Deletion of chromosome 13 detected by conventional cytogenetics is a critical prognostic factor in myeloma

In myeloma, the prognostic impact of different strategies used to detect chromosome 13 deletion (Delta13) remains controversial. To address this, we compared conventional cytogenetics and interphase fluorescence in situ hybridization (iFISH) in a large multicenter study (n=794). The ability to obtain abnormal metaphases was associated with a poor prognosis, which was worse if Delta13, p53 deletion or t(4;14) was present, but only Delta13 remained significant on multivariate analysis. Patients with Delta13, by either cytogenetics or iFISH, had a poor prognosis. However, when cases with Delta13 detectable by both cytogenetics and iFISH were separated from those detected by iFISH only, the poor prognosis of iFISH-detectable Delta13 disappeared; their outcome matched that of patients with no detectable Delta13 (P=0.115). Addition of ploidy status to iFISH-Delta13 did not affect the prognostic value of the test. Indeed both cytogenetics and iFISH Delta13 divided both hyperdiploidy and nonhyperdiploidy into two groups with similar prognoses, indicating that the poor prognosis of ploidy is entirely due to its association with Delta13. We conclude that Delta13 detected by metaphase analysis is a critical prognostic factor in myeloma. Absence of Delta13, even in those patients yielding only normal or no metaphases, is associated with a relatively good prognosis.

Age has a profound effect on the incidence and significance of chromosome abnormalities in myeloma

A simple high throughput micro-fluorescence in situ hybridisation technique (FISH) was used to detect chromosome 13 deletions (delta13), immunoglobulin heavy chain (IgH) rearrangements, t(11;14)(q13;q32), t(4;14)(p16;q32), t(14;16)(q23;q32), p53 loss, and numerical changes of chromosomes 3, 6, 7, 9, 10, 11 and 17 in 228 cases of multiple myeloma (MM), including 33 asymptomatic/smouldering MM (SMM). The patients were not part of a clinical trial and were from 30 different hospitals. In all, 98.4% of cases were abnormal, with 43% having IgH rearrangements and 42% Delta13. The low incidence of IgH rearrangements was due to a decrease in this finding with age (P = 0.001) and the relatively high proportion of elderly patients in our study population (41% >70 years old). The incidence of specific IgH translocations was t(4;14) 11%, t(11;14) 16% and t(14;16) 3%. Univariate statistical testing showed delta13 (P = 0.002), and t(14;16) (P = 0.005) to be associated with shorter survival. This effect was exaggerated for patient's aged 70 years or under but no effect on survival was seen for those over 70 years. In younger patients t(4;14) (P = 0.044) and p53 deletion (P < 0.001) were also significant poor prognostic indicators. Multivariate analysis showed delta13 and t(14;16) to be independent prognostic variables when considered with age and clinical parameters.

One-stage hypospadias repair. Experience with 544 cases

PURPOSE

We evaluated one-stage hypospadias repairs in providing a normal looking penis with a normal functioning urethra. Also we looked critically at the effects of the severity of hypospadias, the type of repair and the experience of the surgeon on the outcome.

MATERIALS AND METHODS

From 1987 to 1996 we performed 578 primary hypospadias repairs. The type and surgical results as well as the effects of certain variables on outcome were reviewed retrospectively.

RESULTS

544 single-stage hypospadias repairs have been followed up for a mean of 19 months (range 12-49). They included: MAGPI (92), ARAP (78), Mathieu (205), Mustarde (12), Duckett's tubularized preputial flap (142) and Onlay preputial flap (15). Despite an initial overall complication rate of 19%, the final success rate was 96%, after a mean of 1.3 procedures. Complications included fistula in 48 (9%) cases, meatal stenosis or retraction in 28 (5%), residual chordee in 17 (3%), stricture in 14 (2.5%), tubal abnormality in 10 (2%), and flap necrosis in 9 (2%). Complication rates were significantly higher (p < 0.05) when the meatus was proximal, the degree of chordee was moderate or severe and in the early series. Complication rates were also significantly higher with flap procedures and when the urethral plate was resected. Cosmetic defects occurred mainly with meatal advancement procedures.

