The Communication and Optimal Resolution (CANDOR) program, a patient safety, medicolegal, and healthcare professional wellness program, has been implemented or in the process of being implemented in over 800 US hospitals. The program was designed to help patients suffering from unexpected adverse outcomes and healthcare professionals whose patients experience injury while under their care. The CANDOR program’s basic premise emphasizes honesty in medical error situations. It aims to prevent the recurrence of medical errors. Studies have found that, compared to the common US practice known as “Deny, Delay, and Defend,” using CANDOR not only benefits current and future patients but can improve the well-being of healthcare professionals. This paper therefore aimed to describe CANDOR and evidence regarding its effects on patients and the healthcare professional’s well-being at hospitals that implemented it in comparison to their previous practice of “Deny, Delay, and Defend.” This paper describes methods used by CANDOR teams, which include physicians, attorneys, patient advocates, and health policy leaders, in their successful endeavor to persuade hospital leaders to implement it, in essence to change the hospital’s culture from a culture of opaqueness regarding medical errors and their consequences to a culture embracing transparency. This paper also describes obstacles the teams faced in their endeavor to implement CANDOR at their institution and how they surmounted the obstacles.
{"title":"CANDOR - A Patient Safety, Medical Liability, and Healthcare Professional Wellness Program","authors":"F. LeCraw","doi":"10.18103/mra.v11i2.3434","DOIUrl":"https://doi.org/10.18103/mra.v11i2.3434","url":null,"abstract":"The Communication and Optimal Resolution (CANDOR) program, a patient safety, medicolegal, and healthcare professional wellness program, has been implemented or in the process of being implemented in over 800 US hospitals. The program was designed to help patients suffering from unexpected adverse outcomes and healthcare professionals whose patients experience injury while under their care. The CANDOR program’s basic premise emphasizes honesty in medical error situations. It aims to prevent the recurrence of medical errors. Studies have found that, compared to the common US practice known as “Deny, Delay, and Defend,” using CANDOR not only benefits current and future patients but can improve the well-being of healthcare professionals. This paper therefore aimed to describe CANDOR and evidence regarding its effects on patients and the healthcare professional’s well-being at hospitals that implemented it in comparison to their previous practice of “Deny, Delay, and Defend.” This paper describes methods used by CANDOR teams, which include physicians, attorneys, patient advocates, and health policy leaders, in their successful endeavor to persuade hospital leaders to implement it, in essence to change the hospital’s culture from a culture of opaqueness regarding medical errors and their consequences to a culture embracing transparency. This paper also describes obstacles the teams faced in their endeavor to implement CANDOR at their institution and how they surmounted the obstacles.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79061595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emilyn Munar, Wilfrido Simbul, Aurora Dionisio, Josefa Turingan
This study links health protocol awareness and appreciation to communicable disease prevention in higher education institution in Santiago City, Isabela, Philippines. If employees and students understand the health regulations and a majority of respondents approve and are more likely to follow, COVID-19 and other infectious diseases can be prevented. This descriptive-correlational cross-sectional study had 368 participants. The researchers prepared a more extensive questionnaire to analyze employees and students returning to face-to-face schooling in 2021-2022's trust and reliance in Covid-19 and other communicable disease prevention. Five of the higher education institution's ten leading causes of morbidity are also identified and ranked in the province. Acute respiratory, urinary, lower respiratory, and skin infections are contagious. Hypertension ranks fifth. The higher education institution's employee and student population has reached the desired herd immunity level, which is much higher than the Regional level; Group I's health problems have been alleviated by the anti-Covid preventive measles vaccination; and all five diseases are preventable, making them good targets for preventive medicine. The findings showed that "There is no significant difference between health data obtained from a general population of a region of the country and that of a school population in terms of the leading causes of morbidity and the current Covid-19 vaccination rate of the vulnerable population" and that "There is no significant difference between the level of appreciation of the relevance of health protocols between a segment of the population in a higher education institution grouped as those with health.”
