Journal of Nephrology & Endocrinology Research
Journal of Nephrology & Endocrinology Research is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Nephrology & Endocrinology Research. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Article acceptance will be in the form of Research, Review, Case Reports, Analysis, Magazines, Editorials, Opinion, Communications, Mini-Review, Short Communications, Picturized, Book Review, Video Type and Power Point Presentations (PPTS). Articles can be submitted through online from https://www.onlinescientificsresearch.com/submit-online or can send through an e-mail with attachment for jner@onlinescientificresearch.net
Epidemiological and Etiological Aspects of Acute Renal Failure in the Nephrology and Haemodialysis Department of the Point G University Hospital
Introduction: Acute renal failure (ARF) represents a major public health problem associated with high mortality. The incidence is increasing with the emergence of multiple risk factors. In Mali, there are currently no data on the extent and severity of this condition in either hospital or community settings. The aim of our study was to describe the epidemiological, therapeutic and prognostic aspects of ARF in adults treated at the University Hospital Centre (CHU) of Bamako. Patients and Methods: This was a retrospective and descriptive study that took place from 1 July 2021 to 30 June 2022 at the CHU du Point G in Bamako. It focused on patients hospitalised and/or followed up on an outpatient basis in the nephrology department during the study period. Results: The prevalence of acute renal failure was 11.55% with a sex ratio of 1.49. The mean age was 42.37±20.7 (range 6-88 years). Elevated plasma creatinine was the main reason for consultation. Creatinine levels were above 500µmol/l in 65.21% of cases. High blood pressure was the main presenting condition in 33.7% of cases. Acute renal failure was organic, obstructive and functional in 72.8%, 15.2% and 12% respectively. Rehydratation was used in 97.8% of cases. Dialysis was indicated in 40% of cases. Age over 60 years was a major risk factor for ARF. The outcome was favourable in 81.5% of cases. Conclusion: Mortality in dialysis patients with ARF remains high. Several factors influence the prognosis of these patients, including the severity of ARF and pre-existing comorbidity
Copyright (c) 2025 Journal of Nephrology & Endocrinology Research
The Role of ICAM-1 Expression in Renal Tissue in the Progression of Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus
Introduction: Diabetic nephropathy is the main microvascular complication of diabetes mellitus (DM). Intercellular adhesion molecule 1 (ICAM-1) plays a critical role in the development of morphological changes in renal tissue in patients with type 2 (T2DM) diabetes mellitus. The work is devoted to studying the role of ICAM-1 (CD54) expression in renal tissue in the development and progression of morphological changes in diabetic kidney disease (DKD) in patients with T2DM. Objective: The examination was carried out in 50 patients with T2DM (mean age 66.58±3.27 years). There were 35 women, 14 men. The duration of disease in patients with diabetes was 17.70 ± 0.35 years. The duration of DKD from the moment of detection of microalbuminuria to the morphological examination of the renal tissue and diagnosis was 1.65±0.34 years. Methods: All patients underwent light and immunofluorescence microscopy of kidney tissue biopsies. Morphological changes in tissue were assessed according to the latest international classification of diabetic nephropathy, developed in 2010. CD54 (ICAM-1) expression was determined using monoclonal antibodies labeled FITC (anti-human CD54 Antibody) (USA). Results: According to light microscopy, class IIa (mild mesangial expansion) was detected in 12 patients, class IIb (severe mesangial expansion) in 14 patients, class III (Kimmelstiel-Wilson lesions) in 19 patients and in 5 patients – class IV (advanced diabetic glomerulosclerosis). It has been shown that there is a regression model between the expression of ICAM-1 in the glomerular endothelium with the development of expansion of the mesangial matrix, thickening of the basement membrane and arteriolar hyalinosis. Expression in peritubular capillaries is associated with the development of tubulointerstitial fibrosis and progression of diabetic kidney disease in patients with T2DM. Conclusions: Based on the data obtained, it was suggested that the study of ICAM-1 expression in kidney tissue can be used as a biomarker for the progression of kidney disease in patients with T2DM.
