Inhibition of gastric emptying by acarbose is correlated with GLP-1 response and accompanied by CCK release

We investigated the effect of acarbose, an alpha-glucosidase and pancreatic alpha-amylase inhibitor, on gastric emptying of solid meals of varying nutrient composition and plasma responses of gut hormones. Gastric emptying was determined with scintigraphy in healthy subjects, and all studies were performed with and without 100 mg of acarbose, in random order, at least 1 wk apart. Acarbose did not alter the emptying of a carbohydrate-free meal, but it delayed emptying of a mixed meal and a carbohydrate-free meal given 2 h after sucrose ingestion. In meal groups with carbohydrates, acarbose attenuated responses of plasma insulin and glucose-dependent insulinotropic polypeptide (GIP) while augmenting responses of CCK, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY). With mixed meal + acarbose, area under the curve (AUC) of gastric emptying was positively correlated with integrated plasma response of GLP-1 (r = 0.68, P < 0.02). With the carbohydrate-free meal after sucrose and acarbose ingestion, AUC of gastric emptying was negatively correlated with integrated plasma response of GIP, implying that prior alteration of carbohydrate absorption modifies gastric emptying of a meal. The results demonstrate that acarbose delays gastric emptying of solid meals and augments release of CCK, GLP-1, and PYY mainly by retarding/inhibiting carbohydrate absorption. Augmented GLP-1 release by acarbose appears to play a major role in the inhibition of gastric emptying of a mixed meal, whereas CCK and PYY may have contributory roles.

Mycobacterium tuberculosis Infection in Renal Transplant Recipients

Mycobacterium tuberculosis (TB) infection is more common among renal allograft recipients compared with the general population due to immunosuppression. The epidemiological risk in a country is an important determinant of transplant TB after transplantation. We retrospectively analyzed 283 renal transplant recipients who underwent renal transplantation between 1990 and 2004. We evaluated the incidence, patient and disease characteristics, prognosis, and outcome of TB infection. Tuberculosis developed in 10 (seven men and three women of mean age of 41+/-9 years) among 283 patients (3.1%). All patients were culture-positive for M tuberculosis. Although pulmonary TB was the most common presentation in the general population, 50% of patients in the study group developed extrapulmonary TB. The mean elapsed time from renal transplantation was 38 months. Three patients (1%) developed TB in the first year after transplantation. All patients were treated with a quartet of anti-TB therapy. One patient developed isoniazid-related reversible hepatotoxicity. No acute allograft rejection occurred during the anti-TB therapy. Two patients (20%) with pulmonary TB died due to dissemination of the disease. In conclusion, extrapulmonary presentations of TB are more common among renal transplant recipients with the increased risk of mortality.

Association between high platelet indices and proteinuria in patients with hypertension

Background

We aimed to determine the association between platelet indices including plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), and proteinuria associated with hypertension (HT) as well as the relative power of each to predict proteinuria.

Methods

The study included 223 patients (68 men and 155 women) with primary HT. PCT, MPV, PDW, and proteinuria levels were measured. The patients were divided into two groups according to proteinuria status based on 24-hr urinary protein excretion: proteinuria (+) group (15 men and 40 women) and proteinuria (-) group (53 men and 115 women).

Results

The mean and SD of platelet count, PDW, PCT, and MPV were 278.8±49.6×10⁹/L, 13.5±1.8%, 0.31±0.07%, and 11.3±2.6 fL, respectively. The mean platelet count, PCT, MPV, and PDW were significantly higher in the proteinuria (+) group than in the proteinuria (-) group (P<0.05); there were no significant differences in the other blood parameters between the two groups. The platelet count, PCT, MPV, and PDW were independent risk factors predictive of proteinuria according to a stepwise regression analysis of PDW, PCT, and MPV. PCT was the strongest independent predictor of proteinuria.

Conclusions

The platelet indices PCT, PDW, and MPV were significantly higher in patients with proteinuria than in those without it. Among these three indices, PCT was the strongest predictor of proteinuria.

