1,25-dihydroxyvitamin D as Predictor of Renal Worsening Function in Chronic Kidney Disease. Results From the PASCaL-1,25D Study

Oral health status in children with chronic kidney disease, kidney transplantation, and nephrotic syndrome: a cross-sectional study

INTRODUCTION

Chronic kidney disease (CKD) has been previously associated with a decline in oral health. This study aimed to examine the oral health of children with CKD, nephrotic syndrome (NS), and children that received kidney transplantation (KTR).

METHODS

A case-control study was conducted involving children with CKD stages 1-3, children with CKD stages 4-5, pediatric kidney transplant recipients, and children with NS. Developmental Defects of Enamel (DDE) were evaluated using the DDE Index, while dental caries was assessed with the Decayed Missing Filled Teeth Index (DMFT). Plaque and debris were measured utilizing the Simplified Oral Hygiene Index (OHI-S), which includes the two subindices Simplified Calculus Index (CI-S) and Simplified Debris Index (DI-S).

RESULTS

Children with CKD 1-3, CKD 4-5, and KTR presented with significantly higher DI-S and CI-S scores and significantly more DDE. There was no difference in the DMFT score in children with CKD 4-5 and KTR. For children with CKD 1-3, a significantly lower DMFT score was observed compared to the control group. Children with NS did not show any differences for DI-S, CI-S, DMFT, and DDE compared to healthy peers.

CONCLUSION

Oral health status is not affected in children with NS. Children with CKD 1-3, CKD 4-5, and KTR have more plaque, debris, and DDE and should be surveyed regularly by their dentists.

The biological variation of serum 1,25-dihydroxyvitamin D and parathyroid hormone, and plasma fibroblast growth factor 23 in healthy individuals

BACKGROUND AND AIMS

Measuring 1,25-dihydroxyvitamin D (1,25(OH)2D), parathyroid hormone 1-84 (PTH 1-84) and intact FGF23 (iFGF23) is crucial for diagnosing a variety of diseases affecting bone and mineral homeostasis. Biological variability (BV) data are important for defining analytical quality specifications (APS), the usefulness of reference intervals, and the significance of variations in serial measurements in the same subject. The aim of this study was to pioneer the provision of BV estimates for 1,25(OH)2D and to improve existing BV estimates for iFGF23 and PTH 1-84.

MATERIALS AND METHODS

Serum and plasma-EDTA samples of sixteen healthy subjects have been collected for seven weeks and measured in duplicate by chemiluminescent immunoassay on the DiaSorin Liaison platform. After variance verification, within-subject (CVI) and between-subject (CVG) BV estimates were assessed by either standard ANOVA, or CV-ANOVA. The APSs were calculated according to the EFLM-BV-model.

RESULTS

We found the following CVI estimates with 95% confidence intervals:1,25(OH)2D, 22.2% (18.9-26.4); iFGF23, 16.1% (13.5-19.5); and PTH 1-84, 17.9% (14.8-21.8). The CVG were: 1,25(OH)2D, 21.2% (14.2-35.1); iFGF23, 21.1% (14.5-35.8); and PTH 1-84, 31.1% (22.1-50.8).

CONCLUSIONS

We report for the first time BV estimates for 1,25(OH)2D and enhance existing data about iFGF23-BV and PTH 1-84-BV through cutting-edge immunometric methods.

Exploring the State of Machine Learning and Deep Learning in Medicine: A Survey of the Italian Research Community

Artificial intelligence (AI) is becoming increasingly important, especially in the medical field. While AI has been used in medicine for some time, its growth in the last decade is remarkable. Specifically, machine learning (ML) and deep learning (DL) techniques in medicine have been increasingly adopted due to the growing abundance of health-related data, the improved suitability of such techniques for managing large datasets, and more computational power. ML and DL methodologies are fostering the development of new “intelligent” tools and expert systems to process data, to automatize human–machine interactions, and to deliver advanced predictive systems that are changing every aspect of the scientific research, industry, and society. The Italian scientific community was instrumental in advancing this research area. This article aims to conduct a comprehensive investigation of the ML and DL methodologies and applications used in medicine by the Italian research community in the last five years. To this end, we selected all the papers published in the last five years with at least one of the authors affiliated to an Italian institution that in the title, in the abstract, or in the keywords present the terms “machine learning” or “deep learning” and reference a medical area. We focused our research on journal papers under the hypothesis that Italian researchers prefer to present novel but well-established research in scientific journals. We then analyzed the selected papers considering different dimensions, including the medical topic, the type of data, the pre-processing methods, the learning methods, and the evaluation methods. As a final outcome, a comprehensive overview of the Italian research landscape is given, highlighting how the community has increasingly worked on a very heterogeneous range of medical problems.

Long-term Efficacy and Safety of Rifampin in the Treatment of a Patient Carrying a CYP24A1 Loss-of-Function Variant

BACKGROUND

Pharmacological therapy may be useful in the treatment of moderate to severe hypercalcemia in patients with infantile hypercalcemia-1 (HCINF1) due to pathogenic variants in the cytochrome P450 24 subfamily A member 1 (CYP24A1). Rifampin is an antituberculosis drug that is a potent inducer of cytochrome P450 3 subfamily A member 4, which is involved in an alternative catabolic pathway of vitamin D. The efficacy of rifampin in improving hypercalcemia was previously reported, but many questions remain on the long-term efficacy and safety. The aim of the study is to test the long-term efficacy and safety of rifampin in a patient with HCINF1.

METHODS

We report clinical, biochemical, and imaging features of a 23-year-old man affected by HCINF1 with moderate hypercalcemia (12.9 mg/dL), symptomatic nephrolithiasis, nephrocalcinosis, and impaired kidney function [estimated glomerular filtration rate (eGFR) 60 mL/min/1.73 m2] treated with rifampin for an overall period of 24 months. Kidney, liver, and adrenal function were evaluated at every follow-up visit.

RESULTS

In 2 months, rifampin induced a normalization of serum calcium (9.6 mg/dL) associated with an improvement of kidney function (eGFR 92 mL/min/1.73 m2) stable during the treatment. After 15 months, rifampin was temporally withdrawn because of asthenia, unrelated to impairment of adrenal function. After 3 months, the timing of drug administration was shifted from the morning to the evening, obtaining the remission of asthenia. At the end of follow-up, the nephrolithiasis disappeared and the nephrocalcinosis was stable.

CONCLUSIONS

Rifampin could represent an effective choice to induce a stable reduction of calcium levels in patients with HCINF1, with a good safety profile.