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Reactogenicity and Peak Anti-RBD-S1 IgG Concentrations in Individuals with No Prior COVID-19 Infection Vaccinated with Different SARS-CoV-2 Vaccines
No full textObjective: To investigate the association of immune response with vaccination adverse effects at peak anti–receptor-binding domain spike subunit 1 (anti-RBDS1) IgG after full vaccination with Comirnaty, Spikevax, or Vaxzevria.
Methods: Anti-RBDS1 IgG concentrations after vaccination were determined in healthy adults vaccinated with the Comirnaty, Spikevax, and Vaxzevria vaccines. The association of reactogenicity and peak antibody response after vaccination was tested.
Results: Anti-RBDS1 IgG values were significantly higher in the Comirnaty and Spikevax group, compared with the Vaxzevria group (P < .001). Fever and muscle pain were found to be significant independent predictors of peak anti-RBDS1 IgG in the Comirnaty and Spikevax groups (P = .03 and P = .02, respectively). The multivariate model, adjusted for covariates, showed that no association between reactogenicity and peak antibody concentrations was found in the Comirnaty, Spikevax, and Vaxzevria groups.
Conclusions: No association between reactogenicity and peak anti-RBDS1 IgG after vaccination with the Comirnaty, Spikevax, and Vaxzevria vaccine was found
Supratentorial Hemangioblastoma in Adults: A Systematic Review and Comparison of Infratentorial and Spinal Cord Locations
No full textBACKGROUND: Supratentorial hemangioblastomas are benign and highly vascularized neoplasms that appear most often in the spine and posterior cranial fossa. They can also be located in the supratentorial compartment of the brain. We conducted a systematic review of the literature to better understand the clinical insights of supratentorial hemangioblastoma in adults.
METHODS: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the authors reviewed the English-language literature in the PubMed/MEDLINE database on supratentorial hemangioblastoma in adults, published in the past 40 years. We analyzed the differences between sporadic hemangioblastomas and hemangioblastomas associated with von Hippel-Lindau disease. In addition, we compared the characteristics of supratentorial hemangioblastomas with infratentorial and spinal cord locations.
RESULTS: We reviewed 92 articles, describing 157 supratentorial hemangioblastomas in a total cohort of 148 adult patients. Most articles reporting supratentorial hemangioblastomas were published in the United States. Supratentorial hemangioblastomas occur more frequently in women than men. The median age at the time of diagnosis was 44.48 years. The sellar/parasellar region was the most commonly tumor location, while the most common morphological type was the solid type. Almost 80% of hemangioblastomas were completely resected; the outcome was favorable in more than 3 fourth of patients.
CONCLUSIONS: Given their rarity, the literature on supratentorial hemangioblastomas is limited and based mostly on case reports. Complete surgical resection is the first choice of treatment and is associated with a good treatment outcome
Comparison of Intratympanic Steroid and Hyperbaric Oxygen Salvage Therapy Hearing Outcomes in Idiopathic Sudden Sensorineural Hearing Loss: A Retrospective Study
No full textObjectives: Systemic steroids are the most common first-line therapy in sudden sensorineural hearing loss (SSNHL), with significant improvement in hearing outcomes in over 60% of patients. It is unknown why 40% of patients do not respond to systemic steroid therapy. Salvage treatment includes intratympanic steroids (ITS) and hyperbaric oxygenation (HBO) therapy, with inconsistent results reported. This study aimed to compare the results of ITS and HBO therapy in patients with SSNHL that previously failed systemic steroid therapy.
Design: This is a comparative retrospective nonrandomized interventional cohort study, enrolling 126 patients with SSNHL. Out of these, 35 patients received HBO therapy, 43 patients received ITS, and 48 patients did not receive any second-line therapy (control group). Pure-tone audiograms were performed before and after the salvage therapy in the IT and HBO groups and at the same time interval in the control group. Study variables included age, time until therapy initiation, tinnitus status, and hearing outcomes, with a cutoff criteria of cumulative >30 dB improvement on all frequencies indicating recovery.
Results: ITS and HBO therapy were associated with statistically significant hearing recovery at all frequencies compared to systemic steroids. The results show an average hearing improvement of 13.6 dB overall frequencies (250 to 8000 Hz) after ITS therapy and 7.4 dB in HBO therapy in comparison to the control group. Presence of significant hearing improvement positively correlated with age, ITS therapy, and HBO therapy. Presence of tinnitus before therapy was negatively correlated with hearing improvement. Patients with tinnitus present at the start of therapy improve 4.67 dB less on average compared to those without tinnitus. ITS therapy significantly reduced tinnitus compared to the other two treatment options. Patients with tinnitus present before therapy significantly improve hearing at low frequencies, compared to the control group.
