This study examined risk factors for post-transplant erythrocytosis (PTE) in 235 kidney transplant recipients. The results showed that being male significantly increased the risk of developing PTE. Patients with polycystic kidney disease or glomerulonephritis also had a higher risk. While smoking was associated with PTE, further analysis revealed this was likely due to the relationship between smoking and male sex rather than a direct effect. The study did not find significant relationships between PTE and other factors like hypertension, diabetes, transplant organ source, or immunosuppressant regimen.
Sydney Sexual Health Centre Journal Club presentation by Gwamaka E.M. on The Journal of Infectious Diseases Volume 214 Issue 10, published in November 2016.
The Journal of Infectious Diseases has been published continuously since 1904 and describes itself as "the premier global journal for original research on infectious diseases". Research published in the JID includes studies in microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. JID is an official publication of the Infectious Diseases Society of America.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
Acute pancreatitis is a common medical problem. Initial phase of acute pancreatitis is characterized by inflammation. This is caused by release of cytokines and other pro inflammatory mediators. These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion. The etiology can be varied but common causes are biliary (stone in CBD) and alcohol. Other causes are drugs, infections, trauma, idiopathic, post ERCP etc. Patients with severe pancreatitis have high risk of mortality (10%) which can go upto 30% if necrosis gets infected, which occurs in about 40% patients. Further, persistent organ failure increases the mortality up to 34–55% as compared to 0.3% with transient organ failure. Traditionally as per Atlanta classification, acute pancreatitis has been classified as mild or severe depending upon organ failure or local complications. Acute pancreatitis is a hyper-catabolic state. Moreover some of these patients may be malnourished to begin with (alcoholics). Thus their nutritional requirements are much more than ordinary person. There are good quality studies available to show that in absence of cholangitis, there is no benefit of doing early ERCP. Also, technically it is more difficult to do in such situations, and procedure related complication may be more. If in doubt, it may be worthwhile to do endoscopic ultrasound to document the presence of CBD stone before attempting to cannulate the CBD.
Cardiac Troponin Elevation in Patients Without a Specific DiagnosisShadab Ahmad
Measurement of cardiac troponin (cTn) levels is a cornerstone in the assessment of patients with acute chest pain.
An elevation in the cTn level together with a significant change in the setting of coronary ischemia indicates myocardial infarction (MI).
However, even other cardiac and noncardiac conditions may result in acute cTn increases (e.g., arrhythmias, severe hyper- or hypotension, pulmonary embolism, neurologic events, or endurance efforts).
Acute but subtle increases in cTn levels may also be difficult to distinguish from chronic cTn elevation which is a common finding in the elderly, patients with renal failure, or patients with chronic cardiac conditions.
Sydney Sexual Health Centre Journal Club presentation by Gwamaka E.M. on The Journal of Infectious Diseases Volume 214 Issue 10, published in November 2016.
The Journal of Infectious Diseases has been published continuously since 1904 and describes itself as "the premier global journal for original research on infectious diseases". Research published in the JID includes studies in microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. JID is an official publication of the Infectious Diseases Society of America.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
Acute pancreatitis is a common medical problem. Initial phase of acute pancreatitis is characterized by inflammation. This is caused by release of cytokines and other pro inflammatory mediators. These further cause vasodilatation, intravascular volume depletion, and end organ hypoperfusion. The etiology can be varied but common causes are biliary (stone in CBD) and alcohol. Other causes are drugs, infections, trauma, idiopathic, post ERCP etc. Patients with severe pancreatitis have high risk of mortality (10%) which can go upto 30% if necrosis gets infected, which occurs in about 40% patients. Further, persistent organ failure increases the mortality up to 34–55% as compared to 0.3% with transient organ failure. Traditionally as per Atlanta classification, acute pancreatitis has been classified as mild or severe depending upon organ failure or local complications. Acute pancreatitis is a hyper-catabolic state. Moreover some of these patients may be malnourished to begin with (alcoholics). Thus their nutritional requirements are much more than ordinary person. There are good quality studies available to show that in absence of cholangitis, there is no benefit of doing early ERCP. Also, technically it is more difficult to do in such situations, and procedure related complication may be more. If in doubt, it may be worthwhile to do endoscopic ultrasound to document the presence of CBD stone before attempting to cannulate the CBD.