CONCLUSIONS

A repertoire of different types of single stage procedures has allowed the successful treatment of most hypospadias cases presenting to one surgeon. Complication rates increases with the severity of hypospadias or transection of the urethral plate. A cumulative experience allows for better results via a proper selection of the procedure and a perfection of a few techniques.

The expression of microRNA 146a in patients with ischemic stroke: an observational study

Aim

We conducted the present prospective study to assess the level of microRNA (miRNA) 146a in patients with ischemic stroke and its correlation with patients' characteristics.

Methods

We conducted an observational study that included adult patients (≥18 years old) who presented within 24 hrs after the onset of the symptoms of acute ischemic stroke. In addition, age- and sex-matched healthy volunteers were included as control group. The primary outcome in the present study was the difference in miRNA 146a expression between patients with ischemic stroke and control group participants. The expression of miRNA 146a was measured using quantitative real-time PCR. Quantitative real-time PCR amplification and analysis were performed using Rotor-Gene Q thermal cycler.

Results

The present study included 44 patients with ischemic stroke and 22 matched controls. Regarding the primary outcome of the present study, the median expression of miRNA 146a in patients with ischemic stroke was -1.98 fold (IQR -27.1-3.9) compared to 1.75 fold (IQR -2.25-5.27) in control group (P<0.001). However, the subgroup analysis showed that the expression of miRNA 146a was significantly downregulated in comatosed patients only (P<0.001). The expression of miRNA 146a correlated negatively with Glasgow Coma Scale score in comatose patients (r=-0.352, P=0.022).

Conclusion

In conclusion, the expression of miRNA 146a is significantly downregulated in ischemic stroke patients. Further studies are needed to assess its diagnostic utility and therapeutic potentials.

Mapping of QTL for downy mildew resistance in maize

Quantitative trait loci (QTLs) of maize involved in mediating resistance to Peronosclerospora sorghi, the causative agent of sorghum downy mildew (SDM), were detected in a population of recombinant inbred lines (RILs) derived from the Zea mays L. cross between resistant (G62) and susceptible (G58) inbred lines. Field tests of 94 RILs were conducted over two growing seasons using artificial inoculation. Heritability of the disease reaction was high (around 70%). The mapping population of the RILs was also scored for restriction fragment length polymorphic (RFLP) markers. One hundred and six polymorphic RFLP markers were assigned to ten chromosomes covering 1648 cM. Three QTLs were detected that significantly affected resistance to SDM combined across seasons. Two of these mapped quite close together on chromosome 1, while the third one was on chromosome 9. The percentage of phenotypic variance explained by each QTL ranged from 12.4% to 23.8%. Collectively, the three QTLs identified in this study explained 53.6% of the phenotypic variation in susceptibility to the infection. The three resistant QTLs appeared to have additive effects. Increased susceptibility was contributed by the alleles of the susceptible parent. The detection of more than one QTL supports the hypothesis that several qualitative and quantitative genes control resistance to P. sorghi.

Expression levels of complement regulatory proteins (CD35, CD55 and CD59) on peripheral blood cells of patients with chronic kidney disease

Background

Altered regulation of the complement system is associated with multiple kidney diseases. CD35, CD55 and CD59 regulate the complement system, and changes in their expression have previously been linked with kidney disease. This study assessed whether changes in the expression levels of these proteins are associated specifically with chronic kidney disease (CKD) to understand its pathogenesis.

Materials and methods

Sixty CKD patients and 60 age-matched controls were enrolled and divided into two groups: Group I (n=30 pediatric patients and n=30 controls) and Group II (n=30 adult patients and n=30 controls). The expression of CD35, CD55 and CD59 on peripheral blood cells was evaluated by flow cytometry as the proportion of positive cells expressing the marker and mean fluorescence intensity (MFI), also the relation of these markers to the stage of CKD was also evaluated.

