Insulin resistance and coronary flow velocity reserve in patients with autosomal dominant polycystic kidney disease

Background: Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD). Aim: The aim of this study was to investigate coronary flow velocity reserve (CFVR) as a marker of endothelial dysfunction, carotid intima media thickness (CIMT) as a marker of subclinical organ damage and insulin resistance (IR) as a cardiovascular risk factor in patients with ADPKD. Methods: Twenty‐two normotensive ADPKD patients with well‐preserved renal function and 19 healthy subjects were included in the study. Creatinine clearances were calculated by the Cockcroft–Gault formula. The homeostasis model of IR (HOMA‐IR) was used to measure IR. CIMT was measured by high‐resolution vascular ultrasound. CFVR was calculated as the ratio of hyperaemic to baseline diastolic peak velocities by echocardiography. Results: There was no significant difference between the two groups regarding age, gender, body mass index, systolic and diastolic blood pressures, cholesterol and triglyceride levels. However, CIMT and HOMA‐IR were significantly increased and CFVR was significantly decreased in patients with ADPKD compared with healthy subjects. Conclusions: The findings of decreased CFVR, increased CIMT and increased IR suggest that cardiovascular risk is elevated even in the early stages of ADPKD.     

Probable dementia associated with Lewy body pathology as a cause of prolonged acute confusional state in a 79-year-old patient

Differentiation of "dementia with Lewy body pathology" (DLB) and delirium may be problematic in some cases, due to some of their common clinical characteristics such as fluctuations and hallucinations. Longer duration of cognitive changes usually aids in DLB diagnosis. However, presentation of DLB with an abrupt onset as a prolonged confusional state and hallucinations is also, even if rarely, described. We report the case of an elderly patient with probable dementia with Lewy body pathology, presenting with a prolonged acute confusional state, in order to draw attention to its diagnostic difficulty and the importance of careful target-oriented anamnesis in such cases. This type of dementia should be included in the differential diagnosis of elderly patients presenting with otherwise unexplained prolonged acute confusional states.     

Changes in electrophysiological properties of regenerating rat peripheral nerves after crush injury

The conduction of action potential in peripheral nerves requires the coordinated opening and closing of Na(+) and K(+) channels. In the present study, we used the sucrose-gap recording technique to determine the electrophysiological changes of the regenerating nerves after sciatic nerve injury by using 4-aminopyridine (4-AP) and tetraethylammonium (TEA), and lidocaine. 4-AP enhanced the amplitude and duration of the compound action potentials (CAPs) of regenerating sciatic nerve 15 days post crush (15 dpc), and elicited delayed depolarizations (Del-dep) in 38 dpc and intact groups. Hyperpolarizing afterpotentials elicited by 4-AP were completely removed by TEA in both 15 and 38 dpc. Lidocaine effectively blocked the CAP amplitude. This blockage was more pronounced in 15 dpc than 38 dpc. This agent also exhibited a partial blockage on the Del-dep amplitude. These results may indicate that the changes in the activities of 4-AP- and TEA-sensitive K(+) channels and slow Na(+) channels may play critical roles in nerve excitability and conduction.     

Effects of calcium and magnesium on peripheral nerve conduction

Divalent cations, such as calcium and magnesium, are constantly present in extracellular compartment of most organisms. Modification of extracellular concentrations of divalent ions causes changes in physiologic functions, such as excitability and conduction of the nerves. The present study was designed to investigate and compare the effects of calcium and magnesium on nerve conduction and lidocaine-induced nerve conduction block. The aim of our study was to contribute to better understanding of physiological and pharmacological roles of divalent cations. Experiments were conducted on the sciatic nerves by using the sucrose-gap recording technique. We evaluated the effects of test solutions containing different calcium or magnesium concentrations, prepared with or without lidocaine, on compound action potentials to determine physiological and pharmacological roles of these cations. After the control recordings, the nerve was exposed to Ringer's solution containing 0, 1.9, 3.8 mM Ca2+ and 1.9 and 3.8 mM Mg2+ with or without 1 mM lidocaine. Decreasing the Ca2+ concentrations in Ringer's solution with or without lidocaine enhanced both tonic and phasic blocks. However, increased Mg2+ concentration did not change the tonic blocks but increased the phasic blocks. In conclusion, the results suggested but not prove that Ca2+ and Mg2+ may have different mechanisms of action on peripheral nerves. While Ca2+ directly affects the gating of Na+ channels, action of Mg2+ can be explained by surface charge theory.     

Which body mass index (BMI) is better in the elderly for functional status?

BMI is commonly used indicator of malnutrition and 18.5-24.9 kg/m² is generally regarded optimal. However, there is an ongoing debate on ideal range for elderly. BMI cut-off values vary also between ethnic groups. We aimed to investigate relationships between BMI, functional status and malnutrition in elderly living in a nursing home in Turkey. BMIs of 254 residents were calculated. Chronic diseases and currently used drugs were noted. Functional status was evaluated with Katz-activities-of-daily-living (ADL) and Lawton-instrumental-activities-of-daily-living (IADL). Nutritional assessment was performed by Mini-Nutritional-Assessment (MNA) test. Mean age was 75.2 ± 8.2 years. Subjects were classified into 4 groups as BMI <18.5, 18.5-24.9, 25-29.9, and ≥30.0 kg/m². ADL scores and IADL scores were higher in higher BMI groups. There were no differences in terms of age-number of chronic diseases. Even in BMI ≥35 kg/m² residents, ADL was significantly higher than 25-34.9 kg/m² residents. BMI was significantly correlated with ADL and IADL scores. In Groups 3 and 4, there were 22.2% and 9.1% residents without normal nutrition, respectively. Better functional status was associated with higher BMI values even in BMIs ≥30 kg/m². In elderly, relative high rates of undernutrition may be present in BMIs regarded as overweight or obese.     

Associated factors with urogenital score in natural and surgical menopause

OBJECTIVE: To anticipate the factors associated with urogenital symptoms in both natural and surgical menopause. METHODS: A retrospective analysis was performed comprising 267 cases with spontaneous menopause and 87 surgical menopause cases without any use of hormone replacement therapy. Sociodemographic characteristics, reproductive and medical history, urogenital scale and psychological subscale of Greene Climacteric Scale were assessed and correlated with the age of menopause, time past since last menstrual period, parity, body mass index (BMI), mode of delivery among two groups. RESULTS: Mean age of women enrolled to the study were 46.8+/-0.3 years and 44.4+/-0.25 years, for natural and surgical menopause cases, respectively. Mean parity had no correlation with urogenital scale in two groups. However, a positive correlation was apparent between the time since last menstrual period, psychological subscore of Green Climacteric Scale and urogenital score in both women with natural and surgical menopause. BMI was negatively correlated with urogenital score among two groups (r(p)=-0.85, p=0.04). CONCLUSIONS: Intensity and frequency of urogenital symptoms and climacteric complaints as expressed in the Greene Climacteric Scale increase during menopausal transition. Care should be taken to ameliorate the quality of life (QOL) and to confront these problems in post-menopausal women.     

Prognostic efficacy of C-reactive protein/albumin ratio in ST elevation myocardial infarction

Objective: Although the prognostic efficacy of C-reactive protein (mg/L) and albumin levels (g/L) has been previously associated with poor prognosis in ST elevation myocardial infarction (STEMI), to the best of our knowledge, the prognostic efficacy of C-reactive protein/Albumin ratio (CAR) (mg/g) has not been investigated yet. Thus, this study aimed to investigate the potential efficacy of the CAR in predicting prognosis in STEMI patients.

Method: We conducted a detailed investigation of 2437 patients with first STEMI treated with a primary percutaneous coronary intervention. After evaluation regarding to exclusion criteria, 2243 patients were found to be eligible for analysis. The mean follow-up of the study was 34?±?15 months.

Results: The median CAR value of the study population was 2.70 (range: 1.44–4.76), and the patients were divided into three tertiles according to their CAR values. Kaplan-Meier survival analysis showed significantly lower in-hospital and long-term survival rates for the patients in a high CAR tertile. In addition, the CAR was found to be an independent predictor of all-cause mortality (Hazards ratio: 1.033, 95% Confidence Interval: 1.007–1.061, p?=?.033), and the prognostic performance of the CAR was superior to that of C-reactive protein, albumin, and neutrophil to lymphocyte ratio in the receiver operating characteristic curve comparison.

