Incidence of hyponatremia in children with gastroenteritis treated with hypotonic intravenous fluids

Hypotonic saline solutions have been used for over five decades to treat children with diarrheal dehydration. However, concern has recently been raised about the potential for iatrogenic hyponatremia as a result of this therapy. We reviewed the medical records of 531 otherwise healthy children with gastroenteritis who had been admitted to the hospital for intravenous fluid therapy. We retrospectively collected data on 141 of these children who had received two serum electrolytes (one upon admission and the other 4–24 h thereafter). The remaining 390 children were excluded because their charts lacked the required data. We analyzed data in 124 of these 141 patients whose initial serum sodium (Na) level was between 130–150 mEq/l and excluded 17 patients whose admission serum sodium fell outside this range. All patients were treated with intravenous hypotonic fluids (5% dextrose in 0.2% saline, n = 4; 5% dextrose in 0.3% saline, n = 102; 5% dextrose in 0.45% saline, n = 18 patients) as maintenance fluid therapy or maintenance fluid plus deficit therapy; 100 of these children had received an initial saline bolus of 21.05 ± 8.5 ml/kg upon admission. The serum Na level decreased by 1.7 ± 4.3 mEq/l in the whole group. Of the 97 children with isonatremia (Na 139.5 ± 2.7 mEq/l) on admission, 18 (18.5%) developed mild hyponatremia (Na 133.4 ± 0.9 mEq/l, range 131–134), with a decrease in serum Na of 5.7 ± 3.1 mEq/l, and 79 remained isonatremic (Na 138.3 ± 2.7 mEq/l), with a decrease in serum Na of 1.8 ± 3.4 mEq/l (p < 0.0005). There was no significant difference in type, rate, or amount of intravenous fluid or saline bolus (26.1 ± 10.4 vs. 20.2 ± 8.6 ml/kg, respectively) administered in these two groups. Children who became hyponatremic were older (5.8 ± 2.7 years) than those who remained isonatremic (2.8 ± 3.1 years) (p < 0.0005), but there was no statistical difference in gender, degree of dehydration, and severity of metabolic acidosis between the two groups. Although serum Na increased by 3.9 ± 2.5 mEq/l in 19 patients with mild hyponatremia upon admission (Na 132.8 ± 1.3 to 136.7 ± 2.6 mEq/l) and 73% of these became isonatremic, hypotonic saline solutions have the potential to cause hyponatremia in children with gastroenteritis and isonatremic dehydration.     

Randomized cross-over trial comparing albumin and frusemide infusions in nephrotic syndrome

The contribution of hypoalbuminemia to impaired diuretic responsiveness can be overcome by administering larger doses of loop diuretics. However, the clinical efficacy of the combination of loop-acting diuretics with human albumin remains controversial. In the study reported here, 16 children with nephrotic syndrome and refractory edema were randomized in a cross-over trial to receive either the combination of 20% human albumin and frusemide infusion (HA+FU infusion group) or frusemide infusion alone (FU infusion group). At the end of study, median urine volume was 3.27 [95% confidence interval (CI) 2.04–4.50] ml/kg per hour in the HA+FU infusion group and 1.33 (95% CI 0.79–1.88) ml/kg per hour in the FU infusion group (P = 0.01); the median daily sodium excretion was 58 (95% CI 30–366) mEq and 30 (95% CI 10–122) mEq (P = 0.08), respectively The changes in other variables included weight loss [HA+FU 5.2% (95% CI 3.1–8.8); FU 0.8% (95% CI −1.9 to 4.1); P = 0.006]; urine osmolality [HA+FU 315 (95% CI 220–426) mOsm/kg; FU 368 (95% CI 318–446) mOsm/kg; P = 0.13]; osmolal clearance [HA+FU 1600 (95% CI 916–4140) ml/day; FU 880 (95% CI 510–2105) ml/day; P = 0.01; free water clearance [HA+FU −190 (95% CI −960 to 280) ml/day; FU −162 (95% CI −446 to −70) ml/day; P = 0.18]. The findings from this study suggest that the co-administration of albumin and frusemide infusions is more effective than the administration of frusemide infusion alone in inducing diuresis and natriuresis in patients with nephrotic syndrome.     

Effect of diet, enalapril, or losartan in post-diarrheal hemolytic uremic syndrome nephropathy

Proteinuria is the main indicator of renal disease progression in many chronic conditions. There is currently little information available on the efficacy, safety, and individual tolerance of patients with post-diarrheal hemolytic uremic syndrome (D+ HUS) nephropathy to therapies involving diet, enalapril, or losartan. A multicenter, double-blind, randomized controlled trail was conducted to evaluate the effect of a normosodic–normoproteic diet (Phase I) and the effect of normosodic–normoproteic diet plus enalapril (0.18–0.27 mg/kg/day) or losartan (0.89–1.34 mg/kg/day) (Phase II) on children with D+ HUS, normal renal function, and persistent, mild (5.1–49.9 mg/kg/day) proteinuria. Dietary intervention reduced the mean protein intake from 3.4 to 2.2 mg/kg/day. Of 137 children, proteinuria normalized in 91 (66.4 %) within 23–45 days; the remaining 46 patients were randomized to diet plus placebo (group 1, n = 16), plus losartan (group 2, n = 16), or enalapril (group 3, n = 14). In groups 1, 2, and 3, proteinuria was reduced by 30.0, 82.0, and 66.3%, respectively, and normalized in six (37.5%), three (81.3%), and 11 (78.6%) patients, respectively (χ²= 8.9, p = 0.015). These results suggest that: (1) a normosodic–normoproteic diet can normalize proteinuria in the majority of children with D+ HUS with mild sequelae, (2) the addition of enalapril or losartan to such dietary restrictions of protein further reduces proteinuria, and (3) these therapeutic interventions are safe and well tolerated. Whether these short-term effects can be extended to the long-term remains to be demonstrated.     

Prednisone dosing per body weight or body surface area in children with nephrotic syndrome—is it equivalent?

The current guidelines recommend a dosage of prednisone of 60 mg/m² body surface area per day (BSA PRED) for the initial therapy of nephrotic syndrome (NS). Alternatively, a dosage of 2 mg/kg body weight per day (W PRED) can be used. We hypothesized that the BSA PRED and W PRED are not equivalent and analyzed the differences between BSA PRED calculated with various formulas for body surface area (BSA), W PRED and the dose of prednisone prescribed for our patients. We performed a retrospective chart review of the patients at their initial presentation of NS. Thirty-three children were included, of median age 3.34 years at presentation. The W PRED was significantly lower than BSA PRED (P < 0.05), with a median W PRED:BSA PRED ratio of 0.85 [interquartile range (IQR) 0.8 to 0.9]. The difference between W PRED and BSA PRED decreased proportionally to patients’ weights up to 30 kg. No differences were noted between the various BSA formulas using both weight and height for the calculation of BSA. The Bland–Altman analysis showed a proportional error between W PRED and BSA PRED up to the average daily dose of 60 mg, with a mean bias of 0.86 (95% limits of agreement = 0.68 to 1.05). Ten out of the 33 patients (30%) were given a lower than recommended BSA PRED dose by more than 5 mg/day. In conclusion, the dosage of prednisone at 2 mg/kg per day versus 60 mg/m² per day is not equivalent for patients with weights <30 kg and/or dose <60 mg/day.     

A Pediatric Amino Acid Solution for Total Parenteral Nutrition Does Not Affect Liver Function Test Results in Neonates

Purpose: We studied the effects of an amino acid mixture used for total parenteral nutrition (TPN) in pediatrics, on the liver function test results (LFTs) of neonates. Methods: Thirty neonatal surgical patients were randomly divided into three groups according to the dose of amino acids given: group H (n= 12, 3.45 ± 0.07 g/kg per day), group M (n= 8, 2.59 ± 0.07 g/kg per day), and group L (n= 10, 1.72 ± 0.06 g/kg per day). All patients received the same amount of dextrose (average 21.5 g/kg per day) and no lipid. Results: There were no significant differences in LFTs, namely, direct bilirubin, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase, γ-glutamyl transpeptidase, and total bile acids, among the three groups on the tenth day of TPN. Conclusion: These findings indicate that this amino acid solution for pediatrics has no significant effect on LFTs in neonates, even when high doses of amino acids (3.5 g/kg per day) are infused. Received: June 20, 2001 / Accepted: March 5, 2002     

Analysis of Safety and Efficacy of Intragastric Balloon in Extremely Obese Patients

Background  The implantation of an intragastric balloon constitutes a short-term effective non-surgical intervention to lose weight. The aim of this study was to evaluate retrospectively the clinical outcome and safety of gastric balloon therapy (GBT) in extremely obese patients. Methods  One hundred and nine super- and super-super-obese patients, 64 males and 45 females, mean age 39.1 ± 8.4 years, mean body mass index (BMI) 68.8 ± 8.9 kg/m², who underwent GBT for weight loss, were studied retrospectively. GBT was assessed in massively obese patients concerning tolerance, weight loss, number of comorbidities and complications. Results  A significant reduction in patients’ weight and BMI was evident after GBT. Regarding safety, no major complications occurred. Minor complications at balloon placement and removal occurred in one (0.9%) and three patients (2.8%) respectively. Mean duration of GBT was 177.6 ± 56.8 days. After GBT, the mean weight loss was 26.3 ± 15.2 kg (p < 0.001) and the mean BMI reduction was 8.7 ± 5.1 kg/m² (p < 0.001) representing a mean percentage of excess BMI lost (%EBL) of 19.7 ± 10.2. The highest BMI loss was observed in patients with BMI > 80 kg/m². A noteworthy improvement of comorbidities in 56.8% of the patients was also noted. Of the 109 patients, 69 received subsequent bariatric surgery. All the procedures were performed laparoscopically. Ten patients, with a mean BMI of 68.6 ± 10.6 kg/m² after the removal of the first BIB, received a second BIB resulting in a non-significant weight and BMI loss of 6.3 ± 9.4 kg and 1.8 ± 2.9 kg/m², respectively. Conclusions  Our study indicates the safety and efficacy of GBT in extremely obese patients particularly as a first step before a definitive anti-obesity operation. GBT appears to be a safe, tolerable, and potentially effective procedure for the initial treatment of morbid obesity.     

Urinary tract infection in preterm infants: the protective role of breastfeeding

Urinary tract infection (UTI) differs between preterm and older infants and children in terms of prevalence, clinical presentation, causative organism, and rate of underlying renal anomalies. Data on risk factors of UTI in preterm infants are limited. The aim of this study was to characterize UTI both clinically and microbiologically in premature infants and to define possible risk factors and the role of breastfeeding in its development. This case–control study was conducted in a tertiary-care neonatal intensive care unit (NICU) between 1995 and 2003. The study group included all premature infants (<37 weeks’ gestation) diagnosed with UTI. Pre-, peri-, and postnatal data on demographic, clinical, laboratory, and imaging variables were collected from the medical records and microbiology laboratory log and compared with a gestational age- and birth weight-matched infants without UTI (control group). The ratio of control infants to cases was 2:1. Of the 6198 premature infants admitted to the NICU during the study period, 56 (0.9%) were included in the study group. The main causative organism was Klebsiella spp. Logistic regression analysis identified gender [odds ratio (OR) 2.96, 95% confidence interval (CI) 1.28–6.85, P < 0.0001] and the presence of a peripheral intravenous catheter on the day of infection to be significantly associated with UTI, while breast milk was associated with a lower risk of infection (OR 0.314, 95% CI 0.140–0.707, P < 0.009).     

Assessment of long-term renal complications in extremely low birth weight children

We assessed the long-term renal complications in a regional cohort of extremely low birth weight (ELBW) children born in 2002–2004. The study group, comprising 78 children born as ELBW infants (88% of the available cohort), was evaluated with measurement of serum cystatin C, urinary albumin excretion, renal ultrasound, and 24-h ambulatory blood pressure measurements. The control group included 38 children born full-term selected from one general practice in the district. Study patients were evaluated at a mean age of 6.7 years, and had a median birthweight of 890 g (25th–75th percentile: 760–950 g) and a median gestational age of 27 weeks (25th–75th percentile: 26–29 weeks). Mean serum cystatin C levels were significantly higher (0.64 vs. 0.59 mg/l; p = 0.01) in the ELBW group. Hypertension was diagnosed in 8/78 ELBW and 2/38 of the control children (p = 0.5). Microalbuminuria (>20 mg/g of creatinine) was detected only in five ELBW children (p = 0.17). The mean renal volume was significantly lower in the ELBW group (absolute kidney volume 81 ml vs. 113 ml; p < 0.001, relative kidney volume 85 vs. 97%; p < 0.001). Abnormally small kidneys (<2/3 of predicted size) were detected in 19 ELBW and four control children (p = 0.08). Multivariate logistic regression revealed that the only independent risk factor for renal complications was weight gained during neonatal hospitalization (odds ratio: 0.67; 95% confidence interval: 0.39–0.94). Serum cystatin C and kidney volume are significantly lower in school-age ELBW children. It is important to include systematic renal evaluation in the follow-up programs of ELBW infants.     

Long-term follow-up after cyclophosphamide therapy in steroid-dependent nephrotic syndrome

Cyclophosphamide (CP) has been used for over 40 years in patients with steroid-sensitive nephrotic syndrome (SSNS) presenting frequent relapses or steroid dependence (SD). We evaluated retrospectively and tried to identify parameters possibly associated with a prolonged and sustained remission (PSR+) ≥5 years in 108 children with steroid-dependent nephrotic syndrome (SDNS) treated with oral CP. Patients had a follow-up time ≥5 years and were divided into two groups according to achievement of PSR (+ and –). Gender, histological injury, cumulative doses of CP, age of onset of illness, and start of treatment and prednisone dose on the occasion of relapse were analyzed. The overall cumulative sustained remission for 5 and 10 years was 25 and 21.6%, respectively. The only factor that influenced a PSR was the degree of SD: the group PSR+ relapsed at prednisone dose of 0.96 ± 0.51 mg/kg vs. 1.29 ± 0.59 mg/kg in group PSR– (p = 0.01). Also, patients who relapsed in the presence of prednisone doses ≤1.4 mg/kg showed a cumulative sustained remission of 43, 35, and 32.7% at 2, 5, and 10 years, respectively, versus 22.5, 12.5, and 5% in those with prednisone >1.4 mg/kg (p = 0.001). Our findings suggest that patients with SDNS who relapse on prednisone dose >1.4 mg/kg are especially prone to an unfavorable response to CP use.     

Mycophenolate mofetil versus cyclosporine for remission maintenance in nephrotic syndrome

We performed a multi-centre randomized controlled trial to compare the efficacy of mycophenolate mofetil (MMF) to that of cyclosporine A (CsA) in treating children with frequently relapsing nephrotic syndrome and biopsy-proven minimal change disease. Of the 31 randomized initially selected patients, seven were excluded. The remaining 24 children received either MMF 1200 mg/m² per day (n = 12) or CsA 4–5 mg/kg per day (n = 12) during a 12-month period. Of the 12 patients in the MMF group, two discontinued the study medication. Evaluation of the changes from the baseline glomerular filtration rate showed an overall significant difference in favour of MMF over the treatment period (p = 0.03). Seven of the 12 patients in the MMF group and 11 of the 12 patients in the CsA group remained in complete remission during the entire study period. Relapse rate in the MMF group was 0.83/year compared to 0.08/year in the CsA group (p = 0.08). None of the patients reported diarrhea. Pharmacokinetic profiles of mycophenolic acid were performed in seven patients. The patient with the lowest area under the curve had three relapses within 6 months. In children with frequently relapsing minimal change nephrotic syndrome, MMF has a favourable side effect profile compared to CsA; however, there is a tendency towards a higher relapse risk in patients treated with MMF.     

Outcome and management of isolated severe renal pelvis dilatation detected at postnatal screening

The aim of this study was to evaluate the incidence and outcome of isolated severe renal pelvis dilatation (RPD; APD > 15 ≤ 20 mm) in an unselected population of 2-month-old infants prospectively followed up for 12–14 months of life. Isolated severe renal pelvis dilatation was detected in 46 of the 11,801 (0.39%) infants screened. Nephro-urological investigations were initiated if RPD persisted, or if urinary tract infection (UTI) occurred during follow-up, and antibiotic therapy was administered only when UTI occurred. At follow-up, RPD persisted in 24 infants. Of these, 8 infants presented with vesico-ureteral reflux (VUR) of grade ≥ 3 and 16 with ureteropelvic junction obstruction (UPJO). Incidence of UTI was significantly higher (p < 0.001) in infants of the study group than in infants of the control group (13.9 vs 2.5%). Our data suggest that isolated severe RPD may be a self-limiting condition and that antibiotic prophylaxis (AP) for the prevention of UTI should not be performed. Considering RDP resolution and the incidence of UTI during follow-up, investigations for uropathy in infants with isolated, severe RPD are justified in persistent cases, or when UTI occurs during follow-up. Careful clinical monitoring for signs of UTI and treatment of each episode of UTI may be sufficient and safe.     

Urinary vitamin A excretion in very low birth weight infants

Vitamin A (VA) deficiency in very low birth weight (VLBW) infants is associated with an increased risk for disorders related to kidney and lung maturation and function. VA losses through increased urinary retinol (ROH) excretion might contribute to this deficiency risk. The mechanism accounting for ROH loss in the urine has not yet been clarified. The aim of this study was to assess the excretion of ROH, retinol-binding protein 4 (RBP4) and transthyretin (TTR) in urine from VLBW infants in comparison with that in term infants in relation to kidney function. Urine specimens were collected from 15 VLBW infants (birth weight < 1,500 g) as well as from 20 term infants during the first 2 days after birth. ROH in urine was detectable in 14 of the 15 VLBW infants at a median concentration of 234 nmol/g creatinine. In the group of term infants, 17 of the 20 excreted ROH, but at an approximately five-times lower concentration (P < 0.001). Excretion of RBP4 and TTR was also much higher in VLBW infants (both P< 0.001). The urinary ROH excretion in VLBW infants may be related to the impaired tubular handling of its carrier proteins RBP4 and TTR. Thus, ROH excretion might contribute to an increased risk of VA deficiency, especially in VLBW infants.     

Vitamin D insufficiency does not affect response of bone mineral density to alendronate

Summary  We investigated whether osteoporosis therapy with alendronate in postmenopausal patients is equally effective in patients who are vitamin D insufficient as in those who are vitamin D sufficient. We found that vitamin D insufficiency is common among patients with low bone density but that vitamin D insufficiency did not impair response to alendronate. Introduction  Treatment of vitamin D deficiency leads to significant improvements in bone mineral density (BMD); however, whether insufficiency affects BMD’s response to bisphosphonate therapy is unknown. Methods  To determine whether vitamin D insufficiency at initiation of alendronate therapy for low BMD affects treatment efficacy, we used data from 1,000 postmenopausal women randomly selected from the vertebral fracture arm (n = 2,027) of the placebo-controlled Fracture Intervention Trial of alendronate. Participants were randomly assigned to placebo (50%) or alendronate therapy and most (83%) to calcium (500 mg/day) and cholecalciferol (250 IU/day). We measured serum 25-hydroxy vitamin D (25OHD) at enrollment, then categorized baseline vitamin D status according to 25OHD concentration ( ≤ 10 ng/ml = deficient; >10 but ≤ 30 ng/ml = insufficient; >30 ng/ml = sufficient) and used linear regression to compare the effects of alendronate treatment among these categories. Results and conclusion  At baseline, participants were vitamin D sufficient (14%), insufficient (83%), and deficient (2%). We found that BMD response to therapy at total hip or spine did not vary by vitamin D status at baseline (p for heterogeneity = 0.6). We determined that vitamin D insufficiency is common among participants with low BMD. However, vitamin D status at initiation of therapy does not affect BMD’s response to alendronate, when it is coadministered with cholecalciferol and calcium. Scholar’s Grant from the National Osteoporosis Foundation (to D.M.A) and National Institutes of Health grant K23 RR020343 (to D.M.A).     

Increase of Bone Resorption and the Parathyroid Hormone in Postmenopausal Women in the Long-term after Roux-en-Y Gastric Bypass

Background  The effects of Roux-en-Y Gastric Bypass (RYGB) on bone in the long-term remains unclear. We assessed bone metabolism and bone mineral density (BMD) 1 to 5 years after RYGB. Methods  We designed a retrospective cohort study in 26 postmenopausal women (58.0 ± 3.9 years old) with RYGB 3.5 ± 1.1 years before (body mass index (BMI) 29.5 ± 3.8 kg/m², presurgery 43.6 ± 5.5 kg/m²) and 26 nonoperated women (57.5 ± 4.7 years old, BMI 29.2 ± 4.1 kg/m²) matched by age and BMI. The main measures were BMD, serum carboxy telopeptide (CTx), total alkaline phosphatases (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and ghrelin. Results  RYGB group, compared to nonoperated women, had higher CTx (0.71 ± 0.21 vs. 0.43 ± 0.15 ng/ml; P < 0.01) and PTH (68.3 ± 35 vs. 49.4 ± 16 pg/ml; P = 0.02). There were no differences between RYGB and nonoperated women in: calcium and vitamin D intake (759 ± 457 vs. 705 ± 460 mg/day; 176 ± 160 vs. 111 ± 86 UI/day), ghrelin (763 ± 336 vs. 621 ± 274 pg/ml), ALP (101 ± 22 vs. 94 ± 25 UI/l), 25OHD (18.8  ± 7.6 vs. 17.4 ± 5.9 ng/ml), lumbar spine BMD (1.059 ± 0.32 vs. 1.071 ± 0.207 g/cm²), or femoral neck BMD (0.892 ± 0.109 vs. 0.934 ± 1.1 g/cm²). Conclusions  RYGB is associated to high bone resorption and hyperparathyroidism prevalence in postmenopausal women in the long-term. This occurs independently of the intake of calcium, vitamin D status, or ghrelin and does not seem to affect BMD after RYGB.     

Intramedullary versus Extramedullary Tibial Cutting Guide in Severely Obese Patients Undergoing Total Knee Replacement: A Randomized Study of 70 Patients with Body Mass Index >35 kg/m<Superscript>2</Superscript>

Background  Patients with obesity have an increased risk of osteoarthritis of the knee, which can lead to the need for total knee replacement (TKR). TKR may be more complex in obese patients and the correct orientation of the implant is more difficult. We selected patients with body mass index (BMI) >35 kg/m² undergoing TKR and studied the utility of an intramedullary tibial cutting guide in facilitating the correct orientation of the tibial implant. Methods  Seventy patients with BMI >35 kg/m² were selected for a prospective, randomized study. Patients were divided into two groups: In group 1 (n = 31), the tibial component was implanted using the aid of a intramedullary tibial guide. In group 2 (n = 39), the tibial component was implanted using the aid of an extramedullary tibial cutting guide. Results  The two groups were comparable with respect to age, BMI, and degree of preoperative deformity. Mean age was 69.35 in group 1 and 70.06 in group 2. Group 1 had a mean BMI of 39.84 kg/m² and group 2 of 40.05 kg/m². Postoperative orientation of the femur and tibia and the mechanical axis were within the normal range in both groups. A statistically significant difference between the two groups was observed in tourniquet time, which was longer in group 2 than in group 1 (p = 0.038). Conclusion  Two types of guide were compared in correctly orienting the tibial component of the TKR in patients with a BMI >35 kg/m². The lesser tourniquet time in the group in which the intramedullary guide was used suggest its usefulness because the positioning and orientation of the tibial cut was carried out more rapidly and anatomical references were not needed for correct orientation, as it is guided by the anatomical axis of the tibia. The use of the intramedullary guide reduces surgical time in these patients.     

A multicenter study of the pharmacokinetics of lisinopril in pediatric patients with hypertension

The pharmacokinetic (PK) parameters of lisinopril were obtained in 46 children aged 6 months to 15 years. A lisinopril suspension (0.15 mg/kg per day) was administered to patients <6 years of age; the remaining children received lisinopril tablets, the daily dose being adjusted according to body weight, i.e., 2.5 mg if <25 kg, 5 mg if 25–45 kg, and 10 mg if >45 kg. Blood was drawn predose and on eight occasions postdose in children aged 4–15 years, and on five occasions in those aged <4 years. PK data are reported for the 46 children in terms of age groups: Group I (n = 9), aged 6–23 months; Group II (n = 8), aged 2–5 years; Group III (n = 12), aged 6–11 years; Group IV (n = 17), aged 12–15 years. The dose of lisinopril ranged from 3.07 mg/m² per day in Group I to 4.78 mg/m² per day in Group IV. C_max of lisinopril, which occurred 5–6 h postdose, varied from 22 ng/ml in Groups I and II to 44 ng/ml in Groups III and IV; AUC_{0–24 h} ranged from 301–311 ng·h/ml in Groups I and II to 550–570 ng·h/ml in Groups III and IV. No serious adverse events related to lisinopril were reported.     

