Prokaryotic expression and functional analysis of molecular chaperone Acr2 protein of Mycobacterium tuberculosis / 中国生物制品学杂志

@#Objective To express the molecular chaperone Acr2 protein of Mycobacterium tuberculosis(Mtb)in E.coli and analyze the function. Methods The recombinant plasmid pET-28a-Acr2 was transformed into competent E. coli BL21(DE3),and induced by IPTG. The expressed His-Acr2 protein was purified by Ni-NTA chromatography and SuperdexTM200 10/300 GL gel filtration chromatography to obtain Acr2 protein. The Acr2 protein was refolded by spontaneous refolding and reassembly after thermal denaturation(100 ℃ for 15 min)and chemical denaturation(8 mol/L urea,37 ℃ for 4 h).The secondary structure of Acr2 protein before and after denaturation-renaturation was detected by circular dichroism spectroscopy and non-denaturing SDS-PAGE,and the molecular chaperone function of Acr2 protein in vitro was detected by substrate binding assay. Results The purified Acr2 protein had the relative molecular mass of about 232 000,the purity of over 90%,and the concentration of about 2 mg/mL,which recovered its natural secondary structure after denaturationrenaturation,and formed stable complexes with the denatured malate dehydrogenase(MDH)at 48 ℃. Conclusion The Acr2protein can restore its natural molecular conformation with molecular chaperone activity in vitro after denaturation-renaturation treatment,providing a new strategy for the preparation of Mtb protein antigen with natural activity.

Stratifying indeterminate cytology thyroid nodules by combining Thyroid Imaging Reporting and Data Systems (TI-RADS) and The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC)

Objective@#To determine the risk of malignancy of Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) indeterminate Thyroid Nodules (Bethesda III, IV and V) by combining cytologic (TSBRTC) and Thyroid Imaging Reporting and Data Systems (TI-RADS) ultrasonographic features based on final histopathology.@*Methods@#Design: Retrospective review of records. Setting: Tertiary Private Training Hospital. Participants: 551 records. @*Results@#Among 81 eligible participants, 59 out of 84 nodules (70.24%) wer malignant on histopathology. The malignancy risk of Bethesda classification was 60.87% (28 out of 46) for Bethesda III, 57.14% (8 out of 14) for Bethesda IV and 95.83% for Bethesda V. The malignancy risk for TI-RADS categories was 0 % (0/1) for TI-RADS 2, 50% (10 out of 20) for TI-RADS 3, 71.05 % for TI-RADS 4 and 91.67 % for TI-RADS 5. The highest risk of malignancy (100%) was associated with [Bethesda IV/TI-RADS 1, 2, and 3], [Bethesda V/TI-RADS 1, 2 and 3 [Bethesda IV and V/TI-RADS 1, 2 and 3] and [Bethesda IV/TI-RADS 5]. The lowest risk of malignancy (33.33%) was associated with [Bethesda III/TI-RADS1, 2 and 3]. A high Bethesda classification (Bethesda V) was almost 5x more likely to have a malignant anatomorphology compared with Bethesda III (p = .05) while a TI-RADS 4 or 5 category was almost 5x more likely to have a malignant anatomorphology compared to TI-RADS 1, 2 or 3 (p = .026).@*Conclusion@#This study showed that TI-RADS scoring is a sensitive diagnostic classification in recognizing patients with thyroid cancer and combining Bethesda classification and TI-RADS scoring increases the sensitivity in the diagnosis of malignant thyroid nodules. A higher likelihood of malignancy is associated with higher Bethesda classification and TI-RADS scoring.

Prevalence of Sjögren's syndrome according to 2016 ACR-EULAR classification criteria in patients with systemic lupus erythematosus

