Semaglutide as a potential therapeutic alternative for HNF1B-MODY: a case study

Maturity-onset diabetes of the young (MODY) is a grouping of monogenic disorders. It is characterized by dominantly inherited, non-insulin-dependent diabetes. MODY is relatively rare, encompassing up to 3.5% in those diagnosed under 30 years of age. Specific types are most commonly treated with sulfonylurea, particularly those identified as HNF4A-MODY and HNF1A-MODY. HNF1B-MODY is another type that is most frequently managed with insulin therapy but lacks a defined precision treatment. We present an 18-year-old, non-obese female patient diagnosed with HNF1B-MODY. She displays complete gene deletion, a renal cyst, and hypomagnesemia. Her treatment plan includes both long- and short-acting insulin, though she frequently encountered hypoglycemia and hyperglycemia. Semaglutide, a GLP-1RA, was administered weekly over 4 months. The patient's glucose level was continuously tracked using Dexcom's Continuous Glucose Monitoring system. The data suggested a notable improvement in her condition: time-in-range (TIR) increased from 70% to 88%, with some days achieving 100%, and the frequency of hypoglycemic episodes, indicated by time-below-range values, fell from 5% to 1%. The time-above-range values also dropped from 25% to 10%, and her HbA1c levels declined from 7% to 5.6%. During the semaglutide therapy, we were able to discontinue her insulin treatment. Additionally, her body mass index (BMI) was reduced from 24.1 to 20.1 kg/m2. However, the semaglutide treatment was halted after 4 months due to side effects such as nausea, vomiting, and reduced appetite. Other contributing factors included exam stress and a COVID-19 infection, which forced a switch back to insulin. Her last recorded HbA1c level under exclusive insulin therapy rose to 7.1%, and her BMI increased to 24.9 kg/m2. In conclusion, semaglutide could potentially replace insulin to improve glucose variability, TIR, and HbA1c in patients with HNF1B-MODY. However, more extensive studies are required to confirm its long-term safety and efficacy.

Case report: Successful treatment of refractory membranous nephropathy with telitacicept

Despite various treatment methods, the remission rate of membranous nephropathy remains limited. Refractory membranous nephropathy especially lacks effective treatment plans. Telitacicept achieves comprehensive inhibition of CD20-positive B cells, plasma cells, and T cells, thereby bringing new hope to the treatment of membranous nephropathy and refractory membranous nephropathy. Here, we report a case of a 46-year-old man with membranous nephropathy. Although the combined treatment with glucocorticoid, tacrolimus, mycophenolate mofetil, cyclophosphamide, and rituximab was not successful, the patient achieved complete remission of urinary protein after glucocorticoid combined with telitacicept. This is the first report on the application of telitacicept in the treatment of membranous nephropathy, especially refractory membranous nephropathy. The application of telitacicept in the treatment of membranous nephropathy deserves further attention.

Treatment outcomes and associated factors among patients with drug-sensitive tuberculosis on daily fixed-dose combination drugs: A cohort study from Ahmedabad, India

Background and Aim

The National Tuberculosis Elimination Program (NTEP) has been progressive in addressing the issues related to tuberculosis (TB) control in the country, with constant programmatic changes based on evidence available from operational research. Our objectives were 1. to assess the sociodemographic and clinical characteristics, and the treatment outcomes of patients on fixed-dose combination (FDC) daily regimen and 2. to assess the factors associated with unsuccessful treatment outcomes among patients with DS-TB.

Materials and Methods

A retrospective cohort study was conducted based on record review. The study population included all patients with drug-sensitive TB, registered and initiated on treatment under NTEP "new category" from January to June 2018 and under "previously treated category" from January to March 2018. Quantitative data downloaded from Nikshay in Excel format was imported.

Results

A total of 8301 patients with DS-TB registered under NTEP. Mean (standard deviation [SD]) age of DS-TB patients was 35.3 + 16.9 years, and 63.2% were in the age group of 15-44 years. Also, 60.1% were male, 2.5% were human immunodeficiency virus (HIV) positive, 65.3% were pulmonary TB cases, and 70.4% obtained treatment from public providers. Proportion of "successful" and "unsuccessful" outcomes was 87.9% and 12.1%, respectively, in the new treatment category and 78.3% and 21.7%, respectively, in the previously treated category. Among the patients classified under new category, the unsuccessful treatment outcome remained significantly high after adjustments with known confounders among patients aged 45-54 years (adjusted relative risks [aRR] 1.59, 95% confidence interval [CI] 1.31-1.93) and 55-64 years (aRR 1.67, 95% CI 1.36-2.05) compared to patients aged <15 years.

Conclusion

Unsuccessful treatment outcome was significantly high among patients aged 45-54 years. Various adherence mechanisms implemented can be evaluated for further upscaling and improving the program effectiveness.

Communication Ecology Model of Successful Aging in Indonesian Context

The communication ecology model of successful aging (CEMSA) as a part of aging studies from a communication perspective was replicated in the Indonesian context. The CEMSA provided a specific perspective from communication scholars about the successful aging process. The study of CEMSA has grown significantly to demonstrate the importance of the interactive-communication process to propagate and enhance aging studies. However, there has been no specific aging study from a communication perspective, especially from communication scholars in the Indonesian context. This study applied all concepts, variables, measurements, and analyses from the replicated study. The result showed that seven domains of communication about aging may be relevant to predict successful aging from a negative effect and positive effect, and efficacy toward aging. The model showed that the uncertainty and combination of a negative and positive effect in seven domains of communication about aging could construct the efficacy and success of the aging process. The model with seven domains of communication about aging could be proved while the data were gathered not by self-report.

Case report: First report of haploidentical allogeneic hematopoietic stem cell transplantation from donors with mild alpha-thalassemia for acute leukemia

For acute leukemia (AL) with adverse prognostic factors, allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the standard care option after the first complete remission. Meanwhile, as the success of haploidentical HSCT (haplo-HSCT), haploidentical donors (HIDs) become a reliable choice. However, there have been no reports on haplo-HSCT from HIDs with mild alpha(α)-thalassemia for AL yet. In the present report, we first describe two cases of successful haplo-HSCT from HIDs with mild α-thalassemia for AL.

Performance Assessment for Rock Climbers: The International Rock Climbing Research Association Sport-Specific Test Battery

PURPOSE

To examine the validity and reliability of a battery of 10 measures designed to assess the key physiological parameters for successful rock climbing performance.

METHODS

In phase 1 of the research, an expert panel, using the Delphi method, established a 10-item test battery based on the key determinants of climbing performance. In phase 2, the tests were assessed for validity and reliability to examine their suitability as sport-specific measures of rock climbing performance. A total of 132 rock climbers, from 7 countries, volunteered to take part in the study. Each climber visited their nearest laboratory on 3 separate occasions in order to enable the required tests and retests to be completed. A minimum of 7 days was allowed between visits.

RESULTS

The 10 tests established for phase 2 were designed as sport-specific measures of flexibility, strength, power, and endurance. Results indicated that, while reliable, the flexibility and strength tests were only partially successful in differentiating across climber abilities. The power and endurance tests, however, performed well with regard to validity and reliability, with the finger hang and powerslap tests being most strongly correlated with performance ability (P < .0005 to P < .002).

CONCLUSION

The authors' data suggest that climbing may require a threshold level of flexibility and strength for successful performance, beyond which further improvements may not be required. In contrast, the finger hang and powerslap tests were not only reliable measures but also differentiated between climber abilities from lower grade to elite levels.

