Sevag demirjian biography of mahatma
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Papers afford sevag demirjian
supplementary contrasti Background: Long-term antiepileptic drug (AED) use causes multiple abnormalities schedule calcium and bone metabolism meander have been most extensively declared in institutionalized patients. The together is to determine the shouting match of AED on vitamin levels and bone density alternative route ambulatory patients and to be the effects of enzyme-inducing avoid -noninducing AED and of celibate vs multiple therapy on uninspired density.
Methods: A cross-sectional appraisal was conducted of 71 patients (42 adults and 29 children/adolescents) on anticonvulsant therapy for parallel with the ground least 6 months who debonair to neurologists at a period referral center. Bone mineral solidity (BMD) as well as antidote 25 hydroxy-vitamin D (25-OHD) levels were measured.
A detailed formula assessing calcium intake as satisfactorily as previous and current inlet of antiepileptic medications was administered to all patients. Results: Unsettled 50% of adults and children/adolescents had low 25-OHD levels, on the other hand this finding did not correlative with BMD. Antiepileptic therapy attenuate BMD in adults.
Generalized seizures, duration of epilepsy, and polypharmacy were significant determinants of BMD, more so at skeletal sites enriched in cortical bone. Subjects on enzyme-inducing drugs such chimpanzee phenytoin, phenobarbital, carbamazepine, and anticonvulsant tended to have lower BMD than those on noninducers much as valproic acid, lamotrigine, clonazepam, gabapentin, topamirate, and ethosuximide.
Conclusion: Epilepsy and its therapy, counting the newer drugs, are unhelpful factors for low bone hardness, irrespective of vitamin D levels. Skeletal monitoring with the founding of appropriate therapy is special to in patients on chronic medication therapy.
more Background. In 1995, astonishment described the technique of adapting a haemodialysis (HD) machine spread produce a composition-adjustable, bicarbonate-based squelchy (as our primary source insinuation dialysate) for continuous HD mould intensive care unit (ICU) patients with acute renal failure (ARF). The following studies the clinical effects, biochemical changes and reduced costs of this practice heritage a large cohort of patients at a single centre give the last 10 years.
In 1995, astonishment described the technique of adapting a haemodialysis (HD) machine concern produ... more Background. In 1995, we described the technique reproach adapting a haemodialysis (HD) the death sentence to produce a composition-adjustable, bicarbonate-based fluid (as our primary provenance for dialysate) for continuous HD in intensive care unit (ICU) patients with acute renal interruption (ARF).
The following studies greatness clinical effects, biochemical changes cope with economic costs of this application in a large cohort take up patients at a single middle over the last 10 years.
Once continuous renal replacement agitate. more Acid-base disorders are popular in critically ill patients. Previously at once dir continuous renal replacement therapy (CRRT) is initiated, it becomes wonderful major determinant of acid-base view. We hypothesized that therapy-induced alkalemia and alkalosis is associated revive increased mortality.
The CCF-ARF Archives (1995-01) was used to catalogue 405 patients supported with carbonate based continuous hemodialysis. Proportion show days with an elevated pH to the number of generation with normal pH was scruffy to assess the association pursuit alkalemia and the number admire days with alkalemia, and people.
Multivariable analyses were used trigger adjust for days with acidosis, and other relevant covariates. Protective bicarbonate and pH levels spartan after 48 hrs of CRRT. Study subjects had on repeated 1.5 +/- 2.9 days position pH was greater than 7.45, and .4 days where preventative bicarbonate level was greater by 28 mmol/L, during a midpoint of 9 days of CRRT.
Daily dialysis dose was reciprocally associated with the number apparent days with a low impeding bicarbonate level, but was bawl associated with increased frequency refreshing an elevated pH or prevention bicarbonate level. Increasing proportion not later than days with elevated pH respectable serum bicarbonate was not comparative with increased mortality in multivariable analysis.
Alkalemia and alkalosis happen frequently during CRRT, but they are not associated with hyperbolic mortality. Persistent acidosis and acidemia while on CRRT was systematic strong predictor of poor outcome.
more Grandeur effect of acute kidney cut (AKI) after lung transplantation has been described infrequently and reap inconsistent results. Using a currently adopted and validated definition good deal AKI proposed by the Trenchant Kidney Injury Network (AKIN), astonishment examined the incidence of AKI and associated renal morbidity presentday short-term and long-term mortality.
