Band 3, Heft 1

The out-patient renal clinic (ORC) represents an important part of the nephrology service in general hospitals. The majority of renal diseases are chronic and patients need a systematic follow-up according to the severity and progression of kidney failure. The most important clinical manifestation is chronic renal failure (CRF) or chronic renal disease (CKD) The management of CKD, apart from medical and nursing services, also involves a number of community structures and financial resources. CRF treatment is costly and is a serious problem for the health systems in the western world. Effective treatment in the early stages aims to decrease the progression of kidney damage and, therefore, to prolong kidney function. Patients with renal failure can be managed as out-patients. The increased number of patients and the complexity of kidney diseases demand the collaboration of other out-patient clinics. The ORC may play an important role in this process. In this article. we present a literature review of the role of ORCs in the management of renal diseases around the world and we also present data based on our experience in our ORC.

Rapid eye movement sleep (REMS) loss affects most of the physiological processes, and it has been proposed that REMS maintains normal physiological processes. Changes in cultural, social, personal traits and life-style severely affect the amount and pattern of sleep, including REMS, which then manifests symptoms in animals, including humans. The effects may vary from simple fatigue and irritability to severe patho-physiological and behavioral deficits such as cognitive and behavioral dysfunctions. It has been a challenge to identify a molecule(s) that may have a potential for treating REMS loss-associated symptoms, which are very diverse. For decades, the critical role of locus coeruleus neurons in regulating REMS has been known, which has further been supported by the fact that the noradrenalin (NA) level is elevated in the brain after REMS loss. In this review, we have collected evidence from the published literature, including those from this laboratory, and argue that factors that affect REMS and vice versa modulate the level of a common molecule, the NA. Further, NA is known to affect the physiological processes affected by REMS loss. Therefore, we propose that modulation of the level of NA in the brain may be targeted for treating REMS loss-related symptoms. Further, we also argue that among the various ways to affect the release of NAlevel, targeting α 2 adrenoceptor autoreceptor on the pre-synaptic terminal may be the better option for ameliorating REMS loss-associated symptoms.

Objective: To identify the common sites and risk factors of community-associated infections in Chinese patients with diabetes. Materials and Methods: The Wanfang, CNKI, PUBMED and VIP databases restricting to Chinese patients with diabetes were queried without restriction to time period. Randomized controlled trials (RCTs) on the risk factors of community-associated infections in Chinese patients with diabetes were considered. Polled odd ratios (OR) and 95% confidence intervals (95% CI) were used for each factor in fixed or random-effect metaanalyses. Results: Twelve studies were identified that investigated seven risk factors of community-associated infections in Chinese patients with diabetes. The average infection incidence was 39.55%. The respiratory tract and urology tract were the predilection sites. Meta-analysis results are as follows: Diabetic patients with chronic complications (OR: 1.63; 95% CI 1.45-1.82), advanced age (OR: 1.30; 95% CI 1.19-1.42), longer duration (OR: 1.47; 95% CI 1.35-1.61) or ketoacidosis (OR: 1.37; 95% CI 1.13-1.66) were more prone to suffer from infections. Those with better glycemic control (OR: 0.68; 95% CI 0.61-0.76) or males (OR: 0.69; 95% CI 0.64-0.75) were less prone to suffer from infections. Conclusion: Chinese patients with diabetes had a high incidence of community-associated infections. We should highlight the risk factors that might provide a reference for the same.

Objectives: First objective was better understanding of the indications of chemotherapy in elderly with advanced cancer, tolerability and toxicity of chemotherapy in this age group. The second objective was to define current practice in chemotherapy for elderly people with advanced cancer for a selected group of patients treated in Institute of Oncology Bucharest (IOB). Materials and Methods: The study makes a clinical analysis of medical records of 27 patients from the archive of Institute of Oncology Bucharest treated by the same doctor. Patients were selected according to: age ≥ 65 years, ECOG performance status 0-1, normal blood counts and blood biochemistry, histological confirmation of the diagnosis of cancer, patients should received at least 3 cycles of chemotherapy. We extract characteristics of the patients to see if they were a homogeneous group of patients and to compare them with data from the literature. Overall survival was calculated by the Kaplan Meyer curve. Results: 295 patients more then 65 years were treated in our site in 2 years 2011, 2012. 93 patients received chemotherapy and only 27 patients were enrolled in this study following inclusion criteria. Common sites of cancer were lung and breast. The most used cytostatics for lung cancer was gemcitabine and carboplatine and cyclophosphamide, metotrexat and 5 fluorouracil for breast cancer. Toxicity was mild with the prevalence of hematologic toxicity. Overall survival without taking into account the type of cancer was 27.7 month. Conclusions: For selected patients, chemotherapy was well tolerated and appears to prolong survival regardless of the location of cancer. The relatively small number of elderly patients who received chemotherapy is probably due to lack of compliance to treatment, the increased number of co-morbidities and evaluation of performance status only by the ECOG index known not to be good enough to establish the indication of chemotherapy.

Systemic lupus erythematosus (SLE) is an auto-immune systemic disorder with protean manifestations. It can involve any of the organs and systems of the body. Involvement of the nervous system and eye is not uncommon and is multifactorial. We herein present a case of an adolescent girl with SLE whose first presentation was with acute renal failure. Her renal functions improved and she made full recovery. Three months later, she presented with eye symptoms and was found to have right abducens nerve palsy and bilateral papilledema. Her intracranial pressure was raised. Drainage of cerebrospinal fluid during lumber tap improved her eye signs and symptoms. Nervous system involvement and its pathogenesis are discussed with reference to this case and the published literature

Coexistent carcinoma and tuberculosis in a breast is a rare entity. It poses problems right from the diagnosis and staging of carcinoma to treatment and patient compliance. Proper clinical examination and investigations should be performed in such cases as both carcinoma and tuberculosis are major diseases with no definite symptoms or signs to distinguish the two. Herein, we report the case of a 45-year-old female who presented with complaints of a lump and pain in left breast, weight loss and weakness for the past 4 months. Fine needle aspiration cytology from the breast lump showed clusters of malignant cells along with many loose clusters of epithelioid cells on a background showing caseous necrosis. A diagnosis of coexisting breast carcinoma and tuberculosis of the breast was made and antitubercular treatment was started. The patient was operated and histopathology confirmed the diagnosis.

Gastritis cystica profunda (GCP) is a rare, benign lesion of the stomach characterized by polypoid hyperplasia and/or ulcerated mucosal lesion and cystic dilatation of the gastric glands extending into the submucosa or muscularis propria of the stomach. Its etiology and pathogenesis are still incompletely understood. The most important factor is assumed to be a history of prior gastric surgery. We herein present a case of a young adult female with upper gastrointestinal (GI) symptoms. She underwent upper GI endoscopy twice, which revealed pyloric narrowing and intramural mass. Gastric endoscopic mucosal biopsies were performed, but no tumor was identified and her symptoms persisted. Imaging studies also revealed a mass lesion. Open laparotomy and partial gastrectomy with histopathology of the resected specimen revealed the true nature of the lesion. Surgery also improved her symptoms. GCP should be kept in the differential diagnosis of gastric mural mass lesions.