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Sample records for microalbuminuria como indicador

  1. Genomic and Metabolomic Profile Associated to Microalbuminuria

    PubMed Central

    Marrachelli, Vannina G.; Monleon, Daniel; Rentero, Pilar; Mansego, María L.; Morales, Jose Manuel; Galan, Inma; Segura, Remedios; Martinez, Fernando; Martin-Escudero, Juan Carlos; Briongos, Laisa; Marin, Pablo; Lliso, Gloria; Chaves, Felipe Javier; Redon, Josep

    2014-01-01

    To identify factors related with the risk to develop microalbuminuria using combined genomic and metabolomic values from a general population study. One thousand five hundred and two subjects, Caucasian, more than 18 years, representative of the general population, were included. Blood pressure measurement and albumin/creatinine ratio were measured in a urine sample. Using SNPlex, 1251 SNPs potentially associated to urinary albumin excretion (UAE) were analyzed. Serum metabolomic profile was assessed by 1H NMR spectra using a Brucker Advance DRX 600 spectrometer. From the total population, 1217 (mean age 54±19, 50.6% men, ACR>30 mg/g in 81 subjects) with high genotyping call rate were analysed. A characteristic metabolomic profile, which included products from mitochondrial and extra mitochondrial metabolism as well as branched amino acids and their derivative signals, were observed in microalbuminuric as compare to normoalbuminuric subjects. The comparison of the metabolomic profile between subjects with different UAE status for each of the genotypes associated to microalbuminuria revealed two SNPs, the rs10492025_TT of RPH3A gene and the rs4359_CC of ACE gene, with minimal or no statistically significant differences. Subjects with and without microalbuminuria, who shared the same genotype and metabolomic profile, differed in age. Microalbuminurics with the CC genotype of the rs4359 polymorphism and with the TT genotype of the rs10492025 polymorphism were seven years older and seventeen years younger, respectively as compared to the whole microalbuminuric subjects. With the same metabolomic environment, characteristic of subjects with microalbuminuria, the TT genotype of the rs10492025 polymorphism seems to increase and the CC genotype of the rs4359 polymorphism seems to reduce risk to develop microalbuminuria. PMID:24918908

  2. Percepción de competencia y adiestramiento profesional especializado relativos al VIH/SIDA en estudiantes y profesionales de la salud: el estigma como un indicador de necesidad

    PubMed Central

    RODRÍGUEZ, Yarimar ROSA; DÍAZ, Nelson VARAS

    2009-01-01

    El proceso de estigmatización asume una devaluación de la persona debido a una característica o marca que haya sido identificada socialmente y que permita que se le describa como diferente. Desde que se desató la epidemia del VIH/SIDA, vivir con la enfermedad ha sido señalado de manera social como una marca estigmatizante. Las manifestaciones de dicha estigmatización se han documentado entre profesionales de la salud. Este estigma puede afectar los servicios de salud que las personas que viven con VIH/SIDA reciben de estos profesionales. Los objetivos de esta investigación fueron explorar: 1) la percepción que tienen estudiantes y profesionales de la salud sobre su nivel de competencia para ofrecer servicios a personas que viven con VIH/SIDA, 2) las opiniones de éstos sobre el tipo de adiestramiento profesional recibido y la necesidad del mismo, y 3) la manifestación de actitudes estigmatizantes como indicadores de necesidad de adiestramiento profesional. La muestra total del estudio estuvo compuesta por 80 de diversas profesiones de la salud. Los resultados reflejan que algunos/as de los/as participantes han recibido formación en VIH pero ésta no ha sido suficiente para contrarrestar las nociones estigmatizantes. Discutimos las implicaciones de los resultados para investigaciones futuras y el desarrollo de intervenciones con vías de minimizar las nociones estigmatizantes en los escenarios de salud. PMID:20011236

  3. Correlation between Microalbuminuria and Hypertension in Type 2 Diabetic Patients

    PubMed Central

    Ali, Alia; Taj, Azeem; Amin, Muhammad Joher; Iqbal, Farrukh; Iqbal, Zafar

    2014-01-01

    Background: Hypertension is commonly found in patients with Diabetic Kidney Disease (DKD). Microalbuminuria is the first clinical sign of involvement of kidneys in patients with type 2 diabetes. Uncontrolled hypertension induces a higher risk of cardiovascular events, including death, increasing proteinuria and progression to kidney disease. Objectives: To determine the correlation between microalbuminuria and hypertension and their association with other risk factors in type 2 diabetic patients. Methods: One hundred and thirteen type 2 diabetic patients attending the diabetic clinic of Shaikh Zayed Postgraduate Medical Institute, Lahore, Pakistan were screened for microalbuminuria and raised blood pressure. The study was conducted from November 2012 to June 2013. Results: Patients were divided into two groups. Group 1, those with normoalbuminuria (n=63) and Group 2, those having microalbuminuria (n=50). Group 2 patients showed higher blood pressure values as compared to Group 1. The results were statistically significant and showed poor glycemic control as a contributing risk factor. Conclusion: The study concluded that there is high frequency of hypertension among type 2 diabetics but still much higher among those having microalbuminuria. So, early recognition of renal dysfunction through detection of microalbuminuria and to start treatment without any delay will confer future protection from end stage renal disease as well as hypertension and its complications in type 2 diabetic patients. PMID:24948969

  4. Association of Microalbuminuria with Metabolic Syndrome among Aged Population

    PubMed Central

    Li, Xiao-Hong; Lin, Hai-Yan; Wang, Shu-Hua; Guan, Li-Ying; Wang, Yi-Bing

    2016-01-01

    Background. The impact of the various components of metabolic syndrome (MetS) on chronic kidney disease has been conflicting. We aim to investigate the association between MetS and microalbuminuria and identify the major contributing components of MetS that result in microalbuminuria in the Chinese aged population. Methods. A total of 674 adults aged 55–98 years (males: 266; mean age: 66.5 ± 7.5 years) were studied. MetS was defined by the 2004 Chinese Diabetes Society criteria and microalbuminuria by urine albumin-creatinine ratio (UACR) ≥3 mg/mmoL. Results. The prevalence of microalbuminuria was gradually increased with increasing number of MetS components (P < 0.05). In multivariate regression, after adjusting for age and sex, MetS was the strongest correlate of microalbuminuria (OR = 1.781, 95% CI = 1.226–2.587; P < 0.05) followed by the fasting plasma glucose (FPG) (OR = 1.217, 95% CI = 1.044–1.092; P < 0.05), systolic blood pressure (SBP) (OR = 1.011, 95% CI = 1.107–1.338; P < 0.05), and high-density lipoprotein cholesterol (HDL-C) (OR = 0.576, 95% CI = 0.348–0.953; P < 0.05). Conclusions. MetS is independently associated with microalbuminuria in the Chinese aged population. Elevated FPG is the most predominant component of metabolic syndrome associated with microalbuminuria followed by elevated SBP and reduced HDL-C. PMID:27200378

  5. Association of Microalbuminuria with Metabolic Syndrome among Aged Population.

    PubMed

    Li, Xiao-Hong; Lin, Hai-Yan; Wang, Shu-Hua; Guan, Li-Ying; Wang, Yi-Bing

    2016-01-01

    Background. The impact of the various components of metabolic syndrome (MetS) on chronic kidney disease has been conflicting. We aim to investigate the association between MetS and microalbuminuria and identify the major contributing components of MetS that result in microalbuminuria in the Chinese aged population. Methods. A total of 674 adults aged 55-98 years (males: 266; mean age: 66.5 ± 7.5 years) were studied. MetS was defined by the 2004 Chinese Diabetes Society criteria and microalbuminuria by urine albumin-creatinine ratio (UACR) ≥3 mg/mmoL. Results. The prevalence of microalbuminuria was gradually increased with increasing number of MetS components (P < 0.05). In multivariate regression, after adjusting for age and sex, MetS was the strongest correlate of microalbuminuria (OR = 1.781, 95% CI = 1.226-2.587; P < 0.05) followed by the fasting plasma glucose (FPG) (OR = 1.217, 95% CI = 1.044-1.092; P < 0.05), systolic blood pressure (SBP) (OR = 1.011, 95% CI = 1.107-1.338; P < 0.05), and high-density lipoprotein cholesterol (HDL-C) (OR = 0.576, 95% CI = 0.348-0.953; P < 0.05). Conclusions. MetS is independently associated with microalbuminuria in the Chinese aged population. Elevated FPG is the most predominant component of metabolic syndrome associated with microalbuminuria followed by elevated SBP and reduced HDL-C. PMID:27200378

  6. Microalbuminuria measurements by two in-house ELISA methods.

    PubMed

    Ng, L C; Teng, L C; Ng, M L; Sazali, B S; Khalid, B A

    2000-12-01

    Detection of microalbuminuria is important in the management of diabetic patients since it is predictive of development of proteinuria and nephropathy. Two sensitive and specific in-house ELISAs for microalbuminuria were established and validated. One of the ELISAs was based on antigen coating while the other employed antibody coating. Recovery and linearity experiments gave acceptable results of 100 +/- 10%, while precision results were <10% for intra-assay and <12% for inter-assay coefficients of variation (CVs). The standard curve ranged from 10-625 ug/l, equivalent to 0.2-12.5 mg/l for urine samples diluted 1:20 fold. When the antibody coated ELISA was compared to antigen coated ELISA, a correlation of r=0.996 was obtained. When compared to commercial kits, the in-house ELISAs gave good correlations of r=0.961 versus the Boehringer Mannheim Micral Test strips and r=0.940 versus Ames Microalb Turbidimetry. The normal microalbumin reference ranges determined for 12h, first morning and random urine samples were 0.7-5.3 mg, 0.1-10.2 mg/l and 0.8-26.1 mg/l respectively. The normal albumin excretion rate (AER) was 1.0-7.3 ug/min while untimed urine samples gave results of 0.1-0.9 and 0.2-1.6 mg/mmol after dividing by creatinine concentrations. The ELISAs were used to detect microalbuminuria in 338 random urine samples from diabetic patients. A high percentage 47.9% was found to be positive for microalbuminuria and 18.0% had macroalbuminuria >25 mg/mmol. Thus screening for microalbuminuria together with creatinine measurements using random urine samples can be used for management of diabetic patients. PMID:16329538

  7. Microalbuminuria and hypertension in pregnancy: role of aldosterone and inflammation.

    PubMed

    Armanini, Decio; Ambrosini, Guido; Sabbadin, Chiara; Donà, Gabriella; Clari, Giulio; Bordin, Luciana

    2013-09-01

    Women with a history of hypertension in pregnancy are at increased risk of microalbuminuria later in life. Microalbuminuria is a marker of kidney dysfunction frequently related to an inflammatory event. Pregnancy is a dynamic process characterized by immune tolerance, angiogenesis, and hormonal regulation. Menstruation and pregnancy are associated with a physiological inflammation, which is altered in preeclampsia and probably in other hypertensive situations of pregnancy. An imbalance between pro-oxidant factors and the ability to scavenge these factors produces oxidative stress, which has been evaluated in many cells, but leukocytes are the main source of inflammatory cytokines and experimental and clinical evidence support a possible role of aldosterone as a mediator of placental and renal damage mediated by growth factors, reactive oxygen species, and cytokines. Angiotensin-converting enzyme inhibitors and aldosterone receptor blockers are frequently effective in reducing the risk of progression of cardiovascular and renal disease. PMID:24034651

  8. Factors related to the presence of microalbuminuria in essential hypertension.

    PubMed

    Redon, J; Liao, Y; Lozano, J V; Miralles, A; Baldo, E; Cooper, R S

    1994-09-01

    The objective of the present study was to assess factors related to the presence of microalbuminuria in essential hypertension. Ninety-five patients with essential hypertension (58 males and 37 females, mean age 38.6 +/- 6.1 years) who had never been treated previously for hypertension were included in the study. Patients with nephropathy or diabetes mellitus, hyperglycemia > 120 mg/dL, glomerular filtration rate < 80 mL/min/1.73 m2, urinary tract infection, or positive dipstick for albumin or glucose were excluded. Blood pressure, echocardiographically determined left ventricular mass, serum biochemistry, and lipid profile were obtained. Twenty-four-hour urinary albumin excretion (UAE) was measured on two separate days using an immunonephelometric assay. Microalbuminuria (UAE 30 to 300 mg/24 h) occurred in 26% of patients and was associated with higher diastolic blood pressure (DBP), left ventricular mass index (LVMI), and a higher prevalence of hypertriglyceridemia and hyperapolipoproteinemia B (apo-B). Logistic regression analysis showed that the risk of microalbuminuria was independently related to diastolic blood pressure and hypertriglyceridemia when controlling for age, sex, body mass index, LVMI, and apo-B. Multiple regression analysis likewise confirmed that both DBP and LVMI were linearly related to UAE independent of age, sex, body mass index, total cholesterol, triglycerides, and apo-B. In conclusion, our study indicates that among hypertensive patients with elevated excretion rates of urinary albumin, even at the subclinical level, an increased cardiovascular risk exists compared to normoalbuminuric patients with a similar blood pressure. Assessment of the presence of microalbuminuria may be useful in the evaluation and management of hypertension. PMID:7811438

  9. Evaluation of microalbuminuria in obese children and its relation to metabolic syndrome.

    PubMed

    Sanad, Mohammed; Gharib, Amal

    2011-12-01

    Several epidemiologic studies have clearly demonstrated that obesity increases the risk of kidney diseases. We have attempted to evaluate the association of obesity with albuminuria, an early marker of kidney disease, among obese children and its relation to metabolic syndrome. This study included 150 obese children. Blood pressure, fasting blood glucose, plasma insulin and the lipid profile were assessed. The homeostasis model assessment of insulin resistance (HOMA-IR) was used to calculate in vivo insulin resistance. Urinary albumin and creatinine were estimated. Microalbuminuria was detected in 22 (14.7%) of the obese children. Waist circumference, blood pressure, triglyceride, low-density lipoprotein (LDL), insulin resistance and fasting blood glucose were significantly higher in obese children with microalbuminuria than in those with normoalbuminuria and showed significant positive correlations with microalbuminuria. High-density lipoprotein (HDL) was significantly lower in obese children with microalbuminuria than in those with normoalbuminuria, with a significant negative correlation with microalbuminuria. We found that body mass index, abdominal obesity, hypertension, impaired fasting glucose level and insulin resistance significantly increased the odds of microalbuminuria in the obese children enrolled in this study. Moreover, high triglyceride, high LDL and low HDL were significantly associated with microalbuminuria. In our patient group, childhood obesity was a risk factor for the development of microalbuminuria, which in turn was significantly associated with metabolic syndrome and its different constituents. PMID:21638155

  10. Microalbuminuria in untreated prehypertension and hypertension without diabetes

    PubMed Central

    Tenekecioglu, Erhan; Yilmaz, Mustafa; Yontar, Osman Can; Karaagac, Kemal; Agca, Fahriye Vatansever; Tutuncu, Ahmet; Kuzeytemiz, Mustafa; Bekler, Adem; Senturk, Muhammed; Aydin, Ufuk; Demir, Şerafettin

    2014-01-01

    Objective: Hypertension (HT) and prehypertension (preHT) were independent predictors of cardiovascular diseases. Urinary albumin leakage is a manifestation of generalized vascular damage. B-type natriuretic peptide (BNP) is a vasoactive peptide secreted by left ventricle in response to myocytic stretch. We aimed to investigate relationship between microalbuminuria (MA) and BNP in untreated elevated blood pressures. Methods: Of 105 untreated prehypertensive subjects (53 men, 52 women), 100 hypertensive subjects (51 men, 49 women) and 57 normotensive subjects (32 men, 25 women) none had history of diabetes. Urine albumin excretion was measured by immunoradiometric assay in morning urine sample. Results: The prevalence of MA was higher in hypertensive group than in prehypertensive group and in normotensive group (Hypertensive group; 33.9%, prehypertensive; 25.9%, normotensive; 10%). Subjects with HT had higher prevalence of microalbminuria; larger body mass index, higher levels of triglycerides, blood glucose and creatinin were more common in subjects with HT than in those with preHT. In hypertensive group; patients with microalbuminuria had higher systolic blood pressure (SBP), BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (β: 0.361; P < 0.001), LVMII (β: 0.267; P = 0.011) and BNP (β: 0.284; P = 0.005) were independent variables associated with MA in hypertensives. In prehypertensive group; patients with microalbuminuria had higher SBP, BNP, LVMI and lower eGFR as compared to those without MA. MA was significantly correlated with LVMI, BNP and SBP. In multivariate regression analysis, SBP (β: 0.264; P = 0.002), LVMI (β: 0.293; P = 0.001) and BNP (β: 0.168; P = 0.045) were associated with MA in prehypertensives. Conclusions: In preHT and HT, SBP, BNP and LVMI are associated with MA. In the evaluation of increased blood pressures, in case of increased BNP

  11. Prognostic value of microalbuminuria during antihypertensive treatment in essential hypertension.

    PubMed

    Pascual, Jose Maria; Rodilla, Enrique; Costa, Jose Antonio; Garcia-Escrich, Miguel; Gonzalez, Carmen; Redon, Josep

    2014-12-01

    Whether changes over time of urinary albumin excretion have prognostic value is a matter of discussion. The objective was to assess the prognostic value of changes in urinary albumin excretion over time in cardiovascular risk during antihypertensive treatment. Follow-up study of 2835 hypertensives in the absence of previous cardiovascular disease (mean age 55 years, 47% men, BP 138/80 mm Hg, 19.1% diabetics, and calibrated systemic coronary risk estimation 5 or >10.6%). Usual-care of antihypertensive treatment was implemented to maintain blood pressure<140/90 mm Hg. Urinary albumin excretion was assessed yearly, and the values were expressed as the creatinine ratio. Incidence of cardiovascular events, fatal and nonfatal, was recorded during the follow-up. During a median follow-up of 4.7 years (17 028 patients-year), 294 fatal and first nonfatal cardiovascular events were recorded (1.73 CVD per 100 patients/year). Independently of blood pressure, estimated glomerular filtration rate, level of cardiovascular risk, and antihypertensive treatment, microalbuminuria at baseline and at any time during the follow-up resulted in higher risk for events, hazard ratio (HR) 1.35 (95% confidence interval [CI], 1.08-1.79) and HR 1.49 (95% CI, 1.14-1.94), respectively. Likewise, development of microalbuminuria (HR 1.60; 95% CI, 1.04-2.46) or persistence from the beginning (1.53; 95% CI, 1.13-2.06) had a significantly higher rate of events than if remained normoalbuminuric (HR 1) or regress to normoalbuminuria (HR 1.37; 95% CI, 0.92-2.06) with an 18%, 18%, 8%, and 11% events, respectively, P<0.001. The study supports the value of urinary albumin excretion assessment as a prognostic factor for cardiovascular risk, but also opens the way to consider it as an intermediate objective in hypertension. PMID:25245391

  12. Low plasma concentrations of diet-derived antioxidants in association with microalbuminuria in Indigenous Australian populations.

    PubMed

    Rowley, Kevin; O'Dea, Kerin; Su, Qing; Jenkins, Alicia J; Best, James D

    2003-11-01

    Microalbuminuria is a risk factor for renal and cardiovascular diseases. Oxidant stress may contribute to vascular disease risk by promoting damage to renal and vascular tissues. This study examined the associations of plasma levels of diet-derived antioxidants with albuminuria in Australian population groups at high risk of renal and cardiovascular disease. Data on microalbuminuria and diet-derived plasma antioxidants were drawn from results of cross-sectional community-based risk factor surveys of Aboriginal and Torres Strait Islander peoples (n =698, 15 years and older). Prevalence of microalbuminuria ranged from 17-21%. After adjustment for age, gender, body mass index, diabetes, smoking status, plasma lipids and blood pressure, microalbuminuria was associated with significantly lower plasma concentrations of lycopene (-29%; P <0.001), beta-carotene (-22%; P <0.001), alpha-carotene (-22%; P <0.001) and cryptoxanthin (-17%; P <0.001) compared with normalbuminuric persons. Significant associations of microalbuminuria with plasma concentrations of alpha-tocopherol, retinol, lutein plus zeaxanthin and homocysteine were absent. The data are consistent with a protective effect of diets rich in carotenoids on vascular endothelium and/or renal tissues, and support the need for interventions to address affordable food supplies and dietary quality among Indigenous Australians. PMID:12826019

  13. Prevalence and Correlates of Microalbuminuria in Children with Sickle Cell Anaemia: Experience in a Tertiary Health Facility in Enugu, Nigeria

    PubMed Central

    Eke, Christopher Bismarck; Okafor, Henrietta Uche; Ibe, Bede Chidozie

    2012-01-01

    Microalbuminuria is a pre-clinical marker of renal damage in children with sickle cell anaemia and can predict renal failure. Reported prevalence rates increased with age. In Nigeria, burden of disease and prevailing poor health facilities necessitate its screening, determination of prevalence and associated risk factors. It is a cross-sectional as well as descriptive study. Screening microalbuminuria used subjects' early morning urine. Socio-demographic as well as clinical details were ascertained using semi-structured questionnaires and case files. Associations and statistical relationship of prevalence rates and clinical/epidemiological data were ascertained using chi-squared and multivariate analysis (P < 0.05). Two hundred children with sickle cell anaemia (4–17 years) in steady state and 200 age/gender-matched controls were enrolled. Prevalence of microalbuminuria was ,respectively, 18.5% and 2.5% for subjects and controls (P = 0.001). Microalbuminuria was commoner in females (19.8%) than males (17.4%) P = 0.70, increased with age (P = 0.016), significantly associated with haemoglobin level (P = 0.002) and hospitalizations (0.001). Subjects had normal renal function. Hospitalizations and haemoglobin levels showed statistical significance on multivariate analysis. Prevalence of microalbuminuria is 18.5%. Age, haemoglobin concentrations, and higher hospitalizations influenced microalbuminuria among subjects. Screening for microalbuminuria should be incorporated in the case management of subjects with identified risk factors. PMID:23056942

  14. Association between Microalbuminuria Predicting In-Stent Restenosis after Myocardial Infarction and Cellular Senescence of Endothelial Progenitor Cells

    PubMed Central

    Ota, Hisanobu; Takehara, Naofumi; Aonuma, Tatsuya; Kabara, Maki; Matsuki, Motoki; Yamauchi, Atsushi; Takeuchi, Toshiharu; Kawabe, Jun-ichi; Hasebe, Naoyuki

    2015-01-01

    Objective Relationship between microalbuminuria and worse outcome of coronary artery disease patients is discussed, but its underlying pathophysiological mechanism remains unclear. We investigated the role of microalbuminuria to the function of endothelial progenitor cells (EPCs), that might affect to outcome of acute myocardial infarction (AMI) patients. Methods Forty-five AMI patients were divided into two groups according to their urinary albumin excretion: normal (n = 24) and microalbuminuria (>30 mg/day, n = 21). At day-2 and day-7 after AMI onset, circulating-EPCs (CD34+Flk1+) were quantified by flow cytometry. The number of lectin-acLDL-positive cultured-EPCs immobilized on fibronectin was determined. To assess the cellular senescence of cultured-EPCs, the expression level of sirtuin-1 mRNA and the number of SA-β-gal positive cell were evaluated. Angiographic late in-stent loss after percutaneous coronary intervention (PCI) was evaluated at a six-month follow-up. Results No significant differences in coronary risk and the extent of myocardial damage were observed between the two groups. Late in-stent loss at the six-month follow-up was significantly higher in the microalbuminuria group (normal : microalbuminuria = 0.76±0.34 : 1.18±0.57 mm, p=0.021). The number of circulating-EPCs was significantly increased in microalbuminuria group at day-7, however, improved adhesion of EPCs was observed in normal group but not in microalbuminuria group from baseline to day-7 (+3.1±8.3 : -1.3±4.4 %: p<0.05). On the other hand, in microalbuminuria group at day-7, the level of sirtuin-1 mRNA expression of cultured-EPCs was significantly decreased (7.1±8.9 : 2.5±3.7 fold, p<0.05), which was based on the negative correlation between the level of sirtuin-1 mRNA expression and the extent of microalbuminuria. The ratio of SA-β-gal-positive cells in microalbuminuria group was increased compared to that of normal group. Conclusions Microalbuminuria in AMI patients is

  15. Urinary MicroRNA Profiling Predicts the Development of Microalbuminuria in Patients with Type 1 Diabetes

    PubMed Central

    Argyropoulos, Christos; Wang, Kai; Bernardo, Jose; Ellis, Demetrius; Orchard, Trevor; Galas, David; Johnson, John P.

    2015-01-01

    Microalbuminuria provides the earliest clinical marker of diabetic nephropathy among patients with Type 1 diabetes, yet it lacks sensitivity and specificity for early histological manifestations of disease. In recent years microRNAs have emerged as potential mediators in the pathogenesis of diabetes complications, suggesting a possible role in the diagnosis of early stage disease. We used quantiative polymerase chain reaction (qPCR) to evaluate the expression profile of 723 unique microRNAs in the normoalbuminuric urine of patients who did not develop nephropathy (n = 10) relative to patients who subsequently developed microalbuminuria (n = 17). Eighteen microRNAs were strongly associated with the subsequent development of microalbuminuria, while 15 microRNAs exhibited gender-related differences in expression. The predicted targets of these microRNAs map to biological pathways known to be involved in the pathogenesis and progression of diabetic renal disease. A microRNA signature (miR-105-3p, miR-1972, miR-28-3p, miR-30b-3p, miR-363-3p, miR-424-5p, miR-486-5p, miR-495, miR-548o-3p and for women miR-192-5p, miR-720) achieved high internal validity (cross-validated misclassification rate of 11.1%) for the future development of microalbuminuria in this dataset. Weighting microRNA measurements by their number of kidney-relevant targets improved the prognostic performance of the miRNA signature (cross-validated misclassification rate of 7.4%). Future studies are needed to corroborate these early observations in larger cohorts. PMID:26239688

  16. The Effect of Resting Heart Rate on the New Onset of Microalbuminuria in Patients With Type 2 Diabetes

    PubMed Central

    Schmieder, Roland E.; Bramlage, Peter; Haller, Hermann; Ruilope, Luis M.; Böhm, Michael

    2016-01-01

    Abstract The association between resting heart rate and new-onset microalbuminuria in patients with type 2 diabetes is not clear. The objective of the current analysis was to assess the relationship between heart rate and incidence of microalbuminuria in patients with type 2 diabetes. Data from the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study were retrospectively analyzed. New-onset microalbuminuria was documented and related to heart rate as recorded at baseline and last assessment, and the mean of the measurements taken during the double-blind part of the ROADMAP trial. Patients (n = 4299) had a mean age of 57.8 ± 8.7 years and 46.3% were male. Characteristics were not different between the olmesartan and the placebo groups, except for a higher systolic blood pressure (136.7 vs 135.7 mm Hg; P = 0.04) and albumin creatinine ratio (5.9 vs 5.5; P = 0.03). Increased risk of microalbuminuria was found with increasing heart rate, independent of whether baseline [highest vs lowest quartile odds ratio (OR) 1.39; 95% confidence interval (95% CI) 1.03–1.87; P = 0.032], last assessment (OR 1.71; 95% CI 1.26–2.31; P = 0.001), or mean heart rate was considered (OR: 1.77; 95% CI: 1.30–2.41; P = 0.0003). The greater risk of new-onset microalbuminuria with a high baseline heart rate was also found when data were adjusted for mean systolic blood pressure (OR: 1.35; 95% CI: 1.00–1.82; P = 0.0496; interaction P < 0.0001). Although there was no risk increase with baseline heart rate in the placebo group (P = 0.8253 for trend), microalbuminuria was less frequent in patients receiving olmesartan in the low heart rate quartiles (P = 0.002 for trend). A low heart rate reduces the risk of patients with type 2 diabetes developing microalbuminuria, independent of blood pressure. The data demonstrate potential benefits of reducing the heart rate of type 2 diabetes patients, and indicate that olmesartan

  17. Microalbuminuria as identified by a spot morning urine specimen in non-insulin-treated diabetes: an eight-year follow-up study.

    PubMed

    Beatty, O L; Ritchie, C M; Bell, P M; Hadden, D R; Kennedy, L; Atkinson, A B

    1995-03-01

    This study followed up a cohort of patients with microalbuminuria identified on a spot morning urine sample 8 years earlier and aimed to determine if a spot morning urinary albumin concentration was able to identify patients with non-insulin treated diabetes at increased risk of mortality and progression to nephropathy. In 1984, 47 of 216 patients chosen by random selection from our teaching hospital-based diabetes clinic were identified as having microalbuminuria (urinary albumin concentration 35-300 micrograms ml-1). Subjects were compared with an age-matched control group from the 1984 cohort who did not have microalbuminuria. Eight years later, 22 of 47 (46.8%) patients with microalbuminuria had died compared to 10 of 47 (21.3%) patients without albuminuria (p < 0.05). The majority of deaths were from cardiovascular disease (53.1%). Logistic regression showed microalbuminuria to be an independent predictor of mortality, not influenced by age, duration of diabetes, blood pressure, glycosylated haemoglobin or creatinine at the initial examination. Eight years later, in the group with initial microalbuminuria, eight still had microalbuminuria and five patients had developed nephropathy. In the group without albuminuria in 1984, only one patient had progressed to microalbuminuria and no patients to nephropathy. In conclusion, a spot urinary albumin concentration is of value in identifying patients with an increased risk of mortality or progression to nephropathy, and is simple to obtain at a clinic. PMID:7758264

  18. Early recognition of autonomic dysfunction in microalbuminuria: significance for cardiovascular mortality in diabetes mellitus?

    PubMed

    Mølgaard, H; Christensen, P D; Hermansen, K; Sørensen, K E; Christensen, C K; Mogensen, C E

    1994-08-01

    The appearance of microalbuminuria in diabetic patients predicts development of macroalbuminuria and coronary heart disease. Autonomic dysfunction in ischaemic heart disease is related to an increased incidence of arrhythmic deaths. To assess sympathovagal balance in relation to microalbuminuria we performed 24-h spectral analysis of RR interval oscillations in 37 insulin-dependent diabetic patients. Patients were divided according to urinary albumin excretion as normo-(< 20 micrograms/min) (n = 12), micro-(> 20 and < 200 micrograms/min) (n = 14) and macro-albuminuria (> 200 micrograms/min) (n = 11). None had symptoms or signs of ischaemic heart disease at clinical examination or during stress testing. Fourteen matched healthy subjects served as controls. Overall RR interval variability was calculated as the 24-h standard deviation. The square root of power of the low-frequency (0.04-0.15 Hz) and high-frequency (0.15-0.40 Hz) component were considered indices of the sympathovagal interaction and vagal function, respectively. Patients with micro and macroalbuminuria had, compared to control subjects, significantly reduced 24-h standard deviation, a much smaller day/night difference in mean RR level and a significantly reduced amplitude of the low frequency and high frequency oscillations, which were even more reduced in macroalbuminuria. The differences in vagal function were also present after correction for mean RR level, and differences in physical training level and smoking. Insulin-dependent diabetic patients who develop microalbuminuria have significantly impaired vagal function and abnormal sympathovagal interaction, which is further deranged in macroalbuminuria. This early autonomic dysfunction may later contribute to a increased risk for sudden cardiac death. PMID:7988781

  19. Reduction of microalbuminuria in type-2 diabetes mellitus with angiotensin-converting enzyme inhibitor alone and with cilnidipine

    PubMed Central

    Singh, V. K.; Mishra, A.; Gupta, K. K.; Misra, R.; Patel, M. L.; Shilpa

    2015-01-01

    The aim of our study was to find out the antiproteinuric effect of enalapril angiotensin-converting enzyme (ACE inhibitor) alone or in combination with cilnidipine in patients with type-2 diabetes mellitus. The study was conducted on 71 patients with type-2 diabetes mellitus patients with hypertension and microalbuminuria. They were divided into two groups randomly as follows: Group I (enalaprilalone, n = 36) and Group II (enalapril with cilnidipine, n = 35). In both the groups, baseline 24 h urinary albumin was estimated and was repeated every 3 months upto 1-year. After 1-year follow-up, reduction in microalbuminuria was found to be greater in Group II. In Group I microalbuminuria came down by 25.68 ± 21.40 while in Group II it reduced by 54.88 ± 13.84 (P < 0.001). We conclude that in diabetic population, cilnidipine has an additive effect in microalbuminuria reduction over and above the well-proven effect of ACE inhibitors. PMID:26664207

  20. Elevated urinary D-lactate levels in patients with diabetes and microalbuminuria.

    PubMed

    Chou, Chu-Kuang; Lee, Ya-Ting; Chen, Shih-Ming; Hsieh, Chi-Wen; Huang, Tzu-Chuan; Li, Yi-Chieh; Lee, Jen-Ai

    2015-12-10

    Diabetic nephropathy (DN) has become the major cause of end-stage renal disease. Early detection of disease risk, to enable intervention before advanced renal damage occurs, is an important goal. Microalbuminuria has been used to monitor renal damage in clinical settings for years. In this study, we divided patients with diabetes into different groups based on their microalbumin values to elucidate the relationship between urinary D-lactate and corresponding microalbumin values. Group DM1 comprised of patients with an albumin-to-creatinine ratio (ACR) of less than 30 μg albumin/mg creatinine (normal range); Group DM2 comprised of patients with an ACR of 30-299 μg albumin/mg creatinine (microalbuminuria); and Group DM3 comprised of patients with an ACR of ≥300 μg albumin/mg creatinine (macroalbuminuria). The urinary D-lactate concentration of patients with diabetes was determined by pre-column fluorescence derivatization with 4-nitro-7-piperazino-2,1,3-benzoxadiazole (NBD-PZ), and the accuracy (recovery) and precision (relative standard deviation; RSD) were validated. The measured values showed an accuracy that was in the acceptable range (91.59-112.96%), with an RSD in the range of 3.13-13.21%. The urinary D-lactate levels of the 3 diabetic groups (groups DM1, DM2, and DM3) were significantly higher than those of healthy subjects (78.31 ± 22.13, 92.47 ± 21.98, and 47.29 ± 17.51 vs. 6.28 ± 2.39 nmol/mg creatinine, respectively; p<0.05), with urinary D-lactate levels in the DM2 group being the highest. This modified fluorescence-based, high-performance liquid chromatography method to quantify D-lactate concentrations in the urine of patients with diabetes was established. Also, measuring the new risk marker identified in this study (D-lactate) in combination with microalbumin may facilitate the prevention of DN. PMID:26166004

  1. Screen-printed carbon electrode-based electrochemical immunosensor for rapid detection of microalbuminuria.

    PubMed

    Tsai, Jang-Zern; Chen, Ching-Jung; Settu, Kalpana; Lin, Yu-Feng; Chen, Chien-Lung; Liu, Jen-Tsai

    2016-03-15

    A urinary microalbumin test is used to detect early signs of kidney damage in people who have a risk of chronic kidney disease, such as those with diabetes or hypertension. In this study, we developed a screen-printed carbon electrode-based immunosensor for the detection of microalbumin in urine. Anti-human albumin antibodies were immobilized on the screen-printed sensor surface by the covalent immobilization method. Cyclic voltammetry (CV) and scanning electron microscopy with an energy dispersive spectroscopical (SEM-EDS) analysis demonstrated that the modification process was well performed. Chronoamperometric (CA) electrochemical measurement technique was employed for the quantitative detection of albumin. The electrochemical measurements performed with some possible interfering compounds normally present in urine (ascorbic acid, uric acid, glucose and creatinine samples) demonstrated a high specificity and selectivity of this immunosensor in albumin detection. Under optimum conditions, the immunosensor can detect urinary albumin in a wide linear range from 10 µg/ml to 300 µg/ml with a detection limit of 9.7 µg/ml. The excellent performance of this immunosensor was confirmed by analyzing microalbumin in urine samples; the results were in good agreement with those obtained by the standard immunoturbidimetric method. The biosensor proposed herein is easy to prepare and can be used for low-cost, rapid, and sensitive screening of microalbuminuria. This approach provides a promising platform for developing clinical point-of-care diagnostic applications. PMID:26579935

  2. Microalbuminuria is related to marked end organ damage in previously untreated, elderly hypertensive patients.

    PubMed

    Terpstra, W F; May, J F; Smit, A J; de Graeff, P A; Crijns, H J G M

    2002-01-01

    We wondered whether, in an elderly hypertensive population in a primary prevention setting, free from diabetes mellitus and clinical atherosclerosis, differences between end organ damage and microalbuminuria (MA) could be found using a lower level of urinary albumin excretion than that of classically defined MA. From a population survey of 173 previously untreated hypertensive patients (4x blood pressure systolic > or = 160 and < or = 220 mmHg, and/or diastolic > or = 95 and < or = 115 mmHg), mean age 67 +/- 4 years, were screened for MA (defined as albumin excretion between 20 and 300 mg/24 h). End organ damage was determined by B-mode ultrasound scanning of carotid and femoral arteries and echocardiography. Out of 173 hypertensives, 14 showed MA (8%). These hypertensives had a significantly higher intima media thickness (IMT; 1.01 +/- 0.21 vs 0.88 +/- 0.6 mm, p < 0.05) and increased left ventricular mass index (118 +/- 31 vs 103 +/- 22 g/m2, p < 0.05) than hypertensives without MA. Linear regression analysis showed that MA, age, male gender and diastolic blood pressure were independently related to IMT, while systolic blood pressure, male gender and body mass index were independently related to left ventricular mass. Even using lower levels of urinary albumin excretion rate, patients with MA had significantly higher IMT and increased left ventricular mass. Moreover, MA was independently related to IMT in these elderly hypertensives. These results suggest that the threshold value for MA should be reconsidered in hypertension. PMID:12035876

  3. Microalbuminuria in Obese Young and Middle Aged Population: A Potential Marker of Cardiovascular Risk.

    PubMed

    Purohit, Purvi; Garg, Kunal; Singh, Vikram; Dwivedi, Shailendra; Sharma, Praveen

    2016-07-01

    Microalbuminuria is an established cardiovascular risk indicator in diabetes, hypertension and the general population. There is lack of information on MAU in healthy obese Indian adults and an ongoing debate whether obese adults deserve targeted identification and clinical intervention for MAU and prediabetes. We aimed to screen the healthy obese, young (group I) and middle aged (group II) adults for prevalence of MAU and prediabetes and study its association with Framingham risk score. The study included 50 healthy obese young (20-30 years) and middle aged adults (31-50 years), attending the outpatient clinic of Dept. of Medicine for a duration of 2 months (July-August). The patients were screened for fasting blood sugar, lipid profile and MAU. Of the total patients 28 % had MAU, 32.14 % of which had prediabetes and 33.33 % had diabetes whereas 10 % were normoglycemic. The group I patients had 50 % cases of MAU and group II had 25 % patients with MAU. Group II 63.63 % pre-diabetics. The values of MAU obtained were correlated with age, gender, body mass index, systolic and diastolic blood pressure, FBS, waist to hip ratio using Pearson's Coefficient (p < 0.05). The 10 year CVD risk calculated using FRS in subjects with MAU was higher as compared to those without MAU. Thus we conclude that Indian, young and middle aged obese adults to be at a risk of prediabetes, MAU and CV risk warranting their routine screening for better clinical outcomes. PMID:27382209

  4. Microalbuminuria is a risk factor for cerebral small vessel disease in community-based elderly subjects.

    PubMed

    Wada, Manabu; Nagasawa, Hikaru; Kurita, Keiji; Koyama, Shingo; Arawaka, Shigeki; Kawanami, Toru; Tajima, Katsushi; Daimon, Makoto; Kato, Takeo

    2007-04-15

    Microalbuminuria (MA) is known as a marker for generalized vascular dysfunction. It occurs most commonly in the setting of diabetes and hypertension; however, its association with cerebral small vessel disease (SVD) in community-based elderly remains to be clarified. In this cross-sectional analysis, we evaluated the association between MA and cerebral SVD in total 651 community-based elderly subjects. We assessed cardiovascular risk factors by interviews and physical examinations, including an evaluation of urinary albumin creatinine ratio (UACR). All subjects underwent brain magnetic resonance imaging (MRI) and carotid ultrasonography. As endothelial markers, the serum levels of thrombomodulin (TM) and a tissue-type plasminogen activator/ plasminogen activator inhibitor-1 complex were also studied. The mean TM and UACR were higher in subjects with lacunar infarcts or with moderate white matter hyperintensities (mWMH) on MRI than in those without them. Additionally, the prevalence of lacunar infarcts or mWMH was higher in the highest tertile of UACR level than in the lowest or middle tertile. Furthermore, in logistic regression analysis, the elevation of logarithmically transformed UACR (log UACR) was associated with the higher likelihood for total lacunar infarcts (odds ratio [OR], 1.85 per one log UACR increase), multiple lacunar infarcts (OR, 1.89 per one log UACR increase), and mWMH (OR, 2.15 per one log UACR increase). The present study revealed that levels of urinary albumin are associated with cerebral SVD, independently of traditional cerebrovascular risk factors, in community-based elderly. PMID:17320908

  5. Presence of Cardiometabolic Risk Factors Is Not Associated with Microalbuminuria in 14-to-20-Years Old Slovak Adolescents: A Cross-Sectional, Population Study

    PubMed Central

    Gurecká, Radana; Koborová, Ivana; Šebek, Jozef; Šebeková, Katarína

    2015-01-01

    Introduction In adults, microalbuminuria indicates generalized endothelial dysfunction, and is an independent risk factor for cardiovascular and all cause mortality. Slovak adults present one of the highest cardiovascular mortality rates in Europe. Thus Slovak adolescents are on a high-risk to develop cardiovascular afflictions early, and screening for microalbuminuria might be useful in early assessment of their cardiovascular risk. We aimed to study the prevalence of microalbuminuria in Slovak adolescents, and the association of urinary albumin-to-creatinine ratio (ACR) to cardiovascular risk factors. Subjects and methods Anthropometric data, blood pressure, blood count, glucose homeostasis, lipid profile, renal function, inflammatory status, concentrations of homocysteine and uric acid were determined and associated with ACR in 2 666 adolescents (49.4% boys, 51.6% girls) aged 14-to-20 years. Microalbuminuria was classified as ACR 2.5–25.0 mg/mmol in boys and 3.5–35.0 mg/mmol in girls. Results Prevalence of microalbuminuria in both genders reached 3.3%, and did not differ significantly between lean and centrally obese subjects. Girls presented higher ACR than boys (normoalbuminuric: 0.6±0.5 mg/mmol vs. 0.5±0.4 mg/mmol, p>0.001; microalbuminuric: 9.3±7.3 mg/mmol vs. 5.0±3.8 mg/mmol; p>0.001). Microalbuminuric adolescents and those presenting normoalbuminuria within the upper ACR quartile were slimmer than their normoalbuminuric counterparts or adolescents with normoalbuminuria within the lower quartile, respectively. No association between microalbuminuria and cardiovascular risk markers was revealed. Conclusion Results obtained in this study do not support our assumption that ACR associates with cardiometabolic risk factors in apparently healthy adolescents. Follow-up studies until adulthood are needed to estimate the potential cardiometabolic risk of apparently healthy microalbuminuric adolescents. PMID:26046923

  6. All Components of Metabolic Syndrome Are Associated with Microalbuminuria in a Chinese Population

    PubMed Central

    Lee, Yi-Yen; Yang, Chih-Kai; Weng, Yi-Ming; Chuang, Chung-Hsun; Yu, Wei; Chen, Jih-Chang; Li, Wen-Cheng

    2016-01-01

    Background and Aim Albuminuria is a well-known predictor of poor renal and cardiovascular outcomes and associated with increased risk of all-cause mortality. The study aimed to evaluate the associations between metabolic characteristics and the presence of albuminuria. Methods This cross-sectional study included 18,384 adult Chinese who participated in health examinations during 2013–2014. Differences in clinical characteristics were compared for microalbuminuria (MAU) and albuminuria, and between genders. Potential risk factors associated with the risk of developing MAU and albuminuria were analyzed using univariate logistic regression. Multiple logistic regression was applied to further identify the independent associations between different levels of risk factors and the presence of MAU and albuminuria. The area under the ROC curve (AUC) was used to determine the discriminatory ability of metabolic risk factors in detecting albuminuria. Results There were significant gender differences in clinical characteristics according to albuminuria status. Risk for the presence of albuminuria was significantly associated with age, male gender, waist circumference (WC), waist-to-height ratio (WHtR), hypertension, fasting plasma glucose (FPG), and triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) in univariate logistic regression. Multiple logistic regression analysis indicated that the factors significantly associated with the presence of MAU were WC > 90cm, WHtR at 0.6–0.7, hypertension, FPG > 6.1 mmole/L, and TG/HDL-C ratio > 1.6. The optimal cutoffs for risk factors of metabolic syndrome (MetS) to predict albuminuria in males and females were: WC, 90.8 vs. 80.0 cm; WHtR, 0.53 vs. 0.52; MAP, 97.9 vs. 91.9 mmHg; FPG, 5.40 vs. 5.28 mmole/L; and TG/HDL-C, 1.13 vs. 1.08. Conclusion MetS and all its components were associated with the presence of MAU in a health check-up population in China. Gender specific and optimal cutoffs for MetS components

  7. La tasa de decaimiento del ciclo solar como indicador de actividad

    NASA Astrophysics Data System (ADS)

    Buccino, A. P.; Mauas, P. J. D.

    The length of the solar cycle has been linked to solar forcing of global climate. Usually, cycle length is defined as the time difference between consecutive sunspot minima. However, sunspot minima is determined both by the diminishing number of spots of the old cycle and by the increasing number of spots of the new one. Therefore, the date of the minimum depends on the properties of both cycles, and is generally ill defined. Furthermore, changes in solar activity should precede climatic changes. On the other hand, it has been suggested that the length of the cycle is related to changes in the Sun's convective energy transport, through the decay rate of individual sunspots. Here, using the concept of extended activity cycle, we define an activity index based on the decay rate of the cycle, and study its correlation with other indexes.

  8. Is there any effect of bolus and/or infusion 5-fluorouracil treatment on microalbuminuria in immediate or long term?

    PubMed

    Tanriverdi, Ozgur

    2014-07-01

    5-Fluorouracil is a widely used cytotoxic chemotherapeutic agent in the treatment settings particularly in patients with gastrointestinal cancer. Various studies on the cardiac adverse effects of 5-fluorouracil, reported the likelihood of altered myocardial contractility and vascular endothelial damage caused by this agent. However, the mechanism underlying 5-fluorouracil-related cardiotoxicity is not clear. In certain experimental studies, thrombotic processes occurring in microvascular field were supposed to play a role in this condition. In the light of this knowledge, the administration of 5-fluorouracil may be considered to cause renal vascular endothelial damage that may result in the altered endothelial permeability. As a result of endothelial dysfunction, increased urinary albumin excretion may be in question and no study investigating this potential direct relationship has been available in medical literature. Based on this evidence, the hypothesis of that 5-fluorouracil might cause renal vascular dysfunction and microalbuminuria, was discussed in this article along with the basic knowledge. PMID:24755457

  9. Correlation of Urine Biomarkers: Microalbuminuria and Spot Urine Protein among Diabetic Patients. Application of Spot Urine Protein in Diabetic Kidney Disease, Nephropathy, Proteinuria Estimation, Diagnosing and Monitoring.

    PubMed

    Aziz, Kamran M A

    2015-01-01

    Current study has invented a new method for utilizing spot urine protein among diabetic patients. There have been various efforts and strategies in research internationally to detect, diagnose and monitor nephropathy/DKD. Although 24-hour urine studies are gold standard, however, there exist some controversies about microalbuminuria and spot urine protein. The current study was designed to utilize spot urine protein among diabetic patients and to find its association with routine dipstick urine test for albumin, and microalbuminuria. The study demonstrated significant association of spot urine protein with urine dipstick albumin, and has demonstrated increasing spot urine protein with increasing albumin in urine (p-value < 0.0001). This study also demonstrated significantly higher levels of spot urine protein between the groups with nephropathy/DKD as compared to those without nephropathy/DKD (p-value < 0.0001). Similarly, spot urine protein and spot urine protein/creatinine were also significantly associated with microalbumin and microalbumin/creatinine in urine. Significant regression models for spot urine protein and microalbuminuria were also developed and proposed to detect and estimate microalbumin in urine while utilizing spot urine protein (< 0.0001). Synthesized regression equations and models can be used confidently to detect, rule out and monitor proteinuria and DKD. ROC curves were utilized to detect spot urine protein cutoff points for nephropathy and DKD with high specificity and sensitivity. Some important patents were also discussed in the paper regarding albuminuria/proteinuria detection and management. Current study has demonstrated and concluded, for the first time, that there exists a significant association of spot urine protein with routine dipstick albumin in urine and microalbuminuria. It is also essential to detect early, monitor and manage proteinuria, hypertension and dyslipidemia with good glycemic control to prevent diabetes

  10. Factors Associated With Serum Albumin in Diabetes Mellitus Type 2 With Microalbuminuria Using Non-Normal Mixed Models: A Prospective Cohort Study

    PubMed Central

    Khoundabi, Batoul; Kazemnejad, Anoshirvan; Mansourian, Marjan; Faghihimani, Elham

    2016-01-01

    Background: The globally increasing epidemic of diabetes will lead to serious problems including diabetic nephropathy and kidney diseases in near future. The first clinical diagnosable stage in a diabetic kidney disease is microalbuminuria (urinary albumin excretion of 30 - 300 g/24 hours). Objectives: This prospective cohort study investigated the risk factors of microalbuminuria in patients with type 2 diabetes who had been registered in endocrine and metabolism research center in Isfahan city, Iran. Patients and Methods: This prospective cohort study was performed on 90 diabetic type 2 patients with microalbuminuria, who were selected according to the consecutive sample selection method during 6 years. Data were collected through regular and systematic measurements of serum albumin as the response variable and body mass index, systolic and diastolic blood pressure, the duration of diabetes, glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride (TG), fasting blood sugar (FBS), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) as the related factors. Non-normal mixed models were used to investigate the impact of effective factors on the amount of excreted serum albumin. Results: According to the deviance information criterion (DIC = 56.2), the non-normal mixed effects model with the skewed t distribution had a best fit and indicated that HbA1c, HDL and total cholesterol had a significant effect on the amount of albumin in urine (P < 0.05). Conclusions: Using nonnormal mixed models may lead to the best results as compared to common normality assumption. PMID:26889385

  11. Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors

    PubMed Central

    Thiel, Gilbert T; Nolte, Christa; Tsinalis, Dimitrios; Steiger, Jürg; Bachmann, Lucas M

    2016-01-01

    Objectives To assess the role of nephrectomy as a risk factor for the development of hypertension and microalbuminuria. Design Prospective, long-term follow-up study. Setting Swiss Organ Living-Donor Health Registry. Participants All living kidney donors in Switzerland between 1993 and 2009. Interventions Data on health status and renal function before 1 year and biennially after donation were collected. Primary and secondary outcome measures Comparison of 1-year and 5-year occurrences of hypertension among normotensive donors with 1-year and 5-year estimates from the Framingham hypertension risk score. Multivariate random intercept models were used to investigate changes of albumin excretion after donation, correcting for repeated measurements and cofactors such as age, male gender and body mass index. Results A total of 1214 donors contributed 3918 data entries with a completed biennial follow-up rate of 74% during a 10-year period. Mean (SD) follow-up of donors was 31.6 months (34.4). Median age at donation was 50.5 years (IQR 42.2–58.8); 806 donors (66.4%) were women. Donation increased the risk of hypertension after 1 year by 3.64 (95% CI 3.52 to 3.76; p<0.001). Those participants remaining normotensive 1 year after donation return to a risk similar to that of the healthy Framingham population. Microalbuminuria before donation was dependent on donor age but not on the presence of hypertension. After nephrectomy, hypertension became the main driver for changes in albumin excretion (OR 1.19; 95% CI 0.13 to 2.25; p=0.03) and donor age had no effect. Conclusions Nephrectomy propagates hypertension and increases susceptibility for the development of hypertension-induced microalbuminuria. PMID:27006347

  12. Association of the PGC-1α rs8192678 variant with microalbuminuria in subjects with type 2 diabetes mellitus.

    PubMed

    Prior, Sarah L; Clark, Amy R; Jones, Danielle A; Bain, Steve C; Hurel, Steve J; Humphries, Steve E; Stephens, Jeffrey W

    2012-01-01

    PPAR-γ co-activator-1α (PGC-1α) is a tissue-specific transcriptional co-activator involved in the regulation of antioxidant enzymes. The A-allele of the rs8192678 PGC-1 α} (G>A) gene variant has previously been associated with nephropathy in Korean and Indian-Asian type 2 diabetes mellitus (T2DM) samples. Our aim was to examine the association between this variant and urine albumin exccretion in European subjects with T2DM. Genotyping was performed on 583 European subjects with T2DM and examined in relation to urinary albumin, plasma oxidized-LDL and small dense-LDL percentage. We observed a significant association between genotype (GG/GA/AA) and urinary albumin (normoalbuminuria v micro/macroalbuminuria: 48.6/39.7/11.7% v 38.2/51.2/10.5%, p=0.02; for GG v GA/AA, p=0.01). The odds ratio for micro/macroalbuminuria in GA and AA subjects relative to GG were 1.70 [1.15-2.50], p=0.008 and 1.20 [0.66-2.16], p=0.56 respectively (for GA/AA v GG: 1.58 [95% CI: 1.09-2.27], p=0.02). There was a significant association between the A allele and a higher percentage of small dense-LDL particles (GG v GA v AA: 70.8 [58.01-81.06] % v 72.8 [56.18-81.19] % v 78.9 [67.16-85.33] %, p=0.03). In European subjects with T2DM the GA relative to the GG genotype is associated with a 70% increase in the risk of micro/microalbuminuria. Furthermore, homozygosity for the A-allele is also associated with a preponderance of small dense-LDL particles. PMID:22684233

  13. Suggested mechanism for the selective excretion of glucosylated albumin. The effects of diabetes mellitus and aging on this process and the origins of diabetic microalbuminuria.

    PubMed

    Kowluru, A; Kowluru, R; Bitensky, M W; Corwin, E J; Solomon, S S; Johnson, J D

    1987-11-01

    In previous studies in the Sprague-Dawley rat, Williams and coworkers reported the phenomenon of selective urinary excretion of glucosylated albumin (editing, i.e., the percent glucosylation of urinary albumin is more than that of plasma albumin) by the mammalian kidney. Ghiggeri and coworkers subsequently found that the extent of editing is reduced in human diabetics. Moreover, the reduction in editing in diabetes correlates inversely with levels of microalbuminuria. We also find reduction in the extent of editing in diabetic humans. We find a striking inverse correlation not only with the magnitude of microalbuminuria but also with the extent of plasma albumin glucosylation. In contrast, we found little correlation between the reduction in editing and the duration of diabetes in human subjects. Stz induced diabetes in the Sprague-Dawley rat is associated with a striking and rapid reduction in editing which develops virtually with the same kinetics exhibited by the appearance of hyperglycemia. This loss of editing is rapidly reversed by daily administration of insulin but not by aldose reductase inhibitors. Mannitol infusion in anesthetized Wistar rats resulted in an increase in urine volume, GFR, and microalbuminuria, and was also accompanied by a marked reduction in editing. This reduction was rapidly reversed by a cessation of mannitol infusion. We propose here that glucosylated albumin (in contrast to unmodified albumin) is not reabsorbed by the proximal tubule, and thus, is preferentially excreted in the urine. We postulate that the increase in GFR which emerges as a consequence of increased plasma osmolality in diabetes mellitus delivers more albumin to the proximal tubule than can be reabsorbed. This results in a dilution of excreted glucosylated albumin molecules by excreted unmodified albumin, which appears as the early microscopic albuminuria of diabetes. Paradoxically, the fall in apparent editing is accompanied by an absolute increase in the total

  14. Microalbuminuria and sRAGE in High-Risk Hypertensive Patients Treated with Nifedipine/Telmisartan Combination Treatment: A Substudy of TALENT

    PubMed Central

    Falcone, Colomba; Buzzi, Maria Paola; Bozzini, Sara; Boiocchi, Chiara; D'Angelo, Angela; Schirinzi, Sandra; Esposito, Ciro; Torreggiani, Massimo; Choi, Jasmine; Ochan Kilama, Michael; Mancia, Giuseppe

    2012-01-01

    Some antihypertensive drugs have also renoprotective and anti-inflammatory properties that go beyond their effect on blood pressure. It has been suggested that microalbuminuria and glomerular filtration rate (GFR) are associated with circulating levels of the soluble form of the receptor, sRAGE (soluble receptor for advanced glycation ends-products). In the present analysis, we used data from the TALENT study to evaluate soluble receptor for advanced glycation end-products (sRAGE) plasma levels in patients with hypertension and high-cardiovascular risk-treated nifedipine and telmisartan in combination. Treatment with nifedipine-telmisartan significantly decreased mean systolic and diastolic ambulatory blood pressure and resulted in a significant increase in sRAGE plasma concentrations after 24 weeks of therapy. We concluded that in hypertensive patients with early-stage renal disease, sRAGE concentrations are not influenced by either microalbuminuria or GFR. Long-term treatment with a combination of nifedipine-telmisartan may have a beneficial effect increasing sRAGE plasma levels, thus exerting an atheroprotective and anti-inflammatory activity. PMID:22474401

  15. Association of the PGC-1α rs8192678 Variant with Microalbuminuria in Subjects with Type 2 Diabetes Mellitus

    PubMed Central

    Prior, Sarah L.; Clark, Amy R.; Jones, Danielle A.; Bain, Steve C.; Hurel, Steve J.; Humphries, Steve E.; Stephens, Jeffrey W.

    2012-01-01

    PPAR-γ co-activator-1α (PGC-1α) is a tissue-specific transcriptional co-activator involved in the regulation of antioxidant enzymes. The A-allele of the rs8192678 PGC-1 α} (G>A) gene variant has previously been associated with nephropathy in Korean and Indian-Asian type 2 diabetes mellitus (T2DM) samples. Our aim was to examine the association between this variant and urine albumin exccretion in European subjects with T2DM. Genotyping was performed on 583 European subjects with T2DM and examined in relation to urinary albumin, plasma oxidized-LDL and small dense-LDL percentage. We observed a significant association between genotype (GG/GA/AA) and urinary albumin (normoalbuminuria v micro/macroalbuminuria: 48.6/39.7/11.7% v 38.2/51.2/10.5%, p=0.02; for GG v GA/AA, p=0.01). The odds ratio for micro/macroalbuminuria in GA and AA subjects relative to GG were 1.70 [1.15–2.50], p=0.008 and 1.20 [0.66–2.16], p=0.56 respectively (for GA/AA v GG: 1.58 [95% CI: 1.09–2.27], p=0.02). There was a significant association between the A allele and a higher percentage of small dense-LDL particles (GG v GA v AA: 70.8 [58.01–81.06] % v 72.8 [56.18–81.19] % v 78.9 [67.16–85.33] %, p=0.03). In European subjects with T2DM the GA relative to the GG genotype is associated with a 70% increase in the risk of micro/microalbuminuria. Furthermore, homozygosity for the A-allele is also associated with a preponderance of small dense-LDL particles. PMID:22684233

  16. TUBERCULOSIS COMO ENFERMEDAD OCUPACIONAL

    PubMed Central

    Mendoza-Ticona, Alberto

    2014-01-01

    Existe evidencia suficiente para declarar a la tuberculosis como enfermedad ocupacional en diversos profesionales especialmente entre los trabajadores de salud. En el Perú están normados y reglamentados los derechos laborales inherentes a la tuberculosis como enfermedad ocupacional, como la cobertura por discapacidad temporal o permanente. Sin embargo, estos derechos aún no han sido suficientemente socializados. En este trabajo se presenta información sobre el riesgo de adquirir tuberculosis en el lugar de trabajo, se revisan las evidencias para declarar a la tuberculosis como enfermedad ocupacional en trabajadores de salud y se presenta la legislación peruana vigente al respecto. PMID:22858771

  17. A pilot study for evaluation of the efficacy and safety of telmisartan in reducing microalbuminuria in hypertensive patients with type 2 diabetes mellitus.

    PubMed

    Kulkarni, R B; Kulkarni, B N; Hariharan, R S; Naikwadi, Akram; Gawde, Ashish; Baliga, Vidyagauri; Desai, Anish

    2005-03-01

    To evaluate efficacy and tolerability of telmisartan, an angiotensim II receptor blocker, in reducing microalbuminuria in adult Indian hypertensive patients with type 2 diabetes mellitus, a prospective, open-label, non-comparative, assessor-blind, multicentric, pilot study was conducted in 60 eligible hypertensive patients with type 2 diabetes mellitus and microalbuminuria after obtaining their informed consent. The study was approved by the respective institutional review boards. Each patient received telmisartan 40 mg initially once daily for first 4 weeks which was titrated upwards to 80 mg once daily for the next 8 weeks. Blood pressure was assessed at the end of every 2 weeks and urinary albumin excretion and creatinine clearance were measured at baseline and after 12 weeks of therapy. Safety outcome measures included monitoring of physical examination, laboratory parameters and monitoring treatment-emergent adverse events. Fifty-five patients completed the study while 5 cases were lost to follow-up. The mean age of the patients was 48.27 years. Of the total patients 63.6% were males and 46.4% were females. At baseline the mean urinary albumin excretion rate was 131.81 +/- 38.82 mg/minute. A statistically significant (p < 0.05) reduction (32.96%) in urinary albumin excretion rate occurred after 12 weeks of therapy (118.36 +/- 37.22). The mean pre-study systolic blood pressure was 165.05 +/- 15.24 mmHg which was significantly (p < 0.05) reduced to 123.72 +/- 5.88 mmHg at the end of 12 weeks. At baseline the mean diastolic blood pressure was 103.55 +/- 9.84 mmHg which was significantly (p < 0.05) reduced to 84.71 +/- 8.54 mmHg. The JNC-VII goal of blood pressure below 130/80 was achieved in 34 (61.8%)of the 55 patients at the end of 12 weeks. Both fasting and postprandial blood sugar levels were well-controlled at the end of the study. Telmisartan was well tolerated with only 9.09% of the patients reported mild and transient adverse events like fatigue

  18. El doblete D del Sodio como indicador de la actividad cromosférica en estrellas de la secuencia principal

    NASA Astrophysics Data System (ADS)

    Díaz, R. F.; Mauas, P. J. D.

    We study the line profile of the sodium D doublet (5890 A and 5896 A) in dwarf stars with spectral type between M5.5 and F6. We find that the equivalent width of these lines shows a very good correlation with spectral type for stars later than K4. The flux absorbed in this region of the spectrum is then compared with the flux absorbed in the calcium H&K lines -a traditional activity indicator. For stars with (B-V)> 1.15 the correlation between absorbed fluxes is good and hence the sodium doublet is a good activity indicator. Since the doublet is found at longer wavelenghts than the calcium H & K lines, it is particularly useful for the study of chromospheric activity in late-type stars.

  19. Development of Diagnostic Fragment Ion Library for Glycated Peptides of Human Serum Albumin: Targeted Quantification in Prediabetic, Diabetic, and Microalbuminuria Plasma by Parallel Reaction Monitoring, SWATH, and MSE.

    PubMed

    Korwar, Arvind M; Vannuruswamy, Garikapati; Jagadeeshaprasad, Mashanipalya G; Jayaramaiah, Ramesha H; Bhat, Shweta; Regin, Bhaskaran S; Ramaswamy, Sureshkumar; Giri, Ashok P; Mohan, Viswanathan; Balasubramanyam, Muthuswamy; Kulkarni, Mahesh J

    2015-08-01

    Human serum albumin is one of the most abundant plasma proteins that readily undergoes glycation, thus glycated albumin has been suggested as an additional marker for monitoring glycemic status. Hitherto, only Amadori-modified peptides of albumin were quantified. In this study, we report the construction of fragment ion library for Amadori-modified lysine (AML), N(ε)-(carboxymethyl)lysine (CML)-, and N(ε)-(carboxyethyl)lysine (CEL)-modified peptides of the corresponding synthetically modified albumin using high resolution accurate mass spectrometry (HR/AM). The glycated peptides were manually inspected and validated for their modification. Further, the fragment ion library was used for quantification of glycated peptides of albumin in the context of diabetes. Targeted Sequential Window Acquisition of all THeoretical Mass Spectra (SWATH) analysis in pooled plasma samples of control, prediabetes, diabetes, and microalbuminuria, has led to identification and quantification of 13 glycated peptides comprised of four AML, seven CML, and two CEL modifications, representing nine lysine sites of albumin. Five lysine sites namely K549, K438, K490, K88, and K375, were observed to be highly sensitive for glycation modification as their respective m/z showed maximum fold change and had both AML and CML modifications. Thus, peptides involving these lysine sites could be potential novel markers to assess the degree of glycation in diabetes. PMID:26023067

  20. The effect of statins on microalbuminuria, proteinuria, progression of kidney function, and all-cause mortality in patients with non-end stage chronic kidney disease: A meta-analysis.

    PubMed

    Zhang, Zhenhong; Wu, Pingsheng; Zhang, Jiping; Wang, Shunyin; Zhang, Gengxin

    2016-03-01

    Conclusive evidence regarding the effect of statins on non-end stage chronic kidney disease (CKD) has not been reported previously. This meta-analysis evaluated the association between statins and microalbuminuria, proteinuria, progression, and all-cause mortality in patients with non-end stage CKD. Databases (e.g., PubMed, Embase and the Cochrane Library) were searched for randomized controlled trials (RCTs) with data on statins, microalbuminuria, proteinuria, renal health endpoints, and all-cause mortality patients with non-end stage CKD to perform this meta-analysis. The mean difference (MD) of the urine albumin excretion ratios (UAER), 24-h urine protein excretion, and risk ratios (RR) of all-cause mortality and renal health endpoints were calculated, and the results are presented with 95% confidence intervals (CI). A total of 23 RCTs with 39,419 participants were selected. The analysis demonstrated that statins statistically reduced UAER to 26.73μg/min [95%CI (-51.04, -2.43), Z=2.16, P<0.05], 24-h urine protein excretion to 682.68mg [95%CI (-886.72, -478.63), Z=6.56, P<0.01] and decreased all-cause mortality [RR=0.78, 95%CI (0.72, 0.84), Z=6.08, P<0.01]. However, the analysis results did not indicate that statins reduced the events of renal health endpoints [RR=0.96, 95%CI (0.91,1.01), Z=1.40, P>0.05]. In summary, our study indicates that statins statistically reduced microalbuminuria, proteinuria, and clinical deaths, but statins did not effectively slow the clinical progression of non-end stage CKD. PMID:26776964

  1. 12-Lipoxygenase Inhibition on Microalbuminuria in Type-1 and Type-2 Diabetes Is Associated with Changes of Glomerular Angiotensin II Type 1 Receptor Related to Insulin Resistance

    PubMed Central

    Xu, Hong-Zhao; Cheng, Yan-Li; Wang, Wan-Ning; Wu, Hao; Zhang, Yuan-Yuan; Zang, Chong-Sen; Xu, Zhong-Gao

    2016-01-01

    (1) Background: 12-lipoxygenase (12-LO) is involved in the development of diabetic nephropathy (DN). In the present study, we investigated whether 12-LO inhibition may ameliorate type-2 DN (T2DN) by interfering with insulin resistance (IR); (2) Methods: Rat glomerular mesangial cells, glomeruli and skeletal muscles were isolated and used in this study. Kidney histological changes were confirmed by periodic-acid Schiff staining; mRNA expression was detected by competitive reverse transcription polymerase chain reaction; and the protein level was determined by Western blot and the enzyme-linked immunosorbent assay, respectively; (3) Results: The inhibition of 12-LO attenuated microalbuminuria (MAU) increases in type-2 diabetic rats, but not in type-1 diabetic rats. Infusion of 12(S)-hydroxyeicosatetraenoic acid (12(S)-HETE) significantly increased the expression of angiotensin II (Ang II) and Ang II type 1 receptor (AT1R), but decreased the expression of AT1R-associated protein (ATRAP) in rat glomeruli, compared to the control. An in vitro study revealed that both 12(S)-HETE and insulin upregulated AT1R expression in rat mesangial cells. In the presence of p38 mitogen-activated protein kinase (MAPK) inhibitor, SB202190, the 12(S)-HETE-induced ATRAP reduction was significantly abolished. Interestingly, 12-LO inhibition did not influence AT1R expression in type-1 diabetic rats, but significantly abolished the increased AT1R and Ang II expression in glomeruli of type-2 diabetic rats. Furthermore, the inhibition of 12-LO significantly corrected impaired insulin sensitivity and fast serum insulin level, as well as the p-AMP-activated protein kinase (AMPK) reduction in skeletal muscle of type-2 diabetic rats; (4) Conclusion: The inhibition of 12-LO potentially ameliorated MAU by preventing IR through the downregulation of glomerular AT1R expression in T2DN. PMID:27164093

  2. Factors Associated With Microalbuminuria in 7,549 Children and Adolescents With Type 1 Diabetes in the T1D Exchange Clinic Registry

    PubMed Central

    Daniels, Mark; DuBose, Stephanie N.; Maahs, David M.; Beck, Roy W.; Fox, Larry A.; Gubitosi-Klug, Rose; Laffel, Lori M.; Miller, Kellee M.; Speer, Heather; Tamborlane, William V.; Tansey, Michael J.

    2013-01-01

    OBJECTIVE To examine factors associated with clinical microalbuminuria (MA) diagnosis in children and adolescents in the T1D Exchange clinic registry. RESEARCH DESIGN AND METHODS T1D Exchange participants <20 years of age with type 1 diabetes ≥1 year and urinary albumin-to-creatinine ratio (ACR) measured within the prior 2 years were included in the analysis. MA diagnosis required all of the following: 1) a clinical diagnosis of sustained MA or macroalbuminuria, 2) confirmation of MA diagnosis by either the most recent ACR being ≥30 mg/g or current treatment with an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB), and 3) no known cause for nephropathy other than diabetes. Logistic regression was used to assess factors associated with MA. RESULTS MA was present in 329 of 7,549 (4.4%) participants, with a higher frequency associated with longer diabetes duration, higher mean glycosylated hemoglobin (HbA1c) level, older age, female sex, higher diastolic blood pressure (BP), and lower BMI (P ≤ 0.01 for each in multivariate analysis). Older age was most strongly associated with MA among participants with HbA1c ≥9.5% (≥80 mmol/mol). MA was uncommon (<2%) among participants with HbA1c <7.5% (<58 mmol/mol). Of those with MA, only 36% were receiving ACEI/ARB treatment. CONCLUSIONS Our results emphasize the importance of good glycemic and BP control, particularly as diabetes duration increases, in order to reduce the risk of nephropathy. Since age and diabetes duration are important nonmodifiable factors associated with MA, the importance of routine screening is underscored to ensure early diagnosis and timely treatment of MA. PMID:23610082

  3. Comparison of the Antialbuminuric Effects of L-/N-type and L-type Calcium Channel Blockers in Hypertensive Patients with Diabetes and Microalbuminuria: The Study of Assessment for Kidney Function by Urinary Microalbumin in Randomized (SAKURA) Trial

    PubMed Central

    Ando, Katsuayuki; Ueshima, Kenji; Tanaka, Sachiko; Kosugi, Shinji; Sato, Tosiya; Matsuoka, Hiroaki; Nakao, Kazuwa; Fujita, Toshiro

    2013-01-01

    Objective: To clarify whether the L-/N-type calcium channel blocker (CCB) cilnidipine is more renoprotective than the L-type CCB amlodipine in patients with early-stage diabetic nephropathy. Methods: In this prospective, multicenter, open-labeled, randomized trial, the antialbuminuric effects of cilnidipine and amlodipine were examined in renin-angiotensin system (RAS) inhibitor-treated patients with hypertension (blood pressure [BP]: 130-180/80-110 mmHg), type 2 diabetes, and microalbuminuria (urinary albumin to creatinine [Cr] ratio [UACR]: 30-300 mg/g). Results: Patients received cilnidipine (n = 179, final dose: 10.27 ± 4.13 mg/day) or amlodipine (n = 186, 4.87 ± 2.08 mg/day) for 12 months. Cilnidipine and amlodipine equally decreased BP. The UACR values for the cilnidipine and amlodipine groups were 111.50 ± 138.97 and 88.29 ± 63.45 mg/g, respectively, before treatment and 107.93 ± 130.23 and 89.07 ± 97.55 mg/g, respectively, after treatment. The groups showed similar changes for the natural logarithm of the UACR, serum Cr, and estimated glomerular filtration rate. Conclusions: Cilnidipine did not offer greater renoprotection than amlodipine in RAS inhibitor-treated hypertensive patients with type 2 diabetes and microalbuminuria. PMID:23935398

  4. Estadísticas de visitas en portales web institucionales como indicador de respuesta del público a propuestas de divulgación

    NASA Astrophysics Data System (ADS)

    Lares, M.

    The presence of institutions on the internet is nowadays very important to strenghten communication channels, both internal and with the general public. The Córdoba Observatory has several web portals, including the official web page, a blog and presence on several social networks. These are one of the fundamental pillars for outreach activities, and serve as communication channel for events and scientific, academic, and outreach news. They are also a source of information for the staff, as well as data related to the Observatory internal organization and scientific production. Several statistical studies are presented, based on data taken from the visits to the official web pages. I comment on some aspects of the role of web pages as a source of consultation and as a quick response to information needs. FULL TEXT IN SPANISH

  5. Como Lo Hago Yo: Myelomeningocele

    PubMed Central

    Lazareff, Jorge

    2014-01-01

    Fortificación con ádico fólico es efectiva, pero aún falta conciencia en los jóvenes. La legalidad del aborto aumenta la importancia de la consulta prenatal. Realizo la cirugía bajo microcoscopio por razones didácticas. Irrigación continua para reducir la temperatura del tejido. Trato a la plaqueta como tejido viable. No suturo la plaqueta. No cierro músculo. ATB por una semana después de cirugía. Hidrocefalia: Válvula en todos los casos de ventriculomegalia. Médula anclada: Desanclar una sola vez. Chiari II: Revisar la válvula. Incluir en el seguimiento rendimiento escolar, puede indicar obstrucción de la válvula o médula anclada. PMID:24791217

  6. Increased plasma serotonin metabolite 5-hydroxyindole acetic acid concentrations are associated with impaired systolic and late diastolic forward flows during cardiac cycle and elevated resistive index at popliteal artery and renal insufficiency in type 2 diabetic patients with microalbuminuria.

    PubMed

    Saito, Jun; Suzuki, Eiji; Tajima, Yoshitaka; Takami, Kazuhisa; Horikawa, Yukio; Takeda, Jun

    2016-01-01

    Although lower extremity arterial disease is frequently accompanied by diabetes mellitus, the association of circulating biomarkers with flow components during the cardiac cycle in lower-leg arteries has yet to be fully elucidated. We enrolled 165 type 2 diabetic patients with normal ankle-brachial index (ABI 1.0-1.4), comprising 106 normoalbuminuric and 59 microalbuminuric patients, and 40 age-matched nondiabetic subjects consecutively admitted to our hospital. Serum high sensitivity C-reactive protein (hsCRP) level and plasma von Willebrand factor ristocetin cofactor activity (VWF) and vasoconstrictor serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) concentrations were measured. An automatic device was used to measure ABI and brachial-ankle pulse wave velocity (baPWV). Flow components during the cardiac cycle, total flow volume, and resistive index at popliteal artery were evaluated using gated magnetic resonance imaging. Although estimated glomerular filtration rate (eGFR), early diastolic flow reversal, heart rate, and ABI were similar between the groups, diabetic patients had higher log hsCRP (p<0.001), VWF (p<0.001), 5-HIAA (p=0.002), resistive index (p<0.001) and baPWV (p<0.001) and lower systolic (p=0.026) and late diastolic (p<0.001) forward flows and total flow volume (p<0.001) than nondiabetic subjects. Multivariate analyses demonstrated that 5-HIAA in microalbuminuric patients showed higher associations with systolic and late diastolic forward flows during the cardiac cycle, total flow volume and resistive index at popliteal artery, and eGFR compared to normoalbuminuric patients. In microalbuminuric patients, 5-HIAA was a significant independent determinant among these factors. Thus, increased plasma 5-HIAA levels are involved in the pathogenesis of impaired blood flow in lower extremities and renal insufficiency in diabetic patients with microalbuminuria. PMID:26567921

  7. Indicadores de actividad estelar

    NASA Astrophysics Data System (ADS)

    Cincunegui, C. C.; Mauas, P.

    There is a strong correlation between some solar activity indexes and average Earth temperature measurements. Thus, determining the range of variation of the solar constant over the years becomes very important. One way to do so, is to consider a large sample of stars with characteristics similar to those of the Sun, and analyze how the activity levels change from one star to another. With this technique one can infer activity variations that may occur over longer periods of time than the ones allowed by direct observations of the Sun. The main index used to measure stellar activity is the flux in the Ca II H and K lines, which are formed in the star's chromosphere. However, these lines are in the blue side of the spectrum, and are, therefore, not useful to study very cool stars, which are intrinsically faint and very red. In this work observations made at CASLEO are presented. Flux calibration of these lines was done in the usual way. We investigate possible correlations between the Ca II line fluxes and those of lines of longer wavelength, which may allow us to study the variability of stars cooler than the Sun.

  8. Como Lo Hago Yo: Mielomeningocele En Bolivia

    PubMed Central

    Dabdoub, Carlos F.; Dabdoub, Carlos B.; Villavicencio, Ramiro; Quevedo, Germán

    2014-01-01

    Introducción: Las malformaciones del tubo neural (MTN) representan la segunda causa más frecuente de anomalías congénitas, luego de las cardiopatías. En este grupo se destaca el mielomeningocele (MMC) por su mayor incidencia, y por ser la más incapacitante y la más compleja entre todas las demás malformaciones del sistema nervioso c`entral (SNC). En Bolivia, como en muchos países de Sudamérica, los bajos niveles socio-culturales y la debilidad en el sistema sanitario, hacen que su incidencia y su morbilidad, sean mayores que en las naciones más desarrolladas. Material y Métodos: Se realizó un estudio retrospectivo y descriptivo de 70 casos de MMC, atendidos por un equipo multidisciplinario en el Hospital Universitario Japonés (HUJ) de Santa Cruz de la Sierra, entre 2008-2011. De ellos, 60 fueron intervenidos quirúrgicamente. Resultados: Se realizaron controles prenatales sólo en 27 mujeres (38.6%), diagnosticándose una disrafia espinal en apenas dos casos (7.4%). La edad de ingreso del MMC en su mayoría fue después de las 24 horas (65.6%), predominando su localización en la región lumbosacra (64.3%). De ellos, 67.2% eran abiertos, presentando un 32.9% un daño neurológico motor parcial mientras que 47.1% tenían paraplejia por debajo de la lesión. De los 70 casos, tres (4.3%) no fueron intervenidos, por presentar defectos congénitos severos o estado general grave. Las principales complicaciones posoperatorias inmediatas fueron: dehiscencia de sutura y/o infección de la herida (16.6%), fístula de líquido cefalorraquídeo (LCR) (10%) e infección del SNC (11.7%). La mortalidad general y postoperatoria fue de 7.1% y 3.3%, respectivamente. Al mes de vida presentaban hidrocefalia un 80% de los pacientes operados, colocándose una derivación ventriculoperitoneal (DVP) de presión media. De 9 pacientes que tuvieron un acompanamiento de dos o más años, seis presentaron una médula anclada, que fueron intervenidas quirúrgicamente. Conclusi

  9. 15. Como gatehouse (outlet tower) and access bridge, looking west ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. Como gatehouse (outlet tower) and access bridge, looking west from dam crest (Trash rack visible in reservoir pool behind and right of tower) - Bitter Root Irrigation Project, Como Dam, West of U.S. Highway 93, Darby, Ravalli County, MT

  10. Harold Varmus investido bajo juramento como 14.º director d

    Cancer.gov

    Ganador del Premio Nobel, doctor Harold E. Varmus, prestó juramento hoy como 14.º director del Instituto Nacional del Cáncer (NCI).  "Es muy estimulante que estés de regreso con nosotros", dijo la secretaria del Departamento de Salud y Servicios Humanos K

  11. LA BIOÉTICA COMO QUEHACER FILOSÓFICO

    PubMed Central

    Ferrer, Jorge José

    2009-01-01

    El artículo examina el estatuto epistemológico de la bioética como disciplina académica. El autor sostiene que el estatuto epistemológico de un discurso lo determina la pregunta fundamental que se plantea y la respuesta que se busca, focos integradores del discurso. En el caso de la bioética, la pregunta fundamental es de índole moral. La bioética es pues una disciplina ética que tiene su hogar epistemológico en la filosofía. El autor también defiende el concepto de “éticas aplicadas”. Sugiere finalmente que el método de la bioética, sobre todo la que se hace desde nuestras latitudes, debería adoptar el círculo hermenéutico como metodología para su filosofar. PMID:20463860

  12. Recent DDT and PCB contamination in the sediment and biota of the Como Bay (Lake Como, Italy).

    PubMed

    Bettinetti, R; Quadroni, S; Boggio, E; Galassi, S

    2016-01-15

    Due to its peculiar geographical and morphological characteristics, Lake Como (Northern Italy) represents an interesting study-case for investigating the sub-basin scale circulation of persistent organic pollutants (POPs) that, despite being banned since the 1970s, have reached surprisingly high concentrations in some southern alpine lakes as a consequence of their release from melting glaciers in recent years. In particular, the Como Bay, which is located in the city of Como, seems noteworthy because its waters have a longer residence time than the other areas of the lake. The analyses of the historical concentration of PCBs, pp′DDT and its metabolites in a sediment core sampled from the Como Bay covering a time-period from their ban to recent times, showed that the DDTs have never experienced a significant (p < 0.05) decrease over time, with concentrations of the most abundant homologue, pp′DDE, ranging from 27 to 75 ng g(-1) d.w. Conversely PCBs significantly (p < 0.05) decreased towards recent times, reaching concentrations around 80 ng g(-1) d.w. The contribution of high altitude and local sources was recorded also in the food web: both zooplankton and the zooplanktivorous fish agone were mainly contaminated by pp′DDE (81.4 ng g(-1) w.w. and 534.6 ng g(-1) w.w. respectively) and by the PCB metabolite hexa-CB (449.7 ng g(-1) w.w. and 1672.1 ng g(-1) w.w. respectively). The DDT concentrations in the agone (sampled during the years 2006–2009) never exceeded the limits for human consumption in Italy, while concentrations of six selected PCBs exceeded human health advisory recommendations in one of the fish samples analysed, when it was approximately two times higher than the recommended value of 125 ng g(-1) w.w. PMID:26520265

  13. Valorisation of Como Historical Cadastral Maps Through Modern Web Geoservices

    NASA Astrophysics Data System (ADS)

    Brovelli, M. A.; Minghini, M.; Zamboni, G.

    2012-07-01

    Cartographic cultural heritage preserved in worldwide archives is often stored in the original paper version only, thus restricting both the chances of utilization and the range of possible users. The Web C.A.R.T.E. system addressed this issue with regard to the precious cadastral maps preserved at the State Archive of Como. Aim of the project was to improve the visibility and accessibility of this heritage using the latest free and open source tools for processing, cataloguing and web publishing the maps. The resulting architecture should therefore assist the State Archive of Como in managing its cartographic contents. After a pre-processing consisting of digitization and georeferencing steps, maps were provided with metadata, compiled according to the current Italian standards and managed through an ad hoc version of the GeoNetwork Opensource geocatalog software. A dedicated MapFish-based webGIS client, with an optimized version also for mobile platforms, was built for maps publication and 2D navigation. A module for 3D visualization of cadastral maps was finally developed using the NASA World Wind Virtual Globe. Thanks to a temporal slidebar, time was also included in the system producing a 4D Graphical User Interface. The overall architecture was totally built with free and open source software and allows a direct and intuitive consultation of historical maps. Besides the notable advantage of keeping original paper maps intact, the system greatly simplifies the work of the State Archive of Como common users and together widens the same range of users thanks to the modernization of map consultation tools.

  14. 78 FR 36163 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-17

    ... FHP covers approximately 5,640 acres of national forest land between Lake Como and Lost Horse Roads... project area lies between Lake Como Road and Lost Horse Road, about three miles northwest of...

  15. Morphological investigation of nanostructured CoMo catalysts

    NASA Astrophysics Data System (ADS)

    Pawelec, B.; Castaño, P.; Zepeda, T. A.

