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Jayme E Locke, Sally Gustafson, Shikha Mehta, Rhiannon D Reed, Brittany Shelton, Paul A MacLennan, Christine Durand, Jon Snyder, Nicholas Salkowski, Allan Massie, Deirdre Sawinski, Dorry L Segev
OBJECTIVE: To determine the survival benefit of kidney transplantation in human immunodeficiency virus (HIV)-infected patients with end-stage renal disease (ESRD). SUMMARY BACKGROUND DATA: Although kidney transplantation (KT) has emerged as a viable option for select HIV-infected patients, concerns have been raised that risks of KT in HIV-infected patients are higher than those in their HIV-negative counterparts. Despite these increased risks, KT may provide survival benefit for the HIV-infected patient with ESRD, yet this important clinical question remains unanswered...
April 26, 2016: Annals of Surgery
Masayoshi Okumi, Yasuyuki Sato, Kohei Unagami, Toshihito Hirai, Hideki Ishida, Kazunari Tanabe
BACKGROUND: The reasons for improved outcomes associated with preemptive kidney transplantation (PKT) are incompletely understood, and post-transplant complications have been scarcely investigated. METHODS: We evaluated the outcomes of PKT in both unmatched (n = 1060) and propensity score matched cohorts (n = 186) of adults who underwent living kidney transplant between 2000 and 2014. Outcomes were estimated glomerular filtration rate (eGFR), biopsy-proven rejection, cytomegalovirus (CMV) infection, post-transplant diabetes mellitus (PTDM), cardiovascular disease (CVD), graft failure (non-censored for death), and malignancy...
October 19, 2016: Clinical and Experimental Nephrology
Elina Järvinen, Markus Holmberg, Marja-Liisa Sumelahti
The objective of this study was to assess long-term use, adherence and efficacy of injectable disease modifying agents (DMAs). Multiple Sclerosis (MS) patients diagnosed during 2002-2010 with early treatment start and at least one year in first choice medication were included in a large university district in Finland. Annualized relapse rates (ARR) during each treatment period were studied, and number of switches by medication evaluated. Use of health care facilities during 2002-2010 was assessed. In the study were included 113 MS patients; 15 (13%) switched medication...
September 30, 2016: Neurology International
Nophanan Chaikittisilpa, Abhijit V Lele, Vivian H Lyons, Bala G Nair, Shu-Fang Newman, Patricia A Blissitt, Monica S Vavilala
BACKGROUND: Current guidelines recommend routine clamping of external ventricular drains (EVD) for intrahospital transport (IHT). The aim of this project was to describe intracranial hemodynamic complications associated with routine EVD clamping for IHT in neurocritically ill cerebrovascular patients. METHODS: We conducted a retrospective review of cerebrovascular adult patients with indwelling EVD admitted to the neurocritical care unit (NICU) during the months of September to December 2015 at a tertiary care center...
October 18, 2016: Neurocritical Care
Marko Poglitsch, Ashraf H Ahmed, Andrea Stoller, Dunja Van Oyen, Cornelia Schwager, Claudia Aigner, Oliver Domenig, Manuel Haschke, Michael Stowasser
OBJECTIVE: Primary aldosteronism (PA) is a widely under-diagnosed, potentially curable and specifically treatable cause of hypertension. PA screening involves measuring the aldosterone-to-renin-ratio (ARR), but false negative results can occur in the setting of medications, which block the renin-angiotensin system (RAS). Withdrawing RAS blockers from patients with resistant hypertension is not without cardiovascular risk. A novel diagnostic approach, the aldosterone-to-angiotensin-II-ratio (AA2-Ratio), has the potential for less drug interference and improved reliability in PA screening and confirmation of diagnosis...
September 2016: Journal of Hypertension
Marko Poglitsch, Ashraf H Ahmed, Michael Resl, Andrea Stoller, Dunja Van Oyen, Cornelia Schwager, Claudia Aigner, Oliver Domenig, Michael Krebs, Manuel Haschke, Michael Stowasser
OBJECTIVE: Primary aldosteronism (PA) is form of hypertension characterized by production of aldosterone by the adrenal that is excessive and relatively autonomous of the renin-angiotensin system. Once detected, unilateral PA can be usually cured by surgical removal of the affected adrenal, while bilateral PA can be specifically treated by medications, which antagonize aldosterone action. Clinical guidelines of Endocrine Societies in Europe and the US recommend screening for PA among most hypertensive patients...
September 2016: Journal of Hypertension
Yoshikiyo Ono, Yoshitsugu Iwakura, Ryo Morimoto, Masataka Kudo, Yasuhiro Igarashi, Masahiro Nezu, Yuta Tezuka, Hiromasa Ogawa, Sadayoshi Ito, Fumitoshi Stash
OBJECTIVE: Primary aldosteronism (PA) and sleep apnea syndrome (SAS) are common form of secondary hypertension. Some papers reported the group of high risk of SAS was higher rate of complication with PA than that of low risk of SAS. However, there are few reports which evaluated CPAP implementation rate of the PA patients with SAS diagnosing by Polysomnography (PSG). We aim to clarify clinical characteristics of patients of PA with SAS. DESIGN AND METHOD: We screened with Apnomonitor 284 PA patients who underwent adrenal venous sampling (AVS)...