The Strategy of Successful Exclusive Breastfeeding of Policewomen in Regional Police Department, East Nusa Tenggara

Exclusive breastfeeding is an effort to obtain optimal growth, as breast milk contains essential nutrients required for the growth and development of infants as well as antibodies for the immune system. This study aimed to explore the strategies of successful exclusive breastfeeding among policewomen in East Nusa Tenggara Regional Police. This was a qualitative study with an explorative design consisting of 10 female police as informants. The result showed that: (1) The informants knew the importance of exclusive breastfeeding for the growth of their children; (2) The informants perceived that occupation was not a barrier to provide exclusive breastfeeding; (3) The informants were adequately exposed to information from mass media related to exclusive breastfeeding; (4) Breastfeeding room was unavailable at the office resulting in their decision to breastfeed at home; (5) Husbands gave support by forbidding their wives to give formula to babies before 6 mo of age; (6) The family provided support to exclusive breastfeeding by taking care of the babies during work time; (7) The chief gave support on exclusive breastfeeding; and (8) The strategy for achieving successful exclusive breastfeeding was originated from the willingness and acceptance of the nature as a woman. Informants had good knowledge, attitudes and information exposure and received support from husbands, families, and supervisors. East Nusa Tenggara Regional Police Office needs to provide breastfeeding rooms to support successful exclusive breastfeeding.

Ten Tips for Pharmacy Faculty Members for Successfully Navigating Promotion and Tenure

This paper presents 10 key tips or recommendations for successful navigation of the promotion and tenure process. The 10 key tips are: know institutional expectations, develop an action plan at least two to three years in advance; identify your balance of teaching, scholarship, service; synergize activities and develop a niche; prioritize time to activities of high-impact to promotion and tenure; track achievements in the format expected for promotion and tenure application; seek out faculty guidance on promotion and tenure; meet with mentor(s) regularly to review progress; have a well-written personal statement; and have your final dossier reviewed by colleagues. Faculty members are more likely to be successful through timely and appropriate planning, balancing and synergizing activities, tracking activities and achievements, developing a well-written personal statement, and requesting help from experienced colleagues.

How to successfully navigate a telephone and/or video interview

During the initial screening process hiring committees will often conduct either a telephone or video interview to narrow the field and select the candidates they feel more closely fits the role. The video interview could be conducted using Skype, WebEx or other on-line technology. Generally, these interviews are brief (30 min) with about five-directed questions, so you must be prepared. The intent of this article is provide tips and strategies on how to be more prepared/successful with these interviewing venues.

Successful management of severe preeclampsia major complications: Case report

Severe preeclampsia (PE) have considerable adverse outcome especially in low-resource countries. A 21-year-old pregnant woman with severe PE and intrauterine fetal death, delivered by cesarean section (CS). The CS complicated by atonic postpartum hemorrhage (PPH). She was transferred by the air ambulance to the tertiary center of West Kazakhstan University-intensive care unit, once she developed anuria. She was carefully monitored after exclusion of maternal sepsis and HELLP (hemolysis, elevated liver enzymes and low platelet) syndrome and she developed postpartum eclampsia and right partial lobe intracranial hemorrhage (ICH). She was managed by multi-disciplinary team with proper and clear management plan and discharged from the hospital on the 20^th postpartum day in good general condition. The complications of severe PE need clear multi-disciplinary team management plan to avoid the adverse outcome of the severe PE.

Keep Your Eye on the Ball; the Impact of an Anticipatory Fixation During Successful and Unsuccessful Soccer Penalty Kicks

The success of a sporting task requiring an object to be kicked or hit toward a target (e.g., kicking a ball into a goal) is impacted by the length of the Quiet Eye (QE). Limitations in the ocular motor system mean that after impact, these fast moving objects are not tracked using smooth pursuit eye movements. Rather, anticipatory fixations are used to re-fixate ahead of the moving object.Using a soccer penalty kick, the current study investigated whether striking a stationary object to generate high ball velocity results in an anticipatory fixation prior to ball contact and if this occurs at detriment to the QE period and task success.Facing a goalkeeper, 12 participants produced a successful (scored) and unsuccessful (saved) penalty whilst wearing a mobile eye tracker.QE was longer in the successful compared to unsuccessful penalty (p = 0.036) and was due to QE offset ending later in the successful compared to unsuccessful penalty (p = 0.008). An anticipatory fixation occurred later (p = 0.025) and was shorter (p = 0.005) in successful compared to unsuccessful penalties. The football was kicked wider (more accurately) within the goal during the successful compared to unsuccessful penalty (p < 0.001). Results highlight the importance of the QE period in successfully executing a soccer penalty kick. Unsuccessful penalties were associated with shorter QE length and earlier QE offset, which was due to initiating an anticipatory fixation in prediction of tracking the fast moving football, resulting in kicking the ball more centrally in the goal, making it easier for the goalkeeper to save.

