Evaluation of the functional state and working capacity of patients with chronic toxoplasmosis

Operator's main functions were studied in 78 patients with chronic toxoplasmosis during the period of disease aggravation and during the following 6 months. It was revealed that marked disorders in higher nervous activity and psychomotor system are observed in the patients during the period of aggravation, significantly more expressed during disease recurring course. It is reasonable to examine servicemen with chronic toxoplasmosis using psychologic and psychophysiologic methods before treatment and in 6 months after its completion. Without clear tendency towards improvement of professionally significant qualities in 6 months after treatment (level of neurotization, psychopathyzation, comparative number of mistakes in attention test and during reckon in head, delayed memory, positive tapping-test) it is not recommended to use servicemen at the posts having operator's profile and connected with long staying in secluded small collectives.     

Management of nucleus and IOL drop

Background: Thirty six cases of lenticular nucleus drop following phacoemulsification and 43 cases of posterior dislocation of intraocular lens (IOL) inclusive of two paediatric cases were managed by a modified vitrectomy procedure without using perfluorocarbon liquid (PFCL).     

Relation between genetic and non-genetic factors of individual susceptibility to silicosis

The study was carried out at a number of industrial enterprises at risk of silicosis by means of the methodological approach based on the mathematical theory of image discrimination. It was shown that under the given conditions of dust exposure higher or lower probability of the development of silicosis and silicotuberculosis in an individual depended on the whole set of environment and endogenic factors, involving genetic predisposition to the disease as one of the leading factors. The impact of the above factors being similar irrespective of the type of the enterprise, their comparative contribution could be different. Thus reliable prediction of high probability of the disease development could be provided by means of the method of multifactorial analysis only as applied to specific conditions of the given enterprise. In spite of low prevalence of the genotype of silicosis- and silicotuberculosis-associated resistance, under the exposure to quartz dust, high probability of the disease development was predicted only in a number of cases if other individual symptoms were taken into account along the genotype. Therefore it became possible to identify the most susceptible persons at the stage of medical vocational selection.     

Effect of renin-angiotensin-aldosterone system inhibition, dietary sodium restriction, and/or diuretics on urinary kidney injury molecule 1 excretion in nondiabetic proteinuric kidney disease: a post hoc analysis of a randomized controlled trial

BACKGROUND: Tubulointerstitial damage plays an important role in chronic kidney disease (CKD) with proteinuria. Urinary kidney injury molecule 1 (KIM-1) reflects tubular KIM-1 and is considered a sensitive biomarker for early tubular damage. We hypothesized that a decrease in proteinuria by using therapeutic interventions is associated with decreased urinary KIM-1 levels. STUDY DESIGN: Post hoc analysis of a randomized, double-blind, placebo-controlled, crossover trial. SETTING & PARTICIPANTS: 34 proteinuric patients without diabetes from our outpatient renal clinic. INTERVENTION: Stepwise 6-week interventions of losartan, sodium restriction (low-sodium [LS] diet), their combination, losartan plus hydrochlorothiazide (HCT), and the latter plus an LS diet. OUTCOMES & MEASUREMENTS: Urinary excretion of KIM-1, total protein, and N-acetyl-beta-d-glucosaminidase (NAG) as a positive control for tubular injury. RESULTS: Mean baseline urine protein level was 3.8 +/- 0.4 (SE) g/d, and KIM-1 level was 1,706 +/- 498 ng/d (increased compared with healthy controls; 74 ng/d). KIM-1 level was decreased by using placebo/LS (1,201 +/- 388 ng/d; P = 0.04), losartan/high sodium (1,184 +/- 296 ng/d; P = 0.09), losartan/LS (921 +/- 176 ng/d; P = 0.008), losartan/high sodium plus HCT (862 +/- 151 ng/d; P = 0.008) and losartan/LS plus HCT (743 +/- 170 ng/d; P = 0.001). The decrease in urinary KIM-1 levels paralleled the decrease in proteinuria (R = 0.523; P < 0.001), but not blood pressure or creatinine clearance. 16 patients reached target proteinuria with protein less than 1 g/d, whereas KIM-1 levels normalized in only 2 patients. Urinary NAG level was increased at baseline and significantly decreased during the treatment periods of combined losartan plus HCT only. The decrease in urinary NAG levels was not closely related to proteinuria. LIMITATIONS: Post hoc analysis. CONCLUSIONS: Urinary KIM-1 level was increased in patients with nondiabetic CKD with proteinuria and decreased in parallel with proteinuria by using losartan, sodium restriction, their combination, losartan plus HCT, and the latter plus sodium restriction. These results are consistent with the hypothesis of amelioration of proteinuria-induced tubular damage. Long-term studies are warranted to evaluate whether targeting treatment on KIM-1 can improve outcomes in patients with CKD with proteinuria.