    2008-04-01

    This work reports the morphological investigation of nanostructured sulfided CoMo catalysts by means of high-resolution transmission electron microscopy (HRTEM). The catalysts were supported on Ti-modified hexagonal mesoporous silica (HMS-Ti) and P-modified HMS-Ti (P/HMS-Ti) materials. The oxide precursors were characterized by specific surface area (S BET), temperature-programmed reduction (TPR), diffuse reflectance infrared Fourier transform spectroscopy in the OH region (DRIFTS-OH) and X-ray photoelectron spectroscopy (XPS) in order to elucidate the influence of the impregnation sequence (successive vs. simultaneous) and the effect of P-incorporation into HMS-Ti material on the morphology of calcined CoMo catalysts. Both TPR and XPS measurements indicate that the catalysts prepared by successive impregnation possess well-dispersed MoO 3 and CoO phases, whereas their counterparts prepared by simultaneous impregnation additionally possess the CoMoO 4 phase. For all sulfided catalysts, the presence of MoS 2 phase with particle size in the range 3.3-4.4 nm was confirmed by HRTEM. Catalytic activity was evaluated in the reaction of hydrodesulfurization (HDS) of dibenzothiophene (DBT) carried out in a flow reactor at 593 K and hydrogen pressure of 5.5 MPa. P-incorporation into the HMS-Ti material led to an overall increase in HDS activity and the hydrogenation ability of the sulfided catalysts. All catalysts proved to be stable during 10 h time-on-stream (TOS) operation. The activity of sulfide catalysts in the target reaction depends linearly on the surface exposure of Co species in the oxide precursors, as determined by XPS, and on the morphology of the sulfide form of catalysts (surface density of MoS 2 particles and their sizes) as determined by HRTEM.

  16. 78 FR 38287 - Bitterroot National Forest, Darby Ranger District, Como Forest Health Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-26

    .... Correction In the Federal Register of June 17, 2013, in FR DOC 2013- 14229 on page 36163 in the second column...,640 acres of national forest between Lake Como and Lost Horse roads, about 6 miles northwest of...

  17. Como preparar un programa de informacion sobre la asistencia economica (Planning a Financial Aid Awareness Program).

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    This booklet, written in Spanish, is intended to be used with a set of slides as part of a presentation to students on "How To Apply for Federal Student Aid" ("Como Solicitar la Asistencia Economica Federal para Estudiantes"). The first part of the book is a script based on the slides. After the script is a guide to hosting a financial aid…

  18. Prevalence of previously undiagnosed abdominal aortic aneurysms in the area of Como: the ComoCuore "looking for AAA" ultrasonography screening.

    PubMed

    Corrado, Giovanni; Durante, Alessandro; Genchi, Vincenzo; Trabattoni, Loris; Beretta, Sandro; Rovelli, Enza; Foglia-Manzillo, Giovanni; Ferrari, Giovanni

    2016-08-01

    The prognosis for abdominal aortic aneurysm (AAA) rupture is poor. Long-term follow-up of population-based randomized trials has demonstrated that ultrasound (US) screening for abdominal aortic aneurysms (AAAs) measuring 3 cm or greater decreases AAA-related mortality rates and is cost-effective. We though to prospectively perform during a 26-month period a limited US examination of the infrarenal aorta in volunteers of both gender aged 60-85 years without history of AAA living in the area of Como, Italy. From September 2010 to November 2013 ComoCuore, a no-profit nongovernmental association, enrolled 1555 people (aged 68.8 ± 6.8 years; 48.6 % males). Clinical data and a US imaging of the aorta were collected for each participant. AAA was found in 22 volunteers (1.4 %) mainly males (2.5 % in males vs. 0.4 % in females p = 0.005). Overall, the prevalence of cardiovascular risk factors was higher in patients with vs. without AAA (mean 2.9 ± 3.0 vs. 1.4 ± 1.0 respectively, p < 0.0001). Independent predictors of AAA on multivariate analysis were age (OR 1.14, 1.06-1.22; p < 0.0001), male gender (OR 8.23, 1.79-37.91; p = 0.007), and both current (OR 4.98, 1.57-15.79; p = 0.007) and previous smoking (OR 2.76, 1.12-8.94; p = 0.03). Our study confirms the feasibility of one time US screening for AAA in a large cohort of asymptomatic people. Independent predictors of AAA were male sex, older age and a history of smoking. Accordingly to recent data the prevalence of AAA seems to be declining, maybe due to a reduction of smoking in Italy. PMID:27215751

  19. The Sefwi-Comoé belt Ghana/Ivory Coast : a major crustal shear zone ?

    NASA Astrophysics Data System (ADS)

    Jessell, Mark

    2010-05-01

    The Palaeoproterozoic Sefwi-Comoé region that straddles Ghana and the Ivory Coast in West Africa has been characterised as resulting from a combination of compression and simple shear during late synkinematic leucogranite intrusion. The analysis of regional geophysical datasets allows us to better define the geometry of the major lithostratigraphic packages and their structural contacts in this region. This analysis reveals a series of well defined leucogranites intrusions enveloped by high strain zones. Recent finite element modelling of two-phase aggregates has shown that we can analyse the geometry of these systems both in terms of their finite defomation and their mechanical contrast. We interpret the geometries we see in the Sefwi-Comoé region as reflecting the activity of a major crustal deformation zone which was dominated by simple shear. The comparison with the modelling suggests a finite shear strain of approximately 5 gamma, which in turn implies a lateral displacement of 400 km across the belt. Our analysis suggests that the leucogranites were already acting as more rigid bodies during the (dextral?) shearing, suggesting that their emplacement was predominantly pre-kinematic, and which has implications for their potential subsequent remobilization by gravitational forces.

  20. Role of altered insulin signaling pathways in the pathogenesis of podocyte malfunction and microalbuminuria

    PubMed Central

    Jauregui, Alexandra; Mintz, Daniel H; Mundel, Peter; Fornoni, Alessia

    2010-01-01

    Purpose of review In diabetic nephropathy (DN), insulin resistance and hyperinsulinemia correlate with the development of albuminuria. The possibility that altered insulin signaling in glomerular cells and particularly podocytes contributes to the development of DN will be discussed. Recent findings While normal podocytes uptake glucose in response to insulin, diabetic podocytes become insulin resistant in experimental DN prior to the development of significant albuminuria. Both clinical and experimental data suggest that insulin sensitizers may be renoprotective independently of their systemic effects on the metabolic control of diabetes. Summary We will review the clinical and experimental evidence that altered insulin signaling correlates with the development of DN in both type 1 and type 2 diabetes, and that insulin sensitizers may be superior to other hypoglycemic agents in the prevention of DN. We will then review potential mechanisms by which altered podocyte insulin signaling may contribute to the development of DN. Understanding the role of podocyte in glucose metabolism is important because it may lead to the discovery of novel pathogenetic mechanisms of DN, it may affect current strategies for prevention and treatment of DN, and it may allow for the identification of novel therapeutic targets. PMID:19724224

  1. Vulnerability and adaptation to climate change in the Comoe River Basin (West Africa).

    PubMed

    Yéo, Wonnan Eugène; Goula, Bi Tié Albert; Diekkrüger, Bernd; Afouda, Abel

    2016-01-01

    Climate change is impacting water users in many sectors: water supply, farming, industry, hydropower, fishing, housing, navigation and health. Existing situations, like population growth, movement of populations from rural to urban areas, poverty and pollution can aggravate the impacts of climate change. The aim of the study is to evaluate the vulnerability of different water user groups to climate change and define communities' adaptation strategies in the Comoe River Basin. Information was collected on communities' concerns and perception on changes in climate and potential adaptation measures and strategies. Results show that 95 % of the sample in the study communities had heard of it and are aware that climate change is occurring. They have been experiencing changes in economic activity and cropping pattern, reduced water level in rivers, crop failure, delay in cropping season, new pests and diseases, food insecurity, drop in income and decline in crop yield. Results also show that communities employ various adaptation strategies including crops diversification, substitution and calendar redefinition, agroforestry, borrowing from friends and money lenders and increasing fertilizer application. PMID:27386296

  2. Catalytic functionalities of supported sulfides. I. Effect of support and additives on the CoMo catalyst

    SciTech Connect

    Muralidhar, G.; Massoth, F.E.; Shabtai, J.

    1984-01-01

    C-S hydrogenolysis (HDS) of thiophene, hydrogenation (HYD) of 1-hexene, and hydrocracking (HCG) of 2,4,4-trimethyl-1-pentene, were used as separate model test reactions to differentiate and assess the catalytic functionalities of sulfided CoMo catalysts, and their dependence on the nature of the support and incorporation of additives. Rate constants and relative catalyst activities for these three reaction types were determined. HDS and HYD activities of CoMo supported on different types of Al/sub 2/O/sub 3/ were higher, while the HCG activity was lower compared with CoMo supported on SiO/sub 2/-Al/sub 2/O/sub 3/, SiO/sub 2/-MgO, or TiO/sub 2/. For SiO/sub 2/-Al/sub 2/O/sub 3/ supports both HDS and HYD activities decreased with increase in SiO/sub 2/ content from 10 to 75%, while HCG activity showed the opposite trend. Additives to a finished CoMo catalyst at 0.5% level caused variations in HDS and HCG activities, while HYD was essentially unaffected. HDS was promoted by NH/sub 4/HF/sub 2/ and NH/sub 4/Cl, but depressed by NaNO/sub 3/, Ca(NO/sub 3/)/sub 2/, and H/sub 3/BO/sub 3/. HCG was promoted by NH/sub 4/HF/sub 2/, NH/sub 4/Cl, and H/sub 3/BO/sub 3/. Additives at 5% level, prior to or after CoMo impregnation, showed a strong depressing effect on HDS and a lesser effect on HYD, while HCG was strongly promoted by NH/sub 4/HF/sub 2/, Ti isopropoxide, and H/sub 3/BO/sub 3/. The changes in catalytic functionalities are rationalized in terms of different interactions between CoMo phase, support, and additives. 3 tables, 1 figure.

  3. DIABETES MELLITUS COMO FACTOR DE RIESGO DE DEMENCIA EN LA POBLACIÓN ADULTA MAYOR MEXICANA

    PubMed Central

    Silvia, Mejía-Arango; Clemente, y Zúñiga-Gil

    2012-01-01

    Introduccion La diabetes mellitus y las demencias constituyen dos problemas crecientes de salud entre la población adulta mayor del mundo y en particular de los paises en desarrollo. Hacen falta estudios longitudinales sobre el papel de la diabetes como factor de riesgo para demencia. Objetivo Determinar el riesgo de demencia en sujetos Mexicanos con diabetes mellitus tipo 2. Materiales y Metodos Los sujetos diabéticos libres de demencia pertenecientes al Estudio Nacional de Salud y Envejecimiento en México fueron evaluados a los dos años de la línea de base. Se estudió el papel de los factores sociodemográficos, de otras comorbilidades y del tipo de tratamiento en la conversión a demencia. Resultados Durante la línea de base 749 sujetos (13.8%) tuvieron diabetes. El riesgo de desarrollar demencia en estos individuos fue el doble (RR, 2.08 IC 95%, 1.59–2.73). Se encontró un riesgo mayor en individuos de 80 años y más (RR 2.44 IC 95%, 1.46–4.08), en los hombres (RR, 2.25 IC 95%, 1.46–3.49) y en sujetos con nivel educativo menor de 7 años. El estar bajo tratamiento con insulina incrementó el riesgo de demencia (RR, 2.83, IC 95%, 1.58–5.06). Las otras comorbilidades que aumentaron el riesgo de demencia en los pacientes diabéticos fueron la hipertensión (RR, 2.75, IC 95%, 1.86–4.06) y la depresión (RR, 3.78, 95% IC 2.37–6.04). Conclusión Los sujetos con diabetes mellitus tienen un riesgo mayor de desarrollar demencia, La baja escolaridad y otras comorbilidades altamente prevalentes en la población Mexicana contribuyen a la asociación diabetes-demencia. PMID:21948010

  4. Hydrotreatment of Athabasca bitumen derived gas oil over Ni-Mo, Ni-W, and Co-Mo catalysts

    SciTech Connect

    Diaz-Real, R.A.; Mann, R.S.; Sambi, I.S. . Dept. of Chemical Engineering)

    1993-07-01

    The hydrotreatment of Athabasca bitumen derived heavy gas oil containing 4.08% S and 0.49% N was carried out in a trickle bed reactor over Ni-W, Ni-Mo, and Co-Mo catalysts supported on zeolite-alumina-silica at 623-698 K, LHSV of 1-4, gas flow rate 890 m[sup 3][sub H2]/m[sup 3][sub oil] (5,000 sef/bbl), and pressure of 6.89 MPa. Analyses for viscosity, density, aniline point, ASTM mid boiling point distillation, C/H ratio, and percentage of N and S in the final product were carried out to characterize the product oil. The amounts of N and S removed indicated the hydrodenitrogenation and hydrodesulfurization activity of the catalysts. Results of zeolite-alumina-silica-supported catalysts are compared to those obtained with commercially available Ni-Mo, Ni-W, and Co-Mo on [gamma]-alumina. Ni-Mo supported on zeolite-alumina-silica was most active and could remove as much as 99 % S and 89% N present in the oil at 698 K. The data for HDN and HDS fitted the pseudo first order model. The kinetic model is described in detail.

  5. Ab initio study of energetics and magnetism of sigma phase in Co-Mo and Fe-Mo systems

    NASA Astrophysics Data System (ADS)

    Pavlů, J.; Vřešťál, J.; Šob, M.

    2016-02-01

    We analyse, from first-principles, the energetics and magnetic ordering of sigma phases in Co-Mo and Fe-Mo systems. Total energy differences between the sigma phase and Standard Element Reference (SER) structures are calculated in the whole concentration range at equilibrium volumes by means of the linear muffin-tin orbitals method in the atomic-sphere approximation (LMTO-ASA), the full-potential linearised augmented-plane waves (FLAPW) method and the pseudopotential approach. They are compared with the enthalpy of formation of sigma phase obtained from the phase equilibria calculations at higher temperature based on the semiempirical CALPHAD (CALculation of PHAse Diagram) method. It turns out that the binary sigma phases are more stable than the weighted average of the sigma phase of elemental constituents and that this stability for Fe-Mo is higher than for Co-Mo. On the other hand it was found that the binary sigma phases do not exhibit any stability with respect to the weighted average of the SER structures. The magnetic configurations in all systems are investigated and the stabilizing effect of magnetic order in sigma phase at 0 K is presented. It turns out that the atomic magnetic moment strongly depends on the type of occupied sublattice and total composition of the alloy.

  6. Alejarse como proceso social: niños y ancianos «abandonados» en Ayacucho1

    PubMed Central

    Leinaweaver, Jessaca

    2013-01-01

    En investigaciones previas sobre el acogimiento familiar y la adopción en Ayacucho, se ha podido descubrir cómo los ayacuchanos adquieren y producen relaciones sociales. Mientras negocian creativamente los discursos y espacios construidos simultáneamente por instituciones, comunidades, y estructuras sociales, van adquiriendo nuevas formas de relacionarse. Este artículo discute el proceso opuesto: el deshacerse de relaciones de parentesco, y el proceso social del abandono o alejamiento. Cuando se aleja a una persona de su familia o su comunidad, los que se quedan en ella llegan a entenderse como ciertos tipos de personas. En los estudios de caso discutidos aquí, recopilados a través de una detallada y cuidadosa observación participante y de entrevistas etnográficas grabadas entre 2001 y 2007, se puede ver cómo, después de un alejamiento social, los individuos que alejan se reinterpretan como sujetos que se encuentran superándose o volviéndose modernos, o bien sacrificándose. PMID:25177044

  7. The stucco decorations from St. Lorenzo in Laino (Como, Italy): The materials and the techniques employed by the "Magistri Comacini".

    PubMed

    Rampazzi, Laura; Rizzo, Biagio; Colombo, Chiara; Conti, Claudia; Realini, Marco; Bartolucci, Ugo; Colombini, Maria Perla; Spiriti, Andrea; Facchin, Laura

    2008-12-01

    The paper reports a cross-cutting and systematic approach to the analytical study of Baroque stucco decorations by Italian artists known as "Magistri Comacini". Samples from the Church of St. Lorenzo in Laino (Como, Italy) were analysed using chemical and mineralogical techniques and the results interpreted with the help of art historians in order to enlighten the artistic techniques. The characterisation of the binder, aggregate and organic fractions was carried out through optical microscopy, scanning electron microscopy with microprobe, X-ray powder diffraction, Fourier transform infrared spectroscopy, gas chromatography-mass spectrometry and laser ablation mass spectrometry equipped with plasma source spectrometry. The results on major, minor and trace components ascertained various recipes. In particular, the investigation of the finishing layers corroborated hypotheses of attribution and chronology and stressed the different skills of the artists working in the building, shedding a light on details of the decoration technique. PMID:19068330

  8. A Utilização da Astronomia como Tema Interdisciplinar e Aplicações de Objetos de Aprendizagem

    NASA Astrophysics Data System (ADS)

    da Silva, L. A.; Voelzke, M. R.

    2008-09-01

    Este trabalho visa analisar a possibilidade de relacionar conteúdos aplicados no ensino fundamental e médio de forma interdisciplinar por intermédio da astronomia, com a intervenção de objetos de aprendizagem que possam integrar as disciplinas e a utilização de recursos tecnológicos. Em uma pesquisa prévia com 20 professores de uma escola estadual situada na cidade de Guarulhos foi observado que apenas 25% dos professores utilizam algum recurso tecnológico para o desenvolvimento de conteúdos pertinentes à sua disciplina, tais como sites e softwares educativos, sendo que a maioria absoluta continua ensinando apenas com livros didáticos. A maior parte dos professores apresenta dificuldades em trabalhar sua disciplina de forma interdisciplinar, ou seja, 75% dos professores preferem aplicar os conteúdos seguindo uma hierarquia linear de tópicos, evitando a discussão de temas que de alguma forma estão relacionados. A astronomia pode vir à fascinar o ser humano e despertar sua curiosidade promovendo um maior interesse no aprendizado, podendo favorecer análises interdisciplinares de forma lógica e objetiva, desta forma colocar a astronomia como tema motivador interdisciplinar, pode ser relevante no que se refere ao distanciamento da fragmentação dos conteúdos. No Estado de São Paulo, a implantação da proposta curricular no ensino fundamental e médio mostra claramente a inserção da astronomia na maior parte das séries, principalmente na 6ª série em que todo o bimestre se fala de astronomia.

  9. Deterioration in the renal function and risk of microalbuminuria after radical, simple and donor nephrectomy: A long-term outcome

    PubMed Central

    Verma, Shashi; Yadav, Sher Singh; Tomar, Vinay; Vyas, Nachiket; Agarwal, Neeraj; Sharma, Umesh

    2016-01-01

    Objectives: Evaluation of deterioration in renal function and risk of micro albuminuria after radical, simple and donor nephrectomy. Materials and Methods: A total of 594 patients underwent nephrectomy (159 radical, 318 simple and 117 donors) from February 2009 to December 2012 in our institute. First 300 eligible patients were divided in 3 groups, each having equalled number of patients. Group 1 was consisted of patients who underwent radical, group 2 had simple and group 3 had donor nephrectomy. These patients were followed up to February 2015. Follow up of all the patients were done at first month following the surgery and then in every six months subsequently. The follow up included the measurement of serum creatinine and urinary micro albumin in a spot urine sample. CKD-EPI equation was used for calculation of e GFR. Results: At the end of our study, 35 patients (41.6%) in group 1 and 8 patients (8.69%) in group 2 developed CKD stage 3. During the follow-up period, 41% patients in group 1, 13% in group 2 and 4% in group 3 developed MA. Conclusion: Nephron-sparing surgery should be the standard treatment of renal tumors, wherever possible. There should be a regular follow up of the patients after radical, simple and donor nephrectomy because of risk of CKD. Early consultation with nephrologists should be done by the patients who are suffering from MA after nephrectomy. PMID:27141189

  10. Associations between microalbuminuria and animal foods, plant foods, and dietary patterns in the Multiethnic Study of Atherosclerosis2

    PubMed Central

    Nettleton, Jennifer A; Steffen, Lyn M; Palmas, Walter; Burke, Gregory L; Jacobs, David R

    2008-01-01

    Background The balance between the intake of animal and the intake of plant foods may influence renal vascular integrity as reflected by urinary albumin excretion. Objective We assessed cross-sectional associations between urinary albumin excretion and dietary patterns and intake of plant and animal foods. Design At baseline, diet (food-frequency questionnaire) and the urinary albumin-to-creatinine ratio (ACR; spot urine collection) were measured in 5042 participants in the Multi-Ethnic Study of Atherosclerosis who were aged 45−84 y and were without clinical cardiovascular disease, diabetes, or macroalbuminuria (sex-adjusted ACR ≥ 250). We derived dietary patterns by principal components analysis. We also summed food groups to characterize plant food intake (fruit, fruit juice, vegetables, nuts, legumes, whole grains, and refined grains), animal food intake (red meat, processed meat, poultry, fish, high-fat dairy, and low-fat dairy), and nondairy animal food intake. Results After adjustment for multiple demographic and lifestyle confounders, a dietary pattern characterized by high consumption of whole grains, fruit, vegetables, and low-fat dairy foods was associated with 20% lower ACR across quintiles (P for trend = 0.004). Neither total animal nor total plant food intake was associated with ACR. However, greater low-fat dairy consumption was associated with 13% lower ACR across quartiles (P for trend = 0.03). Total nondairy animal food consumption was associated with 11% higher ACR across quintiles (P for trend = 0.03). Conclusions A high intake of low-fat dairy foods and a dietary pattern rich in whole grains, fruit, and low-fat dairy foods were both associated with lower ACR. In contrast, collectively, nondairy animal food intake was positively associated with ACR. PMID:18541574

  11. Novel Urinary Protein Biomarkers Predicting the Development of Microalbuminuria and Renal Function Decline in Type 1 Diabetes

    PubMed Central

    Schlatzer, Daniela; Maahs, David M.; Chance, Mark R.; Dazard, Jean-Eudes; Li, Xiaolin; Hazlett, Fred; Rewers, Marian; Snell-Bergeon, Janet K.

    2012-01-01

    OBJECTIVE To define a panel of novel protein biomarkers of renal disease. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes in the Coronary Artery Calcification in Type 1 Diabetes study who were initially free of renal complications (n = 465) were followed for development of micro- or macroalbuminuria (MA) and early renal function decline (ERFD, annual decline in estimated glomerular filtration rate of ≥3.3%). The label-free proteomic discovery phase was conducted in 13 patients who progressed to MA by the 6-year visit and 11 control subjects, and four proteins (Tamm-Horsfall glycoprotein, α-1 acid glycoprotein, clusterin, and progranulin) identified in the discovery phase were measured by enzyme-linked immunosorbent assay in 74 subjects: group A, normal renal function (n = 35); group B, ERFD without MA (n = 15); group C, MA without ERFD (n = 16); and group D, both ERFD and MA (n = 8). RESULTS In the label-free analysis, a model of progression to MA was built using 252 peptides, yielding an area under the curve (AUC) of 84.7 ± 5.3%. In the validation study, ordinal logistic regression was used to predict development of ERFD, MA, or both. A panel including Tamm-Horsfall glycoprotein (odds ratio 2.9, 95% CI 1.3–6.2, P = 0.008), progranulin (1.9, 0.8–4.5, P = 0.16), clusterin (0.6, 0.3–1.1, P = 0.09), and α-1 acid glycoprotein (1.6, 0.7–3.7, P = 0.27) improved the AUC from 0.841 to 0.889. CONCLUSIONS A panel of four novel protein biomarkers predicted early renal damage in type 1 diabetes. These findings require further validation in other populations for prediction of renal complications and treatment monitoring. PMID:22238279

  12. The Shiga Microalbuminuria Reduction Trial (SMART) Group. Reduction of microalbuminuria in patients with type 2 diabetes: the Shiga Microalbuminuria Reduction Trial (SMART). Diabetes Care 2007;30:1581-1583. DOI: 10.2337/dc06-2493. Erratum appears in Diabetes Care 2013;36:4172. DOI: 10.2337/dc13-er12.

    PubMed

    2014-01-01

    Based on the review and recommendation of the American Diabetes Association's Subcommittee on Ethical Scientific Publications (ESP), Diabetes Care formally retracts the above-cited article. For reasons described below, the published data are considered to be unreliable. According to an investigation and analysis of the data conducted by Shiga University of Medical Science (report received 25 November 2013), 10.1% of the albumin-to-creatinine ratio (ACR) data reported in the article did not match original patient records. In the valsartan and amlodipine groups, respectively, 12.5% and 8.1% of the ACR data reported in the article differed from patient records. Close examination of these differences showed that ACR values reported for the valsartan group were smaller, and those for the amlodipine group were larger, than values reported in patient records; these differences "worked to the advantage of valsartan." The investigative panel of Shiga University of Medical Science concluded that the above-cited article is "inappropriate for [a] scientific paper." PMID:24558079

  13. Las fulguraciones como manifestación de reconexión en el campo magnético solar

    NASA Astrophysics Data System (ADS)

    Bagalá, L. G.; Mandrini, M. C.; Rovira, M. G.; Démoulin, P.

    Las fulguraciones solares son fenómenos transitorios de liberación de energía que se desarrollan en las estructuras magnéticas de las regiones activas del Sol. Las fulguraciones pueden llegar a liberar hasta 1032 erg en 100 seg. en todo el rango electromagnético, y acelerar partículas. En este trabajo mostramos que la ubicación de los abrillantamientos en Hα de diversas fulguraciones está relacionado con las propiedades de las conexiones de las líneas del campo magnético de la región, como se espera por las teorías de reconexión en 3D recientemente desarrolladas (Démoulin et al, 1996a). El campo magnético coronal se extrapola del campo fotosférico observado suponiendo una configuración libre de fuerzas lineal. Por medio de un algoritmo se determinan las regiones donde existe un cambio drástico en la conectividad de las líneas de campo (límites ``cuasi-discontinuos'', o cuasi-separatrices CS). Las CS son bandas abiertas que identifican zonas donde el campo magnético se reconectará con más probabilidad y, siempre que las mismas sean lo suficientemente finas, se producirá allíla liberación de energía proveniente del campo magnético. Hemos encontrado que en todas las regiones fulgurantes estudiadas (Démoulin et al, 1996b) existen CS en los mismos lugares donde se observaron los abrillantamientos en Hα. Allídonde coinciden los abrillantamientos con las CS, éstas tienen un espesor menor que 1 Mm. Las líneas de campo coronales extrapoladas de nuestro modelo tienen sus orígenes fotosféricos a ambos lados de las CS, como se espera dados los recientes estudios de reconexión magnética en 3D. Estos resultados ponen a prueba los modelos presentes sobre fulguraciones solares.

  14. In-situ HRTEM study of the reactive carbide phase of Co/MoS2 catalyst.

    PubMed

    Ramos, Manuel; Ferrer, Domingo; Martinez-Soto, Eduan; Lopez-Lippmann, Hugo; Torres, Brenda; Berhault, Gilles; Chianelli, Russell R

    2013-04-01

    Hydrotreatment catalytic operations are commonly performed industrially by layered molybdenum sulfide promoted by cobalt or nickel in order to remove heteroelements (S, N, O) from fossil fuels and biofuels. Indeed, these heteroelements are responsible of the emission of pollutants when these fuels are used in vehicles. In this respect, previous studies made by our research group have shown that the active phase under steady state conditions is partially carbided while strong bending effects of MoS2 slabs were also observed. However, up to now, the morphology of the resulting Co/MoSxCy carbided catalyst has not been fully characterized. In the present study, for the first time, a chemical reaction between the carbon content of a TEM Cu/C grid and a freshly sulfide Co/MoS2 catalyst was in situ observed at 300 °C and 450 °C by HRTEM experimental techniques at ~10 nm of resolution. Results indicate that bending of MoS2 layers occurred due to carbon addition on MoS2 edge sites, as observed in stabilized catalysts after HDS reaction. Using a silicon grid, only cracks of MoS2 slabs were observed without bending effect confirming the role of structural-carbon in this change of morphology. PMID:22925737

  15. XAS Study at Mo and Co K-Edges of the Sulfidation of a CoMo / Al2O3 Hydrotreating Catalyst

    NASA Astrophysics Data System (ADS)

    Pichon, C.; Gandubert, A. D.; Legens, C.; Guillaume, D.

    2007-02-01

    Because of its impact on environment, the removal of sulfur is an indispensable step, called hydrotreatment, in the refining of petroleum. One of the most commonly used hydrotreating catalysts is CoMo-type catalyst which is composed of molybdenum disulfide slabs promoted by cobalt atoms (CoMoS phase) and well dispersed on a high specific area alumina. As far as the highest sulfur content allowed in gasoline and diesel is continually decreasing, more and more efficient and active hydrotreating catalysts are required. In order to optimize the reactivity of the CoMo-type catalyst in hydrotreatment, a better understanding of the processes used to produce the active phase (CoMoS slabs) of the catalyst is necessary. The study reported here deals with the sulfiding mechanism of the slabs and the influence of temperature on the phenomenon. Ex situ X-ray absorption spectroscopy (XANES and EXAFS) was used to study the evolution of the structure of CoMo-type catalyst sulfided at various temperatures (from 293 to 873 K). XAS analysis was performed at both molybdenum and cobalt K-edges to obtain a cross-characterization of the sulfidation of the slabs. It evidenced the formation of various compounds, including two molybdenum oxides, MoS3 (or MoS3-like compound) and Co9S8, at specific steps of the sulfiding process. It showed the role of intermediate played by MoS3 (or MoS3-like compound) during the formation of the slabs and the competition between the appearance of promoted slabs (CoMoS phase) and Co9S8. At last, it leaded to the proposal of a mechanism for the sulfidation of the catalyst.

  16. XAS Study at Mo and Co K-Edges of the Sulfidation of a CoMo / Al2O3 Hydrotreating Catalyst

    SciTech Connect

    Pichon, C.; Gandubert, A. D.; Legens, C.; Guillaume, D.

    2007-02-02

    Because of its impact on environment, the removal of sulfur is an indispensable step, called hydrotreatment, in the refining of petroleum. One of the most commonly used hydrotreating catalysts is CoMo-type catalyst which is composed of molybdenum disulfide slabs promoted by cobalt atoms (CoMoS phase) and well dispersed on a high specific area alumina. As far as the highest sulfur content allowed in gasoline and diesel is continually decreasing, more and more efficient and active hydrotreating catalysts are required. In order to optimize the reactivity of the CoMo-type catalyst in hydrotreatment, a better understanding of the processes used to produce the active phase (CoMoS slabs) of the catalyst is necessary. The study reported here deals with the sulfiding mechanism of the slabs and the influence of temperature on the phenomenon. Ex situ X-ray absorption spectroscopy (XANES and EXAFS) was used to study the evolution of the structure of CoMo-type catalyst sulfided at various temperatures (from 293 to 873 K). XAS analysis was performed at both molybdenum and cobalt K-edges to obtain a cross-characterization of the sulfidation of the slabs. It evidenced the formation of various compounds, including two molybdenum oxides, MoS3 (or MoS3-like compound) and Co9S8, at specific steps of the sulfiding process. It showed the role of intermediate played by MoS3 (or MoS3-like compound) during the formation of the slabs and the competition between the appearance of promoted slabs (CoMoS phase) and Co9S8. At last, it leaded to the proposal of a mechanism for the sulfidation of the catalyst.

  17. Telescópio de pequeno porte como suporte ao ensino em cidades com intensa poluição luminosa II

    NASA Astrophysics Data System (ADS)

    Pereira, P. C. R.; Santos-Júnior, J. M.; Cruz, W. S.

    2003-08-01

    Para a maioria dos estudantes, sua passagem pelo ensino formal fundamental envolve a transmissão de fatos que devem ser guardados para um exame, a habilidade para lembrar fórmulas e, eventualmente, a repetição de experimentos que devem produzir resultados exigidos pelo professor. O resultado deste modelo de ensino, ao longo dos anos, é conhecido por todos: desconhecimento e descontentamento, por parte dos estudantes, de temas relativos ao papel e aos processos da ciência. Acreditamos que a Astronomia, pelo seu caráter observacional, é uma das áreas do conhecimento que pode contribuir neste cenário. A Fundação Planetário da Cidade do Rio de Janeiro possui um telescópio Meade LX-200 (25cm) que, juntamente com as câmeras CCD ST-7E e ST8E, tem sido utilizado em projetos voltados aos estudantes do ensino médio desde o ano 2000. Tais projetos envolvem a condução de um projeto de pesquisa observacional num nível apropriado, e possibilitam o contato com técnicas e novas tecnologias: computador, software para manipulação de dados e gráficos, programas de tratamento e redução de dados, uso de equipamentos óptico-eletrônicos (telescópio e CCD), bem como o processo de aquisição de conhecimento. Dentro da proposta dos anos anteriores, priorizamos projetos de uma noite, ou seja, procuramos trabalhar com fenômenos que apresentem variabilidade com intervalo de recorrência relativamente curto. Em todos os casos, optamos pela fotometria diferencial, que tem se mostrado bastante eficiente para o céu luminoso como o da cidade do Rio de Janeiro. Neste painel, apresentamos alguns dos projetos desenvolvidos no último ano, com 25 estudantes. Apresentamos os resultados da observação da variável pulsante AI Vel (V = 6,6) e da variável cataclísmica FO Aqr (V = 13,5), e do monitoramento do trânsito da lua de Júpiter, Europa, ocorrido em 30 de abril de 2003. As curvas de luz produzidas para as primeiras estão concordantes com as da literatura, assim

  18. Tal Como Somos/Just As We Are: An Educational Film to Reduce Stigma towards Gay and Bisexual Men, Transgender Individuals & Persons Living with HIV/AIDS

    PubMed Central

    Ramirez-Valles, Jesus; Kuhns, Lisa M.; Manjarrez, Dianna

    2013-01-01

    In this paper we describe the development and dissemination of a film-based educational intervention to reduce negative attitudes towards gay and bisexual men and transgender women (GBT) and people living with HIV/AIDS (PLWHA) in Latino communities, with a focus on youth. The intervention, Tal Como Somos/Just as We Are, is based on stigma and attribution theories, extensive formative research, and community input. Evaluation findings among educators and school youth suggest the film has the potential to effectively impact attitudes towards GBT and PLWHA. The film and intervention are being disseminated using diffusion of innovations theory through community-based organizations, schools, television broadcasting and film festivals. PMID:24377496

  19. Tal Como Somos/just as we are: an educational film to reduce stigma toward gay and bisexual men, transgender individuals, and persons living with HIV/AIDS.

    PubMed

    Ramirez-Valles, Jesus; Kuhns, Lisa M; Manjarrez, Dianna

    2014-04-01

    In this article, the authors describe the development and dissemination of a film-based educational intervention to reduce negative attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS in Latino communities, with a focus on youth. The intervention, Tal Como Somos/Just as We Are, is based on stigma and attribution theories, extensive formative research, and community input. Evaluation findings among educators and school youth suggest the film has the potential to effectively influence attitudes toward gay and bisexual men, transgender women, and people living with HIV/AIDS. The film and intervention are being disseminated using diffusion of innovations theory through community-based organizations, schools, television broadcasting, and film festivals. PMID:24377496

  20. Hydro-geochemical modeling of subalpine urbanized area: geochemical characterization of the shallow and deep aquifers of the urban district of Como (first results).

    NASA Astrophysics Data System (ADS)

    Terrana, Silvia; Brunamonte, Fabio; Frascoli, Francesca; Ferrario, Maria Francesca; Michetti, Alessandro Maria; Pozzi, Andrea; Gambillara, Roberto; Binda, Gilberto

    2016-04-01

    One of the greatest environmental and social-economics threats is climate change. This topic, in the next few years, will have a significant impact on the availability of water resources of many regions. This is compounded by the strong anthropization of water systems that shows an intensification of conflicts for water resource exploitation. Therefore, it is necessary a sustainable manage of natural resources thorough knowledge of the hosting territories. The development of investigation and data processing methods are essential to reduce costs for the suitable use and protection of resources. Identify a sample area for testing the best approach is crucial. This research aims to find a valid methodology for the characterization, modeling and management of subalpine urban aquifers, and the urban district of Como appears perfect. The city of Como is located at the southern end of the western sector of Lake Como (N Italy). It is a coastal town, placed on a small alluvial plain, therefore in close communication with the lake. The plain is drained by two streams, which are presently artificially buried, and have an underground flow path in the urban section till the mouth. This city area, so, is suitable for this project as it is intensely urbanized, its dimensions is not too extensive and it is characterized by two aquifers very important and little known. These are a shallow aquifer and a deep aquifer, which are important not only for any water supply, but also for the stability of the ground subsidence in the city. This research is also the opportunity to work in a particular well-known area with high scientific significance; however, there is complete absence of information regarding the deep aquifer. Great importance has also the chosen and used of the more powerful open source software for this type of area, such as PHREEQC, EnvironInsite, PHREEQE etc., used for geological and geochemical data processing. The main goal of this preliminary work is the

  1. Congressional Hispanic Caucus: Como Va?

    ERIC Educational Resources Information Center

    Darrow, Denice

    1978-01-01

    The Caucus aims to develop a national policy on behalf of the Spanish-speaking, and to strengthen the Federal commitment toward Hispanics. The Caucus also plans to serve an educational purpose, informing the Hispanic population about the political process and functioning of government. (NQ)

  2. Tailoring (n,m) structure of single-walled carbon nanotubes by modifying reaction conditions and the nature of the support of CoMo catalysts.

    PubMed

    Lolli, Giulio; Zhang, Liang; Balzano, Leandro; Sakulchaicharoen, Nataphan; Tan, Yongqiang; Resasco, Daniel E

    2006-02-01

    The (n,m) population distribution of single-walled carbon nanotubes obtained on supported CoMo catalysts has been determined by photoluminescence and optical absorption. It has been found that the (n,m) distribution can be controlled by varying the gaseous feed composition, the reaction temperature, and the type of catalyst support used. When using CO as a feed over CoMo/SiO2 catalysts, increasing the synthesis temperature results in an increase in nanotube diameter, without a change in the chiral angle. By contrast, by changing the support from SiO2 to MgO, nanotubes with similar diameter but different chiral angles are obtained. Finally, keeping the same reaction conditions but varying the composition of the gaseous feed results in different (n,m) distribution. The clearly different distributions obtained when varying catalysts support and/or reaction conditions demonstrate that the (n,m) distribution is a result of differences in the growth kinetics, which in turn depends on the nanotube cap-metal cluster interaction. PMID:16471791

  3. From Management to Negotiation: Technical and Institutional Innovations for Integrated Water Resource Management in the Upper Comoé River Basin, Burkina Faso

    NASA Astrophysics Data System (ADS)

    Roncoli, Carla; Kirshen, Paul; Etkin, Derek; Sanon, Moussa; Somé, Léopold; Dembélé, Youssouf; Sanfo, Bienvenue J.; Zoungrana, Jacqueline; Hoogenboom, Gerrit

    2009-10-01

    This study focuses on the potential role of technical and institutional innovations for improving water management in a multi-user context in Burkina Faso. We focus on a system centered on three reservoirs that capture the waters of the Upper Comoé River Basin and servicing a diversity of users, including a sugar manufacturing company, a urban water supply utility, a farmer cooperative, and other downstream users. Due to variable and declining rainfall and expanding users’ needs, drastic fluctuations in water supply and demand occur during each dry season. A decision support tool was developed through participatory research to enable users to assess the impact of alternative release and diversion schedules on deficits faced by each user. The tool is meant to be applied in the context of consultative planning by a local user committee that has been created by a new national integrated water management policy. We contend that both solid science and good governance are instrumental in realizing efficient and equitable water management and adaptation to climate variability and change. But, while modeling tools and negotiation platforms may assist users in managing climate risk, they also introduce additional uncertainties into the deliberative process. It is therefore imperative to understand how these technological and institutional innovations frame water use issues and decisions to ensure that such framing is consistent with the goals of integrated water resource management.

  4. From management to negotiation: technical and institutional innovations for integrated water resource management in the Upper Comoé River Basin, Burkina Faso.

    PubMed

    Roncoli, Carla; Kirshen, Paul; Etkin, Derek; Sanon, Moussa; Somé, Léopold; Dembélé, Youssouf; Sanfo, Bienvenue J; Zoungrana, Jacqueline; Hoogenboom, Gerrit

    2009-10-01

    This study focuses on the potential role of technical and institutional innovations for improving water management in a multi-user context in Burkina Faso. We focus on a system centered on three reservoirs that capture the waters of the Upper Comoé River Basin and servicing a diversity of users, including a sugar manufacturing company, a urban water supply utility, a farmer cooperative, and other downstream users. Due to variable and declining rainfall and expanding users' needs, drastic fluctuations in water supply and demand occur during each dry season. A decision support tool was developed through participatory research to enable users to assess the impact of alternative release and diversion schedules on deficits faced by each user. The tool is meant to be applied in the context of consultative planning by a local user committee that has been created by a new national integrated water management policy. We contend that both solid science and good governance are instrumental in realizing efficient and equitable water management and adaptation to climate variability and change. But, while modeling tools and negotiation platforms may assist users in managing climate risk, they also introduce additional uncertainties into the deliberative process. It is therefore imperative to understand how these technological and institutional innovations frame water use issues and decisions to ensure that such framing is consistent with the goals of integrated water resource management. PMID:19707708

  5. Co-Doped MoS₂ Nanosheets with the Dominant CoMoS Phase Coated on Carbon as an Excellent Electrocatalyst for Hydrogen Evolution.

    PubMed

    Dai, Xiaoping; Du, Kangli; Li, Zhanzhao; Liu, Mengzhao; Ma, Yangde; Sun, Hui; Zhang, Xin; Yang, Ying

    2015-12-16

    Highly active and low-cost catalysts for hydrogen evolution reaction (HER) are crucial for the development of efficient water splitting. Molybdenum disulfide (MoS2) nanosheets possess unique physical and chemical properties, which make them promising candidates for HER. Herein, we reported a facile, effective, and scalable strategy by a deposition-precipitation method to fabricate metal-doped (Fe, Co, Ni) molybdenum sulfide with a few layers on carbon black as noble metal-free electrocatalysts for HER. The CoMoS phase after thermal annealing in Co-doped MoS2 plays a crucial role for the enhanced HER. The optimized Co-doped MoS2 catalyst shows superior HER performance with a high exchange current density of 0.03 mA·cm(-2), low onset potential of 90 mV, and small Tafel slope of 50 mV·dec(-1), which also exhibits excellent stability of 10000 cycles with negligible loss of the cathodic current. The superior HER activity originates from the synergistically structural and electronic modulations between MoS2 and Co ions, abundant defects in the active edge sites, as well as the good balance between active sites and electronic conductivity. Thanks to their ease of synthesis, low cost, and high activity, the Co-doped MoS2 catalysts appear to be promising HER catalysts for electrochemical water splitting. PMID:26599427

  6. Detection and identification of pathogenic trypanosome species in tsetse flies along the Comoé River in Côte d’Ivoire

    PubMed Central

    Djohan, Vincent; Kaba, Dramane; Rayaissé, Jean-Baptiste; Dayo, Guiguigbaza-Kossigan; Coulibaly, Bamoro; Salou, Ernest; Dofini, Fabien; Kouadio, Alain De Marie Koffi; Menan, Hervé; Solano, Philippe

    2015-01-01

    In order to identify pathogenic trypanosomes responsible for African trypanosomiasis, and to better understand tsetse-trypanosome relationships, surveys were undertaken in three sites located in different eco-climatic areas in Côte d’Ivoire during the dry and rainy seasons. Tsetse flies were caught during five consecutive days using biconical traps, dissected and microscopically examined looking for trypanosome infection. Samples from infected flies were tested by PCR using specific primers for Trypanosoma brucei s.l., T. congolense savannah type, T. congolense forest type and T. vivax. Of 1941 tsetse flies caught including four species, i.e. Glossina palpalis palpalis, G. p. gambiensis, G. tachinoides and G. medicorum, 513 (26%) were dissected and 60 (12%) were found positive by microscopy. Up to 41% of the infections were due to T. congolense savannah type, 30% to T. vivax, 20% to T. congolense forest type and 9% due to T. brucei s.l. All four trypanosome species and subgroups were identified from G. tachinoides and G. p. palpalis, while only two were isolated from G. p. gambiensis (T. brucei s.l., T. congolense savannah type) and G. medicorum (T. congolense forest, savannah types). Mixed infections were found in 25% of cases and all involved T. congolense savannah type with another trypanosome species. The simultaneous occurrence of T. brucei s.l., and tsetse from the palpalis group may suggest that human trypanosomiasis can still be a constraint in these localities, while high rates of T. congolense and T. vivax in the area suggest a potential risk of animal trypanosomiasis in livestock along the Comoé River. PMID:26035296

  7. Detection and identification of pathogenic trypanosome species in tsetse flies along the Comoé River in Côte d'Ivoire.

    PubMed

    Djohan, Vincent; Kaba, Dramane; Rayaissé, Jean-Baptiste; Dayo, Guiguigbaza-Kossigan; Coulibaly, Bamoro; Salou, Ernest; Dofini, Fabien; Kouadio, Alain De Marie Koffi; Menan, Hervé; Solano, Philippe

    2015-01-01

    In order to identify pathogenic trypanosomes responsible for African trypanosomiasis, and to better understand tsetse-trypanosome relationships, surveys were undertaken in three sites located in different eco-climatic areas in Côte d'Ivoire during the dry and rainy seasons. Tsetse flies were caught during five consecutive days using biconical traps, dissected and microscopically examined looking for trypanosome infection. Samples from infected flies were tested by PCR using specific primers for Trypanosoma brucei s.l., T. congolense savannah type, T. congolense forest type and T. vivax. Of 1941 tsetse flies caught including four species, i.e. Glossina palpalis palpalis, G. p. gambiensis, G. tachinoides and G. medicorum, 513 (26%) were dissected and 60 (12%) were found positive by microscopy. Up to 41% of the infections were due to T. congolense savannah type, 30% to T. vivax, 20% to T. congolense forest type and 9% due to T. brucei s.l. All four trypanosome species and subgroups were identified from G. tachinoides and G. p. palpalis, while only two were isolated from G. p. gambiensis (T. brucei s.l., T. congolense savannah type) and G. medicorum (T. congolense forest, savannah types). Mixed infections were found in 25% of cases and all involved T. congolense savannah type with another trypanosome species. The simultaneous occurrence of T. brucei s.l., and tsetse from the palpalis group may suggest that human trypanosomiasis can still be a constraint in these localities, while high rates of T. congolense and T. vivax in the area suggest a potential risk of animal trypanosomiasis in livestock along the Comoé River. PMID:26035296

  8. [Nusing-sensitive indicadors: an opportunity for measuring the nurse contribution].

    PubMed

    Planas-Campmany, Carme; Icart-Isern, M Teresa

    2014-01-01

    The measures directed at improving the management and funding of health services that justify the measurement of performance and the purchase of services based on results, have a direct influence on nursing. In this context, concerns about the value and contribution of nursing have been demonstrated worldwide over the last decades. Therefore efforts are being made to ensure that nurses contribute to promote the transformation of health systems. This requires identifying their contribution to the health system and, specifically, in relation to health outcomes. In recent decades, there has been a growing demand to achieve measures which allow nurses to demonstrate and assume responsibility for their contribution. The research and development of nursing-sensitive indicators and results, and its application, provide an opportunity to measure the contribution and professional performance in achieving these set objectives, in order to improve population health. PMID:23999200

  9. The Astronomy Club of Araranguá: Educating Science Teachers as Science Communicators. (Breton Title: Clube de Astronomia de AraranguÁ: a Formação de Professores de Ciências Como Divulgadores Científicos. ) Club de Astronomía de Araranguá: la Formación del Profesorado Como Comunicadores de la Ciencia

    NASA Astrophysics Data System (ADS)

    Damasio, Felipe; Allain, Olivier; Antunes Rodrigues, Adriano

    2013-07-01

    The study reported in this work takes place since 2009 at the Federal Institute of Education, Science and Technology of Santa Catarina, Campus Araranguá. Our main goal is to help form teachers, training undergraduate students in Natural Sciences with specialization in Physics as science communicators, as well as to promote actions of broader scientific popularization in the region of the town of Araranguá through an Astronomy Club called CA2. Among the actions of scientific popularization that the students promote are: video production, radio broadcasts, lectures, nightly observations, preparation and exhibition of posters, physics teaching for children, continuing education activities for teachers and regular physics teaching using Astronomy as a theme. The Club's teacher education and scientific dissemination work is based on the Theory of Meaningful Learning, always trying to reach the student's predisposition to learn and produce potentially meaningful material, the two essential conditions for meaningful learning to occur. O estudo que este trabalho relata ocorre desde 2009 no Instituto Federal de Educação, Ciência e Tecnologia de Santa Catarina, campus Araranguá. Nele procura-se formar divulgadores científicos durante a formação inicial de docentes do curso de Licenciatura em Ciências da Natureza com habilitação em Física, além de promover ações de divulgação científica para o público geral da região da cidade de Araranguá por meio de um Clube de Astronomia chamado CA² (Clube de Astronomia de Araranguá). Entre as ações de divulgação científica que os licenciandos promovem estão: produção de vídeos, programas de rádio, palestras, observações noturnas, confecção e exposição de pôsteres, ensino de física para crianças, formação continuada de professores em atividades e ensino de Física regular utilizando a Astronomia como tema gerador. O trabalho de formação docente e divulgação científica do Clube fundamenta

  10. Como Lo Hago Yo: Lipomas Medulares

    PubMed Central

    Portillo, Santiago

    2014-01-01

    Basados en la experiencia de 82 casos; en 5% se observaron anomalías pélvicas asociadas. En los menores de 3 años el motivo de consulta (85%) fue la tumoración. En los mayores de 3 años (42%) tenía problemas neurológicos. Solo el 24% preocupados por la tumoración. El objetivo de la cirugía es desanclar la médula y no remover la totalidad del lipoma. El lipoma de filum es el que es mas simple para operar. Aún cuando la escuela francesa propone operar solamente cuando hay síntomas favorezco cirugía preventiva. Favorezco una segunda cirugía si hay signos de anclaje postoperatorio, aún cuando observamos empeoramiento postoperatorio motor en 2.5% de los operados y urológico a largo plazo en 6% de los operados. PMID:24791218

  11. Micoinseticidas e Micoacaricidas no Brasil: Como estamos?

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Mycoinsecticides and mycoacaricides can be defined as biopesticide products based on living propagules of entomopathogenic fungi developed for inundative and inoculative biological control of insects and mites. Based on recently published data on global use of entomopathogenic fungi and a proposal f...

  12. Particle-associated contaminants in street dust, parking lot dust, soil, lake-bottom sediment, and suspended and streambed sediment, Lake Como and Fosdic Lake watersheds, Fort Worth, Texas, 2004

    USGS Publications Warehouse

    Wilson, Jennifer T.; Van Metre, Peter C.; Werth, Charles J.; Yang, Yanning

    2006-01-01

    A previous study by the U.S. Geological Survey of impaired water bodies in Fort Worth, Texas, reported elevated but variable concentrations of particle-associated contaminants (PACs) comprising chlorinated hydrocarbons, polycyclic aromatic hydrocarbons, and trace elements in suspended and bed sediment of lakes and streams affected by urban land use. The U.S. Geological Survey, in cooperation with the City of Fort Worth, collected additional samples during October 2004 to investigate sources of PACs in the watersheds of two impaired lakes: Lake Como and Fosdic Lake. Source materials and aquatic sediment were sampled and analyzed for PACs. Source materials sampled consisted of street dust and soil from areas with residential and commercial land use and parking lot dust from sealed and unsealed parking lots. Aquatic sediment sampled consisted of bottom-sediment cores from the two lakes and suspended and streambed sediment from the influent stream of each lake. Samples were analyzed for chlorinated hydrocarbons (organochlorine pesticides and polychlorinated biphenyls), polycyclic aromatic hydrocarbons, major and trace elements, organic carbon, grain size, and radionuclides.

  13. Essays on Eclipses, Transits and Occultations as Teaching Tools in the Introductory Astronomy College Course. (Spanish Title: Ensayos sobre Eclipses, Tránsitos y Ocultaciones Como Herramientas de Enseñanza en el Curso Universitario Introductorio a la Astronomía.) Ensaios sobre Eclipses, Trânsitos e Ocultações Como Ferramentas de Ensino em um Curso Universitário Introdutório de Astromomia

    NASA Astrophysics Data System (ADS)

    Dcruz, Noella L.

    2014-07-01

    estudiantes que escribieran dos ensayos cortos de tres que se proponían. Los ensayos contenían partes descriptivas y conceptuales. Los mismos estaban destinados a servir como herramientas de enseñanza. 62% de los 106 ensayos de 55 estudiantes obtuvo grados A, B o C. 21% de los 47 encuestados que respondieron al cuestionario posterior consideró que los ensayos aumentaron su interés por la astronomía. 49% de los encuestados consideró que los ensayos no eran educacionalmente útiles y que no deben ser propuestos de nuevo. Las respuestas escritas más comunes a nuestra encuesta indicaran que los estudiantes necesitan más orientación y una mejor preparación en la redacción de ensayos exitosos. Dado que los estudiantes encontraron las piezas conceptuales de los ensayos difíciles, en el futuro vamos a ofrecer actividades pertinentes antes de los plazos de redacción para ayudar a los estudiantes a crear ensayos de mayor calidad. Nós ocasionalmente incluímos projetos em nosso curso universitário introdutório centrado no aluno para permitir aos estudantes que pertencem às carreiras não científicas explorar alguns conceitos astronômicos em mais detalhes do que o normal. Tais projetos também enfatizam eventos astronômicos em curso ou futuros. Esperamos que os alunos se sintam mais interessados na astronomia através de projetos ligados a eventos astronômicos. No termo de Primavera de 2012 (EUA), propomos ensaios curtos focados em eclipses, trânsitos e ocultações para promover o raro trânsito de Vênus que ocorreu no dia 5 de junho de 2012. Pedimos aos alunos que escrevessem dois ensaios curtos dentre três que foram propostos. Os ensaios continham partes descritivas e conceituais. Eles foram feitos para servir como ferramentas de ensino. 62% de 106 ensaios de 55 alunos ganhou graus A, B ou C. 21% dos 47 entrevistados que responderam ao levantamento posterior sentiu que os ensaios aumentaram seu interesse na astronomia. 49% dos inquiridos consideraram que os

  14. Joint Effect of Early Microvascular Damage in the Eye & Kidney on Risk of Cardiovascular Events

    PubMed Central

    Yip, Wanfen; Sabanayagam, Charumathi; Ong, Peng Guan; Patel, Uptal D; Chow, Khuan Yew; Tai, E Shyong; Ling, Lieng H; Wong, Tien Yin; Cheung, Carol Yim-lui

    2016-01-01

    Microalbuminuria is associated with an increased risk of cardiovascular disease (CVD), but not all individuals require treatment. Retinal microvascular abnormalities and microalbuminuria reflect early systemic microvascular changes. We examined the joint effect of retinal abnormalities and microalbuminuria on CVD risk in an Asian cohort. We conducted a prospective, population-based study. Retinal abnormalities were defined as presence of retinopathy and/or retinal venular widening. Microalbuminuria was defined as urinary albumin: creatinine ratio between 30–300 mg/g. Incident CVD was defined as newly diagnosed clinical stroke, acute myocardial infarction or CVD death. Cox regression models were performed to determine the associations between retinal abnormalities and microalbuminuria with risk of CVD, while controlling for established risk factors. 3,496 participants (aged ≥ 40) were free of prevalent CVD. During the follow-up (5.8 years), 126 (3.60%) participants developed CVD. Persons presenting with both retinal abnormalities and microalbuminuria were 6.71 times (95% CI, 2.68, 16.79) as likely to have incident CVD compared with those without either abnormalities. There was a significant interaction effect between retinal abnormalities and microalbuminuria on incident CVD. Assessment of retinal abnormalities in patients with microalbuminuria may provide additional value in identifying persons at risk of developing CVD. PMID:27273133

  15. Joint Effect of Early Microvascular Damage in the Eye &Kidney on Risk of Cardiovascular Events.

    PubMed

    Yip, Wanfen; Sabanayagam, Charumathi; Ong, Peng Guan; Patel, Uptal D; Chow, Khuan Yew; Tai, E Shyong; Ling, Lieng H; Wong, Tien Yin; Cheung, Carol Yim-Lui

    2016-01-01

    Microalbuminuria is associated with an increased risk of cardiovascular disease (CVD), but not all individuals require treatment. Retinal microvascular abnormalities and microalbuminuria reflect early systemic microvascular changes. We examined the joint effect of retinal abnormalities and microalbuminuria on CVD risk in an Asian cohort. We conducted a prospective, population-based study. Retinal abnormalities were defined as presence of retinopathy and/or retinal venular widening. Microalbuminuria was defined as urinary albumin: creatinine ratio between 30-300 mg/g. Incident CVD was defined as newly diagnosed clinical stroke, acute myocardial infarction or CVD death. Cox regression models were performed to determine the associations between retinal abnormalities and microalbuminuria with risk of CVD, while controlling for established risk factors. 3,496 participants (aged ≥ 40) were free of prevalent CVD. During the follow-up (5.8 years), 126 (3.60%) participants developed CVD. Persons presenting with both retinal abnormalities and microalbuminuria were 6.71 times (95% CI, 2.68, 16.79) as likely to have incident CVD compared with those without either abnormalities. There was a significant interaction effect between retinal abnormalities and microalbuminuria on incident CVD. Assessment of retinal abnormalities in patients with microalbuminuria may provide additional value in identifying persons at risk of developing CVD. PMID:27273133

  16. Como Planear Mi Vida = Make a Life for Yourself.

    ERIC Educational Resources Information Center

    Haffner, Debra; Casey, Sean

    This booklet for teenagers about life planning is presented in parallel English and Spanish versions with a special focus on young Hispanics growing up in America. It discusses hopes and dreams that adolescents may have and gives tips for reaching goals. A sentence completion exercise is included to help readers set goals. Four important goals for…

  17. Los mitos como memoria colectiva de Los Pueblos.

    NASA Astrophysics Data System (ADS)

    Martín, P. T.

    Myths are essentially something practical that allows those who believe in them to solve any ambiguity which could come up in their relation with nature. Since they bring information about the condition of the reality to which they belong, they are but the appropriate instrument to insert nature into culture by actually achieving an adaptation to the environment. The purpose of this essay is to show how the deification of plants, animals, and stars, which are present in the daily lives of "Amerindian" people, not only constitutes a source of rich mythology but also turns out to be an effective measure towards the continuity of social groups. Similarities or identifications between human life and the life of plants, animals and stars as well as mutual interplay are somehow present in those myths: stars which create or are changed into human being, animals or plants; human beings who create or are transformed into astral bodies; battles between peoples and stars, etc. On this base, mythology can provide not only keys to show how certain human groups have achieved their adaptation to the environment and how the different social systems and their relations to nature have developed, but also hints of changes which have taken place in other heavenly spheres such as the falling of meteors, the appearance of comets or any other significant events of this kind in the lives of these groups.

  18. Make a Life for Yourself = Como Planear Mi Vida.

    ERIC Educational Resources Information Center

    Center for Population Options, Washington, DC.

    This booklet was devised to help Hispanic teenagers develop a life plan. It provides information for making decisions, and is written in both English and Spanish. Tips are provided for setting goals. A sentence-completion task helps the teenager focus on specific issues, and use concrete language when talking about the goals. Specific goals are…

  19. El Espanol como Idioma Universal (Spanish as a Universal Language)

    ERIC Educational Resources Information Center

    Mijares, Jose

    1977-01-01

    A proposal to transform Spanish into a universal language because it possesses the prerequisites: it is a living language, spoken in several countries; it is a natural language; and it uses the ordinary alphabet. Details on simplification and standardization are given. (Text is in Spanish.) (AMH)

  20. [Parenting Information. Informacion Sobre Como Ser Padres Mejores.

    ERIC Educational Resources Information Center

    Moreno, Steve

    These five booklets, containing information on how parenting can effect children's school achievement, are part of a series of 22 innovative booklets designed specifically to help parents understand and help their children learn. Booklet #1, "Parents--Teach Your Children to Learn [Before They Go to School]," defines intelligence and suggests…

  1. Understanding Your Child's Learning Differences = Entienda como aprende su hijo.

    ERIC Educational Resources Information Center

    Fielding, Elizabeth N.

    Children who are bright and hard-working, yet find school a struggle, or children who can discuss things they have learned but whose written work is of surprisingly poor quality, might have learning differences that are hindering them from reaching their full potential. Some children are visual learners, others are auditory learners, and others…

  2. Como Lo Hago Yo: Tratamiento Quirurgico Del Mielomeningocele

    PubMed Central

    Portillo, Santiago

    2014-01-01

    En Argentina hay plan de fortificación con ácido fólico. Diagnostico prenatal no siempre es correcto. Cierre según técnica. Cerramos músculo. No favorecemos corpectomía temprana en casos de cifosis. Suturamos la plaqueta. Cerramos el plano muscular. Hidrocefalia: Válvula de derivación, generalmente dentro de los dos primeros meses. Ventriculostomía no está indicada. Chiari II. Laminectomia cervical alta. Siringomielia: Derivación desde la cavidad al peritoneo. PMID:24791219

  3. Is a random urinary albumin concentration a useful screening test in insulin-treated diabetic patients?

    PubMed

    Beatty, O L; Ritchie, C M; Hadden, D R; Kennedy, L; Bell, P M; Atkinson, A B

    1994-09-01

    The debate continues on how to screen for microalbuminuria in clinical practice in patients with insulin-dependent diabetes mellitus. Our study assesses the value of a spot morning urine specimen obtained at a clinic visit. In 1984, as part of a randomised survey of our diabetes clinic, 43 of 249 patients with insulin treated diabetes mellitus, were found to have microalbuminuria (urinary albumin concentration 35-300 ug ml-1) on a spot morning urine sample. These subjects were compared with an age-matched control group from the 1984 cohort who did not have microalbuminuria. Eight years later, in the group with microalbuminuria, 10 had died compared to six in the control group (p = 0.17) with 62.5% of all deaths being from cardiovascular disease. In the group with microalbuminuria, 10 of 27 still had incipient nephropathy while five had progressed to nephropathy. In the group without microalbuminuria only three of 33 patients had progressed to microalbuminuria while none had progressed to nephropathy. In conclusion a spot morning urine sample is a useful screening test to identify patients at risk of progression to nephropathy. PMID:7982765

  4. 24-hour urine protein

    MedlinePlus

    ... a blockage of blood vessels, or other causes Multiple myeloma Healthy people may have higher than normal urine ... Distal Hemolytic anemia Macroglobulinemia of Waldenstrom Microalbuminuria test Multiple myeloma Nephrotic syndrome Proximal Wilson disease Update Date 11/ ...

  5. The impact of antihypertensive drug groups on urinary albumin excretion in a non-diabetic population

    PubMed Central

    Monster, Taco B M; Janssen, Wilbert M T; de Jong, Paul E; de Jong-van den Berg, Lolkje T W

    2002-01-01

    Aims Microalbuminuria (30–300 mg 24 h−1) is recognized to be independently associated with renal and cardiovascular risk. Antihypertensives may lower microalbuminuria. We questioned whether the use of different antihypertensive drug classes in general practice influences microalbuminuria as related to blood pressure in nondiabetic subjects. Methods To study this, we used the data from 6836 subjects of an on-going population based study, focused on the meaning of microalbuminuria (PREVEND). Odds ratios, adjusted for age, sex, blood pressure, cholesterol level, smoking and the use of other antihypertensive or cardiovascular drugs, were calculated to determine the association of drug groups with microalbuminuria. Influence of antihypertensives on the relation between blood pressure and (log) urinary albumin excretion was determined by comparing linear regression lines. Results Microalbuminuria was significantly associated with the use of dihydropyridine calcium channel blockers (odds ratio: 1.76 [1.22–2.54]), but not with other antihypertensive drug groups. The linear regression line of the relation between blood pressure and (log) urinary albumin excretion was significantly steeper (P = 0.0047) for users of calcium channel blockers, but not for other antihypertensives, compared with subjects using no antihypertensive. Users of a combination of renin-angiotensin system inhibitors and diuretics however, had a less steep regression line (P = 0.037). Conclusions This study suggests a disadvantageous effect of dihydropyridine calcium channel blockers on microalbuminuria compared with other antihypertensive drug groups. Thus, if microalbuminuria is causally related to an increased risk for cardiovascular morbidity and mortality, dihydropyridines do not seem to be agents of choice to lower blood pressure. Furthermore, the combination of renin-angiotensin system inhibition and diuretics seems to act synergistically. PMID:11849192

  6. [How I evaluate...diabetic nephropathy. First part: micro- and macroalbuminuria].

    PubMed

    Weekers, L; Scheen, A J; Lefebvre, P J

    1998-08-01

    Diabetic nephropathy (DN) appears in about 30% of patients with type 1 diabetes (D1) and 15 to 60% of patients with type 2 diabetes (D2). It is preceded by microalbuminuria. Microalbuminuria is defined as an albumin excretion rate between 30 and 300 mg/24 h (on a 24-hour urine collection) or between 20 and 200 micrograms/min (on an overnight collection) in at least two out of three consecutive collections made within a 6-month period. Alternative screening techniques use either dipstick (Micral-Test II) or the albumin to creatinine ratio on an early morning urine sample (30-300 mg/g creatinine). Once persistent microalbuminuria is confirmed, 80% of type 1 diabetic patients and 20 to 50% of type 2 diabetic patients will progress to DN. In D2, microalbuminuria also represents a powerful predictor of early mortality from cardiovascular disease. Macroalbuminuria (AER > 300 mg/24 h, corresponding to a total protein excretion > 500 mg/24 h) will eventually lead to a end-stage renal insufficiency within 10 to 20 years. In D2, numerous patients will die from cardiovascular disease before reaching end-stage renal failure. Angiotensin-converting enzyme inhibitors can slow down the evolution toward DN when prescribed when microalbuminuria appears. Screening for microalbuminuria should therefore be a part of the annual clinical assessment in every diabetic patient. PMID:9810212

  7. [Not Available].

    PubMed

    Vila Nova, Larissa Pessoa; Araújo Tavares de Sá, Cristiane Maria; Freire Clementino da Silva, Maria Cleide; Lustosa, Marinaldo Freire; Batista de Medeiros, Rafael Augusto; Calado Brito, Daniel; De Araújo Burgos, Maria Goretti Pessoa

    2016-01-01

    Introducción: en los últimos años la importancia de identificar la resistencia a la insulina (RI) en pacientes con enfermedades cardiovasculares isquémicas viene siendo debatida. Métodos alternativos, como los indicadores antropométricos y de composición corporal, han sido señalados como una buena opción y contribuyen para identificar anomalías metabólicas y prevenir complicaciones.Objetivo: asociar indicadores antropométricos y de composición corporal como predictores de la resistencia a la insulina (RI) en pacientes con enfermedad de las arterias coronarias.Métodos: estudio transversal realizado en el hospital de referencia cardiológica de Pernambuco, en el periodo de junio a septiembre de 2014, con pacientes adultos y ancianos hospitalizados, de ambos sexos. Se verificaron los siguientes parámetros: estilo de vida, la presencia del síndrome metabólico (SM) y otras comorbilidades. Se analizó la RI por el cálculo del HOMA-IR. Los pacientes se sometieron a la impedancia bioeléctrica (BIA) y a las verificaciones antropométricas.Resultados: la muestra fue constituida por 75 pacientes con edad media de 63,75 ± 12,43 años, con un 64% de ancianos. Se encontró el diagnóstico de SM en el 65,3% de los pacientes, el 81,3% de sedentarios y el 37,4% con exceso de peso. Se diagnosticó la RI en el 28% de los pacientes. Se observó correlación entre el HOMA-IR y el diámetro abdominal sagital (DAS) (r = 0,476; p = 0,016), el índice de masa corporal (r = 0,233; p = 0,040) y el porcentual de grasa corporal (r = 0,276; p = 0,016).Conclusión: el DAS fue el indicador antropométrico que presentó mejor correlación con la RI en pacientes con enfermedad de las arterias coronarias hospitalizados. PMID:27571654

  8. Early Urinary Markers of Diabetic Kidney Disease: A Nested Case-Control Study From the Diabetes Control and Complications Trial (DCCT)

    PubMed Central

    Kern, Elizabeth O; Erhard, Penny; Sun, Wanjie; Genuth, Saul; Weiss, Miriam F

    2010-01-01

    Background Urinary markers were tested as predictors of macroalbuminuria or microalbuminuria in type 1 diabetes. Study Design Nested case:control of participants in the Diabetes Control and Complications Trial (DCCT) Setting & Participants Eighty-seven cases of microalbuminuria were matched to 174 controls in a 1:2 ratio, while 4 cases were matched to 4 controls in a 1:1 ratio, resulting in 91 cases and 178 controls for microalbuminuria. Fifty-five cases of macroalbuminuria were matched to 110 controls in a 1:2 ratio. Controls were free of micro/macroalbuminuria when their matching case first developed micro/macroalbuminuria. Predictors Urinary N-acetyl-β-D-glucosaminidase, pentosidine, AGE fluorescence, albumin excretion rate (AER) Outcomes Incident microalbuminuria (two consecutive annual AER > 40 but <= 300 mg/day), or macroalbuminuria (AER > 300 mg/day) Measurements Stored urine samples from DCCT entry, and 1–9 years later when macroalbuminuria or microalbuminuria occurred, were measured for the lysosomal enzyme, N-acetyl-β-D-glucosaminidase, and the advanced glycosylation end-products (AGEs) pentosidine and AGE-fluorescence. AER and adjustor variables were obtained from the DCCT. Results Sub-microalbuminuric levels of AER at baseline independently predicted microalbuminuria (adjusted OR 1.83; p<.001) and macroalbuminuria (adjusted OR 1.82; p<.001). Baseline N-acetyl-β-D-glucosaminidase independently predicted macroalbuminuria (adjusted OR 2.26; p<.001), and microalbuminuria (adjusted OR 1.86; p<.001). Baseline pentosidine predicted macroalbuminuria (adjusted OR 6.89; p=.002). Baseline AGE fluorescence predicted microalbuminuria (adjusted OR 1.68; p=.02). However, adjusted for N-acetyl-β-D-glucosaminidase, pentosidine and AGE-fluorescence lost predictive association with macroalbuminuria and microalbuminuria, respectively. Limitations Use of angiotensin converting-enzyme inhibitors was not directly ascertained, although their use was proscribed during the

  9. Co/Mo bimetallic addition to electrolytic manganese dioxide for oxygen generation in acid medium.

    PubMed

    Delgado, Dario; Minakshi, Manickam; McGinnity, Justin; Kim, Dong-Jin

    2015-01-01

    An efficient electrocatalyst comprising inexpensive and earth-abundant materials for the oxygen evolution reaction (OER) is crucial for the development of water electrolysis. In this work, in-situ addition of cobalt/molybdenum ions to the electrolytic manganese dioxide has been shown to be beneficial for the OER in acid solution as its overpotential performed better (305 mV) than that of the commercial DSA(®) (341 mV) at 100 mA cm(-2). The OER was investigated at ambient temperature in 2 M H2SO4 solution on the modified EMD (MnMoCoO) electrodes. The energy efficiency of the MnMoCoO electrodes improved significantly with the amount of Co in the plating solution. For the electrodeposited catalysts, physico-chemical and electrochemical measurements were conducted including static overpotentials. The better performance of the modified EMD was attributed to an improved charge transfer resistance (Rct; 0.290 Ω cm(2)), average roughness factor (rf; 429) and decrease in water content in the electrodeposited catalysts. The kinetic parameters obtained on MnMoCoO catalysts were compared and discussed according to the cobalt concentration. PMID:26469204

  10. The New Room Arrangement as a Teaching Strategy = La Nueva Organizacion del Salon como Estrategia Educativa.

    ERIC Educational Resources Information Center

    Dodge, Diane Trister

    Many typical classroom behavior problems--running in the classroom, inability to make choices, failure to stick with activities, fighting over toys, and poor use of materials-- can be traced to how the room is arranged and how materials are displayed. By making a few changes in the classroom environment, early childhood teachers can create a…

  11. Co/Mo bimetallic addition to electrolytic manganese dioxide for oxygen generation in acid medium

    PubMed Central

    Delgado, Dario; Minakshi, Manickam; McGinnity, Justin; Kim, Dong-Jin

    2015-01-01

    An efficient electrocatalyst comprising inexpensive and earth-abundant materials for the oxygen evolution reaction (OER) is crucial for the development of water electrolysis. In this work, in-situ addition of cobalt/molybdenum ions to the electrolytic manganese dioxide has been shown to be beneficial for the OER in acid solution as its overpotential performed better (305 mV) than that of the commercial DSA® (341 mV) at 100 mA cm−2. The OER was investigated at ambient temperature in 2 M H2SO4 solution on the modified EMD (MnMoCoO) electrodes. The energy efficiency of the MnMoCoO electrodes improved significantly with the amount of Co in the plating solution. For the electrodeposited catalysts, physico-chemical and electrochemical measurements were conducted including static overpotentials. The better performance of the modified EMD was attributed to an improved charge transfer resistance (Rct; 0.290 Ω cm2), average roughness factor (rf; 429) and decrease in water content in the electrodeposited catalysts. The kinetic parameters obtained on MnMoCoO catalysts were compared and discussed according to the cobalt concentration. PMID:26469204

  12. Como ayudar a sus hijos a usar la biblioteca (Helping Your Child Use the Library).

    ERIC Educational Resources Information Center

    Perkinson, Kathryn

    Focusing on the cooperative role of parents and public libraries in stimulating reading interests in children of all ages, this booklet addresses the following issues: (1) getting children interested in reading (reading aloud to children; encouraging children to read to you; starting a home library; showing children that you enjoy reading;…

  13. Como Solicitar la Asistencia Economica Federal para Estudiantes (How To Apply for Federal Student Aid).

    ERIC Educational Resources Information Center

    Office of Federal Student Aid (ED), Washington, DC.

    This guide, written in Spanish, discusses reasons for going to college, how to pay for college, and how to apply for federal student aid in a series of brief, clear illustrations. Following outlines of financial benefits of college, college costs, and space to note costs for the student's area, the guide outlines these steps in the application…

  14. Co/Mo bimetallic addition to electrolytic manganese dioxide for oxygen generation in acid medium

    NASA Astrophysics Data System (ADS)

    Delgado, Dario; Minakshi, Manickam; McGinnity, Justin; Kim, Dong-Jin

    2015-10-01

    An efficient electrocatalyst comprising inexpensive and earth-abundant materials for the oxygen evolution reaction (OER) is crucial for the development of water electrolysis. In this work, in-situ addition of cobalt/molybdenum ions to the electrolytic manganese dioxide has been shown to be beneficial for the OER in acid solution as its overpotential performed better (305 mV) than that of the commercial DSA® (341 mV) at 100 mA cm-2. The OER was investigated at ambient temperature in 2 M H2SO4 solution on the modified EMD (MnMoCoO) electrodes. The energy efficiency of the MnMoCoO electrodes improved significantly with the amount of Co in the plating solution. For the electrodeposited catalysts, physico-chemical and electrochemical measurements were conducted including static overpotentials. The better performance of the modified EMD was attributed to an improved charge transfer resistance (Rct; 0.290 Ω cm2), average roughness factor (rf; 429) and decrease in water content in the electrodeposited catalysts. The kinetic parameters obtained on MnMoCoO catalysts were compared and discussed according to the cobalt concentration.

  15. Escuelas sin Drogas. Como Actuar. Edicion 1992. (Schools without Drugs. What Works. 1992 Edition).

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC.

    Across the United States, schools and communities have found ways to turn the tide in the battle against drugs. This guidebook describes the methods they have used and the actions they have taken. The first section, "Children and Drugs" outlines the nature and extent of the drug problem and summarizes the latest research on the effects of drugs on…

  16. Spanish Oral Language Guide: Kindergarten Level. Espanol como Segundo Idioma. Teacher's Guide: Level I.

    ERIC Educational Resources Information Center

    Corbell, Gloria; And Others

    This teacher's guide to Spanish language at the kindergarten level includes a recommended subject presentation sequence for the Spanish curriculum, a sample schedule, a grouping of students using three stations, and a classroom layout. The grouping would be effective when at least one-third of the children are Spanish-speaking or bilingual. The…

  17. Como Ayudar a sus Hijos a Aprender Ciencia (Helping Your Child Learn Science).

    ERIC Educational Resources Information Center

    Paulu, Nancy; Martin, Margery

    Because most parents say they do not or cannot help their children with science, this booklet was designed to help them do so, easily and with pleasure for both parent and child. The introduction presents information on why and how parents should help their children and provides a general orientation to the ideas and activities offered in the…

  18. Cosmic ray soil moisture observing systems comos in cap fields at El Reno Oklahoma

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Soil water content (SWC) partitions rainfall into runoff and infiltration, modulates surface and atmospheric exchanges of water and energy, affects plant growth and crop yields, and impacts chemical and biological activities of soil, among other things. Thus, SWC, especially over large scales, is a...

  19. International Perspectives on Affirmative Action. A Bellagio Conference (Lake Como, Italy, August 16-20, 1982).

    ERIC Educational Resources Information Center

    Rockefeller Foundation, New York, NY.

    This volume presents nine papers read at a conference on affirmative action, sponsored by the Rockefeller Foundation and held at Columbia University in August 1982; a preface, summary paper, and list of participants are also included. Each paper addresses the issue of affirmative action within a different country and describes: (1) the policies…

  20. Contributions of local knowledge to the physical limnology of Lake Como, Italy

    PubMed Central

    Laborde, Sarah; Imberger, Jörg; Toussaint, Sandy

    2012-01-01

    This article shows how local knowledge may be valuably integrated into a scientific approach in the study of large and complex hydrological systems where data collection at high resolution is a challenge. This claim is supported through a study of the hydrodynamics of a large lake where qualitative data collected from professional fishers was combined with theory to develop a hypothesis that was then verified by numerical modeling. First the fishermen’s narratives were found to describe with accuracy internal wave motions that were evident in water column temperature records, which revealed their practical knowledge of the lake’s hydrodynamics. Second, local knowledge accounts emphasized the recurrent formation of mesoscale gyres and return flows in certain zones of the lake in stratified conditions, which did not appear in the physical data because of limitations of sampling resolution. We hypothesized that these features developed predominantly because of the interaction of wind-driven internal motions with the lake’s bathymetry, and the Earth’s rotation in the widest areas of the basin. Numerical simulation results corroborated the fishers’ descriptions of the flow paths and supported the hypothesis about their formation. We conclude that the collaboration between scientific and local knowledge groups, although an unusual approach for a physical discipline of the geosciences, is worth exploring in the pursuit of a more comprehensive understanding of complex geophysical systems such as large lakes. PMID:22493231

  1. Como pagar to educacion, 2004-2005 (Funding Your Education, 2004-2005).

    ERIC Educational Resources Information Center

    Office of Federal Student Aid (ED), Washington, DC.

    This publication, written in Spanish, describes financial aid programs of the U.S. Department of Education and advises students about paying for college. It outlines things a student should ask about college and how to obtain financial aid, whether grants, work-study, or loans. Chapters provide information on: (1) "Education after High School";…

  2. Como pagar tu educacion, 2003-2004 (How To Pay for Your Education, 2003-2004).

    ERIC Educational Resources Information Center

    Office of Federal Student Aid (ED), Washington, DC.

    This Spanish language booklet discusses paying for college. The guide presents information in question-and-answer form about things an applicant should ask and how to obtain financial aid. It describes the criteria for receiving aid and provides information about complying with aid requirements. The booklet also describes federal Pell grants and…

  3. Como Lo Hago Yo: Defectos Del Cierre Del Tubo Neural En Nicaragua

    PubMed Central

    Gonzalez, Juan Bosco

    2014-01-01

    En Nicaragua no hay un plan de forltificación de alimentos con ácido fólico. Las madres son muy jóvenes. En La Mascota operamos mas de cuarenta niños por año. Derivación tardía es un problema. La infección preoperatoria tiene que ser descartada. Vancomicina y Ceftriaxone estan indicadas. Estricta regla de asepsia operatoria. Suturamos la plaqueta para asemejar su forma al cilindro normal de la médula. No ceramos la capa de músculo. PMID:24791221

  4. Como si le Falta un Brazo: Latino Immigrant Parents and the Costs of Not Knowing English

    ERIC Educational Resources Information Center

    Worthy, Jo

    2006-01-01

    This study examined the perspectives of Latino/a immigrant parents about the place of English in their lives. The parents described how they had come to the United States with intentions of learning English, but various obstacles made it an overwhelming challenge. The author questions whether, despite rhetoric to the contrary, financially…

  5. "Tanto Necesitamos De Aqui Como Necesitamos De Alla": "Leer Juntas" among Mexican Transnational Mothers and Daughters

    ERIC Educational Resources Information Center

    de la Piedra, Maria Teresa

    2011-01-01

    This paper presents part of the results of a qualitative study about literacy practices of Mexican transnational mothers, who live in and frequently cross the border between two countries (the United States and Mexico). Drawing on sociocultural approaches to literacy and literature on transnationalism, I analyze one practice: "leer juntas"…

  6. The Struggle for Mexico's First Gay-Straight Alliance: Como una Novela Real

    ERIC Educational Resources Information Center

    Macgillivray, Ian K.

    2006-01-01

    In 2004, a group of high school students at a private American school in Mexico City started the first gay-straight alliance in Mexico. A small group of conservative parents and a Mormon principal organized in opposition. This paper details the students' struggle to keep their club and offers lessons learned about student activism, school change,…

  7. Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause?

    PubMed Central

    2011-01-01

    Background The rising prevalence of chronic kidney disease (CKD) and subsequent end stage renal failure necessitating renal replacement therapy has profound consequences for affected individuals and health care resources. This community based study was conducted to identify potential predictors of microalbuminuria in a randomly selected sample of adults from the North Central Province (NCP) of Sri Lanka, where the burden of CKD is pronounced and the underlying cause still unknown. Methods Exposures to possible risk factors were determined in randomly recruited subjects (425 females and 461 males) from selected areas of the NCP of Sri Lanka using an interviewer administered questionnaire. Sulphosalicylic acid and the Light Dependent Resister microalbumin gel filtration method was used for initial screening for microalbuminuria and reconfirmed by the Micral strip test. Results Microalbumnuria was detected in 6.1% of the females and 8.5% of the males. Smoking (p < 0.001), alcohol use (p = 0.003), hypertension (p < 0.001), diabetes (p < 0.001), urinary tract infection (UTI) (p = 0.034) and consumption of water from wells in the fields (p = 0.025) were associated with microalbuminuria. In the binary logistic regression analysis, hypertension, diabetes mellitus, UTI, drinking well water in the fields, smoking and pesticide spraying were found to be significant predictors of microalbuminuria. Conclusions Hypertension, diabetes mellitus, UTI, and smoking are known risk factors for microalbuminuria. The association between microalbuminuria and consumption of well water suggests an environmental aetiology to CKD in NCP. The causative agent is yet to be identified. Investigations for cadmium as a potential causative agent needs to be initiated. PMID:21726464

  8. Observaciones de la corona solar interior con un coronógrafo de espejo

    NASA Astrophysics Data System (ADS)

    Stenborg, G.; Schwenn, R.; Francile, C.; Rovira, M.

    El plasma de la corona solar es un buen indicador de las líneas de fuerza del campo magnético. Por lo tanto, el análisis de estructuras coronales cuasiestacionarias en la corona da importante información sobre el campo magnético y la actividad asociada. Se trata de poner límites a los modelos teóricos existentes mediante el estudio de distintas estructuras en la corona interior. En agosto de 1997 comenzó a operar el coronógrafo solar (MICA) en El Leoncito como parte del Observatorio Solar Alemán-Argentino. Desde su instalación obtiene imágenes de la corona solar (1.05 a 2.0 radios solares) en 2 líneas espectrales correspondientes a la emisión de Fe XIV y Fe X. El instrumento puede obtener imágenes cada minuto por lo que es ideal para estudiar procesos rápidos. Presentamos observaciones recientes que muestran la capacidad del coronógrafo así como la evolución de algunos eventos dinámicos observados por MICA.

  9. Diabetic nephropathy--a review of the natural history, burden, risk factors and treatment.

    PubMed Central

    Ayodele, Olugbenga E.; Alebiosu, C. Olutayo; Salako, Babatunde L.

