Bone remodeling after renal transplantation

Bone remodeling after renal transplantation. Several studies have indicated that bone alterations after transplantation are heterogeneous. Short-term studies after transplantation have shown that many patients exhibit a pattern consistent with adynamic bone disease. In contrast, patients with long-term renal transplantation show a more heterogeneous picture. Thus, while adynamic bone disease has also been described in these patients, most studies show decreased bone formation and prolonged mineralization lag-time faced with persisting bone resorption, and even clear evidence of generalized or focal osteomalacia in many patients. Thus, the main alterations in bone remodeling are a decrease in bone formation and mineralization up against persistent bone resorption, suggesting defective osteoblast function, decreased osteoblastogenesis, or increased osteoblast death rates. Indeed, recent studies from our laboratory have demonstrated that there is an early decrease in osteoblast number and surfaces, as well as in reduced bone formation rate and delayed mineralization after transplantation. These alterations are associated with an early increase in osteoblast apoptosis that correlates with low levels of serum phosphorus. These changes were more frequently observed in patients with low turnover bone disease. In contrast, PTH seemed to preserve osteoblast survival. The mechanisms of hypophosphatemia in these patients appear to be independent of PTH, suggesting that other phosphaturic factors may play a role. However, further studies are needed to determine the nature of a phosphaturic factor and its relationship to the alterations of bone remodeling after transplantation

The pathogenesis of osteodystrophy after renal transplantation as detected by early alterations in bone remodeling

The pathogenesis of osteodystrophy after renal transplantation as detected by early alterations in bone remodeling.BackgroundLoss of bone mass after transplantation begins in the early periods after transplantations and may persist for several years, even in patients with normal renal function. While the pathogenesis of these abnormalities is still unclear, several studies suggest that preexisting bone disease, glucocorticoid therapy, and alterations in phosphate metabolism may play important roles. Recent studies indicate that osteoblast apoptosis and impaired osteoblastogenesis play important roles in the pathogenesis of glucocorticoid-induced osteoporosis.ObjectivesTo examine the early alterations in osteoblast number and surfaces during the period following renal transplantation.MethodsTwenty patients with a mean age of 36.5 ± 12 years were subjected to bone biopsy 22 to 160 days after renal transplantation. In 12 patients, a control biopsy was performed on the day of transplantation. Bone sections were evaluated by histomorphometric analysis and cell DNA fragmentation by the methods of terminal deoxynucleotidyl transferase-mediated uridine triphosphate nick end labeling (TUNEL), using immunoperoxidase and direct immunofluorescence techniques.ResultsThe main alterations in posttransplant biopsies were a decrease in osteoid and osteoblast surfaces, adjusted bone formation rate, and prolonged mineralization lag time. Peritrabecular fibrosis was markedly decreased. None of the pretransplant biopsies revealed osteoblast apoptosis. In contrast, TUNEL-positive cells in the proximity of osteoid seams or in the medullary space were observed in nine posttransplant biopsies of which four had mixed bone disease, two had adynamic bone disease, one had osteomalacia, one had osteitis fibrosa, and one had mild hyperparathyroid bone disease. Osteoblast number in posttransplant biopsies with apoptosis was lower as compared with posttransplant biopsies without apoptosis. In addition, most of them showed a marked shift toward quiescence from the cuboidal morphology of active osteoblasts. Serum phosphorus levels were lower in patients showing osteoblast apoptosis and correlated positively with osteoblast number and negatively with the number of apoptotic osteoblasts. In addition, posttransplant osteoblast surface correlated positively with parathyroid hormone (PTH) levels and negatively with glucocorticoid cumulative dose.ConclusionThe data suggest that impaired osteoblastogenesis and early osteoblast apoptosis may play important roles in the pathogenesis of posttransplant osteoporosis. The possible mechanisms involved in the pathogenesis of theses alterations include posttransplant hypophosphatemia, the use of glucocorticoids, and the preexisting bone disease. PTH seems to have a protective effect by preserving osteoblast survival

Factores epidemiológicos que influyen en la morbilidad puerperal. hospital Víctor Ramos Guardia. Huaraz. 2006

