Biochemical Improvement Research Articles

In vivo antioxidant and hepatoprotective activity of ethanol leaf extract of Senna hirsuta Mill

Purpose: Liver diseases as a problem all over the world has led to many deaths because the conventional drugs known for the cure are inadequate to effect perfect healing. This study aims to evaluate the in vivo antioxidant and hepatoprotective potentials of ethanol leaf extract of Senna hirsuta using mice model.Methods: After the initial effect of hepatic injury in mice with 1 g/kg body weight of paracetamol in a single dose for three days, 200, 400, 800, 1000 and 2000 mg/kg body weight of extract concentrations were used for treating the mice for five days. Blood and liver tissue samples were collected for analysesResults: The results obtained proved that paracetamol elicited toxicity in the mice. The red blood cells mean count in the negative control (7.67±0.92 million/mm3) was higher than the values obtained from the positive control (4.36±0.12 million/ mm3). The WBC mean values of 3.50±0.18 thousand/mm3 from negative control were lower than the positive control group (9.62±0.39 thousand/ mm3). Also, a higher value above the permissible level (11-19 %) was obtained in the haemoglobin estimation of the positive control (20.11%) than the negative control (11.50%). Values of the positive control and extract treated were higher than the negative control value while lower values were recorded in GSH and CAT in positive control and extract treated. Higher biochemical values were recorded in the positive control, and the extract administered except for albumin and protein. However, the injuries caused that manifested in the mice haematology, biochemical and liver disorders were significantly improved with the 200 – 2000 mg of extract concentrations.Conclusion: Leaf extract of Senna hirsuta proved the hepatoprotective activity of the employed extracts. The observation did by biochemical, hematological indices, and recovery improvement in liver function by histologic findings. Therefore, established that S. hirsuta ethanol leaf extract has hepatoprotective affinity over paracetamol-induced liver toxicity.

Drug Delivery Applications of Three-Dimensional Printed (3DP) Mesoporous Scaffolds.

Mesoporous materials are structures characterized by a well-ordered large pore system with uniform porous dimensions ranging between 2 and 50 nm. Typical samples are zeolite, carbon molecular sieves, porous metal oxides, organic and inorganic porous hybrid and pillared materials, silica clathrate and clathrate hydrates compounds. Improvement in biochemistry and materials science led to the design and implementation of different types of porous materials ranging from rigid to soft two-dimensional (2D) and three-dimensional (3D) skeletons. The present review focuses on the use of three-dimensional printed (3DP) mesoporous scaffolds suitable for a wide range of drug delivery applications, due to their intrinsic high surface area and high pore volume. In the first part, the importance of the porosity of materials employed for drug delivery application was discussed focusing on mesoporous materials. At the end of the introduction, hard and soft templating synthesis for the realization of ordered 2D/3D mesostructured porous materials were described. In the second part, 3DP fabrication techniques, including fused deposition modelling, material jetting as inkjet printing, electron beam melting, selective laser sintering, stereolithography and digital light processing, electrospinning, and two-photon polymerization were described. In the last section, through recent bibliographic research, a wide number of 3D printed mesoporous materials, for in vitro and in vivo drug delivery applications, most of which relate to bone cells and tissues, were presented and summarized in a table in which all the technical and bibliographical details were reported. This review highlights, to a very cross-sectional audience, how the interdisciplinarity of certain branches of knowledge, as those of materials science and nano-microfabrication are, represent a growing valuable aid in the advanced forum for the science and technology of pharmaceutics and biopharmaceutics.

Adrenal artery ablation for primary aldosteronism without apparent aldosteronoma: An efficacy and safety, proof-of-principle trial.