Intercellular Adhesion Molecule-1 (Icam-1)
Similarities and Differences of New-Onset Hyperglycemia Secondary to Different Types of Acute Pancreatitis
With the increasing incidence of acute pancreatitis (AP), new-onset hyperglycemia (prediabetes and diabetes) secondary to AP attracts more attention as one of chronic complications. There are numerous causes of AP, including cholelithiasis, hypertriglyceridemia, alcoholism and so forth, which are both diabetic high-risk factors. Unfortunately, it is still unknown whether the hazards of secondary glucose metabolism impairment resulting from different types of AP are equal. In addition, person suffered from pancreatitis or diabetes is with high-risk for future pancreatic cancer. Thus, identification and analyzation on factors for different types of pancreatogenic diabetes is crucial. The literature review summarizes the incidence of
A Rare Cause of Gastrointestinal Bleeding in a Kidney-Pancreas Transplant Recipient – Case Report
Kidney-pancreas transplantation is the preferable therapeutic option for patients with type 1 diabetes mellitus and end-stage kidney disease. We describe the case of a 35-year-old pancreas-kidney transplant recipient with dual-graft failure that presents with massive hematochezia and hemodynamic instability, evolving into hemorrhagic shock. The diagnostic assessment revealed a fistula between a pseudoaneurysm of the right common iliac artery and the adjacent transplanted duodenum segment, a rare but life-threatening cause of gastrointestinal bleeding in these patients. An endoprosthesis was placed into the iliac artery, prophylactic antibiotics were instituted, and a pancreatic transplantectomy was performed in a second procedure. This case highlights that the diagnostic workup of gastrointestinal bleeding in pancreas-kidney transplant recipients must include the possibility of arterio-enteric fistulas, which is more frequent in the presence of pancreatic graft failure, as was the case of our patient. Endovascular exclusion is the advocated treatment. Pancreatic graft transplantectomy could also be a possible approach for patients with a failed pancreas but it is highly controversial due to potential risks.
The Role of Self-Care Practices in Mental Health and Well-being: A Comprehensive Review
This paper investigates the significant role of self-care practices in promoting mental health and enhancing overall well-being. While many individuals turn to short-term fixes like caffeine and sleep to recover from stress, self-care goes beyond recovery and encompasses holistic practices that nurture the body and mind. By examining relevant scientific literature, this study explores how different self-care activities such as mindfulness, physical activity, nature exposure, and social connection influence mental health outcomes like anxiety, depression, and stress. The paper aims to clarify the distinction between recovery and self-care and emphasize the importance of making self-care an integral part of daily life.
A Study on the Effect of Methanolic Extract of Plumeria alba on Acetaminophen-induced Kidney Damage
Background: Incidence of acetaminophen-induced nephropathy is a growing concern, with limited treatments available. This study evaluated the effects of methanolic extract of Plumeria alba flower (MEPAF) in acetaminophen-induced nephrotoxicity in Wistar rats. Materials and Methods: Twenty-five Wistar rats were divided into five groups (A - E) of five rats each. Group A (Control) received feed and water. Group B received 1800mg/kg/bwt of acetaminophen and Group C received 900mg/kg/bwt of MEPAF. Groups D-E rats received co-administration of 1800mg/kg/ bwt of acetaminophen and 180mg/kg/bwt of MEPAF, 1700mg/kg/bwt of acetaminophen and 850mg/kg/bwt of MEPAF respectively. All administrations were orally and daily for 28 days. On the 29th day, the rats were sacrificed, blood samples collected for kidney function test (urea, uric acid and creatinine evaluations) and kidneys harvested for histopathological examination. Results: Administration of 1800mg/kg/bwt of acetaminophen for 28 days induced a significant (p<0.05) increase in body and relative organ weights, serum urea, uric acid and creatinine along with histopathological changes (acute tubular necrosis, degeneration and haemorrhage). However, co-administration with Plumeria alba flower extract ameliorated these conditions. Conclusion: Plumeria alba flower extract could potentially provide protection against acetaminophen-induced renal toxicity. The observed nephroprotection could be attributed to the inherent antioxidant properties of Plumeria alba.
Ethical Sensitivity Issues among Certified Public Accountancy Firms in Ethiopia
Background and Justification: In different developing nations, managers, leaders and business owners are exposed to money corruption. The root cause of this corruption is unethical decisions made by Public Accountants. This paper focuses on identified areas of ethical dilemma and the most important demographic factors that affect the ethics of professional accountancy. Methodology: The research selected 317 certified public accountants as a sample based on probability sampling techniques. The study used demographic factors as an independent variable and ethical dilemma as a dependant variable. To test the statistical significance of each mean difference, the study used independent samples t test and One-way ANOVA parametric test. Result and suggestions: The finding of the study summarize that Presentation of the financial reports, audit time by tax auditors and tax-related matters are the three most difficult areas of professional conflict of interest that affect professional activities. Result showed demographic variables of gender, age, level of education and professional experiences were a mean significance variations in each group for exposing of ethical dilemma
Innovative Approach of Rapid Dissolving Tablet for Hypertensive Therapy using Box Behnken Design
The development of oral disintegrating tablets (ODTs) for antihypertensive drugs represents a promising approach to improve patient adherence, especially for those with difficulty swallowing traditional tablets. This study focuses on the formulation and optimization of hydrochlorothiazide (HCTZ) ODT using Box-Behnken design (BBD) for process optimization. The research employs excipients such as fenugreek seed powder as a superdisintegrant, Locust bean gum and banana powder as binders, corn starch as a glidant, magnesium stearate as a lubricant, microcrystalline cellulose (MCC) as a filler, and aspartame as a sweetener. Additionally, polyethylene glycol 4000 (PEG-4000) is used as a solubility enhancer through solid dispersion techniques. The BBD method investigates the effect of concentrations of fenugreek seeds, robusta gum and PEG-4000 on tablet properties such as disintegration time, dissolution rate, hardness, friability etc. The optimized formulation exhibits rapid disintegration (within 30 seconds), improved dissolution profile and enhanced bioavailability of hydrochlorothiazide due to the solubility-enhancing properties of PEG-4000. The results indicate that the combination of excipients and solid-phase dispersion methods can significantly improve the efficacy of ODT, providing a potential solution to improve therapeutic outcomes in the treatment of Hypertension.
