Safety of a rapid outpatient hydration protocol for patients with renal impairment requiring intravenous iodinated contrast media for computed tomography

INTRODUCTION@#Patients receiving intravenous iodinated contrast media for computed tomography (CT) are predisposed to contrast-induced nephropathy. Chronic kidney disease is an important risk factor, and hydration is the mainstay of prevention. While inpatients can undergo intravenous hydration, limited knowledge exists regarding regimens for outpatients. We employed a rapid outpatient hydration protocol to reduce postponement of imaging appointments for patients with suboptimal estimated glomerular filtration rate (eGFR).@*METHODS@#From June 2015, we amended our CT preparation protocol to mandate rapid hydration (oral, intravenous or both) for patients with an eGFR of 30-60 mL/min/1.73 m@*RESULTS@#226 outpatients received the hydration protocol, which correlated with a 95% reduction in postponement of imaging appointments. No complications of fluid overload from hydration were encountered. A significant association was observed between age and decrease in eGFR, but this was not significant when stratified by drop in eGFR category. No statistical significance was found between decrease in eGFR and gender or race. Higher baseline eGFR was less likely to be associated with decrease in eGFR after imaging. Type of hydration was not related to a drop in eGFR category for patients with an eGFR of 45-59 mL/min/1.73 m@*CONCLUSION@#We defined a shorter hydration regimen that is safe to use in the outpatient setting.

Narrow-band imaging with magnification and the water immersion technique: a case-finding, cost-effective approach to diagnose villous atrophy

INTRODUCTION@#Narrow-band imaging with magnification endoscopy (NBI-ME) allows real-time visual assessment of the mucosal surface and vasculature of the gastrointestinal tract. This study aimed to determine the performance of NBI-ME combined with the water immersion technique (NBI-ME-WIT) in detecting villous atrophy.@*METHODS@#All patients who underwent gastroscopy were included. The duodenum was further examined with NBI-ME-WIT only after examination with white light endoscopy did not reveal a cause of anaemia or dyspepsia. Targeted biopsies were taken of visualised areas. NBI-ME-WIT findings were compared with the final histopathological analysis. We calculated the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME-WIT in detecting villous atrophy and the hypothetical cost saved by using a biopsy-avoiding approach.@*RESULTS@#124 patients (83 female) with a mean age of 46 (range 18-82) years were included. The most common indication for gastroscopy was abdominal pain (39%), followed by anaemia (35%), chronic diarrhoea/altered bowel habits (19%) and dyspepsia (6%). NBI-ME-WIT was able to detect all nine patients with villous atrophy - eight patchy and one total villous atrophy. The Sn, Sp, PPV and NPV of NBI-ME-WIT in detecting villous atrophy were 100.0%, 99.1%, 90.0% and 100.0%, respectively. Taking into account the cost of biopsy forceps (AUD 17) and pathology (AUD 140), this biopsy-avoidance strategy could have saved AUD 18,055 in these patients.@*CONCLUSION@#NBI-ME-WIT is a specific and sensitive tool to recognise and accurately diagnose villous atrophy. Biopsies can be avoided in patients with normal-sized villi, which may decrease the overall cost of the procedure.

R102G polymorphism of the complement component 3 gene in Malaysian subjects with neovascular age-related macular degeneration

Background: Genetic and environmental factors are known to be risk factors in development of neovascular age-related macular degeneration [nAMD]. Genetic factors such as polymorphisms in the complement component pathway genes might play a role in pathogenesis of nAMD and has been studied in various populations excluding Malaysia

Aim of the study: To determine the association of the R102G polymorphism of the complement component [C3] gene in nAMD subjects

Patients and methods: A total of 301 Malaysian subjects [149 case and 152 controls] were recruited and genotyped for the R102G [rs2230199] variant of the C3 gene. Genotyping was conducted using the PCRRFLP method and association analysis was conducted using appropriate statistical tests

Results: From our findings, no significant association was observed in the allele distribution of C3 R102G between nAMD and controls [OR = 1.42, 95% CI = 0.77-2.62, P = 0.268]. A further analysis that compared three genetic models [dominant, recessive and co-dominant] also recorded no significant difference [P > 0.05]. These findings could be due to the low frequency of the GG variant in the case [4.7%] and control [1.3%] groups, compared to the normal variant CC, which is present in 91.3% of case and 92.8% of control alleles

Conclusion: The present study showed no evidence of association between C3 R102G polymorphism and nAMD in Malaysian subjects