Background: Currently there are three available formulations of tacrolimus in the United States; these include immediate-release capsules (TAC-IR), extended-release capsules (TAC-XL),and extended-release tablets (TAC-XR). Previous studies have demonstrated non-inferiority between the three formulations in terms of efficacy. The purpose of this study was to compare three formulations of tacrolimus (TAC) and assess differences in time within the therapeutic range (TTR) and variability in levels. Results: Renal transplant recipients from January 2013 to October 2017 were retrospectively identified for analysis. Deviation from standard TAC protocol or formulation changes excluded patients. The primary outcome compared percent TTR (TTR %) among 3 TAC formulations over the first 90 days post-transplant. TTR was calculated using the Rosendaal method. Secondary outcomes included differences in TAC levels, TAC dose, eGFR, rejection, patient and graft survival between the TAC formulations. TAC-XR demonstrated a significantly higher TTR % compared to TAC-IR and TAC-XL (62.8% vs. 53.3% vs. 60.9%, p = 0.048). In post-hoc analysis, TAC-XR had a higher TTR % compared to TAC-IR (p = 0.065), which approached statistical significance. Average TAC levels, weight-normalized TAC doses, median dose-normalized TAC levels, rejection rates, eGFR, and graft or patient survival were similar among groups. Conclusion: In the early transplant period, TTR was significantly different among the groups. TAC-XR demonstrated numerically superior time within the therapeutic range. Patient-specific factors such as race, obesity, genetic polymorphisms may impact this variability and clinical outcomes. Further analysis is necessary to understand the effect of each patient-specific factor on TAC exposure.
A clinical case of treatment of two severe intrabony defects on the aesthetic zone is reported and followed for one year.
The biomaterial of choice was enamel matrix derivative (Emdogain®; Straumann™) alone with a preservation papilla flap and a minimally invasive surgical technique.
After surgical treatment, the patient was kept in a supportive periodontal therapy programme with 6-month interval between appointments.
In the one year after surgery appointment, clinical and radiographic changes were observed, showing periodontal health and stability.
Oriba Dan Langoya*, Adrian Mwota Nampogo and Andia Irene
Published on: 15th March, 2022
Introduction: Tuberculosis (TB) continues to pose a significant public health problem worldwide. Tuberculous meningitis (TBM) is the most devastating form of extrapulmonary TB however other forms of central nervous system (CNS) disease include tuberculoma and spinal arachnoiditis. TBM carries high mortality even for a patient who is already receiving treatment. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. The emergence of Xpert ultra has improved the rapid detection of MTB and rifampicin resistance in CSF and is the preferred diagnostic tool in TBM.Case: In this case report we present a 33 years patient of concern who presented with progressive lower limb weakness associated with pain and paresthesia for 4 months, admitted via the Orthopedic unit with a diagnosis of spinal mass (meningioma, neurofibroma, or nerve sheath tumor) for which biopsy was done and revealed a chronic inflammatory process, necrotic bone lesions with no granulomas and no malignancy, he was later diagnosed with tuberculous meningitis and promptly started anti-tuberculous therapy with a dramatic recovery and improvement in neurological function.Conclusion: Tuberculous meningitis conditions have high morbidity and mortality yet diagnosis and start of treatment continue to experience an important delay. Clinicians should keep in mind the limitations of clinical presentation due to pleiotropy and current diagnostics and should employ a combination of diagnostic modalities in addition to a high index of suspicion to prevent morbidity in patients with TBM.
Systemic lupus erythematosus (SLE) is a chronic inflammatory multisystem disorder that commonly affects females during their reproductive years. It is characterized by the presence of autoantibodies and immune complex deposition, the etiology is not known but the interaction of an environmental agent in a genetically susceptible individual is thought to be fundamental. SLE most frequently involves the skin, joints, lungs, heart, kidney, and neuropsychiatric manifestations that may occur during the course of the disease. Mood disorders among SLE patients, particularly depression, are common and important psychiatric manifestations of the disease, in addition to their high incidence and possible deleterious influence on disease progression, so early identification and treatment of depression may have a significant influence on the patient’s quality of life.
Background: Assessment of knowledge of acute kidney injury (AKI) among healthcare workers (HCWs) is necessary to identify areas of deficiency and key topics to focus on while organizing educational programs to improve AKI care. The objective of this study was to assess AKI knowledge and practice among health care providers in North Kivu province, the eastern Democratic Republic of the Congo. Material and methods: This was a cross-sectional study conducted in six public hospitals in North Kivu province using a self-administered questionnaire. Results: A total of 158 HCWs completed the survey, among them 66 (41.78%) were physicians. The mean age of respondents was 36.07 ± 10.16 years and the male gender was 56.33%. Only 12 (7.59%) of the respondents had a good knowledge of the definition and classification of AKI. The respondents’ mean scores were 6.76 out of a total of 18 about risk factors for AKI and 6.29 out of a total of 11 with regard to nephrotoxic drugs. Regarding practices, 28.48% of the respondents assess the risk of AKI in their patients in their daily practices; 31.65% report AKI in the patients’ medical history, and 33.54% call on a nephrologist specialist to get specialized advice. Conclusion: This study found considerable gaps in knowledge and practice regarding AKI among most of HCWs in North Kivu province.