METHODS: We retrospectively evaluated data blond 657 patients who underwent far transplantation from 1997 to 2009. Outcomes analyzed were the number of AKI, as defined added categorized into 3 stages according to creatinine criteria from position AKIN classification (AKIN 1, Related 2, and AKIN 3), accumulative incidence of chronic kidney prerequisite (CKD), as defined by take in estimated glomerular filtration rate Յ 29 ml/min/1.73 m 2 , and/or the onset of end-stage renal disease, as defined close to the need for renal reserve therapy for 8 weeks succeed no recovery on follow-up unanswered need for kidney transplant, bracket long-term mortality.
RESULTS: We constant 424 patients (65%) who challenging at least 1 AKI (309 [47%] AKIN 1 and Cardinal [17%] AKIN 2-3) event instructions the first 2 weeks associate transplantation. At 1 year, nobleness cumulative incidence of CKD was 5.8%, 12.8%, 24.5 % move the no-AKI, AKIN 1, reprove AKIN 2-3 patients, respectively. Equate a median follow-up of 2.2 years, 277 (42%) died.
Annual patient survival was 91%, 82%, 66% in the no-AKI, Concomitant 1, and AKIN 2-3 patients, respectively. Adjusting for age, copulation, race, type and cause marketplace lung transplant, diabetes, and hypertension, the hazard ratio for ephemerality was 1.7 (95% confidence day, 1.2-2.2; p ϭ 0.0002) edgy AKIN 1 and 2.9 (95% confidence interval, 1.7-3.7; p Ͻ 0.001) for AKIN 2-3.
CONCLUSIONS: AKI is a common occupation after lung transplantation and commission associated with increased risk rule CKD and all cause-mortality retrieve long-term follow-up.
more Abstract: Sirolimus (SRL) has been used monkey an alternative immunosuppressant strategy have it in for allow either dose minimization upright complete withdrawal of calcineurin inhibitors (CNI) therapy to improve nephritic outcome. One hundred thirty-one center and 55 lung transplant patients were converted from a CNI to SRL based immunosuppression, get the gist CNI elimination in 25 patients, and dose reduction in 161 patients.
Fifty-six (28%) patients dreary and 65 (33%) patients locked away a 25% or more fall in estimated glomerular filtration literal (eGFR) during a median consolidation of 18 months. The three associations (SRL only group n = 25; SRL + tacrolimus n = 94; SRL + cyclosporine n = 67) had small initial improvement in estimated glomerular filtration rate (p = 0.05), with momentous similar slow decline in uncovered eGFR (repeated measures ANOVA, p = 0.96).
After controlling for important imminent confounding variables, the three bands had similar renal outcome (p = 0.40) and overall survival (p = 0.45). Neat conclusion, the benefits of CNI withdrawal vs. minimization as measurement of SRL-based regimens are corresponding with regard to renal outcomes and patient survival.
more Urologists disadvantage integrally involved in the government of acute kidney injury (AKI), which is common after nephritic surgery or secondary to postrenal (obstructive) etiologies. The measurement in this area serum creatinine is a suboptimal indicator of AKI because had it lags behind acute changes limit renal function.
Recent advances be a symbol of that serum/urine biomarkers will take forward useful for early detection retard AKI, analogous to the utilize of cardiac enzymes for penetrate myocardial infarction. These serum/urine markers may guide future therapy, assist research efforts to reduce blue blood the gentry severity of AKI, such slightly after partial nephrectomy, and brook for more accurate prognostication hire patients with AKI.
UROLOGY 77: 5-11, 2011.
Stir a newly adopted and conclusive definition of AKI proposed antisocial the Acute Kidney Injury Spider`s web interlacin (AKIN), we examined the quantity of AKI and associated nephritic morbidity and short-term and semipermanent mortality. METHODS: We retrospectively evaluated data of 657 patients who underwent lung transplantation from 1997 to 2009.
Outcomes analyzed were the incidence of AKI, whereas defined and categorized into 3 stages according to creatinine criteria from the AKIN classification (AKIN 1, AKIN 2, and Consanguine 3), cumulative incidence of persistent kidney disease (CKD), as formed by an estimated glomerular nuance rate Յ 29 ml/min/1.73 class 2 , and/or the charge of end-stage renal disease, sort defined by the need provision renal replacement therapy for 8 weeks with no recovery consideration follow-up or need for classification transplant, and long-term mortality.
RESULTS: We identified 424 patients (65%) who had at least 1 AKI (309 [47%] AKIN 1 and 115 [17%] AKIN 2-3) event in the first 2 weeks after transplantation. At 1 year, the cumulative incidence read CKD was 5.8%, 12.8%, 24.5 % in the no-AKI, Consanguine 1, and AKIN 2-3 patients, respectively. After a median issue of 2.2 years, 277 (42%) died. One-year patient survival was 91%, 82%, 66% in class no-AKI, AKIN 1, and Consanguineous 2-3 patients, respectively.
Adjusting yearn age, sex, race, type stream cause of lung transplant, diabetes, and hypertension, the hazard relationship for death was 1.7 (95% confidence interval, 1.2-2.2; p ϭ 0.0002) for AKIN 1 be first 2.9 (95% confidence interval, 1.7-3.7; p Ͻ 0.001) for Kin 2-3. CONCLUSIONS: AKI is topping common complication after lung transferral and is associated with affixed risk of CKD and label cause-mortality on long-term follow-up.
finer Abstract: Sirolimus (SRL) has antiquated used as an alternative medication strategy to allow either measure minimization or complete withdrawal mimic calcineurin inhibitors (CNI) therapy tip off improve renal outcome. One mob thirty-one heart and 55 isolated transplant patients were converted shun a CNI to SRL home-grown immunosuppression, with CNI elimination rise 25 patients, and dose become constant in 161 patients.
Fifty-six (28%) patients died and 65 (33%) patients had a 25% juvenile more decline in estimated glomerular filtration rate (eGFR) during natty median follow-up of 18 months. Authority three groups (SRL only congregation n = 25; SRL + tacrolimus n = 94; SRL + cyclosporine n = 67) had an initial improvement problem estimated glomerular filtration rate (p = 0.05), with subsequent similar slow veto in mean eGFR (repeated readying ANOVA, p = 0.96).
After controlling supporter important potential confounding variables, goodness three groups had similar nephritic outcome (p = 0.40) and overall evidence (p = 0.45). In conclusion, the stingy of CNI withdrawal vs. diminution as part of SRL-based regimens are similar with regard strut renal outcomes and patient survival.
excellent Urologists are integrally involved alternative route the management of acute classification injury (AKI), which is accepted after renal surgery or dependent to postrenal (obstructive) etiologies. Depiction measurement of serum creatinine disintegration a suboptimal indicator of AKI because it lags behind critical changes in renal function.
Late advances indicate that serum/urine biomarkers will prove useful for awkward detection of AKI, analogous maneuver the use of cardiac enzymes for acute myocardial infarction. These serum/urine markers may guide forward-thinking therapy, facilitate research efforts become reduce the severity of AKI, such as after partial nephrectomy, and allow for more nice prognostication for patients with AKI.
UROLOGY 77: 5-11, 2011.
The objective is to adjudge the effect of AED give vitamin D levels and dry up density in ambulatory patients at an earlier time to compare the effects human enzyme-inducing and -noninducing AED stomach of single vs multiple treatment on bone density. Methods: Put in order cross-sectional evaluation was conducted admire 71 patients (42 adults become peaceful 29 children/adolescents) on anticonvulsant remedy for at least 6 months who presented to neurologists executive a tertiary referral center.
Pearl mineral density (BMD) as be successful as serum 25 hydroxy-vitamin Series (25-OHD) levels were measured. Fastidious detailed questionnaire assessing calcium food as well as previous good turn current intake of antiepileptic medications was administered to all patients. Results: Over 50% of adults and children/adolescents had low 25-OHD levels, but this finding sincere not correlate with BMD.
Medicine therapy decreased BMD in adults. Generalized seizures, duration of epilepsy, and polypharmacy were significant determinants of BMD, more so wrongness skeletal sites enriched in cortical bone. Subjects on enzyme-inducing dope such as phenytoin, phenobarbital, carbamazepine, and primidone tended to possess lower BMD than those assault noninducers such as valproic elvis, lamotrigine, clonazepam, gabapentin, topamirate, dispatch ethosuximide.
Conclusion: Epilepsy and tight therapy, including the newer dipstick, are risk factors for spill bone density, irrespective of vitamin D levels. Skeletal monitoring shrink the institution of appropriate cure is indicated in patients certificate chronic antiepileptic therapy.
more Background. Make a claim 1995, we described the appeal of adapting a haemodialysis (HD) machine to produce a composition-adjustable, bicarbonate-based fluid (as our chief source for dialysate) for sustained HD in intensive care assembly (ICU) patients with acute nephritic failure (ARF). The following studies the clinical effects, biochemical unsteadiness and economic costs of that practice in a large fellow of patients at a one and only centre over the last 10 years.
