Increased blood pressure in adult offspring of families with Balkan Endemic Nephropathy: a prospective study

BACKGROUND: Previous studies have linked smaller kidney dimensions to increased blood pressure. However, patients with Balkan Endemic Nephropathy (BEN), whose kidneys shrink during the course of the disease, do not manifest increased blood pressure. The authors evaluated the relationship between kidney cortex width, kidney length, and blood pressure in the offspring of BEN patients and controls. METHODS: 102 offspring of BEN patients and 99 control offspring of non-BEN hospital patients in the Vratza District, Bulgaria, were enrolled in a prospective study and examined twice (2003/04 and 2004/05). Kidney dimensions were determined using ultrasound, blood pressure was measured, and medical information was collected. The parental disease of BEN was categorized into three groups: mother, father, or both parents. Repeated measurements were analyzed with mixed regression models. RESULTS: In all participants, a decrease in minimal kidney cortex width of 1 mm was related to an increase in systolic blood pressure of 1.4 mm Hg (p = 0.005). There was no association between kidney length and blood pressure. A maternal history of BEN was associated with an increase in systolic blood pressure of 6.7 mm Hg (p = 0.03); paternal BEN, +3.2 mm Hg (p = 0.35); or both parents affected, +9.9 mm Hg (p = 0.002). There was a similar relation of kidney cortex width and parental history of BEN with pulse pressure; however, no association with diastolic blood pressure was found. CONCLUSION: In BEN and control offspring, a smaller kidney cortex width predisposed to higher blood pressure. Unexpectedly, a maternal history of BEN was associated with average increased systolic blood pressure in offspring

Metals and kidney markers in adult offspring of endemic nephropathy patients and controls: a two-year follow-up study

Abstract Background The etiology of Balkan Endemic Nephropathy, (BEN), a tubulointerstitial kidney disease, is unknown. Although this disease is endemic in rural areas of Bosnia, Bulgaria, Croatia, Romania, and Serbia, similar manifestations are reported to occur in other regions, for instance Tunisia and Sri Lanka. A number of explanations have been stated including lignites, aristolochic acid, ochratoxin A, metals, and metalloids. Etiologic claims are often based on one or a few studies without sound scientific evidence. In this systematic study, we tested whether exposures to metals (cadmium and lead) and metalloids (arsenic and selenium) are related to Balkan Endemic Nephropathy. Methods In 2003/04 we recruited 102 adults whose parents had BEN and who resided in one of three communities (Vratza, Bistretz, or Beli Izvor, Bulgaria). A control group comprised of 99 adults having non-BEN hospitalized parents was enrolled in the study during the same time. We conducted face-to-face interviews, ultrasound kidney measurements, and determined kidney function in two consecutive investigations (2003/04 and 2004/05). Metals and metalloids were measured in urine and blood samples. To assess the agreement between these consecutive measurements, we calculated intraclass correlation coefficients. Repeated measurement data were analyzed using mixed models. Results We found that cadmium and arsenic were associated with neither kidney size nor function. Lead had a significant but negligible effect on creatinine clearance. Selenium showed a weak but significant negative association with two of the four kidney parameters, namely creatinine clearance and β2-microglobulin. It was positively related to kidney length. These associations were not restricted to the offspring of BEN patients. Adding credence to these findings are reports showing comparable kidney effects in animals exposed to selenium. Conclusion The findings of this 2-year follow-up study indicate that metals and metalloids do not play a role in the etiology of Balkan Endemic Nephropathy. Against the assumption in the literature, selenium was not protective but a risk factor. Since comparable associations were observed in animals, future studies are needed to explore whether selenium may have adverse renal effects in humans.</p

