The characteristics of acute renal failure in cardiogenic shock in the elderly

Four patients are presented aged over 65 years in whom a state of cardiogenic shock was present due to myocardial infarction of the following localization: anterior in two and posterior in two. According to the parameters all patients satisfied the criteria of cardiogenic shock. Of the four patients three died. In all patients parameters of renal lesion were analyzed after establishment of diureses: sodium in urine, creatinine quotient in urine and plasma, osmolality of urine, osmolality quotient of urine and plasma, the renal failure index and the excretional fraction of filtered sodium. The parameters quoted were analyzed the day after diuresis was established. All parameters, apart from sodium in urine, indicated functional oliguria. In corroboration of this were the values of creatinine clearance which were determined the day after establishing diuresis, amounting in all patients to more than 20 ml/min./1.73 m2, i.e. ranging from 20.6 to 59.0 ml/min./1.73 m2. Of the cases which ended fatally all had fibroses and myocardial scars, apart from recent infarction of the myocardium, generalized atherosclerosis particularly of the coronary arteries, and in all patients hypertrophy of the left ventricle and dilatation of the whole heart. In one patient anaemic infarction of one kidney was found and in another acute tubular necrosis (with the renal failure index of 0.3 and the excretional fraction of filtered sodium of 0.2), while in third patient no renal changes were found.     

Intestinal absorption of calcium-47 and strontium-85 in lactating rats

The absorption of calcium and strontium from the gastrointestinal tract was determined in lactating rats between the 14th and 16th day of lactation using radioactive isotopes of calcium (⁴⁵Ca and⁴⁷Ca) and strontium (⁸⁵Sr) both in thein vivo and in thein vitro experiments.The absorbed dose of strontium and calcium (expressed as the sum of the radioactivity retained in the skeleton of the mother and litter and eliminated in urine) was determined in lactating animals after a two-day oral administration of radioactive isotopes. The absorbed radioactive dose in lactating animals was found to be 3 times as high for calcium and twice as high for strontium as in controls. The total amount of calcium and strontium absorbed from the intestinal tract of lactating animals was, however, about 6 and 4 times as high as in controls due to a two-fold increase in food consumption.The total passage of calcium and strontium from the mucosal to the serosal side of the everted duodenal sac in lactating animals was 2.8 and 3.4 times as high for strontium and calcium respectively as in controls. The active transport of calcium was also about twice normal in lactating animals.The authors discuss the possible morphological basis for these findings.

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Zusammenfassung Die Absorption von Calcium und Strontium aus dem gastrointestinalen Trakt bei säugenden Ratten zwischen dem 14. und 16. Tag der Lactation wurde mit Hilfe von radioaktiven Isotopen von Calcium (⁴⁵Ca und⁴⁷Ca) und von Strontium (⁸⁵Sr) sowohlin vivo als auchin vitro bestimmt.Die absorbierte Dosis von Strontium und Calcium (ausgedrückt als Summe der im Skelet der Mutter und des Wurfes zurückgehaltenen und im Urin ausgeschiedenen Radioaktivität) wurde bei säugenden Tieren nach 2tägiger oraler Verabreichung von radioaktiven Isotopen bestimmt. Die absorbierte radioaktive Dosis war bei säugenden Tieren 3mal höher für Calcium und 2mal höher für Strontium als bei den Kontrollen. Die Gesamtmenge von Calcium und Strontium, die vom Intestinaltrakt säugender Tiere absorbiert wurde, war jedoch rund 6- und 4mal so hoch wie bei den Kontrollen, infolge einer Verdoppelung des Nahrungsverbrauches.Der gesamte Transport von Calcium und Strontium von der Mucosa zur Serosa des Duodenalsacks säugender Tiere war 2,8- und 3,4mal so hoch für Strontium resp. Calcium, wie bei den Kontrollen. Der aktive Calciumtransport betrug ungefähr das Doppelte von der Norm bei säugenden Tieren.Die Autoren besprechen die mögliche morphologische Grundlage für diese Ergebnisse.

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Résumé L'absorption du calcium et du strontium par l'intestin a été déterminée chez les rattes allaitantes entre le 14e et le 16e jour de la lactation, en utilisant les isotopes radioactifs du calcium (⁴⁵Ca et⁴⁷Ca) et du strontium (⁸⁵Sr) dans les expériencesin vivo ainsi que dans les expériencesin vitro.La dose de strontium et de calcium absorbée (exprimée comme la somme de la radioactivité retenue dans le squelette de la mère et de la portée et éliminée par l'urine) a été évaluée chez les animaux allaitants après une application orale d'isotopes radioactifs pendant 2 jours. On a trouvé que la dose radioactive de calcium et de strontium absorbée était 3 et 2 fois plus élevée chez les rattes allaitantes que chez les animaux témoins. Néammoins, la quantité totale de Ca et de Sr absorbés au niveau du tractus intestinal des rattes allaitantes est environ 6 et 4 fois plus élevée à cause d'une consommation de nourriture qui est deux fois plus grande chez les rattes allaitantes que chez les animaux témoins.Chez les rattes allaitantes, le passage total du calcium et du strontium du côté muqueux au côte séreux du sac duodénal retourné était 2.8 fois plus élevée, pour le strontium et 3.4 fois plus élevée pour le calcium. Le transport actif du calcium était aussi d'environ deux fois plus élevé chez les rattes allaitantes.Les auteurs discutent de la base morphologique possible de ces résultats.

     

Cost‐effectiveness of sunflower oil fortification with vitamin A in Tanzania by scale

In 2011, Tanzania mandated the fortification of edible oil with vitamin A to help address its vitamin A deficiency (VAD) public health problem. By 2015, only 16% of edible oil met the standards for adequate fortification. There is no evidence on the cost‐effectiveness of the fortification of edible oil by small‐ and medium‐scale (SMS) producers in preventing VAD. The MASAVA project initiated the production of sunflower oil fortified with vitamin A by SMS producers in the Manyara and Shinyanga regions of Tanzania. A quasi‐experimental nonequivalent control‐group research trial and an economic evaluation were conducted. The household survey included mother and child pairs from a sample of 568 households before the intervention and 18 months later. From the social perspective, the incremental cost of fortification of sunflower oil could be as low as $0.13, $0.06, and $0.02 per litre for small‐, medium‐, and large‐scale producers, respectively, compared with unfortified sunflower oil. The SMS intervention increased access to fortified oil for some vulnerable groups but did not have a significant effect on the prevention of VAD due to insufficient coverage. Fortification of vegetable oil by large‐scale producers was associated with a significant reduction of VAD in children from Shinyanga. The estimated cost per disability‐adjusted life year averted for fortified sunflower oil was $281 for large‐scale and could be as low as $626 for medium‐scale and $1,507 for small‐scale producers under ideal conditions. According to the World Health Organization thresholds, this intervention is very cost‐effective for large‐ and medium‐scale producers and cost‐effective for small‐scale producers.     

Reversible acute methotrexate leukoencephalopathy: atypical brain MR imaging features

Background: Unusual acute symptomatic and reversible early-delayed leukoencephalopathy has been reported to be induced by methotrexate (MTX). Objective: We aimed to identify the occurrence of such atypical MTX neurotoxicity in children and document its MR presentation. Materials and methods: We retrospectively reviewed the clinical findings and brain MRI obtained in 90 children treated with MTX for acute lymphoblastic leukaemia or non-B malignant non-Hodgkin lymphoma. All 90 patients had normal brain imaging before treatment. In these patients, brain imaging was performed after treatment completion and/or relapse and/or occurrence of neurological symptoms. Results: Of the 90 patients, 15 (16.7%) showed signs of MTX neurotoxicity on brain MRI, 9 (10%) were asymptomatic, and 6 (6.7%) showed signs of acute leukoencephalopathy. On the routine brain MRI performed at the end of treatment, all asymptomatic patients had classical MR findings of reversible MTX neurotoxicity, such as abnormal high-intensity areas localized in the deep periventricular white matter on T2-weighted images. In contrast, the six symptomatic patients had atypical brain MRI characterized by T2 high-intensity areas in the supratentorial cortex and subcortical white matter (n=6), cerebellar cortex and white matter (n=4), deep periventricular white matter (n=2) and thalamus (n=1). MR normalization occurred later than clinical recovery in these six patients. Conclusions: In addition to mostly asymptomatic classical MTX neurotoxicity, MTX may induce severe but reversible unusual leukoencephalopathy. It is important to recognize this clinicoradiological presentation in the differential diagnosis of acute neurological deterioration in children treated with MTX.     

Relation between helper and suppressive/cytotoxic T lymphocytes in the peripheral blood in patients with dilated cardiomyopathy]

In 32 patients with dilated cardiomyopathy the percentages of helper (CD4+) and suppressor (CD8+) T lymphocytes, as well as their ratio, have been analyzed. The percentage of CD8+ lymphocytes in the group with dilated cardiomyopathy was 20.62 +/- 8.27% (X +/- SD), vs. 26.38 +/- 6.19% in control group; the difference was not statistically significant. The percentages of CD4+ lymphocytes were similar in both groups, 39.55 +/- 12.86% vs. 40.52 +/- 6.59%. The CD4+/CD8+ ratio was markedly higher in the group with dilated cardiomyopathy, 2.49 +/- 2.10 vs. 1.65 +/- 0.49, but the difference was not statistically significant, probably because of great variability in the group. In the subgroup of 12 patients with possible alcoholic etiology of dilated cardiomyopathy, the values were almost identical to those of the remaining 20 patients. No correlation between echocardiographic fractional shortening of the left ventricle and any of the aforementioned values of T lymphocytes in the group of patients with dilated cardiomyopathy was found. The tendency toward decline in number of suppressor T lymphocytes is in accordance with the hypothesis that the "overreacting" inflammatory response to (viral) myocarditis might be the cause of dilated cardiomyopathy. However, the specificity of the decline of suppressor activity in respect to the other causes of heart failure is questionable and the analysis of its significance is complex. This is due to dynamic character of immune disorders, and a considerable number of other theories considering the etiology and pathogenesis of the disease also exist. The need to perform complex studies is anticipated, including continual observation of clinical, immunologic and bioptic parameters of the disease.