scholarly journals Empiric Determination of the Daily Glucocorticoid Replacement Dose in Adrenal Insufficiency

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Celina M Caetano ◽  
Aleksandra Sliwinska ◽  
Parvathy Madhavan ◽  
James Grady ◽  
Carl D Malchoff
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Adrenal Insufficiency ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Cortisol Secretion ◽  
Endocrine Society ◽  
The Mean ◽  
Multiple Morbidities

Abstract Background For the treatment of adrenal insufficiency (AI) in adults, the Endocrine Society’s recommended daily glucocorticoid replacement dose (DGRD) is 15 to 25 mg hydrocortisone (HC), which is approximately 1.7 times the reported mean daily cortisol production rate. Prolonged glucocorticoid overtreatment causes multiple morbidities. Hypothesis We tested the hypotheses that the DGRD, empirically determined by individual patient titration, is lower than that of the Endocrine Society guidelines and tolerated without evidence of glucocorticoid under-replacement. Methods We empirically determined the DGRD in 25 otherwise healthy adults with AI by titrating the DGRD to the lowest dose tolerated as judged by body mass index, blood pressure, serum sodium concentration and AI symptoms. Patients received either HC or prednisone (PRED). The HC equivalent of PRED was assumed to be 4:1. Results The mean empirically determined DGRD, expressed as HC equivalent, was significantly less than the midpoint of the Endocrine Society’s recommended DGRD (7.6 ± 3.5 mg/m2 vs 11.8 mg/m2; P < 0.001). The DGRD in the adrenalectomy group was not significantly different than the DGRD of those with other AI causes (7.9 ± 4.0 mg/m2 vs 7.3 ± 3.1 mg/m2; P = ns), demonstrating that the empirically determined DGRD was not biased by residual cortisol secretion. There was no evidence of glucocorticoid under-replacement as determined by measured biometrics and AI symptoms. Conclusions We conclude that an empirically determined DGRD is significantly lower than that of the Endocrine Society guidelines and tolerated without evidence of glucocorticoid under-replacement.

scholarly journals Longitudinal prospective observational type study about determinants of renal resistive index variations in chronic renal failure patients treated with conventional medical and dietetic therapy

2017 ◽  
Vol 89 (4) ◽  
pp. 305
Author(s):  
Simone Brardi ◽  
Gabriele Cevenini ◽  
Vanni Giovannelli ◽  
Giuseppe Romano
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Doppler Ultrasonography ◽  
Urinary Albumin Excretion ◽  
Resistive Index ◽  
Renal Resistive Index ◽  
The Mean ◽  
Renal Doppler Ultrasonography ◽  
Renal Doppler

Objective: This longitudinal prospective observational type study was conceived with the aim to examine the impact on renal resistive index (RRI) of the variables that we can manipulate with therapeutic and or dietetic interventions in a chronic kidney disease population in order to known which of these variables was statistically related to changes in RRI and therefore could become the object of the greatest therapeutic effort. Material and methods: This study was undertaken between May 2016 to May 2017 in the outpatient nephrology and urology clinic of San Donato Hospital in Arezzo. The study population (84 patients: 47 males and 37 females) was randomly selected among the chronic kidney patients (with various degrees of renal impairment) affected by hypertension and or diabetes mellitus. After a comprehensive medical examination these patients were submitted to determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and finally renal Doppler ultrasonography. Then the patients were submitted to a full therapeutic and dietetic intervention to ameliorate the renal impairment by a wide range of actions and after on average a one-year interval were submitted again to a new medical examination and a second determination of serum creatinine, glycated hemoglobin, 24-hour urinary albumin excretion and a new renal Doppler ultrasonography too. Results: The comparison between basal and final data revealed a slight reduction in the mean of bilateral renal resistance indices (Delta RRI: -0.0182 ± 0.08), associated to a slight increase in the mean glomerular filtration rate (Delta GFR: 0.8738 ± 10.95 ml/min/1.73 m2), a reduction in mean body weight (Delta weight: -1.9548 ± 5.26 Kg) and mean BMI (Delta BMI: -0.7643 ± 2.10 Kg/m2) as well as a reduction in the mean systolic blood pressure (Delta systolic blood pressure: -8.8333 ± 25.19 mmHg). Statistical analysis showed statistically significant correlations (p < 0.05) between Delta RRI and Delta weight (p < 0.03), Delta BMI (p < 0.02) and Delta systolic blood pressure (p < 0.05). Conclusion: Despite the many limitations the our study clearly identifies the targets (yet widely known) to act on to prevent kidney alterations related to RRI and provides further evidence, if any, of the utility of RRI as a key parameter in monitoring patients with chronic renal failure and as a valuable tool to drive the clinical efforts to contrast the kidney disease.

scholarly journals Assessment of the Non-Cystic Fibrosis Bronchiectasis Severity: The FACED Score vs the Bronchiectasis Severity Index

2015 ◽  
Vol 9 (1) ◽  
pp. 46-51 ◽  
Author(s):  
J Minov ◽  
J Karadzinska-Bislimovska ◽  
K Vasilevska ◽  
S Stoleski ◽  
D Mijakoski
Keyword(s):  
Body Mass Index ◽  
Cystic Fibrosis ◽  
Clinical Practice ◽  
Observational Study ◽  
Body Mass ◽  
Severity Index ◽  
Sufficient Power ◽  
Chronic Colonization ◽  
The Mean

Introduction : Non-cystic fibrosis bronchiectasis (NCFB) is a multidimensional disease, and no single isolated parameter is proved to have sufficient power for any overall determination of its severity and prognosis. Objective : To compare the results of the assessment of the NCFB severity with respect to its prognosis in the same patients by two different validated scores, i.e. the FACED score and the Bronchiectasis Severity Index (BSI). Methods : An observational study including 37 patients with NCFB (16 males and 21 female aged 46 to 76 years) was performed. All patients underwent evaluation of the variables incorporated in the FACED score (FEV1 % predicted, age, chronic colonization by Pseudomaonas aeruginosa, radiological extent of the disease, and dyspnea) and in the BSI (age, body mass index, FEV1 % predicted, hospitalization and exacerbations in previous year, dyspnea, chronic colonization by Pseudomaonas aeruginosa and other microrganisms, and radiological extent of the disease). Results : According to the value of the derived overall FACED score we found 17 patients (45.9%) with mild bronchiectasis, 14 patients (37.8%) with moderate bronchiectasis and 6 patients (16.2%) with severe bronchiectasis. The mean derived FACED score was 3.4 ± 1.3. In addition, according to the value of the derived overall BSI score, the frequency of patients with low, intermediate and high BSI score was 16 patients (43,2%), 14 patients (37.8%) and 7 patients (18.9%), respectively. The mean derived BSI score was 6.4 ± 2.5. Conclusion : We found similar results by the assessment of the NCFB severity in regard to its prognosis by both the FACED score and the BSI. Further studies determining how these scores may impact clinical practice are needed.

scholarly journals DETERMINATION OF IODINE CONCENTRATION AND DISTRIBUTION IN RAT THYROID FOLLICLES BY ELECTRON-PROBE MICROANALYSIS

1969 ◽  
Vol 43 (1) ◽  
pp. 115-121 ◽  
Author(s):  
William L. Robison ◽  
David Davis
Keyword(s):  
Sample Preparation ◽  
Electron Probe Microanalysis ◽  
Electron Probe ◽  
Freeze Drying ◽  
Iodine Concentration ◽  
Sodium Concentration ◽  
Thyroid Glands ◽  
The Mean ◽  
Rat Thyroid

