The role of the primary care physician in managing early stages of chronic kidney disease

Recent increases in obesity, diabetes, and hypertension, along with the aging of the US population, are driving a dramatic rise in the prevalence of chronic kidney disease (CKD). Despite this increase, the majority of Americans with early-stage CKD remain unaware of their disease. Primary care physicians are at the forefront of efforts for early recognition of CKD and management to control its progression. Patients with CKD should be referred to nephrologists no later than the point at which their estimated glomerular filtration rate reaches 30 mL/min. Nephrology evaluation at this point is essential to facilitate timely preparation for care of end-stage renal disease through preemptive transplantation or planned transition to dialysis. In addition to stringent control of underlying hypertension and/or diabetes, mineral metabolic parameters (serum parathyroid hormone, phosphorus, calcium, and bicarbonate) in patients with advancing CKD should be managed closely to avoid adverse effects on the cardiovascular and skeletal systems.     

Ruthenium(II) phosphine/diimine/picolinate complexes: inorganic compounds as agents against tuberculosis

This paper describes the synthesis and characterization of four new ruthenium complexes containing 1,4 bis(diphenylphosphino)butane (dppb), 2-pyridinecarboxylic acid anion (pic) and the diimines [(2,2′-bipyridine (bipy), 4,4′-dimethyl-2,2′-bipyridine (Me-bipy), 4,4′-dichloro-2,2′-bipyridine (Cl-bipy) and 1,10-phenanthroline (phen) as ligands, with formulae [Ru(pic)(dppb)(bipy)]PF₆ (SCAR01), [Ru(pic)(dppb)(Me-bipy)]PF₆ (SCAR02), [Ru(pic)(dppb)(Cl-bipy)]PF₆ (SCAR03) and [Ru(pic)(dppb)(phen)]PF₆ (SCAR04). Additionally, the in vitro anti-Mycobacterium tuberculosis (MTB) activity, cytotoxicity and activity against in vitro infection of these complexes and two more complexes, cis-[Ru(pic)(dppe)₂]PF₆ (SCAR05) and cis-[RuCl₂(dppb)(bipy)] (SCAR06), and their free ligands are described and discussed. All compounds showed excellent MIC against MTB, low cytotoxicity and a selectivity index higher than 10. Also, all compounds showed significant intracellular inhibition and the compound SCAR05 showed a better activity than rifampin and SQ109. This is the first report of activity against in vitro infection of ruthenium compounds.     

Immunization with the Chlamydia trachomatis major outer membrane protein,using the outer surface protein A of Borrelia burgdorferi as an adjuvant,can induce protection against a chlamydial genital challenge

Two strains of mice C3H/HeN (H-2(k)) and BALB/c (H-2(d)) were immunized with the Chlamydia trachomatis mouse pneumonitis (MoPn) major outer membrane protein (MOMP) using the Borrelia burgdorferi outer surface protein A (OspA) as an adjuvant. As a control, groups of mice were inoculated with ovalbumin instead of MOMP. Female mice were immunized using three different routes: intramuscular (i.m.) plus subcutaneous (s.c.), intranasal (i.n.) and perivaginal and perisacral (p.vag.+p.sac.). Significant humoral and cell mediated immune responses developed particularly in mice inoculated by the i.m.+s.c. routes as determined by the levels of chlamydial specific antibody in the serum and genital secretions and a T-cell proliferative assay. Following immunization the animals were challenged in the genital tract with C. trachomatis MoPn and the course of the infection followed by vaginal cultures. Significant protection against infection was achieved in the C3H/HeN mice inoculated i.m.+s.c. with MOMP+OspA, as shown by the intensity and duration of vaginal cultures, and by the number of mice with positive cultures. On the other hand in BALB/c mice there was only a decrease in the number of animals with positive vaginal cultures. Six weeks after the challenge the mice were mated and the outcome of the pregnancy evaluated. In both the C3H/HeN and the BALB/c mice immunized i.m.+s.c. with MOMP+OspA there was significant protection against infertility as shown by the number of animals with bilateral fertility and number of embryos per uterine horn. In conclusion, immunization using C. trachomatis MOMP, and B. burgdorferi OspA as an adjuvant, can induce significant protection against a chlamydial genital challenge.     

