Seronegative Rheumatoid Arthritis Secondary to Immune Checkpoint Inhibitor in a Renal Cell Carcinoma Patient Encountered in a Rural Community-Based Rheumatology Clinic: A Case Report.

Immune checkpoint inhibitors (ICIs) are a widely used class of cancer immunotherapy. Those drugs have improved the treatment of cancer since its introduction in the 2000s. Nivolumab is an ICI that can be used for previously untreated renal cell carcinoma. Immune-related adverse events (irAEs) are a type of adverse event of immunotherapy that is associated with an overreactive immune system. We report a case of a 69-year-old Caucasian man with stage IV renal cell carcinoma who presented to a rural community-based rheumatology clinic referred by his oncologist, after starting to develop morning stiffness for at least three hours, joint swelling, warmth, and erythema five months after starting immunotherapy with nivolumab. The patient was diagnosed with seronegative rheumatoid arthritis secondary to ICIs and required a higher dose of prednisone (up to 40 mg per day) with methotrexate to achieve remission. With the widespread availability of ICIs, rheumatologic irAEs can be encountered in a rural community-based practice. Practicing physicians taking care of cancer patients need to be aware of the adverse effect of ICIs.

Comparison of choroidal thickness in eyes of diabetic patients with eyes of healthy individuals using optical coherence tomography in a tertiary care hospital.

OBJECTIVES: To compare the choroidal thickness in eyes of diabetic patients with eyes of age matched controls using optical coherence tomography in a tertiary care hospital. METHODS: This Cross sectional study was conducted at the Department of Ophthalmology, Jinnah Postgraduate Medical Centre Karachi, for six months from13thJanuary 2020 to13thJuly 2020. The study group comprised of 44 patients with 88 eyes. Patients who fulfill the inclusion criteria that is age ranging from 35 to 80years, either gender, known case of diabetes mellitus and having any type of diabetic retinopathy (HbA1c >7), non-diabetic healthy individuals (HbA1c < 7) and those giving informed consent were included in the study. However, patients having active ocular infections, history of myocardial infarction, stroke, uveitis, any ocular surgery, lasers, intravitreal injections, poor fundus view and not giving consent were excluded. A pre-designed proforma was filled. A baseline ocular examination was performed and choroidal thickness was assessed from retinal pigment epithelium to choroid sclera junction in diabetic and healthy participants of the study group using high resolution Swept source OCT (DRI-OCT-2 Triton; Topcon). RESULTS: The average age of the patients was 39.41±15.95 years. According to our study mean central subfoveal choroidal thickness in diabetic eyes was 268.5 ± 66.22 (95% CI 240 - 297) and in non-diabetic healthy participants it was 339.3 ± 71.49 (95% CI 308 - 369) with a p-value of 0.001. However, average choroidal thickness was 261.8 ± 61.93 (95% CI 235 - 288) and 336.0 ± 74.35 (95% CI 304 - 367) in diabetic and non-diabetic healthy population with a p-value of 0.001. Choroidal thickness comparison between gender in diabetic and non-diabetic population also showed similar trend. CONCLUSION: In this study, mean central choroidal thickness as well as average choroidal thickness was significantly reduced in eyes having diabetic retinopathy as compared to participants with non-diabetic healthy eyes. These findings indicate that changes in choroid may be a probable route in the pathogenesis of diabetic retinopathy.

Antibiotic Self-Prescribing Trends, Experiences and Attitudes in Upper Respiratory Tract Infection among Pharmacy and Non-Pharmacy Students: A Study from Lahore.

Pharmacists are the custodians of drugs; hence their education, training, behaviors and experiences would affect the future use of drugs at community and hospital pharmacies. Therefore, we aimed at evaluating the self-prescribing antibiotic trends, knowledge and attitudes among pharmacy and non-pharmacy students. We found that pharmacy students had higher risks of experiencing URIs related symptoms such as cough (RR; 1.7, p = 0.002), allergy (RR; 2.07, p = 0.03) and running nose (RR; 3.17, p<0.005), compared to non-pharmacy students -resulting in higher probabilities of selecting cough syrups (OR; 2.3, p<0.005), anti-histamines (OR; 1.8, p = 0.036) and anti-inflammatory/anti-pyretic (OR; 2.4, p<0.005) drugs. Likewise, bachelor's degree pupils (OR; 2, p = 0.045), urban area residents (OR; 2.44; p = 0.002) and pharmacy students (OR; 2.9, p<0.005) exhibited higher propensities of antibiotic self-use-notable classes include, b-lactams (45.9%) followed by macrolides (26.5%) and augmentin (28.94%), respectively. Surprisingly, pharmacy and non-pharmacy students had higher odds of using antibiotics in common cold (OR; 3.2, p<0.005) and pain (OR; 2.37, p = 0.015), respectively. Unlike non-pharmacy students, pharmacy students were likely to select alternative therapy, such as Joshanda (OR; 2.22, p = 0.011) and were well acquainted with antibiotic hazards, with 77% reduction in risk of antibiotics re-use. In conclusion, university students exhibited antibiotic self-prescribing trends in conditions that does not warrant their use, thus are irrational users. The pharmacy education confers very little benefit to rational self-prescribing practices among students, while non-pharmacy students are more vulnerable to repeated antibiotic usage. Thus, the educational and training modules should be designed for university students to disseminate targeted information regarding the potential hazards of antibiotic self-use and importance of consultation with qualified and registered medical doctor/pharmacist before starting with antibiotics.

The prevalence and risk factors of retinopathy of prematurity among preterm babies admitted to Soba Neonatal Intensive Care Unit.

This is a prospective hospital based study conducted in Soba University Hospital (SUH), Neonatal Intensive Care Unit (NICU) between January 2012 and January 2013, to determine the prevalence and risk factors of retinopathy of prematurity (ROP) among preterm babies admitted to Soba NICU and to assess the outcome of those babies. Ninety-two neonates with gestational age less than 34 weeks at birth were included in the study. Thirty-three of them were males and 59 were females. All of them were admitted to the NICU due to prematurity. Data was collected in a structured questionnaire. Thirty-four infants (37%) developed ROP in one or both eyes; 12 (35.3%) of them developed stage 3 and underwent laser therapy, 2 of them had aggressive posterior form, which was treated with Evastin injection. Seven (20.3%) neonates diagnosed as stage 2, and 13 (37.7%) had stage 1. Statistically, there were significant relationships between ROP and gestational age, birth weight (BW), oxygen therapy, sepsis, and blood transfusion (p=0.000). No significant relationship was found between the occurrence of ROP and sex of the baby, respiratory distress syndrome (RDS), hyperbilirubineamia, intraventricular haemorrage (IVH) and necrotizing enterocolitis (NEC), p >0.000 in all of them. The prevalence of ROP in this study was 37%. Low BW, low gestational age, oxygen therapy, and blood transfusion were all significant risk factors for ROP. ROP should be highlighted in Sudan, and screening program should be recommended for all premature babies.