Hypothyroidism and nephrotic syndrome: why, when and how to treat

Hypothyroidism, characterised by low/normal free thyroxine (FT4) and free tri-iodothyronine (FT3) with elevated thyroid-stimulating hormone (TSH), is a well-known complication of nephrotic syndrome (NS). This is a common feature of primary and secondary glomerular diseases and comprises loss of protein in the urine and increased urinary excretion of thyroid hormones and thyroxine-binding globulin. With a normal thyroid reserve, this scenario is associated with the development of subclinical hypothyroidism, with a slight increase in TSH and normal free fractions. However, with a low thyroid reserve the transition toward overt hypothyroidism is almost inevitable, affecting morbidity and mortality. As T4 replacement is a cheap and well-established treatment to achieve a stable hormone status in different types of thyroid deficiency, it is essential to recognise and appropriately treat this condition. In this article we summarise the evidence on this nephro-endocrine disorder in humans and focus on diagnostic and therapeutic strategies

Pharmacological effects of raas blockade in ischemic nephropathy

Background: The management of ischemic nephropathy due to atherosclerotic renal artery stenosis has become increasingly conservative in the modern era, with current guidelines recommending optimized medical therapy as the initial step. The doubts raised by the recently published trials of revascularization strategies have led to a renewed focus on pharmacological strategies promoting blood pressure control and renal protection. It is essential to further elucidate the pathophysiological mechanisms underlying hypoperfusion induced renal microvascular dysfunction with subsequent tissue injury and fibrogenesis. The role of renin angiotensin aldosterone system as a mediator of the main pathophysiological consequences of ischemic nephropathy is well known. However, more recent experimental evidence on the adrenergic system and intrarenal tubular feedback mechanisms has stimulated new interest towards a multi-target therapeutic approach. Methods: This review focuses on the pharmacology of the principle therapeutic drug classes currently used in the treatment of atherosclerotic renal artery stenosis with an analysis of their metabolic aspects and use in clinical practice based on evidence from clinical trials. Results and Conclusions: An optimal pharmacologic approach is crucial for a successful prevention of renal injury and cardiovascular events in this high-risk population. Antihypertensive treatment should include renin angiotensin aldosterone system blockade medication not only for their antihypertensive properties, but especially for those cardio and renoprotectiv

Effect of diet energy source on weight gain and carcass characteristics of lambs

The effect of different sources of energy (lipids and carbohydrates) was studied on 36 Apennine male lambs divided by age, weight and paternity into three homogeneous groups receiving three different diets: lambs on diet 1 received ad libitum lucerne hay+concentrate supplemented with barley flakes (9%) (BC); lambs on diet 2 received ad libitum lucerne hay+concentrate supplemented with maize oil (5%) (MC) while lambs on diet 3 received only the concentrate given in diet 2 (MC). The two concentrates were isoenergetic and isonitrogenous. Lambs were slaughtered at 105 days of age. The conversion indices were similar (4.52, 4.77 and 4.61 Meat FU/kg gain) for the three treatments, but the diet 3 led to heavier carcasses (17.57kg), although with greater adipose covering, and better dressing percentages than the other two diets. The histological dissection of the proximal pelvic limb indicated a good tissue composition (total lean 56.16%) but confirmed the higher fat percentage (total fat 16.24%), particularly subcutaneous (11.44%), of the group receiving only MC. Animals on diet 3 gave carcasses with an adequate commercial weight at the age of 90–95 days and therefore it seems possible to anticipate slaughtering these animals earlier and perhaps obviate the excessive adiposity of the carcass. In general, this study further confirmed the good meat quality of Apennine carcasses slaughtered at 105 days

Positivity to p-ANCA in patients with status epilepticus

BACKGROUND: Status epilepticus (SE) may occur in the setting of several internal or neurologic diseases. Anti-neutrophilic cytoplasmic antibodies (ANCA) are a group of Ig that may be observed in patients with different autoimmune disorders but are particularly associated with systemic vasculitis named ANCA-associated-vasculities (AAV). We herein report 3 patients with SE and positivity to p-ANCA. CASE PRESENTATION: One patient had a catastrophic evolution and died 5 months after disease onset. The other two patients had a good outcome and remained seizure-free at 30 months and 5 years of follow-up respectively. CONCLUSION: This report highlights the importance of considering ANCA dosage in patients with SE of unclear origin

Intelligence and working memory control: Evidence from the WISC-IV administration to Italian children

Working memory (WM) has been associated with general intelligence (GI). However, evidence is contradictory, as the relationship has in some cases resulted to be very high, and in other cases very low. To explain these differences, it has been argued that WM is an articulated system and only its more attentional components are strictly related with GI. In particular, it has been argued that WM tasks can be located – according to the task characteristics and the subject's age – along a continuum, from the most passive tasks, which do not require cognitive control, to the most active tasks, which do require high cognitive control. The present study tested this hypothesis using data collected during the standardization of the Italian version of the WISC-IV. WISC-IV, includes four measures, i.e. the arithmetic test, the letter-number sequencing test, the backward and the forward digit span tests, which represent decreasing levels of cognitive control. The analysis of correlations between the four tasks and a measure of GI – obtained with the six basic tasks (related to verbal comprehension and perceptual reasoning, but not to working memory) – confirmed the hypothesis and showed that the pattern of correlations only slightly changes across ages

The Interplay between Immunity and Microbiota at Intestinal Immunological Niche: The Case of Cancer

The gut microbiota is central to the pathogenesis of several inflammatory and autoimmune diseases. While multiple mechanisms are involved, the immune system clearly plays a special role. Indeed, the breakdown of the physiological balance in gut microbial composition leads to dysbiosis, which is then able to enhance inflammation and to influence gene expression. At the same time, there is an intense cross-talk between the microbiota and the immunological niche in the intestinal mucosa. These interactions may pave the way to the development, growth and spreading of cancer, especially in the gastro-intestinal system. Here, we review the changes in microbiota composition, how they relate to the immunological imbalance, influencing the onset of different types of cancer and the impact of these mechanisms on the efficacy of traditional and upcoming cancer treatments

Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic

Objective: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods: This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results: Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic

Practice patterns and 90-day treatment-related morbidity in early-stage cervical cancer

To evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer