The National medical journal of India最新文献

Background Patients of ovarian cancer who respond to the initial chemotherapy (CT) regimen may respond again to the same drugs after relapse. We aimed to evaluate the survival of patients with recurrent ovarian cancer (ROC) treated with second-line CT drugs such as liposomal doxorubicin, paclitaxel/carboplatin, and/or bevacizumab. Methods Electronic medical records of ovarian cancer patients registered between January 2009 and December 2017 were reviewed to identify those with ROC. Data regarding demographics, clinical characteristics, treatment, recurrence, vital status at last contact, etc. were retrieved. The log-rank test was applied to compare the Kaplan-Meier curves for survival analysis. Results A total of 119 cases met the inclusion criteria. The median age at diagnosis and relapse was 49 and 51 years, respectively. The medians for progression-free survival (PFS) and post-relapse survival (PRS) were 19 (95% CI 10.34-21.66) months and 34 (95% CI 37.17-56.83) months, respectively. The PFS was significantly higher among premenopausal women (p=0.025). Patients treated with paclitaxel/carboplatin-based second-line CT had significantly higher PRS compared to those treated with liposomal doxorubicin/carboplatin (p<0.001). Overall survival was also significantly different between the stage groups (p=0.003). Conclusions The 5-year PFS rate in ROC treated with second-line CT is <20%. The rate of secondary recurrence is moderately high, leading to reduced survival. Paclitaxel/carboplatin-based second-line CT significantly increases PRS among ROC patients. The probability of mortality increases as the stage advances.

Background Chronic kidney disease (CKD) is associated with accelerated cardiovascular (CV) risk, particularly due to subclinical atherosclerosis. Carotid intima-media thickness (CIMT) is a non-invasive marker of early athero-sclerotic changes. Altered mineral metabolism in CKD, also known as CKD-mineral bone disorder (CKD-MBD), may contribute to vascular damage. We evaluated the association between CIMT and mineral metabolism markers in people with diabetes who had pre-dialysis CKD. Methods A cross-sectional observational study was done in 110 adults with diabetes and pre-dialysis CKD. Biochemical markers including serum phosphate, intact parathyroid hormone (iPTH), fibroblast growth factor (FGF)-23, and 24-hour urinary phosphate were analyzed. CIMT was measured using B-mode ultrasonography. Correlation and regression analyses were performed. Results CIMT showed significant positive correlations with serum phosphate, FGF-23, iPTH, and serum creatinine, and negative correlations with nephron index and urinary phosphate excretion. Serum phosphate >6 mg/dl strongly predicted CIMT >0.9 mm. Conclusion Mineral metabolism markers, particularly serum phosphate and FGF-23, are significantly associated with subclinical atherosclerosis in CKD. Monitoring these parameters may aid in assessment of early CV risk in patients with CKD.

Background Long-term Covid-19 symptoms have the potential to negatively impact health and quality of life. We evaluated the incidence and predictors of long Covid-19 among hospitalized patients. Methods We prospectively collected clinical data of 393 patients diagnosed as Covid-19 positive and admitted to our hospital. At 1-year follow-up, all vital parameters and laboratory investigations were recorded. A multiple logistic regression model was used to determine predictors of long Covid-19. Results Long Covid-19 was found in 34.4% of patients at 1-year follow-up. Most commonly reported symptoms were joint pain (40%), fatigue (33%), and dyspnoea (22.9%). Severity of disease at the time of admission (1.5; 95% Confidence Interval [CI] 1.09-2.2; p=0.01), high body-mass index (BMI) (1.1; 95% CI 1.03-1.13; p=0.003) and increased age (1.02; 95% CI 1.00-1.04; p=0.02) were independent predictors of long Covid-19 on follow-up. Conclusion Almost one-third of patients were diagnosed with long Covid-19 at 1-year follow-up. Severity of disease at the time of admission, increased BMI, and increased age were independent predictors of long Covid-19.

Cutaneous tuberculosis (CTB) is an important type of extrapulmonary tuberculosis (EPTB), especially in countries where the tuberculosis (TB) load is high. It is reported from all over the globe with varying incidence, affecting all age groups, and it presents with different clinical forms depending upon the host, environmental and pathogen-related factors. Diagnosis of CTB, especially in atypical forms, is a challenge, even with newer molecular methods, as most cases are paucibacillary. CTB can be considered a neglected disease as there is a paucity of epidemiological data, awareness and research about it. With an aim to end tuberculosis in the near future, it is important to understand the distribution and determinants of CTB. This article, the first of two articles on this subject, reviews the present literature on epidemiology, pathogenesis, clinical features and types of CTB, including its associations and investigations.

Background There is minimal literature on the spectrum and long-term outcomes of acute kidney injury (AKI) from tropical countries. Methods Patients with AKI without underlying chronic kidney disease (CKD), were recruited from March 2017 to December 2018 to assess their outcomes. Survivors were followed for a year post-discharge. A linear model with fixed effects was created to compare the estimated glomerular filtration rate (eGFR) trajectories of patients with and without CKD at the end of follow-up. Results A total of 529 patients with AKI were recruited, of which 288 (54.4%) were hospital-acquired AKI. Infections and sepsis were the most common aetiologies for community-acquired AKI and hospital-acquired AKI. The overall mortality rate was 42.9% (n=227). The ICU stay (HR 1.78; 95% CI 1.08-2.93), mechanical ventilation (HR 1.98; 95% CI 1.09-3.54), and the requirement for inotropic support (HR 2.36; 95% CI 1.65-3.39) were independent risk factors of in-hospital mortality. Among 156 subjects with long-term follow-up, 70 (44.9%) developed CKD after a median follow-up of 12 months. Age (p<0.001) and hospital-acquired AKI (p=0.014) were significant predictors, whereas ICU stay and comorbid conditions did not influence the GFR trajectories. CKD patients showed a lower eGFR from the first follow-up (p<0.001). Conclusions AKI is associated with significant mortality. Even after an apparent recovery, around half the survivors progress to CKD at the end of 1 year.