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' Valued and listened to': the collective experience of patient and public involvement in a national evaluation. Perspect Public Health 2022; 142:199-201. [PMID: 35833551 PMCID: PMC9284077 DOI: 10.1177/17579139221103184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fatty acid profiles of Phaseolus species. FOOD RESEARCH 2021. [DOI: 10.26656/fr.2017.5(5).439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to identify and profile the fatty acids present in the Phaseolus
species using an online Osiris server software. Phaseolus species (pinto beans, lima beans
and kidney beans) were bought in King’s market, Akure, Ondo State, Nigeria and were air
-dried and ground. The Association of Official Analytical Chemists protocol were used for
proximate; mineral analysis was done using atomic absorption spectrophotometer;
extraction of oil was done using Soxhlet apparatus and the extracts were characterized
using gas chromatography mass spectrophotometer and identified compounds were
screened for their chemical properties using online Osiris server. The oil extract for pinto
beans revealed fatty acids in increasing order of percentage quality: Myristic acid,
octadecenoic acid, stearic acid and palmitic acid. Identified fatty acids in kidney beans
were in decreasing order of palmitic acid, linoleic acid, lauric acid, myristic acid and
capric acid. Lima beans had highest palmitic acid and arachidic acid the lowest. However,
from the results of all the Phaseolus species, linoleic acid was found only in kidney beans
with quality of 11.87%. The identified fatty acids showed high toxicity properties and they
exhibited negative drug-likeness. The chemistry of the identified compounds all showed
that they exhibited various chemical properties. In conclusion, this study had revealed the
presence of fatty acids in the selected food crops and their various chemical profiles have
been discovered
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Risk Assessment of Organochlorine Pesticide Residue in Phaseolus vulgaris Purchased in Igbara-oke, Ondo State, Nigeria. Pak J Biol Sci 2021; 24:357-365. [PMID: 34486321 DOI: 10.3923/pjbs.2021.357.365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
<b>Background and Objective:</b> Preservation of agricultural products remains a hallmark of all farmers as a result, both pesticides and herbicides are being applied during planting and after harvesting with the sole aim of maximizing profits. Research had shown the various degree of toxicity of organochlorine pesticides residues, the objective of the research was to identify the organochlorine pesticide residues, analyze their risk assessment vis-a-vis, Hazard Index (HI), Estimate Dietary Intake (EDI), Target Hazard Quotient (THQ) and compare the results with Acceptable Dietary Intake (ADI), Reference dose standard (Rfd) and Maximum Residue Limit (MRL) and characterized the identified organochlorine pesticides residue for their toxicological properties. <b>Materials and Methods:</b> <i>Phaseolus vulgaris</i> were purchased in a local market in Igbara -Oke, Ondo state Nigeria, the sample was powdered using a grinder (Sumeet CM/L 2128945) and solid phase extraction techniques were employed, the extract was subjected to fractionation into two fractions of aliphatic hydrocarbons and the pesticides. The pesticide extract was subjected to characterization using gas chromatography-mass spectrophotometer. <b>Results:</b> Total 4 organochlorine pesticide residues were identified and the contaminant rates (mg kg<sup>1</sup>) were less than 1. Furthermore, EDI values were lower than the ADI, MRL, also, the THQ values were less than 1, an indication that the <i>Phaseolus vulgaris</i> was safe for consumption. <b>Conclusion:</b> The research had shown no toxicity of the <i>Phaseolus vulgaris</i> purchased from the local market and it shows compliance by the local farmers on the application of pesticides to the food crop by obeying the recommended dose.
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Toxicological Characterization of Pesticide Residue in <i>Phaseolus vulgaris</i>. Pak J Biol Sci 2020; 23:1601-1606. [PMID: 33274892 DOI: 10.3923/pjbs.2020.1601.1606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The health implications associated with consumption of food crops preserved with pesticides such as diarrhea, food poisons have been a major challenge to health practitioners and the concerned authorities, the objective of the research was to analyze the pesticide residues and compare the contamination rate with Acceptable Dietary Intake (ADI) and Maximum Residue Limit (MRL). MATERIALS AND METHODS Phaseolus vulgaris were purchased in two different locations, the samples were powdered using a grinder (Sumeet CM/L 2128945). Fifty grams of powdered flour were soaked in 200 mL of Methanol and the crude extracts were concentrated using a rotary evaporator. The extracts were Characterized using GC-MS and percentage compositions of identified pesticide residues were converted into mg/g as contamination rate and the toxic analysis was done by using the Osiris Online server. RESULTS In chromatogram A, identified pesticides residue include Dieldrin (96.1 mg g-1), Indolizine (67.9 mg g-1), permethrin (99.4 mg g-1) and compounds identified in chromatogram B include dichlorvos (8.2 mg g-1), Diazinon (52.3 mg g-1), fenitrothion (17.8 mg g-1) and permethrin (122.0 mg g-1). These pesticide residues exhibited various toxicological effects, such as; mutagenic, tumorigenic effects. Moreover, the contamination rates of the identified residues were higher than both MRL and ADI. CONCLUSION The research work had shown that the two samples had contamination rates higher than both the ADI and MRL, this could pose health hazards to the populace if consumed and it is recommended that the applications of pesticides in foods should be regulated and MRL and ADI should be adhered to.