    2004-01-01

    The earliest clinical evidence of diabetic nephropathy is microalbuminuria. Progression from microalbuminuria to overt nephropathy occurs in 20-40% within a 10-year period with approximately 20% of these patients progressing to end-stage renal disease. End-stage renal disease develops in 50% of type-1 diabetes patients with overt nephropathy within 10 years and in more than 75% by 20 years in the absence of treatment. In type-2 diabetes, a greater proportion of patients have microalbuminuria and overt nephropathy at or shortly after diagnosis of diabetes. The incidence of diabetes is increasing worldwide, with subsequent increase in the incidence of diabetic nephropathy. The risk factors identified in the development of DN from longitudinal and cross-sectional studies include race, genetic susceptibility, hypertension, hyperglycemia, hyperfiltration, smoking, advanced age, male sex, and high-protein diet. Treatment interventions in diabetic nephropathy include glycemic control, treatment of hypertension, hyperlipidemia, cessation of smoking, protein restriction, and renal replacement therapy. Multifactorial approach includes combined therapy targeting hyperglycemia, hypertension, microalbuminuria, and dyslipidemia. PMID:15586648

  10. CUBN Is a Gene Locus for Albuminuria

    PubMed Central

    Böger, Carsten A.; Chen, Ming-Huei; Tin, Adrienne; Olden, Matthias; Köttgen, Anna; de Boer, Ian H.; Fuchsberger, Christian; O'Seaghdha, Conall M.; Pattaro, Cristian; Teumer, Alexander; Liu, Ching-Ti; Glazer, Nicole L.; Li, Man; O'Connell, Jeffrey R.; Tanaka, Toshiko; Peralta, Carmen A.; Kutalik, Zoltán; Luan, Jian'an; Zhao, Jing Hua; Hwang, Shih-Jen; Akylbekova, Ermeg; Kramer, Holly; van der Harst, Pim; Smith, Albert V.; Lohman, Kurt; de Andrade, Mariza; Hayward, Caroline; Kollerits, Barbara; Tönjes, Anke; Aspelund, Thor; Ingelsson, Erik; Eiriksdottir, Gudny; Launer, Lenore J.; Harris, Tamara B.; Shuldiner, Alan R.; Mitchell, Braxton D.; Arking, Dan E.; Franceschini, Nora; Boerwinkle, Eric; Egan, Josephine; Hernandez, Dena; Reilly, Muredach; Townsend, Raymond R.; Lumley, Thomas; Siscovick, David S.; Psaty, Bruce M.; Kestenbaum, Bryan; Haritunians, Talin; Bergmann, Sven; Vollenweider, Peter; Waeber, Gerard; Mooser, Vincent; Waterworth, Dawn; Johnson, Andrew D.; Florez, Jose C.; Meigs, James B.; Lu, Xiaoning; Turner, Stephen T.; Atkinson, Elizabeth J.; Leak, Tennille S.; Aasarød, Knut; Skorpen, Frank; Syvänen, Ann-Christine; Illig, Thomas; Baumert, Jens; Koenig, Wolfgang; Krämer, Bernhard K.; Devuyst, Olivier; Mychaleckyj, Josyf C.; Minelli, Cosetta; Bakker, Stephan J.L.; Kedenko, Lyudmyla; Paulweber, Bernhard; Coassin, Stefan; Endlich, Karlhans; Kroemer, Heyo K.; Biffar, Reiner; Stracke, Sylvia; Völzke, Henry; Stumvoll, Michael; Mägi, Reedik; Campbell, Harry; Vitart, Veronique; Hastie, Nicholas D.; Gudnason, Vilmundur; Kardia, Sharon L.R.; Liu, Yongmei; Polasek, Ozren; Curhan, Gary; Kronenberg, Florian; Prokopenko, Inga; Rudan, Igor; Ärnlöv, Johan; Hallan, Stein; Navis, Gerjan; Parsa, Afshin; Ferrucci, Luigi; Coresh, Josef; Shlipak, Michael G.; Bull, Shelley B.; Paterson, Andrew D.; Wichmann, H.-Erich; Wareham, Nicholas J.; Loos, Ruth J.F.; Rotter, Jerome I.; Pramstaller, Peter P.; Cupples, L. Adrienne; Beckmann, Jacques S.; Yang, Qiong; Heid, Iris M.; Rettig, Rainer; Dreisbach, Albert W.; Bochud, Murielle

    2011-01-01

    Identification of genetic risk factors for albuminuria may alter strategies for early prevention of CKD progression, particularly among patients with diabetes. Little is known about the influence of common genetic variants on albuminuria in both general and diabetic populations. We performed a meta-analysis of data from 63,153 individuals of European ancestry with genotype information from genome-wide association studies (CKDGen Consortium) and from a large candidate gene study (CARe Consortium) to identify susceptibility loci for the quantitative trait urinary albumin-to-creatinine ratio (UACR) and the clinical diagnosis microalbuminuria. We identified an association between a missense variant (I2984V) in the CUBN gene, which encodes cubilin, and both UACR (P = 1.1 × 10−11) and microalbuminuria (P = 0.001). We observed similar associations among 6981 African Americans in the CARe Consortium. The associations between this variant and both UACR and microalbuminuria were significant in individuals of European ancestry regardless of diabetes status. Finally, this variant associated with a 41% increased risk for the development of persistent microalbuminuria during 20 years of follow-up among 1304 participants with type 1 diabetes in the prospective DCCT/EDIC Study. In summary, we identified a missense CUBN variant that associates with levels of albuminuria in both the general population and in individuals with diabetes. PMID:21355061

  11. A cross-sectional study of HIV-seropositive patients with varying degrees of proteinuria in South Africa.

    PubMed

    Han, T M; Naicker, S; Ramdial, P K; Assounga, A G

    2006-06-01

    Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is the most common finding on renal biopsy in HIV-infected black patients and is also the commonest cause of end-stage renal disease in these patients. Early detection of HIVAN may be beneficial in evaluating early treatment. This study examined the pattern of renal diseases in HIV-infected South Africans and also attempted to diagnose HIVAN at an early stage. In this single-center cross-sectional study, 615 HIV-infected patients were screened for proteinuria. Thirty patients with varying degrees of proteinuria underwent renal biopsy. Patients with diabetes mellitus, uncontrolled hypertension, known causes of chronic kidney disease, and serum creatinine above 250 mumol/l were excluded. Patients in this study were not on antiretroviral therapy. HIVAN was found in 25 (83%) patients. Six of them (24%) had microalbuminuria. Altogether, seven patients with persistent microalbuminuria were biopsied and six (86%) showed HIVAN. Other biopsy findings included membranoproliferative nephropathy in two (7%) and interstitial nephritis in three (10%). Four patients with HIVAN had associated membranous nephropathy. HIVAN is the commonest biopsy finding among our study patients with HIV infection who present with varying degrees of proteinuria. Microalbuminuria is a manifestation of HIVAN in our study patients. Therefore, microalbuminuria may be an early marker of HIVAN, and screening for its presence may be beneficial. Renal biopsy may be considered in seropositive patients who present with persistent microalbuminuria, especially with low CD4 counts irrespective of good renal function. This will allow diagnosis and treatment of HIVAN at an early stage and may prevent further disease progression. PMID:16672914

  12. Insertion of Astronomy as a High School Subject. (Spanish Title: Inserción de Astronomia Como Materia del Ciclo Secundario.) Inserção da Astronomia Como Disciplina Curricular do Ensino Médio

    NASA Astrophysics Data System (ADS)

    Dias, Claudio André C. M.; Santa Rita, Josué R.

    2008-12-01

    Astronomy is considered among the first sciences that man dominated, however, the basic skills for the construction of knowledge, relatively to the contents "Earth and the Universe" are not being developed properly for the majority of students concluding the high school level. The students are concluding this teaching cycle without proper knowledge of several subjects in the area of Astronomy, which are mandatory in the national Curricular National Parameters (PCN). Because of this discrepancy, this work stresses the need of the incorporation of a specific subject of Astronomy in the high school, in order to reduce the gap between what is taught and which should be taught. La Astronomía es considerada una de las primeras ciencias que el hombre dominó. Sin embargo, las habilidades básicas para la construcción del conocimento, relativo al eje temático "Tierra y Universo", no vienen siendo trabajadas adecuadamente con la mayoría de los alumnos que concluyen el ciclo escolar medio. Los alumnos están concluyendo este nivel de enseñanza sin conocimentos de varios temas en el área de Astronomía, que son obligatorios según los Parámetros Curriculares Nacionales (PCN). En virtud de esta discrepancia, este trabajo enfatiza la necesidad de incorporar una disciplina específica de Astronomía em el ciclo medio, em pro de la reducción de las distorsiones entre lo que es enseñado y lo que se debe enseñar. A Astronomia é considerada uma das primeiras ciências que o homem dominou, porém as competências básicas para a construção do conhecimento, relativo ao eixo temático "Terra e Universo", não vêm sendo trabalhadas a contento com a maioria dos alunos que concluem o ensino médio. Os alunos estão concluindo este nível de ensino sem conhecimento de vários temas na área de Astronomia, que são obrigatórios nos Parâmetros Curriculares Nacionais (PCN). Em virtude desta discrepância, este trabalho vem evidenciar a necessidade da incorporação de uma disciplina específica de Astronomia, no ensino médio, em prol da redução das distorções entre o que é ensinado e o que se deve ensinar.

  13. How Families Teach, Support, Learn, Make Decisions: Ways for Families To Help Children Do Better in School = Como las Familias Ensenan, Apoyan, Aprenden, Toman Decisiones: Como las Familias Ayudan a los Ninos a Mejorar en la Escuela.

    ERIC Educational Resources Information Center

    RMC Research Corp., Hampton, NH.

    This booklet contains ideas about how families can help children in school in the following basic ways by: (1) teaching their children; (2) learning new things to help their children learn; (3) supporting children and the school; and (4) making decisions about what and how children learn. For each of these areas, a chart is included so that…

  14. Contextualizacion y "Expresiones Pragmaticas": "Che" como Senal de Marco (Contextualization and "Pragmatic Expressions": "Che" as Deictic Marker).

    ERIC Educational Resources Information Center

    Carranza, Isolda

    The pragmatic expressions of Argentine Spanish (e.g., "bueno, viste, no? mira") are defined as deictic signals. They are deictic because they indicate elements of the communicative situation: transitions between text segments, conversational roles, or the social relationship between participants. They also signal contextual suppositions and help…

  15. La Traduccion Simultanea como Materia en Una Carrera de Lenguas (Simultaneous Translation as a Course in a Foreign Language Program)

    ERIC Educational Resources Information Center

    Bradley, D.

    1977-01-01

    A description of the foreign language curriculum at the university level in which courses in simultaneous translation are required. The size and composition of the groups are described as well as methods used to develop skill in translating and interpreting. Results are assessed. (Text is in Spanish.) (AMH)

  16. How To Start a Family Day Care = Como Iniciar una Guarderia en El Hogar. [Videotape and Viewer's Guide].

    ERIC Educational Resources Information Center

    Raphael, Doris; Weisman, Douglas

    Being a family day care provider is work that requires professional responsibilities and attention to the physical, emotional, and educational well-being of children; listening and responding to parents; and running a business. This videotape, in English- and Spanish-language versions, explores the elements involved in starting up a family day…

  17. Como ayudar a los padres a prevenir el envenenamiento por plomo (Helping Parents Prevent Lead Poisoning). ERIC Digest.

    ERIC Educational Resources Information Center

    Binns, Helen J.; Ricks, Omar Benton

    Children are at greater risk than adults for lead poisoning because children absorb lead more readily than adults, and a small amount of lead in children's bodies can do a great deal of harm. This Spanish-language Digest summarizes some of the causes and effects of childhood lead poisoning and suggests some lead poisoning prevention strategies…

  18. Caracteristicas de la Instruccion Programada como Tecnica de Ensenanza (Characteristics of Programed Instruction as a Teaching Technique).

    ERIC Educational Resources Information Center

    Dorrego, Maria Elena

    This discussion of programed instruction begins with the fundamental psychological aspects and learning theories behind this teaching method. Negative and positive reinforcement, conditioning, and their relationship to programed instruction are considered. Different types of programs, both linear and branching, are discussed; criticism of the…

  19. "Tras de un Amoroso Lance" como Estructura Expresiva (The Poem, "Behind the Amorous Cast" as an Expressive Structure).

    ERIC Educational Resources Information Center

    Bratosevich, Nicolas

    1967-01-01

    An analysis of a poem by San Juan de la Cruz (St. John of the Cross), the sixteenth century Spanish mystic, identifies symbols and images, explains themes, and offers a synthesis of his structural patterns. The poem, "Tras de amoroso lance", deals with the theme of the search of the beloved (i.e., the soul) for the lover, and incorporates the…

  20. Significant Learning Experiences for English Foreign Language Students (Experiencias significativas para estudiantes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Becerra, Luz María; McNulty, Maria

    2010-01-01

    This action research examines experiences that students in a grade 10 EFL class had with redesigning a grammar-unit into a topic-based unit. Strategies were formulating significant learning goals and objectives, and implementing and reflecting on activities with three dimensions of Dee Fink's (2003) taxonomy of significant learning: the human…

  1. Las líneas de aluminio neutro como diagnóstico cromosférico

    NASA Astrophysics Data System (ADS)

    Fernández Borda, R.; Mauas, P. J. D.

    Se presenta un modelo atómico para el cálculo de las lí neas del Aluminio neutro que se forman en la cromósfera solar. En particular, se estudia la línea λ 3961 Å, que, por estar muy próxima a la lí nea H del Ca II y a Hɛ es muy frecuentemente observada. Observaciones en esta lí nea obtenidas con el espectrógrafo a instalarse en el CASLEO, serán utilizadas para el estudio de fulguraciones solares.

  2. The English as a Foreign Language/Lingua Franca Debate: Sensitising Teachers of English as a Foreign Language towards Teaching English as a Lingua Franca (El debate del inglés como lengua extranjera o como lengua franca: sensibilización de docentes de inglés como lengua extranjera hacia la enseñanza del inglés como lengua franca)

    ERIC Educational Resources Information Center

    Mansfield, Gillian; Poppi, Franca

    2012-01-01

    The function of English as a lingua franca for communication needs rethinking in the teaching of English as a foreign language classroom as a consequence of globalisation. The present contribution is an empirical study carried out in an Italian university environment which aims to show how teachers should take on board awareness raising activities…

  3. How Can We Provide Safe Playgrounds? = Como podemos proveer lugares con juegos infantiles que no sean peligrosos para los ninos?

    ERIC Educational Resources Information Center

    ACCESS ERIC, Rockville, MD.

    Outdoor playgrounds can be exciting places where children explore their environment and develop motor and social skills; however, they can also pose serious safety hazards. With the exception of California, no mandatory state or federal standards currently exist regarding manufacture or installation of playground equipment or surfaces. The…

  4. Parámetros fundamentales de objetos catalogados como cúmulos estelares en la Nube Mayor de Magallanes

    NASA Astrophysics Data System (ADS)

    Piatti, A. E.

    We present the results of 16 Large Magellanic Cloud (LMC) clusters ob- tained for the first time from CCD Washington CT1 T2 photometry. CMD cluster features turn out to be identifiable when performing annular extrac- tions around their respective centres, once they were cleaned from field star contamination; their main sequences extending from one up to four mag- nitudes downwards. The clusters resulted to be small angular size objects projected or immersed in dense star fields, as judged from their radial stellar density profiles, so that crowding effect could be responsible for the limited magnitude reached in some cases. We estimated their ages from isochrone fitting - along with the E(B - V ) colour excesses - assuming a metallicity of Z = 0.008 ([Fe/H] = -0.4 dex) and a LMC distance modulus of (m - M)o = 18.50 ± 0.10 mag. FULL TEXT IN SPANISH

  5. PubMed

    Rodríguez, Yarimar Rosa; Díaz, Nelson Varas

    2008-01-01

    El proceso de estigmatización asume una devaluación de la persona debido a una característica o marca que haya sido identificada socialmente y que permita que se le describa como diferente. Desde que se desató la epidemia del VIH/SIDA, vivir con la enfermedad ha sido señalado de manera social como una marca estigmatizante. Las manifestaciones de dicha estigmatización se han documentado entre profesionales de la salud. Este estigma puede afectar los servicios de salud que las personas que viven con VIH/SIDA reciben de estos profesionales. Los objetivos de esta investigación fueron explorar: 1) la percepción que tienen estudiantes y profesionales de la salud sobre su nivel de competencia para ofrecer servicios a personas que viven con VIH/SIDA, 2) las opiniones de éstos sobre el tipo de adiestramiento profesional recibido y la necesidad del mismo, y 3) la manifestación de actitudes estigmatizantes como indicadores de necesidad de adiestramiento profesional. La muestra total del estudio estuvo compuesta por 80 de diversas profesiones de la salud. Los resultados reflejan que algunos/as de los/as participantes han recibido formación en VIH pero ésta no ha sido suficiente para contrarrestar las nociones estigmatizantes. Discutimos las implicaciones de los resultados para investigaciones futuras y el desarrollo de intervenciones con vías de minimizar las nociones estigmatizantes en los escenarios de salud. PMID:20011236

  6. [The implications of the automatic blood pressure monitoring (ABPM) in the type I diabetes].

    PubMed

    Cobuz, C

    2009-01-01

    The connection between hypertension and diabetes emerges, in medical practice, from the current belief imposed by the European Society of Cardiology adding to the notion of total cardiovascular risk. An increse in the systolic blood pressure at night time is the first detectable manifestation of the regulation disorders of the blood pressure in type I diabetes. An early increase of the nocturnal blood pressure can play a key role in the detection of the evolution towards diabetic nephropathy. This modification can be a valuable potential marker for the diabetic nephropathy and could provide a reason for treating the high risk patients before the onset of microalbuminuria. The evaluation of the nefropathy risk in the early stages of type I diabetes using Ambulatory Blood Pressure Monitoring (ABPM) method offers the best premisses for preventing the progression of the disease towards microalbuminuria and hypertension. PMID:21495340

  7. The Fluidez en La Lectura Oral (FLO) Portion of the Indicadores Dinamicos De Exito en La Lectura (IDEL) and the English Language Portion of the Illinois Standard Achievement Test (ISAT): A Correlational Study of Second and Third Grade English Language Learners

    ERIC Educational Resources Information Center

    Ganan, Brian J.

    2012-01-01

    This study examined the relationship between Spanish oral reading fluency (ORF) at the end of second grade and students' performance on the third grade ISAT reading test. The major research question guiding this study was: What is the direction and strength of the relationship between performance on the 2nd grade IDEL FLO, a Spanish language…

  8. Quality Markers in Cardiology. Main Markers to Measure Quality of Results (Outcomes) and Quality Measures Related to Better Results in Clinical Practice (Performance Metrics). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): A SEC/SECTCV Consensus Position Paper.

    PubMed

    López-Sendón, José; González-Juanatey, José Ramón; Pinto, Fausto; Cuenca Castillo, José; Badimón, Lina; Dalmau, Regina; González Torrecilla, Esteban; López-Mínguez, José Ramón; Maceira, Alicia M; Pascual-Figal, Domingo; Pomar Moya-Prats, José Luis; Sionis, Alessandro; Zamorano, José Luis

    2015-11-01

    Cardiology practice requires complex organization that impacts overall outcomes and may differ substantially among hospitals and communities. The aim of this consensus document is to define quality markers in cardiology, including markers to measure the quality of results (outcomes metrics) and quality measures related to better results in clinical practice (performance metrics). The document is mainly intended for the Spanish health care system and may serve as a basis for similar documents in other countries. PMID:26315766

  9. [Not Available].

    PubMed

    Flores Navarro-Pérez, Carmen; González-Jiménez, Emilio; Schmidt-RioVilla, Jacqueline; Meneses-Echávez, José Francisco; Correa-Bautista, Jorge Enrique; Correa-Rodríguez, María; Ramírez-Vélez, Robinson

    2016-01-01

    Objetivos: los objetivos de este estudio fueron analizar el nivel nutricional en una población de niños y adolescentes colombianos y determinar la posible relación entre el nivel nutricional y el estado nutricional según el índice de masa corporal (IMC) y la circunferencia de cintura (CC).Material y métodos: estudio transversal en 6.383 niños y adolescentes de entre 9 y 17,9 años de edad, de Bogotá, Colombia. Se aplicó de manera autodiligenciada el cuestionario Krece Plus validado en el estudio enKid como indicador del nivel nutricional con las categorías alto (test ≥ 9), medio (test 6-8) y bajo (test ≤ 5). Se tomaron medidas de peso, talla, CC, y se calculó el IMC como marcadores del estado nutricional.Resultados: de la población general, el 57,9% eran chicas (promedio de edad 12,7 ± 2,3 años). En todas las categorías del IMC, más del 50% de chicos y chicas siguen una dieta de muy baja calidad, que empeora progresivamente con el avance en edad. En ambos sexos, se observaron tendencias entre un nivel nutricional muy bajo con el desarrollo de sobrepeso. Asimismo, la obesidad abdominal por CC se relacionó con una puntuación baja en el Krece Plus en ambos sexos.Conclusiones: en escolares de Bogotá, una dieta de muy baja calidad se relacionó con alteraciones del estado nutricional (IMC y CC), especialmente entre chicas y adolescentes. Estos resultados deben alentar el desarrollo de intervenciones orientadas a mejorar los hábitos nutricionales entre los escolares colombianos. PMID:27571667

  10. Comparison of Methods for Renal Risk Prediction in Patients with Type 2 Diabetes (ZODIAC-36)

    PubMed Central

    Riphagen, Ineke J.; Kleefstra, Nanne; Drion, Iefke; Alkhalaf, Alaa; van Diepen, Merel; Cao, Qi; Groenier, Klaas H.; Landman, Gijs W. D.; Navis, Gerjan; Bilo, Henk J. G.; Bakker, Stephan J. L.

    2015-01-01

    Background Patients with diabetes are at high risk of death prior to reaching end-stage renal disease, but most models predicting the risk of kidney disease do not take this competing risk into account. We aimed to compare the performance of Cox regression and competing risk models for prediction of early- and late-stage renal complications in type 2 diabetes. Methods Patients with type 2 diabetes participating in the observational ZODIAC study were included. Prediction models for (micro)albuminuria and 50% increase in serum creatinine (SCr) were developed using Cox regression and competing risk analyses. Model performance was assessed by discrimination and calibration. Results During a total follow-up period of 10 years, 183 out of 640 patients (28.6%) with normoalbuminuria developed (micro)albuminuria, and 22 patients (3.4%) died without developing (micro)albuminuria (i.e. experienced the competing event). Seventy-nine out of 1,143 patients (6.9%) reached the renal end point of 50% increase in SCr, while 219 (19.2%) died without developing the renal end point. Performance of the Cox and competing risk models predicting (micro)albuminuria was similar and differences in predicted risks were small. However, the Cox model increasingly overestimated the risk of increase in SCr in presence of a substantial number of competing events, while the performance of the competing risk model was quite good. Conclusions In this study, we demonstrated that, in case of substantial numbers of competing events, it is important to account for the competing risk of death in renal risk prediction in patients with type 2 diabetes. PMID:25775414

  11. [DYNAMICS OF METABOLIC CHARACTERISTICS, MARKERS OF OXIDATIVE STRESS AND VASCULAR WALL DAMAGE DURING TREATMENT OF OBESE PRE-DIABETIC PATIENTS].

    PubMed

    Romanenko, L A; Polyatykina T S; Mavrycheva, N V; Budnikova, N V; Grinshtein, V B

    2016-01-01

    We studied lipid and carbohydrate metabolism, markers of oxidative stress (plasma malonic dialdehyde and dienoic conjugates) and vascular wall damage (CRP microalbuminuria, blood desquamated endotheliocytes) before and after 12 week treatment of obese pre-diabetic patients. The study showed positive dynamics of the above metabolic parameters with normalization of carbohydrate metabolism in 60% of the patients and angioprotective effect of prescribed therapy. The proposed treatment can be used to prevent diabetes mellitus. PMID:27522729

  12. Management of Madhumeha Janya Upadrava with special reference to diabetic nephropathy - A clinical study

    PubMed Central

    Akarshini, A.M.; Aruna

    2014-01-01

    Background: Diabetic nephropathy (DN) is a microvascular complication of diabetes mellitus. As the disease DN manifests secondary to Madhumeha, the disease is termed as Madhumeha Janya Upadrava. The diagnosis of DN is microalbuminuria is a powerful screening tool in screening DN earlier stages. A diabetic can develop nondiabetic renal disease like anyone, but the finding of diabetic retinopathy strongly suggests that any proteinuria is due to diabetic glomerulosclerosis. In this dissertation, all diabetic patients who showed positive diabetic retinopathy changes; were screened for 24 h microalbuminuria, at its earlier asymptomatic period itself. This research work is specially intended to instigate effective therapies at earlier stage itself, thereby prevent further progression. Aim: To evaluate the combined effect of Shilajitvadi Vataka, Punarnavadi Mandura, Triphala Guggulu and Pippalimooladi Paneeya added with Amrita and Bringaraja in DN. Materials and Methods: Single blind clinical study with pre-test and post-test was designed. The study conducted on 15 patients of both sex aged between 20 and 80 years, having DN changes through assays for microalbuminuria and other biochemical assays; along with prior confirmation of diabetic retinopathy changes. The duration of the study was 48 days and patients were assessed on every 15 days. Results: After 48 days of treatment, statistically significant improvement in levels of microalbuminuria with mean difference 83.76 μg/24 h, highly significant improvement in status of Agni and statistically no significant improvement in glomerular filtration rate by 2.381 mL/min/1.73m2. No significant side-effects were observed. Conclusion: Overall the study showed encouraging results in treating the malady DN. PMID:26195899

  13. Urinary albumin-to-creatinine ratio is associated with endothelial dysfunction in HIV-infected patients receiving antiretroviral therapy

    PubMed Central

    Pirro, Matteo; Mannarino, Massimo R.; Francisci, Daniela; Schiaroli, Elisabetta; Bianconi, Vanessa; Bagaglia, Francesco; Sahebkar, Amirhossein; Mannarino, Elmo; Baldelli, Franco

    2016-01-01

    Endothelial dysfunction, a marker of cardiovascular (CV) risk, is common in human immunodeficiency virus (HIV)-infected patients. Microalbuminuria is frequent in HIV-infected patients, and is a predictor of renal impairment and CV risk. We investigated the association between microalbuminuria and endothelial dysfunction among HIV-infected patients receiving highly-active antiretroviral therapy (HAART). Endothelial function, measured by brachial artery flow-mediated dilatation (bFMD), and urine albumin-to-creatinine ratio (UACR), were measured in 170 HAART-treated HIV-infected adults. The relationship between UACR and bFMD was evaluated. The prevalence of increased UACR, defined by two cut-off levels (20 mg/g and 30 mg/g), was 29% and 17%. UACR was significantly higher while bFMD was lower among patients with metabolic syndrome (MS). UACR was associated with bFMD (r = −0.31; p < 0.001). This association was stronger in MS-patients (r = −0.44; p = 0.003). UACR above 20 mg/g was associated with an increased risk (OR 2.37, 95% CI 1.15–4.89, p = 0.020) of severely impaired bFMD (bFMD ≤ 2.1%). Patients with MS and increased UACR had the lowest bFMD compared with those with none or one of the two conditions. Microalbuminuria and endothelial dysfunction are positively associated in HIV-infected patients regardless of known confounders. The coexistence of microalbuminuria and MS amplifies their deleterious influence on endothelial function. PMID:27353425

  14. Espectroscopia infravermelha de núcleos ativos de galáxias: resultados adicionais

    NASA Astrophysics Data System (ADS)

    Rodríguez Ardila, A.; Viegas, S.; Pastoria, M. G.

    2003-08-01

    Apresentamos resultados parciais de um levantamento espectroscópico na região do infravermelho próximo (NIR) realizado em 30 núcleos ativos de galáxias (AGN), incluindo vários objetos selecionados do catálogo PG com z de até 0.55. O objetivo é estudar a natureza do contínuo observado e as condições físicas do gas emissor. Todas as fontes de tipo 1 apresentam uma mudança na inclinação do contínuo na região de 1.2mm, associada ao término da contribuição do contínuo emitido pelo AGN e ao início da contribuição do contínuo emitido pela poeira quente atribuída ao tórus que rodeia a fonte central. O índice espectral associado à segunda contribuição varia apreciavelmente de objeto para objeto. Este resultado é comparado com distribuições espectrais de energia preditas por modelos de toroides para testar a validez do modelo unificado. A partir das linhas de FeII observado nos espectros deriva-se, pela primeira vez nessa região espectral, um template empírico de FeII para estudar a intensidade e a origem dessa emissão. A intensidade do FeII é estudada em conjunto com aquela da região visível e comparada às predições de modelos teóricos que incluem fluorescência de Lya, excitação colisional e auto-fluorescência como mecanismos dominantes de exitação. Encontra-se que os dois primeiros processos dominam na formação do espectro de FeII observado. Indicadores de avermelhamento, entre eles Brg/Pab, Pab/Pag, Pab/Pad e [FeII] 1.257/1.644 mm são utilizados para mapear a distribuição de poeira nas regiões emissoras de linhas. Encontra-se valores de extinção Av~3 associados ao último indicador e valores significativamente menores (Av~1.5) para os restantes, o que sugere que o [FeII] se forma em uma região separada da maior parte do gás emissor de linhas estreitas.

  15. [In Process Citation].

    PubMed

    Vivas-Díaz, José Andrés; Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique; Izquierdo, Mikel

    2016-01-01

    Introducción: la evaluación de la fuerza de prensión realizada comúnmente mediante dinamometría manual actualmente es considerada como un indicador del estado nutricional y como un marcador temprano en la morbimortalidad de la enfermedad cardiometabólica. Objetivos: en este estudio, se presentan valores de la fuerza prensil por dinamometría manual en una muestra de estudiantes universitarios de Colombia. Método: estudio descriptivo y transversal realizado en 5.647 estudiantes universitarios aparentemente sanos (58,5% mujeres, edad media 20,6 ± 2,7 años) pertenecientes a instituciones privadas y públicas de Bogotá y Cali (Colombia). La fuerza prensil se midió utilizando dinamómetro manual, ajustado para cada individuo según el tamaño de la mano. Se calcularon percentiles (P 3 , P 10 , P 25 , P 50 , P 75 , P 90 y P 97 ) y curvas centiles ajustado por edad y sexo. Resultados: el valor medio de fuerza prensil fue significativamente mayor en los hombres (37,1 ± 8,3 kg) en comparación con las mujeres (24.2 ± 8.1 kg) (p < 0,001). En ambos sexos, la fuerza prensil aumentó con la edad y fue significativamente mayor y homogénea en los hombres en todas las categorías de edad. Adicionalmente, se presentan tablas de referencia que pueden ser empleadas para identificar estudiantes con niveles de fuerza saludable. Conclusión: este trabajo puede ser tenido en cuenta como referencia para estudiar las tendencias seculares y las variaciones de la fuerza prensil en universitarios y para identificar puntos de corte clínicamente relevantes en el estado nutricional y como un marcador de manifestaciones tempranas asociadas a la enfermedad cardiometabólica en la población Suramericana. PMID:27238795

  16. Neutrophil Gelatinase-Associated Lipocalin as an Early Sign of Diabetic Kidney Injury in Children

    PubMed Central

    Yürük Yıldırım, Zeynep; Nayır, Ahmet; Yılmaz, Alev; Gedikbaşı, Asuman; Bundak, Rüveyde

    2015-01-01

    Objective: There is some evidence indicating that histopathological changes in type 1 diabetes mellitus (T1DM) emerge before onset of microalbuminuria. The aim of our study was to determine whether urine neutrophil gelatinase-associated lipocalin (NGAL) levels can be considered as an early sign of diabetic kidney injury. Methods: Urine NGAL (uNGAL) levels and urinary NGAL/creatinine ratio (uNGAL/Cr) were assessed in 76 patients with T1DM and compared with the findings of 35 healthy individuals. The relationship of uNGAL levels with diabetes duration, body mass index (BMI), serum lipids, HbA1c, and microalbuminuria was also evaluated. Results: Mean uNGAL (100.16±108.28 ng/mL) and uNGAL/Cr (118.93-117.97 ng/mg) levels in both microalbuminuric and non-microalbuminuric diabetic patients were found to be higher than those in the control group (uNGAL: 21.46±18.59 ng/mL and uNGAL/Cr: 32.1±51.48 ng/mg) (p=0.0001). Conclusion: Urine NGAL level increases in the very early phase of T1DM before microalbuminuria develops. The patients with T1DM should be considered to have diabetic kidney injury from the time of diagnosis on and preventive interventions need to be initiated at an early stage to preclude the progression to end-stage renal disease. PMID:26777038

  17. Managing the asymptomatic diabetic patient with silent myocardial ischaemia.

    PubMed

    Doubell, A F

    2002-01-01

    Coronary artery disease is common in diabetic patients and remains the major cause of death in these patients. However myocardial ischaemia resulting from coronary lesions does not always give rise to symptoms. The managing physician must therefore consider the benefit of screening for silent myocardial ischaemia in diabetic patients. Screening all diabetic patients is not recommended. The challenge to the physician is to select the patient subgroups likely to benefit from screening. Patients with more than one cardiac risk factor (dyslipidaemia, hypertension, smoking, family history, micro-albuminuria) in addition to diabetes, as well as patients with established macrovascular disease, e.g. peripheral vascular disease, will benefit most from screening. A standard treadmill stress ECG is the recommended screening test. A number of additional tests have been proposed to select high-risk patients for screening. Of these, testing for microalbuminuria and elevated CRP levels are most likely to influence decision-making. Once silent ischaemia has been detected in a diabetic patient, the mainstay of treatment remains the aggressive control of risk factors, improvement of glycaemic control and aspirin therapy. The use of beta-blockers and ACE-inhibitors often need consideration. The attending physician must then consider referring the patient to a cardiologist for angiography and possible intervention. This decision is based on the presence of poor prognostic signs during the stress ECG and the number of risk factors present. Microalbuminuria and elevated CRP levels are helpful in assisting with the risk stratification process. PMID:12389062

  18. An interaction between the interleukin-6 -174G>C gene variant and urinary protein excretion influences plasma oxidative stress in subjects with type 2 diabetes

    PubMed Central

    Stephens, Jeffrey W; Hurel, Steven J; Acharya, Jayshree; Humphries, Steve E

    2004-01-01

    Background Microalbuminuria and subsequent progression to proteinuria and nephropathy is associated with increased oxidative stress, increased inflammatory cytokines and increased cardiovascular (CVD) risk. The common functional IL-6 -174G>C gene variant is also associated with elevated levels of inflammatory cytokines and CVD risk. Methods The aim of this study was to examine the association between the IL-6 -174G>C gene variant with plasma total antioxidant status (TAOS) in 552 subjects with type 2 diabetes in relation to urinary protein excretion. Results In subjects free from CVD, there was a significant interaction between urinary protein excretion (normoalbuminuria/ microalbuminuria/proteinuria) and the -174C allele (compared to -174GG) in determining plasma TAOS (p value for interaction = 0.03). In the -174C allele carriers there was a significant association between plasma TAOS and urinary protein excretion: normalbuminuria v microalbuminuria v proteinuria: 44.30% ± 11.32 vs. 39.74% ± 14.83 vs. 37.93% ± 16.42, ANOVA p = 0.025. In those with CVD, no interaction or association was observed with the -174C allele (p = 0.246). Conclusion The IL-6 -174G>C gene variant is associated with differences in plasma oxidative stress in response to altered protein excretion in subjects with type 2 diabetes. PMID:14992698

  19. Interculturalidad y anglofonia en la ensenanza del ingles como lengua extranjera (Interculturalism and Anglophone Studies in the Teaching of English as a Foreign Language).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee; Revilla, Teresa Flores

    This article, written in Spanish, proposes to incorporate the subject "Anglophonism" into the curriculum of English as a Foreign Language (EILE) with a view to providing universities with an intercultural division. It provides a brief summary of John Dewey's philosophy with regard to anthropology, politics, and education. It explains the term…

  20. "Mastery Learning" Como Metodo Psicoeducativo para Ninos con Problemas Especificos de Aprendizaje. ("Mastery Learning" as a Psychoeducational Method for Children with Specific Learning Problems.)

    ERIC Educational Resources Information Center

    Coya, Liliam de Barbosa; Perez-Coffie, Jorge

    1982-01-01

    "Mastery Learning" was compared with the "conventional" method of teaching reading skills to Puerto Rican children with specific learning disabilities. The "Mastery Learning" group showed significant gains in the cognitive and affective domains. Results suggested Mastery Learning is a more effective method of teaching reading skills to children…

  1. Uso de exámenes de detección como oportunidad para ayudar a fumadores a dejar el tabaco

    Cancer.gov

    El NCI ha publicado un anuncio de financiamiento para ayudar a estimular la investigación sobre métodos óptimos para dejar de fumar cigarrillos que se entreguen junto con los exámenes de detección.

  2. Effect of the pore size distribution on the activities of alumina supported Co-Mo catalysts in the hydrotreatment of boscan crude

    SciTech Connect

    Plumail, J.C.; Jacquin, Y.; Martino, G.; Toulhoat, H.

    1983-03-01

    The effects of pore size and distribution on the activity of Co-Mo/Al/sub 2/O/sub 3/ catalysts in the hydrotreatment of asphaltenes have been studied using testing methodology designed to provide initial activities for the catalysis of the critical reactions in the process, hydrodesulfurization (HDS), hydrodemineralization (HDM) (V,NI) and asphaltene conversion to resins and oils (HDA) suitable for subsequent use as refining feedstocks. Nine monomodal (micropores) and seven bimodal (micro- and macropores) were tested. Maximum HDS occurs with mono- and bimodal catalysts having an average pore diameter of 100 A/sup 0/. Maximum HDA and HDM activity appears at a pore diameter between 150 and 200 A/sup 0/ and increases with increasing macroporosity, macropores allowing more efficient access of the large asphaltene molecular units to active sites. Overall catalytic efficiency is dependent upon but HDS and asphaltene hydrogenation rates. Variation of pore structures allowed reaction selectivities to be varied and provided control a asphaltene product (resins, oils) composition.

  3. Collaborative Work as an Alternative for Writing Research Articles (El trabajo colaborativo como alternativa para la escritura de artículos investigativos)

    ERIC Educational Resources Information Center

    Carvajal Medina, Nancy Emilce; Roberto Flórez, Eliana Edith

    2014-01-01

    Academic writing in English in our context is a significant aspect that can be innovative when a convergence model of writing stages is used along with collaborative work. This article reports on a study aimed at analyzing how collaborative work relates to undergraduate electronics students' academic writing development in English as a foreign…

  4. La anglofonia y literaturas poscoloniales en la ensenanza de ingles como lengua extranjera (Anglophonism and Postcolonial Literature in Teaching English as a Second Language).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper, written in Spanish, focuses on the instruction of English as a Second Language in the context of cultural understanding, rather than from a purely linguistic point of view. It argues that foreign language instruction should include lessons in the field of sociology, anthropology, history, geography, politics, the arts, and popular…

  5. Prevalence of sarcopenia among community‐dwelling elderly of a medium‐sized South American city: results of the COMO VAI? study

    PubMed Central

    Bielemann, Renata M.; Gonzalez, Maria Cristina; Menezes, Ana Maria B.

    2015-01-01

    Abstract Background There is insufficient data concerning sarcopenia prevalence in South America. The aim of this study was to estimate sarcopenia prevalence and its clinical subgroups in a Southern Brazilian city. Methods A cross‐sectional population‐based study was performed among community‐dwelling elderly aged 60 years or over. Subjects were evaluated according to the European Working Group on Sarcopenia in Older People established criteria. Muscle mass was estimated by calf circumference (CC). Cut‐off CC points were defined by a subsample's dual X‐ray absorptiometry estimation of the appendicular skeletal muscle mass index (ASMI), which was subsequently compared with the values of a young adult population from the same city. Muscle strength was measured by manual dynamometry. Muscle performance was assessed through the 4 m gait speed test. Results The three diagnostic tests were performed in 1291 subjects. CC of ≤34 cm (males) and ≤33 cm (females) were defined as indicatives of low ASMI. The overall sarcopenia prevalence was 13.9% (CI95% 12.0; 15.8%). Its frequency was significantly higher among elderly with low schooling, without a partner, with low socioeconomic status, smokers, inactive, and with low body mass index. A higher prevalence of pre‐sarcopenia was found in the youngest elderly; a higher prevalence of the clinical stages of the syndrome was found in older age groups. Conclusions Approximately one in ten elderly aged 60–69 years was in the preclinical stage of the disease. This is the age group in which public policies should focus to establish early diagnosis and prevent clinical progression of the syndrome. PMID:27493867

  6. Planeamiento de la unidad didactica en le ensenanza del ingles como idioma extranjero (Planning the Teaching Unit in the Instruction of English as a Foreign Language).

    ERIC Educational Resources Information Center

    Medina T., Rene

    1971-01-01

    This paper discusses the use of the teaching unit as a means for organization in English-as-a-foreign-language classes. It lists the essential elements in the construction of such a unit: cultural topic, linguistic elements, time period, main objectives, instructional materials, focus, specific activities, intended results, evaluation techniques,…

  7. Como evalvar la actuacion del profesor en una clase de segundo idioma (How to Evaluate a Teacher in a Second Language Classroom).

    ERIC Educational Resources Information Center

    Galvez de Bracamonte, Teresa

    This guide in Spanish provides performance criteria for evaluating the foreign language teacher. It provides an outline for analyzing the teacher's actions and teaching methods in the classroom. Through the evaluation by an outsider, the teacher can learn his or her faults in the views of others and can improve on them. The aspects to be analyzed…

  8. Estudio de NIH indica que la actividad física en tiempo libre alarga la vida tanto como 4,5 años

    Cancer.gov

    La actividad física en tiempo libre está asociada con una expectativa de vida más larga, aun en un grado de actividad relativamente bajo e independientemente del peso corporal, de acuerdo con un estudio llevado a cabo por un equipo de investigadores del I

  9. Como los padres ocupados pueden ayudar a sus hijos a aprender y desarrollarse (How Busy Parents Can Help Their Children Learn and Develop). Early Childhood Digest.

    ERIC Educational Resources Information Center

    Mayer, Ellen; Kreider, Holly; Vaughan, Peggy

    Although parents are often very busy with work and family responsibilities, there are many things they can do to help their school-age children learn and develop. This Spanish-language early childhood digest for parents provides tips obtained from parents of first and second graders in the School Transition Study on creative ways to stay involved…

  10. Emotions as Learning Enhancers of Foreign Language Learning Motivation (Las emociones como potenciadoras de la motivación en el aprendizaje de una lengua extranjera)

    ERIC Educational Resources Information Center

    Méndez López, Mariza G.; Peña Aguilar, Argelia

    2013-01-01

    The present article reports on a study that explores the effects of the emotional experiences of Mexican language learners on their motivation to learn English. In this qualitative research we present how emotions impact the motivation of university language learners in south Mexico. Results suggest that emotions, both negative and positive,…

  11. The Why, What, and How of a Bilingual Approach for Young Children [and] El Porque, el Cual y el Como de un Enfoque Bilingue para Ninos Preescolares.

    ERIC Educational Resources Information Center

    Flores, Alfredo R.; Riley, Mary Tom

    This guide, in parallel English and Spanish volumes, provides information necessary for implementing bilingual/multicultural programs. Section 1 defines and describes the bilingual approach, examining instructional goals, rationale, philosophical justification, legal foundations, and practical considerations. Section 2 discusses attitudinal…

  12. The Nature of Recognition in TEFL Teachers' Lives (La naturaleza del reconocimiento en la vida de los maestros de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Scholes Gillingsde González, Barbara

    2011-01-01

    This article aims at sharing a vital issue that emerged from the findings of a qualitative research study into collective responses of teachers of English as a foreign language to an extended change process in their Mexican university context from 1989 to 2003. The data generation process employed was comprised of semi-structured interviews as…

  13. How To Talk to Your Teens and Children about AIDS = Como hablar con sus adolescentes y sus ninos sobre el SIDA.

    ERIC Educational Resources Information Center

    National PTA, Chicago, IL.

    Two brochures, one in English and one in Spanish, provide parents with basic information that will enable them to educate their children about Acquired Immune Deficiency Syndrome (AIDS). Contents address 11 questions: (1) What is AIDS? (2) How do you get AIDS? (3) How is AIDS not spread? (4) Who can get AIDS? (5) How can you tell if someone has…

  14. Cidadania Negada: A Educacao como Instrumento de Combate a Pobreza no Brasil (Denial of Citizenship: Education as a Way to Fight Poverty in Brazil).

    ERIC Educational Resources Information Center

    Germano, Jose Willington

    1995-01-01

    Compares two compensatory social/educational programs developed by the Brazilian government in the last 15 years. States that although one was formulated during the military regime and one during the present government, they both combat poverty and encourage privatization. Concludes that this promotes a process that sees education as social…

  15. Tips for Parents on Keeping Children Drug Free = Consejos para Los Padres Sobre Como Mantener a Los Hijos Libres de La Droga.

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC. Office of Intergovernmental and Interagency Affairs.

    Research shows that recent trends in youth drug use have stabilized; however, the rates of use remain at high levels. It has been shown that the earlier drug use is initiated, the more likely a person is to develop drug problems later in life. Youth substance abuse may lead to many other problems that affect not only the child, but also the…

  16. "O Ensaio como Forma" ou Um Ensaio acerca da Teoria Critica da Sociedade ("The Essay as Form" or An Essay about the Critical Theory of Society).

    ERIC Educational Resources Information Center

    Giordano, Rosely

    2000-01-01

    Illuminates the critical theory project, with themes permeating the theoretical constructions of Frankfurt (Germany). Debates the predominance of positivism in the production of knowledge. Speculates that "the essay as form" constitutes itself as a representation of the concept of the Enlightenment. Concludes with a dialogue between Theodor Adorno…

  17. Me escuchas? Como conversar con ninos de cuatro a doce anos (Are You Listening to Me? Communicating with Children from Four to Twelve Years Old).

    ERIC Educational Resources Information Center

    Delfos, Martine F.

    Although talking to children is a daily activity for almost everyone at some stage in one's life and an essential activity for professionals who work with children, there is little research on activity. This Spanish-language book describes communication with children between the ages of 4 and 12 years, focusing on open question-and-answer sessions…

  18. Como Lo Hago Yo: Anomalías del Tubo Neural en Guatemala — Mielomeningocele Unidad de Espina Bífida e Hidrocefalia

    PubMed Central

    Manucci, Graciela; von Quednow, Enzo

    2014-01-01

    En Guatemala nacen por añ 786 niños con defectos de tubo neural. Operamos 65 a 70 niños con mielomenigocele por año. Tenemos equipo multidisciplinario. Recomendamos parto por cesárea. Infección antes de la cirugía es un problema mayor. Derivación tardía es un problema. Disecamos la plaqueta con la técnica clásica. Suturamos la plaqueta para restituir la forma de la médula. Corpectomía en casos de cifósis. Hidrocefalía: Operamos el 80% de los niños. Chiari II: Operamos basados en los síntomas, primero nos aseguramos que la válvula funciona bien. Médula anclada: Operamos basados en los síntomas. PMID:24791216

  19. La Imagen Publica y Professional del Espanol en Yanquilandia - y Como Mejorarla (The Public and Professional Image of Spanish in "Yankee-Land" and How to Improve It).

    ERIC Educational Resources Information Center

    Mead, Robert G., Jr.

    1981-01-01

    Decries the stereotypes and prejudices that affect U. S. relations with the Hispanic world and with its own Hispanic minorities. Points out that these attitudes also affect the study of Spanish as a foreign language and suggests means by which educators can improve the Hispanic image among Anglo Americans. (MES)

  20. El Reto: A Leer America! A Leer Y Escribir Ya! Como Divertirse Leyendo Y Escribiendo. (America Reads Challenge: Read*Write*Now! Activities for Reading and Writing Fun)

    ERIC Educational Resources Information Center

    Kameenui, Edward J.; Simmons, Deborah C.

    Developed by national reading experts for the "America Reads Challenge: Read*Write*Now!" initiative and translated into Spanish, this booklet provides 45 ideas for families, teachers, librarians, and other learning partners to use with all children--including those with disabilities--to help them read well and independently by the end of third…

  1. Building Your Baby's Brain: A Parent's Guide to the First Five Years = Como estimular el cerebro infantil: Una guia para padres de familia.

    ERIC Educational Resources Information Center

    Dodge, Diane Trister; Heroman, Cate

    Noting that all parents can help their baby's brain to grow, this guide, in English- and Spanish-language versions, explores what science has learned about infant brain development and how parents and caregivers can influence cognitive development. Topics covered include: prenatal care, touching your baby, teaching about feelings and self-control,…

  2. The Accented EFL Teacher: Classroom Implications (El acento del profesor de inglés como lengua extranjera: implicaciones pedagógicas)

    ERIC Educational Resources Information Center

    Arboleda Arboleda, Argemiro; Castro Garcés, Ángela Yicely

    2012-01-01

    This article reports the findings of a research study on how significant having a foreign accent is for non-native English as a foreign language teachers and learners at university level. It points out the perceptions that teachers and students have about the most relevant issues in the teaching and learning processes. Data were collected by means…

  3. La efectividad de la educacion a distancia como metodologia en la desarrollo de destrezas de pensamiento (Effectiveness of Distance Education as a Methodology for Developing Thinking Skills).

    ERIC Educational Resources Information Center

    Melendez Alicea, Juan

    1992-01-01

    Presents steps taken in designing, justifying, and implementing an experimental study designed to investigate the effectiveness of distance education as a methodology for developing thinking skills. A discussion reviews major findings of the study by comparing student experiences from multimedia distance education and student experiences from…

  4. Sound in ecclesiastical spaces in Cordoba. Architectural projects incorporating acoustic methodology (El sonido del espacio eclesial en Cordoba. El proyecto arquitectonico como procedimiento acustico)

    NASA Astrophysics Data System (ADS)

    Suarez, Rafael

    2003-11-01

    This thesis is concerned with the acoustic analysis of ecclesiastical spaces, and the subsequent implementation of acoustic design methodology in architectural renovations. One begins with an adequate architectural design of specific elements (shape, materials, and textures), with the intention of elimination of acoustic deficiencies that are common in such spaces. These are those deficiencies that impair good speech intelligibility and good musical audibility. The investigation is limited to churches in the province of Cordoba and to churches built after the reconquest of Spain (1236) and up until the 18th century. Selected churches are those that have undergone architectural renovations to adapt them to new uses or to make them more suitable for liturgical use. The thesis attempts to summarize the acoustic analyses and the acoustical solutions that have been implemented. The results are presented in a manner that should be useful for the adoption of a model for the functional renovation of ecclesiastical spaces. Such would allow those involved in architectural projects to specify the nature of the sound, even though somewhat intangible, within the ecclesiastical space. Thesis advisors: Jaime Navarro and Juan J. Sendra Copies of this thesis written in Spanish may be obtained by contacting the advisor, Jaime Navarro, E.T.S. de Arquitectura de Sevilla, Dpto. de Construcciones Arquitectonicas I, Av. Reina Mercedes, 2, 41012 Sevilla, Spain. E-mail address: jnavarro@us.es

  5. Metodo de Archivar las Observaciones del Comportamiento del Nino, Como Guia para Entenderlo Mejor (Methods of Recording Observations of Children's Behavior, A Guide for Better Understanding)

    ERIC Educational Resources Information Center

    Stamp, Isla M.

    1971-01-01

    Copies of the Behaviour Study Technique described in this article may be obtained in English from the Australian Council for Educational Research, Frederick St., Hawthorn, Victoria, Australia 3122. (RY)

  6. Un currículo interdisciplinario de base teórica para enseñar inglés como segunda lengua1

    PubMed Central

    Fuentes, Brenda O.; Mas, Francisco Soto; Mein, Erika; Jacobson, Holly E.

    2013-01-01

    Among Hispanic immigrants in the United States (US), learning English is considered necessary for economic and social achievement. As a consequence, there is a high demand for English as a Second Language (ESL) classes. Despite the recognized benefits of ESL programs, both at the individual and social levels, more research is needed to identify education strategies that effectively promote all aspects of learning English as a second language. This article describes an ESL curriculum that incorporates a theory-based pedagogical approach specifically designed for immigrant Hispanic adults on the US-Mexico border region. The article also describes the implementation of the curriculum as well as the results of the evaluation, which was conducted using both quantitative and qualitative methods. Quantitative results indicate that the participants significantly improved their English proficiency (L2). Qualitative results suggest that participants were positively impacted by both the content and pedagogical approaches used by the curriculum. Their experience with the ESL class was positive in general. It can be concluded that the curriculum achieved its objective. This approach could serve as a model for second language teaching for adults. PMID:25284915

  7. Finding an Appropriate Preschool for Your Child with Special Needs = Como Encontrar un Programa Pre-escolar para su nino con desabilidades.

    ERIC Educational Resources Information Center

    Bernstein, Sandra; Wonderlick, Mary; Madden, Drina

    This booklet, with English and Spanish versions, provides a step-by-step procedure to help families find an appropriate preschool program in the community for their child with disabilities. The booklet lists six steps for locating a program: (1) decide what kind of program is wanted for the child; (2) complete included form outlining child's needs…

  8. A+chieving Excellence. A Parent's Guide to Site-Based Decision Making. Noteworthy = A+lcanzar la Excelencia. Un manual para padres sobre como hacer decisiones. Notable.

    ERIC Educational Resources Information Center

    Hutchins, C. L.

    The parents' guide in English and Spanish versions, offers a synthesis of the Mid-Continent Regional Educational Laboratory's (McRel) "A+chieving Excellence," a 480-page manual on educational decision-making and management. Four sections examine four broad areas in which policies must be established for improving student achievement--efficiency,…

  9. Como Puede Mejorar el Programa de Educacion Migrante con el Poder e Influencia de los Padres. Parent Power in the Migrant Education Program: How to Make a Difference.

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC.

    The bilingual (English-Spanish) handbook explains the established rights that parents with children enrolled in the Elementary and Secondary Education Act Title I Migrant Education Program have and presents ways in which parents can use these rights to help ensure that their children receive a quality education. Chapters discuss: (1) content of…

  10. [Not Available].

    PubMed

    Perales-García, Aránzazu; Estévez-Martínez, Isabel; Urrialde, Rafael

    2016-01-01

    Introducción: la hidratación se define como el aporte de agua proveniente de alimentos y bebidas. Su estudio constituye desde hace unos años un área en sí misma dentro de la nutrición, que ha supuesto que en 2010 la European Food Safety Authority (EFSA) aprobara las recomendaciones de ingesta de agua; pero el estudio del estado de hidratación implica un elevado nivel metodológico que presenta ciertos desafíos. Objetivo: ofrecer una visión general de los principales problemas metodológicos en estudios sobre el estado de hidratación. Material y métodos: revisión de la bibliografía científica existente. Resultados: los principales problemas metodológicos presentes son: selección de la muestra (ámbito de investigación y diseño muestral), selección del método de evaluación del estado de hidratación (técnicas de dilución, impedancia bioeléctrica, indicadores plasmáticos y urinarios, cambios en la composición corporal, pérdidas de agua y síntomas clínicos), selección del método de valoración de la ingesta de agua (biomarcadores, cuestionarios, programas informáticos, uso de smartphones, registro 24 h, historia dietética y frecuencia de consumo de alimentos), así como sus principales fuentes dietéticas. Conclusiones: el estado de hidratación debe ser entendido como un modelo rutinario, de frecuencia diaria y variable en función de la edad, sexo, actividad física y condiciones ambientales; por todo ello es de especial importancia un correcto diseño metodológico capaz de recoger estos matices. PMID:27571857

  11. Communicacion Expresiva: Como los ninos nos envian mensajes [and] Comunicacion Receptiva: Como los ninos entienden nuestros mensajes [and] Interacciones de Comunicacion: Hacen falta dos. Hojas informativa de DB-LINK (Communication Interactions: It Takes Two [and] Receptive Communication: How Children Understand Your Messages to Them [and] Expressive Communication: How Children Send Their Messages to You. DB-LINK Fact Sheets).

    ERIC Educational Resources Information Center

    Stremel, Kathleen

    This document consists of three separately published fact sheets combined here because of the close relationship of their subject matter. The first fact sheet, "Communication Interactions: It Takes Two" (Kathleen Stremel), defines communication; suggests ways to find opportunities for interactive communication; offers specific suggestions for…

  12. Tc-99m diethylenetriamine pentaacetic acid (DTPA) renal function reserve estimation: is it a reliable predictive tool for assessment of preclinical renal involvement in scleroderma patients?

    PubMed

    Amin, Amr; El-Sayed, S; Taher, N; Sedki, M; Nasr, H

    2012-06-01

    Prognosis of systemic sclerosis (SSc) depends on internal organ involvement. We assessed the value of renal function reserve (RFR) for the detection of preclinical nephropathy in scleroderma. Thirty SSc patients with normal serum creatinine and 30 healthy controls were included. Medsger disease severity score, glomerular filtration rate (GFR), and microalbuminuria were measured. Tc-99m DTPA was utilized for GFR measurement at baseline and after oral protein overload (stimulated GFR). RFR was calculated as the percentile increase of stimulated GFR. SSc patients had lower means of baseline GFR (P=0.001), stimulated GFR (P=0.004), RFR (P=0.046), and higher microalbuminuria (P=0.009) than controls. According to baseline GFR, SSc patients showed three categories-normal baseline GFR (n=12), hyperfiltration GFR (n=3), and reduced baseline GFR (n=15). In the former category, RFR was normal in 6/12 patients and abnormal in the remainders (50%). Hyperfiltration patients and those with reduced baseline GFR showed abnormal RFR. A statistically significant negative association was found between microalbuminuria versus stimulated GFR and RFR (r= -0.5, P=0.007 and r= -0.45, P=0.013, respectively). The majority of SSc patients with abnormal RFR had disease duration of ≥48 months (60% vs. 20%, P=0.008). All SSc patients with pulmonary hypertension had abnormal RFR, while reduced baseline GFR was noted in only 60%. A significant negative correlation was found between reduced baseline GFR and cumulative dose of corticosteroids in SSc patients (r= -0.4, P=0.022). RFR estimation could be a useful predictive marker for preclinical renal involvement in SSc patients so that early prophylactic measures and therapy modifications could be considered. PMID:22362258

  13. The significance of urinary beta-2 microglobulin level for differential diagnosis of familial Mediterranean fever and acute appendicitis.

    PubMed

    Ugan, Yunus; Korkmaz, Hakan; Dogru, Atalay; Koca, Yavuz Savas; Balkarlı, Ayse; Aylak, Firdevs; Tunc, Sevket Ercan

    2016-07-01

    The clinical and laboratory parameters widely used are not specific to discriminate the abdominal pain due to FMF attack from that of acute appendicitis. The present study aims to investigate the urinary beta-2 microglobulin (U-β2M) level as a potential parameter to identify these two diseases mimicking each other. A total of 51 patients with established FMF diagnosis due to Tel Hashomer criteria on colchicine treatment (1-1.5 mg/day), 15 patients with acute appendicitis who had appropriate clinical picture and were also supported pathologically after the surgery, and 20 healthy controls were enrolled in the study. Of the 51 patients with FMF, 25 were at an attack period, while remaining 26 were not. For the diagnosis of acute attack, as well as physical examination, laboratory tests including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were performed. From urine specimens U-β2M, microalbumin, and N-acetyl glucosaminidase (U-NAG) were measured. U-β2M levels were significantly higher in acute appendicitis group compared to FMF attack, FMF non-attack, and control groups (p < 0.001, p < 0.001, and p < 0.001, respectively). U-NAG and microalbuminuria were significantly higher in acute appendicitis, FMF attack, and FMF non-attack groups compared to controls (U-NAG p < 0.001, p = 0.016, p = 0.004, microalbuminuria p < 0.001, p < 0.001, p < 0.001, respectively). Microalbuminuria was significantly higher in acute appendicitis group compared to the FMF attack group (p = 0.004). Determination of U-β2M levels may be helpful for differential diagnosis of peritonitis attacks of FMF patients on colchicine treatment and acute appendicitis. However, this finding should be substantiated with other studies. PMID:26873102

  14. [Not Available].

    PubMed

    Pacheco-Herrera, Javier Darío; Ramírez-Vélez, Robinson; Correa-Bautista, Jorge Enrique

    2016-01-01

    Objetivo: el presente estudio tuvo por objetivos: a) determinar los valores de referencia de la condición muscular mediante el índice general de fuerza (IGF); y b) estudiar si el IGF está asociado con indicadores de adiposidad en niños y adolescentes escolares de Bogotá, Colombia.Métodos: del total de 7.268 niños y adolescentes (9-17,9 años) evaluados en el estudio FUPRECOL, 4.139 (57%) fueron mujeres. Se evaluó el IGF como marcador del desempeño muscular a partir de la tipificación de las pruebas de fuerza prensil (FP) y salto de longitud (SL). El IGF se recodificó en cuartiles (Q), siendo el Q4 la posición con mejor valor del IGF. El índice de masa corporal (IMC), la circunferencia de cintura (CC), el índice cintura/talla (ICT) y el porcentaje de grasa corporal (% GC) por bioimpedancia eléctrica se midieron como marcadores de adiposidad.Resultados: la edad media de los evaluados fue 12,8 ± 2,3 años. Se aprecia una tendencia hacia un incremento del nivel de condición física muscular en los varones conforme aumenta la edad, y hacia la estabilidad o un ligero aumento en el caso de las mujeres. El IGF se relacionóinversamente con el ICT y % GC en los varones (r = -0,280, r = -0,327, p < 0,01), respectivamente. Los escolares ubicados en el Q4 del IGF presentaron menores valores en marcadores de adiposidad IMC, CC, ICT y % GC, p < 0,01, que su contraparte del Q1.Conclusión: se presentan valores de referencia del IGF a partir de la estandarización de los resultados obtenidos en la FP y SL. La evaluación de la fuerza muscular en edades tempranas permitirá implementar programas de prevención de riesgo cardiovascular y metabólico futuro. PMID:27513488

  15. Educación sobre sexualidad y prevención del VIH: un diagnóstico para América Latina y el Caribe

    PubMed Central

    DeMaria, Lisa M.; Galárraga, Omar; Campero, Lourdes; Walker, Dilys M.

    2016-01-01

    RESUMEN Objetivo Mostrar, a través de un diagnóstico en América Latina y el Caribe, el panorama legislativo y curricular sobre sexualidad y prevención contra el virus de inmunodeficiencia humana (VIH) en el ámbito escolar, contrastándolo con los comportamientos sexuales reportados en encuestas demográficas y de salud. Métodos En mayo de 2008 se realizó, con el apoyo del Fondo de Población de las Naciones Unidas (UNFPA), una encuesta a informantes clave en 34 países de la Región. El cuestionario autoaplicado solicitó información sustantiva de agentes de las diferentes partes interesadas, como ministerios de educación y de salud, sobre los programas de prevención contra el VIH/Sida que se están aplicando en las escuelas. Resultados Respondieron a la encuesta 27 países que representan 95,5% de la población objetivo (6 a 18 años de edad). La mayoría de los países informó tener al menos un libro de texto o un capítulo específico para enseñar los temas de educación sobre sexualidad y prevención del VIH. En la escuela secundaria se cubren la mayor parte de los temas pertinentes relevantes para la educación sobre sexualidad, pero no todos. Por ejemplo, el problema de la discriminación por orientación o preferencia sexual no se incluye en los programas escolares. Conclusiones El material educativo sobre sexualidad debe ser revisado y actualizado periódicamente de modo que refleje los avances en los temas y en la forma de tratar los contenidos. En cada país el currículo debe abordar el tema del respeto a la diversidad sobre orientación, preferencia e identidad sexuales, y en particular el manejo apropiado de la educación para prevenir infecciones de transmisión sexual (ITS) en hombres que tienen sexo con hombres. Los esfuerzos de evaluación de la efectividad de los programas deben contemplar desenlaces tales como marcadores biológicos (incidencia y prevalencia de ITS y embarazo) y no únicamente indicadores de conocimiento y

  16. La salud en personas con discapacidad intelectual en España: estudio europeo POMONA-II

    PubMed Central

    Martínez-Leal, Rafael; Salvador-Carulla, Luis; Gutiérrez-Colosía, Mencía Ruiz; Nadal, Margarida; Novell-Alsina, Ramón; Martorell, Almudena; González-Gordón, Rodrigo G.; Mérida-Gutiérrez, M. Reyes; Ángel, Silvia; Milagrosa-Tejonero, Luisa; Rodríguez, Alicia; García-Gutiérrez, Juan C.; Pérez-Vicente, Amado; García-Ibáñez, José; Aguilera-Inés, Francisco

    2011-01-01

    Introducción Estudios internacionales demuestran que existe un patrón diferenciado de salud y una disparidad en la atención sanitaria entre personas con discapacidad intelectual (DI) y población general. Objetivo Obtener datos sobre el estado de salud de las personas con DI y compararlos con datos de población general. Pacientes y métodos Se utilizó el conjunto de indicadores de salud P15 en una muestra de 111 sujetos con DI. Los datos de salud encontrados se compararon según el tipo de residencia de los sujetos y se utilizó la Encuesta Nacional de Salud 2006 para comparar estos datos con los de la población general. Resultados La muestra con DI presentó 25 veces más casos de epilepsia y el doble de obesidad. Un 20% presentó dolor bucal, y existió una alta presencia de problemas sensoriales, de movilidad y psicosis. Sin embargo, encontramos una baja presencia de patologías como la diabetes, la hipertensión, la osteoartritis y la osteoporosis. También presentaron una menor participación en programas de prevención y promoción de la salud, un mayor número de ingresos hospitalarios y un uso menor de los servicios de urgencia. Conclusiones El patrón de salud de las personas con DI difiere del de la población general, y éstas realizan un uso distinto de los servicios sanitarios. Es importante el desarrollo de programas de promoción de salud y de formación profesional específicamente diseñados para la atención de personas con DI, así como la implementación de encuestas de salud que incluyan datos sobre esta población. PMID:21948011

  17. Impaired endocytosis in proximal tubule from subchronic exposure to cadmium involves angiotensin II type 1 and cubilin receptors

    PubMed Central

    2013-01-01

    Background Chronic exposure to low cadmium (Cd) levels produces urinary excretion of low molecular weight proteins, which is considered the critical effect of Cd exposure. However, the mechanisms involved in Cd-induced proteinuria are not entirely clear. Therefore, the present study was designed to evaluate the possible role of megalin and cubilin (important endocytic receptors in proximal tubule cells) and angiotensin II type 1 (AT1) receptor on Cd-induced microalbuminuria. Methods Four groups of female Wistar rats were studied. Control (CT) group, vehicle-treated rats; LOS group, rats treated with losartan (an AT1 antagonist) from weeks 5 to 8 (10 mg/kg/day by gavage); Cd group, rats subchronically exposed to Cd (3 mg/kg/day by gavage) during 8 weeks, and Cd + LOS group, rats treated with Cd for 8 weeks and LOS from weeks 5–8. Kidney Cd content, glomerular function (evaluated by creatinine clearance and plasma creatinine), kidney injury and tubular function (evaluated by Kim-1 expression, urinary excretion of N-acetyl-β-D-glucosaminidase (NAG) and glucose, and microalbuminuria), oxidative stress (measured by lipid peroxidation and NAD(P)H oxidase activity), mRNA levels of megalin, expressions of megalin and cubilin (by confocal microscopy) and AT1 receptor (by Western blot), were measured in the different experimental groups. Data were analyzed by one-way ANOVA or Kruskal-Wallis test using GraphPad Prism 5 software (Version 5.00). P < 0.05 was considered statistically significant. Results Administration of Cd (Cd and Cd + LOS groups) increased renal Cd content. LOS-treatment decreased Cd-induced microalbuminuria without changes in: plasma creatinine, creatinine clearance, urinary NAG and glucose, oxidative stress, mRNA levels of megalin and cubilin, neither protein expression of megalin nor AT1 receptor, in the different experimental groups studied. However, Cd exposure did induce the expression of the tubular injury marker Kim-1 and decreased

  18. Teaching of Astronomy: Scenarios of Teaching Practice in Elementary Schools. (Spanish Title: Enseñanza de la Astronomía: Semblanzas de la Práctica Docente en Educación Primaria.) Ensino de Astronomia: Cenários da Prática Docente no Ensino Fundamental

    NASA Astrophysics Data System (ADS)

    Marchi Gonzatti, Sônia Elisa; Spessatto De Maman, Andréia; Fernandes Borragini, Eliana; Kerber, Júlia Cristina; Haetinger, Werner

    2013-12-01

    atomización de los asuntos, aunque temas como movimientos de la Tierra y fenómenos astronómicos hayan sido citados por la mayoría de los participantes. En cuanto a las estrategias, se verifico que se emplean principalmente clases con el apoyo de recursos bidimensionales, como películas, textos, mapas y búsqueda en internet. Las principales dificultades fueron la falta de formación específica con respecto a los contenidos de Astronomía, y el nivel de abstracción exigido por los contenidos. De modo general, esos indicadores convergen para los resultados ya encontrados en otros estudios, en el que las deficiencias de la formación inicial de los profesores, o incluso su ausencia, dificulta el adecuado abordaje de la Astronomía en las clases. Neste trabalho são apresentados os principais resultados de uma investigação realizada no campo da Educação em Astronomia, com professores do ensino fundamental de duas regiões do Rio Grande do Sul. O objetivo do estudo foi caracterizar o cenário regional do ensino de Astronomia, estabelecendo um comparativo com o cenário nacional. Esse estudo abordou três questões: identificar os principais temas de astronomia trabalhados em sala de aula, as estratégias metodológicas e quais as dificuldades apresentadas pelos professores ao desenvolver sua prática. Quanto aos conteúdos, encontrouse uma pulverização dos assuntos abordados, embora temas como movimentos da Terra e fenômenos astronômicos tenham sido citados pela maioria dos participantes. Sobre estratégias, são utilizadas principalmente aulas com apoio de recursos bidimensionais, como filmes, textos, mapas e pesquisa na internet. As principais dificuldades foram: falta de formação específica em relação a conteúdos de Astronomia; nível de abstração dos conteúdos, que dificultam sua compreensão, tanto pelos alunos quanto pelos próprios professores. De maneira geral, esses indicadores convergem para resultados já encontrados em outros estudos que

  19. Renal function in diabetic nephropathy.

    PubMed

    Dabla, Pradeep Kumar

    2010-05-15

    Diabetic nephropathy is the kidney disease that occurs as a result of diabetes. Cardiovascular and renal complications share common risk factors such as blood pressure, blood lipids, and glycemic control. Thus, chronic kidney disease may predict cardiovascular disease in the general population. The impact of diabetes on renal impairment changes with increasing age. Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population, indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people. The American Diabetes Association and the National Institutes of Health recommend Estimated glomerular filtration rate (eGFR) calculated from serum creatinine at least once a year in all people with diabetes for detection of kidney dysfunction. eGFR remains an independent and significant predictor after adjustment for conventional risk factors including age, sex, duration of diabetes, smoking, obesity, blood pressure, and glycemic and lipid control, as well as presence of diabetic retinopathy. Cystatin-C (Cys C) may in future be the preferred marker of diabetic nephropathy due differences in measurements of serum creatinine by various methods. The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research. Various studies have shown the importance of measurement of albuminuria, eGFR, serum creatinine and hemoglobin level to further enhance the prediction of end stage renal disease. PMID:21537427

  20. Urinary monocyte chemoattractant protein-1 (MCP-1) and connective tissue growth factor (CCN2) as prognostic markers for progression of diabetic nephropathy.

    PubMed

    Tam, Frederick W K; Riser, Bruce L; Meeran, Karim; Rambow, JoAnn; Pusey, Charles D; Frankel, Andrew H

    2009-07-01

    Profibrotic growth factors and inflammatory chemokines have been implicated in the pathogenesis of diabetic nephropathy (DN). However, measurement of urinary monocyte chemoattractant protein-1 (MCP-1) and connective tissue growth factor (CCN2) as prognostic markers has not previously been reported, and neither have two such molecules in urine been examined in a single study of DN. In this prospective observational study, 43 adult diabetic patients were studied, 40 were followed up for 6years. Urinary MCP-1/creatinine ratios were found to be significantly higher in patients with macroalbuminuria (3.3- and 2.1-fold higher (p<0.01) than normoalbuminuric and microalbuminuric patients, respectively). CCN2 exhibited a pattern different from that of urinary MCP-1. Urinary CCN2/creatinine ratios were greatly elevated in both microalbuminuric and macroalbuminuric patients (125- and 74-fold higher than normoalbuminuric patients, respectively, p<0.01 and p<0.05, respectively). Further, urinary CCN2, but not MCP-1, correlated with progression of microalbuminuria (R=0.49, p<0.05). In contrast, MCP-1, but not CCN2, correlated with the rate of eGFR decline for all patients (R=0.61, p<0.0001), reflective of its predictive value in patients with macroalbuminuria, but not for patients with microalbuminuria or normoalbuminuria. In conclusion, increased urinary CCN2 is associated with the early progression of DN, whereas MCP-1 is associated with later stage disease. PMID:19409809

  1. Metabolic Acidosis-Induced Insulin Resistance and Cardiovascular Risk

    PubMed Central

    Souto, Gema; Donapetry, Cristóbal; Calviño, Jesús

    2011-01-01

    Abstract Microalbuminuria has been conclusively established as an independent cardiovascular risk factor, and there is evidence of an association between insulin resistance and microalbuminuria, the former preceding the latter in prospective studies. It has been demonstrated that even the slightest degree of metabolic acidosis produces insulin resistance in healthy humans. Many recent epidemiological studies link metabolic acidosis indicators with insulin resistance and systemic hypertension. The strongly acidogenic diet consumed in developed countries produces a lifetime acidotic state, exacerbated by excess body weight and aging, which may result in insulin resistance, metabolic syndrome, and type 2 diabetes, contributing to cardiovascular risk, along with genetic causes, lack of physical exercise, and other factors. Elevated fruits and vegetables consumption has been associated with lower diabetes incidence. Diseases featuring severe atheromatosis and elevated cardiovascular risk, such as diabetes mellitus and chronic kidney failure, are typically characterized by a chronic state of metabolic acidosis. Diabetic patients consume particularly acidogenic diets, and deficiency of insulin action generates ketone bodies, creating a baseline state of metabolic acidosisworsened by inadequate metabolic control, which creates a vicious circle by inducing insulin resistance. Even very slight levels of chronic kidney insufficiency are associated with increased cardiovascular risk, which may be explained at least in part by deficient acid excretory capacity of the kidney and consequent metabolic acidosis-induced insulin resistance. PMID:21352078

  2. Monitoring Diabetic Nephropathy by Circulating Gangliosides.

    PubMed

    Ene, Corina Daniela; Penescu, Mircea; Anghel, Amalia; Neagu, Monica; Budu, Vlad; Nicolae, Ilinca

    2016-01-01

    Gangliosides are multifunctional molecules, abundantly expressed in renal cell membrane but also in sera of patients with renal disease. The aim of this study was to quantify the serum levels of sialic acid-ganglioside in patients diagnosed with diabetes for an eventual biomarker stratification of patients with renal complications. We included 35 diabetic patients without metabolic complications, 35 patients with diabetic nephropathy, 35 non-diabetic individuals. We found that sialic acid ganglioside serum level was significantly increased in patients with diabetic nephropathy compared to the level obtained in patients with uncomplicated diabetes and to non-diabetic controls. A statistically significant positive correlation was obtained between serum levels of sialic acid gangliosides, HbA1c, and serum creatinine in patients with diabetes without complications. Moreover positive correlation was found between sialic acid ganglioside and blood glucose, HbA1c, urea, creatinine, microalbuminuria in patients with diabetic nephropathy. We can conclude that serum sialic acid-gangliosides are statistically increased in diabetic nephropathy positively correlated with microalbuminuria. PMID:26359623

  3. Levels of albuminuria and risk of developing macroalbuminuria in type 2 diabetes: historical cohort study

    PubMed Central

    Chida, Shoma; Fujita, Yoshikuni; Ogawa, Akifumi; Hayashi, Akinori; Ichikawa, Raishi; Kamata, Yuji; Takeuchi, Akihiro; Takano, Koji; Shichiri, Masayoshi

    2016-01-01

    Although increased urinary albumin excretion may increase the risk of adverse renal outcomes in patients with diabetes, it remains unclear whether microalbuminuria is associated with a higher incidence of macroalbuminuria in the absence of non-diabetic kidney events that frequently develop during the long-term course of type 2 diabetes. This historical cohort study included patients with type 2 diabetes, spot urine albumin:creatinine ratio (ACR) <300 mg/gCr and normal serum creatinine concentrations treated between August 1988 and April 2015. Patients with any evidence suggesting non-diabetic kidney diseases at baseline were excluded. Over a median follow-up of 50 months, 70 of the 1760 included patients developed macroalbuminuria. Twenty-one of these patients were diagnosed with non-diabetic renal events. The five-year cumulative incidence of macroalbuminuria in patients with ACRs of 0–7.5 mg/gCr, 7.5–30 mg/gCr, 30–150 mg/gCr, and 150–300 mg/gCr were 0%, 0.53%, 3.5%, and 36.0%, respectively, with significant differences between each pair of ACR categories. In type 2 diabetes, higher urinary ACR, even within a level of normoalbuminuria, was associated with a greater incidence of macroalbuminuria when non-diabetic renal events were excluded. These results conflict with findings suggesting that microalbuminuria is a poor indicator for the progression of diabetic nephropathy. PMID:27210499

  4. Study of Adiponectin Level in Diabetic Adolescent Girls in Relation to Glycemic Control and Complication of Diabetes

    PubMed Central

    Dayem, Soha M. Abd El; Nazif, Hayam K.; EI-Kader, Mona Abd; El-Tawil, Maha

    2015-01-01

    AIM: To study the relation between adiponectin level with glycemic control and complication of diabetes. PATIENTS AND METHODS: The study included 40 female adolescent type 1 diabetic patients and 40 healthy volunteers of the same age and sex. Blood sample was taken for assessment of glycosylated hemoglobin, lipid profile and adiponectine. Urine sample was taken for assessment of albumin/creatinine ratio. RESULTS: Diabetic patients had a significantly higher diastolic blood pressure, triglyceride, total cholesterol, LDL and adiponectin than controls. Patients with diabetes complication had a significant lower BMI and HDL. On the other hand, they had higher disease duration, total cholesterol, HbA1, albumin/creatinine ratio and adiponectin. Patients with microalbuminuria had a lower BMI, higher disease duration, diastolic blood pressure and adiponectin. Patients with diabetic retinopathy had higher disease duration, insulin dose, HbA1, microalbuminuria and adiponectin. Adiponectin in diabetic patients had a significant negative correlation with BMI and positive correlation with systolic blood pressure and microlabuminuria. CONCLUSION: Serum adiponectin level is high in adolescent type 1 diabetic girls. It can be used as a predictor of diabetes complications rather than a sensitive biochemical marker for glycemic control.

  5. Cardiovascular Autonomic Neuropathy and Early Atherosclerosis in Adolescent Type 1 Diabetic Patient

    PubMed Central

    Dayem, Soha M. Abd El; Battah, Ahmed A.; Bohy, Abo El Magd El

    2015-01-01

    AIM: To evaluate cardiovascular autonomic neuropathy (CAN) in type 1 Diabetics and to detect its relation to coronary artery calcification. PATIENTS AND METHODS: It is a cross sectional study included 62 diabetics and 30 controls. Clinical, laboratory assessment and 24 Hr holter were done for all patients and controls and coronary artery calcium (CAC) scoring by multisclice CT was done for all patients only. T-test, Mann Whitney U test, and stepwise multiple regression were used for statistical analyses. RESULTS: CAC score was positive in 8.1 % of patients. Heart rate variability (HRV) was significantly lower in diabetics. All parameters of HRV were insignificantly lower in diabetics with positive CAC score. Patients with microalbuminuria had a significantly lower HRV. HRV had a significant correlation with age of patients, duration of disease, HbA1, and Qtc in diabetics. CONCLUSION: Percentage of arrhythmia and early atherosclerosis is high in adolescent type 1 diabetic patients. CAN is associated with early atherosclerosis. Cardiac autonomic neuropathy is associated with older age, longer duration, and poor glycemic control and microalbuminuria.

