Alport syndrome is a genetic disease that progresses to chronic kidney failure, with X-linked, autosomal dominant or autosomal recessive type of inheritance. Women are generally carriers of the ...mutation and have a milder form of the disease. During pregnancy, they have an increased risk of impaired kidney function and preeclampsia.
A 27-year old woman, gravida 1, para 0, in her 23rd gestational week came to the outpatient unit of the University Clinic of Nephrology for the first time because of slowly progressing proteinuria and Alport syndrome. She was admitted to the gynaecological ward in her 29th gw for proteinuria which increased from 3.8 g/day up to 20 g/day and the serum creatinine increased to 120- 150 micromol/l. She was delivered in the 30th gestational week due to obstetrical indications with a cesarian section and delivered a baby with a birth weight of 880 g. After delivery, proteinuria decreased to 2 g/d within 2 months and an angiotensin-converting enzyme inhibitor (ACEI) was started. Her second pregnancy, after 2 years, had an uneventful course and she delivered a healthy baby weighing 3000 g in the 39th week. Six months after the second delivery, her renal function remained normal and her proteinuria was 2 g/d.
Pre-pregnancy counselling and frequent controls during pregnancy are necessary for women with Alport syndrome, as well as regular monitoring after delivery. Recent reports are more in favour of good pregnancy and nephrological outcomes in women with Alport syndrome when renal disease is not advanced.
Common colds are the most frequently encountered disease worldwide and the most frequent reason for self-care. According to the cross-sectional European Common Colds study (COCO), patients use as ...many as 12 items on average for self-care. Little is known about the influence of discomfort and knowledge on self-care for common colds.
To understand the influence of patients' discomfort during a cold and their knowledge about the self-limited disease course on the use of self-care measures.
This COCO analysis included 2,204 patients from 22 European primary care sites in 12 countries. Each site surveyed 120 consecutive adults with a 27-item questionnaire asking about patients' self-care, subjective discomfort during a cold (discomfort: yes/no), and knowledge about the self-limited course (yes/no). Country-specific medians of the number of self-care items served as a cut-off to define high and low self-care use. Four groups were stratified based on discomfort (yes/no) and knowledge (yes/no).
Participants' mean age was 46.5 years, 61.7% were female; 36.3% lacked knowledge; 70.6% reported discomfort. The group has discomfort/no knowledge exhibited the highest mean item use (13.3), followed by has discomfort/has knowledge (11.9), no discomfort/no knowledge (11.1), and no discomfort/has knowledge (8.8). High use was associated with discomfort (OR 1.8; CI 1.5-2.2), female gender (OR 1.7; 1.4-2.0), chronic pain/arthritis (OR 1.6; 1.2-2.1), more years of education (OR 1.3; 1.1-1.6), age <48 years (OR 1.3; 1.0-1.5), and lack of knowledge (OR 1.2; 1.0-1.4).
Counseling on common colds should address patients' discomfort and soothing measures in addition to providing information on the natural disease course.
Although generally harmless, the common cold disturbs the lives of billions yearly. It is frequently treated by self-care, yet little is known about the effect gender may have on self-care. Our study ...set out to discover whether self-care for common colds differs by gender. We also wanted to test the 'Man cold' belief: that men 'break down' when they have a cold and suffer more than women when they are sick. We distributed questionnaires asking for a selection of self-care practices in eight categories to 3,240 consecutive patients in 14 Eurasian countries at 27 primary care sites. Of 2,654 patients included, 99% reported engaging in self-care for common colds. Discomfort was reported more frequently by women (74.7% vs. 66.5%, p < 0.001). There were gender differences in several self-care categories. The mean use of self-care items was higher in women than in men (12.0 vs. 10.3, p < 0.001). Women reported a greater variety of self-care items than men. However, more men reported using alcohol (17.8% vs. 8.4%, p < 0.001). This cross-national study documented gender differences in self-care for common colds.
Due to the heterogeneous and systemic nature of the chronic obstructive pulmonary disease (COPD), the new guidelines are oriented toward individualized attention. Multidimensional scales could ...facilitate its proper clinical and prognostic assessment, but not all of them were validated in an international primary care cohort, different from the original ones used for model development. Therefore, our main aim is to assess the prognostic capacity of the ADO, BODEx and DOSE indices in primary care for predicting mortality in COPD patients and to validate the models obtained in subgroups of patients, classified by revised Global Initiative for Chronic Obstructive Lung Disease (2011) and updated Spanish Guideline (2014). Besides, we want to confirm that the prognostic capacity of all indices increases if the number of exacerbations is substituted by the interval between them and to assess the impact on health of the patient's lifestyle, social network and adherence to treatment.
