The ability of insulin to decrease urinary sodium excretion has been recognized for more than 30 years. While most investigators agree that this occurs predominantly through increased tubular sodium reabsorption, the nephron segments at which insulin exerts this effect in vivo remain controversial. Additionally, little information is available in mammalian systems on the mechanism of the insulin response or its relation to other hormonal systems important in the regulation of tubular sodium transport. Data from amphibian transporting epithelia suggest a potential for interactions between insulin and several other peptide hormones in the regulation of sodium transport. The following discussion attempts to review our knowledge of the effects of insulin on renal sodium reabsorption and describes new data suggesting that insulin's antinatriuretic response is dependent on antidiuretic hormone but independent of the angiotensin and prostaglandin systems.
Background and Aim
Treatment trial with antitubercular therapy [ATT] is a common strategy in tuberculosis-endemic countries in case of a diagnostic dilemma between intestinal tuberculosis and Crohn’s disease [CD]. Our aim was to determine the long-term clinical course of patients who received ATT before an eventual diagnosis of CD was made.
Methods
We performed retrospective comparison between CD patients who received ≥6 months of ATT vs those who did not receive ATT. Outcomes assessed were change in disease behaviour during follow-up, requirement of surgery and medication use.
Results
In all, 760 patients with CD were screened for the study and, after propensity matching for location and behaviour of disease, 79 patients in each group were compared. Progression from inflammatory [B1] to stricturing/fistulising [B2/B3] phenotype was increased among CD patients who received ATT [B1, B2, B3: 73.4%, 26.6%, 0% at baseline vs: 41.8%, 51.9%, 6.3% at follow-up, respectively] as compared with those who did not receive ATT [B1, B2, B3: 73.4%, 26.6%, 0% at baseline vs: 72.2%, 27.8%, 0% at follow-up, respectively] with an odds ratio of 11.05[3.17–38.56]. The usage of 5-aminosalocylates, steroids, immunosuppressants and anti-tumour necrosis factor was similar between both the groups. On survival analysis, CD patients who received ATT had a lower probability of remaining free of surgery [45%] than those who did not [76%] at 14 years of follow-up (hazard ratio [HR] = 3.22, 95% confidence interval [CI], 1.46–7.12, p = 0.004].
Conclusions
Crohn’s disease patients diagnosed after a trial with antitubercular therapy had an unfavourable long-term disease course with higher rate of stricture formation and less chance of remaining free of surgery.
Several studies have been done to assess job satisfaction and quantify effects of stressors on anaesthesiologists in different regions and countries. Studies related to stress in Indian anaesthesiologists are very limited, which prompted us to design this study not only to identify the stressors but also to find out how anaesthesiologists react to stress and devise means to minimize it to increase their job satisfaction levels. A set of questions was handed over personally to 200 anaesthesiologists at the national- and state-level anaesthesiology conferences and continuing medical educations with a request to return them duly filled in, with an assurance that confidentiality and anonymity would bemaintained. Main outcome measures were demographics, factors causing stress, how the responding anaesthesiologists and their colleagues react to it and methods they adopt to reduce stress at their workplace. Response rate was 96%. The total number of respondents was 192 (54% males and 46% females; juniors, 76%; and seniors, 24%). Identified stressors were as follows: time constraints (34%), medicolegal concerns (24%), interference with home life (22%), clinical problems (20%) and communication problems (9%). Different strategies for coping with stress were identified. This survey is just a beginning. Indian Society of Anaesthesiologists is requested to look into the matter and take it further on a larger scale by multicentric studies to lay down standards related to number of working hours, number of night-call duties per week, proper assistance, medicolegal protection, etc., which would not only reduce occupational stress but also improve efficiency and job satisfaction among anaesthesiologists.
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