Cardiac Troponin Elevation in Patients Without a Specific DiagnosisShadab Ahmad
Measurement of cardiac troponin (cTn) levels is a cornerstone in the assessment of patients with acute chest pain.
An elevation in the cTn level together with a significant change in the setting of coronary ischemia indicates myocardial infarction (MI).
However, even other cardiac and noncardiac conditions may result in acute cTn increases (e.g., arrhythmias, severe hyper- or hypotension, pulmonary embolism, neurologic events, or endurance efforts).
Acute but subtle increases in cTn levels may also be difficult to distinguish from chronic cTn elevation which is a common finding in the elderly, patients with renal failure, or patients with chronic cardiac conditions.
Sydney Sexual Health Centre Journal Club presentation by Cherie Desreaux on the British Medical Journal and the Medical Journal of Australia editions published between November 2015 and March 2016.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
Abstract— Non Alcoholic Fatty Liver Disease is also becoming public health impotance nowadays. So this study was aimed to determine the association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. This study includes a total of 222 subjects were enrolled as per the inclusion/exclusion criteria, out of which 110 cases who had NAFLD with hepatic steatosis on ultrasonography and 112 subjects who did not have NAFLD were considered control. These cases and controls were interrogated and investigated further. Observations were recorded and association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. Statistical methods used were unpaired student’s t-test for continuous variables, Fischer’s and chi-sq test for categorical variables using bivariate analysis by Graph Pad Instat Version 3.10. Risk was assessed in terms of Odd's Ratio. The patients with MS and NAFLD had a higher proportion of CVD compared with those who did not have NAFLD (29.1 vs 18.1 %). This study concludes that NAFLD is significantly associated with MS; most significant with WC, followed by TG and FBS and thus can be considered as hepatic component of MS. This needs more research with large multi-centric prospective studies to evaluate NAFLD as an independent risk factor for CVD.
This slides contains 3 sections:
a. measurement of renal dysfuntion in cirrhosis
b. Evolution of hepatorenal syndrome
c. treatment of hepatorenal Syndrome
Inflammation plays a crucial role in the initiation and progression of atherosclerotic disease.
Monocyte chemoattractant protein-1 (MCP-1) is a member of the C-C chemokine family that is produced by monocytes or macrophages, smooth muscle cells, and endothelial cells within atherosclerotic plaques.
In addition to its established role in the pathogenesis of atherosclerotic disease progression and plaque rupture, MCP-1 is also involved in the reparative response, such as arteriolar remodeling and restenosis after an acute coronary event.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Statistical analysis of risk factors associated withanamjavaid13
Gallstones are crystal like collections that formed by merging of normal and abnormal gallbladder content. Usually there are two types of gallstones exist i.e. cholesterol stones & pigment stones. The current paper focuses on symptoms of the disease, major cause for the disease and on the treatments that majority of patients preferred. For this purpose, sample of size 170 data from different hospitals in Multan is collected by using convenience sampling. Main demographic factors involved in this study are Gender, Age group, marital status for patients of GSD. Frequency distribution has been formed for these different demographic and social factors and a bar chart is constructed for differentiating between gender as gender is also an important factor in GSD. For weight factor, paired t test is applied to see the difference between before and after weight after having treatment. Findings show that 67 percent people prefer govt. hospitals because of the people suffering from this disease were from backward areas or villages & their income not meet to pay the private hospitals expense.
