Transplant recipient patients are susceptible to infections due to their immunosuppressive treatments and surgical intervention. Vitamin D has positive effects on the immune system and metabolism promoting healthier homeostasis and more efficient immune response, thus is an advisable complementary therapy in kidney transplant recipients (KTRs). Poisson regressions were used to analyse associations between incidence of infections and vitamin D levels and deficiency. Group comparisons explored the connections between vitamin D levels and infections, calcium, and phosphate levels in relation to kidney function and parathyroid hormone (PTH) levels in deficiency/insufficiency/sufficiency periods of KTRs. KTRs had significantly lower level of 25(OH)D during infected compared to infection-free periods (p<0.0001). The incidence/number of infections was significantly higher during vitamin D deficiency compared to insufficiency or sufficiency (p<0.0001). Calcium level was significantly higher in the sufficient group compared to the insufficient or deficient groups (p=0.0031 and p=0.0496, respectively). Periods of vitamin D deficiency in KTRs are associated with vulnerability to infections, therefore monitoring of vitamin D level and applying supplementation reaching the sufficient level (30ng/ml) is recommended if deficiency is detected. Primarily to reduce infections and avoid disturbances in immune activation, but also because it has negative impact on the quality of life of KTRs.
Magyarorszagon 1998-ban egy uj kezelesi protokoll, a Magyar Agytumor Protokoll kerult bevezetesre a gyermekkori medulloblastoma/PNET (primitiv neuroectodermalis tumor) kezelesere. A vizsgalat celja az uj kezeles hatekonysaganak elemzese. 1998 es 2004 kozott 41 beteget kezeltunk a Magyar Agytumor Protokollal a Semmelweis Egyetem ket Gyermekklinikajan medulloblastoma/PNET diagnozissal. A kezelesi sema tumoreltavolito műtettel kezdődott, amelyet korai besugarzas es kemoterapias kezeles kovet. A kemoterapias kezeles a kovetkező kombinaciok ismetelt adasabol allt: vincristin-cyclophosphamid, methotrexat, carboplatin-etoposid, vincristin-carmustin, vincristin-procarbazin. A kezeles teljes időtartama 62 het volt. A 3 evnel fiatalabb betegek kivetelevel, akik nem reszesulhettek sugarkezelesben, minden beteg ugyanazt a kezelest kapta. 49,2 honapos atlagos kovetesi idő utan az osszes beteg 5 eves becsult ossztulelese 44,1%, az alacsony rizikocsoporte (idősebb mint 3 ev, lokalizalt betegseg, teljes
tumoreltavolitas) 74,0%, mig a magas rizikocsoporte (fiatalabb mint 3 ev, vagy primeren kimutathato metasztazis vagy nem teljes tumoreltavolitas) 17,4%. A kezeles minden esetben jol toleralhato volt, a kezeles mellekhatasai miatt egyetlen beteget sem veszitettunk el. Az eredmenyek megfelelnek a nemzetkozi tapasztalatoknak: az alacsony rizikoju csoportba tartozo betegek tulelese jo, ugyanakkor a magas rizikoju csoportba tartozo betegek tulelesenek javitasa csak a kezeles intenzifikalasaval erhető el.
Cancer registration has developed in Europe over the last 50 years, and in the last decade intensive joint activities between the European Cancer Registries, in response to the need of pan-European harmonization of registration practices, have taken place. The Hungarian Paediatric Cancer Registry has been functioning as the database of the Hungarian Paediatric Oncology Network since 1971, aiming to follow the incidence and the treatment efficacy of malignant diseases. The goals of this globally unique open source information system are the following: 1) to raise the quality of the registration system to the European level by developing an Internet-based registration and communication system, modernizing the database, establishing automatic statistical analyses and adding an Internet website, 2) to support clinical epidemiological studies that we conduct with international collaborators on detailed analyses of the characteristics of patients and their diseases, evaluation of new diagnostic and therapeutic methods, prevention programs, and long-term quality of life and side effects. The benefits of the development of the Internet-based registration and communication system are as follows: a) introduction of an Internet-based case reporting system, b) modernization of the registry database according to international recommendations, c) automatic statistical summaries, encrypted mail systems, document repository, d) application of data security and privacy standards, e) establishment of a website and compilation of educational materials. The overall objective of this scientific project is to contribute towards the improvement of cancer prevention and cancer care for the benefit of the public in general and of cancer patients in particular.
