Renal Function following Fluorescein Angiography in Diabetic Patients with Chronic Kidney Disease

Purpose: To evaluate the effect of fluorescein dye usage on renal function in patients with diabetic retinopathy (DR) and chronic kidney disease (CKD). Methods: Diabetic patients with retinopathy who were candidate for fundus fluorescein angiography (FA) were evaluated for serum creatinine and urea levels within five days prior to performing the FA. Serum creatinine levels of 1.5 mg/dl or more in males and 1.4 mg/dl or more in females were both identified as CKD and were included in the study. An increase of 0.5 mg/dl or 25% in creatinine after FA was considered as contrast-induced acute kidney injury (AKI). Estimated glomerular filtration rate (eGFR) was also calculated for all patients using a CKD-Epi formula. CKD grading was determined based on eGFR values. Results: Forty-two patients agreed to participate, of which 23 (54.8%) were male. Seventeen patients were identified with grade 3a or lower CKD, 12 with grade 3b, 11 with grade 4, and two with grade 5 CKD. Considering all grades of CKD, the mean blood urea before and after angiography was 58.48 ± 26.7 and 57 ± 27.81 mg/dl, respectively (P = 0.475). The mean serum creatinine before and after the test was 1.89 ± 1.04 and 1.87±0.99 mg/dl, respectively (P = 0.993). The mean eGFR before and after the test was 44.024 ± 23.5447 and 43.850 ± 21.8581 mL/min/1.73 m2 (P = 0.875). Conclusion: According to the findings of this study, FA does not seem to further deteriorate kidney function in patients with diabetic associated CKD

Myasthenia Gravis Development and Crisis Subsequent to Multiple Sclerosis

During the last decade, sporadic combination of multiple sclerosis (MS) and myasthenia gravis (MG) has been reported repeatedly. Although these are anecdotal, they are important enough to raise concerns about co-occurrence of MG and MS. Here, we present a case of an MS patient who developed an MG crisis. She had received interferon for relapsing remitting MS. Interestingly, she developed an MG crisis 4 years after the diagnosis of MS. MS and MG have relatively the same distribution for age, corresponding to the younger peak of the bimodal age distribution in MG. They also share some HLA typing characteristics. Furthermore, some evidences support the role of systemic immune dysregulation due to a genetic susceptibility that is common to these two diseases. The association may be underdiagnosed because of the possible overlap of symptoms especially bulbar manifestations in which either MG or MS can mimic each other, leading to underestimating incidence of the combination. The evidence warrants physicians, especially neurologists, to always consider the possibility of the other disease when encountering any patients either with MS or MG. Anecdotal and sporadic reports of combination of multiple sclerosis (MS) and myasthenia gravis (MG) have been raised concerns about co-occurrence of them

A Prospective Study on Risk Factors for Acute Kidney Injury and All-Cause Mortality in Hospitalized COVID-19 Patients From Tehran (Iran)

BackgroundSeveral reports suggested that acute kidney injury (AKI) is a relatively common occurrence in hospitalized COVID-19 patients, but its prevalence is inconsistently reported across different populations. Moreover, it is unknown whether AKI results from a direct infection of the kidney by SARS-CoV-2 or it is a consequence of the physiologic disturbances and therapies used to treat COVID-19. We aimed to estimate the prevalence of AKI since it varies by geographical settings, time periods, and populations studied and to investigate whether clinical information and laboratory findings collected at hospital admission might influence AKI incidence (and mortality) in a particular point in time during hospitalization for COVID-19.MethodsHerein we conducted a prospective longitudinal study investigating the prevalence of AKI and associated factors in 997 COVID-19 patients admitted to the Baqiyatallah general hospital of Tehran (Iran), collecting both clinical information and several dates (of: birth; hospital admission; AKI onset; ICU admission; hospital discharge; death). In order to examine how the clinical factors influenced AKI incidence and all-cause mortality during hospitalization, survival analysis using the Cox proportional-hazard models was adopted. Two separate multiple Cox regression models were fitted for each outcome (AKI and death).ResultsIn this group of hospitalized COVID-19 patients, the prevalence of AKI was 28.5% and the mortality rate was 19.3%. AKI incidence was significantly enhanced by diabetes, hyperkalemia, higher levels of WBC count, and blood urea nitrogen (BUN). COVID-19 patients more likely to die over the course of their hospitalization were those presenting a joint association between ICU admission with either severe COVID-19 or even mild/moderate COVID-19, hypokalemia, and higher levels of BUN, WBC, and LDH measured at hospital admission. Diabetes and comorbidities did not increase the mortality risk among these hospitalized COVID-19 patients.ConclusionsSince the majority of patients developed AKI after ICU referral and 40% of them were admitted to ICU within 2 days since hospital admission, these patients may have been already in critical clinical conditions at admission, despite being affected by a mild/moderate form of COVID-19, suggesting the need of early monitoring of these patients for the onset of eventual systemic complications

