Glucocorticoid Receptors and the Pattern of Steroid Response in Idiopathic Nephrotic Syndrome

Introduction: Little is known about the relationships between the T lymphocytes (CD3+) expression of glucocorticoid receptors (GCR) and the response to glucocorticoid treatment in children with idiopathic nephrotic syndrome (NS). The aim of the current study is to determine whether steroid responsiveness is dependent on the amount of T lymphocytes GCR expressionMethods: We studied 60 children with idiopathic NS in the age group from 2-10 years. According to the response to steroids we classified our patients into early responders (ER; n=46) and late responders (LR; n=14). Sixty age and gender matched healthy children represented the control group. The clinical and laboratory findings at baseline and GCR expression by T lymphocytes (CD3+) as determined by flow cytometry were compared between the three groups.Results: The T lymphocytes (CD3+) expression of GCR was significantly lower in the LR than that in the control group (P<0.01), whereas it was similar in the ER and control groups. GCR expression was also decreased in the LR group compared to the ER group (P<0.01). Furthermore, the T lymphocytes (CD3+) expression of GCR correlated inversely with the time to complete remission (CR) (r = -0.54, P<0.05), but not with urinary protein excretion at baseline.Conclusion: The levels of T lymphocytes (CD3+) expression of GCR may be a useful predictor of steroid responsiveness in children presenting with idiopathic NS

Effects of high food prices on consumption pattern of Saudi consumers: A case study of Al Riyadh city

AbstractThis paper investigates how urban households in Riyadh city, capital of Saudi Arabia, coped with higher food prices depending on a survey for selected group of households. The primary data were obtained in a survey from a sample of 286 household heads. Before analysis, the collected data were first grouped and classified according to the income level of respondents and then descriptive statistics and analysis of variance were applied. The results showed that the consumption quantities of major food commodities decrease due to high prices and at the same time expenditure increases, which lead to erosion of some of the consumers’ savings. High food expenditure makes lower income group more fragile and sensitive for any future increase in food prices. The perception of consumers for price increase in the future is also registered which reflects the lower consumer confidence in the food markets. The respondents iterate the absence of the role of the government to control the food market that may reduce the impact of higher food prices. Therefore, the paper recommends that government should intervene through food policy to mitigate the effects of food price volatility

Stiff to Dilate and Risky to Cut Through: Iliac Radiation Arteritis

Radiation arteritis is not an uncommon clinical situation, given that almost 50% of patients with cancer receive radiotherapy in the course of treatment. Radiation effects are non-specific, and late radiation tissue injury presentation can be very variable. However, radiation arteritis has some unique clinical and radiological features, with consequent special therapeutic considerations. Iliac radiation arteritis may be accompanied by radiation-associated iliac vein disease and small vessel disease. Therefore, diagnostic and therapeutic plans should be directed toward all possible late radiation effects as relevant. Despite the complexity of the disease process and diagnostic challenges, treatment can be very straightforward if adequately planned. Otherwise, limb loss and/or life-threatening complications can rapidly ensue. This article highlights the natural history of radiation arteritis, with a particular emphasis on the iliac segment, and discusses the risk potentials of this condition, given that limb loss may be multifactorial, not merely because of the iliac arterial flow interruption. The main lines of management are also briefly discussed

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely