Search

Objective: The aim of this article is to review and discuss the efficacy of the Cognitive-Behavioral Therapy (CBT), in the prevention of postnatal depression (PD) in pregnant women at risk. Method: PubMed, Medline, Psychlnfo, Embase, and the Cochrane Library databases were searched from February 1991 to February 2011. Results: Eight Randomized Controlled Trials (RCT) on the prevention of PD with the CBT were selected and their data were analyzed. The literature analyzed recommends that depression in pregnancy requires an efficient management to provide mother's symptoms relief as well as to prevent the PD. While several studies demonstrated the efficacy of the CBT in the treatment of PD, the efficacy of the CBT in preventing PD in pregnant women at risk has been investigated only by a few studies, presenting a number of methodological flaws. Conclusions: Better designed RCT are needed to support the efficacy of such psycho- therapeutic preventive strategy in women at risk for PD. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasonography (POCUS) with concomitant venous and arterial Doppler assessment enables clinicians to assess organ-specific blood supply. To date, no studies have investigated the usefulness of including a comprehensive perioperative POCUS assessment of patients undergoing major laparoscopic surgery. The primary aim of the present study was to evaluate whether the combined venous and arterial renal flow evaluation, measured at different time points of perioperative period, may represent a clinically useful non-invasive method to predict postoperative acute kidney injury (AKI) after major laparoscopic urologic surgery. The secondary outcome was represented by the development of any postoperative complication at day 7. We included 173 patients, subsequently divided for analysis depending on whether they did (n = 55) or did not (n = 118) develop postoperative AKI or any complications within the first 7 days. The main results of the present study were that: (1) the combination of arterial hypoperfusion and moderate-to-severe venous congestion inferred by POCUS were associated with worst outcomes (respectively, HR: 2.993, 95% CI: 1.522-5.884 and HR: 8.124, 95% CI: 3.542-18, p < 0.001); (2) high intra-operative abdominal pressure represents the only independent determinant of postoperative severe venous congestion (OR: 1.354, 95% CI: 1.017-1.804, p = 0.038); (3) the overall number of complications relies on the balance between arterial inflow and venous outflow in order to ensure the adequacy of peripheral perfusion; and (4) the overall reliability of splanchnic perfusion assessment by Doppler is high with a strong inter-rater reliability (ICC: 0.844, 95% CI: 0.792-0.844). The concomitant assessment of arterial and venous Doppler patterns predicts postoperative complications after major laparoscopic urologic surgery and may be considered a useful ultrasonographic biomarker to stratify vulnerable patients at risk for development of postoperative complications.

The correct determination of volume status is a fundamental component of clinical evaluation as both hypovolaemia (with hypoperfusion) and hypervolaemia (with fluid overload) increase morbidity and mortality in critically ill patients. As inferior vena cava (IVC) accounts for two-thirds of systemic venous return, it has been proposed as a marker of volaemic status by indirect assessment of central venous pressure or fluid responsiveness. Although ultrasonographic evaluation of IVC is relatively easy to perform, correct interpretation of the results may not be that simple and multiple pitfalls hamper its wider application in the clinical setting. In the present review, the basic elements of the pathophysiology of IVC behaviour, potential applications and limitations of its evaluation are discussed.

Background: Acute kidney injury (AKI) is common in critically ill patients admitted to intensive care units (ICU) and is frequently associated with poorer outcomes. Hence, if an indicator is available for predicting severe AKI within the first few hours of admission, management strategies can be put into place to improve outcomes. Materials and methods: This was a prospective, observational study, involving 63 critically ill patients, that aimed to explore the diagnostic accuracy of different Doppler parameters in predicting AKI in critically ill patients from a mixed ICU. Participants were enrolled at ICU admission. All underwent ultrasonographic examinations and hemodynamic assessment. Renal Doppler resistive index (RDRI), venous impedance index (VII), arterial systolic time intervals (a-STI), and venous systolic time intervals (v-STI) were measured within 2 h from ICU admission. Results: Cox proportional hazards models, including a-STI, v-STI, VII, and RDRI as independent variables, returned a-STI as the only putative predictor for the development of AKI or severe AKI. An overall statistically significant difference (p < 0.001) was observed in the Kaplan−Meier plots for cumulative AKI events between patients with a-STI higher or equal than 0.37 and for cumulative severe AKI-3 between patients with a-STI higher or equal than 0.63. As assessed by the area under the receiver operating curves (ROC) curves, a-STI performed best in diagnosing any AKI and/or severe AKI-3. Positive correlations were found between a-STI and the N-terminal brain natriuretic peptide precursor (NT-pro BNP) (ρ = 0.442, p < 0.001), the sequential organ failure assessment (SOFA) score (ρ: 0.361, p = 0.004), and baseline serum creatinine (ρ: 0.529, p < 0.001). Conclusions: Critically ill patients who developed AKI had statistically significant different a-STI (on admission to ICU), v-STI, and VII than those who did not. Moreover, a-STI was associated with the development of AKI at day 5 and provided the best diagnostic accuracy for the diagnosis of any AKI or severe AKI compared with RDRI, VII, and v-STI.

In recent years imaging techniques that use radionuclides have become more and more clinically relevant as they can provide functional information for specific anatomical districts. This has also involved nephrology, where radionuclides are used to study patients with different degrees of renal function failure up to terminal uremia. Although chronic kidney disease, and dialysis in particular, may affect the distribution and the elimination of radiopharmaceuticals, to date there are no consistent data on the risks associated with their use in this clinical context. In addition to the lack of data on the safety of radio-exposure in dialysis patients, there is also a shortage of information concerning the risk for healthcare staff involved in conducting the dialysis sessions performed after a nuclear test. This study, performed on 29 uremic patients who underwent hemodialysis immediately after a scintigraphic examination, assessed the extent of radio-contamination of the staff and of hemodialysis devices such as monitor, kits and dialysate. The data collected has been used to quantify the radiological risk in dialysis after the exposure to the most common radionuclides., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Arteriovenous access ischemic steal is a fairly uncommon complication associated with the creation of a vascular access for hemodialysis, which can sometimes cause potentially devastating complications, with permanent disability. Several old names for this syndrome have now been replaced by two new denominations: Hemodialysis Access-Induced Distal Ischemia (HAIDI) and Distal Hypoperfusion Ischemic Syndrome (DHIS). Clinically, we distinguish between the Peripheral Hypoperfusion Syndrome, which can cause gangrene of the fingers, and the Monomelic Syndrome, characterized by low incidence and by the presence of neurological dysfunctions. Risk factors include diabetes mellitus, atherosclerotic vascular disease, old age, female gender, tobacco use and hypertension. We report the case of a patient with HAIDI in order to increase awareness on this syndrome's early diagnosis and proper management. After describing the case, we also include a literature review., (Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.)

Background: Internal jugular vein cannulation has become increasingly widespread. Compared to the left internal jugular vein (LIJV), the right internal jugular vein (RIJV) is the preferred choice for the placement of central venous catheter (CVC) for hemodialysis, mostly due to the major technical difficulties and higher rate of complications of the LIJV approach. We aimed to investigate whether variability in the direction of the LIJV/brachiocephalic vein (BV) axis on the frontal plane could be a decisive factor in determining CVC dysfunctions., Methods: Retrospective cohort study. From our Register, a total of 1489 consecutive patients (age 69 ± 9 years, males 60%) in whom a CVC for hemodialysis was placed from January 2012 to June 2014 were selected., Results: LIJV cannulation, compared with RIJV, was associated with a higher rate of catheter dysfunction during an observational period of 2 weeks after catheter placement (16 vs.12%; p = 0.005). This complication was strongly correlated with the amplitude of the angle between the LIJV and the ipsilateral BV axis on the frontal plane; an angle ≤ 110° was associated with a higher rate of catheter dysfunction (78 vs.16%; p < 0.001)., Conclusions: The anatomical clarification presented in our study provides useful data that could explain the dysfunction rate of CVC inserted in the LIJV. Clinicians who insert high-flow catheters (such as hemodialysis catheters) should be aware of LIJV/BV axis variability and of the possible risks of CVC dysfunction when the angle between the LIJV and ipsilateral BV is ≤ 110°.