Primary aldosteronism (PA) is associated with resistant hypertension and cardiovascular events. There are some limitations of current medical and surgical therapies for PA. To determine the efficacy and safety of catheter-based adrenal artery ablation for treatment of PA patients who refused both surgery and medical therapy, we performed this prospective cohort study. Thirty-six PA patients without apparent aldosteronoma were treated by adrenal artery ablation. Primary outcome was postoperative blood pressure and defined daily dose (DDD) of antihypertensive medications after adrenal ablation. Secondary outcome was biochemical success. We assessed outcomes based on Primary Aldosteronism Surgical Outcome (PASO) criteria. Adrenal CT scan, biochemical evaluation, adrenal artery ablation and adrenal venous sampling (AVS) were underwent. After adrenal ablation, complete clinical success (normotension without antihypertensive medication) was achieved in 9/36 (25.0%) patients and partial clinical success (reduction in blood pressure or less antihypertensive medication) in 13/36 (36.1%) patients. Complete biochemical success (correction of hypokalemia and normalization of aldosterone-to-renin ratio) was achieved in 16/36 (44.4%) patients. Office-based and ambulatory blood pressures were reduced by 17/7 and 11/2mmHg at 6months after ablation, respectively. The plasma cortisol level in the ablation group decreased slightly, but no patient developed hypoadrenocorticism. Catheter-based adrenal ablation appears to produce substantial and sustained blood pressure reduction and biochemical improvement, with only minor adverse events in PA patients without apparent aldosteronoma. This therapy could be an important supplement for current PA treatments.

The Efficacy of Silymarin and Vitamin E in Non-Alcoholic Fatty Liver Disease: A Clinical Trial

Objective: Nowadays, lifestyle modification is the best treatment recommended to patients with the nonalcoholic fatty liver disease (NAFLD). The therapeutic effects of vitamin E and silybin on liver functions were documented. The present study was conducted to examine the effect of silymarin and vitamin E on patients with NAFLD. Materials and Methods: From September 2014 to March 2015, clinical trial was conducted on 92 patients with NAFLD at 2 Shahid Sadoughi university clinical research centers. Sampling was based on convenient method. There were no randomization or blinding in this study, but two types of treatments were compared. The patients were divided in two groups of daily intake of vitamin E (400 IU) and Silymarin 280 mg for four months. Alanine aminotransferase (ALT) and liver ultrasonography were done at baseline and after four months. Results: Eighty patients completed the course of treatment successfully .After 4 months, both groups had experienced a significant reduction in their serum ALT levels. The mean change in the ALT level from the baseline was -31.6 U/L in the silymarin group vs. -15.1 U/L in the vitamin E group (P-value= 0.07). Treatment with silymarin was more effective than vitamin E (P-value< 0.0001). The mean ALT level changed to normal was 55.0% (22 of 40 patients )in the silymarin group, while it was 45.0% (18 of 40 cases) in the vitamin E group (P-value= 0.04). Conclusion: The treatment of NAFLD with silymarin appears to be significantly effective in biochemical improvement whereas treatment with vitamin E improves ultrasonographic parameters.

Febuxostat mitigates concanavalin A-induced acute liver injury via modulation of MCP-1, IL-1β, TNF-α, neutrophil infiltration, and apoptosis in mice

AimLiver plays a crucial role in innate immunity reactions. This role predisposes the liver to innate-mediated liver injury when uncontrolled inflammation occurs. In this study, the effect of febuxostat administration on acute liver injury induced by concanavalin A (Con A) injection into mouse eye orbital sinus was studied. Materials and methodsTwo doses of febuxostat (10 and 20 mg/kg, orally) were administered either 1 h before or 30 min after the administration of Con A. Febuxostat at a low dose (10 mg/kg) before and after Con A modulated the elevation of serum ALT, liver uric acid, liver myeloperoxidase (MPO), and interleukin-1β (IL-1β) induced by Con A. The same dose of febuxostat before Con A also decreased serum total bilirubin and neutrophil infiltration, as evidenced by flow cytometry and histopathological analysis. Key findingsFebuxostat at a high dose (20 mg/kg) significantly improved serum ALT, AST, albumin, total bilirubin, liver uric acid, MPO, monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-α), interleukin-4 (IL-4), IL-1β, and neutrophil infiltration induced by Con A administration. The results of histopathological examination of liver cells paralleled the observed biochemical improvements. Hepatocyte apoptosis as evidenced by immunohistochemical examination of cleaved caspase-3 was markedly decreased in the febuxostat protection and treatment groups, in a dose-dependent manner SignificanceThese results indicate that febuxostat, especially at the higher dose, may be an effective inhibitor of immune reactions evoked by Con A administration.

Outcome of acute peritoneal dialysis (APD) in renal failure among children admitted at Children’s Hospital and Institute of Child Health, Multan.