Abstract Background Diagnosis of SS is a complex task, as no symptom or test is unique to this syndrome. The American-European Consensus Group (AECG 2002) and the American-European classification criteria of 2016 (ACR/EULAR 2016) emerged through a search for consensus. This study aims to assess the prevalence of Sjögren's Syndrome (SS) in patients with Systemic Lupus Erythematosus (SLE), according to AECG 2002 and ACR-EULAR 2016 classifications, as well as clinical and histopathological features in this overlap. To date, there is no study that has evaluated SS in SLE, using the two current criteria. Methods This cross-sectional study evaluated 237 SLE patients at the outpatient rheumatology clinic between 2016 and 2018. Patients were submitted to a dryness questionnaire, whole unstimulated salivary flow (WUSF), "Ocular Staining Score" (OSS), Schirmer's test I (ST-I), and labial salivary gland biopsy (LSGB). Results After verifying inclusion and exclusion criteria, a total of 117 patients were evaluated, with predominance of females (94%) and mixed ethnicity (49.6%). The prevalence of SS was 23% according to AECG 2002 and 35% to ACR- EULAR 2016. Kappa agreement between AECG 2002 and ACR-EULAR 2016 were 0.7 (p < 0.0001). After logistic regression, predictors for SS were: anti/Ro (OR = 17.86, p < 0.05), focal lymphocytic sialadenitis (OR = 3.69, p < 0.05), OSS ≥ 5 (OR = 7.50, p < 0.05), ST I positive (OR = 2.67, p < 0.05), and WUSF ≤ 0.1 mL/min (OR = 4.13, p < 0.05). Conclusion The prevalence of SS in SLE was 23% (AECG 2002) and 35% (ACR-EULAR 2016). The presence of glandular dysfunction, focal lymphocytic sialadenitis, and anti/Ro were predictors of SS in SLE. The greatest advantage of the new ACR-EULAR 2016 criteria is to enable an early diagnosis and identify the overlapping of these two diseases. ACR- EULAR 2016 criteria is not yet validated for secondary SS and this study is a pioneer in investigating prevalence based on the new criteria.

Clinical and serological characteristics of Cuban patients with Systemic Lupus Erythematosus

Introduction: Systemic lupus erythematosus (SLE) is the prototype of systemic autoimmune disease with clinical characteristics that show geographic variations. However, these differences between regions have not been fully described; therefore, the objective of this study is to describe the clinical and sociodemographic characteristics of Cuban patients with SLE. Patients and methods: 149 patients with SLE and 151 with other systemic autoimmune diseases were studied. Sociodemographic and clinical characteristics according on the criteria of the American College of Rheumatology of 1997 were identified. To evaluate the associations between clinical manifestations and SLE, a logistic regression analysis was performed; the odds ratio (OR) was calculated with its corresponding 95% confidence interval and the method of multiple correspondence analysis was also used. By an analysis of the configurations of frequency the typical combinations of criteria related to the patients with SLE were identified. Results: The most frequent criteria in SLE were immunological disorders (85.2%). ANA positive (85.2%) arthritis (78.5%), photosensitivity (77.2%), and malar rash (61%). The renal involvement and immunological disorders criteria were the best (highest OR) at discriminating SLE patients. The combination of only three criteria (malar rash, positive ANA, and immunological disorder) could be enough to classify a homogeneous population. Conclusions: This study enabled us to determine the main clinical characteristics of patients with SLE in Cuba. This information could be useful to improve the efficiency of SLE diagnosis and facilitate more specific treatments.

Introducción: El lupus eritematoso sistémico (LES) es el prototipo de enfermedad autoinmune sistémica, con características clínicas que muestran variaciones geográficas. Sin embargo, estas diferencias entre regiones no están completamente descritas, por lo cual, el objetivo de este trabajo es describir las características clínicas y sociodemográficas de pacientes cubanos con LES. Pacientes y métodos: Se hizo un estudio con 149 pacientes con LES y 151 con otras enfermedades autoinmunes sistêmicas. Se identificaron sus características sociodemográficas y clínicas, basadas principalmente en los criterios del Colegio Americano de Reumatología de 1997. Para evaluar las asociaciones entre las manifestaciones clínicas y el LES se llevó a cabo un análisis de regresión logística, se calculó la odds ratio, con su correspondiente intervalo de confianza al 95%, y se empleó la técnica de análisis de correspondencia múltiple. Mediante un análisis frecuencial de las configuraciones, se identificaron las combinaciones típicas de criterios relacionadas con los pacientes con LES. Resultados: Los criterios más frecuentes en el LES fueron: alteraciones inmunológicas (85,2%), ANA positivo (85,2%), artritis (78,5%), fotosensibilidad (77,2%) y rash malar (61%). Los criterios afección renal y alteraciones inmunológicas son los que mejor (mayor valor de la odds ratio) discriminan a los pacientes con LES. La combinación de solamente tres criterios (rash malar, ANA positivo y alteraciones inmunológicas) podría ser suficiente para clasificar a una población homogénea. Conclusiones: El estudio permitió conocer las principales características clínicas de pacientes con LES en Cuba. Esta información puede ser útil para mejorar la eficacia del diagnóstico del LES y favorecer la aplicación de tratamientos más específicos.

Pulmonary and neurological profile of vasculitis patients at tertiary care hospital

Background: The vasculitis are a heterogenous group of conditions characterized by blood vessel inflammation and necrosis. Vasculitis are relatively uncommon conditions whose etiology is still poorly understood. Treating vasculitis is as regarding as establishing diagnosis. In the absence of treatment, most of patients will suffer or die. With treatment most of patients improve, many will achieve remission and a few will be cured. Disease classification is the process of categorizing illnesses in a larger framework of medical conditions. Objectives: To study the pulmonary and neurological profile of vasculitis patients at a tertiary care centre. Materials and methods: The present hospital based observational study was conducted in the Department of Internal Medicine, SKIMS Srinagar. The study had two parts; retrospective and prospective. Retrospective part: All patients of vasculitis who were admitted or evaluated in OPD from March 2012 to Sept. 2018, were enrolled for the analysis. Prospective part: All Patients of vasculitis admitted or evaluated in OPD from Oct. 2018 to May 2020 were enrolled for study. Patients were classified as vasculitis if they fulfil ACR / EULAR / EMA / Chapell Hill consensus classification criteria for vasculitis and biopsy. Results: Our study was an observational study of 77 patients. Majority of patients i.e. 5 (33.33%) each in LVV group belonged to age groups of <30 and 31-40 years. In SVV group, majority of patients i.e. 11 (27.5%) belonged to age group of <30 years followed by 9 (22.5%) patients each who aged between 31-40 years and 41-50 years. In group LVV there were 12 (80%) males compared to 3 (20%) females. In group SVV, there were 8 (20%) males compared to 32 (80%) females while as 13 (59%) males and 9 (41%) females constituted others group. Chest x-ray was normal was normal in majority of patients in all three groups. CT Chest was done in 23 patients in which nodules were seen in 7 (35%) patients, 4 (20%) patients each had consolidation, DAH and 2 (10%) patients had ILD. CT head were suggestive of encephalomalacia in 1, ischemic stroke in 1 and normal findings in 1 (33.3%) patients. CT Chest and Head findings were compared in three study groups with SVV group showing abnormal findings as compared to other two groups. Tuberculosis profile was negative in 26 (96.3%) of 27 patients. TB profile was positive in only 1 (11.1%) patient in others group. On NCV, peripheral neuropathy was observed in 11 (68.8%) of the 16 patients. On NCV, peripheral neuropathy was observed in 9 (75%) patients in SVV group and 2 (50%) patients in others group. Conclusion: Most of abnormalities on CT Chest, Head, and NCV were present in SVV group. They mostly presented with ILD, DAH, encephalomalacia, ischemic stroke, peripheral neuropathy.

Relationship between Urinary Albumin Creatinine Ratio and Severity of Coronary Artery Disease in Non-Diabetic Patients

ackground: Coronary artery disease (CAD) is leading cause of mortality worldwide. CAD accounts for 20% of all deaths in the South Asia region. The burden of CAD is emerging as a public health concern in developing countries like Bangladesh. There are some new biomarkers for detection of CAD. The aim of this study was to find out the relationship between ACR and severity of coronary artery disease in non-diabetic.Material & Methods:This cross-sectional analytical study was conducted in the department of cardiology, National Heart Foundation Hospital and Research Institute from April, 2018 to March, 2019. Purposive sampling was done to select a total 101 study subjects. Data were collected in a predesigned data collection form through clinical history, examination, laboratory findings and coronary angiogram report. Study population was divided into two groups: Group朅: Non-diabetic patients with ACR > 30mg/g Group朆: Non-diabetic patients with ACR ? 30mg/g.Results:Participants had a mean age of 52.5 � 9.9 years with 75.24% men. Group A patients had higher ACR level (49.98�.83 vs 13.36�08; p<0.01) than group B patients. Relation between urinary ACR and severity of CAD remained significant. Conclusions:In this study, there found a significant relationship in ACR and severity of coronary artery disease in non-diabetic patients.

