Immune-related adverse kidney events by immune checkpoint inhibitors; a narrative review on current studies

Chemotherapy-associated renal injury is considered one of the major concerns among nephrological and oncological practice. The use of novel anti-neoplastic therapies that target carcinomas has helped in the detection of this form of renal injury. Immune checkpoint inhibitors (ICPIs) are a group of monoclonal antibodies targeting inhibitory receptors that exist on tumor cells and T cells. ICPIs are able to suppress tumors that might have escaped from the immune surveillance. Meanwhile, although ICPIs have shown promising efficacy in cancer treatment, their immune-related side effects limit their widespread use in cancer therapy schedules. One of the major side effects limiting ICPIs' usage is nephrotoxicity. Glomerular disease, acute interstitial nephritis (AIN), and acute tubular necrosis (ATN) are considered different infusion-related adverse events. Infiltration of eosinophils, T lymphocytes, and plasma cells, as well as interstitial inflammation and edema, leading to acute tubulointerstitial nephritis (ATIN). It is conceivable that the rupture of self-tolerance by ICPIs induces an autoimmune reaction against some specific self-antigens in the organs including kidneys. The exact nature of the antigen is unclear; however, it is possible that it is found in the renal tubular cells, as indicated by a greater frequency of ATIN in kidney biopsies. The current review paper discusses the relationship between ICPIs therapy and kidney disorders or more specifically, their possible role in renal damage along with renal toxicity profile in the setting of ICPIs treatment

Correlation of pathologic findings of IgA nephropathy with clinical and laboratory data with regards to the Oxford-MEST-C classification

The Oxford classification system has been found to have significant correlations with clinical and laboratory data in patients with IgA nephropathy. Studies have shown that higher grades of mesangial hypercellularity and endocapillary hypercellularity are associated with younger age, higher blood pressure, and higher levels of proteinuria. Segmental glomerulosclerosis has been found to be associated with more severe proteinuria, lower serum albumin levels, and higher levels of creatinine. Tubular atrophy/interstitial fibrosis has been associated with older age, higher serum creatinine levels, and lower estimated glomerular filtration rates

Collapsing glomerulopathy following COVID 19 infection; a mini-review to the recent data

Collapsing glomerulopathy has been delineated as the most common morphological feature in COVID-19 individuals presenting with rapidly progressive renal failure and massive proteinuria. This condition, also known as COVID-19-associated nephropathy, has a poor prognosis. In COVID-19-related collapsing glomerulopathy, an immune dysfunction-mediated "second hit" to podocytes of African origin with APOL1 risk alleles was suggested. However, further research is still required to clarify this aspect of glomerulopathy

Artificial Intelligence: A New Paradigm in Obstetrics and Gynecology Research and Clinical Practice

Artificial intelligence (AI) is growing exponentially in various fields, including medicine. This paper reviews the pertinent aspects of AI in obstetrics and gynecology (OB/GYN) and how these can be applied to improve patient outcomes and reduce the healthcare costs and workload for clinicians. Herein, we will address current AI uses in OB/GYN, and the use of AI as a tool to interpret fetal heart rate (FHR) and cardiotocography (CTG) to aid in the detection of preterm labor, pregnancy complications, and review discrepancies in its interpretation between clinicians to reduce maternal and infant morbidity and mortality. AI systems can be used as tools to create algorithms identifying asymptomatic women with short cervical length who are at risk of preterm birth. Additionally, the benefits of using the vast data capacity of AI storage can assist in determining the risk factors for preterm labor using multiomics and extensive genomic data. In the field of gynecological surgery, the use of augmented reality helps surgeons detect vital structures, thus decreasing complications, reducing operative time, and helping surgeons in training to practice in a realistic setting. Using three-dimensional (3D) printers can provide materials that mimic real tissues and also helps trainees to practice on a realistic model. Furthermore, 3D imaging allows better depth perception than its two-dimensional (2D) counterpart, allowing the surgeon to create preoperative plans according to tissue depth and dimensions. Although AI has some limitations, this new technology can improve the prognosis and management of patients, reduce healthcare costs, and help OB/GYN practitioners to reduce their workload and increase their efficiency and accuracy by incorporating AI systems into their daily practice. AI has the potential to guide practitioners in decision-making, reaching a diagnosis, and improving case management. It can reduce healthcare costs by decreasing medical errors and providing more dependable predictions. AI systems can accurately provide information on the large array of patients in clinical settings, although more robust data is required