Conclusions: ITS and HBO therapy show superior hearing results compared to observation alone after failed oral steroid therapy for SSNHL. ITS shows an additional positive impact on tinnitus reduction and shows superior hearing outcomes after salvage therapy
Ichthyosis uteri associated with squamous cell carcinoma of the endometrium – a case report
No full textBackground: Ichthyosis uteri is an extremely rare condition in which the entire or extensive parts of endometrial lining are replaced by stratified squamous epithelium. Malignant potential of this entity is unclear and its association with dysplastic changes and primary squamous cell carcinoma of the endometrium and endometrial adenocarcinoma has been reported. However, lack of data makes difficult to interpret the significance of neoplasms arising from this condition.
Patients and Methods: We report a case of ichthyosis uteri associated with squamous cell carcinoma of the endometrium in a 62-year-old female who presented with postmenopausal bleeding and thin endometrium on ultrasound.
Results: Endometrial curettage was performed and revealed high grade squamous intraepithelial lesion. The patient underwent total laparoscopic hysterectomy with bilateral salpingooophorectomy and bilateral pelvic lymph node dissection. Microscopic examination of sections revealed squamous cell cancer along with extensive replacement of the endometrial lining by stratified squamous epithelium, consistent with ichthyosis uteri.
Conclusion: If ichthyosis uteri is suspected we recommend hysterectomy in order to rule out possibility of coexisting carcinoma. Also, thin endometrium in women with postmenopausal bleeding does not reliably exclude endometrial cancer
Validating the predictive ability of the 2MACE score for major adverse cardiovascular events in patients with atrial fibrillation: results from phase II/III of the GLORIA-AF registry
No full textThe 2MACE score was specifically developed as a risk-stratifcation tool in atrial fibrillation (AF) to predict cardiovascular outcomes. We evaluated the predictive ability of the 2MACE score in the GLORIA-AF registry. All eligible patients from phase II/III of the prospective global GLORIA-AF registry were included. Major adverse cardiac events (MACEs) were defned as the composite outcome of stroke, myocardial infarction and cardiovascular death. Cox proportional hazards were used to examine the relationship between the 2MACE score and study outcomes. Predictive capability of the 2MACE score was investigated using receiver-operating characteristic curves. A total of 25,696 patients were included (mean age 71 years, female 44.9%). Over 3 years, 1583 MACEs were recorded. Patients who had MACE were older, with more cardiovascular risk factors and were less likely to be managed using a rhythm-control strategy. The median 2MACE score in the MACE and non-MACE groups were 2 (IQR 1–3) and 1 (IQR 0–2), respectively (p<0.001). The 2MACE score was positively associated with an increase in the risk of MACE, with a score of ≥2 providing the best combination of sensitivity (69.6%) and specificity (51.6%), HR 2.47 (95% CI, 2.21–2.77). The 2MACE score had modest predictive performance for MACE in patients with AF (AUC 0.655 (95% CI, 0.641–0.669)). Our analysis in this prospective global registry demonstrates that the 2MACE score can adequately predict the risk of MACE (defined as myocardial infarction, CV death and stroke) in patients with AF
Kronični multimorbiditet kod križobolje ili drugih kroničnih poremećaja u leđima u Republici Hrvatskoj
No full textThe aim was to assess the prevalence of chronic multimorbidity in patients with chronic low back pain or other chronic back disorders (BD). We analyzed data from the population-based cross-sectional European Health Interview Survey (EHIS) performed in the Republic of Croatia 2014-2015 by the Croatian Institute of Public Health. Outcome was the point-prevalence of chronic multimorbidity defined as having ≥2 chronic illnesses out of 14 contained in the EHIS questionnaire, after adjustment for ten sociodemographic, anthropometric and lifestyle confounders. Amoung fourteen targeted illnesses were asthma, allergies, hypertension, urinary incontinence, kidney diseases, coronary heart disease or angina pectoris, neck disorder, arthrosis, chronic obstructive pulmonary disease, diabetes mellitus, myocardial infarction, stroke, depression, and the common category “other”. We analyzed data on 268 participants with BD and 511 without it. Participants with BD had a significantly higher relative risk of any chronic multimorbidity (RRadj=2.12; 95% CI 1.55, 2.99; p<0.001), as well as of non-musculoskeletal chronic multimorbidity (RRadj=2.29; 95% CI 1.70, 3.08; p=0.001) than participants without BD. All chronic comorbidities except for asthma and liver cirrhosis were significantly more prevalent in participants with BD than in participants without BD. In the population with BD, the participants with multimorbidity had three to four times higher odds for unfavorable self-reported health outcomes than the participants with no comorbid conditions, whereas the existence of only one comorbidity was not significantly associated with a worse outcome compared to the population with no comorbidities. In conclusion, the population suffering from BD has a higher prevalence of chronic multimorbidity than the population without BD and this multimorbidity is associated with unfavorable health outcomes.Cilj