Impact of Subtotal Parathyroidectomy on Clinical Parameters and Quality of Life in Hemodialysis Patients with Secondary Hyperparathyroidism

BACKGROUND: Impairment of quality of life (QOL) is a key clinical characteristic of patients with end-stage renal disease (ESRD), and can be especially severe in the presence of secondary hyperparathyroidism (SHPT). Despite the proven success of parathyroidectomy (PTX) in controlling biochemical parameters in patients with severe SHPT, evidence is lacking regarding the effects of PTX on various clinical outcomes, including QOL.METHODS: Twenty ESRD patients on maintenance hemodialysis with SHPT who underwent subtotal PTX were included in an observational longitudinal study. All studied patients underwent history-taking, clinical examinations, and laboratory investigations, including a complete blood count and measurements of serum calcium, phosphorus, magnesium, parathyroid hormone (PTH), and albumin levels preoperatively and at 3 months postoperatively. QOL was assessed before surgery and at 3 months after surgery using the Kidney Disease Quality of Life 36-Item Short-Form instrument.RESULTS: After PTX, significant decreases in serum PTH and phosphorus levels were observed, as well as a significant increase in serum magnesium levels. Significant weight gain and improvements of QOL were also detected postoperatively.CONCLUSION: Subtotal PTX seems to be an efficient alternative to medical management in uncontrolled cases of SHPT, as it is capable of controlling the biochemical derangements that occur in hyperparathyroidism. Furthermore, PTX had a beneficial effect on clinical outcomes, as shown by weight gain and improvements in all QOL scales.

Obesity may be erythropoietin dose-saving in hemodialysis patients

BACKGROUND: In dialysis patients, the obesity-survival paradox still requires an explanation. Anemia and high doses of erythropoiesis-stimulating agents (ESAs) are associated with worse outcomes in the hemodialysis (HD) population. In the present study, we explored the relation between obesity and anemia control in a sample of maintenance HD patients in Egypt. METHODS: This multicenter observational study included 733 patients on maintenance HD from 9 hemodialysis centers in Egypt. Clinical and laboratory data as well as average doses of ESAs and parenteral iron were recorded. The erythropoietin resistance index (ERI) was calculated. RESULTS: Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, was present in 22.6% of the studied population. The target hemoglobin level (10.0–11.5 g/dL) was achieved in 27.3% of non-obese and 25.3% of obese patients, with no significant difference. The median serum ferritin and the values of transferrin saturation index did not differ significantly between these two groups. The weekly ESA dose was significantly lower in obese than in non-obese patients (P = 0.0001). A trend toward higher ESA doses and ERI values was observed in patients with lower BMIs (P < 0.0001). Multiple linear regression revealed that the BMI and urea reduction ratio were the strongest predictors of the ERI. CONCLUSION: Our study adds more evidence to obesity-associated advantages in HD patients. BMI may determine ESA response, with better responses observed in patients with higher BMIs.

Serum leptin in end-stage renal disease patients on hemodialysis: its value as a malnutrition marker

Leptin is a protein hormone secreted by adipocytes in proportion to the amount of body fat and exerts sustained inhibitory effects on food intake while increasing energy expenditure. It has been reported that serum leptin levels are high in patients with chronic renal failure and may have a potential impact on the development of uremic cachexia. The present study aimed to evaluate serum leptin level and its relation to markers of malnutrition in non diabetic patients with end-stage renal disease [ESRD] treated with hemodialysis. Serum leptin level was measured in 48 ESRD patients [30 males and 18 females] on regular hemodialysis, and in 20 healthy control subjects. The nutritional status was checked by anthropometric measurements [body mass index [BMI] and triceps skin fold thickness [TSFT]] and laboratory data [hemoglobin, hematocrite, serum albumin, pre-albumin, total protein, and blood urea nitrogen]. Patients were included if they were on hemodialysis for more than one year, anuric, had normal C reactive protein values and had no history of diabetes mellitus, liver disease or chronic pulmonary disorders. The mean serum leptin level was higher in ESRD patients [28.5 +/- 15.3ng/ml] compared to the control [5.2 +/- 3.8ng/ml; P<0.001]. The indices of hematological and protein-energy malnutrition were evident in hemodialysed patients compared to controls. The mean serum leptin was significantly higher in male patients compared to the male control group [11.5 +/- 4.7 vs 3.2 +/- 2.1ng/ml, P<0.01]. Also, serum leptin was significantly higher in the female patients compared to the female control group [35.8 +/- 12.1 vs 12.7 +/- 4.5ng/ml, P<0.001]. The mean BMI for female patients was significantly higher than male patients [24.4 +/- 4.1 vs 21.1 +/- 5.6kg/m2, P<0.04]. The mean TSFT for female patients was significantly higher than male patients [13.8 +/- 3.2 vs 10.7 +/- 2.2mm, P<0.05]. A positive correlation was found between the TSFT and leptin, both in male [r=0.44, P<0.03] and female patients [r=0.71, P<0.01]. Also, there was a positive correlation between the BMI and leptin both in male [r=0.41, P<0.02] and female patients [r=0.67, P<0.01]. No correlation was observed between serum leptin with the length of time on dialysis, total protein, serum albumin, pre-albumin, hemoglobin, hematocrite, creatinine and blood urea levels. Serum leptin is markedly elevated in patients with ESRD on hemodialysis. It is significantly correlated with the BMI and TSFT and could be utilized as a potential indicator of malnutrition in these patients. Further studies may provide a therapeutical approach aiming to neutralize serum leptin levels or blocking its effect on the hypothalamus to prevent uremia-associated malnutrition

Clinical evaluation of amiodarone induced ocular toxicity in cardiac patients

Amiodarone is a highly effective treatment in various cardiac arrhythmias however, with number of side effects. Recent studies and case reports found that chronic treatment with amiodarone can induce toxic changes in different parts of the eye. The aim of this work is to study ocular toxic manifestations induced by chronic administration of amiodarone in cardiac patients, its consequence on eyesight, and its correlation with the dose and the duration of treatment, by measuring visual acuity, visual field assessment, slit lamp and fundoscopic examinations. Control group [group I] was: 12 healthy volunteers. Twenty four cardiac patients on amiodarone therapy were classified into 2 groups, group II: receiving oral dose of amiodarone 200 mg/d, group III: receiving oral dose of amiodarone 400mg/d, for less than 1 month. All patients were submitted to ophthalmic examination every 3 months for 12 months. It was found that amiodarone [200 mg/d] after 3 months did not induce ocular changes. After 6 months, bilateral corneal deposits of grade 1 and 2 were noticed in 58.3% of patients. After 9 months, 75.0% of patients showed corneal lesions of grade 3. At the 12[th] month, 83.3% of patients were affected, with a non significant difference between the mean values of visual acuity as compared with the control group [P>0.05], normal visual field and absence of retinal toxic changes all through the study. 66.6% of patients received amiodarone [400 mg/d] had bilateral corneal deposits of grade 1 and 2, after 3 months. After 6 months, 91.6% of patients were affected. At the 9th month, 100% of patients had vortex verticillata of grade 3. At the 12[th] month, keratopathy of grade 3 and 4 was obviously detected in all patients [100%]. Regarding visual acuity, after 6 months of amiodarone administration, 2 patients had mild diminution of vision and visual field defect. Fundus examination revealed toxic retinopathy in the both patients. After 12 months, bilateral optic disc swelling was noticed in one patient and necessitated discontinuation of the drug. Follow up of those patients after discontinuation of amiodarone, showed slight improvement after 3 months. After 6 months, visual fields showed significant improvement with normal optic disc in one patient. The other patient showed complete resolution of the left optic disc swelling with minimal swelling in the right one. It was concluded that chronic administration of amiodarone induces reversible ocular toxic changes including retina and optic disc, can be detected at the first 3 months of therapy, increase by the dose and the duration of treatment that may necessitate discontinuation of the drug. Periodic ophthalmic examination is a valuable measure for early detection of ocular toxicity

Superoxide dismutase in some gstrointestinal malignancies

Erythrocyte Cu/Zn superoxide dismutase [SOD] plays an important role in protecting cells from injury due to oxidative stress hence the role of SOD in cancer has been suggested [Oberley et al, 1979].The present study was done aiming to assess erythrocyte Cu/Zn SOD activity in some gastro-intestinal malignancies. These included 55 patients classified into hepatocellular carcinoma group [HCC; n= 25], and early colorectal cancer group [early CRC; n = 30], and in addition a group of 10 apparently healthy adults [control group] of matched age and sex was selected. Erythrocyte Cu/Zn SOD activity was determined by spectrophotometric method. The results revealed significant decrease of SOD activity in HCC before surgery as compared to their respective values in control group. Surgery induced insignificant increase of erythrocyte SOD activity in these patients. In early CRC group, LDH,CEA and erythrocyte Cu/Zn SOD levels was significantly increased in comparison to control group; however the levels of these parameters were decreased to normal range after surgical resection. In conclusion, SOD activity varies according to the cell type malignancies but in all of them reflect response of tumor to therapy

Comparative study of the hepatotoxic, genotoxic and carcinogenic effects of praziquantel distocide and the natural Myrrh extract Mirazid [R] on adult male albino rats

Praziquantel [PZQ] is widely and effectively used in the control of bilharziasis which constitutes a major endemic health problem in Egypt. However, recent studies recommended that the drug must be re-evaluated because of its potential carcinogenicity and genotoxicity. Mirazid is a new natural anti-schistosomal drug formed of myrrh extract and considered to be a safe drug. This work was conducted to evaluate and compare hepatotoxic, genotoxic and carcinogenic effects of PZQ und mirazid on adult male albino rats by assessment of serum levels of ALT, AST and bilirubin, histopathological study of the liver and cytogenetic study of bone marrow cells. 100 adult male albino rats were equally divided into 4 groups: group I negative control, group II control rats received distilled water, group III received weekly single oral dose of PZQ [1500 mg/kg] for 6 weeks and group IV received daily oral dose of mirazid [500mg/kg] for 6 weeks. At the end of the study, 10 rats of each group were investigated by assessment of the levels of AST, ALT, and bilirubin. After scarification, liver sections were examined by light microscopy. Another 10 rats of each group were submitted to cytogenetic examination. It was found that praziquantel induced a significant increase in the mean values of AST, ALT and bilirubin with areas of hyaline degeneration, fatty changes, dysplasia and necrosis in the liver sections. It also induced a significant increase in the incidence of chromosomal aberrations as polyploidy, fragment, deletion and ring chromosome as compared with control group. Mirazid induced an insignificant increase in the mean values of AST, ALT and bilirubin with a normal hepatic tissue and an insignificant increase in the incidence of chromosomal aberrations as compared with the control group. On comparing both drugs, praziquantel induced a significant hepatotoxic, genotoxic and carcinogenic effects. It was concluded that praziquantel is considered to be a hepatotoxic, genotoxic and carcinogenic drug. On the other hand, mirazid seemed to be a safe and promising antiparasitic drug, free from hepatotoxic, genotoxic and carcinogenic effects