A case of primary hypoparathyroidism presenting with acute kidney injury secondary to rhabdomyolysis

Hypoparathyroidism is the most common cause of symmetric calcification of the basal ganglia. Herein, a case of primary hypoparathyroidism with severe tetany, rhabdomyolysis, and acute kidney injury is presented. A 26-year-old male was admitted to the emergency clinic with leg pain and cramps, nausea, vomiting, and decreased amount of urine. He had been treated for epilepsy for the last 10 years. He was admitted to the emergency department for leg pain, cramping in the hands and legs, and agitation multiple times within the last six months. He was prescribed antidepressant and antipsychotic medications. He had a blood pressure of 150/90 mmHg, diffuse abdominal tenderness, and abdominal muscle rigidity on physical examination. Pathological laboratory findings were as follows: creatinine, 7.5 mg/dL, calcium, 3.7 mg/dL, alanine transaminase, 4349 U/L, aspartate transaminase, 5237 U/L, creatine phosphokinase, 262.000 U/L, and parathyroid hormone, 0 pg/mL.There were bilateral symmetrical calcifications in basal ganglia and the cerebellum on computerized tomography. He was diagnosed as primary hypoparathyroidism and acute kidney injury secondary to severe rhabdomyolysis. Brain calcifications, although rare, should be considered in dealing with patients with neurological symptoms, symmetrical cranial calcifications, and calcium metabolism abnormalities

Harmonized clinical trial methodologies for localized cutaneous leishmaniasis and potential for extensive network with capacities for clinical evaluation

International audienceINTRODUCTION: Progress with the treatment of cutaneous leishmaniasis (CL) has been hampered by inconsistent methodologies used to assess treatment effects. A sizable number of trials conducted over the years has generated only weak evidence backing current treatment recommendations, as shown by systematic reviews on old-world and new-world CL (OWCL and NWCL).MATERIALS AND METHODS: Using a previously published guidance paper on CL treatment trial methodology as the reference, consensus was sought on key parameters including core eligibility and outcome measures, among OWCL (7 countries, 10 trial sites) and NWCL (7 countries, 11 trial sites) during two separate meetings.RESULTS: Findings and level of consensus within and between OWCL and NWCL sites are presented and discussed. In addition, CL trial site characteristics and capacities are summarized.CONCLUSIONS: The consensus reached allows standardization of future clinical research across OWCL and NWCL sites. We encourage CL researchers to adopt and adapt as required the proposed parameters and outcomes in their future trials and provide feedback on their experience. The expertise afforded between the two sets of clinical sites provides the basis for a powerful consortium with potential for extensive, standardized assessment of interventions for CL and faster approval of candidate treatments

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

Examination of the relationship between students' basic physchological needs and their commitment to school at secondary schools