{"title":"Relevance of Preventive Measures against COVID-19 and Other Communicable Diseases for University Employees and Students Returning to Face-to-Face Teaching","authors":"Emilyn Munar, Wilfrido Simbul, Aurora Dionisio, Josefa Turingan","doi":"10.18103/mra.v11i8.4114","DOIUrl":"https://doi.org/10.18103/mra.v11i8.4114","url":null,"abstract":"This study links health protocol awareness and appreciation to communicable disease prevention in higher education institution in Santiago City, Isabela, Philippines. If employees and students understand the health regulations and a majority of respondents approve and are more likely to follow, COVID-19 and other infectious diseases can be prevented. This descriptive-correlational cross-sectional study had 368 participants. The researchers prepared a more extensive questionnaire to analyze employees and students returning to face-to-face schooling in 2021-2022's trust and reliance in Covid-19 and other communicable disease prevention. Five of the higher education institution's ten leading causes of morbidity are also identified and ranked in the province. Acute respiratory, urinary, lower respiratory, and skin infections are contagious. Hypertension ranks fifth. The higher education institution's employee and student population has reached the desired herd immunity level, which is much higher than the Regional level; Group I's health problems have been alleviated by the anti-Covid preventive measles vaccination; and all five diseases are preventable, making them good targets for preventive medicine. The findings showed that \"There is no significant difference between health data obtained from a general population of a region of the country and that of a school population in terms of the leading causes of morbidity and the current Covid-19 vaccination rate of the vulnerable population\" and that \"There is no significant difference between the level of appreciation of the relevance of health protocols between a segment of the population in a higher education institution grouped as those with health.”","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81902993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18103/mra.v11i7.2.4141
M. Jirkovská
The human placenta is crucial for prenatal development and good pregnancy outcome. Maternal diabetic disorder influences normal intrauterine development of individual and expresses itself in the placenta. Due to the progress in diagnostic methods and methods of metabolic compensation the macroscopic signs associated with maternal diabetes, e.g., placentomegaly, occur nowadays rarely. In the microscopic picture of placenta there are no structural differences specific for maternal diabetes. However, the application of quantitative morphological methods has revealed some differences of normal and diabetic placenta. Stereological studies have shown significantly higher total volume of peripheral villi that distorts shapes and dimensions of pores in the intervillous space, and larger surface areas of peripheral villi and villous capillaries. Methods of confocal microscopy and 3D reconstruction gave the evidence that the fetus reacts on the hypoxia in maternal diabetic environment by enhanced angiogenesis and branching of villous capillaries. The enhanced tissue volumes are conditioned by higher mitotic activity. However, it decreases the proliferative potential of cells taking part in the enlargement of key structures for maternofetal transport at the end of pregnancy. Syncytiotrophoblast produces many factors playing important roles in maternal and fetal regulation and in the placenta itself. Quantitative methods of catalytic histochemistry and immunocytochemistry pointed at the role of maternal diabetes in decreased synthesis of some of those factors (e.g., alkaline phosphatase, SP1 glycoprotein). The presented data show that the quantitative morphological methods contribute to better understanding of the influence of maternal diabetes on fetoplacental unit.
{"title":"Microscopic Manifestations of Maternal Diabetes in Placental Structure","authors":"M. Jirkovská","doi":"10.18103/mra.v11i7.2.4141","DOIUrl":"https://doi.org/10.18103/mra.v11i7.2.4141","url":null,"abstract":"The human placenta is crucial for prenatal development and good pregnancy outcome. Maternal diabetic disorder influences normal intrauterine development of individual and expresses itself in the placenta. Due to the progress in diagnostic methods and methods of metabolic compensation the macroscopic signs associated with maternal diabetes, e.g., placentomegaly, occur nowadays rarely. In the microscopic picture of placenta there are no structural differences specific for maternal diabetes. However, the application of quantitative morphological methods has revealed some differences of normal and diabetic placenta. Stereological studies have shown significantly higher total volume of peripheral villi that distorts shapes and dimensions of pores in the intervillous space, and larger surface areas of peripheral villi and villous capillaries. Methods of confocal microscopy and 3D reconstruction gave the evidence that the fetus reacts on the hypoxia in maternal diabetic environment by enhanced angiogenesis and branching of villous capillaries. The enhanced tissue volumes are conditioned by higher mitotic activity. However, it decreases the proliferative potential of cells taking part in the enlargement of key structures for maternofetal transport at the end of pregnancy. Syncytiotrophoblast produces many factors playing important roles in maternal and fetal regulation and in the placenta itself. Quantitative methods of catalytic histochemistry and immunocytochemistry pointed at the role of maternal diabetes in decreased synthesis of some of those factors (e.g., alkaline phosphatase, SP1 glycoprotein). The presented data show that the quantitative morphological methods contribute to better understanding of the influence of maternal diabetes on fetoplacental unit.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81934795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Kyomugisha, M. Balaba, Eva Nakibuuka, R. King, R. Parkes-Ratanshi