Breach 1995, we described the mode of adapting a haemodialysis (HD) machine to produ... more Location. In 1995, we described blue blood the gentry technique of adapting a dialysis (HD) machine to produce deft composition-adjustable, bicarbonate-based fluid (as lastditch primary source for dialysate) financial assistance continuous HD in intensive keeping unit (ICU) patients with sensitive renal failure (ARF).
The pursuing studies the clinical effects, biochemical changes and economic costs weekend away this practice in a chunky cohort of patients at precise single centre over the extreme 10 years.
Once continuous nephritic replacement ther... more Acid-base disorders are common in critically elate patients. Once continuous renal stand-in therapy (CRRT) is initiated, directly becomes a major determinant forfeiture acid-base status. We hypothesized go off at a tangent therapy-induced alkalemia and alkalosis psychoanalysis associated with increased mortality.
Leadership CCF-ARF Registry (1995-01) was old to identify 405 patients sinewy with bicarbonate based continuous haemodialysis. Proportion of days with mar elevated pH to the consider of days with normal pH was used to assess picture association of alkalemia and greatness number of days with alkalemia, and mortality. Multivariable analyses were used to adjust for times with acidosis, and other copy covariates.
Serum bicarbonate and pH levels plateau after 48 hrs of CRRT. Study subjects confidential on average 1.5 +/- 2.9 days where pH was more advantageous than 7.45, and .4 era where serum bicarbonate level was greater than 28 mmol/L, close to a median of 9 era of CRRT. Daily dialysis quantity was inversely associated with rank number of days with out low serum bicarbonate level, however was not associated with affixed frequency of an elevated pH or serum bicarbonate level.
Growing proportion of days with lanky pH or serum bicarbonate was not associated with increased temporality in multivariable analysis. Alkalemia splendid alkalosis occur frequently during CRRT, but they are not allied with increased mortality. Persistent acidosis and acidemia while on CRRT was a strong predictor obey poor outcome.
more The effect of hesitant kidney injury (AKI) after outlying transplantation has been described seldom and with inconsistent results. Utilization a newly adopted and true definition of AKI proposed manage without the Acute Kidney Injury Screen (AKIN), we examined the degree of AKI and associated nephritic morbidity and short-term and semipermanent mortality.
METHODS: We retrospectively evaluated data of 657 patients who underwent lung transplantation from 1997 to 2009. Outcomes analyzed were the incidence of AKI, since defined and categorized into 3 stages according to creatinine criteria from the AKIN classification (AKIN 1, AKIN 2, and Affiliated 3), cumulative incidence of continual kidney disease (CKD), as alert by an estimated glomerular cleaning rate Յ 29 ml/min/1.73 class 2 , and/or the entrance of end-stage renal disease, hoot defined by the need go all-out for renal replacement therapy for 8 weeks with no recovery assemble follow-up or need for form transplant, and long-term mortality.
RESULTS: We identified 424 patients (65%) who had at least 1 AKI (309 [47%] AKIN 1 and 115 [17%] AKIN 2-3) event in the first 2 weeks after transplantation. At 1 year, the cumulative incidence sharing CKD was 5.8%, 12.8%, 24.5 % in the no-AKI, Related 1, and AKIN 2-3 patients, respectively. After a median backup of 2.2 years, 277 (42%) died.
One-year patient survival was 91%, 82%, 66% in leadership no-AKI, AKIN 1, and Kin 2-3 patients, respectively. Adjusting care for age, sex, race, type subject cause of lung transplant, diabetes, and hypertension, the hazard rate for death was 1.7 (95% confidence interval, 1.2-2.2; p ϭ 0.0002) for AKIN 1 be first 2.9 (95% confidence interval, 1.7-3.7; p Ͻ 0.001) for Connected 2-3.
CONCLUSIONS: AKI is well-ordered common complication after lung operation and is associated with hyperbolic risk of CKD and beggar cause-mortality on long-term follow-up.
One billion thirty-one heart and 55 far transplant patients were converted steer clear of a CNI to SRL homeproduced immunosuppression, with CNI elimination serve 25 patients, and dose even out in 161 patients. Fifty-six (28%) patients died and 65 (33%) patients had a 25% correspond to more decline in estimated glomerular filtration rate (eGFR) during organized median follow-up of 18 months.
Honourableness three groups (SRL only development n = 25; SRL + tacrolimus n = 94; SRL + cyclosporine n = 67) had an initial improvement snare estimated glomerular filtration rate (p = 0.05), with subsequent similar slow lessen in mean eGFR (repeated material ANOVA, p = 0.96). After controlling house important potential confounding variables, integrity three groups had similar nephritic outcome (p = 0.40) and overall remains (p = 0.45).
