1,720,985 research outputs found
[Ultrasound-guided paracentesis: technical, diagnostic and therapeutic aspects for the modern nefrologist]
No full textAscites is a pathological accumulation of fluid in the peritoneal cavity due to various etiologies, often associated with renal failure. Paracentesis is a simple method of removing ascitic fluid by inserting a needle into the peritoneal cavity, often performed at the patient's bedside. It can be both diagnostic and therapeutic. Ultrasound imaging allows the diagnosis of ascites, the identification of the puncture site on the abdominal wall during the pre-procedural phase, the real time evaluation of the needle and the continuous course of the maneuver. This eco-guide technique has higher effectiveness and lower risk of complications than the "blind" venipuncture technique. Ultrasound-guided paracentesis, when performed by nephrologists, reduces the waiting time both for the execution of paracentesis and for the diagnosis, treatment and follow-up of ascites
[Talking about medicine through mass media]
No full text: The ability to communicate is central to all professional activities and therefore being able to communicate effectively with mass media is essential. The medical doctor often needs to communicate not with a single patient or with a group of family members, but with "an important number of patients" through a microphone, a newspaper, a radio or a television. In this case it is not necessary to provide specific information on a single clinical case, but to provide simple, general information on a single pathology or a group of diseases to an interviewer or journalist, who will probably elaborate it at his own discretion making it usable to a diverse and unspecified audience. It is therefore important to be relevant to the question, clear in the presentation, but also synthetic to respect the time limits of interview
THE EFFECT OF VITAMIN D ON BONE MINERAL DENSITY: A REAL-LIFE STUDY IN LONG-TERM KIDNEY TRANSPLANT RECIPIENTS NEVER SUPPLEMENTED
No full textBackground and Aims: Vitamin D insufficiency has been associated to reduced bone mineral density (BMD) in kidney transplant patients (KTRs). However, data of vitamin D supplementation on BMD is still conflicting especially for long-term KTRs. The purpose of our study is to ascertain the effect of 25-OH-vitamin D (25-OH-D) supplementation on the BMD over a follow-up period up to 3 years, in a real-life cohort of long-term KTRs never supplemented with 25-OH-D and no treated with active vitamin D, bisphosphonate and calciomimetics. Method: Demographic, clinical and laboratory data were collected. Inclusion criteria were: 1) being a recipient of a kidney from a cadaveric or living donor; 2) age ≥ 18 years; 3) no therapy with inactive vitamin D sterols. Patients with parathyroidectomy, and/or history of bone fractures were excluded. BMD was evaluated with standard DEXA, performed at baseline (before vitamin D supplementation) and at the end of study period. BMD was assessed at lumbar vertebral bodies (LV) and right femoral neck (FN) by a single operator. Bone mineral content (BMC) was calculated in grams (g), bone area in centimetres squared (cm2), and BMD in g/cm2 (BMC divided by the area). According to WHO criteria, results were expressed as T-score (standard deviation [SD] relative to young healthy adults), and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score < −1 and > −2.5 SD, respectively. According to plasma levels, 25-OH-D was supplemented as recommended for general population. Linear mixed model analysis was implemented to test the impact of 25-OH-D use on Z-score, T-score and BMD changes (dependent variables) adjusted for sex, age, BMI and presence of diabetes. Z-score, T-score and BMD changes were defined as Z-score, T-score and BMD at follow-up – Z-score, T-score and BMD at study inception. Results: 107 KTRs consecutive outpatients never supplemented with 25-OH-D were enrolled. 42 KTRs treated with bisphosphonate (n. 13) and/or calcio-mimetics (n. 11) and/or active vitamin D (n. 29) were considered as control group. Clinical and biochemical characteristics are shown in Table 1. The mean study-period was 27.7±3.4 months. Dexa data were reported in Table 2. At linear mixed model analysis, a positive interaction of 25-OH-D supplementation on T-score and Z-score changes at lumbar vertebral bodies was found (p<0.05). At the end of the study, no statistical differences in Z-score, T-score and BMD gains were observed. Conclusion: Prolonged supplementation with 25-OH-D effects on Z-score and T-score at LV in long-term KTRs never supplemented
US and Arteriovenous Fistulas for Hemodialysis
No full textArteriovenous fistula (AVF) created using native vessels is the preferred vascular access for hemodialysis. AVF is associated with a lower incidence of complications and longer survival compared to prosthetic grafts or central venous catheters. Nephrologists and vascular surgeons are facing growing challenges in finding suitable native vessels for creating a well-functioning and consistently patent AVF. This difficulty arises due to the increasing prevalence of advanced age and comorbidities, such as diabetes mellitus and vascular disease, among patients requiring dialysis
[Muscle-wasting in end stage renal disease in dialysis treatment: a review]