Introduction: Significant advances in combination anti-retroviral therapy have been instrumental in improving the quality of lives and life expectancy for people living with HIV. However, in the absence of a cure, sustained investment and innovation is required to improve adherence and quality of life for people living with HIV. We developed ARTAccess, a web-based application that links patient information on anti-retroviral therapy and viral load to an algorithm that guides a private community pharmacist on anti-retroviral therapy refills without the need for an additional nurse in the pharmacy. The aim of this paper is to describe the present the development process of the ARTAccess application and the exploration of the perceptions about its use by end users. Methods: Between October–December 2018, we conducted a qualitative observational study to document the processes of the ART-Access™ application development. Using theoretical frameworks of participatory action research and human-centred design, we undertook structured and unstructured observations of the application development review meetings. We observed and had interactions in 12 stakeholder meetings. Three observers attended each development meeting and independently drafted a reflective narration of the transcript and separately conducted their own analyses. ARTAccess was launched in January 2019 and in March 2019, three in-depth interviews were conducted with the nurse dispensers running the refill program at the three pharmacies where ARTAccess was piloted. Results: The ARTAccess application development meetings generated emerging themes. Introduction of a mHealth application for efficiency introduced job insecurity fears of health workers which needed to be addressed, to allow for increased engagement by health worker stakeholders. Stakeholder meetings provided important perceived gaps and needs for improvement at each stage of the ARTAccess application development. The user-centred design process led to five application versions; three more than the two originally planned; the feedback on the ARTAccess application became more positive as later versions were presented to stakeholders. Conclusions: The study provides evidence that participatory action research in a human-centred design approach enhanced the application development process of a new technology for health. In resource limited settings, where digital technologies may be used to support overstretched health systems, health workers need re-assurance that digital tools being developed will not threaten their employment.
{"title":"Stakeholder Engagement to Drive Iterative Software Development of the ART-Access Web-Based Application for Community Pharmacy Dispensing of Anti-Retroviral Therapy","authors":"E. Kyomugisha, M. Balaba, Eva Nakibuuka, R. King, R. Parkes-Ratanshi","doi":"10.18103/mra.v11i1.3378","DOIUrl":"https://doi.org/10.18103/mra.v11i1.3378","url":null,"abstract":"Introduction: Significant advances in combination anti-retroviral therapy have been instrumental in improving the quality of lives and life expectancy for people living with HIV. However, in the absence of a cure, sustained investment and innovation is required to improve adherence and quality of life for people living with HIV. We developed ARTAccess, a web-based application that links patient information on anti-retroviral therapy and viral load to an algorithm that guides a private community pharmacist on anti-retroviral therapy refills without the need for an additional nurse in the pharmacy. The aim of this paper is to describe the present the development process of the ARTAccess application and the exploration of the perceptions about its use by end users. Methods: Between October–December 2018, we conducted a qualitative observational study to document the processes of the ART-Access™ application development. Using theoretical frameworks of participatory action research and human-centred design, we undertook structured and unstructured observations of the application development review meetings. We observed and had interactions in 12 stakeholder meetings. Three observers attended each development meeting and independently drafted a reflective narration of the transcript and separately conducted their own analyses. ARTAccess was launched in January 2019 and in March 2019, three in-depth interviews were conducted with the nurse dispensers running the refill program at the three pharmacies where ARTAccess was piloted. Results: The ARTAccess application development meetings generated emerging themes. Introduction of a mHealth application for efficiency introduced job insecurity fears of health workers which needed to be addressed, to allow for increased engagement by health worker stakeholders. Stakeholder meetings provided important perceived gaps and needs for improvement at each stage of the ARTAccess application development. The user-centred design process led to five application versions; three more than the two originally planned; the feedback on the ARTAccess application became more positive as later versions were presented to stakeholders. Conclusions: The study provides evidence that participatory action research in a human-centred design approach enhanced the application development process of a new technology for health. In resource limited settings, where digital technologies may be used to support overstretched health systems, health workers need re-assurance that digital tools being developed will not threaten their employment.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84255824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Conclusions: Our findings suggest that ethanol upregulates NQO1 expression by activating the AhR-Nrf2 pathway. Long-term ethanol exposure sustains low level of AhR protein and diminishes the inducibility of its target genes Nrf2 and NQO1 by BaP. These findings will contribute to understanding the synergistic toxicity of ethanol and polycyclic aromatic hydrocarbon compounds, such as BaP.
{"title":"Bidirectional Regulation of NAD(P)H Quinone Dehydrogenase 1 Expression in Mouse Hepatic Stellate Cells- Acute versus Long-Term Ethanol Exposure","authors":"H. Yang, Ningya Zhang, Zhongmao Guo","doi":"10.18103/mra.v11i2.3586","DOIUrl":"https://doi.org/10.18103/mra.v11i2.3586","url":null,"abstract":"Conclusions: Our findings suggest that ethanol upregulates NQO1 expression by activating the AhR-Nrf2 pathway. Long-term ethanol exposure sustains low level of AhR protein and diminishes the inducibility of its target genes Nrf2 and NQO1 by BaP. These findings will contribute to understanding the synergistic toxicity of ethanol and polycyclic aromatic hydrocarbon compounds, such as BaP.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84276883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sickle Cell Disease is a life-threatening hereditary blood disorder which affects millions of people worldwide. Pulmonary complications are important causes of morbidity and mortality in patients with sickle cell disease. Asthma is a recognised comorbidity of sickle cell disease and may occur in between 15 and 28% of children with sickle cell disease. It has been associated with increased episodes of acute chest syndrome and all cause mortality. Obstructive lung disease, however, is common in children with sickle cell disease, independent of an asthma diagnosis. This review explores the pathophysiology, diagnosis and therapeutic opportunities for asthma in sickle cell disease patients. The diagnostic challenges and inconsistencies in current clinical approaches are highlighted. Convergence of inflammatory pathways in sickle cell disease and asthma occurs, but there is also a heightened level of inflammation unique to sickle cell disease. Thus, wheezing may not be due to asthma but be a manifestation of sickle cell disease per se and the result of the increased pulmonary vascular volume. As a consequence, anti-asthma therapy may not be appropriate for all wheezy children with sickle cell disease and commencing treatment on the basis of a physician’s diagnosis alone is inappropriate. Data from paediatric cohorts suggest use of spirometry, aeroallergen sensitisation tests, impulse oscillometry and dedicated interdisciplinary pulmonary clinics could improve diagnosis accuracy. Corticosteroids and bronchodilators are well-established treatments for asthma; observational studies suggest they may provide benefit for some children with sickle cell disease, but therapies such as hydroxyurea may improve respiratory outcomes in others. It is, therefore, essential children are thoroughly investigated and followed-up and a personalised approach taken to their care. Prospective randomised studies are required to establish the effectiveness of asthma therapies in children with sickle cell disease.
{"title":"Asthma in Children with Sickle Cell Disease","authors":"O. Sikdar, A. Greenough","doi":"10.18103/mra.v11i5.3567","DOIUrl":"https://doi.org/10.18103/mra.v11i5.3567","url":null,"abstract":"Sickle Cell Disease is a life-threatening hereditary blood disorder which affects millions of people worldwide. Pulmonary complications are important causes of morbidity and mortality in patients with sickle cell disease. Asthma is a recognised comorbidity of sickle cell disease and may occur in between 15 and 28% of children with sickle cell disease. It has been associated with increased episodes of acute chest syndrome and all cause mortality. Obstructive lung disease, however, is common in children with sickle cell disease, independent of an asthma diagnosis. This review explores the pathophysiology, diagnosis and therapeutic opportunities for asthma in sickle cell disease patients. The diagnostic challenges and inconsistencies in current clinical approaches are highlighted. Convergence of inflammatory pathways in sickle cell disease and asthma occurs, but there is also a heightened level of inflammation unique to sickle cell disease. Thus, wheezing may not be due to asthma but be a manifestation of sickle cell disease per se and the result of the increased pulmonary vascular volume. As a consequence, anti-asthma therapy may not be appropriate for all wheezy children with sickle cell disease and commencing treatment on the basis of a physician’s diagnosis alone is inappropriate. Data from paediatric cohorts suggest use of spirometry, aeroallergen sensitisation tests, impulse oscillometry and dedicated interdisciplinary pulmonary clinics could improve diagnosis accuracy. Corticosteroids and bronchodilators are well-established treatments for asthma; observational studies suggest they may provide benefit for some children with sickle cell disease, but therapies such as hydroxyurea may improve respiratory outcomes in others. It is, therefore, essential children are thoroughly investigated and followed-up and a personalised approach taken to their care. Prospective randomised studies are required to establish the effectiveness of asthma therapies in children with sickle cell disease.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84966551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The risk scenarios supply chain managers encountered during the COVID19 pandemic were unique and provides many opportunities for learning and the development of more robust risk management approaches and strategies. In this reflection we offer five lessons that provide stepping stones for supply chain managers seeking to create more resilient supply chains. These lessons are: (1) the need to move from relational to social contracting, (2) the need to move from compliance to a force for good, (3) the need to move from planned optimization to agile resiliency, (4) the need to move from ERP and reporting the past to visibility into realtime and (5) the need to resist tendency to revert back to comfort zones. In this paper we reflect upon these lessons aiming to inspire progress in industry and research.
{"title":"Good Things that have Come out of the Pandemic: Between Steppingstones and Comfort Zone","authors":"R. Hoek","doi":"10.18103/mra.v11i5.3553","DOIUrl":"https://doi.org/10.18103/mra.v11i5.3553","url":null,"abstract":"The risk scenarios supply chain managers encountered during the COVID19 pandemic were unique and provides many opportunities for learning and the development of more robust risk management approaches and strategies. In this reflection we offer five lessons that provide stepping stones for supply chain managers seeking to create more resilient supply chains. These lessons are: (1) the need to move from relational to social contracting, (2) the need to move from compliance to a force for good, (3) the need to move from planned optimization to agile resiliency, (4) the need to move from ERP and reporting the past to visibility into realtime and (5) the need to resist tendency to revert back to comfort zones. In this paper we reflect upon these lessons aiming to inspire progress in industry and research.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85137680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Casalini, P. Mori, R. Pisi, Federico Maniscalco, M. Corradi, M. Goldoni
A pleural effusion is defined as eosinophilic when eosinophils represent ≥ 10% of the total nucleated cell count, and accounts for approximately 10% of all pleural effusions. The diagnostic significance of eosinophilic pleural effusion has yet to be determined. Objective and Methods: A retrospective study was conducted on 65 patients with eosinophilic pleural effusion to evaluate the correlation between the percentage of eosinophils present in the pleural fluid and the benign or malignant nature of the effusion. An original aspect of current study was the evaluation of other variables in association with pleural eosinophilia, in particular pleural fluid lymphocytosis (≥ 50%), and the presence or absence of fever. Results: Data showed the trend towards a decrease in neoplastic incidence with increasing percentages of eosinophilic counts, although this correlation was not statistically significant. The presence of fever correlated with low incidence of neoplasms (10% of neoplastic effusions in patients with fever) and was the most significant variable (p=0.001), with a Negative Predictive Value of neoplastic disease of 90%, with sensitivity 92.6% and specificity 47.4%. When evaluated together with fever, eosinophils increased their discriminating sensitivity to the benign or malignant nature of the effusion but lost in specificity. When evaluated as absence or presence of lymphocytosis (≥50% lymphocytes), associated with eosinophilia, lymphocytes were significantly associated with the neoplastic nature of the effusion. Conclusions: the study showed that the finding of eosinophilic pleural effusion should not be considered an indicator of benignity of the effusion; the association of other parameters with eosinophilia, lymphocytosis of the pleural fluid and fever can provide more precise prognostic indications; a high percentage of eosinophils, the absence of lymphocytosis and the presence of fever would seem to be associated with a low probability of a neoplastic nature of the effusion.
{"title":"Diagnostic Significance of Eosinophilic Pleural Effusion","authors":"A. Casalini, P. Mori, R. Pisi, Federico Maniscalco, M. Corradi, M. Goldoni","doi":"10.18103/mra.v11i4.3581","DOIUrl":"https://doi.org/10.18103/mra.v11i4.3581","url":null,"abstract":"A pleural effusion is defined as eosinophilic when eosinophils represent ≥ 10% of the total nucleated cell count, and accounts for approximately 10% of all pleural effusions. The diagnostic significance of eosinophilic pleural effusion has yet to be determined. Objective and Methods: A retrospective study was conducted on 65 patients with eosinophilic pleural effusion to evaluate the correlation between the percentage of eosinophils present in the pleural fluid and the benign or malignant nature of the effusion. An original aspect of current study was the evaluation of other variables in association with pleural eosinophilia, in particular pleural fluid lymphocytosis (≥ 50%), and the presence or absence of fever. Results: Data showed the trend towards a decrease in neoplastic incidence with increasing percentages of eosinophilic counts, although this correlation was not statistically significant. The presence of fever correlated with low incidence of neoplasms (10% of neoplastic effusions in patients with fever) and was the most significant variable (p=0.001), with a Negative Predictive Value of neoplastic disease of 90%, with sensitivity 92.6% and specificity 47.4%. When evaluated together with fever, eosinophils increased their discriminating sensitivity to the benign or malignant nature of the effusion but lost in specificity. When evaluated as absence or presence of lymphocytosis (≥50% lymphocytes), associated with eosinophilia, lymphocytes were significantly associated with the neoplastic nature of the effusion. Conclusions: the study showed that the finding of eosinophilic pleural effusion should not be considered an indicator of benignity of the effusion; the association of other parameters with eosinophilia, lymphocytosis of the pleural fluid and fever can provide more precise prognostic indications; a high percentage of eosinophils, the absence of lymphocytosis and the presence of fever would seem to be associated with a low probability of a neoplastic nature of the effusion.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85889960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Primary Membranous Nephropathy is an autoimmune disease caused by the deposition of Immunoglobulin G and complement components on the subepithelial layer of the glomerular capillary wall. It affects 5-10 patients per million population and is the second cause of nephrotic syndrome in adults after diabetic kidney disease. For decades steroids and non-specific immunosuppressive medications have been advocated as a therapeutic option for patients with membranous nephropathy at increased risk of kidney failure because of persistent nephrotic syndrome. These medications, however, have major and potentially fatal adverse effects that offset their potential benefits and should be abandoned. The discovery of nephritogenic autoantibodies against podocyte M-type phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing protein 7A (THSD7A) antigens provided a clear pathophysiological rationale for interventions specifically targeting B cell lineages to prevent antibody production and subepithelial deposition. The first-in-class anti-CD20 monoclonal antibody rituximab is safe and achieves remission in approximately two-thirds of patients with nephrotic membranous nephropathy. In PLA2R-related disease, remission is invariably preceded by depletion of anti PLA2R autoantibodies and relapse by their re-emergence into the circulation. Because of its superior risk/benefit profile as compared to non-specific immunosuppressive therapy, rituximab is now first-line therapy for patients with membranous nephropathy at risk of kidney failure. Novel monoclonal antibodies targeting CD20 cells (such as ofatumumab and obinutuzumab) and their differentiation (belimumab) or targeting long-living antibody producing CD38 memory cells (daratumumab, felzartamab) along with proteasome inhibitors such as bortezomib are being evaluated for the treatment of nephrotic patients with membranous nephropathy who are resistant or intolerant to rituximab. Complement inhibitor therapy might serve to stop the glomerular inflammatory process until the benefits of these medications become effective. Thus, major advances in the understanding of the mechanisms of membranous nephropathy have led to novel treatment perspectives. The integrated evaluation of serum autoantibody titer and proteinuria, together with serum albumin levels in patients with overt nephrotic syndrome, could guide diagnosis of membranous nephropathy and individually tailored treatment protocols. The introduction of monoclonal antibodies targeting disease-specific mechanisms will pave the way for a novel therapeutic paradigm based on the principle of precision medicine and personalized therapy.
{"title":"Disease-Specific Treatment For Primary Membranous Nephropathy: The Role of Monoclonal Antibodies","authors":"P. Ruggenenti","doi":"10.18103/mra.v11i3.3601","DOIUrl":"https://doi.org/10.18103/mra.v11i3.3601","url":null,"abstract":"Primary Membranous Nephropathy is an autoimmune disease caused by the deposition of Immunoglobulin G and complement components on the subepithelial layer of the glomerular capillary wall. It affects 5-10 patients per million population and is the second cause of nephrotic syndrome in adults after diabetic kidney disease. For decades steroids and non-specific immunosuppressive medications have been advocated as a therapeutic option for patients with membranous nephropathy at increased risk of kidney failure because of persistent nephrotic syndrome. These medications, however, have major and potentially fatal adverse effects that offset their potential benefits and should be abandoned. The discovery of nephritogenic autoantibodies against podocyte M-type phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing protein 7A (THSD7A) antigens provided a clear pathophysiological rationale for interventions specifically targeting B cell lineages to prevent antibody production and subepithelial deposition. The first-in-class anti-CD20 monoclonal antibody rituximab is safe and achieves remission in approximately two-thirds of patients with nephrotic membranous nephropathy. In PLA2R-related disease, remission is invariably preceded by depletion of anti PLA2R autoantibodies and relapse by their re-emergence into the circulation. Because of its superior risk/benefit profile as compared to non-specific immunosuppressive therapy, rituximab is now first-line therapy for patients with membranous nephropathy at risk of kidney failure. Novel monoclonal antibodies targeting CD20 cells (such as ofatumumab and obinutuzumab) and their differentiation (belimumab) or targeting long-living antibody producing CD38 memory cells (daratumumab, felzartamab) along with proteasome inhibitors such as bortezomib are being evaluated for the treatment of nephrotic patients with membranous nephropathy who are resistant or intolerant to rituximab. Complement inhibitor therapy might serve to stop the glomerular inflammatory process until the benefits of these medications become effective. Thus, major advances in the understanding of the mechanisms of membranous nephropathy have led to novel treatment perspectives. The integrated evaluation of serum autoantibody titer and proteinuria, together with serum albumin levels in patients with overt nephrotic syndrome, could guide diagnosis of membranous nephropathy and individually tailored treatment protocols. The introduction of monoclonal antibodies targeting disease-specific mechanisms will pave the way for a novel therapeutic paradigm based on the principle of precision medicine and personalized therapy.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80356094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.18103/mra.v11i7.1.4112
Fernanda Zottmann, Jiviane Silva, S. Khatib, Gabriela Guimarães, Julia Coneglian, Bibiana Vinholes, L. Gebrin, C. Borges
In SC hemoglobinopathy, a rare type of sickle cell disease, patients may experience vaso-occlusive phenomena, but in a milder condition than in the SS form, considered classic and the most common among them. This current study aims to present a case of a patient with this rare form of hemoglobinopathy, who received a late diagnosis, and its clinical evolution, including symptoms, treatment and life expectancy based on the literature, but mainly on how the patient is clinically found after seven years of follow-up. It is important to have epidemiological studies about hemoglobinopathies, specially the rare forms, to obtain more information regarding the incidence/prevalence of the disease and clinical manifestations.
{"title":"SC Hemoglobinopathy: a rare case report","authors":"Fernanda Zottmann, Jiviane Silva, S. Khatib, Gabriela Guimarães, Julia Coneglian, Bibiana Vinholes, L. Gebrin, C. Borges","doi":"10.18103/mra.v11i7.1.4112","DOIUrl":"https://doi.org/10.18103/mra.v11i7.1.4112","url":null,"abstract":"In SC hemoglobinopathy, a rare type of sickle cell disease, patients may experience vaso-occlusive phenomena, but in a milder condition than in the SS form, considered classic and the most common among them. This current study aims to present a case of a patient with this rare form of hemoglobinopathy, who received a late diagnosis, and its clinical evolution, including symptoms, treatment and life expectancy based on the literature, but mainly on how the patient is clinically found after seven years of follow-up. It is important to have epidemiological studies about hemoglobinopathies, specially the rare forms, to obtain more information regarding the incidence/prevalence of the disease and clinical manifestations.","PeriodicalId":94137,"journal":{"name":"Medical research archives","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82551335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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