Chronic Disease Group Research Articles

Does Chronic Kidney Disease Affect the Surgical Outcome and Prognosis of Patients with Gastric Cancer? A Meta-Analysis

Purpose: The purpose of this meta-analysis was to evaluate the impact of chronic kidney disease on short-term complications and long-term survival in patients with gastric cancer. Methods: The PubMed, Embase, and Cochrane Library databases were searched from inception to May 18, 2021. The search strategy focused on two keywords: chronic kidney disease and gastric cancer. Pooled odds ratios, mean differences, and hazard ratios were analyzed. RevMan 5.3 was used for data analysis in this meta-analysis. Results: A total of seven studies including 3,346 patients were included in this meta-analysis. The chronic kidney disease group had a higher proportion of males and older patients, lower albumin levels, higher comorbidity rates, and higher N staging. The chronic kidney disease group had higher rates of overall postoperative complications (OR = 2.05, 95% CI = 1.38 to 3.05, P = 0.0004), more severe postoperative complications (OR = 2.06, 95% CI = 1.59 to 2.66, P < 0.00001), and higher rates of cardiovascular-related complications, anastomotic leakage, pneumonia, wound infections, pancreatic-related diseases and short-term death. Furthermore, the chronic kidney disease group had poorer overall survival than the nonchronic kidney disease group (HR = 2.89, 95% CI = 2.20 to 3.80, P < 0.00001). Conclusion: Preexisting chronic kidney disease was associated with higher complications and poorer overall survival following gastrectomy in patients with gastric cancer.

Health-related benefits and adverse events associated with yoga classes among participants that are healthy, in poor health, or with chronic diseases

BackgroundOur previous study demonstrated that 42% of yoga class participants in Japan had chronic diseases requiring medication. This raises the question as to whether those with chronic diseases would benefit from practicing yoga or if they are at higher risk for specific adverse events compared to healthy individuals receiving the same instruction.MethodsTo address these questions, 328 adults who started practicing yoga for the first time were asked to complete the Profile of Mood States (POMS), Perceived Stress Scale (PSS), and Medical Outcomes Study Short Form 8, standard version (SF-8™) and to record any adverse events on the first day of the yoga class and again three months later. The participants consisted of three groups: a healthy (H) group (n = 70), a poor health (PH) group (n = 117), and a chronic disease (CD) group (n = 141). The degree of subjective symptoms was also compared between the pre- and post-intervention period in the PH and CD groups.ResultsTypically, yoga classes were held once a week for 60–90 min. The programs included asanas, pranayamas, meditation, isometric yoga, and sukshma vyayama. In the PH and CD groups, the POMS tension-anxiety and fatigue scores decreased and the vigor score increased significantly after the first class. Furthermore, PSS scores decreased and the SF-8™ scores increased significantly three months later. The degree of subjective symptoms such as easy fatigability, shoulder stiffness, and insomnia also decreased over three months. Individuals in these groups experienced more frequent adverse events than those in the H group. The PH and CD groups also experienced a greater variety of symptoms, including psychological ones, not reported by the H group. Adverse events were not so serious that participants stopped practicing yoga during the class. About 60% of all participants were highly satisfied with participating in yoga classes.ConclusionsIf yoga classes are conducted with attention to possible adverse events, yoga practice in a yoga studio may have beneficial effects for people with functional somatic symptoms and chronic diseases, as well as healthy participants. These benefits include reductions in perceived stress and uncomfortable symptoms as well as improved mood and quality of life.

Clinical significance of serum IgM and IgG levels in COVID-19 patients in Hubei Province, China