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Minimally Invasive Myomectomy: Examining Surgical Route and Racial/Ethnic Trends within a Large Integrated Healthcare System. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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O5 Large-scale trends in contraceptive attitudes over time as expressed on Twitter. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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SUN-111 THE SAFETY OF RENAL BIOPSY IN HIV- INFECTED PATIENTS WITH CHRONIC KIDNEY DISEASE. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Self-reported Sleep Disorder and Ambulatory Blood Pressure Phenotypes in Patients with or without Chronic Kidney Disease: Findings from Ibadan CRECKID Study. West Afr J Med 2019; 36:61-68. [PMID: 30924118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Sleep disordered breathing has been closely linked to pathogenesis, poor control of hypertension, and progression of chronic kidney disease (CKD). Though hypertension and CKD are highly prevalent in Nigeria, the effects of sleep disorders on CKD and hypertension phenotypes have not been widely studied. This study investigated the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP =140mmHg and/or DBP =90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2Equation and CKD was defined as eGFR<60ml/min/1.73m . RESULTS A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; p<0.0001. CONCLUSION This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.
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Prediction of Chemical Multi-target Profiles and Adverse Outcomes with Systems Toxicology. Curr Med Chem 2017; 24:1705-1720. [PMID: 27978797 DOI: 10.2174/0929867323666161214115540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/22/2022]
Abstract
The field of systems biology, termed systems toxicology when applied to the characterization of adverse outcomes following chemical exposure, seeks to develop biological networks to explain phenotypic responses. Ideally, these are qualitatively and quantitatively similar to the actual network of biological entities that have functional consequences in living organisms. In this review, computational tools for predicting chemicalprotein interactions of multi-target compounds are outlined. Then, we discuss how the methods of systems toxicology currently draw on those interactions to predict resulting adverse outcomes which include diseases, adverse drug reactions, and toxic endpoints. These methods are useful for predicting the safety of drugs in drug development and the toxicity of environmental chemicals (ECs) in environmental toxicology.
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The Role of Aripiprazole (An Anti-psychotic Drug) in the Resolution of Acute Peripheral Inflammation in Male Wistar Rats. JOURNAL OF PHARMACEUTICAL RESEARCH INTERNATIONAL 2017. [DOI: 10.9734/jpri/2017/32601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Drug Metabolism in Preclinical Drug Development: A Survey of the Discovery Process, Toxicology, and Computational Tools. Curr Drug Metab 2017; 18:556-565. [PMID: 28302026 PMCID: PMC5892202 DOI: 10.2174/1389200218666170316093301] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/16/2016] [Accepted: 01/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND While establishing efficacy in translational models and humans through clinically-relevant endpoints for disease is of great interest, assessing the potential toxicity of a putative therapeutic drug is critical. Toxicological assessments in the pre-clinical discovery phase help to avoid future failure in the clinical phases of drug development. Many in vitro assays exist to aid in modular toxicological assessment, such as hepatotoxicity and genotoxicity. While these methods have provided tremendous insight into human toxicity by investigational new drugs, they are expensive, require substantial resources, and do not account for pharmacogenomics as well as critical ADME properties. Computational tools can fill this niche in toxicology if in silico models are accurate in relating drug molecular properties to toxicological endpoints as well as reliable in predicting important drug-target interactions that mediate known adverse events or adverse outcome pathways (AOPs). METHODS We undertook an unstructured search of multiple bibliographic databases for peer-reviewed literature regarding computational methods in predictive toxicology for in silico drug discovery. As this review paper is meant to serve as a survey of available methods for the interested reader, no focused criteria were applied. Literature chosen was based on the writers' expertise and intent in communicating important aspects of in silico toxicology to the interested reader. CONCLUSION This review provides a purview of computational methods of pre-clinical toxicologic assessments for novel small molecule drugs that may be of use for novice and experienced investigators as well as academic and commercial drug discovery entities.
