Evolution of Native Kidney Function After Pancreas Transplantation Alone

peer reviewedIntroduction. This study investigated changes in kidney function over time among a cohort of patients undergoing pancreas transplantation alone (PTA) from January 2002 to December 2011. Patients and Methods. Ten of eighteen PTA patients bearing functioning grafts for at least 1 year were recruited for the analysis. Primary endpoints were changes in mean serum creatinine (SCr, mg/L) and mean estimated glomerular filtration rate (eGFR) using the 4-variable Levey-MDRD equation (mL/min/1.73 m2) comparing baseline (pretransplantation) to 6-month, 1-year, 3-year, and 5-year posttransplantation values. Mean follow-up time was 75.7 20.5 months (range, 46–106.5). Results. Baseline eGFR was 89.3 27.9 (range, 58–145). eGFR decreased to 75.7 26.2, 71 20.6, 66.5 14.8, and 62.1 11.2 at 6 months, 1, 3, and 5 years representing 15.2%, 20.5%, 15.8%, and 22.6% percentage decreases respectively (P .05 for all pairwise comparisons). The Baseline SCr was 8.6 2.3 mg/L (range, 5–13). SCr progressively increased to 10.1 3, 10.5 3.1, 10.9 3.1, and 11.3 1.7 at 6 months, 1, 3, and 5 years a 17.1%, 22%, 16.6%, and 19.9% increase respectively (P .05 for all pairwise comparisons). One of ten, 2/8, and 3/7 patients displayed an eGFR 60 at transplantation versus 3 and 5 years thereafter, respectively. No patient developed a SCr 25 mg/L or eGFR 30 or needed dialysis or kidney transplantation. Five of ten patients had micro-albuminuria or proteinuria before transplantation. Tacrolimus levels were within recommended therapeutic ranges over time. Conclusion. Kidney function deteriorated significantly after PTA. Understanding of risk factors for the development of renal impairment is important to preserve kidney function and to select appropriate candidates for PTA

Migrants and emerging public health issues in a globalized world: threats, risks and challenges, an evidence-based framework

International population mobility is an underlying factor in the emergence of public health threats and risks that must be managed globally. These risks are often related, but not limited, to transmissible pathogens. Mobile populations can link zones of disease emergence to lowprevalence or nonendemic areas through rapid or high-volume international movements, or both. Against this background of human movement, other global processes such as economics, trade, transportation, environment and climate change, as well as civil security influence the health impacts of disease emergence. Concurrently, global information systems, together with regulatory frameworks for disease surveillance and reporting, affect organizational and public awareness of events of potential public health significance. International regulations directed at disease mitigation and control have not kept pace with the growing challenges associated with the volume, speed, diversity, and disparity of modern patterns of human movement. The thesis that human population mobility is itself a major determinant of global public health is supported in this article by review of the published literature from the perspective of determinants of health (such as genetics/biology, behavior, environment, and socioeconomics), population-based disease prevalence differences, existing national and international health policies and regulations, as well as inter-regional shifts in population demographics and health outcomes. This paper highlights some of the emerging threats and risks to public health, identifies gaps in existing frameworks to manage health issues associated with migration, and suggests changes in approach to population mobility, globalization, and public health. The proposed integrated approach includes a broad spectrum of stakeholders ranging from individual health-care providers to policy makers and international organizations that are primarily involved in global health management, or are influenced by global health events

New contribution to the mode of action of non-perforating cyclodiathermia

peer reviewe

Severity Indices of Personality Problems (SIPP-118):Dutch Norms, T-scores, and Percentile Rank Scores

For the SIPP-118, a widely used instrument for measuring the severity of personality disorders in 16 facets and five domains, T-scores, and percentile rank scores were established. Various approaches based on classical test theory and item response theory (IRT) for establishing T-scores were compared, which are assumed to achieve in-creasing levels of accuracy. Three approaches were evaluated: (1) a simple linear conversion of raw scores to T-scores, (2) a normalizing conversion (Rankit), and (3) an approach based on IRT. We compared T-scores resulting from these approaches with IRT-based factor scores. The findings show that the linear approach produced distorted T-scores for many facets of the SIPP-118, especially in the lower, more pathological range of scores. The Rankit and IRT-based approaches yielded in practice almost identical T-scores and both corresponded quite well with factor scores that were actually based on an IRT model for these facets or domain scores. Implications for the practice of establishing T-scores are discussed. IRT provided the most accurate trait estimates, but it requires a complex calculation that takes into account item parameters and the individual's response pattern. Regression-based IRT-score approximations and Rankit-based T-scores yielded adequate estimates as well.</p