Day: 12/15/2010

Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies

Posted by

0


Cognitive impairment, including dementia, is a common but poorly recognized problem among patients with end-stage renal disease (ESRD), affecting 16–38% of patients. Dementia is associated with high risks of death, dialysis withdrawal, hospitalization, and disability among patients with ESRD; thus, recognizing and effectively managing cognitive impairment may improve clinical care. Dementia screening strategies should take into account patient factors, the time available, the timing of assessments relative to dialysis treatments, and the implications of a positive screen for subsequent management (for example, transplantation). Additional diagnostic testing in patients with cognitive impairment, including neuroimaging, is largely based on the clinical evaluation. There is limited data on the efficacy and safety of pharmacotherapy for dementia in the setting of ESRD; therefore, decisions about the use of these medications should be individualized. Management of behavioral symptoms, evaluation of patient safety, and advance care planning are important components of dementia management. Prevention strategies targeting vascular risk factor modification, and physical and cognitive activity have shown promise in the general population and may be reasonably extrapolated to the ESRD population. Modification of ESRD-associated factors such as anemia and dialysis dose or frequency require further study before they can be recommended for treatment or prevention of cognitive impairment.

source:JAMA

 

Diabetes Advance: Researchers Grow Insulin-Producing Cells From Testes

Posted by

0


Researchers Say Advancement May Lead to Cure for Type 1 Diabetes

Dec. 13, 2010 — New research suggests it may be possible for people with type 1 diabetes to grow their own insulin-producing cells — an advancement that could lead to a cure for this form of diabetes.

The preliminary findings are slated to be presented at the American Society of Cell Biology 50th annual meeting in Philadelphia.

“The goal here is to cure diabetes, not to treat it,” says study author G. Ian Gallicano, PhD, an associate professor in the department of biochemistry and molecular and cellular biology and the director of the Transgenic Core Facility at Georgetown University Medical Center in Washington, D.C.

Islet cells in the pancreas are responsible for producing insulin, but these cells are destroyed in people with type 1 diabetes.

Of Mice and Men

In the new study, however, researchers were able to take cells from men’s testicular tissue, isolate stem cells, and turn them into insulin-secreting islet cells. These islet cells were then re-injected into mice with diabetes.

And it worked. “These cells behave a lot like beta-islet cells,” Gallicano says. “They secrete insulin in response to glucose, and we were able to secrete insulin in mouse models to reduce high blood sugar or glucose levels.” The effects lasted for one week.

The next step is to see if these cells can produce enough insulin to cure diabetes in people. If this occurs, clinical trials in humans can begin, he says.

Today, islet cells can be transplanted from donors into people with diabetes, but there is the risk of rejection. This risk is eliminated when the islet cells are derived from the recipient. There is also a shortage of available islet cell donors.

Gallicano says there are many unanswered questions, such as how to best deliver these bioengineered cells back into the body, and whether it will work in women.

Resuscitation After Severe Burn Injury Using High-Dose Ascorbic Acid

Posted by

0


Ascorbic acid is associated with a decrease in fluid requirements and an increase in urine output during resuscitation after thermal injury. Although this study did not find a difference in outcomes with vitamin C administration, it demonstrates that vitamin C can be safely used without an increased risk of renal failure. The effects of vitamin C should be further studied in a large–scale, prospective, randomized trial.