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Dosimetric Predictors of Radiation Pneumonitis After Hemithoracic Pleural Intensity Modulated Radiation Treatment. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Aflibercept is the most recently approved vascular endothelial growth factor (anti-VEGF) inhibitor for the management of diabetic macular edema and diabetic retinopathy. The purpose of this article is to review the efficacy and safety of aflibercept in the management of diabetic eye complications and to describe its place in therapy. Anti-VEGF agents have been noted in clinical trials to be superior to laser photocoagulation, the standard therapy ( P < .0001, P ≤ .0085, respectively). Aflibercept has been comparatively studied with other anti-VEGF agents, namely, bevacizumab and ranibizumab, and noted to be equally efficacious and safe in patients with mild visual acuity loss ( P > .50). However, in the treatment of patients with diabetic macular edema having moderate to severe visual acuity loss, aflibercept outperformed the other 2 anti-VEGF agents (aflibercept vs bevacizumab, P < .001; aflibercept vs ranibizumab, P = .003). However, additional studies are needed to fully appreciate the long-term safety and efficacy of aflibercept and the anti-VEGF therapy class.
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A Cost-Benefit Analysis of Government Compensation of Kidney Donors. Am J Transplant 2016; 16:877-85. [PMID: 26474298 PMCID: PMC5057320 DOI: 10.1111/ajt.13490] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 01/25/2023]
Abstract
From 5000 to 10 000 kidney patients die prematurely in the United States each year, and about 100 000 more suffer the debilitating effects of dialysis, because of a shortage of transplant kidneys. To reduce this shortage, many advocate having the government compensate kidney donors. This paper presents a comprehensive cost-benefit analysis of such a change. It considers not only the substantial savings to society because kidney recipients would no longer need expensive dialysis treatments--$1.45 million per kidney recipient--but also estimates the monetary value of the longer and healthier lives that kidney recipients enjoy--about $1.3 million per recipient. These numbers dwarf the proposed $45 000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list. From the viewpoint of society, the net benefit from saving thousands of lives each year and reducing the suffering of 100 000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3. In addition, it would save taxpayers about $12 billion each year.
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APOL1 genotyping of African American deceased organ donors: not just yet. Am J Transplant 2015; 15:1457-8. [PMID: 25809950 DOI: 10.1111/ajt.13230] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/13/2015] [Accepted: 01/20/2015] [Indexed: 01/25/2023]
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Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant 2014; 14:1992-2000. [PMID: 25307034 PMCID: PMC4374739 DOI: 10.1111/ajt.12850] [Citation(s) in RCA: 339] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/21/2014] [Accepted: 05/26/2014] [Indexed: 01/25/2023]
Abstract
A consensus meeting was held in Vienna on September 8-9, 2013, to discuss diagnostic and therapeutic challenges surrounding development of diabetes mellitus after transplantation. The International Expert Panel comprised 24 transplant nephrologists, surgeons, diabetologists and clinical scientists, which met with the aim to review previous guidelines in light of emerging clinical data and research. Recommendations from the consensus discussions are provided in this article. Although the meeting was kidney-centric, reflecting the expertise present, these recommendations are likely to be relevant to other solid organ transplant recipients. Our recommendations include: terminology revision from new-onset diabetes after transplantation to posttransplantation diabetes mellitus (PTDM), exclusion of transient posttransplant hyperglycemia from PTDM diagnosis, expansion of screening strategies (incorporating postprandial glucose and HbA1c) and opinion-based guidance regarding pharmacological therapy in light of recent clinical evidence. Future research in the field was discussed with the aim of establishing collaborative working groups to address unresolved questions. These recommendations are opinion-based and intended to serve as a template for planned guidelines update, based on systematic and graded literature review, on the diagnosis and management of PTDM.
