Mills: Chronic Kidney Disease

first_imgDr. DAVID MILLSMedical Associates of Northern New MexicoChronic kidney disease affects nearly 11 percent of Americans. Most causes of kidney injury are considered to be preventable; three-quarters of chronic kidney disease can be explained by diabetes and hypertension (high blood pressure) alone.Perhaps a more insidious cause is from non-steroidal anti-inflammatory drugs (NSAIDs).Marketed under the generic names ibuprofen and naproxen, NSAIDs are perhaps better known by their brand names Advil, Motrin and Aleve.  These readily available over-the-counter drugs exist in the majority of our medicine cabinets, and few of us think twice about taking a couple for that occasional headache or muscle ache.It is common for a patient’s health care provider to be unaware of the frequency in which these medications are used by their patients.  In my experience, these medications make up a disproportionate number of kidney disease cases in Los Alamos (up to a third).Kidney function can easily be measured with routine blood work.  A test for serum creatinine concentration is obtained to estimate kidney function.  Serum creatinine is measured in milligrams per deciliter and can have a wide variability in interpretation. Using ones age, gender, race, and creatinine, an estimated glomerular filtration rate (eGFR) is obtained. Most people have an eGFR of 90-120 (ml/min/1.73m2) in early adulthood, but will naturally decline with age.  Normal renal function is defined as 60 or above in an average, healthy adult.  eGFR represents the amount of aqueous serum from our blood that is passed through the filters of the kidney each day.  An important determinate of eGFR is kidney blood flow which is roughly three times the eGFR.  Thus, an average 18 year old male has approximately 500 liters of blood that will pass through the kidney each day (every drop of blood goes through the kidneys 100 times per day), roughly a quarter of all blood pumped by the heart.  One hundred eighty liters are filtered, but more than 99 percent of that is reabsorbed during subsequent processing within the kidney. The resulting filtration (and reabsorption) of ones total blood volume 36 times a day provides more than adequate removal of water soluble waste products and toxins.NSAIDs cause a significant dose dependent reduction in kidney blood flow.  This reduction occurs due to the drug-induced constriction of small arteries at the filters.   This can be so profound that NSAIDs alone have served for “medical nephrectomy,” or the removal of a kidney, in extreme cases.  Interestingly, this is not the most common means by which NSAID induced kidney injury occurs.  Rather, this is because NSAIDs are the single most common cause for allergic interstitial nephritis (AIN), or inflammation within the kidney architecture.  Allergic white blood cells lead to inflammation, decreased kidney function, and eventually scarring.  AIN is also responsible for kidney disease related to over-the-counter drugs, omeprazole (Prilosec), pantoprazole (Protonix) and esomeprazole (Nexium).  Fortunately, this condition can sometimes recover, but once suspected, the patient should refrain from NSAIDs indefinitely.  Reduction in kidney blood flow by NSAIDs is significant nonetheless, and frequent harm can come when used during coexisting physiologic stressors.  A frequent example is when a patient with vomiting and diarrhea who is volume depleted (i.e. dehydrated) takes an NSAID to lower a fever.  Reduced blood volume from dehydration prevents normal blood delivery to the kidney and then is exacerbated by constriction of blood vessels from the NSAID.  The injured kidneys then cease to filter as certain cells within the kidney die due to lack of oxygen.  Sometimes, the kidneys can recover. High blood pressure is associated with changes in renal blood flow, whereas diabetes frequently predisposes individuals to volume depletion.  Altitude also has an effect on reducing kidney blood flow, although this effect varies amongst individuals and with acclimatization to altitude.  This brings us to an important question as to when or even if it is safe to take NSAIDs.  While the biases of some physicians may be that NSAIDs should never have been released over-the-counter (also a major cause of peptic ulcer disease and increases risk for stroke and heart attack), the fact remains that they are readily available and will remain to be so.I feel that they should always be avoided in patients with acute dehydration, before or during vigorous exercise, and with alcohol.  Avoid NSAID use when exercising for periods of two hours or more. Although used successfully to reduce muscle soreness after training, it is far safer to train appropriately and gradually to avoid sudden severe soreness from overdoing it.  Remember, altitude also has an effect on kidney blood flow.  There is significant increase risk for kidney damage when NSAIDs are used regularly with diuretics, blood pressure medications, or in diabetics.  I never advise daily use beyond a couple of weeks, but may be suggested by your primary care provider for chronic arthritic pain.  Just make sure your provider knows you are taking them, and they are checking your kidney function regularly.  Finally, any patient with known chronic kidney disease should avoid NSAID use altogether.There are other options for over-the-counter pain relief.  Lidocaine skin patches, analgesic balms and heat/cold therapies can be effective for temporary relief. Acetaminophen may also serve as an alternative to NSAIDs, but also have their own risks, primarily related to the liver (never take with alcohol).  I recommend that patients discuss any and all over-the-counter drugs, vitamins, and natural or herbal supplements with their primary care provider.  Beware that most supplements have not been evaluated for safety in kidney disease, and my general advice is to completely avoid them.last_img read more