Is disulphide/thiol ratio related to blood pressure in masked hypertension?

Dynamic thiol/disulphide homeostasis plays a critical role in numerous intracellular enzymatic pathways including antioxidant defence and detoxification. In this study, we sought to investigate dynamic thiol/disulphide homeostasis in patients with masked hypertension (MHT) and its relationship with blood pressure. Forty patients (23 men, 17 women) with newly diagnosed MHT and not yet on medical therapy, and 40 healthy volunteers (21 men, 19 women) were enrolled. Blood thiol/disulphide homeostasis was measured in both groups. Serum native and total thiol levels were measured using the novel, fully automated colorimetric method developed by Erel et al. Serum disulphide level was calculated as (serum total thiol - serum native thiol)/2. Native and total thiol levels (p = 0.001) and native thiol/total thiol ratio (p = 0.023) were found to be lower in patients with MHT when compared to those of the control group. Disulphide level and ratios of disulphide/native thiol and disulphide/total thiol were higher in patients with MHT than in the control group (p = 0.001). A positive correlation of systolic blood pressure (SBP) and diastolic blood pressure (DBP) was observed with disulphide/native thiol ratio (p < 0.001). Stepwise multivariable regression analysis showed disulphide/native thiol ratio to be an independent risk factor of SBP and DBP, and SBP to be an independent risk factor of disulphide/thiol ratio (p = 0.001). In this study, we found that dynamic thiol/disulphide homeostasis shifted towards disulphide formation due to thiol oxidation in patients with MHT. Prospective randomised controlled studies are required to elucidate whether abnormal thiol/disulphide status lies in the pathogenesis of MHT or is a consequence of MHT.

Blood pressure measurements, blood pressure variability and endothelial function in renal transplant recipients

BACKGROUND/AIMS

Hypertension is an important cardiovascular risk factor in renal transplant recipients. Elevated blood pressure variability (BPV) during 24-h ambulatory blood pressure monitoring (ABPM) is associated with increased risk of target organ damage and cardiovascular events, independent of mean blood pressure levels. We aimed to evaluate the relationship between endothelial function, blood pressure levels obtained by various measurement methods, and BPV in renal transplant recipients.

METHODS

In total, 73 hypertensive renal transplant recipients were included in the study. Office blood pressure measurements, central blood pressure measurements, home blood pressure measurements and 24-h ABPM were obtained from the subjects. BPV was calculated using the average real variability index. All patients underwent brachial flow-mediated vasodilatation tests. Predictive values of blood pressures obtained by different measurement techniques and BPV on endothelial functions were investigated.

RESULTS

Endothelial dysfunction was present in 68.5% of the patients. No difference was found between the group with and without endothelial dysfunction with regard to office systolic or diastolic blood pressure, central blood pressure or home systolic blood pressure. In the group with endothelial dysfunction, 24-h ambulatory systolic blood pressure and night-time ambulatory systolic blood pressure were higher. In patients with endothelial dysfunction, the 24-h systolic, diastolic and mean BPV were all higher. There was also a negative correlation between the percentage of flow-mediated vasodilatation with 24-h mean and systolic BPV.

CONCLUSION

Patients with endothelial dysfunction had significantly higher ambulatory blood pressure values and higher BPV. There was a significant negative correlation between endothelial function and BPV.

Tc-99m sestamibi gated SPECT in patients with left bundle branch block

PURPOSE

The purpose of this study was to assess the diagnostic role of a Tc-99m sestamibi gated SPECT technique in patients with left bundle branch block (LBBB) without known coronary artery disease.

MATERIALS AND METHODS

Twenty consecutive patients with constant complete LBBB were included. A same-day rest-stress protocol was used, and dipyridamole stress (14 patients) or treadmill exercise (6 patients) was applied. Electrocardiograph (ECG)-gated SPECT images were acquired 15 minutes after the administration of 0.31 mCi/kg Tc-99m sestamibi at peak stress. Regional myocardial perfusion was analyzed in relation to the cardiac cycle.