Objectives: Renal failure (RF) is associated with significant mortality and morbidity. its management still remains challenging for treating physicians. Acute peritoneal dialysis (APD) is an option for treatment of renal failure among young children. We aimed to determine the efficacy of peritoneal dialysis (PD) in RF among children admitted. Study Design: Case series study. Setting: Nephrology Department of Children’s Hospital and Institute of Child Health, Multan. Period: February 2018 to July 2018. Material & Methods: A total of 74 children with renal failure were included. All the patients were treated with acute peritoneal dialysis. The outcome of interest was clinical and biochemical improvement. Result: Amongst all there were 46 (62.2%) male and 26 (37.8%) female. Mean age of the children was found to be 57.72 months. Mean weight of children was 12.36 kg with a standard deviation of 6.4 kg. Most of the children, 43 (58.1%) had acute renal failure (ARF) whereas 31 (41.9%) had chronic renal failure (CRF). With PD, mortality was reported in 22 (29.7%) children. Conclusion: Acute peritoneal dialysis showed good rates of improvement in renal function, so, it should be recommending among children with acute renal failure.

Effect of Rectal Ozone (O3) in Severe COVID-19 Pneumonia: Preliminary Results.

The aim of this study is to evaluate the effectiveness of rectal ozone (O3) in COVID-19 patients with severe pneumonia admitted at Hospital Universitario Santa Cristina, Madrid. In a before-and-after study, four patients admitted with severe bilateral pneumonia due to COVID-19 were treated with rectal ozone and confirmed with (+) RT-PCR for SARS-CoV-2 and evaluated afterwards. The analyzed outcome variables were as follows: (a) clinical improvement (O2 saturation and O2 supply); (b) biochemical improvement (fibrinogen, D-dimer, urea, ferritin, LDH, IL-6, and CRP); (c) radiological improvement. The treatment protocol consisted of 5 sessions (1 session/day) of intra-rectal ozone, applied in a volume of 100 mL and a concentration of 35 μg/mL. The Protocol was previously approved by the Hospital’s Health Care Ethics Committee (CEAS) (Report 15/4/2020) for compassionate use in the face of this exceptional pandemic situation, and prior informed consent was obtained from the patient/legal representative. The patients improved oxygen saturation, as observed by the lower number of desaturations and the lower supply of O2. Biomarkers of inflammation decreased (fibrinogen, D-dimer, urea, ferritin, LDH, IL-6, and CRP). Finally, the radiological signs of bilateral viral pneumonitis improved between 1 and 2 grades based on Taylor’s radiological scale. Rectal ozone decreases O2 supply and improves O2 saturation, decreases inflammation biomarkers, and improves Taylor’s radiological grade in patients with severe COVID-19 pneumonia. Rectal ozone is a safe, effective, cheap, and simple alternative capable of acting on the SARS-CoV-2 virus, and it is presented as an adjunctive therapeutic option to consider in the management of severe bilateral COVID-19 pneumonia.

The Effectiveness of Multi-Session FMT Treatment in Active Ulcerative Colitis Patients: A Pilot Study.

The modification of the microbiome through fecal microbiota transplantation (FMT) is becoming a very promising therapeutic option for inflammatory bowel disease (IBD) patients. Our pilot study aimed to assess the effectiveness of multi-session FMT treatment in active ulcerative colitis (UC) patients. Ten patients with UC were treated with multi-session FMT (200 mL) from healthy donors, via colonoscopy/gastroscopy. Patients were evaluated as follows: at baseline, at week 7, and after 6 months, routine blood tests (including C reactive protein (CRP) and calprotectin) were performed. 16S rRNA gene (V3V4) sequencing was used for metagenomic analysis. The severity of UC was classified based on the Truelove–Witts index. The assessment of microbial diversity showed significant differences between recipients and healthy donors. FMT contributed to long-term, significant clinical and biochemical improvement. Metagenomic analysis revealed an increase in the amount of Lactobacillaceaea, Micrococcaceae, Prevotellaceae, and TM7 phylumsp.oral clone EW055 during FMT, whereas Staphylococcaceae and Bacillaceae declined significantly. A positive increase in the proportion of the genera Bifidobacterium, Lactobacillus, Rothia, Streptococcus, and Veillonella and a decrease in Bacillus, Bacteroides, and Staphylococcus were observed based on the correlation between calprotectin and Bacillus and Staphylococcus; ferritin and Lactobacillus, Veillonella, and Bifidobacterium abundance was indicated. A positive change in the abundance of Firmicutes was observed during FMT and after 6 months. The application of multi-session FMT led to the restoration of recipients’ microbiota and resulted in the remission of patients with active UC.

