Vitamin D Deficiency in Renal Disease

Vitamin D deficiency is highly prevalent in patients with renal disease. The abnormal vitamin D (VD) metabolism in chronic kidney disease (CKD) is a key factor for developing CKD-related mineral bone disease (CKD-MBD), which directly influences the survival of the CKD patients. The importance of VD is perhaps of greater value due to its pleiotropic effects that span beyond calcium-phosphorus metabolism (cancer protection, diabetes prevention, and renal protection). The aim of our chapter is to depict the clinical implications of VD deficiency in the setting of CKD, including VD pleiotropy in renal disease, and to propose the most adequate treatment suggested in the literature

System design and validation of multi-band OFDM wireless communications with multiple antennas

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Plasma Exchange in Clinical Practice

Plasma exchange (PEX) is a treatment method with increasing range of indications. However, due to the small number of randomized trials, its effectiveness is still under debate in certain conditions. The aim of our chapter is to present the major principles of PEX, discuss safety issues and reveal current data for treatment effectiveness of the method. Novel indications for PEX will also be discussed

Vitamin D and Renal Disease

The metabolism of vitamin D (VD) is severely impaired in chronic kidney disease (CKD). Uremia is not only associated with the reduction of its active form 1,25-dihydroxyvitamin D but also in the reduction of all VD metabolites. CKD-associated abnormalities in VD are part of the CKD-related mineral-bone disease. However, VD has beneficial effect on the kidneys due to its pleiotropic effects, namely, antiproteinuric effect and renin-angiotensin-aldosterone system suppression, thus making the relationship between VD and the kidney even more complicated. The aim of our chapter is to reveal the changes in vitamin D axis in CKD, to outline the possible beneficial effects of vitamin D in renal patients, including end-stage renal patients and kidney transplant recipients, and to address the current opinions concerning treatment with cholecalciferol, calcitriol, and vitamin D analogs

The Quick Sequential Organ Failure Assessment (qSOFA) Score is a Poor Mortality Predictor in Patients with Complicated Intra-abdominal Infections

BACKGROUND: Despite the evolution in surgical treatment and antimicrobial therapy in the last years the complicated intra-abdominal infections (cIAIs) are still associated with high morbidity and mortality. Different scoring systems are already available for early prognostic evaluation and yet none has been widely accepted. AIM: Our aim was to evaluate the prognostic accuracy of quick sequential organ failure assessment (qSOFA), one of the most recent scores, in patients with cIAIs. MATERIALS AND METHODS: We studied retrospectively 110 patients with cIAIs admitted to the Department of Surgical Diseases (DSD) at University Hospital “Prof. Dr. Stoyan Kirkovich” Stara Zagora from January 2017 to July 2019. Area under receiver operating characteristics (AUROC) curves of systemic inflammatory response syndrome (SIRS), qSOFA, and Mannheim Peritonitis Index (MPI) were analyzed and a comparison of ROC curves was performed to explore their prognostic performance. RESULTS: Twenty-five (22.7%) patients died during hospitalization. qSOFA score showed poor prognostic accuracy (AUROC = 0.698, 95% CI = 0.566–0.829), worse than MPI score (AUROC = 0.698 vs. 0.844), but better than SIRS (AUROC = 0.698 vs. 0.583). The qSOFA score ≥2 points was observed with lack of sensitivity (32.0%) as outcome predictor. ROC curve analysis showed prognostic inferiority of qSOFA compared to MPI (difference between areas = 0.146, p = 0.0232). CONCLUSION: In patients with cIAIs, quick-SOFA score was observed with poor prognostic performance

Therapeutic Apheresis in Renal Transplantation: Indications and Strategies

Kidney transplantation (KT) is the best renal replacement therapy in patients with chronic kidney disease (CKD). However, its success is limited due to insufficient number of donors worldwide and graft or patient loss. A major cause for poorer graft survival is donor-specific antibodies (DSAs). Therapeutic apheresis (TA) is a well-recognized option for increasing the donor pool by treating HLA-sensitized patients and making AB0-incompatible KT possible. In addition, its use in patients with DSA has beneficial effect on graft survival. The aim of our review is to demonstrate the current knowledge on the use of TA (plasma exchange and immunoadsorption) in KT. In addition to the current guidelines, new trends in TA use prior to and after KT will be reviewed