September 2016: Journal of Hypertension
Lebo Gafane, Alta Schutte, Johannes Van Rooyen, Rudolph Schutte
OBJECTIVE: Hypertension, particularly in black populations is often accompanied by low renin levels, indicative of possible blood pressure (BP) dysregulation by the renin-angiotensin-system (RAS). The potential role of aldosterone in sympathetic nerve activation in the context of low renin warrants clarification. We therefore explored whether measures of sympathetic nerve activity (noradrenaline, 24-hour heart rate (HR) and % dipping in night-time HR) relate to renin, aldosterone and aldosterone-to-renin ratio (ARR) in low renin blacks and whites...
September 2016: Journal of Hypertension
Marko Poglitsch
Primary aldosteronism (PA) is severe form of hypertension characterized by a strongly increased aldosterone secretion mediated by adenomas or other forms of adrenal hyper-activity. Once detected, PA can be usually cured by either surgical intervention or by appropriate pharmacologic treatments. The incidence of PA among hypertensive patients varies strongly between different studies, which is in part caused by the complex state-of-the-art testing procedure that is unfortunately far away from being a versatile PA screening tool...
September 2016: Journal of Hypertension
Ami Kwon, Woo-Baek Chung, Tae-Hoon Kim, Suk Min Suh, Eun Ho Chu, Sung-Won Jang, GeeHee Kim, Sang Hyun Ihm
OBJECTIVE: There are many reports about white coat hypertension (WCH), still the clinical significance and pathophysiology of WCH is ambiguous. The aim of this study was to find out the difference of RAAS activity in WCH compared with the essential hypertension (EH) group, which could suggest the role of RAAS activity in the development of WCH. DESIGN AND METHOD: Never treated hypertension patients who visited 8 hospitals of The Catholic University of Korea from January 2011 through July 2012 were enrolled...
September 2016: Journal of Hypertension
Jingyu Yao, Lin Jia, Kecia Feathers, Chengmao Lin, Naheed W Khan, Daniel J Klionsky, Thomas A Ferguson, David N Zacks
Autophagy is a lysosomal degradation pathway critical to preventing the accumulation of cytotoxic proteins. Deletion of the essential autophagy gene Atg5 from the rod photoreceptors of the retina (atg5(Δrod) mouse) results in the accumulation of the phototransduction protein transducin and the degeneration of these neurons. The purpose of this study is to test the hypothesis that autophagic degradation of visual transduction proteins prevents retinal degeneration. Targeted deletion of both Gnat1 (a gene encoding the alpha subunit of the heterotrimeric G-protein transducin) and Atg5 in the rod photoreceptors resulted in a significantly decreased rate of rod cell degeneration as compared to the atg5(Δrod) mouse retina, and considerable preservation of photoreceptors...
October 18, 2016: Autophagy
Chih-Ping Chen, Shuan-Pei Lin, Schu-Rern Chern, Peih-Shan Wu, Yen-Ni Chen, Shin-Wen Chen, Chen-Chi Lee, Dai-Dyi Town, Chien-Wen Yang, Wayseen Wang
OBJECTIVE: To present molecular cytogenetic characterization of an inverted duplication of proximal chromosome 15 [inv dup(15)] presenting as a small supernumerary marker chromosome (sSMC) associated with the inv dup(15) syndrome. CASE REPORT: A 35-year-old woman underwent amniocentesis because of advanced maternal age at 27 weeks of gestation, which revealed an sSMC that was confirmed by fluorescence in situ hybridization (FISH) to be derived from chromosome 15...
October 2016: Taiwanese Journal of Obstetrics & Gynecology
Heloise Buys, Rudzani Muloiwa, Colleen Bamford, Brian Eley
BACKGROUND: Klebsiella pneumoniae (KP) is a significant paediatric bloodstream pathogen in children. There is little data from Africa. In this study we describe the epidemiology of multi-drug resistant Klebsiella pneumoniae bloodstream infection (KPBSI) at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. METHODS: We conducted a retrospective cross-sectional study of KPBSI from 1 January 2006 to 31 December 2011 using conventional descriptive and inferential statistical methods...
October 17, 2016: BMC Infectious Diseases
C L Roberts, C S Algert, J B Ford, T A Nippita, J M Morris
STUDY QUESTION: After an initial midtrimester loss, is the interval to the next conception associated with the risk of a recurrent loss? SUMMARY ANSWER: Among women who had a pregnancy loss at 14-19 weeks gestation, conception at least 3 months after this initial loss was associated with a reduced risk of a recurrent loss. WHAT IS KNOWN ALREADY: A short interpregnancy interval (IPI) has been thought to increase risk but recent studies of pregnancy after a loss have found no effect; however, these studies have been based almost entirely on an initial first trimester (<14 weeks) loss...
October 14, 2016: Human Reproduction
Dina Nair, Pooranaganga D Navneethapandian, Jaya Prasad Tripathy, Anthony D Harries, Joel S Klinton, Basilea Watson, Gomathi N Sivaramakrishnan, Devarajulu S Reddy, Lakshmi Murali, Mohan Natrajan, Soumya Swaminathan
BACKGROUND: India is replacing culture and drug sensitivity testing (CDST) with rapid molecular tests for diagnosing MDR-TB. We assessed the impact of rapid tests on time to initiation of treatment and outcomes in patients with MDR-TB compared with CDST. METHODS: A retrospective cohort study involving MDR-TB patients from six districts in Tamil Nadu state, who underwent CDST (2010-2011) and rapid tests (2012-2013). RESULTS: There were 135 patients in the CDST group and 389 in the rapid diagnostic test group...
October 13, 2016: Transactions of the Royal Society of Tropical Medicine and Hygiene
Ankita Tirath, Sandra Tadros, Samuel L Coffin, Kristina W Kintziger, Jennifer L Waller, Stephanie L Baer, Rhonda E Colombo, Lu Y Huber, Mufaddal F Kheda, N Stanley Nahman
Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea. Patients with end-stage renal disease (ESRD) may be at increased risk for CDI. Patients with ESRD with CDI have increased mortality, longer length of stay, and higher costs. The present studies extend these observations and address associated comorbidities, incidence of recurrence, and risk factors for mortality. We queried the United States Renal Data System (USRDS) for patients with ESRD diagnosed with CDI, and assessed for the incidence of infection, comorbidities, and mortality...
October 13, 2016: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
Nadine E Palermo, Katherine L Modzelewski, Alan P Farwell, Jennifer Fosbroke, Kalpana N Shankar, Sara M Alexanian, William E Baker, Donald C Simonson, Marie E McDonnell
OBJECTIVE: Patients who present to the emergency department (ED) for diabetes without hyperglycemic crisis are at risk of unnecessary hospitalizations and poor outcomes. To address this, the ED Diabetes Rapid-referral Program (EDRP) was designed to provide ED staff with direct booking into the diabetes center. The objective of this study was to determine the effects of the EDRP on hospitalization rate, ED utilization rate, glycemic control, and expenditures. METHODS: We conducted a single-center analysis of the EDRP cohort (n = 420) and compared 1-year outcomes to historic controls (n = 791)...
October 2016: Endocrine Practice
M Daniel Hatch, Stephen D Daniels, Kimberly M Glerum, Laurence D Higgins
BACKGROUND: Increasing methicillin resistance and recognition of Propionibacterium acnes as a cause of infection in shoulder arthroplasty has led to the adoption of local vancomycin powder application as a more effective method to prevent expensive periprosthetic infections. However, no study has analyzed the cost effectiveness of vancomycin powder for preventing infection after shoulder replacement. METHODS: Cost data for infection-related care of 16 patients treated for deep periprosthetic shoulder infection was collected from our institution for the break-even analysis...
October 7, 2016: Journal of Shoulder and Elbow Surgery
Tesera Bitew, Charlotte Hanlon, Eskinder Kebede, Girmay Medhin, Abebaw Fekadu
BACKGROUND: Depressive symptoms during pregnancy can have multiple adverse effects on perinatal outcomes, including maternal morbidity and mortality. The potential impact of antenatal depressive symptoms on maternal health care use, however, has been little explored in low and middle-income countries (LMICs). This paper investigates whether maternal health care utilisation varies as a function of antenatal depressive symptoms. METHODS: In a population-based cross-sectional survey, 1311 women in the second or third trimesters of pregnancy were recruited in Sodo district, Gurage Zone, southern Ethiopia...
October 10, 2016: BMC Pregnancy and Childbirth
Irene Del Pilar Moreno Torres, Antonio García-Merino
INTRODUCTION: The therapeutic utility of the anti-CD20 monoclonal antibodies (mAbs) is currently being evaluated in multiple sclerosis (MS) in line with the better understanding of the role of B lymphocytes in MS pathogenesis. AREA COVERED: We conducted a literature search using Medline/Pub Med database of basic research and available controlled trials about anti-CD20 mAbs in MS. Additionally, ongoing studies were identified in the database. B cells exert multiple inflammatory and regulatory functions playing an important role in MS pathogenesis as is demonstrated by the production of autoantibodies, infiltration of B cells in MS lesions and the formation of ectopic B cell follicle-like structures in meninges, among others...
October 10, 2016: Expert Review of Neurotherapeutics
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