je bio procijeniti prevalenciju kroničnog multimorbiditeta u bolesnika s križoboljom ili drugim kroničnim poremećajima u leđima (KPL). Analizirali smo podatke populacijske presječne Europske zdravstvene ankete (EHIS) koju je u Republici Hrvatskoj tijekom 2014. i 2015. godine proveo Hrvatski zavod za javno zdravstvo. Ishod je bila trenutna prevalencija kroničnog multimorbiditeta, definiranog prisutnošću s dvije ili više kroničnih bolesti od ukupno četrnaest sadržanih u EHIS upitniku, nakon prilagodbe za deset sociodemografskih, antropometrijskih i poremećujućih varijabla povezanih sa životnim stilom. Između četrnaest ciljanih bolesti bile su obuhvaćene astma, alergije, hipertenzija, urinarna inkontinencija, bubrežne bolesti, koronarna bolest ili angina pectoris, vratobolja, artroza, kronična opstruktivna plućna bolest, moždani udar, šećerna bolest, srčani udar, depresija i zajednička kategorija „ostalo”. Analizirali smo podatke o 268 sudionika s KPL i 511 bez njih. Sudionici s KPL imali su značajno veći relativni rizik za bilo koji kronični multimorbiditet (RRadj = 2,12; 95% CI 1,55; 2,99; p<0,001) kao i za kronični nemuskuloskeletni multimobiditet (RRadj = 2,29; 95% CI 1,70, 3,08; p=0,001) od sudionika bez KPL. Svi kronični komorbiditeti osim astme i ciroze jetre, bili su značajno zastupljeniji u sudionika s KPL nego u sudionika bez KPL. U populaciji s KPL, sudionici s multimorbiditetom imali su tri do četiri puta veće izglede za samoprijavljene nepovoljne zdravstvene ishode, nego sudionici bez komorbidnih stanja, dok postojanje samo jednog komorbiditeta nije bilo značajno povezano s lošijim ishodima u usporedbi s populacijom bez kroničnih komorbiditeta. Zaključno, populacija s KPL ima veću prevalenciju kroničnog multimorbiditeta nego populacija bez KPL i taj je multimorbiditet povezan s nepovoljnim zdravstvenim ishodima
Differences and Relations Between Chrono-Biological and Motor-Functional Characteristics of Infants
No full textDifferences and relationships between chrono-biological (body weight-BW, body length-BL, gestational age - GA) and motor-functional characteristics (e.g., muscle tone) of infants with relation to different obstetric mode of delivery and jaundice were analysed. The assessment of muscle tone is an integral part of neuromotor evaluation. The study included 179 infants of both genders (AS±SD: age 158,36±110,91 days; BW 3267,78±708,69 grams; and BL of 49,33±3,09 cm) due to muscle tone disorders with the presence of mild and moderate neurodevelopmental disorders as a sequelae of immature brain impairment. Study revealed statistically significant differences in chrono-biological variables depending upon the different obstetric mode of delivery (BW, BL, and GA), as well upon neonatal jaundice (BW, BL, and possibly GA). Also, there is a statistically significant correlation among chrono-biological variables (BW, BL, GA: 0,62-0,88). When compared to infant’s age at first physiatrist examination (AFE), individually and combined with GA, correlations imply importance of further inter-parametrial insights – in this case with relation to muscle tone classified in 4 groups (normal-, hypo-, hyper-, and changing-). Findings confirm statistically significant differences between infants differently categorized by muscle tone and infant’s AFE- among hypertonic and hypotonic infants as well among hypertonic and alternating ones respectively. Although there are no correlations between the AFE with BW, BL (with GA they are very little correlated – 0,19), there is an indication that the existing categorization by tone demands more frequent or earlier 'screening' - embedded into existing communication for a balanced development overall
Cladribine tablets in people with relapsing multiple sclerosis: A real-world multicentric study from southeast European MS centers
No full textBackground: Cladribine is an oral disease-modifying drug authorized by the European Medicine Agency for the treatment of highly active relapsing multiple sclerosis (MS).
Objectives: To provide real-world evidence of cladribine’s effectiveness and safety in people with MS (pwMS).
Methods: A retrospective observational multi-center, multi-national study of pwMS who were started on cladribine tablets in ten centers from five European countries.
Results: We identified 320 pwMS treated with cladribine tablets. The most common comorbidities were arterial hypertension and depression. Three patients had resolved hepatitis B infection, while eight had positive Quantiferon test prior to cladribine commencement. There were six pwMS who had malignant diseases, but all were non-active. During year 1, 91.6% pwMS did not have EDSS worsening, 86.9% were relapse-free and 72.9% did not have MRI activity. During the second year, 90.2% did not experience EDSS worsening, 86.5% were relapse-free and 75.5% did not have MRI activity. NEDA-3 was present in 58.0% pwMS in year 1 and in 54.2% in year 2. In a multivariable logistic regression model age positively predicted NEDA-3 in year 1. The most common adverse events were infections and skin-related adverse events. Lymphopenia was noted in 54.7% of pwMS at month 2 and in 35.0% at month 6. Two pwMS had a newly discovered malignant disease, one breast cancer, and one melanoma, during the first year of treatment.
Conclusion: Our real-world data on the effectiveness and safety of cladribine tablets are comparable to the pivotal study and other real-world data with no new safety signals
