A rare case report on pediatric shellfish allergy
Published on: 23rd November, 2020
OCLC Number/Unique Identifier: 8796529764
Shellfish are extensively consumed worldwide because of their nutritional value. In general they are good sources of low-fat protein rich in several essential vitamins and minerals as well as in the essential nutrients omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFAs) [1]. Shellfish belongs to “The Big 8” food groups causing allergy, which often does not outgrow during childhood. However, increase in IgE – mediated sea food allergy has been linked to shellfish. Seafood- associated shellfish include crustaceans & molluskans [2]. These may cause mild local symptoms & lead to severe systemic anaphylactic reactions by ingestion, inhalation, or contact. Globally, the prevalence of shellfish allergy estimated to be 0.5% to 2.5% of the general population [3]. There are limited data showing the prevalence of shellfish allergy in children.
A study on US pediatric population showed 1.3% of shellfish allergy. Children were more allergic to crustacean (1.2%) than mollusks (0.5%) [4]. Tropomyosin is the major allergen.
The association between hypoxia, chronic ischemia and alters prostate structure and progress of chronic prostatic disease
Published on: 20th September, 2019
OCLC Number/Unique Identifier: 8286560822
Chronic prostatitis today show high level of relapses and recurrent pathological events even if using the best pharmacological therapy. A better understanding of physiopathological effect of ischemic hypoxic condition (pelvic, prostate tissue) and the lymphatic congestion in same body region contribute in evolution of a complex condition. The same focusing the strategy in biofilm reduction or in leukocyte infiltration can be a right way to reduce relapses and progression of the prostatic disease. Hypoxia is also related to prostatic cancer progression and prostatic biofilm if responsible of making a new micro- environment often drug resistance. A deep knowledge in this kind of phenomena can improve the clinical effect of drug therapy.
Evaluation of influence of IL-6 C-572G gene polymorphism and clinical factors on positive platelet antibody test
Published on: 15th January, 2021
OCLC Number/Unique Identifier: 8899339688
Background: Interleukin-6 (IL-6) promotes antibody production. The objective of this study was to investigate whether IL-6 C-572G single nucleotide polymorphisms (SNP) and clinical factors are associated with positive platelet antibody test.
Materials and methods: Thirty platelet recipients with platelet antibodies (responders) and 20 platelet recipients without platelet antibodies (non-responders) were randomly selected. The -572 C>G (rs 1800796) SNPs in the promoter region of IL-6 gene were genotyped by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) method. Solid phase red cell adherence assay (SPRCA) was used for platelet antibody detection.
Results: Age, sex, percentage patients with benign diseases, and percentage of patients with homozygotes for the C allele at position -572 of the IL-6 gene were similar between responders and non-responders. Although the amounts of platelets pheresis transfused to patients with hematologic diseases were higher than those of non-hematologic diseases (47.2 ± 54.2 vs. 17.4 ± 13.8 units, p = 0.019), detection rate of platelet antibodies was lower in patients with hematologic diseases than that in patients with non-hematologic diseases (42.3% vs. 79.2%, p = 0.01).
Conclusion: There was no association between IL-6 C-572G gene polymorphism and positive reactivity in solid phase platelet antibody detection method in platelet recipients.
To legalize cannabis in Ghana or not to legalize? Reviewing the pharmacological evidence
Published on: 10th December, 2019
OCLC Number/Unique Identifier: 9267251578
Background: Although illegal, Ghana has a long history of cannabis use. With changing perceptions, advocacy for legalization has increased globally. This study exams pharmacological evidence on the prospects and challenges of decriminalization and /or legalization of cannabis in Ghana.