Vitamin D After Kidney Transplantation: Metabolism and Clinical Importance

Vitamin D (VD) is a key factor in calcium-phosphorus metabolism. In addition, it has increasing popularity due to its pleiotropic effects: renal protection, antineoplastic properties, and diabetes mellitus and hypertension control. The VD axis is severely impaired in chronic kidney disease. The changes are present even in the earliest stages and progress as kidney function worsens. Significant changes in VD occur after successful kidney transplantation, as different factors interplay, leading to widespread VD insufficiency in kidney transplant recipients. The aim of our review is to demonstrate the changes in VD metabolism after kidney transplantation and to reveal their full impact on graft and patient survival in the post-transplant setting. Furthermore, current strategies for VD supplementation and their efficacy will be discussed

The Role of the Molecular Subtypes in the Prognosis of Breast Cancer Patients

BACKGROUND: Understanding the biology of the tumor, by dividing it into molecular subtypes, has made it possible to individualize the therapeutic approach in high-risk patients. AIM: We aimed to determine the importance of established molecular subtypes in the prognosis and the importance of disease-free and overall survival (OS) in patients with non-metastatic breast cancer. MATERIALS AND METHODS: We analyzed 94 patients with non-metastatic breast cancer for the period 2010–2018. The median follow-up time was 60 months. The mean age in the study group was 60.03 years (SD ± 10.52). According to the characteristics of the studied indicators, we divided the group into Luminal A (n-59 [62.7%]), Luminal B/HER2 (−) (n-2 [2.1%]), Luminal B/HER2 (+) (n-8 [8.5%]), HER2 overexpressing (n-3 [3.2%]), and triple-negative subtype (n-22 [23.5%]). In all patients in the study group, we analyzed the 5-year overall survival (OS) and disease-free survival (DFS) and referred it to molecular subtypes, lymphatic status, HER-2 status, the presence or absence of endocrine therapy for the follow-up period, tumor differentiation, and type of surgery. RESULTS: We observed the 5-year OS in 92% of patients identified as Luminal A; at 50% of Luminal B/HER2 (−) neg.; in 62.5% with Luminal B/HER2 (+), in 67% with HER2-overexpressing carcinoma; and in 66.7% of patients with triple-negative subtype. The total cancer-associated mortality rate in the analyzed period reached 15.9% (n = 15). Patients with mastectomy (p = 0.019, p = 0.027), positive axilla with more than 4 lymph node (LN) (p = 0.000; p = 0.000), and Luminal B/HER-2 (+) tumors (p = 0.004; p = 0.003) were the independent prognostic factors for worse DFS and OS in our study group. Histological differentiation and HER-2 expression were in unsatisfactory correlation (p = 0.077; p = 0.044 and p = 0.081; p = 0.055, respectively). CONCLUSION: Molecular subtypes are essential in the prognosis of breast cancer and maybe a criterion for an individualized therapeutic approach

Neutrophil CD64 – A potential biomarker in patients with complicated intra-abdominal infections? – A literature review

Complicated intra-abdominal infections (cIaIs) respresent a serious cause of morbidity and mortality. Early diagnosis and well-timed treatment can improve patients’ outcome, whereas the delay in management often result in rapid progression to circulatory collapse, multiple organ failure, and death. Neutrophil CD64 antigen expression has been studied for several years as infectious and sepsis biomarker and has several characteristics that make it good for clinical employment. It has been suggested to be predictive of positive bacterial cultures and a useful test for management of sepsis and other significant bacterial infections. Our review concluded that the neutrophil CD64 expression could be a promising and meaningful biomarker in patients with cIaIs. It shows good potential for evaluating the severity of the disease and could give information about the outcome. However, more large studies should be performed before using it in clinical practice

Prognostic significance of Epidermal Growth factor receptor in colon cancer patients on surgical treatment

Recently, pathological expression of epidermal growth factor receptor (EGFR) is increasingly used in the diagnosis of various epidermal tumours. The aim of this study is to analyze the role of EGFR in comparison to p53 as a prognostic marker in patients with colon cancer who undergo surgical treatment.Two types of immunohistochemical examinations (for EGFR and p53) have been performed in 120 patients with colon cancer histologically verified by using of hematoxylin-eosin staining.Our results clearly demonstrate that EGFR expression is present in 18 patients (in 15% of the cases). It occurs much more often in the patient with TNM stage II and especially in those with TNM stage III and relatively more frequently in the patients aged between 51 and 70 years and presenting with a moderately differentiated tumour. Besides, this expression immediately relates to a recurrence of the disease and worsened clinical course. There exists a correlation between the enhanced expression of EGFR and that of p53. Because of the small sample, our results are not statistically significant.EGFR can serve as an independent prognostic factor and indicator of more common recurrences of the disease, worse quality of life and poorer prognosis in colon cancer patients. Further intensive collaboration between coloproctologists and pathologists is needed to improve the individualized surgical behaviour in such patients