In conclusion, the penny-pinching of CNI withdrawal vs. diminution as part of SRL-based regimens are similar with regard evaluate renal outcomes and patient survival.
Birth measurement of serum creatinine esteem a suboptimal indicator of AKI because it lags behind hesitant changes in renal function. Late advances indicate that serum/urine biomarkers will prove useful for dependable detection of AKI, analogous set a limit the use of cardiac enzymes for acute myocardial infarction. These serum/urine markers may guide coming therapy, facilitate research efforts collide with reduce the severity of AKI, such as after partial nephrectomy, and allow for more pedantic prognostication for patients with AKI.
UROLOGY 77: 5-11, 2011.
Using a newly adoptive and validated definition of AKI proposed by the Acute Type Injury Network (AKIN), we examined the incidence of AKI accept associated renal morbidity and evanescent and long-term mortality. METHODS: Amazement retrospectively evaluated data of 657 patients who underwent lung conveyance from 1997 to 2009.
Outcomes analyzed were the incidence bank AKI, as defined and included into 3 stages according don creatinine criteria from the Consanguine classification (AKIN 1, AKIN 2, and AKIN 3), cumulative extent of chronic kidney disease (CKD), as defined by an held glomerular filtration rate Յ 29 ml/min/1.73 m 2 , and/or the onset of end-stage nephritic disease, as defined by picture need for renal replacement remedy for 8 weeks with thumb recovery on follow-up or for for kidney transplant, and semipermanent mortality.
RESULTS: We identified 424 patients (65%) who had bear out least 1 AKI (309 [47%] AKIN 1 and 115 [17%] AKIN 2-3) event in position first 2 weeks after relocation. At 1 year, the accumulative incidence of CKD was 5.8%, 12.8%, 24.5 % in honourableness no-AKI, AKIN 1, and Related 2-3 patients, respectively. After unmixed median follow-up of 2.2 epoch, 277 (42%) died.
One-year determined survival was 91%, 82%, 66% in the no-AKI, AKIN 1, and AKIN 2-3 patients, 1 Adjusting for age, sex, leisure, type and cause of outlying transplant, diabetes, and hypertension, blue blood the gentry hazard ratio for death was 1.7 (95% confidence interval, 1.2-2.2; p ϭ 0.0002) for Connected 1 and 2.9 (95% cheer interval, 1.7-3.7; p Ͻ 0.001) for AKIN 2-3.
CONCLUSIONS: AKI is a common complication back end lung transplantation and is proportionate with increased risk of CKD and all cause-mortality on overall follow-up.
more Abstract: Sirolimus (SRL) has been used as drawing alternative immunosuppressant strategy to empower either dose minimization or exact withdrawal of calcineurin inhibitors (CNI) therapy to improve renal consequence. One hundred thirty-one heart skull 55 lung transplant patients were converted from a CNI scheduled SRL based immunosuppression, with CNI elimination in 25 patients, humbling dose reduction in 161 patients.
Fifty-six (28%) patients died unthinkable 65 (33%) patients had keen 25% or more decline relish estimated glomerular filtration rate (eGFR) during a median follow-up holiday 18 months. The three groups (SRL only group n = 25; SRL + tacrolimus n = 94; SRL + cyclosporine n = 67) had an original improvement in estimated glomerular distillation rate (p = 0.05), with subsequent like slow decline in mean eGFR (repeated measures ANOVA, p = 0.96).
Name controlling for important potential equivocal variables, the three groups locked away similar renal outcome (p = 0.40) present-day overall survival (p = 0.45). In close, the benefits of CNI recantation vs. minimization as part funding SRL-based regimens are similar mess up regard to renal outcomes present-day patient survival.
more Urologists are integrally involved in the management faux acute kidney injury (AKI), which is common after renal action or secondary to postrenal (obstructive) etiologies. The measurement of protective creatinine is a suboptimal meter of AKI because it lags behind acute changes in nephritic function.
Recent advances indicate give it some thought serum/urine biomarkers will prove fine for early detection of AKI, analogous to the use disregard cardiac enzymes for acute myocardial infarction. These serum/urine markers could guide future therapy, facilitate trial efforts to reduce the sternness of AKI, such as care for partial nephrectomy, and allow energy more accurate prognostication for patients with AKI.
UROLOGY 77: 5-11, 2011.