The relationship between the IgM antibody response, antigenic load as well as the clinical improvement after chemotherapy was studied in order to obtain useful data for the early diagnosis and monitoring leprosy. A level of 82% (94/115) agreement was obtained between IgM UMELISA HANSEN and slit-skin smear examination. Discrepant results were observed in 16 patients who showed positive IgM response despite negative by the skin smear examination. In these patients, the IgM response was seen to be associated to the early signal for bacilli recurrence in the skin. In one of these patients the presence of bacilli was demonstrated in the skin, two months after IgM antibodies being detected by UMELISA HANSEN. Also in one of the treated patients positive by both diagnostic techniques, a remarkable decrease in the IgM antibody levels was seen, correlating with a significant clinical improvement. Moreover it was found a direct relationship between the IgM antibody response and bacterial antigenic load, regardless the time elapsed in the disease's evolution.
Background and importance The use of telepharmacy technology allows pharmacists to provide clinical pharmaceutical services to patients who need regular services during the COVID-19 pandemic while maintaining distance and minimising faceto-face meetings. Aim and objectives To analyse the implementation of a telepharmacy system in a tertiary hospital as a pilot project during the COVID-19 pandemic. Material and methods Prospective observational study conducted from March 2020 to May 2021 in the Outpatient Unit (OU) of the Pharmacy Service of a tertiary hospital. Telepharmacy was implemented by selecting patients who agreed to participate in this project. A circuit was established in which the pharmacist carried out pharmaceutical care to collect relevant information on the pharmacological treatment of the patients, validated the treatment and proceeded to carry out the hospital dispensing, followed by the dispatch of medication to the Pharmacy Office closest to the patient's home. Once the medication had been dispensed, the hospital pharmacist performed pharmacotherapeutic follow-up telephone consultations to check that everything was correct. Results During this period, 5878 patients attended the OU, 2875 (48.9%) were selected to benefit from the implementation of telepharmacy because of their advanced age, mobility problems, vulnerability due to their disease, and distance due to living in a rural area. 33 515 hospital dispensations were done, 15 500 (46.2%) were dispensed through the telepharmacy system, with an average of 6 hospital dispensations per patient.The largest number of patients served by the telepharmacy system were from Neurology (363, 14.6%) with 2136 dispenses (18.0%), followed by Rheumatology (348; 14.0%) with 1832 dispenses (15.5%), in third place was Dermatology (191; 7.7%) with 889 dispenses (7.5%) and in fourth place Pneumology (112, 4.5%) with 792 dispenses (6.0%). The average number of dispensations per month at OU was 2700, of which 1500 were face-to-face and 1200 were shipments.
Conclusion and relevanceThe implementation of telepharmacy has been a new challenge for the Pharmacy Service. It has proved to be a helpful tool to facilitate pharmaceutical care and hospital dispensing of medicines during the pandemic, avoiding face-to-face visits.
Background and Aims
In autosomal dominant polycystic kidney disease (ADPKD) is frequent to find low urinary citrate levels. Recently it has been suggested that urinary citrate could be a marker of covert metabolic acidosis. Our aim was to analyze relationship between urinary citrate levels and renal functionality in ADPKD patients.
Method
We determined citrate, calcium and uric acid in 24-hour collected urine from 91 ADPKD patients
Results
Urinary citrate/creatinine ratio was 214±158 (range 5.3-678) mg/g Cr with levels significantly higher in females. When considering chronic kidney disease (CKD) stages we observed a progressive decrease in urinary osmolality and in urinary citrate, calcium and uric acid elimination. Low levels of citrate (<300 mg/g Cr) were present in 40% in CKD-1 stage, in 69.7% in CKD-2 stage, 92% in CKD-3 stage and 100% in CKD-4 + 5 stages. Urinary citrate was correlated with serum creatinine (r= -0.66, p<0.001) and eGFR (r= 0.56, p<0.001). Urinary citrate significantly correlated with urinary calcium but correlation with urinary uric acid was weaker. We did not find any correlation with serum bicarbonate. Using multiple lineal regression analysis we found as predictors of urinary citrate to glomerular filtration rate, female gender and urinary calcium levels. In a subgroup of patients we measured total kidney volume and we found an inverse correlation with urinary citrate levels that dissappeared when it was corrected with glomerular filtration rate. We did not also find a relationship between urinary elimination of calcium or uric acid and TKV after adjusting with eGFR.
Conclusion
Urinary citrate is very frequently reduced in ADPKD patients being present from very early CKD stages. Their levels are inversely correlated with glomerular filtration rate and directly with urinary calcium excretion. We did not found a relathionship with serum bicarbonate. We think that it would be interesting to study urinary citrate in other nephropathies and verify if it could be a marker of covert metabolic acidosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.