Management of hypertension and renin-angiotensin-aldosterone system blockade in adults with diabetic kidney disease: Association of British Clinical Diabetologists and the Renal Association UK guideline update 2021.

People with type 1 and type 2 diabetes are at risk of developing progressive chronic kidney disease (CKD) and end-stage kidney failure. Hypertension is a major, reversible risk factor in people with diabetes for development of albuminuria, impaired kidney function, end-stage kidney disease and cardiovascular disease. Blood pressure control has been shown to be beneficial in people with diabetes in slowing progression of kidney disease and reducing cardiovascular events. However, randomised controlled trial evidence differs in type 1 and type 2 diabetes and different stages of CKD in terms of target blood pressure. Activation of the renin-angiotensin-aldosterone system (RAAS) is an important mechanism for the development and progression of CKD and cardiovascular disease. Randomised trials demonstrate that RAAS blockade is effective in preventing/ slowing progression of CKD and reducing cardiovascular events in people with type 1 and type 2 diabetes, albeit differently according to the stage of CKD. Emerging therapy with sodium glucose cotransporter-2 (SGLT-2) inhibitors, non-steroidal selective mineralocorticoid antagonists and endothelin-A receptor antagonists have been shown in randomised trials to lower blood pressure and further reduce the risk of progression of CKD and cardiovascular disease in people with type 2 diabetes. This guideline reviews the current evidence and makes recommendations about blood pressure control and the use of RAAS-blocking agents in different stages of CKD in people with both type 1 and type 2 diabetes.

Evaluating S100B as a serum biomarker for central neurosarcoidosis.

BACKGROUND: S100B is a calcium-binding protein found primarily in glial cells. In the setting of neuronal injury and disruption of the blood brain barrier, S100B can leak into the cerebrospinal fluid and systemic circulation. OBJECTIVES: To determine if serum S100B distinguishes patients with central neurosarcoidosis (NS) from patients with extra-neurologic sarcoidosis (ENS) and healthy controls, and if S100B levels correlate with MRI measures of disease burden. METHODS: Patients were enrolled from the Cleveland Clinic Sarcoidosis Center. Patients with traumatic brain injury, central nervous system (CNS) infections, CNS malignancy, neurodegenerative disorders, schizophrenia, bipolar disorder, or melanoma were excluded. S100B levels were compared between patients with NS, ENS, and healthy controls, and between NS patients with varying degrees of post-contrast enhancement on MRI. RESULTS: Median (interquartile range) S100B levels were 101 pg/mL (92, 136) for 11 NS patients, 89 pg/mL (73, 107) for 11 ENS patients, and 60 pg/mL (39, 74) for 26 healthy controls. There was a significant difference between NS and control groups (p = 0.01). The difference between NS and ENS groups did not rise to the level of statistical significance (p = 0.178). S100B levels were significantly different between NS patients with varying degrees of enhancement on MRI (p = 0.04). CONCLUSIONS: S100B deserves additional study as a biomarker for CNS injury in NS. It may be useful as a longitudinal measure of disease activity.

Evaluation of cranial capacity by mustard seed technique.

The volume of the cranium is used as a rough indicator of the size of the brain. In the present study Breitinger's mustard seeds technique was applied for the measurement of cranial capacity. Grossly normal 75 male skulls of Gujarat population were studied at Kesar SAL Medical College, Ahmedabad (Gujarat) in the year 2010. The mean cranial capacity among the study group was recorded to be 1256 cc with a minimum of 1110 cc and maximum of 1430 cc. The results were compared with the similar studies by different authors from different geographical areas.

Topical pseudocatalase mousse and narrowband UVB phototherapy is not effective for vitiligo: an open, single-centre study.

We report an open single-centre trial to assess the efficacy of topical pseudocatalase mousse applied twice daily to the hands and face of vitiligo patients, in combination with twice-weekly suberythemogenic narrowband UVB phototherapy. The regime was generally safe and well tolerated, although several patients experienced mild transient skin rashes in association with application of the mousse and one patient suffered severe pruritus. The primary efficacy variable was the percentage change in area affected by vitiligo as assessed by digital interpretation of standardized photographs of the face and hands. There was no clear evidence of the efficacy of the regime and in fact a slight tendency overall to worsening of the patients' vitiligo.

Efficacy of short-course oral prednisolone in polymorphic light eruption: a randomized controlled trial.

BACKGROUND: Polymorphic light eruption (PLE) is the most common so-called idiopathic photosensitivity disorder and affects up to 15% of the population in the U.K.; brief courses of systemic steroids have been tried and anecdotally have apparently been dramatically effective in the treatment of acute attacks. OBJECTIVES: To assess the efficacy and safety of a short course of moderate-dose oral prednisolone used from the earliest onset of the eruption in the treatment of PLE. METHODS: The study was double-blind placebo-controlled, all patients being given both prednisolone and placebo, but randomized to take either one or the other from the earliest sign of onset of rash; if within 48 h there was no improvement, they transferred to the other medication. Each participant also applied a broad-spectrum, highly protective sunscreen 2-hourly during sun exposure, continued his or her usual degree of exposure after any development of PLE, and kept a diary noting details of the eruption, amount of exposure, weather conditions and any adverse events. Statistical analysis was performed by means of the non-parametric log rank test based on Kaplan-Meier plots and bootstrapped confidence intervals (CIs) for the means, using the time in days for the itch and rash to clear as the end-points. RESULTS: Twenty-one patients entered the study but only 10 required medication. Eight who took prednisolone first and remained on it or transferred to it from placebo all improved, with the itch settling fully within a mean 2.8 days of starting the prednisolone and the rash clearing by 4.2. In the two who took placebo first and remained on it, the itch took a mean 5.4 days to settle and the rash a mean 7.8. No patient who started with prednisolone changed to placebo. Thus, the prednisolone as randomized was better than placebo at settling both the itch (mean 2. 6 days less, CI 0.7-4.0, P = 0.015) and rash (mean 3.6 days less, CI 0.6-6.1, P = 0.036); only one patient experienced mild adverse effects of transient gastrointestinal upset and depressed mood. CONCLUSIONS: The acute eruption of PLE is likely to respond rapidly to short courses of prednisolone therapy given from the earliest onset of the condition, and the treatment is safe.

Atrial fibrillation in acute myocardial infarction: a prospective study based on data from a consecutive series of patients admitted to the coronary care unit.

Atrial fibrillation (AF) is a common and much-studied arrhythmia in patients with acute myocardial infarction (MI). However, documentation of its occurrence in temporal association with MI has been often neglected in the literature; also, its frequent occurrence with mere advanced age, or in the setting of various cardiac conditions or complications, has prevented the definition of an exact role for AF as a marker or determinant of outcome in patients with MI. The purpose of this study was to evaluate prospectively the frequency of AF (present or occurring subsequently) in a consecutive series of patients with MI admitted to the Coronary Care Unit, and to explore for variables associated with this arrhythmia; the role of AF in determining major clinical outcomes of the patients was also examined. A large data base of baseline, clinical, laboratory, and patient outcome variables was generated and continuously updated to examine correlates of AF and its possible role in determining prognosis. AF was found in 72 of 517 patients, of whom 58 experienced this arrhythmia anew. Univariate analyses detected a positive association of AF with age, pulmonary congestion, left ventricular hypertrophy, high admission Killip class, and a large array of complications including in-hospital mortality. Multivariate analyses showed, however, that AF correlated weakly with age and strongly with left ventricular hypertrophy and occurrence of ventricular tachycardia, but that it was not a determinant of ventricular fibrillation or in-hospital mortality.

Synovitis secondary to silicone elastomeric joint implant.

The authors present a case study of synovitis after an arthroplasty of the first metatarsophalangeal joint and placement of a hemisilicone joint implant. This was an unusual presentation because excision of the prosthesis was necessary 1 month after placement. Also, a review of the literature is presented on silicone synovitis and other complications that arise after silicone joint implantation.

Polymetatarsia as an etiology for Tailor's bunion deformity: a surgical approach.

Congenital pedal deformities are well documented within the literature. The following article reviews a case history of a 4-year-old girl with a unique case of polymetatarsia and the complications associated with the resultant deformity. The history, case presentation, surgical treatment rendered, and follow-up care are presented. A review of the literature is also provided.

Prevalence of Coxsackie B virus antibodies in patients with juvenile dermatomyositis.

A number of viruses have been implicated as being the cause of various forms of myositis, including acute transient myositis, chronic polymyositis, and dermatomyositis. However, the cause of juvenile dermatomyositis (JDM) has remained elusive. Our study of serum samples taken within 4 months of the onset of disease in 12 children with JDM showed that 83% had detectable titers of complement-fixing (CF) antibody to 1 or more coxsackie B viral antigens. Detectable titers were found in only 25% of age-, sex-, and date-matched control sera taken from 24 patients with juvenile rheumatoid arthritis (JRA), and in 25% of serum samples taken from 2,192 "normal" children who had been hospitalized because of viral syndromes. Titers of CF antibody to coxsackie B1, B2, and B4 were positive in 58%, 50%, and 58%, respectively, of the JDM patients. In matched JRA controls, the respective values were 8%, 13%, and 8%. There were no significant antiviral titers and no significant differences in the results of tests for 13 other viral CF antigens, hepatitis B surface antigen, and Mycoplasma pneumoniae CF antigen in the JDM patient sera compared with the JRA patient sera. When titers of neutralizing antibody were determined, 58%, 58%, and 67% of the JDM patients were positive for coxsackie B2, B4, and B5, respectively, whereas 16%, 26%, and 21%, respectively, of the JRA controls were positive for the 3 antigens. These data suggest that the host response to coxsackie B virus might be related to the pathophysiology of JDM.

Physical model approach in the study of the transport of alkyl amines across a silicone rubber membrane in a two-chamber diffusion cell.

The transport of hexylamine and octylamine through a silicone rubber membrane was studied as a function of buffer (phosphate) concentration and pH. The results were interpreted using a physical model which assumed a steady-state rate of transport and which accounted for the simultaneous diffusion and rapid equilibrium of all the aqueous species, the possible diffusion of both the amine and its protonated form through the membrane, and the effect of a stagnant aqueous diffusion layer on each side of the membrane. The following conclusions were reached: The thickness of the aqueous diffusion layer is approximately 100 micron, which is about the same as that previously measured for benzoic acid in this system. Transport of octylamine at pH greater than or equal to 10 is approximately 90% aqueous diffusion layer controlled, whereas hexylamine is approximately 50% aqueous diffusion layer controlled at high pH. The membrane permeability of octylamine is approximately 15-20 times that of hexylamine. This gives an incremental pi constant for the partition coefficient of approximately 0.61, as compared with the previously reported value of 0.56. At low pH (less than or equal to 5), the transport of the protonated species becomes important. The membrane permeabilities of these ammonium ions are about four or five orders of magnitude less than the membrane permeabilities of the corresponding amines. The membranes were examined at 30,000X with the scanning electron microscope, and no evidence of holes was found.