The concentration and the distribution of iodine in various sized follicles of rat thyroid glands have been analyzed by electron-probe microanalysis. The results of the iodine analysis were grouped according to uncorrected lumen diameter size. No significant differences in iodine concentration were observed among the various size categories. When the results for all follicles from a given sample were pooled, the standard error of the mean was approximately 4%. Usually 40–50 follicles per animal were analyzed. The concentration of iodine ranged from 0.9 to 2.1% by weight among individual animals. Scanning pictures and step-scan analysis showed the iodine distribution to be quite uniform across the colloid area. Several techniques of sample preparation were used; they produced no significant differences in the iodine concentrations observed. Sodium concentration, also determined in all samples, was found to vary from 2 to 9% by weight. Because of the mobility of the sodium ion, its distribution was greatly affected by the method of sample preparation. The technique that best preserved the natural chemistry of the sample was that of freezing the tissue, sectioning, and then freeze-drying.

Redefinition of the Normal Range for Serum Sodium

1968 ◽  
Vol 14 (2) ◽  
pp. 172-178 ◽  
Author(s):  
R B Payne ◽  
M J Levell
Keyword(s):  
Serum Sodium ◽  
Normal Subjects ◽  
Sodium Concentration ◽  
Normal Serum ◽  
Hospital Environment ◽  
Serum Urea ◽  
Water Metabolism ◽  
Normal Range ◽  
The Mean ◽  
A Prospective Study

Abstract The serum sodium concentrations of three groups of patients selected from laboratory records and of one group of outpatients selected for a prospective study were examined. The mean serum sodium concentration of inpatients with normal serum urea concentrations was 8.5 mEq./ L. lower than that of a group of healthy normal subjects. Part of this difference (2.6 mEq./L.) could be attributed to a nonspecific effect of illness. It was not possible to demonstrate any effect due to the hospital environment, but the results do not exclude the possibility of such an effect. It was concluded that all or most of the remaining difference was due to weighting of the inpatient data by low values of pathologic significance; the proportion of these low values was too great to allow a normal range to be extracted from the data by statistical methods. The concept of the normal range is discussed. It is suggested that two ranges are required for serum sodium, a normal range (137-147 mEq./L. in this laboratory) to make assertions about alterations in specific diseases, and a range derived from patients likely to have no manifest disturbances of salt and water metabolism (135-144 mEq./ L.) to detect such disturbances.

scholarly journals P1051WHICH MODEL OF DIALYSATE SODIUM PRESCRIPTION TO CHOOSE?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Natasha Eftimovska-Otovikj ◽  
Natasha Petkovikj ◽  
Elizabeta Poposka ◽  
Olivera Stojceva-Taneva
Keyword(s):  
Blood Pressure ◽  
Serum Sodium ◽  
Sodium Concentration ◽  
Serum Sodium Concentration ◽  
Sodium Balance ◽  
Hypertensive Patients ◽  
Interdialytic Weight Gain ◽  
Sodium Gradient ◽  
Set Up ◽  
Dialysate Sodium

Abstract Background and Aims The dialysate sodium prescription remain unclear as an important component of sodium balance in HD patients Pre-hemodialysis (pre-HD) serum sodium levels can vary among different patients, therefore, a single dialysate sodium prescription may not be appropriate for all patients. Dialysate sodium is one of the most easy changeable parameter which can influence hemodynamic stability. The aim of the study was to investigate whether dialysis patients will have some beneficial effects of prescription of different models of dialysate sodium Method 77 nondiabetic subjects (41 men; 36 women) performed 12 months hemodialysis (HD) sessions with dialysate sodium concentration set up at 138 mmol/L, followed by additional 3 models of dialysate sodium (each model performed 2 months sessions with 2 months standard dialysate sodium between each model) wherein dialysate sodium was set up: model 1: according to pre-HD serum sodium concentration, model 2: according to sodium concentration in UF fluid, model 3: sodium profiling ( from 144 to 136 mmol/L). Blood pressure (BP), interdialytic weight gain (IDWG), thirst score, sodium gradient were analysed. After the standard dialysate sodium hemodialyses, the subjects were divided into 3 groups: normotensive (N=58), hypertensive (N= 14) and hypotensive (N=5) based on the average pre-HD systolic BP during the standard dialysate sodium hemodialyses. Results Model 1: resulted in significantly lower blood pressure (133,61±11.88 versus 153.60±14.26 mmHg; p=0.000) and IDWG (2.21±0.93 versus 1.87±0.92 kg; p=0.018) in hypertensive patients, whereas normotensive patients showed only significant decrease in IDWG (2.21±0.72 versus 2.06±0.65, p=0,004). Hypertensive patients had significant highest sodium gradient compared to other patients (p&lt;0.05), followed by significant increase of 0,6% IDWG confirmed with univariate regression analysis. Thirst score was significantly lower in all patients with individualized-sodium HD and the use of antihypertensive drugs significantly reduced in hypertensive patients during the individualized phase. Model 2: resulted in significantly lower BP in normotensive and hypertensive patients (126.92±9.71 versus 124.08±8.71 mmHg; p=0.000; 153.60±14.26 versus 138.91±8.48 mmHg, accordingly), with no influence on IDWG, thirst score compared to standard dialysate sodium. Model 3: significantly higher BP and IDWG in all 3 groups (normotensive 126.92±9.71 versus 130.20±9.5 mmHg; p=0.001; IDWG 2.21±0.72 versus 2.34±0.82 kg, p=0,005; hypertensive 153.60±14.26 versus 157.58±5.0 mmHg; IDWG 2.21±0.93 versus 2.39±0.74 kg; p=0.005; hipotensive 79.81±11.78 versus 91.09±24.98 mmHg, IDWG 2.53±0.57 versus 2.73±0.15 kg, p=0.005) and significantly higher thirst score in normotensive and hypotensive patients, with no influence in hypertensive patients. Conclusion A reduction of the dialysate sodium concentration based on the pre HD serum sodium level of the patient, reduced the BP, IDWG, thirst score and use of antihypertensive drug compare to dialysate sodium according to sodium concentration in UF or sodium profiling. We recommend prescription of dialysate sodium according to pre HD serum sodium concentration.

scholarly journals Lack of Association between NYD-SP18 Variant and Obesity. The Health Alcohol and Psychosocial Factors in Eastern Europe Study

2016 ◽  
Vol 68 (4) ◽  
pp. 244-248 ◽  
Author(s):  
Jaroslav A. Hubacek ◽  
Hynek Pikhart ◽  
Ruzena Kubinova ◽  
Anne Peasey ◽  
Sofia Malyutina ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Mass Index ◽  
Eastern Europe ◽  
Psychosocial Factors ◽  
Important Determinant ◽  
Population Sample ◽  
Fat Intake ◽  
The Czech Republic ◽  
The Mean

Aim: To replicate the finding that the polymorphism rs6971091 within the NYD-SP18 gene is associated with body mass index (BMI). Method: We analysed data of 29,284 adults (46.2% of males, mean age 58.9 (SD 7.3), mean BMI 28.6 (5.0 kg/m2)) examined within the Health Alcohol and Psychosocial Factors in Eastern Europe study in the Czech Republic, Poland, Lithuania and Russia. Results: BMI did not differ by rs6971091 genotype. In men, the mean BMI (SEs) in GG, GA and AA carriers were 27.8 (0.05), 27.9 (0.06) and 27.9 (0.14) kg/m2, respectively, (p = 0.26); in women, the corresponding values were 29.2 (0.06), 29.1 (0.07) and 29.1 (0.16), p = 0.57. In Czech subjects (n = 6,752), for whom the FTO rs17817449 genotype was available, there was no interaction between the NYD-SP18 and FTO polymorphisms in determination of BMI. Adjustment for age, energy and fat intake and physical activity did not materially change the results. There was no association of the NYD-SP18 genotype with waist-hip ratio. Conclusion: This study in a large Slavonic population sample suggests that the rs6971091 variant within the NYD-SP18 gene is not an important determinant of obesity in middle-aged persons.

scholarly journals Association Between Body Mass Index and Blood Pressure Among Medical Students of Tertiary Care Teaching Hospital in Birgunj

2021 ◽  
Vol 6 (2) ◽  
pp. 1535-1539
Author(s):  
Esha Shrestha ◽  
Shreesh Shrestha ◽  
Prashanna Shrestha ◽  
Nirjala Laxmi Madhikarmi
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Medical Students ◽  
Body Mass ◽  
Tertiary Care ◽  
Mean Value ◽  
Overweight And Obesity ◽  
World Health ◽  
The Mean ◽  
Health Organization

Introduction: Body mass index is an important parameter associated with a variety of disease processes. The risk of hypertension and cardiovascular diseases increases with an increase in body mass index. The study was conducted to compare the relationship between body mass index and blood pressure. Objective: To evaluate the prevalence and correlate the Obesity and Hypertension in    medical students  Methodology: The study was conducted in 200 students (113 males and 87 females). Height, weight and blood pressure were recorded from all participants and body mass index was calculated. The recorded body mass index was utilized to divide the student into underweight, normal, over weight and obese category according to the World Health organization body mass index classification. Hypertension was determined from the measure of blood pressure. Then comparison of blood pressure with body mass index was made. Results: Among 200 students 6% were obese, 22% were overweight, 65% were normal and 7% underweight. The mean height was 163cm and mean weight 60.48kg. The mean value of systolic blood pressure (105.85, 115.45, 134.95, 137.16 mmHg) and diastolic blood pressure (70.14, 76.15, 90.72, 93.33 mmHg) increased with increasing body mass index. Conclusion: Overweight and obesity increases the risk of hypertension among students.

scholarly journals Biochemical Assessment of Some Trace Elements in Hypertensive Patients

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Oloruntoba A. Ekun ◽  
Isiaq T. Salau ◽  
Nora C. Madu
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Trace Elements ◽  
Body Mass ◽  
Kidney Diseases ◽  
Elevated Serum ◽  
Effective Management ◽  
Blood Samples ◽  
Significant Difference ◽  
The Mean

Background: Hypertension is a chronic disease that has been recognized as an important global public health disorder. It is a leading risk factor for stroke, heart failure, kidney diseases, and sudden death; as such its effective management may go a long way in preventing some of these possible complications. In humans, trace elements play key roles in normal metabolic activities that are required for healthy living. It has been hypothesized that trace elements are key to normal heart functions. Thus, deficiency in one or more trace elements may result(s) in or accentuate heart disease(s). This study, therefore, assessed trace elements in hypertensive and control volunteers. Methods: A total number of two hundred and fifty-six(256) participants comprising of one hundred and sixtynine (169) hypertensive and eighty-seven (87) normotensive control volunteers participated in this study. Anthropometric data and blood samples were collected from all participants. The blood samples were collected into plain vacutainer and were allowed to clot. The samples were centrifuged and the serum from each sample was aspirated and analyzed for trace elements {Selenium (Se), Copper (Cu), Zinc (Zn), Iron (Fe)} using atomic absorption spectrophotometer and calcium using Cobas C-111. Results: There was no significant difference (p>0.05) between the mean age and weight of the participants. However, the mean body mass index (BMI), systolic, and diastolic blood pressure in hypertensive volunteers were significantly higher (p<0.05) than the controls. The mean Cu and Fe were higher (p<0.05) in hypertensive volunteers whereas the mean Zn, Se, and calcium were not different (p>0.05) between the two groups that participated in this study. There were positive associations between body mass index, systolic blood pressure (p<0.05), and Cu whereas negative correlations existed between body mass index, Zn, and Se, among hypertensive volunteers. Conclusion: From this study, it appears that high blood pressure among Nigerian population is associated with elevated serum copper (Cu) and iron (Fe) trace elements. These may play a part in accentuation of hypertension in some of the volunteers if not properly monitored. Also hypertensive individuals also presented an increased body mass index (BMI) which could also complicate effective management of hypertension .

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