Results

Pediatric and adult CKD patients had significantly lower proportion of erythrocytes expressing CD35, CD55 and CD59 than healthy controls (P<0.001). In pediatric CKD patients, there was no significant difference in the three studied markers on neutrophils, lymphocytes and monocytes. The changes in expression of CD35, CD55 and CD59 on leukocytes were more pronounced in adult patients, who had lower proportion of CD59-positive neutrophils, CD35- and CD59-positive lymphocytes, and CD59-positive monocytes, as well as lower expression of CD59 on neutrophils and monocytes than adult controls (P<0.001, P=0.019, P<0.001, P=0.026, P<0.001 and P=0.003, respectively). The eGFR directly correlated with the proportion of positivity of some of those markers on peripheral leukocytes while there was inverse correlation between the disease stage and the same markers.

Conclusion

There are alterations in the patterns of expression of complement regulatory proteins CD35, CD55 and CD59 on peripheral blood cells of patients with CKD compared with healthy controls.

Clinical value of soluble urokinase type plasminogen activator receptors in chronic kidney disease

Chronic kidney disease (CKD) will progress to end stage without treatment, the decline off renal function may not linear. A sensitive marker such as soluble urokinase-type plasminogen activator receptors (suPARs) may allow potential intervention and treatment in earlier stages of CKD.

OBJECTIVES

This study was designed to measure plasma (suPAR) in patients with CKD with different stages and to find its correlation with the disease severity.

METHODS

This study was conducted on 114 subjects, 84 were patients with different stages and different causes of CKD, and 30 healthy subjects as controls. Blood urea, serum creatinine, serum high-sensitive C-reactive protein, estimated glomerular filtration rate, and 24 hours proteinuria were measured, renal biopsy was done for all patients, and plasma (suPAR) was measured using enzyme-linked immunosorbent assay.

RESULTS

suPAR plasma levels were significantly higher in patients with CKD (7.9 ± 3.82 ng/mL) than controls (1.76 ± 0.77 ng/mL, P < .001). suPAR correlated with the disease severity. In stage 1 to 2 group, it was 3.7 ± 1.5 ng/mL, in stage 3 to 4, it was 10.10 ± 1.22 ng/mL, and in stage 5 group, it was 12.34 ± 0.88 ng/mL; the difference between the 3 groups was highly significant (P < .001). A cutoff point 2.5 ng/mL of suPAR was found between controls and stage 1 group. According to the cause of CKD, although patients with obstructive cause and those with focal glomerulosclerosis had the higher levels 9.11 ± 3.32 ng/mL and 8.73 ± 3.19 ng/mL, respectively, but there was no significant difference between patients with CKD according to the cause of the CKD.

CONCLUSION

Plasma (suPAR) increased in patients with CKD and correlated with disease severity.

Subacute Post-Traumatic Ascending Myelopathy (SPAM) in a Spinal Cord Injured Patient - a Rare Presentation: A Case Report

The optimisation of blood pressure management is critical in managing hypotensive episodes in patients with spinal cord injury. Improper handling of this preventable factor will negatively impact the patient recovery prognosis. A 42-year-old man was admitted for a complete spinal cord injury after fell from height. He developed subacute neurological deterioration unrelated to the mechanical instability but due to multiple episodes of hypotension occurring one month after the initial injury. After proper management of blood pressure, his deterioration was halted and no further progression. Spinal cord haemodynamics play an important role in mediating the onset of subacute post-traumatic ascending myelopathy. Better education and awareness on Subacute Post-traumatic Ascending Myelopathy (SPAM) especially to the junior healthcare providers are important to hinder this rare but avoidable condition.

The outcome of ultrasound-guided insertion of central hemodialysis catheter

OBJECTIVE

To point out our experience and assess the efficacy and safety of real-time ultrasound-guided central internal jugular vein (IJV) catheterization in the treatment of hemodialysis patients.