Results: Cannabis and cannabinoids are a “pharmacological enigma” with unique ability to activate at least 3 of the 4 drug receptor super families. This include; inotropic Transient Receptor Potential Vanilloid 1 (TRPV1), metabotropic Cannabinoid Receptors (CB) and nuclear Peroxisome Proliferator Activator Receptors (PPAR). Cannabinoid receptors also dimerize with other receptors creating distinctly new signaling pathways. Cannabis and cannabinoids show good anti- nociceptive, anti-inflammatory, immunosuppressant anti-emetogenic activity and variable anticonvulsant activity. It can play important role in palliative care, some rare intractable epilepsy, multiple sclerosis, cachexia and Opioid Use Disorder. Cannabis precipitates psychosis in individuals with underlying genetic susceptibility. Chronic cannabis use alter the neurobiology of adolescent brain, predisposing them to amotivational syndrome characterized by depersonalization and inhibited motivation for goal directed behavior. Cannabis is also a “gateway drug”; ushering users to “harder” substances of abuse and reinstating extinguished drug seeking behaviours. The recent tramadol abuse in Ghana may have been precipitated by previous and concurrent cannabis use. Furthermore, Ghana’s cannabis may have a higher propensity to induce detrimental effects because of preferential accumulation the psychotropic delta-9-Tetrathydrocannabinol as a result of the high tropical temperature and humidity.
Conclusion: There is not sufficient pharmacological evidence supporting criminalization of medical cannabis in Ghana. However, the same evidence does not support legalization of recreational cannabis.
Co-extract mixture from Strophanthus hispidus (roots) and Aframomum meleguta (seeds) show phytochemical synergy in its anti-inflammatory activity
Published on: 11th December, 2019
OCLC Number/Unique Identifier: 8500735034
Background: Combination of extracts from multiple plants are typically used in ethnomedicine to putatively offer more potent chemotherapeutic and chemopreventive effects than that of individual extracts from single plants. Aqueous extracts from two multipurpose plants Strophanthus hispidus (roots) and Aframomum meleguta (seeds) are topically co-administered in the nasal cavities for the ethnomedicinal management of chronic sinusitis.
Aim: This study assessed the potential phytochemical synergy between constituent extracts of Strophanthus hispidus (roots) and Aframomum meleguta (seeds) in its anti-inflammation, anti-microbial and anti-oxidant effects.
Methods and Materials: Broth dilution assay assessed anti-microbial activities. DPPH radical scavenging assay examined the scope of anti-oxidant activities and inhibition of carrageenan-induced 7-day old chick feet oedema revealed anti-inflammatory activities.
Results: Anti-microbial activities of individual plant extracts in broth dilution assay showed comparable potency to that of the co-extract mixture. Similarly, individual extracts showed levels of DPPH radical scavenging activities in anti-oxidant assay that was comparable to those found for the co-extract mixture. In contrast to these two effects, inhibition of carrageenan-induced 7-day old chick feet oedema revealed an anti-inflammatory activity evoked by co-extract mixtures that was greater than the sum of the individual potencies of the two extracts.
Conclusion: The potential phytochemical synergy of the two plants extracts in its anti-inflammatory response largely validates ethnomedicinal practice and generally confirms growing literature reports that ascribe the net pharmacological activities of herbal extracts to the combined multi-activities of unique phytochemical entities at multiple target sites.
An Audit on the implementation of administering Ondansetron in children with acute gastroenteritis and its effect on admission rate
Published on: 25th March, 2021
OCLC Number/Unique Identifier: 8984626581
Acute gastroenteritis (AGE) is a common presenting complaint in paediatrics. Most often, the reason for admission into hospital is to initiate intravenous rehydration in patients with severe dehydration and inability to tolerate oral intake. We found that Ondansetron acts as a potent antiemetic to support an increased number of children receiving oral hydration, and subsequently leading to decreased rates of admission. This study aims to audit the use of Ondansetron to Oral Rehydration Therapy (ORT) on children with acute gastroenteritis, and its effect on admission rates from the emergency department in University Hospital, Limerick (UHL). Data collected over a 3-month period from June to August 2017 in which Ondansetron was not used was compared to another 3-month period when Ondansetron was used. Several outcomes were measured including admission to hospital.