Dietary Restriction Challenge in Esrd Cases: Let’s Walk the Path in The Patient’s Shoes
Dietary recommendations for dialysis-dependent children with end-stage renal disease (ESRD) include potassium, phosphorus, and sodium limitations. The patient must take phosphate binders with their meals. Adherence issues might pose a challenge to renal diet compliance. The goal of this study was to investigate the effect of adherence to a two-week renal diet on empathy levels among healthcare providers who care for children with ESRD on dialysis. Taking a patient-centric approach, this abstract emphasises the importance of empathy and communication in supporting ESRD patients. By walking in the patient’s shoes, healthcare providers can gain valuable insights into the challenges faced by these individuals. Understanding their perspectives, preferences, and struggles fosters a collaborative approach to managing dietary restrictions, promoting better adherence and overall well-being. Moreover, this abstract underscores the need for tailored interventions and support systems that address the unique needs of pediatric ESRD patients. From dietary counselling and psychosocial support, a holistic approach is essential for empowering these young patients to navigate nutritional restrictions successfully. In conclusion, this abstract advocates for a patient-centred paradigm shift in managing dietary restrictions in ESRD cases. By recognizing the importance of empathy, communication, and tailored support, healthcare providers can enhance the quality of care and improve outcomes for these vulnerable patients.
Is Kidney Trading the Answer for Kidney Shortage? A Case Study Based on Iran’s Experience
Kidney transplantation has been demonstrated to be the treatment of choice for end stage renal disease. However, most patients still end up receiving dialysis rather than receiving transplantation for the kidney as the organ source is fairly limited in most countries. We therefore explore the case of Iran where kidney trading is considered legal. As of now, Iran is also the only country worldwide that allows monetary compensation for kidney donation, whereas there are rules to refrain its abuse. We also discuss the strength and weakness of Iran’s kidney trading system and the applicability of the system to other countries to hopefully help reduce the kidney shortage in organ donation.
Introduction : The diabetes pandemic is classified as the eighth leading cause of death in both sexes and the fifth leading cause of death in women. The aim of this study was to determine diabetes-related mortality in the hospital setting. Method: this was a descriptive study, based on the records of diabetic patients who died in hospital in the various departments of the “National Reference” University Hospital of N’Djamena, from January 2015 to December 2019 (i.e. 5 years). The variables studied were epidemiological, clinical, paraclinical, therapeutic and evolutionary. Data analysis was performed using SPSS.25 software. Results: During the study period, 1282 deaths occurred, 185 of them due to diabetes, i.e. a prevalence of 15.85%. The mean age of patients was 57.24 years (extremes 18 and 88 years). The age group most affected was 40 to 60, with 82 patients (44.3%). The patients were predominantly male (sex ratio 1.56). Their socio-economic level was average in 52.4% (97 cases) and low in 40.5% (75 cases). Type 2 diabetes accounted for 91% (168 patients) and type 1 for 09% (17 patients). Reasons for hospitalization were metabolic complications (23.78%), followed by hypertensive crises (13.51%) and cerebrovascular accidents (08.11%). The risk factors most frequently associated with diabetes were hypertension (57.90%), dyslipidemia (31.35%) and alcohol (22.30%). Complications associated with death were dominated by nephropathy (63.3%) and metabolic complications (61.1%). More patients died in intensive care (58.91%) than in cardiology (16.90%). Conclusion: Diabetes-related mortality in hospitals remains very high, which is why we need to step up awareness-raising to reduce diabetes-related deaths.
Dextra Tibia Fracture Resulting from a Traffic Accident
Background: By definition, blunt force trauma is a force that is caused by a blunt object on the surface of the body, which results in injury. Blunt trauma can be caused by objects that have blunt surfaces such as stones, wood, hammers, fists and so on, which also includes falls from high places, traffic accidents and so on, which are currently increasing in severity. Case Report: It was reported that a victim, initials N, was a pedestrian who was hit by a motorbike Results: on physical and radiological examination the victim suffered an open right tibial fracture. Conclusion: The female victim was involved in a traffic accident and suffered abrasions, lacerations and broken bones due to blunt trauma which required the victim to undergo treatment.