RESULTS

Eleven of 14 patients who underwent a dipyridamole stress test had hypoactivity in the left anterior descending (LAD) artery territory in the ungated (summed) stress-rest images (abnormality ratio, 78%). On the ungated images, the abnormality was completely reversible in one patient (9%), partially reversible in five patients (46%), irreversible in two patients (18%), and reverse perfusion was identified in three patients (27%). Abnormality ratios of end-systolic and end-diastolic data were 93% and 29%, respectively. Conversely, the ungated rest-stress and end-systolic images of all the patients who performed treadmill exercise were abnormal despite the presence of normal or nearly normal end-diastolic myocardial perfusion. The angiographic findings correlated best with those of end-diastolic images. In 13 patients without coronary artery disease, normal or nearly normal regional perfusion was observed on end-diastole, but four patients with abnormal end-diastolic perfusion, which involved the LAD territory in all but one, had substantial coronary artery disease. The number of the involved segments was similar on the end-systolic and ungated data. Most of these artifactual defects were localized to the anteroseptal, septal, and inferoseptal segments.

CONCLUSIONS

These preliminary data indicate that end-diastolic images can significantly reduce artifactual defects in patients with LBBB. The resolution of an LBBB pattern on end-diastolic data would significantly improve the diagnostic role of myocardial perfusion studies in these patients.

Mycophenolate mofetil treatment of crescentic Henoch–Schönlein nephritis with IgA depositions

Mycophenolate mofetil (MMF) is considered to be a promising therapeutic agent in primary glomerulonephritis but there are no data on the use of MMF in Henoch-Schönlein nephritis (HSN). Herein we report the first adult crescentic HSN patient in whom long-term complete remission was achieved after MMF therapy.

Fabry Disease Prevalence in Renal Replacement Therapy in Turkey

BACKGROUND

Fabry disease (FD) is an X-linked lysosomal storage disorder resulting from lack of alpha-galactosidase A (AGALA) activity in lysosomes.

OBJECTIVE

In this multicenter study, we aimed to evaluate the prevalence of FD in renal transplant (Tx) recipients in Turkey. We also screened dialysis patients as a control group.

METHODS

All Tx and dialysis patients were screened regardless of the presence of a primary disease. We measured the AGALA activity in all male patients as initial analysis. Mutation analysis was performed in male patients with decreased AGALA activity and in female patients as the initial diagnostic assay.

RESULTS

We screened 5,657 patients. A total of 17 mutations were identified. No significant difference was observed between the groups regarding the prevalence of patients with mutation. We found FD even in patients with presumed primary kidney diseases. Seventy-one relatives were analyzed and mutation was detected in 43 of them. We detected a patient with a new, unknown mutation (p.Cys223) in the GLA gene.

CONCLUSIONS

There are important implications of the screening. First, detection of the undiagnosed patients leads to starting appropriate therapies for these patients. Second, the transmission of the disease to future generations may be prevented by prenatal screening after appropriate genetic counseling. In conclusion, we suggest screening of kidney Tx candidates for FD, regardless of etiologies of chronic kidney disease.

Glomerulonephritis associating parvovirus B19 infection

We report a previously healthy, immunocompetent 17-year-old male patient, who developed acute glomerulonephritis during the course of Parvovirus B19 infection and this acute glomerulonephritis did not resolve spontaneously. His renal biopsy showed mild mesangial proliferation and focal segmental sclerosis. Parvovirus B19 DNA was detected in renal tissue by polymerase chain reaction.

The relationship between asymptomatic organ damage, and serum soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and Interleukin-17A (IL-17A) levels in non-diabetic hypertensive patients

Background

This study aimed to measure the serum soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and interleukin-17A (IL-17A) levels in hypertensive patients with/without asymptomatic organ damage (AOD), as well as to determine the relationship between the serum sTWEAK and IL17-A levels, and carotid intima media thickness (CIMT), proteinuria, retinopathy, and the left ventricle mass index (LVMI).

Methods

The study included 159 patients diagnosed with and followed-up for primary hypertension (HT); 79 of the patients had AOD (61 female and 18 male) and 80 did not (52 female and 28 male). sTWEAK and IL-17A levels were measured in all patients.

Results

The sTWEAK level was significantly lower in the patients with AOD than in those without AOD (858.4 pg/mL vs. 1151.58 pg/mL, P = 0.001). The sTWEAK level was negatively correlated with the mean microalbuminuria level and LVMI. The median IL-17A level was significantly higher in the patients with AOD than in those without AOD (2.34 pg/mL vs. 1.80 pg/mL, P = 0.001). There was a positive correlation between mean IL-17A level, and mean microalbuminuria level, CIMT, and LVMI. Multivariate logistic regression analysis showed that patient age, sTWEAK level, and mean 24-h systolic blood pressure were predictors of AOD.

Conclusions

The sTWEAK level was lower and IL-17A level was higher in the patients with AOD. It remains unknown if sTWEAK and IL-17A play a role in the pathophysiology of AOD. Prospective observational studies are needed to determine the precise role of sTWEAK and IL-17A in the development of target organ damage.

Are increased oxidative stress and asymmetric dimethylarginine levels associated with masked hypertension?

OBJECTIVE

In this study, our aim was to determine total oxidative stress and asymmetric dimethylarginine (ADMA) levels in patients with masked hypertension (MHT) and to examine their association with blood pressure.

METHODS

Fifty patients diagnosed with MHT and 48 healthy volunteers without any known chronic diseases have been included in this study.

RESULTS

When compared to the control group, patients with MHT had higher levels of mean ADMA (p < 0.001), total oxidant status (TOS) (p < 0.001), and oxidative stress index (OSI) (p < 0.001), and a lower mean total antioxidant status (TAS) (p < 0.001) level. While a positive correlation was determined between the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with ADMA, TOS, and OSI levels, a negative correlation was determined with the TAS level. During the stepwise multivariable logistic regression analysis, age (OR = 1.221; p = 0.003), body mass index (OR = 1.512; p = 0.005), low density lipoprotein (OR = 0.925; p = 0.016), ADMA (OR = 1.200; p = 0.002), and OSI (OR = 3.750; p = 0.002) levels were determined to be the predictors of MHT. During the linear regression analysis, it was determined that the independent risk factors of SBP and DBP are ADMA and OSI, and the independent risk factor of TOS, OSI, and ADMA is SBP. Our study found out that oxidative stress and ADMA levels of patients with MHT are higher than those of the control group. ADMA and OSI were determined to be predictors of MHT.

CONCLUSION

Based on these results, it could be said that oxidative stress, and therefore the ADMA level, could have an effect on the etiopathogenesis of MHT.

Focal segmental glomerulosclerosis associating Kimura disease

Kimura disease presents as a benign subcutaneous mass. Although it principally affects the skin and soft tissues, there is a high prevalence of related renal disease. We report a case of Kimura disease from western Asia, presenting itself as nephrotic syndrome, and this case was seen at a nontransplant kidney presenting with focal segmental glomerulonephritis.

The role of platelet activation in determining response to therapy in patients with primary nephrotic syndrome

