Obesity has become a worldwide epidemic,and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes,cardiovascular disease and also for...Obesity has become a worldwide epidemic,and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes,cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis,and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease,advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.展开更多
BACKGROUND Few studies have examined intestinal motility disorders,which are disabling conditions associated with chronic functional constipation,whose pathogenesis is actually not well-defined.AIM To investigate the ...BACKGROUND Few studies have examined intestinal motility disorders,which are disabling conditions associated with chronic functional constipation,whose pathogenesis is actually not well-defined.AIM To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders.METHODS We performed a prospective case-control study,from May-June to November2017.Glucose/lactulose breath tests,radiopaque markers(multiple capsule techniques)and wireless motility capsule analysis were used to assess colonicand oro-cecal transit time,after excluding small-intestinal bacterial overgrowth condition.Then,we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires,the Irritable Bowel Syndrome Quality of life(IBS-QOL),the Short Form Health Survey 12,and the Hospital Anxiety and Depression Scale 14(HADS-14 A and HADS-14 D).RESULTS We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects.Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels(P<0.001),and they showed a significant impairment of all health-related quality of life and psychological tests(IBS-QOL,Short Form Health Survey 12-Physical Component Summary,Short Form Health Survey 12-Mental Component Summary,HADS-14 A and HADS-14 D),as compared to the control group(P<0.001),which significantly correlated with low vitamin D levels(r=-0.57,P<0.001;r=0.21,P=0.01;r=-0.48,P<0.001;r=-0.57,P<0.001;r=-0.29,P<0.001,respectively).At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder(odds ratio=1.19;95%confidence interval:1.14-1.26,P<0.001).CONCLUSION Vitamin D deficiency,anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders.Vitamin D serum levels should be routinely measured in these patients.展开更多
Patients with kidney diseases continue to experience significant cardiovascular disease(CVD) morbidity and mortality. Although there are many important risk factors playing a role in the pathogenesis of CVD in chronic...Patients with kidney diseases continue to experience significant cardiovascular disease(CVD) morbidity and mortality. Although there are many important risk factors playing a role in the pathogenesis of CVD in chronic kidney disease(CKD) patients, dyslipidemia(elevated triglycerides, elevated oxidized low-densitylipoprotein and low/dysfunctional low high-density) represents one of the modifiable risk factors. Renal failure patients have unique lipid abnormalities which not only have complex role in pathogenesis of CVD but also cause relative resistance to usual interventions. Most of the randomized trials have been in hemodialysis population and data from CKD non-dialysis, peritoneal dialysis and renal transplant populations is extremely limited. Compared to general population, evidence of mortality benefit of lipid lowering medications in CKD population is scarce. Future research should be directed towards establishing long term benefits and side effects of lipid lowering medications, through randomized trials, in CKD population.展开更多
Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK ne...Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy(BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research.展开更多
A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus(NDI), presented with coma and hyperglycemic hyper...A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus(NDI), presented with coma and hyperglycemic hyperosmolar state(HHS). Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained < 300 m Osm/kg after injection of vasopressin. Improvement in serum sodium concentration followed the intake of large volumes of water plus administration of amiloride and hydrochlorothiazide. Severe hyperglycemia may trigger symptomatic lithium-induced NDI years after cessation of lithium therapy. Patients with newonset diabetes mellitus who had been on prolonged lithium therapy in the past require monitoring of their serum sodium concentration after hyperglycemic episodes regardless of whether they do or do not carry the diagnosis of NDI.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection has been associated with a long-term risk of precancerous gastric conditions(PGC)even after H.pylori eradication.AIM To investigate the efficacy of High-Resolution Whi...BACKGROUND Helicobacter pylori(H.pylori)infection has been associated with a long-term risk of precancerous gastric conditions(PGC)even after H.pylori eradication.AIM To investigate the efficacy of High-Resolution White-Light Endoscopy with Narrow-Band Imaging in detecting PGC,before/after H.pylori eradication.METHODS We studied 85 consecutive patients with H.pylori-related gastritis with/without PGC before and 6 mo after proven H.pylori eradication.Kimura-Takemoto modified and endoscopic grading of gastric intestinal metaplasia classifications,were applied to assess the endoscopic