Augusto Octavio Salinas Meneses
Cardiovascular mortality is the leading cause of death in patients with chronic kidney disease and is markedly higher than in the general population when stratified by age, race, and gender. However, a portion of cardiovascular disease (CVD) in the ESRD population cannot be explained by these and other traditional risk factors alone. Defects in mineral metabolism, particularly hyperphosphatemia and secondary hyperparathyroidism, increase the risk of CVD in patients on dialysis. The burden of vascular calcification in the dialysis population is reflected by the higher prevalence and severity of coronary artery calcification when compared to age-matched healthy controls. In addition to abnormalities in serum calcium and phosphorus, risk factors for the development for vascular calcifications also include increased age, longer duration of dialysis, inflammation, hypertension, dyslipidemia, and calcium-based phosphate binders. The process of vascular calcification is a complex process, and attributing the pathogenesis to the precipitation of calcium and phosphate in the walls of arteries oversimplifies the problem. Inflammation, uremia, hyperphosphatemia, hypertension, hyperlipidemia, and hypercalcemia, all could be expected to play a role in this process. Interestingly, some dialysis patients, despite the uremic environment and hyperphosphatemia, do not develop vascular calcifications. Reducing the risk of vascular calcifications has been aimed at controlling serum phosphorus, calcium, and PTH. As with calciphylaxis, in severe cases of coronary and peripheral vascular disease, parathyroidectomy may be indicated and can lower the rate of long-term mortality associated with secondary hyperparathyroidism. Before that, traditional control of serum phosphorus, however, may have the biggest impact in reducing the risk of progression of extraosseous calcification. Use of calcium-based phosphate binders and the nonabsorbable polimer sevelamer both have roles in controlling serum phosphorus; however, the calcium load imposed by high doses of calcium salts may increase the risk of vascular calcification.
Ali Reza Khoshdel
Background: Renal Failure, even at an early stage, increases the risk of developing and exacerbating cardiovascular (CV) disease. The corollary of that observation should be that CV disease would not only increase the risk of renal function deterioration, but also cause renal damage, a concept not previously proposed. Aim: Evaluate renal function after follow-up in different levels of hemodynamic response to exercise stress test, as an index of CV function. Method: The hemodynamic response to a graded exercise stress test was measured in 70 candidates to evaluate the association of heart rate and blood pressure change (â??HR and â?? SBP), heart rate reserve (HRR), chronotropic incompetence (% in achievement of maximal predicted heart rate-%MPHR), and circulatory power (CirP) with the development of severe renal failure (eGFR<30) during a 123 (33-179) month follow-up period. Results: Survival analysis methods demonstrated that the probability of severe renal failure development was greater in subjects with lower levels of â??HR, HRR, %MPHR and CirP (Log-rank test, P=0.002, 0.01, 0.02, 0.008 respectively). These effects remained significant after multivariate adjustment for age, resting pulse pressure (rPP), hypertension, diabetes and exercise test result using a cox-proportional hazard analysis (Hazard Ratio= 5.9, 2.9, 3.3, 2.9, respectively; all P<0.05). Having an rPP ≥60 was accompanied by 7.4 (95% CI: 1.8-30.9) times greater risk of developing severe renal failure, independent of age and resting SBP (P=0.006). However the data did not show a significant association between â?? SBP and development of severe renal failure. Conclusion: The hemodynamic responses to a standard graded exercise stress test independently predicted the development of severe renal failure. While rPP, an indirect measure of arterial compliance, was a strong predictor for developing severe renal impairment, arterial stiffness may also be a factor linking ventricular and kidney function. The results also suggest that the early diagnosis of kidney disease should include a CV assessment and vice versa
Abdulmonim A Alqasim
Diabetic nephropathy (DN) develops in patients with diabetes mellitus (DM) and has become the leading cause of end- stage renal disease. Early identification and subsequent renoprotective treatment are of utmost importance. Renin- angiotensin-aldosterone system (RAAS) has a key role in the pathogenesis of DN. The aim of this study is to compare the efficacy of the anti-angiotensinic drugs; ramipril and irbesartan on the vascular protection of kidneys of Streptozotocin (STZ)- induced diabetic rats (DR). 110 male albino rats were divided into 7 main groups. Group 1 (10 untreated rats) was used as a control. Group 2 (10 rats) was injected intra-peritoneally (i.p) with STZ to induce DM. Group 3 (10 rats) was controlled by insulin after induction of DM with STZ. Groups 4 to 7 consisted of 20 rats, each of which was injected i.p. with STZ and further subdivided into 2 subgroups that received either low or high dose of ramipril or irbesartan with or without insulin. Two months post treatment, rat tail blood samples were collected to measure: fasting blood sugar, HbA1c, Total and free serum proteins (Albumin and Globulin) and lipid profiles. Urine samples were collected to measure Albuminuria. Kidneys were isolated for histopathological study to confirm any biochemical findings. Biochemically, both ramipril and irbesartan lowered albumin concentration in urine samples of DR especially in high doses. However, histopathological examination of the kidneys failed to demonstrate beneficial response of low and high doses of both drugs. Only lowering of blood glucose by insulin together with either drug in DR has beneficial effects biochemically and histopathologically, especially in high doses. Low and high dose irbesartan seems to be more renoprotective as compared to ramipril. The other biochemical parameters showed negligible response to both drugs. In conclusion, low dose irbesartan and high doses of both drugs have renoprotective effect in DR treated with insulin
Ashish Verma
India lags behind in the world average rate of the deceased donor per million. India with a population of 1.2 billion has a renal transplantation rate of 3.25 per million population, which is very low when compared to countries such as Spain, United states of America, Portugal and Thailand. There is a huge burden of morbid disease like diabetes and hypertension in India. The crude and age adjusted incidence rates of end stage renal diseases are estimated to be 151 and 232 per million populations in India. In case of ESRD the only hope for the patient is organ transplantation. This is because the survival rate of the patients after reaching ESRD beyond 3 months is <10%. This signifies how important organ transplantation is in today?s scenario in India. Number of deceased donor per million populations per year for USA, UK, Thialand and India are 21, 15, 1, and 0.12 respectively. Why there was a need for a model for transplantation because due to imbalance between supply and demand, commercialization of the organs increased in various parts of India. This has led to formation of a model for deceased donor transplantation by Tamil Nadu government in clamping down the commercialization of live organ transplantation and promotion of the deceased donor transplantation. The government of India promulgated the transplantation of Human organ Act in 1994 after which deceased donor transplantation initiated. In 2007, Tamil Nadu government decided to make policies and new frameworks to form a model. Deceased donor transplantation is well suited to the main source for organ transplantation requirements. It can save lives and eliminate commercialization, without any moral compulsion on near relative to donate organ and would benefit rich and poor. The structure of this model is comprised of anchor, called the convenor. The convenors role is to maintain a list of recipients awaiting transplantation and allocate organs, call meetings of the advisory committee, collect data on transplantation and take up generation awareness programme. To maintain the transparency of the programme, all the allocation and prioritization of the organs is done under the norms of government orders given by the ministry of family and welfare. Tamil Nadu Cadaver transplant programme facilitated the retrieval of 2460 organ and tissues from 445 donors from October 2008 to 31 January 2014. Out of total organs 814 kidneys were retrieved from 445 donors. It is ten times as compared to the rate of whole country. The deceased donor transplantation programme is successful in Tamil Nadu because this programme is the outcome of a collaborative effort between state government, private sectors and NGOS, the Tamil Nadu model can be a good example for spreading awareness of organ donation in other states of India and other developing countries that can follow this model to eliminate commercialization
A Guerraoui
Purpose: Noncompliance (NC) is not always intentional. The medical team, in the absence of objective evidence, rarely takes into account the non-intentional NC linked to the difficulty of taking drugs regularly and feelings of the patient, unless objective evidence is present. Better understanding of the triggers and determinants of NC would allow elaboration of educational tools designed to help out chronic patients with their treatment. Methods: 340 hemodialysis patients in 9 centers in three areas in France were included on a voluntary basis in this descriptive study. Among them, 10 patients responded to a qualitative interview focused on individual beliefs, attitudes and motivations towards phosphate binders? therapy. 26% of patients attended an educational program. Statistical methods consist of frequencies analysis and Exploratory Factor Analysis to determine combination of factors which significantly influence the compliance to phosphate binders. The semi-structured interviews were analyzed according to qualitative content analysis. Results: 329 self-administered questionnaires (50 items) were analyzed, 297 were complete for analysis (mean age 61 years, 62% male, dialysis duration 4.5 years, number of medication 9 per day) . The majority of patients consider treatment as important (80%). However, they mostly relativize the treatment as vital (45%). Factor analysis helped to identify two kind of independent behaviors: those which indicate concerns for the treatment and those relative to the use of the treatment as a necessity. Age, level of education and gender influence these two factors. Older patients are more compliant. The higher the level of education the more frequently patients adapt the treatment. The swallowable tablets are preferred (75%). The shape and color has little influence on decision. 60% of the patients consider they received enough pre therapeutic information. The involvement into educational formation has a not high enough influence on adherence. Conclusion: In conclusion, this large study provides clues to better understanding of non-compliance to phosphate binder determinants. Based on these assumptions, educational program should be more efficient and fruitful to chronic dialyzed patients
????? ??????, ?????? ?. ?????, ?. ???????, ?. ???????, ???? ???????? ? ??????? ?.
???????????????????? ??????????? ?????????? ?? ???? ??? ???????????? ??????????? ?????????? ??? ?????????????? ???????. ???????????? ?????? ??? ???????????? ?????????? ??????????? ?? ?? ??????????? ??????????? ? ??????????????? ?????? ??????, ?? ????????????? ?????????? ??????????? ?? ????????? ??? ??????? ??????. ??????? ???? ????????? ?????????? ????? 1% ? ????????? ? ???????? ??????????. ???????????????????? ??????????? ?????????? ?? ???? ??? ???????????? ??????????? ?????????? ??? ?????????????? ???????. ???????????? ?????? ??? ???????????? ?????????? ??????????? ?? ?? ??????????? ??????????? ? ??????????????? ?????, ?? ????????????? ?????????? ??????????? ?? ????????? ??? ??????? ??????. ??????? ???? ????????? ?????????? ????? 1% ? ????????? ? ???????? ??????????. ????????? ? ??????: ?? ???????? ? 3 ??????? ????????? ? ?????????? ?????, ??????? ????? ????? ?????????????? ????? ???????????????????? ???????????. ???? ????? ?????? - ????????????????? ???????????, ???????????????, ????????????????? ? ??????????? ????????. ??????????: ??? ????? ???? ????????? ? ?????????? ?????, ???? ??????? ? ???? ??????, ? ???????? 49, 21 ? 65 ???, ?? ???????????. ???????????? ????? ? ????????? ???? ???????? ?? ??????, ???????????? ?????? ????????? ?????, ? ? ???? ?????? ????????? — ?? ????? ?????????????. ?????????? ? ???????????????????? ???????? ? ????????? ???? ???????????????? ????? ????????????????? ????????????, ??? ???????? ? ????????? ???????????, ??????? ??????????? ??????? ?????? ?????. ? ???? ?????? ????????? ???????? ???? ???? ???????? ?????????? ?????????, ???????, ??????????? ? ???? ???? ?????????, ??????? ???????? ?????? ?-???????, ????????? ? ????????????? ??? ???. ?????????? ????? ????? ??????????????? ? ???????????? ?????????? ?? 1,5 ?? 15 ???. ???????????: ??????? ????????????????????? ??????????? ???????????? ????? ????????????? ???????????? ??????, ??????? ????????? ???????? ???????? ????????? ? ??????? ???????????. ??? ??????????? ?????????? ?????????? ? ?????? ??? ???????. ? ????????? ????? ???????????? ????????? ?????????? ?? ???? ???????????????? ? ????????????????? ??? (???????? ??????????????????).
????-???????????? ???????????????????? ???????? (PTLD) - ??? ????????? ?????????, ????????? ? ????? ????-???????????? ???????????????. ???? ???????? ????????-???? (EBV) ? ???????????????? PTLD ??????????; ??? ?? ?????, ????????? PTLD ? EBV-????????????? ????????? ?? ???????? ????????????. ???????? ??????????? ? ?????????? PTLD ???????? ???????? ?????????????????? ????????. ??????????, ???????????? ????????????, ?????? ???? ????????? ? ???????????? ????? ??????????, ???????? ? ????????? ? ?????????? ???????? ??????????????? ? ??????????????? ?? ????? ??????? ????????? ????????? ???????????. ??????? ??????? ???????? ????????? ??? ?????????????? ??????????. ???????? ???????????? ???????? ??????????, ????????????, ??????????????? ?????????, ?????????????? ??????? ? ??????????????? ?????????. ??? ????? ???? ????????? ? ?????????? ?????, ???? ??????? ? ???? ??????, ? ???????? 49, 21 ? 65 ???, ????????. ???????????? ????? ????????? ???? ???????? ?? ??????, ????????????????? ??????, ? ???? ?????? ????????? — ?? ????? ?????????????.
?????? ????????????????????? ??????????? ? ????????? ??? ??????????????? ????? ????????????????? ????????????, ?????? ? ????????????? ???????????, ??????? ??????????? ??????? ?????? ?????. ??? 2 ?????? ????????? ???????? ????. ??? ????? ?????????? ???????????, ???????, ??????????? ? ???? 2 ?????????, ?????????? ???????? ?????? ?-???????, ????????? ? n ????????????? ??? ???. ?????????? ????? ????? ??????????????? ? ??????????? ?????????? ?? 1,5 ?? 15 ???. ??? ????????? ??? ???????? ???????????????????? ?????????, ????????? ?? ?????????????, ?????????????? ? ??????????. ???????? ???? ???????? ??????? ?? ??????????? ? ??????????? ??????? ???????? ????? ???????????? ??????????. ??? 21-??????? ???????? ?? ??????? ?????? ?? ???????????????????? ????????? R·-CHOP ? ???????-?????????????????? ??????????? ? ?????????? ???????? ???????. ??? 65-??????? ???????? ??????? ?? ?????? ??????????? ???? ?????? ? ??????????? ????????????????. ???????? ???? ??????????? ????? ??????? ????????. ???????????????????? ???????? ????? ?????????????? ????? ?????????? ?? ???????? ??????????????????? ???????? ????? ???????????????? ????????? (EBV), ?????????? ??????????????????? ????????????, ???????????? ??????????? ????? ? ????????? ???????? ?? ?????????? ?????????????????? ???????. ??????? ????????????????????? ??????????? ????????????? ????????????? ???????????? ??????, ??????? ????????? ???????? ???????? ????????? ? ??????? ???????????. ??? ??????????? ?????????? ?????????? ? ?????? ?? ???????. ???????????? ????????? ? ????????? ????? ?????????? ????????? ???????????????? ????? (???????? ????????? EBV ??? ?????????????? ?????????) ? ???????? ????? (???????? ?????????????????).
