Effect of socio-demographic factors on endogenous biomarkers (cystatin C and creatinine) among elderly chronic kidney disease patients: a cross-sectional study

Purpose

Creatinine is normally used to evaluate kidney function among elderly patients in clinical practice, which has been reported to be affected by socio-demographic factors like BMI and age. Cystatin C a newly introduced biomarker may be more efficient in identifying kidney function in obese and aged CKD patients. The aim of the current study was to assess the effect of BMI on endogenous biomarkers (cystatin C and creatinine) among elderly CKD patients in Malaysia, a first such study in the country.

Methods

The current study was conducted at the Hospital University Sains Malaysia, Kelantan. A total of 300 elderly Malay participants ≥?65 years, with CKD, were taken in study. Demographic data, blood pressure, weight, and height were documented. Serum creatinine was assayed by Chemistry Analyzer Model Architect-C8000 (Jaffe Method), while serum cystatin C was examined by Human cystatin C ELISA kit (Sigma-Aldrich) using Thermo Scientific Varioskan Flash ELISA reader.

Results

The study participants were divided into three groups on the basis of age. There was a statistically significant difference at the p value?<?0.05 in serum creatinine level for the three age groups [F (2, 297)?=?1.98, p value 0.045]. Patients were divided into four groups on the basis of BMI. The results of one-way ANOVA revealed a statistically significant difference at the p value?<?0.05 in the mean serum creatinine level for the four groups [F (3, 396)?=?2.99, p value 0.032]. However, no statistically significant differences between mean serum cystatin C levels were observed on the basis of patient’s age and BMI.

Conclusion

Cystatin C is not related to BMI and age among elderly chronic kidney disease patients. The study clearly evaluates the role of serum cystatin C as a good competitor of creatinine among the elderly CKD patients.

     

Prevalence of pulmonary hypertension in patients with chronic kidney disease without dialysis: a meta-analysis

Purpose

Recent epidemiological evidence attempts to demonstrate the risk of pulmonary hypertension (PH) among patients with chronic kidney disease (CKD) without dialysis, but prevalence estimates of PH in CKD without dialysis vary widely in the existing studies. This meta-analysis was to summarize the point prevalence of PH in adults with CKD without dialysis.

Methods

PubMed, EMBASE, the Cochrane Collaboration, and the reference lists of relevant articles were searched to identify eligible studies. We used a random-effect meta-analysis model to estimate the prevalence of PH. Associations were tested in subgroups and meta-regression analyses. We also performed sensitivity analyses and assessments of publishing bias.

Results

Twenty-one observational studies (n?=?8012 participants) were included in this meta-analysis. The result of analysis in random-effect model showed that the pooled prevalence was 32% (95% CI 23–42%), with significant heterogeneity between these studies (I²?=?98%, P?<?0.01). Stratified analyses found that the study design, region, sample size, year of publication, and definition of PH based on PASP?≥?35 mmHg may explain the variation between studies. Sensitivity analysis further demonstrated the results to be robust. There was no evidence of publication bias.

Conclusions

PH is highly prevalent in patients with CKD without dialysis. Owing to the high heterogeneity, future well-designed and large prospective studies are encouraged to confirm the findings and definitively clarify the potential biological mechanisms.

     

DNAH6 is a novel candidate gene associated with sperm head anomaly

Globozoospermia and acephalic spermatozoa are two rare sperm head anomalies associated with male infertility. Combination of the two phenotypes in the same patient is extremely rare, so the underlying pathogenesis of this disorder remains unclear. Here, we report a 35‐year‐old infertile male, who presented with 30% of sperm‐lacked heads and 69% of sperm round‐headed or small‐headed with neck thickening in his ejaculate. Subsequent whole‐exome sequencing (WES) analysis identified compound heterozygous variants within the DNAH6 gene. DNAH6 is a testis‐specific‐expressed protein that was localised to the neck region in the spermatozoa of normal control; however, immunofluorescent staining failed to detect DNAH6 protein in the patient's spermatozoa. Quantitative real‐time PCR analysis also showed the complete absence of DNAH6 mRNA in the patient's spermatozoa. Moreover, two cycles of in vitro fertilisation (IVF)‐assisted reproduction were carried out, but pregnancy was not achieved after embryo transfer. Therefore, rare sequence variants in DNAH6 might be susceptibility risks for human sperm head anomaly.     

Sakrale Neuromodulation bei refraktärer überaktiver Blase

Sacral neuromodulation (SNM) is a minimally invasive, established treatment modality for overactive bladder (OAB) as well as for other pelvic functional disorders, such as non-obstructive urinary retention and fecal incontinence. A pacemaker implanted in the upper buttocks delivers mild electrical pulses to the sacral nerves thereby modulating pathological afferent signals from pelvic end organs. The current article conveys the current knowledge on the indications, contraindications, mechanism of action, implantation technique, efficacy and complications of SNM for the treatment refractory OAB.     

