Victor Stoica

Effects of lifestyle changes including specific dietary intervention and physical activity in the management of patients with chronic hepatitis C--a randomized trial.

BackgroundIn patients with chronic hepatitis C (CHC), obesity is involved in the pathogenesis of insulin resistance, fatty liver disease and progression of fibrosis. The objective of this study was to compare a normoglucidic low-calorie diet (NGLCD) with a low-fat diet (LFD) among participants with CHC. Aimed to measure the impact of dietary changes in reduction of insulin resistance, obesity but also in steatosis and fibrosis.MethodsRandomized, controlled trial in three medical centers with assessments at baseline, 6 months and 12 months. Participants were patients over 35 years with chronic hepatitis C (n = 120) with BMI over 25 kg/m2. We evaluated the effects of NGLCD vs. LFD in weight management and metabolic improvement. The primary endpoint was to measure the impact of dietary changes through nutritional intervention in reversibility of insulin resistance, obesity, steatosis, and fibrosis. We performed anthropometric measurements, fasting glucose profile, serum lipids, liver profile, blood count at baseline, 6 and 12 months. Steatosis was evaluated using ultrasonographic criteria. Liver fibrosis was non-invasively assessed.ResultsAfter 6 and 12 months of intervention, both groups had a significant decrease in caloric consumption. At 6 months, weight loss was greater in the NGLCD group (−5.02 ± 3.43 kg vs. −4.1 ± 2.6 kg; p = 0.002) compared to the LFD group. At 1-year, however, weight loss was similar in both groups (−3.9 ± 3.3 kg vs. −3.1 ± 2.6 kg; p = 0.139). At 12 months, fasting plasma glucose, fasting plasma insulin, and HOMA-IR had significant improvements in both groups. With both diets aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT) decreased with significant differences; also there were significant improvements in AST/ALT ratio, Forns fibrosis index. The two diets were associated with reduction of both the prevalence and the severity of steatosis (all p < 0.001). At 12 months, total cholesterol, HDL-cholesterol, triglycerides improved in both groups (all p < 0.05).ConclusionsThe present study establishes the benefits of low-calorie diet and low-fat diet in management of patients with hepatitis C regarding improvement of insulin resistance, steatosis and also fibrosis.Overweight or obese patients with CHC undergoing a lifestyle intervention (specific dietary intervention and physical activity) for 1-year had significant improvements in body weight, lipid and hepatic profile.Trial registrationPNCI2-3343/41008/2007

Renal involvement in antiphospholipid syndrome

Background: Glomerular disease pattern varies in different countries, in different ethnic groups and in the same country with time. As there is limited data regarding this and some previous data was dissimilar from the other neighboring and remote countries, we aimed to evaluate the pattern of glomerular disease on clinicopathological aspect. Method: We retrospectively reviewed the clinical records of 300 patients aged 3 months to 16 years with glomerulonephritis for a one year period from September 2013 to August 2014 admitted in the Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Renal biopsy was done in selected patients with indications percutaneously. Tru-cut biopsy needle was used and specimen were evaluated by light and immunofluorescence microscopy. Results: Total 300 patients with GN, mean age was117.3 months (median 15months -156 months) of whom 68% were male. Nephrotic Syndrome was the most common presentation (77%) other important presentations were AGN (17%)and Lupus nephritis (1.7%). Renal biopsy was done in 65 patients and MesangialprolifrativeGN (MesPGN) was the predominant finding (32%), followed by Minimal change disease (MCD) in 10%, Membranoproliferative GN (MPGN) in 9%, Focal segmental glomerulosclerosis (FSGS) in 6%, acute proliferative GN in 7%, cresentic GN in 5% and Ig A deposition in 6%. biopsy specimen was inadequate in 9.9% patients. Conclusion: Nephrotic syndrome was the most common glomerular disease in this study, followed by AGN and Lupus nephritis. MesPGN was the most common histo-pathologic pattern. The low incidence of FSGS in this study is not comparable with reports from other parts of the world. countries like ours. The combination of LM and IF can diagnose most of the common glomerular diseases encountered in clinical practice and is cost effective. We used these two methods to determine the pattern of glomerulonephritis. The current study was performed to show the frequency of occurrence of primary and secondary GN observed in a tertiary care hospital in Dhaka, Bangladesh. Materials and Methods Three hundred children with glomerulonephritis were reviewed retrospectively from clinical records over a period of one year from September’ 2013 to August’ 2014 in the department of Pediatric nephrology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Patients with congenital nephrotic syndrome (age of onset<3months) were excluded from the study. Renal biopsy was performed in selected patients with definite indications. Indications Citation: Afroza Begum, Abdullah Al Mamun, Tahmina Jesmine, Mohammed Azizur Rahman, Syed Saimul Huque, et al. (2017) Pattern of Glomerular Diseases in Bangladeshi Children: A Clinico-Pathological Study. Nephrol Urol open 1:103. Nephrol Urol open, 2017 Volume 1(1): 8-9 for renal biopsy were steroid resistant nephrotic syndrome, nephrotic syndrome with atypical presentations like age of onset <2 years or >8 years, nephrotic syndrome associated with gross hematuria, impaired renal function, hypo-complementemia or persistent hypertension, nephrotic syndrome due to secondary causes, rapidly progressive glomerulonephritis(RPGN) and some cases of post infectious acute glomerulonephritis(AGN) showed delayed resolution. After describing the whole procedure and all the risks and benefits, a written consent was taken from the legal guardians. All biopsies were performed percutaneously by true cut biopsy needle and examined using a light microscope (LM) and immunofluorescence (IF) and were categorized as per the World Health Organization classification by our histopathologist.Results & Conclusion: Based on clinical and pathological classification: 49 patients with edema and proteinuria (79.0%), 25 patients with hematuria (40.3%), 15 patients with hypertension (24.2%), 7 patients with acute renal injury (9.6%). Renal pathology revealed 45 patients with not otherwise specified type (NOS) (72.6%), 9 with glomerular tip lesion type (Tips) (14.5%), 8 with cellular type (Cellular) (12.9%). The complete remission rate of NOS was 28.9% (13/45) and the partial remission rate was 33.3% (15/45) and no remission rate was 37.8% (17/35). The complete remission rate of Tips was 45.6% (5/9) and the partial remission rate was 33.3% (3/9) and no remission rate was 11.1% (1/9). The complete remission rate of Cellular was 25% (2/8) and no remission rate was 75% (6/8). The prognosis correlated with the pathological characteristics and the therapy plan (r=0.142, 0.327, respectively, P<0.05). Of these FSGS patients, 12% patient experienced remission after Prednisone and cyclophosphamide pulse therapy (P+CTX) and the total efficacy was 40%, which was statistically lower than that of children who received Prednisone and Cyclosporin A (P+CsA) or Prednisone and Tacrolimus (P+TAC) (37.5% and 75% or 42.9% and 71.4%, respectively). No significant statistical difference in prognosis was found in patients with P+CsA or P+TAC group (p>0.05). High blood pressure and persistent large proteinuria do harmful for the prognosis (P<0.05) rather than age, gender, pathological type and treatment plan. 15210938018@163.comRenal tuberculosis is the third most frequent form of extra-pulmonary tuberculosis. About 25% of cases are asymptomatic. It is more common in male and in age group 20-40 years. Urine culture for mycobacteria is the gold standard for the diagnosis. The aim of this study is to use certain clinical criteria that helps in the diagnosis of renal tuberculosis. This is a prospective study of patients with recurrent urinary tract infections from September 2009 to September 2012. Certain clinical criteria were used for the diagnosis. Thirty five patients with renal tuberculosis were studied. Seven (20%) patients had evidence of old pulmonary TB. The most common presenting complaint was frequency in 43.3%. Sterile pyuria in 82.9%. The tuberculin skin test was positive in 74.3%. The intravenous urography (IVU) showed abnormalities in 82.9%. The urine culture for mycobacteria was positive in 5.7%. In conclusion, diagnosis of renal tuberculosis require high index of suspicion with the aids of certain clinical criteria and cheap investigations with a high accuracy.A is associated with increased mortality and carries increased risk for subsequent CKD. Klotho deficiency has been observed in experimental AKI and low Klotho post-AKI is associated with progression to CKD in rodents. We conducted a prospective study of 29 AKI patients and 29 controls without AKI in the ICU setting. We excluded patients with baseline eGFR<60 or kidney transplant. Urine samples were obtained within 24 hours of peak serum creatinine (SCr) or at RRT initiation in AKI cases and within 24 hours of ICU admission in frequency-matched controls (by baseline eGFR and age). AKI was defined by KDIGO stage ≥2 criteria. Longitudinal data from AKI cases were obtained throughout hospital stay. Renal recovery was defined as the ratio of follow-up SCr/ baseline SCr≤1.5. Urine Klotho was measured by immunoprecipitation-immunoblot. Mean (SD) age was 58 (17) years, 62% were men and 75% white. Five (17.2%) patients died and 8 (27.6%) required RRT in the AKI group. Only 3.5% patients died in the control group. Urine Klotho adjusted by urine creatinine (uKlotho/Cr) was significantly lower in AKI cases than in controls, median 10 [IQR 4-20] vs. 28 [14-52] fmol/mg, p=0.003. Furthermore, uKlotho/Cr significantly increased with time in patients that exhibited renal recovery (n=7, Δ+216%, p=0.05) but not in those that did not (n=7, Δ+8%, p=0.91), mean follow-up 8 days. UKlotho/Cr is significantly lower in patients with AKI when compared to ICU controls without AKI. uKlotho/Cr recovered only in patients that recovered kidney function. Klotho may serve as a prognostic marker for AKI recovery.S syndrome is a chronic inflammatory disease characterized by lymphocytic infiltration of the exocrine glands, particularly the lacrimal and salivary glands. Secondary Sjogrens is found in patients with existing autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus. Extraglandular manifestations of Sjogrens such as distal rental tubular acidosis are well reported in the literature, however hypokalemic paralysis associated with distal RTA is a much rarer complication. Here, we present a case of a 41 year old female with a history of SLE and RA who presented to our facility with bilateral lower extremity paralysis of one day duration. Patient was evaluated by neurology with an initial differential diagnosis of Guillian Barre, cervical lesion in her spinal cord or Myasthenic crisis. Initial lab work revealed a severe non-anion gap metabolic acidosis with a positive urine anion gap and severely depleted potassium (K=1.4). Patient was immediately started on potassium supplementation and IVIG, however her weakness progressed to her upper extremities and patient subsequently developed hypercapnic respiratory failure requiring intubation and mechanical ventilation. Patient’s acidosis was corrected with a sodium bicarbonate infusion and her hypokalemia eventually improved with aggressive potassium supplementation. She was weaned from the ventilator and downgraded from the ICU. Further workup revealed positive anti-SSA antibodies indicating secondary Sjogrens syndrome although patient did not report xerostomia or sicca like symptoms. This case is an uncommon presentation of Sjogrens associated distal RTA presenting as hypokalemic paralysis.

Development of a prognostic score for work disability in Romanian patients with ankylosing spondylitis

Abstract Purpose: To develop a prognostic score for predicting work disability (WD) in patients with ankylosing spondylitis (AS) as strong indicator for poor vocational rehabilitation. Method: A cross-sectional study was performed in a group of 170 patients with AS, 120 work disabled and 50 still employed. The variables strongly associated with WD were quantified (scored 0–30) – abnormalities of: anterior–posterior radiograph of pelvis, lateral cervical spine radiograph and lung function tests, certain work factors (occupation, physical strain and microclimate), Bath Ankylosing Spondylitis Mobility Index and Bath Ankylosing Spondylitis Functional Index tests. Results: The eight-item score identifies WD with sensitivity of 91.7% and specificity of 85.7%. The scaling properties were fulfilled: internal consistency – Chronbachs alpha 0.73; reliability – intraclass correlation coefficient 0.73; redundancy weak–moderate, with coefficients ranging from 0.032 to 0.797; the discriminative capacity by the significant variations of the score according to the statute (employed or work disabled) and the degree of WD. Conclusions: The score is a reliable method for assessing the WD risk in patients with AS. It allows a complex evaluation by performing minimal investigations and it is easy to perform. Implications for Rehabilitation Work disability is an important outcome in AS, determined by numerous variables but highly dependent on the national characteristics of economy, social security and healthcare system. The prognostic score for work disability in AS not only contains medical but also socio-demographic and work-related factors and is expected to be a useful tool for specialists to guide the tertiary prevention-oriented rehabilitation measures. Our study suggests the prognostic score to be comprehensive, useful and a reliable method to assess the risk of work disability in AS.

The Role of Distubances of Phosphate Metabolism in Metabolic Syndrome

Abstract Background and Aims: Metabolic syndrome represents a cluster of cardiovascular risk factors and reached epidemic proportions. It was hypothesized that disturbances in phosphate metabolism may represent a feature of the metabolic syndrome. The aim of the study was to investigate the relationship between phosphate levels and the presence of metabolic syndrome components, as well as the putative mechanism for reduced phosphate level in metabolic syndrome. Materials and Methods: We enrolled 155 subjects: 64 with metabolic syndrome and 91 controls. Biochemical parameters of the metabolic syndrome study population were compared with the healthy population. Results: Patients with metabolic syndrome showed significantly lower phosphate (46%) and magnesium levels compared with controls (22.7%) (p<0.001). Women showed significantly greater serum phosphate levels than men (3.32 mg/dl versus 3.18 mg/dl) (p<0.03). Serum magnesium levels did no differ significantly between men and women. Fractional phosphate excretion rates in patients with metabolic syndrome were similar with controls (10.1±10.2% vs 13.1±9.9%), as well as fractional magnesium excretion (3.1±1.6% vs 2.8±1.3%). Conclusions: Patients with metabolic syndrome show significantly lower phosphate and magnesium concentrations compared to controls. This reduction is likely to be attributed to internal redistribution of phosphate and is more pronounced as the number of components of metabolic syndrome increases