  6. Association of Serum Adropin Concentrations with Diabetic Nephropathy

    PubMed Central

    2016-01-01

    Objective. Adropin is a newly identified regulatory protein encoded by the Enho gene and is critically involved in energy homeostasis and insulin sensitivity. This study aims to determine the correlation of serum adropin concentrations with diabetic nephropathy (DN). Methods. This study consisted of 245 patients with type 2 diabetes mellitus (T2DM) and 81 healthy subjects. Then T2DM patients were divided into normoalbuminuria, microalbuminuria, and macroalbuminuria subgroups based on urine albumin to creatinine ratio (ACR). Results. T2DM patients showed significantly lower serum adropin concentrations than those in the controls. T2DM patients with macroalbuminuria had significantly decreased serum adropin concentrations compared with the other three groups. In addition, T2DM patients with microalbuminuria showed lower serum adropin concentrations than those in patients with normoalbuminuria. Logistic regression analysis showed that serum adropin was correlated with decreased risk of developing T2DM and DN. Pearson correlation analysis indicated that serum adropin was negatively correlated with body mass index (BMI), blood urea nitrogen, creatinine, and ACR and positively correlated with glomerular filtration rate. Furthermore, multiple linear regression analysis showed that BMI and ACR were negatively correlated with serum adropin levels. Conclusion. Serum adropin concentrations are negatively associated with renal function. Adropin may be implicated in the pathogenesis of DN development. PMID:27546995

  7. Epidemiology of diabetic kidney disease.

    PubMed

    Reutens, Anne T

    2013-01-01

    The increasing prevalence of diabetes has led to DKD becoming the leading cause of ESRD in many regions. The economic cost of DKD will grow to prohibitive amounts unless strategies to prevent its onset or progression are urgently implemented. In type 1 and type 2 diabetes, the presence of microalbuminuria and macroalbuminuria confers increased risk of developing ESRD and of death. Comparison of recent studies with earlier historical studies shows that the incidence of ESRD and death has decreased in DKD. Increased risk of albuminuria has been identified in certain non-European ethnic groups. However, the initial concept of progression of DKD as an albuminuric phenotype involving development of microalbuminuria, macroalbuminuria, and then ESRD has had to be modified. Albumin excretion frequently regresses, and GFR can decline without abnormality in albumin excretion. There is emerging evidence that changes in renal function occurring early in the course of diabetes predict future outcomes. The major challenges are to prevent DKD onset, to detect it early, and to improve DKD outcomes globally. PMID:23290726

  8. Metabolic acidosis-induced insulin resistance and cardiovascular risk.

    PubMed

    Souto, Gema; Donapetry, Cristóbal; Calviño, Jesús; Adeva, Maria M

    2011-08-01

    Microalbuminuria has been conclusively established as an independent cardiovascular risk factor, and there is evidence of an association between insulin resistance and microalbuminuria, the former preceding the latter in prospective studies. It has been demonstrated that even the slightest degree of metabolic acidosis produces insulin resistance in healthy humans. Many recent epidemiological studies link metabolic acidosis indicators with insulin resistance and systemic hypertension. The strongly acidogenic diet consumed in developed countries produces a lifetime acidotic state, exacerbated by excess body weight and aging, which may result in insulin resistance, metabolic syndrome, and type 2 diabetes, contributing to cardiovascular risk, along with genetic causes, lack of physical exercise, and other factors. Elevated fruits and vegetables consumption has been associated with lower diabetes incidence. Diseases featuring severe atheromatosis and elevated cardiovascular risk, such as diabetes mellitus and chronic kidney failure, are typically characterized by a chronic state of metabolic acidosis. Diabetic patients consume particularly acidogenic diets, and deficiency of insulin action generates ketone bodies, creating a baseline state of metabolic acidosis worsened by inadequate metabolic control, which creates a vicious circle by inducing insulin resistance. Even very slight levels of chronic kidney insufficiency are associated with increased cardiovascular risk, which may be explained at least in part by deficient acid excretory capacity of the kidney and consequent metabolic acidosis-induced insulin resistance. PMID:21352078

  9. Six Months of Hydroxyurea Reduces Albuminuria in Patients with Sickle Cell Disease.

    PubMed

    Bartolucci, Pablo; Habibi, Anoosha; Stehlé, Thomas; Di Liberto, Gaetana; Rakotoson, Marie Georgine; Gellen-Dautremer, Justine; Loric, Sylvain; Moutereau, Stéphane; Sahali, Dil; Wagner-Ballon, Orianne; Remy, Philippe; Lang, Philippe; Grimbert, Philippe; Audureau, Etienne; Godeau, Bertrand; Galacteros, Frédéric; Audard, Vincent

    2016-06-01

    The earliest symptom of glomerular injury in patients with sickle cell disease (SCD) is microalbuminuria. The effect of hydroxyurea (HU) on urine albumin-to-creatinine ratio (ACR) is unclear and should be determined, because increasing numbers of patients with SCD take this drug to improve red blood cell function. In this cohort study of 58 SS-homozygous adults with SCD who initiated HU therapy, we evaluated ACR changes and relationships of these changes with demographic, clinical, and biologic parameters at HU initiation (baseline) and 6 months later (follow-up). Between baseline and follow-up, ACR declined significantly for the entire population (3.0-1.7 mg/mmol; P<0.01), but this was primarily driven by the ACR reduction in the microalbuminuria subgroup (8.1-2.3 mg/mmol; P=0.03; n=23). According to bivariate analyses on 39 patients who did not receive a blood transfusion during the study period, the baseline to follow-up ACR decline was strongly associated with decreases in levels of hemolysis markers, percentage of dense red blood cells, and systolic BP. Bivariate analysis also revealed a close association between the ACR decrease and high baseline levels of hemolysis markers and percentage of dense red blood cells. These results show that urine ACR decreased significantly after 6 months of HU and confirm a close relationship between ACR and hemolysis evolution in patients with SCD. PMID:26586692

  10. Aldosterone receptor blockers spironolactone and canrenone: two multivalent drugs.

    PubMed

    Armanini, Decio; Sabbadin, Chiara; Donà, Gabriella; Clari, Giulio; Bordin, Luciana

    2014-05-01

    Canrenone is a derivative of spironolactone with lower antiandrogen activity. The drug is used only in few countries and can block all the side effects of aldosterone (ALDO). The drug is effective even in the presence of normal concentrations of ALDO. Mineralcorticoid receptor antagonists block the inflammatory activity of ALDO at the level of target tissues as heart, vessels and mononuclear leukocytes. Canrenone reduces the progression of insulin resistance and of microalbuminuria in type 2 diabetes and other related diseases. Both canrenone and hydrochlorothiazide can enhance the effect of treatment with ACE inhibitors and angiotensin II receptor blockers on microalbuminuria, but ALDO receptor blockers are more active. This different action is due to the fact that only canrenone blocks mineralocorticoid receptors. Serum potassium and renal function should be monitored before and during the treatment. ALDO receptor blockers are recommended in addition to polytherapy for resistant hypertension, but there are no studies on the effect of the drug as first-choice therapy. PMID:24617854

  11. Levels of albuminuria and risk of developing macroalbuminuria in type 2 diabetes: historical cohort study.

    PubMed

    Chida, Shoma; Fujita, Yoshikuni; Ogawa, Akifumi; Hayashi, Akinori; Ichikawa, Raishi; Kamata, Yuji; Takeuchi, Akihiro; Takano, Koji; Shichiri, Masayoshi

    2016-01-01

    Although increased urinary albumin excretion may increase the risk of adverse renal outcomes in patients with diabetes, it remains unclear whether microalbuminuria is associated with a higher incidence of macroalbuminuria in the absence of non-diabetic kidney events that frequently develop during the long-term course of type 2 diabetes. This historical cohort study included patients with type 2 diabetes, spot urine albumin:creatinine ratio (ACR) <300 mg/gCr and normal serum creatinine concentrations treated between August 1988 and April 2015. Patients with any evidence suggesting non-diabetic kidney diseases at baseline were excluded. Over a median follow-up of 50 months, 70 of the 1760 included patients developed macroalbuminuria. Twenty-one of these patients were diagnosed with non-diabetic renal events. The five-year cumulative incidence of macroalbuminuria in patients with ACRs of 0-7.5 mg/gCr, 7.5-30 mg/gCr, 30-150 mg/gCr, and 150-300 mg/gCr were 0%, 0.53%, 3.5%, and 36.0%, respectively, with significant differences between each pair of ACR categories. In type 2 diabetes, higher urinary ACR, even within a level of normoalbuminuria, was associated with a greater incidence of macroalbuminuria when non-diabetic renal events were excluded. These results conflict with findings suggesting that microalbuminuria is a poor indicator for the progression of diabetic nephropathy. PMID:27210499

  12. Association of Serum Adropin Concentrations with Diabetic Nephropathy.

    PubMed

    Hu, Wenchao; Chen, Li

    2016-01-01

    Objective. Adropin is a newly identified regulatory protein encoded by the Enho gene and is critically involved in energy homeostasis and insulin sensitivity. This study aims to determine the correlation of serum adropin concentrations with diabetic nephropathy (DN). Methods. This study consisted of 245 patients with type 2 diabetes mellitus (T2DM) and 81 healthy subjects. Then T2DM patients were divided into normoalbuminuria, microalbuminuria, and macroalbuminuria subgroups based on urine albumin to creatinine ratio (ACR). Results. T2DM patients showed significantly lower serum adropin concentrations than those in the controls. T2DM patients with macroalbuminuria had significantly decreased serum adropin concentrations compared with the other three groups. In addition, T2DM patients with microalbuminuria showed lower serum adropin concentrations than those in patients with normoalbuminuria. Logistic regression analysis showed that serum adropin was correlated with decreased risk of developing T2DM and DN. Pearson correlation analysis indicated that serum adropin was negatively correlated with body mass index (BMI), blood urea nitrogen, creatinine, and ACR and positively correlated with glomerular filtration rate. Furthermore, multiple linear regression analysis showed that BMI and ACR were negatively correlated with serum adropin levels. Conclusion. Serum adropin concentrations are negatively associated with renal function. Adropin may be implicated in the pathogenesis of DN development. PMID:27546995

  13. Evaluation of Ischemia-Modified Albumin, Malondialdehyde, and Advanced Oxidative Protein Products as Markers of Vascular Injury in Diabetic Nephropathy

    PubMed Central

    Ahmad, Afzal; Manjrekar, Poornima; Yadav, Charu; Agarwal, Ashish; Srikantiah, Rukmini Mysore; Hegde, Anupama

    2016-01-01

    AIM This study aimed at evaluation of ischemia-modified albumin (IMA), malondialdehyde (MDA), and advanced oxidative protein products (AOPP) as markers of vascular injury in diabetic nephropathy (DN) with derivation of cutoff values for the same. MATERIALS AND METHODS Study population comprised 60 diabetes patients and 30 controls, with diabetes patients further categorized into three groups based on urine albumin/creatinine ratio (UACR) of <30 mg/g (diabetes without microalbuminuria), 30–300 mg/g (early DN), and >300 mg/g of creatinine (overt DN). Serum IMA, MDA, and AOPP were estimated by enzyme-linked immunosorbent assay; HbA1c, serum creatinine, urine albumin, and urine creatinine were estimated using automated analyzers. Statistical analysis was done using analysis of variance, Pearson’s correlation coefficient, and receiver-operating characteristic curve. RESULTS A statistically significant difference was found in the levels of IMA among patients with early DN (154 ng/mL), diabetes without nephropathy (109.4 ng/mL), and healthy controls (45.7 ng/mL), with highest levels in early DN cases. Similar increase was seen in AOPP as well. A significant correlation was observed between IMA and UACR in diabetes without nephropathy (r = 0.448). CONCLUSION The present study postulates serum IMA as a novel biomarker for the assessment of disease progression in diabetes even before microalbuminuria, and a cutoff point ≥99 ng/mL can be used for detection of early DN. PMID:27158221

  14. Level of Albuminuria and Risk of Stroke: Systematic Review and Meta-Analysis

    PubMed Central

    Lee, Meng; Saver, Jeffrey L.; Chang, Kuo-Hsuan; Ovbiagele, Bruce

    2010-01-01

    Background Gross albuminuria is associated with increased stroke risk, but it is unclear whether stroke incidence varies by level of albuminuria. We meta-analyzed prospective cohort studies to investigate the impact of various albuminuria levels and continuous urinary albumin excretion (UAE) change on stroke risk. Methods Systematic search for studies reporting quantitative estimates of the multivariate-adjusted relative risk (RR) and 95% CI for stroke risk associated with microalbuminuria (UAE 30–300 mg/day or nearest equivalent interval) and macroalbuminuria (UAE >300 mg/day) and studies that analyzed the relation of stroke with UAE continuously. Estimates were combined using a random-effect model. Results We identified seven studies comprising 46,638 participants with 1,479 stroke events. Incident stroke risk was greater for macroalbuminuria (RR 2.65, 95% CI 2.25–3.14) than microalbuminuria (RR 1.58, 95% CI 1.39–1.80), a difference that was significant (p for heterogeneity < 0.001, I2 = 96%). In addition, risk of stroke increased proportionally with rising UAE (p < 0.001), even for UAE within normal range (beginning from levels as low as 2–4 mg/g). Conclusions Higher albuminuria level confers greater stroke risk. These findings provide additional weight to evidence that albuminuria is strongly linked to stroke risk, and suggest that persons with elevated UAE levels may especially benefit from more intensive vascular risk reduction. PMID:20733300

  15. Urinary biomarkers for early diabetic nephropathy in type 2 diabetic patients.

    PubMed

    Fiseha, Temesgen

    2015-01-01

    Diabetic nephropathy (DN) is a serious complication of diabetes associated with increased risk of mortality, and cardiovascular and renal outcomes. Diagnostic markers to detect DN at early stage are important as early intervention can slow loss of kidney function and improve patient outcomes. Urinary biomarkers may be elevated in diabetic patients even before the appearance of microalbuminuria, and can be used as useful marker for detecting nephropathy in patients with normoalbuminuria (early DN). We reviewed some new and important urinary biomarkers, such as: Neutrophil gelatinase associated lipocalin (NGAL), N-acetyl-beta-glucosaminidase (NAG), Cystatin C, alpha 1-microglobulin, immunoglobulin G or M, type IV collagen, nephrin, angiotensinogen and liver-type fatty acid-binding protein (L-FABP) associated with early DN in type 2 diabetic patients. Our search identified a total of 42 studies that have been published to date. Urinary levels of these biomarkers were elevated in type 2 diabetic patients compared with non-diabetic controls, including in patients who had no signs indicating nephropathy (without microalbuminuria), and showed positive correlation with albuminuria. Despite the promise of these new urinary biomarkers, further large, multicenter prospective studies are still needed to confirm their clinical utility as a screening tool for early type 2 DN in every day practice. PMID:26146561

  16. Urinary Biomarkers in the Assessment of Early Diabetic Nephropathy

    PubMed Central

    Gluhovschi, Gheorghe; Petrica, Ligia; Timar, Romulus; Velciov, Silvia; Ionita, Ioana; Kaycsa, Adriana; Timar, Bogdan

    2016-01-01

    Diabetic nephropathy (DN) is a frequent and severe complication of diabetes mellitus (DM). Its diagnosis in incipient stages may allow prompt interventions and an improved prognosis. Towards this aim, biomarkers for detecting early DN can be used. Microalbuminuria has been proven a remarkably useful biomarker, being used for diagnosis of DN, for assessing its associated condition—mainly cardiovascular ones—and for monitoring its progression. New researches are pointing that some of these biomarkers (i.e., glomerular, tubular, inflammation markers, and biomarkers of oxidative stress) precede albuminuria in some patients. However, their usefulness is widely debated in the literature and has not yet led to the validation of a new “gold standard” biomarker for the early diagnosis of DN. Currently, microalbuminuria is an important biomarker for both glomerular and tubular injury. Other glomerular biomarkers (transferrin and ceruloplasmin) are under evaluation. Tubular biomarkers in DN seem to be of a paramount importance in the early diagnosis of DN since tubular lesions occur early. Additionally, biomarkers of inflammation, oxidative stress, podocyte biomarkers, and vascular biomarkers have been employed for assessing early DN. The purpose of this review is to provide an overview of the current biomarkers used for the diagnosis of early DN. PMID:27413755

  17. Kathy Learns How Breastfeeding Can Be Used...To Space Pregnancies. Mother-to-Mother Support = Josefa Aprende como la Lactancia Puede Ser Usada...Para Espaciar los Embarazos. Apoyo Madre a Madre.

    ERIC Educational Resources Information Center

    Magalhaes, Rebecca; Stone-Jimenez, Maryanne; Allen de Smith, Paulina; Smith, Natalia

    These magazine-sized booklets, one in English, one in Spanish, are in cartoon format and designed to be used by people with limited literacy in English or Spanish. They explain how breastfeeding can be used to help space pregnancies, the limitations of its effectiveness as a pregnancy-avoiding method, and that the spacing of pregnancies can be…

  18. A Comparison of Chinese and Colombian University EFL Students Regarding Learner Autonomy (Comparación entre estudiantes universitarios de inglés chinos y colombianos con respecto a su autonomía como aprendices)

    ERIC Educational Resources Information Center

    Buendía Arias, Ximena Paola

    2015-01-01

    This research seeks to gain deeper understanding of learner autonomy in English as a Foreign Language students from different cultures through the identification and analysis of similarities and differences between Chinese and Colombian students from two public universities: Tianjin Foreign Studies University in China and Universidad Surcolombiana…

  19. La lectura literaria como arte de "performance": la teoria transaccional de Louise Rosenblatt y sus implicaciones pedagogicas (The Use of Literature as Performance Art: The Transactional Theory of Louise Rosenblatt and Its Pedagogical Implications).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper focuses on the work that Louise Rosenblatt and her followers in the United States have done to improve the teaching and learning of literature at all educational levels. Although these researchers have focused almost exclusively on the use of literature in the native language, the paper uses transactional theory as a basis for teaching…

  20. Estudio del proceso de ebullicion en el interior de un tubo multipuerto extruido en aluminio con mini-canales de geometria triangular usando R32 y R134a como fluidos de trabajo

    NASA Astrophysics Data System (ADS)

    Ramirez Rivera, Francisco Alberto

    The use of multiport mini-channel tubes in compact exchangers has increased in the last few years. They contributing to improve thermal efficient, compactness, energy conservation and required lower refrigerants charge by which reduction of greenhouse gases emission. Those mentioned advantages are very important aspects with regard to modern refrigeration systems design. For that reason, several experimental investigation have been carried out in order to characterize the flow boiling heat transfer process and frictional pressure drop in tubes with parallel channels. Since, the ability to estimate pressure drop and heat transfer coefficient for specific conditions is a fundamental issue to optimise the design of compact heat exchanger. In this study, the characteristics of two- phase flow pressure drop and convective boiling heat transfer have been investigated experimentally inside multiport mini-channel aluminium tube with triangular geometry, hydraulic diameter 0.715 mm and heating length of 1205 mm using R32 and R134a as working fluids. A wide experimental campaign has been carried out to complete an array of measurement under different conditions for both refrigerants studied. The experimental conditions examined included: mass velocity 275-1230 kgm -2s-1, heat flux 0.75-9.30 kWm-2, saturation temperature, 5°C, 7.5°C, 12.5°C, vapour quality 0.012-0.51. The database presented consists of 312 averages values, 223 averages values were recorded for R134a and 89 for R32. The flow boiling averages values were calculated selecting a sample of 40 readings (steps 20s) in stable conditions for all measured variables at each mass velocity tested.

  1. Coping with Social Change: Programs That Work. Proceedings of a Conference (Acapulco, Mexico, June 1989) = Como enfrentarse al cambio social: programas eficaces. Actas de uno Conferencia (Acapulco, Mexico, Junio de 1989).

    ERIC Educational Resources Information Center

    Hoskins, Irene, Ed.

    Written in English and Spanish, this document contains the proceedings of the 14th International Congress of Gerontology on concerns about the impact of rapid social change on the well-being of older women and families in Latin American and the Caribbean and about effective programs that address the needs of the older populations. The first…

  2. When Students Say Far Too Much: Examining Gushing in the ELT Classroom (Cuando los alumnos dicen demasiado: análisis del uso excesivo de palabras en clases de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Mugford, Gerrard; Cuevas, Oscar Ramírez

    2015-01-01

    English foreign-language users often overuse words when faced with difficult situations. Called gushing, such excessive use of words is often legitimately employed by native speakers to express, for instance, gratitude and apologies when a simple "thank you" or "sorry" does not sufficiently convey an interlocutor's feelings.…

  3. Exploring Elementary Students' Power and Solidarity Relations in an EFL Classroom (Exploración de las relaciones de poder y solidaridad entre estudiantes de primaria en la clase de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Méndez, Tatiana; García, Andrea

    2012-01-01

    This article derives from a critical discourse analysis study that reports the characteristics of elementary school students' power and solidarity relations in English as a foreign language classroom in Bogotá, Colombia, while we were doing our teaching English as a foreign language practicum. The study was based on theories of power and…

  4. A Guide for Reading: How Parents Can Help Their Children Be Ready To Read and Ready To Learn = Guia Para Leer: Como los padres pueden preparar a sus hijos a leer y aprender desde la infancia.

    ERIC Educational Resources Information Center

    White House Initiative on Educational Excellence for Hispanic Americans, Washington, DC.

    As part of the White House Initiative on Educational Excellence for Hispanic Americans, this brochure (in English and Spanish) provides a guide to assist parents in helping their children become ready to read and to learn. The suggestions include: (1) talking to infants/toddlers to help them learn to speak and understand the meaning of words; (2)…

  5. “Es como uno bomba de tiempo [It’s like a time bomb]”: A Qualitative Analysis of Perceptions of Diabetes Among First-Degree Relatives of Latino Patients With Diabetes

    PubMed Central

    Boutin-Foster, Carla; Milan, Maria; Kanna, Balavenkatesh

    2014-01-01

    Abstract Background. The South Bronx, a largely Latino community, has become an epicenter of the diabetes epidemic in New York City. In this community, nondiabetic first-degree relatives of people with diabetes are prime targets for intervention. Therefore, the objective of this study was to explore the knowledge of diabetes and attitudes toward health behavior modification of Latino adults who are first-degree relatives of people with diabetes. Methods. Participants were recruited from three settings in the South Bronx (a community-based organization, a faith-based organization, and a taxi station). The Common Sense Model was used to develop focus-group items. This model provides a framework for exploring illness representations along five domains: identity, cause, consequences, timeline, and perceptions of curability. Responses were transcribed verbatim, and data analysis proceeded in the following order: data immersion, assignment of codes, grouping of key concepts to form categories, and construction of higher-order themes. Results. Of the 115 potential participants identified, 53 were found to be eligible, and 23 of these participated in the focus group. Of these, 20 were Dominicans, 2 were Puerto Ricans, and 1 was Salvadorian. The mean age was 46.39 years, 35% were women, 61% were married, and 26% had less than a high school education. Qualitative analyses resulted in 547 codes that were grouped into 52 concepts, from which 9 categories and 4 overarching themes emerged. The dominant themes were 1) family, genetics, and culture play a major role in the etiology of diabetes; 2) being Latino and having a first-degree relative with diabetes makes getting diabetes inevitable, and, like a time bomb exploding, it is destined to happen; 3) once one develops diabetes, the physical and emotional consequences are devastating and destructive; and 4) diabetes can be “cured” through healthy eating and with insulin. Conclusions.In this study, first-degree relatives of patients with diabetes were knowledgeable about the risks and consequences of diabetes. However, some participants felt that being Latino and having a first-degree relative with diabetes made one destined to have diabetes. Addressing this misperception through culturally tailored interventions has implications for diabetes prevention and may help to stem the diabetes epidemic in Latino communities. PMID:26246756

  6. Como ayudar a su hijo durante los primeros anos de la adolescencia: Para los padres con ninos entre las edades de 10 a 14 anos (Helping Your Child through Early Adolescence: For Parents of Children from 10 through 14).

    ERIC Educational Resources Information Center

    Paulu, Nancy

    Recognizing that parents and families can greatly influence the development of their 10- through 14-year-olds, this Spanish-language booklet is part of a national effort to provide parents with the latest research and practical information to help them support their children both at home and in school. The booklet is organized in 13 sections…

  7. Moral Responsibility and Confidence as Factors That Influence Teacher Involvement in Educational Change (Responsabilidad moral y confianza como factores que influyen en la participación del profesor en el cambio educativo)

    ERIC Educational Resources Information Center

    López, Cecilio

    2010-01-01

    Various factors that are not easily observed have a strong impact on educational change. In this paper, I examine some of the issues that emerged from the data collected while exploring my informants' perceptions and attitudes towards their changing roles when confronted with curriculum innovation. This research demonstrates that the…

  8. Estudo da utilizacao da biomassa florestal como fonte de produtos quimicos e energia atraves de processos quimicos e biotechnologicos (Utilization of forest biomass for chemicals and energy by chemical and biotechnological processes). Master's thesis

    SciTech Connect

    de Miranda, I.M.S.S.

    1989-04-01

    The chemical composition and the non-structural carbohydrate composition were determined for 1-year-old Eucalyptus globulus Labill trees, grown in an experimental plantation with different nutrient and water supplies (C-trees, where no treatment was made and IL-trees, which received a nutrient supply and irrigation). Leaf carbohydrates were determined for the same conditions. Pulping experiments were made using kraft cooks of eucalyptus wood. The results of the pretreatments are complemented with scanning electron microscopy observations. Average wood composition was: ash 1.6%, total extractives 5.2%, Klason lignin 21.0%, soluble lignin 3.1% (% of o.d. weight). The results did not show statistical significant differences between the two growth conditions. The average wood carbohydrate composition was: glucose 2.7%, frutose 4.1% sucrose 1.3% and starch 0.5%. The average carbohydrate composition of leaves was: glucose 1.0%, frutose 1.7%, sucrose 0.1% and starch 4.1%. The average yield for the kraft wood delinification was 49%. The saccharification of pretreated eucalyptus chips with a steam-explosion pretreatment was: For H2SO4 impregnation 26.6% and for H2O impregnation 44.2%.

  9. Systemic Functional Linguistics and Discourse Analysis as Alternatives When Dealing with Texts (La lingüística sistémica funcional y el análisis del discurso como alternativas para trabajar con textos)

    ERIC Educational Resources Information Center

    García Montes, Paula Andrea; Sagre Barboza, Ana María; Lacharme Olascoaga, Alba Isabel

    2014-01-01

    This article presents a case study research with aims to find out which activities, methodological and textual aspects used in a reading strategies course were causing a group of students difficulties when analyzing critically written information. We conducted the study at Universidad de Córdoba (Colombia) with seventh semester students from the…

  10. What Makes a Good Teacher? Children Speak Their Minds=Qu'est-ce qu'un bon maitre? Les enfants ouvrent leur coeur=Como debe ser un buen maestro? Los ninos opinan.

    ERIC Educational Resources Information Center

    Khawajkie, Elizabeth, Ed.; And Others

    This booklet is a product of the UNESCO Associated Schools Project, a network of some 3,800 schools in 131 countries, which conducts pilot projects to promote education for peace, international understanding, and cooperation. Schools taking part in the project participated in an international contest asking for spontaneous reactions to the…

  11. Adult EFL Reading Selection: Influence on Literacy (Procesos de selección de lecturas en estudiantes adultos de inglés como lengua extranjera y su influencia en la habilidad lectora)

    ERIC Educational Resources Information Center

    Basallo Gómez, Juan Sebastián

    2016-01-01

    This paper is about the impact of systematic reading selection used to promote English as foreign language learning in adult students. A qualitative action research methodology was used to carry out this project. Ten class sessions were designed to provide students an opportunity to select texts according to criteria based upon their language…

  12. Teachers' Beliefs about Assessment in an EFL Context in Colombia (Creencias de los profesores acerca de la evaluación en un contexto de inglés como lengua extranjera en Colombia)

    ERIC Educational Resources Information Center

    Muñoz, Ana Patricia; Palacio, Marcela; Escobar, Liliana

    2012-01-01

    There is evidence that teachers' beliefs on teaching and learning exert an influence on the way they teach and assess learning, and on what students learn. Therefore, it is central that overt attention is devoted to the perceptions teachers have and how they influence teaching and learning. In this article we describe a study on…

  13. Como Promover el Exito de las Ninas y las Minorias en las Ciencias y en las Matematicas. Para Padres/sobre Padres (How To Promote the Science and Mathematics Achievement of Females and Minorities. For Parents/about Parents).

    ERIC Educational Resources Information Center

    Schwartz, Wendy

    Some minority and female students traditionally have not been given the help they need to enroll and succeed in mathematics and science classes. Now, however, various approaches are available to give these students the extra attention they need. Parents can help children develop an interest in science and mathematics by: (1) identifying role…

  14. Parents as Partners: Planning Early for Your Children's School Success and College Attendance. Revised Edition = Los Padres como Socios: Planificando para el Exito Escolar y la Asistencia al Colegio de Sus Ninos. Edicion Revisada.

    ERIC Educational Resources Information Center

    Reyes, Maria; Rothman, Donald

    This booklet, available in English and Spanish, describes what California parents can do at home and in the school to support and encourage their children's success in school and college. Discussion emphasizes the extent to which parents influence their children's attitudes about learning and school, and points out that parent involvement is…

  15. Parents as Partners: Planning Early for Your Children's School Success and College Attendance = Los Padres como Socios: Planificando para el Exito Escolar y la Asistencia al Colegio de Sus Ninos.

    ERIC Educational Resources Information Center

    California State Univ., Long Beach.

    Presented in both the English and Spanish Language versions is a booklet which describes what parents can do at home and in the school to support and encourage their children's success in school and college. Discussion emphasizes the extent to which parents influence their children's attitudes about learning and school, and points out that parent…

  16. Como ayudar a su hijo a ser un buen lector: Con actividades para los ninos desde el nacimiento hasta los 6 anos (Helping Your Child Become a Reader: With Activities for Children from Infancy through Age 6).

    ERIC Educational Resources Information Center

    Lehr, Fran; Osborn, Jean

    When parents and other family members read with their children, help them with homework, talk with their teachers, and participate in school or other learning activities, they give their children a tremendous advantage. The foundation for learning to read is in place long before children enter school and begin formal reading instruction. Families…

  17. The Role of Genre-Based Activities in the Writing of Argumentative Essays in EFL (El papel de actividades basadas en géneros en la escritura de ensayos argumentativos en inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Chala Bejarano, Pedro Antonio; Chapetón, Claudia Marcela

    2013-01-01

    This article presents the findings of an action research project conducted with a group of pre-service teachers of a program in modern languages at a Colombian university. The study intended to go beyond an emphasis on linguistic and textual features in English as a foreign language argumentative essays by using a set of genre-based activities and…

  18. Como Trabajar y Vivir en la Realidad: Pasos Basicos Para Jovenes con Incapacidades, sus Padres y sus Profesores (How to Work and Live in the Real World: Basic Steps for Youth with Handicaps and Their Parents and Teachers).

    ERIC Educational Resources Information Center

    Patton, Patricia L.; And Others

    This Spanish version of "How to Work and Live in the Real World: Basic Steps for Youth with Handicaps and Their Parents and Teachers" is for young people with handicaps who are getting ready to graduate from high school and begin working and living in the adult world. The booklet places a special focus on individuals with cultural differences. It…

  19. La Capacitacion de Docentes Como Prioridad de los Sistemas Educativos de America Latino y al Caribe (In-Service Teacher Training as a Priority of Latin American and Caribbean Educational Systems).

    ERIC Educational Resources Information Center

    Valle, Victor M.

    Whenever top-level officials in Latin American and Caribbean educational systems are approached, the topic of inservice teacher training is presented as a major priority. This paper outlines some ideas about the subject of inservice teacher training as a priority of educational systems in Latin American and Caribbean countries. The most frequent…

  20. O Imperio como Argumento: Um Contraponto entre Joaquim Nabuco e o Bispo D. Jose Mauricio da Rocha (The Empire as Argument: A Counterpoint between Joaquim Nabuco and the Bishop Dom Jose Mauricio da Rocha).

    ERIC Educational Resources Information Center

    Marson, Izabel Andrade

    1998-01-01

    Dialogs with the previous article establishing a comparative analysis between the political acceptance present in the reactionary speech of Dom Jose Mauricio da Rocha and in the monarchist words of Joaquim Nabuco. (PA)

  1. Encuentros esteticos deweyanos con la cultura popular anglofona en la ensenanza de ingles como lengua extranjera (EILE). Working Paper (Deweyan Aesthetic Encounters with Anglophone Popular Culture in the Teaching of English as a Foreign Language. Working Paper).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper discusses how the introduction of Anglophone popular culture in the English-as-a-foreign-language class can serve to foster critical aesthetic experiences. It is argued that the popular culture of the hegemonic Anglophone countries is already part of students' lives and for that reason should be included in any critical Anglophone…

  2. Ideologies Revealed during the Construction of Meaning in an EFL Class (Ideologías reveladas durante la construcción de significado en una clase de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Fajardo Mora, Néstor Ricardo

    2014-01-01

    This article reports on an interpretive qualitative study conducted at a public university in Bogotá with 26 pre-service social studies teachers. It is focused on unveiling which ideologies are discovered when they construct the meaning of texts through text-based tasks in an English as a foreign language class. The data were collected by using…

  3. The Impact of Different Types of Journaling Techniques on EFL Learners' Self-Efficacy (El impacto de diferentes tipos de diario en la autosuficiencia de estudiantes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Mortazavi, Mahboobeh

    2014-01-01

    This article reports on an investigation of the impact of different methods of journaling on self-efficacy of learners of English as a foreign language. Sixty upper-intermediate Iranian English language learners were randomly assigned to three experimental conditions, namely no-feedback, teacher-feedback, and peer-feedback, and one control…

  4. The Portrayal of EFLTeachers in Official Discourse: The Perpetuation of Disdain (La imagen de los profesores de inglés como lengua extranjera en el discurso oficial: la perpetuación del desdén)

    ERIC Educational Resources Information Center

    Guerrero, Carmen Helena

    2010-01-01

    The purpose of this article is to offer an interpretation of the images of Colombian English teachers constructed in official discourse, particularly (but not exclusively) in the document "Estándares básicos de competencias en lenguas extranjeras: inglés. Formar en lenguas extranjeras, el reto". This is part of a larger critical…

  5. The Preschool Classroom as a Context for Cognitive Development: Type of Teacher Feedback and Children's Metacognitive Control (El aula Preescolar como espacio de desarrollo cognitivo: tipo de feedback docente y control metacognitivo en los niños)

    ERIC Educational Resources Information Center

    Muñoz, Liz; Cruz, Josefina Santa

    2016-01-01

    Introduction: The aim of this work was to determine whether the type of feedback given by the preschool teacher during class impacts the children's metacognitive control. For this purpose, the children's behavior was analyzed while teachers provided feedback during collaborative learning sessions. Method: A quasi-experimental, cross-sectional…

  6. La Migracion Como Una Transicion Critica para la Persona en Su Ambiente. Una Interpretacion Organismico Evolutiva. (Migration as a Critical Person-in-Environment Transition: An Organismic-Developmental Interpretation.)

    ERIC Educational Resources Information Center

    Pacheco, Angel M.; And Others

    In order to explore some of the changes and stresses connected with migration and return migration, a study was conducted among migrants returning from the United States mainland to Puerto Rico. The sample consisted of 75 adolescents participating in a Bilingual Education program in Puerto Rico. Data were collected using Psychological Distance…

  7. Exploring Authorship Development among Mexican EFL Teacher-Researchers (Exploración sobre el desarrollo de la autoría en los profesores-investigadores de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Trujeque Moreno, Eva Estefania; Encinas Prudencio, Fátima; Thomas-Ruzic, Maria

    2015-01-01

    This article presents a multi-theoretical model to address processes of "authorship development" in the English as a foreign language teaching profession. Working within a sociocultural perspective of second-language teacher education, the authors examined six experienced nonnative English-speaking teacher-researchers. Perceptions of…

  8. Developing Academic Literacy and Voice: Challenges Faced by a Mature ESL Student and Her Instructors (Desarrollo del discurso académico y la voz: retos de una estudiante de inglés como segunda lengua y sus profesores)

    ERIC Educational Resources Information Center

    Correa, Doris

    2010-01-01

    Drawing on critical, socio-cultural and sociolinguistic theories of writing, text and voice, this ethnographic study examines the challenges that a mature ESL student and her instructors in a university course on Spanish Language Media face as they co-construct a common understanding of academic literacy and voice in an undergraduate General…

  9. Learning & Growing Together: Understanding and Supporting Your Child's Development = Aprender y crecer juntos: Como comprender y fomentar el desarrollo de sus hijos [with] Tip Sheets: Ideas for Professionals in Programs That Serve Young Children and Their Families.

    ERIC Educational Resources Information Center

    Lerner, Claire; Dombro, Amy Laura; Powers, Stefanie

    Based on the view that the primary caregivers for infants and toddlers are their own best resource for understanding and caring for their child and that parenting is a lifelong learning process, this book provides information and tools to help caregivers build a strong foundation for their child's development. The book, both in English and…

  10. Como ayudar a su hijo a tener exito en la escuela, con actividades para ninos entre las edades de 5 a 11 anos (Helping Your Child Succeed in School, with Activities for Children Ages 5 through 11).

    ERIC Educational Resources Information Center

    Paulu, Nancy

    At the heart of the No Child Left Behind Act of 2001 is a promise to raise standards for all children and to help all children meet those standards. This Spanish-language booklet provides information that parents can use to help their child succeed in school. Following an introduction, the second section of the booklet, "The Basics," offers…

  11. EFL Teaching Methodological Practices in Cali (Prácticas metodológicas en la enseñanza de inglés como lengua extranjera en la ciudad de Cali)

    ERIC Educational Resources Information Center

    Chaves, Orlando; Hernández, Fanny

    2013-01-01

    In this article we aim at showing partial results of a study about the profiles of English as a Foreign Language (EFL) teachers in both public and private primary and secondary strata 1-4 schools in Cali, Colombia. Teachers' methodological approaches and practices are described and analyzed from a sample of 220 teachers. Information was gathered…

  12. Como ayudar a su hijo durante la edad preescolar, con actividades para los ninos desde el nacimiento hasta los 5 anos (Helping Your Preschool Child, with Activities for Children from Infancy through Age 5).

    ERIC Educational Resources Information Center

    Department of Education, Washington, DC. Office of Intergovernmental and Interagency Affairs.

    The first 5 yeas of a child's life are a time of tremendous physical, emotional, social, and cognitive growth. Noting that research shows that children are more likely to succeed in learning when their families actively support them, this Spanish-language booklet is intended for families and caregivers who want to help their preschool children…

  13. The Kindergarten Survival Handbook: The Before School Checklist & a Guide for Parents. (El Manual de Como Sobrevivir El Jardin de Ninos: La Lista Pre-escolar y Una Guia Para Los Padres).

    ERIC Educational Resources Information Center

    Elovson, Allana Cummings

    Written to help parents understand what their children need to know before they start kindergarten, this volume, bound separately in English and Spanish, is intended to help parents become their children's best, as well as their first and most important, teachers. The first part of the book, the before school checklist, is divided into eight…

  14. EFL Students' Perceptions about a Web-Based English Reading Comprehension Course (Percepciones de estudiantes de inglés como lengua extranjera acerca de un curso de comprensión lectora apoyado en la red)

    ERIC Educational Resources Information Center

    Gómez Flórez, Érica; Pineda, Jorge Eduardo; Marín García, Natalia

    2012-01-01

    Web-based distance education is an innovative modality of instruction in Colombia. It is characterized by the separation of the teacher and learners, the use of technological tools and the students' autonomy development. This paper reports the findings of a case study that explores students' perceptions about an English reading…

  15. Un estudio de evaluacion educativa manipulativos en el aprendizaje de las matematicas con estudiantes hispanos adquiriendo ingles academico como segunda lengua (A Study of the Use of Manipulatives in the Assessment of Mathematics Instruction with ESL Hispanic Students).

    ERIC Educational Resources Information Center

    Lara-Alecio, Rafael; Parker, Richard; Aviles, Claudia; Mason, Samantha; Irby, Beverly J.

    1998-01-01

    As an alternative form of mathematics assessment for use with limited-English-proficient students, 14 mathematics tasks using manipulatives were administered to 45 Hispanic students in grades 1-3 and readministered 2-3 weeks later. Test reliability and validity, task difficulty, and the relationship among test subscales across grades were…

  16. Introversion/Extroversion & Teachers' Perception on Dominican EFL College Students' Performance = La Introversion/Extroversion vs. La Percepcion Profesoral en el Desempeno de Estudiantes Universitarios Dominicanos de Ingles como Lengua Extranjera

    ERIC Educational Resources Information Center

    Tavarez Da Costa, Pedro

    2012-01-01

    This article discusses the relationship between introversion/extroversion and a student's performance (academic achievement) as perceived by Teachers of English as a Foreign Language in three regional centers of the Universidad Autonoma de Santo Domingo. There have been a great number of international studies already published to try to explain…

  17. The Impact of Conferencing Assessment on EFL Students' Grammar Learning (Impacto de la evaluación mediante conferencias en el aprendizaje de la gramática en estudiantes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Baleghizadeh, Sasan; Zarghami, Zahra

    2012-01-01

    This article reports on a study that was carried out in order to examine the impact of conferencing assessment on students' learning of English grammar. Forty-two Iranian intermediate university students were randomly assigned to an experimental and a control group. The participants in the experimental group took part in four individual and…

  18. Los padres como maestros de los ninos. Los padres como recursos para los maestros. Serie E: El logro de la participacion de los padres, cuadernos I y II. Edicion para el estudiante. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as the Children's Teachers. Parents as Resources for the Teachers. Series E: Success with Parent Participation, Books I and II. Student Edition. Bilingual Education Teacher Training Packets.)

    ERIC Educational Resources Information Center

    Lazos, Hector

    The student versions of two learning modules for teacher training in bilingual education are part of a series focusing on promoting parent participation in the school system. An introductory section discussing the overall objectives of the materials is followed by two modules, each consisting of introductory sections and two units containing…

  19. Los padres como maestros de los ninos. Los padres como recursos para los maestros. Serie E: [E1] logro de la participacion de los padres. cuadernos 1 y 2. Edicion para el maestro. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as Their Children's Teachers. Parents as Resources for Teachers. Series E: Parent Participation, Book 1 and 2. Teacher Edition. Bilingual Education Teacher Training Packets).

    ERIC Educational Resources Information Center

    Lazos, Hector, Comp.

    This guide on training bilingual education teachers focuses on parent participation in school activities. The guide addresses three groups of people: paraprofessionals and non-graduate students, bilingual teachers, and graduate students. Two units are presented, one dealing with the important influence parents have on their child's language…

  20. Policies for control and prevention of infections related to healthcare assistance in Brazil: a conceptual analysis.

    PubMed

    Oliveira, Hadelândia Milon de; Silva, Cristiane Pavanello Rodrigues; Lacerda, Rúbia Aparecida

    2016-01-01

    This article is a theoretical-reflexive study that aims to discuss the development and changes in the quality of healthcare assistance to the patient over the years in Brazil, in light of the policies of control and prevention of Healthcare-associated Infection (HAI). Aspects of HAI and the process of change in health policy in Brazil, as well as the quality of assistance associated with its control, are approached in relation to policies of patient safety. There are various new theoretical and practical proposals created in Brazil. In spite of the difficulty of measuring patient safety, directed to the prevention and control of HAI, we emphasize that to only create policies and establish norms, guidelines, and indicators is not sufficient. If no structural support or conditions exist for interventions in the practices of healthcare professionals, aiming at results in acceptable levels, the control of HAI will not be achieved. Resumo Trata-se um estudo teórico-reflexivo, que objetiva discutir a evolução e as mudanças na qualidade da assistência ao paciente, ao longo dos anos no Brasil, à luz das políticas de controle e prevenção da Infecção Relacionada à Assistência à Saúde (IRAS). Aspectos sobre IRAS e o processo de mudança nas políticas de saúde no Brasil, bem como a qualidade da assistência associada ao seu controle, são abordados em relação às políticas de segurança do paciente. Há novas e várias propostas teóricas e práticas criadas no Brasil. Apesar da dificuldade de medir a segurança do paciente, direcionada à prevenção e controle das IRAS, enfatiza-se que somente criar políticas, estabelecer normas, diretrizes e indicadores não são suficientes. Se não houver suporte de estrutura e condições para as intervenções nas práticas dos profissionais na assistência prestada ao paciente, visando resultados em níveis aceitáveis, o controle das IRAS não será alcançado. PMID:27556723

  1. Oral health in the agenda of priorities in public health.

    PubMed

    Antunes, José Leopoldo Ferreira; Toporcov, Tatiana Natasha; Bastos, João Luiz; Frazão, Paulo; Narvai, Paulo Capel; Peres, Marco Aurélio

    2016-08-01

    This study describes the scientific production on oral health diffused in Revista de Saúde Pública, in the 50 years of its publication. A narrative review study was carried out using PubMed, as it is the search database that indexes all issues of the journal. From 1967 to 2015, 162 manuscripts specifically focused on oral health themes were published. This theme was present in all volumes of the journal, with increasing participation over the years. Dental caries was the most studied theme, constantly present in the journal since its first issue. Periodontal disease, fluorosis, malocclusions, and other themes emerged even before the decline of dental caries indicators. Oral health policy is the most recurring theme in the last two decades. Revista de Saúde Pública has been an important vehicle for dissemination, communication, and reflection on oral health, contributing in a relevant way to the technical-scientific interaction between professionals in this field. RESUMO Este estudo descreve a produção científica sobre saúde bucal veiculada na Revista de Saúde Pública, nos cinquenta anos de sua publicação. Foi realizado estudo de revisão narrativa, utilizando o PubMed como mecanismo de busca que indexa todos os fascículos da revista. De 1967 a 2015, foram publicados 162 manuscritos com foco específico em temas de saúde bucal. Essa temática esteve presente em todos os volumes da revista, com participação crescente ao longo dos anos. Cárie dentária foi o tema mais estudado, marcando presença constante na revista desde seu primeiro fascículo. Doença periodontal, fluorose, oclusopatias e outros temas emergiram antes mesmo do declínio dos indicadores de cárie. Políticas de saúde bucal é o tema mais recorrente nas duas últimas décadas. A Revista de Saúde Pública tem sido importante veículo de divulgação, comunicação e reflexão sobre saúde bucal, contribuindo de modo relevante para a interação técnico-científica entre os

  2. [In Process Citation].

    PubMed

    Fariña López, E; Estévez-Guerra, G J; Núñez González, E; Calvo Francés, F; Penelo, E

    2016-01-01

    Fundamento. Adaptar y validar en español el cuestionario Perception of Restraint Use Questionnaire, que mide la importancia que dan los profesionales al uso de restricciones físicas en personas mayores.Método. Estudio multicéntrico, descriptivo y transversal. Tras un proceso de traducción-retrotraducción, se obtuvo una versión en español del cuestionario original. La validación se llevó a cabo entre una muestra de 830 profesionales seleccionados en veinte centros de tres comunidades autónomas españolas. Se analizó la viabilidad, la fiabilidad mediante la consistencia interna y la estabilidad temporal (test-retest), así como la validez de contenido (panel de expertos e índice de validez) y de constructo (análisis factorial).Resultados. De los 17 ítems del cuestionario, 15 pudieron traducirse de manera literal; en dos hubo que realizar modificaciones menores. Un estudio piloto confirmó la adecuada viabilidad del cuestionario. El alfa de Cronbach fue de 0,92 y la fiabilidad test-retest (CCI) de 0,908 (IC del 95%: 0,880-0,933). El índice de validez de contenido fue de 0,89. El análisis factorial exploratorio identificó dos dimensiones que explicaban el 63% de la varianza, presentando una fiabilidad de 0,90 y 0,93 respectivamente. Este fue sometido a un análisis confirmatorio, mostrando los indicadores un adecuado ajuste.Conclusiones. Se ha obtenido un instrumento en español con unas buenas características psicométricas y adaptado al contexto cultural de este país. Una herramienta útil para evaluar en qué situaciones se considera más necesario el uso de las restricciones físicas, lo que podría ayudar a diseñar actividades de formación encaminadas a racionalizar su aplicación.Palabras clave. Cuestionarios. Percepción. Restricción física. Anciano. Estudios de validación. PMID:27125606

  3. [In Process Citation].

    PubMed

    Sánchez-Ramírez, Carmen A; Larrosa-Haro, Alfredo; M Vásquez Garibay, Edgar; Rodríguez-Anguiano, Ana K; Cámara-López, María E

    2016-01-01

    Introducción: la ingestión de cáusticos (IC) en niños y adolescentes puede ocasionar esofagitis erosiva, estenosis esofágica y disfagia, entidades que pueden alterar el proceso de alimentación y originar desnutrición y retraso en el crecimiento.Objetivos: evaluar el estado nutricio de niños con IC y su asociación con disfagia y estenosis esofágica.Métodos: estudio transversal analítico en el que se incluyó a 62 niños atendidos en un hospital pediátrico de referencia que sufrieron IC. Lasvariables independientes fueron la presencia/ausencia de disfagia y/o estenosis esofágica; las dependientes fueron el crecimiento y el estado nutricio evaluados mediante antropometría. Análisis estadístico: c2, OR, IC 95%, kappa y t de Student.Resultados: la edad promedio fue 39,7 meses, el 39,7% eran niñas. Cuarenta y dos (77,8%) presentaron esofagitis erosiva (II-b, III-a, and III-b) en la endoscopia. En 24 (38,7%) ocurrió disfagia y en 40 (64,5%) estenosis esofágica. El puntaje z de la talla para la edad fue <-2 DE en cinco niños (8,1%) y el puntaje z del IMC < -2 DE en tres (4,8%). En 24.2% la z-IMC fue > +1 DE. El puntaje z de los indicadores del brazo relacionados a reservas grasa y masa muscular tanto en el grupo de estenosis como de disfagia se localizó en el lado negativo de la curva y ambos fueron significativamente menores a los del grupo sin disfagia o estenosis.Conclusiones: la proporción de esofagitis erosiva, estenosis o disfagia fue elevada. En los niños con disfagia o estenosis esofágica se identificaron reservas de grasa y masa muscular menores a las de los niños sin estas complicaciones. PMID:27019238

  4. Heat and PAHs Emissions in Indoor Kitchen Air and Its Impact on Kidney Dysfunctions among Kitchen Workers in Lucknow, North India

    PubMed Central

    Singh, Amarnath; Kamal, Ritul; Mudiam, Mohana Krishna Reddy; Gupta, Manoj Kumar; Satyanarayana, Gubbala Naga Venkata; Bihari, Vipin; Shukla, Nishi; Khan, Altaf Hussain; Kesavachandran, Chandrasekharan Nair

    2016-01-01

    Indoor air quality and heat exposure have become an important occupational health and safety concern in several workplaces including kitchens of hotels. This study investigated the heat, particulate matter (PM), total volatile organic compounds (TVOCs) and polycyclic aromatic hydrocarbons (PAHs) emissions in indoor air of commercial kitchen and its association with kidney dysfunctions among kitchen workers. A cross sectional study was conducted on 94 kitchen workers employed at commercial kitchen in Lucknow city, North India. A questionnaire-based survey was conducted to collect the personal and occupational history of the kitchen workers. The urine analysis for specific gravity and microalbuminuria was conducted among the study subjects. Indoor air temperature, humidity, wet/ dry bulb temperature and humidex heat stress was monitored during cooking activities at the kitchen. Particulate matter (PM) for 1 and 2.5 microns were monitored in kitchen during working hours using Hazdust. PAHS in indoor air was analysed using UHPLC. Urinary hydroxy-PAHs in kitchen workers were measured using GC/MS-MS. Higher indoor air temperature, relative humidity, PM1 and PM2.5 (p<0.001) was observed in the kitchen due to cooking process. Indoor air PAHs identified are Napthalene, fluorine, acenaphthene, phenanthrene, pyrene, chrysene and indeno [1,2,3-cd) pyrene. Concentrations of all PAHs identified in kitchen were above the permissible OSHA norms for indoor air. Specific gravity of urine was significantly higher among the kitchen workers (p<0.001) as compared to the control group. Also, the prevalence of microalbuminuria was higher (p<0.001) among kitchen workers. Urinary PAH metabolites detected among kitchen workers were 1-NAP, 9-HF, 3-HF, 9-PHN and 1-OHP. Continuous heat exposure in kitchens due to cooking can alter kidney functions viz., high specific gravity of urine in kitchen workers. Exposure to PM, VOCs and PAHs in indoor air and presence of urinary PAHs metabolites may

  5. Efficacy and Safety of Tangshen Formula on Patients with Type 2 Diabetic Kidney Disease: A Multicenter Double-Blinded Randomized Placebo-Controlled Trial

    PubMed Central

    Li, Ping; Chen, Yiping; Liu, Jianping; Hong, Jing; Deng, Yueyi; Yang, Fang; Jin, Xiuping; Gao, Jing; Li, Jing; Fang, Hui; Liu, Geling; Shi, Liping; Du, Jinhang; Li, Yang; Yan, Meihua; Wen, Yumin; Yang, Wenying

    2015-01-01

    Background Persons with diabetes are at high risk of developing diabetic kidney disease (DKD), which is associated with high morbidity and mortality. Current drug therapies for DKD, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), are not entirely satisfactory. This study aimed to evaluate the additional benefit and safety of the Chinese herbal granule Tangshen Formula (TSF) in treating DKD. Methods The study was designed as a six-center randomized, double-blind, placebo-controlled trial. From April 2007 through December 2009, 180 patients with DKD were enrolled. In addition to conventional treatment with ACEIs or ARBs, 122 participants were randomly assigned to receive TSF and 58 participants to receive placebo for 24 weeks. Primary outcome was urinary protein level, measured by urinary albumin excretion rate (UAER) for participants with microalbuminuria, 24-hour urinary protein (24h UP) for participants with macroalbuminuria. Secondary outcomes included renal function, serum lipids, quality of life, symptoms, and adverse events. Findings After 24 weeks of treatment, no statistically significant difference in UAER (TSF −19.53 μg/min compared with placebo −7.01 μg/min, with a mean difference of −12.52 μg/min; 95%CI, −68.67 to 43.63, P = 0.696) was found between TSF and placebo groups. However, TSF displayed a statistically significant decrease in 24h UP (TSF−0.21 g compared with placebo 0.36 g, with a mean difference of −0.57g; 95%CI, −1.05 to −0.09, P = 0.024). Estimated glomerular filtration rate (eGFR) was improved in both patients with microalbuminuria and macroalbuminuria, with a mean difference of 15.51 ml/min/1.73 m2 (95%CI, 3.71 to 27.31), 9.01 ml/min/1.73 m2 (95%CI, −0.10 to 18.13), respectively. Other secondary outcomes showed no statistically significant difference between groups or in the incidence of adverse events. Conclusions Based on conventional

  6. Heat and PAHs Emissions in Indoor Kitchen Air and Its Impact on Kidney Dysfunctions among Kitchen Workers in Lucknow, North India.

    PubMed

    Singh, Amarnath; Kamal, Ritul; Mudiam, Mohana Krishna Reddy; Gupta, Manoj Kumar; Satyanarayana, Gubbala Naga Venkata; Bihari, Vipin; Shukla, Nishi; Khan, Altaf Hussain; Kesavachandran, Chandrasekharan Nair

    2016-01-01

    Indoor air quality and heat exposure have become an important occupational health and safety concern in several workplaces including kitchens of hotels. This study investigated the heat, particulate matter (PM), total volatile organic compounds (TVOCs) and polycyclic aromatic hydrocarbons (PAHs) emissions in indoor air of commercial kitchen and its association with kidney dysfunctions among kitchen workers. A cross sectional study was conducted on 94 kitchen workers employed at commercial kitchen in Lucknow city, North India. A questionnaire-based survey was conducted to collect the personal and occupational history of the kitchen workers. The urine analysis for specific gravity and microalbuminuria was conducted among the study subjects. Indoor air temperature, humidity, wet/ dry bulb temperature and humidex heat stress was monitored during cooking activities at the kitchen. Particulate matter (PM) for 1 and 2.5 microns were monitored in kitchen during working hours using Hazdust. PAHS in indoor air was analysed using UHPLC. Urinary hydroxy-PAHs in kitchen workers were measured using GC/MS-MS. Higher indoor air temperature, relative humidity, PM1 and PM2.5 (p<0.001) was observed in the kitchen due to cooking process. Indoor air PAHs identified are Napthalene, fluorine, acenaphthene, phenanthrene, pyrene, chrysene and indeno [1,2,3-cd) pyrene. Concentrations of all PAHs identified in kitchen were above the permissible OSHA norms for indoor air. Specific gravity of urine was significantly higher among the kitchen workers (p<0.001) as compared to the control group. Also, the prevalence of microalbuminuria was higher (p<0.001) among kitchen workers. Urinary PAH metabolites detected among kitchen workers were 1-NAP, 9-HF, 3-HF, 9-PHN and 1-OHP. Continuous heat exposure in kitchens due to cooking can alter kidney functions viz., high specific gravity of urine in kitchen workers. Exposure to PM, VOCs and PAHs in indoor air and presence of urinary PAHs metabolites may

  7. Diabetes Care, Glycemic Control, Complications, and Concomitant Autoimmune Diseases in Children with Type 1 Diabetes in Turkey: A Multicenter Study

    PubMed Central

    Şimşek, Damla Gökşen; Aycan, Zehra; Özen, Samim; Çetinkaya, Semra; Kara, Cengiz; Abalı, Saygın; Demir, Korcan; Tunç, Özgül; Uçaktürk, Ahmet; Asar, Gülgün; Baş, Firdevs; Çetinkaya, Ergun; Aydın, Murat; Karagüzel, Gülay; Orbak, Zerrin; Orbak, Zerrin; Şıklar, Zeynep; Altıncık, Ayça; Ökten, Ayşenur; Özkan, Behzat; Öçal, Gönül; Semiz, Serap; Arslanoğlu, İlknur; Evliyaoğlu, Olcay; Bundak, Rüveyde; Darcan, Şükran

    2013-01-01

    Objective: Epidemiologic and clinical features of type 1 diabetes mellitus (T1DM) may show substantial differences among countries. The primary goal in the management of T1DM is to prevent micro- and macrovascular complications by achieving good glycemic control. The present study aimed to assess metabolic control, presence of concomitant autoimmune diseases, and of acute and long-term complications in patients diagnosed with T1DM during childhood and adolescence. The study also aimed to be a first step in the development of a national registry system for T1DM, in Turkey. Methods: Based on hospital records, this cross-sectional, multicenter study included 1 032 patients with T1DM from 12 different centers in Turkey, in whom the diagnosis was established during childhood. Epidemiological and clinical characteristics of the patients were recorded. Metabolic control, diabetes care, complications, and concomitant autoimmune diseases were evaluated. Results: Mean age, diabetes duration, and hemoglobin A1c level were 12.5±4.1 years, 4.7±3.2 years, and 8.5±1.6%, respectively. Acute complications noted in the past year included ketoacidosis in 5.2% of the patients and severe hypoglycemia in 4.9%. Chronic lymphocytic thyroiditis was noted in 12%, Graves’ disease in 0.1%, and celiac disease in 4.3% of the patients. Chronic complications including neuropathy, retinopathy, and persistent microalbuminuria were present in 2.6%, 1.4%, and 5.4% of the patients, respectively. Diabetic nephropathy was not present in any of the patients. Mean diabetes duration and age of patients with neuropathy, retinopathy and microalbuminuria were significantly different from the patients without these long-term complications (p<0.01). A significant difference was found between pubertal and prepubertal children in terms of persistent microalbuminuria and neuropathy (p=0.02 and p<0.001, respectively). Of the patients, 4.4% (n:38) were obese and 5% had short stature; 17.4% of the patients had

  8. Profile of metabolic abnormalities seen in patients with type 2 diabetes mellitus and their first degree relatives with metabolic syndrome seen in Benin City, Edo state Nigeria

    PubMed Central

    2014-01-01

    Background To determine the profile of metabolic abnormalities in T2DM persons with metabolic syndrome and their non-diabetic first-degree relatives who also had metabolic syndrome in Benin City. Methodology This was a cross sectional case controlled study in which convenience sampling technique was used to recruit 106 persons with T2DM, 96 people who are first degree relatives of type 2 diabetic persons and 96 controls using a interviewer administered questionnaire technique. The following were assessed: anthropometric indices, blood pressure, serum lipid profile, fasting blood sugar, proteinuria, and microalbuminuria. The data obtained were analyzed using the statistical software-Statistical package for social sciences [SPSS] version 16. A p-value of less than 0.05 was taken as statistically significant. Results The mean age (SD) of the study groups were: persons living with T2DM: 58.6 ± 11.2 years, control: 57.69 ± 60.8 years and FDR: 57.4 ± 10.6 years. No significant age and sex differences were observed in these groups. There were more females (59.7%) than males (40.3%) with T2DM. The prevalence of MS was 13.5%, 16.7%, and 87.1% in the control, FDR and T2DM patients respectively. For the T2DM group of subjects, impaired fasting glycaemia was the commonest metabolic abnormality followed by microalbuminuria, low HDL cholesterol, high LDL cholesterol, hypercholesterolaemia and hypertriglyceridaemia in decreasing frequency. For the FDR group, low HDL cholesterol was the commonest metabolic abnormality followed by hypertriglyceridaemia, impaired fasting glucose, high LDL cholesterol, hypertriglyceridaemia and microalbuminuria in decreasing frequency. Hypercholesterolemia and low HDL cholesterol were the commonest metabolic abnormalities in the control group. Conclusion The prevalence of the MS in persons with T2DM in Nigeria appears to be high. Secondly, there is a high prevalence of lipid abnormalities in all the study groups. PMID:24932458

  9. Role of transforming growth factor-β2 in, and apossible transforming growth factor-β2 gene polymorphism as a marker of, renal dysfunction in essential hypertension: A study in Turkish patients

    PubMed Central

    Bicik, Zerrin; Gönen, Sevim; Bahçebasi, Talat; Reis, Kadriye; Arinsoy, Turgay; Sindel, Sükrü

    2005-01-01

    Background: Many studies have shown that transforming growth factor(TGF)-β has a major role in renal scarring in many renal diseases and hypertension. Objectives: The primary aim of this study was to investigate both the relationship between hypertension and serum and urinary levels of TGF-β2 (a more sensitive isoform for glomeruli than TGF-β1), and the effects of combination therapy with perindopril + indapamide on microalbuminuria, which becomes an early indicator of hypertensive benign nephropathy, and serum and urinary TGF-β2 levels in patients with mild to moderate essential hypertension. In addition, we examined the possible relationship between TGF-β2 gene polymorphism and essential hypertension. Methods: This study was conducted at the Department of Nephrology, Medical Faculty, Gazi University, Ankara, Turkey. Patients aged ≥18 years with newly diagnosed mild to moderate essential hypertension (systolic/diastolic blood pressure [SBP/DBP] >120/>80 mm Hg) who had not previously received antihypertensive treatment were included in the study. Patients with stage I hypertension received perindopril 2 mg + indapamide 0.625 mg (tablet), and patients with stage lI hypertension received perindopril 4 mg + indapamide 1.125 mg (tablet). All study drugs were given OD (morning) PO with food for 6 months. Serum and urinary TGF-β2 and creatinine levels and serum and urinary albumin levels were measured before and after perindopril + indapamide administration. Amplified DNA fragments of the TGF-β2 primer region were screened using amplification refractory mutation system polymerase chain reaction analysis, and the number of ACA repeats was confirmed by DNA sequencing. Genetic studies were performed using a commercial TGF-β2 kit. Results: Forty patients were enrolled in the study, and 38 patients (27 women, 11 men; mean [SD] age, 46.3 [6.5] years) completed it. SBP and DBP were significantly decreased from baseline with perindopril/indapamide (both, P < 0

  10. Transcriptome Analysis of Proximal Tubular Cells (HK-2) Exposed to Urines of Type 1 Diabetes Patients at Risk of Early Progressive Renal Function Decline

    PubMed Central

    Wanic, Krzysztof; Krolewski, Bozena; Ju, Wenjun; Placha, Grzegorz; Niewczas, Monika A.; Walker, William; Warram, James H.; Kretzler, Matthias; Krolewski, Andrzej S.

    2013-01-01

    Background In patients with Type 1 Diabetes (T1D) who develop microalbuminuria, progressive decline in glomerular filtration rate (GFR) may be initiated by leakage into the urine of toxic proteins (txUPs). This study tested this hypothesis. Methods After archiving baseline urine, we followed T1D patients with microalbuminuria for 8–12 years to distinguish those in whom GFR declined (Decliners) and those in whom it remained stable (Non-decliners). Human proximal tubular cells (HK-2 cells) were grown in serum-free medium enriched with pooled urines from Decliners or Non-decliners. We determined genome-wide expression profiles in extracted mRNA. Results The two pooled urines induced differential expression of 312 genes. In terms of gene ontology, molecular functions of the 119 up-regulated genes were enriched for protein binding and peptidase inhibitor activities. Their biologic processes were enriched for defense response, responses to other organisms, regulation of cellular processes, or response to stress or stimulus, and programmed cell death. The 195 down-regulated genes were disproportionately represented in molecular functions of cation binding, hydrolase activity, and DNA binding. They were disproportionately represented in biological processes for regulation of metabolic processes, nucleic acid metabolic processes, cellular response to stress and macromolecule biosynthesis. The set of up-regulated genes in HK-2 cells overlaps significantly with sets of over-expressed genes in tubular and interstitial compartments of kidney biopsies from patients with advanced DN (33 genes in one study and 25 in the other compared with 10.3 expected by chance, p<10−9 and p<10−4, respectively). The overlap included genes encoding chemokines and cytokines. Overlap of down-regulated genes was no more than expected by chance. Conclusions Molecular processes in tubules and interstitium seen in advanced diabetic nephropathy can be induced in vitro by exposure to urine from

  11. Water-Pipe Smoking and Albuminuria: New Dog with Old Tricks

    PubMed Central

    Ishtiaque, Iqra; Shafique, Kashif; Ul-Haq, Zia; Shaikh, Abdul Rauf; Khan, Naveed Ali; Memon, Abdul Rauf; Mirza, Saira Saeed; Ishtiaque, Afra

    2014-01-01

    Water-pipe (WP) smoking is on rise worldwide for the past few years, particularly among younger individuals. Growing evidence indicates that WP smoking is as harmful as cigarette smoking. To date, most of the research has focused on acute health effects of WP smoking, and evidence remains limited when it comes to chronic health effects in relation to long-term WP smoking. Therefore, the aim of this study was to examine the association between WP smoking and albuminuria in apparently healthy individuals. This analysis was conducted on data of a population-based cross-sectional study—the Urban Rural Chronic Diseases Study (URCDS). The study sample was recruited from three sites in Pakistan. Trained nurses carried out individual interviews and obtained the information on demographics, lifestyle factors, and past and current medical history. Measurements of complete blood count, lipid profile, fasting glucose level, and 24-hour albuminuria were also made by using blood and urine samples. Albumin excretion was classified into three categories using standard cut-offs: normal excretion, high-normal excretion and microalbuminuria. Multiple logistic regression models were used to examine the relationship between WP smoking and albuminuria. The final analysis included data from 1,626 health individuals, of which 829 (51.0%) were males and 797 (49.0%) females. Of 1,626 individuals, 267 (16.4%) were current WP smokers and 1,359 (83.6%) were non-WP smokers. WP smoking was significantly associated with high-normal albuminuria (OR  =  2.33, 95% CI 1.68-3.22, p-value <0.001) and microalbuminuria (OR  =  1.75, 95% CI 1.18-2.58, p-value 0.005) after adjustment for age, sex, BMI, social class, hypertension, and diabetes mellitus. WP smoking was significantly associated with high-normal albuminuria and microalbuminuria when analysis was stratified on hypertension and diabetes mellitus categories. WP smoking has a strong association with albuminuria in apparently healthy

  12. Renal Function in Kidney and Liver Transplant Recipients After A 130-km Road Cycling Race

    PubMed Central

    Mosconi, Giovanni; Roi, Giulio Sergio; Totti, Valentina; Zancanaro, Marco; Tacconi, Alessandra; Todeschini, Paola; Ramazzotti, Eric; Di Michele, Rocco; Trerotola, Manuela; Donati, Carlo; Nanni Costa, Alessandro

    2015-01-01

    Abstract Background A few patients, after receiving solid organ transplantation, return to performing various sports and competitions; however, at present, data no study had evaluated the effects of endurance cycling races on their renal function. Methods Race times and short form (36) health survey questionnaires of 10 kidney transplant recipients (KTR) and 8 liver transplant recipients (LTR) transplanted recipients involved in a road cycling race (130 km) were compared with 35 healthy control subjects (HCS), also taking laboratory blood and urine tests the day before the race, at the end of the race, and 18 to 24 hours after competing. Results The 3 groups showed similar race times (KTR, 5 hours 59 minutes ± 0 hours 39 minutes; LTR, 6 hours 20 minutes ± 1 hour 11 minutes; HCS, 5 hours 40 minutes ± 1 hour 28 minutes), similar short form (36) health survey scores, and similar trend of laboratory parameters which returned to baseline after 18 to 24 hours. After the race, there was an increase in creatinine (0.24 mg/dL; effect size [ES] = 0.78; P < 0.001), urea (22 mg/dL; ES = 1.42; P < 0.001), and a decrease of estimated glomerular filtration rate (−17 mL/min; ES = 0.85; P < 0.001). The increase of blood uric acid was more remarkable in HCS and KTR (2.3 mg/dL; ES = 1.39; P < 0.001). The KTR showed an increase of microalbuminuria (167.4 mg/L; ES = 1.20; P < 0.001) and proteinuria (175 mg/mL; ES = 0.97; P < 0.001) similar to LTR (microalbuminuria: 176.0 mg/L; ES = 1.26; P < 0.001; proteinuria: 213 mg/mL; ES = 1.18; P < 0.001), with high individual variability. The HCS had a nonsignificant increase of microalbuminuria (4.4 mg/L; ES = 0.03; P = 0.338) and proteinuria (59 mg/mL; ES = 0.33; P = 0.084). Conclusions Selected and well-trained KTR and LTR patients can participate to an endurance cycling race showing final race times and temporary modifications of kidney function similar to those of HCS group, despite some differences related to baseline clinical

  13. Albuminuria and chronic kidney disease in association with the metabolic syndrome.

    PubMed

    Ninomiya, Toshiharu; Kiyohara, Yutaka

    2007-01-01

    Chronic kidney disease is a worldwide public health problem because it is an important risk factor for cardiovascular disease and premature death. The metabolic syndrome, which is characterized by abdominal obesity, high blood pressure, impaired glucose tolerance, and dyslipidemia, is also an increasingly common disorder and a major risk factor for diabetes and cardiovascular disease. A close association has been found between the metabolic syndrome and the risk for developing renal impairment, clinically expressed in the form of microalbuminuria or chronic kidney disease. Several potential mechanisms, including insulin resistance, renal atherosclerosis, and inflammation, induce the deterioration of renal function. Despite the close association between the metabolic syndrome and renal impairment, it is still unclear whether and to what extent treating the metabolic syndrome will prevent renal impairment. A clinical trial is needed to clarify whether the effect of preventing and treating metabolic syndrome components will result in improved renal prognosis. PMID:17684460

  14. Novel hydrogen sulfide-releasing compound, S-propargyl-cysteine, prevents STZ-induced diabetic nephropathy.

    PubMed

    Qian, Xin; Li, Xinghui; Ma, Fenfen; Luo, Shanshan; Ge, Ruowen; Zhu, Yizhun

    2016-05-13

    In this work, we demonstrated for the first time that S-propargyl-cysteine (SPRC, also named as ZYZ-802), a novel hydrogen sulfide (H2S)-releasing compound, had renoprotective effects on streptozotocin (STZ)-induced diabetic kidney injury. SPRC treatment significantly reduced the level of creatinine, kidney to body weight ratio and in particular, markedly decreased 24-h urine microalbuminuria excretion. SPRC suppressed the mRNA expression of fibronectin and type IV collagen. In vitro, SPRC inhibited mesangial cells over-proliferation and hypertrophy induced by high glucose. Additionally, SPRC attenuated inflammation in diabetic kidneys. SPRC also reduced transforming growth factor β1 (TGF-β1) signaling and expression of phosphorylated Smad3 (p-Smad3) pathway. Moreover, SPRC inhibited phosphorylation of ERK, p38 protein. Taken together, SPRC was demonstrated to be a potential therapeutic candidate to suppress diabetic nephropathy. PMID:27055593

  15. Chronic kidney disease and venous thromboembolism: epidemiology and mechanisms

    PubMed Central

    Wattanakit, Keattiyoat; Cushman, Mary

    2010-01-01

    Purpose of review An estimated 13% of Americans have kidney disease. We sought to describe the association of kidney disease with risk of venous thromboembolism and discuss possible mechanisms explaining this association. Recent findings All severities of kidney disease appear to increase the risk of venous thromboembolism. In the general population the risk associated with mild to moderate kidney disease is 1.3–2-fold increased, and present even for microalbuminuria, although stage 1 chronic kidney disease itself has not been studied. End-stage renal disease is also associated with a 2.3-fold increased risk, compared to the general population. Although data are limited, risk increases after kidney transplant and with nephrotic syndrome as well. Summary Rates of kidney disease are increasing rapidly in the population and kidney disease is a risk factor for venous thromboembolism. An improved understanding of mechanisms linking kidney disease with venous thromboembolism will allow further study of best prevention efforts. PMID:19561505

  16. Evaluation of methods used in the prediction of hypertensive disorders of pregnancy.

    PubMed

    Conde-Agudelo, A; Lede, R; Belizán, J

    1994-03-01

    Several methods used in the prediction of hypertensive disorders of pregnancy (HDP) were evaluated with statistical techniques. Only cohort studies were considered. The data reviewed show that platelet count, hematocrit, serum uric acid, and microalbuminuria are poor predictors of HDP. Mean arterial pressure predicts transient hypertension rather than preeclampsia. Fibronectin, urinary calcium excretion, roll-over test, and Doppler ultrasound showed contradictory and nonconclusive findings among the different authors. Isometric exercise test showed high predictive values but only two studies have been performed. Angiotensin II sensitivity was the test that showed the best predictive values but it is useless in clinical practice. In conclusion, currently, there is no test that fulfills all criteria established to be a good predictor of hypertensive disorders of pregnancy. The search for an adequate method for the screening of HDP with a high sensitivity, inexpensive, and easy to perform should still be a priority in future investigations. PMID:8164916

  17. Management of diabetic renal disease

    PubMed Central

    Eboh, Cecil

    2015-01-01

    Diabetic nephropathy is the leading cause of end stage renal failure (ESRF) worldwide, representing over 50% of patients on renal replacement therapy in some parts of the world. The condition is common in people with type 1 and type 2 diabetes, although the incidence appears to be declining, especially in type 1 diabetes. More than 1 in 3 people with type 2 diabetes have impaired kidney function. Advances in our understanding of the pathogenesis and natural history of the condition have enabled us to consider earlier therapy aimed at renal preservation and reduction in cardiovascular morbidity. Microalbuminuria is now established as the earliest risk marker for nephropathy in type 1 diabetes and cardiovascular disease in type 2 diabetes. This review examines the current concepts in the pathogenesis and management of diabetic nephropathy. PMID:26244141

  18. Microvascular complications of diabetes mellitus: renal protection accompanies cardiovascular protection.

    PubMed

    Brown, W Virgil

    2008-12-22

    The microvascular complications of diabetes mellitus confer substantial morbidity and impair patient quality of life. Dyslipidemia and prolonged hyperglycemia promote an increase in oxidative stress, inflammation, and vascular damage, which together promote endothelial dysfunction and are associated with macrovascular and microvascular complications. Microalbuminuria is an early marker of diabetic nephropathy and an independent risk factor for cardiovascular disease. Diabetic nephropathy is the most common cause of end-stage renal disease in developed countries, and its prevalence is increasing. Preventing or limiting the progression of diabetic nephropathy, as demonstrated in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial, may prevent or delay renal complications, as well as convey important cardioprotective benefits in patients with type 2 diabetes. PMID:19084084

  19. Laboratory Markers of Ventricular Arrhythmia Risk in Renal Failure

    PubMed Central

    2014-01-01

    Sudden cardiac death continues to be a major public health problem. Ventricular arrhythmia is a main cause of sudden cardiac death. The present review addresses the links between renal function tests, several laboratory markers, and ventricular arrhythmia risk in patients with renal disease, undergoing or not hemodialysis or renal transplant, focusing on recent clinical studies. Therapy of hypokalemia, hypocalcemia, and hypomagnesemia should be an emergency and performed simultaneously under electrocardiographic monitoring in patients with renal failure. Serum phosphates and iron, PTH level, renal function, hemoglobin and hematocrit, pH, inflammatory markers, proteinuria and microalbuminuria, and osmolarity should be monitored, besides standard 12-lead ECG, in order to prevent ventricular arrhythmia and sudden cardiac death. PMID:24982887

  20. Diabetic Nephropathy in Women With Preexisting Diabetes: From Pregnancy Planning to Breastfeeding.

    PubMed

    Ringholm, Lene; Damm, Julie Agner; Vestgaard, Marianne; Damm, Peter; Mathiesen, Elisabeth R

    2016-02-01

    In women with preexisting diabetes and nephropathy or microalbuminuria, it is important to deliver careful preconception counselling to assess the risk for the mother and the foetus, for optimizing glycaemic status and to adjust medical treatment. If serum creatinine is normal in early pregnancy, kidney function is often preserved during pregnancy, but complications such as severe preeclampsia and preterm delivery are still common. Perinatal mortality is now comparable with that in women with diabetes and normal kidney function. Besides strict glycaemic control before and during pregnancy, early and intensive antihypertensive treatment is important to optimize pregnancy outcomes. Methyldopa, labetalol, nifedipine and diltiazem are considered safe, whereas angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers should be stopped before or at confirmation of pregnancy. Supplementation with folic acid in early pregnancy and low-dose aspirin from 10 to 12 weeks reduces the risk of adverse pregnancy outcomes. During breastfeeding, several ACE inhibitors are considered safe. PMID:26803648

  1. Plasma Cardiotrophin-1 as a Marker of Hypertension and Diabetes-Induced Target Organ Damage and Cardiovascular Risk

    PubMed Central

    Gamella-Pozuelo, Luis; Fuentes-Calvo, Isabel; Gómez-Marcos, Manuel A.; Recio-Rodriguez, José I.; Agudo-Conde, Cristina; Fernández-Martín, José L.; Cannata-Andía, Jorge B.; López-Novoa, José M.; García-Ortiz, Luis; Martínez-Salgado, Carlos

    2015-01-01

    Abstract The search for biomarkers of hypertension and diabetes-induced damage to multiple target organs is a priority. We analyzed the correlation between plasma cardiotrophin-1 (CT-1), a chemokine that participates in cardiovascular remodeling and organ fibrosis, and a wide range of parameters currently used to diagnose morphological and functional progressive injury in left ventricle, arteries, and kidneys of diabetic and hypertensive patients, in order to validate plasma levels of CT-1 as clinical biomarker. This is an observational study with 93 type 2-diabetic patients, 209 hypertensive patients, and 82 healthy controls in which we assessed the following parameters: plasma CT-1, basal glycaemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), left ventricular hypertrophy (LVH by electrocardiographic indexes), peripheral vascular disease (by pulse wave velocity—PWV, carotid intima-media thickness—C-IMT, and ankle-brachial index—ABI), and renal impairment (by microalbuminuria, albumin/creatinine urinary ratio, plasma creatinine concentrations, and glomerular filtration rate). Hypertensive or diabetic patients have higher plasma CT-1 than control patients. CT-1 positively correlates with basal glycaemia, SBP, DBP, PP, LVH, arterial damage (increased IMT, decreased ABI), and early renal damage (microalbuminuria, elevated albumin/creatinine ratio). CT-1 also correlates with increased 10-year cardiovascular risk. Multiple linear regression analysis confirmed that CT-1 was associated with arterial injury assessed by PWV, IMT, ABI, and cardiac damage evaluated by Cornell voltage duration product. Increases in plasma CT-1 are strongly related to the intensity of several parameters associated to target organ damage supporting further investigation of its diagnostic capacity as single biomarker of cardiovascular injury and risk and, possibly, of subclinical renal damage. PMID:26222851

  2. Evaluation of biochemical and clinical markers of endothelial dysfunction and their correlation with urinary albumin excretion in patients with type 1 diabetes mellitus.

    PubMed

    Polat, Sefika Burcak; Ugurlu, Nagihan; Aslan, Nabi; Cuhaci, Neslihan; Ersoy, Reyhan; Cakir, Bekir

    2016-04-01

    Objective Endothelial dysfunction (ED) plays an important role in the pathogenesis of diabetic nephropathy. The purpose of the study was to determine flow mediated endothelial dependent vasodilatation (FMD) measurements and serum soluble (s) endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule (VCAM-1) levels in patients with type 1 diabetes mellitus (T1DM) with or without increased urinary albumin excretion (UAE) and compare them with the healthy controls. Subjects and methods Seventy three patients with T1DM were enrolled. Patients were divided into two subgroups according to microalbumin measurements in 24-hr urine collections. The diabetic patients without microalbuminuria (41 patients) were defined as Group I and those with microalbuminuria (32 patients) were defined as group II. A hundred age and sex matched healthy subjects participated as the control group (Group III). Serum sET-1, sICAM-1, sVCAM-1 levels and FMD measurements were determined in all participants. Results Median FMD measurement was significantly lower in the diabetic groups compared with the control group (6.6, 6.4 and 7.8% in Group I, II and III, respectively) (p < 0.05). FMD was negatively correlated with age (p = 0.042). Median serum sICAM-1 level was higher in the patient groups compared to the control group (p < 0.05). Median serum sVCAM-1 level was higher in the group of patients with increased albuminuria compared to the normoalbuinuric and the control group (p < 0.05). Serum sVCAM-1 level was found to be positively correlated with degree of urinary albumin excretion (p < 0.001). Conclusion We assume that sVCAM-1 may be used as a predictive marker for risk stratification for nephropathy development and progression. PMID:26886090

  3. Plasma Cardiotrophin-1 as a Marker of Hypertension and Diabetes-Induced Target Organ Damage and Cardiovascular Risk.

    PubMed

    Gamella-Pozuelo, Luis; Fuentes-Calvo, Isabel; Gómez-Marcos, Manuel A; Recio-Rodriguez, José I; Agudo-Conde, Cristina; Fernández-Martín, José L; Cannata-Andía, Jorge B; López-Novoa, José M; García-Ortiz, Luis; Martínez-Salgado, Carlos

    2015-07-01

    The search for biomarkers of hypertension and diabetes-induced damage to multiple target organs is a priority. We analyzed the correlation between plasma cardiotrophin-1 (CT-1), a chemokine that participates in cardiovascular remodeling and organ fibrosis, and a wide range of parameters currently used to diagnose morphological and functional progressive injury in left ventricle, arteries, and kidneys of diabetic and hypertensive patients, in order to validate plasma levels of CT-1 as clinical biomarker.This is an observational study with 93 type 2-diabetic patients, 209 hypertensive patients, and 82 healthy controls in which we assessed the following parameters: plasma CT-1, basal glycaemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), left ventricular hypertrophy (LVH by electrocardiographic indexes), peripheral vascular disease (by pulse wave velocity-PWV, carotid intima-media thickness-C-IMT, and ankle-brachial index-ABI), and renal impairment (by microalbuminuria, albumin/creatinine urinary ratio, plasma creatinine concentrations, and glomerular filtration rate).Hypertensive or diabetic patients have higher plasma CT-1 than control patients. CT-1 positively correlates with basal glycaemia, SBP, DBP, PP, LVH, arterial damage (increased IMT, decreased ABI), and early renal damage (microalbuminuria, elevated albumin/creatinine ratio). CT-1 also correlates with increased 10-year cardiovascular risk. Multiple linear regression analysis confirmed that CT-1 was associated with arterial injury assessed by PWV, IMT, ABI, and cardiac damage evaluated by Cornell voltage duration product.Increases in plasma CT-1 are strongly related to the intensity of several parameters associated to target organ damage supporting further investigation of its diagnostic capacity as single biomarker of cardiovascular injury and risk and, possibly, of subclinical renal damage. PMID:26222851

  4. Low-grade risk of hypercoagulable state in patients suffering from diabetes mellitus type 2*

    PubMed Central

    Ruszkowska-Ciastek, Barbara; Sokup, Alina; Wernik, Tomasz; Rhone, Piotr; Góralczyk, Krzysztof; Bielawski, Kornel; Fijałkowska, Agata; Nowakowska, Aleksandra; Rhone, Elżbieta; Rość, Danuta

    2015-01-01

    Objective: Diabetes, including type 1 and type 2, is associated with the hypercoagulable state. The aim of this study is to evaluate the concentration of selected hemostatic parameters and vascular endothelial growth factor-A (VEGF-A) in diabetic subjects. Methods: The study was conducted in 62 patients with diabetes. Group I consisted of 27 patients having uncontrolled diabetes with microalbuminuria and Group II included 35 well-controlled diabetic patients. The control group was made up of 25 healthy volunteers. In the citrate plasma, the concentrations of tissue factor (TF), tissue factor pathway inhibitor (TFPI), thrombin-antithrombin (TAT) complexes, and D-dimer were assayed. Serum concentrations of VEGF-A, lipid profile, creatinine, and plasma fasting glucose were measured and in the versene plasma the concentration of HbA1c was determined. Results: In the patients with uncontrolled diabetes, higher concentrations of TF, TFPI, and VEGF-A were observed, as compared with the well-controlled diabetics group and the control group. A significantly lower activity of antiplasmin was reported in patients from Group I as compared with the control group. In Group I, using the multivariate regression analysis, the glomerular filtration rate was independently associated with VEGF-A and dependently associated with total cholesterol. Conclusions: The study showed higher concentrations of TF and TFPI in the patients with uncontrolled diabetes with microalbuminuria, which is associated with rapid neutralization of the thrombin formation, since TFPI inhibits the complex of TF/VIIa/Ca2+. The manifestation of the above suggestions is the correct TAT complexes and D-dimer, which indicates a low grade of prothrombotic risk in this group of patients, but a higher risk of vascular complications. PMID:26365121

  5. Short-term blood pressure variability over 24 h and target organ damage in middle-aged men and women.

    PubMed

    Madden, J M; O'Flynn, A M; Dolan, E; Fitzgerald, A P; Kearney, P M

    2015-12-01

    Blood pressure variability (BPV) has been associated with cardiovascular events; however, the prognostic significance of short-term BPV remains uncertain. As uncertainty also remains as to which measure of variability most accurately describes short-term BPV, this study explores different indices and investigates their relationship with subclinical target organ damage (TOD). We used data from the Mitchelstown Study, a cross-sectional study of Irish adults aged 47-73 years (n=2047). A subsample (1207) underwent 24-h ambulatory BP monitoring (ABPM). As measures of short-term BPV, we estimated the s.d., weighted s.d. (wSD), coefficient of variation (CV) and average real variability (ARV). TOD was documented by microalbuminuria and electrocardiogram (ECG) left ventricular hypertrophy (LVH). There was no association found between any measure of BPV and LVH in both unadjusted and fully adjusted logistic regression models. Similar analysis found that ARV (24 h, day and night), s.d. (day and night) and wSD were all univariately associated with microalbuminuria and remained associated after adjustment for age, gender, smoking, body mass index (BMI), diabetes and antihypertensive treatment. However, when the models were further adjusted for the mean BP the association did not persist for all indices. Our findings illustrate choosing the appropriate summary measure, which accurately captures that short-term BPV is difficult. Despite discrepancies in values between the different measures, there was no association between any indexes of variability with TOD measures after adjustment for the mean BP. PMID:25787777

  6. Diabetic Nephropathy and Its Risk Factors in a Society with a Type 2 Diabetes Epidemic: A Saudi National Diabetes Registry-Based Study

    PubMed Central

    Al-Rubeaan, Khalid; Youssef, Amira M.; Subhani, Shazia N.; Ahmad, Najlaa A.; Al-Sharqawi, Ahmad H.; Al-Mutlaq, Hind M.; David, Satish K.; AlNaqeb, Dhekra

    2014-01-01

    Aims The prevalence of diabetic nephropathy and its risk factors have not been studied in a society known to have diabetes epidemic like Saudi Arabia. Using a large data base registry will provide a better understanding and accurate assessment of this chronic complication and its related risk factors. Methodology A total of 54,670 patients with type 2 diabetes aged ≥25 years were selected from the Saudi National Diabetes Registry (SNDR) and analyzed for the presence of diabetic nephropathy. The American Diabetes Association (ADA) criterion was used to identify cases with microalbuminuria, macroalbuminuria and end stage renal disease (ESRD) for prevalence estimation and risk factor assessment. Results The overall prevalence of diabetic nephropathy was 10.8%, divided into 1.2% microalbuminuria, 8.1%macroalbuninuria and 1.5% ESRD. Age and diabetes duration as important risk factors have a strong impact on the prevalence of diabetic nephropathy, ranging from 3.7% in patients aged 25–44 years and a duration of >5 years, to 21.8% in patients ≥65 years with a diabetes duration of ≥15 years. Diabetes duration, retinopathy, neuropathy, hypertension, age >45 years, hyperlipidemia, male gender, smoking, and chronologically, poor glycemic control has a significantly high risk for diabetic nephropathy. Conclusion The prevalence of diabetic nephropathy is underestimated as a result of a shortage of screening programs. Risk factors related to diabetic nephropathy in this society are similar to other societies. There is thus an urgent need for screening and prevention programs for diabetic nephropathy among the Saudi population. PMID:24586457

  7. ACE gene insertion/deletion polymorphism modulates capillary permeability in hypertension.

    PubMed

    Dell'omo, Giulia; Penno, Giuseppe; Pucci, Laura; Lucchesi, Daniela; Fotino, Carmen; Del Prato, Stefano; Pedrinelli, Roberto

    2006-12-01

    A D/D (deletion/deletion) polymorphism within the ACE (angiotensin 1-converting enzyme) gene increases the risk of microalbuminuria, a predictor of atherosclerotic vascular disease, in essential hypertension. It is unknown, however, whether this genetic profile is accompanied by disturbed macromolecular permeability of systemic capillary endothelium, possibly in the context of generalized endothelial dysfunction. In the present study, the ACE gene polymorphism was determined by PCR in 79 never-treated uncomplicated hypertensive men and 16 normotensive men as controls. Evaluation variables were TERalb (transcapillary escape rate of albumin; the 1-h decline rate of intravenous (125)I-albumin, a measure of integrity of systemic capillary endothelium), albuminuria and forearm vasodilation to intra-arterial acetylcholine, an index of NO (nitric oxide)-mediated vasomotion, in addition to a series of sensitive parameters of albumin permeation (blood pressure, metabolic status and smoking habits). Analyses were done by comparing D/D homozygotes with grouped I/D (insertion/deletion) and I/I (insertion/insertion) subjects. TERalb was higher in D/D hypertensives, who had higher albuminuria, more frequent microalbuminuria and comparable forearm responsiveness to intra-arterial acetylcholine. Fasting glucose and insulin, insulin sensitivity, 24-h blood pressure, smoking habits and metabolic parameters did not differ between the two groups. TERalb and urine albumin values were positively associated in the hypertensive subjects. In conclusion, ACE D/D homozygosis, independently of several confounding factors, associates with higher TERalb in men with essential hypertension. This may reflect noxious genetic influences on systemic vascular permeability, a critical control mechanism for atherogenesis in the absence of grossly impaired NO-mediated arteriolar responsiveness. The parallel behaviour of TERalb and albuminuria suggests some shared genetically mediated determinant of renal

  8. Preventing microvascular complications in type 1 diabetes mellitus.

    PubMed

    Viswanathan, Vijay

    2015-04-01

    Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM) by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progression starts at glycated hemoglobin (HbA1c) level of 7%. As per the American Diabetes Association, a new pediatric glycemic control target of HbA1c <7.5% across all ages replaces previous guidelines that had called for different targets by age. Evidence shows that prevalence of microvascular complications is greater in patients with age >20 years as compared to patients <10 years of age. Screening of these complications should be done regularly, and appropriate preventive strategies should be followed. Angiotensin converting enzyme inhibitors and angiotensin II receptor blocker reduce progression from microalbuminuria to macroalbuminuria and increase the regression rate to normoalbuminuria. Diabetic microvascular complications can be controlled with tight glycemic therapy, dyslipidemia management and blood pressure control along with renal function monitoring, lifestyle changes, including smoking cessation and low-protein diet. An integrated and personalized care would reduce the risk of development of microvascular complications in T1DM patients. The child with diabetes who receives limited care is more likely to develop long-term complications at an earlier age. Screening for subclinical complications and early interventions with intensive therapy is the need of the hour. PMID:25941647

  9. Cardiovascular Effects of Copper Deficiency on Activity of Superoxide Dismutase in Diabetic Nephropathy

    PubMed Central

    Al-Bayati, Mohammed A.; Jamil, Dina A.; Al-Aubaidy, Hayder A.