METHODS

This retrospective study comprised 150 patients with end-stage renal disease (ESRD) who had real-time ultrasonography (US)-guided IJV HD catheters placed in our hospital between March 2019 and March 2021. Patients were examined for their demographic data, etiology, site of catheter insertion, type (acute or chronic) of renal failure, technical success, operative time, number of needle punctures, and procedure-related complications. Patients who have had multiple catheter insertions, prior catheterization challenges, poor compliance, obesity, bony deformity, and coagulation disorders were considered at high-operative risk.

RESULTS

All patients experienced technical success. In terms of patient clinical features, an insignificant difference was observed between the normal and high-risk groups (p-value > 0.05). Of the 150 catheters, 62 (41.3%) were placed in high-risk patients. The first-attempt success rate was 89.8% for the normal group and 72.5% for the high-risk group (p = 0.006). IJV cannulation took less time in the normal-risk group compared to the highrisk group (21.2 ± 0.09) minutes vs (35.4 ± 0.11) minutes, (p < 0.001). There were no serious complications. During the placing of the catheter in the internal jugular vein, four patients (6.4%) experienced arterial puncture in the high-risk group. Two participants in each group got a small neck hematoma. One patient developed a pneumothorax in the high-risk group, which was managed with an intercostal chest tube insertion.

CONCLUSIONS

Even in the high-risk group, the real-time US-guided placement of a central catheter into the IJV is associated with a low complication rate and a high success rate. Even under US guidance, experience lowers complication rates. Real-time USguided is recommended to be used routinely during central venous catheter insertion.

Erectile dysfunction pattern in patients with end stage renal disease on regular dialysis

INTRODUCTIONS

Evaluating the epidemiology, pattern, and contributing factors of sexual dysfunction in end-stage renal disease (ESRD) patients is the cornerstone in understanding and enhancing these patients' quality of life. In this study, we aimed to identify the different patterns of erectile dysfunction (ED) among 100 patients undergoing hemodialysis.

MATERIALS AND METHODS

A single-center, cross-sectional, study was conducted on 100 patients with ESRD on hemodialysis. Patients were assessed using the International index of erectile dysfunction (IIEF) and Doppler assessment of the penis.

RESULTS

A total of 100 patients were included in this study with a mean age of 48.77 ± 9.66 years old. The mean erectile index was 7.10 ± 4.62; while the mean free and total testosterone were 10.07 ± 7.69 and 2.93 ± 1.4 ng/dL, respectively. Overall, 67% of the patients had abnormal hormonal levels. Concerning the penile vasculature, 71% of the patients had arterogenic importance and 19% had venous impotence. The comparative analysis demonstrated that hypertensive patients had lower erectile index (p = 0.002). In addition, smokers had lower erectile index (p < 0.001). There was statistical significance between normal hormonal and abnormal hormone level according to erectile index, with lower index in patients with abnormal hormonal level (p = 0.03).

CONCLUSION

In conclusion, our findings indicate that the most common causes of ED with renal failure were hormonal disturbance, including testosterone, and prolactin. Hypertension and smoking are major contributing factors that should be managed carefully to reduce the risk of ED and improve the quality of life.

Dynamics around small irregularly shaped objects modeled as a mass dipole

In this work, we investigate the dynamics of a spacecraft near two primary bodies. The massive body is considered to have a spherical shape, while the less massive one is elongated and modeled as a dipole. The dipole consists of two connected masses, one is spherical and the other is an oblate spheroid. The gravitational potential of the elongated body is determined by four independent parameters. To study the dynamics, we construct the equations of motion of a spacecraft with negligible mass under the effect of the current force model. The existence and locations of the equilibrium points are analyzed for various values of the system parameters. We found that the existence and locations of the points are affected by the system parameters. Also, we studied the linear stability of the equilibrium points. We found some stable collinear points when the oblateness parameter is negative, otherwise the points are not stable. We used the curves of zero velocity to identify the regions of allowed motion. Furthermore, we discussed the 2001 SN263 asteroid system and found some stable collinear points when the oblateness parameter is negative. In addition, the triangular points of the system are stable in a linear sense.