Phytotherapie bei katheterassoziierten Harnwegsinfekten

Background

The rate of infections occurring during hospitalization is increasing. Urinary tract infections (UTIs) comprise the majority of cases (40%), many of which are catheter-associated. Antibiotic resistance due to antibiotic misuse and overuse exacerbates this situation. Alternative therapies are consequently becoming more important in daily clinical practice. One of the few approved alternatives for the treatment of UTIs is Angocin®, a herbal medicinal product containing nasturtium and horseradish powder.

Objectives

Evaluate the efficacy and safety of Angocin® in adult patients with catheter-associated UTIs.

Materials and methods

Ninety-six inpatients with catheter-associated UTI successfully completed a 3-arm, 5-week observational study. Three patient groups were assessed: 1) monotherapy with Angocin® (Repha GmbH, Langenhagen, Germany) (42%), 2) Angocin® as an add-on to antibiotic therapy (29%), and 3) antibiotic therapy alone (29%). Outcome measures included: pathogen number and resistance spectrum in the urine, inflammation markers in the blood, antibiotic use, adverse events (AE), adverse drug reaction (ADR), efficacy, and tolerability.

Results

One-hundred percent of initial UTIs were healed with add-on therapy and pure antibiotic therapy after an average of 10.5 and 9 days, respectively. The Angocin® monotherapy led to a successful treatment rate of 46% after an average of 28 days. Dosages of Angocin® with 3?×?4 or 3?×?3 tablets per day were markedly below the recommended upper dosage level. The recurrence rate of UTI was markedly reduced with Angocin® mono- and add-on therapies (both 50%) in contrast to pure antibiotic therapy (79.3%). The incidence of AEs and ADRs in the Angocin® monotherapy group (23.8%) was also lower than that reported in the add-on therapy group (44.8%) and pure antibiotic group (34.5%).

Conclusion

Mono- and add-on therapies using the herbal medicinal product Angocin® substantially reduced the recurrence of catheter-associated UTIs in comparison to antibiotic therapy alone. This results in a potential prophylactic efficacy by Angocin® which may represent a promising alternative for the treatment and prevention of recurrent catheter-associated UTIs, reducing antibiotic use. Further clinical trials are warranted to confirm these findings.

     

Effect of actual age on outcome at discharge in patients by surgical clipping and endovascular coiling for ruptured cerebral aneurysm in Japan

The Japanese population features the highest rate of elderly individuals worldwide. However, the difference of actual age indication for surgical clipping (SC) and endovascular coiling (EC) has never reported. We clarified the effect of actual age on poor outcome at discharge in patients by each treatment for ruptured cerebral aneurysm according to the Japanese Stroke Data Bank. A total of 3593 patients with ruptured saccular cerebral aneurysm were treated by SC and/or EC between 2000 and 2013. The effect of actual age on poor outcome (modified Rankin scale [mRS] score >?2) at discharge was evaluated by the cutoff age using receiver operating characteristic analysis for each treatment. There were 2666 cases in the SC group and 881 cases in the EC group. The cutoff age for poor outcome was 3 to 9 years older for EC than for SC. The gap of cutoff age between two treatments was 3 years shorter in mild subarachnoid hemorrhage than severe cases. The gap of cutoff age between two treatments was 7 years in elderly patients over 65 years old. The cutoff age was 78 years old for both SC and EC in elderly female patients. In conclusion, the cutoff age for poor mRS score >?2 was 3 to 9 years older for EC than for SC. Actual age was one of the indications for elderly patients to achieve the optimum outcome; however, the treatment indication should be carefully considered based on the condition in each country.     

The quality assessment of clinical practice guidelines for intracranial aneurysms: a systematic appraisal

Neurosurgical Review - Intracranial aneurysms are common in adults. The relevant guidelines for patients with intracranial aneurysms aim to standardize the clinical practice and decision making for...     

The role of surgery in intracranial PCNSL

This aimed to evaluate the effect of surgery for overall survival (OS) and progression-free survival (PFS) in intracranial primary CNS lymphoma (PCNSL) of all patients diagnosed at a single center. A prospective database at Oslo University Hospital of PCNSL was reviewed over a 12-year period (2003–2014). Seventy-nine patients with intracranial PCNSL were identified. Deep brain involvement was shown in 63 patients. Thirty-two patients underwent craniotomy with resection, while all other patients had a biopsy. Fifty-seven patients were given chemotherapy: 18 were treated with the MSKCC (Memorial Sloan-Kettering Cancer Center) with rituximab, 21 with the MSKCC without rituximab, and 14 within a Nordic prospective phase II protocol. Forty-four patients achieved complete response (CR) and had OS of 46.3 months. Patients who underwent resection had a median OS of 28.6 versus 11.7 months for those who had a biopsy performed. Resection showed an insignificant prolongation of OS. Multivariate analysis confirmed statistical significance of deep brain involvement only (p?<?0.005). Neither chemotherapy regimen, Karnofsky Performance Status (KPS), type of surgery, nor patient age was significant factors for OS or PFS. Resective surgery played no role in significantly improving either OS or PFS and therefore it is not recommended as treatment for PCNSL.