Randomised Phase IIB clinical trial.To assess whether increasing the dose of rifampicin (RMP) from 10 mg/kg to 15 or 20 mg/kg results in an increase in grade 3 or 4 hepatic adverse events and/or serious adverse events (SAE).Three hundred human immunodeficiency virus negative patients with newly diagnosed microscopy-positive pulmonary tuberculosis (TB) were randomly assigned to one of three regimens: 1) the control regimen (R10), comprising daily ethambutol (EMB), isoniazid (INH), RMP and pyrazinamide for 8 weeks, followed by INH and RMP daily for 18 weeks; 2) Study Regimen 1 (R15), as above, with the RMP dose increased to 15 mg/kg body weight daily for the first 16 weeks; and 3) Study Regimen 2 (R20), as above, with RMP increased to 20 mg/kg. Serum alanine transferase (ALT) levels were measured at regular intervals.There were seven grade 3 increases in ALT levels, 1/100 (1%) among R10 arm patients, 2/100 (2%) in the R15 arm and 4/100 (4%) in the R20 arm (trend test P = 0.15). One (R15) patient developed jaundice, requiring treatment modification. There were no grade 4 ALT increases. There was a non-significant increase in culture negativity at 8 weeks with increasing RMP dosage: 75% (69/92) in R10, 82.5% (66/80) in R15 and 83.1% (76/91) R20 patients (P = 0.16).No significant increase in adverse events occurred when the RMP dose was increased from 10 mg/kg to 15 mg/kg or 20 mg/kg.
Introduction Uncomplicated urinary tract infections (uUTIs) in women are common infections encountered in primary care. Evidence suggests that rapid point-of-care tests (POCTs) to detect bacteria and erythrocytes in urine at presentation may help primary care clinicians to identify women with uUTIs in whom antibiotics can be withheld without influencing clinical outcomes. This pilot study aims to provide preliminary evidence on whether a POCT informed management of uUTI in women can safely reduce antibiotic use. Methods and analysis This is an open-label two-arm parallel cluster-randomised controlled pilot trial. 20 general practices affiliated with the Bavarian Practice-Based Research Network (BayFoNet) in Germany were randomly assigned to deliver patient management based on POCTs or to provide usual care. POCTs consist of phase-contrast microscopy to detect bacteria and urinary dipsticks to detect erythrocytes in urine samples. In both arms, urine samples will be obtained at presentation for POCTs (intervention arm only) and microbiological analysis. Women will be followed-up for 28 days from enrolment using self-reported symptom diaries, telephone follow-up and a review of the electronic medical record. Primary outcomes are feasibility of patient enrolment and retention rates per site, which will be summarised by means and SDs, with corresponding confidence and prediction intervals. Secondary outcomes include antibiotic use for UTI at day 28, time to symptom resolution, symptom burden, number of recurrent and upper UTIs and re-consultations and diagnostic accuracy of POCTs versus urine culture as the reference standard. These outcomes will be explored at cluster-levels and individual-levels using descriptive statistics, two-sample hypothesis tests and mixed effects models or generalised estimation equations. Ethics and dissemination The University of Würzburg institutional review board approved MicUTI on 16 December 2022 (protocol n. 109/22-sc). Study findings will be disseminated through peer-reviewed publications, conferences, reports addressed to clinicians and the local citizen’s forums. Trial registration number ClinicalTrials.gov NCT05667207 .
Our aim is to present the disease course, frequency of relapses and survival of juvenile and adult dermatomyositis (JDM/DM) patients.Analysis was performed using data on 73 patients. The median follow-up for 38 JDM patients was 32 months and 78 months for 35 adult DM patients.23/38 JDM patients (60%) had monophasic, 12/38 (31.6%) had polycyclic and 3/38 (7.9%) had chronic disease. Among children treated only with glucocorticoids, 12/20 (60%) had monophasic and 8/20 (40%) had polycyclic disease. 10/17 (58.8%) children, who required second-line immunosuppressive agents, had monophasic and 4/17 (23.5%) had polycyclic disease. 18/35 DM (51.4%) patients had monophasic, 13/35 (37.1%) had polycyclic, 1/35 (2.9%) had chronic disease and 3/35 (8.6%) had fulminant myositis. Among DM patients requiring only glucocorticoids, 12/20 (60%) were monophasic and 8/20 (40%) were polycyclic. In patients requiring second-line immunosuppressive agents, 6/15 patients (40%) had monophasic and 5/15 (33.3%) had polycyclic disease. Among patients with polycyclic disease, the risk of relapse was higher during first year than later in the disease course. None of the JDM patients have died, while 4 disease-specific deaths occurred in adult patients. There was no significant difference between the survival of JDM and DM patients.There was no correlation between relapse-free survival and the initial therapeutic regimen. Many of our patients had polycyclic or chronic disease. As relapses can occur after a prolonged disease-free interval, patients should be followed for at least 2 years. Although we found a favourable survival rate, further investigations are needed to assess functional outcome.
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