The rate of admission decreased by 15% [26/74 (35%) in 2017 to 16/81 (20%) in 2019 p = 0.22]. 81 patients received Ondansetron, of which 79% were successfully rehydrated orally. The administration of Ondansetron reduced the need for intravenous fluids and hospital admission overall in these children with AGE. This reduction ultimately accounted for lower costs incurred by the Health Services Executive per patient, and also suggested the anti-emetic use as a cost effective measure for managing and treating patients with AGE.
Antiuropathogenic and antioxidant activities of Hypoxis hemerocallidea Lam. extracts, and compounds from its taxonomically related species
Published on: 22nd January, 0020
OCLC Number/Unique Identifier: 8529692786
Hypoxis hemerocallidea Lam is one of the 43 Hypoxis species in South Africa, marketed extensively as over the counter herbal product for the management of several diseases. The plant commercial products link efficacy to hypoxoside 4, its aglycone (rooperol), or β-sitosterol. This study investigated antibacterial and anti-oxidant activities of four other molecules and two extracts from the Hypoxis plant. Visual antioxidant limit of detection and free radical scavenging activities of test samples were determined using 20 mM hydrogen peroxide, 0.4 mM DPPH or ferric reducing antioxidant power assay. Quantitative free radical was determine by spectrophotometric method while antibacterial activity was evaluated using MICs against uropathogens: S. aureus (ATCC25923), S. marcescens (ATCC 14041), P. aeruginosa (ATCC 9721), P. mirabilis (ATCC 33583) and E. coli (ATCC 10536).
Anti-oxidant activities visual limit of detection of 0.06 mg/mL and percentage free radical scavenging activity (IC50 = 0.048 - 0.032 mg/ml) for pure compounds 1 - 4 and (IC50 = 0.037 - 0.039 mg/ml) for extracts were obtained. The reducing power IC50 ranged between 0.15 - 0.23 mg/ml for extracts and 0.11-0.35 mg/ml for standards. Antibacterial potentials show a noteworthy to moderate MIC values of 0.20 - 1.56 mg/ml against S. aureus (ATCC 25923), S. marcescens (ATCC 14041), P. aeruginosa (ATCC 9721), P. mirabilis (ATCC 33583) and E. coli (ATCC 10536). Galpinoside 5, hemerocalloside 3 and curculigoside C 2 are the other active compounds in Hypoxis plant.
Factors associated with diagnostic delay in children with Wilms’ tumor
Published on: 15th April, 2021
OCLC Number/Unique Identifier: 9006870366
Background: In Wilms’ tumor, the time elapsed between clinical diagnosis and the start of treatment is clearly associated with morbidity and mortality. As treatment delay can influence patient survival, identification of possible causes can mitigate the consequences arising from prolonged diagnostic uncertainty.
Objective: To ascertain whether an initial diagnosis of Wilms’ tumor in the emergency department influences patient prognosis depending on the type of referral for definitive treatment.
Patients and methods: Retrospective chart review of 98 children receiving treatment for Wilms’ tumor at the Brazilian National Cancer Institute (INCA) between April 2003 and December 2016. Patients were categorized into two groups: those referred directly from an emergency public department to INCA and those first transferred to another hospital before being referred to INCA.
Results: Of the 98 cases included in the study, 42.9% were direct referrals and 57.1% were indirect referrals. Presence of an abdominal mass was the most common presenting complaint, followed by abdominal pain. In cases with larger tumors, the mean tumor volume was greater than reported elsewhere in the literature, suggesting longer disease duration. Significantly higher tumor volumes were observed in patients with a palpable abdominal mass as compared to those with the second most frequent complaint (abdominal pain).
Conclusion: The findings of this study support the hypothesis that patients diagnosed with kidney masses in the emergency department are at greater risk of delayed diagnosis when they are referred first to a non-specialized outside hospital than when referred directly to a specialized cancer treatment unit.