Study of Relationship between HbA1c and Microalbuminuria of Diabetic Patients

Background: Globally, as of 2010, an estimated 285 million people had diabetes, with type 2 making up about 90% of the cases. Its incidence is estimated to almost double, by 2030. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. Measurement of glycated hemoglobin (HbA1c) has become the preferred method of diagnosis as well as assessing long-term glycaemic control. The present study was conducted to determine the magnitude and prevalence of microalbuminuria in relation to HbA1c in a group of diabetic patients admitted in Comilla Medical College Hospital of Bangladesh. Objectives: The relationship between HbA1c and microalbuminuria of diabetic patients was assessed in a hospital-based cross-sectional study in a tertiary level hospital.Material & Methods:A hospital-based cross-sectional descriptive study was carried out in department of Medicine, Comilla Medical College Hospital from 1st July, 2011 to 30th June, 2012. One hundred known admitted diabetic patients with age 25� years were included in this study.Results:Microalbuminuria had a significant correlation with HbA1c (p<0.05) (r=0.24). Increasing HbA1c was associated with increasing microalbuminuria above optimal cut-off points of HbA1c 7%. The prevalence of microalbuminuria was 33.33 % at HbA1c(6.1-6.9)%, whereas it was 75% at HbA1c (7.1-7.9)%. Microalbuminuria was 38.74 � 9.76 mg/gm (p<0.05) at HbA1c <7%, whereas it was 65.86 � 21.29 mg/gm (p<0.05) at HbA1c ?7%.Conclusions:The present study found an early onset of microalbuminuria in the selected community which could be due to poor glycaemic control (high HbA1c ? 7%) after excluding other causes of microalbuminuria. Screening for microalbuminuria and HbA1c test should be done in both newly and already diagnosed diabetic patients as an early marker of renal dysfunction and glycaemic control.

Diagnostic criteria and research progress on lung allograft pathology / 器官移植

In recent years, the quantity of lung transplantation has been gradually increased in China along with the accumulation of surgical techniques and postoperative management experience of lung transplantation. Multiple lung allograft complications may occur after lung transplantation, mainly including primary graft dysfunction (PGD) caused by ischemia-reperfusion injury (IRI) of the lung allograft, acute and chronic rejection, opportunistic infection or lymphoproliferative disorder of lymphoid tissues induced by the decrease of host immunity due to postoperative use of immunosuppressants, etc. The diagnosis of complications after lung transplantation mainly relies on biopsy of the lung allograft. In this article, the brief history of lung allograft pathology, main approaches and pathological processing techniques of lung allograft biopsy, major complications after lung transplantation and pathological diagnostic criteria were elucidated, aiming to provide reference for targeted management of these complications in clinical practice.

Research progress on the role of exosome in rejection after lung transplantation / 器官移植

Rejection after lung transplantation, including acute rejection (AR) and chronic rejection manifested with chronic lung allograft dysfunction (CLAD), is the main factor affecting the long-term survival of allografts. Exosome, a type of extracellular nanovesicle for intercellular communication among eukaryotic cells, could carry complex biological information and participate in various physiological and pathological processes. Exosome has become a critical immune medium in rejection, regulates the incidence and development of rejection through multiple pathways, and also plays a key role in the monitoring and management of rejection. In this article, the type of rejection after lung transplantation, the mechanism underlying the role of exosome in regulating rejection, exosome acting as biomarkers and the application in rejection treatment were reviewed, aiming to provide a novel direction for comprehensive diagnosis and treatment of rejection following lung transplantation.

Ultrasound classification of thyroid nodules: does size matter?

ABSTRACT Objective To determine whether the size of thyroid nodules in ACR-TIRADS ultrasound categories 3 and 4 is correlated with the Bethesda cytopathology classification. Methods Thyroid nodules (566) subclassified as ACR-TIRADS 3 or 4 were divided into three size categories according to American Thyroid Association guidelines. The frequency of different Bethesda categories in each size range within ACR-TIRADS 3 and 4 classifications was analyzed. Results Most nodules in both ACR-TIRADS classifications fell in the Bethesda 2 category, regardless of size (90.8% and 68.6%, ACR-TIRADS 3 and 4 respectively). The prevalence of Bethesda 6 nodules in the ACR-TIRADS 4 group was 14 times higher than in the ACR-TIRADS 3 group. There were no significant differences between nodule size and fine needle aspiration biopsy classification in any of the ACR-TIRADS categories. Conclusion Size does not appear to be an important criterion for indication of fine needle aspiration biopsy in thyroid nodules with a high suspicion of malignancy on ultrasound examination.

