Nama : Adibah Nur M. No.

korona : 03
Nama medis : Malocclusion
Nama korona : Dentistry
No. absen : 22
GOUTY ARTHRITIS

Gouty arthritis (GA) is a chronic inflammatory arthritis in which both

clinical and subclinical atherosclerosis are more frequent. The dynamic
equilibrium between coagulation and fibrinolysis is impaired in inflammatory
diseases. We determined TFPI and TAFI antigen levels in GA patients and
evaluated their association with subclinical atherosclerosis. Obtaining a
comprehensive assessment of treatment impact usually requires the use of
multiple outcome measures such as self-reported pain, physical limitations, flare
frequency, and biochemical markers, but the results of multiple measures can be
challenging to consolidate. Gouty arthritis (GA) is one such disorder where
different indicators of improvement can be challenging to interpret when there are
different impacts on the multiple out- comes, and GA domains are not all
impacted equally across all treatments and patients who experience improvement
in gout symptoms. Management of GA involves medications and lifestyle
modification to prevent flares (attacks) from occurring and medications to treat
acute symptoms such as pain, inflammation, and swelling when a flare does occur.
Effectiveness of treatments varies among patients who may have marked
response, poor response, no response, and/or adverse reactions to the medications
themselves. Different levels of response or disagreement among multiple outcome
measures complicates treatment decisions, therefore causing action decisions to
be based on clinical experience or pathophysiologic principles.
Because GA is a complex disorder that has multiple impacts on patients’
quality of life that differ by treatment type and individual patient characteristics, it
would be useful to reflect this complexity by using multidimensional response
criteria. Physicians and patients may not always agree on the relative importance
of different outcomes.
In summary, creation of composite multidimensional endpoints should be
useful for existing data, ongoing studies, and future study designs. GA researchers
usually obtain responses to these items and there is minimal burden for calculating
the response criteria. The score could be calculated retrospectively in existing
databases allowing for new analyses, especially when results were difficult to
interpret. Future studies should explore better determination and weighting of the
criteria and possible inclusion of other measures. Although there may be aspects
of GA that were not represented, this study demonstrated the usefulness of
calculating a composite endpoint as a way to examine the multidimensional
impact of treatments in clinical trials, and as an individual clinical indicator of
treatment success in healthcare settings.

Reference : http://www.scirp.org/journal/ojra
Nama : Adibah Nur M. No. korona : 03
Nama medis : Malocclusion
Nama korona : Dentistry
No. absen : 22
DIABETES MELLITUS

Until recently, the incidence of renal cell carcinoma (RCC) has been
increasing worldwide, mainly in western countries, at a rate between 2% and 4%
per year. However, the reason for this dramatic increase in number has not been
fully understood. Diabetes mellitus (DM) is a known risk factor for RCC, but the
impact of DM on the prognosis of RCC is unclear. In the present study, we
investigated the potential influence of DM on clinicopathological features of
localized and metastatic RCC. Evaluated 863 patients with primary RCC who had
undergone renal surgery between 1991 and 2005 in the University Hospital
Hannover; the mean follow-up was 58 months. To test the association of DM with
survival end-points, Kaplan-Meier Method and Cox multivariable logistic
regression models were applied. In total, identified 123 diabetic patients who
suffered from RCC, 9 patients with diabetes type 1 and 114 with type 2. Patients
with DM type 2 presented significantly more often with pT1a tumours at
diagnosis (40.0% vs 31.7%, p = 0.02), had less frequently high grade cancer
(G3/4; 10.3% vs 16.2%, p = 0.03), were older (median, 65.3 vs 61.6 years; p <
0.001), and had a higher BMI at diagnosis (median, 27.6 vs 25.8, p < 0.001).
However, there was no difference between diabetic and non-diabetic patients
concerning sex, histological subtype, lymphatic and distant metastasis. In
addition, there was no discrepancy in 5-year cancer specific survival between both
groups (62.2% vs 64.9% for patients with and without DM type 2, respectively).
Applying multivariable analysis, unlike age, tumour stage, grade and N/M status,
diabetes was not identified as a significant independent prognostic factor.
Reference : Journal The role of Diabetes Mellitus in Localized and Metastatic
Renal Cell Carcinoma by Sandra Steffens