Endemic Nephropathy Around the World Gifford, Fiona J; Gifford, Robert M; Eddleston, Michael ...
Kidney international reports,
03/2017, Letnik:
2, Številka:
2
Journal Article
Recenzirano
Odprti dostop
There have been several global epidemics of chronic kidney disease of unknown etiology (CKD
). Some, such as Itai-Itai disease in Japan and Balkan endemic nephropathy, have been explained, whereas ...the etiology of others remains unclear. In countries such as Sri Lanka, El Salvador, Nicaragua, and India, CKD
is a major public health problem and causes significant morbidity and mortality. Despite their geographical separation, however, there are striking similarities between these endemic nephropathies. Young male agricultural workers who perform strenuous labor in extreme conditions are the worst affected. Patients remain asymptomatic until end-stage renal failure. Biomarkers of tubular injury are raised, and kidney biopsy shows chronic interstitial nephritis with associated tubular atrophy. In many of these places access to dialysis and transplantation is limited, leaving few treatment options. In this review we briefly describe the major historic endemic nephropathies. We then summarize the epidemiology, clinical features, histology and clinical course of CKD
in Mesoamerica, Sri Lanka, India, Egypt, and Tunisia. We draw comparisons between the proposed etiologies and supporting research. Recognition of the similarities may reinforce the international drive to establish causality and to effect prevention.
Parvoviruses (family Parvoviridae) are small DNA viruses that cause numerous diseases of medical, veterinary, and agricultural significance and have important applications in gene and anticancer ...therapy. DNA sequences derived from ancient parvoviruses are common in animal genomes and analysis of these endogenous parvoviral elements (EPVs) has demonstrated that the family, which includes twelve vertebrate-specific genera, arose in the distant evolutionary past. So far, however, such "paleovirological" analysis has only provided glimpses into the biology of ancient parvoviruses and their long-term evolutionary interactions with hosts. Here, we comprehensively map EPV diversity in 752 published vertebrate genomes, revealing defining aspects of ecology and evolution within individual parvovirus genera. We identify 364 distinct EPV sequences and show these represent approximately 200 unique germline incorporation events, involving at least five distinct parvovirus genera, which took place at points throughout the Cenozoic Era. We use the spatiotemporal and host range calibrations provided by these sequences to infer defining aspects of long-term evolution within individual parvovirus genera, including mammalian vicariance for genus Protoparvovirus, and interclass transmission for genus Dependoparvovirus. Moreover, our findings support a model of virus evolution in which the long-term cocirculation of multiple parvovirus genera in vertebrates reflects the adaptation of each viral genus to fill a distinct ecological niche. Our findings show that efforts to develop parvoviruses as therapeutic tools can be approached from a rational foundation based on comparative evolutionary analysis. To support this, we published our data in the form of an open, extensible, and cross-platform database designed to facilitate the wider utilisation of evolution-related domain knowledge in parvovirus research.
Heat illness (HI) is a growing global concern; its incidence has risen dramatically across the world in recent years. The individual factors whereby elevated core temperature produces HI are not ...well-understood. Given known physiological differences between men and women pertaining to temperature regulation, we hypothesized that women would be at increased risk of HI than men.
We aimed to determine the relative risk of HI in women compared with men through an exhaustive literature review and meta-analysis.
We search PubMed and Ovid Medline databases from inception to Apr 2017. Search terms included all permutations of sex and heat illness (including heatstroke and exertional heat illness) with no language restrictions. We included adult or adolescent human data reporting comparable male and female HI rates. One reviewer identified and screened titles and abstracts. Two independent reviewers applied eligibility criteria. Disagreements were resolved with a third reviewer.
Of 5888 articles identified by searches, 36 were included in the systematic review and 22 in the meta-analysis. The mean (standard deviation) quality score was 3.31(1.25)/5. Overall the rate among women was consistently lower than men across the lifespan. The male: female pooled IRR was 2.28 (p < 0.001, 95% CI: 1.66–3.16). There was modest heterogeneity (between-studies variance (τ2) = 0.02). The rates did not differ significantly when corrected for severity or occupation.
The rate of HI was significantly increased in men compared with women. Risk for HI might be conferred by psychological and behavioral factors rather than physiological ones. Further research is required to delineate which groups are at greatest risk, leading to the development of mitigation strategies against HI.
No funding was received. The authors acknowledge the support of the UK Women in Ground Close Combat Review. The Study was registered with PROSPREO CRD42017064739
•The relative risk of heat illness (HI) in men and women is unknown.•Known physiological differences suggest women would be at greater risk of HI than men.•Women are at reduced risk of HI than men across all ages, HI severities and (where data are available) occupation.•The reason for the reduced HI risk in women is not clear and could relate to sex-associated behavioral differences.•Men may benefit from targeted HI prevention strategies.
The National Patient Safety Alert supporting early recognition and treatment of adrenal crisis is a vital new component of care for adults affected by primary adrenal insufficiency. Benefits for ...patients with secondary and tertiary adrenal insufficiency need to be weighed alongside other considerations such as security of the diagnosis, relative likelihood of adrenal crisis and potential for anxiety and distress from assigning ‘physical dependency’ in relation to glucocorticoid therapy. All clinicians must be vigilant for and responsive to managing risks of adrenal crisis in at-risk patients, while avoiding diagnostic anchoring in the context of acute illness. More research is required to help define who is at greatest risk of adverse outcomes (including avoidance of therapeutic glucocorticoid therapy for fear of adrenal insufficiency) and a cross-specialty approach is advocated.
Increasing evidence supports fetal glucocorticoid exposure with associated altered offspring hypothalamic-pituitary-adrenal (HPA) axis activity as a key mechanism linking early life events with later ...life disease. Alterations in HPA axis activity are linked to a range of cardiometabolic and psychiatric diseases. As many of these diseases manifest sex differences in presentation we review the evidence for programmed sex-differences in the HPA axis. Available literature suggests vulnerability of the female HPA axis to prenatal stressors with female offspring demonstrating increased HPA axis reactivity. This may be due to changes in placental glucocorticoid metabolism leading to increased fetal glucocorticoid exposure. We discuss the potential consequences of increased vulnerability of the female HPA axis for later life health and consider the underlying mechanisms. Further studies are needed to determine whether sex-differences in early-life programming of the HPA axis represent a pathway underpinning the sex-differences in common cardiometabolic and psychiatric diseases.
Servicewomen are at increased risk of common mental disorders compared with servicemen and their female civilian counterparts. The prevalence of eating disorder risk and common mental disorders, and ...associated risk factors in British servicewomen are poorly understood.
All women younger than 45 yr in the UK Armed Forces were invited to complete a survey about demographics, exercise behaviors, eating behaviors, and common mental disorders.
A total of 3022 women participated; 13% of participants were at high risk of an eating disorder based on Brief Eating Disorder in Athletes Questionnaire and Female Athlete Screening Tool scores. Twenty-five percent of participants had symptoms of anxiety (seven-item Generalized Anxiety Disorder Assessment score ≥10), and 26% had symptoms of depression (nine-item Patient Health Questionnaire score ≥10). Older age was associated with a lower risk, and heavier body mass was associated with a higher risk, of eating disorders ( P ≤ 0.043). Older age and higher rank were associated with a lower risk of symptoms of anxiety and depression ( P ≤ 0.031), and a heavier body mass was associated with a higher risk of symptoms of depression ( P ≤ 0.012). Longer habitual sleep duration was associated with a lower risk of eating disorders and symptoms of anxiety and depression ( P ≤ 0.028). A higher volume of field exercise was associated with a lower risk, and a higher volume of military physical training and personal physical training was associated with a higher risk, of eating disorders ( P ≤ 0.024). Job role and deployment history were not associated with any outcome.
Sleeping and training habits provide potential novel targets for exploring how common mental disorders can be managed in British servicewomen.
This study investigated sex differences in energy balance, body composition, and metabolic and endocrine markers during prolonged military training. Twenty-three trainees (14 women) completed 44-wk ...military training (three terms of 14 wk with 2-wk adventurous training). Dietary intake and total energy expenditure were measured over 10 days during each term by weighed food and doubly labeled water. Body composition was measured by dual-energy X-ray absorptiometry (DXA) at baseline and at the end of each term. Circulating metabolic and endocrine markers were measured at baseline and at the end of
and
. Absolute energy intake and total energy expenditure were higher, and energy balance was lower, for men than women (
≤ 0.008). Absolute energy intake and balance were lower, and total energy expenditure was higher, during
than
and
(
< 0.001). Lean mass did not change with training (
= 0.081). Fat mass and body fat increased from
to
and
(
≤ 0.045). Leptin increased from baseline to
and
in women (
≤ 0.002) but not in men (
≥ 0.251). Testosterone and free androgen index increased from baseline to
(
≤ 0.018). Free thyroxine (T4) decreased and thyroid-stimulating hormone (TSH) increased from baseline to
and
(
≤ 0.031). Cortisol decreased from baseline to
(
= 0.030). IGF-I and total triiodothyronine (T3) did not change with training (
≥ 0.148). Men experienced greater energy deficits than women during military training due to higher total energy expenditure.
Energy deficits are common in military training and can result in endocrine and metabolic disturbances. This study provides first investigation of sex differences in energy balance, body composition, and endocrine and metabolic markers in response to prolonged and arduous military training. Men experienced greater energy deficits than women due to higher energy expenditure, which was not compensated for by increased energy intake. These energy deficits were not associated with decreases in fat or lean mass or metabolic or endocrine function.
DNA microarrays are invaluable tools for biosensing applications such as diagnostic detection of DNA and analysis of gene expression. Surface plasmon resonance imaging can detect unlabeled ...oligonucleotide targets adsorbed to the array elements. The variety of biosensing applications can be expanded by enzymatic manipulation of DNA microarray elements, and the sensitivity of detection can be enhanced with the use of oligonucleotide immobilized onto a gold nanoparticle surface. We describe a novel method that couples a template-directed polymerase extension of a surface array element with nanoparticle-enhanced detection of the reaction product. Using this technique, it is possible to see as little as 10−100 amol of polymerase product, representing as little as 0.25% of a monolayer. This sensitivity would allow for the detection of a specific DNA target that is present in low amounts in a sample and with partially unknown sequence. One application of this method would be to identify the presence of the aberrantly recombined DNA sequences, such as those found in the fragile sites of chromosomes.
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