Search

Summary: In patients with systemic lupus erythematosus (SLE), low bone mineral density (BMD) is associated with increased age, prolonged disease, low body mass index (BMI), and overlap with rheumatoid arthritis (RA). Elevated fibroblast growth factor (FGF)-23 in cyclosporine A (CsA) users with SLE are associated with decreased active vitamin D and osteocalcin. Introduction: The objective of this study was to investigate the steroid and CsA effect on bone metabolism and serum FGF-23 in SLE patients. Methods: Seventy-two SLE patients and 10 age- and sex-matched healthy individuals underwent blood tests for bone metabolic biomarkers and FGF-23, and lumbar spine dual-energy X-ray absorptiometry for BMD. Results: Comparisons between patients and controls were made in premenopausal women/men younger than 50 years and postmenopausal women/men older than 50 years separately. SLE patients had more frequent low Z-score (≤ − 2.0, 8.5 vs. 0 %), osteopenia (−2.5 < T-score < −1.0, 52 vs. 50 %), and osteoporosis (T-score ≤ −2.5, 12 vs. 0 %), than the healthy age-compatible counterparts. BMD was significantly lower in patients with advanced age, longer disease duration, lower BMI, and overlap with RA (all p < 0.05 by multiple linear regression analyses). Serum FGF-23 was significantly higher and 1,25-dihydroxyvitamin D (1,25(OH)D) lower in SLE patients treated with glucocorticoid and CsA than in those not taking both of them ( p = 0.027 and 0.002, respectively). The cumulative dose of glucocorticoid was inversely correlated with serum intact parathyroid hormone ( r = −0.299, p = 0.011), C-terminal telopeptide of type I collagen ( r = −0.581, p < 0.001), and osteocalcin ( r = −0.648, p < 0.001). FGF-23 and the cumulative dose of CsA were positively correlated ( r = 0.38, p = 0.001) and both were negatively correlated with 1,25(OH)D ( r = −0.266, p = 0.016 and r = −0.55, p < 0.001) and osteocalcin ( r = −0.234, p = 0.034 and r = −0.274, p = 0.02). Conclusion: SLE patients treated with glucocorticoid and CsA exhibited markedly decreased bone turnover. Those taking CsA had higher serum FGF-23 associated with suppression of 1,25(OH)D and bone formation. Such high-risk patients necessitate regular screening of osteoporosis. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the refractive outcomes in children treated after intravitreal injection of bevacizumab (IVB) for retinopathy of prematurity (ROP).MethodsA retrospective, bi-centre study of 34 patients (64 eyes) was conducted. The patients were divided into three groups, patients received intravitreal IVB (IVB group), patients received combined IVB and laser treatment (IVB+Laser group), or patients received lens-sparing vitrectomy (IVB+LSV group). Cycloplegic refraction and axial length (AXL) were evaluated at 2 years old.ResultsThe prevalences of myopia and high myopia were 47.5 and 10.0% in the IVB group, respectively, which were lower than those in the IVB+Laser (82.4 and 29.4%) and IVB+LSV (all 100%) groups (P=0.001 and P<0.001). The prevalences of emmetropia in the IVB group, IVB+Laser group, and IVB+LSV group were 50, 5.9, and 0% (P=0.001). The AXL were similar among all groups.ConclusionsAt the 2-year follow-up, severe ROP patients treated with IVB alone were more likely to remain emmetropic and had lower prevalences of myopia and high myopia. The development of high myopia in severe ROP patients could not be explained by AXL changes but may be associated with abnormalities in the anterior segment. [ABSTRACT FROM AUTHOR]

The aims of this study were to compare the clinical features of patients with extensively drug-resistant tuberculosis (XDRTB) and multidrug-resistant tuberculosis (MDRTB) and the genotypic characteristics of these Mycobacterium tuberculosis isolates. A total of 90 non-HIV-infected patients having MDRTB ( n = 80, not including XDRTB, 88.9%) and XDRTB ( n = 10, 11.1%) were identified from 2000 to 2007. Genotypes of the 39 available isolates were evaluated by spoligotyping and the 24-locus mycobacterial interspersed repetitive units–variable number of tandem repeats (MIRU-VNTR) scheme. Patients with XDRTB were more likely to have previous history of TB and cavitary lung lesions than patients with MDRTB ( P < 0.05). Among the 39 isolates for spoligotyping analysis, the Beijing genotype was the most common ( n = 21, 53.8%). Four (44.4%) isolates of XDRTB and 17 (56.7%) isolates of MDRTB belonged to Beijing family genotypes. There was no significant difference in the anti-tuberculosis drug resistance rates between Beijing and non-Beijing genotype isolates or in the clinical features of infected patients. In conclusion, significant differences in clinical manifestations existed among patients with XDRTB and MDRTB. The clinical features of patients infected with the Beijing genotype and the drug resistance profile of the Beijing genotype isolates were similar to those for the non-Beijing family genotype. [ABSTRACT FROM AUTHOR]

Liver abscess caused by Actinomyces odontolyticus is rarely reported. We report an immunocompetent patient who developed A. odontolyticus liver abscess, and was successfully treated with antibiotics for 6 weeks and abscess drainage. The isolate could not be identified accurately by one commercial biochemical method and was documented to species level by partial sequencing analysis of 16S rRNA genes. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 88-year-old woman who has an abdominal pain and history of end-stage renal disease and liver cirrhosis. It states that a computed tomography of the abdomen and sonography have confirmed the presence of bilateral intrahepatic duct stones with general dilatation of the biliary tract, which was caused by Vibrio fluvialis, a curved gram-negative rod. It also says that a piperacillin-tazobactam was administered under the impression of biliary tract infection.

Problem: There are low rates of treatment of osteoporosis following hip fractures in the elderly. Design: Controlled before-after trial of the ortho-geriatric-led ‘ICHIBAN’ program. Data were collected by a blinded observer in 2 phases: over the year before and 10-months following intervention. The data is collected from orthopaedic wards in a large metropolitan hospital. Improvement Measures: Rate of measurement: 25-hydroxyvitamin levels (25-OHD), thyroid-stimulating hormone (TSH), and parathyroid hormone (PTH). Prescription of osteoporosis medications (vitamin D, calcium supplements, oral bisphosphonates). Documentation of rationale for non-prescription. Conclusion: Three-hundred-and-fifty-two patients presented during a period of 22-months: 202 during 12-months prior to and 150 in the 10 months following intervention. Investigation of 25-hydroxyvitamin levels increased from 31.6% to 71.2%, focused tests for secondary osteoporosis (TSH, PTH) from 9.4% to 37.1%, prescription of osteoporosis medications improved from 40.1% to 78.2% for vitamin D, 41.3% to 75.6% for calcium supplements and 34.8% to 53.8% for oral bisphosphonates (p < 0.001). Ninety percent documented rationale for non-prescription of treatment. A 6-month follow-up of the first 60 patients following intervention showed that 51.6% were still on appropriate treatment. The ICHIBAN program has improved delivery of osteoporosis care to appropriate at-risk patients following hip fracture. [ABSTRACT FROM AUTHOR]