Varicocelectomy in Male Subfertility Treatment: ‘‘Updated’’ Indications for Surgery
We analyzed the recent literature data on varicocelectomy in treatment men from infertile couples. There are still a lot of unresolved issues that require clarification. It is still unclear the exact pathogenesis of testicular malfunction in some men with varicocele. Recent European and American urological guidelines recommend varicocele repair in men from infertile couples with “abnormal” semen parameters. Although, according to the 6th ed. of WHO laboratory manual for the examination and processing of human semen it is not clear the cut-off values between normal and abnormal semen parameters. Also, still unclear why approximately third part of patients do not experience any improvement after varicocele repair. According to the recent data analysis, total progressively motile sperm count (TMSC) and sperm concentration can be the significant predictors of semen improvement and pregnancy after varicocele repair. However, it should be remarked that the mean quality of existed data from low to moderate. All mentioned issues indicate the necessity of further large-scale multicenter randomized clinical trials.
Incidence, Risk Factors, and Outcome of Acute Kidney Injury in Patients Admitted to Intensive Care Unit in a Tertiary Care Hospital
Introduction: Acute Kidney Injury (AKI) is the major cause of morbidity and mortality in hospitalized patients. Knowing the magnitude and outcome of AKI in patients admitted to ICU will help to increase awareness and prepare the resources required in improving care. Objective: To examine the incidence and outcome of AKI in an intensive care unit in tertiary care hospital, in Tigray, Ethiopia. Method: Prospective observational type of study was carried out to assess the incidence and outcome of AKI in a tertiary hospital from November 1 to April 1, 2020, G.C. Results: Of 152 patients admitted to the ICU during the study period 51.3% were males. The most common reasons for admission were the disease of the circulatory system (35%) and all forms of injury and poisoning (15.2%). The most common comorbidities were cardiac disease (41.6%), hypertension (25.7%), and diabetes mellitus (9.9%). Hemodialysis was given for 15.2% of patients and the mortality rate after hemodialysis was high around 85.7% and the overall mortality rate of patients with AKI was 56.5 %. The presence of anemia (AOR= 3.8 95%CI 1.8, 8.03), shock (AOR= 3.2 95%CI 1.5, 6.7), any focus of infection (AOR= 1.8 95%CI 0.8, 4.05) and liver function test derangement (AOR= 3.3 95%CI 1.5, 6.9) significantly affect the occurrence of AKI. Conclusion: The incidence of AKI was high in patients admitted to the ICU, and the development of AKI was associated with poor outcomes and reduced survival.
Predictive Factors for Complete Resolution of Hypertension After Adrenalectomy for Aldosteronoma
Introduction: Primary hyperaldosteronism, 1st cause of secondary hypertension, 2nd cause of hypertension potentially curable by surgery. The objective of this work is to determine the predictive factors for complete resolution of hypertension after adrenalectomy. Material: We conducted a retrospective study of 25 patients with primary hyperaldosteronism operated and followed between 1985 and 2018. Results: Our patients were divided into 16 women and 9 men, mean age 54 years. 40% of our patients were smokers, 36% dyslipidemic, 68% diabetic and 76% had a BMI ≥ 25 kg / m2. Patients underwent unilateral adrenalectomy, the surgical approach was posterior lumbar in 9 cases and laparoscopic in 16 cases. No per or postoperative complication was noted. The postoperative course was marked by the HTA in 36% of the cases, an improvement in 36% of the cases and persistence in 31% of the cases. We found a significant decrease of the PAS and the PAD at six months of the surgery. The comparative study of the patients whose HTA was cured versus unhealed did not show a statistically significant correlation with the following predictors of healing: young age, female gender, lack of family history of hypertension, adenoma’s dimension, the presence of comorbidities including diabetes and dyslipidemia and the average number of antihypertensive treatment.Only the absence of overweight or obesity was a predictor of healing in our series. Conclusion: Knowing the predictive factors of healing aims to pose the operative indication and especially to improve the prognosis of hypertension after surgery by acting on certain modifiable factors.
Primary Hyperaldosteronism-Hypertension-SurgeryCure
Copyright (c) 2023 Journal of Nephrology & Endocrinology Research
Importance of Renal Dietitians in Nutritional Counselling and Dietary Interventions in The Early Stages of Chronic Kidney Disease
Chronic kidney disease (CKD) is becoming a public-health problem, at a global level. In CKD, patients progressively lose the ability to excrete phosphorus. Several observational studies have determined hyperphosphatemia emerging as an independent cardiovascular risk factor in CKD-Mineral and Bone Disorder (CKD-MBD). In early CKD, serum Klotho declines and fibroblast growth factor-23 (FGF‐23) starts increasing which coincides with its effects on augmenting urinary phosphate excretion with reduced serum phosphate reabsorption and decreased levels of calcitriol. The Klotho/FGF23 axis should be a novel target for renal clinicians being pathogenic contributors to CKD progression and cardiovascular disease (CVD) development. The high phosphorous load has been found to increase serum FGF-23 levels in the early stages of CKD which further leads to CVD and increased mortality. To control hyperphosphatemia, a potentially simple and effective approach of dietary phosphate control should be incorporated to reduce the early clinical consequences of CKD-MBD. Along with the amount of dietary phosphorus intake, its type (organic vs. inorganic), its source (animal vs. plant derived), phosphorus-to-protein ratio and preparation of food by boiling should also be made aware to patients which is likely a neglected aspect of dietary counselling in CKD. A kidney-friendly diet plan is needed to protect kidneys from further damage which is rather an arduous period for making patients follow a phosphate-restricted diet. Here, the role of the renal dietitian appears mandatory in counselling and educating the patients to effectively integrate dietary interventions into the therapeutic approach of CKD-MBD.
Burden and Predictors of Chronic Kidney Disease in Developing Country
Chronic Kidney Disease (CKD) is being recognized as a global public health problem. It is a major non-communicable disease with the global prevalence varying between 10.5% and 13.1%. Diabetes and hypertension appear to be the leading causes of chronic kidney disease worldwide. An institution based cross-sectional study was undertaken from Oct 20, 2018 to Nov 20, 2019 G.C. Data was collected using a pre-tested questionnaire designed to meet the study objective. After describing variables, logistic regression was conducted to identify independent associated factors of CKD. Statistical significance was declared at P<0.05. Of the 450 studied patients, 260(57.8%) were males and more than half (54.2%) were between ages of 25 to 40 years. The prevalence of CKD among patients admitted to medical ward was 17.3% (95% CI 13 - 29.9) and 14.4% (95 % CI 6.2 – 12.3) by Cockcroft Gault and MDRD equations, respectively and majority (61.5%) of them were stage 5. Hypertension (AOR= 7.8 95%CI 4.1, 14.9), history of recurrent urinary tract infection (AOR= 3.5 95% CI 1.1, 7.3) and history of using nephrotoxic drugs (AOR=3.4 95% CI 2, 9.3) were significantly associated with CKD. The burden of CKD among patients in a medical inpatient unit was high and majority of the patients present late. Hypertension, use of nephrotoxic agents and recurrent urinary tract infections were found to be important predictors.
Nuclear Factor Erythroid 2-Related Factor 2 (Nrf2) and Nuclear Factor-Kappa B (NF- κB) Expression in Chronic Kidney Disease Patients (CKD) from South India
Aim: The present study elucidated the expression level of Nrf2 and NF-κB, in chronic kidney disease (CKD) patients from South India. Further, the expression levels of these genes are analyzed for cytokines TNF-α and IFN-γ and various subgroups of cases including dialysis, non-dialysis, diabetic and non-diabetic CKD patients, and correlation analysis performed. Methods: 133 CKD patients and 133 healthy individuals were enrolled for the evaluation of NF-κB and Nrf2 expression by qPCR. Results: Upregulated Nrf2 mRNA expression (as fold change) was observed in diabetic (Fc: 1.13), and non-diabetic (Fc: 1.30) patients. Inversely, Nrf2 mRNA expression was down regulated in non-dialysis groups (Fc: 0.80). NF-κB expression was significantly upregulated in non-diabetic (Fc:1.92), non-dialysis (Fc:1.59), dialysis (Fc: 1.36) and CKD patients (pooled) (Fc: 1.27). A dysregulated NF-κB expression was observed in diabetic groups (Fc: 0.69). Nrf2 mRNA expression were positively correlated with IFN-γ expression in diabetes (r = 0.28, p = 0.05) and non-diabetic CKD patients (r = 0.37, p < 0.002). Likewise, TNF-α expression was positively correlated with Nrf2 expression in CKD (pooled) patients (r = 0.33, p < 0.000). A negative correlation was observed in Nrf2 and NF-κB expression in CKD (pooled) (r = -0.028, p = 0.833). Conclusion: The study concluded the down regulated Nrf2 and upregulated NF-κB expressions in non-dialysis patients. On the contrary, in diabetic CKD patients, the expression level of NF-κB was downregulated and Nrf2 was upregulated. Thus, a negative correlation was observed between Nrf2 and NF-κB genes with respect to their expression patterns.
Is it Feasible to Completely Prevent Diabetic Kidney Disease?
When SGLT2Is were first introduced as hypoglycemic agents during the year 2008, no body was aware about their protective action on the heart, kidney, and retina of patients suffering type 2 diabetes mellitus (T2DM). SGLT2Is have revolutionized the treatment of T2DM patients with established or at risk for diabetic kidney disease (DKD). When Dapagliflosin was studied in T2DM patients with estimated glomerular filtration rate [eGFR] >90 mL/min/1.73m2, and normal urine albumin excretion, these cases were still susceptible to develop the renal end points. These results have raised the question about the ideal time to use SGLT2Is to completely abort the incidence of DKD. This review will try to answer this question.
