Anemia after kidney transplantation

Background: Anemia is a major cardiovascular riskfactor in renal disease. It might be appropriate toextrapolate this association of anemia with cardiovasculardisease to renal transplant recipients who continue tohave a significant cardiovascular risk.The aim of our study was to elucidate the prevalence andrisk factors of anemia after kidney transplantation.Methods: We studied 118 stable adult kidney transplantrecipients [age at transplant ranged between 22 and 58,42 12], 74 (62.7%) were males and 44 were females(37.3%) who received allograft between December 1998and October 2008 and had at least 1 year of posttransplantfollow up data at Sugar Medical Center,Theodor Bilharz Research Institute (TBRI), and HealthInsurance Organization Cairo. Hemoglobin (Hb) level at6 months, and 1 year after renal transplantation wasrecorded, the eGFR was calculated using the MDRDformula. Risk factors for anemia were evaluated usingunivariate and multivariate regression analysis.Results: Anemia (Hb <12 g/dl in females and <13 g/dl inmales) was common (28.8% at 6 months, 31.4% at 1year). Significant anemia (Hb <11 g/dl in females and<12 g/dl in males) was also common (15.3% at 6 months,16.8% at 1 year). Severe anemia (Hb <10 g/dl in bothgenders) at 6 months post-transplant was less commonaffecting 4 out of 118 (3.4%) patients. At 1 year, 8 out of118 (6.8%) had severe anemia. Univariate andmultivariate analysis showed that a higher serumcreatinine level and lower eGFR were significant riskfactors at 6 months and 1 year post transplant. At 1 year,in addition to higher creatinine level and lower eGFR,female gender and immunosuppressive drugs(azathioprine and sirolimus) also were significant riskfactors.Conclusions: Anemia is common during the first yearafter kidney transplantation. High serum creatinine, loweGFR, female gender and immunosuppressive drugs[azathioprine, sirolimus] are independent risk factors forpost-transplant anemia

The use of objective assessments in the evaluation of technical skills in cardiothoracic surgery: A systematic review

OBJECTIVES: With reductions in training time and intraoperative exposure, there is a need for objective assessments to measure trainee progression. This systematic review focuses on the evaluation of trainee technical skill performance using objective assessments in cardiothoracic surgery and its incorporation into training curricula. METHODS: Databases (EBSCOHOST, Scopus and Web of Science) and reference lists of relevant articles for studies that incorporated objective assessment of technical skills of trainees/residents in cardiothoracic surgery were included. Data extraction included task performed; assessment setting and tool used; number/level of assessors; study outcome and whether the assessments were incorporated into training curricula. The methodological rigour of the studies was scored using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS: Fifty-four studies were included for quantitative synthesis. Six were randomized-controlled trials. Cardiac surgery was the most common speciality utilizing objective assessment methods with coronary anastomosis the most frequently tested task. Likert-based assessment tools were most commonly used (61%). Eighty-five per cent of studies were simulation-based with the rest being intraoperative. Expert surgeons were primarily used for objective assessments (78%) with 46% using blinding. Thirty (56%) studies explored objective changes in technical performance with 97% demonstrating improvement. The other studies were primarily validating assessment tools. Thirty-nine per cent of studies had established these assessment tools into training curricula. The mean ± standard deviation MERSQI score for all studies was 13.6 ± 1.5 demonstrating high validity. CONCLUSIONS: Despite validated technical skill assessment tools being available and demonstrating trainee improvement, their regular adoption into training curricula is lacking. There is a need to incorporate these assessments to increase the efficiency and transparency of training programmes for cardiothoracic surgeons

The relationship between serum osteopontin level and parameters of Chronic Kidney Disease – mineral bone disease in patients on regular hemodialysis

Background: Chronic Kidney Disease (CKD) is becoming a major health concern worldwide. For many patients, CKD is associated with substantial morbidity and mortality. Osteopontin (OPN) is an extracellular matrix protein first identified in bone tissue and has pleiotropic functions due to its common expression in the main organs and apparatuses. It is a phosphorylated glycophosphoprotein composed of 314 amino acids, involved in biomineralization and remodeling.Objective: This research aimed to assess the serum level of osteopontin in patients with end-stage renal disease (ESRD) on regular haemodialysis and to correlate osteopontin level in patients with ESRD on hemodialysis with other biomarkers CKD-MBD.Patients & Methods: This Study was conducted on 160 participants that were divided into two groups. Control group included 80 healthy subjects of both sexes, and patients group that included 80 ESRD patients on regular hemodialysis of both sexes. All studied groups were subjected to osteopontin level by enzyme-linked immunosorbent assay (ELISA).Results: Serum osteopontin levels were higher in ESRD patients on regular dialysis than in healthy individuals, where it might have a higher predictive value for CKD development. Also, they were positively correlated with serum phosphorus, serum alkaline phosphatase and serum parathyroid hormone, which are parameters of chronic kidney disease-mineral and bone disorder.Conclusion: Osteopontin may be considered an early marker of chronic kidney disease