YÖK Tez No: 674112Bu araştırmada taşımalı eğitim kapsamında olan ve olmayan öğrencilerin okuldaki temel psikolojik ihtiyaçları ile okula bağlanmaları arasındaki ilişkinin incelenmesi amaçlanmıştır. Betimsel bir araştırma olan bu çalışmada ilişkisel tarama modeli kullanılmıştır. Bu araştırmanın çalışma grubunu 2020-2021 eğitim öğretim yılı Karaman il Merkez ve ilçelerinde öğrenimlerine devam etmekte olan 467 (%61,3)'si kız ve 295 (%38,7)'i erkek, toplamda 762 ortaokul öğrencisi oluşturmaktadır. Bu öğrencilerin 342 (%44,9)'si taşımalı eğitim, 420 (%55,1)'si taşımalı eğitim kapsamında olmayan bir okulda öğrenim görmektedir. Veri toplama aracı olarak Kişisel Bilgi Formu, Ergen Öğrencilerin Okulda Temel Psikolojik Gereksinimleri Ölçeği ve Çocuk ve Ergenler için Okula Bağlanma Ölçeği kullanılmıştır. Verilerin analizinde taşımalı eğitim kapsamında olan ve olmayan öğrencilerin okuldaki temel psikolojik ihtiyaçları ve okula bağlanma düzeylerinin demografik özelliklerine göre farklılaşıp farklılaşmadığına bağımsız gruplar için iki yönlü ANOVA analizi uygulanmıştır. Öğrencilerin okuldaki temel psikolojik ihtiyaçları, okul türü (taşımalı kapsamında olmayan bir okulda öğrenim görmek) ve okula bağlanma düzeyi arasında anlamlı düzeyde ilişki olup olmadığını belirlemek için Pearson korelasyon analizi ve son olarak okuldaki temel psikolojik ihtiyaçlar ve okul türünün okula bağlanmayı anlamlı düzeyde yordayıp yordamadığını belirlemek için çoklu Regresyon analizi yapılmıştır. Bulgulara göre taşımalı eğitim kapsamında olan öğrencilerin okuldaki temel psikolojik ihtiyaç düzeyleri taşımalı eğitim kapsamında olmayan öğrencilerinkinden anlamlı düzeyde düşük bulunmuştur. Dahası okuldaki temel psikolojik ihtiyaçlar öğrencilerin cinsiyetine göre kızların lehine, sınıf düzeyine göre 8. Sınıfta olanlara göre 6.sınıfta olanların lehine, yılsonu başarı düşük olanlarınkine göre yılsonu başarı puanı yüksek olanların lehine anlamlı düzeyde bulgular elde edilmiştir. Ancak öğrencilerin okuldaki temel psikolojik ihtiyaçları yaş, anne eğitim düzeyi ve baba eğitim düzeyine göre anlamlı düzeyde farklılaşmamaktadır. Taşımalı eğitim kapsamında olan öğrencilerin okula bağlanma düzeyleri taşımalı eğitim kapsamında olmayan öğrencilerinkinden anlamlı düzeyde düşük bulunmuştur. Öğrencilerin okula bağlanma düzeyleri cinsiyetine göre kızların lehine, yaşına göre 13 ve 14 yaşında olanlarınkine göre 11 yaşında olanların lehine, 14 yaşında olanlarınkine göre 13 yaşında olanların lehine, sınıf düzeyine göre 7 ve 8. sınıfta olanlarınkine göre 6.sınıfta olanların lehine, yılsonu başarı puanı düşük olanlarınkine göre yılsonu başarı puanı yüksek olanların lehine anlamlı düzeyde bulgular elde edilmiştir. Ancak öğrencilerin okula bağlanma düzeyleri anne eğitim düzeyi ve baba eğitim düzeyine göre anlamlı düzeyde farklılaşmamaktadır. Öğrencilerin okuldaki temel psikolojik ihtiyaçları, okul türü ve okula bağlanmaları arasında pozitif yönde anlamlı düzeyde ilişkiler bulunmuştur. Son olarak öğrencilerin okuldaki temel psikolojik ihtiyaçları ve okul türü okula bağlanmalarının toplam varyansının yaklaşık %20'sini açıklamıştır. Sonuçlara göre öğrencilerin taşımalı eğitim kapsamında olmaması ve okuldaki temel psikolojik ihtiyaçlarının karşılanması okula bağlılıklarını arttıracak etmenler arasında sayılabilir. Politika yapıcıların taşımalı eğitim yerine yerinde eğitimi yaygınlaştırıcı çözümler üretmesi ve okuldaki psikolojik ihtiyaçlarını karşılayacak şekilde okul ortamlarını düzenlemeleri önerilmektedir.The study aims to examine the relationship between students' basic psychological needs at schools and their commitment to schools within the bussed to school and non-bussed to school. The sample consists of 467 (61.3%) girls and 295 (38.7 %) boys in Karaman in 2020-2021 academic year. 342 (44.9 %) of these students are from the bussed to school, 420 (55.1 %) of these students attend are from non-bussed to school. Personal Information Form, Adolescent Students' Basic Psychological Needs at School Scale and Students' Commitment to School were given to these students. Two-way ANOVA was used to see the significant differences between students' basic psychological needs at schools and their commitment to school according to their demographic variables. Additionally, Pearson Correlation Analysis was conducted whether there is a significant relationship between students' basic psychological needs, school type (attending a non-bussed to school) and their commitment to school. Regression analysis was also done to find out whether their basic psychological needs at school, school type predict and commitment to school. Findings indicated that students' basic psychological needs at school are significantly lower than their commitment to non-bussed to schools. Moreover, basic psychological needs at school are found in favor of girls according to the gender of the students, in favor of 6th grade students in comparison with 8th grade students according to their class level and in favor of students who have higher year-end success grade than students who have lower year-end success grade. However, students' basic psychological needs at school are not differentiated significant according to mothers' education level and fathers' education level. There are positive relationships among students' school type, their commitment to school and their basic psychological needs. Regression results show that students' basic psychological needs at school and school type are the significant predictors of their commitment to school and these variables explained nearly 20% of total variance of commitment to school. According to the results being students within non-bussed to school and meeting students' basic psychological needs at school are the factors to increase their commitment to school. It is recommended that policy makers should find solutions to extend on-site education instead of bussed to school and they should develop policies to arrange schools' environment, meeting students' basic psychological needs at school

Acute Kidney Injury and Chronic Kidney Disease: A Bidirectional Road

Acute kidney injury (AKI) and chronic kidney disease (CKD) have many common points regarding risk factors, etiology, clinical and laboratory factors. We aimed in this review to discuss the outcome, the risk of CKD, cardiovascular and overall mortality risk after AKI, and the mechanisms underlying the relationship between AKI and CKD

A Case of Pseudo-Bartter Syndrome with Severe Metabolic Alkalosis

INTRODUCTION: The Pseudo-Bartter Syndrome, unlike the Bartter and Gitelman Syndromes, is characterized with metabolic alkalosis without a tubular defect. We aimed to summarize the management of metabolic alkalosis by discussing a case of Pseudo-Bartter Syndrome with severe metabolic alkalosis