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1.4 PULSE WAVE VELOCITY AND INCIDENT HEART FAILURE IN CHRONIC KIDNEY DISEASE. Artery Res 2011. [DOI: 10.1016/j.artres.2011.10.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Cadmium uptake by across the gut of rainbow trout in vivo and in vitro: The influence of calcium. Comp Biochem Physiol A Mol Integr Physiol 2008. [DOI: 10.1016/j.cbpa.2008.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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An overview of dietary Cu absorption in rainbow trout. Comp Biochem Physiol A Mol Integr Physiol 2008. [DOI: 10.1016/j.cbpa.2008.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Effect of Processing Factors on Rheological Properties of Ogi. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2007. [DOI: 10.1081/jfp-120020118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Efficacy of Valganciclovir in the Treatment of Cytomegalovirus Disease in Kidney and Pancreas Transplant Recipients. Transplant Proc 2006; 38:3673-5. [PMID: 17175363 DOI: 10.1016/j.transproceed.2006.10.105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Indexed: 11/20/2022]
Abstract
Cytomegalovirus (CMV) disease is relatively common following solid organ transplant, particularly if a serologically negative recipient receives an organ from a serologically positive donor (D+/R-). Although valganciclovir is approved for the treatment of CMV retinitis in AIDS patients and is used for the prophylaxis against CMV infection in solid organ transplant patients, the current standard treatment for CMV disease in solid organ transplant recipients remains intravenous ganciclovir. We retrospectively reviewed our experience using valganciclovir as treatment for CMV disease in CMV D+/R- kidney and/or pancreas transplant recipients from March 2002 to June 2005. A total of 37 cases with primary CMV disease were diagnosed and treated with either intravenous ganciclovir as induction followed with valganciclovir or valganciclovir from the beginning. We compared clinical outcomes and viremia between the two groups. Our data suggest that valganciclovir is an effective treatment modality for primary CMV disease in kidney and/or pancreas transplant recipients. It led to the resolution of disease and undetectable viremia. Valganciclovir allowed for early initiation of treatment and for treatment to be given as an outpatient. These advantages of valganciclovir have both health and economic impact for patients with CMV disease.
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Effect of Some Selected Processing Routes on the Nutritional Value of Soy Yoghurt. ACTA ACUST UNITED AC 2006. [DOI: 10.3923/jas.2006.527.530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Meningioma - a review of 52 cases. SA J Radiol 2004. [DOI: 10.4102/sajr.v8i4.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Meningiomas are extra-axial neoplasms representing 15 - 20% of primary intracranial neoplasms. Incidence peaks in patients aged 40 - 60 years, and they more commonly affect women than men. Most meningiomas arise from arachnoidal cells on the inner surface of the dura and they thefore grow inward toward the brain to form bulky intradural tumour masses. Most meningiomas are benign, but ~6% are atypical or aggressive, and 1 - 2% are frankly malignant. Common locations for meningiomas include the cerebral convexity, parasagittal region, sphenoid wing, olfactory groove, tuberculum sella, posterior fossa, and cavernous sinus.
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Comparison of cross-sectional renal function measurements in African Americans with hypertensive nephrosclerosis and of primary formulas to estimate glomerular filtration rate. Am J Kidney Dis 2001; 38:744-53. [PMID: 11576877 DOI: 10.1053/ajkd.2001.27691] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal function measurements were obtained in 1,703 African Americans with presumed hypertensive nephrosclerosis who were screened for entry into the African-American Study of Hypertension and Kidney Disease (AASK). We examined the effect of race on relationships involving renal variables by comparing African Americans enrolled into the AASK with non-African Americans enrolled into the Modification of Diet in Renal Disease (MDRD) study. We examined the effect of gender on renal variables by comparing African American men and women. We compared various methods for estimating glomerular filtration rate (GFR) with iodine 125-labeled ((125)I)-iothalamate GFR. AASK data were also used to derive a new formula for estimating GFR in African Americans. After adjusting for age, sex, and baseline GFR, African American patients on the AASK study were heavier and had larger body surface areas and body mass indices than either MDRD African Americans or non-African Americans. African Americans had greater serum creatinine levels and urinary creatinine excretions for any given level of GFR. Mean GFR was greater in African American men than African American women (59.7 versus 51.7 mL/min/1.73 m(2)), although serum creatinine levels were also greater in men (1.91 versus 1.73 mg/dL). Seventy-eight percent of women with serum creatinine levels between 1.2 and 1.5 mg/dL had GFRs less than 65 mL/min/1.73 m(2). For African Americans in the AASK, GFR was overestimated by the 24-hour creatinine clearance and underestimated by the Cockcroft-Gault formula. A prediction formula developed in the MDRD study more accurately predicted GFR in AASK patients than these measurements. AASK data were also used to derive a new five-term formula for estimating GFR that was slightly more accurate in the African Americans in the AASK than the MDRD formula (median percentage of error, 12.4% for the MDRD formula versus 12.1% for the AASK formula). Important differences exist in renal variables between African Americans and non-African Americans and between African American men and African American women. Formulas using demographic data and readily measured serum values estimate (125)I-iothalamate GFR.
