Non-traditional risk factors predict coronary calcification in chronic kidney disease in a population-based cohort

The increased burden of cardiovascular disease in chronic kidney disease cannot be explained by traditional risk factors alone. Here, we evaluated the impact of non-traditional factors on the association of chronic kidney disease with coronary artery calcification using logistic regression among 2672 Dallas Heart Study patients of whom 220 had chronic kidney disease. The prevalence of coronary calcification significantly increased across all chronic kidney disease stages and this remained independently associated with coronary calcification after adjusting for traditional factors. The calcium x phosphorus product, homocysteine, and osteoprotegerin each diminished the magnitude of association between kidney disease and coronary calcification. After adjustment for these, the association between kidney disease and coronary calcification was no longer significant with the effects most prominent in the stages 3-5 subgroup. Our study has identified three non-traditional independent predictors of coronary calcification that diminished the association between chronic kidney disease and coronary calcification. These factors may represent novel mechanistic links warranting further investigation.     

Agrochemicals and human health: contributions of healthcare professionals

This paper focuses on the scientific production of health professionals, especially nurses, about agrochemicals and human health. The essay combines and presents information by means of literature review, with a view to acknowledge the contribution of each author and their use for the human health field. Thirty-two research articles, published in Brazilian journals, were located. The analysis of these articles highlights that healthcare professionals' contributions focus on human health, especially, workers' health and food quality. With a view to minimize the effects from agrochemicals on human and environmental health, the authors exposes action suggestions both for health professionals and for the institutions associated.     

Use and misuse of cardiac troponins in clinical practice

Cardiac troponins are very sensitive and specific markers of myocardial injury. Elevated troponin levels in the setting of acute coronary syndrome are diagnostic of acute myocardial infarction and provide guidance to clinicians with regard to appropriate use of intensive medical and revascularization therapies. However, elevated troponin levels are commonly seen in several noncoronary ischemia presentations and create considerable confusion among clinicians in these settings. In this review article, we discuss the utility of troponins in various clinical settings and present a "common sense" approach to interpreting troponin elevation outside the setting of acute coronary syndrome.     

Cutaneous amyloidosis associated with primary biliary cirrhosis

Primary cutaneous amyloidosis is defined as the deposition of amyloid in the skin in the absence of systemic involvement. The association between primary cutaneous amyloidosis and other diseases, although rare, has been documented for connective tissue disorders such as systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis. We report the case of a 41-year-old woman who developed primary biliary cirrhosis in association with primary cutaneous amyloidosis. This association has not been reported before in the literature.     

Risks, symptoms, and management of pelvic nerve damage secondary to surgery for pelvic organ prolapse: a report of 95 cases

Introduction and hypothesis  

This study aims to report pelvic nerve damage secondary to surgical treatment of pelvic organ prolapse and the role of laparoscopy in the diagnosis and treatment of such nerve damage.