共查询到20条相似文献，搜索用时 31 毫秒
1.
Antonio Ascione Massimo De Luca Mario Melazzini Simona Montilla Maria Paola Trotta Salvatore Petta Massimo Puoti Vincenzo Sangiovanni Vincenzo Messina Savino Bruno Antonio Izzi Erica Villa Alessio Aghemo Anna Linda Zignego Alessandra Orlandini Luca Fontanella Antonio Gasbarrini Marco Marzioni Edoardo G. Giannini Antonio Craxì For the ABACUS Study Group 《Infection》2018,46(5):607-615
Purpose
To analyse safety and efficacy of treatment based on ombitasvir/paritaprevir/ritonavir/dasabuvir plus ribavirin in the sub-group of GT1 patients older than 65 years.Methods
We collected data extracted from the ABACUS compassionate-use nationwide Italian programme, in patients with cirrhosis due to hepatitis C virus (HCV) Genotype-1 (GT1) or 4 and at high risk of decompensation. GT1-HCV-infected patients received once-daily ombitasvir/paritaprevir, with the pharmacokinetic enhancer ritonavir (25/150/100 mg) and twice-daily dasabuvir (250 mg) plus Ribavirin (RBV) (OBV/PTV/r?+?DSV?+?RBV) for 12 (GT1b) or 24 (GT1a) weeks. Endpoints were to evaluate safety and efficacy, the latter defined as HCV RNA negative 12 weeks after the end of treatment (SVR12).Results
Patients who suffered any adverse event (AE) were 74/240 (30.8%); 13/240 (5.4%) discontinued the treatment. A multivariate analysis found albumin <?3.5 g/dL (OR 2.04: 95% CI 1.0–4.2, p?<?0.05) and hypertension (OR 4.6: 95% CI 2.3–9.2, p?<?0.001) as variables independently associated with AE occurrence. The SVR12 was 95% (228/240). Multivariate analysis identified baseline bilirubin <?2 mg/dL (OR 4.9: 95% CI 1.17–20.71, p?=?0.029) as the only variable independently associated with SVR12.Conclusion
Our findings suggest that OBV/PTV/r?+?DSV?+?RBV is safe and effective in real-life use in patients with compensated cirrhosis, HCV-GT1 infection, and age over 65.2.
Ana Lleo Andrea Aglitti Alessio Aghemo Patrick Maisonneuve Savino Bruno Marcello Persico 《Digestive and liver disease》2019,51(2):310-317
Background
Despite the dramatic improvement in viral eradication rates that has been reached with direct antiviral agents (DAAs), the real benefit of viral eradication after DAAs on hepatocellular carcinoma (HCC) development is still controversial.Aim
To prospectively assess the risk of HCC occurrence and early recurrence in a large cohort of DAA-treated HCV-cirrhotic patients and to identify potential predictors of HCC development.Methods
We analyzed data prospectively collected from 1927 consecutive HCV-infected cirrhotic patients treated with DAA from January to December 2015 in 10 tertiary liver centers in Italy and followed-up for one year after therapy. 161 patients had a previous HCC.Results
38/161 subjects developed tumor recurrence during the follow-up (recurrence rate?=?24.8 per 100-year), patients with SVR had a significantly lower rate of recurrence. Lack of SVR and alpha-fetoprotein (AFP) were independent predictors of HCC recurrence. 50/1766 patients without a previous HCC history developed HCC during follow-up (incidence rate?=?2.4 per 100-year). Lack of SVR was the strongest predictor of HCC development. Furthermore, patients with SVR and no stigmata of portal hypertension have a lower incidence rate of HCC (1.0 per 100-year).Conclusions
SVR is associated with a significant decrease of recurrent or de novo HCC. Baseline AFP and signs of portal hypertension can help to stratify the risk of HCC. 相似文献3.