Durability of biochemical improvements through six years of open label treatment with obeticholic acid in patients with primary biliary cholangitis who did not achieve the poise criteria

Durability of biochemical improvements through six years of open label treatment with obeticholic acid in patients with primary biliary cholangitis who did not achieve the poise criteria

Self-Care Education Program among Type II DM Patients

Introduction: The prevalence of Type 2 Diabetes Mellitus was substantially increased around the world, resulting complications and death. Objective: The self-care education program aimed patients to prevent complications and to increase their quality of life is needed. Method: The method used with the help of an electronic data base from journals that have been published through PubMed, Wiley, and Google Scholar as many as 7 articles from 646 articles reviewed. Results: Description of Diabetes Mellitus self-care education program implementation on body biochemical improvement, life quality improvement from physiological, psychological, knowledge, and attitude side. Conclusion: self-care education program that consisted of providing health education to patients and families with a variety of learning methods, training and discussion where patients and families are involved in activities, both in exploring the patient's feelings to goal setting and intervention. Implementation of this self-care education program can be applied to health services with the adjustment of media based on the local conditions.

Improvement in ornamental, medicinal, and aromatic plants through induced mutation

In several crop breeding programs, high selection pressure has been applied since its domestication which resulted in narrowing in the genetic variability. Therefore, obtaining new crop cultivars has become a difficult task for breeders. Development of strategies to increase the genetic variability has now become the prime area of research in crop breeding for several research groups. Mutation breeding is able to create lot of genetic diversity in the crops naturally as well as through induced mutagenesis. Mutation breeding is an important tool in plant breeding which has proven highly successful in improving crop varieties globally to feed an ever increasing and nutritionally demanding human population. Moreover, it has the advantage of improving a defective, but an elite cultivar, for a single trait without significantly affecting its acceptable phenotype. Till date, induced mutagenesis has been used in several crops including cereals, pulses, flowering plant, medicinal and aromatic plants for their many physical and biochemical trait improvement. Several physical and chemical mutagens like ethyl methane sulfonate, X-rays, or γ-rays have proven their importance in plant mutation breeding. After mutagenesis, selected superior mutants are recommended for large-scale production or further breeding in similar or different environments. Mutation breeding has been successfully applied in release of nearly 3,000 plant varieties especially in cereals, pulses, and flower and has a limited role in improvement of medicinal and aromatic plants. This review discusses the prospective effects of induced mutation in many medicinal and aromatic plants using different mutagens for their improvement in both quantitative and qualitative traits.

Surgical Management of Portal Biliopathy – A Prospective Analysis.

Background: Portal biliopathy denotes intrahepatic and extra hepatic biliary ductal abnormalities in portal hypertension. It is usually associated with extra hepatic portal vein obstruction (EHPVO). These patients are also prone to develop obstructive jaundice as a result of strictures and/or choledocholithiasis. Surgical management of obstructive jaundice in such patients becomes difficult in the presence of these collaterals. The aim of the study is to prospectively analyze the approach to management of patients with Symptomatic portal biliopathy. Subjects and Methods: The study was conducted at Narayana Medical College & Hospital, Chintareddy Palem, Nellore, Andhra Pradesh on surgical management of the patients of EHPVO with portal biliopathy presenting to the surgical clinic of this tertiary referral center between November 2016 and October 2017. The data was analyzed for presentation, clinical features, imaging and results of surgical management. Results: During the study period, total of 44 patients of EHPVO were referred for surgical management. Of these 14 patients (9 males, mean age 34.6 years) were diagnosed to have portal biliopathy. Ten patients had prior history of variceal bleed which was managed endoscopically. Jaundice was the most common symptom followed by right upper quadrant pain and recurrent cholangitis. Four patients had prior unsuccessful endoscopic management. ERCP/ MRCP was used for delineation of the biliary tree, which showed irregularity (14 patients), dominant strictures (8 patients), filling defects (5 patients), and intrahepatic biliary dilatation (7 patients). Proximal splenorenal shunt (PSRS) was performed in 13 patients. While in 1 patient peroperatively liver was found to be grossly nodular, hence gastro-esophageal devascularization with simultaneous biliary drainage was done. Of the 13 patients who underwent PSRS, all patients were intensively followed for 4-6 weeks with history and liver function tests. After 6 weeks, five patients showed clinical as well as biochemical improvement and they are being followed up regularly. Eight patients had persistent symptoms and abnormal liver function tests. These were the patients with dominant stricture and choledocholithiasis. Of these, 6 patients underwent Roux-en-Y hepaticojejunostomy. The average blood transfusion requirement at second surgery was 1 unit. Postoperative complications were minimal with no mortality. One patient and was lost to follow up and the remaining one is awaiting second surgery (RYHJ). Over a follow up of 3-28 months the patients are asymptomatic and well. Conclusion: Portal biliopathy with symptomatic biliary obstruction needs intervention. Surgical decompressive shunt followed by biliary drainage is the best possible treatment. While for most of the early biliary changes shunt alone is effective, patients with dominant stricture will need a biliary diversion which can be safely performed following Porto systemic shunt without increase in morbidity or mortality.