    2015-01-01

    Background: Copper (Cu) is essential both for its role in antioxidant enzymes, like Cu/zinc (Zn) superoxide dismutase (SOD) and ceruloplasmin, as well as its role in lysyl oxidase, essential for the strength and integrity of the heart and blood vessels. With such a central role in cardiovascular health, Cu has been generally overlooked in the debate over improving our cardiovascular health. Cu deficiency has produced many of the same abnormalities present in cardiovascular disease. It seems almost certain that Cu plays a large role in the development of this killer disease, not because of its excess in the diet, but rather its deficiency. Aim: This study was undertaken to investigate the cardiovascular effects of Cu deficiency on the activity of SOD in patients with type 2 diabetes mellitus (T2DM) with and without diabetic nephropathy. Materials and Methods: Fifty-five patients with T2DM were recruited in this study which were divided into two subgroups based on the presence of microalbuminuria, the first group (microal buminuric group, n = 31) had a microalbuminuria between 30 and 299 μg/mg. The second group (normoal buminuric group, n = 29) had an albumin level less than 30 μg/mg. The two diabetic groups were compared to the control group (n = 37). Results: The results of our study showed a significant reduction in the levels of SOD enzyme associated with an increased urinary Cu excretion in microalbuminuric group compared to the control group at P < 0.05. Conclusions: The current study illustrates that the regulation of the blood concentrations of Cu may be a potential therapeutic target for prevention and treatment of diabetic nephropathy. PMID:25789247

  10. Urinary Fetuin-A Is a Novel Marker for Diabetic Nephropathy in Type 2 Diabetes Identified by Lectin Microarray

    PubMed Central

    Inoue, Kentaro; Wada, Jun; Eguchi, Jun; Nakatsuka, Atsuko; Teshigawara, Sanae; Murakami, Kazutoshi; Ogawa, Daisuke; Terami, Takahiro; Katayama, Akihiro; Tone, Atsuhito; Iseda, Izumi; Hida, Kazuyuki; Yamada, Masao; Ogawa, Tomohisa; Makino, Hirofumi

    2013-01-01

    We analyzed the urine samples of patients with type 2 diabetes at various stages of diabetic nephropathy by lectin microarray to identify a biomarker to predict the progression of diabetic nephropathy. Japanese patients with type 2 diabetes at various stages of nephropathy were enrolled and we performed lectin microarray analyses (n = 17) and measured urinary excretion of fetuin-A (n = 85). The increased signals of urine samples were observed in Siaα2-6Gal/GalNAc-binding lectins (SNA, SSA, TJA-I) during the progression of diabetic nephropathy. We next isolated sialylated glycoproteins by using SSA-lectin affinity chromatography and identified fetuin-A by liquid chromatography–tandem mass spectrometer. Urinary excretion of fetuin-A significantly increased during the progression of albuminuria (A1, 0.40±0.43; A2, 0.60±0.53; A3 1.57±1.13 ng/gCr; p = 7.29×10−8) and of GFR stages (G1, 0.39±0.39; G2, 0.49±0.45; G3, 1.25±1.18; G4, 1.34±0.80 ng/gCr; p = 3.89×10−4). Multivariate logistic regression analysis was employed to assess fetuin-A as a risk for diabetic nephropathy with microalbuminuria or GFR<60 mL/min. Fetuin-A is demonstrated as a risk factor for both microalbuminuria and reduction of GFR in diabetic nephropathy with the odds ratio of 4.721 (1.881–11.844) and 3.739 (1.785–7.841), respectively. Collectively, the glycan profiling analysis is useful method to identify the urine biomarkers and fetuin-A is a candidate to predict the progression of diabetic nephropathy. PMID:24143207

  11. Methylenetetrahydrofolate reductase and methionine synthase reductase gene polymorphisms and protection from microvascular complications in adolescents with type 1 diabetes.

    PubMed

    Wiltshire, Esko J; Mohsin, Fauzia; Chan, Albert; Donaghue, Kim C

    2008-08-01

    Folate status has been associated with endothelial dysfunction in adolescents with type 1 diabetes, and elevated total plasma homoocyst(e)ine (tHcy) is a risk for vascular disease in the non-diabetic population. Polymorphisms in genes involved in folate and homocysteine metabolism are implicated in vascular disease. We aimed to determine whether polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) and methionine synthase reductase (MTRR) genes are risk factors for early microvascular disease in a large group of adolescents with type 1 diabetes. Four hundred and eighty adolescents were screened annually for retinopathy and microalbuminuria for a median of 4 yr. Molecular analysis for the polymorphisms 677C-->T, 1298A-->C in MTHFR, and 66A-->G in MTRR was performed. The MTRR 66GG genotype reduced the risk for elevated albumin excretion rate (AER) (OR 0.47, CI 0.25, 0.88, p = 0.018) and showed a trend to reduced risk for microalbuminuria (OR 0.27, CI 0.06-1.21, p = 0.09). Survival without elevated AER was increased with the MTRR 66GG genotype (12.4 vs. 9.7 yr, p = 0.04) and with the MTHFR 1298CC genotype (15.2 vs. 10.2 yr, p = 0.007). Conversely, survival without retinopathy was reduced with the MTHFR 677TT and MTRR 66GG combined genotype (6.2 vs. 10.2 yr, p = 0.015). The MTRR 66GG and MTHFR 1298 CC genotypes may confer protection against early nephropathy, possibly because they are associated with lower tHcy. The MTHFR 677 TT was only related to earlier onset retinopathy in combination with MTRR 66GG. PMID:18774994

  12. Increased plasma Kidney Injury Molecule-1 suggests early progressive renal decline in non-proteinuric patients with Type 1 diabetes

    PubMed Central

    Nowak, Natalia; Skupien, Jan; Niewczas, Monika A.; Yamanouchi, Masayuki; Major, Melissa; Croall, Stephanie; Smiles, Adam; Warram, James H.; Bonventre, Joseph V.; Krolewski, Andrzej S.

    2015-01-01

    Progressively decreasing glomerular filtration rate (GFR), or renal decline, is seen in patients with type 1 diabetes (T1D) and normoalbuminuria or microalbuminuria. Here we examined the associations of kidney injury molecule-1 (KIM-1) in plasma and urine with the risk of renal decline and determine whether those associations are independent of markers of glomerular damage. The study group comprised patients with T1D from the 2nd Joslin Kidney Study of which 259 had normoalbuminuria and 203 had microalbuminuria. Serial measurements over 4 to 10 years of follow-up (median 8 years) of serum creatinine and cystatin C were used jointly to estimate eGFRcr-cys slopes and time of onset of CKD stage 3 or higher. Baseline urinary excretion of IgG2 and albumin were used as markers of glomerular damage, and urinary excretion of KIM-1 and its plasma concentration were used as markers of proximal tubular damage. All patients had normal renal function at baseline. During follow-up, renal decline (eGFRcr-cys loss 3.3% or more per year) developed in 96 patients and 62 progressed to CKD stage 3. For both outcomes, the risk rose with increasing baseline levels of plasma KIM-1. In multivariable models, elevated baseline plasma KIM-1 was strongly associated with risk of early progressive renal decline, regardless of baseline clinical characteristics, serum TNFR1 or markers of glomerular damage. Thus, damage to proximal tubules may play an independent role in the development of early progressive renal decline in non-proteinuric patients with T1D. PMID:26509588

  13. Hemolytic uremic syndrome: late renal injury and changing incidence-a single centre experience in Canada.

    PubMed

    Robitaille, Pierre; Clermont, Marie-José; Mérouani, Aïcha; Phan, Véronique; Lapeyraque, Anne-Laure

    2012-01-01

    Aims. To assess trends in the incidence of pediatric diarrhea-associated hemolytic uremic syndrome (D(+) HUS) and document long-term renal sequelae. Methods. We conducted a retrospective cohort study of children with D(+) HUS admitted to a tertiary care pediatric hospital in Montreal, Canada, from 1976 to 2010. In 2010, we recontacted patients admitted before 2000. Results. Of 337 cases, median age at presentation was 3.01 years (range 0.4-14). Yearly incidence peaked in 1988 and 1994-95, returning to near-1977 levels since 2003. Twelve patients (3.6%) died and 19 (5.6%) experienced long-term renal failure. Almost half (47%) The patients required dialysis. Need for dialysis was the best predictor of renal sequelae, accounting for 100% of severe complications. Of children followed ≥1 year (n = 199, mean follow-up 8.20 ± 6.78 years), 19 had severe and 18 mild-to-moderate kidney injury, a total sequelae rate, of 18.6%. Ten years or more after-HUS (n = 85, mean follow-up 15.4 ± 5.32 years), 8 (9.4%) patients demonstrated serious complications and 22 (25.9%) mild-to-moderate, including 14 (16%) microalbuminuria: total sequelae, 35.3%. Conclusions. Patients with D(+) HUS should be monitored at least 5 years, including microalbuminuria testing, especially if dialysis was required. The cause of the declining incidence of D(+)HUS is elusive. However, conceivably, improved public health education may have played an important role in the prevention of food-borne disease. PMID:24278685

  14. If Your Child Learns in Two Languages: A Parent's Guide for Improving Educational Opportunities for Children Acquiring English as a Second Language = Si su nino aprende en dos idiomes: Una guia para que las familias sepan como mejorar las oportunidades educativas de los ninos que adquieren el ingles como segunda lengua = Neu lon Ban Hoc Bang Hai Thu Tieng: Chi-nam cua phu-huynh de cai tien co hoi hoc van cua con em dang hoc Anh van nhu sinh ngu thu hai.

    ERIC Educational Resources Information Center

    Zelasko, Nancy; Antunez, Beth

    This guide, in English, Spanish, and Vietnamese, aims to inform parents of students who have learned or are learning English as a Second Language about appropriate approaches for educating children so that they can work with schools to ensure a high quality education for their children. The emphasis is on explaining the laws, schools, and research…

  15. [In Process Citation].

    PubMed

    Martínez González, Olaia; Vélez de Mendizábal, Itsaso Zabaleta; Galarza Iriarte, Uxue; Vicente Martín, María Soledad; De Vega Castaño, María Del Carmen; Salmerón Egea, Jesús

    2016-01-01

    Introducción: la disfagia o dificultad de deglución afecta a 1 de cada 2 mayores hospitalizados y genera problemas de desnutrición o deshidratación, y aparición de neumonía por aspiración. En situaciones de disfagia orofaríngea, cuando la alimentación oral aún es posible, se deben espesar las texturas líquidas de cara a evitar dichas complicaciones. A los alimentos, tanto fríos como calientes, habitualmente se les añaden espesantes comerciales consistentes en almidones modificados siguiendo especificaciones muy generales que hacen difícil conseguir la textura adaptada a las necesidades personales. Objetivo: el objetivo de este trabajo fue estudiar el efecto de la temperatura del alimento (10 oC y 50 oC), la dosificación (néctar, miel y pudin) y el tiempo transcurrido desde la preparación (0, 3, 5, 10, 20 min) sobre los parámetros de textura de agua espesada a base de uno de los espesantes más ampliamente comercializados. Método: las muestras se analizaron por triplicado en un texturómetro TA.XT2i (Stable Micro Systems, UK) mediante ensayo de compresión-extrusión, empleando una sonda de 2,5 cm de diámetro a una velocidad de 3 mm/s y con una célula de carga de 5 kg. A partir de las curvas fuerza vs. tiempo obtenidas se cuantificaron parámetros indicadores de la firmeza, la adhesividad y el trabajo de las muestras. Resultados y conclusión: en general, los parámetros relacionados con la consistencia fueron significativamente (α < 0,05) superiores en las muestras a mayor temperatura, lo que se puede relacionar con fenómenos incipientes de gelatinización. A su vez, se observó un incremento en los valores de todos los parámetros de textura al aumentar la concentración del espesante y a medida que transcurría el tiempo desde la mezcla de este en el agua. Estos resultados apuntan a la necesidad de realizar un trabajo exhaustivo de caracterización, ampliado también a otros productos y matrices alimentarias, de cara a modelizar la

  16. Teachers' Perceptions about Oral Corrective Feedback and Their Practice in EFL Classrooms (Percepciones de los docentes acerca de la retroalimentación correctiva y su práctica en las aulas de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Hernández Méndez, Edith; Reyes Cruz, María del Rosario

    2012-01-01

    Corrective feedback has been discussed mainly in second language acquisition contexts, but less has been done concerning corrective feedback in foreign language settings. In this descriptive study, conducted at a Mexican university, our aims were to identify the perceptions of instructors of English as a foreign language about corrective feedback…

  17. How Do EFL Student Teachers Face the Challenge of Using L2 in Public School Classrooms? (¿Cómo enfrentan los docentes practicantes de inglés como lengua extranjera el reto de usar una segunda lengua en las aulas de clase de la escuela pública?)

    ERIC Educational Resources Information Center

    Viáfara, John Jairo

    2011-01-01

    As an EFL Student teachers' advisor, I had constantly perceived that they regarded using the target language with their pupils inside their classroom as a challenge. That is why I became interested in investigating how thirteen student teachers in Tunja public schools faced this issue. While participants were involved in a reflective teaching…

  18. An Exploration of EFL Teachers' Awareness of the Sources of Pedagogical Knowledge in a Teacher Education Program (Una exploración del nivel de conciencia de docentes de inglés como lengua extranjera respecto a las fuentes del conocimiento pedagógico en un programa de formación de docentes)

    ERIC Educational Resources Information Center

    Macías, Diego Fernando

    2013-01-01

    This project set out to investigate the extent to which the sources of English as a foreign language teachers' pedagogical knowledge are acknowledged and addressed in a teacher education program in a public university in Colombia. It involved the participation of teacher educators and novice teachers as well as the analysis of documents. This…

  19. Effects of Strategy Instruction in an EFL Reading Comprehension Course: A Case Study (Efectos de la instrucción de estrategias en un curso de comprensión de lectura en inglés como lengua extranjera: un estudio de caso)

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2012-01-01

    Strategy instruction is useful in teaching contexts. This paper examines the effects of strategy instruction in an EFL reading comprehension course carried out with 26 undergraduate students at a Colombian university. As a research method, a case study was implemented. There were three instruments with which to collect data: reading comprehension…

  20. "Don't Tell My Father": Important Lessons Learned through EFL Classroom Small Talk ("No le digan a mi padre": lecciones importantes aprendidas a través de la comunión fática en el salón de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Ayala González, Gabriela; de Cervantes Orozco, Miguel Adrián Leonel; González Cabrera, Víctor Daniel; Romero Mayora, Faviola; Mugford Fowler, Gerrard Edwin

    2011-01-01

    All too often phatic communion is neglected in the English as a foreign language classroom or relegated to the level of formulaic language which merits little or no attention. In this article we argue that phatic communion plays an important role in establishing, developing and maintaining interpersonal relationships between teacher and learners…

  1. Motivation Conditions in a Foreign Language Reading Comprehension Course Offering Both a Web-Based Modality and a Face-to-Face Modality (Las condiciones de motivación en un curso de comprensión de lectura en lengua extranjera (LE) ofrecido tanto en la modalidad presencial como en la modalidad a distancia en la web)

    ERIC Educational Resources Information Center

    Lopera Medina, Sergio

    2014-01-01

    Motivation plays an important in role in education. Based on the ten macro-strategies proposed by Dörnyei and Csizér (1998), this article analyzes the motivation conditions in a foreign language reading comprehension course using both a web-based modality and a face-to-face modality. A case study was implemented as the primary research method, and…

  2. The Impact of a Teacher Development Program for Strategic Reading on EFL Teachers' Instructional Practice (El impacto de un programa de desarrollo profesional en lectura estratégica en la práctica instruccional de docentes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Salimi, Mahin

    2010-01-01

    Research on teacher development has been the focus of attention in recent decades. The overall aim of this study was to explore the impact of reading strategy training on high school teachers' reading instructional practices. The study was conducted in the EFL context of Iran. To meet this aim, four EFL high school teachers voluntarily took…

  3. Los padres como consejeros o coparticipes en la toma de decisiones. Serie E: [E1] logro de la participacion de los padres. cuaderno 3. Edicion para el maestro. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as Advisors or Participants in Decision Making. Series E: Parent Participation, Book 3. Teacher Edition. Bilingual Education Teacher Training Packet).

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

    This guide on training bilingual education teachers focuses on parents as advisors in the decision making process at bilingual schools. The two units, "An Introduction to Parent Participation" and "Parent Participation in Educational Decision Making," include objectives, definitions of terms, lists of materials and equipment, and learning…

  4. O Passado como Nacao: Imagens do Imperio nas Falas Reacionarias dos Anos 30 e 40 do Seculo XX: Uma Pequena Arqueologia do Debate Publico e Privado (The Past as Nation: Images of the Empire in the Reactionary Words of the 30s and 40s in the 20th Century: A Small Archaeology of the Public Debate versus the Private One).

    ERIC Educational Resources Information Center

    de Freitas, Marcos Cezar

    1998-01-01

    Suggests an archaeology of the public debate versus the private one in Brazil through analysis of the reactionary speech of a religious leader, Dom Jose Mauricio da Rocha, which produced innumerable representations of the Brazilian Empire. (PA)

  5. EFL Teachers' Perceptions of Continuing Professional Development: A Case of Iranian High School Teachers (La percepción de docentes de inglés como lengua extranjera acerca del desarrollo profesional continuado: el caso de profesores iraníes de bachillerato)

    ERIC Educational Resources Information Center

    Alibakhshi, Goudarz; Dehvari, Najibeh

    2015-01-01

    English, particularly regarding a foreign language teachers' professional development, has been studied in depth. However, it is not known how Iranian English as a foreign language teachers perceive continuing professional development. This study explored the perceptions of Iranian English as a foreign language teachers of continuing professional…

  6. ...And That's How It All Began: Putting Information about Your Child's Growth, Health and Safety All within Your Reach...Because the First Years Last Forever! = ...Y asi es como empezo todo: Ponemos a su alcance en forma conjunta la informacion sobre el crecimiento, la salud y la seguridad de su hijo...Porque los primeros anos duran para siempre!

    ERIC Educational Resources Information Center

    North Carolina Partnership for Children, Raleigh.

    Smart Start is North Carolina's model early childhood initiative to help all North Carolina children enter school healthy and prepared for success. This resource guide, in Spanish and English versions, is designed to provide parents with information on infant and child development, health care, and resources for further assistance. Presented in an…

  7. Using the EPOSTL for Dialogic Reflection in EFL Teacher Education (El Uso de EPOSTL para la Reflexión Dialógica en la Educación de los Docentes de Inglés como Lengua Extranjera)

    ERIC Educational Resources Information Center

    Schauber, Holli

    2015-01-01

    For many pre-service English as a Foreign Language (EFL) teachers and their mentors, the theory and practice driven European Portfolio for Student Teachers of Languages (EPOSTL) occupies a prominent and practical role in their preparation programs as a delivery system of core pedagogical skills and knowledge. Interest in the role that dialogical…

  8. How To Talk to Your Doctor (and Get Your Doctor To Talk to You!). An Educational Workshop on Doctor Patient Communication = Como Hablarle a su Doctor (iY que su doctor le hable a usted!). Un seminario educativo sobre la comunicacion entre el doctor y el paciente.

    ERIC Educational Resources Information Center

    Baylor Coll. of Medicine, Houston, TX.

    This workshop, written in both English and Spanish, focuses on improving communication between physician and patient. In the workshop, the trainers will talk about "building bridges" between patient and doctor by understanding the doctor's role and his/her duty to the patient. According to the workshop, a person's doctor should communicate…

  9. Teacher Activities and Adolescent Students' Participation in a Colombian EFL Classroom (Actividades de enseñanza y participación de estudiantes adolescentes en una clase de enseñanza de inglés como lengua extranjera en Colombia)

    ERIC Educational Resources Information Center

    Caicedo, Jefferson

    2015-01-01

    The present study concerns the activities teachers develop and ninth-graders' participation in responses to those activities. The objectives of this study were to identify and describe the types of teaching activities developed and how students respond to them and to show how the target language is used in the classroom. The data collection was…

  10. Pronunciation Instruction and Students' Practice to Develop Their Confidence in EFL Oral Skills (La instrucción de la pronunciación y la práctica de los estudiantes para el desarrollo de la confianza en habilidades orales en inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Tlazalo Tejeda, Ana Cristina; Basurto Santos, Nora M.

    2014-01-01

    The aim of this article is to inform on research intended to find out how pronunciation instruction of English as a foreign language was handled in the language classroom with elementary students and also understand if pronunciation instruction had an impact on students' confidence when using it. In order to do this, a qualitative case study was…

  11. Facilitating Professional Development during International Practicum: Understanding Our Work as Teacher Educators through Critical Incidents (Facilitando el desarrollo profesional durante la práctica internacional: Comprendiendo nuestro trabajo como formadores de profesores a través de incidentes críticos)

    ERIC Educational Resources Information Center

    Williams, Judy; Grierson, Arlene

    2016-01-01

    This collaborative self-study details the experiences of an Australian teacher educator and a Canadian teacher educator, who led teacher candidates on international practicum placements to the Cook Islands and Kenya respectively. Focusing on critical incidents, they collaboratively analyzed dilemmas that occurred when providing professional…

  12. For a Child, Life is a Creative Adventure: Supporting Development and Learning through Art, Music, Movement, and Dialogue. A Guide for Parents and Professionals. = Para los ninos, la vida es una aventura creativa: Como estimular el desarrollo y el aprendizaje por medio de las artes visuales, la musica, el movimiento y el dialogo. Guia para padres de familia y profesionales.

    ERIC Educational Resources Information Center

    Cohen, Elena

    Recognizing that creativity facilitates children's learning and development, the Head Start Program Performance Standards require Head Start programs to include opportunities for creative self-expression. This guide with accompanying videotape, both in English- and Spanish- language versions, encourages and assists adults to support children's…

  13. Pedagogical Factors That Influence EFL Teaching: Some Considerations for Teachers' Professional Development (Factores pedagógicos que influyen en la enseñanza del inglés como lengua extranjera: algunas consideraciones para el desarrollo profesional de docentes)

    ERIC Educational Resources Information Center

    Abad, José Vicente

    2013-01-01

    In this article we present the results of a qualitative research study on the pedagogical factors that influence English teaching in four public schools of Medellín, Colombia. Twelve teachers were interviewed regarding three linguistic principles: communicative competence, native language effect, and interlanguage. The data analysis led to the…

  14. The Implications of Orthographic Intraference for the Teaching and Description of ESL: The Educated Nigerian English Examples (Implicaciones de la Intraferencia Ortográfica para la Enseñanza y Descripción del Inglés como Segunda Lengua: Ejemplos Inglés Nigeriano Formal)

    ERIC Educational Resources Information Center

    Ekundayo, Omowumi Steve Bode

    2015-01-01

    This paper examines orthographic intraference and its implications for teaching and describing English as a second language (ESL). Orthographic intraference is used here to denote instances of single word spelling, acronyms, mix up of homophones, homonyms and compound word spelling arising not from interference but from orthographic rules and…

  15. Los padres como consejeros o coparticipes en la toma de decisiones. Serie E: El logro de la participacion de los padres, cuaderno III. Edicion para el estudiante. Cuadernos para el entrenamiento de maestros de educacion bilingue. (Parents as Advisors or Participants in Decision Making. Series E: Success with Parent Participation, Book III. Student Edition. Bilingual Education Teacher Training Packet).

    ERIC Educational Resources Information Center

    Rodriguez, Rodolfo, Comp.

    The student version of a learning module for teacher training in bilingual education is one of three focusing on promoting parent participation in the school system, and concentrates specifically on the role of parents as counselors and co-participants in decisionmaking. An introductory section discussing the overall objectives of the materials is…

  16. Efectos Especiales de Anclaje (Estudio sobre Regresiones de Juicios Condicionales). Parte 2: Invariancia del Juicio No-Condicional Como Valor Estandar Para el Juicio Condicional (Special Effects of Anchoring (Study of Regression of Conditional Judgements) Part 2: Invariance of Unconditional Judgments as Standard Value for the Conditional Judgment). Publication No. 31.

    ERIC Educational Resources Information Center

    Lopez Alonso, A. O.

    From the best-fit lines corresponding to sets of families of conditional judgements, the constant stimulus family and the constant condition family, both defined for a same scale object, the coordinate values of the point of intersection of both lines (indifference point) are obtained. These values are studied in relation to the mean values of the…

  17. Experiencias interculturales y la pedagogia de la anglofonia en la ensenanza de ingles como lengua extranjera (EILE) desde una perspectiva deweyana. Working Paper (A Deweyan Perspective on Cross-Cultural Experiences and Anglophone Pedagogy in the Teaching of English as a Foreign Language. Working Paper).

    ERIC Educational Resources Information Center

    Zoreda, Margaret Lee

    This paper discusses a framework for teaching English as a foreign language that incorporates significant cultural content and fosters critical encounters with Anglophone culture. It reviews relevant contemporary perspectives for understanding cross-cultural processes within the foreign language teaching environment with emphasis on the issue of…

  18. Metacognitive Awareness and Comprehension Monitoring in Reading Ability of Iranian EFL Learners (Monitoreo de la conciencia metacognitiva y de la comprensión en la habilidad lectora de estudiantes iraníes de inglés como lengua extranjera)

    ERIC Educational Resources Information Center

    Khonamri, Fatemeh; Mahmoudi Kojidi, Elahe

    2011-01-01

    We report an investigation on the relationship between metacognitive awareness of reading strategies and comprehension monitoring of language learners in English as a foreign language context. Participants were thirty first year university students majoring in electronics. They completed a questionnaire aimed at discerning the strategies that…

  19. EFL Teenagers' Social Identity Representation in a Virtual Learning Community on Facebook (Representación de la identidad social de los estudiantes adolescentes de inglés como lengua extranjera en una comunidad de aprendizaje virtual en Facebook)

    ERIC Educational Resources Information Center

    Jiménez Guamán, Laura Verónica

    2012-01-01

    In this article I report the findings of a descriptive and interpretative qualitative study carried out in a public school in Bogotá, Colombia. The study aimed at analyzing, describing and exploring teenage students' social identity representation as observed in their participation in a learning community on Facebook. Data were collected from…

  20. Building Adult Relationships: Are You Treated as an Equal in Your Family? (A Pamphlet for People with Disbilities) [and] Como Establecer Relaciones Adultas: Se Lo Trata a UD. Igual que a Los Demas Adultos en Su Familia? (Un Panfleto para las Personas con Impedimentos).

    ERIC Educational Resources Information Center

    Baron, Carla

    Two booklets, in English and Spanish, are addressed to disabled adults and offer guidelines for building adult relationships within the family. Stressed are the importance of feeling good about oneself, learning to make decisions, and developing good communication skills so that family balance is maintained. Also included are lists of the types of…

  1. Clinical Audits in a Postgraduate General Practice Training Program: An Evaluation of 8 Years' Experience

    PubMed Central

    Al-Baho, Abeer; Serour, Maleka; Al-Weqayyn, Adnan; AlHilali, Mohammed; Sadek, Ali A. A.

    2012-01-01

    Background Clinical audit can be of valuable assistance to any program which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at evaluating audits' effectiveness, valuable opportunities will be overlooked. Clinical audit projects are required as a part of the formative assessment of trainees in the Family Medicine Residency Program (FMRP) in Kuwait. This study was undertaken to draw a picture of trainees' understanding of the audit project with attention to the knowledge of audit theory and its educational significance and scrutinize the difficulties confronted during the experience. Methodology/Principal Findings The materials included the records of 133 audits carried out by trainees and 165 post course questionnaires carried out between 2004 and 2011. They were reviewed and analyzed. The majority of audit projects were performed on diabetic (44.4%) and hypertensive (38.3%) care. Regarding audits done on diabetic care, they were carried out to assess doctors' awareness about screening for smoking status (8.6%), microalbuminuria (19.3%), hemoglobin A1c (15.5%), retinopathy (10.3%), dyslipidemia (15.8%), peripheral neuropathy (8.8%), and other problems (21.7%). As for audits concerning hypertensive care, they were carried out to assess doctors' awareness about screening for smoking status (38.0%), obesity (26.0%), dyslipidemia (12.0%), microalbuminuria (10.0%) and other problems (14.0%). More than half the participants (68.48%) who attended the audit course stated that they ‘definitely agreed’ about understanding the meaning of clinical audit. Most of them (75.8%) ‘definitely agreed’ about realizing the importance of clinical audit in improving patients' care. About half (49.7%) of them ‘agreed’ that they can distinguish between ‘criteria’ and ‘standards’. Conclusion The eight years of experience were beneficial. Trainees showed a good understanding of the idea behind auditing the services

  2. Differential microRNA Profiles Predict Diabetic Nephropathy Progression in Taiwan

    PubMed Central

    Chien, Hung-Yu; Chen, Chang-Yi; Chiu, Yen-Hui; Lin, Yi-Chun; Li, Wan-Chun

    2016-01-01

    Objectives: Diabetic nephropathy (DN) is a major leading cause of kidney failure. Recent studies showed that serological microRNAs (miRs) could be utilized as biomarkers to identify disease pathogenesis; the DN-related miRs, however, remained to be explored. Methods: A prospective case-control study was conducted. The clinical significance of five potential miRs (miR-21, miR-29a, miR-29b, miR-29c and miR192) in type 2 Diabetes Mellitus (T2DM) patients who have existing diabetic retinopathy with differential Albumin:Creatinine Ratio (ACR) and estimated Glomerular Filtration Rate (eGFR) was performed using quantitative RT-PCR analysis. The subjects with diabetic retinopathy enrolled in Taipei City Hospital, Taiwan, were classified into groups of normal albuminuria (ACR<30mg/g; N=12); microalbuminuria (30mg/g300mg/g; N=21) as well as 18 low-eGFR (eGFR<60ml/min) and 32 high-eGFR (eGFR>60ml/min). The level of serum miRs was statistically correlated with age, Glucose AC, ACR, eGFR and DN progression. Results: The levels of miR-21, miR-29a and miR-192 were significantly enriched in the overt proteinuria group compared with microalbuminuria and/or overt proteinuria groups. It was shown that only miR-21 level was significantly up-regulated in low-eGFR group compared with high-eGFR patients. Interestingly, Pearson's correlation coefficient analysis demonstrated that DN progressors showed significantly greater levels of miR-21, miR-29a, miR-29b and miR-29c in comparison with non-progressors implying the clinical potential of DN associated miRs in monitoring and preventing disease advancement. Conclusion: Our findings showed that miR-21, miR-29a/b/c and miR-192 could reflect DN pathogenesis and serve as biomarkers during DN progression. PMID:27279796

  3. Differences in Cardiometabolic Risk between Insulin-Sensitive and Insulin-Resistant Overweight and Obese Children

    PubMed Central

    McGinn, Aileen P.; Isasi, Carmen R.; Groisman-Perelstein, Adriana; Diamantis, Pamela M.; Ginsberg, Mindy; Wylie-Rosett, Judith

    2015-01-01

    Abstract Background: It is known that 15–30% overweight/obese adults do not suffer cardiometabolic consequences. There is limited literature examining factors that can be used to assess cardiometabolic health in overweight/obese children. If such factors can be identified, they would aid in differentiating those most in need for aggressive management. Methods: Baseline data from 7- to 12-year-old, overweight, and obese children enrolled in a weight management program at an urban hospital were analyzed. Homeostatic model assessment for insulin resistance (HOMA-IR) <2.6 was used to define insulin-sensitive and HOMA-IR ≥2.6 was used to defined insulin-resistant participants. Demographics, physical activity measures, and cardiometabolic risk factors were compared between the two phenotypes. Odds ratios (ORs) examining the association between intermediate endpoints (metabolic syndrome [MetS], nonalcoholic fatty liver disease [NAFLD], systemic inflammation, and microalbuminuria) and the two metabolic phenotypes were evaluated. Results: Of the 362 overweight/obese participants, 157 (43.5%) were insulin sensitive and 204 (56.5%) were insulin resistant. Compared to the insulin-sensitive group, the insulin-resistant group was older (8.6±1.6 vs. 9.9±1.7; p<0.001) and had a higher BMI z-score (1.89±0.42 vs. 2.04±0.42; p=0.001). After multivariable adjustment, compared to the insulin-sensitive group, the insulin-resistant group had higher odds of having MetS (OR, 5.47; 95% confidence interval [CI]: 1.72, 17.35; p=0.004) and NAFLD (OR, 8.66; 95% CI, 2.48, 30.31; p=0.001), but not systemic inflammation (OR, 1.06; 95% CI: 0.56, 2.03; p=0.86) or microalbuminuria (OR, 1.71; 95% CI, 0.49, 6.04; p=0.403). Conclusions: Using a HOMA-IR value of ≥2.6, clinical providers can identify prepubertal and early pubertal children most at risk. Focusing limited resources on aggressive weight interventions may lead to improvement in cardiometabolic health. PMID:25774664

  4. Decreased expression of circulating microRNA-126 in patients with type 2 diabetic nephropathy: A potential blood-based biomarker

    PubMed Central

    Al-Kafaji, Ghada; Al-Mahroos, Ghazi; Al-Muhtaresh, Haifa Abdulla; Skrypnyk, Cristina; Sabry, Mohamed Abdalla; Ramadan, Ahmad R.

    2016-01-01

    Circulating microRNAs (miRNAs) have been proposed as promising biomarkers for multiple diseases. miR-126 is reported to be associated with type 2 diabetes mellitus (T2D), diabetic nephropathy (DN) and end stage renal disease. The aim of this study was to investigate the expression of circulating miR-126 and to assess its potential as a blood-based biomarker for DN in T2D patients. In 52 patients with T2D without history of DN (with noromoalbuminuria), 50 patients with T2D and DN (29 with microalbuminuria and 21 with macroalbuminuria), and 50 non-diabetic healthy controls, the expression of circulating miR-126 in peripheral whole blood was evaluated by quantitative polymerase chain reaction. The expression levels of circulating miR-126 were significantly decreased in T2D patients and further decreased in DN patients compared with those in the controls. Multivariate logistic regression analysis confirmed the independent association of lower miR-126 levels with T2D [adjusted odds ratio (OR), 0.797; 95% confidence interval (CI), 0.613–0.960] and DN (adjusted OR, 0.513; 95% CI, 0.371–0.708). miR-126 levels were associated with the degree of albuminuria and showed significantly low expression in DN patients with microalbuminuria (adjusted OR, 0.781; 95% CI; 0.698–0.952) and further lower expression in DN patients with macroalbuminuria (adjusted OR, 0.433; 95% CI, 0.299–0.701), respectively compared with T2D patients with normoalbuminuria. miR-126 levels negatively correlated with albuminuria positively with glomerular filtration rate (P<0.05), and in addition, negatively correlated with fasting glucose, glycated hemoglobin, triglyceride and LDL (P<0.05). Stepwise multiple regression analysis identified albuminuria as a significant predictor of miR-126 (P<0.001). miR-126 in peripheral blood yielded area under the receiver operating characteristic curves of 0.854 (95% CI, 0.779–0.929) and 0.959 (95% CI, 0.916–1.000) in the differentiation of DN patients from T2

  5. Renal effects of Dirofilaria immitis in experimentally and naturally infected cats.

    PubMed

    Atkins, C E; Vaden, S L; Arther, R G; Ciszewski, D K; Davis, W L; Ensley, S M; Chopade, N H

    2011-03-22

    Canine heartworm infection has been associated with glomerular disease and proteinuria. We hypothesized that proteinuria, likely due to glomerular damage, would also be found in cats experimentally and naturally infected with Dirofilaria immitis. Two populations of cats were evaluated, including 80 that were each experimentally infected with 60 infective heartworm larvae as part of a drug safety study, and 31 that were naturally infected with D. immitis. Each had a control population with which to be compared. In the experimentally infected group, we evaluated urine from 64 cats. Ten of these cats were shown to have microalbuminuria 8 months post infection. No cat refractory to infection with larvae and no cats from the control group demonstrated microalbuminuria. All 10 microalbuminuric cats were shown to have significant proteinuria, as measured by the urine protein:creatinine ratio. There was a subtle, but significant, association between worm burden and proteinuria, and although the presence of adult heartworms was required for the development of proteinuria, both microfilaremic and amicrofilaremic cats were affected. Neither the presence of circulating heartworm antibodies and antigen nor the presence of antigenuria predicted the development of proteinuria. Both heavily infected cats (5-25 adult heartworms) and cats with worm burdens compatible with natural infections (1-4 adult heartworms) developed proteinuria, and the relative numbers of cats so affected were similar between heavily and more lightly infected cats. Naturally infected cats, for which only dipstick protein determinations were available, were shown to have a significantly greater incidence of proteinuria (90% vs 35%) than did those in an age- and gender-matched control population. Additionally, the proteinuria in heartworm-infected cats was 3- to 5-fold greater in severity. We conclude that cats infected with mature adult heartworms are at risk for developing proteinuria and that this is

  6. Cadmium Level, Glycemic Control, and Indices of Renal Function in Treated Type II Diabetics: Implications for Polluted Environments

    PubMed Central

    Anetor, John I.; Uche, Chukwuemelie Z.; Ayita, Emmanuel B.; Adedapo, Solomon K.; Adeleye, Jokotade O.; Anetor, Gloria O.; Akinlade, Sola K.

    2016-01-01

    Cadmium (Cd) has recently emerged as a major concern not only in environmental toxicology but also in metabolic diseases such as diabetes mellitus and its complications. Conflicting data aside, these studies have not been examined in a clinical population undergoing management as well as possible modulation by the prominent metabolic antagonist of Cd such as zinc (Zn). This study examined the relationship between cadmium levels, glycemic control, and renal pathology in established type II diabetic patients with focus on populations exposed to modern environmental health hazards (MEHHs). Sixty-five participants, consisting of 45 type-2 diabetics and 20 non-diabetics were enrolled for the study, mean age 61.51 ± 5.27 years. Glycated hemoglobin (HbA1c) was used to classify them into three sub-groups: (A) good glycemic control (44.4%), (B) fair glycemic control (24.4%), and (C) poor glycemic control (31.1%). Plasma levels of glucose, Cd, Zn, HbA1c, creatinine, urinary creatinine, microalbuminuria, and estimated glomerular filtration rate (eGFR) were determined in all participants using standard methods. Fasting plasma glucose was higher in diabetics than in non-diabetics (p = 0.000) as well as Zn level, though not significantly. Interestingly, Cd level, Cd/Zn ratio, and urinary creatinine were significantly lower in diabetics than in non-diabetics. The group with poor glycemic control (C) had significantly higher Cd level compared to the one with good glycemic control (group A). The renal function revealed that microalbuminuria and urinary albumin/creatinine ratio (UACR) was significantly higher in diabetics than in non-diabetics, while eGFR was found to be similar in both diabetics and non-diabetics. UACR inversely correlated with Cd level, while plasma creatinine level positively correlated with Cd but not significantly. Correlation between Cd and HbA1c revealed non-significant inverse correlation (r = −0.007; p > 0.05), while Zn showed a

  7. Early Diabetic Nephropathy

    PubMed Central

    Bjornstad, Petter; Snell-Bergeon, Janet K.; Rewers, Marian; Jalal, Diana; Chonchol, Michel B.; Johnson, Richard J.; Maahs, David M.

    2013-01-01

    OBJECTIVE Diabetic nephropathy (DN) is a major cause of mortality in type 1 diabetes. Reduced insulin sensitivity is a well-documented component of type 1 diabetes. We hypothesized that baseline insulin sensitivity would predict development of DN over 6 years. RESEARCH DESIGN AND METHODS We assessed the relationship between insulin sensitivity at baseline and development of early phenotypes of DN—microalbuminuria (albumin-creatinine ratio [ACR] ≥30 mg/g) and rapid renal function decline (glomerular filtration rate [GFR] loss >3 mL/min/1.73 m2 per year)—with three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations over 6 years. Subjects with diabetes (n = 449) and without diabetes (n = 565) in the Coronary Artery Calcification in Type 1 Diabetes study had an estimated insulin sensitivity index (ISI) at baseline and 6-year follow-up. RESULTS The ISI was lower in subjects with diabetes than in those without diabetes (P < 0.0001). A higher ISI at baseline predicted a lower odds of developing an ACR ≥30 mg/g (odds ratio 0.65 [95% CI 0.49–0.85], P = 0.003) univariately and after adjusting for HbA1c (0.69 [0.51–0.93], P = 0.01). A higher ISI at baseline conferred protection from a rapid decline of GFR as assessed by CKD-EPI cystatin C (0.77 [0.64–0.92], P = 0.004) and remained significant after adjusting for HbA1c and age (0.80 [0.67–0.97], P = 0.02). We found no relation between ISI and rapid GFR decline estimated by CKD-EPI creatinine (P = 0.38) or CKD-EPI combined cystatin C and creatinine (P = 0.50). CONCLUSIONS Over 6 years, a higher ISI independently predicts a lower odds of developing microalbuminuria and rapid GFR decline as estimated with cystatin C, suggesting a relationship between insulin sensitivity and early phenotypes of DN. PMID:24026551

  8. Chronic kidney disease in human immunodeficiency virus infection.

    PubMed

    Fabian, J; Katz, I; Gerntholtz, T; Goetsch, S; Naicker, S

    2007-06-01

    The number of people living with human immunodeficiency virus (HIV) worldwide was estimated to be 39.5 million in 2006, 2.6 million more than in 2004. The manifestations of HIV infection in the kidney are multiple and varied, highlighting the complexity of the disease process. There is a wide spectrum of renal disease that occurs in the course of HIV infection. Biopsy studies reveal varying frequencies of histological patterns. HIV-associated nephropathy (HIVAN) is most common. A biopsy study at Chris Baragwanath Hospital in Soweto, South Africa showed that HIVAN was present in 27% and immune complex disease in 21%. Han et al. studied HIV-positive patients in Durban, South Africa and screened for proteinuria, including microalbuminuria. They found persistent proteinuria in 6%; HIVAN in 21/30 (72.4%) and the prevalence of HIVAN in patients with persistent microalbuminuria was 85.7%. Studies in black patients have shown a higher prevalence of both severe glomerular lesions (focal glomerulosclerosis) and nephrotic range proteinuria with renal dysfunction in the presence of normo-hypotension. There have been no prospective randomised controlled studies with any form of therapy for HIVAN to date. Therapy of HIVAN has included corticosteroids, cyclosporine and antiretroviral therapy (ART). ART appears to be a logical choice in the management of HIV-associated renal disease. Regimens containing protease inhibitors have been shown to be associated with significant slowing of the decline in creatinine clearance. Both peritoneal dialysis and haemodialysis are appropriate treatment modalities for HIV-infected patients with end stage renal disease. The choice of dialysis modality between haemodialysis and peritoneal dialysis is not a factor in predicting survival, if patients are stable on ART. Preliminary short-term data in case reports and small cohorts of liver, kidney, and heart transplant recipients suggest that patient survival rates may be similar to those in HIV

  9. Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study.

    PubMed Central

    Gall, M. A.; Hougaard, P.; Borch-Johnsen, K.; Parving, H. H.

    1997-01-01

    OBJECTIVE: To evaluate putative risk factors for the development of incipient diabetic nephropathy (persistent microalbuminuria) and overt diabetic nephropathy (persistent macroalbuminuria) in patients with non-insulin dependent diabetes. DESIGN: Prospective, observational study of a cohort of white, non-insulin dependent diabetic patients followed for a median period of 5.8 years. SETTING: Outpatient clinic in tertiary referral centre. SUBJECTS: 191 patients aged under 66 years with non-insulin dependent diabetes and normoalbuminuria (urinary albumin excretion rate < 30 mg/24 h) who attended the clinic during 1987. MAIN OUTCOME MEASURES: Incipient and overt diabetic nephropathy. RESULTS: Fifteen patients were lost to follow up. Thirty six of the 176 remaining developed persistent microalbuminuria (30-299 mg/24 h in two out of three consecutive 24 hour urine collections) and five developed persistent macroalbuminuria (> or = mg/24 h in two out of three consecutive collections) during follow up. The five year cumulative incidence of incipient diabetic nephropathy was 23% (95% confidence interval 17% to 30%). Cox's multiple stepwise regression analysis revealed the following risk factors for the development of incipient or overt diabetic nephropathy: increased baseline log urinary albumin excretion rate (relative risk 11.1 (3.4 to 35.9); P < 0.0001); male sex (2.6 (1.2 to 5.4); P < 0.02); presence of retinopathy (2.4 (1.3 to 4.7); P < 0.01); increased serum cholesterol concentration (1.4 (1.1 to 1.7); P < 0.01); haemoglobin A1c concentration (1.2 (1.0 to 1.4); P < 0.05); and age (1.07 (1.02 to 1.12); P < 0.01). Known duration of diabetes, body mass index, arterial blood pressure, serum creatinine concentration, pre-existing coronary heart disease, and history of smoking were not risk factors. CONCLUSION: Several potentially modifiable risk factors predict the development of incipient and overt diabetic nephropathy in normoalbuminuric patients with non

  10. Cadmium Level, Glycemic Control, and Indices of Renal Function in Treated Type II Diabetics: Implications for Polluted Environments.

    PubMed

    Anetor, John I; Uche, Chukwuemelie Z; Ayita, Emmanuel B; Adedapo, Solomon K; Adeleye, Jokotade O; Anetor, Gloria O; Akinlade, Sola K

    2016-01-01

    Cadmium (Cd) has recently emerged as a major concern not only in environmental toxicology but also in metabolic diseases such as diabetes mellitus and its complications. Conflicting data aside, these studies have not been examined in a clinical population undergoing management as well as possible modulation by the prominent metabolic antagonist of Cd such as zinc (Zn). This study examined the relationship between cadmium levels, glycemic control, and renal pathology in established type II diabetic patients with focus on populations exposed to modern environmental health hazards (MEHHs). Sixty-five participants, consisting of 45 type-2 diabetics and 20 non-diabetics were enrolled for the study, mean age 61.51 ± 5.27 years. Glycated hemoglobin (HbA1c) was used to classify them into three sub-groups: (A) good glycemic control (44.4%), (B) fair glycemic control (24.4%), and (C) poor glycemic control (31.1%). Plasma levels of glucose, Cd, Zn, HbA1c, creatinine, urinary creatinine, microalbuminuria, and estimated glomerular filtration rate (eGFR) were determined in all participants using standard methods. Fasting plasma glucose was higher in diabetics than in non-diabetics (p = 0.000) as well as Zn level, though not significantly. Interestingly, Cd level, Cd/Zn ratio, and urinary creatinine were significantly lower in diabetics than in non-diabetics. The group with poor glycemic control (C) had significantly higher Cd level compared to the one with good glycemic control (group A). The renal function revealed that microalbuminuria and urinary albumin/creatinine ratio (UACR) was significantly higher in diabetics than in non-diabetics, while eGFR was found to be similar in both diabetics and non-diabetics. UACR inversely correlated with Cd level, while plasma creatinine level positively correlated with Cd but not significantly. Correlation between Cd and HbA1c revealed non-significant inverse correlation (r = -0.007; p > 0.05), while Zn showed a

  11. Low-grade albuminuria in children with obstructive sleep apnea.

    PubMed

    Varlami, Vasiliki; Malakasioti, Georgia; Alexopoulos, Emmanouel I; Theologi, Vasiliki; Theophanous, Eleni; Liakos, Nikolaos; Daskalopoulou, Euphemia; Gourgoulianis, Konstantinos; Kaditis, Athanasios G

    2013-06-01

    Small urinary protein loss (low-grade albuminuria or microalbuminuria) may reflect altered permeability of the glomerular filtration barrier. In the present study, it was hypothesized that children with obstructive sleep apnea have an increased risk of microalbuminuria compared with control subjects without sleep-disordered breathing. Albumin-to-creatinine ratio was measured in morning spot urine specimens collected from consecutive children with or without snoring who were referred for polysomnography. Three groups were studied: (i) control subjects (no snoring, apnea-hypopnea index < 1 episode h(-1) ; n = 31); (ii) mild obstructive sleep apnea (snoring, apnea-hypopnea index = 1-5 episodes h(-1) ; n = 71); and (iii) moderate-to-severe obstructive sleep apnea (snoring, apnea-hypopnea index > 5 episodes∙h(-1) ; n = 27). Indications for polysomnography in control subjects included nightmares, somnambulism and morning headaches. An albumin-to-creatinine ratio > median value in the control group (1.85 mg of albumin per g of creatinine) was defined as elevated. Logistic regression analysis revealed that children with moderate-to-severe obstructive sleep apnea, but not those with mild obstructive sleep apnea, had increased risk of elevated albumin-to-creatinine ratio relative to controls (reference) after adjustment for age, gender and presence of obesity: odds ratio 3.8 (95% confidence interval 1.1-12.6); P = 0.04 and 1.5 (0.6-3.7); P > 0.05, respectively. Oxygen desaturation of hemoglobin and respiratory arousal indices were significant predictors of albumin-to-creatinine ratio (r = 0.31, P = 0.01; and r = 0.43, P < 0.01, respectively). In conclusion, children with moderate-to-severe obstructive sleep apnea are at significantly higher risk of increased low-grade excretion of albumin in the morning urine as compared with control subjects without obstructive sleep apnea. These findings may reflect altered permeability of the glomerular

  12. Four-Year Incidence of Diabetic Retinopathy in a Spanish Cohort: The MADIABETES Study

    PubMed Central

    Salinero-Fort, Miguel Á.; San Andrés-Rebollo, Francisco Javier; de Burgos-Lunar, Carmen; Arrieta-Blanco, Francisco Jesús; Gómez-Campelo, Paloma

    2013-01-01

    Objective To evaluate the incidence of diabetic retinopathy in patients with Type 2 Diabetes Mellitus, to identify the risk factors associated with the incidence of retinopathy and to develop a risk table to predict four-year retinopathy risk stratification for clinical use, from a four-year cohort study. Design The MADIABETES Study is a prospective cohort study of 3,443 outpatients with Type 2 Diabetes Mellitus, sampled from 56 primary health care centers (131 general practitioners) in Madrid (Spain). Results The cumulative incidence of retinopathy at four-year follow-up was 8.07% (95% CI = 7.04–9.22) and the incidence density was 2.03 (95% CI = 1.75–2.33) cases per 1000 patient-months or 2.43 (95% CI = 2.10–2.80) cases per 100 patient-years. The highest adjusted hazard ratios of associated risk factors for incidence of diabetic retinopathy were LDL-C >190 mg/dl (HR = 7.91; 95% CI = 3.39–18.47), duration of diabetes longer than 22 years (HR = 2.00; 95% CI = 1.18–3.39), HbA1c>8% (HR = 1.90; 95% CI = 1.30–2.77), and aspirin use (HR = 1.65; 95% CI = 1.22–2.24). Microalbuminuria (HR = 1.17; 95% CI = 0.75–1.82) and being female (HR = 1.12; 95% CI = 0.84–1.49) showed a non-significant increase of diabetic retinopathy. The greatest risk is observed in females who had diabetes for more than 22 years, with microalbuminuria, HbA1c>8%, hypertension, LDL-Cholesterol >190 mg/dl and aspirin use. Conclusions After a four-year follow-up, the cumulative incidence of retinopathy was relatively low in comparison with other studies. Higher baseline HbA1c, aspirin use, higher LDL-Cholesterol levels, and longer duration of diabetes were the only statistically significant risk factors found for diabetic retinopathy incidence. This is the first study to demonstrate an association between aspirin use and diabetic retinopathy risk in a well-defined cohort of patients with Type 2 Diabetes Mellitus at low risk of

  13. Dealing with spatial heterogeneity

    NASA Astrophysics Data System (ADS)

    Marsily, Gh.; Delay, F.; Gonçalvès, J.; Renard, Ph.; Teles, V.; Violette, S.

    2005-03-01

    ès fins de barrières de perméabilité, qui ont une influence importante sur les écoulement, et, plus encore, sur le transport. Les modè les génétiques récemment apparus ont la capacité de mieux incorporer dans les modèles de faciès les observations géologiques, chose courante dans l'industrie pétrolière, mais insuffisamment développée en hydrogéologie. On conclut que les travaux de recherche ultérieurs devraient s'attacher à développer les modèles de faciès, à les comparer entre eux, et à mettre au point de nouvelles méthodes d'essais in situ, comprenant les méthodes géophysiques, capables de reconnaître la géométrie et les propriétés des faciès. La constitution d'un catalogue mondial de la géométrie et des propriétés des faciès aquifères, ainsi que des méthodes de reconnaissance utilisées pour arriver à la détermination de ces systèmes, serait d'une grande importance pratique pour les applications. La heterogeneidad se puede manejar por medio de la definición de características homogéneas equivalentes, conocidas como promediar o tratando de describir la variabilidad espacial de las características de las rocas a partir de observaciones geológicas y medidas locales. Las técnicas disponibles para estas descripciones son generalmente modelos geoestadísticos continuos o modelos de facies discontinuos como los modelos Boolean, de Indicador o de umbral de Gaussian y el modelo de cadena de Markow. Estos modelos de facies son mas adecuados para tratar la conectvidad de estratos geológicos (por ejemplo canales de alta permeabilidad enterrados o barreras de baja permeabilidad que tienen efectos importantes sobre el flujo y especialmente sobre el transporte en los acuíferos. Los modelos genéticos ofrecen nuevas formas de incorporar más geología en las descripciones de facies, un enfoque que está bien desarollado en la industria petrolera, pero insuficientemente en la hidrogeología. Se concluye que los trabajos futuros deber

  14. Dealing with spatial heterogeneity

    NASA Astrophysics Data System (ADS)

    Marsily, Gh.; Delay, F.; Gonçalvès, J.; Renard, Ph.; Teles, V.; Violette, S.

    2005-03-01

    ès fins de barrières de perméabilité, qui ont une influence importante sur les écoulement, et, plus encore, sur le transport. Les modè les génétiques récemment apparus ont la capacité de mieux incorporer dans les modèles de faciès les observations géologiques, chose courante dans l'industrie pétrolière, mais insuffisamment développée en hydrogéologie. On conclut que les travaux de recherche ultérieurs devraient s'attacher à développer les modèles de faciès, à les comparer entre eux, et à mettre au point de nouvelles méthodes d'essais in situ, comprenant les méthodes géophysiques, capables de reconnaître la géométrie et les propriétés des faciès. La constitution d'un catalogue mondial de la géométrie et des propriétés des faciès aquifères, ainsi que des méthodes de reconnaissance utilisées pour arriver à la détermination de ces systèmes, serait d'une grande importance pratique pour les applications. La heterogeneidad se puede manejar por medio de la definición de características homogéneas equivalentes, conocidas como promediar o tratando de describir la variabilidad espacial de las características de las rocas a partir de observaciones geológicas y medidas locales. Las técnicas disponibles para estas descripciones son generalmente modelos geoestadísticos continuos o modelos de facies discontinuos como los modelos Boolean, de Indicador o de umbral de Gaussian y el modelo de cadena de Markow. Estos modelos de facies son mas adecuados para tratar la conectvidad de estratos geológicos (por ejemplo canales de alta permeabilidad enterrados o barreras de baja permeabilidad que tienen efectos importantes sobre el flujo y especialmente sobre el transporte en los acuíferos. Los modelos genéticos ofrecen nuevas formas de incorporar más geología en las descripciones de facies, un enfoque que está bien desarollado en la industria petrolera, pero insuficientemente en la hidrogeología. Se concluye que los trabajos futuros deber

  15. Eco-hydrology: Groundwater flow and site factors in plant ecology

    NASA Astrophysics Data System (ADS)

    Klijn, Frans; Witte, Jan-Philip M.

    proporciona unas condiciones de vida adecuadas que permiten el crecimiento de una especie o una comunidad botánica. En un material inicialmente homogéneo, el flujo subterráneo gravífico influencia las condiciones del emplazamiento variando la distribución espacial de los nutrientes y de otros agentes químicos relevantes. En especial, el flujo ascendente puede producir y mantener una serie de condiciones que son esenciales para algunas especies y comunidades de plantas relativamente raras. La especial atención hacia este fenómeno ha dado lugar a una cooperación entre ecologistas e hidrogeólogos y a la aparición de una nueva disciplina - eco-hidrología -, en la frontera de los dos campos científicos. En Holanda, se ha usado una clasificación sencilla de tipos de agua para crear una base de datos, a nivel nacional, de lugares donde la presencia de flujos ascendentes pueda ser de interés ecológico. El análisis de correspondencias entre esta base de datos y los tipos de plantas existentes muestra que en los suelos arenosos pobres del Pleistoceno los flujos ascendentes explican la presencia de algunas especies y comunidades de plantas. Por el contrario, en las llanuras fluviales y pólders, con suelos más arcillosos, la influencia de estos flujos es despreciable frente a la relativa a las propias características de los suelos. Se concluye que las especies botánicas se pueden usar como indicadores de la presencia de flujo ascendente sólo en campañas preliminares, pero que el método presenta grandes limitaciones para su extensión a casos generales.

  16. Hyperhomocysteinemia predicts renal function decline: a prospective study in hypertensive adults.

    PubMed

    Xie, Di; Yuan, Yan; Guo, Jiangnan; Yang, Shenglin; Xu, Xin; Wang, Qin; Li, Youbao; Qin, Xianhui; Tang, Genfu; Huo, Yong; Deng, Guangpu; Wu, Shengjie; Wang, Binyan; Zhang, Qin; Wang, Xiaobin; Fang, Pu; Wang, Hong; Xu, Xiping; Hou, Fanfan

    2015-01-01

    Hyper-homocysteinemia (HHcy) is associated with microalbuminuria and glomerular injury in general and diabetic populations. However, HHcy's role in hypertensive patients was not studied. We investigated whether HHcy is an independent risk factor for renal function decline and development of chronic kidney disease (CKD) in hypertensive men and women. This was a community-based prospective cohort study of 2,387 hypertensive adults without CKD at baseline, with a mean follow-up of 4.4 years. Baseline and follow-up levels of plasma Hcy, folate, vitamin B12, blood pressure and other pertinent covariables were obtained. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/per 1.73 m(2) and an eGFR decline rate >1 ml/min/per 1.73 m(2)/year. There was a graded association between Hcy tertiles and eGFR decline. Subjects in the 3(rd) tertile of Hcy levels had an accelerated rate of eGFR decline and an increased risk of incident CKD, as compared with those in the 1st tertile, after adjusting for age, gender, baseline diabetes, SBP, BMI, smoking, dyslipidemia, eGFR, folate and vitamin B12 levels. In conclusion, in this prospective cohort of Chinese hypertensive adults, elevated baseline plasma Hcy can serve as an independent biomarker to predict renal function decline and incident CKD. PMID:26553372

  17. Endothelial dysfunction in patients with primary aldosteronism: a biomarker of target organ damage.

    PubMed

    Liu, G; Yin, G-S; Tang, J-y; Ma, D-J; Ru, J; Huang, X-H

    2014-12-01

    Primary aldosteronism (PA) has been associated with increased target organ damage (TOD), most likely through mineralocorticoid receptor-dependent endothelial dysfunction, in comparison with essential hypertension (EH). The aim of this study was to evaluate the level of biomarkers of endothelial dysfunction in PA and the relationship with left ventricular hypertrophy (LVH) and microalbuminuria (MAU). A total of 50 PA patients and 51 patients with EH individually matched for age, sex, blood pressure and duration of hypertension participated in this study. Biomarkers of endothelial dysfunction, including von Willebrand factor (vWF), intercellular adhesion molecule 1 (ICAM-1) and oxidized low-density lipoprotein (ox-LDL), were measured. Plasma aldosterone concentration (PAC), MAU and echocardiography were also evaluated. In PA patients, vWF, ICAM-1, ox-LDL, LVH and MAU were all significantly higher than in EH patients (all P<0.05). Furthermore, LVH was positively correlated with PAC (P=0.002), vWF (P=0.013) and ox-LDL (P=0.020). MAU was positively correlated with PAC (P<0.001), vWF (P=0.013) and ICAM-1 (P=0.001). Multiple regression analysis indicated that vWF, ICAM-1 and PAC independently predicted MAU (all P<0.05). Likewise, PAC, vWF and ox-LDL were significant predictors of LVH (all P<0.05). Taken together, our results suggest that endothelial dysfunction may contribute to TOD in PA patients. PMID:24553636

  18. Urine albumin excretion, within normal range, reflects increasing prevalence of metabolic syndrome in patients with essential hypertension.

    PubMed

    Vyssoulis, Gregory; Karpanou, Eva; Spanos, Pangiotis; Kyvelou, Stella-Maria; Adamopoulos, Dionysios; Stefanadis, Christodoulos

    2010-08-01

    Microalbuminuria is a prognostic marker of cardiovascular disease and is related to metabolic syndrome (MetS). For this purpose, the authors examined the relationship of low grade albuminuria to MetS, using 4 current definitions and a MetS score. They studied 6650 consecutive, nondiabetic, hypertensive patients with normal microalbumin excretion. MetS was defined by Adult Treatment Panel III, American Heart Association, World Heart Organization, International Diabetes Federation criteria, and MetS Gruppo Italiano per lo Studio della Streptochinasi nell'Infarcto Miocardico (GISSI) score. Urine microalbumin concentration was measured after a 24-hour urine collection by immunonephelometry. By all definitions, hypertensive patients with MetS had higher microalbumin levels. Significantly higher microalbumin levels were observed as the number of metabolic components rose. After adjustment for systolic blood pressure, the strength of this association was reduced to a nonsignificant level. Microalbumin levels, within normal range, are increased in patients with MetS, irrespective of the definition criteria. PMID:20695936

  19. Multi-Ethnic Study of Atherosclerosis: objectives and design.

    PubMed

    Bild, Diane E; Bluemke, David A; Burke, Gregory L; Detrano, Robert; Diez Roux, Ana V; Folsom, Aaron R; Greenland, Philip; Jacob, David R; Kronmal, Richard; Liu, Kiang; Nelson, Jennifer Clark; O'Leary, Daniel; Saad, Mohammed F; Shea, Steven; Szklo, Moyses; Tracy, Russell P

    2002-11-01

    The Multi-Ethnic Study of Atherosclerosis was initiated in July 2000 to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) in a population-based sample of 6,500 men and women aged 45-84 years. The cohort will be selected from six US field centers. Approximately 38% of the cohort will be White, 28% African-American, 23% Hispanic, and 11% Asian (of Chinese descent). Baseline measurements will include measurement of coronary calcium using computed tomography; measurement of ventricular mass and function using cardiac magnetic resonance imaging; measurement of flow-mediated brachial artery endothelial vasodilation, carotid intimal-medial wall thickness, and distensibility of the carotid arteries using ultrasonography; measurement of peripheral vascular disease using ankle and brachial blood pressures; electrocardiography; and assessments of microalbuminuria, standard CVD risk factors, sociodemographic factors, life habits, and psychosocial factors. Blood samples will be assayed for putative biochemical risk factors and stored for use in nested case-control studies. DNA will be extracted and lymphocytes will be immortalized for genetic studies. Measurement of selected subclinical disease indicators and risk factors will be repeated for the study of progression over 7 years. Participants will be followed through 2008 for identification and characterization of CVD events, including acute myocardial infarction and other coronary heart disease, stroke, peripheral vascular disease, and congestive heart failure; therapeutic interventions for CVD; and mortality. PMID:12397006

  20. Diagnosis, Epidemiology, and Management of Hypertension in Children.

    PubMed

    Rao, Goutham

    2016-08-01

    National guidelines for the diagnosis and management of hypertension in children have been available for nearly 40 years. Unfortunately, knowledge and recognition of the problem by clinicians remain poor. Prevalence estimates are highly variable because of differing standards, populations, and blood pressure (BP) measurement techniques. Estimates in the United States range from 0.3% to 4.5%. Risk factors for primary hypertension include overweight and obesity, male sex, older age, high sodium intake, and African American or Latino ancestry. Data relating hypertension in childhood to later cardiovascular events is currently lacking. It is known that BP in childhood is highly predictive of BP in adulthood. Compelling data about target organ damage is available, including the association of hypertension with left ventricular hypertrophy, carotid-intima media thickness, and microalbuminuria. Guidelines from both the United States and Europe include detailed recommendations for diagnosis and management. Diagnostic standards are based on clinic readings, ambulatory BP monitoring is useful in confirming diagnosis of hypertension and identifying white-coat hypertension, masked hypertension, and secondary hypertension, as well as monitoring response to therapy. Research priorities include the need for reliable prevalence estimates based on diverse populations and data about the long-term impact of childhood hypertension on cardiovascular morbidity and mortality. Priorities to improve clinical practice include more education among clinicians about diagnosis and management, clinical decision support to aid in diagnosis, and routine use of ambulatory BP monitoring to aid in diagnosis and to monitor response to treatment. PMID:27405770

  1. In Vivo Platelet Activation and Aspirin Responsiveness in Type 1 Diabetes.

    PubMed

    Zaccardi, Francesco; Rizzi, Alessandro; Petrucci, Giovanna; Ciaffardini, Flavia; Tanese, Luigi; Pagliaccia, Francesca; Cavalca, Viviana; Ciminello, Angela; Habib, Aida; Squellerio, Isabella; Rizzo, Paola; Tremoli, Elena; Rocca, Bianca; Pitocco, Dario; Patrono, Carlo

    2016-02-01

    Platelet activation is persistently enhanced, and its inhibition by low-dose aspirin is impaired in type 2 diabetes mellitus. We investigated in vivo thromboxane (TX) and prostacyclin (PGI2) biosynthesis and their determinants, as well as aspirin responsiveness, in young adult subjects with type 1 diabetes mellitus (T1DM) without overt cardiovascular disease and stable glycemic control. The biosynthesis of TXA2 was persistently increased in subjects with T1DM versus matched healthy subjects, with females showing higher urinary TX metabolite (TXM) excretion than male subjects with T1DM. Microalbuminuria and urinary 8-iso-PGF2α, an index of in vivo oxidative stress, independently predicted TXM excretion in T1DM. No homeostatic increase in PGI2 biosynthesis was detected. Platelet COX-1 suppression by low-dose aspirin and the kinetics of its recovery after drug withdrawal were similar in patients and control subjects and were unaffected by glucose variability. We conclude that patients with T1DM and stable glycemic control display enhanced platelet activation correlating with female sex and microvascular and oxidative damages. Moreover, aspirin responsiveness is unimpaired in T1DM, suggesting that the metabolic disturbance per se is unrelated to altered pharmacodynamics. The efficacy and safety of low-dose aspirin in T1DM warrant further clinical investigation. PMID:26470782

  2. Oxidative Stress in Diabetic Nephropathy with Early Chronic Kidney Disease.

    PubMed

    Miranda-Díaz, Alejandra Guillermina; Pazarín-Villaseñor, Leonardo; Yanowsky-Escatell, Francisco Gerardo; Andrade-Sierra, Jorge

    2016-01-01

    The increase in the prevalence of diabetes mellitus (DM) and the secondary kidney damage produces diabetic nephropathy (DN). Early nephropathy is defined as the presence of microalbuminuria (30-300 mg/day), including normal glomerular filtration rate (GFR) or a mildly decreased GFR (60-89 mL/min/1.73 m(2)), with or without overt nephropathy. The earliest change caused by DN is hyperfiltration with proteinuria. The acceptable excretion rate of albumin in urine is <30 mg/day. Albuminuria represents the excretion of >300 mg/day. Chronic kidney disease (CKD) is characterized by abnormalities in renal function that persist for >3 months with health implications. Alterations in the redox state in DN are caused by the persistent state of hyperglycemia and the increase in advanced glycation end products (AGEs) with ability to affect the renin-angiotensin system and the transforming growth factor-beta (TGF-β), producing chronic inflammation and glomerular and tubular hypertrophy and favoring the appearance of oxidative stress. In DN imbalance between prooxidant/antioxidant processes exists with an increase in reactive oxygen species (ROS). The overproduction of ROS diminishes expression of the antioxidant enzymes (manganese superoxide dismutase, glutathione peroxidase, and catalase). The early detection of CKD secondary to DN and the timely identification of patients would permit decreasing its impact on health. PMID:27525285

  3. Comparison of Clinical Trajectories before Initiation of Renal Replacement Therapy between Diabetic Nephropathy and Nephrosclerosis on the KDIGO Guidelines Heat Map.

    PubMed

    Abe, Masanori; Okada, Kazuyoshi; Maruyama, Noriaki; Takashima, Hiroyuki; Oikawa, Osamu; Soma, Masayoshi

    2016-01-01

    This study investigated differences between the clinical trajectories of diabetic nephropathy and nephrosclerosis using the Kidney Disease: Improving Global Outcomes (KDIGO) heat map and the clinical characteristics between the two diseases at RRT initiation. This single-center, retrospective study enrolled 100 patients whose estimated glomerular filtration rate (eGFR) was ≥45 mL/min/1.73 m(2) at their first visit and who were initiated on RRT. Fifty consecutive patients were assigned to each of the diabetic nephropathy and nephrosclerosis groups. All data for simultaneously measured eGFR and urinary albumin to creatinine ratio (UACR) were collected from first visit to RRT initiation and were plotted on the KDIGO heat map. Diabetic nephropathy was characterized by higher blood pressure and UACR and lower age, eGFR, and serum albumin levels compared with nephrosclerosis at RRT initiation. The vast majority of patients with diabetic nephropathy and eGFR < 60 mL/min/1.73 m(2) had concomitant macroalbuminuria, whereas for patients with nephrosclerosis, even when eGFR was <45 mL/min/1.73 m(2), many still had normoalbuminuria or microalbuminuria. The rate of decline of eGFR was significantly faster in the diabetic nephropathy group than that in the nephrosclerosis group. The clinical trajectories of diabetic nephropathy and nephrosclerosis differed markedly on the KDIGO heat map. PMID:26839894

  4. Serum uric acid in new and recent onset primary hypertension

    PubMed Central

    Anand, N. N.; Padma, V.; Prasad, Arun; Alam, Krishna Chaitanya; Javid, M. S. A. Syed Mohammed

    2015-01-01

    Introduction: Hyperuricemia is common among adults with prehypertension, especially when the microalbuminuria is present. Hyperuricemia precedes the development of hypertension. Aim: (1) To find the association of hyperuricemia in new-onset hypertensive patients. (2) To find the association of hyperuricemia in hypertensive patients with regard to gender and risk factors such as smoking and central obesity. Material and Methods: A total of 50 adults aged between 20 and 50 years who had mild early hypertension were selected for the study. Fifty controls without hypertension were enrolled and investigated. Results: The association between uric acid (UA) and hypertension was analyzed using Student's t-test and statistical difference were assessed using Pearson coefficient. The study showed a significant difference in UA between the hypertensive subjects and the normotensive controls. There was not a significant difference between waist abnormality, smoking and UA in cases. Males have a higher degree of hyperuricemia than females in hypertensive patients. Conclusion: Serum UA is strongly associated with blood pressure (BP) in new and recent onset primary hypertension. The remarkable association of UA with BP in adults is consistent with recent animal model data and the hypothesis that the UA might have a pathogenic role in the development of hypertension. PMID:26015744

  5. The Incidence of Cardiovascular Events Is Comparable Between Normoalbuminuric and Albuminuric Diabetic Patients With Chronic Kidney Disease

    PubMed Central

    Lee, Eunyoung; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Ryu, Dong-Ryeol; Kang, Shin-Wook; Yoo, Tae-Hyun

    2016-01-01

    Abstract Diabetic kidney disease leads to microalbuminuria and gradually progresses to overt proteinuria with renal insufficiency. Recent studies have demonstrated that 20% to 40% of patients with diabetic kidney disease are normo- to microalbuminuric, despite reduced renal function. We investigated renal and cardiovascular outcomes in patients with diabetes and renal insufficiency who were normo-, micro-, and macroalbuminuric. Patients with diabetes and stage III or IV chronic kidney disease were recruited and divided into normoalbuminuric, microalbuminuric, and macroalbuminuric groups. New-onset cardiovascular events and renal outcomes, defined by end-stage renal disease or a 50% decline in estimated glomerular filtration rate, were evaluated. Among the 1136 study patients, 255 (22.4%) were normoalbuminuric. During a mean follow-up duration of 44 months, the incidence of cardiovascular disease was similar among groups (P = 0.68). However, renal outcomes were significantly more common in patients with macroalbuminuria than in those who were normoalbuminuric or microalbuminuric (P < 0.001). Multivariate Cox analysis identified macroalbuminuria and estimated glomerular filtration rate as independent predictors of renal outcomes. The amount of albuminuria was not associated with cardiovascular events in this population. Although cardiovascular events were similar in patients with diabetic kidney disease and renal insufficiency, renal outcomes differed significantly according to the amount of albuminuria. PMID:27082557

  6. Circulatory Syndrome: An Evolution of the Metabolic Syndrome Concept!

    PubMed Central

    Khoshdel, Ali Reza; Carney, Shane L; Gillies, Alastair

    2012-01-01

    The metabolic syndrome has been a useful, though controversial construct in clinical practice as well as a valuable model in order to understand the interactions of diverse cardiovascular risk factors. However the increasing importance of the circulatory system in particular the endothelium, in both connecting and controlling organ function has underlined the limitations of the metabolic syndrome definition. The proposed “Circulatory Syndrome” is an attempt to refine the metabolic syndrome concept by the addition of recently documented markers of cardiovascular disease including renal impairment, microalbuminuria, arterial stiffness, ventricular dysfunction and anaemia to more classic factors including hypertension, dyslipidemia and abnormal glucose metabolism; all of which easily measured in clinical practice. These markers interact with each other as well as with other factors such as aging, obesity, physical inactivity, diet and smoking. The final common pathways of inflammation, oxidative stress and hypercoagulability thereby lead to endothelial damage and eventually cardiovascular disease. Nevertheless, the Circulatory (MARC) Syndrome, like its predecessor the metabolic syndrome, is only a small step toward an understanding of these complex and as yet poorly understood markers of disease. PMID:22845817

  7. How to prevent and treat pharmacological hypoglycemias.

    PubMed

    Reyes García, R; Mezquita Raya, P

    2014-05-01

    A 58 year-old woman with type 2 diabetes diagnosed 3 years before came to our clinic. Her treatment was metformin 850 mg every 12 hours and glimepiride 4 mg every 24 hours. After the initiation of glimepiride 9 months before her weight has increased 5 kg, and she suffers frequent hypoglycemias which have affected her while driving. Her BMI is 35.5 kg/m². She has a normal eye fund exam. She has hypertension treated with telmisartán and hidroclorotiazide with adequate control, and also hypercholesterolemia treated with atorvastatine 40 mg every 24 hours. Her blood test shows an HbA1c of 7.0%, normal values of microalbuminuria, total cholesterol 149 mg/dl, HDL cholesterol 52 mg/dl, LDL cholesterol 98 mg/dl and triglycerides 123 mg/dl. Her blood pressure is 129/81 mmHg, there was no orthostatic hypotension, and her peripheral neurological examination shows normal results. In summary, our case is a young woman with type 2 diabetes and obesity, without chronic complications and which has frequent hypoglycaemia. How must this woman be evaluated and treated? PMID:24468002

  8. Diabetes and osteoporosis: Action of gastrointestinal hormones on the bone.

    PubMed

    García-Martín, A; Reyes-García, R; García-Castro, J M; Muñoz-Torres, M

    2013-01-01

    A 62-year-old woman consulted for evaluation of treatment for her type 2 diabetes diagnosed four years ago. He had been received treatment with metformin 850mg twice, with no chronic associated complications. She had hypertension and dyslipidemia. She was being treated with candesartan/hydrochlorothiazide 32/12.5mg and atorvastatin 40mg. Her weight was 92kg and height 162cm (BMI, 35.1kg/m(2)). The last analysis showed fasting glucose 168mg/dl and glycated hemoglobin 7.5%, Microalbuminuria was negative. Blood pressure and lipid profile were within the therapeutic range. Two years ago she suffered a nontraumatic Colle's fracture in her left arm for which she was taking a daily calcium and vitamin D supplement and weekly alendronate. In summary, this is an obese female patient with type 2 diabetes mellitus and inadequate metabolic control, She also has a history of fragility fracture. How should this patient be evaluated and treated? PMID:26530941

  9. Mouse Models of Diabetes, Obesity and Related Kidney Disease.

    PubMed

    Glastras, Sarah J; Chen, Hui; Teh, Rachel; McGrath, Rachel T; Chen, Jason; Pollock, Carol A; Wong, Muh Geot; Saad, Sonia

    2016-01-01

    Multiple rodent models have been used to study diabetic kidney disease (DKD). The purpose of the present study was to compare models of diabetes and obesity-induced metabolic syndrome and determine differences in renal outcomes. C57BL/6 male mice were fed either normal chow or high fat diet (HFD). At postnatal week 8, chow-fed mice were randomly assigned to low-dose streptozotocin (STZ, 55 mg/kg/day, five consecutive days) or vehicle control, whereas HFD-fed mice were given either one high-dose of STZ (100 mg/kg) or vehicle control. Intraperitoneal glucose tolerance tests were performed at Week 14, 20 and 30. Urinary albumin to creatinine ratio (ACR) and serum creatinine were measured, and renal structure was assessed using Periodic Acid Schiff (PAS) staining at Week 32. Results showed that chow-fed mice exposed to five doses of STZ resembled type 1 diabetes mellitus with a lean phenotype, hyperglycaemia, microalbuminuria and increased serum creatinine levels. Their kidneys demonstrated moderate tubular injury with evidence of tubular dilatation and glycogenated nuclear inclusion bodies. HFD-fed mice resembled metabolic syndrome as they were obese with dyslipidaemia, insulin resistance, and significantly impaired glucose tolerance. One dose STZ, in addition to HFD, did not worsen metabolic features (including fasting glucose, non esterified fatty acid, and triglyceride levels). There were significant increases in urinary ACR and serum creatinine levels, and renal structural changes were predominantly related to interstitial vacuolation and tubular dilatation in HFD-fed mice. PMID:27579698

  10. Biological Activities of Chinese Propolis and Brazilian Propolis on Streptozotocin-Induced Type 1 Diabetes Mellitus in Rats

    PubMed Central

    Zhu, Wei; Chen, Minli; Shou, Qiyang; Li, Yinghua; Hu, Fuliang

    2011-01-01

    Propolis is a bee-collected natural product and has been proven to have various bioactivities. This study tested the effects of Chinese propolis and Brazilian propolis on streptozotocin-induced type 1 diabetes mellitus in Sprague-Dawley rats. The results showed that Chinese propolis and Brazilian propolis significantly inhibited body weight loss and blood glucose increase in diabetic rats. In addition, Chinese propolis-treated rats showed an 8.4% reduction of glycated hemoglobin levels compared with untreated diabetic rats. Measurement of blood lipid metabolism showed dyslipidemia in diabetic rats and Chinese propolis helped to reduce total cholesterol level by 16.6%. Moreover, oxidative stress in blood, liver and kidney was improved to various degrees by both Chinese propolis and Brazilian propolis. An apparent reduction in levels of alanine transaminase, aspartate transaminase, blood urea nitrogen and urine microalbuminuria-excretion rate demonstrated the beneficial effects of propolis in hepatorenal function. All these results suggested that Chinese propolis and Brazilian propolis can alleviate symptoms of diabetes mellitus in rats and these effects may partially be due to their antioxidant ability. PMID:21785625

  11. Attenuation of renal dysfunction by anti-hyperglycemic compound isolated from fruit pulp of Eugenia jambolana in streptozotocin-induced diabetic rats.

