Molecular, morphological and histopathological evidence of Spirometra mansoni in wild and domestic animals from Costa Rica.

Spirometra mansoni is a diphyllobothroid cestode and one of the causing agents of sparganosis, a zoonotic foodborne and waterborne infection in humans. This parasite has an indirect life cycle with domestic and wild canids or felids as definitive hosts. The last report of S. mansoni in Costa Rica was done in 2004 by morphological assessment of worms, whereas molecular evidence of this species was obtained recently in the Americas. Herein, we present seven cases of spirometrosis in four dogs, three cats and a coyote from different regions of Costa Rica occurring in a time span of a year. Dog cases presented vomiting, hyporexia, lethargy and diarrhea, whereas cats were mostly asymptomatic. Moreover, the coyote was found with Spirometra sp. proglottids incidentally. Cytochrome oxidase subunit 1 (cox1) sequences of eggs or proglottids derived from all cases were analyzed with a Bayesian Inference phylogenetic tree and a haplotype network. These analyses showed the clustering of S. mansoni from Costa Rica with other sequences derived from Asia and America. Moreover, cox1 sequences clustered in two separate haplotypes, suggesting the high genetic diversity of the species. The present cases represent the first molecular evidence of the parasite in Central America; thus, extending its known range in the American continent.

Antibody Response after 3-Dose Booster against SARS-CoV-2 mRNA Vaccine in Kidney Transplant Recipients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with a high rate of mortality in kidney transplant recipients (KTRs). Current vaccine strategies for KTRs seem to be unable to provide effective protection against coronavirus disease 2019 (COVID-19), and the occurrence of severe disease in some vaccinated KTRs suggested a lack of immunity. We initially analyzed the antibody response in a group of 32 kidney transplant recipients (KTRs) followed at the nephrology and dialysis unit of the Hospital Pio XI of Desio, ASST-Brianza, Italy. Thus, we studied the differences in antibody levels between subjects who contracted SARS-CoV-2 after the booster (8 individuals) and those who did not contract it (24 individuals). Furthermore, we verified if the antibody response was in any way associated with creatinine and eGFR levels. We observed a significant increase in the antibody response pre-booster compared to post-booster using both a Roche assay and DIAPRO assay. In the latter, through immunotyping, we highlight that the major contribution to this increase is specifically due to IgG S1 IgM S2. We observed a significant increase in IgA S1 and IgA NCP (p = 0.045, 0.02) in the subjects who contracted SARS-CoV-2. We did not find significant associations for the p-value corrected for false discovery rate (FDR) between the antibody response to all assays and creatinine levels. This observation allows us to confirm that patients require additional vaccine boosters due to their immunocompromised status and therapy in order to protect them from infections related to viral variants. This is in line with the data reported in the literature, and it could be worthwhile to deeply explore these phenomena to better understand the role of IgA S1 and IgA NCP antibodies in SARS-CoV-2 infection.

Uso de Electromiografía de Alta Densidad en las Distrofias Musculares: una Mirada Actual / Use of high-density electromyography in muscular dystrophies: a current look

Introducción. Las distrofias musculares son trastornos genéticamente heredados que causan la degeneración progresiva de las fibras musculares. La electromiografía, especialmente la de alta densidad, se ha convertido en una herramienta valiosa para el diagnóstico y el estudio de la función muscular de trastornos neuromusculares. Objetivo. Describir y discutir el uso actual de esta técnica en las distrofias musculares. Métodos. Se realizó un Scoping Review sobre el uso de electromiografía de alta densidad en personas con distrofia muscular. Se buscó en PubMed, ScienceDirect, Scopus, Web of Science y Biblioteca Cochrane Plus, usando palabras clave en inglés y español. Se consideraron estudios desde 2015 a la fecha. Se identificaron tres artículos que cumplían con los criterios establecidos. Resultados. Los estudios se centraron en aplicaciones clínicas y de bioingeniería para personas con distrofia muscular de Duchenne y distrofia facioescapulohumeral. Los resultados sugieren que variables como la fatiga, la activación temporo-espacial y la dimensionalidad en gestos motores están determinados por la degeneración de las fibras musculares, el reemplazo por tejido fibrótico, los cambios adaptativos y la debilidad muscular progresiva característica de este grupo de condiciones. Se resalta la utilidad de la electromiografía de alta densidad en la evaluación y el manejo de la distrofia muscular. Conclusiones. El uso de esta técnica en estos trastornos neuromusculares sigue en aumento, pero se hace necesario explorar más aristas para ampliar su uso como herramienta en el estudio y en el desarrollo de intervenciones terapéuticas en esta condición por parte de profesionales de la salud.