U.S. offshore rigs up by two

first_imgThe number of offshore drilling rigs operating in the U.S. rose this week by two active units, Baker Hughes said in its report on Friday.BHI Rig Count: U.S. +11 to 522 rigsU.S. Rig Count is up 11 rigs from last week to 522, with oil rigs up 7 to 425, gas rigs up 4 to 96, and miscellaneous rigs unchanged at 1.U.S. Rig Count is down 287 rigs from last year’s count of 809, with oil rigs down 189, gas rigs down 99, and miscellaneous rigs up 1.The U.S. Offshore Rig Count is 22, up 2 rigs from last week, and down 8 rigs year over year.BHI Rig Count: Canada +24 to 162 rigsCanadian Rig Count is up 24 rigs from last week to 162, with oil rigs up 7 to 84, and gas rigs up 17 to 78.Canadian Rig Count is down 17 rigs from last year’s count of 179, with oil rigs up 14, and gas rigs down 31.last_img read more

Make it legal

first_imgSubscribe now for unlimited access To continue enjoying Building.co.uk, sign up for free guest accessExisting subscriber? LOGIN Stay at the forefront of thought leadership with news and analysis from award-winning journalists. Enjoy company features, CEO interviews, architectural reviews, technical project know-how and the latest innovations.Limited access to building.co.ukBreaking industry news as it happensBreaking, daily and weekly e-newsletters Get your free guest access  SIGN UP TODAY Subscribe to Building today and you will benefit from:Unlimited access to all stories including expert analysis and comment from industry leadersOur league tables, cost models and economics dataOur online archive of over 10,000 articlesBuilding magazine digital editionsBuilding magazine print editionsPrinted/digital supplementsSubscribe now for unlimited access.View our subscription options and join our communitylast_img read more

Building buys a pint … for McDowell + Benedetti

first_imgGet your free guest access  SIGN UP TODAY Subscribe now for unlimited access Stay at the forefront of thought leadership with news and analysis from award-winning journalists. Enjoy company features, CEO interviews, architectural reviews, technical project know-how and the latest innovations.Limited access to building.co.ukBreaking industry news as it happensBreaking, daily and weekly e-newsletters To continue enjoying Building.co.uk, sign up for free guest accessExisting subscriber? LOGIN Subscribe to Building today and you will benefit from:Unlimited access to all stories including expert analysis and comment from industry leadersOur league tables, cost models and economics dataOur online archive of over 10,000 articlesBuilding magazine digital editionsBuilding magazine print editionsPrinted/digital supplementsSubscribe now for unlimited access.View our subscription options and join our communitylast_img read more

Back on track

first_imgSubscribe now for unlimited access To continue enjoying Building.co.uk, sign up for free guest accessExisting subscriber? LOGIN Get your free guest access  SIGN UP TODAY Stay at the forefront of thought leadership with news and analysis from award-winning journalists. Enjoy company features, CEO interviews, architectural reviews, technical project know-how and the latest innovations.Limited access to building.co.ukBreaking industry news as it happensBreaking, daily and weekly e-newsletters Subscribe to Building today and you will benefit from:Unlimited access to all stories including expert analysis and comment from industry leadersOur league tables, cost models and economics dataOur online archive of over 10,000 articlesBuilding magazine digital editionsBuilding magazine print editionsPrinted/digital supplementsSubscribe now for unlimited access.View our subscription options and join our communitylast_img read more

Vossmann tackles vortex

first_imgThe industrial part measured almost 20 m in length and over 7 m in diameter. It was transported on a 12-axle trailer from Dinklage, Germany to the harbour in Meppen via the Lindern, Sögel and Werlte rivers.From Meppen, the vortex left the harbour to sail to Voerde, where the components were assembled in a heavy load workshop before continuing to Duisburg.According to Faymonville, the German heavy haulage company recently added 16 axle lines with a flatbed, excavator deck and vessel deck to its fleet.Speaking of the new acquisitions, Swen Siefken, Vossmann’s project manager, said: “Naturally, the advantage is the great flexibility. It allows us to respond to very diverse challenges with numerous possible combinations… We have only recently been active again in the segment above 100-tonne gross weight.” www.spedition-vossmann.dewww.faymonville.comlast_img read more

Partners cannot be treated as workers, Supreme Court hears

first_imgPartners cannot be treated as workers as it would mean firms would effectively be ‘contracting with theirselves’, the Supreme Court heard yesterday in a landmark employment appeal case.Andrew Stafford QC was speaking in Clyde & Co LLP and another v Bates van Winkelhof, the long-running dispute between international firm Clyde & Co and former partner Krista Bates van Winkelhof. The case hinges on whether partners are entitled to protection under ‘whistleblowing’ laws. Under the Employment Rights Act 1996 (ERA), partners in firms are not entitled to protection from unfair dismissal. Bates van Winkelhof (pictured) alleges she was sacked by Clyde & Co in 2011 after making allegations against the managing partner of the firm’s Tanzanian operation. Central to the appeal is the issue of whether LLP members should be classed as ‘workers’ for the purposes of whistleblower protection.Stafford, representing Clyde & Co, told the court yesterday that under section 44 of the ERA, partners could not be treated as employees ‘because [it would mean] the partnership is contracting with theirselves’.Thomas Linden QC, representing Bates van Winkelhof, said that for all practical purposes members of LLPs could be treated as workers. He said there is a public interest argument for partners to ‘raise issues of wrongdoing without the fear of victimisation.’He also cited protection for whistleblowers under Article 10 of the European Convention on Human Rights, which covers freedom of expression.If the Supreme Court rules in Bates van Winkelhof’s favour, her allegations of unfair dismissal due to whistleblowing will be heard in the Employment Tribunal in September, along with allegations of sex discrimination.Clyde & Co said it strongly denies all claims made by Bates van Winkelhof.The hearing continues today.last_img read more

Free entrance at Panaad for Ceres-Negros games

first_img“No more tickets needed in those sections,” Ceres-Negros wrote on its press statement. “This will be the standard procedure moving forward in PFL Regular Season in Panaad Stadium.”There will be payment, however, in the VIP section.Ceres-Negros still has three remaining home matches — against Kaya-Makati Football Club today and against JP Voltes-Marikina Football Club on Oct. 18 and 28.The Negros Occidental-based football club also has two remaining matches against Stallion-Laguna Football Club on Oct. 21 and 25 at the Biñan Football Stadium in Biñan, Laguna.The Risto Vidakovic-mentored Ceres-Negros is very much in the running for a Final Four spot with its current third place ranking with 35 points on 11 wins, two draws and three losses./PN[/av_textblock][/av_one_full] [av_one_full first min_height=” vertical_alignment=” space=” custom_margin=” margin=’0px’ padding=’0px’ border=” border_color=” radius=’0px’ background_color=” src=” background_position=’top left’ background_repeat=’no-repeat’ animation=”][av_heading heading=’ Free entrance at Panaad for Ceres-Negros games ‘ tag=’h3′ style=’blockquote modern-quote’ size=” subheading_active=’subheading_below’ subheading_size=’15’ padding=’10’ color=” custom_font=”]BY ADRIAN STEWART CO[/av_heading][av_textblock size=” font_color=” color=”]MANILA – To entice more Bacolodnon fans, Ceres-Negros Football Club there would be no entrance fee in most parts of the Panaad Park and Stadium in Bacolod City in the ongoing 2017 Philippines Football League.Based on the announcement on its website, tickets are not needed for those who will seat at the Grandstand A, C, D and E and Bleachers North, East and South section.last_img read more

