relapse

摘要： Introduction: The increase in cases of drug-resistant pulmonary tuberculosis, especially in endemic areas, is mainly associated with re-treatment, although resistant tubercle bacilli can be easily transmitted between all susceptible persons. Objective: The study aimed to describe pulmonary tuberculosis, risk factors and MDR in new and re-treated suspected patients attending Wad Madani Tuberculosis Center that provides service in central Sudan. Methods: Cross-sectional laboratory based study among 300 presumptive pulmonary tuberculosis patients during 2018 and 2019 was conducted. Cases were divided into new and re-treated. Mycobacterium tuberculosis DNA and rpoB gene of multi-drug resistance (MDR) were detected in sputum samples by GeneXpert assay as manufacturer instructions. Results: Out of 300 suspected participants, 34% (103/300) were diagnosed as pulmonary tuberculosis using GeneXpert method. The frequency of males, the age group from 21 to 40 and rural housing were the most with percentage reach 68% (70/103), 51% (53/103) and 58.3% (60/103) respectively. All observed symptoms were significantly associated with pulmonary tuberculosis. New cases represented 59.2% (61/103) while re-treated was 40.8% (39/103). The overall frequency of MDR patients was 9.7% (10/103) of which 50% (5/103) had relapse situation. Conclusion: It appeared that the cases of MDR pulmonary tuberculosis are on the increase compared to previous findings, recommended measures must be taken to control the spread of tuberculosis and the causes of re-treatment and relapse must be studied.

摘要： BACKGROUND In Korea,infliximab was approved for use in children with ulcerative colitis(UC)in October 2012.AIM To compare the clinical course of UC before and after the introduction of biological agents,and to compare with the IBSEN study.METHODS Patients under 18 years of age,who were diagnosed with UC and followed from January 2003 to October 2020,were included in the study.Group A(n=48)was followed for at least 2 years between January 2003 and October 2012,and Group B(n=62)was followed for at least 2 years between November 2012 and October 2020.We compared endoscopic remission,drug composition,relapse rate,steroidfree period,and the quality of life of each group.We plotted the clinical course of the included patients using the pediatric UC activity index score,and compared our patients with those in the IBSEN study.RESULTS After 2 years of treatment,colonoscopy evaluation revealed different outcomes in the two treatment groups.Remission was confirmed in 14 patients(29.2%)of Group A,and in 31 patients(50.0%)of Group B(P<0.012).The median cumulative corticosteroid-free period was 3.0 years in Group A and 4.4 years in Group B.Steroid-free period of Group B was significantly longer than that of Group A(P<0.001).There was a statistically significant difference between the two groups in evaluation of the relapse rate during the observation period(P<0.001).The plotted clinical course graphs of Group A showed similar proportions to the graphs in the IBSEN study.However,in Group B,the proportion of patients corresponding to curve 1(remission or mild severity after initial high activity)was high at 76%(47/62).CONCLUSION The incidence of relapse has decreased and the steroid-free period has increased after the introduction of the biological agent.The clinical course also showed a different pattern from that of IBSEN study.The active use of biological agents may change the long-term disease course in moderate to severe pediatric UC.

摘要： Most of the literature focused on the proliferative forms of the lupic Glomerulonephritis. Clinicians are increasingly confronted with cases of lupic nephropathy purely mesangial (class II). The aim of our study is to describe the mode of presentation of the class II Lupus nephropathy, evaluate its evolutionary profile, and investigate possible risk factors for therapeutic misresponse, relapse or histological transformation. This is a retrospective descriptive and analytical study conducted in nephrology depratement at the Hassan II university hospital Fez from January 2009 until September 2018. We included 20 patients. The average age was 33.8 ± 7.25 years [22 - 50 years]. Nephropathy was inaugurated in half of the cases. The mean time of onset of nephropathy in relation to the lupic disease was 36.7 ± 45.4 months [1 - 144 months]. The main reason for consultation was non-nephrotic proteinuria (65%). Renal failure revealed diagnosis in three patients. All patients had a positive immunologic assessment. 90% of our patients received oral corticosteroid therapy with immunosuppressive therapy in 3 cases. Remission has been noted in all of our patients. After an average follow-up period of 39 ± 23 months [6 - 92 months], 45% relapsed. A second biopsy was performed in 80% of patients showing histologic transformation in four patients, requiring immunosuppressive therapy. The analytical study showed that the occurrence of relapse was significantly related to the presence of a known Lupus and its seniority. Proteinuria at 12 months was also significantly higher in the relapsed group. One patient died as a result of neurological complications. Another has Evolved into chronic end stage renal failure and has been put on hemodialysis.

摘要： To control the pandemic,efficient vaccines must be applied to the population,including patients with autoimmune diseases.Therefore,one can expect that coronavirus disease 2019(COVID-19)vaccines may influence the underlying autoimmune processes in these patients.Additionally,it is essential to understand whether COVID-19 vaccines would be effective,safe,and provide long-lasting immunological protection and memory.However,the currently available and approved COVID-19 vaccines turned out to be safe,effective,and reliable in patients with autoimmune inflammatory and rheumatic diseases.Furthermore,most patients said they felt safer after getting vaccinations for COVID-19 and reported enhanced overall quality of life and psychological wellbeing.In general,the COVID-19 vaccines have been highly tolerated by autoimmune patients.Such findings might comfort patients who are reluctant to use COVID-19 vaccines and assist doctors in guiding their patients into receiving vaccinations more easily and quickly.

摘要： BACKGROUND Cronkhite-Canada syndrome(CCS)is a rare nonhereditary disease characterized by chronic diarrhoea,diffuse gastrointestinal polyposis and ectodermal manifestations.The lethality of CCS can be up to 50%if it is untreated or if treatment is delayed or inadequate.More than 35%of the patients do not achieve long-term clinical remission after corticosteroid administration,with relapse occurring during or after the cessation of glucocorticoid use.The optimal strategy of maintenance therapy of this disease is controversial.CASE SUMMARY A 47-year-old man presented to the hospital with a 3-mo history of frequent watery diarrhoea,accompanied by macular skin pigmentation that included the palms and soles,and onychodystrophy of the fingernails and toenails.Gastroscopy and colonoscopy revealed numerous polyps in the stomach and colon.After other possibilities were ruled out by a series of examinations,CCS was diagnosed and treated with prednisone.The patient took prednisone for more than 1 year before achieving complete resolution of his symptoms and endoscopic findings.The patient was then given prednisone 5 mg/d for 6 mo of maintenance therapy.With clinical improvement and polyp regression,prednisone was discontinued.Eight mo after the discontinuation of prednisone,the diarrhoea and gastrointestinal polyps relapsed.Therefore,the patient was given the same dose of prednisone,and complete remission was achieved again.CONCLUSION It is necessary to extend the duration of prednisone maintenance therapy for CCS.Prednisone is still effective when readministered after relapse.Surveillance endoscopy at intervals of 1 year or less is recommended to assess mucosal disease activity.

摘要： BACKGROUND Electroconvulsive therapy(ECT)is used to treat major depressive disorder(MDD).Relapse is often observed even after successful ECT,followed by adequate pharmaceutical treatment for MDD.AIM To investigate the diagnostic factors and treatment strategies associated with depression relapse.METHODS We analyzed the relationships between relapse,the diagnostic change from MDD to bipolar disorder(BP),and treatment after the initial ECT.We performed a 3-year retrospective study of the prognoses of 85 patients of the Shiga University of Medical Science Hospital.The relative risk of relapse of depressive symptoms was calculated based on the diagnostic change from MDD to BP.A receiver operating characteristic(ROC)curve was generated to evaluate the predictive accuracy of diagnostic changes from MDD to BP based on the duration between the first course of ECT and the relapse of depressive symptoms.RESULTS Eighty-five patients initially diagnosed with MDD and successfully treated with ECT were enrolled in the study.Compared with the MDD participants,more BP patients experienced relapses and required continuation and/or maintenance ECT to maintain remission(65.6%vs 15.1%,P<0.001;relative risk=4.35,95%CI:2.19-8.63,P<0.001).Twenty-nine patients experienced relapses during the three-year follow-up.In 21(72.4%,21/29)patients with relapse,the diagnosis was changed from MDD to BP.The duration from the first course of ECT to relapse was shorter for the BP patients than for the MDD patients(9.63±10.4 mo vs 3.38±3.77 mo,P=0.022);for most patients,the interval was less than one month.The relative risk of depressive symptoms based on diagnostic changes was 4.35(95%confidence interval:2.19–8.63,P<0.001),and the area under the ROC curve for detecting diagnostic changes based on relapse duration was 0.756(95%CI:0.562-0.895,P=0.007).CONCLUSION It may be beneficial to suspect BP and change the treatment strategy from MDD to BP for patients experiencing an early relapse.

