Vitamin d sufficiency in hemodialysis patients and its association with nutritional and clinical parameters

Renal failure is a complicating factor in the maintenance of vitamin D adequate levels, which can interfere in the patients’ nutritional status. The aim of this study was to evaluate the association of serum 25-hydroxyvitamin D [25(OH)D] with clinical and nutritional parameters. Prevalent hemodialysis (HD) patients were submitted to a single evaluation about demographic characteristics, clinical data and laboratory measurements. Anthropometric measurements and electrical bioimpedance were performed to obtain BMI, percentage of standard MAMC (%MAMC), fat percentage (%Fat) and phase angle (PA). Deficiency was defined as a 25(OH)D level<15ng/mL, insufficiency as 15-30 ng/mL and sufficiency as>30ng/mL. Univariate models were constructed and the variables associated with 25(OH)D sufficiency were included subsequently in the multiple regression model. Statistical significance was p<0.05.One hundred twelve patients (59 male, 53 female) were included. Twenty seven (24.1%) were 25(OH)D deficient, 43 (38.4%) insufficient and 42 (37.5%) sufficient. In univariate regression, creatinin, albumin and PA were positively associated with serum 25(OH)D, while age, glucose, BMI and %MAMC were negatively associated. In multivariate regression, age and %MAMC were negatively associated with sufficiency. Most studied sample showed inadequate 25(OH)D levels. In our study, the result to be highlighted was the negative associations of 25(OH)D sufficiency with age and %MAMC, but all the findings suggest that fat interferes with vitamin D stores in HD patients

Analisis isi buku “Islam Kita, Islam Nusantara” karya Mohamad Guntur Romli

Munculnya wacana tentang Islam Nusantara pada tahun 2015 sempat memancing munculnya berbagai reaksi dari kalangan muslim di Negeri ini. Pro dan Kontra terus saja bergulir, bahkan hingga saat ini. Meski begitu bagi para pendukung gagasan Islam Nusantra, wacana tersebut justru harus dihadirkan sebagai solusi atas permasalahan umat. Atas dasar hal itu, Guntur Romli kemudian menyajikan sebuah buku berjudul “Islam Kita, Islam Nusantara” sebagai sebuah jawaban atas tudingan miring kepada para pengusung gagasan Islam Nusantara yang notabene sama sekali tidak merubah ajaran Islam, sebaliknya justru menghadirkan Islam rahamatan lil alamin dalam bingkai kearifan hazanah bangsa. Berangkat dari fenomena tersebut, maka peneliti berusaha mengkaji dan mengetahui isi dari buku “Islam Kita, Islam Nusantara”. Metode yang digunakan adalah analisis isi sebagai pisau analisa kulaitatif, diharapkan peneliti mampu menemukan dan merefleksikan esensi dan subtasnsi dari Buku “Islam Kita, Islam Nusantara” itu sendiri. Dari penelitian ini dapat diketahui bahwa bahwa Islam Nusantara yang terdapat dalam buku karya Guntur Romli yang berjudul “Islam Kita, Islam Nusantara” adalah sebagai berikut:Pertama,Islam Nusantara Bukanlah aliran baru atau firqoh melainkan sebuah cara berislam yang sesuai dengan manhaj ahlussunnah wal jama’ah serta dilaksanakakn dalam konteks budaya lokal nusantara ( selama budaya itu tidak bertentangan dengan hukum syari’at)Kedua,Perbedaan antatra kaum tradisional dan modernis yang pernah terjadi pada paruh awal abad ke-20 tentu sudah tidak lagi relevan dengan kondisi saat ini, dimana NU sebagai kelompok yang di identikan dengan tradisionalis dan Muhammadiyah sebagai modernis justru sudah mampu berelaborasi dalam menampakkan wajah Islam yang Rahmatan Lil ‘Alamin.Ketiga,Islam Nusantara terbukti mampu menunjukan sinergi dengan nilai-nilai esensial Islam, Pancasila dan HAM dengan berbagai dinamika sosial yang terjadi di Negara Kesatuan Republik Indonesia. Hal ini bisa terwujud karena Islam Nusantara memiliki karakter Toleran, tasamuh, tawasuth (moderat), tawazun (berimbang)