Calidad de vida relativa a la función visual en pacientes con implante de lente intraocular fáquico ACR-128 / Vision-related quality of life in patients undergoing ACR-128 phakic intraocular lens implantation

Introducción: El implante de una lente intraocular fáquico para corregir defectos de la refracción presenta una serie de ventajas respecto a otras técnicas como la cirugía refractiva corneal o la extracción de cristalino transparente. Objetivo: Describir los cambios en la calidad de vida relacionados con la función visual en la corrección de alta miopía con implante de lente fáquico ACR-128. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo con análisis estadístico separado por ojos. La muestra total se correspondió con 91 ojos (46 derechos y 45 izquierdos) de 49 pacientes a los que se les implantó lente fáquico ACR-128 para la corrección de miopía. Mediante el test de Pelli-Robson se determinó la sensibilidad al contraste binocular a varias frecuencias espaciales y se les aplicó el cuestionario NEI-VFQ-25 antes de la cirugía (pretest) y a los tres meses de realizada la misma (postest). El análisis estadístico se realizó con la prueba T para datos pareados, con una significación del 95 por ciento. Resultados: Edad media 28,73 ± 5,85 años. Predominio del sexo femenino (71,43 por ciento). Hubo diferencias significativas en todas las frecuencias espaciales de la sensibilidad al contraste binocular entre el pre- y posoperatorio (p < 0,01). Al comparar el pretest y el postest (valoración retrospectiva de la calidad de vida prequirúrgica) no se encontraron diferencias significativas, lo que indicó que no hubo recalibración y que las diferencias con el postest que fueron significativas corroboren el verdadero cambio en la calidad de vida de estos pacientes tras la cirugía. Conclusiones: El implante de lentes fáquicos ACR-128 para la corrección de la alta miopía mejora la calidad de vida relacionada con la función visual sin cambios en su percepción antes y después de la cirugía(AU)

Introduction: Phakic intraocular lens implantation to correct refraction defects has a number of advantages with respect to techniques such as corneal refractive surgery or clear lens extraction. Objective: Describe the changes in vision-related quality of life resulting from high myopia correction by ACR-128 phakic lens implantation. Methods: A prospective longitudinal descriptive study was conducted with independent statistical analysis for each eye. The total sample was 91 eyes (46 right and 45 left) of 49 patients undergoing ACR-128 phakic lens implantation for myopia correction. The Pelli-Robson test was used to determine binocular contrast sensitivity at various spatial frequencies, and the NEI VFQ-25 questionnaire was applied before surgery (pre-test) and three months after surgery (post-test). Statistical analysis was based on the paired T-test with a significance level of 95 percent. Results: Mean age was 28.73 ± 5.85 years. Female sex prevailed (71.43 percent). Significant differences were found in all the spatial frequencies of binocular contrast sensitivity between the pre- and postoperative periods (p < 0.01). Comparison of pre- and post-test results (retrospective assessment of presurgical quality of life) did not find any significant differences, indicating that there was no recalibration. Significant differences with respect to the post-test confirm the actual change in these patients' quality of life after surgery. Conclusions: ACR-128 phakic lens implantation for high myopia correction improves vision-related quality of life without changes in its perception before and after surgery(AU)

Diagnostic criteria and research progress on heart allograft pathology / 器官移植

With the improvement of surgical technique of heart transplantation and clinical application of potent immunosuppressant, the quantity of heart transplantation and the survival time of heart allograft have been significantly improved. However, a series of complications, such as right ventricular failure, ischemia-reperfusion injury, acute rejection, "Quilty lesion", infection and chronic rejection characterized by transplant coronary artery disease (TCAD) may still occur at different stages after heart transplantation. The application of endomyocardial biopsy (EMB) makes it possible to observe and understand the pathological features of multiple complications of heart allograft including rejection, which has become the most accurate diagnostic tool for postoperative complications. In this article, the brief history of heart allograft pathology, main postoperative complications and pathological diagnostic criteria, and cutting edge research progress on diagnostic criteria of rejection were illustrated, aiming to bring clinical benefits to more recipients undergoing heart transplantation.