extension of atrophy and intestinal metaplasia.The histological result was considered to be the gold standard.The Sydney System,the Operative-Link on Gastritis-Assessment,and the Operative-Link on Gastric-Intestinal Metaplasia were used for defining histological gastritis,atrophy and intestinal metaplasia,whereas dysplasia was graded according to World Health Organization classification.Serum anti-parietal cell antibody and anti-intrinsic factor were measured when autoimmune atrophic gastritis was suspected.RESULTS After H.pylori eradication histological signs of mononuclear/polymorphonuclear cell infiltration and Mucosal Associated Lymphoid Tissue-hyperplasia,disappeared or decreased in 100%and 96.5%of patients respectively,whereas the Operative-Link on Gastritis-Assessment and Operative-Link on Gastric-Intestinal Metaplasia stages did not change.Low-Grade Dysplasia prevalence was similar on random biopsies before and after H.pylori eradication(17.6%vs 10.6%,P=0.19),but increased in patients with visible lesions(0%vs 22.4%,P<0.0001).At a multivariate analysis,the probability for detecting dysplasia after resolution of H.pylori-related active inflammation was higher in patients with regression or reduction of Mucosal Associated Lymphoid Tissue hyperplasia,greater alcohol consumption,and anti-parietal cell antibody and/or anti-intrinsic factor positivity[odds ratio(OR)=3.88,95%confidence interval(CI):1.31-11.49,P=0.01;OR=3.10,95%CI:1.05-9.12,P=0.04 and OR=5.47,95%CI:1.33-22.39,P<0.04,respectively].CONCLUSION High-Resolution White-Light Endoscopy with Narrow-Band Imaging allows an accurate diagnosis of Low-Grade Dysplasia on visible lesions after regression of H.pylori-induced chronic gastritis.Patients with an overlap between autoimmune/H.pylori-induced gastritis may require more extensive gastric mapping.展开更多
Objective: To observe the influence of the treatment of depression on the regularization of blood pressure and heart rate of individuals with hypertension and depression. Methods: A total of 30 individuals who were be...Objective: To observe the influence of the treatment of depression on the regularization of blood pressure and heart rate of individuals with hypertension and depression. Methods: A total of 30 individuals who were being treated for hypertension were diagnosed for depression participated in this study. Escitalopram (10 - 20 mg) was administered to 15 individuals, while the other 15 received placebo. These individuals were followed for 8 weeks with regular monitoring of blood pressure and heart rate. Scores on the Hamilton Depression Rating Scale were evaluated within the first, second, fourth, and eighth weeks of the study onset. The same 30 individuals were further divided into groups who had or had not undergone depression remission, regardless of whether the individual was receiving the active drug or placebo. Likewise, in order to observe the influence of sleep regularization, the patients were divided into groups based on whether their sleep quality had improved. Results: There was a significant decrease in the average systolic blood pressure of the normal-sleep group (-20.07 ± 13.45 vs. -9.43 ± 14.87 mmHg, p = 0.04). Heart rate was lower in the escitalopram than in the placebo group: 66.88 ± 9.62 vs. 74.19 ± 9.55 bpm, p = 0.04. Conclusion: Treatment with escitalopram decreased heart rate, improved sleep quality, and decreased blood pressure.展开更多
Background:Although 99mTc-dimercaptosuccinic acid(DMSA)scan is considered the gold standard for the diagnosis of acute pyelonephritis(AP),sometimes it produces false results in children with clinical features of AP.Th...Background:Although 99mTc-dimercaptosuccinic acid(DMSA)scan is considered the gold standard for the diagnosis of acute pyelonephritis(AP),sometimes it produces false results in children with clinical features of AP.There are no studies on the comparison of the sensitivity of DMSA and concentrating capacity test.Methods:Eighty-fi ve infants with AP of less than one year old were studied to evaluate whether they had real AP or not.Data were compared between infants with an abnormal(group A,n=64)and those with a normal DMSA scan(group B,n=21)respectively.A DDAVP test was performed for each infant.Results:All the infants in both groups presented a high level of C-reactive protein and fever(≥38oC).There were no differences in clinical and analytical variables except C-reactive protein level in the two groups.Both groups exhibited a low urinary osmolality(87.5%in the group A vs.85.7%in the group B).The patients with normal DMSA and decreased concentrating capacity have some renal parenchymal damage and not only a lower urinary infection.Of the infants with an abnormal DMSA scan,33.9%showed renal scars after 6-12 months.No infant with a normal DMSA scan showed scars.The biochemical variables in both groups of infants were not related to vesicoureteral refl ux.Conclusion:Infants with AP,normal DMSA scan and low concentrating capacity may be characterized by a localized infection in the medulla(medullonephritis)or by a false negative DMSA scan.展开更多
文摘Obesity has become a worldwide epidemic,and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes,cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis,and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease,advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.
