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Sep 2024 DOI 10.14302/issn.2694-2275.jzr-24-5256
O. Henderson JeffreyCorresponding author
Stimulating precocious metamorphosis in anuran larvae is an important pedagogical tool for understanding vertebrate development. However, historically, artificially provoking metamorphosis by immersing tadpoles in exogenous inducing agents (e.g., thyroxine, and iodine) compromises the longevity of the experimental animals, resulting in up to 100% mortality within a week. In our undergraduate teaching lab, we house our experimental tadpoles in circular glass dishes having a surface area of 182 cm2. Over the past four academic years this lab was performed, we observed 100% mortality of experimental animals within 10, 12, or 15 days when treated with 10-5 M, 10-6 M, or 10-7 M thyroxine, respectively. Here, we investigated whether increasing the surface area to 413 cm2 using square glass dishes would reduce the mortality of the treated animals. Omnibus Kaplan-Meier survival analysis demonstrates a statistically significant decrease in mortality in tadpoles reared in the larger square dishes compared to those housed in the smaller round dishes (P < 0.05). However, increasing the surface area of our reaction vessels could not rescue survivability of those tadpoles immersed in thyroxine, but did increase survivability of control tadpoles maintained in pond water (P < 0.01), tadpoles subjected to iodine (P < 0.05) or treated with actinomycin D (P < 0.05). These data demonstrate that increasing available reaction vessel surface area reduces overall tadpole mortality during chemically modified metamorphosis in an undergraduate teaching lab setting.
Apr 2024 DOI 10.14302/issn.2329-9487.jhc-24-5040
Dangwe Temoua NaibéCorresponding author
Objective Hypertensive crisis is an increasingly frequent medical condition in our context. Its management in medical emergencies is a real challenge for physicians. Few data on hypertensive crisis are available in Chad. The aim of this study was to investigate the epidemiological, clinical and prognostic characteristics of hypertensive crisis in the medical emergency department of Reference National Teaching Hospital in N'Djamena. Patient and methods This was a prospective cohort study running from 1er March 2020 to October 31 2020. Patients presenting with a sudden and severe rise in blood pressure (systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg) with or without acute target-organs damage, had been consecutively included and followed up over a period of one (01) month. Epidemic and clinical characteristics on admission, and morbidity and mortality parameters during the course of the disease were collected. The Kaplan-Meier method and the Cox model were used to analyze survival and factors associated with death, with a significance level of p<0.05. Results Of the 3978 hypertensive patients admitted to medical emergencies, 252 had a hypertensive crisis, i.e. a prevalence of 6.3%. Two hundred and seventeen (217) patients were included in the study, divided into 149 cases (69%) of hypertensive emergency and 67 cases (31%) of hypertensive hypertensive urgencies. The mean age of the patients was 55.2 ± 14 years (20 and 80 years) and 67% were male. Hypertension was known in 138 patients (64%). At least one complication was present on admission in 69% of patients. Complications were classified as cardiac (50.7%), neurological (38.2%), kidney impairment (46.5%) and ocular (46.1%). The average number of antihypertensive drugs used was 2 ± 0.83 14. Calcium antagonists (86.5%), diuretics (35.5%), converting enzyme inhibitors or angiotensin II receptor antagonists (33.3%) and betablockers (18%) were the pharmacological classes prescribed. Good compliance during follow-up was observed in 124 patients. One-month survival was 84% for all patients, with a 16% mortality rate. Factors associated with death were the duration of hypertension, and the occurrence of cardiovascular, renal dysfunction and ocular disease (p < 0.05). Conclusion Hypertensive crisis is a frequent pathology in sub-Saharan Africa, with high morbidity and mortality. Prevention requires early detection and effective management of hypertension.