????? ??????
???????????: ???????? - ??? ????????? ?????????, ??????? ??????????? ??????? ????????? ????, ??????? ????? ???????? ? ??????????? ???????????????. ?????? ???????? ??????????????? (???) - ??? ????????? ??????????? ?????????, ????????? ?? ??????????, ??????? ????????? ? 15% -39% ???????. ???????????? ???????: ????? ???????? 14-?????? ??????? ??? ??????? ? ????????? ????????? ??????? ? ?????? ? ?????????? ????????? ????????. ?? ????????? ???? ????????????? ? ???? ???????? ???? ????? ???? ? ??????????? ??????? ????. ??-?? ?????????? ??????????????? ??????? ?? ??? ????????? ?? ?????????? ? ?????? ???????? ????????? ? ????? ???????? (? 32 ??/?? ?? 150 ??/??) ? ?????????? (?? 0,9 ??/?? ?? 6,2 ?/??). ???????? ?? ??? ??????, ? ???? ???????? ????????? ????????? ???????????????, ? ?? ????????? ?? ?????? ???? ?????????????. ??????: ??? — ??? ???????? ??????, ?????????? ??? ?????? ? ?? ?????????????. ???????????? ?????????? ?????????? ???????? ? ????, ?????????? ??????????? ? ???????????, ????????? ?? ???????????????? ???????? ?????????. ?????????? ???????????, ??? ???????, ??????????? ? ?????? ???????????? ???? ?????????. ?????: ?????????????????? ? ?????????? ?? ?????? ?????? ? ???????????. ????? ? ???????? ?????? ????? ?? ???? ????????? ??????, ????? ????????? ??????????????? ???????????????? ???? ? ???????????? ? ?????????????? ??? ?? ?????? ??????.
???????? ?????: ??????????, ?????? ???????? ???????????????, ???, ???????, ??????????. ???????? — ??? ??????? ???????, ??????? ??????????????? ??????? ????????? ????, ??????? ????? ????????? ? ??????????? ???????????????. ??????????? — Clostridium tetani, ?????? ??????????? ? ???????, ? ??? ????? ????? ????????? ? ???????? ????? ?????? ??? ????????, ??????? ??????. ??????? ????????? ???????????? ????????????? ? ???????????, ?????????? ?? ???????? ????????? ?????????, ??????????? ?? ??????????? ? ??????????? ??????? ??????????, ??????? ??????????? ????????????. ???????? ??????? ????????? — ???????? ????; ???????? ???????? 95,7% ?????????????? ?????????, ??? — 89,3%, ????????????/????????? — 73% ? ???????? — 38,9%. ??????????? ????? ??????? ????????? ? ????????? ????? ?????????? ? ????? ????; ???? ????? ?????????????? ?????????? ? ???? ?????? ????????? ? 14 ???, ? ????? 1 000 000 ??????? ? 1990 ???? ?? 33 000 ? 2017 ???? (????? ??????, 2019), ??????? ?????????? ? ????????? ??????? ??-???????? ?????????? 50–70%.
???????? ?? ??????????? ????????????? ???????????? ? ???????? ??????????? ?? ?????????, ??? ????????? ?????????? ???????? ????????? ????????? ??? ???????? ? ???????? ?????? ? ????????????? ?????????? ????? ? ?????? ? ??????? ??????? ?????????? ?????. ????? ?????? ????? ??????????, ??? ???????? ??????, ????? ?????? ????? ??????? ??????????????? ? ????????? ?????? ? ????????? ?????? ?????????, ??????? ?? ????????. ????? ???????? ??????????, ??? ? ?????????? ???????????. ???????????? ????????????? ??????????????? ??????????? (MoPH) ???????????? ????????? ????? ?????????? ????? ?????? ??????? ? ????????, ??????? ? ????????? (DPT) ?? 90%, ?????? 40 ?? 329 ???????? ?? ?????? ?????? ???????? ? ????? ??? ?????????? ?????? DPT3, ? 15%–25% ????????? ?? ????? ??????? ? ?????????? ??????????? ???????????. ?????????? ?????? ? ????????? ?????? ?????? ?????? ???????? ????????? ??????????? ?????? ??????????. ????? ???????? ????? ?? ???????? ?????? ??????????? ? ???????????? ?????????? ? ???????????; ? ????? ????????? ????????? ?????? ??????? ????????? ?????????? ??????, ?????????? ???????? ? ?????? ?? ????? ???????????? ? 2017 ????, ???????? ????? 36%, ? ??????? ????????, ?????????????? ?? ????????????? ??????, ???????? 53% ((MoPH) 2018). ?? ?????? ????????? ??????????? ??????????????? (???) ? ???????? ????? ??????????? ???????????? ????? (??????), ????????? ????? ?????? ??????? ???????? ???? ? ??????????? ? 2016 ???? ???????? 73%, ??? ?? 3% ????, ??? ? 2005 ????, ? ?? ????? ??? ????? ??????? ??????? ???????? ????? 65% (????????? ??????????? ??????????????? (???), 2018a, ????????? ??????????? ??????????????? (???), 2018b).