COVID-19 immunologic and toxicological implication: Innate immune sensor and immune escape
Published on: 25th March, 2021
OCLC Number/Unique Identifier: 8980360578
Related COVID-19 and new Variant and treatment like vaccine it is relevant to deeply verify the immunologic implication and in a special way regarding the innate immune sensor system and the evasion of the immune system.
This can be crucial to search for new strategies to fight this severe disease under a Toxicology-antidotes point of view.
The rapid emergence of a new variant is under study by researchers because some of these show different responses to antibodies as reported in literature (vaccine efficacy?).
In this article after a review part it is submitted a collection of hypothesis of solution to contrast COVID-19.
Spread and mortality and project hypothesis.
A new toxicological approach also in a viral respiratory disease can be a novelty to adequately fight this severe condition and this focusing not only towards specific immunity but also a specific measures.
A toxicological approach in drug- vaccine like products designing makes it possible to get the clinical outcomes needed.
A rare cause of neonatal diarrhoea: Microvillositary inclusion disease: about a case report
Published on: 20th May, 2021
OCLC Number/Unique Identifier: 9137583742
Microvillositary inclusion disease also known as microvillositary atrophy is a rare congenital enteropathy containing a border abnormality in the brushes of enterocytes, manifesting as severe rebellious diarrhea in newborns and infants. It was first described in 1978 by Davidson, et al. The autosomal recessive mode of transmission is suggested because of the frequency of familial cases and inbreeding. Histopathology plays an essential role in establishing the diagnosis. In 2008, a common mutation was identified in most of the patients studied in the MYO5B gene that codes for the Myosin Vb protein, which helped in understanding the etiopathogeny of this pathology poorly described in the literature. The prognosis for this pathology is extremely bleak, requiring total parenteral nutrition for child survival. Intestinal transplantation is for the moment the only long-term solution.
Materials and methods: We report the case of an infant aged 6 months, with no perinatal antecedent. There is 1st degree consanguinity, the mother has a history of deaths in younger siblings in undetermined circumstances. Who since the age of 3 days presents profuse liquid diarrhoea with malnutrition, dehydration and enormous abdominal distension? Several diagnoses were suspected before the jejune biopsy was carried out, which led to the diagnosis of a microvilliositary inclusion disease.
The aim of our work is to highlight the rarest cause of neonatal rebel diarrhoea and to know how to include it among other differential diagnoses.
Criteria for paediatric oral liquid form
Published on: 26th March, 2021
OCLC Number/Unique Identifier: 8980371069
Paediatric hospitals frequently have to face the lack of commercially available medicines suitable or even licensed for their use in paediatrics. Thus, only one-third of all medicines approved by the European Medicines Agency over the period of 1995 to 2005 were licensed for use in children [1].
Predictors of mortality in neonatal sepsis in a resource-limited setting
Published on: 16th June, 2021
OCLC Number/Unique Identifier: 9272394428
Introduction: Sepsis remains a major cause of death in neonatal period. Although significant advances in diagnosis, therapeutic and prevention strategies have been noted, sepsis remains a common concern in clinical practice especially in low-resource countries. The aim of this study was to determine the predictors of mortality in neonatal sepsis in Lubumbashi city (Democratic Republic of Congo).
Methods: The records of newborns with sepsis managed in Neonatal Intensive Care Units in two University Hospitals between November 2019 and October 2020 were studied. Binary and multiple logistic regressions have been used to observe the association between independent variables and dependent variable.
Results: A total of 162 cases of neonatal sepsis were reviewed. The mortality rate of neonatal sepsis was 21% of babies admitted. Very low birth weight (< 1500 grams) and primiparity were significantly associated with mortality in neonatal sepsis (AOR = 12.66; 95% CI 2.40 to 66.86; p = 0.003 and AOR = 3.35; 95% Cl 1.31 to 8.59; p = 0.012, respectively).