Study of root aqueous extract of Prosopis farcta effect on wound healing of diabetic adult male rats

Background and Aim: Wound healing is a complex process which is divided into four overlapping phases: heamostasis, inflammation, proliferation, and remodeling. In diabetic patients, progression of healing takes longer and thus using new medication to accelerate it is required. It is expected that Prosopis farcta which has antibacterial, antidiabetic and antiinflammation effects will facilitate diabetic wound healing. Thus, the present study aimed at investigation the effect of aqueous extract of Prosopis farcta root on wound healing in diabetic rats. Materials and Methods: In this experimental study, 18 wistar male rats were randomly divided into 3 equal groups: normal control, Diabetic- control, and experimental group (diabetes treatment with root extract). Diabetes was induced through intraperitoneally injection of Streptozocin (STZ). Then, in all groups, in two lateral posterial parts 3 holes (4 mm in diameter) were punched. For 2days, 3 times on each, the experimental group was locally treated with root aqueous extract of Prosopis farcta. In the control groups normal saline was used in the same way. On the 4th, 8th and 10th day after punching samples were collected from the healing hole (which were now 6 mm in diameter). Histological observations revealed inflammatory cells, reepithelization, and neovascularization in the areas. Results: Significant changes in proliferation of inflammatory cells (on the 10th day), epithelium thickness (on the 4th and 8th day,), more angiogenesis (on the 4th- 10th day) in the experimental wounds were compared with those in the diabetic control group (Respectively P<0.001, P<0.01). Conclusion: Considering the above findings, the extract of Prosopis farcta root, has effective roles on wound healing in diabetic rats, probably due to its anti- inflammatory, reepithelization, and neovascularization properties. However, more studies are needed in this respect

Cancer recurrence or aggravation following COVID-19 vaccination

COVID-19 infection has been a global health issue in the past recent years and numerous topics are studied in order to discover its pathophysiology and potential side effects. The potential for disease recurrence following the administration of the COVID-19 vaccine is one of the issues that has recently attracted attention. Several studies have revealed that the COVID-19 vaccines, like other vaccines, may have side effects and, in some cases, they may even deteriorate the underlying illnesses, such as rheumatic diseases, autoimmune diseases, and cancers. The effectiveness and safety of the COVID-19 vaccine for patients with malignancies are one of the factors that are considered regarding this vaccine. Lymph node involvement, disease recurrence, and potential paraclinical changes after receiving the COVID-19 vaccine are some of the concerns of patients with malignancy. In this mini-review, we attempted to investigate cases of cancer recurrence or recovery as well as lymphadenopathy following vaccination

Assessing the Relationship between Gastrointestinal and Pancreatic Neuroendocrine Tumor Grade and Overall Survival: A Systematic Review and Meta-Analysis

Background: Neuroendocrine tumors (NET) are a rare group of epithelial neoplasms present in the gastrointestinal tract (GI) (67.5%) and bronchopulmonary tree (25.3–30%), and in 15% of cases, their primary sites cannot be identified. Although endoscopic screening, improvements in pathological techniques, and early detection have shown improvements in NET survival rates, the prognosis of advanced, metastatic, and poorly differentiated NET is very poor. In this study, we aimed to evaluate the effect of gastrointestinal and pancreatic (GEPs) NETs’ grade on overall survival. Method: We searched observational studies describing the overall survival or prognostic factors of primary GEP NETs from May 2011–May 2021 following the PRISMA guidelines. Studies describing the effect of primary grade 3 GEP NETs on overall survival were included. A meta-analysis was performed, and a pooled hazard ratio and their 95% confidence interval (95% CI) were obtained. Forest plots were created using random effects models and a sensitivity analysis was performed to account for the heterogeneity. Results: Seven studies with 7692 confirmed patients were included. In our meta-analysis, grade 3 GEP NETs were associated with higher odds of poor survival (pooled HR: 2.73; 95% CI: 1.36–5.47; p = 0.005), with a 92% heterogeneity between studies (p p p = 0.72; I2 = 0%). Conclusions: Our meta-analysis found that grade 3 GEP NETs are associated with poor survival and additional future studies are needed to identify other risk factors associated with poor survival in GEP NETs to improve their mortality

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)