Carolyne Ghobrial Rodina Sobhy Engy Mogahed Hala Abdullatif Hanaa El-Karaksy 《Digestive and liver disease》2019,51(2):258-262
Background
Symptomatic bradycardia has been reported in adults treated for chronic hepatitis C using sofosbuvir based regimens.Aim
We studied the cardiac safety of sofosbuvir/ledipasvir in Egyptian children, treated for chronic hepatitis C.Methods
The study included 40 hepatitis C virus infected children and adolescents 12–17 years old, using the combination of sofosbuvir (400?mg)/ledipasvir (90?mg) in a single oral tablet (Harvoni) taken daily for 12 weeks. All subjects underwent a baseline standard 12-lead surface Electrocardiography that was repeated at 4 and 12 weeks of therapy. Electrocardiography parameters (Heart Rate, RR interval, PR interval, QRS, QT interval, corrected QT interval, QT dispersion, JT interval, corrected JT interval, JT dispersion, Tpeak-Tend interval) were compared at the 3 different time points during antiviral therapy.Results
No symptoms related to the cardiovascular system were reported during treatment. There were no cases of symptomatic bradycardia/syncope. Heart rate was noted to be significantly lower and RR and QT intervals were significantly longer in the baseline electrocardiography. Heart rate was significantly lower and RR interval was significantly longer in patients with higher viral load.Conclusion
No adverse cardiovascular events were observed in this group of HCV infected children and adolescents treated with sofosbuvir/ledipasvir. None of the patients developed bradyarrhythmias during treatment. 相似文献4.
Erika Monguzzi Laura Marabini Luca Elli Valentina Vaira Stefano Ferrero Francesca Ferretti Federica Branchi Gabriella Gaudioso Alice Scricciolo Vincenza Lombardo Luisa Doneda Leda Roncoroni 《Digestive and liver disease》2019,51(1):47-54
Background
Gliadins are involved in gluten-related disorders and are responsible for the alteration of the cellular redox balance. It is not clear if the gliadin-related oxidative stress can induce DNA damage in enterocytes.Aim
To investigate any possible genotoxicity caused by gliadin and to assess its relationship with oxidative stress in vitro and ex vivo.Methods
Caco-2 cells were exposed for 6–12–24?h to increasing concentrations (250?μg/mL–1000?μg/mL) of digested gliadin. We investigated: cytotoxicity, oxidative balance (reactive oxygen species, ROS), DNA damage (comet assay and γ-H2AX detection), transglutaminase type 2 (TG2) activity and annexin V expression. H2AX and 8-OHG immunohistochemistry has been evaluated on duodenal biopsies of celiac subjects and controls.Results
Gliadin induced a significant increase (+50%) of ROS after 12?h of exposition starting with a 500?μg/mL dose of gliadin. Comet assay and γ-H2AX demonstrated DNA damage, evident at the gliadin concentration of 500?μg/mL after 24?h. TG2 activity increased in chromatin and cytoskeleton cellular compartments at different gliadin doses (250/500/1000?μg/mL). The γ-H2AX and 8-OHG immunohistochemistry was altered in the duodenal biopsies of celiac patients.Conclusions
Gliadin induces cellular oxidative stress, DNA damage and pro-apoptotic stimulation in Caco-2 cells and in the duodenal mucosa of celiac patients. 相似文献5.
Tatiana Duarte Sara Gonçalves Catarina Sá Rita Marinheiro Marta Fonseca José Farinha Rita Rodrigues Filipe Seixo Leonor Parreira Rui Caria 《Revista portuguesa de cardiologia》2019,38(2):105-111
Introduction
In iatrogenic or potentially reversible bradyarrhythmia, drug discontinuation or metabolic correction is recommended before permanent cardiac pacemaker (PM) implantation. These patients often have conduction system disease and there are few data on recurrence or the need for a permanent PM.Objective
To analyze the need for PM implantation in patients with iatrogenic bradyarrhythmia or bradyarrhythmia associated with other potentially reversible causes.Methods
We assessed consecutive symptomatic patients admitted to the emergency department with a primary diagnosis of bradyarrhythmia (atrioventricular [AV] node disease – complete or second‐degree AV block (AVB) [CAVB: 2nd‐degree AVB – 2:1], sinus bradycardia [SB] and atrial fibrillation [AF] with slow ventricular response [SVR]) in the context of iatrogenic causes or metabolic abnormalities. We determined the percentage of patients who required PM implantation.Results
We studied 153 patients (47% male) admitted for iatrogenic or potentially reversible bradyarrhythmia. Diagnoses were SB 16%, CAVB 63%, second‐degree AVB 12%, and AF with SVR 10%. Eighty‐five percent of patients were under negative chronotropic therapy, 3% had hyperkalemia and 12% had a combined etiology. After correction of the cause, 55% of patients (n=84) needed a PM. In these patients the most common type of bradyarrhythmia was CAVB, in 77% (n=65) patients.Conclusion
In a high percentage of patients with bradyarrhythmia associated with a potentially reversible cause, the arrhythmia recurs or does not resolve during follow‐up. Patients with AV node disease constitute a subgroup with a higher risk of recurrence who require greater vigilance during follow‐up and should be considered for PM implantation after the first episode. 相似文献6.
Anna Viola Daniela Pugliese Sara Renna Federica Furfaro Flavio Caprioli Renata D’Incà Fabrizio Bossa Stefano Mazza Giuseppe Costantino Massimo Claudio Fantini Gionata Fiorino Angela Alibrandi Ambrogio Orlando Alessandro Armuzzi Walter Fries 《Digestive and liver disease》2019,51(4):510-515
Background
Anti-TNF therapies infliximab (IFX), adalimumab (ADA), and golimumab (GOL) are approved for treating moderate to severe ulcerative colitis (UC). In UC, only the switch from IFX to ADA has been investigated, reaching no more than 10–43% remission rates at 12 months.Aim
Of the present study was to investigate disease outcome after a switch from subcutaneous (SC) agents to the intravenous (IV) agent (IFX).Methods
In this retrospective multicentre study, we analysed the charts of UC patients unresponsive/intolerant or with secondary loss of response (LOR) to ADA or GOL who were switched to IFX. We evaluated clinical response and remission together with adverse events at 3, 6, and 12 months follow-up.Results
Seventy-six patients were included; 38 patients started ADA and 38 started GOL for a mean therapy duration of 6?±?6 months. Indications for switch were adverse events in 3%, primary failure in 79%, and LOR in 18% of patients. Clinical remission was reached by 47%, 50%, and 77% of patients, respectively. Patients that switched for LOR did numerically, but not statistically, better than patients who switched for primary failure.Conclusions
Our data show a superior remission rate in SC to IV anti-TNF switch in UC compared to the IV to SC switch reported in literature. 相似文献7.
Francesc Maduell Lara Belmar Jésica Ugalde Montserrat Laguno María Martínez-Rebollar Raquel Ojeda Marta Arias Lida Rodas Florencia Rossi Laura-Patricia Llovet Leonardo Nicolás González Josep Mallolas Maria-Carlota Londoño 《Gastroenterologia y hepatologia》2019,42(3):164-170
Introduction
In the interferon era, the treatment of hepatitis C virus (HCV) infection in patients on haemodialysis (HD) was limited due to the significant number of treatment-related adverse events (AEs). Direct-acting antivirals (DAAs) have demonstrated their efficacy and safety in the treatment of HCV in patients with advanced chronic kidney disease on haemodialysis. The objective of the study was to evaluate the success in eliminating HCV infection from our dialysis unit using DAAs, and to assess the impact of HCV elimination on clinical and analytical outcomes.Patients and methods
This is a prospective, interventional, single-center study at Hospital Clínic de Barcelona. All HCV-RNA positive patients who received antiviral therapy with DAAs within a 3-year period (2014–2017) were analyzed (n = 20). Data on virologic response, adverse events, and biochemical and hematological parameters during and after DAA therapy were analyzed.Results
All patients achieved sustained virologic response (SVR) and only 40% of patients presented with mild AEs. None of the patients presented with HCV reinfection after a 1-year follow-up period, and thus HCV was eliminated from our HD unit. SVR was associated with a significant increase in hemoglobin and hematocrit, and a tendency toward the need for lower doses of iron supplementation with no changes in darbepoetin dose.Conclusion
HCV infection can be safely eliminated from HD units with the use of DAAs, preventing new infections in patients and healthcare staff. In the short term, the achievement of SVR is associated with an improvement in the control of anemia. 相似文献8.
9.