Myositis, rhabdomyolysis and severe hypercalcaemia in a body builder.

SummaryA 53-year-old man who used growth hormone (GH), anabolic steroids and testosterone (T) for over 20 years presented with severe constipation and hypercalcaemia. He had benign prostatic hyperplasia and renal stones but no significant family history. Investigations showed – (1) corrected calcium (reference range) 3.66 mmol/L (2.2–2.6), phosphate 1.39 mmol/L (0.80–1.50), and PTH 2 pmol/L (1.6–7.2); (2) urea 21.9 mmol/L (2.5–7.8), creatinine 319 mmol/L (58–110), eGFR 18 mL/min (>90), and urine analysis (protein 4+, glucose 4+, red cells 2+); (3) creatine kinase 7952 U/L (40–320), positive anti Jo-1, and Ro-52 antibodies; (4) vitamin D 46 nmol/L (30–50), vitamin D3 29 pmol/L (55–139), vitamin A 4.65 mmol/L (1.10–2.60), and normal protein electrophoresis; (5) normal CT thorax, abdomen and pelvis and MRI of muscles showed ‘inflammation’, myositis and calcification; (6) biopsy of thigh muscles showed active myositis, chronic myopathic changes and mineral deposition and of the kidneys showed positive CD3 and CD45, focal segmental glomerulosclerosis and hypercalcaemic tubular changes; and (7) echocardiography showed left ventricular hypertrophy (likely medications and myositis contributing), aortic stenosis and an ejection fraction of 44%, and MRI confirmed these with possible right coronary artery disease. Hypercalcaemia was possibly multifactorial – (1) calcium release following myositis, rhabdomyolysis and acute kidney injury; (2) possible primary hyperparathyroidism (a low but detectable PTH); and (3) hypervitaminosis A. He was hydrated and given pamidronate, mycophenolate and prednisolone. Following initial biochemical and clinical improvement, he had multiple subsequent admissions for hypercalcaemia and renal deterioration. He continued taking GH and T despite counselling but died suddenly of a myocardial infarction.Learning points:The differential diagnosis of hypercalcaemia is sometimes a challenge.Diagnosis may require multidisciplinary expertise and multiple and invasive investigations.There may be several disparate causes for hypercalcaemia, although one usually predominates.Maintaining ‘body image’ even with the use of harmful drugs may be an overpowering emotion despite counselling about their dangers.

Homocysteine metabolism in rats with metabolic syndrome and the impacts of nigella sativa oil on some biochemical parameters

The high level of fructose taken in the diet is one of the reasons for the increased prevalence of metabolic syndrome, which is increasing day by day globally in association with the effects of genetic and environmental factors. In the study, 21 male Sprague-Dawley rats of 220±20 gr body weight were used. The rats were assigned to 3 groups as the control group, metabolic syndrome group, and the group where Nigella sativa oil was administered. The serum homocysteine levels were increased in the metabolic syndrome group compared to the control group but without statistical significance (p>0.05). Homocysteine levels decreased significantly after Nigella sativa oil compared to metabolic syndrome group. LDH (p <0.001) and uric acid (p <0.05) levels which were higher in metabolic syndrome group were decreased in Nigella sativa oil group. Hyperhomocysteinemia is a risk factor for endothelial dysfunction. In our study, the treatment of the metabolic syndrome and regulation of the increased levels of homocysteine with Nigella sativa oil in metabolic syndrome were discussed. Some biochemical parameters and improvements in homocysteine levels with Nigella sativa oil has been identified. In this study, we have concluded that the occurrence of elevated levels of plasma homocysteine are closely associated with the development of inflammation, cellular adhesion, hepatic dysfunction, and cell proliferation and that the reduction in the serum levels of homocysteine by the administration of Nigella sativa oil will lead to favorable out comes.