VEGF-B antibody and interleukin-22 fusion protein ameliorates diabetic nephropathy through inhibiting lipid accumulation and inflammatory responses

Diabetic nephropathy (DN) is considered the primary causes of end-stage renal disease (ESRD) and is related to abnormal glycolipid metabolism, hemodynamic abnormalities, oxidative stress and chronic inflammation. Antagonism of vascular endothelial growth factor B (VEGF-B) could efficiently ameliorate DN by reducing renal lipotoxicity. However, this pharmacological strategy is far from satisfactory, as it ignores numerous pathogenic factors, including anomalous reactive oxygen species (ROS) generation and inflammatory responses. We found that the upregulation of VEGF-B and downregulation of interleukin-22 (IL-22) among DN patients were significantly associated with the progression of DN. Thus, we hypothesized that a combination of a VEGF-B antibody and IL-22 could protect against DN not only by regulating glycolipid metabolism but also by reducing the accumulation of inflammation and ROS. To meet these challenges, a novel anti-VEGFB/IL22 fusion protein was developed, and its therapeutic effects on DN were further studied. We found that the anti-VEGFB/IL22 fusion protein reduced renal lipid accumulation by inhibiting the expression of fatty acid transport proteins and ameliorated inflammatory responses

Clinical Study of Urine Albumin Creatinine Ratio as an Earlier Predictor of Diabetic Nephropathy.

Diabetic nephropathy (DN) is a chronic microvascular complication of diabetes mellitus (DM). Microalbuminuria is an earliest marker of DN. Effective screening measures are required for early diagnosis and management to halt the progression of diabetic nephropathy. We wanted to evaluate urine Albumin Creatinine Ratio (ACR) as an earlier predictor of diabetic nephropathy in comparison to the gold standard test 24-hours urine protein.METHODSThis is a cross sectional study conducted among 210 patients of type-2 DM admitted in the medical ward of a tertiary care hospital, who fulfilled the inclusion and exclusion criteria. Relevant history including duration of DM, and other comorbidities was taken from the patients. Vital parameters such as heart rate, systolic and diastolic blood pressure were recorded. CBC, RFT, FBS, PPBS, HbA1c, Fundoscopy were done in all patients. Urine analysis for ACR from random urine sample and 24-hours urine protein from 24-hour urine sample were done.RESULTSProteinuria was present in 80.95% of patients and that with 24-hour urinary protein, in 59.04% patients. ACR showed sensitivity of 100%, specificity of 46.51% with PPV of 72.94% and NPV of 100%. ACR has strong positive correlation with 24-hours urinary protein. Positive correlation of urine ACR was seen with serum creatinine, blood urea, HbA1c, anaemia, duration of diabetes and the presence of diabetic retinopathy.CONCLUSIONSACR shows high sensitivity in the detection of proteinuria, especially microalbuminuria and hence can be considered as an alternative to 24-hour urine protein in an early screening for DN.

Meta-analysis of RCT studies on clinical efficacy of single administration of Tripterygium Glycosides Tablets or combined administration with methotrexate against rheumatoid arthritis / 中国中药杂志

To evaluate the clinical efficacy of single administration of Tripterygium Glycosides Tablets(TGT) or combined administration with methotrexate(MTX) against rheumatoid arthritis(RA) based on American College of Rheumatology(ACR) efficacy standard. Six databases, namely CNKI, WanFang, VIP, PubMed, Embase and Cochrane Library, were retrieved for randomized controlled trials(RCT), and clinical trials were screened out according to the preset inclusion and exclusion criteria. Then, the study quality was evaluated by the risk assessment tools. Data extraction and analysis were performed by using RevMan 5.3 software for Meta-analysis. Sensitivity analysis and publication bias analysis were made to test the stability and reliability of results. Until December 2018, a total of 1 709 articles were obtained, and finally 10 clinical RCT studies with a total of 1 184 patients were included. As a result, the single administration of TGT showed a significantly better ACR efficiency(RR=1.31, 95%CI[1.15, 1.49], P<0.000 1) than methotrexate(MTX). The combined administration of TGT and MTX showed a significantly better ACR efficiency(RR=1.28, 95%CI[1.20, 1.38], P<0.000 01) than the single administration of MTX. In conclusion, the single administration of TGT and the combined administration of TGT and MTX were more effective in achieving ACR20, ACR50, ACR70 compliance than the single administration of MTX. Further validations based on more RCT studies with high-quality are required.