文摘BACKGROUND Few studies have examined intestinal motility disorders,which are disabling conditions associated with chronic functional constipation,whose pathogenesis is actually not well-defined.AIM To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders.METHODS We performed a prospective case-control study,from May-June to November2017.Glucose/lactulose breath tests,radiopaque markers(multiple capsule techniques)and wireless motility capsule analysis were used to assess colonicand oro-cecal transit time,after excluding small-intestinal bacterial overgrowth condition.Then,we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires,the Irritable Bowel Syndrome Quality of life(IBS-QOL),the Short Form Health Survey 12,and the Hospital Anxiety and Depression Scale 14(HADS-14 A and HADS-14 D).RESULTS We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects.Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels(P<0.001),and they showed a significant impairment of all health-related quality of life and psychological tests(IBS-QOL,Short Form Health Survey 12-Physical Component Summary,Short Form Health Survey 12-Mental Component Summary,HADS-14 A and HADS-14 D),as compared to the control group(P<0.001),which significantly correlated with low vitamin D levels(r=-0.57,P<0.001;r=0.21,P=0.01;r=-0.48,P<0.001;r=-0.57,P<0.001;r=-0.29,P<0.001,respectively).At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder(odds ratio=1.19;95%confidence interval:1.14-1.26,P<0.001).CONCLUSION Vitamin D deficiency,anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders.Vitamin D serum levels should be routinely measured in these patients.
文摘Patients with kidney diseases continue to experience significant cardiovascular disease(CVD) morbidity and mortality. Although there are many important risk factors playing a role in the pathogenesis of CVD in chronic kidney disease(CKD) patients, dyslipidemia(elevated triglycerides, elevated oxidized low-densitylipoprotein and low/dysfunctional low high-density) represents one of the modifiable risk factors. Renal failure patients have unique lipid abnormalities which not only have complex role in pathogenesis of CVD but also cause relative resistance to usual interventions. Most of the randomized trials have been in hemodialysis population and data from CKD non-dialysis, peritoneal dialysis and renal transplant populations is extremely limited. Compared to general population, evidence of mortality benefit of lipid lowering medications in CKD population is scarce. Future research should be directed towards establishing long term benefits and side effects of lipid lowering medications, through randomized trials, in CKD population.
文摘Nephropathy secondary to BK virus, a member of the Papoviridae family of viruses, has been recognized for some time as an important cause of allograft dysfunction in renal transplant recipients. In recent times, BK nephropathy(BKN) of the native kidneys has being increasingly recognized as a cause of chronic kidney disease in patients with solid organ transplants, bone marrow transplants and in patients with other clinical entities associated with immunosuppression. In such patients renal dysfunction is often attributed to other factors including nephrotoxicity of medications used to prevent rejection of the transplanted organs. Renal biopsy is required for the diagnosis of BKN. Quantitation of the BK viral load in blood and urine are surrogate diagnostic methods. The treatment of BKN is based on reduction of the immunosuppressive medications. Several compounds have shown antiviral activity, but have not consistently shown to have beneficial effects in BKN. In addition to BKN, BK viral infection can cause severe urinary bladder cystitis, ureteritis and urinary tract obstruction as well as manifestations in other organ systems including the central nervous system, the respiratory system, the gastrointestinal system and the hematopoietic system. BK viral infection has also been implicated in tumorigenesis. The spectrum of clinical manifestations from BK infection and infection from other members of the Papoviridae family is widening. Prevention and treatment of BK infection and infections from other Papovaviruses are subjects of intense research.
