|Year : 2013 | Volume
| Issue : 1 | Page : 46-47
K Shreedhara Avabratha
Department of Pediatrics, Father Muller Medical College, Mangalore, India
|Date of Web Publication||20-May-2013|
K Shreedhara Avabratha
Department of Pediatrics, Father Muller Medical College, Mangalore - 575 005
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Avabratha K S. Journal Beat. Muller J Med Sci Res 2013;4:46-7
| Relationship between Serum Ferritin Levels and Amikacin Oto-Toxicity|| |
Aminoglycosides are one of the most effective anti-microbial agents against majority of bacteria. However, they have side-effects such as nephrotoxicity and ototoxicity. One of the theories in aminoglycoside ototoxicity is that iron-aminoglycoside complex produces free radicals, which cause otoxicity by damaging the anterior hair cells of the inner ear. Serum ferritin level was considered as a marker of body's iron storage. Less than 150 ng/ml of serum ferritin is diagnosed as the absence of body's iron storage. In this study, the relationship between hearing loss (ototoxicity) by amikacin and serum iron level was investigated. Patients were divided into two groups in terms of serum ferritin levels (group 1 >150 ng/ml and group 2 <150 ng/ml). Audiological assessments were carried out before receiving amikacin injections and 6 weeks after amikacin injections. The results were analyzed by t-test and paired t-test. 
A total of 181 patients were studied with 89 cases in group 1 and 92 in group 2. Though both groups had an increase in mean thresholds in all frequencies after treatment with amikacin, threshold of group 1 were statistically significantly higher than group 2 at all frequencies. The maximum threshold shift in group 1 was greater than 20 dB and in group 2 it was less than 10 dB at 8000 Hz. The study also noted that mean corpuscular volume was higher in group 1 than group 2. The authors conclude that iron can create more ototoxicity and iron deficiency may inhibit aminoglycoside ototoxicity and suggest to delay iron supplementation (for co-existent anemia) till completion of treatment with aminoglycosides.
Disease Course in Steroid Sensitive Nephrotic Syndrome
Nephrotic syndrome (NS) is a common condition in children and majority are steroid sensitive. It has a varied course ranging from single episode to infrequent to frequent relapses. An understanding of factors that determine the course is useful in taking decisions regarding therapy and helps in counseling. This retrospective study, comes from All India Institute of Medical Sciences, New Delhi evaluated records of patients presented between 1990 and 2005. Records of 2603 patients were reviewed. 1071 steroid sensitive NS patients having minimum 12 months follow-up constituted the study group. At follow-up of 12 months disease course was categorized as no relapses in 6.9%, infrequent relapses in 30.5%, frequent relapses or steroid-dependant in 56.8% and late resistance in 5.9%. Alternate medications were used for frequent relapses in 501 (46.8%) patients. Most received oral cyclophosphamide or levamisole initially, followed by mycophenolate mofetil or a calcineurin inhibitor. Compared to infrequent relapses patients with frequent relapses were younger (54.9 ± 36.0 vs. 43.3 ± 31.4 months), fewer had received ≥8 weeks initial treatment (86.8% vs. 81.7%) and had shorter initial treatment (7.5 ± 8.6 vs. 3.1 ± 4.8 months). At follow-up 56.0 ± 42.6 months, 77.3% patients were in remission or had infrequent relapses and 17.3 had frequent relapses. The present study, as a large and recent group of patients with steroid sensitive NS, identifies the course of the illness and existing therapeutic practices. It reconfirms the importance of age at onset of NS, the need for adequate initial steroid therapy and duration of initial remission in predicting the risk of frequent relapses. The outcomes were satisfactory and on follow-up most patients were in sustained remission or had infrequent relapses. 
Effect of Three Decades of Screening Mammography on Breast-cancer Incidence
In the US, clinicians now have more than 3 decades of experience with the wide spread use of screening mammography. Authors used surveillance, epidemiology, and end results data to examine trends from 1976 through 2008 in the incidence of early stage breast cancer (ductal carcinoma in situ and localized disease) and late stage breast cancer (regional and distant disease) among women 40 years of age or older. 
The introduction of screening mammography in the US has been associated with a doubling in number of cases of early-stage breast cancer that are detected each year, from 112-234 cases per 100,000 women, an absolute increase of 122 cases per 100,000 women. Concomitantly, the rate at which women present with late-stage cancer has decreased by 8%, from 102 to 94 cases per 100,000 women. With the assumption of a constant underlying disease burden, only 8 of 122 additional early stage cancers diagnosed were expected to progress to advanced disease. After excluding the transient excess incidence associated with hormone replacement therapy and adjusting for trends in the incidence of breast cancer among women younger than 40 years of age, authors estimated that breast cancer was over diagnosed (i.e. tumors were detected on screening that would never have led to clinical symptoms) in 1.3 million US women in the past 30 years. They estimated that in 2008, breast cancer was over diagnosed in more than 70,000 women; this accounted for 31% of all breast cancers diagnosed.
The authors conclude that the decreasing mortality in breast cancer is largely due to improved treatment and not due to screening. This study raises serious questions about the value of screening mammography. It clarifies that the benefit of mortality reduction is probably smaller, and the harm of over diagnosis probably larger. The authors end the article with the remark that their study does not answer the question "should I be screened for breast cancer?" However, they say that the question has more than one right answer.
| References|| |
|1.||Shayaninasab M, Fatoloomi M, Behnood F, Alizamir A, Relationship between serum ferritin levels and Amikacin oto-toxicity. Oman Med J 2012;27:297-9. |
|2.||Sinha A, Hari P, Sharma PK, Gulati A, Kalaivani M, Mantan M, et al. Disease course in steroid sensitive nephrotic syndrome. Indian Pediatr 2012;49:881-7. |
|3.||Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med 2012;367:1998-2005. |