Serum levels of insulin-like growth factor-1 and insulin-like growth factor-1 binding proteins after radical prostatectomy

PURPOSE: Elevated serum levels of insulin-like growth factor-1 (IGF-1) have been consistently shown to be a risk factor for prostate cancer. Alterations in serum IGF-1 binding proteins 1 to 3 have also been associated with prostate cancer risk. A potentially important complication in these studies is that prostate tissue, perhaps especially malignant prostate tissue, may secrete IGF-1 and its binding proteins into serum. In fact, it is possible that altered levels of these proteins observed in subjects at risk for prostate cancer are the result of prostate cancer rather than related to its cause. MATERIALS AND METHODS: The contribution of prostate cancer to serum levels of IGF-1 and IGF-1 binding proteins was determined by analyzing serum samples from 86 patients with prostate cancer 2 weeks before and 8 weeks after radical prostatectomy. Preoperative and postoperative values for IGF-1 and its 3 major binding proteins were analyzed using univariate and multivariate analysis models. RESULTS: On univariate analysis significant increases and not decreases in IGF-1, IGF binding protein-1 and 3 were observed after prostatectomy. On multivariate analysis a significant post-prostatectomy increase was observed for IGF-1 binding proteins 1 and 3 but the increase in IGF-1 was not significant. CONCLUSIONS: Increased levels of IGF-1 and IGF-1 binding proteins were unexpected after prostatectomy. This result makes it extremely unlikely that secretion from the prostate, even if it contains cancer, affects serum levels of these proteins. The implication of these findings is that endocrine production of IGF-1 is a factor in prostate cancer risk. Therefore, strategies to lower serum IGF-1 may be potentially useful.     

Synthesis and characterization of a new mebendazole salt: mebendazole hydrochloride

Mebendazole hydrochloride [(5-benzoyl-1H-benzimidazole-2-yl)-carbamic acid methyl ester hydrochloride, MBZ.HCl], a new stable salt of mebendazole (MBZ), has been synthesized and characterized. It can easily be obtained from recrystallization of forms A, B, or C of MBZ in diverse solvents with the addition of hydrochloric acid solution. Crystallographic data reveals that the particular conformation adopted by the carbamic group contributes to the stability of the network. The crystal packing is stabilized by the presence of three N-H...Cl intermolecular interactions that form chains along the b axis. The XRD analyses of the three crystalline habits found in the crystallization process (square-based pyramids, pseudohexagonal plates, and prismatic) show equivalent diffraction patterns. The vibrational behavior is consistent with crystal structure. The most important functional groups show shifts to lower or higher frequencies in relation to the MBZ polymorphs. The thermal study on MBZ.HCl indicates that the compound is stable up to 160 degrees C approximately. Decomposition occurs in four steps. In the first step the HCl group is eliminated, and after that the remaining MBZ polymorph A decomposes in three steps, as happens with polymorphs B and C. (     

Hand-operated and rotary ProTaper instruments: a comparison of working time and number of rotations in simulated root canals

The aim of this study was to compare the effective shaping time and number of rotations required by an endodontist working with hand and rotary ProTaper instruments to completely shape simulated root canals. Eighty Endo Training Blocks (curved canal shape) were used. Manual preflaring was performed with K-Flexofiles #08-10-12-15-17 and #20 Nitiflex at a working length of 18 mm. Specimens were then randomly assigned to 2 different groups (n = 40); group 1 was shaped by using hand ProTaper and group 2 with ProTaper rotary. The number of rotations made in the canal and the effective time required to achieve complete canal shaping were recorded for each instrument. Differences between groups were analyzed with the nonparametric Mann-Whitney U test (P < .05). Hand ProTaper required significantly fewer rotations (P < .001) than rotary ProTaper, whereas the effective working time to fully shape the simulated canal was significantly higher (P < .001) with hand ProTaper.     

Neuroendocrine and inflammatory factors associated with positive affect in healthy men and women: the Whitehall II study

Positive affective states are associated with favorable health outcomes, but the underlying mechanisms are poorly understood. The authors assessed associations between positive affect, cortisol sampled over the day, and inflammatory markers (C-reactive protein and interleukin-6) among 2,873 healthy members of the Whitehall II study. Data for this study were collected in 2002-2004 in London, United Kingdom. Saliva free cortisol was assessed on waking, 30 minutes later, and four times over the day and evening. Positive affect was indexed by aggregating ecological momentary assessments of positive mood over the day. Salivary cortisol averaged over the day was inversely associated with positive affect after controlling for age, gender, income, ethnicity, body mass index, waist/hip ratio, smoking, paid employment, time of waking in the morning, and depression (p = 0.003). There was no association with cortisol responses to waking. The adjusted odds of C-reactive protein >/=3.00 mg/liter was 1.89 (95% confidence interval: 1.08, 3.31) in low- compared with high-positive-affect women, and plasma interleukin-6 was also inversely related to positive affect in women (p = 0.016). Neither inflammatory marker was related to positive affect in men. These results confirm findings from smaller studies relating cortisol with positive affect while suggesting that in women, positive affect is associated with reduced levels of inflammatory markers.