[Safe and Effective Management of Epilepsy in Pregnancy].

In women with epilepsy, antiepileptic drugs with low teratogenic risk should be used at the lowest dose necessary to control seizures. The medication adjustment and folic acid supplementation are started before pregnancy. Valproic acid should be avoided unless indispensable. Levetiracetam and lamotrigine are often used as less teratogenic agents. Moreover, appropriate information on possible changes in seizure frequency with pregnancy and childbirth preparation and breastfeeding should be provided. Generally, women taking antiepileptic drugs for epilepsy treatment may undergo natural delivery and breastfeeding. We should collaborate with obstetricians and other professionals to help ensure a safe environment for pregnancy and childbirth.

Association of Circulatory Iron Deficiency With an Enlarged Heart in Patients With End-Stage Kidney Disease.

OBJECTIVES: High prevalence of iron deficiency (ID) and cardiomyopathy have been observed in patients with end-stage kidney disease (ESKD). Our objective was to clarify associations between ID and cardiac remodeling in patients with ESKD. DESIGN AND METHODS: A cross-sectional study was conducted using 1974 Japanese patients with ESKD at the initiation of maintenance dialysis. Levels of hemoglobin (Hb), iron status, and cardiac enlargement as assessed by the cardiothoracic ratio (CTR) were determined immediately before the first hemodialysis session. Circulatory ID was defined as transferrin saturation (TSAT) < 20%, and stored ID was defined as ferritin level <100 ng/dL. RESULTS: The mean age was 67 years. Median CTR was 54.0%. The prevalence of circulatory and stored ID was found to be 38% and 34%, respectively. CTR was higher in patients with circulatory ID than in those without. Even in ESKD patients without overhydration, significant negative association was observed between TSAT and CTR. Higher odds ratios in parallel with higher CTR categories compared with the reference category of CTR <45% were found in patients with TSAT <20% on multinomial analysis, but ferritin did not show any significant associations. The odds ratio for CTR >54% showed an upward trend in patients with TSAT <20% (odds ratio: 1.3) and <10% (odds ratio: 1.6) compared with the reference, even after adjusting for confounding variables such as Hb and ferritin. However, that phenomenon was eliminated by adding usage of an iron agent. CONCLUSIONS: Circulatory ID is closely associated with an enlarged heart independent of ferritin and Hb. Iron supplementation in the predialysis phase of chronic kidney disease may prevent cardiac remodeling independent of Hb level in patients chronic kidney disease.

Efficacy of tea catechin-rich beverages to reduce abdominal adiposity and metabolic syndrome risks in obese and overweight subjects: a pooled analysis of 6 human trials.

This post hoc pooled analysis assessed the effectiveness of green tea catechins (GTC) to reduce the risk of metabolic syndrome (MetS) associated with abdominal fat reduction, because previous findings are unclear. Data were pooled from six human trials (n=921, 505 men) comparing the effects of GTC-containing beverages (540-588 mg GTC/beverage) and a placebo beverage. Outcome measures were abdominal fat [total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA)], and MetS risk. We estimated mean changes from baseline and calculated confidence intervals (CI) to assess reductions in abdominal fat accumulation and MetS improvement. Subclass analyses were performed by classifying subjects as Pre-MetS or MetS at trial initiation. Additional subclass analyses were performed with Pre-MetS and MetS subjects further stratified according to whether GTC intake reduced TFA, VFA, or SFA. Consumption of GTC-containing beverages for 12 weeks significantly reduced TFA (-17.7cm2, 95%CI: -20.9 to -14.4), VFA (-7.5cm2, 95%CI: -9.3 to -5.7), SFA (-10.2cm2, 95%CI: -12.5 to -7.8), body weight, body mass index, and waist circumference; and improved blood pressure. Subclass analyses of Pre-MetS and MetS subjects showed improved MetS in the GTC group [odds ratio (OR), 1.67; 95%CI: 1.08-2.57]. The ORs for improved MetS in the TFA- and VFA-reduced groups were 2.79 (95%CI: 1.28-6.09) and 4.36 (95%CI: 2.03-9.39), respectively. Continual consumption of GTC-containing beverages reduced abdominal fat and improved MetS, suggesting its potential to prevent diabetes and cardiovascular disease. Additional large-scale intervention trials are needed to evaluate the effects of GTC on the risk of MetS in high-risk populations.

[Kidney and bone update : the 5-year history and future of CKD-MBD. Vascular calcification in CKD patients].

The one of the main concept of CKD-MBD theory is to prevent and to retard progression of vascular calcification. Recently many basic researches have approached to clear the mechanism of uremic specific vascular calcification. However it remains unclear in clinical setting what examination is best for evaluating vascular calcification. Moreover it is still not sure whether the management based on guidelines can prevent progression of vascular calcification or not in CKD patients. We review about the most accessible clinical factors for vascular calcification.