Cistatin C as an early marker for renal function loss in type 2 diabetic patients with concomitant albuminuria

BACKGROUND. Type 2 diabetes is the main cause of the end-stage renal insufficiency needed renal replacement therapy. Vascular damage turn leads to diabetic nephropathy leads and progress from onset of hyperglycemia. Albuminuria is first laboratory indicator confirm the damage of the renal glomerulus. Cystatin C is sensitive marker of a developing renal dysfunction. Aim of the research: what are the relations between concentration of cystatin C in blood and albuminuria and HbA1c in type 2 diabetes? MATERIAL AND METODS. The research included 68 patients with type 2 diabetes and confirmed albuminuria. Based on the degree of metabolic control expressed by the percentage of HbA1c, the patients were divided into two groups: I group &#8212; 29 patients with type 2 diabetes with HbA1c &#8805; 6.1% to &#163; 6.5%, with the average duration of diabetes of 5.3 years. II group &#8212; 39 patients with type 2 diabetes with HbA1c > 6.5% to &#163; 10.0%, with the average duration of diabetes of 7.2 years. K &#8212; the control group consisted of 21 patients with essential hypertension and albuminuria, not suffering from carbohydrates disorders. Concentration cystatin C in blood was assessed with the ELISA test, the percentage of HbA1c was measured immunoturbidimetric method. A Mann-Whitney test was used for the comparison between the values of the parameters in the research groups and the control group. Spearman&#8217;s rank correlation coefficient was used for measuring the relation between the axtent of albuminuria and the other parameters. RESULTS. The average concentration of HbA1c in group II was 7.54% and was connected with significantly larger average glycaemia (p < 0.001) in comparison with group I with normal HbA1c concentration. The highest albumin excretion in urine and highest average concentration cystatin C in blood was in group II patients with type 2 diabetes with HbA1c > 6.5% to &#163; 10.0%. In group II patients with type 2 diabetes and abnormal metabolic control the average concentration of cystatin C was significantly higher than in the control group patients with essential hypertension. This difference however was not statistically significant. Nevertheless a positive correlation was found between the concentration of cystatin C in blood and the extent of albuminuria in research group I patients with type 2 diabetes with HbA1c < 6.5% (p = 0.005). CONCLUSIONS. The positive correlation between the concentration of cystatin C and the extent of albuminuria, found in the research on patients with type 2 diabetes and normal percentage of HbA1c (p = 0.005) with shorts average duration of diabetes about of 5 years, confirms the sensitivity of this marker even at early stages of renal dysfunction. (Diabet. Prakt. 2011; 12, 3: 103&#8211;112)WSTĘP. Cukrzyca typu 2 jest główną przyczyną krańcowej niewydolności nerek wymagającej leczenia nerkozastępczego. Zmiany naczyniowe prowadzące do powstania cukrzycowej choroby nerek tworzą się i postępują od początku pojawienia się hiperglikemii. Albuminuria jest pierwszym laboratoryjnym objawem potwierdzającym uszkodzenie kłębuszka nerkowego. Cystatynę C uznaje się za czuły parametr początkowej dysfunkcji nerek. Celem badania było wykazanie zależności między stężeniem cystatyny C we krwi a wielkością albuminurii i odsetkiem hemoglobiny glikowanej (HbA1c) u chorych na cukrzycę typu 2. MATERIAŁ I METODY. Badaniami objęto 68 chorych na cukrzycę typu 2 z potwierdzoną albuminurią. Na podstawie stopnia wyrównania metabolicznego, wyrażonego odsetkiem HbA1c, chorych podzielono na 2 grupy: I &#8212; 29 chorych na cukrzycę typu 2 z HbA1c &#8805; 6,1% do &#163; 6,5%, z średnim czasem trwania cukrzycy 5,3 roku; II &#8212; 39 chorych na cukrzycę typu 2 z HbA1c > 6,5% do &#163; 10,0%, z średnim czasem trwania cukrzycy 7,2 roku. Do grupy kontrolnej (K) włączono 21 osób z pierwotnym nadciśnieniem tętniczym, ze współistniejącą albuminurią, bez zaburzeń gospodarki węglowodanowej. Stężenie cystatyny C we krwi oznaczano metodą immunoenzymatyczną (ELISA), a odsetek HbA1c &#8212; metodą immunoturbidymetryczną. W celu porównania rozkładu wartości oznaczanych poszczególnych parametrów między badanymi grupami zastosowano test Manna-Whitneya (p*). W oznaczaniu zależności między wartością albuminurii a pozostałymi parametrami wykorzystano współczynnik korelacji Spearmana (p**). WYNIKI. Średni odsetek HbA1c w II grupie wyniósł 7,54% i wiązał się z istotnie wyższym średnim stężeniem glukozy we krwi (p < 0,001), w porównaniu z I grupą chorych z prawidłowym odsetkiem HbA1c. Największe wydalanie albumin z moczem oraz najwyższe średnie stężenie cystatyny C we krwi stwierdzono w II grupie chorych na cukrzycę typu 2 z HbA1c > 6,5% do &#163; 10,0%. W II grupie chorych ze źle wyrównaną metabolicznie cukrzycą typu 2 średnia wartość cystatyny C była znacznie wyższa, w porównaniu z grupą kontrolną chorych z pierwotnym nadciśnieniem tętniczym. Różnice między otrzymanymi wartościami nie były jednak istotne statystycznie. Uzyskano dodatnią korelację między stężeniem cystatyny C we krwi a wielkością albuminurii w I grupie chorych na cukrzycę typu 2 z HbA1c < 6,5% (p = 0,005). WNIOSKI. Wykazana w badaniu dodatnia korelacja między stężeniem cystatyny C a wielkością albuminurii u chorych na cukrzycę typu 2 z prawidłowym odsetkiem HbA1c (p = 0,005), z krótszym, około 5-letnim wywiadem chorobowym, potwierdza wysoką czułość tego wskaźnika już w początkowych stadiach rozpoczynającej się dysfunkcji nerek. (Diabet. Prakt. 2011; 12, 3: 103&#8211;112

