Prevalence of Diabetes Mellitus in Patients with Chronic Kidney Disease

BACKGROUND: Chronic kidney disease (CKD) became a new epidemic of the twentieth and twenty-first centuries. Diabetic nephropathy is one of the leading causes of end-stage renal failure as a result of the diabetes epidemic worldwide.AIM: The aim of our study was to assess the prevalence of CKD in the Republic of Macedonia and its association with diabetes mellitus.MATERIALS AND METHODS: The study was a part of a study conducted in 2006 in terms of screening for early detection of kidney disease. It was a cross-sectional study based on a random sample of patients aged > 20, consecutively consulting their primary physician for any cause. Fifty physicians throughout the country were included in the study. A total of 2637 patients have been analyzed based on integrity data. GFR was estimated using corrected values of serum creatinine and calculating kidney function by the Cockroft & Gault formula, adjusted for body surface using the Gehan & George formula. Patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min were considered as having CKD. Blood pressure, body weight, height, serum creatinine, glucose, hemoglobin, hematocrit, urinalysis and medical history for presence of cardiovascular diseases or diabetes were also assessed.RESULTS: The mean age of the subjects was 45.97 ± 16.55 SD and 17.97% were older than 60. Regarding gender, 44.14% were males. The prevalence of diabetes mellitus was 13.9%. Subjects with CKD (eGFR less than 60 ml/min) were 7.53% of the total. Subjects aged 60 or above, had 20 times higher risk of having CKD (eGFR less than 60 ml/min/1.73 m2). Out of the total group of subjects, 13.9% had diabetes mellitus and they had 3.13 times higher risk of having CKD stage 3-5 (eGFR less than 60 ml/min/1.73 m2) when compared to non-diabetics. The results showed that diabetes was significantly more associated with lower eGFR (less than 60 ml/min/1.73 m2) in younger subjects (age less than 60) compared to older ones (odds ratio 3.29 versus 1.21).CONCLUSION: Our study showed that chronic kidney disease is frequent in the Republic of Macedonia and is associated with older age and diabetes. Diabetes had a significantly stronger association with CKD at younger age

Clinical Effects of Standard and Individualized Dialysate Sodium in Patients on Maintenance Hemodialysis

BACKGROUND: The degree to which the dialysate prescription and, in particular, the dialysate sodium concentration influences blood pressure and interdialytic weight gain (IDWG) via changes in sodium flux, plasma volume or the other parameters is not well understood. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of dialysate sodium set up according to serum sodium or sodium modeling.MATERIAL AND METHODS: Ninety-two nondiabetic subjects (52 men and 40 women) performed 12 consecutive hemodialysis (HD) sessions (4 weeks) with dialysate sodium concentration set up on 138 mmol/L (standard sodium – first phase), followed by 24 sessions (second phase) wherein dialysate sodium was set up according to individualized sodium. Variables of interest were: systolic, diastolic and mean blood pressure, pulse, IDWG, thirst score – (Xerostomia Inventory (XI) and Dialysis Thirst Inventory (DTI)) and side effects (occurrence of hypotension and muscle cramps). After the first phase, the subjects were divided into 3 groups: normotensive (N=76), hypertensive (N= 11) and hypotensive (N=5) based on the average pre-HD systolic BP during the whole period of the first phase.RESULTS: Sodium individualization resulted in significantly lower blood pressure (133.61 ± 11.88 versus 153.60 ± 14.26 mmHg; p=0.000) and IDWG (2.21 ± 0.93 versus 1.87 ± 0.92 kg; p=0.018) in hypertensive patients, whereas normotensive patients showed only significant decrease in IDWG (2.21 ± 0.72 versus 2.06 ± 0.65, p=0,004). Sodium profiling in hypotensive patients significantly increased IDWG (2.45 vs. 2.74, p= 0,006), and had no impact on blood pressure. Thirst score was significantly lower in normotensive patients with individualized-sodium HD and showed no change in the other two groups. During the second phase, hypotension occurred in only 1 case and muscle cramps in 10 normotensive patients.CONCLUSION: Individualized sodium resulted in clinical benefits in normotensive and hypertensive patients

A “How-To” Guide for Designing Judgment Bias Studies to Assess Captive Animal Welfare

Robust methods to assess nonhuman animal emotion are essential for ensuring good welfare in captivity. Cognitive bias measures such as the judgment bias task have recently emerged as promising tools to assess animal emotion. The simple design and objective response measures make judgment bias tasks suitable for use across species and contexts. In reviewing 64 studies published to date, it emerged that (a) judgment biases have been measured in a number of mammals and birds and an invertebrate; (b) no study has tested judgment bias in any species of fish, amphibian, or reptile; and (c) no study has yet investigated judgment bias in a zoo or aquarium. This article proposes that judgment bias measures are highly suitable for use with these understudied taxa and can provide new insight into welfare in endangered species housed in zoos and aquariums, where poor welfare impacts breeding success and, ultimately, species survival. The article includes a “how-to” guide to designing judgment bias tests with recommendations for working with currently neglected “exotics” including fishes, amphibians, and reptiles

Patient with Antineutrophil Cytoplasmic Antibody Associated Small Vessel Vasculitis, Acute Renal Failure, and Coronavirus Disease-19 Pneumonia: A Diagnostic and Therapeutic Challenge

BACKGROUND: Antineutrophil cytoplasmatic antibody (ANCA)-associated vasculitis (AAV) has a predilection for the kidney and more than three quarters of patients have renal involvement with rapidly progressive glomerulonephritis. Small-vessel systemic vasculitis may present as pulmonary-renal syndrome and is characterized by necrotizing glomerulonephritis and pulmonary hemorrhage. Diagnosis and therapy for AAV in coronavirus disease (COVID) COVID-19 pandemic require multi-disciplinary collaboration due to the affection of multiple systems and risks associated with immunosuppressive medications. CASE REPORT: A 69-year-old non-smoker, non-diabetic female presented in the outpatient unit at the department of pulmonology with dry cough, malaise, and sub-febrile temperature, lasting for 1 month. The patient had a high suspicion of severe pulmonary-renal syndrome, ANCA-AAV, and acute renal failure requiring hemodialysis. She was treated with corticosteroids, cyclophosphamide, and plasma exchange. The treatment led to temporary improvement. Infections with COVID-19, Enterococcus in the urine, and Acinetobacter in the tracheal aspirate further complicated the clinical picture and despite antibiotic treatment, use of tocilizumab and convalescent plasma, the outcome was lethal. CONCLUSION: It is important to establish the diagnosis and distinguish accurately between vasculitis and infection to provide adequate and timely therapy

Effects of transportation, transport medium and re-housing on Xenopus laevis (Daudin)

Understanding the immediate and longer-term effects of transportation and re-housing in a laboratory species is crucial in order to refine the transfer process, enable the optimal introduction of new animals to a novel environment and to provide a sufficient acclimatisation period before usage. Whilst consideration of animal welfare in most model vertebrate species has received attention, little quantitative evidence exists for the optimal care of the common laboratory amphibian Xenopus laevis. Techniques for the non-invasive welfare assessment of amphibians are also limited and here a non-invasive physiological assay was developed to investigate the impacts of transportation, transport medium and re-housing on X. laevis. First the impacts of transportation and transport medium (water, damp sponge or damp sphagnum moss) were investigated. Transportation caused an increase in waterborne corticosterone regardless of transport medium. Frogs transported in damp sphagnum moss also had a greater decrease in body mass in comparison to frogs not transported, suggesting that this is the least suitable transport medium for X. laevis. Next the prolonged impacts of transportation and re-housing were investigated. Frogs were transported between research facilities with different housing protocols. Samples were collected prior to and immediately following transportation, as well as 1 day, 7 days and 35 days after re-housing. Water-borne corticosterone increased following transportation and remained high for at least 7 days, decreasing to baseline levels by 35 days. Body mass decreased following transportation and remained lower than baseline levels across the entire 35 day observation period. These findings suggest the process of transportation and re-housing is stressful in this species. Together these findings have important relevance for both improving animal welfare and ensuring optimal and efficient scientific research

Reconciliation in Mandrills (Mandrillus sphinx)

This study aimed to examine whether mandrills (Mandrillus sphinx) reconcile their conflicts. The data were collected from a captive group of nine mandrills (5 males and 4 females) at the Lowry Park Zoo that ranged in age from 3 to 16 years at the time of study. After a conflict was observed, the behavior of one of the two former opponents was documented for a period of ten minutes using continuous recording methods. On the next possible observation day, at the same time of the previous conflict, the behavior of the same individual was recorded for an additional ten minutes. Former opponents exchanged peaceful or affiliative signals sooner after a conflict than during control periods. These post-conflict signals were selectively directed towards former opponents, and were most likely to be exchanged in the first two minutes after a conflict\u27s termination. The silent bared-teeth face comprised 62.5% of the first peaceful interactions between former opponents. The best predictor of the likelihood of reconciliation was the dyad\u27s baseline rate of silent bared-teeth face exchange. Mandrill dyads with higher rates of silent bared-teeth face exchange at baseline had higher conflict rates and spent less time in non-aggressive proximity than those with lower rates of silent bared-teeth face exchange. These results are consistent with the Insecure Relationship Hypothesis, which posits that individuals with insecure relationships are more likely to reconcile because their relationships are more likely to be damaged by a conflict than those with secure relationships. The exchange of peaceful post-conflict signals did not appear to have an effect on the behavior of the former opponents