Background. Muscular dystrophies are genetically inherited disorders that cause progressive degeneration of muscle fibers. Electromyography, especially high-density electromyography, has become a valuable tool for the diagnosis and study of muscle function in neuromuscular disorders, so the objective of this study is to describe and discuss the current use of this technique in muscular dystrophies. Methods. A Scoping Review was carried out on the use of high density electromyography in people with muscular dystrophy. PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane Plus Library were searched using keywords in English and Spanish. Studies from 2015 to date were considered. Three articles were identified that met the established criteria. Results. The studies focused on clinical and bioengineering applications for people with Duchenne muscular dystrophy and facioscapulohumeral dystrophy. The results suggest that variables such as fatigue, temporal-spatial activation and dimensionality in motor gestures are determined by the degeneration of muscle fibers, replacement by fibrotic tissue, adaptive changes and progressive muscle weakness characteristic of this group of conditions. The usefulness of high-density electromyography in the evaluation and management of muscular dystrophy is highlighted. Conclusions. The use of this technique in these neuromuscular disorders continues to increase, but it is necessary to explore more aspects to expand its use as a tool in the management of this condition.

A mechanistic study identifying improved technology critical metal delamination from printed circuit boards at lower power sonications in a deep eutectic solvent.

Deep eutectic solvents (DESs) are an emerging class of ionic liquids that offer a solution to reclaiming technology critical metals (TCMs) from electronic waste, with potential for improved life cycle analysis. The high viscosities typical of DESs, however, impose mass transport limitations such that passive TCM removal generally requires immersion over extended durations, in some cases in the order of hours. It is postulated that, through the targeted application of power ultrasound, delamination of key structures in electronic components immersed in DESs can be significantly accelerated, thereby enabling rapid recovery of TCMs. In this paper, we fully characterise cavitation in a Choline Chloride-Ethylene Glycol DES as a function of sonotrode input power, by the acoustic detection of the bubble collapse shockwave content generated during sonications at more than 20 input powers over the available range. This justifies the selection of two powers for a detailed study of ultrasonically enhanced TCM-delamination from printed circuit boards (PCBs). Dual-perspective high-speed imaging is employed, which facilitates simultaneous observation of TCM removal, and the cavitation evolution and interaction with the PCB surface. Bubble jetting is identified as a key contributor to initial pitting of the TCM layers, exposing the larger underlying copper layer, with the contributions of additional inertial cavitation-mediated phenomena such as bubble-collapse shockwaves also demonstrated as important for delamination. Optimal cavitation activity throughout the sonication then promotes etching of the copper base layer of the PCB structure targeted by the DES, liberating the overlaying TCMs in sections as large as 0.79 mm2. We report a thirtyfold improvement in processing time compared to passive delamination, with sonications at the lower power outperforming those at the higher power. The results demonstrate the potential for industrially scalable recovery of TCMs from the growing quantities of global e-waste, using combined power ultrasonics and DESs.

A novel method for extracting metals from asteroids using non-aqueous deep eutectic solvents.

Extra-terrestrial mining and metal processing are vital for access to strategic metals for space exploration. This study demonstrates for the first time the catalytic dissolution of metals from meteorite proxies of metal-rich asteroids using a deep eutectic solvent (DES). DESs are of particular interest for extra-terrestrial mining as they can be designed to have relatively low vapour pressures and could potentially be made from organic waste products created in extra-terrestrial settlements. Three types of meteorites were investigated: two chondrites (H3, H5) and one iron (IAB-MG) meteorite. Chondrite samples were composed of silicates (olivine, pyroxene) with metal-rich phases occurring as native metal alloys, sulphides and oxides. Metallic Fe-Ni and troilite (FeS) are the most abundant metal-bearing phases in all three samples, particularly in the iron-rich meteorite. The samples were subjected to chemical micro-etching experiments with iodine and iron(III) chloride as oxidising agents in a DES formed from the mixture of choline chloride and ethylene glycol. Micro-etching experiments demonstrated that Fe-Ni rich phases are effectively leached out in this system, while other mineral phases remain unreactive.