No full text: Progressive and generalized loss of muscle mass (muscle wasting) is a frequent complication in dialysis patients. Common uremic signs and symptoms such as insulin-resistance, increase in glucocorticoid activity, metabolic acidosis, malnutrition, inflammation and dialysis per se contribute to muscle wasting by modulating proteolytic intracellular mechanisms (ubiquitin-proteasome system, activation of caspase-3 and IGF-1/PI3K/Akt pathway). Since muscle wasting is associated with an increase in mortality, bone fractures and worsening in life quality, a prompt and personalised diagnostic and therapeutic approach seems to be essential in dialysis patients. At present, nuclear magnetic resonance (NMR), computed tomography (CT), dual-energy x-ray absorptiometry (DXA), impedance analysis, bioelectric impedance analysis (BIA) and anthropometric measurements are the main tools used to assess skeletal muscle mass. Aerobic and anaerobic training programmes and treatment of uremic complications reduce muscle wasting and increase muscle strength in uremic patients. The present review analyses the most recent data about the physiopathology, diagnosis, therapy and future perspectives of treatment of muscle wasting in dialysis patients
[Chest ultrasound in nephrology]
No full text: The pulmonary study represents a constant appointment for Nephroplogist who frequently asks for a chest-xray in the nephrologic patient, especially in dialysis therapy. The chest x-ray and the Computed Tomography are normally used in pulmonary study, but they are not always rapidly executable and not practicable in the ambulatory and in dialysis room. The ultrasonography has recently been proposed for the study of the lung because it can be carried out rapidly in every nephro-dialytic room, also in frequent follow-up and it doesn't need particular equipment and probes. In this paper we present the fundamental notions of the management of a correct pulmonary ultrasonographic examination and some of the most common pathological pictures (pleural effusion, interstitial and alveolar syndrome, pneumothorax, etc)
Vitamin D status in kidney transplant recipients: an Italian cohort report
No full textINTRODUCTION AND AIMS
Abnormal low levels of vitamin D are frequent in both general
population and in patients with chronic kidney disease.
In kidney transplant recipients, serum vitamin D levels are
reported to increase from early post-transplant period. In this
population, however, the assessment of vitamin D levels is not
routinely performed despite the pleiotropic action of the
hormone involved in both bone health control and in the
reduction of diabetes, cardiovascular disease and cancer.
Therefore, it is clinically relevant to assess calcidiol
concentration and find any potential factor which may affect its
concentration.
The aim of this cross-sectional study is to assess the levels of
serum calcidiol and find out any potential factor associated with
low calcidiol concentration in kidney transplant patients.
METHODS
132 kidney transplant recipients, followed in one nephrology
unit, were enrolled.
The analyzed variables were immunosuppressive agents,
supplementary intake of calcidiol or 1-25-dihydroxyvitamin D,
intact PTH, eGFR, serum calcium, serum phosphorus, urinary
calcium excretion, urinary phosphorus excretion, lactate
dehydrogenase, creatine phosphokinase, total protein, albumin.
On the basis of serum calcidiol levels patients were classified as
suffering from hormone insufficiency (< 30 ng/mL), deficiency
(< 20 ng/mL) or severe deficiency (<10 ng/mL). Hip and
lumbar spine BMD was measured by dual-energy X-ray
absorptiometry (DXA).
RESULTS 1
Cohort clinical characteristics and blood chemistry are listed in
Tab 1.
Primary renal diseases were: glomerulonephritis (40.9%),
ADPKD (18.2%), hypertension (3%), diabetes mellitus (4.5%),
interstitial nephritis (9.8%), other diseases (23.6%).
Mean serum calcidiol levels were 17.5±8.7 ng/mL. Vitamin D
insufficiency, deficiency and severe deficiency was observed in
19.7 %, 34.5 %, 34.1%, respectively. No differences were
observed between males (15.9±8.8 ng/mL) and females
(14.5±8,5 ng/mL), seasonal blood collections (winter/autumn
15.4±8.6 ng/mL VS summer/spring 16.0±9.6 ng/mL) or
exposure to sunlight (outdoor job 16.5±8.9 ng/mL VS indoor job
13.1±8.0 ng/mL). RESULTS 2
Only 9.8 % of the patients had normal calcidiol levels. In an
univariate analysis, calcidiol levels were associated with eGFR
(r= ,180; p=0.04), PTH (r= -,334; p=0.01), serum calcium ( r= ,
208; p=0.02) and PTH (r=−0.254, P<0.001).
On multiple regression analysis, PTH (Beta= -252; p=0.003) and
serum calcium (Beta= ,180; p=0.03) predicted levels of calcidiol/
On multiple regression analysis, levels of calcidiol were expected
with PTH (Beta= -252; p=0.003) and serum calcium (Beta= ,180;
p=0.03).
In 53% of the patients, BMD T-score from lumbar spine
(-1.48±0.95) and hip (-1.27±1.4) was considered osteopenia
according to WHO.
CONCLUSIONS
Low levels of calcidiol are very frequent in kidney transplant
patients. Less than 10% of the patients have normal serum
concentration of calcidiol. By contrast, PTH and calcium serum
concentrations influence calcidiol levels.
These findings should be taken into account in kidney transplant
recipients with low calcidiol levels, who may benefit from oral
vitamin D supplementatio
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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