Is the New Mayo Clinic Quadratic Equation Useful for the Estimation of Glomerular Filtration Rate in Type 2 Diabetic Patients?

OBJECTIVE—To test the Mayo Clinic Quadratic (MCQ) equation against isotopic glomerular filtration rate, compared with the Modification of Diet in Renal Disease (MDRD) and the Cockcroft-Gault formulas, in type 2 diabetes.RESEARCH DESIGN AND METHODS—Based on values obtained with iothalamate, 118 type 2 diabetic patients were divided into three groups according to renal function: hyperfiltration (26), normal function (56), or chronic kidney disease (CKD) stages 3–4 (36). ANOVA, the Bland-Altman procedure, and Lins coefficient (Rc) were performed to study accuracy.RESULTS—In the hyperfiltration and normal function groups, all prediction equations significantly underestimated the value obtained with isotopic glomerular filtration rate (P < 0.05). In the CKD group, all equations also presented significant differences with the isotopic method. However, MDRD had a bias of −5.3 (Rc 0.452), Cockcroft-Gault formula −0.2 (Rc 0.471), and the MCQ −4.5 (Rc 0.526).CONCLUSIONS—The MCQ and prediction equations proved inaccurate (excessive underestimation) in type 2 diabetic patients with hyperfiltration or normal renal function. With regard to CKD, the results obtained provided no evidence of superiority of the MCQ over the MDRD or the Cockcroft-Gault formula.According to current epidemiologic data, type 2 diabetes is considered one of the most frequent causes of end-stage chronic renal disease and inclusion in renal substitution programs (1,2). In a previous study, our group evaluated the accuracy of different prediction equations for the ambulatory follow-up of a cohort of type 2 diabetic patients (3). From the results obtained, it can be concluded that the application of these equations is inadequate in situations of normal renal function and hyperfiltration. Recently, the Mayo Clinic group has developed a new Mayo Clinic Quadratic (MCQ) equation based on the results of both healthy subjects (n = 580), who had an iothalamate clearance test specifically for kidney donor evaluation, and patients with chronic kidney disease (CKD) (n = 320) (4). However, only 13% of 320 patients with CKD were diabetic, and the validity of the MCQ for patients outside the Mayo Clinic has been questioned (5).The aim of the present study was to test the MCQ against isotopic glomerular filtration rate (GFR), compared with the recommended MDRD and Cockcroft-Gault formulas, in type 2 diabetic patients with a wide range of GFR (15–209 ml/min per 1.73 m²)—particularly in those with hyperfiltration or normal renal function.     

Hydroxyapatite recovery from fish byproducts for biomedical applications

The solid waste that is generated during industrial fish processing causes environmental deterioration after it is discarded. However, these aquatic materials are a source of valuable compounds such as hydroxyapatite (HAp). HAp is a calcium phosphate with physicochemical and biological properties that are similar to those of native human bone. HAp has been used in biomedical material development because it is biocompatible and does not cause adverse effects. It has been combined with many other chemical compounds to improve their mechanical, structural, and bioactive properties and has noteworthy application benefits in the food supplement, drug delivery, cosmetology, odontology, and bone implant fields. In this review, recent research related to the isolation of HAp and the development of materials with health benefits due to its bioactive properties are discussed. Moreover, the HAp derived from industrial fish processing adds value to the byproduct and reduces the environmental risks caused by aquatic waste disposal in landfills.     

Oral absorption of ampicillin: role of paracellular route vs. PepT1 transporter

The beta-lactam antibiotic ampicillin has a relatively poor oral bioavailability in animals and man (30-40%), and its widespread agricultural use in livestock may be contributing to the emergence of antibiotic resistance in the environment. The aim of this study was to define the absorption mechanism by which ampicillin crosses the small intestinal epithelium. The improved rat everted gut sac system was used, with an emphasis on the role of the PepT1 transporter. The absorption kinetics, effects of pH and the use of competitive substrates failed to provide any substantive evidence that the transporter played a major role in ampicillin absorption. Ethylenediaminetetraacetic acid enhanced the absorption, and tissue levels remained low, suggesting that paracellular transport was predominant. pH and competition studies with glycylsarcosine, the widely used PepT1 substrate, also failed to show any transporter activity. Despite evidence from studies with Caco-2 cells that beta-lactam antibiotics are transported by the PepT1 transporter in rat small intestine, the results rather suggest that paracellular diffusion is the major mechanism of absorption, at least for beta-lactam antibiotics with poor bioavailability, such as ampicillin. We suggest that the use of Caco-2 cells underestimates the role of the paracellular route in the absorption of hydrophilic drugs in vivo, and may exaggerate the role of influx transporters.     

Contribution of the serotoninergic system to anxious and depressive traits that may be partially responsible for the phenotypical variability of bulimia nervosa

Eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN), are complex psychiatric phenotypes influenced by both genetic and environmental factors. We investigated the genetic contribution of four single nucleotide polymorphisms (SNPs) within the serotonin receptor 5HT2C and two sequence variants within the serotonin transporter SLC6A4 to different ED-related psychopathological symptoms in a total sample of 82 ED patients. All patients were diagnosed according to DSM-IV criteria and underwent diagnostic and psychopathological assessments by means of structured clinical interviews and rating scales. We detected significant evidence of association between the -995A/-759T/-697C/Cys23 haplotype of the 5HT2C gene and different anxious and depressive subscales of the SCL90-R instrument, that included Somatization (p = 0.029), Obsessive-Compulsiveness (p = 0.021), Depression (p = 0.032), Anxiety (p = 0.004), Hostility (p = 0.028), Phobic Anxiety (p = 0.029) and Paranoid Ideation (p = 0.008), in BN patients. We also observed a strong association between the 5HTTLPR polymorphism of the SLC6A4 gene and Anxiety in the same group of BN patients (p = 0.004). However, no epistatic effects between the 5HT2C and SLC6A4 genes on the different anxious and depressive subscales were observed. Our preliminary data suggest that the serotoninergic system contributes to the different psychopathological symptoms that may be partially responsible for the phenotypical variability within the bulimic phenotype.     

Effects of non-pharmacological therapies on hand function and the ability to perform daily activities in people with systemic sclerosis: A systematic review and meta-analysis of randomized control trials

Background

Systemic sclerosis (SSc) is an autoimmune rheumatic disease. Individuals with a diagnosis of SSc describe repercussions on their activities of daily living and instrumental activities of daily living that affect their everyday functional capacity. The objective of this systematic review was to explore the effectiveness of non-pharmacological interventions to improve hand function and the ability to perform activities of daily living.

Methods

A systematic review was conducted on the Cochrane Library, Medline/PubMed, OTseeker, PEDro, Scopus, Web of Science up to September 10, 2022. Inclusion criteria were defined following PICOS recommendations (Populations, Intervention, Comparison and Outcome measures). Methodological quality was assessed with the Downs and Black Scale and risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). A meta-analysis of each outcome was performed.

Results

A total of 8 studies met the inclusion criteria, providing data on 487 individuals with SSc. The non-pharmacological intervention applied the most was exercise. The effects of non-pharmacological interventions were better than those of the waiting list or no treatment control conditions in both outcomes – hand function (mean difference [MD] = −6.98; 95% CI [−11.45, − 2.50], P = 0.002, I² = 0%) and performance of daily activities (MD = −0.19; 95% CI [−0.33, − 0.04], P = 0.01, I² = 0%). Moderate risk of bias was found in the majority of the studies included.

Conclusion

There is emerging evidence that non-pharmacological interventions can improve hand function and performance of daily activities in individuals with a diagnosis of SSc. Given the moderate risk of bias found in the studies included, the results should be considered with caution.     

Albendazole and its derivative JVG9 induce encystation on Giardia intestinalis trophozoites

In the present study, we evaluated the effect of an albendazole (ABZ) derivative JVG9 on cultured Giardia intestinalis. To assess the JVG9 effects, we evaluated the tubulin cytoskeleton by confocal microscopy, and we found that the characteristic staining was modified. The scanning electron microscopy images revealed extremely damaged trophozoites and cyst-like cells. The confocal images revealed that this drug triggered the expression of cyst wall protein 1 and encystation. We also found that at low doses, AL triggered the encystation process too.