To test the role of platelet activation in the prognosis of nephrotic syndrome (NS), we evaluated the mean platelet volume (MPV) in patients with NS undergoing treatment. In this prospective, multicenter clinical study 156 patients with primary NS under treatment were assigned and followed for one year. Patients were divided into three groups for complete remission, partial remission, and resistance. Biochemical parameters, estimated glomerular filtration rate, proteinuria level, and MPV levels were compared at baseline and 12 months after treatment. MPV, proteinuria, total cholesterol, triglyceride, LDL cholesterol, HDL cholesterol, total protein, albumin, and hs-CRP levels significantly decreased in partial and complete remission group after 12 months compared to the baseline (p < 0.05). However, MPV levels significantly increased and only LDL cholesterol significantly decreased in the resistance group (p < 0.05). Univariate analyses demonstrated that ΔMPV was significantly associated with Δproteinuria (r = 0.41, p < 0.001), Δhs-CRP (r = 0.39, p < 0.001), and ΔAlbumin (r = -0.30, p < 0.001). We found that ΔAlbumin (β = -0.33, p < 0.001), ΔTotal cholesterol (β = -0.20, p = 0.011), and Δhs-CRP (β = 0.19, p = 0.018) were statistically significant predictors of the Δproteinuria in multiple regression analysis. In subjects with primary NS, MPV is associated with the prognosis or the disease. This study provides the background for longer trials and the role of platelet activation in NS.

Aspiration of nasal secretions into the lungs in patients with acute sinonasal infections

OBJECTIVES

To compare the amounts of nasal secretions aspirated into the lower airway by patients with acute sinonasal infection with that aspirated by healthy adults during sleep.

STUDY DESIGN

Sixteen patients who had received a diagnosis of acute sinonasal infections by accurate history, anterior rhinoscopic examination, and radiological assessment and 13 healthy volunteers, aged 14 to 45 years.

METHODS

A 10-mCi dose of technetium 99m-labeled macroaggregated albumin (Tc-99m MAA) with a concentration of 1 mCi/mL was prepared at midnight, just before sleep. Each subject was administered two puffs of this spray. At 8 AM the next morning transmission and emission views of the thorax were taken with a gamma camera.

RESULTS

No significant difference between the two groups was observed in the amounts of nasal secretions aspirated into the lungs.

CONCLUSIONS

The amount of nasal secretions aspirated does not increase during acute sinonasal infection. However, by irritating the mucosa of the lower respiratory tracts, bacteria, toxins, and inflammatory products existing in purulent secretions may play a major role in the pathophysiology of asthma and sinusitis.

Unusual presentation of tuberculosis as a splenic mass

Tuberculosis is an important health problem in developing countries, with varying clinical presentations depending on the organs/systems involved. Tuberculosis is mostly seen in immuno-compromised individuals, such as those with acquired immune deficiency syndrome or malignancies. Here we report a case of a spleen tuberculoma in a 29-year-old male patient with no known immune deficiency. He first presented with abdominal pain, and subsequent ultrasonographic examination revealed a splenic lesion of 10 cm in diameter. A computerized tomography scan of the abdomen confirmed the presence of a solitary, hypodense, septated cystic lesion. Lack of evidence supporting the presence of a splenic infection or a primary/metastatic malignancy prompted explorative surgery where a septated abscess formation was discovered and splenectomy was performed. Histopathological examination revealed granulomatous inflammatory changes with Langerhans-type giant cells, which are consistent with tuberculosis. For a period of two months, antituberculosis therapy with four drugs, isoniazid, rifampicin, pyrazinamide, and ethambutol, was carried out. Pyrazinamide and ethambutol were quitted at the end of two months. Therapy with isoniazid and rifampicin was planned for an additional 10 months. We would like to call attention to yet another atypical presentation of extrapulmonary tuberculosis.

A case report on allergic rash caused by icodextrin

Icodextrin may be used as an alternative to glucose as the osmotic agent in peritoneal dialysis with ultrafiltration failure. In general, icodextrin is known to be safe and well tolerated, but it can also cause hypersensitivity reactions such as skin rashes. Allergic rashes are generally defined as erythematous, itchy and maculopapular, visible over the trunk and the extremities. When a rash occurs, it generally develops early in therapy, is self-limited, and resolves without sequelae after the discontinuation of icodextrin. Although the safety and efficacy of icodextrin peritoneal dialysis solution is well documented, clinicians should be aware of the possibility of severe adverse cutaneous reactions to it. We report the case of a 23-year-old female who developed a skin rash following the use of icodextrin.