Oct 2022 DOI 10.14302/issn.2641-4538.jphi-22-4343
Rutayisire ErigeneCorresponding author
Department of public Health, Mount Kenya University Rwanda Kigali Rwanda
Most hospitals have infection prevention and control committees but some of them are struggling to maintain and to apply infection prevention and control protocols due to lack of enough resources. Healthcare workers’ (HCWs) knowledge, attitude and practices (KAP) of infection prevention and control procedures are crucial for effective infection prevention and control (IPC). The study aimed to assess HCW’s KAP towards IPC in Rwanda. A cross-sectional hospital based study was directed in three hospitals in Karongi district from February to March 2022. Data were collected from 215 healthcare workers using a pre-tested self-administered questionnaire using a stratified sampling technique. Data were collected, checked, coded, and entered into the Kobo Collect Toolbox before being transferred to SPSS version 21 for analysis. Bivariate and multiple logistic regression analyses were performed. The KAP Score was also calculated. P-values of less than 0.05 were considered statistically significant. We found that 50.7% of HCWs were males, 63.3% were between the ages of 18 and 58.2% had a secondary education. The overall 78.6% of HCWs demonstrated high level of knowledge, 79.5% with a positive attitude, and 63.3% with good IPC practice. The results revealed that being over 45 years old(AOR=3.1;95%,CI=(2.16-5.25; p=0.024) having university level(AOR=3.3); 95%CI=(1.56-7.56;p=0.035), working experience between 5-10years(AOR=1.7; 95%CI=(1.37-5.45); (p=0.003), having high level of knowledge (AOR=2.7;95%CI: (1.68–7.95; p=0.045)and positive attitude(AOR=2.3; 95%CI:(1.36-7.72); p=0.017) towards IPC were associated with IPC good practice. Improving institutional supplies such as hand hygiene supplies, PPE, water supply and other facilities can improve safe infection prevention and control.
Jul 2022 DOI 10.14302/issn.3070-3360.ijco-22-4231
Mulani AmanCorresponding author
PG-Scholars(rognidan) DPU. D.Y.Patil vidyapeeth's, Dr.d.y.patil College of Ayurved and research center pimpri pune-18
Nidana Panchaka is one of Ayurveda's several diagnostic procedures. It is the most significant way for determining the source of an illness, as well as predicting its prognosis. Nidana Panchaka comprises of five items which are Nidana (etiological factors), Purvaroopa (primordial symptoms), Roopa (signs and symptoms), Upashaya (like and dislike) and Samprati (etiopathogensis) (etiopathogensis). Diagnosis of sickness depends on Tridoshas which are Vata, Pitta, Kapha which are responsible for any disease that arises in the body. These imbalances in the Doshas of the body are caused by etiological variables such as a person's lifestyle and eating habits. Prior to seeking therapy for a condition, a proper diagnosis is required. There are numerous additional procedures for diagnosing the ailment, such as Ashtavidha Pareeksha, Dashavidha Pareeksha, and Chaturvidha Pareeksha, but the focus of this article is on the significance of Nidana Panchaka.
May 2022 DOI 10.14302/issn.2641-4538.jphi-22-4189
Rutayisire ErigeneCorresponding author
Department of public Health, Mount Kenya University Rwanda Kigali Rwanda
In Rwanda, CVDs accounts around 14% of all death. Studies on knowledge, attitude, and practice (KAP) would be of great value in helping public health professionals develop targeted programs and measure the effectiveness of interventional programs. The main objective of this study was to analyze the KAP about CVDs among adult patients attending public health centers located in the City of Kigali, Rwanda. A total of 384 adult patients were enrolled in this study. A structured questionnaire was used. Data entry and analysis was done using SPSS version 21. Findings were presented as frequencies and percentages in tables. For determining the KAP-levels, the overall scores were determined for each respondent by adding up the scores through the KAP-related questions. The mean age was 36.4 years, primary school (57.3%), married (62.8%), self-employed (40.9%), and females predominated (61.5%). The knowledge mean score was 14.2 and 76% had high level of knowledge of CVD risks and prevention. The average attitude score for all respondents was 17.6 and 22.9% of the respondents showed negative attitude towards CVDs prevention. Research findings revealed that 36.5 % were not practicing physical activity and exercise. The mean practice score for all respondents was 3.9 and 70% of respondents had negative practice towards CVDs prevention. Poor CVDs prevention practices were observed among the study participants. Therefore, it is necessary to establish more effective educational interventions intended to promote positive health behaviors related CVD prevention
Dec 2020
Eclarinal B.Corresponding author
Mount Sinai South Nassau Hospital, New York USA
Background In Brunei Darussalam, cancer has been the leading cause of death, and breast cancer as the leading cause of death among women. With a nationally-funded cancer treatment, it is essential to determine the survival rates among breast cancer patients which can serve as a basis for comparison across timelines with the end view of improving healthcare delivery, hence, survival among the patient population. Methods This study was conducted from January – May 2019. Medical records data were abstracted for breast cancer patients treated between years 2011-2016 in a tertiary specialist cancer center. Kaplan-Meier Product Limit estimation was used for the over-all observed survival rates within 5 years after diagnosis. STATA Version 15 was used for statistical analysis. Ethical approval was obtained. Results Over-all, five-year breast cancer survival rates was favorable at 88.89%. . Survival rates according to TNM staging showed lowest at stage IV at 59% five-year survival. Survival rates according to age at the time of diagnosis showed favorable survival across age groups except for age groups 30-39 years and 80 years old and above. Survival rates according to treatment combinations were highest in surgery (mastectomy) and hormonal therapy. Conclusions The Center’s 5-year breast cancer survival rates were relatively high and comparable to survival figures of developed countries. The Center’s high survival rates could have been related to the ‘treatment factors’ due to the following: prompt treatment of early stage breast cancer stages, responsive coordination, government-funded cancer treatment which allowed patients uninterrupted, free access to standard treatment.
Nov 2020 DOI 10.14302/issn.2473-1005.jdoi-20-3595
C SzuhanekCorresponding author
Department of Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy ‘Victor Babes’, Timisoara, Romania
Aesthetic and functional problems associated with significant facial asymmetry can negatively affect the patient's facial appearance, nutritional and psychosocial development. Therefore, a critical assessment and accurate treatment planning is absolutely necessary. The aim of this study was to evaluate the parameters of PA cephalometric analysis defined by Ricketts and Grummons and establish statistically relevant correlations and their importance in diagnosing orthodontic patients with varying degrees facial asymmetries. The research included facial asymmetry Romanian patients from the Department of Orthodontics and Dento-Facial Orthopedics of UMF "Victor Babes", Timisoara. The PA cephalogram investigations that met the inclusion criteria were digitally analyzed. Dental and skeletal cephalometric parameters described by Ricketts, Grummons and Kappeyne Van De Coppello were collected through linear, angular and volumetric measurements. Statistically significant correlations between the degree of asymmetry and the dimension of the internal structures were observed.Our conclusion is that PAcephalograms are cost effective and useful investigations in identifying and evaluating skeletal and dental imbalances in orthodontic facial asymmetry patients.
Oct 2020 DOI 10.14302/issn.2576-6694.jbbs-20-3517
S.U. DOSSOU CamilleCorresponding author
Laboratoire de Recherche en Biologie Appliquée, Ecole Polytechnique d’Abomey-Calavi (EPAC), University of Abomey-Calavi, 01 BP 2009 Cotonou, Benin.
Background of the Study African countries are facing frequent blackout. Thus in sub Saharan region, due to frequent power cut, the laboratory professionals find sometimes difficulty to carry out earlier diverse diagnostic tests. Objective The aim of this work is to evaluate the feasibility of enzyme immunoassay tests in the absence of a conventional source of electricity. Methods We developed a battery-powered experimental device, which was then applied to diagnose measles. The samples included 45 sera randomly selected from non-haemolysed serum samples received and stored at the National Public Health Laboratory of Benin. The experimental device is composed of two devices (Devices 1 and 2). The Device 1 provided an average temperature of 34.47 °C, 20 min after starting. With Device 2 an average temperature of 20.32 °C is obtained 15 min after starting. Results With the experimental device the same rate of measles antibody-positive sera (44.68%) was obtained as recorded from the test using the standard equipment of laboratory. The experimental device detected 18 negative and 8 intermediate results against respectively 19 and 7 by the standard equipment. The analysis of the results of both equipments shows a concordance rate of 93.33% with a kappa reproducibility coefficient of 0.89. Conclusion The device conceived in our study is a simply equipment allowing the realization of the enzyme immunoassay tests, in this case the ELISA anti-measles test. The rate of concordance obtained shows that this device can be used with commercial kits and at temperatures close to those recommended by the manufacturer without altering the results.
Oct 2020 DOI 10.14302/issn.2379-7835.ijn-20-3610
Maiti Choudhury SujataCorresponding author
Department of Human Physiology, Vidyasagar University, Midnapore-721102, West Bengal, India
Aim To assess the sanitation and hygienic practices of women and its effects on the nutritional status of the mother and preschool children of the Lodha tribal community in two districts of West Bengal. Methods A cross-sectional study was conducted during November, 2014 - December, 2018 of 941 Lodha mothers and 1043 of their preschool children in Paschim Medinipur and Jhargram districts. All information was collected by using KAP questionnaire following interview and group discussion. Mother nutritional status was assessed based on body mass index (BMI) and mid upper arm circumference (MUAC). A child was classified as underweight, stunting and wasting as weight-for-age, height-for-age and weight-of -height Z-score below -2 standard deviation of WHO standard. Results This study found 35% of the households used safe drinking water. Almost 97.2% of the mother had the low hand wash score and about 67.1% of them had an average WaSH score. Overall, 41.6% and 1.6% mothers were suffered from undernutrition (BMI <18.5 kg/m2) and overweight/obesity (BMI≥25kg/m2). Whereas, 48.9% women were undernourished based on MUAC<22.0cm. Moreover, the overall prevalence of wasting, stunting and underweight of preschool children was 31.9%, 62.1% and 61.3%, respectively. The WaSH score of family was significantly associated with child stunted and underweight. Conclusion There is a good association between poor household WaSH practices with child undernutrition and morbidity. Hence, there is an urgent need to develop the comprehensive knowledge, attitude and practice (KAP) guidelines in their language to educate them about appropriate water storage, retrieval methods, sanitation and hand washing practices.
Sep 2020 DOI 10.14302/issn.2372-6601.jhor-20-3552
Qing XinCorresponding author
Department of Pathology, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90502, USA
Plasma cell neoplasms of the thyroid gland are uncommon. They may occur either as a primary extraosseous (extramedullary) plasmacytoma or as secondary involvement by multiple myeloma (MM). Here, we report the case of a 62-year-old female, presenting with goiter and Hashimoto’s thyroiditis, in whom the histologic diagnosis of extraosseous plasmacytoma was unexpected. Histology of the total thyroidectomy specimen showed a diffuse infiltration of well-differentiated plasma cells against a background of Hashimoto’s thyroiditis. By immunohistochemistry, the majority of the plasma cells are positive for IgG heavy chain and kappa light chain (kappa:lambda ratio was about 6-7:1). PCR analysis of the immunoglobulin heavy and kappa chain (IGH, IGK) gene rearrangements showed clonal IGH and IGK gene rearrangements. MM was ruled out by lack of MM-related end organ damage and negative serum protein electrophoresis, immunofixation, and bone marrow biopsy. Although rare, plasmacytoma should be considered in patients presenting with enlarging thyroid gland and autoimmune thyroiditis. Histologic diagnosis and differential diagnoses are comprehensively discussed.
Aug 2020 DOI 10.14302/issn.2641-5526.jmid-20-3494
I. Kheder SalahCorresponding author
Faculty of Pharmacy, National University, Khartoum, Sudan
Introduction Antimicrobial stewardship (ASP) is of the utmost importance as a way to optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. So, it is worthwhile to assess the knowledge, attitude and awareness regarding antimicrobial stewardship in hospitals. Objective The aim of this study is to assess knowledge, attitudes and practices (KAP) of prescribers towards antimicrobial stewardship at hospitals in Khartoum state and to identify the associations between prescriber’s demographic information and their knowledge. Methodology This descriptive cross-sectional study multi-centered study conducted in 10 hospitals at Khartoum state -Sudan, during period from November to December 2018. Study population included all prescribers who is available at study’s hospitals during study period and willing to participate in the study. A self-administered questionnaire addressing participants’ knowledge, attitudes, and practice (KAP) regarding antibiotic resistance and ASP distributed in the selected hospitals among attending house-officers, registrars and consultants completed then analyzed. Results Of the 294 medical staff targeted, 287 responded to the survey (response rate 97.6%). Only (26.4%) were familiar with the term ASP and (31.5%) claimed that it is effective in reducing resistance. (43.0%) of respondents believe that ASP play vital role on antibiotic prescribing. Only (9.5%) had ASP in their hospital and (13.5%) having policy and team. (45.3%) of participants had good level of knowledge about antimicrobial stewardship, but majority show negative attitude (63.1%), and poor practices (92.0%) regarding ASP. There was no observed correlation between knowledge and attitude, knowledge with practice (p-value ≥ 0.05). Only attitude with practice shows significance correlation (P=0.0001), which means that prescribers with positive attitude had the better practices towards antimicrobial stewardship. Age, occupation and experience are the only significant predictors of prescriber's knowledge and attitude towards antibiotic stewardship, while no association between these factors and practice. Conclusion The present study concludes that the knowledge of prescribers regarding ASP is moderate and their attitude is negative. Unfortunately, practices regarding ASP were poor, despite, the good knowledge regarding the effects of ASP on antimicrobial resistance.
Apr 2020 DOI 10.14302/issn.2470-0436.jos-20-3303
Manikandan R.Corresponding author
Department of Zoology, University of Madras, Guindy Campus, Chennai-600025
The effect of resveratrol, a free radical scavenger, during cataract development was evaluated in the Wistar rat pup model. This study investigated the possible free radical scavenging potential of resveratrol at 40 mg/ kg body wt dose in selenite-induced cataract in rat pups. Intraperitoneal injection of sodium selenite (15 µm mol/ kg body wt) in 8 to 10 day old rat pups lead to severe oxidative stress in the tissues evidenced by decreased antioxidants and increased lipid peroxidase, nitric oxide, superoxide anion, hydroxyl radical generation, inducible nitric oxide synthase (iNOS) as well as nuclear factor kappa B (NF-kB) expression levels that probably led to cataract formation. Selenite exposure also caused an increase in total calcium in the eye lens and significantly inhibited the activity of Ca2+ ATPase but not Na+/ K+ ATPase or Mg2+ ATPase. However, both pre- and co-treatments with resveratrol, but not post-treatment, led to an increase in antioxidant levels with a concomitant reduction in oxidative stress and also rescued the selenite-mediated increase in lens Ca2+ and inhibition of Ca2+ ATPase activity in the eye lens. The results of this study demonstrate antioxidants decrease and increase in free radical generation triggered by selenite causes the inactivation of lens Ca2+ ATPase leading to a rise in intracellular Ca2+ level. Resveratol treatment was able to prevent selenite-induced oxidative stress and in turn the inhibition of lens opacification. Thus, resveratrol has the potential to function as an anti-cataractogenic agent, possibly by preventing free radical-mediated accumulation of Ca2+ in the eye lens.
Apr 2019 DOI 10.14302/issn.2470-0436.jos-19-2693
E. Moroi SayokoCorresponding author
Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, Michigan, 48105 USA.
Given limited knowledge regarding validity of the Titmus vision screener, we sought to compare visual acuity measurements obtained from the Titmus with that from the Snellen chart and assess the validity properties of the Titmus as a screening instrument to detect vision impairment. Visual acuity was measured in 150 participants recruited from an academic ophthalmology practice, using the Snellen chart as well as the Titmus vision screener. Visual acuities from the Titmus and Snellen were compared and validity of the Titmus vision screener was assessed by computing sensitivity and specificity. Using Snellen visual acuity as the reference standard, the sensitivity of the Titmus vision screener to detect vision impairment, defined as visual acuity worse than 20/40, was 92% (95% CI (72.5, 98.6)) and the specificity was 64% (95% CI (57.9, 70.1)). Comparisons of the precise visual acuity level revealed poor agreement between the two methods (weighted Kappa: 0.15, 95% CI (0.08, 0.21)). Visual acuities obtained from the Titmus were, on average, two lines worse than Snellen visual acuities. ((logMAR Snellen – logMAR Titmus) = - 0.19 ± 0.29, 95% confidence interval (CI) (-0.23, -0.16)). Titmus vision screener is a sensitive tool to detect visual impairment. However high false positive results and poor agreement with Snellen limits its widespread use in clinical applications.
Aug 2018 DOI 10.14302/issn-2470-0436.jos-18-2222
B. Iguban EleonoreCorresponding author
Department of Ophthalmology and Visual Sciences, University of the Philippines Manila, Philippines.
Objective: The aim of the present study is to determine the efficiency of third year ophthalmology residents from a tertiary hospital in performing preliminary retinal examination to identify eyes at risk retinopathy of prematurity on the basis of retinal fundus findings up to International Classification of Retinopathy of Prematurity (ICROP) Zone II. Methods: This is a single-center, cross-sectional, prospective comparative research conducted from June to October 2015 at a tertiary training hospital in the Philippines. All infants referred for retinopathy of prematurity screening within the study period where included. The presence of retinal vessel dilatation and tortuosity were identified by third year ophthalmology residents using indirect funduscopy. The residents’ fundus findings were then compared to that of a retina consultant who is proficient in the diagnosis and management of retinopathy of prematurity (ROP). The Kappa index was used to rate inter-observer agreement. The correlation between ROP risk factors and the presence of abnormal retinal vessels were assessed using odd ratio computations. Fisher’s exact test was used to determine the correlation between retinopathy of prematurity and the presence of retinal dilatation and tortuosity. The McNemar’s test was also applied to determine significant differences in the retinal findings of the consultant and ophthalmology residents. Results: A total of 82 eyes of 41 premature infants were evaluated to determine if retinal findings observed by ophthalmology residents were comparable to that of a retina consultant. Odds ratios show that age of gestation, birth weight, and history of blood transfusion are significantly associated with the presence of retinopathy of prematurity. Retinal vessel tortuosity and dilatation are also more common among infants diagnosed with retinopathy of prematurity. There was no significant difference between the retinal vascular findings of the retina consultant and the third year ophthalmology resident in terms of identifying retinal vessel dilatation and tortuosity (P < 0.05). Conclusion: After sufficient and in-depth ophthalmology training, third year ophthalmologists, who will be general ophthalmologists in the future, can reliably identify eyes at risk for severe retinopathy of prematurity on the basis of retinal vascular dilatation and/or tortuosity.
