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Post-transplantation diabetes mellitus (PTDM) is an important complication related to kidney transplantation (KT), and its occurrence is associated with increased morbidity and mortality. Nevertheless, KT is considered to be the most effective treatment option that offers better quality of life for patients with end-stage kidney disease. This study aimed to describe the occurrence of PTDM and the risk factors associated with its development in kidney transplant patients of a transplantation reference center in the State of Ceará (Brazil). This historical cohort study, based on medical records data, included adult patients undergoing KT from January 2006 to December 2010 in a public tertiary hospital. Multivariate analysis was performed with the use of a logistic regression model, with PTDM presence as dependent variable and the possible risk factors under study as independent variables. Throughout the evaluated period, 430 KTs were performed; 92 patients were excluded. Diabetes mellitus was already present in 9.2% of patients before KT. Hyperglycemia during the 1st month after transplantation occurred in 34.5% of recipients, and the occurrence of PTDM to the end of study was 19.9%. Factors associated with PTDM development were: fasting plasma glucose 1 month after KT (P < .001; odds ratio [OR] 1.05), deceased-donor KT (P = .015; OR 3.53), impaired fasting glucose before transplantation (P = .014; OR 4.10), and acute rejection occurrence (P = .003; OR 6.43). High PTDM occurrence was found, in accordance with the literature. Identification of factors associated with PTDM development, as well as its early diagnosis, could result in long-term improvement in patient and graft survivals. [ABSTRACT FROM AUTHOR]

What is known and Objective: Some antimicrobial agents are active in vitro against Leptospiras. The use of penicillins at the late stage of leptospirosis is still controversial. We aimed to evaluate the use of penicillin in patients with leptospirosis-associated acute kidney injury (AKI). Methods: A retrospective study was conducted of patients with leptospirosis admitted to two hospitals in Fortaleza city, Brazil, between 1985 and 2008. AKI was defined according to the RIFLE and AKIN classifications. Patients were divided in two groups according to whether they were treated with a penicillin or not. Results: Two hundred and eighty-seven patients were included, with an average age of 36·8 ± 15·6 years and mostly male (80·8%). One hundred and twelve patients (39%) received a penicillin. Patients treated with a penicillin were younger (32 ± 14 years vs. 39 ± 16 years, P = 0·0002) and had a shorter hospital stay (8·4 ± 5·0 vs. 11 ± 7·7 days, P < 0·0001). There was no difference in the onset of symptoms before hospital admission between the two groups (6·5 ± 3·0 vs. 7·7 ± 4·7, P = 0·33). Systolic blood pressure was lower in the penicillin group (111 ± 21 vs. 119 ± 22 mmHg, P = 0·04). AKI, need of dialysis and renal recovery at the time of hospital discharge were more frequent in patients who did not use a penicillin ( P < 0·05). Mortality was similar in both groups (11·6% vs. 13·7%, P = 0·60). Conclusion: Treatment of leptospirosis with antibiotics, including the penicillin, remains controversial. The main benefit of using penicillin in the present study was a reduction in the length of hospital stay and fewer complications, such as AKI, but its use was not associated with a decrease in mortality. On balance of risks and benefits, we recommend the use of penicillin in late-stage leptospirosis. [ABSTRACT FROM AUTHOR]

Abstract: Three independent geothermal systems have been identified, so far, in the Asal region of the Republic of Djibouti (i.e. Gale le Goma, Fiale and South of Lake). Six deep wells have been drilled in the region, the first two in 1975 and the others in 1987–88. Well A2 was damaged and wells A4 and A5 encountered impermeable yet very hot (340–365°C) rocks. Wells A1, A2, A3 and A6 produce highly saline (120g/L TDS) fluids leading to mineral scaling. Well test data indicate that the reservoir might be producing from fractured and porous zones. The estimated permeability-thickness of the deep Gale le Goma reservoir is in the 3–9darcy-meter range. Lumped-parameter modeling results indicate that well A3 should be operated at about 20kg/s total flow rate and that injection should be considered to reduce pressure drawdown. The estimated power generation potential of well A3 is 2.5MWe, and that of all Asal high-temperature hydrothermal systems is between 115 and 329MWe for a 25-year exploitation period. [ABSTRACT FROM AUTHOR]

