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Udomkarnjananun, Suwasin; Schagen, Maaike R.; Hesselink, Dennis A.
doi: 10.2478/abm-2024-0015pmid: 39175954
AbstractImmunosuppressive medications play a pivotal role in kidney transplantation, and the calcineurin inhibitors (CNIs), including cyclosporine A (CsA) and tacrolimus (TAC), are considered as the backbone of maintenance immunosuppressive regimens. Since the introduction of CNIs in kidney transplantation, the incidence of acute rejection has decreased, and allograft survival has improved significantly. However, CNI nephrotoxicity has been a major concern, believed to heavily impact long-term allograft survival and function. To address this concern, several CNI-sparing regimens were developed and studied in randomized, controlled, clinical trials, aiming to reduce CNI exposure and preserve long-term allograft function. However, more recent information has revealed that CNI nephrotoxicity is not the primary cause of late allograft failure, and its histopathology is neither specific nor pathognomonic. In this review, we discuss the historical development of maintenance immunosuppressive regimens in kidney transplantation, covering the early era of transplantation, the CNI-sparing era, and the current era where the alloimmune response, rather than CNI nephrotoxicity, appears to be the major contributor to late allograft failure. Our goal is to provide a chronological overview of the development of maintenance immunosuppressive regimens and summarize the most recent information for clinicians caring for kidney transplant recipients (KTRs).
Huang, Lipeng; Li, Shanshan; Jiang, Ronglin; Lei, Shu; Wu, Jiannong; Huang, Liquan; Zhu, Meifei
doi: 10.2478/abm-2024-0016pmid: 39175949
AbstractBackgroundCatheter-related candidemia (CRC) is a serious catheter-related bloodstream infection (CRBSI) caused by Candida spp., with higher mortality than CRBSIs caused by other organisms.ObjectiveTo identify the risk factors for Candida CRBSI. The clinical characteristics of 297 patients with CRBSI in a local hospital from January 2007 to June 2015 were collected, including 33 Candida CRBSI and 264 non-Candida CRBSI.MethodThe associations of Candida CRBSI with the clinical variables were examined using univariate and multivariate analyses.ResultsMultivariate analysis showed that glucocorticoid use (odds ratio [OR] = 10.313, 95% confidence interval [CI] = 2.032–52.330, P = 0.005) and parenteral nutrition (OR = 5.400, 95% CI = 0.472–61.752, P = 0.0175) were independent risk factors for Candida CRBSI. The most prevalent species were Candida tropicalis (42.4%) and Candida albicans (36.36%). Of the 33 Candida CRBSI cases, 31 (93.93%) had indwelling central venous catheters (CVC) for ≥14 d. The mortality of Candida CRBSI was remarkably higher than that of bacteria CRBSI. Patients with timely catheter removal and appropriate antifungal treatment had dramatically increased 28-d survival compared with those with untimely catheter removal + inappropriate antifungal treatment (88.89% vs. 0, P = 0.006).ConclusionThe study identified glucocorticoid use and parenteral nutrition as independent risk factors for Candida CRBSI. The outcome of candidemia was associated with the duration of CVC indwelling and antifungal treatment.
Zakerihamidi, Maryam; Hassan, Boskabadi; Samin, Amirkhani
doi: 10.2478/abm-2024-0017pmid: 39175955
AbstractBackgroundThe antioxidant system in a preterm neonate is premature. The imbalance between the prooxidant and antioxidant systems can make these neonates prone to oxidative stress. Birth asphyxia is one of the factors that can disturb this balance.ObjectiveWe studied the prooxidant–antioxidant balance (PAB) in the diagnosis and developmental prognosis of preterm neonates with asphyxia.MethodsThis cohort study has been conducted between 2016 and 2022 with 2 years follow-up on 183 premature neonates admitted to Ghaem Hospital Mashhad, by using a convenience sampling method. The data-collection tool and the researcher-made checklist included the mothers' and the neonate's information, and the third segment included laboratory information. PAB was studied by using standard solutions and the Enzyme immunoassays (ELISA) method. After discharging the newborns from the hospital, they were under follow-up at 6 months, 12 months, 18 months, and 24 months, by using the Denver II test. PAB was compared among newborns with asphyxia, those without asphyxia, and also newborns with normal and abnormal outcomes in both groups.ResultsThe mean ± standard deviation of the PAB factor reported is as follows: in newborns without asphyxia (21.00 ± 18.14 HK), those with asphyxia (31.00 ± 45.42 HK), in newborns with asphyxia having abnormal outcomes (40.00 ± 60.84 HK), and those having normal outcomes (21.00 ± 18.67 HK) (P ≤ 0.05). PAB results >25 HK have been used for the diagnosis of asphyxia prognosis in newborns, with 83.3% sensitivity and 81% specificity.ConclusionThe PAB index showed a significant increase after asphyxia. It can be used as a diagnostic marker for the prognosis of premature newborns with asphyxia. Thus, diagnosis and prognosis of asphyxia in premature newborns can be predicted by using the PAB index.
