- Firing of an Implantable Cardiac Defibrillator: An Unusual Presentation of Celiac Crisis. [Journal Article]
- ACACG Case Rep J 2016; 3(4):e137
- Celiac crisis, an atypical presentation of celiac disease, is characterized by acute diarrhea and severe metabolic derangements. This diagnosis is often missed in the differential of acute diarrheal ...
Celiac crisis, an atypical presentation of celiac disease, is characterized by acute diarrhea and severe metabolic derangements. This diagnosis is often missed in the differential of acute diarrheal illness. Our patient is a 69-year-old man who presented with ICD firing and was found to have profound metabolic derangements. Further evaluation revealed undiagnosed celiac disease and his symptoms resolved with a gluten-free diet. Celiac crisis should be considered in all patients presenting with acute diarrhea, metabolic acidosis, and severe electrolyte abnormalities as management can be life-saving.
- A Case of Biotinidase Deficiency in an Adult with Respiratory Failure in the Intensive Care Unit. [Journal Article]
- BMBalkan Med J 2016; 33(5):563-565
- CONCLUSIONS: Even though biotinidase deficiency is not frequently seen in the intensive care unit, metabolic syndromes such as biotinidase deficiency should be considered. Patients should be evaluated holistically with attention to medical history, family history and clinical findings.
- [Analysis on clinical features and functional MRI of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes]. [Journal Article]
- ZYZhonghua Yi Xue Za Zhi 2016 Oct 11; 96(37):2969-2972
- Objective: To explore the clinical and perfusion weighted imaging (PWI) characteristics of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) in order to improve th...
Objective: To explore the clinical and perfusion weighted imaging (PWI) characteristics of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) in order to improve the early diagnosis rate. Methods: Clinical and imaging data of 46 patients with final diagnosis of MELAS treated in Henan Province People's Hospital from January 2012 to June 2016 were collected. Results: Patients presented with symptoms of epilepsy, hemiplegia, language disorders, and decreased visual acuity and so on. Diffusion-weighted imaging (DWI) of the lesion area showed a high signal, apparent diffusion coefficient (ADC) chart with the course of disease development can be a high signal, low signal, high and low signal. Vascular stenosis was not seen in all the patients by magnetic resonance angiography (MRA). PWI perfusion increased in acute phase and was normal or decreased in the chronic phase. Conclusions: The clinical manifestations of MELAS patients are complex and various, and lack of specificity. Routine MRI examination is of great significance for the screening of the lesion, which has a characteristic performance and is helpful to improve the early diagnosis rate of the disease.
- Risks of Metformin in Type 2 Diabetes and Chronic Kidney Disease: Lessons Learned from Taiwanese Data. [Journal Article]
- NNephron 2016 Oct 20
- Like other biguanide agents, metformin is an anti-hyperglycemic agent with lower tendency towards hypoglycemia compared to other anti-diabetic drugs. Given its favorable effects on serum lipids, obes...
Like other biguanide agents, metformin is an anti-hyperglycemic agent with lower tendency towards hypoglycemia compared to other anti-diabetic drugs. Given its favorable effects on serum lipids, obese body habitus, cardiovascular disease, and mortality, metformin is recommended as the first-line pharmacologic agent for type 2 diabetes in the absence of contraindications. However, as metformin accumulation may lead to type B non-hypoxemic lactic acidosis, especially in the setting of kidney injury, chronic kidney disease, and overdose, regulatory agencies such as the United States Food and Drug Administration (FDA) have maintained certain restrictions regarding its use in kidney dysfunction. Case series have demonstrated a high fatality rate with metformin-associated lactic acidosis (MALA), and the real-life incidence of MALA may be underestimated by observational studies and clinical trials that have excluded patients with moderate-to-advanced kidney dysfunction. A recent study of advanced diabetic kidney disease patients in Taiwan in Lancet Endocrinology and Diabetes has provided unique insight into the potential consequences of unrestricted metformin use, including a 35% higher adjusted mortality risk that was dose-dependent. This timely study, as well as historical data documenting the toxicities of other biguanides, phenformin and buformin, suggest that the recent relaxation of FDA recommendations to expand metformin use in patients with kidney dysfunction (i.e., those with estimated glomerular filtration rates ≥30 instead of our recommended ≥45 ml/min/1.73 m2) may be too liberal. In this article, we will review the history of metformin use; its pharmacology, mechanism of action, and potential toxicities; and policy-level changes in its use over time.
