31 research outputs found
Optimizing response to desmopressin in patients with monosymptomatic nocturnal enuresis
Most patients with monosymptomatic nocturnal enuresis can be effectively treated with an enuresis alarm or antidiuretic therapy (desmopressin), depending on the pathophysiology of the condition in the individual patient. Desmopressin is first-line therapy for enuresis caused by nocturnal polyuria, an excessive urine output during the night. However, in a recent study, around one-third of patients thought to be resistant to desmopressin were subsequently treated effectively with desmopressin monotherapy in a specialist centre. The aim of this article is to review best practice in selecting patients for desmopressin treatment, as well as outline eight recommendations for maximizing the chances of treatment success in patients receiving desmopressin. The roles of formulation, dose, timing of administration, food and fluid intake, inter-individual variation in response, body weight, adherence, withdrawal strategies and combination therapies are discussed in light of the most recent research on desmopressin and enuresis. Possible reasons for suboptimal treatment response are explored and strategies to improve outcomes in patients for whom desmopressin is an appropriate therapy are presented. Through optimization of the treatment plan in primary and specialist care centres, the hope is that fewer patients with this distressing and often embarrassing condition will experience unnecessary delays in receiving appropriate care and achieving improvements
Neuropathy in adolescents with type 1 diabetes:confirmatory diagnostic tests, bedside tests, and risk factors
Parathyroid hormone and phosphate homeostasis in patients with Bartter and Gitelman syndrome:an international cross-sectional study
Background:Small cohort studies have reported high parathyroid hormone (PTH) levels in patients with Bartter syndrome and lower serum phosphate levels have anecdotally been reported in patients with Gitelman syndrome. In this cross-sectional study, we assessed PTH and phosphate homeostasis in a large cohort of patients with salt-losing tubulopathies. Methods:Clinical and laboratory data of 589 patients with Bartter and Gitelman syndrome were provided by members of the European Rare Kidney Diseases Reference Network (ERKNet) and the European Society for Paediatric Nephrology (ESPN). Results:A total of 285 patients with Bartter syndrome and 304 patients with Gitelman syndrome were included for analysis. Patients with Bartter syndrome type I and II had the highest median PTH level (7.5 pmol/L) and 56% had hyperparathyroidism (PTH >7.0 pmol/L). Serum calcium was slightly lower in Bartter syndrome type I and II patients with hyperparathyroidism (2.42 versus 2.49 mmol/L; P = .038) compared to those with normal PTH levels and correlated inversely with PTH (rs −0.253; P = .009). Serum phosphate and urinary phosphate excretion did not correlate with PTH. Overall, 22% of patients had low serum phosphate levels (phosphate—standard deviation score < −2), with the highest prevalence in patients with Bartter syndrome type III (32%). Serum phosphate correlated with tubular maximum reabsorption of phosphate/glomerular filtration rate (TmP/GFR) (rs 0.699; P < .001), suggesting renal phosphate wasting. Conclusions:Hyperparathyroidism is frequent in patients with Bartter syndrome type I and II. Low serum phosphate is observed in a significant number of patients with Bartter and Gitelman syndrome and appears associated with renal phosphate wasting.</p
Parathyroid hormone and phosphate homeostasis in patients with Bartter and Gitelman syndrome:an international cross-sectional study
Background:Small cohort studies have reported high parathyroid hormone (PTH) levels in patients with Bartter syndrome and lower serum phosphate levels have anecdotally been reported in patients with Gitelman syndrome. In this cross-sectional study, we assessed PTH and phosphate homeostasis in a large cohort of patients with salt-losing tubulopathies. Methods:Clinical and laboratory data of 589 patients with Bartter and Gitelman syndrome were provided by members of the European Rare Kidney Diseases Reference Network (ERKNet) and the European Society for Paediatric Nephrology (ESPN). Results:A total of 285 patients with Bartter syndrome and 304 patients with Gitelman syndrome were included for analysis. Patients with Bartter syndrome type I and II had the highest median PTH level (7.5 pmol/L) and 56% had hyperparathyroidism (PTH >7.0 pmol/L). Serum calcium was slightly lower in Bartter syndrome type I and II patients with hyperparathyroidism (2.42 versus 2.49 mmol/L; P = .038) compared to those with normal PTH levels and correlated inversely with PTH (rs −0.253; P = .009). Serum phosphate and urinary phosphate excretion did not correlate with PTH. Overall, 22% of patients had low serum phosphate levels (phosphate—standard deviation score < −2), with the highest prevalence in patients with Bartter syndrome type III (32%). Serum phosphate correlated with tubular maximum reabsorption of phosphate/glomerular filtration rate (TmP/GFR) (rs 0.699; P < .001), suggesting renal phosphate wasting. Conclusions:Hyperparathyroidism is frequent in patients with Bartter syndrome type I and II. Low serum phosphate is observed in a significant number of patients with Bartter and Gitelman syndrome and appears associated with renal phosphate wasting.</p
Ανάπτυξη και επικύρωση μεθόδου προσδιορισμού βιογενών πτητικών οργανικών ενώσεων και δευτερογενών βιογενών ενώσεων στα αιωρούμενα σωματίδια PM10
Η παρούσα εργασία εκπονήθηκε στο Εργαστήριο Χημείας Περιβάλλοντος του τμήματος Χημείας Αθήνας. Σκοπός της διπλωματικής αυτής εργασίας ήταν η μελέτη των βιογενών πτητικών οργανικών ενώσεων (BVOCs) και των δευτερογενών βιογενών ενώσεων στα αιωρούμενα σωματίδια PM10 στην περιοχή της Πανεπιστημιούπολης των Αθηνών. Πιο συγκεκριμένα εξετάστηκαν οι βιογενείς πτητικές οργανικές ενώσεις : κουμένιο, α-πινένιο, β-πινένιο, 3-καρένιο και λιμονένιο. Για τον προσδιορισμό των δευτερογενών βιογενών ενώσεων μελετήθηκαν οι ενώσεις : του ηλεκτρικού οξέος, του γλουταρικού οξέος, του αδιπικού οξέος, του πινονικού οξέος, της μεθυλερυθριτόλης, του πιμελικού οξέος, του πινικού οξέος, του φθαλικού οξέος, του σουβερικού οξέος, του ισοφθαλικού οξέος, του παλμιτικού οξέος και του στεατικού οξέος. Πραγματοποιήθηκαν δύο σειρές δειγματοληψιών και χρησιμοποιήθηκαν ενεργοί δειγματολήπτες (αντλία) για τις βιογενείς πτητικές οργανικές ενώσεις και ένας δειγματολήπτης μεγάλου όγκου HiVol για τα αιωρούμενα σωματίδια PM10. Η πρώτη σειρά πραγματοποιήθηκε τους θερινούς μήνες Ιούνιο-Αύγουστο του έτους 2016 και η δεύτερη σειρά τους χειμερινούς μήνες Νοέμβριο-Δεκέμβριο του έτους 2016. Ακόμα συλλέχθηκαν 24 ώρα και 3 ώρα δείγματα κατά την διάρκεια μιας πλήρους ημέρας. Εξαιτίας των πολικών ομάδων των ενώσεων που προσδιορίστηκαν για τις δευτερογενείς βιογενείς ενώσεις χρησιμοποιήθηκε το αντιδραστήριο παραγωγοποίησης BSTFA. O προσδιορισμός των ουσιών που αναφέρθηκαν πραγματοποιήθηκε με τη χρήση αέριου χρωματογράφου συζευγμένου με φασματοσκοπία μαζών.
Η επικύρωση της μεθόδου έγινε μέσω εξέτασης χαρακτηριστικών όπως η ειδικότητα, η γραμμικότητα , η πιστότητα, οι ανακτήσεις και τα όρια ανίχνευσης και ποσοτικοποίησης. Η μέθοδος παρουσιάζει ικανοποιητικά αποτελέσματα ανακτήσεων και επαναληψιμότητας. Η απόκριση του ανιχνευτή ήταν γραμμική στην περιοχή 5 έως 100 ng/mL για τις βιογενείς πτητικές οργανικές ενώσεις και στην περιοχή 0.5 έως 50 μg/mL για τις δευτερογενείς βιογενείς ενώσεις.
Στόχος της παρούσας εργασίας ήταν ο συσχετισμός των βιογενών πτητικών οργανικών ενώσεων με τα προϊόντα οξείδωσης τους δηλαδή τις δευτερογενείς βιογενείς ενώσεις στα αιωρούμενα σωματίδια PM10.This thesis took place at the Laboratory of Environmental Chemistry of the University of Athens. The goal of this thesis was to study the biogenic volatile organic compounds and the secondary biogenic organic compounds in particulate matter PM10 in the wider area of Athens and more specifically in the area of the University of Athens. To be more accurate cumene, a-pinene, b-pinene, 3-carene and limonene was the compounds which was examined for the category of biogenic volatile organic compounds. For the determination of the secondary biogenic organic compounds in particulate matter PM10 the compounds that was examined are: succinic acid, glutaric acid, adipic acid, pinonic acid, methylerythritol, pimelic acid, pinic acid, phthalic acid, suberic acid, isophthalic acid, palmitic acid and stearic acid. Two series of samplings took place. One pump sampler and one high volume sampler were used for the samplings of biogenic volatile organic compounds and for the particulate matter PM10. The first series of samplings took place during the summer months June-August of the year 2016 and the second series of samplings took place during the winter months November-December of the year 2016. Moreover the samplings are divided in samplings of 24 hours and 3 hours during a full day. A derivatization reagent BSTFA it was used because of the polar groups of the compounds in the particulate matter PM10. The determination of the compounds which have already mentioned above it was done with the use of gas chromatography mass spectrometry.
The validation of the method was realized through the examination of some characteristics such as specificity, linearity, precision, recoveries and limits of detection and quantification. The method represents satisfactory results recoveries and repeatability. The detector’s response was linear, within the range 5 to 100 ng/mL for the biogenic volatile organic compound and 0.5 to 50 ug/mL for the secondary biogenic organic compounds.
The purpose of this thesis was the correlation of biogenic volatile organic compounds with their oxidation products namely the secondary biogenic organic compounds in particulate matter PM10
Inappropriate Arginine Vasopressin Levels and Hyponatremia Associated with Cyclic Vomiting Syndrome
We herein describe two children who presented with attacks of severe cyclic vomiting. The primary case was a 2.5-year-old girl with a history of several admissions with vomiting and altered mental status. She was diagnosed with cyclic vomiting syndrome (CVS). During her attacks she developed significant hyponatremia on several occasions, which prompted us to measure plasma arginine vasopressin (AVP) levels during attacks. We found inappropriately high AVP levels with concomitant hyponatremia. We also measured plasma AVP and plasma sodium in another child with CVS who did not develop manifest hyponatremia but showed inappropriately elevated plasma AVP levels. Since the standard treatment of CVS consists of fluids, high plasma AVP levels may lead to dilutional hyponatremia. We would therefore like to emphasize the importance of close assessment of electrolyte levels in patients with CVS to avoid water intoxication