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Abstract
CONTEXT Incidence of end-stage renal disease due to hypertension has increased in recent decades, but the optimal strategy for treatment of hypertension to prevent renal failure is unknown, especially among African Americans. OBJECTIVE To compare the effects of an angiotensin-converting enzyme (ACE) inhibitor (ramipril), a dihydropyridine calcium channel blocker (amlodipine), and a beta-blocker (metoprolol) on hypertensive renal disease progression. DESIGN, SETTING, AND PARTICIPANTS Interim analysis of a randomized, double-blind, 3 x 2 factorial trial conducted in 1094 African Americans aged 18 to 70 years with hypertensive renal disease (glomerular filtration rate [GFR] of 20-65 mL/min per 1.73 m(2)) enrolled between February 1995 and September 1998. This report compares the ramipril and amlodipine groups following discontinuation of the amlodipine intervention in September 2000. INTERVENTIONS Participants were randomly assigned to receive amlodipine, 5 to 10 mg/d (n = 217), ramipril, 2.5 to 10 mg/d (n = 436), or metoprolol, 50 to 200 mg/d (n = 441), with other agents added to achieve 1 of 2 blood pressure goals. MAIN OUTCOME MEASURES The primary outcome measure was the rate of change in GFR; the main secondary outcome was a composite index of the clinical end points of reduction in GFR of more than 50% or 25 mL/min per 1.73 m(2), end-stage renal disease, or death. RESULTS Among participants with a urinary protein to creatinine ratio of >0.22 (corresponding approximately to proteinuria of more than 300 mg/d), the ramipril group had a 36% (2.02 [SE, 0.74] mL/min per 1.73 m(2)/y) slower mean decline in GFR over 3 years (P =.006) and a 48% reduced risk of the clinical end points vs the amlodipine group (95% confidence interval [CI], 20%-66%). In the entire cohort, there was no significant difference in mean GFR decline from baseline to 3 years between treatment groups (P =.38). However, compared with the amlodipine group, after adjustment for baseline covariates the ramipril group had a 38% reduced risk of clinical end points (95% CI, 13%-56%), a 36% slower mean decline in GFR after 3 months (P =.002), and less proteinuria (P<.001). CONCLUSION Ramipril, compared with amlodipine, retards renal disease progression in patients with hypertensive renal disease and proteinuria and may offer benefit to patients without proteinuria.
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African-American renal transplant recipients experience decreased risk of death due to infection: possible implications for immunosuppressive strategies. Transplantation 2000; 70:375-9. [PMID: 10933166 DOI: 10.1097/00007890-200007270-00024] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION African-American renal transplant recipients tend to experience more acute rejection episodes and have shorter graft survival than Caucasian renal transplant recipients. Various factors have been posited to be responsible for this difference, including relative under immunosuppression. We reasoned that by looking at the balance of acute rejections versus death due to infection, we could ascertain whether African-American renal recipients might have more reserve to tolerate an increase in pharmacological immunosuppression. METHODS We analyzed the United States Renal Data System (USRDS) data from 1987 to 1997 regarding acute rejection episodes and infectious deaths. All other pertinent factors were gathered for a multivariate analysis. A total number of 68,885 adult renal transplant recipients were analyzed. RESULTS When corrected for all covariates, the relative risk for acute rejection (1.3) was higher although the relative risk for infectious death was lower (0.7) in African-Americans as compared with Caucasians (P<0.01). CONCLUSION Our study would indicate that relative to Caucasians, African-American renal transplant recipients are at decreased risk for infectious death and therefore may tolerate the more intensive immunosuppression that may be necessary to narrow the gap in acute rejection rates between African-Americans and Caucasian renal transplant recipients.
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Abstract
INTRODUCTION Fabry's disease is an X-linked error of glycosphingolipid metabolism. Clinical manifestations of the disease are secondary to accumulation of glycosphingolipids in various tissues. Renal failure and vascular complications are common. There are conflicting reports regarding the outcomes of patients with Fabry's disease after renal transplantation. METHODS We reviewed the United States Renal Data System Registry database from 1988 and 1998, and found 93 patients with Fabry's disease who had received a renal transplant. Case-matched patients were identified to serve as controls. RESULTS Patients with Fabry's disease demonstrated equivalent 5-year patient and graft survival, compared with controls (83% and 75%, respectively, for those with Fabry's disease vs. 82% and 67% for controls). CONCLUSION Despite their high risk for cardiovascular complications, patients with Fabry's disease have excellent outcomes after renal transplantation.
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Prognosis after primary renal transplant failure and the beneficial effects of repeat transplantation: multivariate analyses from the United States Renal Data System. Transplantation 1998; 66:1651-9. [PMID: 9884254 DOI: 10.1097/00007890-199812270-00014] [Citation(s) in RCA: 204] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Survival of transplant recipients after primary renal allograft failure has not been well studied. METHODS A cohort of 19,208 renal transplant recipients with primary allograft failure between 1985 and 1995 were followed from the date of allograft loss until death, repeat transplantation, or December 31, 1996. The mortality, wait-listing, and repeat transplantation rates were assessed. The mortality risks associated with repeat transplantation were estimated with a time-dependent survival model. RESULTS In total, 34.5% (n=6,631) of patients died during follow-up. Of these deaths, 82.9% (n=5,498) occurred in patients not wait-listed for repeat transplantation, 11.9% (n=789) occurred in wait-listed patients, and 5.2% (n=344) occurred in second transplant recipients. Before repeat transplantation, the adjusted 5-year patient survival was 36%, 49%, and 65% for type I diabetes mellitus (DM), type II DM, and nondiabetic end-stage renal disease, respectively (P<0.001; DM vs. nondiabetics). The adjusted 5-year patient survival was lower in Caucasians (57%, P<0.001) compared with African-Americans (67%) and other races (64%). The 5-yr repeat transplantation rate was 29%, 15%, and 19%, whereas the median waiting time for a second transplant was 32, 90, and 81 months for Caucasians, African-Americans, and other races, respectively (P<0.0001 each). Repeat transplantation was associated with 45% and 23% reduction in 5-year mortality for type I DM and nondiabetic end-stage renal disease, respectively, when compared with their wait-listed dialysis counterparts with prior transplant failure. CONCLUSIONS The loss of a primary renal allograft was associated with significant mortality, especially in recipients with type I DM. Repeat transplantation was associated with a substantial improvement in 5-year patient survival. Recipients with type I DM achieved the greatest proportional benefit from repeat transplantation.
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Magnetic resonance guided breast surgery. Eur J Cancer 1998. [DOI: 10.1016/s0959-8049(98)80188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Racial differences in kidney transplantation have received recent attention both in the medical community and in the general public. Most efforts to improve renal transplantation among minority groups have been directed toward cadaveric donation and transplantation. Since evaluation of the comparative trends by race of living related donor (LRD) kidney transplantation have been lacking, we examined trends of LRD transplantation from 1983 through 1990 using national data from the US Renal Data System. The total number of LRDs in blacks did not change during the 8-year period between 1983 and 1990 (198 in 1983 and 197 in 1990). During this same period, the total number of LRDs in whites increased by 11% (1,390 in 1983 and 1,548 in 1990). Rates of LRD transplantation per nontransplanted dialysis patients were consistently lower in blacks and females compared with whites and males, respectively. White males have a fivefold higher rate of LRD transplantation than black males, whereas white females have a fourfold higher rate then black females. When intraracial gender differences were examined, black males were transplanted with LRD kidneys at a rate 20% higher than black females. This difference was present between 1983 and 1989, but was nonexistent in 1990. Among whites, males also had a higher rate of LRD transplantation than females, which gradually decreased from 34% in 1983 to 20% in 1990. In view of the ever-increasing demand for cadaver organs, additional effort in the medical community and society toward increasing LRD transplantation rates represents a more promising approach to increasing organ donation in all groups than a single focus on cadaveric donation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Who is the elderly primigravida in Nigeria? Int J Gynaecol Obstet 1988; 26:51-5. [PMID: 2892738 DOI: 10.1016/0020-7292(88)90195-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A retrospective study of 792 primigravidae, divided into four age-groups, was made in order to detect which group showed features of the elderly primigravida. Adolescent primigravidae showed significantly highest incidences of pre-eclampsia, anemia, premature labor and cephalopelvic disproportion. The 20-24 year age-group showed the least incidence of pregnancy and labor complications. The 25-29 year age-group showed significantly increased incidences of uterine fibroids, pre-eclampsia, post-term pregnancy, premature labor, slow labor, fetal distress, failed induction, vacuum and cesarean section deliveries, when compared with the 20-24 year age-group. Most of the complications in the 25-29 year age-group were continued into 30-34 years. A woman 25 years and above in her first pregnancy in Nigeria should be termed "elderly primigravida".
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