Comparing Left Ventricular Structure and Functions in End-Stage Renal Disease Using Conventional Echocardiography and 2D Speckle Tracking Echocardiography

BACKGROUND

Patients on hemodialysis (HD) are prone to various cardiovascular complications. Two-dimensional speckle tracking echocardiography (2D STE) is an innovative technique for early myocardial dysfunction detection, even with normal ejection fraction (EF).

OBJECTIVE

We aim to detect left ventricle (LV) dysfunction in regular hemodialysis patients using 2D STE compared to traditional echocardiography.

METHODS

The study comprised 30 patients with end-stage renal disease (ESRD), subdivided according to left ventricular mass index (LVMI) into group 1 with left ventricular hypertrophy (LVH) (n=19) and group 2 without LVH (n=11). Another 30 healthy control subjects were recruited as group 3. The EF, average systolic velocity (Sa), and 2D LV strain were taken as measures of LV systolic function. The indicators for diastolic function included the E/A ratio and E velocity/peak early diastolic velocity.

RESULTS

Regarding the parameters of LV systolic and diastolic functions assessed by traditional echocardiography, we found no significant difference between groups 1 and 2. However, using 2D STE, we observed significant differences in the average Sa velocity (p=0.025), average LV strain (p=0.03), 2D global longitudinal strain (GLS) (p=0.03), E/Ea (p=0.003), and LV myocardial performance index (MPI) (p=0.006). Also, a significant positive correlation was found between LVMI and left ventricular end-diastolic diameter (LVEDD) (p<0.01, r=0.63), EF measured by 2D (p=0.034, r=0.39), mitral E/A ratio (p=0.03, r=0.49), and mitral E/Ea (p<0.01, r=0.72). There was a significantly strong negative correlation between LVMI and 2D average LV strain (p=0.034, r=-0.39).

CONCLUSION

We concluded that 2D STE is more sensitive than a conventional echo in detecting early LV systolic and diastolic dysfunction even in patients with normal EF.

PATHWAYS TO CARE AMONG PATIENTS WITH MENTAL ILLNESS AT USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL, SOKOTO, NIGERIA

Background

The first line of care is a paramount stage in the management of the mentally ill persons. In Nigeria, traditional and faith-based healers compete with medical professionals in providing care.

Aim

Pathway to care among patients with Mental Illness at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

Materials and methods

The characteristics of the patients and their pathways to care were assessed using a questionnaire specifically designed by the researchers, based on previous studies. A total of 270 participants were recruited over three months using a convenience sampling technique. Data analysis was performed using SPSS version 25. Chi-square tests were applied to examine associations, with significance set at P-values less than 0.05. Binary logistic regression was used to identify determinants of the pathway to care.

Results

A Few respondents (15.9%) had consulted a psychiatrist and at least 3.6 (SD ± 6.0) non-medical healers were consulted before seeing a psychiatrist. There was a statistically significant association between the pathway to care and the level of education (p = 0.047), ethnicity (p = 0.001), religion (p < 0.001), diagnosis (p = 0.002), and family history of mental illness (p = 0.002). However, religion, family history of mental illness, and diagnosis emerged as determinants of the pathway to care.

Conclusion

The use of alternative medicine in the management of mentally ill persons is still more common than orthodox care in our environment, highlighting the need for further advocacy.

A cross-sectional survey of general practitioners’ experiences with, views of, and attitudes towards, practice-based pharmacists

Introduction

Five-year pilot schemes were announced in both England and Northern Ireland (NI) to integrate practice-based pharmacists (PBPs) into general practices. The NI scheme anticipates that there will be 300 whole time equivalent PBPs in post by the end of the pilot (2020/2021).[1] There is little existing UK literature on PBPs’ role evolution and few studies have explored general practitioners’ (GPs) experiences of pharmacist integration into primary care practice.