Objective: The relationship between coronary endothelial function and insulin resistance remains speculative. We sought to determine whether pioglitazone, an insulin-sensitizing peroxisome proliferator-activated receptor (PPAR)-gamma agonist, improves cardiac endothelial function in individuals with type 2 diabetes.Research Design and Methods: Sixteen subjects with insulin-treated type 2 diabetes and without overt cardiovascular disease were randomly assigned to receive either 45 mg of pioglitazone or matching placebo for 3 months. Rest and adenosine-stimulated myocardial blood flow (MBF) were quantified with [(13)N]ammonia and positron emission tomography at baseline and study conclusion.Results: After 3 months, HbA(1c) levels dropped by 0.68% in the pioglitazone group and increased by 0.17% in the placebo group (P = 0.009 for difference between groups). Triglyceride (-93 vs. -39 mg/dl, P = 0.026) and HDL concentrations (+4.8 vs. -6.0 mg/dl, P = 0.014) improved significantly in the pioglitazone group compared with placebo. Despite these favorable changes, there was no demonstrable change in baseline MBF (-0.05 +/- 0.24 vs. -0.09 +/- 0.24 ml . min(-1) . g(-1), P = 0.45), adenosine-stimulated MBF (0.10 +/- 0.75 vs. 0.14 +/- 0.31 ml . min(-1) . g(-1), P = 0.25), or coronary flow reserve (0.45 +/- 1.22 vs. 0.35 +/- 0.72 ml . min(-1) . g(-1), P = 0.64) after 12 weeks of exposure to pioglitazone or placebo, respectively. Regression analysis revealed that lower glucose concentration at the time of the study was associated with higher coronary flow reserve (P = 0.012).Conclusions: Pioglitazone treatment for 12 weeks in subjects with insulin-requiring type 2 diabetes had no demonstrable effect on coronary flow reserve despite metabolic improvements. Higher ambient glucose levels contribute to impaired vascular reactivity in individuals with diabetes. [ABSTRACT FROM AUTHOR]

The pathophysiological mechanisms of arterial hypertension during hemodialysis (HD) in patients with end-stage renal disease (ESRD) are still poorly understood. The aim of this study is to investigate physiological, cardiovascular and neuroendocrine changes in patients with ESRD and its correlation with changes in blood pressure (BP) during the HD session. The present study included 21 patients with ESRD undergoing chronic HD treatment. Group A (study) consisted of patients who had BP increase and group B (control) consisted of those who had BP reduction during HD session. Echocardiograms were performed during the HD session to evaluate cardiac output (CO) and systemic vascular resistance (SVR). Before and after the HD session, blood samples were collected to measure brain natriuretic peptide (BNP), catecholamines, endothelin-1 (ET-1), nitric oxide (NO), electrolytes, hematocrit, albumin and nitrogen substances. The mean age of the studied patients was 43±4.9 years, and 54.6% were males. SVR significantly increased in group A (P<0.001). There were no differences in the values of BNP, NO, adrenalin, dopamin and noradrenalin, before and after dialysis, between the two groups. The mean value of ET-1, post HD, was 25.9 pg ml−1 in group A and 13.3 pg ml−1 in group B (P=<0.001). Patients with ESRD showed different hemodynamic patterns during the HD session, with significant BP increase in group A, caused by an increase in SVR possibly due to endothelial dysfunction, evidenced by an increase in serum ET-1 levels. [ABSTRACT FROM AUTHOR]

Pheochromocytoma is a rare disease charactrized by excessive production of catecholamines, manifestating mainly with hypertension. We report the case of a 45-year-old woman with history of sudden onset dyspnea, headache, palpitations and sudoresis. An abdominal ultrasound was suggestive of chronic kidney disease (CKD). An abdominal computed tomography and magnetic resonance was performed and showed a mass in the topography of left adrenal. The patient underwent a surgery for the removal of the mass and became stable with normal blood pressure levels, but remained with CKD. The dalayed diagnosis of pheochromocytoma in the present case has contributed to the development of CKD. [ABSTRACT FROM AUTHOR]