Alessandro Loglio Mauro Viganò Glenda Grossi Sara Labanca Maria Goldaniga Alessandra Pompa Lucia Farina Mariagrazia Rumi Paolo Corradini Floriana Facchetti Giovanna Lunghi Luca Baldini Pietro Lampertico 《Digestive and liver disease》2019,51(3):419-424
Backgound
A significant proportion of hepatitis B surface antigen (HBsAg) negative/anti-hepatitis B core antigen (anti-HBc) positive patients with non-Hodgkin lymphoma (NHL) undergoing rituximab-based chemotherapy (R-CT) may suffer hepatitis B virus (HBV) reactivation.Aims
We wanted to assess efficacy and safety of lamivudine (LMV) prophylaxis to prevent this complication.Methods
Eighty-five consecutive HBsAg negative/anti-HBc positive NHL patients (71 years, 100% serum HBV DNA undetectable, 74% anti-HBs positive) received LMV coadministered with R-CT and for 18 months after the end of R-CT. Serum ALT, HBsAg, anti-HBs and HBV DNA were assessed every 4 months during and after end of LMV.Results
During 39 (2–108) months of study period, including 21 months of LMV and 27 additional months after LMV discontinuation, one patient (2%) had HBV reactivation, 31 months after stopping LMV and during administration of new immunosuppressive regimens, without LMV prophylaxis, owing to incomplete oncological response. A 50% decline of anti-HBs titers occurred in 22/63 (35%) patients, including 12 who became anti-HBs seronegative. Five (6%) patients had ALT increase during R-CT but none required R-CT discontinuation. Seventeen (20%) patients died, all for tumour progression.Conclusion
LMV prophylaxis is safe and effective in preventing HBV reactivation in HBsAg negative/anti-HBc positive NHL patients receiving R-CT. 相似文献10.
José S. Merino Liliana Araneda Paulina Lincoñir-Campos Cristian Parra Katia Sáez Apolinaria García 《Enfermedades infecciosas y microbiología clínica》2019,37(2):109-111
Introduction
Mainly due to the high percentage of infection and the ineffectiveness of treatments, Helicobacter pylori is a global health problem. Knowing the age at acquisition is key to preventing the infection.Patients
Sixty-seven mothers and their respective children participated. To evaluate the presence of H. pylori, the faeces of the mother and her child were analysed using the HpSA antigen test.Results
71.6% (48/67) of pregnant mothers were positive for H. pylori at the term of their pregnancy. In newborns, 8.96% (6/67) of them showed H. pylori colonisation/persistent infection. During the first month of life, a prevalence and incidence of infection of 23.9% and 13%, respectively, was observed.Conclusion
Overall, the results suggest that there is a high risk of H. pylori infection during the first month of life, even of the persistent type. 相似文献11.
Georgios Giannakopoulos Hans Verbaan Inga-Lill Friis-Liby Per Sangfelt Nils Nyhlin Sven Almer 《Digestive and liver disease》2019,51(2):253-257
Background
Data on rescue treatment of autoimmune hepatitis in patients that fail standard treatment are sparse.Aims
To report our long-term experience with mycophenolate mofetil.Methods
Retrospective study in 22 patients with autoimmune hepatitis who failed azathioprine and prednisolone due to adverse events (n?=?14, 64%), lack of remission (n?=?5, 23%) or a combination (n?=?3, 13%).Results
Mycophenolate mofetil was started at a dose of 20?mg/kg/day and increased to a maximum of 3?g/day. Follow-up was 0–6 months in 7 patients; more than 12 months in 15 (68%) and more than 24 months in 10. Normal aminotransferase levels were obtained (n?=?3) or maintained (n?=?7) in 10 patients (45%) after three to 30 weeks. 12 patients (55%) were withdrawn during the first 6 months, due to adverse events. Three patients were switched to cyclosporine and one underwent liver transplantation. Successful treatment with mycophenolate mofetil continued in 10 patients (45%) for a median of 71 months (range 20–124). Of these, one stopped prednisolone, five have a prednisolone dose <5?mg daily and four patients 5–10?mg.Conclusion
Approximately one of two patients with autoimmune hepatitis that fail standard treatment benefit from long-term maintenance with mycophenolate mofetil, especially those with previous intolerance to thiopurines, where mycophenolate mofetil is effective in two thirds. 相似文献12.
