Eplerenone add-on treatment in resistant hypertension in peritoneal dialysis patient. A case report

Resistant hypertension (RH) is frequently seen in clinical practice in kidney disease patients. Mineralocorticoid receptor antagonists (MRAs) especially spironolactone are highly effective in the management of RH. Eplerenone — highly selective MRA has been also shown to be effective in RH patients but it is rarely used in this clinical condition, especially in kidney disease patients. Eplerenone is mainly recommended in congestive heart failure after myocardial infarction. A case of peritoneal dialysis (PD) patient with RH successfully treated with eplerenone was reported

Membranoproliferative glomerulonephritis in type 2 diabetic patient

Nietypowy przebieg kliniczny nefropatii cukrzycowej nakazuje podejrzewać obecność innego schorzenia nerek. Wymaga to niejednokrotnie odrębnego postępowania diagnostyczno-terapeutycznego. W niniejszej pracy omówiono przypadek chorego na cukrzycę typu 2 ze współistniejącym zespołem nerczycowym, u którego na podstawie biopsji rozpoznano kłębuszkowe zapalenie nerek. Przedstawiono postępowanie diagnostyczne oraz korzyści wynikające z zastosowanego leczenia immunosupresyjnego.Atypical clinical course of diabetic nephropathy may indicate other non-diabetic kidney disease. It requires diverse diagnostic and therapeutic approach. We presented a case of patient who suffered from diabetes mellitus type 2 and nephrotic syndrome with superimposed primary glomerulonephitis - membranoproliferative glomerulonephritis histollogically proven. We described diagnostic tools and therapeutic procedure i.e. immunosupessive treatment with its benefits

Efficacy of double vs. standard empagliflozin dose for METabolic syndromE tReatment (DEMETER — SIRIO 11) study. Rationale and protocol of the study

Complex metabolic disorders associated with obesity and diabetes pose a serious therapeutic challenge. The DEMETER-SIRIO 11 study is a phase III, multicenter, randomized, open-label, investigator-initiated clinical trial with a 6-month follow-up aimed at performing a comparative evaluation of the effect of two empagliflozin doses (10 mg vs. 20 mg) on selected metabolic parameters in patients with metabolic syndrome. The primary hypothesis of the study is that a higher dose of empagliflozin will result in a significant reduction of BMI and HbA1c in patients with obesity and MS receiving empagliflozin 20 mg as compared to 10 mg. Sample size and power calculation were based on a superiority assumption for the primary efficacy endpoint (the difference in decrease of body weight by > 1.5 kg and HbA1c by > 0.4%) for the higher vs. standard dose arm at 6-months of follow-up. Therefore, a sample size of 79 patients per arm is required to provide 80% power to detect a higher decrease in BMI, and 85 patients per arm is required to provide 80% power to detect a higher decrease in HbA1c in the 20 mg versus 10 mg arm with a type I error rate of 0.05. Summing up, enrollment of a total of 200 patients (100 in each arm) is planned to compensate for the potential drop-out rate from the study of up to 15%. Prespecified subanalyses will be performed according to: 1) diabetes mellitus; 2) chronic kidney disease (GFR < 60 mL/min/1.73 m2); 3) gender; and 4) age. A greater comprehensive improvement in biochemical, functional, and anthropometric parameters reflecting favorable metabolic changes is expected at the higher dose of empagliflozin compared to the standard dose

Assessment of the eye surface and subjective symptoms after using 0.1% dexamethasone drops with and without preservatives in patients after cataract surgery