Correlation of HbA1c with urinary ACR, serum creatinine and eGFR in type-2 diabetes mellitus at Puducherry, South India

Background: Diabetes Mellitus (DM) is a major emerging clinical health problem in this world. Anemia is a common problem in diabetes. Type 2 DM comprises about 90% of diabetic population of any country.Methods: A cross-sectional study carried out among 125 type 2 diabetic mellitus patients’ area at Department of Medicine Aarupadai Veedu Medical college (AVMC) and hospital, Puducherry during the period from May 2018 to October 2018.The objectives of the study were to evaluate the association of HbA1c with urinary ACR, eGFR and serum creatinine in Type 2 diabetes mellitus. Data was analyzed using the SPSS version 20.0 software.Results: The randomly selected study group comprised 100 type 2 DM patients and 25 control peoples of 35-70 years of age. Type 2 DM patients were evaluated of HbA1c, normotensives or hypertensives. FBS, serum creatinine, urinary albumin and creatinine were estimated. Urinary ACR and eGFR and were calculated. The data result was expressed as mean and standard deviation. A probability value is less than 0.05 and it was considered statistically significant.Conclusions: Type 2 diabetes mellitus patients, HbA1c and duration of diabetes were the strongest predictors of micro albuminuria and age was the strongest predictors of a low eGFR. The diabetes was poorly controlled, making the progression to end stage renal failure in concern patients. They measure the prevention of urinary albumin excretion, development of renal abrasion, smoking termination, strict glycaemic control and initiating lipid lowering therapy.

To Evaluate the Therapeutic Efficacy of Vildagliptin on Microalbuminuria in Type 2 Diabetes Mellitus

Introduction: Diabetic kidney disease (DKD) representsone of the most frequent microvascular complications ofdiabetes with an overall prevalence of approximately 40% intype 2 diabetes population. Microalbuminuria is one of themost serious problems in type 2 DM. Vildagliptin, DPP-4inhibitors, is a novel oral anti-diabetic drug for the treatmentof type 2 diabetes mellitus (T2DM). The objective of the studywas to evaluate the therapeautic efficacy of vildagliptin onmicroalbuminuria in type 2 diabetes mellitus.Material and methods: We included in our study 103 T2DMpatients with microalbuminuria. Exclusion criteria: NSAIDsinduced nephropathy, Lupus nephropathy, Polycystic KidneyDisease, Medullary Sponge Kidney, All causes of nephriticand nephrotic syndrome, ESRD due to diabetes mellitus andmoderate to severe hepatic failure. We measured UrinaryACR value of parameters at 0,3.6,9,12 months respectively.Vildagliptin was given to those patient and was observed thatafter giving vildagliptin was there any change in albumin tocreatinine i.e microalbuminuria.Result: The mean of ACR baseline (mean±s.d.) of patientswas 125.1436 ± 58.810 with range 50.7000 - 298.0000 and themedian was 100.0000. The mean of ACR of 3, 6, 9, 12months(mean±s.d.) of patients were 110.3184 ± 57.5647, 106.7340 ±48.8492, 103.7252 ± 45.6745, 95.4466 ± 62.342 respectively.Association of ACR in five groups was not statisticallysignificant (p=0.6118).Conclusion: We found that after 12 months of therapy withvildagliptin, a DPP-4 inhibitor, there was some reduction ofACR and it is approximately 30%