文摘A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus(NDI), presented with coma and hyperglycemic hyperosmolar state(HHS). Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained < 300 m Osm/kg after injection of vasopressin. Improvement in serum sodium concentration followed the intake of large volumes of water plus administration of amiloride and hydrochlorothiazide. Severe hyperglycemia may trigger symptomatic lithium-induced NDI years after cessation of lithium therapy. Patients with newonset diabetes mellitus who had been on prolonged lithium therapy in the past require monitoring of their serum sodium concentration after hyperglycemic episodes regardless of whether they do or do not carry the diagnosis of NDI.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection has been associated with a long-term risk of precancerous gastric conditions(PGC)even after H.pylori eradication.AIM To investigate the efficacy of High-Resolution White-Light Endoscopy with Narrow-Band Imaging in detecting PGC,before/after H.pylori eradication.METHODS We studied 85 consecutive patients with H.pylori-related gastritis with/without PGC before and 6 mo after proven H.pylori eradication.Kimura-Takemoto modified and endoscopic grading of gastric intestinal metaplasia classifications,were applied to assess the endoscopic extension of atrophy and intestinal metaplasia.The histological result was considered to be the gold standard.The Sydney System,the Operative-Link on Gastritis-Assessment,and the Operative-Link on Gastric-Intestinal Metaplasia were used for defining histological gastritis,atrophy and intestinal metaplasia,whereas dysplasia was graded according to World Health Organization classification.Serum anti-parietal cell antibody and anti-intrinsic factor were measured when autoimmune atrophic gastritis was suspected.RESULTS After H.pylori eradication histological signs of mononuclear/polymorphonuclear cell infiltration and Mucosal Associated Lymphoid Tissue-hyperplasia,disappeared or decreased in 100%and 96.5%of patients respectively,whereas the Operative-Link on Gastritis-Assessment and Operative-Link on Gastric-Intestinal Metaplasia stages did not change.Low-Grade Dysplasia prevalence was similar on random biopsies before and after H.pylori eradication(17.6%vs 10.6%,P=0.19),but increased in patients with visible lesions(0%vs 22.4%,P<0.0001).At a multivariate analysis,the probability for detecting dysplasia after resolution of H.pylori-related active inflammation was higher in patients with regression or reduction of Mucosal Associated Lymphoid Tissue hyperplasia,greater alcohol consumption,and anti-parietal cell antibody and/or anti-intrinsic factor positivity[odds ratio(OR)=3.88,95%confidence interval(CI):1.31-11.49,P=0.01;OR=3.10,95%CI:1.05-9.12,P=0.04 and OR=5.47,95%CI:1.33-22.39,P<0.04,respectively].CONCLUSION High-Resolution White-Light Endoscopy with Narrow-Band Imaging allows an accurate diagnosis of Low-Grade Dysplasia on visible lesions after regression of H.pylori-induced chronic gastritis.Patients with an overlap between autoimmune/H.pylori-induced gastritis may require more extensive gastric mapping.
文摘Objective: To observe the influence of the treatment of depression on the regularization of blood pressure and heart rate of individuals with hypertension and depression. Methods: A total of 30 individuals who were being treated for hypertension were diagnosed for depression participated in this study. Escitalopram (10 - 20 mg) was administered to 15 individuals, while the other 15 received placebo. These individuals were followed for 8 weeks with regular monitoring of blood pressure and heart rate. Scores on the Hamilton Depression Rating Scale were evaluated within the first, second, fourth, and eighth weeks of the study onset. The same 30 individuals were further divided into groups who had or had not undergone depression remission, regardless of whether the individual was receiving the active drug or placebo. Likewise, in order to observe the influence of sleep regularization, the patients were divided into groups based on whether their sleep quality had improved. Results: There was a significant decrease in the average systolic blood pressure of the normal-sleep group (-20.07 ± 13.45 vs. -9.43 ± 14.87 mmHg, p = 0.04). Heart rate was lower in the escitalopram than in the placebo group: 66.88 ± 9.62 vs. 74.19 ± 9.55 bpm, p = 0.04. Conclusion: Treatment with escitalopram decreased heart rate, improved sleep quality, and decreased blood pressure.
文摘Background:Although 99mTc-dimercaptosuccinic acid(DMSA)scan is considered the gold standard for the diagnosis of acute pyelonephritis(AP),sometimes it produces false results in children with clinical features of AP.There are no studies on the comparison of the sensitivity of DMSA and concentrating capacity test.Methods:Eighty-fi ve infants with AP of less than one year old were studied to evaluate whether they had real AP or not.Data were compared between infants with an abnormal(group A,n=64)and those with a normal DMSA scan(group B,n=21)respectively.A DDAVP test was performed for each infant.Results:All the infants in both groups presented a high level of C-reactive protein and fever(≥38oC).There were no differences in clinical and analytical variables except C-reactive protein level in the two groups.Both groups exhibited a low urinary osmolality(87.5%in the group A vs.85.7%in the group B).The patients with normal DMSA and decreased concentrating capacity have some renal parenchymal damage and not only a lower urinary infection.Of the infants with an abnormal DMSA scan,33.9%showed renal scars after 6-12 months.No infant with a normal DMSA scan showed scars.The biochemical variables in both groups of infants were not related to vesicoureteral refl ux.Conclusion:Infants with AP,normal DMSA scan and low concentrating capacity may be characterized by a localized infection in the medulla(medullonephritis)or by a false negative DMSA scan.
