Primary male osteoporosis is associated with enhanced glucocorticoid availability

Objective. While systemic glucocorticoids compromise bone metabolism, altered intracellular cortisol availability may also contribute to the pathogenesis of primary male osteoporosis (MO). The objective of this study was to assess whether intracellular cortisol availability is increased in MO due to a distorted local cortisol metabolism. Methods. Forty-one patients with MO were compared with age- and BMI-matched non-osteoporotic subjects after excluding overt systemic hypercortisolism (N = 41). Cortisol, cortisone and the respective tetrahydro-, 5α-tetrahydro- and total cortisol metabolites were analysed by GC-MS in 24 h urine. Apparent 11β-hydroxysteroid dehydrogenase (11β-HSD) enzyme activities, excretion of cortisol metabolites and calcium, and fractional urinary calcium excretion were assessed and related to BMD. Results. Fractional and total urinary calcium excretion negatively correlated with BMD at all (P < 0.05) and at three of five (P < 0.05) measurement sites, respectively. While systemic cortisol was unchanged, apparent 11β-HSD enzyme activity in MO patients (P < 0.01) suggested increased intracellular cortisol availability. Total and fractional urinary calcium excretion was higher, with apparent 11β-HSD enzyme activities consistent with an enhanced intracellular cortisol availability (P < 0.05). Conclusion. Apparent 11β-HSD enzyme activities consistent with increased intracellular cortisol availability correlated with urinary calcium loss and reduced bone mineral density in MO. The changes in 11β-HSD activity were associated with both the fractional calcium excretion, suggesting altered renal calcium handling, and the absolute urinary calcium excretion. Both mechanisms could result in a marked bone calcium deficiency if insufficiently compensated for by intestinal calcium uptak

Prevalence and densitometric characteristics of incomplete distal renal tubular acidosis in men with recurrent calcium nephrolithiasis

The aim of this study was to assess the prevalence of incomplete distal renal tubular acidosis (idRTA) in men with recurrent calcium nephrolithiasis and its potential impact on bone mineral density. We conducted a retrospective analysis of 150 consecutive, male idiopathic recurrent calcium stone formers (RCSFs), which had originally been referred to the tertiary care stone center of the University Hospital of Berne for further metabolic evaluation. All RCSFs had been maintained on a free-choice diet while collecting two 24-h urine samples and delivered second morning urine samples after 12h fasting. Among 12 RCSFs with a fasting urine pH >5.8, a modified 3-day ammonium chloride loading test identified idRTA in 10 patients (urine pH >5.32, idRTA group). We matched to each idRTA subject 5 control subjects from the 150 RCSFs, primary by BMI and then by age, i.e., 50 patients, without any acidification defect (non-RTA group) for comparative biochemistry and dual energy X-ray absorptiometry (DEXA) analyses. The prevalence of primary idRTA among RCSFs was 6.7% (10/150). Patients with idRTA had significantly higher 2-h fasting and 24-h urine pH (2-h urine pH: 6.6±0.4 vs. 5.2±0.1, p=0.001; 24-h urine pH: 6.1±0.2 vs. 5.3±0.3, p=0.001), 24-h urinary calcium excretion (7.70±1.75 vs. 5.69±1.73mmol/d, p=0.02), but significantly lower 24-h urinary urea excretion (323±53 vs. 399±114mmol/d, p=0.01), urinary citrate levels (2.32±0.82 vs. 3.01±0.72mmol/d, p=0.04) and renal phosphate threshold normalized for the glomerular filtration rate (TmPO4/GFR: 0.66±0.17 vs. 0.82±0.21, p=0.03) compared to non-RTA patients. No significant difference in bone mineral density (BMD) was found between idRTA and non-RTA patients for the lumbar spine (LS BMD (g/cm2): 1.046±0.245 SD vs. 1.005±0.119 SD, p=0.42) or femoral neck (FN BMD (g/cm2): 0.830±0.135 SD vs. 0.852±0.127 SD). Thus, idRTA occurs in 1 in 15 male RCSFs and should be sought in all recurrent calcium nephrolithiasis patients. Bone mineral density, however, does not appear to be significantly affected by idRT

Dysnatraemias in the emergency room: Undetected, untreated, unknown?

