Time-dependent Cox regression model is superior in prediction of prognosis in primary sclerosing cholangitis

More precise prognostic models are needed for prediction of survival in patients with primary sclerosing cholangitis (PSC), particularly for the selection of candidates for liver transplantation. The aim of this study was to develop a time-dependent prognostic model for the calculation of updated short-term survival probability in PSC. Consecutive clinical and laboratory follow-up data from the time of diagnosis were collected from the files of 330 PSC patients from 5 European centers, followed for a median of 8.4 years since diagnosis. Time-fixed and time-dependent Cox regression analyses, as well as the additive regression model, were applied. The reliability of the models was tested by a cross-validation procedure. Bilirubin (on a logarithmic scale), albumin, and age at diagnosis of PSC were identified as independent prognostic factors in multivariate analysis of both the time-fixed and the time-dependent Cox regression models. The importance of bilirubin was more pronounced in the time-dependent model (hazard ratio [HR], 2.84) than in the time-fixed analysis (hazard ratio, 1.51). The additive regression model indicated that once the patients survive beyond the first 5 years, the impact on prognosis of albumin at diagnosis ceases. The time-dependent prognostic model was superior to the time-fixed variant in assigning low 1-year survival probabilities to patients that actually survived less than 1 year. In conclusion, a time-dependent Cox regression model has the potential to estimate a more precise short-term prognosis in PSC compared with the traditional time-fixed models.     

Erythema annulare centrifugum and pregnancy

A 28‐year‐old woman came to our attention in the 33rd week of her first pregnancy with a 2‐week history of asymptomatic skin eruptions on the arms and legs. She was otherwise well and no other symptoms were present. She used only vitamin and iron supplements during pregnancy. The eruption began as erythematous papules before spreading peripherally while clearing centrally. This produced polycyclic plaques with indurated margins and trailing scales on the inner aspect of the advancing edge. The diameter of the lesions varied from a few to several centimeters ( Fig. 1 ).

Figure 1 Open in figure viewer PowerPoint Superficial erythema annulare centrifugum: a central clearing and “trailing scale” behind an advancing, annular, erythematous border     

Iron supplementation during pregnancy – a cross-sectional study undertaken in four German states

Background

Iron deficiency but also iron overload during pregnancy has been associated with unwanted health effects. In Germany, iron supplements are only recommended for pregnant women with diagnosed iron deficiency/anaemia. Prevalence of anaemia among pregnant women was reported at 24.4% in 2011. However, limited data suggest that more than 60% of women in Germany use iron supplements during gestation. Against this background, we investigated the prevalence of iron supplement intake among pregnant women and explored determining factors in order to assess whether women are following the advice to only supplement iron in case of a diagnosed iron deficiency/anaemia.

Methods

A cross-sectional study was carried out in four German states in 2015 where, with the help of midwives, women in childbed were asked to retrospectively answer a questionnaire about iron intake from various sources and reasons for supplementing iron during their recent pregnancy. We used Chi-square-tests and logistic regression analysis to evaluate associations between iron supplementation and other nutritional, sociodemographic and maternal variables and to assess attitudes of women meeting versus not meeting the official recommendation on iron supplement intake during pregnancy.

Results

Of 207 participants, 65.2% had supplemented iron. 84.4% reported to have done this because of a diagnosed iron deficiency/anaemia. Iron intake ranged from 5 to 200?mg/day, and duration of supplementation varied between two weeks and throughout gestation. Of women who reported to have been diagnosed with iron deficiency/anaemia, 47.5% had supplemented ≥80?mg/day iron, while 26.2% had taken iron in lower amounts ≤40?mg/day. Six percent of the participating women had not supplemented iron in spite of a diagnosed iron deficiency/anaemia, whereas 19.7% of women without iron deficiency/anaemia still had supplemented iron (range: 7 to 80?mg/day).

Conclusion

The majority of pregnant women used iron supplements in case of a diagnosed iron deficiency/anaemia. However, not all women with iron deficiency/anaemia supplemented (sufficient amounts of) iron, while there was also indiscriminate use of iron supplements in women without iron deficiency/anaemia. Further research is warranted to confirm these findings in representative samples.

     

Dynamics and management of oral anticoagulant treatment in chronic hepatitis C patients undergoing therapy with direct antiviral agents

Current regimens of direct-acting antiviral agents (DAA) are effective and safe for chronic hepatitis C (CHC). However, DAA often interfere with concomitant medications. We treated seven CHC patients with DAA who were on chronic anticoagulant treatment with warfarin, and describe the dynamics of prothrombin time, providing novel data, useful for the clinician.     

Scintigraphy false‐positive results for cardiac amyloidosis in a patient with Danon disease

Common diagnostic approach in patients with suspected cardiac amyloidosis includes cardiac magnetic resonance imaging and scintigraphy. We report the first clinical case of false‐positive results of scintigraphy in a patient with Danon disease.