N-acetylcysteine does not prevent contrast-induced nephropathy after cardiac catheterization in patients with diabetes mellitus and chronic kidney disease: a randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) constitute to be a high-risk population for the development of contrast-induced nephropathy (CIN), in which the incidence of CIN is estimated to be as high as 50%. We performed this trial to assess the efficacy of <it>N</it>-acetylcysteine (NAC) in the prevention of this complication.</p> <p>Methods</p> <p>In a prospective, double-blind, placebo controlled, randomized clinical trial, we studied 90 patients undergoing elective diagnostic coronary angiography with DM and CKD (serum creatinine ≥ 1.5 mg/dL for men and ≥ 1.4 mg/dL for women). The patients were randomly assigned to receive either oral NAC (600 mg BID, starting 24 h before the procedure) or placebo, in adjunct to hydration. Serum creatinine was measured prior to and 48 h after coronary angiography. The primary end-point was the occurrence of CIN, defined as an increase in serum creatinine ≥ 0.5 mg/dL (44.2 μmol/L) or ≥ 25% above baseline at 48 h after exposure to contrast medium.</p> <p>Results</p> <p>Complete data on the outcomes were available on 87 patients, 45 of whom had received NAC. There were no significant differences between the NAC and placebo groups in baseline characteristics, amount of hydration, or type and volume of contrast used, except in gender (male/female, 20/25 and 34/11, respectively; P = 0.005) and the use of statins (62.2% and 37.8%, respectively; P = 0.034). CIN occurred in 5 out of 45 (11.1%) patients in the NAC group and 6 out of 42 (14.3%) patients in the placebo group (P = 0.656).</p> <p>Conclusion</p> <p>There was no detectable benefit for the prophylactic administration of oral NAC over an aggressive hydration protocol in patients with DM and CKD.</p> <p>Trial registration</p> <p>NCT00808795</p

Educational Needs Assessment of Faculty Members of Tabriz University of Medical Sciences, Tabriz Iran

Introduction: The present study aimed to determine the educational and research needs of faculty members of Tabriz University of Medical Sciences, Tabriz, Iran so that educational priorities can be found and presented to the authorities for the purpose of educational planning.Methods: This cross-sectional descriptive study was conducted in 2013 at aforementioned University. Overall, 250 faculty members were randomly selected from 10 faculties and recruited. Research tool, a researcher-made questionnaire whose validity had been confirmed by a number of experts, was distributed in person, and eventually 230 were completed. Data were analyzed in SPSS-21 software using descriptive statistical tests. Results: Faculty members of the University declared student assessment as their first educational priority. They also considered the following as their educational needs: teaching and learning, writing scientific articles, educational needs assessment, research in education and health systems, teaching methods and techniques, educational planning, program evaluation, educational guidance and counseling, professional ethics, and computer application in education, respectively. Conclusion: This study investigated the educational needs of faculty members in three areas and 50 subjects and prioritized these needs according to each area. Based on these needs, educational planning authorities of faculty members, by appropriate educational planning, can take an effective step in improving scientific knowledge of professors and play an important role in enhancing the overall quality of education

A high-resolution assessment on global nitrogen flows in cropland

Crop production is the single largest cause of human alteration of the global nitrogen cycle. We present a comprehensive assessment of global nitrogen flows in cropland for the year 2000 with a spatial resolution of 5 arc-minutes. We calculated a total nitrogen input (IN) of 136.60 trillion grams (Tg) of N per year, of which almost half is contributed by mineral nitrogen fertilizers, and a total nitrogen output (OUT) of 148.14 Tg of N per year, of which 55% is uptake by harvested crops and crop residues. We present high-resolution maps quantifying the spatial distribution of nitrogen IN and OUT flows, soil nitrogen balance, and surface nitrogen balance. The high-resolution data are aggregated at the national level on a per capita basis to assess nitrogen stress levels. The results show that almost 80% of African countries are confronted with nitrogen scarcity or nitrogen stress problems, which, along with poverty, cause food insecurity and malnutrition. The assessment also shows a global average nitrogen recovery rate of 59%, indicating that nearly two-fifths of nitrogen inputs are lost in ecosystems. More effective management of nitrogen is essential to reduce the deleterious environmental consequences

Differentialrechnung in Grundkursen

SIGLECopy held by FIZ Karlsruhe / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman