Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis

BACKGROUND

The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme.

METHODS

This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results.

RESULTS

In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56-0.83, p < .01 and HR 0.93, 95% CI 0.70-1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60-0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I2 = 55.79%).

CONCLUSIONS

A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.

A discursive presentation of community pharmacies: Premises, storage, staff, documentation and legal compliance

Objectives

This study aimed to assess compliance with legal requirements, safe medication storage and staffing standards in community pharmacies in Punjab, Pakistan.

Method

We conducted a three-step cross-sectional study using observations, questionnaires and face-to-face interviews in 544 systematically-selected community pharmacies. We used descriptive statistic and one-way ANOVA to assess the data.

Results

Only 23 (4.2 %) pharmacies had accurate area and only 3.9 % had appropriate walls. In total, 23.3 % had glass-fronted shelves and 38.2 % had a glass door. More than half (53.8 %) had separate narcotics shelves and 43.0 % a separate shelf of expired medicines. Less than half (47.5 %) of the pharmacies were able to maintain hygiene. About 36.2 % of the pharmacies segregated different types of product. Drugs were protected from direct sunlight in most (61.3 %) pharmacies, but the refrigerator was working properly in less than half (43.4 %) and only a very small number (2.4 %) had an alternative power supply for the refrigerator. Only 37 (6.8 %) were able to maintain an appropriate room temperature. The vast majority (93.0 %) displayed a valid drug sale license, but a qualified person/pharmacist was only present in 4.8 %. The average number of employees was 4.2, and more than 71.0 % of staff had 10-12 years of formal education. Only 0.2 % of employees could explain term "PRN", although 57.3 % explained "IV" correctly. About 22.8 % replied correctly about the room temperature but the vast majority (97.6 %) did not know about cold chain temperature. The location of the pharmacy (p-value = 0.045) affected its performance.

Conclusions

Noncompliance with legal requirements, unsafe drug storage and limited human resources reflect the poor enforcement of drug laws in Pakistan. The findings suggest that there is a need to strengthen inspection and management of community pharmacies.

Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia

Background

With the huge number of patients who suffer from chronic and incurable diseases, medical scientists continue to search for new curative methods for patients in dire need of treatment. Interest in stem cells is growing, generating high expectations in terms of the possible benefits that could be derived from stem cell research and therapy. However, regardless of the hope of stem cells changing and improving lives, there are many ethical, religious, and political challenges and controversies that affect the research, and mandated to establish ethical guidelines and regulations. In Saudi Arabia, key stakeholders play an active role in discussing the ethics of stem cell research and therapy. The focus of the study was to explore professionals’ perceptions related to the ethical challenges of using stem cells in research and treatment in Saudi Arabia.

Results

A qualitative research study was conducted to explore and describe the perceptions of 25 professionals employed at different tertiary hospitals in the various regions of Saudi. A thematic analysis was performed to search for and identify the most significant perceptions shared by the participants. Four themes were generated based on the ethical challenges of four areas related to stem cell use, including (1) forbidden and permitted sources of stem cells, (2) informed consent, (3) beneficence, and (4) ethical regulations and guidelines.

Conclusion

The study identified that there is a growing need to advance the knowledge, education, and awareness related to stem cell research and treatment in Saudi Arabia.

The impact of a combined intervention program: an educational and clinical pharmacist's intervention to improve prescribing pattern in hospitalized geriatric patients at King Abdulaziz Medical City in Riyadh, Saudi Arabia

Background

There is a difference between evidence-based guidelines for geriatric patients and clinical practice of physicians. Prescribing potentially inappropriate medications (PIMs) can be attributed to the fact that many physicians are not aware of PIMs usage.

Aim

The aim of this study was to assess the effectiveness of a combined intervention program comprising an educational and clinical pharmacist intervention to reduce the incidence of PIMs among hospitalized geriatric patients.

Methods

This was a prospective pre-test versus post-test design study. The screening tool of older persons’ prescriptions, 2nd version, and 2015 American Geriatric Society Beers’ criteria were used to assess the appropriateness of medications prescribed for geriatric inpatients. The study was carried out in the medical wards of the Department of Medicine at King Abdulaziz Medical City in Riyadh, Saudi Arabia.