????????? ??????????? ??????? ????????? ? ??????????? ?????????? ??? ??????????? ???????????? ????????????, ???????????? ????? ???????? ???????? ???????? ???????????? ? ????????? ?????????-????????????? ???????? ???????????. ? ????? ??????, ??? ?? ?????? ??????? ???????? ??????? ??????????? ? ?????? ?????????? ???????, ??????? ??????? ?????? ????????????. ? ??????? ???????????? ?? ??????????? ????????? ?????????? 24 ??????? ?????????????????? ???????? ??????? ?????? ?? ????? ???????????, ??????? ????????? ?????????? ? ?????????????? ???? ?????????????? ???????. ?????????? ?????? ???? ?????? ?? ???????????? ??????? ??????, ??????? ????? ???????? ????????? ????? ???????? ??????????????? ? ?????????????, ???????? ???????? ? ????????????? ???????? ?????? ? ???????????. ????? ?????????? ??????????? ??????????? ? ?????????? ????????????? ??????? ????????? ?????? ? ???????? ?????????? ? ?????????????? ???? ?????????????? ???????. ???? ?????????? ??????????? ?????? 24 ? ????? ?????????, ?????????????? ?????? ??????, ?????????????????? ? ?????? ? ????? 2017 ???? ?? ??????? 2018 ???? ? ???????? ?????? ??????, ??????????. ??? ???????? ????????? ???????????: ? 18 ????????? (75%) ???? ???????, ?????? ???, ? 1 ??? ???, ?????????? ???????? ??????, ? 1 ??? ???????? ????????????? ???????? ????????; ? 4 ????????? ?? ???? ??????? ??? ??? ???. ???????? ???? ???????? ??????????? ?????????, ?? ???????? ???????? ?????? ??????????? ??????? ?? 12 ?????????, ??????? ??????????, ? 7 ???? ???????????? ? ????????, ? 1 ???? ??????? ??????????? ????? ? ? 2 ???? ?????????.
??????, ?. ?????, ?. ???????, ?. ???????, ?. ????, ?. ???????? ? ?. ???????
????????: ?????????????? ????? ?? ?????? ?????? ??? ???????? ???????? ???????? ??????? ?????? ??? ???????? ??????? ? ???????????? ?????? ???????? ???????????????. ??? ??????? ?? ?????????? ???????? ? ????????, ??????? ?? ????? ???? ?????????? ??? ?????????. ????? ????????????? ????????? ?????? ???????? ????? ?? ??????? ??????? ? ????????? ????? ??-?? ?????????? ?????????? ?????????? ? ?????????? ????????????, ??????? ??? ?????????. ??? ???????????? ???? ????????? ??? ????????? ????????? ?????? ??? ????? ?????? ?, ????? ????, ????????? ? ??? ??????????.
????????? ? ?????? : ??? ????? ?????????? ?????, ???????????? ????????????, ???????????? ????? 10 ??? (2010-2019), ?????????? ??? ?????? ???? ????????????? ???????????????, ??????? ?? ??????, ?????????? ????? ???????????? ???????????????? ????????????? ??????? ? ??????. ?? ????????? ?????? ??????? ?????? ????? ? ???? 2015 ???? ?? ??????? 2016 ????. ??????? ????????????, ????????????? ?? ?????? ? ??????? ?????????????, ??????? ??????? ?????? ?? ??????? ??????? ??????????????? ??????, ??????? ??? ?????????? ????? ????????? ? ??????, ?? ?????????? ????????????????, ?? ????????. ?????????? ???? ???????????? ? ????????????, ??????????? ??? ????????????? ????? ????? ? 2009 ????. ????? ???? ??????? ?????????? ?????? ?????? ? ?????????? ????????????? ? ?????????? ??????????? ????????.
??????????: 134 ???????? ? ???????????? ????????? ???? ??????????, ???? ??????? ????? 28,3, ? ???????? 2 ???? - 62 ????, ? ???????? ??????? (74%), ???????? ?????? ???? ??????? ???????? ???????-???????? ?????? (60%), ?? ??????? ???????? ??????????????? ??????? (23%), ?????????? ????????? 11,13 ??/?, 60% ????????? ?????????? ?? ?????????????. 80% ???????? ?????? ???? ??????? ? ?????????, ??????? ??? ???????. ??? ???????? ??????, ?? ??????? ?? ???? ??????? ???????, ??? ???? ? ???????? ??-?? ?????? ????? (63%),
??????? ????, ?????? ? ???????, ?????????? ??????, ??? ???????? ? ????????????????? ????, ??????? ???????, ?????????? ??????????????? ???????? ????????? ??? ???????? ?????? ???????????? ????. ?????? ??????????? ?????????, ????????????? 14% ???????????????, ? 57% ????????? ???????????????, ??? ?????? ???, 2 ?????? ????????? ???????? ? ? 2 ?????? ????????????? ?????????. ????????? ??????? ???????? 2 ????????? ??? ????? ? ?????? ????????????? ?????????? ??????.