Abstract Cataract surgery can cause dry eye symptoms. One of the many factors compromising the ocular surface is the use of benzalkonium chloride (BAC)-preserved topical eye drops administered during the postoperative period. In this open-label, prospective, randomized, comparative clinical trial, 40 patients not previously affected by dry eye disease were assigned to receive either preservative-free (PFD) or preserved (PD) dexamethasone 0.1% eye drops for two weeks after a standard phacoemulsification procedure. Fluorescein break-up time, ocular surface staining score, Schirmer test, Ocular Surface Disease Index and anterior chamber (AC) cells were evaluated at baseline prior to the surgery and 2 weeks after surgery. No statistically significant differences in baseline assessments were observed between groups. At week 2, a significant increase in corneal staining scores (p = 0.003) and foreign body sensation (p = 0.04) was observed for the PD group only. The conjunctival staining score was significantly higher in both groups. The mean AC cell grading was higher in the PFD group than in the PD group (0.28 ± 0.30 and 0.07 ± 0.18, respectively; p = 0.013). Preservative-free dexamethasone eye drops after cataract surgery caused milder dry eye symptoms as compared with preserved dexamethasone. The AC inflammation control comparison may require a larger study group. Trial registration: ClinicalTrials.gov identifier NCT05753787, 03/03/2023

The corneo-scleral junction assessed with optical coherence tomography

Purpose To evaluate corneo-scleral junction (CSJ) using anterior segment optical coherence tomography (AS-OCT) and describe the pattern of cornea and sclera interfusion based on tissue reflectivity. Methods This prospective observational study enrolled candidates for vision correction. Eyes with previous ocular surgery or irregular corneas were excluded. Temporal and nasal CSJ width and reflectivity patterns were assessed with AS-OCT horizontal scans. Correlations between manual and automated variables and multivariate linear regression analyses with age and spherical equivalent were performed. Results 101 right eyes were analysed. Temporal CSJ was wider (median 1.62; 1.13 to 2.22 mm) compared to the nasal side (median 1.18; 0.73 to 1.80 mm) (pConclusions The temporal CSJ was wider and had regular (V or U-shaped) reflectivity patterns, while nasal CSJ was narrower and more irregular. The CSJ width was independent of age and refractive error and could not be predicted from other parameters. The HVID measurement accuracy may benefit from CSJ analysis based on AS-OCT

The corneo-scleral junction assessed with optical coherence tomography.

PurposeTo evaluate corneo-scleral junction (CSJ) using anterior segment optical coherence tomography (AS-OCT) and describe the pattern of cornea and sclera interfusion based on tissue reflectivity.MethodsThis prospective observational study enrolled candidates for vision correction. Eyes with previous ocular surgery or irregular corneas were excluded. Temporal and nasal CSJ width and reflectivity patterns were assessed with AS-OCT horizontal scans. Correlations between manual and automated variables and multivariate linear regression analyses with age and spherical equivalent were performed.Results101 right eyes were analysed. Temporal CSJ was wider (median 1.62; 1.13 to 2.22 mm) compared to the nasal side (median 1.18; 0.73 to 1.80 mm) (pConclusionsThe temporal CSJ was wider and had regular (V or U-shaped) reflectivity patterns, while nasal CSJ was narrower and more irregular. The CSJ width was independent of age and refractive error and could not be predicted from other parameters. The HVID measurement accuracy may benefit from CSJ analysis based on AS-OCT

Descriptive statistics of analysed ocular anterior segment variables: Mean, standard deviation (SD), median, minimum (Min), maximum (Max), interquartile range (IR) and coefficient of variation (CV).

Descriptive statistics of analysed ocular anterior segment variables: Mean, standard deviation (SD), median, minimum (Min), maximum (Max), interquartile range (IR) and coefficient of variation (CV).</p

The assessment of corneo-scleral junction width.

The horizontal AS-OCT scan of the right eye with callipers set to measure the corneo-scleral junction width (red lines) as a distance between last optically clear corneal section and first optically opaque scleral section. Determination of posterior limbal border was supported with the optical shadowing of iris from the scleral tissue (white arrows). Dashed lines perpendicular to the iris, with a starting point at the last visible iris pigment epithelium, point at the first fully opaque scleral section.</p

Inter- and intra-observer agreement of manual CSJt and CSJn measurements.

Inter- and intra-observer agreement of manual CSJt and CSJn measurements.</p

Statistically significant correlations of HVID and SS-SS with other anterior segment parameters.

Statistically significant correlations of HVID and SS-SS with other anterior segment parameters.</p