Results

Four hundred geriatric patients were enrolled in the study: 200 in a pre-intervention group (control) and 200 in the intervention group. After the combined intervention, the incidence rate of PIMs decreased significantly from 61% to 29.5% (p<0.001). Out of 317 recommendations given by the clinical pharmacist, the physicians accepted a total of 196 (61.83%) recommendations. The most common PIMs to avoid regardless of diagnosis of geriatric patients before interventions were first-generation antihistamines (46%), sliding scale insulin (18.5%), antipsychotics (6.5%), benzodiazepines (9.5%), and antiarrhythmic drugs (15%).

Conclusion

Using a combined intervention program that comprises an educational intervention of updated evidence-based guidelines and clinical pharmacist intervention would add a significant value to improve prescribing patterns in hospitalized geriatric patients.

[Dyslipidemia and suicidal risk in patients with psychiatric disorders]

The aim of this work is to study the association between dyslipidemia and suicidal risk in patients with psychiatric pathology. Our study has involved 155 patients suffering from major depressive disorder and 124 schizophrenic patients aged 40.58±12.16 and 43.43±10.60 years, respectively. Total cholesterol (TC), triglycerides (TG) and HDL-c were determined by enzymatic methods, LDL-c was calculated by the Friedewald formula. Plasma cholesterol level was significantly lower among suicidal schizophrenic or depressive patients. There were no significant differences in the others lipid levels. The results of our study suggest that total cholesterol values less than 3.59mmol/L could be an indicator of suicide vulnerability in patients with schizophrenia or major depressive disorder.

Is low total cholesterol levels associated with suicide attempt in depressive patients?

BACKGROUND

Patients with major depressive disorder (MDD) have a high risk of suicide. Many pathophysiological factors involved in MDD and suicide such us a low cholesterol levels have been associated with MDD and increased vulnerability to suicide. In this study, we investigate the relation between lipid parameters and suicide risk in patients with MDD.

METHODS

Plasma levels of total cholesterol, triglycerides, and high-density lipoprotein cholesterol (HDL-c) and low-density lipoprotein cholesterol (LDL-c) were determined in 160 patients meeting the DSM-IV-TR criteria for MDD (110 patients without suicidal behavior and 52 suicidal attempters) and 151 healthy controls.

RESULTS

A significant decrease in plasma cholesterol levels was observed in the group of suicidal depressive patients compared to those without suicidal behavior (p < 0.001). For the other lipid levels (triglycerides, HDL cholesterol, and LDL cholesterol), there were no significant differences between suicidal and non-suicidal patients.

CONCLUSIONS

Our study showed a significant decrease in plasma cholesterol levels in suicidal patients. This result support the hypothesis of the association of low plasma cholesterol level and suicidal behavior in patients with major depressive disorder.

Effect of cigarette smoking on insulin resistance risk

OBJECTIVES

Smoking is one of the main risk factors for cardiovascular disease (CVD). The mechanism(s) of the effects of smoking on CVD are not clearly understood; however, a number of atherogenic characteristics, such as insulin resistance have been reported. We aim to investigate the effects of cigarette smoking on insulin resistance and to determine the correlation between this parameter with smoking status characteristics.

STUDY DESIGN

This study was conducted on 138 non-smokers and 162 smokers aged respectively 35.6±16.0 and 38.5±21.9 years. All subjects are not diabetic.

METHODS

Fasting glucose was determined by enzymatic methods and insulin by chemiluminescence method. Insulin resistance (IR) was estimated using the Homeostasis Model of Assessment equation: HOMA-IR=[fasting insulin (mU/L)×fasting glucose (mmol/L)]/22.5. IR was defined as the upper quartile of HOMA-IR. Values above 2.5 were taken as abnormal and reflect insulin resistance.

RESULTS

Compared to non-smokers, smokers had significantly higher levels of fasting glucose, fasting insulin and HOMA-IR index. These associations remained significant after adjustment for confounding factors (age, gender, BMI and alcohol consumption). A statistically significant association was noted between the smoking status parameters, including both the number of cigarettes smoked/day and the duration of smoking, and fasting insulin levels as well for HOMA-IR index. Among smokers, we noted a positive correlation between HOMA-IR index and both plasma thiocyanates and urinary cotinine.

CONCLUSION

Our results show that smokers have a high risk to developing an insulin resistance and hyperinsulinemia, compared with a matched group of non-smokers, and may help to explain the high risk of cardiovascular diseases in smokers.