Role of family physician in patient with chronic kidney disease care

Przewlekła choroba nerek (PChN) jako choroba ogólnoustrojowa prowadząca do zaburzenia równowagi organizmu, zarówno w kompartmencie wodno-elektrolitowym, jak i białkowo-energetycznym, stanowi znamienny problem w postępowaniu terapeutycznym. Im szybsza progresja choroby nerek, tym szybciej chory wymaga leczenia nerkozastępczego. Dlatego tak ważne jest szybkie i prawidłowe rozpoznanie PChN przez lekarza rodzinnego, dalsze postępowanie terapeutyczne i pokierowanie pacjenta do nefrologa. Rola lekarza rodzinnego w pierwszym etapie diagnozowania tej jednostki chorobowej jest kluczowym elementem postępowania diagnostyczno-terapeutycznego. Istotna jest również wiedza o procesach w zakresie czasokresu trwania choroby, zakresu badań specjalistycznych niezbędnych do postępowania diagnostyczno-nefrologicznego oraz monitorowanie przebiegu choroby. W opiece nad pacjentem z PChN leczonym hemodializami bardzo ważną rolę pełni również pielęgniarka środowiskowa. To ona w ścisłej współpracy i pod kierunkiem lekarza rodzinnego, który planuje i koordynuje opiekę pielęgniarską zgodnie z wybranym modelem pielęgnowania, ustala sposoby, formy, metody realizacji kompleksowej opieki pielęgniarskiej zgodnie z wiedzą i standardami obowiązującymi w medycynie i zgodnie z kodeksem etyki zawodowej. Właściwa współpraca lekarza rodzinnego, pielęgniarki środowiskowej i nefrologa na etapie diagnostyczno-terapeutycznym w PChN jest nieodzownym elementem sukcesu w szybkim wdrożeniu odpowiedniego leczenia, zminimalizowania działań niepożądanych, co w sposób bardzo istotny poprawi komfort życia i wydłuży okres przeżycia pacjentów z PChN.Chronic kidney disease (CKD), as a systemic disease leading to body balance disturbance in both water-electrolytic and protein-energetic compartments, is a serious problem in the therapeutic management. The more rapid the progression of kidney disease, the sooner the patient requires renal replacement therapy. Therefore, making a quick and correct diagnosis of CKD by a family physician, further therapeutic management, and referral of the patient to a nephrologist is extremely important. The role of a family physician at the first stage of diagnosing this pathological entity is the key element of the diagnostic-therapeutic management. Knowledge of the processes within the area of duration of the disease, scope of specialist tests indispensable in diagnostic-nephrologic management and monitoring of the course of the disease. An environmental nurse also plays a very important role in the care of a patient with CKD treated with dialyses. This nurse, in close cooperation and under supervision of a family physician who plans and coordinates nursing care in accordance with a selected model of nursing, establishes the ways, forms and methods of provision of a complex nursing care, according to the knowledge and standards valid in medicine, as well as the professional ethical code. Proper cooperation among a family physician, environmental nurse, and nephrologist at the diagnostic-therapeutic stage in CKD is an indispensable element of success in a quick implementation of appropriate treatment and minimization of adverse effects, which would considerably improve the life comfort and the period of survival of patients with CKD

Kultura i społeczeństwo na Środkowym Nadodrzu w XIX i XX wieku

303 s. : il., portr.