- Use of Elements of the Stewart Model (Strong Ion Approach) - SID3, SID4, Atot/A-, SIDe and SIG for the Diagnostics of Respiratory Acidosis in Brachycephalic Dogs. [Journal Article]
- PJPol J Vet Sci 2016 Sep 1; 19(3):633-638
- CONCLUSIONS: On the basis of the results obtained, it can be stated that the values of SID3, SIDe and SIG change during respiratory acidosis and may be helpful in the diagnostics of ABB disorders in brachycephalic dogs.
- Usefulness of Acidity and Temperature of the Rumen and Abomasum in Diagnosing SARA in Dairy Cows after Calving. [Journal Article]
- PJPol J Vet Sci 2016 Sep 1; 19(3):553-558
- The aim of the research was to determine the relationship between the acidity and temperature of the contents of the reticulorumen and abomasum in the first 10 days after calving and to evaluate thes...
The aim of the research was to determine the relationship between the acidity and temperature of the contents of the reticulorumen and abomasum in the first 10 days after calving and to evaluate these factors as predictive traits for the diagnosis of subclinical acidosis. The acidity and temperature of the contents of the reticulorumen and abomasum were measured using specific smaXtec boluses manufactured for animal care. According to the directions of the manufacturer, the boluses were inserted into the reticulorumen of the cows researched with the help of a specific tool. The boluses were inserted into the abomasa by way of surgery, laparotomy and abomasotomy through the right flank. The readings of 7 cows were taken on a total of 10 days, twice a day (at 9 a.m. and at 9 p.m.). In total, 140 measurements were taken. The acidity of the reticulorumen is associated with the acidity of the abomasum. The acidity of the rumen increases, if the acidity of the reticulorumen increases also. A negative correlation was observed between the pH of the contents of the abomasum and this temperature. The increase in the acidity (decrease of pH) of the contents of the reticulorumen increases its temperature and also increases the temperature of the contents of the abomasum. There is a positive statistically significant dependence between the reticulorumen content temperature and the rectal temperature. Through measurement of the ruminoreticular temperature, it is possible to predict the health status of a cow's stomach in regard to acidosis.
- The role of low protein diet in ameliorating proteinuria and deferring dialysis initiation: what is old and what is new. [Journal Article]
- PMPanminerva Med 2016 Oct 19
- In the management of patients with chronic kidney diseases (CKD), a low-protein diet usually refers to a diet with protein intake of 0.6 to 0.8 grams per kilogram of body weight per day (g/kg/day) an...
In the management of patients with chronic kidney diseases (CKD), a low-protein diet usually refers to a diet with protein intake of 0.6 to 0.8 grams per kilogram of body weight per day (g/kg/day) and should include at least 50% high-biologic-value protein. It may be supplemented with essential acids or nitrogen- free ketoanalogues if <0.6 g/kg/d. Low-protein diet can reduce proteinuria especially in non-diabetic CKD patients. In hypoalbuminemic patients it may lead to an increase in serum albumin level. By lowering proteinuria, decreasing nitrogen waste products, ameliorating metabolic burden, mitigating oxidative stress and acidosis, and lowering phosphorus burden, a low-protein diet can help delay dialysis start in advanced CKD. Low-protein diet is safe, since most CKD patients can maintain nitrogen balance by mechanisms of decreasing amino acid oxidation and protein degradation in addition to increased utilization of amino acids for protein synthesis. We suggest a dietary protein intake below 1.0 g/kg/day when estimated glomerular filtration rate (eGFR) falls below 60 ml/min/1.73m2 or when there is solitary kidney or proteinuria at any level of GFR. Protein intake should be reduced progressively based on severity and progression of CKD and patient's nutritional status with a target of 0.6-0.8 g/kg/d in most patients with eGFR<45 ml/min/1.73m2. The risk of protein-energy wasting can be overcome by careful attention to quantity and quality of the ingested proteins, sufficient energy intake of 30-35 Kcal/kg/d, and use of dietary supplements. Long-term observations and individualized approaches are needed to further demonstrate the benefits and safety of low-protein diet.