Clinical and biochemical improvement with galactose supplementation in SLC35A2-CDG

PurposeWe studied galactose supplementation in SLC35A2-congenital disorder of glycosylation (SLC35A2-CDG), caused by monoallelic pathogenic variants in SLC35A2 (Xp11.23), encoding the endoplasmic reticulum (ER) and Golgi UDP-galactose transporter. Patients present with epileptic encephalopathy, developmental disability, growth deficiency, and dysmorphism. MethodsTen patients with SLC35A2-CDG were supplemented with oral D-galactose for 18 weeks in escalating doses up to 1.5 g/kg/day. Outcome was assessed using the Nijmegen Pediatric CDG Rating Scale (NPCRS, ten patients) and by glycomics (eight patients). ResultsSLC35A2-CDG patients demonstrated improvements in overall Nijmegen Pediatric CDG Rating Scale (NPCRS) score (P = 0.008), the current clinical assessment (P = 0.007), and the system specific involvement (P = 0.042) domains. Improvements were primarily in growth and development with five patients resuming developmental progress, which included postural control, response to stimuli, and chewing and swallowing amelioration. Additionally, there were improvements in gastrointestinal symptoms and epilepsy. One patient in our study did not show any clinical improvement. Galactose supplementation improved patients’ glycosylation with decreased ratios of incompletely formed to fully formed glycans (M-gal/disialo, P = 0.012 and monosialo/disialo, P = 0.017) and increased levels of a fully galactosylated N-glycan (P = 0.05). ConclusionsOral D-galactose supplementation results in clinical and biochemical improvement in SLC35A2-CDG. Galactose supplementation may partially overcome the Golgi UDP-galactose deficiency and improves galactosylation. Oral galactose is well tolerated and shows promise as dietary therapy.

728 SUSTAINED CLINICAL RESPONSE WITH EUS GUIDED RFA OF PANCREATIC INSULINOMA

Insulinoma is the commonest functional Pancreatic Neuro-Endocrine Tumor (f-PNET). Surgical resection is the standard management, often associated with significant morbidity. Alternate less invasive management options with EUS guided local therapy (Radio-frequency ablation or alcohol injection) are reportedly effective in short term follow-up. To evaluate the long-term efficacy of EUS guided RFA (EUS-RFA) used for the ablation of f-PNET. EUS-RFA of f-PNET was performed using a dedicated internally cooled 19G device. Lesions located close (≤5mm) to the pancreatic duct (PD) underwent prophylactic PD stent. Patients with a persistent symptomatic lesion or those with multiple lesions were considered for subsequent session/s of EUS-RFA. All patients post RFA underwent systematic follow up (3 monthly in the first year, 6 monthly in next year and at 1-year interval thereafter). 10 Insulinoma patients with 13 lesions underwent EUS-RFA over 5 years. One patient had 4 lesions. The mean tumor size was 11.5 mm (range ?). Three patients had prophylactic PD stent. Eight subjects had one EUS-RFA session. Two patients required >1 session. All subjects had rapid relief of symptoms along with biochemical improvement (blood sugar, insulin, C-peptide) within 24 hours that has remained sustained over the next 10 – 64 months. Post-procedure, one subject had mild self-limiting abdominal pain. Another patient developed acute pancreatitis after 3rd session of EUS RFA leading to pseudocyst that required EUS drainage. Tumor size decreased in 10/14 lesions (undetectable in 6, significantly reduced in 4). Remaining 4 lesions are stable in size with reduced vascularity. EUS guided RFA is safe and effective with sustained beneficial outcomes for Pancreatic Insulinoma.