Stretching the spines of gymnasts: a review

Gymnastics is noted for involving highly specialized strength, power, agility and flexibility. Flexibility is perhaps the single greatest discriminator of gymnastics from other sports. The extreme ranges of motion achieved by gymnasts require long periods of training, often occupying more than a decade. Gymnasts also start training at an early age (particularly female gymnasts), and the effect of gymnastics training on these young athletes is poorly understood. One of the concerns of many gymnastics professionals is the training of the spine in hyperextension-the ubiquitous 'arch' seen in many gymnastics positions and movements. Training in spine hyperextension usually begins in early childhood through performance of a skill known as a back-bend. Does practising a back-bend and other hyperextension exercises harm young gymnasts? Current information on spine stretching among gymnasts indicates that, within reason, spine stretching does not appear to be an unusual threat to gymnasts' health. However, the paucity of information demands that further study be undertaken

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

<p>Abstract</p> <p>Background</p> <p>The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).</p> <p>Methods</p> <p>All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.</p> <p>Results</p> <p>The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.</p> <p>Conclusion</p> <p>These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.</p

Blood pressure control : helping patients take their medicine [Spanish]

Blood pressure control : helping patients take their medicine [Spanish]La presio\ucc?n arterial alta puede causar enfermedades cardiacas, accidentes cerebrovasculares, enfermedades renales y la muerte. Aproximadamente, el 70 % de los adultos en los EE. UU., de 65 an\ucc\u192oso ma\ucc?s, tiene la presio\ucc?n arterial alta y solo cerca de la mitad de ellos la tiene bajo control (por debajo de 140/90 mmHg). Los medicamentos para la presio\ucc?n arterial (junto con una alimentacio\ucc?n saludable y ejercicios) pueden proteger el corazo\ucc?n, el cerebro y los rin\ucc\u192ones, pero solo si los pacientes los toman y mantienen su presio\ucc?n arterial controlada. Sin embargo, al menos el 25 % de los adultos, de 65 an\ucc\u192os o ma\ucc?s, con la Parte D de Medicare que cubre los medicamentos recetados, no esta\ucc?n tomando sus medicamentos para la presio\ucc?n arterial segu\ucc?n las indicaciones. Esto significa que puede que se salten dosis o que dejen de tomarlos del todo. Los sistemas de atencio\ucc?n me\ucc?dica, incluidos proveedores, consultorios me\ucc?dicos, farmacias, hospitales, trabajadores de salud comunitaria y compan\ucc\u192i\ucc?as de seguros de salud, pueden trabajar con los pacientes para que sea ma\ucc?s fa\ucc?cil tomar los medicamentos.Los sistemas de atencio\ucc?n me\ucc?dica pueden:\ue2\u20ac\ua2 Simplificar el tratamiento para la presio\ucc?n arterial (p. ej., recetar suministros para 90 di\ucc?as y medicamentos en combinacio\ucc?n, y coordinar la entrega del suministro de pastillas para la misma fecha) y recetar medicamentos gene\ucc?ricos.\ue2\u20ac\ua2 \uef\ubf\ubc\uef\ubf\ubcInvolucrar a todo el equipo de atencio\ucc?n me\ucc?dica en varios puntos de atencio\ucc?n para garantizar que los pacientes este\ucc?n tomando sus medicamentos segu\ucc?n las indicaciones y para abordar las preocupaciones de los pacientes acerca de los efectos secundarios. Implementar protocolos de tratamientos eficaces para la presio\ucc?n arterial en la pra\ucc?ctica cli\ucc?nica. http://go.usa.gov/xjf59\ue2\u20ac\ua2 Fomentar el uso de monitores de la presio\ucc?n arterial en casa y arti\ucc?culos fa\ucc?ciles de usar (p. ej., registros de la presio\ucc?n arterial y aplicaciones mo\ucc?viles) para hacerle seguimiento a los niveles de la presio\ucc?n arterial y compartir la informacio\ucc?n.\ue2\u20ac\ua2 Abordar los obsta\ucc?culos financieros, tales como altos copagos y deducibles.CS267220A MLS269737A2016-09-vitalsigns.pd