Anion effect on the redox properties of copper ions in ionic liquids and deep eutectic solvents.

It has long been claimed that the anion of the DES or IL is critical for controlling the redox properties of metal ions. In this study we investigate the effect of different salt anions on the copper redox properties and speciation, and compare that with the effect of the different solvent anions, when a single copper salt is used in a range of solvents. It is shown that the effect of the solvent anion is much more significant than that of the salt anion on the redox properties. It is also found that copper species remain the same copper tetrachloride species despite the starting salt. An exception is seen for the copper(I) salt, which makes linear dichloride species, as well as the copper(II) acetate system, which displays concentration dependence. When the anion of the ionic liquid is changed, the copper species change correspondingly with the coordinating strength of the solvent anion, leading to a greater difference in redox response, which is due to the different species present. Thus, these speciation differences can be used to modify the redox potentials in the solution.

Distrofias Musculares en Adultos y Actividad Física: una Revisión Narrativa / Muscular Dystrophies in Adults and Physical Activity: a Narrative Review

Introducción. Las distrofias musculares son un grupo heterogéneo de trastornos genéticos degenerativos del músculo que comparten características clínicas de debilidad muscular. Recientemente, la actividad física ha vuelto a ser posicionada como una intervención clave en esta población, sin embargo, no existe consenso terapéutico relativo a la prescripción de ejercicio. Junto con describir los principales tipos de distrofias musculares del adulto, el objetivo de esta revisión es describir los efectos clínicos y eventos adversos del ejercicio y la actividad física en las personas adultas con distrofias musculares. Método. Se realizó una revisión narrativa con enfoque cuantitativo en las bases de datos PubMed, Scielo, Scopus y Biblioteca Cochrane Plus utilizando las palabras claves en inglés "muscular dystrophy", "muscular dystrophies", "physical activity", "exercise" y, en español, "distrofia muscular", "distrofias musculares", "actividad física" y "ejercicio" con estudios hasta la fecha. Se seleccionaron siete ensayos controlados aleatorios y un metaanálisis para su revisión. Resultados. En los ocho estudios seleccionados se presentan los outcomes respecto a la fuerza muscular, capacidad aeróbica, capacidades funcionales, dolor, fatiga y efectos adversos. Se presentan resultados que muestran que las intervenciones en modalidad de entrenamiento de fuerza, aeróbica o ambas pueden tener mejoras y/o no tener efecto significativo en sus resultados. Asimismo, ningún estudio mostró efectos negativos y/o deletéreos posteriores a las intervenciones realizadas. Conclusiones. La realización de actividad física en las diversas distrofias musculares prevalentes en el adulto presenta efectos clínicos positivos y/o nulos, sin embargo, se requiere de estudios que aporten una mayor calidad de evidencia.

Introduction. Muscular dystrophies are a heterogeneous group of genetic degenerative muscle disorders that share clinical characteristics of muscle weakness. Recently, physical activity has been positioned as a key intervention in this population. However, there is no therapeutic consensus regarding the exercise prescription. Along with describing the main types of adult muscular dystrophies, this review aims to describe the clinical effects and adverse events of exercise and physical activity in adults with muscular dystrophies. Method. A narrative review with a quantitative approach was carried out in the PubMed, Scielo, Scopus and Cochrane Plus Library databases using the keywords in English "muscular dystrophy", "muscular dystrophies", "physical activity", "exercise" and in Spanish "distrofia muscular", "distrofias musculares", "actividad física" and "ejercicio" with studies to date. Seven randomized controlled trials and one meta-analysis were selected for review. Results. In the eight selected studies, the outcomes regarding muscle strength, aerobic capacity, functional capacities, pain, fatigue, and adverse effects are presented. Results show that interventions in strength training, aerobic training, or both may have improvements and/or not have a significant effect on their results. Likewise, no study showed adverse and/or harmful effects after the interventions were carried out. Conclusions. The performance of physical activity in the various muscular dystrophies prevalent in adults has positive and/or null clinical effects. However, studies that provide a higher quality of evidence are required.

Cardiovascular implantable electronic devices in hemodialysis patients: an updated review.

