Supplementation of Antioxidants in Chronic Kidney Disease: Clinical Necessity or Wishful Thinking? A Bench to Bedside Translational Research.

Chronic Kidney Disease (CKD) patients are at increased risk for atherosclerosis, cardiovascular disease (CVD) and progression to end stage kidney disease (ESKD). This heavy CVD risk cannot be solely at-tributed to traditional Framingham risk factors. Oxidative stress (OS), defined as the disruption of balance between prooxidants and antioxidants in favor of the former, has emerged as a novel risk factor for CVD and CKD progression. Specifically, lipid peroxidation has been identified as a trigger for endothelial dys-function, the first step towards atherogenesis and protein oxidation has been associated with CKD progres-sion. The oxidation of proteins and lipids starts early in CKD, increases gradually with disease progression and is further exacerbated in ESKD, due to dialysis related factors. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease and progression of CKD, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from ex-perimental and clinical studies that test antioxidants for their possible beneficial effects against CVD and CKD progression such as vitamins E and C, statins, omega-3 fatty acids, trace elements, polyphenols and N-acetylcysteine.

Vitamin K for Vascular Calcification in Kidney Patients: Still Alive and Kicking, but Still a Lot to Learn.

Patients with chronic kidney disease (CKD) suffer disproportionately from a high burden of cardiovascular disease, which, despite recent scientific advances, remains partly understood. Vascular calcification (VC) is the result of an ongoing process of misplaced calcium in the inner and medial layers of the arteries, which has emerged as a critical contributor to cardiovascular events in CKD. Beyond its established role in blood clotting and bone health, vitamin K appears crucial in regulating VC via vitamin K-dependent proteins (VKDPs). Among these, the matrix Gla protein (MGP) serves as both a potent inhibitor of VC and a valuable biomarker (in its inactive form) for reflecting circulating vitamin K levels. CKD patients, especially in advanced stages, often present with vitamin K deficiency due to dietary restrictions, medications, and impaired intestinal absorption in the uremic environment. Epidemiological studies confirm a strong association between vitamin K levels, inactive MGP, and increased CVD risk across CKD stages. Based on the promising results of pre-clinical data, an increasing number of clinical trials have investigated the potential benefits of vitamin K supplementation to prevent, delay, or even reverse VC, but the results have remained inconsistent.

Association of Red Blood Cell Distribution Width and Neutrophil-to-Lymphocyte Ratio with Calcification and Cardiovascular Markers in Chronic Kidney Disease.

We aimed to investigate the association between Red Blood Cell Distribution Width (RDW) and Neutrophil-to-Lymphocyte Ratio (NLR), simple, rapidly assessed markers from the complete blood count with vascular calcification (VC)/stiffness and cardiovascular disease (CVD) in chronic kidney disease (CKD). Dephosphorylated, uncarboxylated matrix Gla-protein (dp-ucMGP), and central/peripheral hemodynamics' parameters were measured in 158 CKD patients, including Hemodialysis and Peritoneal Dialysis. Spearman's rho analysis showed that RDW correlated with C-reactive protein (CRP) (r = 0.29, p < 0.001), dp-ucMGP (r = 0.43, p = < 0.0001), central diastolic blood pressure (DBP) (r = -0.19, p = 0.02), and albuminuria (r = -0.17, p = 0.03). NLR correlated with the duration of CVD (r = 0.32, p < 0.001), CRP (r = 0.27, p = 0.01), dp-ucMGP (r = 0.43, p < 0.0001), central DBP (r = -0.32, p < 0.0001) and eGFR (r = -0.25, p = 0.04). In multiple regression models, circulating dp-ucMGP was an independent predictor of RDW (ß = 0.001, p = 0.001) and NLR (ß = 0.002, p = 0.002). In CKD patients, RDW and NLR are associated with traditional and novel markers of VC and CVD.

Persistent unilateral diaphragmatic paralysis in the course of Coronavirus Disease 2019 pneumonia: a case report.

Coronavirus Disease 2019 infections can cause a wide range of symptoms, particularly in the respiratory system. Diaphragmatic paralysis is a rare condition that is poorly documented in the literature. We present the case of a 38-year-old Caucasian male adult who developed unilateral diaphragmatic paralysis during the course of the disease. The patient presented to the Emergency Department with fever, cough, and dyspnea, was admitted, and was immediately fitted with a high flow nasal cannula. When his condition worsened eight days later, he was admitted to the Intensive Care Unit and a tracheostomy was performed. A CT scan of the chest revealed significant left diaphragm elevation. On the 48th day, the patient gradually improved and was discharged. The paralysis of the diaphragm persisted three months later in the follow-up examination. This case illustrates a possible neuromuscular virus invasion that may have an impact on the patient's health after discharge.

Patient presenting with lipoma of the index finger: a case report.

INTRODUCTION: Lipomas can be found anywhere in the body with the majority located in the head and neck region as well as in the shoulder and back. They are not very common in the hand and those involving the fingers are very rare. Although, it is not the only case reported, lipoma of the index finger is very uncommon. CASE PRESENTATION: A 52-year-old Caucasian man presented with a lipoma of the right index finger. He complained of no pain but he had difficulty in manual movements. Treatment was surgical excision of the lipoma. There has been no recurrence for two years. CONCLUSION: Although lipomas of the fingers are rare entities, their awareness is imperative since the differential diagnosis from other soft tissue tumors and from the special lipomatous subtype involved is quite extensive.

A case of primary isolated non-Hodgkin's lymphoma of the esophagus in an immunocompetent patient.

Primary non-Hodgkin's lymphoma of the esophagus is a rare disease. A case of primary isolated non-Hodgkin's lymphoma of the esophagus in a 77-year-old man without acquired immunodeficiency syndrome is presented. We describe the clinical features and the imaging findings (barium swallow, endoscopic ultrasonography and CT) of a biopsy proven B-cell lymphoma with diffuse transmural involvement of the esophagus wall, which was discovered incidentally. We also briefly review the literature.

Lower limb veins color and spectral Doppler ultrasonography examination. An examination protocol.

Lower extremity's venous pathology was traditionally investigated by intravenous venography. Nowadays Color Doppler flow imaging is widely accepted as a well established, noninvasive method for the evaluation of deep pelvic and lower extremity's venous system. The vast majority of authors conclude that the method can safely replace diagnostic venography in all patients with venous thrombosis, thrombophlebitis and valve or communicating veins insuffciency. Optimal performance of Color Doppler flow imaging as a diagnostic tool for the whole lower limb veins requires: Proper equipment specifications and settings. Knowledge of regional venous anatomy. Established examination protocols. Evaluation of morphological and functional findings. Documentation of the findings. All these steps are described as a sequence of guidelines, photographs and multiple ultrasonographic images. Our paper can be useful to all physicians or sonographers involved with color Doppler studies for the evaluation of lower limb venous diseases and abnormalities.