Sydney Sexual Health Centre Journal Club presentation by Cherie Desreaux on the British Medical Journal and the Medical Journal of Australia editions published between November 2015 and March 2016.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
Abstract— Non Alcoholic Fatty Liver Disease is also becoming public health impotance nowadays. So this study was aimed to determine the association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. This study includes a total of 222 subjects were enrolled as per the inclusion/exclusion criteria, out of which 110 cases who had NAFLD with hepatic steatosis on ultrasonography and 112 subjects who did not have NAFLD were considered control. These cases and controls were interrogated and investigated further. Observations were recorded and association of Non Alcoholic Fatty Liver Disease with metabolic syndrome and Cardio-Vascular disease along with assessment of degree of severity of NAFLD with respect to number of components of metabolic syndrome. Statistical methods used were unpaired student’s t-test for continuous variables, Fischer’s and chi-sq test for categorical variables using bivariate analysis by Graph Pad Instat Version 3.10. Risk was assessed in terms of Odd's Ratio. The patients with MS and NAFLD had a higher proportion of CVD compared with those who did not have NAFLD (29.1 vs 18.1 %). This study concludes that NAFLD is significantly associated with MS; most significant with WC, followed by TG and FBS and thus can be considered as hepatic component of MS. This needs more research with large multi-centric prospective studies to evaluate NAFLD as an independent risk factor for CVD.
This slides contains 3 sections:
a. measurement of renal dysfuntion in cirrhosis
b. Evolution of hepatorenal syndrome
c. treatment of hepatorenal Syndrome
Inflammation plays a crucial role in the initiation and progression of atherosclerotic disease.
Monocyte chemoattractant protein-1 (MCP-1) is a member of the C-C chemokine family that is produced by monocytes or macrophages, smooth muscle cells, and endothelial cells within atherosclerotic plaques.
In addition to its established role in the pathogenesis of atherosclerotic disease progression and plaque rupture, MCP-1 is also involved in the reparative response, such as arteriolar remodeling and restenosis after an acute coronary event.
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Statistical analysis of risk factors associated withanamjavaid13
Gallstones are crystal like collections that formed by merging of normal and abnormal gallbladder content. Usually there are two types of gallstones exist i.e. cholesterol stones & pigment stones. The current paper focuses on symptoms of the disease, major cause for the disease and on the treatments that majority of patients preferred. For this purpose, sample of size 170 data from different hospitals in Multan is collected by using convenience sampling. Main demographic factors involved in this study are Gender, Age group, marital status for patients of GSD. Frequency distribution has been formed for these different demographic and social factors and a bar chart is constructed for differentiating between gender as gender is also an important factor in GSD. For weight factor, paired t test is applied to see the difference between before and after weight after having treatment. Findings show that 67 percent people prefer govt. hospitals because of the people suffering from this disease were from backward areas or villages & their income not meet to pay the private hospitals expense.
Review (ca 2007) of Uremic Toxins Accumulating in Patients with Chronic and End Stage Renal Disease modified from a presentation I gave in Fellow's Grand rounds.
Relied heavily on publications from the EU Toxin Work Group Work, which provides more up to date information:
http://www.uremic-toxins.org/
Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population o...ijtsrd
Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence. Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with CKD. In view of variability of thyroid profile in CKD patients in previous studies, a prospective study of various thyroid function has been undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases . Total number of 50 patients with Chronic Kidney Disease on conservative management fulfilling the criteria for CKD who were admitted in Department of Medicine under nephrology unit, Dr. Bhimrao Ambedkar Hospital Raipur C.G. , during the period of February 2018-March 2018 were selected in this prospective study. The result showed that out of the 50 patients with CKD 29 patients had low T3 syndrome 0.2-2.0ng ml, mean 0.67 which accounts for 58 of the patients, 12 patients had low T4 syndrome 0.5-8.5µg ml, mean 5.65 which accounts for 24 of the patients and 4 patients had primary hypothyroidism TSH 20µIU ml. Excluding Primary Hypothyroidism, analysis of serum T3, T4 and TSH in the study subjects shows very high significance, p 0.001. Thyroid Dysfunction occurred in 66 of the patients with chronic kidney disease in our study, it does not indicate a state of hypothyroidism, but a reflection of the state of chronic illness malnutrition. The low T3 state of CKD can be viewed as being protective, promoting conservation of protein. The number of patients with low T3 syndrome progressively increases with the severity of renal failure. Priya Banjare "Thyroid Abnormalities in Correlation with Stage of CKD in Tribal Population of Chhattisgarh" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd21418.pdf
Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/21418/thyroid-abnormalities-in-correlation-with-stage-of-ckd-in-tribal-population-of-chhattisgarh/priya-banjare
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical Prostatectomy
The Impact of Lymph Node Dissection on Survival in Intermediate- and High-Ris...semualkaira
Aimed to evaluate the therapeutic effect of pelvic lymph node dissection (PLND) on survival and determine the
predictors of lymph node involvement (LNI) in patients with intermediate- or high-risk prostate cancer (PCa) treated with Radical
Prostatectomy
3TC-DTG Dual Therapy and Its Implications in Hepatic Steatosis in People Livi...semualkaira
Hepatic disease is one of the major comorbidities
in people living with HIV. We intended to define the incidence of
NAFLD and to identify any factors which may be associated with
such a condition.