MSC 2016 Rd 3 – A First Timer’s Perspective

first_imgRace Results of MSC 2016 Round 3SUPERBIKE (RACE 1 – 12 LAPS)Category A 2NDJouni KarhuChia PJ KawasakiKawasaki ZX-10R 2NDMohd Rizal Mohd Johari65 Garage Dot COMHonda CBR1000 HRC 1STMuhammad Jazil JuraimiChia PJ KawasakiKawasaki Ninja 250 2NDAhmad Fuad BaharudinTeam Project XHonda CBR1000RR A look at the Pirelli MSC 2016 national series from a first timer’s perspective. Category B Category B Category B Category B Category B 2NDKhairul Anwar JamilHonda CBR250R 1STAzwan Abdul MalekS4M MotorsportsBMW S1000RR 3RDRajini Krishnan KChia PJ KawasakiKawasaki ZX-10R SUPERBIKE (RACE 2 – 12 LAPS)Category A 3RDWan Mohd FaizdeharMotoris VenturesHonda CBR1000RR Category B 3RDLuth HarithFastthrottle MotorsportsHonda CBR250R 1STYap Teck ChowKawasaki Ninja 250SL 3RDAmirul Hafiq Mhd AzmiYamaha YZF-R6 1STYap Teck ChowKawasaki Ninja 250SL 1STAzlan Shah KamaruzamanKawasaki ZX-6R 1STM. Iqbal Quzaimy AzharARD Performance MotorsportsYamaha YZF-R6 3RDMohd Hariz AhmadKawasaki Ninja 250 2NDAzroy Hakeem AnuarHonda CBR600 PRODUCTION 250 ( RACE 1 – 8 LAPS)Category A 1STAzwan Abdul MalekS4M MotorsportsBMW S1000RR 1STMohd Radzi OmarTeam Project XHonda CBR1000RR Story By: Sep IrranRound 3 of the Pirelli Malaysia Superbike Championship 2016, or simply known as MSC 2016 (NOT the Multimedia Super Corridor), got underway at the glorious Sepang International Circuit (SIC) last weekend. The event has been around for a while now and, if you aren’t familiar with it, here’s what you ought to know about it.What is the MSC?As mentioned earlier, the race series has been around for quite a while. It was previously known as the Malaysian Super Series or simply MSS and through a rebranding exercise, MSS evolved itself into its current MSC form. Partnering up with Pirelli as its official tyre supplier, the event has been catching the attention of more and more racing fans.MSC was developed to support and nurture Malaysia’s motorcycle racing scene further apart from the Malaysian Cub Prix national underbone racing series and the two major international races – World Superbikes (WSBK) and MotoGP – that are annually at SIC too.The Pirelli MSC 2016 season consists of five rounds held in the period between May to December 2016. It features four main racing categories – 1000cc Superbike, 1000cc Superstock, 600cc Supersport and the recently revamped Pirelli 250cc & 300cc Race Series (Open 250). As the old saying goes, “the more, the merrier”.What’s special about this MSC?1) Free Access to the Main Grandstand during MSC race weekendsAs fans of the motorsports, the Pirelli MSC 2016 series offers the mass public something that no other motorcycle event can. For one thing, spectators can access the Main Grandstand for free during race weekends.So, if you need to fuel your motorcycle racing addiction in between WSBK and MotoGP, MSC 2016 weekends are something you shouldn’t miss.However, if you feel like the action from the Main Grandstand is not nearly close enough, rest assured that there is another option. For a small amount of money, you can gain access to the Paddock where all the action happens! It is something that is very, VERY hard to come by especially during the major races but not during MSC.2) Get closer to the all the actionYou can get up close and personal with the bikes, teams and even riders during the race weekends. During my first experience in the Paddock, I can’t help but grin with joy upon seeing all the race machines ready to tackle the super technical SIC course. As a motorsports enthusiast myself, getting up close with all the bikes ranging from 250cc & 300cc up to 1000cc Superbikes was a ‘magical’ experience so to speak.Being at the paddock, one can also get a definite feel on how races are conducted on a professional level. All the marshals, racing crews, circuit staff and even supporters are moving about in a ‘controlled chaos’ as sorts.At the same time, the racers head out on track and push their machines to the maximum not for money, but bragging rights on who’s the fastest of them all. It was a sublime experience to see machines mirroring those from WSBK such as the Kawasaki Ninja ZX-10R, Honda CBR1000RR, BMW S1000RR and a few Yamaha YZF-R1, all tearing up the track, hitting speeds close