Myositis and acute kidney injury in bacterial atypical pneumonia: Systematic literature review.

Abstract Background Bacterial community-acquired atypical pneumonia is sometimes complicated by a myositis or by a renal parenchymal disease. Available reviews do not mention the concurrent occurrence of both myositis and acute kidney injury. Methods In order to characterize the link between bacterial community-acquired atypical pneumonia and both myositis and a renal parenchymal disease, we reviewed the literature (United States National Library of Medicine and Excerpta Medica databases). Results We identified 42 previously healthy subjects (35 males and 7 females aged from 2 to 76, median 42 years) with a bacterial atypical pneumonia associated both with myositis (muscle pain and creatine kinase ≥5 times the upper limit of normal) and acute kidney injury (increase in creatinine to ≥1.5 times baseline or increase by ≥27 μmol/L above the upper limit of normal). Thirty-six cases were caused by Legionella species (N = 27) and by Mycoplasma pneumoniae (N = 9). Further germs accounted for the remaining 6 cases. The vast majority of cases (N = 36) presented a diffuse myalgia. Only a minority of cases (N = 3) were affected by a calf myositis. The diagnosis of rhabdomyolysis-associated kidney injury was retained in 37 and that of acute interstitial nephritis in the remaining 5 cases. Conclusion Bacterial atypical pneumonia may occasionally induce myositis and secondary kidney damage

Which laboratory technique is used for the blood sodium analysis in clinical research? A systematic review

Abstract Background Circulating sodium is analyzed by flame spectrometry and indirect or direct potentiometry. The differences between estimates returned by the three techniques are often relevant. It is unknown whether peer-reviewed international publications focusing on this parameter provide information about the technique. Objectives of the study were to ascertain if information about the employed technique is provided. Content A search in the National Library of Medicine for articles whose title contains "hyponatr[a]emia" was performed. We restricted the search to clinical reports including 10 or more humans published in the 2013–2015 and 2017–2019 periods. Authors of papers not reporting the technique were contacted to obtain this information. The study design and journal quartile ranking of each article were also evaluated. Summary For the final analysis, we included 361 articles (2013–2015, n=169; 2017–2019, n=192). Information about the laboratory technique was given in 61(17%) articles. Thanks to our inquiry, we collected this information for 116(32%) further reports. Indirect potentiometry was the most frequently used technique, followed by direct potentiometry. Spectrometry was used in a small minority of studies. Study design, journal ranking and study period did not modulate the mentioned frequency. Outlook Most articles focusing on hyponatremia do not provide information on the laboratory technique. This parameter is nowadays analyzed by indirect or, less frequently, direct potentiometry. The figures are similar for high and low impact factor journals and for the 2013–2015 and the 2017–2019 periods. Many authors, reviewers and editors likely assume that the results of this parameter are not influenced by the technique

R.H. Moreno-Durán: fantasía y verdad. Valoración múltiple

Pocos escritores colombianos han explorado diversos géneros literarios con resultados satisfactorios; Moreno-Durán destaca en el panorama artístico de Colombia al cosechar logros en una amplia producción creativa que incluye novelas, cuentos, ensayos y en los últimos tiempos el teatro. / Contenido. Preliminares; Capítulo 1 - R.H. Moreno-Durán: a fondo; Capítulo 2 - R.H. Moreno-Durán: en breve; Anexos

"Ubi Petrus, ibi Ecclesia". Le visite ad limina, una prassi di comunione

Le relazioni stilate in occasione delle visite ad limina dei vescovi delle Chiese locali appaiono, pur con i loro limiti intrinseci, delle fonti importanti per la ricostruzione, specialmente nei secoli dlel'et\ue0 moderna, della storia religiosa, sociale e culturale della popolazione di un determinato territorio. Dopo una premessa di carattere metodologico, viene qui analizzato il caso relativo all'edizione delle relazioni della diocesi di Brescia dal 1589 al 1931

Non-Alcoholic Fatty Liver Disease is Not Associated with Vitamin D Deficiency in Essential Hypertension.

An independent association between non-alcoholic fatty liver disease (NAFLD), a condition characterized by insulin-resistance, and low serum 25-hydroxyvitamin D [25(OH)D] levels has been reported. 25(OH)D concentrations are directly related with insulin sensitivity, whereas low [25(OH)D] predicts development of hypertension independent of glucose homeostasis alterations. We hypothesized that hypertensive patients with NAFLD have lower 25(OH)D than those without. Forty-four essential hypertensive (EH) patients with (n = 23) or without (n = 21) NAFLD were studied. No patient had diabetes mellitus, obesity, hyperlipidemia. The two hypertensive groups were compared with 24 healthy normotensive sex-, age-, body mass index (BMI)-matched subject, as controls. The two hypertensive groups had comparable age, sex, and blood pressure. BMI, glucose, insulin, homeostasis model assessment (HOMA) index and alanine aminotransferase were higher (P < 0.001 to <0.05) and plasma adiponectin was lower (P < 0.05) in EH patients with NAFLD than in those without NAFLD. Vitamin D deficiency, as defined by 25(OH)D levels <50 nmol/L, was similarly frequent in EH patients and controls (47.7 % vs. 45.8 %, P NS). Prevalence of hypovitaminosis D was not different in EH patients with and without NAFLD (37.5 % vs. 38.8 %, P NS). In patients with EH and no additional cardiometabolic risk factors NAFLD is not associated with vitamin D deficienc

Lumbar spine bone mineral density changes in patients with primary hyperparathyroidism according to age and gender