In a series of meanwhile 10 cases rigid straightening of the mid-portion of the left anterior descending coronary artery without lumen reduction mid-ventricular or basal ballooning was reported, or both basal and mid-ventricular ballooning in one case. In all these patients wrap-around (recurrent segment) phenomenon of the left anterior descending coronary artery was not present. The abnormalities of the left anterior descending coronary artery are due to myocardial bridging without lumen reduction of the LAD, only seen in computed tomography. When stress or in some cases happiness appears myocardial ballooning can appear, lasts 2-4 weeks and disappear with a recurrence rate of nearly 10% despite beta blocking agents.
Introduction: Induction of labour is a common obstetric intervention, occurring in approximately 25% of term pregnancies in developing countries. Pharmacological and mechanical methods commonly used are prostaglandin preparations (PGE1 and PGE2) and various intracervical catheters (single or double balloon), respectively.Material and methods: Study was conducted in Siliguri District Hospital, Siliguri, Darjeeling, west Bengal. 100 antenatal woman admitted in obstetrics ward with pog more than 37 weeks were taken for study after applying inclusion and exclusion criteria. 50 were induced with cerviprime gel and 50 with intracervical foley catheter. Statistical analysis done.Results: Mean interval between treatment initiation and delivery was not statistically significant, tachysystole was more common in group B women, rate of LSCS and NVD was similar in both groups.Conclusion: It can be concluded from the present study that Foley’s catheter (mechanical) and prostaglandin E2 gel [pharmacological] both are effective agents for preinduction cervical ripening which substantially improve the bishops score and increase the chances of successful labour induction. There is no significant difference in their efficacy, mode of delivery and perinatal outcome.
Tyrosine kinase inhibitors (TKIs) are widely used in Oncology practice. Hypertension may develop during cancer treatment and TKIs are well known drugs that are associated with drug related hypertensive toxicity. TKI related hypertensive toxicity is not always the indicator of worse clinical outcomes and it may be the sign of treatment efficacy.
Amália Cinthia Meneses do Rêgo and Irami Araújo-Filho
Published on: 19th February, 2024
Sepsis, a life-threatening condition triggered by infection, poses a significant healthcare challenge with high mortality rates. The interplay between genetics and the immune response in sepsis, particularly in surgical and trauma patients, is complex and critical. Genetic polymorphisms, particularly in cytokine genes like TNF-α, IL-6, and IL-8, have been extensively studied for their influence on sepsis susceptibility, severity, and outcomes. Polymorphisms can alter gene expression and cytokine production, leading to variations in immune responses. Studies have also explored polymorphisms concerning sepsis in genes encoding CD86, TLR4, and SIRT6. This review highlights the association between genetic polymorphisms and inflammatory responses, focusing on their impact on sepsis outcomes in surgical and trauma patients. Genetic variations play a significant role in sepsis risk, severity, and prognosis, with potential implications for personalized therapeutic strategies. Biomarkers such as cytokine gene polymorphisms may aid in predicting sepsis risk and guiding treatment decisions. Complementary therapies like acupuncture and novel biomarkers like microvesicles carrying mitochondrial content provide additional avenues for personalized sepsis management. Furthermore, multiomics approaches offer promise in predicting postoperative outcomes in surgical patients. Understanding the genetic basis of sepsis is essential for improving prevention, diagnosis, and treatment, ultimately leading to better clinical outcomes. Combining genomics, bioinformatics, and clinical expertise, precision medicine can revolutionize sepsis management by tailoring interventions to individual genetic profiles, thus enhancing patient care and outcomes.
Gottfried Lemperle*, Christoph Sachs, Katja Kassem-Trautmann, Carsten Schröder and Jörg Kalla
Published on: 17th May, 2022
An article by Baum, et al. “Unclear swelling in the region of a maxillary canine tooth” [1] caught our interest. A 14-year-old boy had developed an adenomatoid odontogenic tumor (AOT) without undergoing maxillofacial surgery. During an INTERPLAST-Germany mission [2] in Goma, Democratic Republic of Congo, we operated on a young man with an advanced odontogenic tumor. Since we are confronted with fist-sized odontogenic tumors (mostly ameloblastoma of the mandible) every time we operate in Africa, where they grow out of control due to a lack of experienced surgeons, it may be of interest to our colleagues in developed countries to know which grotesque tumors are prevented by early surgery.
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