International journal of clinical practice
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Int. J. Clin. Pract. · Apr 2021
Renal expression of PLA2R, THSD7A, and IgG4 in patients with membranous nephropathy and correlation with clinical findings.
Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in nondiabetic adults. M-type phospholipase A2 receptor (PLA2R), thrombospondin type-1 domain-containing 7A (THSD7A) are known as target podocyte antigens in membranous nephropathy (MN). Antibodies against these podocyte antigens are used in the initiation of treatment and response monitoring. However, the relationship between renal podocyte antigens and treatment response is not clear yet. We evaluated the relationship between immunohistochemical PLA2R, THSD7A and IgG4 staining, clinical findings and treatment response in kidney biopsies. ⋯ It was found no correlation between PLA2R, THSD7A and IgG4 staining in kidney tissue and treatment response. Interestingly, dual positivity (PLA2R + THSD7A) was detected only in primary MN.
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Int. J. Clin. Pract. · Apr 2021
Outcomes in VKA-Treated Patients with Atrial Fibrillation and Chronic Kidney Disease: Clinical Trials vs 'Real-World'.
Our objectives were to evaluate the risk of adverse events in a 'real-world' vs 'clinical trial' cohort of atrial fibrillation (AF) patients with chronic kidney disease (CKD). ⋯ Vitamin K antagonist-treated AF patients with CKD are exposed to significant annual rates of major adverse events including all-cause mortality. This risk may be under-appreciated in the idealised environment of randomised controlled trials.
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Int. J. Clin. Pract. · Apr 2021
Randomized Controlled TrialLung deposition and systemic bioavailability of dose delivered to smoker compared to non-smoker COPD subjects.
Inhaled drugs are the most commonly used class of medications for COPD subjects. No studies have been performed to assess the influence of smoking on lung deposition of aerosolized medication, especially for the exacerbated COPD subject. The present study aimed to assess the influence of smoking on the lung deposition of the aerosol delivered to exacerbated COPD subjects. ⋯ The study demonstrated that smoking reduced the lung deposition of inhaled salbutamol delivered by nebulizer or pMDI. However, the smoking effect on cytochrome p450 was observed to increase systemic absorption of the ingested portion of the inhaled dose. The lower lung deposition and possible higher systemic absorption should be taken into consideration while prescribing inhaled medication to COPD smokers especially exacerbated patients that need ventilation. Further studies are needed.
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Int. J. Clin. Pract. · Apr 2021
The perception of nurses towards their roles during the COVID-19 pandemic.
The study aims to evaluate the available content on local Jordanian Facebook nursing groups regarding perception of their roles during coronavirus pandemic. ⋯ Nurses in general, nursing leaders and managers are in the forefront of responding to the unique needs of their workforces during the COVID-19 crisis. There must be an explicit adoption of strategy in all clinical environments and other clinical institutions to enhance the nurse image among themselves and community members.
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Int. J. Clin. Pract. · Apr 2021
Diagnostic and investigative approach of consultant neurologists in a real-world clinical setting: A pilot study.
Whilst core curricula in neurology are nationally standardised, in real-world clinical practice, different approaches may be taken by individual consultants. The aims of this study were to investigate differences by assessing: (a) variance in diagnostic and investigative practice, using a case-based analysis of inter-rater agreement; (b) potential importance of any differences in terms of patient care; (c) relationships between clinical experience, diagnostic certainty, diagnostic peer-agreement and investigative approach. The objective was to develop novel individualised metrics to facilitate reflection and appraisal. ⋯ It appears that variance in diagnostic and investigative practice between consultant neurologists exists and may result in differing management. Mean diagnostic certainty was associated with greater diagnostic peer-agreement and lower investigation rates. Metrics reflecting concordance with peers, and relationships to diagnostic confidence, could be developed in larger cohorts to inform reflective practice.