Cardiovascular diseases are the leading life-threatening complications in hemodialysis patients. In this scenario, both tachy-arrhythmias and brady-arrhythmias are involved with related hemodialysis and nonhemodialysis-dependent mechanisms; moreover, those arrhythmias usually occur in different time intervals before sudden cardiac death (SCD). Furthermore, current evidence shows that the presence of advanced chronic kidney disease (CKD) reduces the benefits of implantable cardioverter--defibrillators (ICDs), which increases the risk of both arrhythmic and nonarrhythmic death, especially in patients with advanced stages of heart failure. Notably, patients with advanced CKD show a more severe degree of heart failure compared with mild CKD patients. However, the benefits of the ICD implantation in the primary prevention of hemodialysis patients is still controversial, and by now, no significant benefits have emerged compared with nonhemodialysis-dependent CKD patients. In secondary prevention, hemodialysis patients with ICD implantation have higher mortality rates compared with nonhemodialysis-dependent CKD patients with ICD. On the other hand, most articles include hemodialysis patients with reduced left ventricular ejection fraction, neglecting those with preserved systolic function. This review focuses on the epidemiology of SCD in the setting of hemodialysis and the current evidence on ICD implantation in patients on hemodialysis therapy analyzing novel strategies, which might reduce the risk of ICD placing.

[Covid-19 vaccination and renal patients: overcoming unwarranted fears and re-establishing priorities].

The SARS-CoV-2 (Covid-19) has infected about 124 million people worldwide and the total amount of casualties now sits at a staggering 2.7 million. One enigmatic aspect of this disease is the protean nature of the clinical manifestations, ranging from total absence of symptoms to extremely severe cases with multiorgan failure and death. Chronic Kidney Disease (CKD) has emerged as the primary risk factor in the most severe patients, apart from age. Kidney disease and acute kidney injury have been correlated with a higher risk of death. Notably the Italian Society of Nephrology have reported a 10-fold increase in mortality in patients undergoing dialysis compared to the rest of the population, especially during the second phase of the pandemic (26% vs 2.4). These dramatic numbers require an immediate response. At the moment of writing, three Covid-19 vaccines are being administered already , two of which, Pfizer-BioNTech and Moderna, share the same mRNA mechanism and Vaxzevria (AstraZeneca) based on a more traditional approach. All of them are completely safe and reliable. The AIFA scientific commission has suggested that the mRNA vaccines should be administered to older and more fragile patients, while the Vaxzevria (AstraZeneca) vaccine should be reserved for younger subjects above the age of 18. The near future looks bright: there are tens of other vaccines undergoing clinical and preclinical validation, whose preliminary results look promising. The high mortality of CKD and dialysis patients contracting Covid-19 should mandate top priority for their vaccination.

Cardiovascular implantable electronic devices and native arteriovenous fistula in hemodialysis patients: novel perspectives.

The benefits from cardiovascular implantable electronic devices (CIED) implantation in hemodialysis (HD) patients are still far to be thoroughly defined, especially on primary prevention. In addition, CIED placement is not a risk-free procedure, because it could be followed by a not negligible burden of complications that could compromise the health and the vascular access of HD patients. In fact, the arteriovenous fistula (AVF) dysfunction following CIED implantation is usually due to a hemodynamically significant alteration of blood flow. This condition could lead to a potential decrease of dialysis efficacy and a raised risk of thrombosis of both the central vein and the efferent vein of the AVF.The pathological pathway that leads to AVF dysfunction after CIED implantation may involve the irritating actions of the CIED and their leads to the vascular wall in HD patients that are more prone to show previous vascular diseases.The aim of this review is to focus the physiopathology of the CIED-induced AVF dysfunction, the current treatment strategies and the novel perspectives that could be taken into consideration and offered to the HD population to preserve both their AVF and their quality of life.

[Neprilysin inhibition and chronic kidney disease]. / Gli inibitori della Neprilisina nei pazienti affetti da Malattia Renale Cronica e Sindrome Cardio:Renale.