Effect of Mycophenolate Mofetil on Plasma Bioelements in Renal Transplant Recipients

The proper concentrations of plasma bioelements may favorably reduce the incidence of metabolic disorders, which often occur during immunosuppressive therapy. Mycophenolate mofetil (MMF) is currently one of the most frequently administered immunosuppressive agents; however, MMF treatment is often related to gastrointestinal side effects. The aim of this study was thus to verify whether the MMF treatment itself, or its metabolite pharmacokinetics, has an effect on the concentrations of plasma bioelements. To determine this, the effect of MMF on the levels of both major (sodium [Na], potassium [K], calcium [Ca], magnesium [Mg]), and trace (iron [Fe], zinc [Zn], copper [Cu]) plasma bioelements in 61 renal transplant recipients was assessed in comparison to a control group (n = 45). The pharmacokinetic parameters of mycophenolic acid were determined by the high-performance liquid chromatography method. All patients filled out a 24-h diet history questionnaire. The results showed high plasma concentrations of Fe and low plasma concentrations of Mg and Zn as compared with diagnostic norms. The patients treated with MMF had significantly lower plasma Na (P < 0.001) and significantly higher plasma Zn (P = 0.030) and Cu concentrations (P < 0.001). In conclusion, MMF treatment was found to affect plasma Fe, Zn, and Cu levels by increasing their concentrations while decreasing the plasma Na concentration. Mg and Zn deficiencies, as well as excessive Fe levels, are frequently observed irrespective of the immunosuppressive regimen applied, which suggests that monitoring of these bioelements may be favorable

