Medical therapy to facilitate urinary stone passage : a meta-analysis. Commentary

The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients.We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m2 of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m2 with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to <10 ml per minute per 1.73 m2, a sustained decrease in eGFR of ≥40% from baseline, or death from renal causes) or death from cardiovascular causes.A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P<0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P = 0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups.Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo. (Funded by Boehringer Ingelheim and others; EMPA-KIDNEY ClinicalTrials.gov number, NCT03594110; EudraCT number, 2017-002971-24.). 

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Empagliflozin in Patients with Chronic Kidney Disease

Metabolic syndrome (MetS) forms a cluster of metabolic dysregulations including insulin resistance, atherogenic dyslipidemia, central obesity, and hypertension. The pathogenesis of MetS encompasses multiple genetic and acquired entities that fall under the umbrella of insulin resistance and chronic low-grade inflammation. If left untreated, MetS is significantly associated with an increased risk of developing diabetes and cardiovascular diseases (CVDs). Given that CVDs constitute by far the leading cause of morbidity and mortality worldwide, it has become essential to investigate the role played by MetS in this context to reduce the heavy burden of the disease. As such, and while MetS relatively constitutes a novel clinical entity, the extent of research about the disease has been exponentially growing in the past few decades. However, many aspects of this clinical entity are still not completely understood, and many questions remain unanswered to date. In this review, we provide a historical background and highlight the epidemiology of MetS. We also discuss the current and latest knowledge about the histopathology and pathophysiology of the disease. Finally, we summarize the most recent updates about the management and the prevention of this clinical syndrome.

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Metabolic Syndrome: Updates on Pathophysiology and Management in 2021

White adipose tissue, once regarded as morphologically and functionally bland, is now recognized to be dynamic, plastic and heterogenous, and is involved in a wide array of biological processes including energy homeostasis, glucose and lipid handling, blood pressure control and host defence1. High-fat feeding and other metabolic stressors cause marked changes in adipose morphology, physiology and cellular composition1, and alterations in adiposity are associated with insulin resistance, dyslipidemia and type 2 diabetes2. Here we provide detailed cellular atlases of human and mouse subcutaneous and visceral white fat at single-cell resolution across a range of body weight. We identify subpopulations of adipocytes, adipose stem and progenitor cells, vascular and immune cells and demonstrate commonalities and differences across species and dietary conditions. We link specific cell types to increased risk of metabolic disease and provide an initial blueprint for a comprehensive set of interactions between individual cell types in the adipose niche in leanness and obesity. These data comprise an extensive resource for the exploration of genes, traits and cell types in the function of white adipose tissue across species, depots and nutritional conditions. 

A single-cell atlas of human and mouse white adipose tissue

Clinical laboratory diagnostics : use and assessment ofclinical laboratory results

Background/Aims: Magnesium is an essential mineral for many metabolic functions. There is very little information on the effect of magnesium supplementation on me

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Magnesium Replacement Improves the Metabolic Profile in Obese and Pre-Diabetic Patients with Mild-to-Moderate Chronic Kidney Disease: A 3-Month, Randomised, Double-Blind, Placebo-Controlled Study

PURPOSE To evaluate the effect of diabetic polyneuropathy on choroidal thickness in type 2 diabetes patients. METHODS Forty-one diabetic polyneuropathy (DPN) patients with no or mild retinopathy, 50 non-DPN diabetic patients with no or mild retinopathy, and 42 healthy controls without any retinal complaint were included in the study. All participants underwent detailed ophthalmic examinations. Choroidal thickness (CT) measurements were performed by the same independent technician in the morning between 9 and 11 AM to avoid diurnal variations. Perpendicular CT was measured from the outer edge of the hyperreflective retinal pigment epithelium to the inner sclera at seven locations: the fovea; and 500, 1000, and 1500 μm temporally and nasally to the fovea. RESULTS The groups were age and sex matched (P > 0.05). The mean subfoveal CT values were significantly different in groups with a thickening trend from control to non-DPN and DPN (P < 0.01). The mean values for subfoveal CT in control, non-DPN, and DPN groups were 241.12 ± 52.71, 279.82 ± 51.42, and 304.71 ± 54.92 μm, respectively. The same thickening trend was also evident in all other six measurement points with statistical significance (P < 0.01). CONCLUSIONS Diabetic patients had increased CT compared to healthy controls. The presence of neuropathy in diabetes patients caused additional choroidal thickening, compared to nonneuropathic patients.

Alterations of choroidal thickness with diabetic neuropathy

Background: Mean platelet volume (MPV) level is known to increase in diabetes mellitus (DM).
Objective: In this study, the first aim is to examine whether there is a correlation between MPV and hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG). The second aim is to investigate whether a correlation exists between MPV and HbA1c and FPG changes after treatment
Method: In the study, we examined baseline and final HbA1c, MPV and FPGA values of 343 patients. Including the study group (SG) consisted of 169 patients with diabetes whose HbA1c levels decreased %1 and the control group involving 174 patients whose HbA1c levels did not change.
Results: Similar to CG, HbA1c level of SG decreased to 7.58, and MPV level reduced to 8.68. There existed a positive correlation between MPV and HbA1c levels (r=154; p

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Changing of Hemoglobin A1c Affects Mean Platelet Volume in Type-2 Diabetes Mellitus

Objective: Mean platelet volume (MPV) level is known to increase in diabetes mellitus (DM), and prediabetes. In this study the first aim was to compare MPV levels of individuals with normal glucose tolerance (NGT) and individuals with prediabetes or DM. The second aim was to identify whether the initial lower limit value of impaired fasting glucose (IFG) being 100 mg/dl or 110 mg/dl had any impact on MPV values.
Methods: Five hundred and six individuals included in the study were divided into 7 groups according to oral glucose tolerance test results and their MPV values were examined. Group 1 was the NGT group. The IFG group was divided into two groups with one group having fasting plasma glucose (FPG) of 100-109 mg/dl and the other a FPG of 110-125 mg/dl. Group 4 was the impaired glucose tolerance (IGT) group. The IFG and IGT combination group was divided into two with a FPG of 100-109 mg/dl and a FPG of 110-125 mg/dl. Finally, group seven was the DM group.
Results: MPV values of the NGT group were significantly lower compared to all other groups (p 0.05). In IGT group a positive correlation existed between MPV and 2 h-PG (p<0.05, r=309) and between MPV and hemoglobinA1c (p<0.05, r=463).
Conclusion: Both the DM and prediabetes group had higher MPV values compared to the NGT group. Individuals with FPG values between 100-109 mg/dl have higher MPV values than NGT. If a high MPV level is detected in individuals with a FPG of lower than 110 mg/dl, OGTT should be planned in terms of the development of DM.

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The increment of mean platelet volume in early stages of prediabetes and type 2 diabetes mellitus

Purpose: To evaluate the effects of acetylsalicylic acid (aspirin) on tear film parameters and dry eye disease. Methods: Fifty-seven patients using low-dose aspirin regularly for antiaggregant purposes as well as 49 controls, who required antiaggregant treatment but who had not yet started, were included in the study. Tear osmolarity, tear break-up time (TBUT), Schirmer and Oxford grading of ocular surface staining were performed on all patients and dry eye symptomatology was assessed using the ocular surface disease index questionnaire (OSDI). Results: The mean osmolarity was 302.11 ± 16.22 mOsm/L in the aspirin group and 313.88 ± 19.57 mOsm/L in the control group (P < 0.01). The mean Schirmer's score was 24.16 ± 10.52 mm and 21.94 ± 10.11 mm (P = 0.232), TBUT was 13.61 ± 3.31 s and 10.39 ± 4.46 s (P < 0.01), OSDI score was 5.15 ± 5.98 and 16.94 ± 14.17 (P < 0.01), and Oxford score was 0.12 ± 0.33 and 0.12 ± 0.44 in aspirin and control groups, respectively (P = 0.99). Dry eye diagnosis was lower...

Huseyin Kurt

Papers

Magnesium Replacement Improves the Metabolic Profile in Obese and Pre-Diabetic Patients with Mild-to-Moderate Chronic Kidney Disease: A 3-Month, Randomised, Double-Blind, Placebo-Controlled Study

Alterations of choroidal thickness with diabetic neuropathy

Changing of Hemoglobin A1c Affects Mean Platelet Volume in Type-2 Diabetes Mellitus

The increment of mean platelet volume in early stages of prediabetes and type 2 diabetes mellitus

The Effect of Low-Dose Aspirin on Dry Eye Parameters and Ocular Surface Disease Index Questionnaire