Conclusion: The mortality rate of neonatal sepsis was 21%. Very low birth weight and primiparity were significantly associated with mortality in neonatal sepsis.
Revisiting childhood pneumonia in low-recourse setting hospitals
Published on: 12th July, 2021
OCLC Number/Unique Identifier: 9137597336
Introduction: Pneumonia, defined as infection of lung parenchyma, is associated with severe complications especially in the very young and old patients. It is the world’s leading cause of childhood mortality. The World Health Organization (WHO) classification and guidelines are commonly used in Sudan in the diagnosis and management of pneumonia patients. This review was the outcome of some researches done in Sudan by the author and his colleagues. Management Systems were evaluated to give complete end to end solutions for serving patients along with their records in hospitals and clinics in Sudan. The objective of the study was: To reflect author experience in management of childhood pneumonia in Sudan and to determine feasible, affordable approach to pneumonia in Sudan.
Methodology: Searching through PubMed for the author publication and review of publication by author in Sudan regarding management of pneumonia.
Conclusion: Simple tests like chest X-ray, high WBC high-reactive protein, together with high temperature can predict the need for urgent blood culture. Antibiotic treatment for childhood pneumonia weather that recommended by WHO, b-lactam inhibitors or 3rd generation cephalosporin has the same outcome.
Effect on Vitamin D status of Breastfeeding Infants after Vitamin D3 Supplementation during Breastfeeding Lactation: A double-blind randomized controlled trial
Published on: 4th August, 2017
OCLC Number/Unique Identifier: 7317627573
Background: Vitamin D deficiency in pregnancy increases several risks of breastfed mothers. To prevent these adverse events, vitamin D supplementation during pregnancy and lactation is recommended, but suggested dose ranges vary.
Objective: To determine whether vitamin D3 1,800 IU/d supplementation in lactating mothers improves the vitamin D status of their breastfed infants.
Materials and Methods: A randomized, placebo–controlled trial with Thai pregnant women was conducted. Lactating mothers (n=72) and their breastfed infants with insufficient maternal 25 hydroxyvitamin D (25(OH)D) levels in the third trimester were randomly assigned to two groups, one of which received 1,800 IU/d vitamin D supplementation and the other a placebo. Maternal serum 25(OH)D during lactation, cord blood, and 6-week breastfed infant serum were measured using LC-MS/MS.
Results: Mean maternal age (±SD) was 27±5 years, and pre-gestational BMI was 22.29±5 kg/m2. Maternal serum 25(OH)D at baseline was 22.29±7.15 nmol/L. At 6 weeks, both maternal 25(OH)D and infant 25 (OH)D levels had increased significantly in the vitamin D supplement group of mothers and infants (68.30±15.40, 40.40±12.56 nmol/L) compared to those in placebo groups (55.15±13.57, 24.28±17.20 nmol/L) (p <0.001, p<0.001). The changes in infant 25(OH)D levels increased substantially in the vitamin D supplement group but decreased in placebo(17.49±16.27 ng/ml compared to -1.34±19.23 nmol/L in the placebo group, p<0.001). The change of maternal 25(OH)D were positively correlation to the change of 25(OH)D level in breastmilk mothers and infants by r=0.697, p<0.001 and r=0.379, p=0.003 respectively.
Conclusions: Vitamin D3 supplementation to breastfed mother during lactation can increase serum 25(OH)D level in Thai breastfed mother and infants. Further work is needed to determine the optimum duration of vitamin D supplementation to normalized breastfed infants with 25(OH)D level >75 nmol/L.