Primary hyperparathyroidism (PHPT) results from excessive secretion of parathyroid hormone (PTH), and catabolic and anabolic effects of PTH on bone may lead to overall deleterious effects on skeleton. The aim of this study was to analyze the changes in lumbar spine bone mineral density (BMD) in patients with PHPT who underwent parathyroidectomy (PTx), and to correlate the main emographics and biochemical parameters with pre- and postoperative BMD values. Two groups of age-matched patients (groupA=14 postmenopausalwomen; group B=13 men, overall median age 53 years, range 26\u201356 years) with confirmed PHPT were enrolled in the study. All patients underwent lumbar (L2-L4 region) spine osteodensitometry using a dual-energy X-ray absorptiometry (DXA) prior to surgery. A significant correlation between alkaline phosphatase (ALP) and PTH (R = 0.73, P = 0.003) was found in group A patients. In group B correlations were found between calcemia and ALP (R = 0.71, P = 0.007), and between osteocalcin and both PTH (R = 0.65, P = 0.01) and ALP (R = 0.59, P = 0.03). No correlation (P = NS) was found between BMD, both basal and postoperative, and age or biochemical parameters. The 1-year BMD were 0.937\ub10.115 and 0.940 \ub1 0.201 g/cm2 (P = NS) in group A and B, respectively. A significant (P = 0.03) difference between basal and 1-year BMD was found only in group A, while in group B the difference was not significant. In conclusion, in patients with PHPT bone turnover is increased and consequently the BMD is reduced, but unfortunately PTx does not allow for complete bone restoring. However, in premenopausal women the BMD values of the lumbar spine significantly improve after PTx, suggesting a higher bone sensitivity to serum PTH normalization due to a synergic action with estrogens

Bone mineral density improvement after successful parathyroidectomy in pre- and postmenopausal women with primary hyperparathyroidism. A prospective study.

The aim of this study was to evaluate the short-term (1 year) changes of the lumbar spine (L2\u2013L4) bone mineral density (LS-BMD) after parathyroidectomy (PTx) in pre- and postmenopausal women with primary hyperparathyroidism (PHPT). A series of 48 women (median age 56 years, range 23\u201382 years) with confirmed PHPT were prospectively enrolled in the study.Patientswho received both oral contraceptives less than 2 years before the diagnosis and estrogen replacement therapy have previously been excluded. All patients underwent LS-BMD by dual energy x-ray absorptiometry before surgery. Patients were divided into two groups: group A (n = 12) premenopausal, and group B (n = 36) postmenopausal patients. The LS-BMD was repeated 12 months after successful PTx. Basal LS-BMD (0.852 \ub1 0.061 vs. 0.748 \ub1 0.142 g/cm2), serum calcium (2.95 \ub1 0.23 vs. 2.94 \ub1 0.26 mmol/L), creatinine (69.2 \ub1 17.5 vs. 82.0 \ub1 24.2 mol/L), alkaline phosphatase (107.4 \ub1 43.6 vs. 151.3\ub195.7 U/L), osteocalcin (28.6\ub19.3 vs. 28.2\ub18.3 g/L), and PTH (192.7 \ub1 133.2 vs. 175.2 \ub1 132.1 ng/L) levels did not differ significantly (P = NS) between groups. The 1-year LS-BMD was 0.921 \ub1 0.048 and 0.825 \ub1 0.151 g/cm2 in group A and B, respectively. In group B patients, the 1-yearLS-BMDvalue did not improve significantly (P=NS),while in group A patients the difference between basal and postsurgical LS-BMD was significant (P < 0.01). In conclusion, PTx should be considered for all patients with PHPT and loss of bone density, but in premenopausal patients a greatest improvement of BMD may be found, suggesting the need of endogenous estrogens in complete lumbar bone recovery after surgery

Relationship between serum parathyroid hormone, serum calcium and arterial blood pressure in patients with primary hyperparathyroidism: results of multivariate analysis

OBJECTIVE: To evaluate the possible relationship between serum calcium, serum parathyroid hormone (PTH) levels and arterial blood pressure (BP) in patients with primary hyperparathyroidism (HPT). DESIGN: A retrospective population-based study. METHODS: Charts of 194 patients with proven primary HPT were reviewed, and the main clinical and biochemical parameters were recorded. There were 48 men (24.7%) and 146 women (75.3%), with a median age of 59 years (range 23\u201382 years). Patients who used antihypertensive drugs or hormone replacement therapy had been previously excluded. All patients underwent successful parathyroidectomy, and were cured of their disease. RESULTS: There were no differences (P=NS) between men and women in systolic \u85143.3\ub119.1 vs. 145.4\ub117.1 mmHg, and diastolic \u8587.1\ub112.3 vs. 88.4\ub19.9 mmHg BP, and in the main biochemical parameters. A significant (P<0.01) correlation was found between (i) serum calcium and serum PTH levels (r=0.39; F=88:36); (ii) age and BP, both systolic \u85(r=0.61; F=118.16) and diastolic (r=0.48; F=64.5); and (iii) body mass index (BMI) and BP (r=0.45 and 0.36, respectively). There was no significant association of serum calcium levels with systolic \u85(r=0.0974; t=1.3422; P=0.18) or diastolic (r=0.1117; t=1.5409; P=0.12)\u86 BP, and of serum PTH levels with systolic \u85(r=20.0349; t=20.4783; P=0.63) or diastolic (r=20.0793; t=21.0913; P=0.28) BP. Multivariate analysis confirmed that none of the independent biochemical parameters significantly correlated with BP, both systolic and diastolic. CONCLUSIONS: In patients with primary HPT there is no relationship between PTH, calcium and BP. Thus, in hyperparathyroid patients, BP should be considered as an independent variable, mainly related to age and BMI