Impact of Glucose Exposure on Outcomes of a Nation-Wide Peritoneal Dialysis Cohort – Results of the BRAZPD II Cohort

Background: Data investigating the association of glucose exposure with technique failure and patient survival are limited to retrospective cohorts and was never tested outside Asia and considering the presence of competing risks.Methods: Prospective multicenter cohort study of incident peritoneal dialysis patients where the association of cumulative glucose exposure in 6, 12, and 24 months with patient survival and technique failure was tested using Cox regression analysis and competing risk analysis.Results: We analyzed 4367 incident peritoneal dialysis patients with mean age 59.0 ± 15.8 years, 43.9% were diabetics, 46.7% males and 64.4% Caucasians. Glucose exposure was not associated with patient survival independent of the time of exposure and even after adjustments for confounders. In contrast, higher glucose exposure was associated with more technique failure in the Cox and competing risk models. The higher risk for technique failure was found in the subgroup exposed to the higher amount of glucose to a maximum of 86% in the model analyzing cumulative glucose exposure for 1 year.Conclusion: Glucose exposure was associated with technique failure but not with patient survival

Peritoneal Dialysis-Related Peritonitis Due to Staphylococcus aureus: A Single-Center Experience over 15 Years

Peritonitis caused by Staphylococcus aureus is a serious complication of peritoneal dialysis (PD), which is associated with poor outcome and high PD failure rates. We reviewed the records of 62 S. aureus peritonitis episodes that occurred between 1996 and 2010 in the dialysis unit of a single university hospital and evaluated the host and bacterial factors influencing peritonitis outcome. Peritonitis incidence was calculated for three subsequent 5-year periods and compared using a Poisson regression model. The production of biofilm, enzymes, and toxins was evaluated. Oxacillin resistance was evaluated based on minimum inhibitory concentration and presence of the mecA gene. Logistic regression was used for the analysis of demographic, clinical, and microbiological factors influencing peritonitis outcome. Resolution and death rates were compared with 117 contemporary coagulase-negative staphylococcus (CoNS) episodes. The incidence of S. aureus peritonitis declined significantly over time from 0.13 in 1996–2000 to 0.04 episodes/patient/year in 2006–2010 (p = 0.03). The oxacillin resistance rate was 11.3%. Toxin and enzyme production was expressive, except for enterotoxin D. Biofilm production was positive in 88.7% of strains. The presence of the mecA gene was associated with a higher frequency of fever and abdominal pain. The logistic regression model showed that diabetes mellitus (p = 0.009) and β-hemolysin production (p = 0.006) were independent predictors of non-resolution of infection. The probability of resolution was higher among patients aged 41 to 60 years than among those >60 years (p = 0.02). A trend to higher death rate was observed for S. aureus episodes (9.7%) compared to CoNS episodes (2.5%), (p = 0.08), whereas resolution rates were similar. Despite the decline in incidence, S. aureus peritonitis remains a serious complication of PD that is associated with a high death rate. The outcome of this infection is negatively influenced by host factors such as age and diabetes mellitus. In addition, β-hemolysin production is predictive of non-resolution of infection, suggesting a pathogenic role of this factor in PD-related S. aureus peritonitis