Sodium Glucose Cotransporters-2 Inhibitors
Renal Infarction: Clinical and Evolutionary Aspects in the Nephrology Department Ibn Sina University Hospital of Rabat-Morocco
Introduction: Renal infraction is a rare medical-surgical emergency that should be evoked before any lumbar pain syndrome. We report in this work, two cases of renal infraction with their clinical evolution. Clinical Observation: These patients, aged respectively 48 and 70 years, were hospitalized in our department concomitant for low back pain. Emboligenic heart disease was responsible for the renal infraction in both cases. Diagnostic certainty was established by a CT scan with injection of contrast medium. Renal function was normal in the young patient versus renal insufficiency at 20mg/l creatinine for a GFR estimated at 35ml/minute according to MDRD in the elderly patient. We had a clinical and biological improvement with a curative anticoagulant treatment relayed by a long term treatment with an anti vitamin K in both cases but the elderly man kept a sequential renal insufficiency. Conclusion: Acute renal infarction is a rare pathology which must be systematically evoked in front of a lumbar pain syndrome. Angioscan with injection of contrast medium allows to make the diagnosis. Heparinization at an effective dose is the mainstay of treatment in the case of unilateral involvement, or surgery if bilateral.
Scleroderma Renal Crisis in Mixed Connective Tissue Disease in a Patient: A Challenging Disease
A 52-year-old woman with Raynaud syndrome diagnosed less than 1 year ago, consulted the emergency room due to 4 months of progressive symmetrical edema in the lower limbs, muscle weakness, dyspnea, hypertension crisis, and dark urine. Investigations revealed left ventricular dysfunction (ejection fraction 14%) without coronary artery disease and acute renal injury. Mixed Connective Tissue Disease was diagnosed and because of the renal and systemic findings in the patient a renal biopsy was performed confirming scleroderma renal crisis. To the best of our knowledge, this is the tenth patient who reported scleroderma renal crisis as a complication in patients with Mixed Connective Tissue Disease, from these 4 patients who became hemodialysis dependent, 1 died, and 4 responded to therapy. The treatment chosen was Angiotensin-converting-enzyme inhibitors and steroids based on what is known in renal scleroderma crisis with a substantial recovery of the left ventricular function and stabilization of the glomerular filtration rate followed by discharge from hospitalization.
Cystatin C and Chronic Complications of Diabetes Mellitus in a Subsaharian Population
Background: Type 2 diabetes (T2D) is a chronic and progressive condition whose early management is crucial in preventing the occurrence of its chronic degenerative complications. Cystatin C (CysC) is a biomarker that may have a beneficial interest in the early detection of microvascular and macrovascular complications of T2D. Methods: We carried out a cross-sectional analytic study at the National Obesity Center of the Yaounde Central Hospital. We recruited 135 patients with T2D and performed a neurologic physical exam using the Toronto clinical score, a fundoscopy, ECG, ABI, and the following paraclinicals: dosage of serum levels of Cystatin C, lipid profile (with determination of Atherogenic indexes), Creatinine (with calculation of glomerular filtration rate using CKD-EPI formula) and hs-CRP. Results: Prevalences of diabetic retinopathy, nephropathy, neuropathy and PAD were 3.0%, 8.9%, 38.5%, 28.1% respectively. Electrocardiographic signs of myocardial ischemia were present in 5.9 % of the participants. We found 0.3[0.5-0.3] mg/l as median levels of the HDL-cholesterol and 0.9[1.2-0.7] mg/l for LDL-cholesterol. The median value of GFR was 105.7[119,0-85.7] ml/min/1.73m². The median serum CysC level was 0.8[0.9-0.6]mg/l and varied with age (p=0.01), A1C (p=0.016) and high blood pressure (HBP) (p=0.006). There was a relationship between serum CysC and diabetic nephropathy (p=0.01) and neuropathy (p=0.025). There was no significant relationship with diabetic retinopathy (p=0.225), PAD (p=0.169) and ECG signs of myocardial ischemia (p=0.669). Conclusion: Chronic microvascular and macrovascular complications of type 2 diabetes are common and in our study are predominantly represented by diabetic neuropathy and PAD. Serum CysC can be useful in the diagnosis of chronic complications of T2D.
Background: Infanticide has varying terminology and definitions in different jurisdictions. It is usually defined as the murder of a child in the first 24 hours of life, whereas in the US it is defined as the murder of a person one week or less. In the UK, the adultery of a baby, who is not yet one year old by his own mother is referred to as infanticide and is given a lighter sentence due to considerations of mental status. Meanwhile, in Indonesia, the basis for consideration used is the motive for fear of being caught giving birth to a child and the murder is carried out immediately during childbirth. As for determining that murder is the murder of one’s own child or ordinary murder, a forensic examination is required. Case: A case was reported with the victim of a baby boy in a cardboard box on the road around the housing complex and an examination of the body was carried out in the autopsy room of the Forensic Medicine and Medicolegal Medical Installation of Bhayangkara General Hospital, TK II Medan City according to the Visum Request Letter. Results: it was found that the baby was born alive, viabel, did not get treatment with the estimated age of the baby in the womb was 9-10 months (mature). The cause of death is due to exposure that causes suffocation due to the obstruction of air entering the respiratory tract. Discussion: On examination, the baby was estimated to be aged 9-10 months in the womb (viable). There is no sign of treatment. Bruises were found on the upper and lower lips of the outer and inner parts which indicated the presence of closure of the baby’s mouth by the perpetrator. There are also signs of asphyxia. On internal examination, a positive pulmonary buoyancy test was found and the results of pulmonary histopathology showed that the baby was viable and quite a month. Conclusion: The baby is a victim of murder, so the perpetrator must be held accountable for his actions and can be prosecuted under articles 341, 342 of the Criminal Code if the perpetrator is a biological mother and article 343 of the Criminal Code if there are people who help / do.
Prevalence, Characteristics and Outcome of Post-Operative Acute Kidney Injury in Cameroon: A Prospective Study in Three Hospitals in Douala
Objective: Post-operative acute kidney injury (AKI) is a frequent surgical complication. Data on this disorder are scare in our setting. We aimed to study the prevalence, characteristics and outcome of postoperative AKI in Cameroon. Methods: A prospective and analytical study from December 2020 to Mai 2021 including all consenting adults’ patients admitted in the departments of surgery, obstetrics/gynecology and intensive care unit (ICU) of 3 referral hospitals in Douala. For each patient, 3 serum creatinine assays were done on admission before the surgery, on days 2 and 7 after surgery. Postoperative AKI was defined and classified according to the modified KDIGO 2012 criteria. Outcome measure were kidney recovery at day 7 and mortality. Kidney recovery was total if serum creatinine on day 7 was less or equal to the preoperative value, partial if less than diagnostic value of day 2 but not the preoperative value and absent if creatinine on day 7 did not decrease or if the patient required dialysis. p <0.05 was considered significant. Result: Out of 203 patients included, 52 developed postoperative AKI, giving a prevalence of 26.6%. Mean age of AKI patients was 35.34 (13.74) years with 61.6% being (32/52) male; AKI stage 1 accounts for 55.7% (29/52), 19.3% (10/52) stage 2 and 25% (13/52) stage 3. AKI was functional in 61.5% (32/52) of cases mainly due to hypovolemia 42.5% (22/52) and sepsis 34.6% (18/52). For the 40 patients diagnosed on D2, kidney recovery was known in 75% (30/40); with 66.6% (20/30) total recovery, 23.4% (7/30) partial recovery and 10 % (3/30) without recovery. Mortality rate was 19% (10/52) mainly due to hemorrhagic shock. Intra operative hypotension (aOR: 6.09; CI: 1.4 - 26.33; p = 0.016) and dirty surgery (aOR: 6.22; CI: 1.35 - 28.75; p = 0.019) were factors associated with AKI. Conclusion: Postoperative AKI occurred in 1/4 of patients in our setting. It is mainly due to hypovolemia and sepsis, renal recovery and mortality were high.
Prevalence and Associated Factors of Chronic Kidney Disease among Diabetic and Hypertensive Patients at Ambo Town Public Hospitals of West Shewa Zone, Oromia Region, Ethiopia
Background: Chronic kidney disease is a global public health important disease that is associated with life threatening outcomes including renal failure and premature mortality unless diagnosed and treated promptly. Diabetes Mellitus and hypertension are the two major causes of chronic kidney disease worldwide. This study is aimed to determine prevalence and associated factors of chronic kidney disease among diabetes mellitus and hypertensive patients at Ambo town public hospitals, Ethiopia. Methods: A cross-sectional study was conducted at Ambo University referral and general hospitals on 308 study participants. The participants were interviewed using interviewer administered questionnaire when they come for follow up at a chronic illness follow-up clinic. The patient charts were reviewed to retrieve information regarding medications, blood pressure, serum Creatinine and glucose level. A chronic kidney disease epidemiology collaboration equation was used to estimate Glomerular filtration rate from serum Creatinine. Data were analyzed SPSS version 23 for statistical analysis. Binary logistic regression analysis was used to identify factors associated with chronic kidney disease. Variables with a p-value below 0.2 at bivariable analysis were entered into the multivariable logistic regression model. Multivariable logistic regression analysis was used to examine the association between dependent and independent variables and p-value less than 0.05 was used to declare statistical significance. Results: A total of 308 diabetic and hypertensive patients were included in the study. Of which 156 (50.6%) participants were female with mean (± SD) age of 47.15 ± 12.06 years. The prevalence of chronic kidney disease (stage 3-5) was 20.5% with (95% CI: 16%-25%). Long duration of hypertension (AOR=4.89, 95% CI=1.93-12.40), elevated systolic blood pressure (>140mmHG) (AOR=3.20, 95% CI=1.36-7.51), family history (AOR=3.36, 95% CI=1.56-7.24) and age greater than 55 years (AOR=2.17, 95% CI=1.09-4.31) were factors associated with chronic kidney disease. Conclusion: The prevalence of chronic kidney disease was high. Older age, elevated SBP, long duration of hypertension and family history of kidney disease were factors associated with chronic kidney disease. A preventive plan is mandatory to reduce the disease and complications in the community.
