Decreased renal function in overweight and obese prepubertal children

BACKGROUND: Obesity is a potentially modifiable risk factor for the development and progression of kidney disease, both in adults and children. We aim to study the association of obesity and renal function in children, by comparing estimated glomerular filtration rate (eGFR) in nonoverweight and overweight/obese children. Secondarily, we aim to evaluate the accuracy of equations on eGFR estimation when compared to 24-h urinary creatinine clearance (CrCl). METHODS: Cross-sectional study of 313 children aged 8-9 y, followed in the birth cohort Generation XXI (Portugal). Creatinine and cystatin C, GFR estimated by several formulas and CrCl were compared in 163 nonoverweight and 150 overweight/obese, according to World Health Organization growth reference. RESULTS: Overweight/obese children had significantly lower eGFR, estimated by all methods, except for CrCl and revised Schwartz formula. Despite all children having renal function in the normal range, eGFR decreased significantly with BMI z-score (differences ranging from -4.3 to -1.1 ml/min/1.73 m(2) per standard deviation of BMI). The Zappitelli combined formula presented the closest performance to CrCl, with higher correlation coefficients and higher accuracy values. CONCLUSION: Young prepubertal children with overweight/obesity already present significantly lower GFR estimations that likely represent some degree of renal impairment associated with the complex deleterious effects of adiposity

Effect of Carnitine and herbal mixture extract on obesity induced by high fat diet in rats

<p>Abstract</p> <p>Background</p> <p>Obesity-associated type 2 diabetes is rapidly increasing throughout the world. It is generally recognized that natural products with a long history of safety can modulate obesity.</p> <p>Aim</p> <p>To investigate the development of obesity in response to a high fat diet (HFD) and to estimate the effect of L-carnitine and an Egyptian Herbal mixture formulation (HMF) (consisting of T. chebula, Senae, rhubarb, black cumin, aniseed, fennel and licorice) on bodyweight, food intake, lipid profiles, renal, hepatic, cardiac function markers, lipid Peroxidation, and the glucose and insulin levels in blood and liver tissue in rats.</p> <p>Method</p> <p>White male albino rats weighing 80-90 gm, 60 days old. 10 rats were fed a normal basal diet (Cr), 30 rats fed a high-fat diet (HFD) for 14 weeks during the entire study. Rats of the HFD group were equally divided into 3 subgroups each one include 10 rats. The first group received HFD with no supplement (HFD), the 2^ndgroup HFD+L-carnitine and the third group received HFD+HMF. Carnitine and HMF were administered at 10^thweek (start time for treatments) for 4 weeks.</p> <p>Body weight, lipid profile & renal function (urea, uric acid creatinine) ALT & AST activities, cardiac markers, (LDH, C.K-NAC and MB) the oxidative stress marker reduced glutathione (GSH), and Malondialdehyde (MDA) catalase activity, in addition to glucose, insulin, and insulin resistance in serum & tissues were analyzed.</p> <p>Results</p> <p>Data showed that feeding HFD diet significantly increased final body weight, triglycerides (TG), total cholesterol, & LDL concentration compared with controls, while significantly decreasing HDL; meanwhile treatment with L-carnitine, or HMF significantly normalized the lipid profile.</p> <p>Serum ALT, urea, uric acid, creatinine, LDH, CK-NAC, CK-MB were significantly higher in the high fat group compared with normal controls; and administration of L-carnitine or herbal extract significantly lessened the effect of the HFD. Hyperglycemia, hyperinsulinemia, and high insulin resistance (IR) significantly increased in HFD in comparison with the control group. The treatment with L-carnitine or HMF improved the condition. HFD elevated hepatic MDA and lipid peroxidation associated with reduction in hepatic GSH and catalase activity; whereas administration of L-carnitine or herbal extract significantly ameliorated these hepatic alterations.</p> <p>Conclusion</p> <p>HFD induced obesity associated with a disturbed lipid profile, defective antioxidant stability, and high values of IR parameters; this may have implications for the progress of obesity related problems. Treatment with L-carnitine, or HMF extract improved obesity and its associated metabolic problems in different degrees. Also HMF has antioxidant, hypolipidaemic insulin sensitizing effects. Moreover HMF might be a safe combination on the organs whose functions were examined, as a way to surmount the obesity state; and it has a distinct anti-obesity effect.</p

Reformative perspective on the principle of legitimate expectation in Turkish administrative law