Patients with chronic kidney disease (CKD) have a higher incidence of cardiovascular (acute and chronic) events, which in turn have an increased risk of progression to end-stage renal disease (ESRD) Inhibition of neprilysin, in addition to offering a new therapeutic target in patients with heart failure, could represent a potential improvement strategy in cardiovascular and renal outcome of patients with CKD. Inhibition of neprilysin by inhibiting the breakdown of natriuretic peptides, increases their bioavailability resulting in an increase in diuresis and sodium excretion and, in addition to exerting an inhibition of the renin-angiotensin-aldosterone (RAAS) system. Inhibition of RAAS, in turn, generates a series of counter-regulations that can balance the adverse effects present in CKD and heart failure (HF). The idea of blocking neprilysin is not very recent, but the first drugs used as inhibitors had an inadmissible incidence of angioedema. Among the latest generation molecules that can perform a specific inhibitory action on the neprilysin receptor and, at the same time, on the angiotensin II receptor thanks to the association with valsartan there is the LCZ696 (sacubitril / valsartan). This drug has shown promising benefits both in the treatment arterial hypertension and heart failure. It is hoped that equally positive effects may occur in CKD patients, particularly those with macroproteinuria.

[Clinical management of anemia in patients with CKD].

Anemia is a frequent complication in chronic kidney disease (CKD), and it is often accompanied by various clinical symptoms. The primary cause of anemia in CKD patients is the reduction in the erythropoietin production, which results in a decrease of signaling molecule that stimulates red blood cell production. Other possible causes of anemia in CKD include iron deficiency, inflammation, and the accumulation of uremic toxin. This chapter focuses the discussion on the strategy of the management of anemia in patients with CKD. Erythropoiesis-stimulating agents (ESAs) and adjuvant iron therapy represent the primary treatment for anemia in chronic kidney disease. The introduction of ESAs into clinical practice was a success goal, mediating an increase in hemoglobin concentrations without the risk for recurrent blood transfusions and improving quality of life substantially.

Impact of European medicines agency recommendations for hypersensitivity reactions on intravenous iron prescription in haemodialysis centres of the Lombardy region.

BACKGROUND: The European Medicines Agency (EMA) has recommended measures to minimize the risk of hypersensitivity reactions (HSRs) to intravenous iron (IVFe). We analysed the effects of these recommendations on IVFe clinical management among haemodialysis centres (HDCs) in Lombardy, Italy. MATERIALS AND METHODS: A questionnaire was sent to all 117 HDCs to collect information on centre characteristics, e.g. HDC type [hospital centre (HC) vs. centre with limited assistance (CAL)], presence/absence of intensive care unit (ICU) and/or emergency trained staff, IVFe therapy regarding molecules, administration modalities, side effects, and percentage variations in iron prescription between 2014 and 2013 (outcome, Δ-IVFe%). A linear regression model was applied to evaluate the focus effect (ß) of HDC type on the outcome, controlling for possible confounding effects of the other characteristics. RESULTS: Response rate was 73.5 %. IVFe therapy was used in 69.1 % (HDC range 11-100) of patients. Following EMA recommendations, prescription was reduced by 12.6 %, with the largest reduction observed in CALs. No severe HSRs were reported. HCs had more frequently an ICU [97.2 vs. 20 %, odds ratio (OR) = 63.6 (95 % confidence interval 15.56; 537.47), p < 0.001], emergency trained staff [97.2 vs. 61.2 %, OR = 10.7 (2.68; 85.33), p < 0.001] and instrumental facilities (91.7 vs. 58 %, OR = 5.8 (2.03; 23.55), p < 0.001] than CALs. Linear regression demonstrated a significant raw effect of HDC type on Δ- IVFe% [ß =  19.6 (9.82; 30.63), p < 0.001]. No association was found when HDC type was adjusted for ICU-presence [ß = 6.7 (-2.32; 18.30), p = 0.199] or for all-confounding factors [ß = 5.6 (-5.50; 17.08), p = 0.337]. CONCLUSIONS: This survey shows a disparity in IVFe therapy prescription following EMA recommendations, which is largely influenced by the presence/absence of ICUs in HD centres.

Enfoque actual del tratamiento farmacológico del síndrome coronario agudo sin elevación del segmento ST desde la fisiopatología al manejo: Una revisión de tema / Current approach to drug treatment of acute coronary syndrome without ST-segment elevation pathophysiology handling: A review of subject

Los síndromes coronarios agudos son un problema mayor de salud pública en todo el mundo. El síndrome coro-nario agudo (SCA) incluye infarto agudo del miocardio (IAM), con o sin elevación del ST (SEST) y la angina inesta-ble. La incidencia anual de IAM sin elevación del segmento ST es de 565.000 nuevos eventos y 300.000 ataques recurrentes cada año. La evaluación inicial de un SCA SEST debe enfocarse en el dolor torácico, signos y síntomas asociados y factores de riesgo para SCA. Los marcadores biológicos de lesión miocárdica han evolucionado en la actualidad para una mejor precisión del abordaje diagnóstico y aportan datos para el pronóstico de los pacientes. El uso de nuevas drogas disminuye la mortalidad, mejora la calidad de vida y el pronóstico de los pacientes. Esta revisión bibliográfica se realizó con el propósito de actualizar los conocimientos sobre la fisiopatología, diagnósti-co y tratamiento del SCA SEST.

Acute coronary syndromes are a major public health problem worldwide. Acute coronary syndrome (ACS) includes acute myocardial infarction (AMI), with or without ST elevation and unstable angina. The annual incidence of AMI without ST-segment elevation is 565,000 new events and 300,000 recurrent attacks each year. The initial assess-ment should focus on NSTEACS chest pain, associated signs and symptoms and risk factors for SCA. Biomarkers of myocardial injury today have evolved for better diagnostic precision approach and provide data for the prognosis of patients. The use of new drugs reduces mortality, improves quality of life and prognosis of patients. This liter-ature review was conducted with the purpose of updating the knowledge of the pathophysiology, diagnosis and treatment of SCA SEST.

Enfoque actual del tratamiento farmacológico del síndrome coronario agudo sin elevación del segmento ST. de la fisiopatología al manejo / Current approach to drug treatment of acute coronary syndrome without ST-segment elevation pathophysiology handling

Los síndromes coronarios agudos son un problema mayor de salud pública en todo el mundo. El síndrome coro-nario agudo (SCA) incluye infarto agudo del miocardio (IAM), con o sin elevación del ST (SEST) y la angina inesta-ble. La incidencia anual de IAM sin elevación del segmento ST es de 565.000 nuevos eventos y 300.000 ataques recurrentes cada año. La evaluación inicial de un SCA SEST debe enfocarse en el dolor torácico, signos y síntomas asociados y factores de riesgo para SCA. Los marcadores biológicos de lesión miocárdica han evolucionado en la actualidad para una mejor precisión del abordaje diagnóstico y aportan datos para el pronóstico de los pacientes. El uso de nuevas drogas disminuye la mortalidad, mejora la calidad de vida y el pronóstico de los pacientes. Esta revisión bibliográfica se realizó con el propósito de actualizar los conocimientos sobre la fisiopatología, diagnósti-co y tratamiento del SCA SEST.

Acute coronary syndromes are a major public health problem worldwide. Acute coronary syndrome (ACS) includes acute myocardial infarction (AMI), with or without ST elevation and unstable angina. The annual incidence of AMI without ST-segment elevation is 565,000 new events and 300,000 recurrent attacks each year. The initial assess-ment should focus on NSTEACS chest pain, associated signs and symptoms and risk factors for SCA. Biomarkers of myocardial injury today have evolved for better diagnostic precision approach and provide data for the prognosis of patients. The use of new drugs reduces mortality, improves quality of life and prognosis of patients. This liter-ature review was conducted with the purpose of updating the knowledge of the pathophysiology, diagnosis and treatment of SCA SEST.

Fibroblast growth factor 23 and parathyroid hormone predict extent of aortic valve calcifications in patients with mild to moderate chronic kidney disease.

BACKGROUND: Cardiac valve calcifications are present in dialysis patients and regarded as dependent on a deranged mineral metabolism. Few data are available for patients with chronic kidney disease (CKD) not on dialysis. This study evaluates the potential association between the extent of cardiac valve calcification and levels of intact parathyroid hormone (i-PTH), phosphorus, calcium, 25-OH vitamin D, fibroblast growth factor 23 (FGF-23), Klotho and C-reactive protein (CRP) simultaneously measured in patients with mild to moderate CKD. METHODS: Consecutive non-hospitalized patients referring to five nephrology units were evaluated. Inclusion criteria were age >18 years, CKD Stages 3-4, and the presence of aortic and/or mitral valve calcification assessed by echocardiography as routinely clinical evaluation. Patients underwent clinical examination and routine biochemistry. Baseline i-PTH, phosphorus, calcium, 25-OH vitamin D, FGF-23, Klotho and CRP were simultaneously ascertained. RESULTS: Extent of aortic valve calcification (n = 100 patients) was moderate in 68 patients and mild in the remaining patients. Mitral valve calcification (n = 96 patients) score was 1, 2 and 3 in 61, 34 and 1 patients, respectively. In univariate analysis, no association was found between extent of mitral valve calcification and markers of mineral metabolism and CRP; aortic valve extent of calcification was positively associated with i-PTH (r(2) = 0.212; P = 0.03) and FGF-23 (r(2) = 0.272; P = 0.01), and negatively with Klotho (r(2) = -0.208; P = 0.04). In multivariable analysis, extent of aortic valve calcification was associated with FGF-23 (P = 0.01) and PTH (P = 0.01) levels. CONCLUSIONS: Extent of aortic valve calcification is associated to FGF-23 and PTH in naïve CKD patients with mild to moderate CKD. Further studies should examine whether FGF-23 assay should be included in routine clinical evaluation of CKD as part of cardiovascular risk stratification.

[Troponins and chronic kidney disease]. / Malattia renale cronica e sindrome coronarica acuta: il ruolo della troponina.

Coronary thrombosis was recognized since 19th century as clinical entity with bad outcomes; only in 1912 it was reported that acute myocardial infarction had to been distinguished from angina pectoris. First diagnostic test was electrocardiogram, while white blood cells count and erythrocytes sedimentation rate were the only available laboratory tests. Late in the 60s and 70s glutammic oxaloacetic and glutamic pyravate transaminase, lactate dehydrogenase and creatine kinase were added to biomarkers pool to provide a diagnosis of myocardial infarction related to myocardial cells injury. Only in 1987 assays for cardiac troponin were developed to assess structural damage of myocardial cells and in 2010 high sensibility troponins first dosage kits became available. It is well known that the population with chronic kidney disease (CKD) is at greater risk for cardiovascular disease and death than the general population. The use and interpretation of high sensitivity cardiac troponin (hs-cTn) assays have been particularly challenging in these patients with the majority having elevated levels at baseline. Aim of this review is to evaluate hs-cTn in patients with CKD for the diagnosis of AMI and for the prognostic significance of elevated levels in CKD patients without AMI.

Pterygopalatine fossa infiltration: A radio-anatomic study among adult patients in a tertiary private hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> As   a   guide   to   the   clinical   practice   of   infiltration   of   local   anesthesia   into   the pterygopalatine fossa via the greater palatine canal, this study sought to determine and record the  mean  CT  scan  measurements  of  the  following:  1)  palatal  mucosal  thickness,  2)  length  and width  of  greater  palatine  canal,  and  3)  length  and  width  of  pterygopalatine  fossa  among  adult patients in a private tertiary hospital in Quezon City.<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective, Descriptive Study<br /><strong>Setting:</strong> Tertiary Private Hospital<br /><strong>Subjects:</strong> Paranasal Sinus (PNS) CT Scans of 113 adult patients from January 2014 to May 2014 were reviewed and evaluated. Excluded were images with pathology that distorted the anatomy of the sinuses and surrounding structures.<br /><strong>RESULTS:</strong> Our study showed average CT scan measurements of 5.98 mm palatal mucosal thickness, 16.99  mm  greater  palatine  canal  length,  18.75  mm  pterygopalatine  fossa  length,  2.37  mm greater palatine canal width and 2.58 mm pterygopalatine fossa width. Comparison of average measurements  by  sex  was  not  statistically  significant.  There  was  statistical  significance  when comparing the right palatal mucosal thickness of 5.86 mm with the left which was 6.11 mm with p-value of 0.001. Comparison between the length of the right pterygopalatine fossa of 18.48 mm with the  left side at 19.01 mm showed statistical significance with p-value of 0.01.<br /><strong>CONCLUSION:</strong> As the average measurement of the mucosal palatal thickness combined with the length of the greater palatine canal was 22.97 mm, we recommend bending the needle 23 mm from  the  tip  in  a  45  degree  angle  for  adult  patients  who  will  undergo  sinus surgery,  control  of posterior epistaxis, trigeminal nerve block and minor oral cavity surgeries.</p>