Immunoglobulin-A and the pathogenesis of schistosomal glomerulopathy

Immunoglobin-A and the pathogenesis of schistosomal glomerulopathy. Several observations suggest that the evolution of schistosomal glomerulopathy into clinically overt and progressive disease may involve pathogenetic mechanisms other than simple glomerular deposition of parasitic antigens. In a previous study, IgA was suggested tobe a mediator of late glomerular lesions in this disease. This issue is further addressed in this work. The study includes 32 patients with hepatosplenic schistosomiasis, of whom 16 had overt glomerular involvement, along with four control groups: (a) 15 healthy volunteers; (b) 15 patients with simple intestinal mansoniasis; (c) 17 patients with non-schistosomal chronic liver disease; and (d) 21 subjects with primary nephrotic syndrome not associated with schistosomiasis. Routine assessment was done for all subjects including confirmatory tests for schistosomal infection, liver and renal function tests, hepatitis viral markers and abdominal ultrasonography. The total serum concentrations of IgG, IgM, IgA were measured, as well astheir respective circulating immune complexes, rheumatoid factors, anti-gliadin- and anti-DNA-antibodies. Liver and renal biopsies were obtained from the relevant groups and studied by light microscopy. Renal biopsies were also examined by immunofluorescence. Patients with simple intestinal schistosomiasis had a significant increase in IgM antigliadin antibodies. Those complicated with hepatosplenic involvement also had a significant increase in the mean IgG anti-gliadin antibodies, IgG rheumatoid factor and IgM anti-DNA activity. Cases further complicated by overt glomerular disease showed a distinct IgA predominance, mainly expressed in the serum anti-gliadin antibody pool and anti-DNA activity. This profile was essentially similar to that observed in control cirrhotics. There was a significant increase in the frequency of IgA glomerular deposits in renal biopsies obtained from patients with overt schistosomal glomerulopathy, in contrast to control nephrotics. The deposits were mainly mesangial, but were also encountered in subendothelial, subepithelial and peritubular locations. Their frequency was significantly higher with more advanced lesions as seen by light microscopy. The relevance of these data is discussed, leading to the following conclusions: (a) serum IgA-anti-gliadin and -anti-DNA antibodies, and glomerular IgA deposits are markers of significant renal involvement in patients with hepatosplenic schistosomiasis, (b) IgA may be involved in the pathogenesis of advanced glomerular pathology when superimposed on parasite-induced lesions, (c) There is a significant increase in serum auto-reactivity in hepatosplenic schistosomiasis, which may also have pathogentic implications, (d) Increased production by the inflammatory bowel lesions, impaired clearance by the fibrotic livers and probable switching of immunoglobulin synthesis are suggested to explain the observed IgA predominance in those who develop renal complications

Insights into the Role of Chemokines, Damage-Associated Molecular Patterns, and Lymphocyte-Derived Mediators from Computational Models of Trauma-Induced Inflammation

Significance: Traumatic injury elicits a complex, dynamic, multidimensional inflammatory response that is intertwined with complications such as multiple organ dysfunction and nosocomial infection. The complex interplay between inflammation and physiology in critical illness remains a challenge for translational research, including the extrapolation to human disease from animal models. Recent Advances: Over the past decade, we and others have attempted to decipher the biocomplexity of inflammation in these settings of acute illness, using computational models to improve clinical translation. In silico modeling has been suggested as a computationally based framework for integrating data derived from basic biology experiments as well as preclinical and clinical studies. Critical Issues: Extensive studies in cells, mice, and human blunt trauma patients have led us to suggest (i) that while an adequate level of inflammation is required for healing post-trauma, inflammation can be harmful when it becomes self-sustaining via a damage-associated molecular pattern/Toll-like receptor-driven feed-forward circuit; (ii) that chemokines play a central regulatory role in driving either self-resolving or self-maintaining inflammation that drives the early activation of both classical innate and more recently recognized lymphoid pathways; and (iii) the presence of multiple thresholds and feedback loops, which could significantly affect the propagation of inflammation across multiple body compartments. Future Directions: These insights from data-driven models into the primary drivers and interconnected networks of inflammation have been used to generate mechanistic computational models. Together, these models may be used to gain basic insights as well as serving to help define novel biomarkers and therapeutic targets. Antioxid. Redox Signal. 23, 1370?1387.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140310/1/ars.2015.6398.pd