This PhD thesis aims to reform the principle of legitimate expectation in Turkish Administrative Law by considering European Union Law, decisions of the European Court of Human Rights (ECtHR), and utilizing Hohfeld analysis. The narrow interpretation and labelling of the principle of legitimate expectation in Turkish law have resulted in legal problems in practice. In order to tackle these issues, the thesis posits that the expansive interpretation of the principle of legitimate expectation within the framework of European Union law, as exemplified by the jurisprudence of the European Union courts, specifically the Court of Justice of the European Union (CJEU) and the General Court (formerly known as the Court of First Instance, CFI), provides viable legal avenues for redress. The principle of legitimate expectation in European Union law is grounded in the rule of law, legal certainty, equality/non-discrimination, and good administration. It is a general principle of law and holds a prominent position in the hierarchy of EU norms, along with the Founding Treaties and the Charter of Fundamental Rights; hence it is considered ex officio by the Courts. The decisions of the Court of Justice of the European Union (CJEU) have most likely influenced the decisions of the ECtHR, and the concept of legitimate expectation has gradually been established in the case law of the ECtHR. Notably, the ECtHR refers to the protection of legitimate expectations through only a few articles of the European Convention on Human Rights. Furthermore, Turkish Courts are perceived to tend to follow the approach adopted by the ECtHR in the context of legitimate expectations. The thesis identifies a conceptual framework problem in Turkish law concerning legitimate expectations, established situations, and vested rights. The distinctions between these similar and often confused concepts need further clarification. Hohfeld analysis can be applied to concretely clarify these distinctions, as the abstract content of the concepts can be clarified through Hohfeld's analysis.The principle of legitimate expectation in Turkish Administrative Law and in ECtHR judgments is interpreted narrowly compared to the principle of legitimate expectation in European Union law. Therefore, the thesis proposes a framework for the principle of legitimate expectation in Turkish Administrative Law, drawing on decisions of the European Union Courts. This framework categorizes the principle of legitimate expectation into procedural protection; and substantive protection, that is, lawful decisions (vested rights), unlawful decisions (established situations), established practices, departure from existing policy, lawful representation, unlawful representation, and expectations arising from legal norms

Hybrid approach: an alternative prior to corrective surgery in a patient with arch hypoplasia and complete atrioventricular septal defect

The hybrid approach is mostly preferred in patients with hypoplastic left heart syndrome or univentricular physiology. Here, the hybrid approach is applied as a palliative procedure prior to corrective surgery in a patient with complete atrioventricular septal defect associated with arcus hypoplasia and results are discussed according to the literature

Integrating Patients' Expectations into the Management of Their Depression: Report of a Symposium at the European College of Neuropsychopharmacology Congress

A symposium held at the 31st European College of Neuropsychopharmacology congress in October 2018 in Barcelona, Spain discussed patients' expectations of treatment of their depression and how these can be integrated into patient management. Since treatment non-compliance is a major problem in patients suffering from depression, it is important to identify patients' expectations to improve treatment compliance and in turn efficacy. Currently, there is no established protocol for choosing the right antidepressant therapy, and physicians need to tailor the choice based on the type of depression, its predominant symptoms, medical and psychiatric history of patients, and their previous response to, and adverse events with, treatment. Treatment strategies also need to be adapted to each patient's personality/persona and their personal beliefs, and patients need to be aware of the potential for drug-associated adverse events such as emotional blunting, sexual dysfunction and loss of functional outcomes, as the expectation of these events may limit their impact on treatment discontinuation. Also, placebo effects remain frequent with treatment, and there is currently no agreed method for predicting response to therapy. Of the available methods to determine treatment response, pharmacogenetic testing has limited value while functional imaging may be valuable, but is not practical in routine clinical practice. Online cognitive behavioural therapy (CBT) represents a new option in the clinical management of patients with depression, particularly for patients who may not be able to access direct interaction with a psychotherapist because of the severity of their condition, their geographic location or socioeconomic situation. Online CBT can act as an adjunct to drug treatment and face-to-face psychotherapy, rather than as the sole form of treatment to aid in identifying a patient's needs, thus meeting the treatment gap and improving compliance and efficacy.Funding: Servier

BATI AKDENİZ BÖLGESİNDE YERALAN ORMAN ÜRÜNLERİ SANAYİ FİRMALARININ İHRACAT PROBLEMLERİ

Ülkeler sahip oldukları ekonomik kaynaklarını kullanabildikleri ve Dünya piyasaları ile entegre olabildikleri düzeyde gelişme hızını arttırabilir ve ekonomik kalkınma ve büyümeyi yakalayabilir. Hızla gelişen rekabet ortamı içerisinde işletmelerin istenilen konumu yakalayabilmeleri için ekonomik faaliyetlerini etkileyen faktörleri kapsamlı analize tabi tutmalıdırlar. Böylelikle gerek iç ve gerekse dış piyasalarda işletmeler daha etkin konuma taşınabilirler. Bu çalışmada Batı Akdeniz Bölgesi (Antalya, Burdur, Isparta) imalat sanayi ve istihdamının önemli bir kesimini elinde bulunduran orman ürünleri sanayi işletmelerinin mevcut durumları ve ihracat problemlerinin incelenmesi amacıyla seçilen 150 adet işletmeye anket uygulanmıştır. Bürokratik engeller, finansman ve eğitimli çalışan eksikliği ihracat alanında yaşanan en önemli sorunlar olarak belirlenmiştir. Anahtar kelimeler: Batı Akdeniz, Orman endüstrisi, İhracat problemler