Predictors of successful trial without catheter following acute urinary retention in benign prostatic enlargement: A single centre, multivariate analysis

OBJECTIVE

To evaluate the parameters which predict the success or failure of trial without catheter (TWOC) for acute urine retention (AUR).

MATERIALS AND METHODS

Medical records of 2 188 patients presenting with first episode of AUR were analyzed. All patients underwent catheterization and were started on α-blocker followed by TWOC. Age, baseline American urological association (AUA) score, prostate volume (PV), residual volume of urine (RV) and intravesical prostatic protrusion (IPP), prostate specific antigen (PSA) were recorded.

RESULTS

TWOC was successful in 737 patients (33.7%) and failed in 1 451 patients (66.3%). Patients with successful TWOC had lower mean age, PV, IPP, RV, AUA score, and PSA than those with failed TWOC. On multivariate analysis, the significant independent predictors were IPP, age, AUA score, PV, and RV at odds ratios of 3.11, 1.84, 1.78, 1.53, and 1.23, respectively. From ROC curve, IPP had cut off value of 9 mm and detected success of TWOC with sensitivity (S) of 91% and failure with specificity (s) of 90%. Similarly, cut off value of 64 years for age (S:86%, s:87%), 20 for AUA symptom score (S:83%, s:81%), 56 cc for PV (S:80%, s:74%) and 750 mL for RV (S:71%, s:68%) were obtained.

CONCLUSION

Age, baseline AUA score, IPP, PV, and RV independently predict the outcome of TWOC. Patients with IPP > 9 mm, age > 65 years, baseline AUA score > 20, PV > 56 cc, or RV > 750 mL have less probability of successful TWOC in AUR and can be considered for immediate surgery following an episode of AUR.

Perceptions and factors affecting pharmaceutical market access: results from a literature review and survey of stakeholders in different settings

BACKGROUND

A change in the pharmaceutical environment has occurred from previously only needing to convince regulators of a product's safety and efficacy to obtain marketing authorisation to now needing to satisfy the value perceptions of other stakeholders, including payers, to attain market access for products. There is thus the need to understand the concept of market access that may be defined as 'the process that ensures the development and commercial availability of pharmaceutical products with appropriate value propositions, leading to their prescribing and to successful uptake decisions by payers and patients, with the ultimate goal of achieving profitability and best patient outcomes'. The aim of this research therefore was to explore the understanding of market access among various stakeholders and how their understanding of this concept could improve patient access to pharmaceutical products.

METHODS

A literature review was conducted on MEDLINE by using the term 'market access' to find articles with explicit definitions of market access for pharmaceutical products; non-peer-reviewed and other grey literature sources were also examined. A paper-based interview survey was also conducted in three different settings. The respondents were asked about what factors they think contribute to the successful development of pharmaceutical products, as well as their definition of market access for these medicines.

RESULTS

The peer-reviewed literature review did not reveal appropriate comprehensive definitions for market access, although several definitions were proposed from the non-peer-reviewed literature. These definitions ranged from basic to detailed. The survey of 110 respondents revealed differing levels of understanding of market access. Factors considered to influence successful market access, as described by the respondents, included unmet need/burden of disease (68.2%), clinical efficacy (47.3%), comparator choice (36.4%), safety profile (36.4%), and price (35.5%).