Conclusion: The CAR, a newly introduced inflammation-based risk index, was found to be a potentially useful prognostic tool for predicting a poor prognosis in STEMI patients. However, this finding needs to be validated in the future prospective studies.     

Clinical characteristics and predictors of progression of chronic kidney disease in autosomal dominant polycystic kidney disease: a single center experience

Background

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disease. The course and progression of the disease is highly variable. In this study, we aimed to investigate the impact of clinical characteristics and basic biochemical parameters on progression of chronic kidney disease (CKD) in ADPKD patients.

Materials and methods

A total of 323 consecutive patients with ADPKD were enrolled into the study and followed with a mean duration of 100 ± 38 months. Patients were grouped as rapid progressors (RP) and slow progressors (SP) according to median rates of decline in glomerular filtration rate (ΔGFR) per year, namely 1 ml/min/year.

Results

History of macroscopic hematuria, urinary stone and smoking were more common in male patients; hepatic and other organ cysts were more common in female patients. ?GFR/year was similar between males and females [0.95 (0–3.02) vs. 1.11 (0.10–2.74) ml/min/year, p = 0.21]. History of smoking and pack-year of cigarettes smoked were significantly higher in the RP compared to the SP group (36 vs. 18 %, p = 0.01 and 5.24 ± 1.20 vs. 3 ± 1.32 pack-year, p = 0.02, respectively). Baseline 24 h-proteinuria was found to be significantly correlated with the percent decline of GFR (?%GFR) per year (r = 0.303, 0.001). In Cox regression analysis for predicting the progression of CKD, age, hypertension, urinary stone and proteinuria were retained as the significant independent factors predicting progression of CKD in the model.

Conclusion

Baseline proteinuria was significantly correlated with ?%GFR per year. Hypertension and proteinuria were found to be the major treatable risk factors for the progression of CKD in ADPKD patients.     

Structural,Functional and Autonomic Changes in the Cardiovascular System in Growth Hormone Deficient Patients

Background: Growth hormone deficiency (GHD) is known to cause higher rates of cardiovascular mortality. The purpose of the study was to analyze the structural and functional changes in the heart and investigate their relation to autonomic function as assessed with heart rate variability (HRV). Methods: Eleven untreated GHD patients (mean age 50.4 ± 10.7 years, M/F: 3/8) and 15 age‐ and sex‐matched healthy persons (mean age 45.3 ± 10.4 years, M/F: 5/10) were compared. Both groups were examined with echocardiography, HRV, and exercise testing and findings were analyzed. Results: The groups were similar in height, weight, body mass index, body surface area, systolic and diastolic blood pressure, heart rate. The GHD patients had lower exercise duration and metabolic equivalent (MET) compared to controls (7.94 ± 1.26 vs. 9.8 ± 1.9 min, P < 0.001, for MET 8.85 ± 0.86 vs. 10.7 ± 2.23, P = 0.03). On echocardiography, GHD patients had lower interventricular septum diastolic diameter (9 ± 0.89 vs. 10.7 ± 0.88 mm, P < 0.001) and posterior wall thickness (8.4 ± 0.93 vs. 9.8 ± 0.91 mm, P = 0.002), and lower left ventricle mass index (90.9 ± 20 vs. 112 ± 8 g/m², P = 0.01). Left ventricular ejection fraction was lower in the GHD patients (57.4 ± 5.12% vs. 65.5 ± 4.1%, P < 0.001). Time and frequency domain heart rate variability parameters, SDNN, SDANN, VLF, LF ve LF/HF were lower in GHD patients compared to controls. There was a significant correlation between left ventricle diastolic diameter and LF (r = 0.62, P = 0.02). Conclusion: GHD seemed to cause decreased left ventricle mass and decreases in the sympathetic components of HRV that may have a bearing on the increased cardiovascular risk seen in these patients.