Con el objetivo de identificar algunos factores epidemiológicos que influyen en la morbilidad puerperal, se realizó un estudio transversal-retrospectivo de casos y controles en el Hospital "Víctor Ramos Guardia" de Huaraz, entre enero y diciembre del 2006. La muestra estuvo integrada por 60 puérperas con morbilidad (casos) y 120 puérperas sin morbilidad (control). En ambos grupos se aplicó la Ficha Materna, cuyos datos fueron obtenidos de las Historias Clínicas seleccionadas para cada uno de ellos. El análisis de datos se realizó a través del Odd ratio (OR). La morbilidad materna se relacionó significativamente con la adolescencia y la mujer añosa en ambos grupos. Teniendo como predominio las edades entre 23-27 años respectivamente (30,00% de los casos y 28,30% en los controles). Por otro lado la via de terminación del parto influye significativamente en la morbilidad puerperal, teniendo el parto espontáneo como vía de terminación más frecuente (50,00% en los casos y 81,70% para los controles); sin embargo llama la atención el parto por vacum que fue (6,70% en los casos y 10,00% en los controles). La infección de la herida operada (36.70%) y la anemia (20,00%) fueron los procesos morbosos más frecuentes en la vía de terminación del parto por cesárea y la infección del tracto urinario (20,00%) y la retención de membranas (20,00%) fueron las morbilidades más frecuentes en la vía de terminación del parto espontáneo; lo que significa que el tipo de morbilidad según la vía de terminación del parto influye significativamente en la morbilidad puerperal. Por otro lado se verificó que la mayoría de las variables estudiadas se relaciona con la morbilidad puerperal, constituyéndose en factores de riesgo para que se produzc

Bone Disease in Chronic Kidney Disease and Kidney Transplant

Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD) comprises alterations in calcium, phosphorus, parathyroid hormone (PTH), Vitamin D, and fibroblast growth factor-23 (FGF-23) metabolism, abnormalities in bone turnover, mineralization, volume, linear growth or strength, and vascular calcification leading to an increase in bone fractures and vascular disease, which ultimately result in high morbidity and mortality. The bone component of CKD-MBD, referred to as renal osteodystrophy, starts early during the course of CKD as a result of the effects of progressive reduction in kidney function which modify the tight interaction between mineral, hormonal, and other biochemical mediators of cell function that ultimately lead to bone disease. In addition, other factors, such as osteoporosis not apparently dependent on the typical pathophysiologic abnormalities resulting from altered kidney function, may accompany the different varieties of renal osteodystrophy leading to an increment in the risk of bone fracture. After kidney transplantation, these bone alterations and others directly associated or not with changes in kidney function may persist, progress or transform into a different entity due to new pathogenetic mechanisms. With time, these alterations may improve or worsen depending to a large extent on the restoration of kidney function and correction of the metabolic abnormalities developed during the course of CKD. In this paper, we review the bone lesions that occur during both CKD progression and after kidney transplant and analyze the factors involved in their pathogenesis as a means to raise awareness of their complexity and interrelationship

ESTUDIO FITOQUIMICO DE ARGYROCHOSMA NIVEA (POIR.) WINDHAM (CUTI CUTI): Phytochemical study of argyrochosma nivea (poir.) windham (poir.) desv. (cuti cuti)

Introducción: Nuestro país presenta un gran potencial de plantas medicinales en todo su territorio, por ser megadiverso, con muchas regiones agroecologicas y formaciones vegetales, pese a ello es incipiente la atención al desarrollo de las cadenas de valor del potencial de plantas medicinales, constituyendo un desafío el registro adecuado, con calidad y seguridad porque previenen y solucionan dificultades de salud por sus principios activos. Argyrochosma nivea (Poir.) Windham, “cuti cuti” conocido también como Notholaena nivea. Objetivos: Determinar los grupos metabólicos del extracto alcohólico al 20% de Argyrochosma nivea (Poir.) Windham, administrado a pacientes de diabetes del programa de medicina complementaria, EsSALUD Huancayo. Materiales y métodos: Estudios descriptivo, comparativo. La recolección de información relevante de aspectos botánicos, etnobotánicos, etnofarmacológicos y fitoquímicos sobre Argyrochosma nivea se realizó mediante la búsqueda en las bases de datos Scopus, ScienceDirect, PubMed y la biblioteca virtual del CONCYTEC (servicio de esa institución que reúne revistas de SciELO-Perú y la producción científica y tecnológica del Perú); además, se utilizó el buscador Google-Académico con el fin de agotar la búsqueda. Los términos de búsqueda fueron “Argyrochosma nivea”, “Notholaena nivea” o “cuti cuti”. Resultados: La Tintura de Argyrochosma nivea al 20% preparado con alcohol etílico al 50% en el analisis fitoquimico realizado se encontro compuestos de Flavanoides totales 0.111 mg de Catequina/ml, Flavonoides totales 0.133 mg de Quercitina /ml, Polifenoles totales 5.189 mg de ácido gálico/ml, Capacidad Antioxidante* 424.701 µ mol trolox/ml, Rutina 0.00579 mg de Rutina/ml, Quercitina 0.105mg/ml y Cumarinas 0.170 mg /ml. Ausencia de antocianinas totales, estos valores aportan la capacidad antioxidante de “cuti cuti”, y el contenido de flavonoides (quercetina), permite la prevalencia en el tratamiento de la diabetes. Conclusión: El Estudio fitoquimico de Argyrochosma nivea (Poir.) Windham (Cuti cuti) mediante el análisis por espectrofotometría y análisis por HPLC verifico la existencia de 7 compuestos Flavanoides totales 0.111 mg de Catequina/ml, Flavonoides totales 0.133 mg de Quercitina /ml, Polifenoles totales 5.189 mg de ácido gálico/ml, Capacidad Antioxidante* 424.701 µ mol trolox/ml, Rutina 0.00579 mg de Rutina/ml, Quercitina 0.105mg de Qu ercitina/ml y Cumarinas 0.170 mg de Cumarina/ml.   SUMMARY Introduction: Our country has a great potential for medicinal plants throughout its territory, as it is megadiverse, with many agroecological regions and plant formations, despite this, attention to the development of value chains for the potential of medicinal plants is incipient, constituting a I challenge the proper registration, with quality and safety because they prevent and solve health difficulties due to their active ingredients. Argyrochosma nivea (Poir.) Windham, "cuti cuti" also known as Notholaena nivea. Objectives: To determine the metabolic groups of the 20% alcoholic extract of Argyrochosma nivea (Poir.) Windham, administered to diabetes patients of the complementary medicine program, EsSALUD Huancayo. Methods: Descriptive, comparative studies. The collection of relevant information on botanical, ethnobotanical, ethnopharmacological and phytochemical aspects of Argyrochosma nivea was carried out by searching the Scopus, ScienceDirect, PubMed databases and the virtual library of CONCYTEC (a service of that institution that brings together SciELO-Peru journals). and the scientific and technological production of Peru); In addition, the Google Academic search engine was used in order to exhaust the search. The search terms were  “Argyrochosma nivea”, “Notholaena nivea” or “cuti cuti”. Results: The Argyrochosma nivea tincture at 20% prepared with 50% ethyl alcohol in the phytochemical analysis carried out found compounds of total Flavanoids 0.111 mg of Catechin / ml, total Flavonoids 0.133 mg of Quercetin / ml, total Polyphenols 5.189 mg of acid gallic/ml, Antioxidant Capacity* 424.701 µmol trolox/ml, Rutin 0.00579 mg Rutin/ml, Quercetin 0.105mg/ml and Coumarins 0.170 mg/ml. Absence of total anthocyanins, these values provide the antioxidant capacity of "cuti cuti", and the content of flavonoids (quercetin), allows prevalence in the treatment of diabetes. Conclusion: The phytochemical study of Argyrochosma nivea (Poir.) Windham (Cuti cuti) through spectrophotometric analysis and HPLC analysis verified the existence of 7 total Flavanoid compounds 0.111 mg of Catechin/ml, total Flavonoids 0.133 mg of Quercetin /ml, Total polyphenols 5.189 mg of gallic acid/ml, Antioxidant Capacity* 424.701 µ mol trolox/ml, Rutin 0.00579 mg of Rutin/ml, Quercetin 0.105mg of Quercetin/ml and Coumarins 0.170 mg of Coumarin/ml

ESTUDIO COMPARATIVO DE LA TERAPIA DE METFORMINA SOLA Y METFORMINA COMBINADA CON TERAPIA DE TINTURA DE NOTHOLAENA NIVEA EN PACIENTES CON DIABETES TIPO 2: Comparative study of metformin therapy alone and metformin combined with notholaena nivea tincture therapy in patients with type 2 diabetes

Introducción: La diabetes tipo 2 es un trastorno metabólico progresivo complejo, que representa una amenaza significativa para la salud humana y representa más del 91% de todos los casos de diabetes. Objetivo: evaluar el efecto de la adición de tintura de Notholaena nivea al tratamiento con metformina en pacientes con tolerancia alterada a la glucosa (IGT) y diabetes de tipo 2 (DMT2). Materiales y Método: Ensayo clínico unicentral, aleatorizado, simple ciego, controlado con placebo. Todos los participantes con diagnóstico de IGT y DMT2 que tomaban metformina fueron asignados aleatoriamente a recibir kits con tintura de Notholaena nivea autentica (40 pacientes) o placebo (58 pacientes), fijando 6 gotas diarias, 30 minutos antes del desayuno y almuerzo durante 26 semanas, se hicieron 3 controles (0, 13 y 26 semanas) midiendo glucosa plasmática en ayunas (FPG), nivel de hemoglobina glucosilada (HbA1C) y perfil lipídico. Resultados: del grupo de tratamiento (tintura de Notholaena nivea más metformina) fueron significativamente eficientes a las 13 semanas de iniciado el ensayo, manteniendo la directriz de reducción de glucosa plasmática (FPG), al iniciar el estudio el grupo control y tratamiento obtuvieron niveles de FPG similares con valores de .57±1.7 y 7.84±1.9 mmol/l respectivamente (p>0.05), a las 13 semanas se redujo a 7.21±1.mmol/l para el grupo control y 6.49±2.33 mmol/l para el grupo tratamiento (p<0.01), mientras que a la semana 26 el grupo control reporto 7.09±1.41 mmol/l en tanto el grupo tratamiento obtuvo 5.98±0.71 mmol/l (p<0.01). Hubo reducción de los niveles de HbA1C dentro de los grupos, pero no se evidenciaron diferencias por efecto del tratamiento. En el perfil lipídico el tratamiento de Metformina sola evidencio una mejor respuesta con la reducción de colesterol total y aumento de lipoproteínas de alta densidad (HDL) pero aumento la concentración de triglicéridos, mientras que el tratamiento con tintura de Notholaena nivea mantuvo los perfiles lipídicos al igual que en un inicio (p>0.05). Conclusiones: el tratamiento combinado de metformina más tintura de Notholaena nivea reduce acelerada y eficazmente las concentraciones de FPG en sangre de pacientes con IGT o DMT2, pero es ineficaz en el tratamiento del perfil lipídico.   SUMMARY Introduction: Type 2 diabetes is a complex progressive metabolic disorder, which represents a significant threat to human health and accounts for more than 91% of all diabetes cases. Objective: to evaluate the effect of adding Notholaena nivea tincture to metformin treatment in patients with impaired glucose tolerance (IGT) and type 2 diabetes (DMT2). Materials and Method: Unicentral, randomized, single-blind, placebo- controlled clinical trial. All participants diagnosed with IGT and T2DM who were taking metformin were randomly assigned to receive authentic Notholaena nivea tincture kits (40 patients) or placebo (58 patients), setting 6 drops daily, 30 minutes before breakfast and lunch for 26 weeks. , 3 controls were made (0, 13 and 26 weeks) measuring fasting plasma glucose (FPG), glycosylated hemoglobin level (HbA1C) and lipid profile. Results: the treatment group (Notholaena nivea tincture plus metformin) were significantly efficient at 13 weeks from the start of the trial, maintaining the plasma glucose reduction guideline (FPG), at the start of the study the control and treatment groups obtained levels of Similar FPG with values of .57±1.7 and 7.84±1.9 mmol/l respectively (p>0.05), at 13 weeks it was reduced to 7.21±1.mmol/l for the control group and 6.49±2.33 mmol/l for the treatment group (p<0.01), while at week 26 the control group reported 7.09±1.41 mmol/l while the treatment group obtained 5.98±0.71 mmol/l (p<0.01). There was a reduction in HbA1C levels within the groups, but no differences due to treatment effect were observed. In the lipid profile, the treatment with Metformin alone showed a better response with the reduction of total cholesterol and an increase in high-density lipoproteins (HDL) but increased the concentration of triglycerides, while the treatment with Notholaena nivea tincture maintained the lipid profiles at the same as at the beginning (p>0.05).  Conclusions: the combined treatment of metformin plus Notholaena nivea tincture rapidly and effectively reduces FPG concentrations in the blood of patients with IGT or DMT2, but it is ineffective in the treatment of the lipid profile.Keywords: Type 2 diabetes, Notholaena nivea, FPG, Metformin, lipids &nbsp

Diagnostic accuracy of bone turnover markers and bone histology in patients with CKD treated by dialysis

Background: The management of chronic kidney disease-mineral and bone disorder requires the assessment of bone turnover, which most often is based on parathyroid hormone (PTH) concentration, the utility of which remains controversial. Study Design: Cross-sectional retrospective diagnostic test study. Setting & Participants: 492 dialysis patients from Brazil, Portugal, Turkey, and Venezuela with prior bone biopsy and stored (-20 degrees C) serum. Index Tests: Samples were analyzed for PTH (intact [iPTH] and whole PTH), bone-specific alkaline phosphatase (bALP), and amino-terminal propeptide of type 1 procollagen (P1NP). Reference Test: Bone histomorphometric assessment of turnover (bone formation rate/bone surface [BFR/BS]) and receiver operating characteristic curves for discriminating diagnostic ability. Results: The biomarkers iPTH and bALP or combinations thereof allowed discrimination of low from nonlow and high from nonhigh BFR/BS, with an area under the receiver operating characteristic curve > 0.70 but 323.0 pg/mL. The best cutoff for bALP to discriminate low from nonlow BFR/BS was <33.1 U/L, and for high from nonhigh BFR/BS, 42.1 U/L. Using the KDIGO practice guideline PTH values of greater than 2 but less than 9 times the upper limit of normal, sensitivity and specificity of iPTH level to discriminate low from nonlow turnover bone disease were 65.7% and 65.3%, and to discriminate high from nonhigh were 37.0% and 85.8%, respectively. Limitations: Cross-sectional design without consideration of therapy. Potential limited generalizability with samples from 4 countries. Conclusions: The serum biomarkers iPTH, whole PTH, and bALP were able to discriminate low from nonlow BFR/BS, whereas iPTH and bALP were able to discriminate high from nonhigh BFR/BS. Prospective studies are required to determine whether evaluating trends in biomarker concentrations could guide therapeutic decisions. (C) 2016 by the National Kidney Foundation, Inc.Abbott-AbbVieAmgenCytochromaFresenius Medical CareViforAbbottSanofi/GenzymeNovartisCelgeneShireBaxterDiasorinChugaiKirinUniv Chicago, NorthShore Univ HealthSyst, 2650 Ridge Ave, Evanston, IL 60201 USAUniv Hosp Caracas, Caracas, VenezuelaUniv Sao Paulo, Sch Med, Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo, BrazilUniv Kentucky, Med Ctr, Lexington, KY USAUniv Nova Lisboa, Fac Ciencias Med, Hosp Curry Cabral, P-1200 Lisbon, PortugalUniv Antwerp, B-2020 Antwerp, BelgiumUPJV, UFR Med Pharm, INSERM, U1088, Amiens, FranceNatl Kidney Fdn, New York, NY USAIndiana Univ Sch Med, Indianapolis, IN 46202 USARoudebush Vet Adm Hosp, Indianapolis, IN USAUniv Fed Sao Paulo, Sao Paulo, BrazilWeb of Scienc