?? ??????? ???? 353 ????????????? ?????? ?????? ?????????? ? ???? ????????? ?? ????????? ???????. ??????? ??????? ???????? 42,6 ????, ? 62 % ?? ??? ???? ?????????. ???????? ???????? ???????? ????????? ????? ???? ?????????????????? ????????? ? ?????? (41,2 % ? 32,6 %). ??????? ???????? ????? ???????? 84,4 %, ? 55 ????? ????????? ??????????? ? ??????? ???????. ???????? ???????? ?????? ????? ???? ??????? ????????, ??????? ? ???????? ???????? ?? ????? ????????? ?????????? (43,6 %). «????? ?? ?????? ??????» ? ????? ???????? ? 44,4 % ? 2009 ???? ?? 12,7 % ? 2015–2016 ?????. «???????? ??????? ??????????????», «???????????? ???????? ????????», «???????????? ? ????????????????? ????» ? «????????????? ? ????» ???? ??????? ?????????, ??????? ?? ????? ?????????????????? ?????????. ?? ???? ???????? ?? ??????? ?????????? ??? ??????????? ????????, ?? ??? ??????????? ??????????. ? ??????? ???????? ? ?????? ? ???? ????????. ? ????? ??????, ??? ?????????? ?? ??? ?????????? ??????, ??? ????????? ??????????? ???????? ? ????? ?????? ?? ??????? ????? ?????????? ?????. (P < 0,001). ????????????? ?????????????? ???????? ???????? ???? ????? ??????? ? ???????? ?? ??????? ????? ????? ? ??????? ?? ???? ????? ??????????? ?????????. ?????? ?????? ????????? ????? ????????????? ? ??????? ???????? ? ??????, ?? ??? ???? ? ????????????? ??????????????? ???????? ????????, ? ?????????????? ????? ????????-???????. (6,6 ± 2,7 ?????? 9,1 ± 3,1, P < 0,001). ???????? ?? ??, ??? ?????? ?????????, ??????? ???????? ????? ??? ???? ? ???? ??????. ?????????????, ???? ???-b ???????? ??????? ????????????? ????? ????? ?????????? ? ???????? ???????? ?????. (p < 0,05 ? ??????????? ????? = −0,812)
????????: ?????????? ??????? ?????? ????????? ????? ???????, ??? ???? ???????? ? ??????, ???????? ??????????? ??????? ???????? ????????, ? ?? ????? ??? ? ????? ??????????, ????????????? ???????-????????? ????????, ??????????? ? ?????????? ??????? ????????????, ??????????????. ?????????? ???? ???????? ???????? ?????????? ?????????? ? ????????? ??????????????.
??????????: ??? ????? ? ???? ??????? ????????? ???????? ??????????????? ????????? ??????? ? ?????????????? ????? ??? ??????? ??? ?????????? ?????? ??????. ?????? ? ???? ??????????? ????? ?????????????? ???????, ????????? ?????? ?????? ??????, ??????? ?????? ???? ??????????? ???, ????? ????, ????????????? ??????? ???? ?????? ? ??? ???????? ??? ????????
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????????: ???????????? ?????? ???????? ??????????????? ???????? ????????? ????????? ????????????? ??????????????? ? ???????. ??? ???????? ??????????? ??????????? ????? ?????????????? ? ??????????????????. ??? ????????? ??????? ????????????? ??????????? ? ??????????? ?????? ?? ???????? ????? ?????????.
????? ??????? ???????????? ???? ??????? ???????????????, ???????????, ?????????????, ??????????????? ? ???????????? ??????? ????????? ? ???????????? ??????? ???????? ???????????????, ??????????? ?? ??????????? ? ????????? ?????????? ???????????????? ????????? ???????????????? ??????????? ?????? ??. ??? ?????.
???????? ? ??????: ??????????????? ?????? ??????? ??????? 1061 ???????? ? ???????????? ??????? ???????? ???????????????, ??????????? ?????????? ? ????????? ?????????? ???????????????? ????????? ???????????????? ??????????? ?????? ??? ????? ? ??????? 8 ???, ? 1 ?????? 2008 ???? ?? 31 ??????? 2015 ????.
??????????: ????????? ?????????????? ????????? 132 ??????/???, ??????? ??????? ???????? 49,8 ???, ? ????????? ???????????? ?????? ? ???????????? ????? 1,11. ????? ??????????? ??????????? ??????????? ?????? (33,18%) ? ??????? ???????? ???????? (32,28%). ???????? ????????????????? ?????????? ????????? ?????????????? ???? ?????? ???? ?????? (14,5%), ?? ??????? ????????? ????????? ???????? (11,78%), ????? ????????????? (6,31%). ????????????? ???? ???????? ? 38,56% ???????, ? ?????? ? 59,5% ???????. ??????? ?????????? ??? ??????? ???????? ?? 18%.
??????????: ? ????? ???? ?????? ?? ???????? ??????? ???? ??????? ??????? ?????????????? ? ??????????; ??? ????? ?? ??????????:
??? ??????????? ???????? ? ?????? ??????? ??? ?????? ? ?????????, ?????????? ? ?????????? ??????? ? ??????? ???????? ???????? ? ??????????????, ? ???????? ??????????? ?????????? ??????, ?????????? ? 2009 ????. ??? ?????????? ?? ?????????????? ???????????? ? ???, ??? ????????? ?? ?????????? ? ??? ????????? ??????????? ???????, ? ????? ????????????? ?????????, ? ?????????? ??????? ????????? ?????? ?????????? ? ?????. ?? ?? ?? ?????????? ????????? ???????????????? ??????????? ??? ???? ??????, ??, ????????, ??? ?????? ?? ??????: «??? ???????? ???????????? ???????????»
??????????? ????????? ?? ???????: ?????? ?????????? ? ?????????? ???????????, ??????? ??????????? ?? ???? (1 — ??????? ????????????, 2 — ?????? ???????? ???????????), ? ???? ????????? ????????????, ?????????????? ???????????, ?? A (????????? ???????? ????????, ??????? ?? ???????, ??? ??? ?????????) ?? D (?????? ?????? ?? ?????? ?????????, ??? ?? ??, ??? ???????? ?????????). ????? ??????????? ??????? ??????? ??????, ???????????, ?????? ?? ??? ??????, ????? ?????????? ?????????? ????????? ???????? ???????? ????????????. ????? ??????? ?????? ???????? ?????? ??????????? ??????, ??????? ?? ?????? ????????? ??????, ???? ???????? — ??????? ????? ?? ????? ????????? ? ????????? ??????? ? ?????????, ?? ??????? ???? ? ???? ??????.
?????????? ?????????? ??????????? ? ??????????????, ? ? ????????? ????? ??? ???????? ????? 25 000 ?????????, ??? ?? 10% ??????, ??? ? ?????????? ??????????? Renal Association ?? ???????????. ????? ????, ?????? ????????? ?????????? ???????????: ???????? ??????? ?????? ? ???????? 67 ??? ?? ??????? ?????????????????? ?????????????? ???????? ??????? 3,2 ????. ?????? ????? ??????????? ? ???????? ?????????? ???????? ?????????? ??????????? ? ???????????? ? ?????????? ?????????????? ? ??????, ? ????? ????????? ????? ?????????? ? ????????, ??????? ????? ?? ????????????, ?? ????? ????????? ? ???????? ???????????.
??????????? ???? ???????? ?????????: ??????? ? ???????? ??????? ??????? ??????? ?????? ?????????? ? ???????? ?????? ????????? ????????? ? ???????????. ?????? ? ?????????? ???? ????????????? ????? ???????? ??????????? ?????? ??????????? ?????? ? ??????, ?????????????? ?????? ???? ???????????? ? ???????????? ??????? ????????????, ? ??? ???? ???????????? ??????????? ????? ????????. ??? ??????? ???????? ?? ??????????? ???? ?????? ?? ???? ? ??????????.
?????: ??? ??????????? ??????????????? ???????????, ?????????? ????? ??????????? ????????????, ????????? ?????????? ??????? ? ????????? ?????????????? ?????????????.
Arjun. V. Anandappa, Sachin Bongale, K. Siddappa
Intense febrile ailment is characterized as an intense febrile disorder with oral temperature over 37.5 degree Celsius inside most recent 24 hours and under about fourteen days of span with vague Symptoms that won't assist us with restricting to a specific system7,8,9,11. The vague indications resemble fever, rashes body torment, free stools, spewing, summed up body expanding, diminished pee yield, cerebral pain, hack and breathlessness1.
Intense febrile ailment with Thrombocytopenia is quite possibly the most well-known reasons for horribleness and mortality in Tropical nations like India2,3,4,5,6. Intense kidney injury (AKI) because of Fever with Thrombocytopenia is one of the successive, potential and deadly difficulty and cause for grimness and mortality. The present circumstance requests a superior syndromic approach, early treatment and anticipation of complexities.
AKI is normal in sicknesses with Fever with Thrombocytopenia like Malaria, Dengue, Typhoid, Rickettsial fever, leptospira and Chikungunya infections10,11,12,13. The intense kidney injury in the event of tropical diseases is principally due to prerenal and intrarenal causes. Rise of hazard factors like worldwide travel, relocation, urbanization and an Earth-wide temperature boost might be the reason for expanded rate of tropical diseases related with thrombocytopenia, along these lines prompting expanded frequency of intense kidney injury1,2.