Relation Between Carbohydrate Intake and Weight Loss After Bariatric Surgery

Background  Weight loss and long-term weight maintenance in bariatric surgery patients are related to maintaining satiety. It can be related to glycemic load (GL) and carbohydrate (g CHO) intake. The aim of this study was to investigate the effect of g CHO and GL and in weight loss on patients who had undergone bariatric surgery. Method  The following measurements/calculations were conducted as follows: current body weight (kg), current BMI, percentage of excess weight loss (PEWL), average monthly weight loss (AMWL), energy intake (kcal per day), and GL calculation. Correlations were found among the studied variables. A multiple linear regression analysis of diet variables executed with GL and weight loss. Results  The population presented 66% of EWL. The average of total energy intake (TEI) was 1220 ± 480, and the calculated GL resulted in an average of 73.2. Negative correlations were found between AMWL and TEI (p = 0.04), and between AMWL and GL (p = 0.009); furthermore, a negative correlation was found between carbohydrate intake in grams and AMWL (p = 0.003). A positive correlation (p = 0.017) was found between GL and TEI. Weight loss and GL were also correlated. Among the intake variables, GL and g CHO consumed are held accountable for 62 percent of AMWL. The multiple linear regression analysis showed that GL and carbohydrate grams (g CHO) account for 62% of AMWL. Conclusion  The glycemic load and grams of carbohydrate are intake factors that can be useful tools in weight loss and long-term weight maintenance on patients who have undergone Roux-en-Y Gastric Bypass (RYGB).     

Circadian rhythms of diuresis,proteinuria and natriuresis in children with chronic glomerular disease

The aim of our study was to examine diurnal variation in urine volume (UV) output, proteinuria (UPRT), urine creatinine (UCr) and urine sodium ion excretion (UNa) in children with chronic glomerulopathy. In 56 patients (20 boys/36 girls, aged 11.7 ± 0.6 years) samples for UPRT, UCr and UNa were collected during the day and night, with continuous ambulatory blood pressure (BP) monitoring. On the basis of creatinine clearance (CrCl) the patients were divided into group I (n = 44, with CrCl 131 ± 3.6 ml/min per 1.73 m² body surface area), or group II (n = 12, with CrCl 44.6 ± 7.7 ml/min per 1.73 m² body surface area). Nocturnal polyuria was defined as night time UV ≥ 35% of the 24 h UV. Age, gender, body mass index of the patients, 24 h UV, UCr and UNa were similar in both groups. However, arterial hypertension and nocturnal polyuria were widespread (P < 0.01) in group II. In addition, proteinuria was higher (P < 0. 05) in group II. The nocturnal decline in CrCl, UV, UPRT and UNa was significantly attenuated (P < 0.005) in patients in group II compared with those in group I. The night time mean arterial pressure (MAP), as well as the night/day ratios of MAP, UV, UPRT and UNa, showed negative associations with CrCl. Our findings strongly suggest that renal function diurnal variation and nocturnal MAP are related to decreased glomerular filtration rate at the time of examination.     

Pregnancy Following Gastric Bypass for Morbid Obesity: Effect of Surgery-to-Conception Interval on Maternal and Neonatal Outcomes

Background  Conception is discouraged during the period of maximal weight loss following Roux-en-Y gastric bypass (RYGB) because of speculative maternal and fetal concerns. We therefore performed a retrospective cohort study of obstetrical and neonatal outcomes by surgery-to-conception interval. Methods  Women with RYGB were stratified into two groups by surgery-to-conception interval of ≤18 or >18 months. Pregnancy and newborn outcomes excluding miscarriages were compared using the chi-square or unpaired t-test for dichotomous and continuous variables, respectively. Results  Twenty subjects conceived ≤18 months (11.4 ± 5.0) and 32 conceived >18 months (47.5 ± 41) after RYGB, p < .05. Maternal age, parity, body mass index, and weight gain were similar by group. There were no statistically significant differences in adverse obstetrical outcomes (preterm premature membrane rupture, gestational diabetes, oligohydramnios, intrauterine growth restriction, preterm or post-term delivery) or adverse newborn outcomes (5-min Apgar score < 7, intensive care admission, or birth defect). Conclusion  Obstetrical and neonatal outcomes are similar in women conceiving during or after the period of maximal weight loss following RYGB.