The critical dialogical method in Educommunication to develop narrative thinking

En la conceptualización de la Educomunicación se ha de avanzar hacia la integración de sus dos grandes perspectivas. Fomentar el diálogo crítico es un objetivo compartido por ambas, por lo que es preciso profundizar en sus propiedades, métodos y funciones educativas. Se presenta un modelo formativo en educomunicación que ha sido testado mediante una investigación empírica. Durante dos semanas, 246 niños entre seis y once años asisten a sesiones formativas con dos tipos de productos audiovisuales. La mitad de los niños sigue un proceso formativo según la metodología dialógicocrítica y la otra mitad una metodología de diálogo-conversacional. Los resultados muestran que los niños que siguen la formación dialógico-crítica se benefician significativamente en la construcción de su competencia mediática y pensamiento narrativo, en comparación con los niños de los grupos dialógico-conversacional. Los resultados revelan también que no todos los tipos de contenidos audiovisuales son beneficiosos para la formación del pensamiento del niño. Esta investigación pone de manifiesto cuáles son las propiedades del método dialógico-crítico propuesto que permiten al niño mejorar su competencia mediática e ilustra la complementariedad entre el proceso de diagnóstico-estático de competencias y el proceso formativo-dinámico que conduce al pensamiento crítico. Desde un punto de vista aplicado, este método ha mostrado su utilidad para ser utilizado por el profesor para fomentar en su grupo de alumnos una educación mediática que contribuya al desarrollo del pensamiento narrativoIn the conceptualization of Educommunication, progress must be made towards the integration of its two great perspectives. Encouraging critical dialogue is a goal shared by both, so it is necessary to delve into its educational properties, methods and functions. A training model in Educommunication that has been tested through empirical research is presented. For two weeks, 246 children between six and eleven years old, attended training sessions with two types of audiovisual products. Half of the children were involved in a training process using critical dialogical methodology, whereas the training process for the other half of the children followed conversational dialogue methodology. The results show that children who follow the critical dialogical training benefit significantly in the construction of their media competence and narrative thinking, compared to the children of the conversational dialogical groups. The results also reveal that not all types of audiovisual content are beneficial to the construction of children's thinking. This research reveals the properties of the proposed critical dialogical method that allows children to improve their media competence and illustrates the complementarity between the diagnostic-static process of competences and the formative-dynamic process that leads to critical thinking. From an applied point of view, the critical dialogical method has been useful for use by teachers to foster a media education in their group of students that contributes to the development of narrative thinkin

Kidney volume to GFR ratio predicts functional improvement after revascularization in atheromatous renal artery stenosis

Background: Randomized controlled trials (RCT) have shown no overall benefit of renal revascularization in atherosclerotic renovascular disease (ARVD). However, 25% of patients demonstrate improvement in renal function. We used the ratio of magnetic resonance parenchymal volume (PV) to isotopic single kidney glomerular filtration rate (isoSKGFR) ratio as our method to prospectively identify "improvers" before revascularization. Methods: Patients with renal artery stenosis who were due revascularization were recruited alongside non-ARVD hypertensive CKD controls. Using the controls, 95% CI were calculated for expected PV:isoSK-GFR at given renal volumes. For ARVD patients, “improvers” were defined as having both >15% and >1ml/min increase in isoSK-GFR at 4 months after revascularization. Sensitivity and specificity of PV:isoSK-GFR for predicting improvers was calculated. Results: 30 patients (mean age 68 ±8 years), underwent revascularization, of whom 10 patients had intervention for bilateral RAS. Stented kidneys which manifested >15% improvement in function had larger PV:isoSK-GFR compared to controls (19±16 vs. 6±4ml/ml/min, p = 0.002). The sensitivity and specificity of this equation in predicting a positive renal functional outcome were 64% and 88% respectively. Use of PV:isoSK-GFR increased prediction of functional improvement (area under curve 0.93). Of note, non-RAS contralateral kidneys which improved (n = 5) also demonstrated larger PV:isoSK-GFR (15.2±16.2 ml/ml/min, p = 0.006). Conclusion: This study offers early indicators that the ratio of PV:isoSK-GFR may help identify patients with kidneys suitable for renal revascularization which could improve patient selection for a procedure associated with risks. Calculation of the PV:isoSK-GFR ratio is easy, does not require MRI contrast agent

Comparison of the CBA-H and SF-36 for the screening of the psychological and behavioural variables in chronic dialysis patients