Secondary Malignancy after Treatment of Prostate Cancer. Radical Prostatectom...asclepiuspdfs
Background: This study aims to determine whether the treatment of locally confined prostate cancer (PCa) with external radiotherapy (EBRT) increases the risk to develop secondary malignancies (SM) compared to radical prostatectomy (RPE). Materials and Methods: Data from patients who were treated curatively with RPE or EBRT from 2010 to 2018 and who did not have distant metastases, previous malignancy, or previous treatment with radiotherapy or chemotherapy at the time of diagnosis were reviewed to determine the incidence of SM over a median follow-up period of 47 months (range 12–96 months). Regression models were used to correlate the clinicopathological factors with the incidence of SM.
Comparative Study of Hscrp in Chronic Kidney Diseaseiosrphr_editor
Chronic kidney disease (CKD) is a global threat to health mainly in developing countries because therapy is expensive and lifelong. over 1 million people worldwide are on dialysis or with a functioning graft. Early detection of Chronic kidney disease (CKD) and its consequent complications can prevent its grave complications . It causes not only significant morbidity but also it causes high mortality. Because of increase in incidence of Diabetes mellitus, hypertension, obesity and an aging population there is increase in progression of chronic kidney disease to end stage renal disease (ESRD). . Cardiovascular disease (CVD) is the major cause of mortality in haemodialysis patients and so it has become imperative to have a screening programme at all levels to detect CKD at an early stage and to initiate specific therapy to reduce the progression of renal disease and also the burden of ESRD (1). High sensitive C-Reactive protein (Hs CRP) assay is useful for sensitive detection of inflammatory state (2,3). This study aims at estimating Hs CRP as a marker of inflammation in CKD patients...
frequency of hepatitis C virus infection in patients with type 2 diabetes mel...Dr Tarique Ahmed Maka
ABSTRACT
Objective: To determine the frequency of hepatitis C virus infection in patients with type 2 diabetes mellitus and to look for the common risk factors leading to this infection in diabetics. Study Design: Descriptive cross sectional study design. Place and Duration of Study: Department of Medicine, Combined Military Hospital (CMH) Kharian, from Jan 2015 to Jun 2015. Patients and Methods: This study was conducted in the department of Medicine, Combined Military Hospital Kharian. Through a descriptive cross sectional study design, a total of 140 patients with type 2 diabetes mellitus, admitted through casualty, OPD or private clinics were selected and tested for Hepatitis C virus infection. The common risk factors leading to such infection among positive cases were also scrutinized. Results: The mean age of patients was 48.82 ± 10.14 with 60.7% female gender predominating the overall sample of diabetics. Using 3rd generation ELISA method, hepatitis C virus was found in 45 (32.1%) of patients with 41-50 years of age group most commonly affected age group (34.7%) and female (57.8%) commonly affected gender. The distribution of risk factors leading to hepatitis C virus in diabetics are: 21 (46.7%) had history of surgery in the past, 13 (28.9%) had history of blood transfusion in the past, 7 (15.55%) had history of hemodialysis while only 4 (8.9%) had history of tattooing in the past. Conclusion: Hepatitis C virus infection is still a common problem in diabetic patients of our local population and we recommend further research work over its risk factors so that the guidelines for its control may be formulated. Keywords: Blood transfusion, Diabetes Mellitus, Haemodialysis, Hepatitis C virus infection, Risk Factors, Surgery, Tattooing.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
1. A study of the risk factors for post transplant erythrocytosis at
Sina and Baghiat -Allah Hospital
ABSTRACT
Background: Post-transplant erythrocytosis (PTE) is characterized by persistent
hematocrit level above 51%. This complication is reported to develop in 10-20% of the kidney
recipients, mostly 2 years after kidney transplantation. PTE is self limited in 25% of the patients;
however it may persist in patients with an increased susceptibility for thrombosis. The purpose of this
study was to assess the prevalence of the risk factors of PTE in our center.
Methods: 235 of the patients who had undergone renal transplant from 1999 through 2004 in at least 3
months prior to this study were enrolled. 45 of the patients with polycythemia were randomly selected.
Two patients with no sign of polycythemia were selected for each of these cases, age and sex matched.
The considered variables included demographic data, accompanied disease, history of blood
transfusion and the laboratory data.
Results: There was no significant difference between the age, history of hypertension, diabetes,
pretransplant hematocrit level, pretransplant history of transfusion, graft's function and source of
kidney. A significantly higher proportion of PTE patients were male, also the case group had a
significantly higher frequency for personal history of polycystic kidney disease, glomerulonephritis.
Conclusion: PTE is an important complication of kidney transplantation that can be fatal. There are
multiple risk factors that should be addressed to prevent this complication.
Keywords: Erythrocytosis, PTE, renal transplantation, thrombosis
Introduction
Nowadays we encounter more cases of post transplant complications, due to recent improvements in
renal transplant techniques and as a result, the increased chance of living in this group of patients. Post
transplant erythrocytosis is one of the complications occurring in 10 to 20% of the recipients most often
in the first 2 years following transplantation. It is defined as a permanently high level of hematocrit
usually more than 51%. Spontaneous recovery is reported in 1/4 of the patients within 2 years from the
onset of this problem, while in others, the problem remained for several years until the occurrence of
rejection. Being Masculine, having native kidneys, diabetes mellitus, and dysfunction or arterial
stenosis in the transplanted kidney are the known risk factors for such a disease (1, 2, 3). Although
smoking is not believed to be an essential factor, it is considered to be an important one. Some studies
have not revealed any relation between drug consumption specially corticosteroids, and this disease (3);
whereas many others have noted a higher prevalence of erythrocytosis in those taking cyclosporine
compared with Azathiopurine (Immuran) and prednisolone (4, 5). Thromboembolic accidents are
reported in 10-30% of these patients, which may lead to death in 1-2% of them (1, 6).
2. Considering the relatively high incidence of post transplant erythrocytosis (PTE) and its life threatening
complications, in-time diagnosis and treatment of the disease would play an important role in
preventing the aforementioned complications. Hence, the purpose of this study was to assess the
prevalence of the risk factors of PTE in our center.
Material and Methods
235 of our renal transplant clinics' patients whom had undergone renal transplant from 1999 through
2004 were enrolled in our study. The transplant was performed for all the subjects at least 3 months
prior to this study. Those with a positive history of polycythemia (hct > 51) prior to transplant, apparent
pulmonary disease, and polycythemia vera (thrombocytosis plus leukocytosis and splenomegaly) were
excluded. The patients' records and also their charts of each visit to transplant clinics were reviewed in
order to complete the pre designed questionnaire.
45 of the patients with polycythemia were randomly selected and classified as the Case Group. On the
other hand, for each of these cases, age and sex matched 2 patients were selected from those without
any sign of polycythemia and classified as Control Group. In other words, 45 cases and 90 controls
entered this study.
The variables considered in the study include age, gender, smoking habit, accompanied disease such as
hypertension and diabetes mellitus, phlebitis, pulmonary emboli, cerebrovascular accidents, underlying
renal disease, renal artery stenosis, obstruction of urinary tract, hydronephrosis, positive history of
nephrectomy, splenectomy and parathyroidectomy, history of blood transfusion before transplant (0,
1-3, 4-6 and more than 6 times). The laboratory data consists of hemoglobin and hematocrit rates prior
to transplant, liver enzymes, existence of the native kidneys, origin of the transplanted kidney and its
performance ( creatinine> 1.5 was considered as a low performance) as well as the treatment protocols.
Results were analyzed with SPSS version 11.5 using chi-square, student t-test and Mann- Whitney
tests. In addition, in order to assess the effect of risk factors on development of erythrocytosis, Binary
Logistic Regression analysis was carried out.
Results
The mean age of the case and control groups were 41.5 ± 12.1 and 38.4 ±14.1, respectively which did
not have a statistically significant difference (p value = 0.182). Moreover, there was not any significant
difference between the mean age of male and female patients enrolled in this study (40.5 ± 13.5 vs.
37.5 ± 13.5, p value = 0.2). Forty two out of 86 male subjects (48.8%) developed PTE, while this figure
3. among the females was a mere 3 (6.1%). Thus, males were at more risk for PTE compared with
females (p value<0.001, RR= 7.97 CI 95%: 2.6 – 24.4).
PTE was reported in 10 of the 17 smokers (58.8%) and 35 of the 118 non-smokers (29.7%). There was
a statistically significant relation between smoking and erythrocytosis (p value = 0.017, RR= 1.98 CI
95%: 1.29-3.22). It should be noted that only one of the members of the smoker group was female,
demonstrating a meaningful difference between smoking habits in different genders (p value = 0.005,
RR=6.9 CI 95%: 1.02-46.88). Mantel- Haenszel test revealed gender to have an altering effect on the
relation between smoking habit and the incidence of erythrocytosis (OR= 13.24, CI 95%: 3.77-46.5). In
other words, smoking indirectly influenced the development of PTE and being a masculine was the real
risk factor.
The number of patients developing PTE in each group is outlined in Table 1. There was no statistically
significant relation between any of these risk factors and PTE. Mann Whitney test did not showed any
relation between PTE and the number of previous transfusions (p value = 0.85).
Table 2 shows the subjects' laboratory data. Mild elevation in liver enzymes occurred in 6 (4.4%)
patients, 2 of which developed PTE.
When underlying renal diseases were addressed, it was noted that 16(72.7%) of 22 subjects with
glomerulonephritis and 6(75%) of 8 patients with PCKD, contracted PTE (p value=0.001, RR=2.72, CI
95%: 1.36-5.43 for GN and p value= 0.01, RR=2.44, CI 95%: 1.51-3.93). Table 3 shows the prevalence
of PTE in different underlying renal diseases reported in this study. As a matter of fact because all the
patients studied in this study had their native kidney, the influence of this factor in PTE could not be
assessed.
Doppler ultrasonography with the aim of observing renal artery stenosis was performed in 101 cases.
None of the 27 patients with PTE who had undergone this test had renal artery stenosis; however
6(8.1%) subjects of non- PTE group were reported to have stenosis. Statistical analysis showed no
significant difference between the two groups (p value= 0.189).
Three patients (2.2%) who had strictures in their urinary tract were all classified in the non PTE group.
Nephrectomy or splenectomy had been performed in 7(5.2%) of the cases, while neither
parathyroidectomy nor bilateral nephrectomy was reported in our subjects. Three of these cases
(42.9%) had contracted PTE (p value = 0.686). Hydronephrosis was seen in only 3 (2.2%) of patients,
all from the non PTE group.
A survey on therapeutic regimens showed PMC (Prednisolone, Mycophenolate Mofetil, Cyclosporine),
PIC (Prednisolone, Immuran, Cyclosporine) and PC(Prednisolone, Cyclosporine) the most frequent
regimens used in 33(32.4), 11(47.8) and 1(10%) of the patients in the case group. Prednisolone-
Immuran or Cyclosporine- Mycophenolate Mofetil was not used in any of the cases. Statistical analysis
did not reveal any relation between therapeutic regimen and PTE (p value = 0.097).
In a sub analysis carried out on the complications, CVA was reported in 2 patients: a case of PTE and a
non PTE case; in addition thrombophlebitis was also reported in a case in PTE group. No statistically
significant difference was seen in the two groups (p value = 0.319).
4. The Binary Logistic Regression test showed men to have PTE, 13.8 times more than women. Moreover
patients with PCKD and glomerulonephritis had 9.6 and 7.9 times higher risks to develop PTE. And
also PIC users compared with those using other regimen are 3.5 times more at risk.
Discussion
According to the results of this study being a man was the most important risk factor for PTE which is
the same as other studies; for instance, an American research in the mid 90's had shown 50% of PTE
patients to be men (1, 2, 3).