P1616ASSESSMENT OF SEQUENTIAL CHANGES OCCURRING IN THE BODY FLUID COMPOSITION BY BIO-IMPEDANCE ANALYSER IN PRE AND EARLY POST RENAL TRANSPLANT PATIENTS

Abstract Background and Aims Chronic kidney disease is now recognized as major causes of death in India. The Global Burden of Disease (GBD) study 2015, ranked chronic kidney disease as 17th among the causes of deaths globally (age standardized annual death rate of 19·2 deaths per 100 000 population). Deaths due to renal failure constituted 2·9% of all deaths in 2010–13 among 15–69 year-olds, an increase of 50% from 2001–03. These are varies metabolic derangements in CKD patients, among which volume overload is the major problem contributing uncontrolled hypertension and increases cardiovascular mortality. There will be increased total body water (TBW) and extracellular water (ECW) at the expense of reduced intracellular water (ICW). Renal replacement therapies such as dialysis or kidney transplantation are the major treatment modalities. Renal transplantation is the treatment of choice for end stage renal failure patients. Despite improving renal dysfunction, patients are at risk for existing or new onset of conditions after transplantation and may alter the body fluid physiology. Till date, renal transplant patients received little attention towards fluid balance and nutritional status. There are many studies supporting the use of bioimpedance analyzer as a reliable tool in assessing the fluid status in haemodialysis patients, but there are very few studies done in post renal transplant patients to know their fluid status with single functioning kidney where Glomerular filtration rate are generally much lower than normal. Method fifty renal transplant recipients were followed in our centre for 6 months (68 males, maximum were in 31-45years of age). Biochemical parameters like haemoglobin, urea, creatinine, electrolytes, albumin, estimated glomerular filtration rate (eGFR); TBW, ECW, ICW and over hydration (OH) measured using bioimpedance analysis (BCM, Fresenius) were evaluated at baseline (pre-transplant) and after transplant at 3 and 6 months. Baseline biochemical and bio-impedance values were compared with 3 and 6 months post transplant. Patients were divided into 3 sub-groups based on eGFR: good graft function (eGFR >60 ml/min), borderline graft function (eGFR 30-60 ml/min) and severe graft dysfunction (eGFR >30 ml/min/1.73m2). TBW, ECW, OH and ICW were compared between the sub groups of eGFR at 3 and 6 months post transplant. Results Comparing before transplant with 3 and 6 months post-transplant, TBW, ECW and OH were reduced while ICW increased significantly with good graft function. On comparing 3 months to 6 months post-transplant, ECW, TBW, OH reduced further but there was not much difference in ICW. OH at 6 months post-transplant was 0.6 L (within normal range of gender-matched individuals from the reference population, that is, −1.1 to 1.1 L). In patients with severe graft dysfunction (<30ml/min), TBW, ECW and OH were remained high when compared to borderline (31-60ml/min) and with good graft function group (>60ml/min). Biochemical improvement was comparable with bio-impedance parameters at 3 months and 6 months post transplant with good graft function. Conclusion The BIA showed significant reduction in TBW, ECW and OH by 6 months post transplant and ICW increased as graft function improved post transplantation by 3 months and thereafter, change was not significant. Parameters of Bio-impedance analyzer of well-functioning kidney transplant recipients showed that the altered body water compartments quickly normalizes which is never achieved by a hemodialysis session. We found that Bio-impedance analyzer was useful to know the changes in body fluid composition in post renal transplant patients.

Su1265 CLINICAL UTILITY OF ENDOSCOPIC ULTRASOUND-GUIDED DEPLOYMENT OF LUMEN-APPOSING METAL STENTS FOR MALIGNANT AFFERENT LIMB SYNDROME; A DESCRIPTIVE ANALYSIS