Zusammenfassung: HINTERGRUND: Hypo- und Hypernatriämie sind die häufigsten Elektrolytstörungen im Krankenhaus und wurden mit erhöhter Mortalität assoziiert. Zur Zeit gibt es nur wenige Daten zur Prävalenz der Dysnatriämien an der Notfallaufnahme sowie zu den Charakteristika der Patienten mit Hypo- und Hypernatriämien. METHODIK: In diese retrospektive Studie wurden Patienten welche zwischen 01.09.2010 und 30.11.2010 an der Notfallaufnahme einer Universitätsklinik eine Bestimmung des Serum-Natriums erhielten eingeschlossen. RESULTATE: Insgesamt wurden während des Studienzeitraumes an 3.182 Patienten Bestimmungen des Serum-Natriums durchgeführt. 124 Patienten (4 %) wiesen bei Aufnahme in die Notfallaufnahme eine Hyponatriämie auf, während 400 Patienten (13 %) eine Hypernatriämie aufwiesen. Es zeigte sich kein Unterschied im Alter zwischen jenen Patienten welche eine Hypernatriämie aufwiesen und jenen welche normonaträm waren. Patienten mit Hyponatriämie waren hingegen signifikant älter. SCHLUSSFOLGERUNGEN: Beinahe 1 von 5 Patienten weist bei Aufnahme an der Notfallaufnahme eine Störung des Natriumhaushalts auf. Im Gegensatz zu hospitalisierten Patienten war an der Notfallaufnahme die Prävalenz der Hypernatriämie bedeutend grösser als jene der Hyponatriämie. Überraschenderweise waren Patienten mit Hyponatriämie signifikant älter als jene mit Hypernatriämie und jene mit normalen Serum-Natriumwerte

Lunar Tractive Forces and Renal Stone Incidence

Background. Several factors are implicated in renal stone formation and peak incidence of renal colic admissions to emergency departments (ED). Little is known about the influence of potential environmental triggers such as lunar gravitational forces. We conducted a retrospective study to test the hypothesis that the incidence of symptomatic renal colics increases at the time of the full and new moon because of increased lunar gravitational forces. Methods. We analysed 1500 patients who attended our ED between 2000 and 2010 because of nephrolithiasis-induced renal colic. The lunar phases were defined as full moon ± 1 day, new moon ± 1 day, and the days in-between as “normal” days. Results. During this 11-year period, 156 cases of acute nephrolithiasis were diagnosed at the time of a full moon and 146 at the time of a new moon (mean of 0.4 per day for both). 1198 cases were diagnosed on “normal” days (mean 0.4 per day). The incidence of nephrolithiasis in peak and other lunar gravitational phases, the circannual variation and the gender-specific analysis showed no statistically significant differences. Conclusion. In this adequate powered longitudinal study, changes in tractive force during the different lunar phases did not influence the incidence of renal colic admissions in emergency department

Postpartal recurrent non-ST elevation myocardial infarction in essential thrombocythaemia: case report and review of the literature

Normal pregnancy corresponds to a procoagulant state. Acute myocardial infarction during pregnancy is rare, yet considering the low non-pregnant risk score of childbearing women it is still surprisingly frequent. We report a case of postpartum recurrent non-ST elevation myocardial infarction in a 40-year-old caucasian woman with essential thrombocythaemia in the presence of a positive JAK-2 mutation and an elevated anti-cardiolipin IgM antibody titer. In the majority of cases of myocardial infarction in pregnancy or in the peripartal period, atherosclerosis, a thrombus or coronary artery dissection is observed. The combination of essential thrombocythaemia and elevated anti-cardiolipin IgM antibody titer in the presence of several cardiovascular risk factors seems to be causative in our case. In conclusion, with the continuing trend of childbearing at older ages, rare or unlikely conditions leading to severe events such as myocardial infarction must be considered in pregnant women

Impaired kidney function at ED admission: a comparison of bleeding complications of patients with different oral anticoagulants.

BACKGROUND Up to a fourth of patients at emergency department (ED) presentation suffer from acute deterioration of renal function, which is an important risk factor for bleeding events in patients on oral anticoagulation therapy. We hypothesized that outcomes of patients, bleeding characteristics, therapy, and outcome differ between direct oral anticoagulants (DOACs) and vitamin-K antagonists (VKAs). METHODS All anticoagulated patients older than 17 years with an impaired kidney function treated for an acute haemorrhage in a large Swiss university ED from 01.06.2012 to 01.07.2017 were included in this retrospective cohort study. Patient, treatment, and bleeding characteristics as well as outcomes (length of stay ED, intensive care unit and in-hospital admission, ED resource consumption, in-hospital mortality) were compared between patients on DOAC or VKA anticoagulant. RESULTS In total, 158 patients on DOAC and 419 patients on VKA with acute bleeding and impaired renal function were included. The renal function in patients on VKA was significantly worse compared to patients on DOAC (VKA: median 141 μmol/L vs. DOAC 132 μmol/L, p = 0.002). Patients on DOAC presented with a smaller number of intracranial bleeding compared to VKA (14.6% DOAC vs. 22.4% VKA, p = 0.036). DOAC patients needed more emergency endoscopies (15.8% DOAC vs, 9.1% VKA, p = 0.020) but less interventional emergency therapies to stop the bleeding (13.9% DOAC vs. 22.2% VKA, p = 0.027). Investigated outcomes did not differ significantly between the two groups. CONCLUSIONS DOAC patients were found to have a smaller proportional incidence of intracranial bleedings, needed more emergency endoscopies but less often interventional therapy compared to patients on VKA. Adapted treatment algorithms are a potential target to improve care in patients with DOAC

Dysnatraemias in the emergency room: Undetected, untreated, unknown?

Hypo- and hypernatraemia are the most common electrolyte disorders in hospitalized patients and have been associated with increased mortality. However, data on the prevalence of dysnatraemias in the emergency room and the characteristics of patients presenting with them are rare

Erratum to “The Challenge of Triaging Chest Pain Patients: The Bernese University Hospital Experience”

Accurate diagnosis of the causes of chest pain and dyspnea remain challenging. In this preliminary observational study with a 5-year follow-up, we attempted to find a simplified approach to selecting patients with chest pain needing immediate care based on the initial evaluation in ED. During a 24-month period were randomly selected 301 patients and a conditional inference tree (CIT) was used as the basis of the prognostic rule. Common diagnoses were musculoskeletal chest pain (27%), ACS (19%) and panic attack (12%). Using variables of ACS symptoms we estimated the likelihood of ACS based on a CIT to be high at 91% (32), low at 4% (198) and intermediate at 20.5–40% in (71) patients. Coronary catheterization was performed within 24 hours in 91% of the patients with ACS. A culprit lesion was found in 79%. Follow-up (median 4.2 years) information was available for 70% of the patients. Of the 164 patients without ACS who were followed up, 5 were treated with revascularization for stable angina pectoris, 2 were treated with revascularization for myocardial infarction, and 25 died. Although a simple triage decision tree could theoretically help to efficient select patients needing immediate care we need also to be vigilant for those presenting with atypical symptoms

Urine Flow Cytometry Parameter Cannot Safely Predict Contamination of Urine-A Cohort Study of a Swiss Emergency Department Using Machine Learning Techniques.

BACKGROUND Urine flow cytometry (UFC) analyses urine samples and determines parameter counts. We aimed to predict different types of urine culture growth, including mixed growth indicating urine culture contamination. METHODS A retrospective cohort study (07/2017-09/2020) was performed on pairs of urine samples and urine cultures obtained from adult emergency department patients. The dataset was split into a training (75%) and validation set (25%). Statistical analysis was performed using a machine learning approach with extreme gradient boosting to predict urine culture growth types (i.e., negative, positive, and mixed) using UFC parameters obtained by UF-4000, sex, and age. RESULTS In total, 3835 urine samples were included. Detection of squamous epithelial cells, bacteria, and leukocytes by UFC were associated with the different types of culture growth. We achieved a prediction accuracy of 80% in the three-class approach. Of the n = 126 mixed cultures in the validation set, 11.1% were correctly predicted; positive and negative cultures were correctly predicted in 74.0% and 96.3%. CONCLUSIONS Significant bacterial growth can be safely ruled out using UFC parameters. However, positive urine culture growth (rule in) or even mixed culture growth (suggesting contamination) cannot be adequately predicted using UFC parameters alone. Squamous epithelial cells are associated with mixed culture growth

Seed oil and seed oil byproducts of common purslane (Portulaca oleracea L.): a new insight to plant-based sources rich in omega-3 fatty acids

In the present study, nutritional value, chemical composition and bioactive properties of purslane seeds, seed oils and seedcakes were examined. Data were analyzed by a one-way ANOVA, while means were compared with Tukey's HSD test. For seed oil extraction mechanical and ultrasound assisted methods were tested. Cold extraction methods (CE1 and CE2) resulted in higher oil yield (increased by 33.7% and 38.1%, respectively) comparing to hot extraction (HE) method. Seeds contained the highest amount of fats and energy (15.03 ± 0.06 g/100 g dry basis (db) and 459 ± 1 kcal/100 g db, respectively), while seedcakes from CE2 had the highest content in proteins and ash (31.20 ± 0.03 and 4.27 ± 0.06 g/100 g db, respectively). Seeds and seedcakes contained a balanced content of linoleic and α-linolenic acids (33.80–34.74% and 32.83–34.64%, respectively). HE and CE1 oils had slightly higher amounts of α-linolenic (39.67% and 39.57%, respectively) than linoleic acid (35.44% and 35.13%, respectively), whereas CE2 oils contained twice as much linoleic as α- linolenic acid (49.77% and 24.18%, respectively). In conclusion, the tested materials are good sources of omega- 6 and omega-3 fatty acids and proteins, while extraction method affected oil yield and fatty acids composition of seed oils.Agricultural Machinery, University of Thessaly, Greece, for providing the equipment and technical assistance for hot extraction of seed oils. We are also thankful to Mr. Tsolakidis C. (Giachanas - Cold Pressed Seed Oils S.A.; Evros, Greece) for providing the equipment and technical assistance for cold extraction of seed oils. The authors are also grateful to the Foundation for Science and Technology (FCT, Portugal) and FEDER under Programme PT2020 for financial support to CIMO (UID/AGR/00690/2019). L. Barros and A. Fernandes would like to thank the national funding by FCT, P.I., through the institutional scientific employment program-contract for their contracts.info:eu-repo/semantics/publishedVersio