The current role for clinical and renal histological findings as predictor for outcome in Australian patients with lupus nephritis.

Objectives To investigate the current demographic, clinical and histological characteristics of patients with lupus nephritis (LN) in Western Australia (WA) with regards to their predictive value for patient and renal outcome. Methods Retrospective study of adult systemic lupus erythematosus (SLE) patients with a first renal biopsy demonstrating LN between 1997 and 2017 at a metropolitan tertiary hospital in WA. Clinical data were collected at baseline and last follow-up with renal biopsy findings classified by International Society of Nephrology (ISN) criteria. Annual incidence rates (AIRs)/100,000, Kaplan-Meyer curves and Cox regression hazard ratio for independent predictors for patient and renal survival were applied. Results The AIR was 3.3, 3.1 and 0.4 for Asian ( n = 29), Indigenous Australian (IA) ( n = 11) and Caucasian ( n = 43) patients, respectively ( p < 0.01). There was no significant subgroup difference regarding ISN class (proliferative 66%, membranous 19%, mesangial 15%), levels of proteinuria (median PCR 300 mg/mmol) or frequency of raised creatinine (31%), anti-dsDNA antibody (89%) or hypocomplementaemia (88%). Treatment included corticosteroids (91%), cyclophosphamide (30%), mycophenolate (67%) and antihypertensive drugs (67%). Five- (81%) and 10-year (70%) survival was lower for IAs than for Caucasians and Asians (95% each at both time points) ( p = 0.016). Five- and 10-year renal survival (endpoint renal replacement therapy (RRT)) was 86% and 64% for IA vs 100% for Asian, 100% and 96% for Caucasian patients ( p = 0.02). IA background was the only independent predictor for poor patient survival and together with male gender also for renal survival. Only 25% of all patients remained free of any organ damage with non-renal damage observed in 53% of survivors. Conclusions LN incidence in WA was 0.75/100,000 with the lowest rate observed in Caucasians. While Asian patients have the same favourable outlook as Caucasians, the outcome is much bleaker for IA patients. Other clinical and histological findings did not predict outcomes, and importantly more than half of all surviving patients accrued non-renal damage.

Associations between major dietary patterns and testicular function in a population-based cohort of young men: results from the Western Australian Pregnancy Cohort (Raine) Study.

BACKGROUND: Controversial speculation suggestions that dietary intake may affect semen quality and testicular function, however, there are limited comprehensive studies observing dietary patterns. OBJECTIVE: To study associations between major dietary patterns and markers of testicular function in adulthood. MATERIAL AND METHODS: Observational cross-sectional study of two hundred and ninety men with an average age of 20 years, from the Western Australian Pregnancy Cohort (Raine) Study. Usual dietary intake assessed using a semi-quantitative food frequency questionnaire at 20 years of age. Two dietary patterns previously identified using exploratory factor analysis ("Healthy" or "Western") and participants received z-scores for each dietary pattern. Primary endpoints were testicular volume, total sperm per ejaculate, morning serum testosterone concentration. Secondary endpoints were semen sample parameters, inhibin B and sex steroids (DHT: 3α-diol, 3ß-diol; LH; FSH; DHEA; estradiol; estrone). RESULT(S): Participants were on average 20.0 ± 0.4 years old, had a median of 2 days sexual abstinence and a body mass index of 24.1 ± 3.9 kg/m2 , 13% were smokers, 52% were 'moderate' alcohol drinkers, 23% frequently used recreational drugs and 68% reported 'high' physical activity levels. Sperm concentration and DHT 3α-diol were negatively associated with a greater z-score for the "Western" dietary pattern (p = 0.007 and; p = 0.044, respectively), and serum estradiol concentration was positively associated with a "Western" dietary pattern (p = 0.007) after adjustment for BMI, varicocele, cryptorchidism and sexual abstinence. DISCUSSION: Despite associations between greater intake of the "Western" dietary pattern and a decreased male reproductive health markers, our lack of consistent associations of either a "Healthy" or a "Western" dietary pattern, limit clinical or biological significance in isolation. CONCLUSIONS: A potential negative association of a "Western" dietary pattern with male reproductive health was detected and should be studied further in population-based studies.

Peripheral nerve war injuries.