Polish statement on food allergy in children and adolescents

An adverse food reaction is defined as clinical symptoms occurring in children, adolescents or adults after ingestion of a food or chemical food additives. This reaction does not occur in healthy subjects. In certain individuals is a manifestation of the body hypersensitivity, i.e. qualitatively altered response to the consumed food. The disease symptoms observed after ingestion of the food can be triggered by two pathogenetic mechanisms; this allows adverse food reactions to be divided into allergic and non-allergic food hypersensitivity (food intolerance). Food allergy is defined as an abnormal immune response to ingested food (humoral, cellular or mixed). Non-immunological mechanisms (metabolic, pharmacological, microbiological or other) are responsible for clinical symptoms after food ingestion which occur in non-allergic hypersensitivity (food intolerance). Food allergy is considered a serious health problem in modern society. The prevalence of this disorder is varied and depends, among other factors, on the study population, its age, dietary habits, ethnic differences, and the degree of economic development of a given country. It is estimated that food allergy occurs most often among the youngest children (about 6-8% in infancy); the prevalence is lower among adolescents (approximately 3-4%) and adults (about 1-3%). The most common, age-dependent cause of hypersensitivity, expressed as sensitization or allergic disease (food allergy), are food allergens (trophoallergens). These are glycoproteins of animal or plant origine contained in: cow's milk, chicken egg, soybean, cereals, meat and fish, nuts, fruits, vegetables, molluscs, shellfish and other food products. Some of these allergens can cause cross-reactions, occurring as a result of concurrent hypersensitivity to food, inhaled or contact allergens. The development of an allergic process is a consequence of adverse health effects on the human body of different factors: genetic, environmental and supportive. In people predisposed (genetically) to atopy or allergy, the development of food allergy is determined by four allergic-immunological mechanisms, which were classified and described by Gell-Coombs. It is estimated that in approximately 48-50% of patients, allergic symptoms are caused only by type I reaction, the IgEmediated (immediate) mechanism. In the remaining patients, symptoms of food hypersensitivity are the result of other pathogenetic mechanisms, non-IgE mediated (delayed, late) or mixed (IgE mediated, non-IgE mediated). Clinical symptomatology of food allergy varies individually and depends on the type of food induced pathogenetic mechanism responsible for their occurrence. They relate to the organ or system in which the allergic reaction has occurred (the effector organ). Most commonly the symptoms involve many systems (gastrointestinal tract, skin, respiratory system, other organs), and approximately 10% of patients have isolated symptoms. The time of symptoms onset after eating the causative food is varied and determined by the pathogenetic mechanism of the allergic immune reaction (immediate, delayed or late symptoms). In the youngest patients, the main cause of food reactions is allergy to cow’s milk. In developmental age, the clinical picture of food allergy can change, as reflected in the so-called allergic march, which is the result of anatomical and functional maturation of the effector organs, affected by various harmful allergens (ingested, inhaled, contact allergens and allergic cross-reactions). The diagnosis of food allergy is a complex, long-term and time-consuming process, involving analysis of the allergic history (personal and in the family), a thorough evaluation of clinical signs, as well as correctly planned allergic and immune tests. The underlying cause of diagnostic difficulties in food allergy is the lack of a single universal laboratory test to identify both IgE-mediated and non-IgE mediated as well as mixed pathogenetic mechanisms of allergic reactions triggered by harmful food allergens. In food allergy diagnostics is only possible to identify an IgE-mediated allergic process (skin prick tests with food allergens, levels of specific IgE antibodies to food allergens). This allows one to confirm the diagnosis in patients whose symptoms are triggered in this pathogenetic mechanism (about 50% of patients). The method allowing one to conclude on the presence or absence of food hypersensitivity and its cause is a food challenge test (open, blinded, placebo-controlled). The occurrence of clinical symptoms after the administration of food allergen confirms the cause of food allergy (positive test) whereas the time elapsing between the triggering dose ingestion and the occurrence of clinical symptoms indicate the pathogenetic mechanisms of food allergy (immediate, delayed, late). The mainstay of causal treatment is temporary removal of harmful food from the patient’s diet, with the introduction of substitute ingredients with the nutritional value equivalent to the eliminated food. The duration of dietary treatment should be determined individually, and the measures of the effectiveness of the therapeutic elimination diet should include the absence or relief of allergic symptoms as well as normal physical and psychomotor development of the treated child. A variant alternative for dietary treatment of food allergy is specific induction of food tolerance by intended contact of the patient with the native or thermally processed harmful allergen (oral immunotherapy). This method has been used in the treatment of IgE-mediated allergy (to cow's milk protein, egg protein, peanut allergens). The obtained effect of tolerance is usually temporary. In order to avoid unnecessary prolongation of treatment in a child treated with an elimination diet, it is recommended to perform a food challenge test at least once a year. This test allows one to assess the body's current ability to acquire immune or clinical tolerance. A negative result of the test makes it possible to return to a normal diet, whereas a positive test is an indication for continued dietary treatment (persistent food allergy). Approximately 80% of children diagnosed with food allergy in infancy "grow out" of the disease before the age of 4-5 years. In children with non-IgE mediated food allergy the acquisition of food tolerance is faster and occurs in a higher percentage of treated patients compared to children with IgE-mediated food allergy. Pharmacological treatment is a necessary adjunct to dietary treatment in food allergy. It is used to control the rapidly increasing allergic symptoms (temporarily) or to achieve remission and to prevent relapses (long-term treatment). Preventive measures (primary prevention of allergies) are recommended for children born in a "high risk" group for the disease. These are comprehensive measures aimed at preventing sensitization of the body (an appropriate way of feeding the child, avoiding exposure to some allergens and adverse environmental factors). First of all, the infants should be breast-fed during the first 4-6 months of life, and solid foods (non milk products, including those containing gluten) should be introduced no earlier than 4 months of age, but no later than 6 months of age. An elimination diet is not recommended for pregnant women (prevention of intrauterine sensitization of the fetus and unborn child). The merits of introducing an elimination diet in mothers of exclusively breast-fed infants, when the child responds with allergic symptoms to the specific diet of the mother, are disputable. Secondary prevention focuses on preventing the recurrence of already diagnosed allergic disease; tertiary prevention is the fight against organ disability resulting from the chronicity and recurrences of an allergic disease process. Food allergy can adversely affect the physical development and the psycho-emotional condition of a sick child, and significantly interfere with his social contacts with peers. A long-term disease process, recurrence of clinical symptoms, and difficult course of elimination diet therapy are factors that impair the quality of life of a sick child and his family. The economic costs generated by food allergies affect both the patient's family budget (in the household), and the overall financial resources allocated to health care (at the state level). The adverse socio-economic effects of food allergy can be reduced by educational activities in the patient’s environment and dissemination of knowledge about the disease in the society

Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality

Objectives. To evaluate the spectrum of neurological symptoms in patients with COVID-19 during the first 14 days of hospitalisation and its association with in-hospital mortality. Material and methods. We included 200 patients with RT-PCR-confirmed COVID-19 admitted to University Hospital in Krakow, Poland. In 164 patients, a detailed questionnaire concerning neurological symptoms and signs was performed prospectively within 14 days of hospitalisation. In the remaining 36 patients, such questionnaires were completed retrospectively based on daily observations in the Department of Neurology. Results. During hospitalisation, 169 patients (84.5%) experienced neurological symptoms; the most common were: fatigue (62.5%), decreased mood (45.5%), myalgia (43.5%), and muscle weakness (42.5%). Patients who died during hospitalisation compared to the remainder were older (79 [70.5–88.5] vs. 63.5 [51–77] years, p = 0.001), and more often had decreased level of consciousness (50.0% vs. 9.3%, p &lt; 0.001), delirium (33.3% vs. 4.4%, p &lt; 0.001), arterial hypotension (50.0% vs. 19.6%, p = 0.005) or stroke during (18.8% vs. 3.3%, p = 0.026) or before hospitalisation (50.0% vs. 7.1, p &lt; 0.001), whereas those who survived more often suffered from headache (42.1% vs. 0%, p = 0.012) or decreased mood (51.7% vs. 0%, p = 0.003). Conclusions. Most hospitalised patients with COVID-19 experience neurological symptoms. Decreased level of consciousness, delirium, arterial hypotension, and stroke during or before hospitalisation increase the risk of in-hospital mortality

Machine Learning Identifies Stemness Features Associated with Oncogenic Dedifferentiation.

Cancer progression involves the gradual loss of a differentiated phenotype and acquisition of progenitor and stem-cell-like features. Here, we provide novel stemness indices for assessing the degree of oncogenic dedifferentiation. We used an innovative one-class logistic regression (OCLR) machine-learning algorithm to extract transcriptomic and epigenetic feature sets derived from non-transformed pluripotent stem cells and their differentiated progeny. Using OCLR, we were able to identify previously undiscovered biological mechanisms associated with the dedifferentiated oncogenic state. Analyses of the tumor microenvironment revealed unanticipated correlation of cancer stemness with immune checkpoint expression and infiltrating immune cells. We found that the dedifferentiated oncogenic phenotype was generally most prominent in metastatic tumors. Application of our stemness indices to single-cell data revealed patterns of intra-tumor molecular heterogeneity. Finally, the indices allowed for the identification of novel targets and possible targeted therapies aimed at tumor differentiation

Native and migrant townsmen. Te migration of the inhabitants of Przemyśl (according to the census from mid-1918)

Niniejsze badania przeprowadzono na bazie spisu mieszkańców Przemyśla z poł. 1918 r., sporządzonego na podstawie nietypowych dla tego rodzaju źródła formularzy ankiet. Materiały te znajdują się obecnie w zasobie Archiwum Państwowego w Rzeszowie (oddział w Sanoku) oraz w mniejszej części w zbiorach Archiwum Państwowego w Przemyślu. W obu wypadkach zachowały się fragmentarycznie. Częścią zasadniczą tekstu jest studium demografczno-historyczne ukazujące kształtowanie się struktury narodowej i wyznaniowej mieszkańców miasta tego okresu. Szczególną uwagę zwraca ruch wędrówkowy skierowany w stronę Przemyśla w latach 1880–1918 oraz jego tempo. W artykule zajęto się również rozmieszczeniem migrantów w mieście, zwłaszcza w jego centrum oraz na przedmieściach (Zasania po jego lewej, północnej stronie, i przedmieścia Lwowskiego po prawej, wschodniej części).The present study was performed on the basis of the census of the inhabitants of Przemyśl from mid-1918, prepared based on questionnaire forms which were not typical for thus type of source. These materials are currently stored in the State Archive in Rzeszów (department in Sanok) and, partially in the archives of the State Archive in Przemyśl. In both cases they were only fragmentarily preserved. The main part of the present study presents a demographic analysis showing how the national and denomination structure of the city dwellers from that time was shaped. Special attention was put on the migration movement directed towards Przemyśl in the years 1880–1918 and its rate. The article focuses also on the location of migrants in the city, especially in its center and in the suburbs (Zasanie on its right, northern side and the Lviv suburbs on its right, eastern side)