A Clinical Profile of Hepatitis a Patients in Jakarta, Indonesia

Background: To determine the incidence of hepatitis A infections and the clinical profiles of adult patients admitted to public hospitals in Jakarta, Indonesia. Methods: This was a cross-sectional study that utilised consecutive secondary data from internal medicine wards of seven public hospitals in Jakarta between 2011 and 2013. Eligibility criteria included patients over the age of 18 years and an ICD-10 diagnosis code of B15, acute hepatitis A. Case proportion was reported per 1000 people by dividing incidence per year to total in-ward patients. Clinical profiles were reported descriptively. Laboratory results were compared and categorised into groups of patients aged below and above 25 years old. Results: Data revealed that hospitalisations of patients with hepatitis A had decreased from 2011 to 2013. 289 patients were studied, the majority were young adults (18-25 years old) and their common chief complaints were nausea (36%), fever (24%), and jaundice (21%). Higher bilirubin levels were seen in older patients. There were 13 patients coinfected with hepatitis B, one patient coinfected with hepatitis C, and one patient coinfected with HIV. Conclusions: The proportion of hepatitis A infection amongst adults admitted to public hospitals in Jakarta was low and had decreased during the study period. Most of the patients reported classical clinical manifestations. This study found that the targeted age group may benefit from receiving routine hepatitis A vaccinations

Eletriptan in the management of acute migraine. An update on the evidence for efficacy, safety, and consistent response

Migraine is a multifactorial, neurological and disabling disorder, also characterized by several autonomic symptoms. Triptans, selective serotonin 5-HT1B/1D agonists, are the first-line treatment option for moderate-to-severe headache attacks. In this paper, we review the recent data on eletriptan clinical efficacy, safety, and tolerability, and potential clinically relevant interactions with other drugs. Among triptans, eletriptan shows a consistent and significant clinical efficacy and a good tolerability profile in the treatment of migraine, especially for patients with cardiovascular risk factors without coronary artery disease. It shows the most favorable clinical response, together with sumatriptan injections, zolmitriptan and rizatriptan. Additionally, eletriptan shows the most complex pharmacokinetic/dynamic profile compared with the other triptans. It is metabolized primarily by the CYP3A4 hepatic enzyme and therefore the concomitant administration of CYP3A4-potent inhibitors should be carefully evaluated. A relatively low risk of serotonin syndrome is given by the co-administration with serotoninergic drugs. No clinically relevant interaction has been found with drugs used for migraine prophylactic treatment or other acute drugs, with the exception of ergot derivatives that should not be co-administered with eletriptan

Predicting outcome in acute low back pain using different models of patient profiling

Study Design: Prospective observational study of prognostic indicators, utilising data from a randomised, controlled trial of physiotherapy care of acute low back pain (ALBP) with follow up at 6 weeks, 3 months and 6 months. Objective: To evaluate which patient profile offers the most useful guide to long-term outcome in ALBP. Summary of Background Data: The evidence used to inform prognostic decision-making is derived largely from studies where baseline data is used to predict future status. Clinicians often see patients on multiple occasions so may profile patients in a variety of ways. It is worth considering if better prognostic decisions can be made from alternative profiles. Methods: Clinical, psychological and demographic data were collected from a sample of 54 ALBP patients. Three clinical profiles were developed from information collected at baseline, information collected at 6 weeks, and the change in status between these two time points. A series of regression models were used to determine the independent and relative contributions of these profiles to the prediction of chronic pain and disability. Results: The baseline profile predicted long-term pain only. The 6-week profile predicted both long-term pain and disability. The change profile only predicted long-term disability (p \u3c 0.01). When predicting long-term pain, after the baseline profile had been added to the model, the 6-week profile did not add significantly when forced in at the second step (p \u3e 0.05). A similar result was obtained when the order of entry was reversed. When predicting long-term disability, after the 6-week profile was entered at the first step, the change profile was not significant when forced in at the second step. However, when the change profile was entered at the first step and the 6-week clinical profile was forced in at the second step, a significant contribution of the 6-week profile was found. Conclusions: The profile derived from information collected at 6 weeks provided the best guide to long-term pain and disability. The baseline profile and change in status offered less predictive value

Prospective study of a molecular selection profile for RAS wild type colorectal cancer patients receiving irinotecan-cetuximab

Background: The aim of our study was to evaluate whether a panel of biomarkers, prospectively analysed might be able to predict patients' clinical outcome more accurately than RAS status alone. Methods: K-RAS (exons 2, 3, 4) wild type colorectal cancer patients, candidates to second/third-line cetuximab with chemotherapy were prospectively allocated into 2 groups on the basis of their profile: favourable (BRAF and PIK3CA exon 20 wild type, EGFR GCN ≥ 2.6, HER-3 Rajkumar score ≤ 8, IGF-1 immunostaining < 2) or unfavourable (any of the previous markers altered or mutated). After the introduction of N-RAS status (exons 2, 3, 4) only RAS wild type patients were considered eligible. Results: Forty-six patients were enrolled. Seventeen patients (37%) were allocated to the favourable and 29 patients (63%) to the unfavourable profile. RR in the favourable and unfavourable group was 11/17 (65%) and 2/29 (7%) (p = 0.007) respectively. The favourable group also showed an improved PFS (8months vs. 3months, p < 0.0001) and OS (15months vs. 6months, p < 0.0001). Conclusions: Our results suggest that prospective selection of optimal candidates for cetuximab treatment is feasible and may be able to improve clinical outcom