The end-stage renal disease is characterized by a profound impairment in the regulation of body fluid distribution, and volume assessment in hemodialysis is one of the challenging goals for the nephrologist. To determine a state of euvolemia, different validated techniques have been employed and among them lung ultrasonography (LUS) has recently attracted growing attention on account of its capacity to estimate accurately extra vascular lung water and to detect lung edema even in its early asymptomatic stage, that is, hidden lung congestion.With its noninvasiveness, freedom from radiation, the ease of use, acceptable intra/inter-operator reproducibility and availability of portable ultrasound devices, LUS can be considered one of the most interesting "cards to play" for the volume assessment in patients on hemodialysis., (© 2017 S. Karger AG, Basel.)

As a consequence of the central role of the arteriovenous fistula for dialysis (AVF) in the clinical management of the dialysis patient the necessity to limit the puncture-related complications to extend as much as possible the life of the vascular access. Accordingly, the AVF needling technique has gained growing attention. Alongside the traditional rope ladder (RL) puncture method, the buttonhole technique (BH) is increasingly popular; this technique employs the same cannulation sites of AVF in every dialysis associated with the use of dull needles to minimize vessels damage. The BH technique, utilized only for native AVF, is considered an appropriate alternative to the RL and is now recommended by several scientific societies for its reported benefits such as: AVF greater ease of cannulation, less pain, faster hemostasis and less tendency to the creation of aneurysms and hematomas. The use of BH is especially recommended in cases in which the RL is problematic with short or winding venous sections and in home dialysis in which the patient performs the needling. However recent evidence in literature, countering these theoretical advantages, indicates that the BH technique appears to be closely related to an increased risk of local and systemic infections. Furthermore, the purported benefits of BH have not held up under closer examination., (© 2016 Wiley Periodicals, Inc.)

A large amount of recent epidemiological studies have shown the worldwide growth on the incidence and prevalence of diabetes mellitus type II (DM2), especially in industrialized countries where DM2 is the most frequent cause of chronic kidney disease. Diabetic nephropathy progression to ESRD (End Stage Renal Disease) may be slowed down only with a tight glycemic control, since no hypoglycemic drugs have been shown to possess renoprotective effects. Treatment with oral hypoglycemic agents should be closely and regularly monitored in patients with diabetic nephropathy since the decline of renal function below 60 ml/min of glomerular filtration rate (GFR) could cause multiple pharmacokinetic alterations. It may expose the patient to serious side effects if cautious dose reduction or even withdrawal of these drugs is not considered. Pharmacological approaches to the treatment of diabetes type 2 include the traditional oral hypoglycemic drugs (insulin sensitizers, insulin secretagogues and drugs inhibiting the absorption of glucose), incretin system drugs (orally or intravenously administered) and insulin therapy, if these drugs are insufficient or are contraindicated. The objective of this review is to evaluate the evidence regarding the use of oral hypoglycemic agents (with particular attention to the DPP-4 inhibitors) in diabetes type 2 with chronic kidney disease stage III- IV and ESRD, while in case of eGFR > 60 ml / min no dosage adjustment is usually required.

Background and Objectives: Several factors might alter serum phosphate homeostasis and induce hyperhosphatemia in patients with chronic kidney disease (CKD) not requiring dialysis. However, whether and to what extent hyperphosphatemia is associated with a poor prognosis in different CKD patient groups remain to be elucidated., Design, Setting, Participants & Measurements: We utilized the "Prevenzione Insufficienza Renale Progressiva" (PIRP) database, a large project sponsored by the Emilia-Romagna Health Institute. PIRP is a collaborative network of nephrologists and general practitioners located in the Emilia-Romagna region, Italy, aimed at increasing awareness of CKD complications and optimizing CKD patient care. We identified 1716 patients who underwent a GFR and serum phosphorous assessment between 2004 and 2007. We tested whether phosphate levels ≥4.3 mg/dl are associated with the risk of CKD progression or all causes of death., Results: Older age and male sex were associated with lower phosphate levels. Instead, higher phosphate levels were noted in patients with diabetes. Patients with phosphate levels ≥4.3 mg/dl were at an increased risk of starting dialysis or dying (hazard ratio 2.04; 95% confidence interval [1.44, 2.90]). Notably, subgroup analyses revealed that the magnitude of the risk associated with hyperphosphatemia varied depending on age, sex, diabetes, and different stages of CKD., Conclusions: These analyses lend support to the hypothesis that phosphorous abnormalities might have a negative effect on the residual renal function and prognosis in different groups of CKD patients. However, the risk associated with hyperphosphatemia might vary in specific CKD patient subgroups., (© 2011 by the American Society of Nephrology)