- Light chains removal by extracorporeal techniques in acute kidney injury due to multiple myeloma: a position statement of the Onconephrology Work Group of the Italian Society of Nephrology. [Journal Article]
- JNJ Nephrol 2016 Oct 18
- Acute kidney injury (AKI) is a frequent complication of multiple myeloma and is associated with increased short-term mortality. Additionally, even a single episode of AKI can eventually lead to end-s...
Acute kidney injury (AKI) is a frequent complication of multiple myeloma and is associated with increased short-term mortality. Additionally, even a single episode of AKI can eventually lead to end-stage renal disease (ESRD), significantly reducing quality of life and long-term survival. In the setting of multiple myeloma, severe AKI (requiring dialysis) is typically secondary to cast nephropathy (CN). Renal injury in CN is due to intratubular obstruction from precipitation of monoclonal serum free light chains (sFLC) as well as direct tubular toxicity of sFLC via stimulation of nuclear factor (NF)κB inflammatory pathways. Current mainstays of CN treatment are early removal of precipitating factors such as nephrotoxic drugs, acidosis and dehydration, together with rapid reduction of sFLC levels. Introduction of the proteasome inhibitor bortezomib has significantly improved the response rates in multiple myeloma due to its ability to rapidly reduce sFLC levels and has been referred to as "renoprotective" therapy. As an adjunct to chemotherapy, several new extracorporeal techniques have raised interest as a further means to reduce sFLC concentrations in the treatment of CN. Whether addition of extracorporeal therapies to renoprotective therapy can result in better renal recovery is still a matter of debate and there are currently no guidelines in this field. In this positon paper, we offer an overview of the available data and the authors' perspectives on extracorporeal treatments in CN.
- GBT440 Inhibits Sickling of Sickle Cell Trait Blood Under In Vitro Conditions Mimicking Strenuous Exercise. [Journal Article]
- HRHematol Rep 2016 Sep 28; 8(3):6637
- In sickle cell trait (SCT), hemoglobin A (HbA) and S (HbS) are co-expressed in each red blood cell (RBC). While homozygous expression of HbS (HbSS) leads to polymerization and sickling of RBCs result...
In sickle cell trait (SCT), hemoglobin A (HbA) and S (HbS) are co-expressed in each red blood cell (RBC). While homozygous expression of HbS (HbSS) leads to polymerization and sickling of RBCs resulting in sickle cell disease (SCD) characterized by hemolytic anemia, painful vaso-occlusive episodes and shortened life-span, SCT is considered a benign condition usually with minor or no complications related to sickling. However, physical activities that cause increased tissue oxygen demand, dehydration and/or metabolic acidosis leads to increased HbS polymerization and life-threatening complications including death. We report that GBT440, an agent being developed for the treatment of SCD, increases the affinity of oxygen for Hb and inhibits in vitro polymerization of a mixture of HbS and HbA that simulates SCT blood. Moreover, GBT440 prevents sickling of SCT blood under in vitro conditions mimicking strenuous exercise with hypoxia, dehydration and acidosis. Together, our results indicate that GBT440 may have the potential to protect SCT individuals from sickling-related complications during conditions that favor HbS polymerization.
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- Acidosis reduces the function and expression of α1D-adrenoceptor in superior mesenteric artery of Capra hircus. [Journal Article]
- IJIndian J Pharmacol 2016 Jul-Aug; 48(4):399-406
- CONCLUSIONS: (i) Adrenergic receptor mediates vasoconstriction in GSMA under normal physiological pHo, and α1D is the possible subtype involved in this event (ii) acidosis attenuates the vasocontractile response due to reduced function and expression of α1D-AR and also increased the release of endothelial-relaxing factors.