    PubMed

    Tanwar, Reenu Singh; Sharma, Suman Bala; Singh, Usha Rani; Prabhu, Krishna Madhava

    2010-04-01

    The renal protective effect of an active principle isolated from the aqueous extract of fruit pulp of Eugenia jambolana was investigated in streptozotocin (45 mg/kg body weight)-induced severely diabetic rats (FBG > or = 300 mg/dl). For isolation of active principle, crude aqueous extract of E. jambolana fruit pulp was subjected to purification by ion-exchange column chromatography, which yielded a partially purified compound (FII), which on further purification by rechromatography gave a purified active compound (FIIc). Purity of FIIc was confirmed by high pressure liquid chromatography. Detailed UV, NMR, IR spectra suggested that FIIc is a small aliphatic organic compound having molecular formula C4H7O4N. Oral administration of FIIc to diabetic rats (10, 15 and 20 mg/kg body weight per day for a period of 60 days) produced significant (P<0.001) fall in fasting blood glucose (FBG) in a dose-dependent manner. Treatment with FIIc (15 mg/kg body wt.) showed significant (P<0.001) improvement in body weight, blood urea, plasma creatinine levels, urinary volume, urinary sugar and microalbuminuria. Renal hypertrophy, assessed as the ratio of the weight of the two kidneys to total body weight was also significantly (P<0.05) improved after treatment with FIIc. The above results suggest that FIIc possesses significant nephroprotective activity. PMID:20521620

  12. Effect of tobacco smoking on renal function.

    PubMed

    Cooper, Ross G

    2006-09-01

    Nicotine is one of many substances that may be acquired through active and passive smoking of tobacco. In man, nicotine is commonly consumed via smoking cigarettes, cigars or pipes. The addictive liability and pharmacological effects of smoking are primarily mediated by the major tobacco alkaloid nicotine. High stress jobs favour repeated smoking and further reinforce addictive behaviours. There are elevated serum cadmium and lead levels in smokers resulting in glomerular dysfunction. Nephropathies are accelerated by nicotine with an increased incidence of microalbuminuria progressing to proteinuria, followed by type-1 diabetes mellitus induced renal failure. Cigarette smoke-induced renal damage is due, at least in part, to activation of the sympathetic nervous system resulting in an elevation in blood pressure. Ethanol, nicotine, or concurrent intake significantly increases lipid peroxidation in liver, and decreased superoxide dismutase activity and increased catalase activity in the kidney. This review describes the effects of nicotine, smoking, smoke extracts and other tobacco constituents on renal and cardiovascular functions, and associated effects on the nervous system. Both active and passive smoking is toxic to renal function. PMID:17085829

  13. Oxidative Stress in Diabetic Nephropathy with Early Chronic Kidney Disease

    PubMed Central

    Andrade-Sierra, Jorge

    2016-01-01

    The increase in the prevalence of diabetes mellitus (DM) and the secondary kidney damage produces diabetic nephropathy (DN). Early nephropathy is defined as the presence of microalbuminuria (30–300 mg/day), including normal glomerular filtration rate (GFR) or a mildly decreased GFR (60–89 mL/min/1.73 m2), with or without overt nephropathy. The earliest change caused by DN is hyperfiltration with proteinuria. The acceptable excretion rate of albumin in urine is <30 mg/day. Albuminuria represents the excretion of >300 mg/day. Chronic kidney disease (CKD) is characterized by abnormalities in renal function that persist for >3 months with health implications. Alterations in the redox state in DN are caused by the persistent state of hyperglycemia and the increase in advanced glycation end products (AGEs) with ability to affect the renin-angiotensin system and the transforming growth factor-beta (TGF-β), producing chronic inflammation and glomerular and tubular hypertrophy and favoring the appearance of oxidative stress. In DN imbalance between prooxidant/antioxidant processes exists with an increase in reactive oxygen species (ROS). The overproduction of ROS diminishes expression of the antioxidant enzymes (manganese superoxide dismutase, glutathione peroxidase, and catalase). The early detection of CKD secondary to DN and the timely identification of patients would permit decreasing its impact on health. PMID:27525285

  14. Prognostic value of low and moderately elevated C-reactive protein in acute coronary syndrome: A 2-year follow-up study

    PubMed Central

    Lukin, Ajvor; Novak, Katarina; Polić, Stojan; Puljak, Livia

    2013-01-01

    Background The main goal of this study was to improve diagnostic and predictive value of low and moderately elevated C-reactive protein (CRP) in patients with acute coronary syndrome (ACS), related to noninvasive clinical parameters, in order to improve and prolong patient life with low or no additional costs. Material/Methods A prospective, open clinical study was conducted at the University Hospital Split, Croatia with 112 patients with ACS and low or moderately elevated CRP (<3.0 mg/L). After diagnosing ACS, data on physical activity, alcohol consumption, and functional status were recorded. Anthropometric measurements were made. Blood and urine samples were taken for analyses. Electrocardiographic, ergometric, and echocardiographic testing was performed. A total of 72 parameters were monitored at the time of hospital admission in ACS patients to analyze which ones could predict disease outcome at the end of follow-up in patients with low or moderately elevated CRP. Patients were followed up for 2 years. Results The variables that were predictive of major adverse cardiac events (MACE) within 2 years of ACS hospitalization were hemoglobin, fibrinogen, antithrombin III, cholesterol levels, brain natriuretic peptide, and microalbuminuria. ACS patients with CRP <3.0 mg/L had significantly higher risk of developing MACE within 2 years if ≥50% of the 8 key parameters were outside the reference values. Conclusions Major adverse cardiac events can be predicted in patients with acute coronary syndrome whose CRP values are low or moderately elevated. PMID:24051868

  15. Renal denervation for the treatment of cardiovascular high risk-hypertension or beyond?

    PubMed

    Böhm, Michael; Linz, Dominik; Ukena, Christian; Esler, Murray; Mahfoud, Felix

    2014-07-18

    Hypertension imposes a major burden of morbidity and mortality and is associated with sympathetic nervous system overactivity. Renal sympathetic denervation has been shown to reduce office blood pressure, ambulatory blood pressure, and sympathetic activity in patients with resistant hypertension. Therefore, the procedure has attracted a lot of attention. Beyond blood pressure, renal denervation has been shown to improve glucose tolerance, microalbuminuria, and arrhythmias in several experimental models and, in admittedly, often uncontrolled clinical studies. It has been demonstrated to reduce myocardial hypertrophy in a blood pressure-independent and blood pressure-dependent way. The first studies on heart failure with preserved and reduced ejection fraction are ongoing. Renal sympathetic denervation holds promise for future indications in hypertension and related comorbidities and consequences, such as metabolic disease, renal failure, and heart failure. Published data in a placebo-control blinded study, however, are needed. The aim of this review is to provide a critical and comprehensive overview of heretofore generated data on renal denervation in experimental models, in human hypertension, and on early developments in new indications, which should indicate the way to powered and performed, controlled clinical studies appropriately. PMID:25035133

  16. Cardiovascular risk reduction by reversing endothelial dysfunction:ARBs, ACE inhibitors, or both? Expectations from The ONTARGET Trial Programme

    PubMed Central

    Ruilope, Luis Miguel; Redón, Josep; Schmieder, Roland

    2007-01-01

    Endothelial dysfunction is the initial pathophysiological step in a progression of vascular damage that leads to overt cardiovascular and chronic kidney disease. Angiotensin II, the primary agent of the renin–angiotensin system (RAS), has a central role in endothelial dysfunction. Therefore, RAS blockade with an angiotensin receptor blocker (ARB) and/or angiotensin-converting enzyme (ACE) inhibitor provides a rational approach to reverse endothelial dysfunction, reduce microalbuminuria, and, thus, improves cardiovascular and renal prognosis. ARBs and ACE inhibitors act at different points in the RAS pathway and recent evidence suggests that there are differences regarding their effects on endothelial dysfunction. In addition to blood pressure lowering, studies have shown that ARBs reduce target-organ damage, including improvements in endothelial dysfunction, arterial stiffness, the progression of renal dysfunction in patients with type 2 diabetes, proteinuria, and left ventricular hypertrophy. The ONgoing Telmisartan Alone in combination with Ramipril Global Endpoint Trial (ONTARGET) Programme is expected to provide the ultimate evidence of whether improved endothelial function translates into reduced cardiovascular and renal events in high-risk patients, and to assess possible differential outcomes with telmisartan, the ACE inhibitor ramipril, or a combination of both (dual RAS blockade). Completion of ONTARGET is expected in 2008. PMID:17583170

  17. Living donor kidney transplantation in patients with hereditary nephropathies.

    PubMed

    Niaudet, Patrick

    2010-12-01

    Patients with some hereditary nephropathies-including autosomal dominant polycystic kidney disease (ADPKD), Fabry disease and Alport syndrome-can progress to end-stage renal disease (ESRD) and are candidates for kidney transplantation. When considering whether a potential living donor is appropriate for a particular patient, clinicians should be aware of the increased risk of adverse outcomes for the donor and the recipient. Renal transplantation from a living related donor is not contraindicated in most nephropathies that have an autosomal recessive mode of inheritance (for example, autosomal recessive polycystic kidney disease and cystinosis). Renal transplant recipients with ADPKD, however, should only receive a kidney from a related donor if the disease has been excluded in the donor by imaging and/or genetic testing. Potential living related donors for patients with Alport syndrome should be evaluated carefully for the presence of microhematuria and microalbuminuria before a decision is made to perform transplantation, and mothers or heterozygous sisters of affected male recipients with X-linked Alport syndrome should be informed about the possible long-term increased risk of renal dysfunction associated with donation. Most patients with atypical hemolytic uremic syndrome should not receive a kidney transplant from a living donor because there is a high risk of disease recurrence and graft loss. PMID:20877305

  18. Metabolic syndrome and right ventricle: an updated review.

    PubMed

    Tadic, Marijana; Ivanovic, Branislava; Cuspidi, Cesare

    2013-10-01

    The cluster of metabolic and hemodynamic abnormalities which characterize the metabolic syndrome (MS) is responsible for subclinical cardiac and extra-cardiac damage such as left ventricular hypertrophy, diastolic dysfunction, carotid atherosclerosis and microalbuminuria. The development of different non-invasive imaging methods enabled a detail investigation of right ventricular structure and function, and revealed that right ventricular remodeling followed changes in the left ventricular structure and function in patients with arterial hypertension, diabetes or obesity. Previous investigations also reported that the coexistence of two components of the MS induced more significant cardiac remodeling than the presence of only one MS risk-factor. The relationship between different components of the MS (increased blood pressure, abdominal obesity, increased fasting glucose level and dyslipidemia) and right ventricular remodeling could be explained by several hemodynamic and non-hemodynamic mechanisms. However, the association between right ventricular remodeling and the MS has not been sufficiently investigated so far. The aim of this article was to review recent articles focusing on the association between metabolic syndrome components and the metabolic syndrome itself with impairments in right ventricular structure and function assessed by different imaging techniques. PMID:24001437

  19. Diabetic kidney disease and vascular comorbidities in patients with type 2 diabetes mellitus in a developing country.

    PubMed

    Bentata, Yassamine; Chemlal, A; Karimi, I; El Alaoui, F; Haddiya, I; Abouqal, Redouane

    2015-09-01

    Type 2 diabetes mellitus (T2DM) is associated with an increased risk of progression toward end-stage renal disease and cardiovascular (CV) risk mortality. To investigate this association, we studied 637 patients with T2DM in the Eastern area of Morocco. The mean follow-up period was 42 ± 11 months. At the baseline visit, 22.8%, 59.1% and 18.1% of the patients had normo-albuminuria, micro-albuminuria and macro-albuminuria, respectively. Of all patients, 51.6% had a history of hypertension and 37.4% had hypertension on admission. At the end of follow-up, rapid progression (estimated glomerular filtration rate >5 mL/min/1.73 m² /year) was observed in 24.1% of the cases and the frequency of occurrence of CV events was 5%, 18.5% and 32.5% in the normo-, micro- and macro-albuminuria groups, respectively (P <0.001). In multivariate analysis, arterial hypertension was identified as an independent risk factor related to diabetic kidney disease (DKD, P = 0.04) and occurrence of CV events (P = 0.02), while albuminuria was not identified as an independent risk factor, either for DKD or for the occurrence of CV events. Our study found that hypertension was an independent risk factor for the DKD and the occurrence of the CV events in T2DM patients. PMID:26354588

  20. The thromboxane receptor antagonist S18886 attenuates renal oxidant stress and proteinuria in diabetic apolipoprotein E-deficient mice.

    PubMed

    Xu, Shanqin; Jiang, Bingbing; Maitland, Karlene A; Bayat, Hossein; Gu, Jiali; Nadler, Jerry L; Corda, Stefano; Lavielle, Gilbert; Verbeuren, Tony J; Zuccollo, Adriana; Cohen, Richard A

    2006-01-01

    Arachidonic acid metabolites, some of which may activate thromboxane A(2) receptors (TPr) and contribute to the development of diabetes complications, including nephropathy, are elevated in diabetes. This study determined the effect of blocking TPr with S18886 or inhibiting cyclooxygenase with aspirin on oxidative stress and the early stages of nephropathy in streptozotocin-induced diabetic apolipoprotein E(-/-) mice. Diabetic mice were treated with S18886 (5 mg . kg(-1) . day(-1)) or aspirin (30 mg . kg(-1) . day(-1)) for 6 weeks. Neither S18886 nor aspirin affected hyperglycemia or hypercholesterolemia. There was intense immunohistochemical staining for nitrotyrosine in diabetic mouse kidney. In addition, a decrease in manganese superoxide dismutase (MnSOD) activity was associated with an increase in MnSOD tyrosine-34 nitration. Tyrosine nitration was significantly reduced by S18886 but not by aspirin. Staining for the NADPH oxidase subunit p47(phox), inducible nitric oxide synthase, and 12-lipoxygenase was increased in diabetic mouse kidney, as were urine levels of 12-hydroxyeicosatetraenoic acid and 8-iso-prostaglandin F(2alpha). S18886 attenuated all of these markers of oxidant stress and inflammation. Furthermore, S18886 significantly attenuated microalbuminuria in diabetic mice and ameliorated histological evidence of diabetic nephropathy, including transforming growth factor-beta and extracellular matrix expression. Thus, in contrast to inhibiting cyclooxygenase, blockade of TPr may have therapeutic potential in diabetic nephropathy, in part by attenuating oxidative stress. PMID:16380483

  1. Screening for Nephropathy in Diabetes Mellitus: Is Micral-Test Valid among All Diabetics?

    PubMed Central

    Afifa, Koubaa; Belguith Asma, Sriha; Nabil, Harzallah; Ahlem, Bellaleh; Mounira, Sahtout; Kawthar, Younes; Sonia, Triki; Ilhem, Hellara; Fadoua, Neffati; Fadhel, Najjar; Mohamed, Soltani

    2016-01-01

    Background. Using Micral-test (MT) for screening microalbuminuria (MA) among type 2 diabetics (T2D) is helpful. We aimed at determining prevalence of MA and at describing the MT validity. Methods. We studied 182 T2D followed up in family medicine. Two 24-hour urinary quantitative assays of MA had been used as a gold standard. Results. Prevalence of MA was 23%, CI 95%: 16.9–29.1. MT validity was 77% for sensitivity, 88% for negative predictive value, and 0.2 for Kappa coefficient (p = 0.001). Among subjects having a blood pressure ≥130/80 mmHg, having a CHT/HDL ratio ≥ 3, being a T2D for more than 5 years, and being women, negative predictive values were, respectively, 91%, 89%, 95%, and 91%. The area under the ROC curve was 0.81 in men (p = 0.008) and 0.80 when diabetes duration exceeds 5 years (p = 0.001). The MA value at 100% Sp for MT was 35 mg/L. Conclusion. The use of MT in primary healthcare for yearly screening for MA in T2D must be accentuated especially when diabetes duration exceeds 5 years or when associated with other cardiovascular risks. PMID:27294192

  2. Prevalence of nephropathy in the German diabetes population—Is early referral to nephrological care a realistic demand today?

    PubMed Central

    Pommer, Wolfgang

    2008-01-01

    In Germany, diabetes mellitus in the general population has increased to ∼8 million people. The implication of this trend for future nephrological care is not well known, as data on this issue are rather limited. Results from different population-based studies suggest that microalbuminuria in diabetic patients is present in 20–30% of the cases. Findings from the diabetes disease management programme in the North-Rhine area revealed the prevalence of chronic kidney disease (CKD) stage II in half of the participants (CKD stage III was present in ∼20%). Only a small proportion of this cohort (∼1–2%) will reach end-stage renal failure, probably due to the excess mortality risks attributed to advanced kidney disease. Results from the QUASI-Niere registry, which reports on renal replacement therapy in Germany, indicate almost constant incidence and prevalence rates of diabetes in the last 5 years (30.6–34.2% and 23.6–27.1%, respectively). The high percentages of early stages of CKD in the diabetes population indicate a potentially high burden of future nephrological care, especially if patients are referred to nephrologists at an early stage. In reality, in nephrological care, bearing this burden is impossible without expanding the resources for this patient group. PMID:25983981

  3. Obstetric nephrology: pregnancy in women with diabetic nephropathy--the role of antihypertensive treatment.

    PubMed

    Mathiesen, Elisabeth R; Ringholm, Lene; Feldt-Rasmussen, Bo; Clausen, Peter; Damm, Peter

    2012-12-01

    This review highlights factors of importance for the clinical care of pregnant women with pregestational diabetes and microalbuminuria or diabetic nephropathy with particular focus on the role of intensive antihypertensive treatment during pregnancy. Most information in the literature comes from women with type 1 diabetes and diabetic nephropathy, but this is probably also valid for women with type 2 diabetes. Careful counseling of women with diabetic nephropathy before pregnancy with estimation of the risk for the mother and fetus is important. Pregnancy does not result in worsening of kidney function in women with diabetic nephropathy and normal serum creatinine, but pregnancy complications such as pre-eclampsia and preterm delivery are common. Intensive metabolic control before and during pregnancy, low-dose aspirin from 12 gestational weeks onward, and intensive antihypertensive treatment are important. Methyldopa, labetalol, and nifedipine are regarded safe in pregnancy, whereas angiotensin converting enzyme inhibitors, AngII antagonists, or statins should be paused before pregnancy. Case series and pathophysiological studies support the use of a stringent goal for BP and albumin excretion in pregnant women with diabetic nephropathy. Screening for diabetic retinopathy before and during pregnancy is mandatory and laser treatment should be performed if indicated. Pregnancy outcome in women with diabetic nephropathy has improved considerably with a take-home-baby rate of approximately 95%. Further research on the benefits and risks of intensive antihypertensive treatment in this population is needed. PMID:22917698

  4. The effects of dipeptidyl peptidase-4 inhibition on microvascular diabetes complications.

    PubMed

    Avogaro, Angelo; Fadini, Gian Paolo

    2014-10-01

    We performed a review of the literature to determine whether the dipeptidyl peptidase-4 inhibitors (DPP4-I) may have the capability to directly and positively influence diabetic microvascular complications. The literature was scanned to identify experimental and clinical evidence that DPP4-I can ameliorate diabetic microangiopathy. We retrieved articles published between 1 January 1980 and 1 March 2014 in English-language peer-reviewed journals using the following terms: ("diabetes" OR "diabetic") AND ("retinopathy" OR "retinal" OR "nephropathy" OR "renal" OR "albuminuria" OR "microalbuminuria" OR "neuropathy" OR "ulcer" OR "wound" OR "bone marrow"); ("dipeptidyl peptidase-4" OR "dipeptidyl peptidase-IV" OR "DPP-4" OR "DPP-IV"); and ("inhibition" OR "inhibitor"). Experimentally, DPP4-I appears to improve inflammation, endothelial function, blood pressure, lipid metabolism, and bone marrow function. Several experimental studies report direct potential beneficial effects of DPP4-I on all microvascular diabetes-related complications. These drugs have the ability to act either directly or indirectly via improved glucose control, GLP-1 bioavailability, and modifying nonincretin substrates. Although preliminary clinical data support that DPP4-I therapy can protect from microangiopathy, insufficient evidence is available to conclude that this class of drugs directly prevents or decreases microangiopathy in humans independently from improved glucose control. Experimental findings and preliminary clinical data suggest that DPP4-I, in addition to improving metabolic control, have the potential to interfere with the onset and progression of diabetic microangiopathy. Further evidence is needed to confirm these effects in patients with diabetes. PMID:25249673

  5. Glomerular endothelial cell injury and cross talk in diabetic kidney disease.

    PubMed

    Fu, Jia; Lee, Kyung; Chuang, Peter Y; Liu, Zhihong; He, John Cijiang

    2015-02-15

    Diabetic kidney disease (DKD) remains a leading cause of new-onset end-stage renal disease (ESRD), and yet, at present, the treatment is still very limited. A better understanding of the pathogenesis of DKD is therefore necessary to develop more effective therapies. Increasing evidence suggests that glomerular endothelial cell (GEC) injury plays a major role in the development and progression of DKD. Alteration of the glomerular endothelial cell surface layer, including its major component, glycocalyx, is a leading cause of microalbuminuria observed in early DKD. Many studies suggest a presence of cross talk between glomerular cells, such as between GEC and mesangial cells or GEC and podocytes. PDGFB/PDGFRβ is a major mediator for GEC and mesangial cell cross talk, while vascular endothelial growth factor (VEGF), angiopoietins, and endothelin-1 are the major mediators for GEC and podocyte communication. In DKD, GEC injury may lead to podocyte damage, while podocyte loss further exacerbates GEC injury, forming a vicious cycle. Therefore, GEC injury may predispose to albuminuria in diabetes either directly or indirectly by communication with neighboring podocytes and mesangial cells via secreted mediators. Identification of novel mediators of glomerular cell cross talk, such as microRNAs, will lead to a better understanding of the pathogenesis of DKD. Targeting these mediators may be a novel approach to develop more effective therapy for DKD. PMID:25411387

  6. [Type 2 diabetes complications].

    PubMed

    Schlienger, Jean-Louis

    2013-05-01

    People with type 2 diabetes are at increased risk of many complications, which are mainly due to complex and interconnected mechanisms such as hyperglycemia, insulino-resistance, low-grade inflammation and accelerated atherogenesis. Cardi-cerebrovascular disease are frequently associated to type 2 diabetes and may become life threatening, particularly coronaropathy, stroke and heart failure. Their clinical picture are sometimes atypical and silencious for a long time. Type 2 diabetes must be considered as an independent cardiovascular risk factor. Nephropathy is frequent in type 2 diabetes but has a mixed origin. Now it is the highest cause of end-stage renal disease. Better metabolic and blood pressure control and an improved management of microalbuminuria are able to slowdown the course of the disease. Retinopathy which is paradoxically slightly progressive must however be screened and treated in these rather old patients which are globally at high ophthalmologic risk. Diabetic foot is a severe complication secondary to microangiopathy, microangiopathy and neuropathy. It may be considered as a super-complication of several complications. Its screening must be done on a routine basis. Some cancer may be considered as an emerging complication of type 2 diabetes as well as cognitive decline, sleep apnea syndrome, mood disorders and bone metabolism impairments. Most of the type 2 diabetes complications may be prevented by a strategy combining a systematic screening and multi-interventional therapies. PMID:23528336

  7. Comparing the Levels of Trace Elements in Patients With Diabetic Nephropathy and Healthy Individuals

    PubMed Central

    Makhlough, Atieh; Makhlough, Marjan; Shokrzadeh, Mohammad; Mohammadian, Mozhdeh; Sedighi, Omid; Faghihan, Mansooreh

    2015-01-01

    Background: Diabetic nephropathy is the most common cause of end stage renal disease (ESRD) in developed countries. Several trace elements were reported to be changed in diabetic nephropathy. Objectives: The aim of this study was to investigate changes in serum levels of zinc, copper and chromium and their association with the incidence of ESRD in patients with diabetes. Patients and Methods: This study was performed on 70 patients with type 2 diabetic nephropathy (macro and micro-albuminuria) and 70 healthy individuals. Samples were collected to survey metals by atomic absorption spectrophotometer. Data was analyzed by SPSS18 using descriptive and inferential analysis methods. Results: Mean ± SD levels of Zn, Cu and Cr were significantly decreased in blood samples of patients compared to healthy subjects (P < 0.01). Also the mean concentrations of Cu, Zn and Cr in drinking water of Sari were lower than the accepted limit. Only in one case, Cu was higher than the accepted limit, which was the possibility of contamination by water supply pipes. Conclusions: Cu, Zn and Cr play a specific role in the pathophysiology of diabetic nephropathy. Meanwhile in these patients, low serum levels of Cu, Zn and Cr were not associated with factors such as drinking water. Possible causes should be sought in other factors like urine, intervention factors in absorption and utilization and individual conditions. PMID:26539418

  8. Recent advances of the impact of obstructive sleep apnea on systemic hypertension.

    PubMed

    Pedrosa, Rodrigo P; Krieger, Eduardo M; Lorenzi-Filho, Geraldo; Drager, Luciano F

    2011-08-01

    Obstructive sleep apnea (OSA) is a common clinical condition in the general population, especially among patients with cardiovascular diseases. More than just a local phenomenon of upper respiratory tract obstruction, OSA leads to systemic consequences that may include intermittent hypoxia, sudden reduction of the intrathoracic pressure, and the occurrence of micro-awakenings with sleep fragmentation. In the past decades, innumerous evidences have consistently pointed to OSA as an important factor related to the presence of cardiovascular diseases. In particular, the relationship between OSA and systemic hypertension (SH) is the one supported by the largest body of evidence. Currently, there are data suggesting that OSA is an important secondary cause of SH. More importantly, OSA is independently associated with poorer blood pressure control, changes in sleep dip, and presence of target-organ damage such as left ventricular hypertrophy and microalbuminuria. Randomized studies suggest that the management of OSA, especially with continuous positive airway pressure (CPAP) - which is considered the standard treatment for OSA - promotes a significant 24-hour blood pressure reduction, and this effect is more significant in the subgroup of patients with uncontrolled SH and drug-resistant SH. Despite all those evidences, OSA has still been underdiagnosed. The objective of this review is to discuss the recent advances in the pathophysiological mechanisms, clinical presentation, and treatment of OSA, as well as the benefits this treatment can bring on blood pressure. PMID:21359488

  9. Relationship of Vascular Factors on Electrophysiologic Severity of Diabetic Neuropathy

    PubMed Central

    Hwang, Jeong-Won; Kwon, Hee Kyu

    2016-01-01

    Objective To investigate the impact of vascular factors on the electrophysiologic severity of diabetic neuropathy (DPN). Methods Total 530 patients with type 2 diabetes were enrolled retrospectively. We rated severity of DPN from 1 (normal) to 4 (severe) based on electrophysiologic findings. We collected the data concerning vascular factors (including brachial-ankle pulse wave velocity [PWV], ankle brachial index, ultrasound of carotid artery, lipid profile from the blood test, and microalbuminuria [MU] within 24 hours urine), and metabolic factors of diabetes (such as glycated hemoglobin [HbA1c]). We analyzed the differences among the four subgroups using χ2 test and ANOVA, and ordinal logistic regression analysis was performed to investigate the relationship between significant variables and severity of DPN. Results The severity of DPN was significantly associated with duration of diabetes, HbA1c, existence of diabetic retinopathy and nephropathy, PWV, presence of plaque, low density lipoprotein-cholesterol and MU (p<0.05). Among these variables, HbA1c and presence of plaque were more significantly related with severity of DPN in logistic regression analysis (p<0.001), and presence of plaque showed the highest odds ratio (OR=2.52). Conclusion Our results suggest that markers for vascular wall properties, such as PWV and presence of plaque, are significantly associated with the severity of DPN. The presence of plaque was more strongly associated with the severity of DPN than other variables. PMID:26949670

  10. Endothelial dysfunction as a predictor of cardiovascular disease in type 1 diabetes

    PubMed Central

    Bertoluci, Marcello C; Cé, Gislaine V; da Silva, Antônio MV; Wainstein, Marco V; Boff, Winston; Puñales, Marcia

    2015-01-01

    Macro and microvascular disease are the main cause of morbi-mortality in type 1 diabetes (T1DM). Although there is a clear association between endothelial dysfunction and atherosclerosis in type 2 diabetes, a cause-effect relationship is less clear in T1DM. Although endothelial dysfunction (ED) precedes atherosclerosis, it is not clear weather, in recent onset T1DM, it may progress to clinical macrovascular disease. Moreover, endothelial dysfunction may either be reversed spontaneously or in response to intensive glycemic control, long-term exercise training and use of statins. Acute, long-term and post-prandial hyperglycemia as well as duration of diabetes and microalbuminuria are all conditions associated with ED in T1DM. The pathogenesis of endothelial dysfunction is closely related to oxidative-stress. NAD(P)H oxidase over activity induces excessive superoxide production inside the mitochondrial oxidative chain of endothelial cells, thus reducing nitric oxide bioavailability and resulting in peroxynitrite formation, a potent oxidant agent. Moreover, oxidative stress also uncouples endothelial nitric oxide synthase, which becomes dysfunctional, inducing formation of superoxide. Other important mechanisms are the activation of both the polyol and protein kinase C pathways as well as the presence of advanced glycation end-products. Future studies are needed to evaluate the potential clinical applicability of endothelial dysfunction as a marker for early vascular complications in T1DM. PMID:26069717

  11. Practice recommendations for the monitoring of renal function in pediatric non-renal organ transplant recipients.

    PubMed

    Filler, Guido; Melk, Anette; Marks, Stephen D

    2016-05-01

    The management of non-renal pediatric solid organ transplant recipients has become complex over the last decade with innovations in immunosuppression and surgical techniques. Post-transplantation follow-up is essential to ensure that children have functioning allografts for as long as possible. CKD is highly prevalent in these patients, often under recognized, and has a profound impact on patient survival. These practice recommendations focus on the early detection and management of hypertension, proteinuria, and renal dysfunction in non-renal pediatric solid organ transplant recipients. We present seven practice recommendations. Renal function should be monitored regularly in organ transplant recipients, utilizing assessment of serum creatinine and cystatin C. GFR should be calculated using the new Schwartz formula. Transplant physicians should also monitor blood pressure using automated oscillometric devices and confirm repeated abnormal measures with manual blood pressure readings and ambulatory 24-h blood pressure monitoring. Proteinuria and microalbuminuria should also be assessed regularly. Referrals to a pediatric nephrologist should be made for non-renal organ transplant recipients with repeated blood pressures >95th percentile using the Fourth Task Force reference intervals, microalbumin/creatinine ratio >32.5 mg/g (3.7 mg/mmol) creatinine on repeated testing and/or GFR <90 mL/min/1.73 m(2) . PMID:26917052

  12. Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients.

    PubMed

    Erbas, Tomris; Ertas, Mustafa; Yucel, Aysen; Keskinaslan, Abdulkadir; Senocak, Mustafa

    2011-02-01

    The aim of this study was to determine the prevalence of diabetic peripheral neuropathy (DPN) and neuropathic pain in diabetic patients attending university outpatient clinics in Turkey. In this multicenter cross-sectional study, neurologic examinations and nerve conduction studies along with clinical diabetic neuropathy score, and Leeds Assessment of Neuropathic Symptoms and Signs pain scale were performed on 1,113 patients (46.2% male) from 14 centers. Prevalence of DPN determined only by clinical examination was 40.4% and increased to 62.2%, by combining nerve conduction studies with clinical examination. According to Leeds Assessment of Neuropathic Symptoms and Signs scores, neuropathic pain prevalence was 16.0% in those who reported pain. Poor glycemic control, retinopathy, microalbuminuria, hyperlipidemia, diabetic foot, and foot amputation were more commonly observed in patients with DPN. Clinical DPN affected 40.4% of diabetic patients, and neuropathic pain prevalence in diabetic patient population was 14.0%. Clinical examinations and nerve conduction studies are important components for early detection and accurate diagnosis of DPN and painful DPN. PMID:21221008

  13. Urine Free Light Chains as a Novel Biomarker of Acute Kidney Allograft Injury

    PubMed Central

    Zhang, Rubin; Li, Min; Chouhan, Kanwaljit K.; Simon, Eric E.; Hamm, L. Lee; Batuman, Vecihil

    2015-01-01

    Background We evaluated urine free light chains (FLC) as a potential biomarker for acute kidney allograft injury (AKAI). Methods Urine κ and λ FLC were compared with urine β-2 microglobulin (β2-M), RBP, KIM-1, NGAL and microalbuminuria (MAB) in biopsy-confirmed acute rejection (AR) and ATN. Healthy volunteers (Normal) and transplant recipients with normal allograft function (Control) were used as references. Results Compared to Control or Normal group (N=15), urine FLC, MAB and RBP were higher in ATN (N=29) and AR (N=41) groups (p<0.05). There was no difference in KIM-1, NGAL or β2-M between 4 groups. In AR group, urine κFLC demonstrated the highest predictive value with sensitivity of 95.12% and specificity of 87.5% (p<0.0001). Urine κFLC also performed best with a sensitivity of 96.55% and specificity of 93.33% (p<0.0001) in ATN group. The AUC by ROC analysis is greatest in urine RBP (100%) and FLC (99%), and lowest in KIM-1 (53.5%), then NGAL (71.5%) in AR group. The AUC is also greatest in urine FLC (100%) and RBP (99%), and lowest in urine KIM-1 (55.6%) and NGAL (69.9%) in ATN group. Conclusions Urine FLC appears sensitive for both AR and ATN, and it may be a novel AKAI biomarker. PMID:24304377

  14. Extract of green tea leaves partially attenuates streptozotocin-induced changes in antioxidant status and gastrointestinal functioning in rats.

    PubMed

    Juśkiewicz, Jerzy; Zduńczyk, Zenon; Jurgoński, Adam; Brzuzan, Łucja; Godycka-Kłos, Irena; Zary-Sikorska, Ewa

    2008-05-01

    Rats with severe streptozotocin (STZ)-induced diabetes were subjected to dietary green tea extract supplementation at 2 doses (0.01% and 0.2%; GTL and GTH groups, respectively) to evaluate their effects on antioxidant, gastrointestinal, and renal parameters of experimental animals. The lower dietary supplementation reflects daily consumption of 3 cups of green tea for an average adult weighing 70 kg. Supplementation of a diet with green tea extract had no influence on elevated food intake, body weight loss, increased glucose concentration, or declined antioxidant capacity of water-soluble substances in plasma in the diabetic rats. In cases of intestinal maltase activity, attenuation of liver and kidney hypertrophy, triacylglycerol concentration, and aspartate aminotransferase activity in the serum, both dietary treatments normalized metabolic disorders caused by STZ injection to a similar extent. Unlike the GTL group, the GTH treatment significantly ameliorated development of diabetes-induced abnormal values for small intestinal saccharase and lactase activities, renal microalbuminuria, thiobarbituric acid-reactive substance content in kidney tissue, as well as total antioxidant status in the serum of rats. The GTH group was also characterized by higher antioxidant capacity of lipid-soluble substances in plasma and superoxide dismutase activity in the serum. Although the higher dose of green tea extract did not completely protect against STZ-induced hyperglycemia and oxidative stress in experimental rats, this study suggests that green tea extract ingested at high amounts may prove to be a useful therapeutic option in the reversal of diabetic dysfunction. PMID:19083430

  15. Values of Alpha 1 Microglobulin Does Not Differ between Individuals with and without Family History of Balkan Endemic Nephropathy

    PubMed Central

    Trnacevic, Senaid; Hodzic, Emir; Atic, Mirza; Dugonjic, Maida; Hasanovic, Evlijana

    2014-01-01

    Aim. The aim of this study was to compare urinary alpha 1 microglobulin (A1MG) in healthy individuals with and without family burden for Balkan endemic nephropathy (BEN) in an endemic village. Methods. Otherwise healthy inhabitants with microalbuminuria or proteinuria were divided into two groups: with (n = 24) and without (n = 32) family BEN burden and screened for urinary A1MG and A1MG/urine creatinine ratio. Results. Average value of urinary A1MG was 10.35 ± 7.01 mg/L in group with and 10.79 ± 8.27 mg/L in group without family history for BEN (NS, P = 0.87). A1MG was higher than 10 mg/L in eight (33.33%) inhabitants with family history and in 12 (37.5%) without (NS, P = 0.187). Average values of urinary A1MG/creatinine ratio were 1.30 ± 1.59 and 0.94 ± 0.78 in group with and group without family BEN history (NS, P = 0.39, resp.). Elevated values of this ratio were found in 13 (54.17%) inhabitants with and 14 (43.75%) without family history for BEN (NS, P = 0.415). Conclusion. We did not find statistically significant difference in the examined markers between healthy individuals with and without family burden for BEN. We concluded that these markers are not predictive of risk for BEN. PMID:24563783

  16. Comprehensive approach to diabetic nephropathy

    PubMed Central

    Satirapoj, Bancha; Adler, Sharon G.

    2014-01-01

    Diabetic nephropathy (DN) is a leading cause of mortality and morbidity in patients with diabetes. This complication reflects a complex pathophysiology, whereby various genetic and environmental factors determine susceptibility and progression to end-stage renal disease. DN should be considered in patients with type 1 diabetes for at least 10 years who have microalbuminuria and diabetic retinopathy, as well as in patients with type 1 or type 2 diabetes with macroalbuminuria in whom other causes for proteinuria are absent. DN may also present as a falling estimated glomerular filtration rate with albuminuria as a minor presenting feature, especially in patients taking renin–angiotensin–aldosterone system inhibitors (RAASi). The pathological characteristic features of disease are three major lesions: diffuse mesangial expansion, diffuse thickened glomerular basement membrane, and hyalinosis of arterioles. Functionally, however, the pathophysiology is reflected in dysfunction of the mesangium, the glomerular capillary wall, the tubulointerstitium, and the vasculature. For all diabetic patients, a comprehensive approach to management including glycemic and hypertensive control with RAASi combined with lipid control, dietary salt restriction, lowering of protein intake, increased physical activity, weight reduction, and smoking cessation can reduce the rate of progression of nephropathy and minimize the risk for cardiovascular events. This review focuses on the latest published data dealing with the mechanisms, diagnosis, and current treatment of DN. PMID:26894033

  17. Glomerular endothelial cell injury and cross talk in diabetic kidney disease

    PubMed Central

    Fu, Jia; Lee, Kyung; Chuang, Peter Y.; Liu, Zhihong

    2014-01-01

    Diabetic kidney disease (DKD) remains a leading cause of new-onset end-stage renal disease (ESRD), and yet, at present, the treatment is still very limited. A better understanding of the pathogenesis of DKD is therefore necessary to develop more effective therapies. Increasing evidence suggests that glomerular endothelial cell (GEC) injury plays a major role in the development and progression of DKD. Alteration of the glomerular endothelial cell surface layer, including its major component, glycocalyx, is a leading cause of microalbuminuria observed in early DKD. Many studies suggest a presence of cross talk between glomerular cells, such as between GEC and mesangial cells or GEC and podocytes. PDGFB/PDGFRβ is a major mediator for GEC and mesangial cell cross talk, while vascular endothelial growth factor (VEGF), angiopoietins, and endothelin-1 are the major mediators for GEC and podocyte communication. In DKD, GEC injury may lead to podocyte damage, while podocyte loss further exacerbates GEC injury, forming a vicious cycle. Therefore, GEC injury may predispose to albuminuria in diabetes either directly or indirectly by communication with neighboring podocytes and mesangial cells via secreted mediators. Identification of novel mediators of glomerular cell cross talk, such as microRNAs, will lead to a better understanding of the pathogenesis of DKD. Targeting these mediators may be a novel approach to develop more effective therapy for DKD. PMID:25411387

  18. Glycosaminoglycan Regulation by VEGFA and VEGFC of the Glomerular Microvascular Endothelial Cell Glycocalyx in Vitro

    PubMed Central

    Foster, Rebecca R.; Armstrong, Lynne; Baker, Siân; Wong, Dickson W.L.; Wylie, Emma C.; Ramnath, Raina; Jenkins, Robert; Singh, Anurag; Steadman, Robert; Welsh, Gavin I.; Mathieson, Peter W.; Satchell, Simon C.

    2014-01-01

    Damage to endothelial glycocalyx impairs vascular barrier function and may contribute to progression of chronic vascular disease. An early indicator is microalbuminuria resulting from glomerular filtration barrier damage. We investigated the contributions of hyaluronic acid (HA) and chondroitin sulfate (CS) to glomerular microvascular endothelial cell (GEnC) glycocalyx and examined whether these are modified by vascular endothelial growth factors A and C (VEGFA and VEGFC). HA and CS were imaged on GEnCs and their resynthesis was examined. The effect of HA and CS on transendothelial electrical resistance (TEER) and labeled albumin flux across monolayers was assessed. Effects of VEGFA and VEGFC on production and charge characteristics of glycosaminoglycan (GAG) were examined via metabolic labeling and liquid chromatography. GAG shedding was quantified using Alcian Blue. NDST2 expression was examined using real-time PCR. GEnCs expressed HA and CS in the glycocalyx. CS contributed to the barrier to both ion (TEER) and protein flux across the monolayer; HA had only a limited effect. VEGFC promoted HA synthesis and increased the charge density of synthesized GAGs. In contrast, VEGFA induced shedding of charged GAGs. CS plays a role in restriction of macromolecular flux across GEnC monolayers, and VEGFA and VEGFC differentially regulate synthesis, charge, and shedding of GAGs in GEnCs. These observations have important implications for endothelial barrier regulation in glomerular and other microvascular beds. PMID:23770346

  19. Association between serum cystatin C levels and cardiovascular disease in type 2 diabetic patients.

    PubMed

    Triki, Sonia; Fekih, Ons; Hellara, Ilhem; Neffati, Fadoua; Douki, Wahiba; Hamda, Khaldoun Ben; Maatouk, Faouzi; Najjar, Mohamed Fadhel

    2013-01-01

    Serum cystatin C concentration was recently reported as a marker of cardiovascular disease (CVD). In the present study, we evaluated the association between the increase of serum cystatin C levels and the risk of CVD in type 2 diabetes. 42 patients with type 2 diabetes were included in the present study; 27 of them have CVD. The control group consisted of 30 healthy adults. Cystatin C, creatinine, microalbuminuria and CRP were measured on Cobas 6000(TM). Cystatine C level was significantly higher in patients with CVD. A significant difference in serum cystatin C was found in patients with and without CVD among albuminuria. No difference in serum cystatin C levels was found according to number of affected vessels. A cystatin C level above 1.10 mg/L was associated with increase of risk of CVD with significant difference (OR = 42.52; IC 95% 1.455 to 1242.827 and p = 0.029). Our results suggested that the increase of serum cystatin C concentrations is a potential marker for CVD in diabetes. PMID:23906571

  20. The Association between Urine Albumin to Creatinine Ratio and Osteoporosis in Postmenopausal Women with Type 2 Diabetes

    PubMed Central

    Lee, Ye Yeon; Kim, Han Byul; Lee, Jong Won; Lee, Gyu Min; Kim, Sang Yoon; Hur, Ji An

    2016-01-01

    Background Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass density and destruction of microstructure, which can lead to an increased risk of fracture. Although many studies have been published about the relationship between end-stage renal disease and osteoporosis, research on the relationship between proteinuria and the prevalence of osteoporosis is still lacking. Methods We assessed 91 postmenopausal women with type 2 diabetes who visited our hospital from January 2009 to January 2012. Results Among 91 patients, the prevalence of osteoporosis and osteopenia was 35.2% (32 cases) and 32.9% (30 cases) according to bone mineral density. The patients with microalbuminuria and macroalbuminuria (urine albumin-to-creatinine ratio [UACR] ≥ 30) had a significantly higher incidence of osteoporosis compared to subjects with normoalbuminuria (P<0.05). Conclusions This study indicates that UACR may be a useful biomarker for increased risk of osteoporosis in postmenopausal women with type 2 diabetes who have been linked to higher UACR levels. PMID:26981514

  1. Prevention of renal failure: the Malaysian experience.

    PubMed

    Hooi, Lai Seong; Wong, Hin Seng; Morad, Zaki

    2005-04-01

    Renal replacement therapy in Malaysia has shown exponential growth since 1990. The dialysis acceptance rate for 2003 was 80 per million population, prevalence 391 per million population. There are now more than 10,000 patients on dialysis. This growth is proportional to the growth in gross domestic product (GDP). Improvement in nephrology and urology services with widespread availability of ultrasonography and renal pathology has improved care of renal patients. Proper management of renal stone disease, lupus nephritis, and acute renal failure has decreased these as causes of end-stage renal disease (ESRD) in younger age groups. Older patients are being accepted for dialysis, and 51% of new patients on dialysis were diabetic in 2003. The prevalence of diabetes is rising in the country (presently 7%); glycemic control of such patients is suboptimal. Thirty-three percent of adult Malaysians are hypertensive and blood pressure control is poor (6%). There is a national coordinating committee to oversee the control of diabetes and hypertension in the country. Primary care clinics have been provided with kits to detect microalbuminuria, and ACE inhibitors for the treatment of hypertension and diabetic nephropathy. Prevention of renal failure workshops targeted at primary care doctors have been launched, opportunistic screening at health clinics is being carried out, and public education targeting high-risk groups is ongoing. The challenge in Malaysia is to stem the rising tide of diabetic ESRD. PMID:15752245

  2. Risk Factors for Retinopathy and DME in Type 2 Diabetes—Results from the German/Austrian DPV Database

    PubMed Central

    Hammes, Hans-Peter; Welp, Reinhard; Kempe, Hans-Peter; Wagner, Christian; Siegel, Erhard; Holl, Reinhard W.

    2015-01-01

    To assess the prevalence and risk factors for early and severe diabetic retinopathy and macular edema in a large cohort of patients with type 2 diabetes Retinopathy grading (any retinopathy, severe retinopathy, diabetic macular edema) and risk factors of 64784 were prospectively recorded between January 2000 and March 2013 and analyzed by Kaplan–Meier analysis and logistic regression. Retinopathy was present in 20.12% of subjects, maculopathy was found in 0.77%. HbA1c > 8%, microalbuminuria, hypertension, BMI > 35 kg/m2 and male sex were significantly associated with any retinopathy, while HbA1c and micro- and macroalbuminuria were the strongest risk predictors for severe retinopathy. Presence of macroalbuminuria increased the risk for DME by 177%. Retinopathy remains a significant clinical problem in patients with type 2 diabetes. Metabolic control and blood pressure are relevant factors amenable to treatment. Concomitant kidney disease identifies high risk patients and should be emphasized in interdisciplinary communication. PMID:26177037

  3. Biomarkers in diabetic nephropathy: Present and future

    PubMed Central

    Currie, Gemma; McKay, Gerard; Delles, Christian

    2014-01-01

    Diabetic nephropathy (DN) is the leading cause of end stage renal disease in the Western world. Microalbuminuria (MA) is the earliest and most commonly used clinical index of DN and is independently associated with cardiovascular risk in diabetic patients. Although MA remains an essential tool for risk stratification and monitoring disease progression in DN, a number of factors have called into question its predictive power. Originally thought to be predictive of future overt DN in 80% of patients, we now know that only around 30% of microalbuminuric patients progress to overt nephropathy after 10 years of follow up. In addition, advanced structural alterations in the glomerular basement membrane may already have occurred by the time MA is clinically detectable.Evidence in recent years suggests that a significant proportion of patients with MA can revert to normoalbuminuria and the concept of nonalbuminuric DN is well-documented, reflecting the fact that patients with diabetes can demonstrate a reduction in glomerular filtration rate without progressing from normo-to MA. There is an unmet clinical need to identify biomarkers with potential for earlier diagnosis and risk stratification in DN and recent developments in this field will be the focus of this review article. PMID:25512779

  4. Association between serum uric acid, urinary albumin excretion, and glycated hemoglobin in Type 2 diabetic patient

    PubMed Central

    Neupane, Sunita; Dubey, Raju Kumar; Gautam, Narayan; Agrawal, Krishna Kumar; Jayan, Archana; Shrestha, Sujata; Jha, Amit Chandra

    2016-01-01

    Background: Diabetes mellitus (DM) is a chronic disease characterized by insulin deficiency or peripheral resistance resulting in hyperglycemia. Poor glycemic control leads to diabetic complications. Hyperuricemia has been reported with increased risk of renal insufficiency. The aim of this study was to evaluate the relationship between serum uric acid concentration, degree of urinary albumin excretion (UAE) and glycated hemoglobin (HbA1c) in Type 2 DM (T2DM) patients. Materials and Methods: Serum uric acid concentrations, urine microalbumin, and HbA1c were measured in fifty T2DM patients. We then evaluated relationship between uric acid concentrations, degree of UAE and glycemic control as well as other confounding variables. Results: Serum uric acid concentration correlated positively with UAE (r = 0.323, P < 0.05), age (r = 0.337, P < 0.05), age at onset (r = 0.341, P < 0.05), and duration of DM (r = 0.312, P < 0.05). Multiple regression analysis demonstrated that serum uric acid concentration (β = 0.293, P < 0.0001), duration of DM (β = 0.261, P < 0.0001), HbA1c (β = 0.173, P < 0.005), and systolic blood pressure (β = 0.268, P < 0.005) were independent determinants of UAE. Conclusions: Serum uric acid concentration is associated with microalbuminuria and HbA1c in T2DM patients. PMID:27226687

  5. Urinary Markers of Tubular Injury in Early Diabetic Nephropathy

    PubMed Central

    Fiseha, Temesgen; Tamir, Zemenu

    2016-01-01

    Diabetic nephropathy (DN) is a common and serious complication of diabetes associated with adverse outcomes of renal failure, cardiovascular disease, and premature mortality. Early and accurate identification of DN is therefore of critical importance to improve patient outcomes. Albuminuria, a marker of glomerular involvement in early renal damage, cannot always detect early DN. Thus, more sensitive and specific markers in addition to albuminuria are needed to predict the early onset and progression of DN. Tubular injury, as shown by the detection of tubular injury markers in the urine, is a critical component of the early course of DN. These urinary tubular markers may increase in diabetic patients, even before diagnosis of microalbuminuria representing early markers of normoalbuminuric DN. In this review we summarized some new and important urinary markers of tubular injury, such as neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), N-acetyl-beta-glucosaminidase (NAG), alpha-1 microglobulin (A1M), beta 2-microglobulin (B2-M), and retinol binding protein (RBP) associated with early DN. PMID:27293888

  6. Urinary Markers of Tubular Injury in Early Diabetic Nephropathy.

    PubMed

    Fiseha, Temesgen; Tamir, Zemenu

    2016-01-01

    Diabetic nephropathy (DN) is a common and serious complication of diabetes associated with adverse outcomes of renal failure, cardiovascular disease, and premature mortality. Early and accurate identification of DN is therefore of critical importance to improve patient outcomes. Albuminuria, a marker of glomerular involvement in early renal damage, cannot always detect early DN. Thus, more sensitive and specific markers in addition to albuminuria are needed to predict the early onset and progression of DN. Tubular injury, as shown by the detection of tubular injury markers in the urine, is a critical component of the early course of DN. These urinary tubular markers may increase in diabetic patients, even before diagnosis of microalbuminuria representing early markers of normoalbuminuric DN. In this review we summarized some new and important urinary markers of tubular injury, such as neutrophil gelatinase associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), N-acetyl-beta-glucosaminidase (NAG), alpha-1 microglobulin (A1M), beta 2-microglobulin (B2-M), and retinol binding protein (RBP) associated with early DN. PMID:27293888

  7. Mineralocorticoid Receptor Antagonists Therapy in Resistant Hypertension: Time to Implement Guidelines!

    PubMed Central

    Maiolino, Giuseppe; Azzolini, Matteo; Rossi, Gian Paolo

    2015-01-01

    Despite the availability of anti-hypertensive medications with increasing efficacy up to 50% of hypertensive patients have blood pressure levels (BP) not at the goals set by international societies. Some of these patients are either not optimally treated or are non-adherent to the prescribed drugs. However, a proportion, despite adequate treatment, have resistant hypertension (RH), which represents an important problem in that it is associated to an excess risk of cardiovascular events. Notwithstanding a complex pathogenesis, an abundance of data suggests a key contribution for the mineralocorticoid receptor (MR) in RH, thus fostering a potential role for its antagonists in RH. Based on these premises randomized clinical trials aimed at testing the efficacy of MR antagonists (MRAs) in RH patients have been completed. Overall, they demonstrated the efficacy of MRAs in reducing BP and surrogate markers of target organ damage, such as microalbuminuria, either compared to placebo or to other drugs. In summary, owing to the key role of the MR in the pathogenesis of RH and on the proven efficacy of MRAs we advocate their inclusion as an essential component of therapy in patients with presumed RH. Conversely, we propose that RH should be diagnosed only in patients whose BP values show to be resistant to an up-titrated dose of these drugs. PMID:26664875

  8. Diabetic Kidney Disease in Adolescents With Type 2 Diabetes: New Insights and Potential Therapies.

    PubMed

    Bjornstad, Petter; Cherney, David Z; Maahs, David M; Nadeau, Kristen J

    2016-02-01

    Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease (ESRD) and dialysis in the Western world. Early DKD, including microalbuminuria and renal hyperfiltration, is common in adolescents with type 2 diabetes (T2D). Furthermore, youth-onset T2D carries a higher risk of progressive DKD than adult-onset T2D of similar diabetes duration. DKD is characterized by a long clinically silent period without signs of disease. Therefore, a major challenge in preventing DKD is the difficulty in identifying high-risk T2D patients at an early stage. The Type 2 Diabetes in Adolescents and Youth (TODAY) study demonstrated a high initial prevalence that increased over time, irrespective of treatment arm. This key observation underscores the importance of discovering new therapeutic targets to supplement conventional management, in order to reduce DKD risk. In this review, we focus on early DKD in T2D and summarize potential novel biomarkers and therapeutic targets. PMID:26803647

  9. Symmetric dimethyl arginine and N-acetyl-β-D-glucosaminidase lysozimuria of proximal renal tubules as a target for nephrotoxicity in patients with rheumatoid arthritis treated with disease modifying antirheumatic drugs

    PubMed Central

    Spasovski, Dejan; Latifi, Arif; Marina, Nada; Calovski, Jordan; Kafedziska, Irena; Božinovski, Gjorgi; Percinkova, Snežana; Slaninka-Micevska, Maja; Balkanov, Trajan; Dejanova, Beti; Alabakovska, Sonja; Krstevska-Balkanov, Svetlana; Spasovski, Goce; Spasovski, Dejan

    2013-01-01

    Background The aim of this study was to determine the effect of initial therapy with some disease modifying antirheumatic drugs (DMARDs) (Methotrexate and Ketoprofen) on glomerular and tubular integrity in patients with Rheumatoid arthritis (RA). Objectives Objectives: To determine whether there is a change in clinical and laboratory indicators of renal function in course of the follow up of treatment and whether that change correlates with the dynamics of the quantity of enzymes excreted in urine and reactants of the acute phase. Materials and Methods Using colorimetric method for determination of NAG, samples of 70 participants were examined (35 RA patients treated with Ketoprofen only, 35 RA patients treated with combined use of Methotrexate and Ketoprofen). The follow up was 5 time-intervals in the course of 24 weeks. Results There was moderate correlation between NAG and microalbuminuria (r=0,34) in the group of patients treated with Ketoprofen only, while statistically significant correlation (r=0,21) was seen in group of patients with combined use of Methotrexate and Ketoprofen. NAG enzymuria in size, number of patients registered, and time of appearance were greater and appears earlier in the group with the combined use of Methotrexate and Ketoprofen compared with the mono-therapy with Ketoprofen. Mean urinary NAG induction was increasing with the concomitant use of Methotrexate and Ketoprofen. Conclusions Methotrexate is more potent NAG inductor than Ketoprofen and provokes greater tubular enzymuria than Ketoprofen. PMID:24475424

  10. Deregulation of adipokines related to target organ damage on resistant hypertension.

    PubMed

    Sabbatini, A R; Faria, A P; Barbaro, N R; Gordo, W M; Modolo, R G P; Pinho, C; Fontana, V; Moreno, H

    2014-06-01

    Resistant hypertension (RHTN) includes patients with controlled blood pressure (BP) (CRHTN) and uncontrolled BP (UCRHTN). In fact, RHTN patients are more likely to have target organ damage (TOD), and resistin, leptin and adiponectin may affect BP control in these subjects. We assessed the relationship between adipokines levels and arterial stiffness, left ventricular hypertrophy (LVH) and microalbuminuria (MA). This cross-sectional study included CRHTN (n=51) and UCRHTN (n=38) patients for evaluating body mass index, ambulatory blood pressure monitoring, plasma adiponectin, leptin and resistin concentrations, pulse wave velocity (PWV), MA and echocardiography. Leptin and resistin levels were higher in UCRHTN, whereas adiponectin levels were lower in this same subgroup. Similarly, arterial stiffness, LVH and MA were higher in UCRHTN subgroup. Adiponectin levels negatively correlated with PWV (r=-0.42, P<0.01), and MA (r=-0.48, P<0.01) only in UCRHTN. Leptin was positively correlated with PWV (r=0.37, P=0.02) in UCRHTN subgroup, whereas resistin was not correlated with TOD in both subgroups. Adiponectin is associated with arterial stiffness and renal injury in UCRHTN patients, whereas leptin is associated with arterial stiffness in the same subgroup. Taken together, our results showed that those adipokines may contribute to vascular and renal damage in UCRHTN patients. PMID:24284384

  11. [Microvascular and macrovascular complications in children and adolescents with type 1 diabetes mellitus].

    PubMed

    Fröhlich-Reiterer, Elke E; Borkenstein, Martin H

    2010-08-01

    Diabetes-related microvascular and macrovascular complications, as retinopathy, nephropathy and neuropathy are life-threatening complications in children and adolescents with type 1 diabetes mellitus (T1DM). Risk factors for the development of complications are longer duration of diabetes, older age and puberty. Further risk factors include smoking, hypertension, higher body mass index and dyslipoproteinaemia. Therefore prevention and screening for complications is an important part in the care of children and adolescents with T1DM. Target levels to reduce the risk of microvascular and macrovascular complications in children and adolescents with T1DM are the following: HbA1c<7.5%, lipids in normal range, blood pressure<90th percentile by age, sex and height, BMI<95th percentile, no smoking and physical activity. Screening for retinopathy and microalbuminuria should start from 11 years with two years diabetes duration and from 9 years with 5 years duration and after 2 years diabetes duration in an adolescent. Thereafter screening should be performed annually. Blood pressure should be measured at least annually. Screening for fasting blood lipids should be performed soon after diagnosis in all children with T1DM aged over 12 years. If normal results are obtained, this should be repeated every 5 years. PMID:20812053

  12. A workshop on urinalysis and a survey on urine microscopy among kidney centers of Iran.

    PubMed

    Hami, Maryam; Shahidi, Shahrzad; Nouri-Majalan, Nader; Atapour, Abdolamir; Fogazzi, Giovanni B

    2013-11-01

    Urinalysis is a mandatory diagnostic tool for the evaluation of patients with kidney diseases. A workshop on urinalysis was held for nephrologists in Isfahan, Iran, on October 11-12, 2012. After the presentation of the results of a survey of the nephrology centers of Iran on urine microscopy, the most important aspects of urinalysis were presented and discussed. These included the following: (1) urinalysis by dipstick, which provides results in a few seconds, is simple to use, has a low cost, and is used worldwide for screening purposes, in spite of some limitations; (2) measurement of proteinuria by 24-hour urine collection, which still represents the reference method in spite of limitations due to frequent over or under collection errors; (3) protein-creatinine ratio in a random urine sample, which is recommended by international guidelines as an alternative to the measurement of 24-hour protein excretion; (4) microalbuminuria, which is seen as a marker of systemic endothelial damage; and (5) the urinary sediment, which is underused even among nephrologists in spite of the relevant diagnostic information it can supply in a wide spectrum of kidney diseases. PMID:24241087

  13. [In Process Citation].

    PubMed

    Miqueleiz Autor, E; Lostao, L; Reques, L; Giráldez-García, C; Regidor, E

    2016-01-01

    RESUMENFundamento. Mostrar las desigualdades en mortalidad prematura según indicadores de bienestar material en Navarra.Método. Todos los ciudadanos menores de 75 años residentes en Navarra en 2001 fueron seguidos durante 7 años para conocer su estado vital. El indicador de posición socioeconómica usado ha sido la superficie de la casa y el número de vehículos del hogar. Se han estimado las tasas de mortalidad general y por causa de muerte ajustadas por edad según estos indicadores.Resultados. La razón de tasas por todas las causas de muerte en las categorías inferiores es según la superficie de la vivienda de 1,14 (IC 95%: 1,05-1,24) y 1,25 (IC 95%: 1,18-1,32) en mujeres y hombres respectivamente y de 1,46 (IC 95%: 1,36-1,57) y 1,97 (IC 95%: 1,89-2,05) según el número de vehículos. El sida es la causa de muerte que presenta una mayor diferencia en las tasas de mortalidad entre las personas con menor y mayor bienestar material. Otras causas de muerte con elevada diferencia en las tasas de mortalidad son las enfermedades digestivas y la diabetes mellitus en mujeres y las enfermedades del aparato digestivo y respiratorio en hombres.Conclusiones. La tasa de mortalidad en la población navarra muestra un gradiente inverso con el bienestar material, a excepción de algunas localizaciones de cáncer. Este gradiente es mayor entre los hombres que entre las mujeres.Palabras clave. Mortalidad prematura. Bienestar material. PMID:27125605

  14. [An automated registry program for nosocomial infections].

    PubMed

    Castañón-González, Jorge Alberto; Polanco-González, Carlos; Samaniego-Mendoza, José Lino; Buhse, Thomas

    2014-12-01

    Las infecciones nosocomiales presentan un gran reto para la medicina hospitalaria, en general, y para las Unidades de Cuidados Intensivos, en particular. Su elevada prevalencia, la gran morbilidad y mortalidad asociadas, el incremento de la estancia hospitalaria y, en consecuencia, los costos de la atención médica han hecho que los programas de vigilancia, control y prevención de infecciones nosocomiales sean una parte toral de los protocolos de seguridad para el paciente y un indicador de calidad de la atención médica. PMID:25643679

  15. Improving knowledge and changing behavior towards guideline based decisions in diabetes care: a controlled intervention study of a team-based learning approach for continuous professional development of physicians

    PubMed Central

    2013-01-01

    Background Continuing Professional Development (CPD) courses should ideally improve a physician’s knowledge and change their professional behavior in daily practice towards a best clinical practice reference model and guideline adherence. Interactive methods such as team-based learning and case-based learning, as compared to lectures, can impart sustainable knowledge and lead to high satisfaction among participants. We designed an interactive case-based CPD-seminar on diabetes care using a team-based learning approach to evaluate whether it leads to an improvement of short-term knowledge and changing of behavior towards guideline based decisions and how this learning approach is perceived by participants. Methods Questionnaires and an electronic voting system were used to evaluate motivation, acceptance and knowledge of voluntary participants. Furthermore, we analyzed data on index diagnostic tests and referrals of patients with diabetes of participating physicians over a period of six months before and after the course in comparison with a matched control group in a quasi-experimental design. Results Participants (n=103) rated the interactivity and team-based discussions as the main reasons for enhanced learning. They also expected that the course would change their professional behavior. Participants scored a mean of 43.9% right answers before and 62.6% after the course (p<0.001). The referral to diabetes specialists increased by 30.8% (p<0.001). Referral for fundoscopy also increased (8.5%, n.s.) while it dropped in the control group. Furthermore, the participating physicians tested their patients more often for microalbuminuria (7.1%, n.s.). Conclusions Our team-based learning CPD-approach was highly accepted and resulted in an increase of short-term knowledge. It significantly increased the referral to diabetes specialists in daily practice whereas all other key professional behavior indicators did change but not significantly. PMID:23320976

  16. Biomarkers of kidney integrity in children and adolescents with dental amalgam mercury exposure: Findings from the Casa Pia children's amalgam trial

    SciTech Connect

    Woods, James S. Martin, Michael D.; Leroux, Brian G.; DeRouen, Timothy A.; Bernardo, Mario F.; Luis, Henrique S.; Leitao, Jorge G.; Kushleika, John V.; Rue, Tessa C.; Korpak, Anna M.

    2008-11-15

    Mercury is toxic to the kidney, and dental amalgam is a source of mercury exposure. Few studies have evaluated the effects of dental amalgam on kidney function in a longitudinal context in children. Here, we evaluated urinary concentrations of glutathione S-transferases (GSTs) {alpha} and {pi} as biomarkers of renal proximal and distal tubular integrity, respectively, and albumin as a biomarker of glomerular integrity in children and adolescents 8-18 years of age over a 7-year course of dental amalgam treatment. Five hundred seven children, 8-12 years of age at baseline, participated in a clinical trial to evaluate the neurobehavioral and renal effects of dental amalgam in children. Subjects were randomized to either dental amalgam or resin composite treatments. Urinary GSTs {alpha} and {pi}, albumin, and creatinine concentrations were measured at baseline and annually in all subjects. Results were evaluated using linear regression analysis. GST-{alpha} concentrations were similar between treatment groups and in each sex and race (white vs. non-white) group in each follow-up year. GST-{pi} levels tended upward over the course of follow-up by four- to six-fold. This increase was seen in all groups irrespective of the treatment, race, or gender. Females had GST-{pi} levels approximately twice those of males at all ages. Albumin concentrations were constant throughout the follow-up period and did not differ by treatment, although females had 39% higher albumin levels than males. Additionally, we found no significant effects of amalgam treatment on the proportion of children with microalbuminuria (>30 mg/g creatinine). These findings are relevant within the context of children's health risk assessment as relates to the safety of mercury exposure from dental amalgam on kidney function. These data also provide normative values for sensitive indices of renal functional integrity that may serve in the evaluation of children and adolescents with renal disorders.

  17. The protective effect of Liu-Wei-Di-Huang-Fang in salt-sensitive hypertension rats.

    PubMed

    Yang, Qiang; He, Yanming; Wang, Wenjian

    2014-01-01

    Abstract Hypertension is considered as a chronic and complex disease relating to multiple systemic systems. Apart from lowering blood pressure, the final purpose of the treatment lies in reducing the variability of blood pressure and other risk factors. Traditional Chinese medicine (TCM) has a long history of treating hypertension. This study was designed to determine the effect of Liu-Wei-Di-Huang-Fang (L-W-D-H-F), a compound used in traditional Chinese herbal medicine, to treat salt-sensitive hypertension (SSHT) induced by a high-salt and high-fat diet. L-W-D-H-F was prepared from six plant extracts. It was dissolved in 0.9% sodium chloride solution prior to use. Male Sprague-Dawley (6 weeks) rats were randomly divided into four groups: normal diet (CON); HSF (Without Drug Intervention); VAL (Valsartan 13.33 mg/kg/day); and LW (L-W-D-H-F 8.13 g/kg/day). Six weeks after blood pressure treatment, plasma biochemical analyses and histological and functional examination of the kidney were performed. L-W-D-H-F decreased the levels of mean arterial pressure (MAP), fasting blood glucose (FG), insulin (INS), high-density lipoprotein cholesterol (HDL-c), homeostasis model assessment of basal insulin resistance (HOMA-IR) and angiotensin II (Ang II) from plasma and Ang II and renin from kidney. It also promoted the excretion of urinary Na(+), reducing the loss of urinary K(+) and microalbuminuria (MAU), and improved the glomerular afferent arteriole, arterioles and each kidney unit. Together, these results suggest that L-W-D-H-F is capable of moderately reducing MAP in salt-sensitive hypertension and can work at different levels on multiple differential targets. PMID:24164386

  18. Validation of the automatic image analyser to assess retinal vessel calibre (ALTAIR): a prospective study protocol

    PubMed Central

    Garcia-Ortiz, Luis; Gómez-Marcos, Manuel A; Recio-Rodríguez, Jose I; Maderuelo-Fernández, Jose A; Chamoso-Santos, Pablo; Rodríguez-González, Sara; de Paz-Santana, Juan F; Merchan-Cifuentes, Miguel A; Corchado-Rodríguez, Juan M

    2014-01-01

    Introduction The fundus examination is a non-invasive evaluation of the microcirculation of the retina. The aim of the present study is to develop and validate (reliability and validity) the ALTAIR software platform (Automatic image analyser to assess retinal vessel calibre) in order to analyse its utility in different clinical environments. Methods and analysis A cross-sectional study in the first phase and a prospective observational study in the second with 4 years of follow-up. The study will be performed in a primary care centre and will include 386 participants. The main measurements will include carotid intima-media thickness, pulse wave velocity by Sphygmocor, cardio-ankle vascular index through the VASERA VS-1500, cardiac evaluation by a digital ECG and renal injury by microalbuminuria and glomerular filtration. The retinal vascular evaluation will be performed using a TOPCON TRCNW200 non-mydriatic retinal camera to obtain digital images of the retina, and the developed software (ALTAIR) will be used to automatically calculate the calibre of the retinal vessels, the vascularised area and the branching pattern. For software validation, the intraobserver and interobserver reliability, the concurrent validity of the vascular structure and function, as well as the association between the estimated retinal parameters and the evolution or onset of new lesions in the target organs or cardiovascular diseases will be examined. Ethics and dissemination The study has been approved by the clinical research ethics committee of the healthcare area of Salamanca. All study participants will sign an informed consent to agree to participate in the study in compliance with the Declaration of Helsinki and the WHO standards for observational studies. Validation of this tool will provide greater reliability to the analysis of retinal vessels by decreasing the intervention of the observer and will result in increased validity through the use of additional information, especially

  19. Various patterns of disrupted daily rest-activity rhythmicity associated with diabetes.

    PubMed

    Kadono, Mayuko; Nakanishi, Naoko; Yamazaki, Masahiro; Hasegawa, Goji; Nakamura, Naoto; Fukui, Michiaki

    2016-08-01

    Disruptions to sleep and circadian rhythms have now been recognized as common comorbidities in patients with medical illnesses. We aimed to determine if the diurnal rhythms for rest and activity were disrupted in parallel with the development of diabetic complications. Ninety outpatients in our diabetes clinic who had a body mass index <25 kg m(2) wore an actigraph for 7 consecutive days (42 men; mean age 68.7 ± 8.2 years). Patients with neuropsychiatric diseases, liver cirrhosis, renal failure, chronic obstructive pulmonary disease or blindness, or those who performed shiftwork were excluded. We grouped the actigraph recordings into 1-h periods and counted the number of minutes that showed activity. Stepwise regression analysis showed an association between a diabetic clinical background and measurements of circadian rhythms such as daytime activity, night-time activity, phase, interdaily stability, intradaily variability and relative amplitude. Higher age, body mass index, total cholesterol levels and insulin usage were associated with lower daytime activity and higher intradaily variability, whereas higher haemoglobin A1c levels and the presence of neuropathy were associated with greater daytime activity. The presence of proliferative retinopathy and increased levels of microalbuminuria were associated with higher intradaily variability and lower interdaily stability and amplitude. The presence of cardiovascular disease was associated with advanced phase, whereas painful neuropathy was associated with delayed phase. Our study demonstrated that different diabetic complications were associated independently with a variety of alterations in the circadian rest and activity rhythms. Our findings have provided novel insights that may be helpful in developing interventions for sleep-wake disorders associated with diabetes. PMID:26853999

  20. Arterial stiffness in adolescents and young adults with and without type 1 diabetes: the SEARCH CVD study

    PubMed Central

    Shah, Amy S.; Wadwa, R. Paul; Dabelea, Dana; Hamman, Richard F.; D’Agostino, Ralph; Marcovina, Santica; Daniels, Stephen R.; Dolan, Lawrence M.; Fino, Nora F.; Urbina, Elaine M.

    2016-01-01

    Background Arterial stiffness is a useful parameter to predict future cardiovascular disease. Objective We sought to compare arterial stiffness in adolescents and young adults with and without type 1 diabetes (T1D) and explore the risk factors associated with the differences observed. Subjects and methods Carotid-femoral pulse wave velocity (PWV), augmentation index (AI75), and brachial distensibility (BrachD) were measured in 402 adolescents and young adults with T1D (age 18.8 ± 3.3 yr, T1D duration 9.8 ± 3.8 yr) and 206 non-diabetic controls that were frequency-matched by age, sex, and race/ethnicity in a cross-sectional study. General linear models were used to explore variables associated with an increase in arterial stiffness after adjustment for demographic and metabolic covariates. Results T1D status was associated with a higher PWV (5.9 ± 0.05 vs. 5.7 ± 0.1 m/s), AI75 (1.3 ± 0.6 vs. −1.9 ± 0.7%), and lower BrachD (6.2 ± 0.1 vs. 6.5 ± 0.1%Δ/mmHg), all p < 0.05. In multivariate models, age, sex, race, adiposity, blood pressure, lipids, and the presence of microalbuminuria were found to be independent correlates of increased arterial stiffness. After adjustment for these risk factors, T1D status was still significantly associated with arterial stiffness (p < 0.05). Conclusions Peripheral and central subclinical vascular changes are present in adolescents and young adults with T1D compared to controls. Increased cardiovascular risk factors alone do not explain the observed differences in arterial stiffness among cases and controls. Identifying other risk factors associated with increased arterial stiffness in youth with T1D is critical to prevent future vascular complications. PMID:25912292

  1. Akt Links Insulin Signaling to Albumin Endocytosis in Proximal Tubule Epithelial Cells

    PubMed Central

    Coffey, Sam; Costacou, Tina; Orchard, Trevor; Erkan, Elif

    2015-01-01

    Diabetes mellitus (DM) has become an epidemic, causing a significant decline in quality of life of individuals due to its multisystem involvement. Kidney is an important target organ in DM accounting for the majority of patients requiring renal replacement therapy at dialysis units. Microalbuminuria (MA) has been a valuable tool to predict end-organ damage in DM but its low sensitivity has driven research efforts to seek other alternatives. Albumin is taken up by albumin receptors, megalin and cubilin in the proximal tubule epithelial cells. We demonstrated that insulin at physiological concentrations induce albumin endocytosis through activation of protein kinase B (Akt) in proximal tubule epithelial cells. Inhibition of Akt by a phosphorylation deficient construct abrogated insulin induced albumin endocytosis suggesting a role for Akt in insulin-induced albumin endocytosis. Furthermore we demonstrated a novel interaction between Akt substrate 160kDa (AS160) and cytoplasmic tail of megalin. Mice with type 1 DM (T1D) displayed decreased Akt, megalin, cubilin and AS160 expression in their kidneys in association with urinary cubilin shedding preceding significant MA. Patients with T1D who have developed MA in the EDC (The Pittsburgh Epidemiology of Diabetes Complications) study demonstrated urinary cubilin shedding prior to development of MA. We hypothesize that perturbed insulin-Akt cascade in DM leads to alterations in trafficking of megalin and cubilin, which results in urinary cubilin shedding as a prelude to MA in early diabetic nephropathy. We propose that utilization of urinary cubilin shedding, as a urinary biomarker, will allow us to detect and intervene in diabetic nephropathy (DN) at an earlier stage. PMID:26465605

  2. Synthesis of new pyrazolyl-2, 4-thiazolidinediones as antibacterial and antifungal agents

    PubMed Central

    2011-01-01

    Background Thiazolidine-2, 4-diones (TZDs) have become a pharmacologically important class of heterocyclic compounds since their introduction in the form of glitazones into the clinical use for the treatment of type 2 diabetes. TZDs lower the plasma glucose levels by acting as ligands for gamma peroxisome proliferators-activated receptors. In addition, this class of heterocyclic compounds possesses various other biological activities such as antihyperglycemic, antimicrobial, anti-inflammatory, anticonvulsant, insecticidal, etc. TZDs are also known for lowering the blood pressure thereby reducing the chances of heart failure and micro-albuminuria in the patients with type 2 diabetes. Results We have described herein the synthesis of three series of compounds, namely, ethyl 2-((Z)-5-((3-aryl-1-phenyl-1H-pyrazol-4-yl)methylene)-2, 4-dioxothiazolidin-3-yl)acetates (4), methyl 2-((Z)-5-((3-aryl-1-phenyl-1H-pyrazol-4-yl)methylene)-2, 4-dioxothiazolidin-3-yl)acetates (5), and 2-((Z)-5-((3-aryl-1-phenyl-1H-pyrazol-4-yl)methylene)-2, 4-dioxothiazolidin-3-yl)acetic acids (6). The compounds 4 and 5 were synthesized by Knoevenagel condensation between 3-aryl-1-phenyl-1H-pyrazole-4-carbaldehydes (1) and ethyl/methyl 2-(2, 4-dioxothiazolidin-3-yl)acetates (3, 2) in alcohol using piperidine as a catalyst. The resultant compounds 4 and 5 having ester functionality were subjected to acidic hydrolysis to obtain 6. All the new compounds were tested for their in vitro antibacterial and antifungal activity. Conclusions Knoevenagel condensation approach has offered an easy access to new compounds 4-6. Antimicrobial evaluation of the compounds has shown that some of the compounds are associated with remarkable antifungal activity. In case of antibacterial activity, these were found to be effective against Gram-positive bacteria. However, none of the compounds were found to be effective against Gram-negative bacteria. PMID:22373217

  3. Prevalence and determinants of microalbuminurea among type 2 diabetes mellitus patients, Baghdad, Iraq, 2013.

    PubMed

    Ali, Ali Abdalkader; Al Lami, Faris Hassan

    2016-03-01

    Microalbuminuria (MAU) is an early marker of diabetic nephropathy (DN), which accounts for a significant reduction in life expectancy of diabetic patients. The progression of DN from the appearance of clinical proteinuria to end stage renal failure is usually irreversible. Increased levels of urinary albumin secretion may represent a more generalized vascular damage. This is the first study conducted in Iraq to determine the prevalence and potential risk factors of MAU among Type 2 diabetes mellitus (T2DM) patients. A cross-sectional study was conducted on a systematic random sample of 224 eligible T2DM patients aged 25-64 years attending a DM clinic in Baghdad. A questionnaire was developed to gather basic and clinical data, besides anthropometric measurements, and laboratory assessment of lipid profile, HbA1c, serum creatinine, albumin, and microalbumin/creatinin in urine. MAU was defined as albumin/creatinine ratio 30-300 mg/g on two occasions. Only 36 cases (16.1%) had MAU. A statistical significant association found between MAU and educational level (P = 0.009), family history of hypertension (P = 0.024) and DN (P = 0.013), history of hypertension (P = 0.001), duration of angiotensin-converting-enzyme inhibitor drug intake in hypertensive patients (P = 0.001), body mass index (BMI) (P = 0.014), and waist to hip ratio (P = 0.006). Logistic regression analyses revealed two independent risk factors influencing MAU: diastolic blood pressure [odds ratio (OR) = 1.08, 95% confidence interval (CI): 1.007-1.118] and BMI (OR = 1.17, 95% CI: 1.037-1.220). The prevalence of MAU is not low among DM patients. Mandatory screening of all DM patients and amelioration of the assigned significant risk factors are recommended. PMID:26997390

  4. Specific MAPK inhibitors prevent hyperglycemia-induced renal diseases in type 1 diabetic mouse model.

    PubMed

    Hong, Zhe; Hong, Zongyuan; Wu, Denglong; Nie, Hezhongrong

    2016-08-01

    Mitogen-activated protein kinase (MAPK) and renin-angiotensin system (RAS) play critical roles in the process of renal diseases, but their interaction has not been comprehensively discussed. In the present studies, we investigated the renoprotective effects of MPAK inhibitors on renal diseases in type 1 diabetic mouse model, and clarify the crosstalk among MAPK signaling. Type 1 diabetic mouse model was established in male C57BL/6 J mice, and treated with or without 10 mg/kg MAPK blockers, including ERK inhibitor PD98059, p38 inhibitor SB203850, and JNK inhibitor SP600125 for four weeks. Hyperglycemia induced renal injuries, but treating them with MAPK inhibitors significantly decreased glomerular volume and glycogen in renal tissues. Although slightly changed body weight and fasting blood glucose levels, MAPK inhibitors attenuated blood urea nitrogen, urea protein, and microalbuminuria. Administration also reduced the diabetes-induced RAS activation, including angiotensin II converting enzyme (c) and Ang II, which contributed to its renal protective effects in the diabetic mice. In addition, the anti-RAS of MAPK inhibitor treatment markedly reduced gene expression of tumor necrosis factor-α, interleukin-6, and inducible nitric oxide synthase, fibrotic accumulation, and transforming growth factor-β1 levels in renal tissues. Furthermore, chemical inhibitors and genetic siRNA results identified the crosstalk among the three MAPK signaling, and proved JNK signaling played a critical role in MAPK-mediated ACE pathway in hyperglycemia state. Collectively, these results support the therapeutic effects of MAPK-specific inhibitors, especially JNK inactivation, on hyperglycemia-induced renal damages. PMID:27389030

  5. Association between Mitochondrial DNA Copy Number in Peripheral Blood and Incident CKD in the Atherosclerosis Risk in Communities Study.

    PubMed

    Tin, Adrienne; Grams, Morgan E; Ashar, Foram N; Lane, John A; Rosenberg, Avi Z; Grove, Megan L; Boerwinkle, Eric; Selvin, Elizabeth; Coresh, Josef; Pankratz, Nathan; Arking, Dan E

    2016-08-01

    Mitochondrial dysfunction in kidney cells has been implicated in the pathogenesis of CKD. Mitochondrial DNA (mtDNA) copy number is a surrogate measure of mitochondrial function, and higher mtDNA copy number in peripheral blood has been associated with lower risk of two important risk factors for CKD progression, diabetes and microalbuminuria. We evaluated whether mtDNA copy number in peripheral blood associates with incident CKD in a population-based cohort of middle-aged adults. We estimated mtDNA copy number using 25 high-quality mitochondrial single nucleotide polymorphisms from the Affymetrix 6.0 array. Among 9058 participants, those with higher mtDNA copy number had a lower rate of prevalent diabetes and lower C-reactive protein levels and white blood cell counts. Baseline eGFR did not differ significantly by mtDNA copy number. Over a median follow-up of 19.6 years, 1490 participants developed CKD. Higher mtDNA copy number associated with lower risk of incident CKD (highest versus lowest quartile: hazard ratio 0.65; 95% confidence interval, 0.56 to 0.75; P<0.001) after adjusting for age, sex, and race. After adjusting for additional risk factors of CKD, including prevalent diabetes, hypertension, C-reactive protein level, and white blood cell count, this association remained significant (highest versus lowest quartile: hazard ratio 0.75; 95% confidence interval, 0.64 to 0.87; P<0.001). In conclusion, higher mtDNA copy number associated with lower incidence of CKD independent of traditional risk factors and inflammation biomarker levels in this cohort. Further research on modifiable factors influencing mtDNA copy number may lead to improvement in the prevention and treatment of CKD. PMID:26794963

  6. Type 2 diabetes in Sudanese children and adolescents

    PubMed Central

    Osman, Hala A M; Elsadek, Nadia; Abdullah, Mohamed A.