Design: External validation of scales, open and prospective cohort study in primary care.
36 health centres in 6 European high, medium and low income countries.
477 patients diagnosed with COPD, captured in clinical visit by their General Practitioner/Nurse.
Detailed patient history, exacerbations, lung function test and questionnaires at baseline.
Exacerbations, all-cause mortality and specific mortality, within 5 years of recruitment.
Multivariate logistic regression and Cox regression will be used. Possible non-linear effect of the indices will be studied by using Structured Additive Regression models with penalised splines. Subsequently, we will assess different aspects of the regression models: discrimination, calibration and diagnostic precision. Clinical variables modulated in primary care and the interval between exacerbations will be considered and incorporated into the analysis.
The Research Agenda for General Practice/Family Medicine highlights that the evidence on predictive values of prognostic indices in primary care is scarce. A prospective cohort like that of PROEPOC/COPD provides good opportunities for research into COPD and make communication easier between family practitioners, nursing staff, pneumologists and other professionals, supporting a multi-disciplinary approach to the treatment of these patients.
ISRCTN52402811 . Date: 15/01/2015. Prospectively registered.
Neurofibromatosis type 1 is an autosomal dominant condition that has a variety of clinical manifestations. Essential or secondary hypertension may be associated with neurofibromatosis. A rare finding ...is hypertension due to pheochromocytoma in patient with neurofibromatosis type 1.
We present a case with a 7-year medical history of hypertension which was poorly controlled and with wide variations of blood pressure before the examination. Investigations did not reveal a secondary cause of hypertension. After the physical examination and establishing the diagnosis of neurofibromatosis, as well as the history of symptomes suggestive of catecholamine discharge, diagnostic procedures for pheochromocytoma were undertaken. Abdominal CT and MRI have proven the presence of a right adrenal tumor mass which was suspected to be a pheochromocytoma. Patient was preoperatively treated for two weeks with alpha and beta blokers and right adrenalectomy was performed. Perioperatively and on a longer term, blood pressure remained well controlled with less antihypertensive therapy. Diagnosis and management of pheochromocytoma in neurofibromatosis involves a dermatologist, endocrinologist, nephrologist and an urologist and requires a well-coordinated multidisciplinary approach.
Pheochromocytoma, although a rare condition in patients with neurofibromatosis, may be a cause for uncontrolled hypertension, as well as other cardiovascular complications and the clinician should do all available clinical investigations to confirm it or exclude it on time.
Objectives: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences ...in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences.
Design: This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed.
Setting: GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland.
Subjects: This study included 2543 GPs from 29 countries.
Main outcome measures: GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country.
Results: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98).
Conclusions: GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old.
Key Points
* General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age).
* In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years.
* However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60.
* These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.
Preeclampsia is a condition characterized by hypertension, proteinuria after 20th week of gestation, dysfunction of other maternal organs or uteroplacentary dysfunction and is associated with ...short-term renal damage. Recent studies report on potential association of preeclampsia with chronic kidney disease in later life. The aim of this study was to determine this potential association by literature review and our results.
A Pubmed (Medline) literature search on the association of preeclampsia and subsequent chronic kidney disease was carried out. Our study was conducted at the Department of Nephrology of the University Clinical Centre Skopje in 2010 and included women who consulted the Clinic due to hypertension or impaired renal function and who had either preeclampsia or hypertensive disorders in pregnancy. Thirty patients with decreased glomerular filtration that occurred 1-28 years after pregnancy with hypertensive disorder were included in the study.
Literature search yielded 227 abstracts, of which 19 papers were selected, and they referred only to chronic kidney disease in the period after delivery in patients with preeclampsia. Various risks for emergence of chronic kidney disease in later life were reported in recent literature, varying from 1.2 to 14 for preeclampsia and in patients with superimposed preeclampsia, the risk was 45 times higher. In our study, risk of reduction in glomerular filtration rate was highest in the first 5 years (OR 3.6, 95% CI 1.06-22.5). Delivery before 27 weeks of gestation insignificantly increased the risk of reduced glomerular filtration in the later period (OR 1.33 95% CI 0.2-8.5). Preeclampsia is not a direct risk factor for chronic kidney disease, however, proteinuria over 0.3 g/24h in the group of patients with hypertension or preeclampsia in pregnancy, increased the risk of reduced glomerular filtration rate by 28 times (OR 28.5, 95% CI 2.7-30.9).
Patients with preeclampsia need careful monitoring in postpartal and long-term period, not only for cardiovascular but for chronic kidney disease.
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