Surg ; 81: 122-129, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-37137193

RESUMEN

BACKGROUND: Contralateral C7 transfer (cC7) is an important treatment for total brachial plexus avulsion (TBPA), which sacrifices the recovery of the ulnar nerve (UN). The present study aimed to introduce an animal model of modified cC7 that preserved the deep branch of ulnar nerve (dbUN) and verify its feasibility. METHODS: Anatomical study: Lengths, diameters, and axon counts of dbUN and anterior interosseous (AIN) branches in six rats were measured. In vivo surgery: 18 rats were divided into three groups. Group A: Traditional cC7. Group B: Modified cC7 finished in one stage. Group C: Modified cC7 and AIN branch anastomosed with dbUN one month after the first stage. Electrophysiological examinations, muscle wet weight, muscle cross-sectional areas, and nerve axon counts were evaluated six months postoperatively. RESULTS: Anatomical study: The distances from dbUN and AIN branches to the midpoint of the inner and outer epicondyles connection of the humerus, diameters, and axon numbers of dbUN and AIN branches were analyzed, then AIN terminal branch (tbAIN) was anastomosed with dbUN. In vivo surgery: The differences in median nerve fiber counts were not significant. There were more UN axons in group A than in groups B and C. In electrophysiological examinations, muscle wet weight and cross-sectional area of the flexor digitorum profundus showed no significant difference, but the second interosseus cross-sectional areas in groups B and C were significantly larger than in group A. CONCLUSIONS: This study established an animal model of preserving dbUN in cC7 and verified its feasibility. The possibility of restoring dbUN was established.


Asunto(s)
Neuropatías del Plexo Braquial , Plexo Braquial , Transferencia de Nervios , Ratas , Animales , Nervio Cubital/cirugía , Plexo Braquial/cirugía , Nervio Mediano , Neuropatías del Plexo Braquial/cirugía
19.
Int J Clin Oncol ; 28(5): 625-636, 2023 May.
Artículo en Inglés | MEDLINE | ID: mdl-36872414

RESUMEN

Nephrotoxicity is one of the most important complications in cancer patients. In particular, acute kidney injury (AKI) is known to be associated with discontinuing effective oncological treatments, longer hospitalizations, increased costs, and a higher risk of death. In addition to acute kidney injury, clinical signs associated with nephrotoxicity during treatment with anticancer agents include chronic kidney disease, proteinuria, hypertension, electrolyte abnormalities, and other characteristic manifestations. Many of these signs are caused both by cancer treatment as well as by cancer itself. Therefore, it is important to carefully recognize whether the underlying causes of renal impairment in cancer patients are cancer-related, treatment-related, or both. This review describes the epidemiology and pathophysiology of anticancer agent-induced acute kidney injury, proteinuria, hypertension, and other characteristic manifestations.


Asunto(s)
Lesión Renal Aguda , Antineoplásicos , Hipertensión , Neoplasias , Humanos , Nefrólogos , Antineoplásicos/efectos adversos , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiología , Proteinuria/inducido químicamente , Neoplasias/tratamiento farmacológico , Neoplasias/complicaciones
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