Although smoking was associated with higher risk of PTE in the primary analysis, final revisions
proved the contrary. As a matter of fact fewer women were smokers comparing to men and as
mentioned before, being a man was the real risk factor influencing PTE in this group. However several
other studies have mentioned smoking as a main risk factor (1, 2, 3).
PCKD patients were shown to have a higher risk of PTE in our study; as in this group of patients
anemia occurs less and on the other hand hemoglobin loss and renal failure are not proportional. In
addition, structural changes in the kidney of this group of patients may result in renin- angiotensin-
aldestrone activation which leads to development of PTE. Similar explanation for glomerulonephritis is
not available (7, 8).
PTE was more frequently reported in those administering PIC regimen. Considering different agents in
each group, Immuran is suggested to be the culprit; whilst as this drug is a known as the cause of
anemia and studies such as Perazella's has shown the effect of cyclosporine on developing PTE, this
theory is not totally accepted (1). On the contrary, Koziak and also the study carried out in Oregan
University have shown no difference in the level of hematocrit of patients using different cytotoxic
agents (2, 3).
In the present study, PTE did not result in a higher incidence of thromboembolic accidents; however,
other studies have mentioned 10-30% of PTE patients to be at risk of these complications (4, 5). The
lower incidence of thromboembolic complications in the very study may be the result of rapid
diagnosis and treatment in our patients.
Conclusion
Despite all the limitations, the study indicated several factors influencing PTE, more consideration of
which may reduce the complications. However, larger studies are needed in order to identify and
investigate all the risk factors.
5. Références
Vlahakos DV, Marathias KP, Agroyannis B, Madias NE. Post transplant erythrocytosis. Kidney Int
2003; 63: 1187-94.
Einollahi B, Lessan pezeshki M, Nafar M, Pour Reza Gholi F, Firouzan A, Farhangi F et al.
Erythrocytosis after renal transplantation: Review of 101 cases. Transplantation proceeding 2005; 37:
3101-02.
Wickre CG, Norman DJ, Bennion A, Barry JM, Bennet WM, post renal transplant erythrocytosis: a
review of 53 patients. Kidney Int 1983; 23: 731-7.
Panjwani DD, Sabawi NM, White AG, Kumar Msa, Aref MS, Abouna GM. Post renal transplant
erythrocytosis: Existence of two distinct types. Clin Transplant 1990; 4: 23-25.
Macdougall IC, Karim S, Amos R, Baker Lri, Raine Aeg. Polycythemia in renal transplant recipients is
not mediated solely by enhanced erythropoietin activity. J AM soc Nephrol 1992; 3: 428.
Kazory A. Post transplant erythrocytosis and thromboembolic events: an error. Nephrol dial transplant
2004; 19: 260-61.
Yildiz A, Yazici H, Ine N, Kazancioglu R, Akkaya V, Sever MS et al. angiotensin converting enzyme
gene polymorphism and development of post-transplant erythrocytosis. J Nephrol 2003; 16: 399-403.
6. Glicklich D, Burris L, Urban A, Tellis V, Greenstein S, Schechner R et al. Angiotensin converting
enzyme inhibition induces apoptosis in erythroid precursors and affects insulin- like growth factor-1 in
post transplantation erythrocytosis. J Am Soc Nephrol 2001; 12: 1958-64.
Tables
Table 1- Number of patients developing PTE in each group of patients with known risk factors
HTN Diabetes History of Cadaver Dysfunction in the transplanted
transfusion donor kidney
Dysfunction in the transplanted
kidney
+(%) 22(36.7) 5(32.6) 21(33.9) 1(11.1) 12(36.4)
-(%) 23(30.7) 40(54.5) 24(32.9) 44(34.9) 33(32.4)
P value 0.642 0.424 0.90 0.143 0.671
7. Table 2- Reported lab data in case and control group
Case Control P value
Mean Hb prior 9.56 ± 2.3 9.78 ±2.3 0.61
to transplant
Mean Hct prior 28.42 ± 6.9 29.91 ± 7.0 0.24
to transplant
8. Table 3- The prevalence of PTE in different underlying renal diseases reported in this study
Underlying PTE