Indian spices and Caffeine treatment for Obesity and Cardiovascular disease
Published on: 31st January, 2018
OCLC Number/Unique Identifier: 7355979500
The global obesity epidemic that was previously reported [1,2] is now to worsen with obesity to double in 73 countries around the world [3,4]. Improving the health of obese individuals by dietary restriction, anti-obese foods and increased physical activity [1] has not reduced the global obesity epidemic. Obesity is linked to nonalcoholic fatty liver disease (NAFLD) [5,6] with complications relevant to the metabolic syndrome and cardiovascular disease [7]. Appetite control has become critical to endocrinology and metabolism with the apelinergic pathway and nuclear receptor Sirtuin 1 (Sirt 1) now connected to the endocrine system [8] and critical to metabolism. The apelin-Sirt 1 interaction involves nitric oxide (NO) [9] that is now considered as the defect [10] in the interaction between the peptide apelin and calorie sensitive gene Sirt 1 involved in NO imbalances in the adipose tissue, liver and the brain.
Does serum uric acid play a protective role against tissue damage in cardiovascular and metabolic diseases?
Published on: 18th July, 2017
OCLC Number/Unique Identifier: 7317650796
Previous clinical, observation and epidemiologic studies have demonstrated strong association between serum uric acid (SUA) and cardiovascular disease (hypertension, heart failure, and asymptomatic atherosclerosis), metabolic states (abdominal obesity, diabetes mellitus, metabolic syndrome, insulin resistance) and kidney disease. There is a large body of evidence regarding the role of SUA as predictor of CV events and CV mortality in general population and individuals with established CV disease and metabolic diseases. However, SUA may exhibit protective effects on endothelium and vasculature as well as attenuate endogenous repair system through mobbing and differentiation of cell precursors. Although SUA lowering drugs are widely used in patients with symptomatic hyperuricemia and gout beyond their etiologies, there is no agreement of SUA below target level 6.0 mg/dL in asymptomatic individuals with kidney injury and CV disease and data of ones are sufficiently limited. The short communication is depicted on the controversial role of SUA as primary cell toxicity agent and secondary cell protector against hypoxia, ischemia and apoptosis
Exercise preserves pancreatic β-cell mass and function in obese OLETF rats
Published on: 19th June, 2018
Although exercise has been proposed to be beneficial to type 2 diabetes, its effects on β-cell function and mass remain unclear. In the present study, the effects of long-term swimming training on the function and mass of β-cells in diabetic OLETF rats were examined. At 44 weeks of age after developing diabetes, the OLETF rats were divided into two groups: a control group and an exercise group. The exercise group had a daily swimming for 12 weeks. While not found with the control rats, in the obese OLETF rats, the exercise reduced the weight gain which was associated with improved glucose tolerance and elevated circulating insulin levels as determined by the oral glucose tolerance test and insulin ELISA. The exercise improved plasma total cholesterol and triglyceride levels, and also significantly increased the islet β-cell mass and pancreatic insulin content associated with decreased β-cell apoptosis and elevated activation of the serine/threonine kinase, Akt. The present studies suggest that exercise improves diabetes symptoms via enhancement of the β-cell mass and function through decreasing glucolipotoxicity and reducing β-cell apoptosis by activating Akt in obese OLETF rats.
Comparison of Efficacy and Safety of Hydroxychloroquine and Teneligliptin in Type 2 Diabetes Patients who are Inadequately Controlled with Glimepiride, Metformin and Insulin therapy: A Randomized Controlled Trial with Parallel Group Design
Published on: 13th September, 2018
OCLC Number/Unique Identifier: 7856189396
Aim: The aim of the present study is to assess the efficacy and safety of Hydroxychloroquine in comparison with Teneligliptin in type 2 diabetes patients whose blood glucose levels were inadequately controlled with metformin, Glimepiride and insulin therapy.
Methods: This was a randomized, prospective, parallel-group, experimental trial done in 300 Type 2 Diabetes patients who were uncontrolled (HbA1c=7.5–10%) with metformin, Glimepiride and insulin therapy. Patients were randomly divided into two groups one received Teneligliptin 20 mg (n=152) and other received Hydroxychloroquine 400 mg (n=148) while continuing insulin therapy with other 2 OHA. Insulin doses were adjusted to maintain normal blood glucose levels.