Aim

To investigate GPs’ experiences with PBPs, their views about the PBP role and its impact upon patients and GPs, and their attitudes towards collaboration with PBPs.

Methods

A paper-based self-administered questionnaire was mailed to all general practices (n=329) across Northern Ireland (NI) on two occasions during September and October 2019, and was completed by one GP in every practice who had most contact with the PBP. The questionnaire was developed following a comprehensive literature review and comprised four sections (Table 1). Descriptive analyses were conducted using SPSS v26 and responses to open-ended questions were analysed thematically.

Results

The response rate was 61.7% (203/329). Respondents had a median age of 52.0 years and there was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n=159) meeting with the PBP more than once a week. GPs reported that two-thirds of PBPs (62.4%, n=126) were qualified as independent prescribers, with 76.2% of prescribers (n=96) currently prescribing for patients. The most common PBP activities were medication reconciliation and medication reviews. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n=162) and knowledge (87.0%, n=167) to provide safe and effective care for patients. However, only 31.1% (n=61) stated that PBPs sometimes had the confidence to make clinical decisions. The majority of GPs (&gt;85%) displayed largely positive attitudes towards collaboration with PBPs. Most respondents agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n=192) and can provide a better link between general practices and community pharmacists (96.1%, n=194). However, 24.8% of GPs (n=50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. Thematic analysis of the open comments indicated that GPs were in favour of more PBP sessions and full-time posts.

Conclusion

This study has revealed that the majority of GPs had positive views and attitudes about the PBP role, its impact in primary care and collaboration with PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Our target sample included all general practices within NI and the response rate enhanced generalisability at the practice level. However, the study sample was limited to NI, and some findings may not be relevant to other parts of the UK. Further work is required to explore PBPs’, community pharmacists’ and patients’ views of this role in general practice to corroborate study findings.

References

1. Strategic Leadership Group for Pharmacy. Practice-based pharmacists' statement. 2016. (Online) Available at: https://www.health-ni.gov.uk/sites/default/files/publications/health/practice-based-pharmacists.pdf (accessed 06 Oct 2020).

2. Van C, Costa D, Mitchell B, Abbott P, Krass I. Development and validation of a measure and a model of general practitioner attitudes toward collaboration with pharmacists. Res Soc Adm Pharm. 2013; 9(6): 688–699.

Use of Basilic vein in arteriovenous fistulas construction for hemodialysis access. Is it a good option alternative to prosthetic arteriovenous grafts?

PURPOSE

For patients with a failed forearm autogenous fistula (AF) and an exhausted cephalic vein, there is controversy about whether a brachial basilic AF with transposition or an arteriovenous prosthetic bridging graft (BG) must be the second vascular access option. This work measured and compared these two modalities according to patency rates, complications, and revisions.

PATIENTS AND METHODS

A retrospective study of 104 cases that had either a brachial basilic AF (72) or an Arteriovenous BG (32). Technical success, operative complications, procedurerelated mortality, maturation time, functional primary, secondary, and overall patency rates were all assessed.

RESULTS

Technical success was obtained in all participants. No procedure-linked mortality. Maturation time for BGs was significantly shorter than AFs. The complication rate was significantly higher in BGs than in AFs. The most prevalent complication was access thrombosis. The functional primary patency rate was significantly higher in AF than in BG at 12-month followup: 77.7% vs 53.1% (p < 0.012). secondary patency rate was higher in AF than in BG at 1-year follow-up 62.5% vs 42.8% (p = 0.063), respectively. In addition, BGs required more interventions to preserve patency.

CONCLUSIONS

AF had higher primary, secondary and overall functional patency rates and needed fewer procedures to keep patency than BGs. Cases that need early vascular access as a result of central venous catheter complications or who have a reduced life expectancy may benefit from BGs.