Endoscopic ultrasound-guided deployment of a lumen apposing metal stent (LAMS) has recently emerged as a favorable interventional modality for the treatment of malignant afferent limb syndrome (ALS). However, data regarding the safety and feasibility of this approach is limited. A systematic literature search was performed of Medline(Ovid) and Embase from inception-July 2019. All studies were screened by two authors to identify studies reporting EUS-guided deployment of LAMS for the treatment of malignant ALS. Due to the expected paucity of data, case reports were included in our analysis. Pooled data was reported as proportions with 95% confidence interval (CI). Overall, we identified 15 reports enrolling 32 patients with a mean age of 62, of whom 16 (50%) were female. A history of pancreatoduodenectomy was reported in 23 (72%) patients (Table 1). The mean time from surgical tumor resection to ALS presentation was 14 months (SD 6.5). The most common cause of ALS was peritoneal carcinomatosis (11; 34%). Prior endoscopic intervention for ALS was performed in 4 (13%) patients. Electrocautery enhanced LAMS insertion was performed in 17 (53%) cases, and a needle knife was utilized in 2 (6%) cases. All patients successfully underwent EUS-guided deployment of a LAMS to create a gastroenterostomy with subsequent symptomatic and biochemical improvement of ALS. The most common anastomosis created was a gastrojejunostomy (22, 69%), followed by a jejunojejunostomy (7, 22%). No adverse events were reported over the study duration. Re-obstruction and reintervention were reported in 3 (9%) and 4 (13%) cases, respectively. Over a mean follow-up period of 98.27 days (95%CI 74.58-121.96), one mortality due to ALS was reported. EUS-guided gastroenterostomy (EUS-GE) by deployment of a LAMS for the treatment of ALS is a technically feasible and clinically favorable intervention, particularly in patients who are poor surgical candidates. A lack of long-term follow up was identified upon systematically analyzing the literature. Future well-designed studies with long-term follow-up are needed to further explore the clinical utility of EUS-GE for the treatment of ALS.

Recommendation of an ideal mixed fluid preparation to be used as partial parenteral nutrition in surgical Neonatal Intensive Care Unit

Background: This study was conducted to assess the role of Partial Parenteral Nutrition (PPN) and a specially prepared “mixed fluid formula” used as PPN in sick surgical neonates.Methods: This single institution based Randomised Control Trial was performed in Surgical NICU of a tertiary care Centre. Surgical neonates who required bowel rest for >3 days like Esophageal Atresia (22), Duodenal Atresia (38), Jejuno-Ileal Atresia (50), Necrotising Enterocolitis (29) and others (11), were chosen. As a CONTROL population half (75) neonates were allowed maintenance fluid only (Isolyte P) and rest (75) were given a combination of maintenance fluid (Isolyte P) and PPN (specially prepared mixed fluid). This mixed fluid each 100 ml was prepared with 65ml Isolyte P, 15 ml 25% Dextrose, 10 ml Normal Saline, 7 ml Astymin 3, 2 ml Multivitamin and 1 ml Injection KCl. Fluid was continued till enteral feeding was established.Results: Neonates according to their body weight were divided in three groups <1 kg (50), 1-2.5 kg (71) and >2.5 kg (29) and their post-operative outcome was assessed as Clinical Positive/Negative and Laboratory Positive/Negative. Results were separately assessed in 3 body weight groups under “Control” and “Study” which showed both Clinical and Biochemical improvement in “Study group”.Conclusions: The composition of mixed fluid, its nutritional value, calorie supplementation, compatible osmolarity for peripheral venous administration and most importantly its easy and cost-effective preparation were assessed thoroughly and we recommend this “mixed fluid” preparation as a very useful PPN for sick surgical neonates.

The Emerging Role of Convalescent Plasma in the Treatment of COVID-19.

Various agents are currently under evaluation as potential treatments in the fight against coronavirus disease 2019 (COVID-19). Plasma from patients that have overcome COVID-19 infection, referred to as convalescent plasma, is a treatment option with considerable background in viral diseases such as Spanish influenza, H1N1, Ebola, Severe Acute Respiratory Syndrome (SARS), and Middle East Respiratory Syndrome (MERS). Although convalescent plasma has historically proven beneficial in the treatment of some viral diseases, its use is still explorative in the context of COVID-19. To date, preliminary evidence from case series is favorable as significant clinical, biochemical improvement and hospital discharge have been reported. A detailed overview of randomized as well non-randomized trials of treatment with convalescent plasma, which have been registered worldwide, is provided in this review. Based on these studies, data from thousands of patients is anticipated in the near future. Convalescent plasma seems to be a safe option, but potential risks such as transfusion-related acute lung injury and antibody-dependent enhancement are discussed. Authorities including the Food and Drug Administration (FDA), and scientific associations such as the International Society of Blood Transfusion (ISBT) and the European Blood Alliance (EBA), have provided guidance into the selection criteria for donors and recipients. A debatable, pivotal issue pertains to the optimal timing of convalescent plasma transfusion. This treatment should be administered as early as possible to maximize efficacy, but at the same time be reserved for severe cases. Emerging risk stratification algorithms integrating clinical and biochemical markers to trace the cases at risk of significant deterioration can prove valuable in this direction.