Result: The adjusted mean change from baseline to endpoint in HbA1c was −1.2±0.5% in patient group receiving Hydroxychloroquine and −0.9±0.5% in patients group receiving Teneligliptin, respectively, with a significant between-treatment difference (p<0.001). The incidence of adverse events was similar in the Hydroxychloroquine (72%) and Teneligliptin (77%) groups. However, hypoglycaemic events were less common (p<0.001) and less severe (p<0.05) in patients receiving Hydroxychloroquine than in those receiving Teneligliptin.
Conclusion: Hydroxychloroquine decreases HbA1c in patients whose type 2 diabetes is poorly controlled with high doses of insulin as compare to Teneligliptin. Addition of hydroxychloroquine to insulin therapy is also associated with reduced incidence of confirmed and severe hypoglycaemia.
Cardiovascular risk reduction: Past, present and future in Mexico
Published on: 17th July, 2018
OCLC Number/Unique Identifier: 7815004265
Atherosclerotic cardiovascular disease (ASCVD) is globally defined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin and it is the leading cause of morbidity and mortality for individuals with or without diabetes and is the largest contributor to the direct and indirect catastrophic costs of cardiovascular disorder. Very common conditions coexisting into the cardiovascular risk (e.g., obesity, hypertension, diabetes and dyslipidemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. Numerous studies have shown the efficacy of controlling individual cardiovascular risk factors in preventing or slowing ASCVD in people with these disorders. In other words it is not enough control one risk factor. We need to develop novel strategies to detect and control all of them at the same time. Thus, large benefits are seen when multiple cardiovascular risk factors are addressed simultaneously. Under the current paradigm of aggressive risk factor modification in patients with cardiovascular risk, there is evidence that measures of 10-year coronary heart disease (CHD) risk among U.S. adults with cardiovascular risk have improved significantly over the past decade and that ASCVD morbidity and mortality have decreased. In Mexico the Mexican Institute of Social Security is implementing new strategies of primary and secondary prevention in order to confront this pandemic.
In this review, we analyze the state of the art to approach at the same time the different cardiovascular risk factors, in an integral form because of this is the real worldwide challenge of health.
Role of the Kidneys in the Regulation of Intra-and Extra-Renal Blood Pressure
Published on: 17th July, 2018
OCLC Number/Unique Identifier: 7814987529
Hypertension is one of the most common chronic diseases of human, affecting more than one billion people worldwide. When it becomes chronic, hypertension leaves behind cardiac hypertrophy, heart failure, stroke, and kidney disease, resulting in substantial morbidity and mortality. Treatments that effectively reduce blood pressure can prevent these complications. Abnormalities in the production of urine by the kidneys have been implicated in increased vascular resistance, leading to high blood pressure and increased cardiac mass. By matching urinary excretion of salt and water with dietary intake, balance is usually attained, thereby maintaining a constant extracellular fluid volume and blood pressure. Based on the capacity for the kidney to excrete sodium, this blood pressure-altering mechanism should have sufficient advantage to limit intravascular volume and consequently lower blood pressure in response to a range of stimuli from elevated heart rate to increase peripheral vascular resistance. A major determinant of the level of intra- and extra- renal blood pressure is therefore sodium handling, and it is controlled by complex physiological mechanism by hormones, inflammatory mediators, and the sympathetic nervous system. Homoeostasis and favourable influence sodium balance are a basic mechanism of efficacy for diuretics and dietary sodium restriction in hypertension. Renin Angiotensin System (RAS) inhibitors, vasodilators, and β-blockers work to facilitate pressure-natriuresis. Also, WNK signaling pathways, soluble inflammatory mediators, and pathways regulating extra-renal sodium disposition may be the focus towards elimination of sodium and reducing blood pressure in hypertension.
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