Zearalenone-induced changes in biochemical parameters, oxidative stress and apoptosis in cardiac tissue

Zearalenone (ZEN) is a mycotoxin from Fusarium species commonly found in food commodities and is known to cause reproductive disorders. Several in vivo studies have shown that ZEN is haematotoxic and hepatotoxic and causes several alterations of immunological parameters. Meantime, the available information on the cardiotoxic effects of ZEN is very much limited. In the present study, we investigated the toxic effects of ZEN in heart tissues of Balb/c mice. We demonstrated that ZEN (40 mg kg−1 body weight (b.w.)) increased creatine phosphokinase, lactate dehydrogenase, aspartate transaminase, alanine transaminase, total cholesterol and triglyceride levels and induced oxidative stress as monitored by measuring the malondialdehyde level, the generation of protein carbonyls, the catalase and superoxide dismutase activity and the expression of the heat shock proteins (Hsp 70). We also demonstrated that acute administration of ZEN triggers apoptosis in cardiac tissue. Furthermore, we aimed to evaluate the safety and efficacy of crocin (CRO), a natural carotenoid, to prevent ZEN-induced cardiotoxicity in mice. In fact, combined treatment of ZEN with different doses of CRO (50, 100, and 250 mg kg−1 b.w.) showed a significant reduction of ZEN-induced toxicity for all tested markers in a dose-dependent manner. It could be concluded that CRO was effective in the protection against ZEN-induced toxicity in cardiac tissue.

[Is PON1 a factor of cardiovascular risk in type 2 diabetes?]

OBJECTIVE

We evaluate the association between the decrease of serum paraxonase 1 activity and the risk of cardiovascular disease in type 2 diabetes.

METHODS

One hundred and fourteen patients with type 2 diabetes were included in the present study. Seventy-one of them have significant coronary disease. The control group consisted of 53 healthy adults.

RESULTS

PON1 activity was significantly reduced in diabetic patients compared to controls (P=0.021), especially in those with significant coronary disease (P=0.013). No significant variation in PON1 activity according to age was observed both in controls and in patients. When HDLc≥1.03mmol/L, the PON1 activity was significantly higher in patients without significant coronary disease compared to those with significant coronary disease (0.030). In case of significant coronary disease, a decrease of 12.23% in PON1 activity was observed in smokers compared with non-smokers, but without statistical significance. The PON1 activity did not very significantly according to the presence or absence of hypertension in patients with significant coronary disease.

CONCLUSION

The implication of diabetes in the decrease of PON1 activity seems highly probable but PON1 activity seems not to be in itself a marker of cardiovascular disease.

Idiopathic urolithiasis in Tunisian children: a report of 134 cases

We evaluated the metabolic and the nutritional aspects of 134 urolithiasis children in order to outline the characteristics of idiopathic urolithiasis in children. This prospective study group of 134 children (56 females, 78 males) with renal calculi was evaluated. The age range of the patients was six months to 16 years. A dietary survey was performed on every child. All patients were investigated with respect to stone localization and serum and urine risk factors. Statistical analysis of data was carried out using software SPSS 11.0 for Windows. Hypercalciuria was the most common risk factor detected in this group (28.3%). A decrease of water intake was noted in all age groups, especially in the rural area (549.6 mL/day vs. 1150.6 mL/day), and there was an increase in animal protein intake in 17 cases (mean: 1.9 g/kg). In addition, increased intake of starchy foods and food with high oxalate content (sorgum) were detected in the ten to 16 years age group (51%) of our study. Calcium oxalate monohydrate represents the principal component of idiopathic stone (58.2%), which is more frequent in children (68%) than in infants (51.7%) (P <0.02). The major etiology of idiopathic urolithiasis highlights the influence of dietary habit in stone formers in our country. The increased occurrence of calcium oxalate stones in school age children confirms the change in the etiology of urolithiasis according to age.

[Ochronosis: report of two familial cases]

BACKGROUND

Ochronosis of alkaptonuria is a rare hereditary autosomal recessive disease in which there is an absence of homogentisic acid oxidase resulting in accumulation of homogentisic acid in tissues.

AIM

To report a new case of alkaptonuria

CASE REPORT

A 49-year-old man had been followed for 4 years for chronic lombalgia and arthropaty of two knees. He is married to his cousin and father of 4 girls. His parents are also cousins. The clinical examination has found a cutaneuous pigmentation and a lumbar stiffness. At biological checking, creatininemia was at 190 μmol/L and there are not inflammatory indicators. The radiography have shown a discal dorsolumbar calcifications, anterior inter somatic bridges and bilateral arthritis of knees without articular chondrocalcinosis. The diagnosis of ochronosis have been suspected and confirmed by the blackness of urine and the dosage of alkaptonuria. The patient has been treated symptomatiquely. Familial investigation have revealed that his daughter suffered from the same disease with the notion of blackness of urine. She is 12 year old and she's asymptomatic on the osteoarticular level.

CONCLUSION

Alkaptonuria causes a degenerative arthropaty which can endanger functional prognosis. Early diagnosis and scanning of this innate error of metabolism by genetic study play a fundamental interest, especially for molecular and genetic advisement.

Accumulation of mercury and its effects on testicular functions in rats intoxicated orally by methylmercury

All forms of mercury are considered poisonous. Methylmercury, one organic form, is highly toxic to many organs. The aim of the present study was to assess the effects of this form on the reproductive system in the rat. For this, 20 male rats were divided into two groups. One, which is considered as reference, received tap water. The second group received tap water containing methylmercury at the rate of 20 mg l⁻¹ for 8 weeks. At the end of the experiment, blood samples were collected for the determination of total mercury and plasma testosterone. The left testes were used for the determination of total mercury and histological examination. Appropriate centrifugation was applied on right testes to extract interstitial and seminiferous tubular fluids. The epididymides were homogenised for the sperm count. Our results showed a dramatic fall in the plasma testosterone in the contaminated animals. The fall in plasmatic testosterone seems to be in relation with the decrease in the secretion of testosterone. In association with this, the concentration of testosterone in seminiferous tubules fluid dropped about 55% in the poisoned animals in comparison with the controls. Despite this, no decrease in the epididymal sperm count in contaminated rats was observed.

Changes in stone composition according to age and gender in Tunisian children

OBJECTIVE

Studies evaluating the influence of age and gender on the distribution of the various types of pediatric urinary calculi are scarce. The aim of this study was to highlight the modification of epidemiological characteristics of this pathology according to patients' sex and age.

PATIENTS AND METHODS

A total of 205 calculi (from 122 boys and 83 girls) were analyzed by infrared spectroscopy between 1993 and 2007; 54.6% of the patients were under 5 years.

RESULTS

Calcium oxalate was the predominant constituent in 54.7% of stones, followed by calcium phosphate and purines (14.6% each). We found a predominance of calcium oxalate in females (59.1% vs 50.8%), and a male preponderance for struvite stones (12.3% vs 1.2%). There was an increasing prevalence of calcium oxalate stones with age in both genders (42.9% in infants vs 59.3% in older children). Purine stones were predominant in 20% of cases, but prevalence decreased with age (28.6% in infants vs 18.5% in older children).

CONCLUSION

The increase in calcium oxalate stones in school-age children and the decrease in stones containing purines confirm a change in the etiology of urolithiasis according to age.

Pediatric urolithiasis in the central coast of Tunisia: Epidemiologic changes over the past twenty-five years

The incidence of pediatric urolithiasis has been constantly decreasing during the past twenty-four years (1982-2007) in Tunisia as well as in other Mediterranean countries. This study was undertaken to observe the incidence of stone disease and its composition in children. Our study shows a downward trend of incidence of urolithiasis in pediatric patients over the last 25 years. The prevalence of calcium oxalate stones has constantly increased with decrease in the stones related to infections Whewellite (calcium oxalate) was more frequent in children of school age. In conclusion, the decrease in struvite frequency in children patients during the past twenty-five years and the stabilization of calcium phosphate stones are the result of a significant improvement of diagnostics and the treatment of urinary tract infections in the young children in our country.

[A case of hypernatremic dehydration due to breast-feeding]

The authors report an 11-day-old exclusively breast-fed female, with a birth weight of 3 300 g, who had suffered from dehydration stage I, with acute renal failure and metabolic acidosis, with 170 mmol/L of serum sodium. Renal ultrasounds were normal but the rate of sodium in mother's milk was three times higher than controls (87 versus 21 mmol/L). Intravenous rehydration allowed the correction of hydroelectrolytic disorders.

[Cervical myelopathy revealing bone fluorosis]

Bone fluorosis is a rare metabolic disease characterized by massive bone fixation of fluorine. It is seen endemically around phosphate mines in North Africa. Neurologic complications, such as medullar compression may rarely reveal the disease. We report a case of cervical myelopathy due to bone fluorosis causing tetraparesis. Medullar compression was caused by posterior vertebral ligament calcification. Diagnosis was based on the characteristic radiologic aspect, and confirmed by the dosage of serum and urine levels of fluorine. Cervical laminectomy resulted in significant pain improvement, despite persistent motor deficit.

[Skeletal fluorosis: a case report]

The authors report a case of skeletal fluorosis described in a 60 years old man living in south-west Tunisian. The main clinical sign is a severe functional legs disability. Radiographic examination has shown a diffused osteocondensation, with cervical spine degenerative discopathy, a pelvis bilateral osteoarthritis and an interosseous membrane ossification of forearms and legs. The skeletal fluorosis diagnosis has been confirmed by high serum and urinary fluoride levels.

Multiresidue analysis of pesticides in fruits and vegetables by gas chromatography-mass spectrometry

A multiresidue method was assessed for the determination of several pesticides (organochlorine, organophosphorus, pyrethroids, triazole, amidine) using gas chromatography/mass spectrometry. The extraction of pesticides was carried out by liquid-liquid extraction (LLE) and solid-phase extraction (SPE) using two types of columns (CN and C18). The extracts were cleaned by the addition of florisil, the pesticides were separated by capillary column gas chromatography and detected by mass spectrometry in the electron impact mode. The extraction using C18 column provided the best results for most of the analyzed pesticides. The majority of pesticides recoveries from the four fruits and vegetables (apples, pears, tomatoes and pepper) were greater than 60%. Linearity and precision were satisfactory. The estimated limits of detection and limits of quantification ranged from 0.01 to 0.1 mg/kg and from 0.02 to 0.3 mg/kg, respectively. The proposed procedure was found to be useful for the multiresidue analyses of pesticides in agricultural products for routine monitoring programs.

Pediatric urolithiasis in Tunisia: a multi-centric study of 525 patients

PURPOSE

To investigate retrospectively the clinical and epidemiological characteristics, and method of treatment of childhood urolithiasis, a major urological problem in Tunisia.

MATERIALS AND METHODS

The records of 525 children with urolithiasis treated in Tunisia between 1990 and 2004 were reviewed in a multi-centric study with regard to age at diagnosis, sex, history, and physical, laboratory, and radiologic findings. Metabolic evaluation when performed included serum electrolytes, calcium, phosphorus, uric acid, 24-h urine collection for calcium and creatinine, and a sodium nitroprusside test for cystine. In all cases urine specimens were sent for culture.

RESULTS

The stone was located in the upper tract in 420 (80%) and lower tract in 105 children. Of the urine cultures, 40% were positive. Metabolic investigation was performed in 201 patients and was normal in 170 (84%). Urinary stasis secondary to a urinary tract anomaly that led to the formation of stones was found in 77 patients. Stones were treated by surgery (80%), extracorporeal shock wave lithotripsy (ESWL) (5%) and ureteroscopic extraction (4%), and percutaneous nephrolithotomy was performed in 10 patients (2%). The stone passed spontaneously in 9% of cases.

CONCLUSION

The use of ESWL and endourological methods of treatment for childhood urolithiasis must be generalized, with open surgery being reserved for particular and complex cases.

[Evaluation of a spectrophotometric technique for plasmatic haemoglobin determination on Konelab 30]

INTRODUCTION

the measurement of plasma haemoglobin is utilized in the evaluation of various haemolytic phenomenons, especially at the time of sampling. Besides, the methods used to titrate plasmatic haemoglobin, an analysis which is of great interest to cardiac surgery, must be very accurate, because plasmatic levels are much lower than those found in whole blood.

BACKGROUND

the purpose of this work is to present a new technique for direct determination of plasmatic haemoglobin.

MATERIAL AND METHODS

this method was studied and adapted on a multiparametric analyzer Konelab 30 (Thermo Electron Corporation). The correlation was assessed with a Sigma Diagnostics spectrophotometric method, using the 3,3',5,5'-tetramethylbenzidine (TMB), a non carcinogenic reagent. The reaction of haemoglobin with TMB was studied with a SECOMAM S500P UV-Visible spectrometer.

RESULTS AND DISCUSSION

the method demonstrates linearity, precision, and sensitivity suitable for clinical use and not affected by the presence of bilirubin, nor triglycerides. The method was precise (CV < 1,00%), accurate (CE < 5,00%) and showed excellent recovery of haemolysis (R > 0,95). The CV for the automated assay was less than 1%. Reference ranges were studied and lithium heparinate seems to be the best anticoagulant to use so as to minimize haemolysis.

CONCLUSION

the studied technique is practical, specific, accurate, fast, reliable and inexpensive, and was adopted in emergency as in daily routine in our laboratory for plasmatic haemoglobin determination in various situations.

[Adaptation of Biomerieux enzymatic UV ammonia on Konelab analysers]

INTRODUCTION

Circulating ammonia in normal patients is relatively low, despite the fact that ammonia is continually produced from endogenous amino acid metabolism. The physiopathological interest of plasmatic ammonia determination lies primarily in its relationships to hepatic insufficiency (cirrhotic or neoplasic), or the diagnosis and the forecast of the Reye's syndrome.

OBJECTS

This study describes an evaluation of plasmatic ammonia determination by the UV end point enzymatic method using GLDH on KONELAB(TM) analyzers.

METHODS

The glutamate dehydrogenase (GLDH : EC.1.4.1.3) catalyses the reducing amination of alpha-cetoglutarate in the presence of NH(4)(+) and of NADPH, H(+) to form glutamate and NADP(+). The reduction of NADPH,H(+)'s concentration, directly proportional to ammonia rates, is evaluated at 340 nm. All the conditions were met to optimize the method, while covering a satisfying field of measurement.

RESULTS AND COMMENTS

The evaluation of the modified method showed a good precision (repeatability: CV < 4 %; interserial reproducibility: CV from 2.01 to 2.93 %; Intraserial reproducibility: CV equal to 0.67%) and a very good accuracy. The field of measurement extends from 27 to 250 micromol/L, with a limit of detection (L(D)) lowered to 0.325 micromol/L.

CONCLUSION

The adapted technique is simple, fast, inexpensive and especially automatizable. It is in addition reliable and chiefly more sensitive, adapting particularly to the determination of plasmatic ammonia in urgency as in routine within our laboratory.

Effect of hyperprotidic diet associated or not with hypercalcic diet on calcium oxalate stone formation in rat

The aim of this study was to determine whether protein, administered alone or simultaneously with a hypercalcic diet, was able to aggravate calcium oxalate stone formation in rats. Thirty-two male Wistar rats were randomly divided into four groups of 8 rats each and assigned a calcium oxalate lithogenic diet added to their drinking water for 3 weeks. One group, used as reference, received a standard diet prepared in our laboratory. The second was assigned the same diet but supplemented with 7.5 g animal proteins/100 g diet. The third received a diet containing 500 mg calcium more than the standard group. The diet given to the last group was supplemented with calcium and protein at the same doses indicated previously. One day before the end of treatment, each animal was placed in a metabolic cage to collect 24-hour urine samples and determine urinary creatinine, urea, calcium, magnesium, phosphate, uric acid, citric acid and oxalate levels. Immediately thereafter, aortic blood was collected to determine the same parameters as in urine. The kidneys were also removed to determine calcium oxalate deposits. Our results showed an increased 24-hour urinary excretion of calcium, oxalate and uric acid and decreased urinary citric acid excretion only in groups that received protein supplementation. At the same time, calcium oxalate deposits were found significantly higher in hyperprotidic diets than reference or calcium-supplemented groups. According to these findings, glomerular filtration, fractional excretion of urea and reabsorption of water, calcium and magnesium were found significantly lower in hyperprotidic diets compared to other groups. These results demonstrate that proteins could seriously aggravate calcium oxalate stones and cause renal disturbances.

[Possible role of vitamin A and E deficiency in human idiopathic lithiasis]

The purpose of our study is to compare the status of vitamin A and E enters a group of male patients aged 30-40 years and having idiopathic lithiasis in the other whose origin of the lithiasis is awarded to a hypercalciuria and/or hypercalciuria and/or hyperoxaluria. Reference values were established from a normal subjects aged 30-40 years and having no history of nephrolithiasis. Our results showed that the mean levels of vitamin A was significantly lower in idiopathic renal stone-formers than metabolic stone-formers (p < 0.001). Compared to control group, the status of vitamin A was found lower only in idiopathic renal stone patients (p < 0.05). On the contrary, the mean levels of vitamin E were found similar in the two patient groups, but significantly lower compared to control group. These results suggested that idiopathic renal stone genesis could be generated by vitamin A deficiency.

Effects of intraperitoneally administered vitamin E and selenium on calcium oxalate renal stone formation: experimental study in rat

Forty-eight Wistar rats were treated for 3 weeks with water containing 0.7% ethylene-glycol and divided into four groups. The first group, used as control, has received sodium chloride at 1 ml/100 g BW daily. The second group was intraperitoneally injected with selenium at 10 micrograms/d per 100 g BW as NaSeO3 for 3 weeks. The third group was intraperitoneally administered with 15 mg Vit E/d per 100 g BW as alpha-tocopherol acetate for 3 weeks. The last group was simultaneously administered vitamin E and Se at the same doses and periods as the precedent groups. One day before the end of the treatment, each animal was placed in a metabolic cage for collection of 24 h urine samples and determination of urinary creatinin, urea, calcium, magnesium, phosphate and oxalate levels. Immediately thereafter, all the rats were anesthetized and aortic blood was collected to determine the same parameters as in urine. The kidneys were also removed to determine calcium oxalate deposits, dry weight and to conduct a histological examination. Our results showed decreased ionic product and increased magnesium fractional reabsorption in the group receiving only selenium and in the group receiving selenium in combination with vitamin E, in comparison with the control animals. In view of the knowledge concerning the same protective action of Vit E and selenium, regardless of tubular membrane alteration, the absence of any inhibitory effect of Vit E on calcium oxalate formation suggests that selenium, like other minerals, could be stuck onto the crystal surface and would inhibit induction of new crystals, growth and aggregation.

Blood folate and vitamin B12: United States, 1988-94

OBJECTIVES

This report presents national estimates of serum and red blood cell (RBC) folate and serum vitamin B12 distributions for persons 4 years and over, by sociodemographic variables.

METHODS

The third National Health and Nutrition Examination Survey (NHANES III) (1988-94), provides information on the health and nutritional status of the civilian noninstitutionalized U.S. population. The analytic sample included 23,378 participants with serum folate data, 23,082 with RBC folate data, and 11,851 with serum vitamin B12 data.

RESULTS

The mean serum and RBC folate concentrations are 7.2 and 196 nanograms per milliliter (ng/mL), respectively, and the mean serum vitamin B12 concentration is 518 picograms per milliliter (pg/mL). Non-Hispanic white people have higher mean serum and RBC folate concentrations than non-Hispanic black or Mexican American people. Serum vitamin B12 concentrations are lowest for older adults, and non-Hispanic black people have higher serum B12 concentrations than non-Hispanic white individuals. Only approximately 3 percent of the population has a serum B12 concentration less than 200 pg/mL.

CONCLUSIONS

Inadequate folate status may be more prevalent among non-Hispanic black and Mexican American people. Data also suggest a modest prevalence of low serum B12 concentrations. Future assessments of folate and vitamin B12 status will be important to evaluate the impact of a recently enacted fortification policy.

[Absence of litholytic effects of zinc sulfate and copper sulfate in experimental lithiasis in rats]

Seventy two male Wistar-strain rats were fed lithogenic diet with ethylene-glycol within three weeks. At the end of this treatment, six rats were killed in order to determine the oxalate and calcium concentrations in renal tissue. Remained rats was randomly divided in four series, each series consisting of three groups. In first series (T), the animals were treated with distilled water; in the second (D1Zn), the animals were treated intramuscularly with the zinc at the rate of 24 micrograms per 100 grams of body weight and per day; in the third (D2Zn), 240 micrograms of zinc were administrated to animals and in the last series (D2Cu), the animals were treated at the same dose as the previous series, but with the copper. The groups which making up each series were killed successively at the 5th, 10th and 15th day after ending treatment with ethyleneglycol in order to determine urinary pH, percentage of water in renal tissue, uremia and concentrations of oxalate and calcium in renal tissue. Then, the comparisons of means were carried out, at each time, between different treated groups and reference group which was treated with distilled water. Litholytic effect was found in all series, including that which had been treated with distilled water. However, compared to reference animals, no acceleration of litholytic process was induced by zinc or copper. The high doses used in these experimentations proved therefore that calcium oxalate calculi were insoluble by zinc and copper.

[C-reactive protein in bacterial meningitis in adults]

In order to assess the benefits of serial assays of C-reactive protein in the course of bacterial meningitis in adults, daily blood samples were taken for CRP measurement during 10 days in 21 consecutive patients (mean age: 24 +/- 8 years) hospitalized for bacterial meningitis principally due to Neisseria meningitidis (n = 15). The highest CRP level (178 +/- 38 mg/l) was present on admission, followed by a regular decrease occurring in uncomplicated meningitis until normal level was achieved on day 9. The CRP kinetics was not influenced by the type of causative micro-organism. This study shows that CRP kinetics in adults is similar to that reported in children. The benefit of CRP assays in optimizing the duration of antibiotic treatment of meningitis needs to be more carefully assessed.

[Blood donors and anemia]

Biological examinations of 2,630 blood donors showed that 8.6% of them were suffering with anemia. In 4% of the cases we discovered iron deficit and an hemoglobinopathy was found in 0.64% of all the cases.

Hellp syndrome: incidence and maternal-fetal outcome--a prospective study

OBJECTIVE

To determine the incidence of Hellp syndrome (HS) and the maternal fetal outcome associated with its occurrence.

DESIGN

A prospective study during a 6-month period.

SETTING

The department of obstetrics and gynecology and the Intensive Care Unit of a 700 bed teaching hospital.

PATIENTS

Sixty-two consecutive preeclamptic and eclamptic women.

MEASUREMENTS AND RESULTS

All patients were systematically investigated for the biological markers of HS. The effects of the occurrence of HS on maternal and fetal prognosis were evaluated by comparing for prognosis indicators usually assessed in gravidic hypertension, pre-eclamptic and eclamptic woman who exhibited HS (HS+ subgroup) with HS free patients (HS- subgroup). HS was found in 12 out of the 62 pre-eclamptic and eclamptic women (19.3%). Its occurrence was associated with higher maternal mortality (16.7% vs 0%; p = 0.03), a greater incidence of eclamptic crisis (50% vs 20%; p = 0.03), severe hypertension (33% vs 8%; p = 0.03) and episodes of acute renal failure (66% vs 30%; p = 0.02). Mean proteinuria was also higher in HS+ patients (4.6 +/- 3.3 vs 2.2 +/- 2.5 g/day; p = 0.001). However, fetal outcome was not significantly altered.

CONCLUSION

Pre-eclampsia and eclampsia may be more severe in the presence of HS with a worsening of maternal prognosis while fetal outcome seems not altered.

Folate status of Mexican American, Cuban, and Puerto Rican women

The objective of this study was to estimate the prevalence of low serum and red blood cell (RBC) folate values of Mexican American (MA), Cuban (C), and Puerto Rican (PR) women examined in the Hispanic Health and Nutrition Examination Survey, 1982-1984. Serum and RBC folate were determined for all women aged 18-44 y by use of a radio-assay kit. The percent of women with low serum folate (less than 6.8 nmol/L) was 11.9% for MA, 10.1% for C, and 8.1% for PR. The prevalence of low concentrations of RBC folate (less than 363 nmol/L) was 7.8%, 16.7%, and 13.6% for MA, C, and PR, respectively. The percentages of women with reduced tissue stores of folate were 4.3% for MA, 6.0% for C, and 4.0% for PR. Years of education completed and poverty status did not significantly affect folate concentrations; however, the prevalence of low folate concentrations among users of vitamin or mineral supplements was significantly lower than it was among nonusers in selected subgroups.

[Contribution of scanning electron microscopy in children with lithiasis]

Infrared spectroscopy (IR) was used as the preferential method for determination of the composition of calculi and scanning electron microscopy (SEM) for observation of the IR shape. Our results show the role of SEM for visualisation of the internal ultrastructure and architecture of calculi in children. The authors confirm their previous hypothesis that phosphates favour the nucleation of other compounds, and demonstrate the presence of some trace elements which could play an important role in lithogenesis (eg Si).