OBJECTIVE: The purpose of this study is to evaluate peripheral nerve war injuries sustained during the war in southern Croatia and Bosnia and Herzegovina. PATIENTS AND METHODS: During the war in Croatia, 713 patients (99% male and 1% female) with wounds inflicted by firearms were examined at the Laboratory of Neurophysiology, University Hospital, Split. The patients, soldiers and civilians alike, ranged in age from 6 to 73 years (average, 28 years). All patients with firearm nerve war injuries underwent detection by electromyography and plurisegmental examination of the damaged peripheral nerve (neurography). The patients were examined and controlled on three occasions: within 2 months after wounding; up to 6 months after wounding; and more than 6 months after wounding. RESULTS: Single peripheral nerve lesions were present in 80% of the patients, and multiple peripheral nerve or plexus lesions were present in 20% of the patients. Peroneal and ulnar nerves were most often involved (20.9% and 19.8%, respectively). Associated massive injuries to the muscles, large blood vessels, or vital organs were present in 45% of the patients. Wounds were inflicted by shell fragments in 80% of the patients and by projectiles in 20% of the patients. CONCLUSION: According to our results, better recovery was achieved with conservative treatment and when physical therapy was initiated early with maximal patient cooperation. Electromyoneurographic findings were the most valid in the prognostic classification of war-inflicted peripheral nerve injuries.

Physiological anthropology and the Internet.

The Internet is the greatest computer network with many services like Web, FTP, Gopher, E-mail Discussion Groups, and Usenet Discussion Groups, that provides a rapid and the cheapest exchange of information. The benefits to anthropologists of using the Internet are growing rapidly, as the Internet becomes easier to use and ever more anthropological resources become available on line. Physiological anthropology is concerned with the evolution and biological features of human population and it's sources on the Internet are growing continuously. However, in that enormous number of data, is not easy to find a needed information. Currently, number of indexed physiological anthropology related sites on Web only is 233990 (October 98). This paper provides informations about Internet and needed hardware and software for using it. It also describes and lists the most important physiological anthropology addresses, together with physiological anthropology-related journals on the Internet, as well as the ways of searching them.

Oral lichen planus and HLA A.

Oral lichen planus (OLP) is autoimmune disease that appears on the oral mucosa only, or in combination with skin lesions. The occurrence of squamous cell carcinoma in areas of lichen erosions makes it necessary to follow up patients suffering from chronic lesions. Prevalence in general population varies from 0.9% to 1.2% and varies in different ethnic groups. It is known that cell-mediated immune mechanisms and genetic factors underline OLP pathogenesis. We tested 50 OLP unrelated patients (5 males) for HLA A and compared them to 1089 healthy controls. OLP patients had 3 times less frequently HLA A w19 and 5 times less frequently HLA A28, compared with controls. Erosive OLP type had 4 times less frequently HLA A11 and 2 times less frequently HLA A26 than plaque form. In conclusion, HLA A w19 and A28 appeared associated with OLP in particular, while HLA A11 and A26 with erosive types of OLP.

Oral lichen planus and HLA B.

Oral lichen planus (OLP) is mucocutaneous autoimmune disease of still unknown etiology. Among all etiological factors, OLP can be associated with carbohydrate disorders. As it is known that some HLA B and DR 3/4 antigens are cross-linked, we have determined the frequencies of HLA B antigens in group of 50 Croatian patients (5 males) with OLP and compared them with the 1089 healthy controls. Alterations in the frequencies of several HLA B antigens were noted, in particular, the frequencies of HLA B 15 were 4 times higher, and HLA B18 were 4 times lower compared with controls. The OLP patients with carbohydrate metabolism disorders had more frequently HLA B16, B2 and B40 and the patients with OLP without disturbed carbohydrate metabolism had more frequently HLA B5, B7 and BX. HLA B15 and B18 are closely connected with DR 3/4 antigens in diabetes mellitus, so these particular antigens may predispose a person to a lichen planus.

Influence of war circumstances on tumor morphological characteristics in patients with breast cancer.

The influence of war circumstances on tumor morphological characteristics in patients with breast cancer has not been studied up to now. The aim of this study is to investigate if war circumstances have influenced breast cancer incidence. The study covered both the patients in which during a period of observation a breast cancer was diagnosed as well as those who died of the same disease in the same period. Three sources of data were used: 1) The archives of the Oncology and Radiotherapy Center of the University Hospital "Split" (UHS): hospital data of 768 patients were reviewed. The war sample consisted of 380 patients aged 59.4+/-12.1 (31 to 86) (including 5 males), whereas the pre-war sample was made up of 388 patients aged 58.4+/-12.7 (19 to 88) (including 3 males); 2) Register of death of the Pathology Department of UHS with 162 analyzed persons whose death was caused by breast cancer in the six-year period between 1988 and 1993. The list of 162 dead patients included 79 people who died from breast cancer diagnosed in that period (1988-1993) and another 83 people that had been diagnosed before that period; 3) The biopsy register of the Pathology Department of UHS with 851 breast biopsies performed between 1988 and 1993. Breast cancer is predominantly a female illness (99.1%). The war circumstances influenced the of T, N and M rate. The rate of N2, N3, Ml were conspicuously higher in the war period. There were significantly more malignant histological diagnoses found in new patients and also significantly more patients died due to breast cancer. Stress and other war circumstances undoubtedly have a negative impact on the numerous markers of breast cancer which we have proved in this study.