摘要： Nucleos(t)ide analogs(NUC)are the first-line therapy for patients with chronic hepatitis B(CHB)recommended by most current guidelines.NUC therapy decreases progression of liver disease,reduces the risk of liver-related complications,and improves the quality of life of patients with CHB.Although indefinite or long-term NUC therapy is usually recommended,this strategy raises several concerns,such as side-effects,adherence,costs,and patient willingness to stop therapy.Recent data showed the feasibility,efficacy,and safety of stopping antiviral therapy in carefully selected CHB patients,leading to its incorporation in international guidelines.Patients who discontinue NUC have a higher likelihood of hepatitis B surface antigen(HBsAg)loss compared to patients who continue on therapy.Recommendations pertaining endpoints allowing safety discontinuation of NUC therapy differ among international guidelines.For hepatitis B e antigen(HBeAg)-positive patients,durable HBeAg seroconversion is considered an acceptable treatment endpoint.For HBeAg-negative patients,some guidelines propose undetectability hepatitis B virus DNA for at least 2 or 3 years,while others consider HBsAg loss as the only acceptable endpoint.CHB patients who stop therapy should remain under strict clinical and laboratorial follow-up protocols to detect and manage relapses in a timely manner.No reliable predictor of relapse has been consistently identified to date,although quantitative HBsAg has been increasingly studied as a reliable biomarker to predict safe NUC discontinuation.

摘要： Long-term antiviral treatment of chronic hepatitis B patients has been proven to be beneficial in reducing liver-related complications.However,lengthy periods of daily administration of medication have some inevitable drawbacks,including decreased medication adherence,increased cost of treatment,and possible longterm side effects.Currently,discontinuation of antiviral agent has become the strategy of interest to many hepatologists,as it might alleviate the aforementioned drawbacks and increase the probability of achieving functional cure.This review focuses on the current evidence of the outcomes following stopping antiviral treatment and the factors associated with subsequent hepatitis B virus relapse,hepatitis B surface antigen clearance,and unmet needs.

摘要： BACKGROUND Distal cholangiocarcinoma(DCC)presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis.Curative resection is currently the most appropriate therapy for patients with DCC because of the lack of effective adjuvant therapies.Therefore,it is important to accurately predict the prognosis for formulating a reasonable treatment plan and avoiding unnecessary surgical trauma.AIM To minimize the interference of obstructive jaundice on carbohydrate antigen 19-9(CA19-9)level by adapting CA19-9 toγ-glutamyltransferase(GGT)as an indicator,to determine the strong associations between CA19-9/GGT and postoperative neoplasm recurrence and long-term outcome of DCC.METHODS We enrolled 186 patients who were diagnosed with DCC between January 2010 and December 2019 and performed radical excision with strict criteria as follows in our hospital.Receiver operating characteristic curves were drawn according to preoperative CA19-9/GGT and 1-year survival.Based on this,patients were divided into two groups(group 1,low-ratio,n=81;group 2,high-ratio,n=105).Afterwards,by the way of univariate and multivariate analysis,the risk factors influencing postoperative tumor recrudesce and long-term prognosis of patients with DCC were screened out.RESULTS Optimum cut-off value of CA19-9/GGT was 0.12.Patients in group 2 represented higher CA19-9 and lymphatic metastasis rate accompanied by lower GGT,when compared with group 1(P<0.05).The 1-,3-and 5-year overall survival rates of patients in groups 1 and 2 were 88.3%,59.2%and 48.1%,and 61.0%,13.6%and 13.6%,respectively(P=0.000).Multivariate analysis indicated that CA19-9/GGT,lymphatic metastasis and tumor differentiation were independent risk factors for tumor recurrence and long-term prognosis of DCC.CONCLUSION Elevation of CA19-9/GGT performed better as a biomarker of aggressive carcinoma and predictor of poor clinical outcomes by reducing the effect of obstruction of biliary tract on CA19-9 concentration in patients with DCC.