    2013-01-01

    The objective of this study was to determine the prevalence of T2 DM among children and adolescents attending a paediatric and adolescent diabetic clinic in Khartoum –Sudan and to find out the etiological factors, clinical presentation, management and associated co morbidities. This was a retrospective, descriptive hospital based study. The records of all children attending the clinic at Jabir Abu Izz Diabetic Center from January 2006 to December 2009 were reviewed and those who were diagnosed as type 2 DM were identified. Out of 985 patients 38 (4%) were labeled as having type 2 DM. Out of these, 35 (92.1%) had onset between 11–18 years of age and were all pubertal. Three patients (7.9%) were under 10. Female to male ratio was 1.2: 1. Thirty two (84.2%) were from tribes of Arab origin. There were no cases from tribes of southern Sudan of African origin. Risk factors for obesity included: diabetes during pregnancy 15 (39.5%), large for dates 16 (43%) small for dates 12(32%), family history of obesity 10 (26.3%), lack of exercise 32 (87.6%), TV watching for long hours 32(84.3%) and consumption of fast foods. Almost 70% were symptomatic at presentation. Co morbidities included hypertension 22(57.9%), microalbuminuria 7 (18.4%), hyperlipidaemia 6(7%) and none had retinopathy. The mean HbA1C was 9.1% gm/dl. This data confirms that T2 DM is emerging as a health problem among children and adolescents in Sudan mostly as a result of obesity particularly among high socioeconomic group in urban areas and more prevalent in certain ethnic groups. PMID:27493369

  7. Elevated urinary level of vitamin D-binding protein as a novel biomarker for diabetic nephropathy

    PubMed Central

    TIAN, XIAO-QIN; ZHAO, LI-MIN; GE, JIA-PU; ZHANG, YAN; XU, YAN-CHENG

    2014-01-01

    Improving the early prediction and detection of diabetic nephropathy (DN) remains a great challenge in disease management. The aim of this study was to evaluate the early detection power of urinary vitamin D-binding protein (VDBP) for the diagnosis of DN. Urine samples were obtained from 45 healthy volunteers and 105 diabetic patients with normoalbuminuria (DM group), microalbuminuria (DN1 group) and macroalbuminuria (DN2 group) (n=35 per group). The VDBP expression patterns in urine from patients and controls were quantified by western blot analysis. The excretion levels of urinary VDBP were quantified with enzyme-linked immunosorbent assay. The quantification results were obtained by correcting for creatinine expression and showed that urinary VDBP levels were significantly elevated in the patients of the DN1 and DN2 groups compared with those of the DM group and normal controls (1,011.33±325.30 and 1,406.34±239.66 compared with 466.54±213.63 and 125.48±98.27 ng/mg, respectively) (P<0.001). Receiver operating characteristic analysis of urinary VDBP levels for the diagnosis of DN rendered an optimum cut-off value of 552.243 ng/mg corresponding to 92.86% sensitivity and 85.00% specificity, which also showed an area under the ROC curve of 0.966. In conclusion, the findings of the present study suggest that urinary VDBP may be a potential biomarker for the early detection and prevention of DN. Further studies are required to examine the pathogenic mechanisms of elevated VDBP levels and their role in the diagnosis of DN. PMID:24396416

  8. A cross-sectional survey of depression, anxiety, and cognitive function in patients with type 2 diabetes.

    PubMed

    Trento, M; Raballo, M; Trevisan, M; Sicuro, J; Passera, P; Cirio, L; Charrier, L; Cavallo, F; Porta, M

    2012-06-01

    To evaluate the prevalence of depression in outpatients with type 2 diabetes and its possible correlation with anxiety, cognitive function, and clinical variables. The Zung Self-Rating Depression and Anxiety Scales and the Mini-Mental-State Examination were administered to 249 non-insulin-treated (NIT) and 249 insulin-treated (IT) outpatients with type 2 diabetes, aged 40-80, in a cross-sectional survey. Compared with a reported prevalence of 6-13% in the general population, 104 (20.9%) patients had either a score indicative of depression or were on anti-depressant medication. Assuming that medication might modify the responses to questionnaires, the latter patients were excluded from further analysis. IT patients had higher age, known duration of diabetes, HbA1c, more foot ulcers, retinopathy, microalbuminuria and practised more self-monitoring of blood glucose (P < 0.01 all) but a slightly lower mean depression score (P = 0.004) and similar anxiety or cognitive function. At multivariate analysis, depression was associated with anxiety (P < 0.001), age (P < 0.001), gender (men having lower scores than women, P = 0.042), and insulin treatment, IT patients being less depressed than NIT (P < 0.001), but none of the clinical variables. Anxiety correlated with age (P < 0.001). The association between depression and anxiety became progressively weaker with increasing age. These data confirm increased prevalence of depression in a population of patients with type 2 diabetes who did not show impaired cognitive function. The lack of correlation with disease duration, metabolic control, and complications suggests that depression may not appear/worsen with diabetes and/or its complications but rather supports suggestions that it might predate both. PMID:21442429

  9. A practical approach to the management of patients with chronic renal failure.

    PubMed

    McCarthy, J T

    1999-03-01

    The number of patients with significant chronic renal failure is expanding rapidly in the United States. All physicians and medical-care providers will have an increasingly important role in the detection and management of renal failure in patients who are not undergoing dialysis. Patients with diabetes or hypertension should be carefully monitored for the development of renal insufficiency by using screening tools such as blood pressure measurement, determination of serum creatinine, urinalysis, and determination of 24-hour urinary microalbuminuria. In order to slow the progression of renal disease, attenuate uremic complications, and prepare patients with renal failure for renal replacement therapy, all medical-care providers should "take care of the BEANS." Blood pressure should be maintained in a target range lower than 130/85 mm Hg, and in many patients, angiotensin-converting enzyme inhibitors may be beneficial. Erythropoietin should be used to maintain the hemoglobin level at 10 to 12 g/dL. Access for long-term dialysis should be created when the serum creatinine value increases above 4.0 mg/dL or the glomerular filtration rate declines below 20 mL/min. Nutritional status must be closely monitored in order to avoid protein malnutrition and to initiate dialysis before the patient's nutritional status has deteriorated. Nutritional care also involves correction of acidosis, prevention and treatment of hyperphosphatemia, and administration of vitamin supplements to provide folic acid. Specialty referral to nephrology should occur when the creatinine level increases above 3.0 mg/dL or when the involvement of a nephrologist would be beneficial for ongoing management of the patient. PMID:10089997

  10. DiabCare survey of diabetes management and complications in the Gulf countries

    PubMed Central

    Omar, Muhamed Shahed; Khudada, Khaled; Safarini, Saher; Mehanna, Sherif; Nafach, Jalal

    2016-01-01

    Aim: To describe the status of diabetes control and complications, and the quality of diabetes management in Saudi Arabia, Kuwait, and the United Arab Emirates, and to obtain an insight into the relationship between these factors. Methods: Patients with diabetes for>12 months were enrolled from specialist clinics and general hospitals. All available data from the patients’ medical files including patient demographics; glycemic, lipid, and blood pressure status; diabetes-related complications; and diabetes management were recorded in data collection forms and analyzed. Results: Overall, 1290 patients with diabetes were enrolled with a mean (±standard deviation) age of 49.4 ± 12.3 years and duration of diabetes of 8.7 ± 5.9 years. Glycemic control was poor: Mean glycated hemoglobin A1c of 8.3 ± 2.0%, fasting and postprandial plasma glucose levels of 155.9 ± 57.1 mg/dL (8.7 ± 3.2 mmol/L), and 218.2 ± 87.4 mg/dL (12.1 ± 4.9 mmol/L), respectively. Diabetes-related complications such as neuropathy (34.9% of patients), background retinopathy (29.9%), and cataract (14.1%) were common. Cardiovascular complications were reported in <10% of patients, and microalbuminuria was detected in 34.4% of patients. Oral antidiabetic drug (OAD) monotherapy (43.3%) was the most common treatment, followed by insulin + OADs (39.3%) and insulin monotherapy (17.6%). Conclusion: The status of diabetes care was found to be suboptimal. Further improvements in diabetes management are necessary to prevent or delay the development of diabetes-related complications. PMID:27042419

  11. Relation between Anemia and Vulnerable Coronary Plaque Components in Patients with Acute Coronary Syndrome: Virtual Histology-Intravascular Ultrasound Analysis

    PubMed Central

    Hong, Young Joon; Choi, Yun Ha; Song, Jin A; Kim, Dong Han; Lee, Ki Hong; Yamanaka, Futoshi; Lee, Min Goo; Park, Keun Ho; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

    2012-01-01

    The aim of the present study was to evaluate the plaque components and the predictors of thin-cap fibroatheroma (TCFA) in anemic patients with acute coronary syndrome using virtual histology-intravascular ultrasound (VH-IVUS). Anemia was defined according to criteria of the World Health Organization, (i.e. , hemoglobin levels < 13 g/dL in men and < 12 g/dL in women) and we compared VH-IVUS findings between anemia group (171 patients, 260 lesions) and non-anemia group (569 patients, 881 lesions). Anemia group had greater % necrotic core (NC) volume (21% ± 9% vs 19% ± 9%, P = 0.001) compared with non-anemia group. Hemoglobin level correlated negatively with absolute NC volume (r = -0.235, P < 0.001) and %NC volume (r = -0.209, P < 0.001). Independent predictors of TCFA by multivariate analysis were diabetes mellitus (odds ratio [OR], 2.213; 95% confidence interval [CI], 1.403-3.612, P = 0.006), high-sensitivity C-reactive protein (OR, 1.143; 95% CI, 1.058-1.304, P = 0.012), microalbuminuria (albumin levels of 30 to 300 mg/g of creatinine) (OR, 2.124; 95% CI, 1.041-3.214, P = 0.018), and anemia (OR: 2.112; 95% CI 1.022-3.208, P = 0.028). VH-IVUS analysis demonstrates that anemia at the time of clinical presentation is associated with vulnerable plaque component in patients with acute coronary syndrome. PMID:22468099

  12. Use and Isolation of Urinary Exosomes as Biomarkers for Diabetic Nephropathy

    PubMed Central

    Musante, Luca; Tataruch, Dorota Ewa; Holthofer, Harry

    2014-01-01

    Diabetes represents a major threat to public health and the number of patients is increasing alarmingly in the global scale. Particularly, the diabetic kidney disease (nephropathy, DN) together with its cardiovascular complications cause immense human suffering, highly increased risk of premature deaths, and lead to huge societal costs. DN is first detected when protein appears in urine (microalbuminuria). As in other persisting proteinuric diseases (like vasculitis) it heralds irreversible damage of kidney functions up to non-functional (end-stage) kidney and ultimately calls for kidney replacement therapy (dialysis or kidney transplantation). While remarkable progress has been made in understanding the genetic and molecular factors associating with chronic kidney diseases, breakthroughs are still missing to provide comprehensive understanding of events and mechanisms associated. Non-invasive diagnostic tools for early diagnostics of kidney damage are badly needed. Exosomes – small vesicular structures present in urine are released by all cell types along kidney structures to present with distinct surface assembly. Furthermore, exosomes carry a load of special proteins and nucleic acids. This “cargo” faithfully reflects the physiological state of their respective cells of origin and appears to serve as a new pathway for downstream signaling to target cells. Accordingly, exosome vesicles are emerging as a valuable source for disease stage-specific information and as fingerprints of disease progression. Unfortunately, technical issues of exosome isolation are challenging and, thus, their full potential remains untapped. Here, we review the molecular basis of exosome secretion as well as their use to reveal events along the nephron. In addition to novel molecular information, the new methods provide the needed accurate, personalized, non-invasive, and inexpensive future diagnostics. PMID:25309511

  13. The socioeconomic correlates of global complication prevalence in type 1 diabetes (T1D): a multinational comparison.

    PubMed

    Walsh, Michael G; Zgibor, Janice; Songer, Thomas; Borch-Johnsen, Knut; Orchard, Trevor J

    2005-11-01

    We sought to determine the extent to which the geographic variation in the complications of type 1 diabetes (T1D) may reflect the socioeconomic status (SES) conditions and health care performance (HCP) of countries around the world. The World Health Organization (WHO) DiaMond complications study (DiaComp) is a multinational, cross-sectional study of complications in T1D. Information on complications was identified for 892 subjects from 14 clinical centers in 12 countries. All participants were diagnosed with diabetes in childhood (<15 years of age) and had disease duration of 5-24 years. Complications were assessed by self-report, and by clinical exam, with microalbuminuria identified by Micral II dipstick, neuropathy by the Michigan Neuropathy Screening Instrument exam and hypertension using the HDFP protocol. These data were linked to center-specific information on the local social and economic landscape, health care access and diabetes management practices and health care costs. Country-specific indicators of social and economic development were also linked to the complications data. Both diabetes complications and economic and health care factors vary widely across the DiaComp centers. Health system performance, as measured by disability adjusted life expectancy (DALE), gross national investment (GNI) per capita and purchasing power all showed strong consistent correlations with complications, and significant independent associations with complication prevalence after controlling for HbA1c and hypertension. In conclusion, health system performance, social distribution of wealth and purchasing power may play important roles in explaining the geographic variation of diabetes complications. PMID:16188576

  14. Association between chronic kidney disease and coronary artery calcification: the Dallas Heart Study.

    PubMed

    Kramer, Holly; Toto, Robert; Peshock, Ronald; Cooper, Richard; Victor, Ronald

    2005-02-01

    The hypothesis that chronic kidney disease (CKD) is associated with increased coronary artery calcification (CAC) was tested using data from the Dallas Heart Study, a representative sample of Dallas County residents aged 30 to 65 yr. CKD was defined as presence of microalbuminuria and GFR > or =60 ml/min per 1.73 m(2) (stage 1 to 2), or GFR <60 ml/min per 1.73 m(2) (stage 3 to 5), excluding end-stage kidney disease. Logistic regression was used to examine the association between stages of CKD and CAC scores >10, >100, and >400 versus scores < or =10 compared with no CKD while adjusting for covariates. Analyses were repeated after stratifying by presence of diabetes. The mean age was 43.9 yr, and hypertension and diabetes were noted in 31.0 and 9.8%, respectively. No association was noted between stage 1 to 2 CKD and increased CAC scores. Compared with no CKD, stage 3 to 5 CKD was associated with CAC scores >100 (odds ratio, 2.85; 95% confidence interval, 0.92 to 8.80) and >400 (odds ratio, 8.35; 95% confidence interval, 1.94 to 35.95) in the total population after adjustment for covariates, but these associations were substantially reduced after exclusion of participants with diabetes. Participants with diabetes and stage 3 to 5 CKD had a ninefold increased odds of CAC scores >10 versus scores < or =10 compared with participants with diabetes and without CKD, whereas no association was noted between stage 3 to 5 CKD and CAC scores >10 in the nondiabetic population. In conclusion, stage 3 to 5 CKD is associated with increased CAC scores, but this association may be substantially stronger among adults with diabetes. These findings need to be confirmed in study populations that include adults >65 yr of age and a larger number of CKD cases. PMID:15601745

  15. Population Study of Urban, Rural, and Semiurban Regions for the Detection of Endovascular Disease and Prevalence of Risk Factors and Holistic Intervention Study: Rationale, Study Design, and Baseline Characteristics of PURSE-HIS.

    PubMed

    Thanikachalam, Sadagopan; Harivanzan, Vijayakumar; Mahadevan, Murugappapillai V; Murthy, J S N; Anbarasi, Chandrasekar; Saravanababu, Chidambaram S; Must, Aviva; Baliga, Ragavendra R; Abraham, William T; Thanikachalam, Mohan

    2015-12-01

    We designed and implemented the PURSE-HIS (Population Study of Urban, Rural and Semiurban Regions for the Detection of Endovascular Disease and Prevalence of Risk Factors and Holistic Intervention Study) to understand the prevalence and progression of subclinical and overt endovascular disease (EVD) and its risk factors in urban, semiurban, and rural communities in South India. The study is also designed to generate clinical evidence for effective, affordable, and sustainable community-specific intervention strategies to control risks factors for EVD. As of June 2012, 8,080 (urban: 2,221; semiurban: 2,821; rural: 3,038) participants >20 years of age were recruited using 2-stage cluster sampling. Baseline measurements included standard cardiovascular disease risk factors, sociodemographic factors, lifestyle habits, psychosocial factors, and nutritional assessment. Fasting blood samples were assayed for putative biochemical risk factors and urine samples for microalbuminuria. All nondiabetic participants underwent oral glucose tolerance test with blood and urine samples collected every 30 min for 2 h. Additional baseline measurements included flow-mediated brachial artery endothelial vasodilation, assessment of carotid intimal medial wall thickness using ultrasonography, screening for peripheral vascular disease using ankle and brachial blood pressures, hemodynamic screening using a high-fidelity applanation tonometry to measure central blood pressure parameters, and aortic pulse wave velocity. To assess prevalence of coronary artery disease, all participants underwent surface electrocardiography and documentation of ventricular wall motion abnormality and function using echocardiography imaging. To detect subclinical lesions, all eligible participants completed an exercise treadmill test. Prospectively, the study will assess progression of subclinical and overt EVD, including risk factor-outcome relation differences across communities. The study will also evaluate

  16. Smoking and Chronic Kidney Disease in Healthy Populations

    PubMed Central

    Noborisaka, Yuka

    2012-01-01

    The objective of this review is to explore the link between smoking and the development of chronic kidney disease (CKD) in generally healthy populations without pre-existing renal dysfunction such as diabetic nephropathy. Twenty-eight epidemiological studies concerning the renal effects of smoking in the general population were collected from the MEDLINE database and were reviewed for indications of proteinuria and/or the decline of glomerular filtration rate (GFR), and evaluated on the level of evidence and the quality of the study. Sixteen of the 28 studies were cross-sectional in design. Most articles had some weakness in scope, such as the 6 articles which did not fully exclude DM patients from the subjects, the 4 that did not consider the effects of ex-smoking, and the 3 that focused on only a small number of subjects. From these cases, it is difficult to draw firm conclusions. However, proteinuria or microalbuminuria was persistently high in current smokers; as much as 5-8% or 8-15% respectively, which was up to 2 to 3-times the rate of lifelong non-smokers. On the other hand, only 5 studies broader in scope detected any decline of GFR in smokers, while 9 other studies suggested a higher GFR in smokers than in non-smokers. Two good quality studies showed an even a significantly lower risk of a decreased GFR in smokers. These paradoxical CKD markers in smokers, i.e., a higher appearance of proteinuria with a higher GFR, could be a focus for further studies to reveal the underlying reasons for smoking-induced CKD. Workplaces may be an excellent place to study this subject since the long-term changes in renal function of smokers can be observed by collecting data in the annual health check-ups mandated at places of employment. PMID:23577327

  17. Red cell distribution width and end-organ damage in patients with systo-diastolic hypertension

    PubMed Central

    Akgul, Ozgur; Erturk, Mehmet; Surgit, Ozgur; Tasbulak, Omer; Akkaya, Emre; Yazan, Serkan; Gül, Mehmet; Türen, Selahattin

    2016-01-01

    Introduction Both end-organ damage and high red cell distribution width (RDW) values are associated with adverse cardiovascular events, inflammatory status, and neurohumoral activation in hypertensive disease and in the general population. In this study, we investigated the relationship between RDW and end-organ damage in hypertensive patients. Material and methods The 446 systo-diastolic hypertensive patients included in the study received 24-hour ambulatory blood pressure monitoring. Left ventricular mass index, glomerular filtration rate, and microalbuminuria were measured to identify end-organ damage. High-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels of all patients were also examined. Results The mean age of the participants was 49.96 ±11.04 years. The mean RDW was 13.06 ±1.05%. Red cell distribution width was positively correlated with left ventricular myocardial index (LVMI), urinary albumin, hs-CRP, and NT-proBNP (r = 0.298, p < 0.001; r = 0.228, p < 0.001; r = 0.337, p < 0.001; r = 0.277, p < 0.001, respectively), while RDW was negatively correlated with eGFR (r = –0.153, p < 0.001). Additionally, while there was a positive correlation between RDW and 24-h systolic blood pressure, no correlation was found between RDW and 24-h diastolic blood pressure (r = 0.132, p = 0.006 and r = 0.017, p = 0.725, respectively). Multiple linear regression analysis revealed that RDW levels were independently associated with eGFR, LVMI, and severity of albuminuria (β = 0.126, p = 0.010; β = –0.149, p = 0.002; β = 0.114, p = 0.035). Conclusions High RDW levels in systo-diastolic hypertensive patients were found to be an independent predictor of end-organ damage. PMID:27186175

  18. C-Reactive Protein Promotes Diabetic Kidney Disease in db/db Mice via the CD32b-Smad3-mTOR signaling Pathway

    PubMed Central

    You, Yong-Ke; Huang, Xiao-Ru; Chen, Hai-Yong; Lyu, Xia-Fei; Liu, Hua-Feng; Lan, Hui Y.

    2016-01-01

    C-reactive protein (CRP) is associated with progressive diabetic nephropathy in patients with type-2 diabetes (T2DN). However, role of CRP in T2DN remains unclear. We report here that CRP is pathogenic in T2DN in db/db mice that express human CRP (CRPtg-db/db). Compared to the littermate db/db mice, CRPtg-db/db developed more severe T2DN, showing higher levels of fasting blood glucose and microalbuminuria and more progressive renal inflammation and fibrosis. Enhanced T2DN in CRPtg-db/db mice were associated with over-activation of CRP-CD32b, NF-κB, TGF-β/Smad3, and mTOR signaling. Further studies in vitro defined that CRP activated Smad3 directly at 15 mins via the CD32b- ERK/p38 MAP kinase crosstalk pathway and indirectly at 24 hours through a TGF-β1-dependent mechanism. Importantly, CRP also activated mTOR signaling at 30 mins via a Smad3-dependent mechanism as Smad3 bound mTOR physically and CRP-induced mTOR signaling was abolished by a neutralizing CD32b antibody and a specific Smad3 inhibitor. Finally, we also found that CRP induced renal fibrosis through a CD32b-Smad3-mTOR pathway because blocking mTOR signaling with rapamycin inhibited CRP-induced CTGF and collagen I expression. Thus, CRP is pathogenic in T2DN. CRP may promote CD32b- NF-κB signaling to mediate renal inflammation; whereas, CRP may enhance renal fibrosis in T2DN via CD32b-Smad3-mTOR signaling. PMID:27221338

  19. C-Reactive Protein Promotes Diabetic Kidney Disease in db/db Mice via the CD32b-Smad3-mTOR signaling Pathway.

    PubMed

    You, Yong-Ke; Huang, Xiao-Ru; Chen, Hai-Yong; Lyu, Xia-Fei; Liu, Hua-Feng; Lan, Hui Y

    2016-01-01

    C-reactive protein (CRP) is associated with progressive diabetic nephropathy in patients with type-2 diabetes (T2DN). However, role of CRP in T2DN remains unclear. We report here that CRP is pathogenic in T2DN in db/db mice that express human CRP (CRPtg-db/db). Compared to the littermate db/db mice, CRPtg-db/db developed more severe T2DN, showing higher levels of fasting blood glucose and microalbuminuria and more progressive renal inflammation and fibrosis. Enhanced T2DN in CRPtg-db/db mice were associated with over-activation of CRP-CD32b, NF-κB, TGF-β/Smad3, and mTOR signaling. Further studies in vitro defined that CRP activated Smad3 directly at 15 mins via the CD32b- ERK/p38 MAP kinase crosstalk pathway and indirectly at 24 hours through a TGF-β1-dependent mechanism. Importantly, CRP also activated mTOR signaling at 30 mins via a Smad3-dependent mechanism as Smad3 bound mTOR physically and CRP-induced mTOR signaling was abolished by a neutralizing CD32b antibody and a specific Smad3 inhibitor. Finally, we also found that CRP induced renal fibrosis through a CD32b-Smad3-mTOR pathway because blocking mTOR signaling with rapamycin inhibited CRP-induced CTGF and collagen I expression. Thus, CRP is pathogenic in T2DN. CRP may promote CD32b- NF-κB signaling to mediate renal inflammation; whereas, CRP may enhance renal fibrosis in T2DN via CD32b-Smad3-mTOR signaling. PMID:27221338

  20. Soluble Klotho and fibroblast growth factor 23 levels in diabetic nephropathy with different stages of albuminuria.

    PubMed

    Inci, Ayca; Sari, Funda; Coban, Melahat; Olmaz, Refik; Dolu, Suleyman; Sarıkaya, Metin; Yılmaz, Necat

    2016-08-01

    The relationship between soluble Klotho (s-Klotho) levels, fibroblast growth factor 23 (FGF23) levels, and albuminuria in patients with diabetic chronic kidney disease (CKD) remains unclear. A total of 109 patients with type 2 diabetes (mean age 61.63±9.77 years), at the outpatient clinic of the Antalya Research and Training Hospital Nephrology Unit between January and June 2014, as well as 32 healthy controls (mean age 49.53±7.32 years) were enrolled for this cross-sectional study. Patients were classified into three groups according to their urinary albumin creatinine ratio (UACR), normoalbuminuria (UACR<30 mg/g), microalbuminuria (UACR 30-300 mg/g), and macroalbuminuria (UACR>300 mg/g). The blood was analyzed for FGF23, s-Klotho, parathyroid hormone (PTH), P, Ca, creatinine, and 25-hydroxyvitamin D3 (25hD) levels. Creatinine, s-Klotho, FGF23, and PTH levels were significantly higher and 25hD levels were significantly lower in the patient group than in the healthy controls (p<0.001). Between the groups according to UACR, 1-way analysis of variance revealed statistically significant differences for creatinine (p<0.001), 25hD (p<0.001), PTH (p=0.002), Ca (p=0.002), and albumin levels (p<0.001). A statistically significant positive correlation was found between s-Klotho and FGF23 (r=0.768; p=0.001), and between FGF23 levels and UACR (r=0.768; p=0.001). In conclusion, the results of the present study suggest that s-Klotho levels are significantly elevated in patients with diabetes and s-Klotho levels decreased with increasing albumin excretion in our patients despite a reduction in estimated glomerular filtration rate. PMID:27323770

  1. Plasma Triglycerides Predict Incident Albuminuria and Progression of Coronary Artery Calcification in Adults with Type 1 Diabetes: the Coronary Artery Calcification in Type 1 Diabetes Study

    PubMed Central

    Bjornstad, Petter; Maahs, David M.; Wadwa, R. Paul; Pyle, Laura; Rewers, Marian; Eckel, Robert H.; Snell-Bergeon, Janet K.

    2014-01-01

    Background Coronary artery disease and diabetic nephropathy, which are thought to share pathogenic mechanisms, remain the most common causes of mortality in type 1 diabetes (T1D). Data from basic and clinical studies indicate that hypertriglyceridemia plays an important role in the pathogenesis of vascular complications, but the role of triglycerides (TG) in the normal range remains unresolved in T1D. Objective We hypothesized that fasting TG would independently predict cardiorenal disease in adults with T1D and normal-to-low levels of TG. Methods Subjects (N=652) were 19–56 years old at baseline and reexamined 6-years later. Urinary albumin excretion was measured, and categorized as microalbuminuria or greater. Progression of coronary artery calcification (CACp), measured using electron beam CT, was defined as a change in the square root transformed CAC volume ≥2.5. The association of low-density-lipoprotein-C (LDL-C), high-density-lipoprotein-C (HDL-C), apolipoprotein B, nonHDL-C, lnTG, ln(TG/HDL-C) ratio with CACp and incident albuminuria were examined in logistic regression. The models were adjusted for age, sex, T1D-duration, hemoglobin A1c, SBP, DBP, BP-medications, statins and smoking status. Integrated discrimination index and net-reclassification improvement were used to examine prediction performance. Results Incident albuminuria was independently associated with CACp. LnTG independently predicted both incident albuminuria (OR: 1.53, 1.02–2.30, p=0.04) and CACp (1.41, 1.11–1.80, p=0.006). The addition of lnTG to ABC risk factors (HbA1c, SBP, DBP and LDL-C) moderately improved discrimination and reclassification of CACp and incident albuminuria. Conclusion In adults with type 1 diabetes, fasting TG independently predicted cardiorenal disease over 6 years and improved reclassification of risk by conventional risk factors. PMID:25499940

  2. [Acyclovir-induced neurotoxicity and acute kidney injury in an elderly diabetic patient treated with valacyclovir: report of a case].

    PubMed

    Sagawa, Naoko; Tsurutani, Yuya; Nomura, Kazushi; Okuyama, Tomoko; Kondo, Mai; Sata, Akira; Miyao, Mariko; Mizuno, Yuzo

    2014-01-01

    An 83-year-old Japanese man had a 29-year history of well-controlled diabetes mellitus. His HbA1c level was approximately 6.0%, with no microalbuminuria and a serum creatinine level seven days before admission of 0.8 mg/dl (eGFR: 69.67 ml/min/1.73 m(2)). Five days before admission, he visited an ophthalmologist with inflammation of the right palpebra and conjunctiva and began taking valacyclovir at a dose of 3,000 mg for the treatment of herpes zoster. Two days before admission, he was prescribed loxoprofen at a dose of 180 mg for a headache. One day prior to admission, he developed dysarthria, wandering and loss of appetite. He was subsequently admitted to our hospital with progressive deterioration of consciousness (Japan Coma Scale: II-20). On admission, he exhibited renal dysfunction, with a serum creatinine level of 5.11 mg/dl (eGFR: 9.16 ml/min/1.73 m(2)). Based on his diverse symptoms and current treatment with valacyclovir, the patient was diagnosed with acyclovir-induced neurotoxicity and his symptoms rapidly improved after hemodialysis. The serum acyclovir level on admission was found to be 9.25 μg/ml. Although acyclovir-induced neurotoxicity is commonly seen in elderly patients with renal dysfunction, there are also reports of this condition in patients with a normal renal function. Valacyclovir is frequently prescribed to the elderly to treat diseases such as herpes zoster. As valacyclovir induces renal dysfunction, which raises the serum acyclovir level to the toxic range, special attention must be paid when administering this drug in elderly subjects. PMID:25749332

  3. Performance of an integrated network model

    PubMed Central

    Lehmann, François; Dunn, David; Beaulieu, Marie-Dominique; Brophy, James

    2016-01-01

    Objective To evaluate the changes in accessibility, patients’ care experiences, and quality-of-care indicators following a clinic’s transformation into a fully integrated network clinic. Design Mixed-methods study. Setting Verdun, Que. Participants Data on all patient visits were used, in addition to 2 distinct patient cohorts: 134 patients with chronic illness (ie, diabetes, arteriosclerotic heart disease, or both); and 450 women between the ages of 20 and 70 years. Main outcome measures Accessibility was measured by the number of walk-in visits, scheduled visits, and new patient enrolments. With the first cohort, patients’ care experiences were measured using validated serial questionnaires; and quality-of-care indicators were measured using biologic data. With the second cohort, quality of preventive care was measured using the number of Papanicolaou tests performed as a surrogate marker. Results Despite a negligible increase in the number of physicians, there was an increase in accessibility after the clinic’s transition to an integrated network model. During the first 4 years of operation, the number of scheduled visits more than doubled, nonscheduled visits (walk-in visits) increased by 29%, and enrolment of vulnerable patients (those with chronic illnesses) at the clinic remained high. Patient satisfaction with doctors was rated very highly at all points of time that were evaluated. While the number of Pap tests done did not increase with time, the proportion of patients meeting hemoglobin A1c and low-density lipoprotein guideline target levels increased, as did the number of patients tested for microalbuminuria. Conclusion Transformation to an integrated network model of care led to increased efficiency and enhanced accessibility with no negative effects on the doctor-patient relationship. Improvements in biologic data also suggested better quality of care. PMID:27521410

  4. Dapagliflozin reduces albuminuria in patients with diabetes and hypertension receiving renin‐angiotensin blockers

    PubMed Central

    Johnsson, E.; Gause‐Nilsson, I.; Cain, V. A.; Sjöström, C. D.

    2016-01-01

    Aims To characterize the effect of dapagliflozin on albuminuria and estimated glomerular filtration rate (eGFR) and to determine whether effects on albuminuria were mediated through changes in glycated haemoblogin (HbA1c), systolic blood pressure (SBP), body weight or eGFR. Methods We conducted a post hoc analysis of data pooled from two phase III clinical trials in hypertensive patients with type 2 diabetes (T2DM) on stable angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker therapy, randomly assigned to dapagliflozin 10 mg/day or matched placebo. This analysis included only patients with microalbuminuria or macroalbuminuria at baseline. Results Patients were randomized to receive dapagliflozin 10 mg (n = 167) or placebo (n = 189). Dapagliflozin resulted in greater 12‐week reductions in albuminuria compared with placebo: −33.2% [95% confidence interval (CI) −45.4, −18.2]. The reduction in albuminuria was also present after adjusting for age, sex and changes in HbA1c, SBP, body weight and eGFR: −23.5% (95% CI −37.6, −6.3). There was a decrease in eGFR with dapagliflozin versus placebo that was readily reversed 1 week after last dose. No serious renal‐related adverse events were observed in any group. Conclusions Dapagliflozin was effective in lowering albuminuria in patients with T2DM and hypertension using renin‐angiotensin system blockade therapy. Reductions in albuminuria were still present after adjusting for changes in HbA1c, SBP, body weight and eGFR. Dapagliflozin‐induced improvements in glycaemic control and reductions in SBP, coupled with other potentially beneficial renal effects, may lead to a reduced long‐term renal and cardiovascular risk. PMID:26936519

  5. Exercise-induced albuminuria is related to metabolic syndrome.

    PubMed

    Greenberg, Sharon; Shenhar-Tsarfaty, Shani; Rogowski, Ori; Shapira, Itzhak; Zeltser, David; Weinstein, Talia; Lahav, Dror; Vered, Jaffa; Tovia-Brodie, Oholi; Arbel, Yaron; Berliner, Shlomo; Milwidsky, Assi

    2016-06-01

    Microalbuminuria (MA) is a known marker for endothelial dysfunction and future cardiovascular events. Exercise-induced albuminuria (EiA) may precede the appearance of MA. Associations between EiA and metabolic syndrome (MS) have not been assessed so far. Our aim was to investigate this association in a large sample of apparently healthy individuals with no baseline albuminuria. This was a cross-sectional study of 2,027 adults with no overt cardiovascular diseases who took part in a health survey program and had no baseline MA. Diagnosis of MS was based on harmonized criteria. All patients underwent an exercise test (Bruce protocol), and urinary albumin was measured before and after the examination. Urinary albumin-to-creatinine ratio (ACR) values before and after exercise were 0.40 (0.21-0.89) and 1.06 (0.43-2.69) mg/g for median (interquartile range) respectively. A total of 394 (20%) subjects had EiA; ACR rose from normal rest values (0.79 mg/g) to 52.28 mg/g after exercise (P < 0.001); this effect was not shown for the rest of the study population. EiA was related to higher prevalence of MS (13.8% vs. 27.1%, P < 0.001), higher metabolic equivalents (P < 0.001), higher baseline blood pressure (P < 0.001), and higher levels of fasting plasma glucose, triglycerides, and body mass index (P < 0.001). Multivariate binary logistic regression model showed that subjects with MS were 98% more likely to have EiA (95% confidence interval: 1.13-3.46, P = 0.016). In conclusion, EiA in the absence of baseline MA is independently related to MS. PMID:27076648

  6. Patterns and predictors of statin prescription in patients with type 2 diabetes

    PubMed Central

    Berthold, Heiner K; Gouni-Berthold, Ioanna; Böhm, Michael; Krone, Wilhelm; Bestehorn, Kurt P

    2009-01-01

    Background The benefit of statins for prevention of cardiovascular events in type 2 diabetes is established, but a gap exists between guideline recommendations and clinical practice. The aim of the study was to identify patient-related factors predicting statin prescription. Methods We assessed the quality of care in 51,640 patients with type 2 diabetes in a German diabetes registry. Patients were stratified according to primary and secondary prevention. Five-year risk for cardiovascular events was calculated in primary prevention patients. A multivariate adjusted logistic regression model was constructed to determine which parameters influenced statin prescription. Results 34% had established atherosclerotic disease and 25.5% received a statin. Prescription was significantly higher in the secondary compared to the primary prevention group (38.1% [95% CI 37.4–38.9%] vs. 18.5% [95% CI 18.0–19.0%], respectively). In primary prevention the odds for statin prescription increased with estimated cardiovascular risk (OR 1.17 per 5% increase in 5-year risk, 95% CI 1.11–1.22). Positive predictors for statin prescription were secondary prevention, hypertension, former smoking, baseline LDL-cholesterol, and microalbuminuria. The odds of receiving a statin had an inverted U-shaped relation with age (nadir, 66 years), age at first diagnosis of diabetes (nadir, 56 years), and body mass index (nadir, 32 kg/m2). The model predicted prescription in 70% of the patients correctly. Conclusion The majority of patients with type 2 diabetes are not receiving statins. The predominant factors determining statin prescription are the patient's prevention status and, in primary prevention, estimated cardiovascular risk. The results suggest that although physicians are aware of the general concept of cardiovascular risk, they fail to consistently implement guidelines. PMID:19439071

  7. Costs, outcomes and challenges for diabetes care in Spain

    PubMed Central

    2013-01-01

    Background Diabetes is becoming of increasing concern in Spain due to rising incidence and prevalence, although little information is known with regards to costs and outcomes. The information on cost of diabetes in Spain is fragmented and outdated. Our objective is to update diabetes costs, and to identify outcomes and quality of care of diabetes in Spain. Methods We performed systematic searches from secondary sources, including scientific literature and government data and reports. Results Diabetes Type II prevalence is estimated at 7.8%, and an additional 6% of the population is estimated to be undiagnosed. Four Spanish diabetes cost studies were analyzed to create a projection of direct costs in the NHS and productivity losses, estimating €5.1 billion for direct costs along with €1.5 billion for diabetes-related complications (2009) and labour productivity losses represented €2.8 billion. Glycemic control (glycolysated hemoglobin) is considered acceptable in 59% of adult Type II cases, in addition to 85% with HDL cholesterol ≥40mg/dl and 65% with blood pressure <140/90 mmHg, pointing to good intermediate outcomes. However, annual figures indicate that over half of the Type II diabetics are obese (BMI >30), 15% have diabetic retinopathy, 16% with microalbuminuria, and 15% with cardiovascular disease. Conclusions The direct health care costs (8% of the total National Health System expenditure) and the loss of labour productivity are high. The importance of a multi-sectoral approach in prevention and improvements in management of diabetes are discussed, along with policy considerations to help modify the disease course. PMID:23635075

  8. Insulin Pump Therapy Is Associated with Lower Rates of Retinopathy and Peripheral Nerve Abnormality

    PubMed Central

    Zabeen, Bedowra; Craig, Maria E.; Virk, Sohaib A.; Pryke, Alison; Chan, Albert K. F.; Cho, Yoon Hi; Benitez-Aguirre, Paul Z.; Hing, Stephen; Donaghue, Kim C.

    2016-01-01

    Objective To compare rates of microvascular complications in adolescents with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI). Research Design and Methods Prospective cohort of 989 patients (aged 12–20 years; diabetes duration >5 years) treated with CSII or MDI for >12 months. Microvascular complications were assessed from 2000–14: early retinopathy (seven-field fundal photography), peripheral nerve function (thermal and vibration threshold testing), autonomic nerve abnormality (heart rate variability analysis of electrocardiogram recordings) and albuminuria (albumin creatinine ratio/timed overnight albumin excretion). Generalized estimating equations (GEE) were used to examine the relationship between treatment and complications rates, adjusting for socio-economic status (SES) and known risk factors including HbA1c and diabetes duration. Results Comparing CSII with MDI: HbA1C was 8.6% [70mmol/mol] vs. 8.7% [72 mmol/mol]) (p = 0.7), retinopathy 17% vs. 22% (p = 0.06); microalbuminuria 1% vs. 4% (p = 0.07), peripheral nerve abnormality 27% vs. 33% (p = 0.108) and autonomic nerve abnormality 24% vs. 28% (p = 0.401). In multivariable GEE, CSII use was associated with lower rates of retinopathy (OR 0.66, 95% CI 0.45–0.95, p = 0.029) and peripheral nerve abnormality (OR 0.63, 95% CI 0.42–0.95, p = 0.026), but not albuminuria (OR 0.46, 95% CI 0.10–2.17, p = 0.33). SES was not associated with any of the complication outcomes. Conclusions In adolescents, CSII use is associated with lower rates of retinopathy and peripheral nerve abnormality, suggesting an apparent benefit of CSII over MDI independent of glycemic control or SES. PMID:27050468

  9. Metabolic syndrome definitions and components in predicting major adverse cardiovascular events after kidney transplantation.

    PubMed

    Prasad, G V Ramesh; Huang, Michael; Silver, Samuel A; Al-Lawati, Ali I; Rapi, Lindita; Nash, Michelle M; Zaltzman, Jeffrey S

    2015-01-01

    Metabolic syndrome (MetS) associates with cardiovascular risk post-kidney transplantation, but its ambiguity impairs understanding of its diagnostic utility relative to components. We compared five MetS definitions and the predictive value of constituent components of significant definitions for major adverse cardiovascular events (MACE) in a cohort of 1182 kidney transplant recipients. MetS definitions were adjusted for noncomponent traditional Framingham risk factors and relevant transplant-related variables. Kaplan-Meier, logistic regression, and Cox proportional hazards analysis were utilized. There were 143 MACE over 7447 patient-years of follow-up. Only the World Health Organization (WHO) 1998 definition predicted MACE (25.3 vs 15.5 events/1000 patient-years, P = 0.019). Time-to-MACE was 5.5 ± 3.5 years with MetS and 6.8 ± 3.9 years without MetS (P < 0.0001). MetS was independent of pertinent MACE risk factors except age and previous cardiac disease. Among MetS components, dysglycemia provided greatest hazard ratio (HR) for MACE (1.814 [95% confidence interval 1.26-2.60]), increased successively by microalbuminuria (HR 1.946 [1.37-2.75]), dyslipidemia (3.284 [1.72-6.26]), hypertension (4.127 [2.16-7.86]), and central obesity (4.282 [2.09-8.76]). MetS did not affect graft survival. In summary, although the WHO 1998 definition provides greatest predictive value for post-transplant MACE, most of this is conferred by dysglycemia and is overshadowed by age and previous cardiac disease. PMID:25207680

  10. Renal disease and hypertension in non-insulin-dependent diabetes mellitus.

    PubMed

    Ismail, N; Becker, B; Strzelczyk, P; Ritz, E

    1999-01-01

    Recent epidemiologic data demonstrate a dramatic increase in the incidence of end-stage renal disease (ESRD) in patients with non-insulin-dependent diabetes mellitus (NIDDM), thus dispelling the mistaken belief that renal prognosis is benign in NIDDM. Currently, the leading cause of ESRD in the United States, Japan, and in most industrialized Europe is NIDDM, accounting for nearly 90% of all cases of diabetes. In addition to profound economic costs, patients with NIDDM and diabetic nephropathy have a dramatically increased morbidity and premature mortality. NIDDM-related nephropathy varies widely among racial and ethnic groups, genders and lifestyles; and gender may interact with race to affect the disease progression. While the course of insulin-dependent diabetes mellitus (IDDM) progresses through well-defined stages, the natural history of NIDDM is less well characterized. NIDDM patients with coronary heart disease have a higher urinary albumin excretion rate at the time of diagnosis and follow-up. This greater risk may also be associated with hypertension and hyperlipidemia, and genes involved in blood pressure are obvious candidate genes for diabetic nephropathy. Hyperglycemia appears to be an important factor in the development of proteinuria in NIDDM, but its role and the influence of diet are not yet clear. Tobacco smoking can also be deleterious to the diabetic patient, and is also associated with disease progression. Maintaining euglycemia, stopping smoking and controlling blood pressure may prevent or slow the progression of NIDDM-related nephropathy and reduce extrarenal injury. Treatment recommendations include early screening for hyperlipidemia, appropriate exercise and a healthy diet. Cornerstones of management should also include: (1) educating the medical community and more widely disseminating data supporting the value of early treatment of microalbuminuria; (2) developing a comprehensive, multidisciplinary team approach that involves physicians

  11. Patients with Fabry Disease after Enzyme Replacement Therapy Dose Reduction Versus Treatment Switch

    PubMed Central

    Krämer, Johannes; Duning, Thomas; Lenders, Malte; Canaan-Kühl, Sima; Krebs, Alice; González, Hans Guerrero; Sommer, Claudia; Üçeyler, Nurcan; Niemann, Markus; Störk, Stefan; Schelleckes, Michael; Reiermann, Stefanie; Stypmann, Jörg; Brand, Stefan-Martin; Wanner, Christoph; Brand, Eva

    2014-01-01

    Because of the shortage of agalsidase-beta in 2009, many patients with Fabry disease were treated with lower doses or were switched to agalsidase-alfa. This observational study assessed end-organ damage and clinical symptoms during dose reduction or switch to agalsidase-alfa. A total of 105 adult patients with Fabry disease who had received agalsidase-beta (1.0 mg/kg body weight) for ≥1 year were nonrandomly assigned to continue this treatment regimen (regular-dose group, n=38), receive a reduced dose of 0.3–0.5 mg/kg (dose-reduction group, n=29), or switch to 0.2 mg/kg agalsidase-alfa (switch group) and were followed prospectively for 1 year. We assessed clinical events (death, myocardial infarction, severe arrhythmia, stroke, progression to ESRD); changes in cardiac, renal, and neurologic function; and Fabry-related symptoms (neuropathic pain, hypohidrosis, diarrhea, and disease severity scores). Organ function and Fabry-related symptoms remained stable in the regular-dose group. In contrast, estimated GFR decreased by about 3 ml/min per 1.73 m2 (P=0.01) in the dose-reduction group, and the median albumin-to-creatinine ratio increased from 114 (0–606) mg/g to 216 (0–2062) mg/g (P=0.03) in the switch group. Furthermore, mean Mainz Severity Score Index scores and frequencies of pain attacks, chronic pain, gastrointestinal pain, and diarrhea increased significantly in the dose-reduction and switch groups. In conclusion, patients receiving regular agalsidase-beta dose had a stable disease course, but dose reduction led to worsening of renal function and symptoms. Switching to agalsidase-alfa is safe, but microalbuminuria may progress and Fabry-related symptoms may deteriorate. PMID:24556354

  12. A meta-analysis of renal outcomes in living kidney donors

    PubMed Central

    Li, Sha-Sha; Huang, Yan-Mei; Wang, Min; Shen, Jian; Lin, Bing-Jie; Sui, Yi; Zhao, Hai-Lu

    2016-01-01

    Abstract Given the increased burden of end-stage renal disease (ESRD), renal outcomes of kidney donation by living donors are of particular interest. PubMed, ProQuest, MEDLINE, EMBASE, Chinese national knowledge infrastructure, and Wanfang databases were searched for clinical outcomes of living kidney donors (LKDs) including renal death, ESRD, proteinuria/albuminuria, and renal function after donation. We included 62 studies from 19 countries involving 114,783 kidney donors and nondonors to evaluate the renal consequences less than 6 months, 6 months to 5 years, 5 to 10 years, and 10 years onward after donation. The pooled data showed that uninephrectomy significantly decreased glomerular filtration rate and creatinine clearance rate in parallel with increased serum creatinine concentration (all P < 0.05). The drastic changes in renal function occurred within 6 months rather than 5 to 10 years after donation. Ten years and onward, rate of proteinuria/albuminuria increased gradually: microalbuminuria from 5.3% to 20.9%, proteinuria from 4.7% to 18.9%, and overt proteinuria from 2.4% to 5.7% (all P < 0.05). Prevalence of ESRD was 1.1%. All-cause mortality was 3.8% and all the renal deaths on average occurred 10 years postnephrectomy. LKDs might have aggravated glomerular filtration and creatinine clearance within 6 months after donation. Five years and onward, albuminuria, proteinuria, ESRD, and death might be the major concerns of LKDs. Long-term studies may clarify the survival time after donation. PMID:27310964

  13. Peripheral Neuropathy in Adolescents and Young Adults With Type 1 and Type 2 Diabetes From the SEARCH for Diabetes in Youth Follow-up Cohort

    PubMed Central

    Jaiswal, Mamta; Lauer, Abigail; Martin, Catherine L.; Bell, Ronny A.; Divers, Jasmin; Dabelea, Dana; Pettitt, David J.; Saydah, Sharon; Pihoker, Catherine; Standiford, Debra A.; Rodriguez, Beatriz L.; Pop-Busui, Rodica; Feldman, Eva L.

    2013-01-01

    OBJECTIVE To estimate the prevalence of and risk factors for diabetic peripheral neuropathy (DPN) in a pilot study among youth participating in the SEARCH for Diabetes in Youth study. RESEARCH DESIGN AND METHODS DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI) (examination for foot abnormalities, distal vibration perception, and ankle reflexes). An MNSI exam (MNSIE) score >2 is diagnostic for DPN. RESULTS The MNSIE was completed in 399 subjects, including 329 youth with type 1 diabetes (mean age 15.7 ± 4.3 years, duration 6.2 ± 0.9 years) and 70 with type 2 diabetes (mean age 21.6 ± 4.1 years, duration 7.6 ± 1.8 years). Glycated hemoglobin (A1C) was similar in both groups (8.8 ± 1.8% for type 1 vs. 8.5 ± 2.9% for type 2). The prevalence of DPN was significantly higher in youth with type 2 compared with those with type 1 diabetes (25.7 vs. 8.2%; P < 0.0001). In unadjusted analyses, diabetes type, older age, longer duration of diabetes, increased waist circumference, elevated blood pressure, lower HDL cholesterol, and presence of microalbuminuria (urinary albumin-to-creatinine ratio >30 mg/g) were associated with DPN. The association between diabetes type and DPN remained significant after adjustment for age and sex (odds ratio 2.29 [95% CI 1.05–5.02], P = 0.03). CONCLUSIONS DPN prevalence among youth with type 2 diabetes approached rates reported in adult populations with diabetes. Our findings suggest not only that youth with diabetes are at risk for DPN but also that many already show measurable signs of DPN. PMID:24144652

  14. Skin Advanced Glycation End Products Glucosepane and Methylglyoxal Hydroimidazolone Are Independently Associated With Long-term Microvascular Complication Progression of Type 1 Diabetes

    PubMed Central

    Sun, Wanjie; Cleary, Patricia; Gao, Xiaoyu; Sell, David R.; Lachin, John

    2015-01-01

    Six skin collagen advanced glycation end products (AGEs) originally measured near to the time of the Diabetes Control and Complications Trial (DCCT) closeout in 1993 may contribute to the “metabolic memory” phenomenon reported in the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. We have now investigated whether the addition of four originally unavailable AGEs (i.e., glucosepane [GSPNE], hydroimidazolones of methylglyoxal [MG-H1] and glyoxal, and carboxyethyl-lysine) improves associations with incident retinopathy, nephropathy, and neuropathy events during 13–17 years after DCCT. The complete 10-AGE panel is associated with three-step Early Treatment of Diabetic Retinopathy Study scale worsening of retinopathy (P ≤ 0.002), independent of either mean DCCT or EDIC study A1C level. GSPNE and fructose-lysine (furosine [FUR]) correlate with retinopathy progression, independently of A1C level. The complete panel also correlates with microalbuminuria (P = 0.008) and FUR with nephropathy independently of A1C level (P ≤ 0.02). Neuropathy correlates with the complete panel despite adjustment for A1C level (P ≤ 0.005). MG-H1 and FUR are dominant, independent of A1C level (P < 0.0001), whereas A1C loses significance after adjustment for the AGEs. Overall, the added set of four AGEs enhances the association of the original panel with progression risk of retinopathy and neuropathy (P < 0.04) but not nephropathy, while GSPNE and MG-H1 emerge as the principal new risk factors. Skin AGEs are robust long-term markers of microvascular disease progression, emphasizing the importance of early and sustained implementation of intensive therapy. PMID:25187362

  15. Skin advanced glycation end products glucosepane and methylglyoxal hydroimidazolone are independently associated with long-term microvascular complication progression of type 1 diabetes.

    PubMed

    Genuth, Saul; Sun, Wanjie; Cleary, Patricia; Gao, Xiaoyu; Sell, David R; Lachin, John; Monnier, Vincent M

    2015-01-01

    Six skin collagen advanced glycation end products (AGEs) originally measured near to the time of the Diabetes Control and Complications Trial (DCCT) closeout in 1993 may contribute to the "metabolic memory" phenomenon reported in the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. We have now investigated whether the addition of four originally unavailable AGEs (i.e., glucosepane [GSPNE], hydroimidazolones of methylglyoxal [MG-H1] and glyoxal, and carboxyethyl-lysine) improves associations with incident retinopathy, nephropathy, and neuropathy events during 13-17 years after DCCT. The complete 10-AGE panel is associated with three-step Early Treatment of Diabetic Retinopathy Study scale worsening of retinopathy (P ≤ 0.002), independent of either mean DCCT or EDIC study A1C level. GSPNE and fructose-lysine (furosine [FUR]) correlate with retinopathy progression, independently of A1C level. The complete panel also correlates with microalbuminuria (P = 0.008) and FUR with nephropathy independently of A1C level (P ≤ 0.02). Neuropathy correlates with the complete panel despite adjustment for A1C level (P ≤ 0.005). MG-H1 and FUR are dominant, independent of A1C level (P < 0.0001), whereas A1C loses significance after adjustment for the AGEs. Overall, the added set of four AGEs enhances the association of the original panel with progression risk of retinopathy and neuropathy (P < 0.04) but not nephropathy, while GSPNE and MG-H1 emerge as the principal new risk factors. Skin AGEs are robust long-term markers of microvascular disease progression, emphasizing the importance of early and sustained implementation of intensive therapy. PMID:25187362

  16. [New features in the recommendations of the Second Hungarian Therapeutic Consensus Conference].

    PubMed

    Pados, Gyula; Karádi, István; Paragh, György; Halmy, László; Jermendy, György; Zámolyi, Károly; Kiss, István

    2006-07-16

    The First Hungarian Therapeutic Consensus Conference took place on 3rd Nov. 2003 with the participation of 9 medical societies. Over the past 2 years the results of new major studies have been published and the American ATP III has also updated its guidelines issued in 2004. Based on the above proposals, the Second Hungarian Therapeutic Consensus Conference held on 3rd Nov. 2005 partly confirmed its earlier suggestions, but made some changes as well. Within the high risk category the Conference optionally created a very high risk group from those patients who - in addition to their cardiovascular disease--have either diabetes or metabolic syndrome or acut coronaria syndrome or who are chain smokers. We have included - as a complement - into the asymptomatic high risk category such newly emerging risk factors, one of which already in itself means high risk: ankle/arm index < or = 0.9, GFR <60 ml/min, microalbuminuria (30-300 mg), preclinical atherosclerosis (plaque). Besides, 4 other risk factors were also categorised such as Lp/a (> or = 30 mg/dl), CRP (> or = 3mg/l), homocysteine (> or = 12 micromol), familiarity--atherogenic gene constellation, but only the presence of at least two of these verify high risk. In very high risk group the goals of 3.5 mmol/l and 1.8 mmol/l were determined as therapeutic option. The goal in obese patients--expressed earlier only in BMI--can now be equally determined by the abdominal circumference (94 cm for men, 80 cm for women respectively). ACE inhibitors were recommended earlier as a preventive therapy in case of dysfunction of the left ventricle, while at present they are suggested for all patients with cardiovascular disease. In the recent recommendations guidelines related to nutrition, smoking, exercise have also been included. PMID:16999015

  17. Complications and comorbidities of T2DM in adolescents: findings from the TODAY clinical trial.

    PubMed

    Tryggestad, Jeanie B; Willi, Steven M

    2015-03-01

    With the rise in childhood obesity, type 2 diabetes mellitus (T2DM) has been recognized to occur in adolescents with increasing frequency. Although much is known about T2DM in adults, few studies have examined the treatment and complications of T2DM in youth. The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study was designed to evaluate the efficacy of various treatments and provided a unique opportunity to study the disease progression and appearance of complications in a pediatric cohort with recent onset of the disease. In the TODAY study, hypertension was present in 11.6% of the population at baseline and increased to 33.8% by the end of the study. Prevalence of high-risk LDL-cholesterol rose from 4.5% at baseline to 10.7% at the end of the study. Microalbuminuria was found in 6.3% of the cohort at baseline and increased to 16.6%. Retinopathy was not assessed upon entry into TODAY, but was present in 13.9% of the TODAY cohort at the end of the study. Experience to date indicates that these complications and comorbidities are similar to those seen in adults, but occur on an accelerated timeline. The early manifestation of diabetes complications in youth-onset T2DM suggests that this group will be burdened with the tangible consequences of cardiovascular disease, nephropathy, and retinopathy in the third and fourth decades of life. It is hoped that through an early, aggressive approach to treatment and prevention, we may be able to curb the onset and progression of these potentially devastating outcomes. PMID:25468310

  18. An audit of blood pressure control in clinical practice in Thailand.

    PubMed

    Buranakitjaroen, Peera

    2006-11-01

    To gain "real life" data on the BP control of hypertensive patients in clinical practice in Thailand, a multi-centre cross-sectional study was carried out. Demographic data, cardiovascular risk factors, and antihypertensive regimens were collected. A total of 1,259 patients were enrolled between October 2003 and December 2003, 924 cases from 6 regions of different levels of health care and 335 cases from 4 medical training centres and a tertiary care hospital in Bangkok. Eighty one percent of the patients, age ranged from 45 to 75 years (61.2 +/- 11.6). Forty four percent of patients in audit had a BP < 140/90 mm Hg and only 12.3% of DM patients had attained a JNC 7 recommended BP target of 130/80 mm Hg. Hypercholesterolaemia (65.3%) was the most prevalent risk followed by DM (27. 7%). Antihypertensive drug used at the initial visit compared with the last visit were ARB (0.9% vs 6.1%), ACE Inhibitors (30.1% vs 40.0%), beta-blockers (27.3% vs 46. 7%), CCBs (23.2% vs 37.7%), and diuretics (46.0% vs 53.5%). In addition, the numbers of antihypertensive drugs used at the initial visit compared with the last clinic visit were one drug (62.0% vs 33.0%), two drugs (29.7% vs 45.8%), three drugs or more (3.7% vs 20.4%), with an average of 1.3 +/- 0.6 vs 1.9 +/- 0.8 drugs per patient. Two thirds of patients (66.2%) were on 2 or more antihypertensive drugs. Among the type 2 DM, 5% had records of microalbuminuria, and 50.6% and 9.8% were receiving ACE Inhibitors and ARBs, respectively at the last clinic visit. PMID:17718243

  19. Auditing paediatric diabetes care and the impact of a specialist nurse trained in paediatric diabetes

    PubMed Central

    Cowan, F; Warner, J; Lowes, L; Riberio, J; Gregory, J

    1997-01-01

    Accepted 13 May 1997
 AIMS—To define outcome measures for auditing the clinical care of children and adolescents with insulin dependent diabetes mellitus (IDDM) and to assess the benefit of appointing a dedicated paediatric trained diabetes specialist nurse (PDSN).
METHODS—Retrospective analysis of medical notes and hospital records. Glycaemic control, growth, weight gain, microvascular complications, school absence, and the proportion of children undergoing an annual clinical review and diabetes education session were assessed. The effect of the appointment of a PDSN on the frequency of hospital admission, length of inpatient stay, and outpatient attendance was evaluated.
RESULTS—Children with IDDM were of normal height and grew well for three years after diagnosis, but grew suboptimally thereafter. Weight gain was above average every year after diagnosis. Glycaemic control was poor at all ages with only 16% of children having an acceptable glycated haemoglobin. Eighty five per cent of patients underwent a formal annual clinical review, of whom 16% had background retinopathy and 20% microalbuminuria in one or more samples. After appointing the PDSN the median length of hospital stay for newly diagnosed patients decreased from five days to one day, with 10of 24 children not admitted. None of the latter was admitted during the next year. There was no evidence of the PDSN affecting the frequency of readmission or length of stay of children with established IDDM. Non-attendance at the outpatient clinic was reduced from a median of 19 to 10%.
CONCLUSIONS—Outcome measures for evaluating the care of children with IDDM can be defined and evaluated. Specialist nursing support markedly reduces the length of hospital stay of newly diagnosed patients without sacrificing the quality of care.

 PMID:9301347

  20. A Meta-Analysis of Randomized Controlled Trials of Yiqi Yangyin Huoxue Method in Treating Diabetic Nephropathy.

    PubMed

    Ou, Jiao Ying; Huang, Di; Wu, Yan Sheng; Xu, Lin; He, Fei; Wang, Hui Ling; Shi, Li Qiang; Wan, Qiang; He, Li Qun; Dong Gao, Jian

    2016-01-01

    Objective. The purpose of this systematic review is to evaluate the evidence of Yiqi Yangyin Huoxue Method for diabetic nephropathy. Methods. 11 electronic databases, through September 2015, were searched to identify randomized controlled trials of Yiqi Yangyin Huoxue Method for diabetic nephropathy. The quality of the included trials was assessed using the Jadad scale. Results. 26 randomized controlled trials were included in our review. Of all the included trials, most of them were considered as high quality. The aggregated results suggested that Yiqi Yangyin Huoxue Method is beneficial to diabetic nephropathy in bringing down the microalbuminuria (SMD = -0.98, 95% CI -1.22 to -0.74), serum creatinine (SMD = -0.56, 95% CI -0.93 to -0.20), beta-2 microglobulin (MD = 0.06, 95% CI 0.01 to 0.12), fasting plasma glucose (MD = -0.35, 95% CI -0.62 to -0.08), and 2-hour postprandial blood glucose (MD = 1.13, 95% CI 0.07 to 2.20), but not in decreasing blood urea nitrogen (SMD = -0.72, 95% CI -1.47 to 0.02) or 2-hour postprandial blood glucose (SMD = -0.48, 95% CI -1.01 to 0.04). Conclusions. Yiqi Yangyin Huoxue Method should be a valid complementary and alternative therapy in the management of diabetic nephropathy, especially in improving UAER, serum creatinine, fasting blood glucose, and beta-2 microglobulin. However, more studies with long follow-up are warrant to confirm the current findings. PMID:27313643

  1. A Meta-Analysis of Randomized Controlled Trials of Yiqi Yangyin Huoxue Method in Treating Diabetic Nephropathy

    PubMed Central

    Ou, Jiao Ying; Huang, Di; Wu, Yan Sheng; Xu, Lin; He, Fei; Wang, Hui Ling; Shi, Li Qiang; Wan, Qiang; He, Li Qun; Dong Gao, Jian

    2016-01-01

    Objective. The purpose of this systematic review is to evaluate the evidence of Yiqi Yangyin Huoxue Method for diabetic nephropathy. Methods. 11 electronic databases, through September 2015, were searched to identify randomized controlled trials of Yiqi Yangyin Huoxue Method for diabetic nephropathy. The quality of the included trials was assessed using the Jadad scale. Results. 26 randomized controlled trials were included in our review. Of all the included trials, most of them were considered as high quality. The aggregated results suggested that Yiqi Yangyin Huoxue Method is beneficial to diabetic nephropathy in bringing down the microalbuminuria (SMD = −0.98, 95% CI −1.22 to −0.74), serum creatinine (SMD = −0.56, 95% CI −0.93 to −0.20), beta-2 microglobulin (MD = 0.06, 95% CI 0.01 to 0.12), fasting plasma glucose (MD = −0.35, 95% CI −0.62 to −0.08), and 2-hour postprandial blood glucose (MD = 1.13, 95% CI 0.07 to 2.20), but not in decreasing blood urea nitrogen (SMD = −0.72, 95% CI −1.47 to 0.02) or 2-hour postprandial blood glucose (SMD = −0.48, 95% CI −1.01 to 0.04). Conclusions. Yiqi Yangyin Huoxue Method should be a valid complementary and alternative therapy in the management of diabetic nephropathy, especially in improving UAER, serum creatinine, fasting blood glucose, and beta-2 microglobulin. However, more studies with long follow-up are warrant to confirm the current findings. PMID:27313643

  2. 2012 update on diabetic kidney disease: the expanding spectrum, novel pathogenic insights and recent clinical trials.

    PubMed

    Fernández Fernández, B; Elewa, U; Sánchez-Niño, M D; Rojas-Rivera, J E; Martin-Cleary, C; Egido, J; Ortiz, A

    2012-08-01

    Diabetic kidney disease (DKD) is the most frequent cause of end-stage renal disease in western countries. This implies that current methods based of renin angiotensin aldosterone system (RAAS) targeting for preventing, slowing or promoting regression of DKD are insufficient. Podocyte injury and albuminuria are thought to be key events in DKD. Indeed several DKD stages are recognized based on the magnitude of albuminuria. However, the spectrum of DKD has recently expanded, as lack of significant albuminuria is present in 30% of diabetics with kidney function impairment. This may result from the widespread use of drugs targeting the RAAS. However, it may also indicate that additional pathogenic factors contribute to renal function deterioration despite control of albuminuria. In this regard, double blockade of the RAAS is more effective in reducing albuminuria that blockade of a single component. However, clinical trials assessing double blockade for renal function preservation have been disappointing and raised safety issues. Non-biased -omics approaches have uncovered alternative therapeutic targets, including the cytokine TRAIL, the MIF receptor CD74 and the proapoptotic intracellular protein BASP1. In addition, urinary proteomics has uncovered a peptidomic fingerprint for DKD progression that precedes the onset of microalbuminuria. Studies are underway to validate this fingerprint for early treatment of high risk patients. Recent clinical trials suggest a potential role of bardoxolone methyl to improve renal function in advanced DKD, while trials of avosentan, pirfenidone, sulodexide and pyridoxamine have been disappointing and further data are needed for paricalcitol and vitamin D, newer generation endothelin receptor antagonists and pentoxifylline. PMID:22805616

  3. Akt Links Insulin Signaling to Albumin Endocytosis in Proximal Tubule Epithelial Cells.

    PubMed

    Coffey, Sam; Costacou, Tina; Orchard, Trevor; Erkan, Elif

    2015-01-01

    Diabetes mellitus (DM) has become an epidemic, causing a significant decline in quality of life of individuals due to its multisystem involvement. Kidney is an important target organ in DM accounting for the majority of patients requiring renal replacement therapy at dialysis units. Microalbuminuria (MA) has been a valuable tool to predict end-organ damage in DM but its low sensitivity has driven research efforts to seek other alternatives. Albumin is taken up by albumin receptors, megalin and cubilin in the proximal tubule epithelial cells. We demonstrated that insulin at physiological concentrations induce albumin endocytosis through activation of protein kinase B (Akt) in proximal tubule epithelial cells. Inhibition of Akt by a phosphorylation deficient construct abrogated insulin induced albumin endocytosis suggesting a role for Akt in insulin-induced albumin endocytosis. Furthermore we demonstrated a novel interaction between Akt substrate 160kDa (AS160) and cytoplasmic tail of megalin. Mice with type 1 DM (T1D) displayed decreased Akt, megalin, cubilin and AS160 expression in their kidneys in association with urinary cubilin shedding preceding significant MA. Patients with T1D who have developed MA in the EDC (The Pittsburgh Epidemiology of Diabetes Complications) study demonstrated urinary cubilin shedding prior to development of MA. We hypothesize that perturbed insulin-Akt cascade in DM leads to alterations in trafficking of megalin and cubilin, which results in urinary cubilin shedding as a prelude to MA in early diabetic nephropathy. We propose that utilization of urinary cubilin shedding, as a urinary biomarker, will allow us to detect and intervene in diabetic nephropathy (DN) at an earlier stage. PMID:26465605

  4. 24-hour ambulatory blood pressure and renal disease in young subjects with type I diabetes.

    PubMed

    Garg, S K; Chase, H P; Icaza, G; Rothman, R L; Osberg, I; Carmain, J A

    1997-01-01

    Twenty-four hour ambulatory blood pressure (ABP) was evaluated in 150 teenage and young adults with insulin-dependent diabetes mellitus (IDDM) to define high-risk subjects who are likely to develop early diabetic nephropathy. Their age range was 16-28 years with diabetes of 3.5-25.8 years duration. All subjects had office blood pressure (BP) measured, wore an ABP monitor for 24 h, and collected two or more timed urine samples for albumin excretion rates (AERs). Eighty-six subjects had no elevation of AER (< 7.6 micrograms/min), 29 subjects had borderline elevations (7.6-20 micrograms/min), 24 subjects had microalbuminuria (20.1-200 micrograms/min), and 11 had macroalbuminuria (> 200 micrograms/min). Age, gender, duration of diabetes, and single office BP readings were similar in the four groups (p > 0.05, logistic regression). All 24-h ABP parameters were significantly higher in subjects with diabetes having AER values greater than 7.6 micrograms/min when compared with healthy age- and gender-matched nondiabetic controls (p < 0.05, Dunnett's t test). The percent of nighttime systolic and diastolic ABP readings above the 90th percentile of normal for age, gender, and race and the percent of readings in the hypertensive range (> 140/90) were significantly related with AERs (p < 0.01; logistic regression). A higher percentage of ABP values above the 90th percentile for age, gender, and ethnic group or of ABP readings above hypertensive levels (> or = 140/90) are associated with diabetic renal disease. PMID:9334907

  5. Effect of birth weight on adulthood renal function: A bias-adjusted meta-analytic approach.

    PubMed

    Das, Sumon Kumar; Mannan, Munim; Faruque, Abu Syed Golam; Ahmed, Tahmeed; McIntyre, Harold David; Al Mamun, Abdullah

    2016-07-01

    While the association between low birth weight (LBW; <2500 g) and development of adult chronic renal disease (CKD) is inconsistently reported, less information is available regarding association of high birth weight (HBW; ≥4000 g) with CKD. We undertook a systematic review and meta-analysis on studies published before 30 September 2015 and report associations between birth weight and renal function. Blood (glomerular filtration rate (GFR)) and urine (microalbuminuria/albumin excreation rate (AER)/urinary albumin creatinine ratio (ACR)) parameters were used to define CKD. Three different effect size estimates were used (odds ratio, regression coefficient and mean difference). The odds of developing CKD in the life course among those born LBW was 1.77 (95% CI: 1.42, 2.20) times and 1.68 (1.27, 2.33) times, assessed by blood and urine parameters respectively. Higher risk was also observed among Asian and Australian populations (blood: OR 2.68; urine: OR 2.28), individuals aged ≤30 years (blood: OR 2.30; urine: OR 1.26), and ≥50 years (blood: OR 3.66; urine: OR 3.10), people with diabetes (blood: OR 2.51), and aborigines (urine: OR 2.32). There was no significant association between HBW and CKD. For every 1 kg increase in BW, the estimated GFR increased by 2.09 mL/min per 1.73 m(2) (1.33-2.85), and it was negatively associated with LogACR (ß -0.07, 95% CI: -0.14, 0.00). LBW inborn had lower mean GFR -4.62 (-7.10, -2.14) compared with normal BW. Findings of this study suggest that LBW increased the risk of developing CKD, and HBW did not show any significant impact. PMID:26807855

  6. A cardiovascular educational intervention for primary care professionals in Spain: positive impact in a quasi-experimental study

    PubMed Central

    Gil-Guillén, Vicente; Hermida, Enrique; Pita-Fernandez, Salvador; Palazon-Bru, Antonio; Durazo-Arvizu, Ramon; Pallares-Carratala, Vicente; Orozco-Beltran, Domingo; Carratala-Munuera, Concepcion; Lopez-Pineda, Adriana; Navarro, Jorge

    2015-01-01

    Background Routine general practice data collection can help identify patients at risk of cardiovascular disease. Aim To determine whether a training programme for primary care professionals improves the recording of cardiovascular disease risk factors in electronic health records. Design and setting A quasi-experimental study without random assignment of professionals. This was an educational intervention study, consisting of an online-classroom 1-year training programme, and carried out in the Valencian community in Spain. Method The prevalence rates of recording of cardiovascular factors (recorded every 6 months over a 4-year period) were compared between intervention and control group. Clinical relevance was calculated by absolute risk reduction (ARR), relative risk reduction (RRR), and number of patients needed-to-attend (NNA), to avoid under-recording, with their 95% confidence intervals (CIs). Linear regression models were used for each of the variables. Results Of the 941 professionals initially registered, 78.1% completed the programme. The ARR ranged from 1.87% (95% CI = 1.79 to 1.94) in the diagnosis of diabetes to 15.27% (95% CI = 15.14 to 15.40) in the recording of basal blood glucose. The NNA ranged from 7 in blood pressure, cholesterol, and blood glucose recording to 54 in the diagnosis of diabetes. The RRR ranged from 26.7% in the diagnosis of diabetes to 177.1% in the recording of the Systematic Coronary Risk Evaluation (SCORE). The rates of change were greater in the intervention group and the differences were significant for recording of cholesterol (P<0.001), basal blood glucose (P<0.001), smoking (P<0.001), alcohol (P<0.001), microalbuminuria (P = 0.001), abdominal circumference (P<0.001), and SCORE (P<0.001). Conclusion The education programme had a beneficial effect at the end of the follow-up that was significant and clinically relevant. PMID:25548314

  7. Discovery and verification of urinary peptides in type 2 diabetes mellitus with kidney injury.

    PubMed

    Fu, Guangzhen; Du, Ye; Chu, Lina; Zhang, Man

    2016-06-01

    Varying degrees of renal injury could lead to different changes in urinary protein composition. We want to find urinary candidate peptide biomarkers in type 2 diabetic patients with different extents of kidney injury. Two sets of patients were recruited. Discovery set: weak cationic-exchange magnetic beads coupled with matrix-assisted laser desorption ionization time-of-flight mass spectrometry were used to profile the low-molecular weight peptidome in urine samples from type 2 diabetes patients with normoalbuminura and microalbuminuria. The differently expressed urinary peptides were screened by ClinProTools2.1 bioinformatics software and identified through nano-liquid chromatography-tandem mass spectrometry. Verification set: the above screened urinary peptides were validated by use matrix-assisted laser desorption ionization time-of-flight mass spectrometry on another group of type 2 diabetes patients with different extents use of kidney injury. In the screening and identification stages, seven urinary peptides were selected as the most promising biomarker candidates, and they were identified as fragments of vitronectin precursor, isoform 1 of fibrinogen alpha chain precursor, prothrombin precursor and inter-alpha-trypsin inhibitor heavy chain H4. The diagnostic efficacy of these urinary peptides was evaluated by area under the receiver operating characteristic curve, and they were 0.767, 0.768, 0.868, 0.910, 0.860, 0.843, and 0.865, respectively. In the verification stage, m/z 1743.9, 2154, 2175.5, and 2184.9 were decreased as albumin-to-creatinine (Alb/Cre) increased and m/z 2231.1, 2430.8, and 2756.1 were elevated as Alb/Cre rose. These small molecule peptides are related to type 2 diabetes kidney damage, and they may play an important role in monitoring type 2 diabetes. PMID:26846977

  8. [Circadian variations of urinary excretions of microproteins and N-acetyl-beta-D-glucosaminidase (NAG) during the ordinary activity day].

    PubMed

    Suzuki, M; Ikawa, S

    1990-06-01

    The present investigation was performed to confirm the relationship between the circadian variation of microproteinuria and physical activity. Urine samples from 10 normal male volunteers, collected during six consecutive 4-h periods, were examined for albumin, alpha 1-, beta 2-microglobulin, NAG, electrolytes and hormones. The fluctuations in heart rate (HR) and blood pressure (BP) over 24-h were measured at 30-min and 1-h intervals, respectively. Energy expenditure (EE) was calculated using the equation of regression between HR and oxygen uptake measured on another day. The variations of HR (delta HR) and EE (delta EE) based on a 24-h average (bpm and kcal/kg/h) were used as indices of change in physical activity during an ordinary day. The correlation coefficients between delta HR and the variations of albumin (delta Alb) and beta 2-microglobulin (delta beta 2M) from the 24-h average (micrograms/h.cr 1 mg) were 0.619 and 0.670 (p less than 0.001), respectively. Increased excretions of both glomerular and tubular proteins were correlated with the increase in HR and/or EE during daytime activity. During rest time at night, the variations in alpha 1M, beta 2M and NAG excretion were different from the variations in albumin. A temporary inhibition of tubular protein excretion was observed only in the early morning (04:00-08:00), although albumin excretion was inhibited throughout the nighttime. These findings suggested that physical activity may influence the diurnal variations in protein excretions, that albuminuria may be more sensitive to daytime activity, and that fluctuation of tubular protein excretion may be preferably controlled by an endogenous mechanism. Timed overnight or first-morning urine may be recommendable as a sample for determination of microalbuminuria for screening of clinical diabetic nephropathy. PMID:1699014

  9. Clinical significance of urinary liver-type fatty acid binding protein at various stages of nephropathy.

    PubMed

    Viswanathan, V; Sivakumar, S; Sekar, V; Umapathy, D; Kumpatla, S

    2015-01-01

    This cross-sectional study was to evaluate the levels of urinary liver-type fatty acid binding protein (u-LFABP pg/mg urine creatinine ratio) at different stages of diabetic nephropathy and to see its correlation with other clinical parameters in South Indian patients with type 2 diabetes mellitus (T2DM). A total of 65 (M: F; 42:23) T2DM subjects were divided into three groups, and were compared with 13 (M: F; 3:10) nondiabetic controls. The study groups were as follows: normoalbuminuric (n = 22), microalbuminuric (n = 22) and macroalbuminuric (n = 21). Estimated glomerular filtration rate (eGFR) was calculated using Cockcroft and Gault formula. u-LFABP levels in spot urine samples were measured with a solid phase enzyme linked immunosorbent assay. This study showed that u-LFABP levels were undetectable in healthy controls and was very low in the normoalbuminuric subjects. Elevated levels of u-LFABP are evident from the microalbuminuric stage indicating tubular damage. The levels of u-LFABP increased gradually with declining renal function. Geometric mean (95% confidence interval) for normoalbuminuria was 0.65 (0.47-0.97), microalbuminuria was 0.99 (0.55-1.97) and macroalbuminuria was 5.16 (1.8-14.5), (P = 0.005). In conclusion, u-LFABP levels were elevated in patients with reduced eGFR and showed a positive correlation with systolic blood pressure and protein to creatinine ratio in the total study subjects. PMID:26628791

  10. Clinical significance of urinary liver-type fatty acid binding protein at various stages of nephropathy

    PubMed Central

    Viswanathan, V.; Sivakumar, S.; Sekar, V.; Umapathy, D.; Kumpatla, S.

    2015-01-01

    This cross-sectional study was to evaluate the levels of urinary liver-type fatty acid binding protein (u-LFABP pg/mg urine creatinine ratio) at different stages of diabetic nephropathy and to see its correlation with other clinical parameters in South Indian patients with type 2 diabetes mellitus (T2DM). A total of 65 (M: F; 42:23) T2DM subjects were divided into three groups, and were compared with 13 (M: F; 3:10) nondiabetic controls. The study groups were as follows: normoalbuminuric (n = 22), microalbuminuric (n = 22) and macroalbuminuric (n = 21). Estimated glomerular filtration rate (eGFR) was calculated using Cockcroft and Gault formula. u-LFABP levels in spot urine samples were measured with a solid phase enzyme linked immunosorbent assay. This study showed that u-LFABP levels were undetectable in healthy controls and was very low in the normoalbuminuric subjects. Elevated levels of u-LFABP are evident from the microalbuminuric stage indicating tubular damage. The levels of u-LFABP increased gradually with declining renal function. Geometric mean (95% confidence interval) for normoalbuminuria was 0.65 (0.47–0.97), microalbuminuria was 0.99 (0.55–1.97) and macroalbuminuria was 5.16 (1.8–14.5), (P = 0.005). In conclusion, u-LFABP levels were elevated in patients with reduced eGFR and showed a positive correlation with systolic blood pressure and protein to creatinine ratio in the total study subjects. PMID:26628791

  11. Hepatitis C virus as a systemic disease: reaching beyond the liver.

    PubMed

    Gill, Kirat; Ghazinian, Hasmik; Manch, Richard; Gish, Robert

    2016-05-01

    Chronic hepatitis C (CHC) is associated with multiple extrahepatic manifestations that may impact infected patients. The mechanisms through which these develop include those which are immunological, in which the chronic persistence of virus leads to the circulation of immune complexes (mixed cryoglobulinemia) and other autoimmune phenomena, and those which are virological and related to the extrahepatic tropism of the virus to other tissues. It is estimated that 40-74 % of patients with CHC may develop at least one extrahepatic manifestation during the course of the disease. Extrahepatic syndromes may represent the first signal of hepatitis C infection in some patients. CHC is associated with a four-fold increased risk of insulin resistance and type 2 diabetes mellitus; with cardiovascular disease in 17-37 % of patients; and with increased risk for cerebrovascular deaths, with a biological gradient of cerebrovascular mortality correlating with an increasing serum viral load. CHC is also associated with lymphoproliferative disorders, particularly non-Hodgkin B-cell lymphoma. The kidney is involved in 35-60 % of patients with CHC-associated mixed cryoglobulinemia. The prevalent type of glomerulonephritis associated with mixed cryoglobulinemia is membranoproliferative glomerulonephritis. In 30 % of cases, renal involvement begins with a nephritis syndrome and acute renal failure, while in 55 % there is only mild hematuria, microalbuminuria, proteinuria and renal insufficiency. CHC is also associated with cognitive impairment, especially in memory and concentration. Thus, extrahepatic CHC manifestations involve multiple organ systems outside the liver linked to a variety of comorbidities which may lead to significantly increased mortality from non-liver-related events. PMID:26660706

  12. Drug Targets for Oxidative Podocyte Injury in Diabetic Nephropathy

    PubMed Central

    Usman, Muhammad

    2015-01-01

    Diabetic nephropathy (DN) is one the most prevalent chronic complications of diabetes mellitus that affects as much as one-third of diabetic patients irrespective of the type of diabetes. Hyperglycemia is the key trigger for DN that initiates a number of microscopic and ultramicroscopic changes in kidney architecture. Microscopic changes include thickening of the glomerular basement membrane (GBM), tubular basement membrane (TBM), mesangial proliferation, arteriosclerosis, and glomerulotubular junction abnormalities (GTJA). Among the ultramicroscopic changes, effacement of podocytes and decrease in their density seem to be the centerpiece of DN pathogenesis. These changes in kidney architecture then produce functional deficits, such as microalbuminuria and decreased glomerular filtration rate (GFR). Among several mechanisms involved in inflicting damage to podocytes, injuries sustained by increased oxidative stress turns out to be the most important mechanism. Different variables that are included in increased production of reactive oxygen species (ROS) include a hyperglycemia-induced reduction in glutathione (GSH), nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activation via hyperglycemia, advanced glycation end products (AGEs), protein kinase C (PKC), and renin-angiotensin-aldosterone system (RAAS). Unfortunately, control of podocyte injury hasn’t received much attention as a treatment approach for DN. Therefore, this review article is mainly concerned with the exploration of various treatment options that might help in decreasing the podocyte injury, mainly by reducing the level of NADPH oxidase-mediated generation of ROS. This article concludes with a view that certain NADPH oxidase inhibitors, RAAS inhibitors, statins, antidiabetic drugs, and antioxidant vitamins might be useful in decreasing podocyte injury and resultant structural and functional kidney impairments in DN. PMID:26798569

  13. Drug Targets for Oxidative Podocyte Injury in Diabetic Nephropathy.

    PubMed

    Bhatti, Adnan Bashir; Usman, Muhammad

    2015-01-01

    Diabetic nephropathy (DN) is one the most prevalent chronic complications of diabetes mellitus that affects as much as one-third of diabetic patients irrespective of the type of diabetes. Hyperglycemia is the key trigger for DN that initiates a number of microscopic and ultramicroscopic changes in kidney architecture. Microscopic changes include thickening of the glomerular basement membrane (GBM), tubular basement membrane (TBM), mesangial proliferation, arteriosclerosis, and glomerulotubular junction abnormalities (GTJA). Among the ultramicroscopic changes, effacement of podocytes and decrease in their density seem to be the centerpiece of DN pathogenesis. These changes in kidney architecture then produce functional deficits, such as microalbuminuria and decreased glomerular filtration rate (GFR). Among several mechanisms involved in inflicting damage to podocytes, injuries sustained by increased oxidative stress turns out to be the most important mechanism. Different variables that are included in increased production of reactive oxygen species (ROS) include a hyperglycemia-induced reduction in glutathione (GSH), nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activation via hyperglycemia, advanced glycation end products (AGEs), protein kinase C (PKC), and renin-angiotensin-aldosterone system (RAAS). Unfortunately, control of podocyte injury hasn't received much attention as a treatment approach for DN. Therefore, this review article is mainly concerned with the exploration of various treatment options that might help in decreasing the podocyte injury, mainly by reducing the level of NADPH oxidase-mediated generation of ROS. This article concludes with a view that certain NADPH oxidase inhibitors, RAAS inhibitors, statins, antidiabetic drugs, and antioxidant vitamins might be useful in decreasing podocyte injury and resultant structural and functional kidney impairments in DN. PMID:26798569

  14. Albumin stimulates renal tubular inflammation through an HSP70-TLR4 axis in mice with early diabetic nephropathy

    PubMed Central

    Jheng, Huei-Fen; Tsai, Pei-Jane; Chuang, Yi-Lun; Shen, Yi-Ting; Tai, Ting-An; Chen, Wen-Chung; Chou, Chuan-Kai; Ho, Li-Chun; Tang, Ming-Jer; Lai, Kuei-Tai A.; Sung, Junne-Ming; Tsai, Yau-Sheng

    2015-01-01

    ABSTRACT Increased urinary albumin excretion is not simply an aftermath of glomerular injury, but is also involved in the progression of diabetic nephropathy (DN). Whereas Toll-like receptors (TLRs) are incriminated in the renal inflammation of DN, whether and how albumin is involved in the TLR-related renal inflammatory response remains to be clarified. Here, we showed that both TLR2 and TLR4, one of their putative endogenous ligands [heat shock protein 70 (HSP70)] and nuclear factor-κB promoter activity were markedly elevated in the kidneys of diabetic mice. A deficiency of TLR4 but not of TLR2 alleviated albuminuria, tubulointerstitial fibrosis and inflammation induced by diabetes. The protection against renal injury in diabetic Tlr4−/− mice was associated with reduced tubular injuries and preserved cubilin levels, rather than amelioration of glomerular lesions. In vitro studies revealed that albumin, a stronger inducer than high glucose (HG), induced the release of HSP70 from proximal tubular cells. HSP70 blockade ameliorated albumin-induced inflammatory mediators. HSP70 triggered the production of inflammatory mediators in a TLR4-dependent manner. Moreover, HSP70 inhibition in vivo ameliorated diabetes-induced albuminuria, inflammatory response and tubular injury. Finally, we found that individuals with DN had higher levels of TLR4 and HSP70 in the dilated tubules than non-diabetic controls. Thus, activation of the HSP70-TLR4 axis, stimulated at least in part by albumin, in the tubular cell is a newly identified mechanism associated with induction of tubulointerstitial inflammation and aggravation of pre-existing microalbuminuria in the progression of DN. PMID:26398934

  15. Endothelial dysfunction, vascular disease and stroke: the ARTICO study.

    PubMed

    Roquer, J; Segura, T; Serena, J; Castillo, J

    2009-01-01

    Endothelial dysfunction is a fundamental step in the atherosclerotic disease process. Its presence is a risk factor for the development of clinical events, and may represent a marker of atherothrombotic burden. Also, endothelial dysfunction contributes to enhanced plaque vulnerability, may trigger plaque rupture, and favors thrombus formation. The assessment of endothelial vasomotion is a useful marker of atherosclerotic vascular disease. There are different methods to assess endothelial function: endothelium-dependent vasodilatation brachial flow-mediated dilation, cerebrovascular reactivity to L-arginine, and the determination of some biomarkers such as microalbuminuria, platelet function, and C-reactive protein. Endothelial dysfunction has been observed in stroke patients and has been related to stroke physiopathology, stroke subtypes, clinical severity and outcome. Resting ankle-brachial index (ABI) is also considered an indicator of generalized atherosclerosis, and a low ABI is associated with an increase in stroke incidence in the elderly. Despite all these data, there are no studies analyzing the predictive value of ABI for new cardiovascular events in patients after suffering an acute ischemic stroke. ARTICO is an ongoing prospective, observational, multicenter study being performed in 50 Spanish hospitals. The aim of the ARTICO study is to evaluate the prognostic value of a pathological ABI (

  16. Cigarette smoking: an important renal risk factor – far beyond carcinogenesis

    PubMed Central

    Orth, SR

    2003-01-01

    In recent years, it has become apparent that smoking has a negative impact on renal function, being one of the most important remediable renal risk factors. It has been clearly shown that the risk for high-normal urinary albumin excretion and microalbuminuria is increased in smoking compared to non-smoking subjects of the general population. Data from the Multiple Risk Factor Intervention Trial (MRFIT) indicate that at least in males, smoking increases the risk to reach end-stage renal failure. Smoking is particularly "nephrotoxic" in older subjects, subjects with essential hypertension and patients with preexisting renal disease. Of interest, the magnitude of the adverse renal effect of smoking seems to be independent of the underlying renal disease. Death-censored renal graft survival is decreased in smokers, indicating that smoking also damages the renal transplant. Cessation of smoking has been show to reduce the rate of progression of renal failure both in patients with renal disease or a renal transplant. The mechanisms of smoking-induced renal damage are only partly understood and comprise acute hemodynamic (e.g., increase in blood pressure and presumably intraglomerular pressure) and chronic effects (e.g., endothelial cell dysfunction). Renal failure per se leads to an increased cardiovascular risk. The latter is further aggravated by smoking. Particularly survival of smokers with diabetes mellitus on hemodialysis is abysmal. In the present review article the current state of knowledge about the renal risks of smoking is reviewed. It is the aim of the article to point out that smoking not only increases the risk of renal cell carcinoma or uroepithelial cell carcinoma, but also the risk of a faster decline of renal function. The latter is a relatively new negative aspect which has not been widely recognized. PMID:19570254

  17. Cigarette smoking: an important renal risk factor – far beyond carcinogenesis

    PubMed Central

    Orth, SR

    2003-01-01

    In recent years, it has become apparent that smoking has a negative impact on renal function, being one of the most important remediable renal risk factors. It has been clearly shown that the risk for high-normal urinary albumin excretion and microalbuminuria is increased in smoking compared to non-smoking subjects of the general population. Data from the Multiple Risk Factor Intervention Trial (MRFIT) indicate that at least in males, smoking increases the risk to reach end-stage renal failure. Smoking is particularly "nephrotoxic" in older subjects, subjects with essential hypertension and patients with preexisting renal disease. Of interest, the magnitude of the adverse renal effect of smoking seems to be independent of the underlying renal disease. Death-censored renal graft survival is decreased in smokers, indicating that smoking also damages the renal transplant. Cessation of smoking has been show to reduce the rate of progression of renal failure both in patients with renal disease or a renal transplant. The mechanisms of smoking-induced renal damage are only partly understood and comprise acute hemodynamic (e.g., increase in blood pressure and presumably intraglomerular pressure) and chronic effects (e.g., endothelial cell dysfunction). Renal failure per se leads to an increased cardiovascular risk. The latter is further aggravated by smoking. Particularly survival of smokers with diabetes mellitus on hemodialysis is abysmal. In the present review article the current state of knowledge about the renal risks of smoking is reviewed. It is the aim of the article to point out that smoking not only increases the risk of renal cell carcinoma or uroepithelial cell carcinoma, but also the risk of a faster decline of renal function. The latter is a relatively new negative aspect which has not been widely recognized.