Oral lichen planus and HLA DR.

Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease, predominantly seen in middle-aged female patients. Histopathologically, OLP includes parakeratosis with T-lymphocyte subepithelial infiltration. In etiology of OLP, chronically liver and biliary diseases, stress-induced hypertension, inheritance and most commonly carbohydrate metabolism disorders including diabetes mellitus are mentioned. Considering the autoimmune nature of the illness and the role of the HLA DR 3/4 antigens in development of diabetes mellitus we hypothesized that the same antigens could play role in the development of OLP. We examined 50 unrelated Croatian patients (5 males) from Institute of Oral Pathology, Faculty of Dental Medicine, Zagreb, with clinical and histopathological diagnosis of OLP. They were all tested for HLA DR and compared with 1089 Croatian controls that underwent the tissue standardization in fathership cases. OLP patients had blood sugar level controlled, and those with HLA DR 3/4 and those with blood sugar level higher then 5.6 mmol/l additionally underwent standard oral glucose tolerance test. Carbohydrate metabolism disorder was found in 13 OLP patients (26%) while 10 of them (20%) had diabetes mellitus type I. This finding is 400 times more frequent than is appearance of diabetes in healthy controls (0.05%) in Croatia.

Perinatal outcome of pregnancies in women aged 40 and over.

Perinatal outcome of pregnancies at forty and over was analyzed starting from the diagnosis of pregnancy to seven days following delivery. Retrospectively, pre-gestational health and reproduction status were dealt with, as well as the course of pregnancy, deliveries, and newborn children (study group). The control group was composed of pregnant women aged 20 to 29, who were identical to study group in terms of parity. Statistical data processing was done by means of chi2-test, and contingency 2 x 2 tables. The difference was significant if p < 0.05. Out of 2,099 diagnosed wanted pregnancies at forty and over, 415 (19.8%) had a miscarriage, in 33 (1.6%) an artificial abortion was performed after determining the fetus karyotype and 1,651 (78.2%) of pregnant women delivered. In 66.2% of pregnancies the fetus karyotype was determined and in 33 (2.5%) fetuses chromosomal abnormalities were found Incidence of deliveries at 40 and over is 1.38%, which is a 35.6-percent increase in the last ten years. Nullipara and pluripara had an increase, and multipara had a decrease. Pre-gestational health and reproduction status in study group is lower than in control group. Complications during pregnancy: threatened abortion, EPH gestosis, placenta praevia, gestational diabetes, late fetal death are more frequent than in control group (p < 0.05). In intrapartal terms, more frequent were induction of delivery, meconium-stained amniotic fluid, fetal distress, operative vaginal deliveries, and Cesarean section (p < 0.05). In neonatal outcome there are more premature infant, there are more VLBW, LBW, SGA, newborn with low Apgar index values, and the total perinatal death is greater than in the control group (p < 0.05). In perinatal terms, (from the diagnosis to the seventh day following delivery) 1,617 children survived (77.0%), meaning that perinatal loss was 482 (23.0%). Authors conclude that pregnancy at 40 and over is a high-risk pregnancy. There is a high risk of pre-gestational and gestational complications, and perinatal loss is high. Therefore, those pregnancies are not desirable from the medical point of view.

[Percutaneous biopsy of the kidney in children: indications, results, and complications]. / Perkutana biopsija bubrega kod dece: indikacije, rezultati i komplikacije.

The authors present results of systematic use of percutaneous renal biopsy in children in the first three years of practice. From 1986 to 1989, 153 renal biopsies were done in 144 children and adolescents (75 males, 69 females) aged 4 months to 18 years. The most common indications were as follow: primary nephrotic syndrome, most often resistant to corticosteroid treatment (28.5%), haematuria (28.5%), secondary glomerulopathies, either with or without nephrotic syndrome (9.7% and 15.3%, respectively), and proteinuria (4.9%). 90.8% of biopsies were successful obtaining adequate tissue for light microscopic diagnosis, containing a n average number of 16 glomeruli. An overall number of 29 complications (18.9% of biopsies) in 23 patients was observed. Gross haematuria was the most common, lasting no more then one (9.8% of biopsies) or three days (2.6%) requiring blood transfusions in three cases (1.96% of biopsies). Others complications were fever (1.96%), perirenal haematoma (1.3%), and severe pain at the site of biopsy (1.3%). There were no significant differences between three annual periods with regard to the incidence of successful biopsies or complications, but more serious complications occurred during the first year of practice. In children younger than five years the rate of successful biopsies was higher and incidence of complications was lower than in older children. The authors' results correlate favourably with data published in the foreign literature.