Compararea diferitelor metode de estimare a vitezei de filtrare glomerulară

Discipline of Rheumatology and Nephrology, Nicolae Testemitanu SUMPhBackground. Glomerular filtration rate (GFR) is a measure of how much blood is filtered by the kidneys each minute accordingly is considered as the best overall indicator for how well an individual's kidneys are functioning at a given moment.GFR cannot be measured directly in people. Objective of the study. To bring out the difference between estimation of GFR via commonly used different methods and compare them using clearance measures or serum levels of filtration indicators. Material and Methods. Study design - descriptive. WHO information sources, scientific papers from the PubMed database on different methods of estimation of GFR were studied using the selected keywords and the following criteria 1)English language 2)10 and more citations of the article 3)publications within 10 years Results. In both the immature and mature kidney, urinary clearance of inulin, remains the reference against which alternative clearance techniques and filtration indicators are assessed. GFR in newborns is assessed using creatinine, the most extensively used GFR measure in adults. Cystatin C is less affected by muscles than creatinine, but eGFR based on serum cystatin C (eGFRcys) is not more accurate than eGFRcr, because of various conditions affecting non-GFR determinants of serum cystatin-C. However, equations combining both these filtration markers(eGFRcr-cys) appear to be more precise than equations using either marker alone. Conclusion. The glomerulus filters inulin freely, and is neither released or reabsorbed in the tubules, and is nor synthetized or metabolized. As a result, urine inulin clearance is regarded as the golden standard for diagnosis.Background. Glomerular filtration rate (GFR) is a measure of how much blood is filtered by the kidneys each minute accordingly is considered as the best overall indicator for how well an individual's kidneys are functioning at a given moment.GFR cannot be measured directly in people. Objective of the study. To bring out the difference between estimation of GFR via commonly used different methods and compare them using clearance measures or serum levels of filtration indicators. Material and Methods. Study design - descriptive. WHO information sources, scientific papers from the PubMed database on different methods of estimation of GFR were studied using the selected keywords and the following criteria 1)English language 2)10 and more citations of the article 3)publications within 10 years Results. In both the immature and mature kidney, urinary clearance of inulin, remains the reference against which alternative clearance techniques and filtration indicators are assessed. GFR in newborns is assessed using creatinine, the most extensively used GFR measure in adults. Cystatin C is less affected by muscles than creatinine, but eGFR based on serum cystatin C (eGFRcys) is not more accurate than eGFRcr, because of various conditions affecting non-GFR determinants of serum cystatin-C. However, equations combining both these filtration markers(eGFRcr-cys) appear to be more precise than equations using either marker alone. Conclusion. The glomerulus filters inulin freely, and is neither released or reabsorbed in the tubules, and is nor synthetized or metabolized. As a result, urine inulin clearance is regarded as the golden standard for diagnosis

Comparison of different methods of estimation of glomerular filtration rate

Discipline of Rheumatology and Nephrology, Nicolae Testemitanu SUMPhIntroduction:Glomerular filtration rate (GFR)- measures how much blood is filtered by the kidneys each minute and is considered as the best overall indicator for how well an individual's kidneys are functioning at a given moment. Purpose: To bring out the difference between estimation of GFR via commonly used different methods and compare them. Material and methods:Study design - descriptive. WHO information sources, scientific papers from the PubMed database were studied using the selected keywords. Results:Smith's classical technique for GFR assessment, urinary clearance of inulin, remains the reference against which alternative clearance techniques and filtration indicators are assessed. Conclusions: There are many methods used to measure the GFR, depending on the clinical application and availability. Although using inulin is still the gold standard, due to being a cumbersome technique, clinicians usually estimate the GFR using serum creatinine and/or cystatin C

Clip Artifact after Closure of Large Colorectal Endoscopic Mucosal Resection Sites: Incidence and Recognition

Background Clip closure of large colorectal EMR defects sometimes results in bumpy scars that are normal on biopsy. We refer to these as “clip artifact.” If unrecognized, clip artifact can be mistaken for residual polyp, leading to thermal treatment and potential adverse events. Objective To describe the incidence of and define predictors of clip artifact. Design Review of photographs of scars from consecutive clipped EMR defects. Setting University outpatient endoscopy center. Patients A total of 284 consecutive patients with clip closure of defects after EMR of lesions 20 mm or larger and follow-up colonoscopy. Interventions EMR, clip closure. Main Outcome Measurements Incidence of clip artifact. Results A total of 303 large polyps met the inclusion criteria. On review of photographs, 96 scars (31.7%) had clip artifact. Clip artifact was associated with increased numbers of clips placed (odds ratio for each additional clip, 1.2; 95% confidence interval, 1.02-1.38) but not polyp histology, size, or location. The rate of residual polyp by histology was 8.9% (27/303), with 21 of 27 scars with residual polyp evident endoscopically. The rate of residual polyp evident only by histology in scars with clip artifact (3/93; 3.2%) was not different from the rate in scars without clip artifact (3/189; 1.6%). Limitations Retrospective design. Sites closed primarily with 1 type of clip. Single-operator assessment of endoscopic photographs. Conclusion Clip artifact occurred in the scars of approximately one-third of large clipped EMR sites and increased with number of clips placed. Clip artifact could be consistently distinguished from residual polyp by its endoscopic appearance