  18. The Impact of Nonalcoholic Fatty Liver Disease on Renal Function in Children with Overweight/Obesity.

    PubMed

    Pacifico, Lucia; Bonci, Enea; Andreoli, Gian Marco; Di Martino, Michele; Gallozzi, Alessia; De Luca, Ester; Chiesa, Claudio

    2016-01-01

    The association between nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease has attracted interest and attention over recent years. However, no data are available in children. We determined whether children with NAFLD show signs of renal functional alterations, as determined by estimated glomerular filtration rate (eGFR) and urinary albumin excretion. We studied 596 children with overweight/obesity, 268 with NAFLD (hepatic fat fraction ≥5% on magnetic resonance imaging) and 328 without NAFLD, and 130 healthy normal-weight controls. Decreased GFR was defined as eGFR < 90 mL/min/1.73 m². Abnormal albuminuria was defined as urinary excretion of ≥30 mg/24 h of albumin. A greater prevalence of eGFR < 90 mL/min/1.73 m² was observed in patients with NAFLD compared to those without liver involvement and healthy subjects (17.5% vs. 6.7% vs. 0.77%; p < 0.0001). The proportion of children with abnormal albuminuria was also higher in the NAFLD group compared to those without NAFLD, and controls (9.3% vs. 4.0% vs. 0; p < 0.0001). Multivariate logistic regression analysis revealed that NAFLD was associated with decreased eGFR and/or microalbuminuria (odds ratio, 2.54 (confidence interval, 1.16-5.57); p < 0.05) independently of anthropometric and clinical variables. Children with NAFLD are at risk for early renal dysfunction. Recognition of this abnormality in the young may help to prevent the ongoing development of the disease. PMID:27472326

  19. Comparison of nephrotoxicities of different polyoxyethyleneglycol formulations of amphotericin B in rats.

    PubMed Central

    Tasset, C; Preat, V; Bernard, A; Roland, M

    1992-01-01

    The aim of the present study was to assess whether amphotericin B (AmB)-Myrj 59, AmB-polyoxyethyleneglycol 24 cholesterol (PC), and AmB-Synperonic A50 (SA50) were less nephrotoxic than AmB-deoxycholate (DC). Rats were treated with the different AmB formulations (10 mg/kg of body weight) intraperitoneally or with the surfactants alone. A group of control rats receiving the vehicle was also examined. After 6 days of daily intraperitoneal injections of AmB-DC, decreased body weight and glomerular filtration rate as well as increased degree of diuresis, uremia, microalbuminuria, and N-acetyl-beta-D-glucosaminidase excretion in urine were noted. Urinary excretion of potassium and sodium was also decreased in AmB-DC-treated rats. Most of these effects were more pronounced with AmB-PC and AmB-SA50. In contrast, AmB-Myrj 59 was less nephrotoxic than AmB-DC. Indeed, after 6 days of treatment with AmB-Myrj 59, the natriuria, kaliuria, albuminuria, and glomerular filtration rates were unchanged compared with those of controls. Moreover, the body weight loss and uremia increase of the rats treated by AmB-Myrj 59 were less than those of the rats treated with the commercial preparation. Among the surfactants, only PC was toxic for the rats. The intrinsic toxicity of PC and the higher systemic exposure to AmB could contribute to increased toxicities of AmB-PC and AmB-SA50, respectively. AmB-Myrj 59 was less nephrotoxic than AmB-DC at equivalent areas under the plasma concentration-time curves. These preliminary results suggest that this formulation could be a good alternative to the commercial product. PMID:1510450

  20. Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes

    PubMed Central

    Mauer, Michael; Zinman, Bernard; Gardiner, Robert; Suissa, Samy; Sinaiko, Alan; Strand, Trudy; Drummond, Keith; Donnelly, Sandra; Goodyer, Paul; Gubler, Marie Claire; Klein, Ronald

    2010-01-01

    Background Nephropathy and retinopathy remain important complications of type 1 diabetes. It is unclear whether early administration of drugs that block the renin-angiotensin system slows their progression. Methods The Renin Angiotensin System Study [RASS] was a multicenter controlled trial in 285 normoalbuminuric, normotensive type 1 diabetic patients who were randomized to losartan (100mg daily), enalapril (20mg daily) or placebo and followed for 5 years. The primary endpoint was change in glomerular mesangial fractional volume in kidney biopsies. The retinopathy endpoint was a 2-step or greater progression in retinopathy severity scale. Intention-to-treat data analyses used linear and logistic regression models. Results Ninety and 82% of patients had complete renal biopsy and retinopathy data, respectively. Change in mesangial fractional volume per glomerulus over 5 years in placebo (0.016 units) was not significantly different from enalapril (p=0.38) or losartan (p=0.26), nor were there significant changes in other biopsy assessed renal structural variables. Five-year cumulative microalbuminuria incidence was higher for losartan than placebo (14% vs. 4%; logrank p=0.015) but not for enalapril (6% vs. 4%; logrank p=0.96). Two-step or more retinopathy progression incidence was reduced by 65% in the enalapril (O.R. 0.35; 95% C.I., 0.14–0.85) and 70% in the losartan group (O.R. 0.30; 95% C.I., 0.12–0.73) independent of changes in blood pressure. There were three biopsy-related serious adverse events that completely resolved. Chronic cough occurred in 12 enalapril, 6 losartan and 4 placebo patients. Conclusions Early renin-angiotensin system blockade did not modify nephropathy progression in type 1 diabetic patients, but had important effects in slowing retinopathy. PMID:19571282

  1. GLUCOSE CONTROL IN RWANDAN YOUTH WITH TYPE 1 DIABETES FOLLOWING ESTABLISHMENT OF SYSTEMATIC, HBA1C BASED, CARE AND EDUCATION

    PubMed Central

    Marshall, Sara L.; Edidin, Deborah; Arena, Vincent C.; Becker, Dorothy J.; Bunker, Clareann H.; Gishoma, Crispin; Gishoma, Francois; LaPorte, Ronald E.; Kaberuka, Vedaste; Ogle, Graham; Sibomana, Laurien; Orchard, Trevor J.

    2014-01-01

    AIMS To assess change in glycemic control concurrent with increased clinic visits, HbA1c testing, and education. Rates of complications were also examined. METHODS A 1–2 year follow-up of 214 members of the Rwanda Life for a Child program (aged < 26 years) with a first HbA1c between June 2009 and November 2010 was conducted. Data were analyzed for the entire cohort and by age (< 18 years, ≥ 18 years). Trajectory analysis was performed to identify trends in HbA1c. RESULTS Mean overall HbA1c decreased significantly from baseline (11.2±2.7%; 99±30 mmol/mol) to one- (10.2±2.6%; 88±28 mmol/mol) and two- (9.8±26%; 84±25 mmol/mol) year follow up visits. The prevalence of microalbuminuria did not significantly change (21.0%, 18.8%, and 19.6%), nor did nephropathy (4.7%, 7.8%, and 5.4%). However, rates of hypertension (31.8%, 44.9%, and 40.3%) were higher than expected. Five HbA1c groups were identified by trajectory analysis, and those with the worst control monitored their glucose significantly fewer times per week. CONCLUSIONS The establishment of regular care, HbA1c testing, and increased education is associated with significant improvements in glycemic control in youth with type 1 diabetes (T1D) in sub-Saharan Africa, but the high prevalence of hypertension is of concern. PMID:25458328

  2. Immunosuppressive agents and metabolic factors of cardiovascular risk in renal transplant recipients.

    PubMed

    Sessa, A; Esposito, A; Giliberti, A; Iavicoli, G; Costa, C; Bergallo, M; Lettieri, E; Rossano, R; Capuano, M

    2009-05-01

    Cardiovascular disease (CVD) accounts for 35% to 50% of deaths among renal transplant recipients. Beside the atherogenic risk factors related to hemodialysis, renal function, and use of immunosuppressive agents, other relevant risk factors for CVD include acute rejection episodes, microalbuminuria (muAlb), diabetes, arterial hypertension, lipid disorders, inflammatory triggers, hyperhomocysteinemia, anemia, erythrocytosis, obesity, and hyperuricemia. We studied the prevalence of risk factors and the impact of various drugs on CVD among 103 renal transplant recipients with measured glomerular filtration rates showing values >45 mL/min. We measured uric acid, triglycerides (TG), low-density lipoprotein (LDL)/high-density lipoprotein (HDL) LDL/HDL ratio, homocysteine (HOMO), insulin resistance, muAlb, C-reactive protein (CRP), and fibrinogen. Subsequently, patients were divided into 8 groups based on the immunosuppressive protocol to evaluate its impact on CVD risk factors. Insulin resistance and hyperhomocysteinemia were present in >2/3 of patients. Considering the impact of protocols, the combination of cyclosporine (CsA) + everolimus (EVL) resulted in the most favorable profile in terms of reduction of hyperuricemia, hyperlipidemia, and hyperhomocysteinemia. Insulin resistance tended to be more frequent among patients treated with protocols including calcineurin inhibitors (CNI) and steroids. The prevalence of hyperhomocyteinemia was similar among patients on CsA and on tacrolimus (Tac). Sirolimus (SRL) was associated with higher levels of HOMO. The combination of CNI and proliferative signal inhibitors (PSI) seemed to be the most promising one to reduce the impact of CVD risk factors. The reduction in CVD morbidity can improve expectancy and quality of life, as well as graft function and survival among renal transplant patients. PMID:19460510

  3. Cardiovascular disease risk profile and microvascular complications of diabetes: comparison of Indigenous cohorts with diabetes in Australia and Canada

    PubMed Central

    2012-01-01

    Background Indigenous populations of Australia and Canada experience disproportionately high rates of chronic disease. Our goal was to compare cardiovascular (CVD) risk profile and diabetes complications from three recent comprehensive studies of diabetes complications in different Indigenous populations in Australia and Canada. Methods We compared participants from three recent studies: remote Indigenous Australians (2002-2003, n = 37 known diabetes), urban Indigenous Australians (2003-2005, n = 99 known diabetes), and remote Aboriginal Canadians (2001-2002, n = 188 known diabetes). Results The three groups were similar for HbA1c, systolic BP, diabetes duration. Although leaner by body-mass-index criteria, remote Indigenous Australians displayed a more adverse CVD risk profile with respect to: waist-hip-ratio (1.03, 0.99, 0.94, remote Indigenous Australians, urban Indigenous Australians, remote Canadians, p < 0.001); HDL-cholesterol (0.82, 0.96, 1.17 mmol/L, p < 0.001); urine albumin-creatinine-ratio (10.3, 2.4, 4.5 mg/mmol); and C-reactive protein. With respect to diabetes complications, microalbuminuria (50%, 25%, 41%, p = 0.001) was more common among both remote groups than urban Indigenous Australians, but there were no differences for peripheral neuropathy, retinopathy or peripheral vascular disease. Conclusions Although there are many similarities in diabetes phenotype in Indigenous populations, this comparison demonstrates that CVD risk profiles and diabetes complications may differ among groups. Irrespective, management and intervention strategies are required from a young age in Indigenous populations and need to be designed in consultation with communities and tailored to community and individual needs. PMID:22455801

  4. The Impact of Nonalcoholic Fatty Liver Disease on Renal Function in Children with Overweight/Obesity

    PubMed Central

    Pacifico, Lucia; Bonci, Enea; Andreoli, Gian Marco; Di Martino, Michele; Gallozzi, Alessia; De Luca, Ester; Chiesa, Claudio

    2016-01-01

    The association between nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease has attracted interest and attention over recent years. However, no data are available in children. We determined whether children with NAFLD show signs of renal functional alterations, as determined by estimated glomerular filtration rate (eGFR) and urinary albumin excretion. We studied 596 children with overweight/obesity, 268 with NAFLD (hepatic fat fraction ≥5% on magnetic resonance imaging) and 328 without NAFLD, and 130 healthy normal-weight controls. Decreased GFR was defined as eGFR < 90 mL/min/1.73 m2. Abnormal albuminuria was defined as urinary excretion of ≥30 mg/24 h of albumin. A greater prevalence of eGFR < 90 mL/min/1.73 m2 was observed in patients with NAFLD compared to those without liver involvement and healthy subjects (17.5% vs. 6.7% vs. 0.77%; p < 0.0001). The proportion of children with abnormal albuminuria was also higher in the NAFLD group compared to those without NAFLD, and controls (9.3% vs. 4.0% vs. 0; p < 0.0001). Multivariate logistic regression analysis revealed that NAFLD was associated with decreased eGFR and/or microalbuminuria (odds ratio, 2.54 (confidence interval, 1.16–5.57); p < 0.05) independently of anthropometric and clinical variables. Children with NAFLD are at risk for early renal dysfunction. Recognition of this abnormality in the young may help to prevent the ongoing development of the disease. PMID:27472326

  5. Erythrocyte sodium-lithium countertransport and blood pressure in identical twin pairs discordant for insulin dependent diabetes.

    PubMed Central

    Hardman, T. C.; Dubrey, S. W.; Leslie, D. G.; Hafiz, M.; Noble, M. I.; Lant, A. F.

    1992-01-01

    OBJECTIVE--To investigate whether insulin dependent diabetes is responsible for the abnormal behaviour of the carrier in sodium-lithium countertransport and whether the diabetic state is associated with rise in blood pressure. DESIGN--Case-control study. SETTING--London teaching hospital. SUBJECTS--44 twin pairs discordant for insulin dependent diabetes living in United Kingdom and 44 healthy control subjects matched for age, sex, and body mass index. None of the twin pairs or the controls had evidence of microalbuminuria. MAIN OUTCOME MEASURES--Sodium-lithium countertransport activity in erythrocytes and arterial blood pressure. RESULTS--The mean (95% confidence interval) sodium-lithium countertransport activity (mmol Li per litre of red blood cells per h) of the diabetic twins (0.291 (0.244 to 0.338)) was similar to that of their non-diabetic cotwins (0.247 (0.204 to 0.290)); both values were significantly higher than that of the controls (0.187 (0.157 to 0.216); p < 0.05). In addition, systolic blood pressure was higher in those twins with diabetes (127 (122 to 133) mm Hg) than in the non-diabetic cotwins (122 (117 to 127) mm Hg; p < 0.01). There were no significant differences in mean diastolic blood pressure between any of the groups studied. CONCLUSIONS--The raised erythrocyte sodium-lithium countertransport activity in the diabetic twins compared with the controls seems to be inherited rather than a consequence of overt diabetes. The higher systolic blood pressure in diabetic twins than non-diabetic cotwins indicates that insulin dependent diabetes does exert a small influence on systolic blood pressure. PMID:1392822

  6. Adiponectin -11377C/G and +276G/T polymorphisms affect adiponectin levels but do not modify responsiveness to therapy in resistant hypertension.

    PubMed

    de Faria, Ana Paula C; Modolo, Rodrigo; Sabbatini, Andréa R; Barbaro, Natália R; Corrêa, Nathália B; Brunelli, Veridiana; Tanus-Santos, José E; Fontana, Vanessa; Moreno, Heitor

    2015-07-01

    Resistant hypertension (RHTN) is a multifactorial and polygenic disease, frequently associated with obesity. Low plasma adiponectin levels, a hormone produced by the adipose tissue, were associated with RHTN. Single nucleotide polymorphisms (SNPs) -11377C/G (rs266729) and +276G/T (rs1501299) in ADIPOQ (adiponectin gene) were associated with hypertension. This study evaluated the association between two SNPs (-11377C/G and +276G/T) and adiponectin levels in RHTN. This study comprised 109 patients with RHTN genotyped for both polymorphisms. A cross-sectional study was designed to compare features of CC homozygous versus G allele carriers for -11377C/G and GG homozygous versus T allele carriers for +276G/T. Office and ambulatory BP measurements were similar among genotypes subgroups in both SNPs as well as the markers of target organ damage (arterial stiffness, left ventricular mass index and microalbuminuria). Adiponectin concentrations were significantly higher in CC compared to G carrier for -11377C/G (CC:7.0 (4.0-10.2) versus G allele:5.5 (2.5-7.9), p = 0.04) and lower in GG compared to T carrier for +276G/T (GG:5.3 (2.3-7.7) versus T allele:7.1 (3.6-10.5), p = 0.04). Adjusting for systolic ambulatory BP, body mass index, age, gender, race and presence of type 2 diabetes, multiple linear regression analyses revealed that the minor alleles G (β-coefficient= -0.14, SE=0.07, p = 0.03) and T (β-coefficient=0.12, SE=0.06, p = 0.04) were independent predictors of adiponectin. The -11377C/G and +276G/T SNPs in ADIPOQ were associated with adiponectin levels in RHTN individuals. PMID:25546819

  7. Identification of high-risk population and prevalence of kidney damage among asymptomatic central government employees in Delhi, India.

    PubMed

    Mahapatra, Himanshu Sekhar; Gupta, Yadunanandan Prasad; Sharma, Neera; Buxi, Gurdeep

    2016-03-01

    Chronic kidney disease (CKD) has attained epidemic proportions in India due to increased incidence of diabetes and hypertension (HTN). It was surmised that identification of only high-risk groups (HRGs) through a questionnaire would be sufficient to identify cases of kidney damage (KD). The study attempted to device a questionnaire to classify the subjects in to HRG and low-risk group (LRG) and assess the extent of early KD. The central government employees were classified into HRG and LRG based on "SCreening for Occult REnal Disease (SCORED)" and "EXTENDED" questionnaire formulated after addition of 10 more parameters apart from diabetes and HTN. Urine examination by dipstick, quantitative microalbumin, serum creatinine, and estimated glomerular filtration rate were assessed to determine KD. The data were analyzed for risk-group classification. Sensitivity was calculated based on the number of KD cases in the HRG. Of the 1104 employees screened, 58% and 42% were classified in HRG and LRG, respectively. There were 306 KD cases of whom, 65% were in the HRG. The sensitivity of the EXTENDED questionnaire to detect CKD was much higher (60%) compared to the SCORED questionnaire (25%). The prevalence of KD according to stage was: stage-1, 13.4%; stage-2, 9.9%; and late stages (3, 4, and 5), 4.5%. Microalbuminuria and dipstick-positive proteinuria showed statistically higher proportion in the HRG (25% and 4.1%) than in the LRG (19% and 1%, respectively) (P <0.05). Although the EXTENDED questionnaire was more sensitive in detecting KD, only screening the high-risk population will leave behind 35% of KD cases. There is, therefore, a need for mass screening at regular intervals. PMID:26997392

  8. Mediators of Atherosclerosis in South Asians Living in America (MASALA) study: Objectives, Methods, and Cohort Description

    PubMed Central

    2013-01-01

    Background South Asians (individuals from India, Pakistani, Bangladesh, Nepal, and Sri Lanka) have high rates of cardiovascular disease which cannot be explained by traditional risk factors. There are no prospective cohort studies investigating antecedents of cardiovascular disease in South Asians. Methods The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study is investigating the prevalence, correlates and outcomes associated with subclinical cardiovascular disease (CVD) in a population-based sample of South Asian men and women between ages 40 – 79 years from two U.S. clinical field centers. This cohort is similar in methods and measures to the Multi-Ethnic Study of Atherosclerosis to allow for efficient cross-ethnic comparisons. Measurements obtained at the baseline examination include sociodemographic information, lifestyle and psychosocial factors, standard CVD risk factors, oral glucose tolerance testing, electrocardiogram, assessment of microalbuminuria, ankle and brachial blood pressures, carotid intima media wall thickness using ultrasonagraphy, coronary artery calcium measurement and abdominal visceral fat using computed tomography. Blood samples will be assayed for biochemical risk factors. Results Between October 2010 and March 2013 we enrolled 906 South Asians with mean age of 55±9 years, 46% women, 98% immigrants who have lived 27±11 years in the US. Conclusions The sociodemographic characteristics of this cohort are representative of US South Asians. Participants are being followed with annual telephone calls for identification of CVD events including acute myocardial infarction and other coronary heart disease, stroke, peripheral vascular disease, congestive heart failure, therapeutic interventions for CVD, and mortality. PMID:24194499

  9. [In situ FTIR and XPS study on selective hydrodesulfurization catalyst of FCC gasoline].

    PubMed

    Qiherima; Yuan, Hui; Zhang, Yun-hong; Li, Hui-feng; Xu, Guang-tong

    2011-07-01

    Improvement of the selectivity of hydrodesulfurization (HDS) for hydrogenation (HYD) of olefins is crucial to produce sulfur-free (S < 0.001%) gasoline from fluid catalytic-cracked (FCC) gasoline. A series of sulfided CoMo/Al2O3 catalysts with different metal loading were prepared by pore-filling impregnation. MoS2 and COMoS active phases on the surface of sulfided COMo/Al2O3 catalyst were identified and analyzed quantitatively by XPS and in-situ FTIR of adsorbed CO. The results reveal that the increase in COMoS phase on the catalyst surface improves the HDS activity and selectivity. And the HDS selectivity correlates linearly with the ratio of active site number of CoMoS and MoS2, the higher the ratio of active site number of CoMoS and MoS2, the better the HDS selectivity. In situ variable temperature FTIR analysis shows that CoMoS phase has stronger electron accepting ability than MoS2. The strong electron deficient property of CoMoS active sites is the main reason for its excellent HDS activity and selectivity. PMID:21942017

  10. The advantages of combination therapy on hypertension: development of immediate release perindopril-indapamide tablet and assessment of bioequivalence studies.

    PubMed

    Ölçer, A; Ölçer, M; İnce, I; Karasulu, E

    2016-03-01

    Hypertension has a major associated risk for organ damage and mortality, which is further heightened in patients with prior cardiovascular events, comorbid diabetes mellitus, microalbuminuria and renal impairment. Convers Plus tablet including perindopril erbumine (PE), which is an angiotensin converting enzyme (ACE) inhibitor, and indapamide, which is diuretic, was designed as a combined tablet to succes in the treatment of hypertension. Physico-pharmaceutical properties and characterization studies were evaluated in vitro conditions. Later on in vivo study was planned as a cross-designed, randomized, open-labeled, single-dose, single-center study via peroral route in 24 healthy male subjects. In this study, bioequivalence with primary pharmacokinetical target parameters reference (Bipreterax 4/1.25 mg Tablet-S.A.Servier Benelux N.V.) and test (Convers Plus 4/1.25 mg Tablet-ARGESAN Pharmaceutical Company) tablets have been found bioequivalent. The results of pharmacokinetic parameters for perindopril, perindoprilat and indapamide were found as Cmax = 23.179 µg/mL, tmax = 0.729 h, t1/2 = 1.429 h; AUC0-t = 26.998 µgs/mL, AUC0-inf = 27.117 µgs/mL; Cmax = 1.834 µg/mL, tmax = 8.792 h, t1/2 = 40.699 h; AUC0-t = 54.828 µgs/mL, AUC0-inf = 77.113 µgs/mL; Cmax = 18.994 µg/mL, tmax = 3.417 h, t1/2 = 16.626 h and AUC0-t = 385.829 µgs/mL, AUC0-inf = 410.728 µgs/mL respectively. In conclusion, physico-pharmaceutical properties and results of clinical trials show that Convers Plus tablets have been found as bioequivalent for perindopril, perindoprilat and indapamide in terms of AUC and Cmax, in 90% confidence limits. PMID:26794937

  11. Are there long-term benefits of experiential, interprofessional education for non-specialists on clinical behaviours and outcomes in diabetes care? A cohort study

    PubMed Central

    Ching, Daniel; Forte, Denise; Aitchison, Elizabeth; Earle, Kenneth

    2016-01-01

    Objectives Our aim was to assess the impact of an educational initiative for non-specialist, healthcare professionals in the community on the process and quality measures of diabetes care delivered, and changes in their learning experiences and clinical management behaviour in the short and long term. Setting Single locality of 26 primary care practices associated with one secondary centre. Participants General practitioners and practice nurses managing 4167 patients with diabetes. Intervention A rolling 10-week, experiential, interprofessional education programme delivered to 57 practitioners and observations in practice. Primary and secondary outcome measures Primary outcomes were changes in the proportion of patients receiving foot care, urine albumin:creatinine ratio assessments and achieving National Quality Outcome Framework targets for blood pressure (<145/80 mm Hg), glycated haemoglobin (HbA1c; >86 mmol/mol (10%) and <57.4 mmol/mol (7.4%)) and total cholesterol (<5 mmol/L) thresholds. Secondary outcomes were evidence of sustained learning and changes in the number of patients referred to secondary care. Results Evaluation of care processes and quality outcomes took place 15 months after the programme was initiated. The proportion of patients with a HbA1c of <57.4 mmol/mol (7.4%) and >85 mmol/mol (10%) was significantly higher (44% vs 53% p=0.0001) and lower (12.5% vs 10%; p=0.002) respectively. There was an increase in the proportion (95% CI) of patients receiving foot care reviews (+26.0% (24.0% to 28.1%)), microalbuminuria screening (+29.8% (27.7% to 31.9%)) and who achieved targets for blood pressure (+9.6% (7.5% to 11.6%)) and total cholesterol (+14.4% (12.3% to 16.5%); p<0.001). 241 fewer patients were referred to secondary care. Increases in the healthcare professional's confidence and collaborative clinical behaviour were evident 3 years after completing the programme. Conclusions An experiential, interprofessional intervention can

  12. Renal Doppler ultrasound in patients with hypertension and metabolic syndrom.

    PubMed

    Lubomirova, Mila; Djerassi, Regina; Kiperova, Boryana; Boyanov, Mihail; Christov, Vladimir

    2007-01-01

    Evaluation of the renal changes by conventional and Doppler ultrasound (US) was performed in patients with hypertension and obesity. 67 persons were examined and divided in 3 groups. Group I includes 27 patients--15 M and 12 F, average age 52+/-4.87 with well controlled diabetes mellitus type II and hypertension, Ccr.--139+/-1.31. Group II includes 20 patients--9 M and 11 F, average age 53+/-7 with well controlled hypertension without diabetes, with Ccr 128+/-7.8. Group III--20) pts. 8 F and 12 M, average age 54+/-5 with uncontrolled hypertension without diabetes, with Ccr 128+/-7.8. All examined pts. were with BMI>30 and hyperlipidemia--total cholesterol>6.5 mmol/l. Tests for microalbuminuria were negative in all 3 groups. In all three groups, using conventional US, the following parameters were detected by Aloca 4000 machine: renal (RV) and parenchyma (PV) volumes as well as Doppler parameters RI, PI, Vmax, Vmin, and Vmean. There were no significant differences between RV and PV of all examined groups: Group I--254+/-53, Group II--238+/-38, Group III--263+/-38, p=0.1. The strong correlation between renal volumes and BMI was found (Pearson's r 0.58). There were no significant differences between Vmax, Vmin, Vmean in all three groups. RI is normal <0.7 in all examined patients: Group I--0.63+/-0.06, Group II--0.61+/-0.02, Group III--0.66+/-0.03. RI in group III was significantly higher, p<0.05 compared to RI indices detected in other two groups but remains at normal levels. Intrarenal hemodynamics exhibited no difference in all examined groups. Analysis of the Doppler spectrum of the intrarenal arteries provides an accurate information about renal vascular changes but has no significant advantages in patients with hypertension and obesity with normal renal function and signs of hypertensive nephropathy "benign nephrosclerosis". Nevertheless Duplex Doppler Ultrasound is a noninvasive method which is an important part of the diagnostic algorithm in patients with

  13. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes

    PubMed Central

    Freeman, Roy

    2015-01-01

    Treatment-induced neuropathy in diabetes (also referred to as insulin neuritis) is considered a rare iatrogenic small fibre neuropathy caused by an abrupt improvement in glycaemic control in the setting of chronic hyperglycaemia. The prevalence and risk factors of this disorder are not known. In a retrospective review of all individuals referred to a tertiary care diabetic neuropathy clinic over 5 years, we define the proportion of individuals that present with and the risk factors for development of treatment-induced neuropathy in diabetes. Nine hundred and fifty-four individuals were evaluated for a possible diabetic neuropathy. Treatment-induced neuropathy in diabetes was defined as the acute onset of neuropathic pain and/or autonomic dysfunction within 8 weeks of a large improvement in glycaemic control—specified as a decrease in glycosylated haemoglobin A1C (HbA1c) of ≥2% points over 3 months. Detailed structured neurologic examinations, glucose control logs, pain scores, autonomic symptoms and other microvascular complications were measured every 3–6 months for the duration of follow-up. Of 954 patients evaluated for diabetic neuropathy, 104/954 subjects (10.9%) met criteria for treatment-induced neuropathy in diabetes with an acute increase in neuropathic or autonomic symptoms or signs coinciding with a substantial decrease in HbA1c. Individuals with a decrease in HbA1c had a much greater risk of developing a painful or autonomic neuropathy than those individuals with no change in HbA1c (P < 0.001), but also had a higher risk of developing retinopathy (P < 0.001) and microalbuminuria (P < 0.001). There was a strong correlation between the magnitude of decrease in HbA1c, the severity of neuropathic pain (R = 0.84, P < 0.001), the degree of parasympathetic dysfunction (R = −0.52, P < 0.01) and impairment of sympathetic adrenergic function as measured by fall in blood pressure on tilt-table testing (R = −0.63, P < 0.001). With a decrease in HbA1c of 2

  14. A pilot study on the effect of telmisartan & ramipril on 24 h blood pressure profile & dipping pattern in type 1 diabetes patients with nephropathy

    PubMed Central

    Anantharaman, R.; Bhansali, Anil; Bhadada, Sanjay K.; Kohli, Harbir S.; Walia, Rama; Shanmugasundar, G.; Jayaprakash, P.

    2011-01-01

    Background & objectives: Angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) have been used to normalize the blood pressure and the dipping pattern in patients with type 1 diabetes mellitus (T1DM) and nephropathy. However, there are no data on the effect of the dual blockade on the dipping pattern in these subjects. We therefore, carried out this study to evaluate the effect of administrating an ACEI followed by ARB in the optimum doses in T1DM patients with nephropathy on 24 h blood pressure (BP) profile and nocturnal dipping pattern. Methods: An open label interventional pilot study was done during a one year period involving 30 consecutive patients who were treated with telmisartan 80 mg (0800-1000 h) for eight weeks followed by addition of ramipril 10 mg (1200-1400 h) for the next eight weeks. Ambulatory BP, dipping pattern and albumin excretion rate were studied after each phase. Twenty patients were hypertensive and 10 patients had macro- and 20 patients had microalbuminuria. Results: Telmisartan produced a fall in the clinic BP by 4/1.3 mm Hg (P<0.05 and P<0.362, respectively), 2/1.9 mm Hg in the mean 24 h BP, 1.4/1.1 mm Hg in the day BP and 3.7/3 mm Hg in the trough BP. Addition of ramipril to telmisartan produced a further reduction of 6.3/5.9 mm Hg in the clinic BP (P<0.001 for both), 4.3/4.2 mm Hg in the mean 24 h BP (P<0.01 and P<0.0001, respectively), 5.8/3.9 mm Hg in the day BP (P<0.01 for both), 4.2/2.5 mm Hg in the trough BP, with a reduction of clinic SBP and DBP of 10.3/7.2 mm Hg from the baseline. Telmisartan restored normal systolic dipping pattern in 33.3 per cent of the nondippers (P<0.01) but addition of ramipril was not complimentary. Hyperkalamia (>5.5 mmol/l) was observed only in 2 patients towards the end of the study. Interpretation & conclusions: The dual blockade with telmisartan and ramipril had complimentary effect on lowering of the BP, however, similar beneficial effect on the nocturnal dipping

  15. Hyperaldosteronism and cardiovascular risk in patients with autosomal dominant polycystic kidney disease.

    PubMed

    Lai, Silvia; Petramala, Luigi; Mastroluca, Daniela; Petraglia, Emanuela; Di Gaeta, Alessandro; Indino, Elena; Panebianco, Valeria; Ciccariello, Mauro; Shahabadi, Hossein H; Galani, Alessandro; Letizia, Claudio; D'Angelo, Anna Rita

    2016-07-01

    Hypertension is commonly associated with autosomal dominant polycystic kidney disease (ADPKD), often discovered before the onset of renal failure, albeit the pathogenetic mechanisms are not well elucidated. Hyperaldosteronism in ADPKD may contribute to the development of insulin resistance and endothelial dysfunction, and progression of cardiorenal disease. The aim of study was to evaluate the prevalence of primary aldosteronism (PA) in ADPKD patients and identify some surrogate biomarkers of cardiovascular risk.We have enrolled 27 hypertensive ADPKD patients with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min, evaluating the renin-angiotensin-aldosterone system (RAAS), inflammatory indexes, nutritional status, homocysteine (Hcy), homeostasis model assessment-insulin resistance (HOMA-IR), mineral metabolism, microalbuminuria, and surrogate markers of atherosclerosis [carotid intima media thickness (cIMT), ankle/brachial index (ABI), flow mediated dilation (FMD), renal resistive index (RRI) and left ventricular mass index (LVMI)]. Furthermore, we have carried out the morpho-functional magnetic resonance imaging (MRI) with high-field 3 T Magnetom Avanto.We have divided patients into group A, with normal plasma aldosterone concentration (PAC) and group B with PA, present in 9 (33%) of overall ADPKD patients. Respect to group A, group B showed a significant higher mean value of LVMI, HOMA-IR and Hcy (P = 0.001, P = 0.004, P = 0.018; respectively), and a lower value of FMD and 25-hydroxyvitamin D (25-OH-VitD) (P = 0.037, P = 0.019; respectively) with a higher prevalence of non-dipper pattern at Ambulatory Blood Pressure Monitoring (ABPM) (65% vs 40%, P < 0.05) at an early stage of the disease.In this study, we showed a high prevalence of PA in ADPKD patients, associated to higher LVMI, HOMA-IR, Hcy, lower FMD, and 25-OH-VitD, considered as surrogate markers of atherosclerosis, compared to ADPKD patients with normal PAC values. Our

  16. Urinary Elafin and Kidney Injury in Hematopoietic Cell Transplant Recipients

    PubMed Central

    Finn, Laura S.; Pao, Emily; Lawler, Rick; Schoch, Gary; McDonald, George B.; Najafian, Behzad; Sandmaier, Brenda; Gooley, Ted

    2015-01-01

    Background and objectives Graft-versus-host disease (GVHD) is associated with kidney injury after hematopoietic cell transplantation (HCT). Because plasma elafin levels correlate with skin GVHD, this study examined urinary elafin as a potential marker of renal inflammation and injury. Design, setting, participants, & measurements Urine was collected prospectively on 205 patients undergoing their first HCT from 2003 to 2010. Collections were done at baseline, weekly through day 100, and monthly through year 1 to measure elafin and urine albumin-to-creatinine ratio (ACR). Associations between urinary elafin levels and microalbuminuria, macroalbuminuria, AKI and CKD, and mortality were examined using Cox proportional hazards or linear regression models. Available kidney biopsy specimens were processed for immunohistochemistry. Results Mean urinary elafin levels to day 100 were higher in patients with micro- or macroalbuminuria (adjusted mean difference, 529 pg/ml; P=0.03) at day 100 than in those with a normal ACR (adjusted mean difference, 1295 pg/ml; P<0.001). Mean urinary elafin levels were higher in patients with AKI compared with patients without AKI (adjusted mean difference, 558 pg/ml; P<0.01). The average urinary elafin levels within the first 100 days after HCT were higher in patients who developed CKD at 1 year than in patients without CKD (adjusted mean difference, 894 pg/ml; P=0.002). Among allogeneic recipients, a higher proportion of patients with micro- or macroalbuminuria at day 100 also had grade II-IV acute GVHD (80% and 86%, respectively) compared with patients with a normal ACR (58%; global P<0.01). Each increase in elafin of 500 pg/ml resulted in a 10% increase in risk of persistent macroalbuminuria (hazard ratio, 1.10; 95% confidence interval [95% CI], 1.06 to 1.13; P<0.001) and a 7% increase in the risk of overall mortality (95% CI, 1.02 to 1.13, P<0.01). Renal biopsy specimens from a separate cohort of HCT survivors demonstrated elafin staining

  17. Urinary Exosomal miRNA Signature in Type II Diabetic Nephropathy Patients

    PubMed Central

    Delić, Denis; Eisele, Claudia; Schmid, Ramona; Baum, Patrick; Wiech, Franziska; Gerl, Martin; Zimdahl, Heike; Pullen, Steven S.; Urquhart, Richard

    2016-01-01

    MicroRNAs (miRNAs) are short non-coding RNA species which are important post-transcriptional regulators of gene expression and play an important role in the pathogenesis of diabetic nephropathy. miRNAs are present in urine in a remarkably stable form packaged in extracellular vesicles, predominantly exosomes. In the present study, urinary exosomal miRNA profiling was conducted in urinary exosomes obtained from 8 healthy controls (C), 8 patients with type II diabetes (T2D) and 8 patients with type II diabetic nephropathy (DN) using Agilent´s miRNA microarrays. In total, the expression of 16 miRNA species was deregulated (>2-fold) in DN patients compared to healthy donors and T2D patients: the expression of 14 miRNAs (miR-320c, miR-6068, miR-1234-5p, miR-6133, miR-4270, miR-4739, miR-371b-5p, miR-638, miR-572, miR-1227-5p, miR-6126, miR-1915-5p, miR-4778-5p and miR-2861) was up-regulated whereas the expression of 2 miRNAs (miR-30d-5p and miR-30e-5p) was down-regulated. Most of the deregulated miRNAs are involved in progression of renal diseases. Deregulation of urinary exosomal miRNAs occurred in micro-albuminuric DN patients but not in normo-albuminuric DN patients. We used qRT-PCR based analysis of the most strongly up-regulated miRNAs in urinary exosomes from DN patients, miRNAs miR-320c and miR-6068. The correlation of miRNA expression and micro-albuminuria levels could be replicated in a confirmation cohort. In conclusion, urinary exosomal miRNA content is altered in type II diabetic patients with DN. Deregulated miR-320c, which might have an impact on the TGF-β-signaling pathway via targeting thrombospondin 1 (TSP-1) shows promise as a novel candidate marker for disease progression in type II DN that should be evaluated in future studies. PMID:26930277

  18. Multifactorial intervention to prevent cardiovascular disease in patients with early rheumatoid arthritis: protocol for a multicentre randomised controlled trial

    PubMed Central

    Svensson, Annemarie Lyng; Løgstrup, Brian Bridal; Giraldi, Annamaria; Graugaard, Christian; Blegvad, Jesper; Thygesen, Tina; Sheetal, Ekta; Svendsen, Lone; Emmertsen, Henrik

    2016-01-01

    and (4) microalbuminuria (intervention group). Ethics and dissemination This protocol is approved by the local ethics committee (DK-S-2014007) and The Danish Health and Medicines Authority. Dissemination will occur through presentations at National and International conferences and publications in international peer-reviewed journals. Trial registration number NCT02246257 PMID:27098820

  19. Tetrahydrobiopterin lowers muscle sympathetic nerve activity and improves augmentation index in patients with chronic kidney disease

    PubMed Central

    Liao, Peizhou; Sher, Salman; Lyles, Robert H.; Deveaux, Don D.; Quyyumi, Arshed A.

    2014-01-01

    Chronic kidney disease (CKD) is characterized by overactivation of the sympathetic nervous system (SNS) that contributes to cardiovascular risk. Decreased nitric oxide (NO) bioavailability is a major factor contributing to SNS overactivity in CKD, since reduced neuronal NO leads to increased central SNS activity. Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase that increases NO bioavailability in experimental models of CKD. We conducted a randomized, double-blinded, placebo-controlled trial testing the benefits of oral sapropterin dihydrochloride (6R-BH4, a synthetic form of BH4) in CKD. 36 patients with CKD and hypertension were randomized to 12 wk of 1) 200 mg 6R-BH4 twice daily + 1 mg folic acid once daily; vs. 2) placebo + folic acid. The primary endpoint was a change in resting muscle sympathetic nerve activity (MSNA). Secondary endpoints included arterial stiffness using pulse wave velocity (PWV) and augmentation index (AIx), endothelial function using brachial artery flow-mediated dilation and endothelial progenitor cells, endothelium-independent vasodilatation (EID), microalbuminuria, and blood pressure. We observed a significant reduction in MSNA after 12 wk of 6R-BH4 (−7.5 ± 2.1 bursts/min vs. +3.2 ± 1.3 bursts/min; P = 0.003). We also observed a significant improvement in AIx (by −5.8 ± 2.0% vs. +1.8 ± 1.7 in the placebo group, P = 0.007). EID increased significantly (by +2.0 ± 0.59%; P = 0.004) in the 6R-BH4 group, but there was no change in endothelial function. There was a trend toward a reduction in diastolic blood pressure by −4 ± 3 mmHg at 12 wk with 6R-BH4 (P = 0.055). 6R-BH4 treatment may have beneficial effects on SNS activity and central pulse wave reflections in hypertensive patients with CKD. PMID:25477424

  20. Central blood pressure and pulse wave velocity: relationship to target organ damage and cardiovascular morbidity-mortality in diabetic patients or metabolic syndrome. An observational prospective study. LOD-DIABETES study protocol

    PubMed Central

    2010-01-01

    Background Diabetic patients show an increased prevalence of non-dipping arterial pressure pattern, target organ damage and elevated arterial stiffness. These alterations are associated with increased cardiovascular risk. The objectives of this study are the following: to evaluate the prognostic value of central arterial pressure and pulse wave velocity in relation to the incidence and outcome of target organ damage and the appearance of cardiovascular episodes (cardiovascular mortality, myocardial infarction, chest pain and stroke) in patients with type 2 diabetes mellitus or metabolic syndrome. Methods/Design Design: This is an observational prospective study with 5 years duration, of which the first year corresponds to patient inclusion and initial evaluation, and the remaining four years to follow-up. Setting: The study will be carried out in the urban primary care setting. Study population: Consecutive sampling will be used to include patients diagnosed with type 2 diabetes between 20-80 years of age. A total of 110 patients meeting all the inclusion criteria and none of the exclusion criteria will be included. Measurements: Patient age and sex, family and personal history of cardiovascular disease, and cardiovascular risk factors. Height, weight, heart rate and abdominal circumference. Laboratory tests: hemoglobin, lipid profile, creatinine, microalbuminuria, glomerular filtration rate, blood glucose, glycosylated hemoglobin, blood insulin, fibrinogen and high sensitivity C-reactive protein. Clinical and 24-hour ambulatory (home) blood pressure monitoring and self-measured blood pressure. Common carotid artery ultrasound for the determination of mean carotid intima-media thickness. Electrocardiogram for assessing left ventricular hypertrophy. Ankle-brachial index. Retinal vascular study based on funduscopy with non-mydriatic retinography and evaluation of pulse wave morphology and pulse wave velocity using the SphygmoCor system. The medication used for

  1. [What glycemic control can be achieved in diabetic children and adolescents to avoid complications? Personal experience].

    PubMed

    Dorchy, H

    2006-01-01

    The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications by maintaining blood glucose concentrations close to the normal range and an HbA1c level under 7%. The number of daily insulin injections, 2 or > or =4 or pumps, by itself does not necessarily give better results, but the 4-injection regimen allows greater freedom, taking into account that the proper insulin adjustment is difficult before adolescence. Successful glycaemic control in young patients depends mainly on the quality and intensity of diabetes education. Any dogmatism must be avoided. Dietary recommendations issued over the last few years are the same for diabetic and nondiabetic individuals in order to avoid degenerative diseases. In the twice-daily injection regimen, the allocation of carbohydrates throughout the day is essential. Due to their pharmakokinetic characteristics, fast-acting and long-acting insulin analogues have specific indications in both the twice-daily injection regimen and the basal-bolus insulin therapy. They improve quality of life, without necessarily reducing HbA1c. In the two daily insulin injection regimen, fast-acting analogues are very useful to rapidly correct hyperglycaemia, to allow sleeping in and eating something sweet. In the basal-bolus regimen, long-acting analogues reduce nocturnal hypoglycaemias and improve fasting blood glucose. Clinical studies, conducted since the 1970s by our team, have demonstrated that screening for subclinical retinopathy (fluorescein angiography), neuropathy (conduction velocities), nephropathy (microalbuminuria), should be started at puberty and at least 3 years after the diagnosis of diabetes. The goal is to detect early abnormalities responsible for subclinical disorders that can be reversed by improved metabolic control, thus preventing the occurrence of irreversible potentially incapacitating lesions. This motivates

  2. Diabetes in Sub Saharan Africa 1999-2011: Epidemiology and public health implications. a systematic review

    PubMed Central

    2011-01-01

    Background Diabetes prevalence is increasing globally, and Sub-Saharan Africa is no exception. With diverse health challenges, health authorities in Sub-Saharan Africa and international donors need robust data on the epidemiology and impact of diabetes in order to plan and prioritise their health programmes. This paper aims to provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa. Methods We conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact. Results Type 2 diabetes accounts for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Proportions of patients with diabetic complications ranged from 7-63% for retinopathy, 27-66% for neuropathy, and 10-83% for microalbuminuria. Diabetes is likely to increase the risk of several important infections in the region, including tuberculosis, pneumonia and sepsis. Meanwhile, antiviral treatment for HIV increases the risk of obesity and insulin resistance. Five-year mortality proportions of patients with diabetes varied from 4-57%. Screening studies identified high proportions (> 40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic

  3. Age-related macular degeneration and mortality in community-dwelling elders: The Age, Gene/Environment Susceptibility-Reykjavik Study

    PubMed Central

    Fisher, Diana E.; Jonasson, Fridbert; Eiriksdottir, Gudny; Sigurdsson, Sigurdur; Klein, Ronald; Launer, Lenore J; Gudnason, Vilmundur; Cotch, Mary Frances

    2014-01-01

    Objective To investigate the association between age-related macular degeneration (AMD) and mortality in older persons. Design Population-based prospective cohort study. Participants Participants aged 67–96 years old (43.1% male) enrolled between 2002 and 2006 in the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES). Methods Retinal photography of the macula was digitally acquired and evaluated for the presence of AMD lesions using the Wisconsin Age-Related Maculopathy grading scheme. Mortality was assessed prospectively through 2013 with cause of death available through 2009. The association between AMD and death, due to any cause and specifically, cardiovascular disease (CVD), was examined using Cox proportional hazards regression with age as the time scale, adjusted for significant risk factors and comorbid conditions. To address a violation in the proportional hazards assumption, analyses were stratified into two groups based on the mean age at death (83 years). Main Outcome Measures Mortality from all-causes and cardiovascular disease. Results Among 4910 participants, after a median follow-up period of 8.6 years, 1742 died (35.5%), of whom 614 (35.2%) had signs of AMD at baseline. CVD was the cause of death for 357 people who died before the end of 2009, of whom 144 (40%) had AMD (101 early and 43 late). After considering covariates, including comorbid conditions, having early AMD at any age, or late AMD in individuals under age 83 (n=4179), were not associated with all-cause or CVD mortality. In individuals aged 83 years and older (n=731), late AMD was significantly associated with increased risk of all-cause [hazard ratio (HR): 1.76 (95% confidence interval (CI): 1.20–2.57)] and CVD-related mortality [HR: 2.37 (95% CI: 1.41–3.98)]. In addition to having AMD, older individuals who died were more likely to be male, have low body mass index, impaired cognition, and microalbuminuria. Conclusions Competing risk factors and concomitant conditions

  4. Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors

    PubMed Central

    Moody, William E.; Ferro, Charles J.; Edwards, Nicola C.; Chue, Colin D.; Lin, Erica Lai Sze; Taylor, Robin J.; Cockwell, Paul; Steeds, Richard P.

    2016-01-01

    Abstract— There is a robust inverse graded association between glomerular filtration rate (GFR) and cardiovascular risk, but proof of causality is lacking. Emerging data suggest living kidney donation may be associated with increased cardiovascular mortality although the mechanisms are unclear. We hypothesized that the reduction in GFR in living kidney donors is associated with increased left ventricular mass, impaired left ventricular function, and increased aortic stiffness. This was a multicenter, parallel group, blinded end point study of living kidney donors and healthy controls (n=124), conducted from March 2011 to August 2014. The primary outcome was a change in left ventricular mass assessed by magnetic resonance imaging (baseline to 12 months). At 12 months, the decrease in isotopic GFR in donors was −30±12 mL/min/1.73m2. In donors compared with controls, there were significant increases in left ventricular mass (+7±10 versus −3±8 g; P<0.001) and mass:volume ratio (+0.06±0.12 versus −0.01±0.09 g/mL; P<0.01), whereas aortic distensibility (−0.29±1.38 versus +0.28±0.79×10−3 mm Hg−1; P=0.03) and global circumferential strain decreased (−1.1±3.8 versus +0.4±2.4%; P=0.04). Donors had greater risks of developing detectable highly sensitive troponin T (odds ratio, 16.2 [95% confidence interval, 2.6–100.1]; P<0.01) and microalbuminuria (odds ratio, 3.8 [95% confidence interval, 1.1–12.8]; P=0.04). Serum uric acid, parathyroid hormone, fibroblast growth factor-23, and high-sensitivity C-reactive protein all increased significantly. There were no changes in ambulatory blood pressure. Change in GFR was independently associated with change in left ventricular mass (R2=0.28; P=0.01). These findings suggest that reduced GFR should be regarded as an independent causative cardiovascular risk factor. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01028703. PMID:26754643

  5. Association of Comorbid and Metabolic Factors with Optimal Control of Type 2 Diabetes Mellitus

    PubMed Central

    Roy, Satyajeet; Sherman, Anthony; Monari-Sparks, Mary Joan; Schweiker, Olga; Jain, Navjot; Sims, Etty; Breda, Michelle; Byraiah, Gita P; Belecanech, Ryan George; Coletta, Michael Domenic; Barrios, Cristian Javier; Hunter, Krystal; Gaughan, John P

    2016-01-01

    Background: Type 2 diabetes mellitus (T2DM) is a poorly controlled epidemic worldwide that demands active research into mitigation of the factors that are associated with poor control. Aims: The study was to determine the factors associated with suboptimal glycemic control. Materials and Methods: Electronic medical records of 263 adult patients with T2DM in our suburban internal medicine office were reviewed. Patients were divided into two groups: Group 1 [optimal diabetes control with glycosylated hemoglobin (HbA1c) of 7% or less] and Group 2 (suboptimal diabetes control with HbA1c greater than 7%). The influence of factors such as age, gender, race, social history, comorbid conditions, gestational diabetes, family history of diabetes, diabetes management, statin use, aspirin use, angiotensin convertase enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) use, body mass index (BMI), blood pressures, lipid profile, and urine microalbumin level were analyzed in the two groups. Results: In the suboptimal diabetes control group (N = 119), the majority (86.6%) of the patients were 41-80 years old. Factors associated with the suboptimal control were male gender [odds ratio (OR) 2.6, 95% confidence interval (CI), 1.579-4.321], Asian ethnicity (OR 1.4, 95% CI, 0.683-3.008), history of peripheral arterial disease (PAD; OR 3.9, 95% CI, 1.017-14.543), history of congestive heart failure (CHF; OR 3.9, 95% CI, 1.017-14.543), elevated triglycerides (OR 1.004, 95% CI, 1.000-1.007), and elevated urine microalbumin level of 30 mg/24 h or above (OR 4.5, 95% CI, 2.446-8.380). Patients with suboptimal diabetes control had a 3.8 times greater odds (95% CI, 1.493-6.885) of receiving the insulin and oral hypoglycemic agent together. Conclusions: In adult patients with T2DM, male gender, Asian ethnicity, CHF, PAD, management with insulin along with oral hypoglycemic agents, hypertriglyceridemia, and microalbuminuria were associated with suboptimal control. PMID:27011945

  6. Assessment of Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Retinol-Binding Protein 4 (RBP4) in Type 2 Diabetic Patients with Nephropathy

    PubMed Central

    Mahfouz, Mohamed H.; Assiri, Adel M.; Mukhtar, Mohammed H.

    2016-01-01

    Diabetic nephropathy (DN) is one of the most serious microvascular complications of diabetes. The study aims to evaluate the diagnostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) and retinol-binding protein 4 (RBP4) as biomarkers for early detection of nephropathy in type 2 diabetic patients. The current study was performed on 150 type 2 diabetic patients. These patients were classified into three equal groups according to their albumin/creatinine ratio (ACR), including patients with normoalbuminuria (ACR <30 mg/g creatinine), patients with microalbuminuria (ACR = 30–300 mg/g creatinine), and patients with macroalbuminuria (ACR >300 mg/g creatinine). Fifty apparently healthy subjects matching the same age and socioeconomic status with diabetic subjects were selected as a control group. The plasma glucose, insulin, glycosylated hemoglobin (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR), lipid profile, urea, creatinine, cystatin C, glomerular filtration rate (GFR), NGAL, and RBP4 were measured in the studied groups. Significantly elevated NGAL and RBP4 levels were observed in micro- and macroalbuminuric diabetic groups when compared to the control and normoalbuminuric diabetic groups. NGAL and RBP4 were found to correlate positively with duration of diabetes, systolic and diastolic blood pressure, glucose, HbA1c, HOMA-IR, triacylglycerol, and ACR, but correlate inversely with GFR in DN groups. Receiver operating characteristic curves revealed that for early detection of DN, the best cutoff values to discriminate DN and diabetic without nephropathy groups were 91.5 ng/mL for NGAL with 87% sensitivity, 74% specificity, and area under the curve (AUC) = 0.881; 24.5 ng/mL for RBP4 with 84% sensitivity, 90% specificity, and AUC = 0.912; and 37.5 mg/g creatinine for ACR with 89% sensitivity, 72% specificity, and AUC = 0.819. RBP4 is more specific (90% specificity) than NGAL (74% specificity) and ACR (72% specificity). Therefore

  7. Does albuminuria predict renal risk and/or cardiovascular risk in obese type 2 diabetic patients?

    PubMed

    Bentata, Yassamine; Abouqal, Redouane

    2014-01-01

    Increased urinary albumin excretion (UAE) is a marker of renal and cardiovascular risk in patients with type 2 diabetes (DT2). What about the obese patient with DT2? Does albuminuria predict the progression of renal disease and/or cardiovascular disease? The objective of this study is to determine the link between albuminuria, renal risk and cardiovascular risk in a cohort of obese DT2 patients. This is a prospective study begun in September 2006. It included DT2 patients presenting obesity defined by a body mass index (BMI)>30 Kg/m(2). Three groups of patients were defined: normo-albuminuria (Urinary Albumin Excretion UAE<30 mg/day or Albumin Creatinine Ratio ACR<30 mg/g), micro-albuminuria (UAE=30-300 mg/day or ACR=30-300 mg/g) and macro-albuminuria (UAE>300 mg/day or ACR>300 mg/g). Data on 144 obese DT2 patients were compiled: The mean age of our patients was 59 ± 9 years and the sex ratio 0.26. The incidence of ESRD was higher in the macro-albuminuria group than in the two other groups (26.5% vs. 1.2%, p<0.001). The incidence of cardiovascular events was 15.4%, 14.3% and 23.5% in the normo, micro and macro-albuminuria groups (p=0.48). A history of cardiovascular comorbidities was the main cardiovascular risk in multivariate analysis (0R=15.07; 95% CI=5.30-42.82; p<0.001) and the low admission GFR (0R=5.67; 95% CI=1.23-9.77; p=0.008) was the main factor for progression of kidney disease in multivariate analysis. Albuminuria may be a better marker of kidney disease progression than of cardiovascular risk in the obese DT2 patient, according to our results. However, to accurately demonstrate the link albuminuria - renal risk and albuminuria - cardiovascular risk in the obese DT2 patient, additional studies using very strict criteria of selection and judgment are needed. PMID:24551483

  8. INTERMAP: background, aims, design, methods, and descriptive statistics (nondietary).

    PubMed

    Stamler, J; Elliott, P; Dennis, B; Dyer, A R; Kesteloot, H; Liu, K; Ueshima, H; Zhou, B F

    2003-09-01

    Blood pressure (BP) above optimal (< or =120/< or =80 mmHg) is established as a major cardiovascular disease (CVD) risk factor. Prevalence of adverse BP is high in most adult populations; until recently research has been sparse on reasons for this. Since the 1980s, epidemiologic studies confirmed that salt, alcohol intake, and body mass relate directly to BP; dietary potassium, inversely. Several other nutrients also probably influence BP. The DASH feeding trials demonstrated that with the multiple modifications in the DASH combination diet, SBP/DBP (SBP: systolic blood pressure, DBP: diastolic blood pressure) was sizably reduced, independent of calorie balance, alcohol intake, and BP reduction with decreased dietary salt. A key challenge for research is to elucidate specific nutrients accounting for this effect. The general aim of the study was to clarify influences of multiple nutrients on SBP/DBP of individuals over and above effects of Na, K, alcohol, and body mass. Specific aims were, in a cross-sectional epidemiologic study of 4680 men and women aged 40-59 years from 17 diverse population samples in China, Japan, UK, and USA, test 10 prior hypotheses on relations of macronutrients to SBP/DBP and on role of dietary factors in inverse associations of education with BP; test four related subgroup hypotheses; explore associations with SBP/DBP of multiple other nutrients, urinary metabolites, and foods. For these purposes, for all 4680 participants, with standardized high-quality methods, assess individual intake of 76 nutrients from four 24-h dietary recalls/person; measure in two timed 24-h urine collections/person 24-h excretion of Na, K, Ca, Mg, creatinine, amino acids; microalbuminuria; multiple nutrients and metabolites by nuclear magnetic resonance and high-pressure liquid chromatography. Based on eight SBP/DBP measurements/person, and data on multiple possible confounders, utilize mainly multiple linear regression and quantile analyses to test prior

  9. Metabolic syndrome: Performance of five different diagnostic criterias

    PubMed Central

    Onesi, S Ogedengbe; Ignatius, U Ezeani

    2014-01-01

    Background: The aim of this study is to describe the metabolic syndrome (MS) and to evaluate five diagnostic criteria of the MS with respect to their sensitivity and specificity in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: It is a cross-sectional case control study of T2DM patients and their first degree relatives (FDRs) recruited using convenience sampling and data collected through questionnaire administered technique. Variables of interest included anthropometric indices, blood pressure, serum lipid profile, fasting blood sugar (FBS), proteinuria, and microalbuminuria. The Chi-square test was used for comparison of proportions. A P value of less than 0.05 was taken as statistically significant. Kappa statistic was used to test the degree of agreement between the diagnostic criteria. Results: The World Health Organization (WHO), International Diabetes Federation (IDF), revised National Cholesterol Education Program (NCEP-R), NCEP Adult Treatment Panel (ATP)-III, and American Association of Clinical Endocrinologists (AACE) criteria reported a prevalence of 87.1, 64.5, 61.3, 55.6, and 22.6%, respectively in persons with T2DM. Using the WHO criteria as a reference or gold standard, the sensitivity of the IDF, NCEP-R, NCEP ATP-III, and AACE criteria among persons with T2DM were 71.3, 67.6, 61.1, and 25.9% respectively. Using the WHO criteria as a reference or gold standard, the specificity of the IDF, NCEP-R, NCEP ATP-III, and AACE criteria among persons with T2DM were 81.3, 81.3, 81.3, and 100%, respectively. Using the WHO criteria as a reference or gold standard, the level of agreement of the IDF, NCEP-R, NCEP ATP-III, and AACE criteria with the WHO criteria among persons with T2DM (as estimated by the kappa statistics) were 0.30, 0.26, 0.21, and 0.08 respectively. Conclusion: The level of agreement appears to be generally poor, though the IDF criteria showed a fair level of agreement with the WHO criteria: Therefore the IDF criteria is

  10. Associations of serum Magnesium levels with diabetes mellitus and diabetic complications

    PubMed Central

    Arpaci, D; Tocoglu, A G; Ergenc, H; Korkmaz, S; Ucar, A; Tamer, A

    2015-01-01

    Background Magnesium (Mg) deficiency is a common problem in diabetic patients. Deficiency of Mg may increase the incidence of diabetes mellitus (DM) and occurrence of diabetic complications. In this study, our aim was to evaluate an association between serum Mg level,  glycemic regulation, and diabetic complications. Material-Methods In this retrospective study 673 diabetic patients were evaluated. According to Mg levels, the patients were divided into two groups; as normomagnesemic patients and hypomagnesemic patients. Results Among the patients, 57.8% were men and 42.2% were women. Mean age was 55.6 years and the mean duration of diabetes was 81 ± 86.9 months. The mean glycosylated hemoglobin (HbA1c) was 9.0 ±2.4 % (4.5-18); mean magnesium level was 1.97 ± 0.25 (1.13 to 3.0) mg / dl.  There were 55 patients (8.2%) with diabetic retinopathy and 95 patients (14.1%) with diabetic neuropathy. Five hundred patients (74.3%)  had normoalbuminuria; 133 patients (19. 8%) had microalbuminuria (MA) and 40 patients (5.9%) had overt proteinuria. One hundred and seventy one patients (25.4%) had HbA1c levels equal or below 7%; and 502 patients (74.6%) had HbA1c levels above 7%. There was no statistical difference in age or duration of diabetes between the groups formed according to Mg levels. Although there were no differences between the groups for retinopathy and neuropathy, MA was more common in hypomagnesemic patients (p =0.004). HbA1c levels did not differ between the groups (p =0.243). However there was a weak negative correlation between serum Mg and HbA1c levels (r =-0.110, p =0.004) and also between serum Mg and urine protein level  (r =-0.127, p =0.018). Conclusion Mg depletion is a common problem in patients with DM. It affects both glycemic regulation and the occurence of complications. Also, poor glycemic regulation affects serum Mg levels. Hippokratia 2015; 19 (2):153-157.

  11. The association between skin collagen glucosepane and past progression of microvascular and neuropathic complications in type 1 diabetes

    PubMed Central

    Monnier, Vincent M.; Sell, David R.; Strauch, Christopher; Sun, Wanjie; Lachin, John M.; Cleary, Patricia A.; Genuth, Saul

    2012-01-01

    PURPOSE We determined the association between novel and acid-labile skin collagen-linked advanced glycation endproducts (AGEs) and the progression of microvascular and neuropathic complications from baseline to near study closeout in the Diabetes Control and Complications Trial (DCCT). METHODS From a skin biopsy obtained near the close of the DCCT, proteolytic collagen digests were analyzed by liquid chromatography/mass spectrometry (LC/MS/MS) for glucosepane (GSPNE), glyoxal and methylglyoxal hydroimidazolones (G-H1 and MG-H1) and the glycation product fructose-lysine(FL) using isotope dilution method. RESULTS GSPNE and MG-H1 correlated with age and diabetes duration (p<0.02), while GSPNE and FL correlated with the history of glycemia expressed as mean A1c(p≤0.003). Age and duration-adjusted GSPNE and FL levels were lower in intensive (INT) vs. conventional (CONV) treatment subjects in the primary prevention DCCT cohort (p < 0.0001), and FL lower in INT in the secondary intervention cohort (p < 0.0001). GSPNE was associated with increased incidence of retinopathy progression (odds ratio (OR)/unit increase in GSPNE: 2.5 for 3 step progression on the ETDRS scale, p=0.003) and sustained ≥ 3 microaneurysms (MA) (OR=4.8, p<0.0001) from DCCT baseline up to the time of the biopsy, and prevalence of microalbuminuria or AER>40 mg/24 hr (OR=5.3, P<0.0001), and confirmed clinical neuropathy (OR=3.4, p=0.015) at the time of the biopsy. GSPNE adjusted for mean A1c remained significant for ≥ 3 MA (p=0.0252) and AER (p=0.0006). The strong association of complications with A1c was reduced or eliminated when adjusted for GSPNE. CONCLUSIONS Glucosepane is a novel AGE marker of diabetic complications that is robustly associated with nephropathic, retinopathic and neuropathic outcomes despite adjustment for A1c, suggesting that it could be one mediator of these complications with possible diagnostic implications. PMID:23153673

  12. Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy in TYpe 2 diabetic patients with normoalbuminuria (PRIORITY): essential study design and rationale of a randomised clinical multicentre trial

    PubMed Central

    Lindhardt, Morten; Currie, Gemma; Pontillo, Claudia; Beige, Joachim; Delles, Christian; von der Leyen, Heiko; Mischak, Harald; Navis, Gerjan; Noutsou, Marina; Ortiz, Alberto; Ruggenenti, Piero Luigi; Rychlik, Ivan; Spasovski, Goce; Rossing, Peter

    2016-01-01

    Introduction Diabetes mellitus affects 9% of the European population and accounts for 15% of healthcare expenditure, in particular, due to excess costs related to complications. Clinical trials aiming for earlier prevention of diabetic nephropathy by renin angiotensin system blocking treatment in normoalbumuric patients have given mixed results. This might reflect that the large fraction of normoalbuminuric patients are not at risk of progression, thereby reducing power in previous studies. A specific risk classifier based on urinary proteomics (chronic kidney disease (CKD)273) has been shown to identify normoalbuminuric diabetic patients who later progressed to overt kidney disease, and may hold the potential for selection of high-risk patients for early intervention. Combining the ability of CKD273 to identify patients at highest risk of progression with prescription of preventive aldosterone blockade only to this high-risk population will increase power. We aim to confirm performance of CKD273 in a prospective multicentre clinical trial and test the ability of spironolactone to delay progression of early diabetic nephropathy. Methods and analysis Investigator-initiated, prospective multicentre clinical trial, with randomised double-masked placebo-controlled intervention and a prospective observational study. We aim to include 3280 type 2 diabetic participants with normoalbuminuria. The CKD273 classifier will be assessed in all participants. Participants with high-risk pattern are randomised to treatment with spironolactone 25 mg once daily, or placebo, whereas, those with low-risk pattern will be observed without intervention other than standard of care. Treatment or observational period is 3 years. The primary endpoint is development of confirmed microalbuminuria in 2 of 3 first morning voids urine samples. Ethics and dissemination The study will be conducted under International Conference on Harmonisation – Good clinical practice (ICH-GCP) requirements

  13. Associations among environmental exposure to manganese, neuropsychological performance, oxidative damage and kidney biomarkers in children.

    PubMed

    Nascimento, Sabrina; Baierle, Marília; Göethel, Gabriela; Barth, Anelise; Brucker, Natália; Charão, Mariele; Sauer, Elisa; Gauer, Bruna; Arbo, Marcelo Dutra; Altknecht, Louise; Jager, Márcia; Dias, Ana Cristina Garcia; de Salles, Jerusa Fumagalli; Saint' Pierre, Tatiana; Gioda, Adriana; Moresco, Rafael; Garcia, Solange Cristina

    2016-05-01

    Environmental exposure to manganese (Mn) results in several toxic effects, mainly neurotoxicity. This study investigated associations among Mn exposure, neuropsychological performance, biomarkers of oxidative damage and early kidney dysfunction in children aged 6-12 years old. Sixty-three children were enrolled in this study, being 43 from a rural area and 20 from an urban area. Manganese was quantified in blood (B-Mn), hair (H-Mn) and drinking water using inductively coupled plasma mass spectrometry (ICP-MS). The neuropsychological functions assessed were attention, perception, working memory, phonological awareness and executive functions - inhibition. The Intelligence quotient (IQ) was also evaluated. The biomarkers malondialdehyde (MDA), protein carbonyls (PCO), δ-aminolevulinate dehydratase (ALA-D), reactivation indexes with dithiothreitol (ALA-RE/DTT) and ZnCl2 (ALA-RE/ZnCl2), non-protein thiol groups, as well as microalbuminuria (mALB) level and N-acetyl-β-D-glucosaminidase (NAG) activity were assessed. The results demonstrated that Mn levels in blood, hair and drinking water were higher in rural children than in urban children (p<0.01). Adjusted for potential confounding factors, IQ, age, gender and parents' education, significant associations were observed mainly between B-Mn and visual attention (β=0.649; p<0.001). Moreover, B-Mn was negatively associated with visual perception and phonological awareness. H-Mn was inversely associated with working memory, and Mn levels from drinking water with written language and executive functions - inhibition. Rural children showed a significant increase in oxidative damage to proteins and lipids, as well as alteration in kidney function biomarkers (p<0.05). Moreover, significant associations were found between B-Mn, H-Mn and Mn levels in drinking water and biomarkers of oxidative damage and kidney function, besides between some oxidative stress biomarkers and neuropsychological tasks (p<0.05). The findings of this

  14. Renal Function Trajectories in Patients with Prior Improved eGFR Slopes and Risk of Death

    PubMed Central

    Xie, Yan; Bowe, Benjamin; Xian, Hong; Balasubramanian, Sumitra; Al-Aly, Ziyad

    2016-01-01

    Background Multiple prior studies demonstrated that patients with early Chronic Kidney Disease (CKD) and positive estimated Glomerular Filtration Rate (eGFR) slopes experience increased risk of death. We sought to characterize patients with positive eGFR slopes, examine the renal function trajectory that follows the time period where positive slope is observed, and examine the association between different trajectories and risk of death. Methods and Findings We built a cohort of 204,132 United States veterans with early CKD stage 3; eGFR slopes were defined based on Bayesian mixed-effects models using outpatient eGFR measurements between October 1999 and September 2004; to build renal function trajectories, patients were followed longitudinally thereafter (from October 2004) until September 2013. There were 41,410 (20.29%) patients with positive eGFR slope and they exhibited increased risk of death compared to patients with stable eGFR slope (HR = 1.33, CI:1.31–1.35). There was an inverse graded association between severity of albuminuria and the odds of positive eGFR slope (OR = 0.94, CI:0.90–0.98, and OR = 0.76, CI:0.69–0.84 for microalbuminuria and albuminuria; respectively). Following the time period where positive eGFR slope is observed, we characterized 4 trajectory phenotypes: high eGFR intercept and positive trajectory (HIPT) (12.42%), intermediate intercept and mild negative trajectory (IIMNT) (60.04%), low intercept and fast negative trajectory (LIFNT)(23.33%), and high intercept and fast negative trajectory (HIFNT) (4.20%). Compared to IIMNT (reference group), HIPT is associated with younger age, dementia, HIV, chronic lung disease, peripheral artery disease, weight loss, and inversely associated with albuminuria; LIFNT and HIFNT were associated with diabetes, hypertension, cardiovascular disease, peripheral artery disease, and albuminuria. The risk of death at 9 years was lowest in IIMNT (HR = 1.12, CI:1.09–1.14), highest in HIPT (HR = 1.71, CI

  15. Characteristics of Adolescents and Youth with Recent-Onset Type 2 Diabetes: The TODAY Cohort at Baseline

    PubMed Central

    Copeland, Kenneth C.; Zeitler, Philip; Geffner, Mitchell; Guandalini, Cindy; Higgins, Janine; Hirst, Kathryn; Kaufman, Francine R.; Linder, Barbara; Marcovina, Santica; McGuigan, Paul; Pyle, Laura; Tamborlane, William; Willi, Steven

    2011-01-01

    Context: The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) cohort represents the largest and best-characterized national sample of American youth with recent-onset type 2 diabetes. Objective: The objective of the study was to describe the baseline characteristics of participants in the TODAY randomized clinical trial. Design: Participants were recruited over 4 yr at 15 clinical centers in the United States (n = 704) and enrolled, randomized, treated, and followed up 2–6 yr. Setting: The study was conducted at pediatric diabetes care clinics and practices. Participants: Eligible participants were aged 10–17 yr inclusive, diagnosed with type 2 diabetes for less than 2 yr and had a body mass index at the 85th percentile or greater. Interventions: After baseline data collection, participants were randomized to one of the folllowing groups: 1) metformin alone, 2) metformin plus rosiglitazone, or 3) metformin plus a lifestyle program of weight management. Main Outcome Measures: Baseline data presented include demographics, clinical/medical history, biochemical measurements, and clinical and biochemical abnormalities. Results: At baseline the cohort included the following: 64.9% were female; mean age was 14.0 yr; mean diabetes duration was 7.8 months; mean body mass index Z-score was 2.15; 89.4% had a family history of diabetes; 41.1% were Hispanic, 31.5% were non-Hispanic black; 38.8% were living with both biological parents; 41.5% had a household annual income of less than $25,000; 26.3% had a highest education level of parent/guardian less than a high school degree; 26.3% had a blood pressure at the 90th percentile or greater; 13.6% had a blood pressure at the 95th percentile or greater; 13.0% had microalbuminuria; 79.8% had a low high-density lipoprotein level; and 10.2% had high triglycerides. Conclusions: The TODAY cohort is predominantly from racial/ethnic minority groups, with low socioeconomic status and a family history of diabetes

  16. Hypertension in people with Type 2 diabetes: knowledge-based diabetes-specific guidelines.

    PubMed

    2003-12-01

    The International Diabetes Federation (Europe) has updated these guidelines on hypertension management specifically in Type 2 diabetes in the light of recent results of the first prospective, randomized controlled studies to investigate clinical outcomes in people with diabetes and hypertension. The guidelines are knowledge based, i.e. based not only on evidence originating from clinical trials, but also from epidemiological and pathophysiological studies. A successful management strategy requires the following components: 1. Regular surveillance to detect developing hypertension and other cardiovascular (CV) risk factors. 2. Considering more frequent monitoring and review of CV risk factors if any single blood pressure (BP) measurement > 140/85 mmHg (or 130/75 if microalbuminuria); when appropriate, using ambulatory or home monitoring to establish the baseline BP. 3. Considering other CV risk factors, such as a raised albumin excretion rate, in setting the intervention threshold. 4. Individualizing the target BP in accordance with other CV risk factors. 5. Agreeing lifestyle and therapeutic interventions with the patient, with education and empowerment as required. 6. Implementing lifestyle modifications, including controlling calorie, salt and alcohol intake, increased physical activity, weight control and smoking cessation. 7. Therapeutic strategy: the primary goal of therapy is to reduce BP markedly. Combination therapy is often necessary, e.g. an angiotensin converting enzyme (ACE) inhibitor and a diuretic. Some classes are particularly useful for certain patients, notably longer-acting ACE inhibitors, angiotensin 2 receptor antagonists (A2RAs) and calcium antagonists in those at risk of diabetic nephropathy, loop diuretics and thiazides in those at risk of hyperkalaemia, beta-blockers and calcium antagonists (except short-acting dihydropyridines) in patients with angina, beta-blockers and ACE inhibitors after a myocardial infarction or in those with left

  17. Tetrahydrobiopterin lowers muscle sympathetic nerve activity and improves augmentation index in patients with chronic kidney disease.

    PubMed

    Park, Jeanie; Liao, Peizhou; Sher, Salman; Lyles, Robert H; Deveaux, Don D; Quyyumi, Arshed A

    2015-02-01

    Chronic kidney disease (CKD) is characterized by overactivation of the sympathetic nervous system (SNS) that contributes to cardiovascular risk. Decreased nitric oxide (NO) bioavailability is a major factor contributing to SNS overactivity in CKD, since reduced neuronal NO leads to increased central SNS activity. Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase that increases NO bioavailability in experimental models of CKD. We conducted a randomized, double-blinded, placebo-controlled trial testing the benefits of oral sapropterin dihydrochloride (6R-BH4, a synthetic form of BH4) in CKD. 36 patients with CKD and hypertension were randomized to 12 wk of 1) 200 mg 6R-BH4 twice daily + 1 mg folic acid once daily; vs. 2) placebo + folic acid. The primary endpoint was a change in resting muscle sympathetic nerve activity (MSNA). Secondary endpoints included arterial stiffness using pulse wave velocity (PWV) and augmentation index (AIx), endothelial function using brachial artery flow-mediated dilation and endothelial progenitor cells, endothelium-independent vasodilatation (EID), microalbuminuria, and blood pressure. We observed a significant reduction in MSNA after 12 wk of 6R-BH4 (-7.5 ± 2.1 bursts/min vs. +3.2 ± 1.3 bursts/min; P = 0.003). We also observed a significant improvement in AIx (by -5.8 ± 2.0% vs. +1.8 ± 1.7 in the placebo group, P = 0.007). EID increased significantly (by +2.0 ± 0.59%; P = 0.004) in the 6R-BH4 group, but there was no change in endothelial function. There was a trend toward a reduction in diastolic blood pressure by -4 ± 3 mmHg at 12 wk with 6R-BH4 (P = 0.055). 6R-BH4 treatment may have beneficial effects on SNS activity and central pulse wave reflections in hypertensive patients with CKD. PMID:25477424

  18. Serum anti-collagen type IV IgM antibodies and development of diabetic nephropathy in diabetics with essential hypertension

    PubMed Central

    Tsinlikov, Ivan; Tsinlikova, Ivanka; Nicoloff, George; Blazhev, Alexander; Garev, Antoan

    2016-01-01

    Introduction and aims Arterial hypertension and diabetic vascular complications are connected with an elevated degradation of elastic tissue. This process leads to an increased production of antibodies to collagen type IV (ACIV Abs). In the present investigation we studied whether the serum levels of antibodies (IgG, IgM and IgA) to collagen are related with microvascular complications. Material and methods Serum levels of antibodies to collagen type IV (ACIV) IgG, IgM and IgA were measured using an ELISA method in 93 patients with type 2 diabetes mellitus and arterial hypertension (AH) (mean age 61.4 ±11.3 years, diabetes duration 9.88 ±3.12 years; hypertension duration 9.28 ±4.98). These values were compared to serum antibodies to CIV in 42 age and sex matched controls. Results ACIV IgM antibodies levels in patients with AH and T2DM were statisticaly significantly higher than controls 0.178 (0.145÷0.220) vs. 0.142 (0.118÷0.173) (KW = 6.31; p = 0.01). Group 1 (patients with microvascular complications) showed significantly higher levels of ACIV IgM than controls 0.180 (0.136÷0.223) vs. 0.142 (0.118÷0.173) (KW = 5.03; p = 0.02). Patients from Group 2 showed statistically significantly higher levels of ACIV IgM than controls 0.176 (0.151÷0.202) vs. 0.142 (0.118÷0.173) (KW = 6.15; p = 0.01). ACIV IgM antibodies showed correlation with microalbuminuria (r = 0.21); (p = 0.04), BMI (r = 0.19); (p = 0.04), creatinine clearance (r = –0.36); (p = 0.01) and GFR (r = –0.34); (p = 0.02). Conclusions Our study showed an association between elevation of serum levels of ACIV IgM and development of diabetic nephropathy. We suggest that levels of ACIV IgM can be useful method for identfying a high risk for development of diabetic nephropathy. PMID:27095927

  19. Endogenous glucose production and glucose effectiveness in type 2 diabetic subjects derived from stable-labeled minimal model approach.

    PubMed

    Nagasaka, S; Tokuyama, K; Kusaka, I; Hayashi, H; Rokkaku, K; Nakamura, T; Kawakami, A; Higashiyama, M; Ishikawa, S; Saito, T

    1999-05-01

    Insulin sensitivity, glucose effectiveness, and endogenous glucose production (EGP) during stable-labeled, frequently sampled insulin-modified intravenous glucose tolerance test (FSIGT) were evaluated by a single-and two-compartment minimal model combined with nonparametric deconvolution in eleven nonobese Japanese type 2 diabetic patients. Four patients were treated with sulfonylureas, and the remaining seven with diet therapy alone. None had diabetic retinopathy and microalbuminuria. Their fasting glucose level was 117+/-7 mg/dl (mean +/- SE), and HbA1c was 6.6+/-0.3%. Age-, sex-, and BMI-matched subjects with normal glucose tolerance served as control subjects. Plasma insulin response to the stimuli and insulin sensitivity indexes (S(I), S(I)*, and S(I)2* were derived from a minimal model and single- and two-compartment-labeled minimal models) were impaired in the type 2 diabetic patients. The combined ability of glucose, per se, to increase its own uptake and suppress EGP (glucose effectiveness [SG]), which was derived from kinetic analysis of plasma glucose by a minimal model, was significantly lower in the type 2 diabetic patients (0.0132+/-0.0015 vs. 0.0203+/-0.0022; P<0.05). However, the ability of glucose, per se, to stimulate glucose uptake, assessed as S(G)* and S(G)2* from the kinetic analysis of labeled glucose by single- and two-compartment minimal model, was not impaired in those patients. EGP of the type 2 diabetic patients as a whole was suppressed to the level similar to that of the control subjects despite a higher plasma glucose level throughout FSIGT. When EGP in the diabetic subjects was analyzed, considering their recent glycemic control, the initial suppression was blunted in the patients with higher HbA1c levels. In conclusion, glucose mass action to stimulate glucose uptake remains near-normal in the lean Japanese type 2 diabetic patients of this study, whereas ability of glucose to suppress EGP is impaired in the patients with recent

  20. Allelic variations in the CYBA gene of NADPH oxidase and risk of kidney complications in patients with type 1 diabetes.

    PubMed

    Patente, Thiago A; Mohammedi, Kamel; Bellili-Muñoz, Naïma; Driss, Fathi; Sanchez, Manuel; Fumeron, Frédéric; Roussel, Ronan; Hadjadj, Samy; Corrêa-Giannella, Maria Lúcia; Marre, Michel; Velho, Gilberto

    2015-09-01

    Oxidative stress plays a pivotal role in the pathophysiology of diabetic nephropathy, and the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system is an important source of reactive oxygen species in hyperglycemic conditions in the kidney. Plasma concentration of advanced oxidation protein products (AOPP), a marker of oxidative stress, is increased in patients with diabetic nephropathy. We investigated associations of variants in the CYBA gene, encoding the regulatory subunit p22(phox) of NADPH oxidase, with diabetic nephropathy and plasma AOPP and myeloperoxidase (MPO) concentrations in type 1 diabetic patients. Seven SNPs in the CYBA region were analyzed in 1357 Caucasian subjects with type 1 diabetes from the SURGENE (n=340), GENEDIAB (n=444), and GENESIS (n=573) cohorts. Duration of follow-up was 10, 9, and 6 years, respectively. Cox proportional hazards and logistic regression analyses were used to estimate hazard ratios (HR) or odds ratios (OR) for incidence and prevalence of diabetic nephropathy. The major G-allele of rs9932581 was associated with the incidence of renal events defined as new cases of microalbuminuria or the progression to a more severe stage of nephropathy during follow-up (HR 1.59, 95% CI 1.17-2.18, P=0.003) in SURGENE. The same allele was associated with established/advanced nephropathy (OR 1.52, 95% CI 1.22-1.92, P=0.0001) and with the incidence of end-stage renal disease (ESRD) (HR 2.01, 95% CI 1.30-3.24, P=0.001) in GENEDIAB/GENESIS pooled studies. The risk allele was also associated with higher plasma AOPP concentration in subsets of SURGENE and GENEDIAB, with higher plasma MPO concentration in a subset of GENEDIAB, and with lower estimated glomerular filtration rate (eGFR) in the three cohorts. In conclusion, a functional variant in the promoter of the CYBA gene was associated with lower eGFR and with prevalence and incidence of diabetic nephropathy and ESRD in type 1 diabetic patients. These results are consistent with