CONCLUSION

The concept of market access is still poorly understood, and the definition varies depending on the stakeholders' perspectives. For cost-effective products to be developed and made accessible to patients, there is a need for wider understanding of market access and the value perspectives of the various stakeholders. There is also a need to determine whether and how involved payers should be in the development of pharmaceutical products.

Successful ageing for psychiatrists

OBJECTIVE

This paper aims to explore the concept and determinants of successful ageing as they apply to psychiatrists as a group, and as they can be applied specifically to individuals.

CONCLUSIONS

Successful ageing is a heterogeneous, inclusive concept that is subjectively defined. No longer constrained by the notion of "super-ageing", successful ageing can still be achieved in the face of physical and/or mental illness. Accordingly, it remains within the reach of most of us. It can, and should be, person-specific and individually defined, specific to one's bio-psycho-social and occupational circumstances, and importantly, reserves. Successful professional ageing is predicated upon insight into signature strengths, with selection of realistic goal setting and substitution of new goals, given the dynamic nature of these constructs as we age. Other essential elements are generativity and self-care. Given that insight is key, taking a regular stock or inventory of our reserves across bio-psycho-social domains might be helpful. Importantly, for successful ageing, this needs to be suitably matched to the professional task and load. This lends itself to a renewable personal ageing plan, which should be systemically adopted with routine expectations of self-care and professional responsibility.

Ovarian small-cell carcinoma hypercalcemic type successfully treated: a case report and literature review

Ovarian small-cell carcinoma hypercalcemic type (OSCCHT) is a relatively rare and highly fatal gynecological malignancy. Prognosis is generally poor, and no treatment guidelines are offered. Here, we report a case of OSCCHT successfully treated by complete excision and a postoperative chemotherapy scheme of carboplatin and paclitaxel. A 29-year-old female with with pelvic mass and significantly increased serum calcium (4.90 mmol/L) was referred to our hospital on August 22, 2013. Abdominal ultrasonography and computed tomography revealed a pelvic nonhomogeneous echo of a 113×102 mm mass, possibly coming from the adnexa of the uterus. Preoperative examinations indicated high levels of serum calcium and relevant acute renal dysfunction; hence, continuous renal replacement therapy was performed until all tests reached minimum operation requirements. Interestingly, after excision, serum calcium levels decreased rapidly and therefore, extra calcium had to be taken in order to take the level back up to normal. The patient was diagnosed with OSCCHT based on the clinical data and pathological examinations. After six cycles of chemotherapy, the patient was in a good condition and on follow-up there were no signs of recurrence.

Factors Affecting Successful Implementation of Hospital Information Systems

BACKGROUND

Today, the use of information systems in health environments, like any other fields, is necessary and organizational managers are convinced to use these systems. However, managers' satisfaction is not the only factor in successfully implementing these systems and failed information technology projects (IT) are reported despite the consent of the directors. Therefore, this study aims to determine the factors affecting the successful implementation of a hospital information system.

METHODS

The study was carried out as a descriptive method in 20 clinical hospitals that the hospital information system (HIS) was conducted in them. The clinical and paraclinical users of mentioned hospitals are the study group. 400 people were chosen as samples in scientific method and the data was collected using a questionnaire consisted of three main human, managerial and organizational, and technological factors, by questionnaire and interview. Then the data was scored in Likert scale (score of 1 to 5) and were analyzed using the SPSS software.

RESULTS

About 75 percent of the population were female, with average work experience of 10 years and the mean age was 30 years. The human factors affecting the success of hospital information system implementation achieved the mean score of 3.5, both organizational and managerial factors 2.9 and technological factors the mean of 3.

CONCLUSION

Human factors including computer skills, perceiving usefulness and perceiving the ease of a hospital information system use are more effective on the acceptance and successful implementation of hospital information systems; then the technological factors play a greater role. It is recommended that for the successful implementation of hospital information systems, most of these factors to be considered.