Tunnelling Induced ground settlement considering soil variability

Ground settlement need to be predicted well so that necessary precautionary measures could be adopted. Ground deformation behavior due to tunnel construction in inhomogeneous soil has been studied in the past few decades by many researchers. When tunnel-induced ground, settlement is predicted by considering average soil properties, it is likely to miss the true settlement characteristics and failure mechanism due to the inherent heterogeneity of the ground. In this paper, spatial variability of the ground is considered in the numerical analysis to simulate the ground settlement. A numerical model is developed using the Finite-Difference based numerical code FLAC3D to simulate tunnel construction with earth pressure balance (EPB) TBMs for a case study. Both 2D and 3D random fields are simulated in the numerical model. Results are systematically compared with some of the empirical and analytical methods for predicting ground settlement. Spatial distribution is found to have a significant effect on surface settlements and overall ground behavior

Low-grade systemic inflammation in subclinical hypothyroidism

Background: Hypothyroidism is the deficiency in the production of thyroid hormones to meet the requirements of peripheral tissues. Subclinical hypothyroidism (SCH) is defined biochemically as normal serum free thyroxin concentration in the presence of an elevated serum thyroid-stimulating hormone (TSH) concentration. SCH may be associated with low-grade systemic inflammation (increased high sensitivity-C reactive protein (hs-CRP), one possible explanation may be that TSH in adipocytes promotes the release of interleukin-6 (IL-6). Studies have confirmed inflammatory biomarkers like hs-CRP and IL-6 to be a predictor of cardiovascular (CV) events. However, the treatment of SCH remains subject to debate. Conclusions: It is increasingly evident that SCH has prognostic values and crucial clinical effects, which leads to the view of SCH not being a compensated biochemical change sensu strictu. Even a modest but consistent fluctuation in the circulating thyroid hormone levels can create a response from the human heart. Well-timed treatment should be considered as a precaution to avoid the unfavourable CV diseases. The inflammatory biomarkers, namely CRP and IL-6 are exceptionally robust markers of cardiovascular risk. Thus, using these biomarkers may be helpful in assessing the cardiovascular risk in patients with subclinical hypothyroidism

Studiu privind încercarea COLCORONA și rezultatele lui

Discipline of Rheumatology and Nephrology, Nicolae Testemitanu SUMPhBackground. The COLCHICINE Coronavirus SARS-CoV2 trial (COLCORONA TRIAL) evaluates efficacy and safety of colchicine in adult patients, diagnosed with COVID-19 infection .The patients were not under immediate consideration for hospitalization and with atleast one high risk criteria. Objective of the study. To understand the efficiency and safety of colchicine as a treatment modality in patient population. Material and Methods. A systematic review of the COLCORNA trial conducted as a randomized,double-blind trial, placebo-controlled, multicenter investigator- initiated trial comparing colchicine(0.5mg twice daily for the first 3 days and then once daily for the 7days therafter)with placebo in a 1:1 ration, in non hospitalized COVID-19 patients . Results. Among the 4159 patients with PCR-confirmed, the primary endpoint occurred in 4.6% and 6.0% of patients in the colchicine and placebo groups, respectively (odds ratio, 0.75; 95% CI, 0.57 to 0.99; P=0.04). In these patients with PCR-confirmed COVID-19, the odds ratios were 0.75 (95% CI, 0.57 to 0.99) for hospitalization due to COVID-19, 0.50 (95% CI, 0.23 to 1.07) for mechanical ventilation, and 0.56 (95% CI, 0.19 to 1.66) for death. Serious adverse events were reported in 4.9% and 6.3% in the colchicine and placebo groups (P=0.05); pneumonia occurred in 2.9% and 4.1% of patients (P=0.02). Conclusion. Among non-hospitalized patients with COVID-19, colchicine reduces the composite rate of death or hospitalization.Introducere. Studiul COLCHICINE Coronavirus SARS-CoV2 (COLCORONA TRIAL) evaluează eficacitatea și siguranța colchicinei la pacienții adulți, diagnosticați cu infecția COVID-19. Pacienții nu au fost luați în considerare imediată pentru spitalizare și cu cel puțin un criteriu de risc ridicat. Scopul lucrării. Înțelegerea eficientă și siguranța colchicinei ca modalitate de tratament a pacienților. Material și Metode. O revizuire sistematică a studiului COLCORNA randomizat, dublu-orb, controlat cu placebo, inițiat de un investigator multicentric, care a comparat colchicina (0,5 mg de două ori pe zi în primele 3 zile și apoi o dată pe zi pentru 7 zile după aceea) cu placebo în o rată 1:1, la pacienții cu COVID-19 ne-spitalizați. Rezultate. Dintre cei 4 159 de pacienți cu COVID-19 confirmat de PCR, obiectivul primar a apărut la 4,6% și 6,0% dintre pacienții din grupurile de colchicină și, respectiv, placebo (probabilitate de 0,75; Iî 95%, 0,57 până la 0,99; P = 0,04). La acești pacienți cu COVID-19 confirmat de PCR, raporturile de probabilitate au fost 0,75 (Iî 95%, 0,57 până la 0,99) pentru spitalizare din cauza COVID-19, 0,50 (95% CI, 0,23 până la 1,07) pentru ventilație mecanică și 0,56 (Iî 95%, 0,19- 1,66) pentru deces. Evenimente adverse grave au fost raportate la 4,9% și 6,3% în grupurile cu colchicină și placebo (P = 0,05); pneumonia s-a dezvoltat la 2,9% și 4,1% dintre pacienți (P = 0,02). Concluzii. Dintre pacienții ne-spitalizați cu COVID-19, colchicina reduce rata compusă a decesului sau a spitalizării

Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

Superior haplotypes towards the development of blast and bacterial blight-resistant rice

Rice blast and bacterial leaf blight, are major disease, significantly threatens rice yield in all rice growing regions under favorable conditions and identification of resistance genes and their superior haplotypes is a potential strategy for effectively managing and controlling this devastating disease. In this study, we conducted a genome-wide association study (GWAS) using a diverse set of 147 rice accessions for blast and bacterial blight diseases in replications. Results revealed 23 (9 for blast and 14 for BLB) significant marker-trait associations (MTAs) that corresponded to 107 and 210 candidate genes for blast and BLB, respectively. The haplo-pheno analysis of the candidate genes led to the identification of eight superior haplotypes for blast, with an average SES score ranging from 0.00 to 1.33, and five superior haplotypes for BLB, with scores ranging from 1.52cm to 4.86cm superior haplotypes. Among these, superior haplotypes LOC_OS12G39700-H4 and LOC_Os06g30440-H33 were identified with the lowest average blast scores of 0.00-0.67, and superior haplotype LOC_Os02g12660-H39 exhibited the lowest average lesion length (1.88 - 2.06cm) for BLB. A total of ten accessions for blast and eight accessions for BLB were identified carrying superior haplotypes were identified. These haplotypes belong to aus and indx subpopulations of five countries (Bangladesh, Brazil, India, Myanmar, and Pakistan). For BLB resistance, eight accessions from six countries (Bangladesh, China, India, Myanmar, Pakistan, and Sri Lanka) and four subpopulations (aus, ind1A, ind2, and ind3) were identified carrying superior haplotypes. Interestingly, four candidate genes, LOC_Os06g21040, LOC_Os04g23960, LOC_Os12g39700, and LOC_Os01g24640 encoding transposon and retrotransposon proteins were among those with superior haplotypes known to play a crucial role in plant defense responses. These identified superior haplotypes have the potential to be combined into a single genetic background through haplotype-based breeding for a broader resistance spectrum against blast and bacterial blight diseases

Table_1_Superior haplotypes towards the development of blast and bacterial blight-resistant rice.xlsx

Rice blast and bacterial leaf blight, are major disease, significantly threatens rice yield in all rice growing regions under favorable conditions and identification of resistance genes and their superior haplotypes is a potential strategy for effectively managing and controlling this devastating disease. In this study, we conducted a genome-wide association study (GWAS) using a diverse set of 147 rice accessions for blast and bacterial blight diseases in replications. Results revealed 23 (9 for blast and 14 for BLB) significant marker-trait associations (MTAs) that corresponded to 107 and 210 candidate genes for blast and BLB, respectively. The haplo-pheno analysis of the candidate genes led to the identification of eight superior haplotypes for blast, with an average SES score ranging from 0.00 to 1.33, and five superior haplotypes for BLB, with scores ranging from 1.52cm to 4.86cm superior haplotypes. Among these, superior haplotypes LOC_OS12G39700-H4 and LOC_Os06g30440-H33 were identified with the lowest average blast scores of 0.00-0.67, and superior haplotype LOC_Os02g12660-H39 exhibited the lowest average lesion length (1.88 - 2.06cm) for BLB. A total of ten accessions for blast and eight accessions for BLB were identified carrying superior haplotypes were identified. These haplotypes belong to aus and indx subpopulations of five countries (Bangladesh, Brazil, India, Myanmar, and Pakistan). For BLB resistance, eight accessions from six countries (Bangladesh, China, India, Myanmar, Pakistan, and Sri Lanka) and four subpopulations (aus, ind1A, ind2, and ind3) were identified carrying superior haplotypes. Interestingly, four candidate genes, LOC_Os06g21040, LOC_Os04g23960, LOC_Os12g39700, and LOC_Os01g24640 encoding transposon and retrotransposon proteins were among those with superior haplotypes known to play a crucial role in plant defense responses. These identified superior haplotypes have the potential to be combined into a single genetic background through haplotype-based breeding for a broader resistance spectrum against blast and bacterial blight diseases.</p