Wongjarit, Kanphai; Ukritchon, Sittichai
doi: 10.2478/abm-2024-0018pmid: 39175952
AbstractBackgroundDisseminated gonococcal infection (DGI) caused by Neisseria gonorrhoeae commonly presents with the classic triad of polyarthritis, tenosynovitis, and dermatitis. There is no clinical and microbiological data of DGI in Thailand.ObjectiveTo study the clinical features, outcomes of treatments, and antimicrobial susceptibility data of DGI patients.MethodsAll medical records of DGI patients at King Chulalongkorn Memorial Hospital (KCMH) from January 2002 through September 2019 were reviewed and analyzed. The patients were defined as definite DGI (the clinical features and the evidence of gonococcal infection) and probable DGI (clinical features with response to treatment with third-generation cephalosporins and with no evidence of gonococcal infection).ResultsThere were 41 patients (27 definite and 14 probable DGI), with a male-to-female ratio of 1:1.4 and median age of 30 years. The middle-age and elderly group accounted for 20% of the patients. The clinical features were fever (90.27%), arthritis (92.7%), tenosynovitis (63.4%), and genitourinary symptoms (29.3%). The most common pattern of joint involvement was oligoarthritis (52.6%). The majority of the patients had good clinical outcomes, while complications occurred in 4.8% of the patients including osteomyelitis and pyomyositis. All 19 antimicrobial-susceptibility results were susceptible to ceftriaxone.ConclusionsDuring the past 2 decades in KCMH, the age of the DGI patients tends to be older, and there is no gender difference as in the historical studies. The clinical features are still similar to the previous studies. The majority of the patients had good clinical outcomes. There is no case of ceftriaxone-resistant N. gonorrhoeae.
doi: 10.2478/abm-2024-0019pmid: 39175950
AbstractBackgroundDuring breast cancer treatment, approximately half of the patients are prescribed psychotropic medication, such as selective serotonin reuptake inhibitors (SSRIs). Escitalopram oxalate is an SSRI used as an antidepressant.ObjectivesIn this study, by creating a breast cancer microenvironment with THP-1, MCF-7 and MDA-MB-231 breast cancer co-culture models were created.MethodsMCF-7, MDA-MB-231, and THP-1 cell lines to determine the concentration range of the cytotoxic effect of escitalopram oxalate MTS and MTT test were used. IC50 values were determined by the xCELLigence real-time cell analysis (RTCA) system. Apoptotic activities and cytokine levels were determined by flow cytometry.ResultsIn the xCELLigence real-time analysis made according to the results, the IC50 value of escitalopram oxalate was measured as 13.7 μM for MCF-7 and 10.9 μM for MDA-MB-231. The IC50 value was measured as 54.6 μM for MCF-7 and 58.4 μM for MDA-MB-231 in xCELLigence analysis with tamoxifen. According to the MTS test results, the IC50 value of tamoxifen for THP-1 was 92.03 μM and the IC50 value for escitalopram oxalate was 95.32 μM. In the co-culture model, the immunological effects of escitalopram oxalate on MCF-7 cells were 2.8%, 11.1%, 15.6%, 10.6%, and 12.1% for interleukin (IL)-1β, IL-6, IL-8, IL-10, and TNF-α, respectively, while MDA effects on MB-231 cells, respectively, were 2.1%, 15.9%, 16.2%, 8.8%, and 11.8%.ConclusionsAccording to the results obtained, it was concluded that the immunological effects of escitalopram oxalate are more effective than tamoxifen and that it can be used as an adjunctive agent in breast cancer treatment.
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