Dec 2017 DOI 10.14302/issn.2575-1212.jvhc-17-1773
J. Kavana NicholasCorresponding author
Department of Parasitology and Entomology, Faculty of Medicine, St. Francis University College of Health and Allied Sciences
The knowledge,attitudes, and practice among inhabitants of Babati district in Tanzania on sparganosis were evaluated. A cross-sectional study was carried out among 160 participants from the district. Demographic and socioeconomic information of the participants and their KAP on sparganosis was collected by using a pre-tested questionnaire. All 160(100%) participants had no knowledge about sparganosis. Regarding attitude of participants to keeping dogs and cats; all 160 (100%) participants were not aware of dangers associated with dogs and cats to transmission of sparganosis. 39 (30.0%) of the participants had knowledge of drinking boiled water. There is a need to organise health education programme about sparganosis to increase community knowledge.
Aug 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1115
Tatemichi MasayukiCorresponding author
Department of Preventive Medicine, Tokai University, School of Medicine, Kanagawa, Japan
Purpose: To determine an appropriate time interval for conducting mass screening for glaucoma, it is important to gather information on the annual incidence rate. Thus, a retrospective cohort study was conducted to determine the annual incidence rate of visual field abnormalities (VFA) among a workplace cohort. Methods: In an initial visual field test using frequency doubling technology (FDT) perimetry conducted on 3443 employees (mean age 47.4 ± 8.9, men/women = 2967/476), no abnormalities were observed. Subjects were followed-up with annual perimetric testing for seven years, with VFA being determined using FDT test (FDT-VFA). Results: Using theKaplan–Meier method (log rank test, p < 0.001), cumulative FDT-VFA rates (SE) at seven years for subjects in their 30s, 40s, 50s, and 60s or older were found to be 3.0% (0.6), 4.2 % (0.6), 4.8 (0.8), and 11.3% (0.2), respectively. A linear fit to the Kaplan–Meier results yielded an annual incidence rate of 0.42%, 0.60%, 0.77%, and 1.60% for the 30s, 40s, 50s, and ≥60s age groups, respectively. Conclusion: Our data suggest that the annual incidence rate of VFA is <0.7% per year in subjects younger than 60 years of age; however, it increases to 1.6% per year in older subjects, thus suggesting that the monitoring frequency of glaucoma patients may need to be adjusted as a function of their age and be performed more frequently after the age of 60 years
Dec 2015 DOI 10.14302/issn.2372-6601.jhor-14-397
Gabbay EzraCorresponding author
Division of Adult Nephrology,
Immunotactoid glomerulopathy (ITG) is a rare cause of chronic kidney disease (CKD) and end-stage-renal-disease (ESRD). It is often associated with monoclonal gammopathy and/or hematologic malignancy. We report a patient originally diagnosed with ITG in 1998. He presented with nephrotic-range proteinuria, hypertension, and a gradual decline in glomerular filtration rate. A published case report of this patient at the time the disease was originally diagnosed described only a small peak of IgM paraprotein without lymphoma or plasma cell dyscrasia. He was diagnosed with monoclonal gammopathy of unknown significance. He later developed ESRD and initiated hemodialysis in 2004. Fourteen years after the diagnosis of ITG and MGUS was made he developed headache, lymphadenopathy, borderline splenomegaly, thrombocytopenia, and coagulopathy. Workup revealed a very high level of monoclonal IgM-kappa (4390 mg/dL),and low grade B-cell lymphoma, consistent with lymphoplasmacytic lymphoma, leading to a diagnosis of Waldenstrom’s macroglobulinemia (WM). He died shortly thereafter of complicated gram-negative sepsis. To our knowledge this is the first report of WM associated with ITG. The patient's course illustrates that plasma cell dyscrasia and lymphoma can present many years after the original diagnosis of ITG is made and that continued vigilance for these conditions is warranted.