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The prevalence of suboptimal Vitamin D levels is higher in patients with chronic kidney disease (CKD) than in the general population. Recent findings suggest that progression of CKD is linked to a suboptimal Vitamin D level. A high percentage of CKD patients have severe Vitamin D deficiency. These patients also have a low level of 25-hydroxy-vitamin D [25(OH)D] and consequently, a reduced ability to form active 1,25-dihydroxyvitamin D. Various factors underlie the low level of 25(OH)D, including a sedentary lifestyle, decreased intake of Vitamin D due to CKD-related dietary restrictions, and decreased synthesis of Vitamin D in skin due to uremia. All these factors may be particularly influential in patients with progressively worsening CKD, including those receiving chronic dialysis. The objective of our study is to determine the prevalence of Vitamin D deficiency in children with CKD stages three to five and those receiving chronic dialysis, to ascertain whether there is a relationship between Vitamin D deficiency and the stage of CKD, and to identify any clinical correlates associated with the Vitamin D status. A single-center, retrospective review was conducted of 46 children (younger than 18 years) with CKD stages 3–5D who attended the renal clinic of the Red Cross Children’s Hospital between October 2013 and November 2014. In total, 73.9% of the study population had suboptimal Vitamin D levels (43.5% and 30.4% had Vitamin D deficiency and insufficiency, respectively). The prevalence of Vitamin D deficiency was significantly higher in older children (≥10 years of age) than in younger children (P = 0.000) but did not significantly differ between males and females (P = 0.693). In total, 12 of 15 black children (80%), 19 of 26 colored children (73.1%), two of four white children (50%), and one Asian child (100%) had suboptimal Vitamin D levels

Background : multiple studies have suggested that chronic spontaneous urticaria (CSU) may be an autoimmune condition occurred in a substantial proportion of cases, but it is important to identify the potential triggers of the disease. there is no study in which the authors tried to answer the question of whether patch testing to common contact urticariogens should be routinely done in patients with CSU. objectives : we assessed urticarial, eczematous, and dual contact reactivity in patients with CSU to common contact urticariogens, the frequency and etiology, and compared with patients suffering from atopic dermatitis (ad) and healthy non-atopic persons. methods : all consecutive patients with chronic urticaria (cu) oradreferred to us fromvojvodina province (serbia) betweennovember 2015 and may 2017, and healthy volunteers were recruited. contact reactivity was defined as a positive patch-test to at least one of 15 well-known contact urticariogens. results : during the study period, 155 patients with cu and 100 patients with ad were referred, and 100 healthy control volunteers were also recruited. among them, 90 patients with cu, 75 with ad and 70 healthy volunteers gave their written informed consent. moreover, those who did not fulfill the proposed criteria were excluded. finally, the patients were divided into three groups : the CSU group included 28 patients with current CSU selected from 73 patients with cu; the group a included 60 persons with current extrinsic ad, and the group c included 50 healthy non-atopic persons. in all groups, benzoin, cinnamic acid, benzoic acid, and peru balsam were among the top five allergens in contact-urticarial response, whereas nickel and cinnamic acid were among the top three in eczematous response. the rates of urticarial, delayed, anddual contact reactivity to at least one allergen did not significantly differ [(_2-boot = 1.410; p = 0.480). (_2-boot = 1.341; p = 0.527) and (_2-boot = 0.316; p = 0.907), respectively] among different groups. the difference was detected to benzoin urticarial reactivity (_2-boot = 8.487; p = 0.016): in the CSU or ad groups, it was significantly higher than the c group (p = 0.025 and 0.010, respectively). a significant difference was detected in female urticarial reactivity to benzoin (_2-boot = 6.998; p = 0.031): in the group ad, it was higher than the c group (p = 0.018). conclusions : this could be of the first studies in which the researchers tried to answer the question of whether patch testing to common contact urticariogens should be routinely proposed in patients with chronic spontaneous urticaria. the authors suggest that more investigations have to be designed through multicentric research.

Published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of PD in Tunisia is poor. The purpose of this study is to report long-term clinical outcomes of PD patients through a 10-year experience at a single unit. This is a retrospective review of the medical records of 182 PD patients who were followed up from January 2006 to June 2016. All patients were followed till death, renal transplant, switch over to hemodialysis (HD) or the end of the study in June 2016. The mean age of the incident patients was 43.93 ± 16.95 years. Nineteen (10.4%) were aged >65 years and 59.3% were male. The average duration of follow-up was 27.75 ± 26.18 months. The mean duration of PD treatment was 27.75 ± 26.18 months. There were 186 episodes of peritonitis that occurred over the total study period (54 episodes during the 1 st year). The overall incidence of peritonitis during the 10-year study period was 1 per 27.25 patient months . Mechanical complications were noted in 31.2% of cases. Thirtytwo (17.6%) patients had catheter displacement. Only 26 cases of hemoperitoneum (14.3%) were recorded. Death occurred in 23.1% of cases. Twenty-two patients (27.5%) were transplanted; 56 patients (70%) were transferred to HD, one patient had renal recovery and one case had voluntarily interrupted PD. In Kaplan–Meier curves of residual renal function (RRF) loss, there was a significant difference between peritonitis group and peritonitis-free group (P = 0.01). Technique and patient survival were associated with diabetes with a significant difference. The main cause of technique failure was peritonitis (61.4%). Moreover, the main repertoried causes of death were cardiovascular and septic causes. The mortality of diabetic and elderly PD patients was higher than mortality in nondiabetic and nonelderly groups, respectively, in our study. Peritonitis was associated with loss of RRF and technique failure.

Background: Gestational diabetes is the most common antenatal medical complication that is associated with adverse short- and long-term maternal, fetal, and neonatal outcomes. Reducing maternal and fetal complications requires the early diagnosis of gestational diabetes. Unconjugated Estriol (UE) has led to insulin resistance under in vitro conditions. Objectives: This study aimed to determine the predictive power of unconjugated estriol in the diagnosis of gestational diabetes in Tehran, Iran. Methods: The present historical cohort study was conducted on 523 pregnant women presenting to two university-affiliated hospitals in Tehran, Iran, 2017 - 2018. The level of unconjugated estriol was determined at the 14th - 17th week of pregnancy, and gestational diabetes was diagnosed at the 24th - 28th week of pregnancy using the oral glucose tolerance test with 75 grams of glucose. Data were collected through interviews and sampling was carried out using a convenience sampling method. Results: Out of 523 pregnant women examined, 63 (12%) were placed in the gestational diabetes group and 460 (88%) in the nongestational diabetes group. The best cutoff point for unconjugated estriol was determined using the ROC curve as 0.965 MOM.We obtained 66.66% sensitivity, 54.78% specificity, 16.8% positive predictive value, and 92.30 negative predictive value for the UE test. Conclusions: Given the acceptable sensitivity (66.66%) and specificity (54.78%) obtained for the UE test and the area under the ROC curve of 0.60, it appears that the UE test can be considered a new, accessible, and reliable screening test for gestational diabetes.

Since human recombinant insulin preparations has been introduced in medicine, allergies to insulin have rarely been reported, especially in pregnant women, who experience immune system alterations that are due to physiologic changes that occur during pregnancy. We describe a 41-year old woman who developed gestational diabetes during the second trimester and was initially treated with insulin aspart and detemir. She complained of itching, redness and a burning sensation at insulin injection sites a few weeks after administration of both insulin types. This warranted cessation of her current insulin regimen and switching to Humulin R and Humulin N due to the unavailability of insulin lispro in the hospital. In addition, patient couldn’t aff ord buying it from outside the hospital. Her serum glucose was well controlled on this insulin regimen, and no allergic reaction was reported by the patient. Insulin allergy is an unusual fi nding in pregnancy, which can be managed by switching treatment regimens.

Accessory breast tissue is a relatively common congenital condition in which abnormal accessory breast tissue is seen as a mass anywhere along the course of embryologic mammary streak in addition to the presence of normal breast tissue. Ciclosporin therapy has been associated with benign breast disease in women. However, to the best of our knowledge, there are no reported cases of accessory breast tissue growth associated with ciclosporin therapy and regression after adjusting the dose. A 48-year-old woman had renal transplantation in 2009 with her brother as the donor. Her transplant follow-up over eight years had been unremarkable. She presented to our transplant follow-up clinic with bilateral painful axillary masses approximately 3 cm × 3 cm in diameter, not attached to the skin or underlying structures with no skin changes and no lymphadenopathy. Breast examination did not reveal any abnormalities. Her ciclosporin levels over the previous three years ranged between 130 and 150 ng/mL. These levels were within the acceptable recommended level of 100–150 ng/mL at that time (currently reduced to 80–120 ng/ml). Ultrasound of both axilla showed well-defined hypoechoic smooth outline masses in both axillary regions 3 cm × 4 cm. Fine-needle aspiration showed lesions consisting of cohesive ductal cells. The findings were consistent with accessory breast tissue with no evidence of inflammatory infiltrate or malignant changes. Her ciclosporin dose was reduced with the subsequent follow-up visits levels ranging between 90 and 110 ng/mL. Clinical examination four months later showed dramatic reduction in the axillary masses on both sides. Ultrasound confirmed the regression in the size of both masses. We conclude that ciclosporin was probably responsible for the formation of accessory breast tissue and reduction in the dose of ciclosporin resulted in substantial reduction in the tissue size.

The objective of our study is to assess the subjective and objective oral manifestations and salivary pH in diabetic and nondiabetic uremic patients at a nephrology clinic. A total of 194 diabetic and nondiabetic patients with chronic kidney disease (CKD), who were divided into four groups, Group A, B, C, D, and who were attending a nephrology clinic were included in the study. Predialytic unstimulated whole salivary pH was recorded using pHmeasuring strips. Subjective and objective findings were evaluated and recorded in the specially designed pro forma. Dental health assessment consisted of decayed, missing, and filled teeth index and community periodontal index (CPI). Dysgeusia was found to be significantly more prevalent in nondiabetic patients on dialysis. Uremic odor showed high significance (P <0.05) with 75 % patients being positive in diabetic dialysis. There was no significant difference in the incidence of tongue coating between the four groups. A statistically high significance was observed with the objective oral manifestation of mucosal petechiae, with P = 0.01. There was an increased periodontal pocket depth among diabetic CKD patients as compared to that in nondiabetic patients. A moderate significance was found, with a CPI score showing P <0.05. Increased prevalence of caries was noticed among the diabetic CKD patients (Groups A, B). Recorded salivary pH showed no significant difference among diabetic and nondiabetic CKD patients. Findings suggest that these patients are at risk of developing complications, related to systemic health causing morbidity and mortality. Hence, these patients are to be motivated for comprehensive professional oral care and self oral hygiene instructions. Additional research is necessary to elucidate and correlate the combined influence of diabetes, CKD, and dialysis on oral health.