The aim of the study was to perform an analysis of the emotional reactions, perception of stressful life and behavioural changes related to Haemodialysis (HD) in order to identify those variables that can improve lifestyle and the adherence to treatment. Some psycho- metric assessment, such as the Cognitive Behavioural Assessment, Hospital Form, (CBA- H) and the Health Survey (SF-36), which provides two indexes: the Physical Component Score (PCS) and the Mental Component Score (MCS), are suitable to assess a patient’s psychological and behavioural style and their health-related quality of life. The study involved 37 Italian out-patients with end-stage renal disease under HD therapy. We calcu- lated the Spearman correlation between variables of CBA-H, SF-36, age and time on HD. We also performed a multivariate linear regression using the CBA-H variables as predictors and PCS and MCS as dependent variables. From the CBA-H, 95% of participants self- reported psychological characteristics comparable to Type A personality, which identifies an anxious, hyperactive and hostile subject. Physical limitations were found to be directly pro- portional to the time on dialysis (rs = -0.42). The condition of perceived stress worsens the state of mental health (rs = -0.68) and general health perception (rs = -0.44). The condition of vital exhaustion correlates both the PCS and the MCS (p<0.01) with possible outcomes of physical and mental illness. The psychological wellbeing of a dialyzed patient could be due to the combination of several factors, including life parameters, the positive perception of psychosocial outcomes, and the perceived quality of life. A multidisciplinary team (neurolo- gists, psychiatrists, psychologists, and nurses) is essential to plan effective psychological and psychotherapeutic interventions to improve a mind-body integration

The role of virulence factors in the outcome of staphylococcal peritonitis in CAPD patients

<p>Abstract</p> <p>Background</p> <p>Peritonitis continues to be the most frequent cause of peritoneal dialysis (PD) failure, with an important impact on patient mortality. Gram-positive cocci such as <it>Staphylococcus epidermidis</it>, other coagulase-negative staphylococci (CoNS), and <it>Staphylococcus aureus </it>are the most frequent etiological agents of PD-associated peritonitis worldwide. The objective of the present study was to compare peritonitis caused by <it>S. aureus </it>and CoNS and to evaluate the factors influencing outcome.</p> <p>Methods</p> <p>Records of 86 new episodes of staphylococcal peritonitis that occurred between 1996 and 2000 in the Dialysis unit of a single university hospital were studied (35 due to <it>S. aureus</it>, 24 to <it>S. epidermidis </it>and 27 to other CoNS). The production of slime, lipase, lecithinase, nuclease (DNAse), thermonuclease (TNAse), α- and β-hemolysin, enterotoxins (SEA, SEB, SEC, SED) and toxic shock syndrome toxin-1 (TSST-1) was studied in <it>S. aureus </it>and CoNS. Antimicrobial susceptibility was evaluated based on the minimal inhibitory concentration determined by the E-test. Outcome predictors were evaluated by two logistic regression models.</p> <p>Results</p> <p>The oxacillin susceptibility rate was 85.7% for <it>S. aureus</it>, 41.6% for <it>S. epidermidis</it>, and 51.8% for other CoNS (p = 0.001). Production of toxins and enzymes, except for enterotoxin A and α-hemolysin, was associated with <it>S. aureus </it>episodes (p < 0.001), whereas slime production was positive in 23.5% of CoNS and 8.6% of <it>S. aureus </it>strains (p = 0.0047). The first model did not include enzymes and toxins due to their association with <it>S. aureus</it>. The odds of resolution were 9.5 times higher for <it>S. epidermidis </it>than for <it>S. aureus </it>(p = 0.02) episodes, and were similar for <it>S. epidermidis </it>and other CoNS (p = 0.8). The resolution odds were 68 times higher for non-slime producers (p = 0.001) and were not influenced by oxacillin resistance among vancomycin-treated cases (p = 0.89). In the second model, the resolution rate was similar for <it>S. aureus </it>and <it>S. epidermidis </it>(p = 0.70), and slime (p = 0.001) and α-hemolysin (p = 0.04) production were independent predictors of non-resolution.</p> <p>Conclusion</p> <p>Bacterial species and virulence factors rather than antibiotic resistance influence the outcome of staphylococcal peritonitis.</p