Lieven Pouillon Anne Lamoureux Guillaume Pineton de Chambrun Lucine Vuitton Benjamin Pariente Camille Zallot Gaspard Dufour Mathurin Fumery Cédric Baumann Aurélien Amiot Stéphane Nancey Hélène Rousseau Laurent Peyrin-Biroulet 《Digestive and liver disease》2019,51(2):236-241
Background
Data about the outcomes after adalimumab dose de-escalation in inflammatory bowel disease (IBD) are scarce.Objectives
To assess the outcomes after adalimumab dose de-escalation, and to identify potential factors associated with failure.Methods
Retrospective, observational study including all IBD patients who had undergone adalimumab dose de-escalation to 40?mg every three weeks across seven GETAID centers, between June 2011 and September 2017. Failure of adalimumab dose de-escalation was defined as the need for treatment re-escalation, discontinuation of adalimumab, or clinical, biochemical and/or morphologic disease relapse.Results
Fifty-six patients were identified (n?=?46 Crohn’s disease, n?=?10 ulcerative colitis). Median (IQR) duration of follow-up after adalimumab dose de-escalation was 15.9 (7.9–30.6) months. Adalimumab dose de-escalation was a failure in 21/56 (37.5%) patients and successful in 35/56 (62.5%) patients. Median (IQR) time until failure was 8.9 (4.6–15.6) months. At multivariate analysis, inactive disease at magnetic resonance imaging and/or endoscopy in the year before adalimumab dose de-escalation decreased the risk of failure with a factor five (P?=?0.02).Conclusions
Adalimumab dose de-escalation to 40?mg every three weeks is possible in almost two thirds of IBD patients. Objective morphologic signs of active disease should be ruled out before considering a de-escalation strategy with adalimumab. 相似文献13.
D. Ozceker F. Haslak F. Dilek S. Sipahi E. Yucel N. Guler Z. Tamay 《Allergologia et immunopathologia》2019,47(1):47-51
Background
Atopic dermatitis is a common illness in childhood. Children with atopic dermatitis are prone to develop cutaneous sensitization due to skin barrier dysfunction.Aim
The aim of this study was to evaluate the frequency of cutaneous sensitizations in patients with atopic dermatitis and to identify the most frequent causative allergens.Study design
The study group consisted of 112 children with atopic dermatitis, aged 1–18 years (median 88.5 months) and 39 healthy controls, aged 1–8 years (median 88.48 months).Methods
The diagnosis of atopic dermatitis was established by modified Hanifin and Rajka criteria; severity of the disease was assessed by scoring of atopic dermatitis. Serum blood eosinophil count, total IgE and skin prick tests for common aeroallergens and food allergens were performed. Patch tests with cosmetic series and European standard patch test series (Stallegenes© Ltd, Paris, France) were applied.Results
Of the children with atopic dermatitis, 17% (n = 19) were sensitized to either cosmetic or standard series or both of them; no children in the control group had a positive patch test (p = 0.001). Atopy and severity of atopic dermatitis was not a significant risk factor for cutaneous sensitization. The most common allergens were Nickel sulphate and Methychloroisothiazinolone (4.5% and 4.5%) in the European standard patch test and cocamidoproplybetaine (12.5%) in the cosmetic series patch test.Conclusion
Cutaneous sensitization can develop in children with atopic dermatitis, therefore allergic contact dermatitis should be kept in mind. 相似文献14.
Nieves M. Coronado-Álvarez Diego Parra Jorge Parra-Ruiz 《Enfermedades infecciosas y microbiología clínica》2019,37(1):4-10
Introduction
Over recent years we have witnessed an increase in the resistance of microorganisms to the available antimicrobials and a decrease in the number of new antimicrobials. Fosfomycin is a safe and cheap broad-spectrum antibiotic which has shown very promising results in combination therapy, mainly against gram-negative microorganisms. Little is known, however, about its clinical efficacy against gram-positive microorganisms.Methods
We performed a retrospective review of all patients with severe gram-positive infections who received fosfomycin as part of their treatment from 2011 to 2017. We also performed in vitro time-kill assays to study the behaviour of fosfomycin with different antimicrobials against two strains of methicillin-resistant Staphylococcus aureus (MRSA) and two strains of methicillin-susceptible S. aureus (MSSA).Results
Seventy-five patients were treated with different fosfomycin combinations. Among them, 61 (81%) were successfully treated. Daptomycin plus fosfomycin was the most effective combination. Overall, the treatment with fosfomycin was safe, and side effects were minor. There was only one major side effect that resolved after discontinuation of therapy. Time-kill studies demonstrated increased activity of fosfomycin combinations, with daptomycin–fosfomycin being the most active combination against both MRSA and MSSA strains.Conclusions
Our results suggest that antimicrobial combinations including fosfomycin are an alternative and effective approach for gram-positive infections. 相似文献15.
MELD is the only predictor of short-term mortality in cirrhotic patients with C. difficile infection
Background
Clostridium difficile infection (CDI) is the most common nosocomial infection in the US and cirrhotic patients with CDI have increased risk for poor outcome.Aim
The aim of this study is to evaluate the impact of CDI on short-term mortality in patients with cirrhosis and identify predictors of mortality in these patients.Methods
We retrospectively identified patients at Montefiore Medical Center from 2010 to 2014 with cirrhosis, diarrhea and a C. difficile toxin assay. Demographics, co-morbidities, medications, laboratory data and outcomes were recorded.Results
Of 701 patients with cirrhosis who had a CDI assay, 183 were CDI+ and 518 CDI?. Patients with CDI were older, had more frequent CKD on hemodialysis and heart failure, were less frequently on rifaximin and lactulose and had increased glucocorticoid exposure. 30-day mortality was higher in patients with CDI (23.0% vs 16.6%, p?<?0.05) compared to those without. Univariate predictors of 30-day mortality included WBC, corticosteroid use, AST, ALT, MELD, albumin, HBV and HCV infection; however, via multivariate analysis, only MELD (HR: 1.04?±?0.02, p?<?0.05) remained significant.Conclusion
Patients with cirrhosis and CDI are at greater risk of 30-day mortality than those without CDI and the only multivariate predictor of mortality is MELD. These patients should have their disease severity triaged based upon MELD score. 相似文献16.
Samantha Morais Luís Antunes Maria José Bento Nuno Lunet 《Digestive and liver disease》2019,51(4):584-588
Background
The growing number of gastric cancers together with improved survival resulted in an increasing population of survivors at risk of multiple primary cancers.Aims
To estimate the 10-year risk and survival of third primary cancers (TPCs) among gastric first primary cancers (FPCs).Methods
Gastric FPCs from the Portuguese North Region Cancer Registry, diagnosed in 2000-2006 (n?=?7409), were followed for a TPC (31/12/2012), and for all-cause death (31/12/2017). The cumulative incidence of TPCs was estimated. Patients with a TPC were matched (1:1, by sex, age group, years between FPC and second primary cancer [SPC] diagnosis, and SPC location) to FPC?+?SPC patients without a TPC.Results
Overall, 25 (0.3% of FPCs and 6.8% of SPCs) TPCs were diagnosed. The most common sites were tobacco-related, mainly including digestive organs. Among all FPCs, 10-year cumulative incidence (95% confidence interval [CI]) of a TPC was 0.4% (0.2–0.5%) and among SPCs 7.6% (4.4–10.8%). For TPCs, compared to matched patients, age-adjusted hazard ratio (95%CI) for death was 1.68 (0.77–3.67). The 10-year cumulative mortality of TPCs and matched patients was 92.6% and 67.9%, respectively.Conclusions
A clustering of tobacco-related cancers was observed in TPCs, with a 10-year cumulative incidence of 0.4% among FPCs. TPCs had worse survival than patients without a TPC. 相似文献17.
Lara Belmar Vega Emilio Rodrigo Galabia Jairo Bada da Silva Marta Bentanachs González Gema Fernández Fresnedo Celestino Piñera Haces Rosa Palomar Fontanet Juan Carlos Ruiz San Millán Ángel Luis Martín de Francisco 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2019,39(3)
Background
Hyperkalaemia is a significant electrolyte imbalance in chronic kidney disease (CKD). Renin-angiotensin-aldosterone system inhibitors (RAASi) have beneficial cardio-renal properties, although they can often cause hyperkalaemia.Objective
To examine the prevalence of hyperkalaemia in CKD, identify factors associated with its appearance and the relationship between hyperkalaemia and mortality.Patients and methods
Retrospective observational study on patients with CKD in the period 1971-2017. The population was categorised into 3 groups: Group 1, patients with CKD without renal replacement therapy; Group 2, patients on haemodialysis; and Group 3, patients on continuous ambulatory peritoneal dialysis.Results
A total of 2,629 patients were evaluated. The prevalence observed in the different groups was: 9.6%, 16.4% and 10.6%, respectively. Risk factors related to the appearance of hyperkalaemia in the CKD group were glomerular filtration rate (GFR) (P<.001), plasma creatinine (P<.001), plasma sodium (P<.001), haemoglobin (P=.028), diastolic blood pressure (P=.012), intake of ACE inhibitors and/or angiotensin ii receptor blockers (P=.008), treatment with metformin (P<.001) and diabetes (P=.045). Treatment with RAASi significantly increased hyperkalaemia as GFR decreased, as well as in patients with diabetes or heart failure.Conclusions
Hyperkalaemia is a frequent metabolic alteration in CKD patients that increases in the presence of drugs with beneficial cardio-renal properties (RAASi), which means that patients often lose the benefit associated with these drugs. New, recently-appearing non-absorbable compounds, which bind to potassium in the gastrointestinal tract, enhancing faecal excretion and thus maintaining the cardio-renal benefit of the RAASi, could be relevant in the progress of patients with CKD. 相似文献18.
Objective
To assess the impact of providing integrated psycho-socio-economic support to drug resistant tuberculosis (DRTB) patients on the treatment outcome under programmatic conditions.Study design
Retrospective cohort study.Setting
An urban district TB centre in India under the Revised National Tuberculosis Control Programme.Participants
A cohort of 123 patients who started DRTB treatment between June 2010 and May 2013.Methods
Patients started on treatment for DRTB between June 2010 and May 2013 who were provided with the integrated support package for at least 3 months formed the supported group while the other patients of the cohort formed the non-supported group. The treatment outcomes and sputum culture conversion rates were compared between the two groups.Results
The supported group consisted of 60 patients and the non-supported group of 63 patients. The treatment success rate was found to be significantly higher in the supported group (65% vs 46.03%; p = 0.0349). Support duration was significantly associated with lower incidence of death [HR 0.876, 95% CI 0.811–0.947; p = 0.0009] and loss to follow up [OR: 0.752, 95% CI 0.597–0.873; p = 0.0023]. The treatment failure rate was higher in the supported group (16.66% vs 4.76%) with 60% of the failures in the supported group occurring after 24 months of compliant treatment. There was no significant association found between support duration and treatment failure or sputum culture conversion.Conclusion
Integrated support seems to significantly increase the treatment success rate and improve survival and treatment adherence of DRTB patients. However, early diagnosis and effective pharmacotherapy are crucial for reducing treatment failures. 相似文献19.
Alessandra Zilli Federica Cavalcoli Clorinda Ciafardini Sara Massironi 《Digestive and liver disease》2019,51(4):505-509
Background
Chronic atrophic autoimmune gastritis (CAAG) leads to vitamin B12 deficiency, but other micronutrient deficiencies are largely understudied.Aims
To investigate the prevalence of micronutrient deficiencies in CAAG patients and their potential relationship with the grading of gastric atrophy or entero-chromaffin-like cells hyperplasia or body mass index (BMI).Methods
From 2005 to 2016 a number of CAAG patients underwent regular follow-up with annual blood testing and upper gastrointestinal tract endoscopy every years.Results
Out of the 122 CAAG patients checked (100?F; median age 65 years), 76 presented nutritional deficiencies, single in 24 and multiple in 52 cases: a deficiency of B12 and iron showed in 42 patients, 25-OH vitamin D lacked in 76 and folic acid in 6 cases. 25-OH vitamin D levels directly correlated with B12 levels and were significantly lower in patients with macronodular than in those with linear or micronodular hyperplasia. No significant correlation was observed between B12, folic acid or ferritin levels and BMI, blood gastrin levels, the grading of gastric atrophy or ECL cells hyperplasia.Conclusions
25-OH vitamin D deficiency was the main one in CAAG patients: its correlation with B12 deficiency may indicate underlying shared pathogenic mechanisms, although further studies are needed to confirm this hypothesis. 相似文献20.
Carlos Taxonera Antonio López-Sanromán Isabel Vera-Mendoza Eugeni Domènech Vicente Vega Ruiz Ignacio Marín-Jiménez Jordi Guardiola Luisa Castro María Esteve Eva Iglesias Daniel Ceballos Pilar Martínez-Montiel Javier P. Gisbert Miguel Mínguez Ana Echarri Xavier Calvet Jesús Barrio Joaquín Hinojosa Pilar Nos 《Digestive and liver disease》2019,51(4):529-535