Role of ACR-TIRADS in risk stratification of thyroid nodules

Background: This study was performed to prospectively investigate the diagnostic reliability of the daily use of ACR-TIRADS classification system, in differentiating between a benign and a malignant lesion.Methods: In this prospective observational study, 50 patients with thyroid nodules underwent ultrasound examination and fine needle aspiration. The ultrasound studies were evaluated according to the ACR-TIRADS greyscale characteristics of composition, echogenicity, margins, shape, and echogenic foci. Each feature in a particular USG characteristic was scored and ACR-TIRADS categorization done from 1 to 5. This was compared to FNAC/histopathology findings and risk of malignancy was calculated for each feature and ACR-TIRADS category.Results: Of the 50 nodules included in the study, 38 were found to be benign and 12 were found to be malignant. Risk of malignancy for all ultrasound features showed an increasing trend with higher scored feature. Risk of malignancy for various features were as follows: Composition-cystic (0%), spongiform (0%), solid-cystic (0%) and solid (36%); echogenicity-anechoic(0%), hyperechoic (4%), isoechoic (11%), hypoechoic (47%) and markedly hypoechoic (100%); shape-wider-than-tall (21%) and taller-than-wide (66%); margins-smooth (18%), illdefined (0%), lobulated/irregular (38%) and extrathyroid extension (100%); echogenic foci-none (13%), large comet-tail artefacts (0%), macrocalcification (42%), rim calcification (50%) and punctate echogenic foci (50%). Amongst ACR-TIRADS(TR) categories TR1, TR2 and TR3 had 0% risk while TR4 had 30% and TR5 had 56% risk of malignancy with p value of 0.001.Conclusions: ACR-TIRADS is a high specific, accurate classification system for categorizing the thyroid nodules based on ultrasound features, for assessing the risk of malignancy.

Anti-albuminuric effects of spironolactone and its effect along with ramipril in type-2 diabetic nephropathy

Background: The study was conducted to evaluate and compare the protective effects of spironolactone (alone) and its effects along with ACE inhibitor (ramipril) on diabetics (30-70year) in relation to proteinuria and state of diabetic nephropathy.Methods: A comparative, prospective, non-randomized, non-blinded experimental study was conducted on 56 patients (30-70year) of diagnosed type 2 diabetes mellitus showing proteinuria. Total duration of study was about one year from October 2017 to October 2018. Patients were divided in two groups, group A (n=28, spironolactone 25mg and ramipril 5mg) and group B (n=27, spironolactone 25mg). Subjects were followed over 12weeks and baseline and 12-week urine ACR being compared.Results: Both the group after receiving respective drug were followed for 3month duration and response were assessed by measuring urine ACR value at end of 3months. Mean values of baseline and follow up urine ACR for group A and group B were 471.5±465.62, 244.66±237.54 and 474.88±438.94, 268.42±268.16 respectively, P value found to be >0.05 at 95%C.I. It was observed that percentage reduction of urine ACR were 48% and 43.47% in group A and group B respectively.Conclusions: In the study, it was concluded that spironolactone had significant effect over proteinuria reduction over follow up period in patient with diabetic nephropathy though there was no additional statistically significant advantage of addition of spironolactone and ACE inhibitor over proteinuria reduction. Significant reduction of proteinuria occurred in both group A and group B over 12weeks follow up period, 48 % reduction in group A and 43.47% in group B. This difference proved statistically not significant after applying independent t-test.

Serum Inflammatory Markers Of Diabetic Kidney Disease And Their Correlation To Lipid Parameters Among Diabetic Individuals Of Eastern India

Background : Diabetes mellitus is the leading cause of chronic renal failure . As the period of diabetes progresses there is simultaneous increase of inflammatory markers like high sensitive C reactive protein (hsCRP) with degree of renal involvement, suggested by albumin creatinine ratio and also dyslipidemia in diabetic patients. Materials & Methods: 120 diabetic individuals aged (30-60) yrs, divided in 3 groups of 40 subjects in each, namely: a) newly diagnosed˂5 years b) 5-10 years after diagnosis and c) ≥10 years after diagnosis were recruited as study subjects from a tertiary care hospital in sub Himalayan region. Results : Descriptive studies showing mean values of hsCRP ,ACR & lipid parameters were done in all 3 groups. One-way ANOVAwith post hoc analysis after Bonferroni correction in 3 different groups enunciated a significant and statistical increase (p <.001) of both hsCRP &ACR with duration of diabetes unlike the lipid parameters. hsCRP, ACR, cholesterol & LDLeven illustrated a very significant correlation between each other (p<0.001) , TG to hsCRPwhile HDLshowed no correlation to any parameters. Conclusion: Early detection, monitoring of inflammatory markers hsCRP, ACR & deranged lipid parameters are predictors of diabetic nephropathy that can help in modulating diabetes and its complications.