Dysfunction of the peripheral and central auditory pathway in patients with type 1 diabetes mellitus

Although auditory alterations are not a typical symptom of diabetes mellitus (DM), they can occur in patients with type 1 DM. The findings of previous studies are controversial, because the frequency and degree of hearing loss varies, and quite often alterations are still subclinical. The typical test used to detect and manage hearing loss is the audiogram, but this test alone is only capable of detecting alterations due to injury of the inner hair cells and/or alterations in the central auditory pathway. However, auditory alterations resulting from a dysfunction that is still subclinical are only able to be detected through electrophysiological auditory tests, such as the otoacoustic emissions (OAE) and the auditory brainstem response (ABR) tests. Thus, the purpose of this paper is to review the studies that utilize the OAE and ABR tests, and to verify if the dysfunction is cochlear and/or neural in patients with type 1 DM. The findings of this review demonstrate that patients with type 1 DM can have auditory alterations stemming from a central cochlear origin. Following this finding, early diagnosis is very important in order to implement preventative treatments and initiate therapy.

Impact of tacrolimus intra-patient variability in adverse outcomes after organ transplantation

Tacrolimus(Tac)is currently the most common calcineurin-inhibitor employed in solid organ transplantation.High intra-patient variability(IPV)of Tac(Tac IPV)has been associated with an increased risk of immune-mediated rejection and poor outcomes after kidney transplantation.Few data are available concerning the impact of high Tac IPV in non-kidney transplants.However,even in kidney transplantation,there is still a controversy whether high Tac IPV is indeed detrimental in respect to graft and/or patient survival.This may be due to different methods employed to evaluate IPV and distinct time frames adopted to assess graft and patient survival in those reports published up to now in the literature.Little is also known about the influence of high Tac IPV in the development of other untoward adverse events,update of the current knowledge regarding the impact of Tac IPV in different outcomes following kidney,liver,heart,lung,and pancreas tran-splantation to better evaluate its use in clinical practice.

Acute kidney injury and electrolyte disorders in COVID-19

Acute kidney injury(AKI)and electrolyte disorders are important complications of hospitalized coronavirus disease 2019(COVID-19)patients.AKI is thought to occur due to multiple pathophysiological mechanisms,such as multiple organ dysfunction(mainly cardiac and respiratory),direct viral entry in the renal tubules,and cytokine release syndrome.AKI is present in approximately one in every ten hospitalized COVID-19 patients.The incidence rates of AKI increase in patients who are admitted to the intensive care unit(ICU),with levels higher than 50%.Additionally,renal replacement therapy(RRT)is used in 7%of all AKI cases,but in nearly 20%of patients admitted to an ICU.COVID-19 patients with AKI are considered moderate-to-severe cases and are managed with multiple interdisciplinary conducts.AKI acts as a risk factor for mortality in severe acute respiratory syndrome coronavirus 2 infection,especially when RRT is needed.Electrolyte disorders are also common manifestations in hospitalized COVID-19 patients,mainly hyponatremia,hypokalemia,and hypocalcemia.Hyponatremia occurs due to a combination of syndrome of inappropriate secretion of antidiuretic hormone and gastrointestinal fluid loss from vomiting and diarrhea.When it comes to hypokalemia,its mechanism is not fully understood but may derive from hyperaldosteronism due to renin angiotensin aldosterone system overstimulation and gastrointestinal fluid loss as well.The clinical features of hypokalemia in COVID-19 are similar to those in other conditions.Hypocalcemia is the most common electrolyte disorder in COVID-19 and seems to occur because of vitamin D deficiency and parathyroid imbalance.It is also highly associated with longer hospital and ICU stay.

Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease

AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease(CAD)in patients with acute chest pain.METHODS We studied individuals who were consecutively admitted to our Chest Pain Unit.At admission,investigators performed a standardized interview and recorded14 chest pain features.Based on these features,a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability,both numerically and categorically.As the reference standard for testing the accuracy of gestalt,angiography was required to rule-in CAD,while either angiography or non-invasive test could be used to rule-out.In order to assess reproducibility,a second cardiologist did the same procedure.RESULTS In a sample of 330 patients,the prevalence of obstructive CAD was 48%.Gestalt’s numerical probability was associated with CAD,but the area under the curve of0.61(95%CI:0.55-0.67)indicated low level of accuracy.Accordingly,categorical definition of typical chest pain had a sensitivity of 48%(95%CI:40%-55%)and specificity of 66%(95%CI:59%-73%),yielding a negligible positive likelihood ratio of 1.4(95%CI:0.65-2.0)and negative likelihood ratio of 0.79(95%CI:0.62-1.02).Agreement between the two cardiologists was poor in the numerical classification(95%limits of agreement=-71%to 51%)and categorical definition of typical pain(Kappa=0.29;95%CI:0.21-0.37).CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.

Blue LED as a new treatment to vaginal stenosis due pelvic radiotherapy:Two case reports

BACKGROUND Currently,the advancement cancer treatment technology improves overall survival,however,adverse events are still a challenge for health professional.Genitourinary syndrome of menopause and vaginal stenosis are conditions that impact the quality of life of patients undergoing radiotherapy.We present two such cases in patients with previous cervical and endometrial cancer.These conditions were handled with an innovative method using an energy-based device with blue light emitting diode for concomitant vaginal and vulvar irradiation.Positive impact in clinical findings,cytologic changes,and referred symptoms were documented.CASE SUMMARY One patient diagnosed with vaginal severe vaginal stenosis with previous cervix cancer treatment and other patient diagnosed with mild stenosis with severe dyspareunia and recent endometrium cancer treatment were considered for vulvovaginal treatment with weekly blue led device and closely evaluated with repeated validated questionnaires and cytological samples.CONCLUSION This innovative technique showed an improvement in all areas of the examiner's criteria,the cytological criteria,and most bothered symptoms.

COVID-19 in dialysis units: A comprehensive review

The coronavirus disease 2019(COVID-19)pandemic has been challenging for healthcare professionals worldwide.One of the populations affected by the pandemic are patients on renal replacement therapy,as kidney disease is an independent risk factor for severe COVID-19 and maintenance dialysis(a lifesustaining therapy)cannot be interrupted in the vast majority of cases.Over the past months,several authors and medical societies have published recommendations and guidelines on the management of this population.This article is a comprehensive review regarding the measures to prevent,contain and deal with a COVID-19 pandemic in the dialysis setting.We recapitulate the epidemiology and pathophysiology of COVID-19 in kidney dysfunction and present the main recommendations concerning the screening of healthcare personnel,dialysis patients and visitors as well as measures to improve the safety of the dialysis facilities’environments.In addition to preventive measures,this article briefly describes actions directed towards management of an outbreak of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)within a dialysis facility,the management of complications in dialysis patients with COVID-19 and overall data regarding the management of children with kidney disease.