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Exploring the impact of Ramadan entertainment in Egypt: a qualitative analysis of social media engagement, media stakeholders' perspectives, and societal implications

Treball de fi de Màster en Cultura Digital i Mitjans Emergents (DiCEM). Tutora: Mercè OlivaExploring the impact of Ramadan entertainment in Egypt: a qualitative analysis of social media engagement, media stakeholders' perspectives, and societal implications Ramadan entertainment has immense sway over Egyptian audiences and despite its popularity, there is a gap in the research conducted around this topic, particularly when it comes to the role played by social media as well as the perspective of media stakeholders. This study aims to identify and analyze the key elements that contributed to the popularity of Ramadan entertainment. Additionally, the study aims to assess the extent to which the audience's engagement with these series on social media is creating momentum for reform and raising awareness about the topics discussed on these dramas. Furthermore, the researcher aims to investigate how Ramadan entertainment fits into the broader media landscape of Egypt and how Egyptian media stakeholders perceive the paradigm shift caused by social media. The study employs a qualitative methodology using two main methods of data collection: semi-structured in-depth interviews and thematic social media content analysis. The findings contribute to deeper understanding of the dynamics within Ramadan entertainment and the audience. Additionally, this study provides recommendations for media practitioners on leveraging Ramadan entertainment to address social justice issues and promote responsible media practices. Overall, this research expands the existing knowledge base on Ramadan entertainment in Egypt, shedding light on its cultural significance, the influence of social media, and its potential for driving societal reform. The findings have broader implications for the media landscape and can guide future Research exploring the complexities and implications of Ramadan entertainment on Egyptian society

PCSK9 in Liver Cancers at the Crossroads between Lipid Metabolism and Immunity

International audienceMetabolic rewiring and defective immune responses are considered to be the main driving forces sustaining cell growth and oncogenesis in many cancers. The atypical enzyme, proprotein convertase subtilisin/kexin type 9 (PCSK9), is produced by the liver in large amounts and plays a major role in lipid metabolism via the control of the low density lipoprotein receptor (LDLR) and other cell surface receptors. In this context, many clinical studies have clearly demonstrated the high efficacy of PCSK9 inhibitors in treating hyperlipidemia and cardiovascular diseases. Recent data implicated PCSK9 in the degradation of major histocompatibility complex I (MHC-I) receptors and the immune system as well as in other physiological activities. This review highlights the complex crosstalk between PCSK9, lipid metabolism and immunosuppression and underlines the latest advances in understanding the involvement of this convertase in other critical functions. We present a comprehensive assessment of the different strategies targeting PCSK9 and show how these approaches could be extended to future therapeutic options to treat cancers with a main focus on the liver

IL10 in Lupus Nephritis: Detection and relationship with disease activity

Introduction: Glomerulonephritis is a major determinant of the course and prognosis of systemic lupus erythematosus (SLE) and is evident in 40%–85% of patients. IL10, a cytokine produced by monocytes and-to a lesser extent-lymphocytes, has pleiotropic effects in immune regulation and inflammation. It enhances B cell survival, proliferation, differentiation, and antibody production; these effects play a role in autoimmune diseases. Among identified polymorphisms in the IL10 promoter, three linked single nucleotide polymorphisms (SNPs) of -1082 G/A, 819 T/C, and -592 A/C have been shown to influence the IL10 gene expression. Compared with the - 592 C allele, the 592 A is associated with lower IL10 production in vitro. The objectives of this study were to investigate the -592 A/C polymorphism in patients with and without lupus nephritis and to assess its influence on IL10 secretion in vivo and its role in pathogenesis and clinicopathological characteristics of lupus nephritis. Methods: This case control study was conducted on 40 SLE patients recruited for the study from those attending the nephrology department of the Theodor Bilharz Research Institute (outpatient clinic and inpatient ward) in 2013. Patients were divided into two groups, group I (SLE patients without evidence of nephritis) and group II (SLE patients with lupus nephritis). Data were analyzed using SPSS (version 12), a t-test, Chi square, ANOVA, and the Pearson product–moment correlation coefficient. Results: Our study found an increase in IL10 serum in lupus nephritis patients compared to those without renal involvement (without statistical significance). No significant differences emerged in the level of IL10 serum among different pathological classes. Conclusion: The IL10 gene (-592 A/C) polymorphism, though not associated with lupus nephritis’s susceptibility in the present study, does play a role