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Wadie BS, Ashour R, Ali IM. Psychological and mental impact of long-standing incontinence on children and adolescents with complex urologic disorders. Neurourol Urodyn 2023; 42:1476-1484. [PMID: 37358325 DOI: 10.1002/nau.25234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/22/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Incontinence has a negative impact on the quality of life and is associated with psychiatric disturbances in humans. This study evaluates the impact of long-standing incontinence on psychological and mental development. METHODS This is a cohort study carried out in a tertiary care urologic facility. After obtaining an IRB approval, we enrolled 49 children with severe incontinence (incontinence for at least 1 year duration and one surgical intervention) and interviewed between October 2019 and March 2020. Child Behavior Checklist (CBCL) and intelligence quotient (IQ) testing was performed for each using Stanford-Binet-4th edition. An age-matched control group was recruited for comparison. A total of 51 children in the control group were later recruited from March 2020 to October 2020 from the Psychiatry Department. RESULTS A total of 49 children fulfilled the inclusion criteria. Mean age was 9.93 years, 31 males and 18 females. The etiology of incontinence was neuropathic bladder in 30, exstrophy in 8, incontinent epispadius in 4, valve bladder in 4; common urogenital sinus in 2, and refractory OAB in 1. Median number of procedures was 2 (Range 0-9). Median pads were 5 per day and median hospital stay was 32 days. Median total score of CBCL was 26.5 compared to 7 for the control group (p = 0.00023). Mean IQ of the study group was 88.3 as compared to that of the control (94.65), the difference is significant (p = 0.00023). CONCLUSION Children with severe degree of incontinence suffered from significant psychiatric disorders and negative affection of their intelligence. A multidisciplinary approach is advised for management of those children.
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Affiliation(s)
- Bassem S Wadie
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rawdy Ashour
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ibtihal M Ali
- Psychiatry Department, Mansoura University Hospital, Mansoura, Egypt
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Miyata M, Hirabayashi Y, Munakata Y, Urata Y, Saito K, Okuno H, Yoshida M, Kodera T, Watanabe R, Miyamoto S, Ishii T, Nakazawa S, Takemori H, Ando T, Kanno T, Komagamine M, Kato I, Takahashi Y, Komatsuda A, Endo K, Murai C, Takakubo Y, Miura T, Sato Y, Ichikawa K, Konta T, Chiba N, Muryoi T, Kobayashi H, Fujii H, Sekiguchi Y, Hatakeyama A, Ogura K, Sakuraba H, Asano T, Kanazawa H, Suzuki E, Takasaki S, Asakura K, Suzuki Y, Takagi M, Nakayama T, Watanabe H, Miura K, Mori Y. Feasibility of methotrexate discontinuation following tocilizumab and methotrexate combination therapy in patients with long-standing and advanced rheumatoid arthritis: a 3-year observational cohort study. Fukushima J Med Sci 2023; 69:11-20. [PMID: 36990790 PMCID: PMC10122970 DOI: 10.5387/fms.2022-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/30/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Methotrexate (MTX) is associated with extensive side effects, including myelosuppression, interstitial pneumonia, and infection. It is, therefore, critical to establish whether its administration is required after achieving remission with tocilizumab (TCZ) and MTX combination therapy in patients with rheumatoid arthritis (RA). Therefore, the aim of this multicenter, observational, cohort study was to evaluate the feasibility of MTX discontinuation for the safety of these patients. METHODS Patients with RA were administered TCZ, with or without MTX, for 3 years; those who received TCZ+MTX combination therapy were selected. After remission was achieved, MTX was discontinued without flare development in one group (discontinued [DISC] group, n = 33) and continued without flare development in another group (maintain [MAIN] group, n = 37). The clinical efficacy of TCZ+MTX therapy, patient background characteristics, and adverse events were compared between groups. RESULTS The disease activity score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR) at 3, 6, and 9 months was significantly lower in the DISC group (P < .05, P < .01, and P < .01, respectively). Further, the DAS28-ESR remission rate at 6 and 9 months and Boolean remission rate at 6 months were significantly higher in the DISC group (P < .01 for all). Disease duration was significantly longer in the DISC group (P < .05). Furthermore, the number of patients with stage 4 RA was significantly higher in the DISC group (P < .01). CONCLUSIONS Once remission was achieved, MTX was discontinued in patients who responded favorably to TCZ+MTX therapy, despite the prolonged disease duration and stage progression.
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Affiliation(s)
- Masayuki Miyata
- Department of Internal Medicine, Fukushima Red Cross Hospital
| | | | | | | | | | - Hiroshi Okuno
- Department Orthopedic Surgery, Tohoku Rosai Hospital
| | | | - Takao Kodera
- Center for Arthritis and Rheumatic Diseases, Tohoku Pharmaceutical University Hospital
| | - Ryu Watanabe
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University
| | - Seiya Miyamoto
- Department of Orthopedic Surgery, Tohoku Orthopedic Clinic
| | - Tomonori Ishii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
| | | | | | - Takanobu Ando
- Department of Orthopedics, General Hanamaki Hospital
| | - Takashi Kanno
- Department of Rheumatology, Ohta Nishinouchi Hospital
| | | | - Ichiro Kato
- Department Orthopedic Surgery, Tohoku Rosai Hospital
| | | | | | - Kojiro Endo
- Department of Rheumatology and Department of Orthopedic Surgery, Hoshi General Hospital
| | | | - Yuya Takakubo
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine
| | - Takao Miura
- Department of Orthopedic Surgery, Hirosaki Memorial Hospital
| | - Yukio Sato
- Department of Rheumatology, Kaiyama Central Hospital
| | - Kazunobu Ichikawa
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Tsuneo Konta
- Department of Public Health and Hygiene/Nephrology and Collagen Disease
| | - Noriyuki Chiba
- Department of Internal Medicine, Morioka National Hospital
| | | | | | - Hiroshi Fujii
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
| | | | | | | | - Hirotake Sakuraba
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine
| | - Tomoyuki Asano
- Department of Rheumatology and Collagen Disease, Fukushima Medical University Hospital
| | | | - Eiji Suzuki
- Department of Rheumatology, Ohta Nishinouchi Hospital
| | | | - Kenichi Asakura
- Department of Internal Medicine, Yuri Kumiai General Hospital
| | | | - Michiaki Takagi
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine
| | | | - Hiroshi Watanabe
- Department of Rheumatology and Collagen Disease, Fukushima Medical University Hospital
| | - Keiki Miura
- Department of Orthopedic Surgery, Wakuya-Town National Health Insurance Hospital
| | - Yu Mori
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine
| | - the Michinoku Tocilizumab Study Group
- Department of Internal Medicine, Fukushima Red Cross Hospital
- Department of Rheumatology, Hikarigaoka Spellman Hospital
- Munakata Yasuhiko Clinic
- Department of Rheumatology, Tsugaru General Hospital
- Suminoya Rheumatism & Orthopedics Clinic
- Department Orthopedic Surgery, Tohoku Rosai Hospital
- Yoshida Orthopedic Surgery and Rheumatology Clinic
- Center for Arthritis and Rheumatic Diseases, Tohoku Pharmaceutical University Hospital
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University
- Department of Orthopedic Surgery, Tohoku Orthopedic Clinic
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine
- Nakazawa Sports Clinic
- Department of Rheumatology, Aomori Prefectural Central Hospital
- Department of Orthopedics, General Hanamaki Hospital
- Department of Rheumatology, Ohta Nishinouchi Hospital
- Komagamine Orthopedic and Rheumatology Clinic
- Yu Family Clinic
- Department of Internal Medicine, Ogachi Central Hospital
- Department of Rheumatology and Department of Orthopedic Surgery, Hoshi General Hospital
- Murai Clinic
- Department of Orthopedic Surgery, Yamagata University Faculty of Medicine
- Department of Orthopedic Surgery, Hirosaki Memorial Hospital
- Department of Rheumatology, Kaiyama Central Hospital
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
- Department of Public Health and Hygiene/Nephrology and Collagen Disease
- Department of Internal Medicine, Morioka National Hospital
- Muryoi Clinic
- Minami-Fukushima Clinic
- NTT East Tohoku Hospital
- Ogura Orthopedic Surgery Clinic
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine
- Department of Rheumatology and Collagen Disease, Fukushima Medical University Hospital
- Department of Internal Medicine, Saiseikai Yamagata Hospital
- Department of Internal Medicine, Yuri Kumiai General Hospital
- Izumi Himawari Clinic
- Department of Internal Medicine, Nihonkai General Hospital
- Department of Orthopedic Surgery, Wakuya-Town National Health Insurance Hospital
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine
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Boucher BJ. Vitamin D deficiency in British South Asians, a persistent but avoidable problem associated with many health risks (including rickets, T2DM, CVD, COVID-19 and pregnancy complications): the case for correcting this deficiency. Endocr Connect 2022; 11:e220234. [PMID: 36149836 PMCID: PMC9641767 DOI: 10.1530/ec-22-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022]
Abstract
High vitamin D deficiency rates, with rickets and osteomalacia, have been common in South Asians (SAs) arriving in Britain since the 1950s with preventable infant deaths from hypocalcaemic status-epilepticus and cardiomyopathy. Vitamin D deficiency increases common SA disorders (type 2 diabetes and cardiovascular disease), recent trials and non-linear Mendelian randomisation studies having shown deficiency to be causal for both disorders. Ethnic minority, obesity, diabetes and social deprivation are recognised COVID-19 risk factors, but vitamin D deficiency is not, despite convincing mechanistic evidence of it. Adjusting analyses for obesity/ethnicity abolishes vitamin D deficiency in COVID-19 risk prediction, but both factors lower serum 25(OH)D specifically. Social deprivation inadequately explains increased ethnic minority COVID-19 risks. SA vitamin D deficiency remains uncorrected after 70 years, official bodies using 'education', 'assimilation' and 'diet' as 'proxies' for ethnic differences and increasing pressures to assimilate. Meanwhile, English rickets was abolished from ~1940 by free 'welfare foods' (meat, milk, eggs, cod liver oil), for all pregnant/nursing mothers and young children (<5 years old). Cod liver oil was withdrawn from antenatal clinics in 1994 (for excessive vitamin A teratogenicity), without alternative provision. The take-up of the 2006 'Healthy-Start' scheme of food-vouchers for low-income families with young children (<3 years old) has been poor, being inaccessible and poorly publicised. COVID-19 pandemic advice for UK adults in 'lockdown' was '400 IU vitamin D/day', inadequate for correcting the deficiency seen winter/summer at 17.5%/5.9% in White, 38.5%/30% in Black and 57.2%/50.8% in SA people in representative UK Biobank subjects when recruited ~14 years ago and remaining similar in 2018. Vitamin D inadequacy worsens many non-skeletal health risks. Not providing vitamin D for preventing SA rickets and osteomalacia continues to be unacceptable, as deficiency-related health risks increase ethnic health disparities, while abolishing vitamin D deficiency would be easier and more cost-effective than correcting any other factor worsening ethnic minority health in Britain.
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Thewjitcharoen Y, Krittiyawong S, Vongterapak S, Nakasatien S, Aroonparkmongkol S, Khurana I, El-Osta A, Himathongkam T. Clinical Characteristics, Residual Beta-Cell Function and Pancreatic Auto-Antibodies in Thai people with Long-Standing Type 1 Diabetes Mellitus. J ASEAN Fed Endocr Soc 2020; 35:158-62. [PMID: 33442186 DOI: 10.15605/jafes.035.02.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives To describe the characteristics of long-standing T1DM in Thai patients and assess residual beta-cell function with status of pancreatic autoantibodies. Methodology This is a cross-sectional study of Thai subjects with T1DM and disease duration ≥ 25 years seen at the Theptarin Hospital. Random plasma C-peptide and pancreatic auto-antibodies (Anti-GAD, Anti-IA2, and Anti-ZnT8) were measured. Patients who developed complications were compared with those who remained free of complications. Results A total of 20 patients (males 65%, mean age 49.4±12.0 years, BMI 22.5±3.1 kg/m2, A1C 7.9±1.6%) with diabetes duration of 31.9±5.1 years were studied. Half of the participants remained free from any diabetic complications while the proportions reporting retinopathy, nephropathy, and neuropathy were 40%, 30%, and 15%, respectively. HDL cholesterol was significantly higher and triglyceride concentration significantly lower in patients who were free from diabetic nephropathy but not in those who were free from other complications. The prevalence rates of anti-GAD, anti-IA2, and anti-ZnT8 were 65%, 20%, and 10%, respectively. None of the patients who tested negative for both anti-GAD and anti-IA2 was positive for anti-ZnT8. Residual beta-cell function based on detectable random plasma C-peptide (≥ 0.1 ng/mL) and MMTT was found in only 3 patients (15%). There was no relationship between residual beta-cell function and protective effects of diabetic complications. Conclusion Endogenous insulin secretion persists in some patients with long-standing T1DM and half of longstanding T1DM in Thai patients showed no diabetic complications. HDL cholesterol was significantly higher and triglyceride concentration significantly lower in patients who were free from diabetic nephropathy.
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AlBader B, Sallam A, Moukaddem A, Alanazi K, Almohammed S, Aldabas H, Algmaizi S. Prevalence of Varicose Veins Among Nurses at Different Departments in a Single Tertiary Care Center in Riyadh. Cureus 2020; 12:e12319. [PMID: 33520517 PMCID: PMC7835718 DOI: 10.7759/cureus.12319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Varicose veins (VV) is a chronic venous disease that affects the lower extremities. It is the dilation of subcutaneous veins, three to four millimeters in diameter. VV can be attributed to several risk factors such as age, obesity, multiple parities, heavy lifting, and long-standing hours. Direct and indirect complications can occur due to VV. Several studies were conducted to estimate the prevalence of VV. Methods A self-administered questionnaire was used to estimate the prevalence of VV among nurses from different departments in the National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia. The questionnaire included questions on weight, height, work history, lifestyle, and multiple diseases. The chi-square test and Fisher’s exact test were used for testing the association between the various predictors and the diagnosis of VV. Results A total of 366 nurses participated in the study. There were 40 (39 females and one male) cases of VV accounting for 11.0%. Variables that have a statistically significant association with VV were social status and lifting heavy objects (p=0.02), a family history of VV (p-value=<0.001), and the number of childbirths (p=0.04). The observation of each department was not statistically significant with VV (p=0.35). Conclusion Among nurses, positive family history, age, marital status, long-standing hours, and heavy object lifting were significant risk factors for the development of VV. However, the prevalence of VV in the four departments was low.
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Affiliation(s)
- Bader AlBader
- Family Medicine, King Abdulaziz Medical City, Riyadh, SAU
| | - Asma Sallam
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Afaf Moukaddem
- Medical Education, King Saud Bin Abdulaziz University for Health Science, Riyadh, SAU
| | - Kout Alanazi
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Sara Almohammed
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Haya Aldabas
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Shahad Algmaizi
- Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
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Wong JX, Assia EI. Intraocular foreign body and traumatic cataract removal 65 years after penetrating trauma. Eur J Ophthalmol 2020; 31:NP15-NP18. [PMID: 31973552 DOI: 10.1177/1120672120902021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of successful intraocular foreign body/traumatic cataract removal and anterior segment reconstruction surgery of a patient's eye that suffered penetrating injury 65 years earlier. Surgery was not recommended by ophthalmologists that she had earlier consulted. The patient opted for surgery to improve cosmesis due to leukocoria, but the level of regained vision exceeded expectations of both the patient and the surgeon. This case adds further evidence that the duration of occlusion time has no effect on visual potential in patients out of amblyogenic age. The ethical considerations of operating on such an eye with poor prognosis after traumatic injury are also discussed. To our knowledge, our patient has the longest reported duration (65 years) between the time of injury and successful surgery with good outcome.
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Affiliation(s)
- John Xh Wong
- Center for Applied Eye Research, Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Ehud I Assia
- Center for Applied Eye Research, Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ein Tal Eye Center, Tel Aviv, Israel
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Siddiq MAB, Jahan I, Masihuzzaman S. Wallet Neuritis - An Example of Peripheral Sensitization. Curr Rheumatol Rev 2017; 14:279-283. [PMID: 28294069 PMCID: PMC6204659 DOI: 10.2174/1573397113666170310100851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/27/2017] [Accepted: 03/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Wallet neuritis is an example of extra-spinal tunnel neuropathy concerning sciatic nerve. Its clinical appearance often gets confused with sciatica of lumbar spine origin. Wallet- induced chronic sciatic nerve constriction produces gluteal and ipsilateral lower extremity pain, tingling, and burning sensation. It was Lutz, first describing credit-card wallet sciatica in an Attorney, surfaced on Journal of American Medical Association (JAMA), 1978; however, the condition has not been well-studied in various other occupations. CASE SUMMARY In this write-up, we take the privilege of demonstrating wallet neuritis as an example of peripheral sensitization in three different professionals' namely specialist doctor, driver, and banker first time in Bangladesh. All the three patients' demonstrated aggravated gluteal pain with radiation on the homo-lateral lower extremity while remained seated on heavy wallet for a while, fortunately improved discontinuing such stuff with. Alongside radical wallectomy, piriformis stretching exercise on the affected side had also been recommended and found worthy in terms of pain relief. CONCLUSION long-standing use of rear pocket wallet may compress and sensitize ipsilateral sciatic nerve, generating features resembling lumbago sciatica; thereby, remains a source of patients' misery and diagnostic illusion for pain physicians as well.
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Affiliation(s)
- Md Abu Bakar Siddiq
- Physical Medicine and Rheumatology, Brahmanbaria Medical College, Brahmanbaria, Bangladesh
| | - Israt Jahan
- Department of Biochemistry and Biotechnology, University of Science and Technology, Chittagong, Bangladesh
| | - Sam Masihuzzaman
- Department of Neurology, Chittagong Medical College, Chittagong, Bangladesh
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