Study Design: Observational cross sectional investigation of conceded patients who meet the incorporation and avoidance rules in SSIMS and RC emergency clinic from admission to release.
Study Area: Data for the investigation will be gathered from the patients conceded in Department of General Medicine at SS foundation of clinical sciences and exploration Center, Davangere with intense febrile sickness with thrombocytopenia.
AKI is normal, destructive, and possibly treatable. Indeed, even a minor intense decrease in kidney work has an unfavorable guess. Early identification and treatment of AKI may improve results.
According to the new KDIGO4,5,15,16 AKI Guidelines - AKI is characterized as any of the accompanying:
Technique for assortment of information (counting examining strategy, assuming any)
Test Size:
The cases which meet the incorporation and avoidance measures will be read for year and a half.
Study Duration: year and a half.
Incorporation Criteria: -
Patients over 18 years old having intense febrile disease with platelet check under 1.5 lakhs/cumm with intense kidney injury because of Dengue, Malaria, Leptospira contamination, Ricketssial fever, Typhoid and Chikungunya will be taken after research center affirmation.
Rejection Criteria: -
Bacterial sepsis – Clinical and Radiological highlights reminiscent of pyelonephritis, pneumonia, meningitis, gastroenteritis, intense viral hepatitis and intra stomach sore. Immunocompromised, Acquired thrombocytopenia, persistent liver sickness.
Techniques:
Proposed technique for measurable examination: -
The information is gathered from the inpatients of SS establishment of clinical science and examination focus will be broke down, the outcomes will be classified.
Procedure:
A complete number of hospitalized Patients of Acute febrile ailment with Thrombocytopenia is read for year and a half period and to associate the turn of events and range of intense kidney injury among them and its result is estimated.
On the off chance that standard creatinine isn't referred to, we have considered as 0.8. We have likewise seen the decrease of creatinine in the medical clinic stay till release for thinking about a case as intense kidney injury.
Result is estimated by eGFR utilizing MDRD equation at release of the patient and separated into three gatherings,
RESULTS:
The present observational cross sectional investigation was done in the Department of general medication, SSIMS and RC, Davangere. We assessed 100 patients who were having intense kidney injury in intense febrile disease with thrombocytopenia and contemplated their result till release. Intense kidney injury is one of the significant inconveniences of intense febrile sickness with thrombocytopenia. This examination writes about seriousness and range of intense kidney injury among the different intense febrile sickness with thrombocytopenia for the range of year and a half from 2016 to 2018, its administration and result till release.
In this examination we have incorporated an absolute number of 100 patients of intense kidney injury with thrombocytopenia. Among them least time of case was 18 years, while most extreme time of show of old age bunch was 65 years. Mean age bunch was 36.5 +/ - 9.7 years. Most basic period of show was middle age bunch. In this investigation out of complete 100 patients 38(38%) were female patients and 62(62%) were male patients.HCV in Tianjin was 5.87/100,000 out of 2018, which was just about as much as 1.4-overlay higher contrasted with the numbers assessed in 2016. In China, HCV is considerably more predominant among more established individuals (Liu et al., 2018), who are bound to encounter constant liver illness. Long haul HCV disease is a main source of hepatic irritation, broad fibrosis, cirrhosis, hepatocellular carcinoma (HCC), and liver-related demise (Polaris Observatory, 2017). The HCV-related illnesses address a gigantic wellbeing and financial weight in China.
The presentation of direct-acting antiviral specialists (DAAs), with their high paces of supported virological reaction (SVR) (European Association for the Study of the Liver, 2018), has altered the administration of persistent HCV contamination. On account of DAAs, HCV would now be able to be relieved in many patients, even in those with cutting edge cirrhosis (Feld et al., 2015; Forns et al., 2017), genotype (GT) 3 (Kwo et al., 2017), and history of earlier treatment disappointments (Feld et al., 2015; Lawitz et al., 2017). Yet, the use of brand DAA drugs is restricted in many districts of territory China because of their costly expense, distinctive treatment rules, and repayment arrangements set up by neighborhood governments (Bian et al., 2017). Therefore, conventional HCV drugs stand firm on a high driving footing in China. Luckily, since April 2018, Tianjin neighborhood medical coverage can cover HCV therapy (Bureau, 2018). Moreover, the brand DAAs utilized for the treatment incorporate sofosbuvir (SOF), elbasvir/grazoprevir (EBR/GZR), ombitasvir, paritaprevir, ritonavir, dasabuvir (OBV/PTV/r/DSV), daclatasvir (DCV), and asunaprevir (ASV). Before long, the as of late authorized SOF/velpatasvir (SOF/VEL) will be added to the repayment drug list. Tianjin health care coverage repays up to $5,660 per HCV patient, which represents 85–90% of the expense (Bureau, 2018). The ideal repayment strategy and early admittance to DAAs in Tianjin comprise an ideal condition to initially report genuine involvement in accessible brand DAAs in the treatment of Chinese HCV-contaminated patients.
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