to 300km/h.Seeing and experiencing all this first-hand at such close proximity gives you quite a rush – one unlike any other if I’m honest.3) Good platform to begin or improve racing as a hobby or careerApart from all that is visible, MSC race weekends also stand as an excellent platform for those who want to enter racing world. In fact, MSC caters to those who want to race professionally and welcomes those who are new in racing.One can witness major teams that are well known in the local racing community running a fleet of race bikes, but alongside them you also see small privateer outfits with their machines chasing the same glory of winning races.Furthermore, the teams and riders competing here aren’t just Malaysian, you can also see teams and riders hailing from other neighbouring countries, as well as a few coming from as far as Australia and New Zealand. Each category also has and its divisions within it, meaning there’s something for every racer covering a wide spectrum of competition levels too.4) Meet up with  national riders and top international ridersIf you are lucky, you can even rub shoulders with a few great names in the local and international racing scene during MSC weekends. For example, former Moto2 and current ARRC racer Azlan Shah Kamaruzaman also competes in the MSC’s Supersport category, and he’s one rider that clearly dominated the class last after winning both Supersport races with ease.Other national riders like current Moto2 rider Hafizh Syahrin can also be seen during MSC race weekends. Some even use it as a training ground to keep themselves sharp whilst on break from competing at international races – Azlan Shah being one prime example of this.Another surprise was the presence of renowned Isle of Man TT racer and winner Cameron Donald, who raced last weekend for the SBR Racing Team. Though a brilliant and blistering fast rider, Cameron’s actually a very down to earth bloke when we met him in the pits, and one can easily get close to the man and strike up a conversation with ease. This is one of the magical bits that the Pirellis MSC 2016 series holds for fans.All in all, the Pirelli MSC 2016 is an experience all motorcycle enthusiasts should take part in, whether you’re an expert rider looking for a place to train, a beginner wanting to launch a racing career, or even if you’re just a true fan of racing. There’s really something for everyone in MSC.The last 2 rounds will be a double header and it is scheduled later this year from Dec 2 to Dec 4, 2016. 2NDKeith ParrotSportsrider Racing TeamYamaha YZF-R1 1STJouni KarhuChia PJ KawasakiKawasaki ZX-10R Category B 2NDLinggam RammooHKM TimesBike Racing TeamBMW S1000RR 3RDMohd Ahmad Hawash KhanKawasaki ZX-10R SUPERSPORT (RACE 1 – 12 LAPS)Category A 3RDMuhammad Helmi AzmanARD Performance MotorsportsYamaha YZF-R6 1STLinggam RammooSportsrider Racing TeamBMW S1000RR 2NDMuhd Aiman TahiruddinYamaha YZF-R25 2NDWong Wai MunKawasaki Ninja 250SL 3RDAhmad Nashrul BaharudinTeam Project XKawasaki ZX-10R 1STCameron DonaldSBR Racing TeamKawasaki ZX-10R 3RDHarish NayarSportsRider Racing TeamKawasaki ZX-10R SUPERSPORT (RACE 2 – 12 LAPS)Category A 1STAzlan Shah KamaruzamanKawasaki ZX-6R 1STAhmad Fuad BaharudinTeam Project XHonda CBR1000RR 1STM. Iqbal Quzaimy AzharARD Performance MotorsportsYamaha YZF-R6 Category B 2NDAmirul Hafiq Mhd AzmiYamaha YZF-R6 2NDMuhammad Azmirul AzharARD Performance MotorsportsSuzuki GSX-R 600 1STWan Mohd FaizdeharMotoris VenturesHonda CBR1000RR SUPERSTOCK (RACE 1 – 12 LAPS)Category A 3RDMohd Ahmad Hawash KhanKawasaki ZX-10R PRODUCTION 250 (RACE 2 – 8 LAPS)Category A 3RDAhmad Fariz ZafriKawasaki Ninja 250 3RDMuhamad Syafiq AnuarHKM TimesBike Racing TeamYamaha YZF-R6 –Ads– 2NDMohd Rizal Mohd Johari65 Garage Dot COMHonda CBR1000 HRC 2NDKhairul Anwar JamilHonda CBR250R 3RDAngelo NeoHonda CBR250R 1STMuhammad Jazil JuraimiChia PJ KawasakiKawasaki Ninja 250 3RDLiam Mac DonaldSportsrider Racing TeamKawasaki ZX-6R 2NDMuhammad Azmirul AzharARD Performance MotorsportsSuzuki GSX-R 600 2NDCameron DonaldSBR Racing TeamKawasaki ZX-10R SUPERSTOCK (RACE 2 – 12 LAPS)Category A 3RDLinggam RammooSportsrider Racing TeamBMW S1000RR 3RDJouni KarhuChia PJ KawasakiKawasaki ZX1-0R 2NDAhmad Nashrul BaharudinTeam Project XKawasaki ZX-10Rlast_img read more