Clinical Profile and Outcome of Non-Variceal Upper Gastrointestinal Bleeding in Relation to Timing of Endoscopic Procedure in Patients Undergoing Elective Endoscopy

Background: Endoscopy is the most accurate method for diagnosing the source of upper gastrointestinal bleeding. This study was aimed to evaluate the correlation between the timing of elective endoscopy and the length of hospital stay, the amount of transfusion given and incidence of recurrent bleeding or patient mortality. Method: A retrospective study was conducted in all patients with non-variceal upper gastrointestinal bleeding who had experienced elective endoscopy at Cipto Mangunkusumo Hospital between January 2007 and August 2008. Identification of clinical risk using clinical Rockall score was performed at the emergency room. Persistent bleeding, recurrent bleeding, surgical treatment and death were the outcome variables. Statistical analysis was performed using Chi-square/fisher exact test and linear regression. Results: There were 40 eligible cases with mean age of 53 ± 13 years; the greatest occurrence was at the age group of 50-59 years (12%), male (52.5%) and those who had clinical symptom of melena (52.5%). Twenty seven (67.5%) patients had Rockall score of 1-3 points and 13 (32.5%) had 4-6 points. There was only one patient who had adherent clots (Forrest grade II B). Endoscopy results revealed that the most common cause of bleeding was gastric ulcer, which occurred in 12 (30%) patients. There was no correlation between the timing of endoscopic procedures and outcome variable; however the length of hospital stay had a significant correlation with timing of endoscopic procedures. Conclusion: Elective endoscopy does not affect the variables of mortality and recurrent bleeding; however, it affects the length of hospital stay. Further prospective studies are required to find causal relation between them

Computational purification of individual tumor gene expression profiles leads to significant improvements in prognostic prediction.

Tumor heterogeneity is a limiting factor in cancer treatment and in the discovery of biomarkers to personalize it. We describe a computational purification tool, ISOpure, to directly address the effects of variable normal tissue contamination in clinical tumor specimens. ISOpure uses a set of tumor expression profiles and a panel of healthy tissue expression profiles to generate a purified cancer profile for each tumor sample and an estimate of the proportion of RNA originating from cancerous cells. Applying ISOpure before identifying gene signatures leads to significant improvements in the prediction of prognosis and other clinical variables in lung and prostate cancer

Predicting outcome in acute low back pain using different models of patient profiling

This is a non-final version of an article published in final form in Spine, 34(18), 1970 - 1975, 2009. Copyright © 2009 Lippincott Williams & Wilkins, Inc.Study Design. Prospective observational study of prognostic indicators, using data from a randomized, controlled trial of physiotherapy care of acute low back pain (ALBP) with follow-up at 6 weeks, 3 months, and 6 months. Objective. To evaluate which patient profile offers the most useful guide to long-term outcome in ALBP. Summary of Background Data. The evidence used to inform prognostic decision-making is derived largely from studies where baseline data are used to predict future status. Clinicians often see patients on multiple occasions so may profile patients in a variety of ways. It is worth considering if better prognostic decisions can be made from alternative profiles. Methods. Clinical, psychological, and demographic data were collected from a sample of 54 ALBP patients. Three clinical profiles were developed from information collected at baseline, information collected at 6 weeks, and the change in status between these 2 time points. A series of regression models were used to determine the independent and relative contributions of these profiles to the prediction of chronic pain and disability. Results. The baseline profile predicted long-term pain only. The 6-week profile predicted both long-term pain and disability. The change profile only predicted long-term disability (P 0.05). A similar result was obtained when the order of entry was reversed. When predicting long-term disability, after the 6-week profile was entered at the first step, the change profile was not significant when forced in at the second step. However, when the change profile was entered at the first step and the 6-week clinical profile was forced in at the second step, a significant contribution of the 6-week profile was found. Conclusion. The profile derived from information collected at 6 weeks provided the best guide to long-term pain and disability. The baseline profile and change in status offered less predictive value

Personalised mobile services supporting the implementation of clinical guidelines

Telemonitoring is emerging as a compelling application of Body Area Networks (BANs). We describe two health BAN systems developed respectively by a European team and an Australian team and discuss some issues encountered relating to formalization of clinical knowledge to support real-time analysis and interpretation of BAN data. Our example application is an evidence-based telemonitoring and teletreatment application for home-based rehabilitation. The application is intended to support implementation of a clinical guideline for cardiac rehabilitation following myocardial infarction. In addition to this the proposal is to establish the patient’s individual baseline risk profile and, by real-time analysis of BAN data, continually re-assess the current risk level in order to give timely personalised feedback. Static and dynamic risk factors are derived from literature. Many sources express evidence probabilistically, suggesting a requirement for reasoning with uncertainty; elsewhere evidence requires qualitative reasoning: both familiar modes of reasoning in KBSs. However even at this knowledge acquisition stage some issues arise concerning how best to apply the clinical evidence. Furthermore, in cases where insufficient clinical evidence is currently available, telemonitoring can yield large collections of clinical data with the potential for data mining in order to furnish more statistically powerful and accurate clinical evidence