Viscoelastic or Viscoplastic Glucose Theory (VGT #65): Estimated Risk Probability Percentages of Having Kidney Cancer and its Moving Trend over a 7+ Year Period from 1/1/2015 To 4/20/2022 Using a Combined Score of Hyperglycemia (Hyperg or Hg for T2d), Insulin Resistance (Ir), Hypertension (Bp), and Albumin-To-Creatinine Ratio(Acr), Obesity, Diet, and Exercise as the 4 Key Influential Factors for Developing Kidney Cancer Based on GH-Method: Math-Physical Medicine (No. 654-A)
Recently, the author read a few published medical articles regarding kidney cancer. He then lists these articles in the Reference section.
Cardio-Pulmonary-Renal Interaction (CPRI) - A Syndrome of Death
Two deaths due to renal failure in the last 2 month led me to a review the current, state-of-the-art understanding of cardio-pulmonary-renal interactions and their related pathophysiology, perpetuating nature, and cycles of increased susceptibility and reciprocal progression. It indicates that Organ injury is the consequence of maladaptive neurohormonal activation, oxidative stress, abnormal immune cell signalling, and a host of other mechanisms that precipitate adverse functional and structural changes. This syndrome has many complex physiologic, biochemical, and hormonal abnormalities and its pathophysiology is not fully understood. The possible mechanisms include reduced kidney perfusion due to decreased forward flow, increased right ventricular and venous pressure, and neurohormonal adaptations. Assessment of biomarkers are valuable clinical strategies to screen and detect disease, assist in diagnosis, assess prognosis, and predict recovery or progression to chronic disease or even death. Reduced kidney function is associated with increased mortality in such patients. Treatment options include inotropic medications; diuretics; ultrafiltration; and medications, such as β-blockers, inhibitors of the renin-angiotensinaldosterone system, and more novel treatments. Recent observational studies suggest that treatments that result in a decrease in venous pressure and lead to haemoconcentration may be associated with improved outcomes. I report here a male and female case who succumbed to Cardiac failure following renal failure in the last 2 months.
Tumour calcinosis is a rare disorder of phosphate metabolism. Familial tumour calcinosis is caused due to gene mutations affecting the activity of FGF23, a phosphoturic hormone. The presentation is hyperphosphatemia and calcified deposits in the periarticular regions. Surgery though being the mainstay of treatment, recurrence is often common without additional treatment. Phosphate restricted diet and phosphate binder before and after surgery would be beneficial. We present two cases of tumour calcinosis with hyperphosphatemia and calcified deposits, evaluated and followed up. We discuss various treatment options available for this rare condition.
Chronic Kidney Disease: Risk Factors and Prevention
Chronic kidney disease (CKD) is considered as a serious metabolic health problem among population worldwide, about 1 in 4-7 of adults and elderly. It is a gradual loss of kidney function due to glomerular microvascular damage. CKD can be diagnosed using estimated glomerular filtration rate (eGFR) test.
Effectiveness of Homoeopathic Medications in Comparison with Hormone Replacement Therapy in Hypothyroid Patients and Assessing their Comorbidity and Risk Factors
Introduction: Insufficient synthesis and release of thyroid hormone give rise to hypothyroidism. At present, thyroid disease forms the second most common endocrine disorder in India next to Diabetes mellitus. The women are affected more than men .10% prevalence in adult women and 3% in adult men. Symptoms include fatigue, lethargy, aches and pains, increased sensitivity to cold, constipation, excessive tendency to sleep and angina pain .Thyroid hormone replacement must be taken for the rest of their life in case of hypothyroidism patients, if they are following allopathic system of medicine and the side effects which these medicines produced are much harmful than hypothyroidism. If homoeopathic similimum could stimulate the body to produce its hormones in a balanced level, then the need for lifelong hormonal replacement in hypothyroidism becomes unnecessary. Methodology: A comparative cross sectional study has been conducted using questionnaire on 60 hypothyroid patients, in such a way that female patients who has been diagnosed with hypothyroidism between the ages of 35 to 55 were selected. They were divided as 30 homoeopathic users and 30 non-homoeopathic users. Field study was conducted and allopathic users were obtained through NSS camp surveys and homoeopathic users through patients attending SKHMC OPDs .The questionnaires were filled by the patient. Details regarding TFT values height, weight, were recorded. The comorbidities suffered by each patient were recorded and analysis was made. Regarding symptomatic change before and after medication and also risk factors were added in the questionnaire. Analysis was done using chi square test to compare the treatment groups. Result: From the study conducted, it has been observed that the disease is prevalent in patients between 35 and 39 years. Majority of the patients had conditions like increased BMI(>25). Regarding symptomatic relief in patients before and after medication in both groups, homoeopathic users got better symptomatic relief when compared with non-users. Many of the symptoms has persist even after using conventional treatment when statistically analysed with a p value <0.01.