Litiasis en receptores de trasplante renal: revisión sistemática / Kidney stones in renal transplant recipients: A systematic review

Introducción La litiasis en el receptor del injerto renal puede ser una enfermedad peligrosa cuyo riesgo potencial es el deterioro de la función renal. Adquisición de la evidencia Se realizó una búsqueda sistemática de la literatura hasta febrero del 2023. El objetivo primario era evaluar la incidencia de litiasis en receptores de trasplante renal (TR). El secundario era valorar el momento de formación, la localización y la composición de la litiasis, las opciones de tratamiento disponibles y la incidencia de la pérdida del injerto. Síntesis de la evidencia Un total de 41 estudios no aleatorizados compuestos por 699 pacientes cumplieron los criterios de inclusión. La edad en el momento del diagnóstico de la litiasis oscilaba entre 29 y 53 años. La incidencia de urolitiasis se encontraba entre 0,1 y 6,3%, siendo diagnosticada generalmente a los 12 meses del TR. La mayoría de las litiasis detectadas se localizaron en los cálices o en la pelvis. La composición más frecuente fue la de oxalato cálcico. Se consideraron diferentes estrategias de tratamiento como vigilancia activa, ureteroscopia, abordaje percutáneo/combinado o cirugía abierta. Del total de pacientes, 15,73% fueron tratados con litotricia extracorpórea por ondas de choque (LEOCh) y 26,75% se sometieron a litotricia endoscópica o extracción quirúrgica. De estos sujetos, 18,03% se abordaron mediante nefrolitotomía percutánea, mientras que 3,14% se sometieron a un manejo combinado. Se realizó litotomía quirúrgica en 5,01% de los casos. La tasa libre de litiasis (TLL) global se situó en torno a 80%. Conclusiones La litiasis en el TR es una patología poco frecuente que suele diagnosticarse al año de la cirugía. Su localización más común son los cálices y la pelvis renal, y en la mayoría de los casos está compuesta de oxalato cálcico. Todos los tratamientos activos han demostrado resultados satisfactorios en términos de TLL, ... . (AU)

Introduction Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment. Evidence acquisition A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss. Evidence synthesis A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1 to 6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%. Conclusions Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences. (AU)

Advances in diagnostic approaches to Fasciola infection in animals and humans: An overviews.

Fasciolosis, caused by Fasciola hepatica and F. gigantica, is an impediment to the livestock industry's expansion and has a massively negative socio-economic impact due to its widespread prevalence in livestock. It is a waterborne zoonosis affecting human populations in the countries where rural economies are associated with livestock rearing. Conventional diagnosis of Fasciola infection is done by detecting parasite eggs in the faeces of infected animals or by immunological methods. Accurate and quick immunodiagnosis of Fasciola infection in animals and humans is based on the detection of antibodies and specific antigens expressed in the prepatent stage of the parasite. Both molecular and serodiagnostic tests developed thus far have enhanced the reliability of Fasciola diagnosis in both man and animals but are not widely available in resource-poor nations. A pen-side diagnostic test based on a lateral flow assay or a DNA test like loop-mediated isothermal amplification (LAMP) would be simple, fast, and cost-effective, enabling clinicians to treat animals in a targeted manner and avoid the development of drug resistance to the limited flukicides. This review focuses on the recent advances made in the diagnosis of this parasite infection in animals and humans.

Kidney stones in renal transplant recipients: A systematic review.

INTRODUCTION: Lithiasis in renal graft recipients might be a dangerous condition with a potential risk of organ function impairment. EVIDENCE ACQUISITION: A systematic literature search was conducted through February 2023. The primary objective was to assess the incidence of lithiasis in kidney transplant (KT) recipients. The secondary objective was to assess the timing of stone formation, localization and composition of stones, possible treatment options, and the incidence of graft loss. EVIDENCE SYNTHESIS: A total of 41 non-randomized studies comprising 699 patients met our inclusion criteria. The age at lithiasis diagnosis ranged between 29-53 years. Incidence of urolithiasis ranged from 0.1-6.3%, usually diagnosed after 12 months from KT. Most of the stones were diagnosed in the calyces or in the pelvis. Calcium oxalate composition was the most frequent. Different treatment strategies were considered, namely active surveillance, ureteroscopy, percutaneous/combined approach, or open surgery. 15.73% of patients were submitted to extracorporeal shock wave lithotripsy (ESWL), while 26.75% underwent endoscopic lithotripsy or stone extraction. 18.03% of patients underwent percutaneous nephrolithotomy whilst 3.14% to a combined approach. Surgical lithotomy was performed in 5.01% of the cases. Global stone-free rate was around 80%. CONCLUSIONS: Lithiasis in kidney transplant is a rare condition usually diagnosed after one year after surgery and mostly located in the calyces and renal pelvis, more frequently of calcium oxalate composition. Each of the active treatments is associated with good results in terms of stone-free rate, thus the surgical technique should be chosen according to the patient's characteristics and surgeon preferences.

Effect of protective coating agents on microleakage and flexural strength of glass ionomer cement and zirconomer. an in vitro study.

PURPOSE: The objective of this study was to assess the microleakage and flexural strength of glass ionomer cement (GIC) and modified GIC (Zirconomer) when coated with protective coating agents such as COAT-IT and G-COAT plus. METHODS: Sixty tooth specimens were grouped into two groups based on the type of restorations (GIC (n = 30) and Zirconomer (n = 30)). The samples were further divided into three subgroups (n = 10) based on the protective coating agent (Petroleum jelly, G-COAT Plus, or COAT IT) applied. This study evaluated the microleakage at the occlusal and cervical margins of class V restoration after being subjected to dye penetration and sectioning. Each specimen was viewed under a 40 × microscope and was given scores based on the depth of dye penetration. They were statistically analyzed using the Kruskal-Wallis test and compared within the groups using the Mann- Whitney Test. In addition, flexural strength was assessed using standardized cuboid (25 × 2 × 2 mm) specimens of restorative materials with and without protective coating agents. The mean flexural strength data of all the subgroups were statistically evaluated using a one-way analysis of variance (ANOVA) and compared within the subgroups using the student t test. RESULTS: A statistically significant difference was found when occlusal margin microleakage scores were evaluated with G-COAT Plus demonstrating the lowest occlusal margin microleakage when applied over GIC restoration. The increasing order of occlusal margin microleakage scores is as follows: GIC with G-COAT Plus, Zirconomer with COAT-IT, GIC with COAT-IT, GIC, Zirconomer with G-COAT Plus, and Zirconomer. However, the cervical margin microleakage scores revealed no significant difference. While flexural strength was found to be highest for the GIC group coated with G-COAT Plus, it was observed that there was a significant improvement in the flexural strength of both GIC and Zirconomer when coated with either of the protective coating agents. CONCLUSION: Within the limitations of this in vitro study, it was observed that the application of protective coating agents can significantly reduce the potential microleakage and improve the flexural strength of the restorative material especially when zirconia-reinforced GIC is the restorative material.

Effect on oral pH changes and taste perception in 10-14-year-old children, after calcium fortification of a fruit juice.

AIM: The aim was to determine the effect of calcium fortification of a commercially available mixed-fruit juice on oral pH changes and taste perception in a group of 10 to 14 year-old Indian children. METHOD: A controlled, blinded, non-randomised clinical trial was adopted, consisting of a sample of 100 healthy children (DMFT <3; age 10-14 years), who were exposed to three test juices one by one [Group A: original fruit juice (control group); Group B: calcium-fortified fruit juice and Group C: calcium + vitamin D fortified fruit juice]. Oral pH, collection of saliva and plaque sampling was undertaken, before and after the juice exposure by each subject at 0, 1, 5, 15, 30 and 45 min. The respective pH was measured with a digital pH meter. For taste perception, a scoring system was used after exposure of the juices to the subjects in a blind manner. The statistical evaluation was done using one-way ANOVA for salivary and plaque pH and Kruskal-Wallis test for buffer capacity and taste perception. RESULTS: There was a smaller drop in salivary and plaque pH (p < 0.5) and a significant reduction in perceived taste (p < 0.001) by the subjects after calcium modification of fruit juice. CONCLUSION: The calcium-modified mixed fruit juices was less acidogenic compared with the unfortified juice, and hence will be less cariogenic and erosive towards teeth.

An in-vitro assessment of erosive potential of a calcium-fortified fruit juice.

AIM: To evaluate and compare the in vitro pH, buffer capacity and calcium loss from tooth enamel before and after calcium fortification of a packaged fruit juice. METHODS: An approved brand of packaged mixed fruit juice was selected as a test drink on the basis of a pilot questionnaire. The test drink was fortified with 1,000 mg/l (0.1% w/v) of calcium citrate malate to obtain two test groups: Group 1: original beverage (serving as control) and Group 2: calcium-fortified drink. The pH and buffering capacity for the test drinks were measured before and after calcium fortification; 90 prepared enamel samples were divided and immersed into three test subgroups: (1) buffer solution pH 7 (positive control), (2) original fruit juice (negative control) and (3) calcium-fortified fruit juice for 3 min. Calcium loss from the enamel of immersed teeth was measured as a quantitative estimate of tooth mineral loss. RESULTS: After calcium fortification of the fruit juice the mean pH raised from 3.4 to 4.0 (p = 0.029), the mean buffer capacity decreased from 9.73 to 9.16 (p < 0.001) and the mean calcium loss from enamel specimens decreased from 3.5 to 0.26 mg/dl (p < 0.001). STATISTICS: To compare the change in mean pH and buffering capacity between the subject groups, t test was used, and to compare the calcium loss from enamel specimens, among the three subgroups, ANOVA was used. CONCLUSION: Calcium fortification of packaged fruit juice in vitro, improves its pH and buffering capacity. Consequently, the fortified juice causes significantly less mineral loss from human enamel. Fortifying juice with calcium may exert a significant protective potential against dental erosion particularly due to frequent exposure of acidic drinks.

Differential expressions of bilaterally unerupted supernumerary teeth.

This article presents a case of bilateral unerupted supernumerary teeth in the mandibular premolar region. Surgical removal of the right-sided supernumerary tooth had to be carried out as it was impeding the eruption of the mandibular first premolar. However, its supernumerary antimere, lay dormant.

Interactive Atlas of Sign in Musculoskeletal Radiology

It presents images and information related to common and not so common signs used in Musculoskeletal Radiology, which can be reviewed by sign name (from Absent bow tie sign to Vacuum phenomenon), pathological diagnosis or locations (from Ankle to Wrist). The signs are illustrated with radiographs and diagrams. The references are linked to PubMed, allowing access to the abstract, if available.

MRI of soft tissue pathology of the foot

It presents images and discusses the common and rare soft tissue pathology that may occur in the plantar soft tissues of the foot with specific MRI findings.

Lipohemarthrosis

It describes the CT, MRI, and radiographic appearance of lipohemarthrosis of the elbow, hip, knee, and shoulder joints.

Musculoskeletal radiology of fractures

It presents radiologic images of fractures of the skull, chest, spine, shoulder, humerus, elbow, radius and ulna, hand and wrist, hip and pelvis, femur, knee, tibia and fibula, and foot and ankle, fracture eponyms, and fractures by profession.

Lower extremity amputations

It presents information and images related to lower extremities amputations (above and below the knee, knee disarticulation, Symes, Chopart, Lisfranc, transmetatarsal, Ray amputation, and toe amputation).

Peritoneal equilibration test in Indian patients on continuous ambulatory peritoneal dialysis: does it affect patient outcome?

The variations in peritoneal equilibration test (PET) characteristics in various ethnic groups have been reported. Data are scarce regarding the pattern of membrane characteristics in Indian patients. The factors affecting PET and the PET, in turn, affecting patient outcome are controversial issues. We prospectively analyzed 41 patients to evaluate: (1) the pattern of PET characteristics in Indian patients; (2) the factors affecting the PET; (3) the effect of membrane characteristics on patient outcome. The mean period of follow up was 17.1 +/- 9.3 months. The PET results revealed 21 high transporters (51%), 13 high-average transporters (32%), 6 low-average transporters (15%), and 1 low transporter (2%). The distribution of the various PET categories in patients below the age of 60 years and those 60 years or above was not significant (p = 0.70). The sex distribution (p = 0.94) and prevalence of diabetes (p = 0.62) were not significantly different in various PET categories. On regression analysis, PET values were not affected by the age of patients (beta = 0.80, p = 0.61). Patient survival among high and high-average transporters was significantly less compared with low and low-average transporters (p = 0.01). We conclude that Indian patients on continuous ambulatory peritoneal dialysis (CAPD) have a higher proportion of high and high-average transporters. The pattern of membrane kinetics cannot be explained by differences in patient characteristics and diabetic status. Patients with high PET values have poorer patient survival on CAPD.

Atypical adult non-calcified pilomatricoma.

We present a rare case of a non-calcified pilomatricoma in a 67-year-old man. This tumor was extremely large in size, and its location, in the lower extremity, was very unusual. The clinical, radiographic, and histopathological features are described in detail. The role of magnetic resonance imaging (MRI) in the diagnosis of this entity is discussed. Definite internal reticulations and septations were observed. A possible explanation for this observation is that the high signal intensity reticulations may represent edematous stroma surrounding basaloid cells.

Pictorial review: foot axes and angles.

Using radiographs and diagrams, this article reviews the most commonly used axes and angles of the foot, including: longitudinal axis of the rearfoot, collum tali axis, talocalcaneal angle, cuboid abduction angle, longitudinal axis of the lesser tarsus, lesser tarsus angle, talonavicular angle, longitudinal axis of the metatarsus, forefoot adductus angle, metatarsus adductus angle, first intermetatarsal angle, hallux valgus angle, proximal and distal articular set angles, and hallux interphalangeal angle, plane of support, collum tali axis, talar declination angle, calcaneal inclination axis, lateral talocalcaneal angle, first metatarsal declination axis and calcaneal inclination angle.

Pelvic fused kidneys: magnetic resonance imaging and intravenous pyelogram correlation.

This is a case presentation of pelvic fused kidneys as demonstrated by intravenous pyelogram and magnetic resonance imaging (MRI). The authors wish to stress the importance of anatomical imaging with MRI in the coronal plane. No reconstruction is required as with computerized tomography.

Effect of formulation and process variables on bioequivalency of nitrofurantoin I: preliminary studies.

Fifty-two combinations of nitrofurantoin were developed to assess the effect of dosage form type, particle size, diluent, and process on in vitro availability. With the official procedure and conditions, dissolution rates fell in a 66-fold range. Statistical analysis of the dissolution rates indicated no significant differences as a result of particle size, processing method, or compression force. The diluent choice and dosage form type significantly influenced the dissolution rate. Based on in vitro screening, six formulations presenting a broad range of dissolution rates were selected for further study relating to human bioavailability and bioequivalence.

Effect of formulation and process variables on bioequivalency of nitrofurantoin II: in vivo-in vitro correlation.

Based on preliminary in vitro evaluation, six formulations presenting a broad range of dissolution rates were selected for bioequivalency determination in a randomized complete block crossover. In vitro-in vivo correlations were developed relating cumulative percent dissolved to cumulative percent excreted. These correlations appear to be useful for comparing different formulations as well as different batches of the same formulation.