BackgroundThere have been many studies about coronavirus disease 2019 (COVID-19), but the clinical significance of quantitative serum severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-specific IgM and IgG levels of COVID-19 patients have not been exhaustively analyzed. We aimed to investigate the time profiles of these IgM/IgG levels in COVID-19 patients and their correlations with clinical features. MethodsA multicenter clinical study was conducted from February 20 to March 5 2020. It involved 179 COVID-19 patients (108 males and 71 females) from five hospitals in Huangshi in Hubei Province, China. To detect SARS-CoV-2-specific IgM/IgG, quantitative antibody assays (two-step indirect immunoassays with direct chemiluminescence technology) based on the nucleocapsid protein (NP) and spike protein 1 (S1) were used. For normally distributed data, means were compared using the t-test, χ2-test, or exact probability method. For categorical data, medians were compared using Mann–Whitney U test. ResultsThe median age was 57 (44–69) years (58 [38–69] for males and 57 [49–68] for females). The median duration of positive nucleic acid test was 22.32 (17.34–27.43) days. The mortality rate was relatively low (3/179, 1.68%). Serum SARS-CoV-2-specific IgG was detected around week 1 after illness onset, gradually increased until peaking in weeks 4 and 5, and then declined. Serum IgM peaked in weeks 2 and 3, then gradually declined and returned to its normal range by week 7 in all patients. Notably, children had milder respiratory symptoms with lower SARS-CoV-2-specific IgM/IgG levels. The duration of positive nucleic acid test in the chronic obstructive pulmonary disease (COPD) group was 30.36 (18.99–34.76) days, which was significantly longer than that in the non-COPD group (21.52 [16.75–26.51] days; P = 0.025). The peak serum SARS-CoV-2-specific IgG was significantly positively correlated with the duration of positive nucleic acid test. The incidence rate of severe and critical cases in the IgMhi group (using the median IgM level of 29.95 AU/mL as the cutoff for grouping) was about 38.0% (19/50), which was twice as much as that in the IgMlo group (18.4%; 9/49). The patients with positive chest imaging and lymphocytopenia (<1 × 109/L) had a higher SARS-CoV-2-specific IgM level. ConclusionsQuantitative SARS-CoV-2-specific IgM and IgG levels are helpful for the diagnosis, severity classification, and management of COVID-19 patients, and they should be monitored in each stage of this disease.

Diabetes Mellitus and Periodontitis Share Intracellular Disorders as the Main Meeting Point

Diabetes and periodontitis are two of the most prevalent diseases worldwide that negatively impact the quality of life of the individual suffering from them. They are part of the chronic inflammatory disease group or, as recently mentioned, non-communicable diseases, with inflammation being the meeting point among them. Inflammation hitherto includes vascular and tissue changes, but new technologies provide data at the intracellular level that could explain how the cells respond to the aggression more clearly. This review aims to emphasize the molecular pathophysiological mechanisms in patients with type 2 diabetes mellitus and periodontitis, which are marked by different impaired central regulators including mitochondrial dysfunction, impaired immune system and autophagy pathways, oxidative stress, and the crosstalk between adenosine monophosphate-activated protein kinase (AMPK) and the renin-angiotensin system (RAS). All of them are the shared background behind both diseases that could explain its relationship. These should be taken in consideration if we would like to improve the treatment outcomes. Currently, the main treatment strategies in diabetes try to reduce glycemia index as the most important aspect, and in periodontitis try to reduce the presence of oral bacteria. We propose to add to the therapeutic guidelines the handling of all the intracellular disorders to try to obtain better treatment success.

Genetics, Epigenetics, and Gender Impact in Axial-Spondyloarthritis Susceptibility: An Update on Genetic Polymorphisms and Their Sex Related Associations.

Spondyloarthritis (SpA) is a group of chronic inflammatory rheumatic disease that can be divided into predominantly axial or predominantly peripheral involvement, with or without associated psoriasis, inflammatory bowel disease or previous infection. Axial SpA (axSpA) encompasses ankylosing spondylitis (AS) with radiological sacroiliitis, and a type without radiographic sacroiliitis, called “non-radiographic axial SpA” (nr-axSpA). Males and females show large differences in their susceptibility to SpA, such as distinctions in clinical patterns, phenotypes and in therapeutical response, particularly to TNF inhibitors (TNFi). Several studies indicate that AS women have doubled risk to failure TNFi compared with males. This diversity in drugs’ efficacy among women and men may be caused by differences in the balance of sex hormones and in gene-specific expression likely triggered by X-chromosome instability and gene-specific epigenetic modifications. Evidence reported that polymorphisms in microRNAs on X- and other chromosomes, such as miR-146a, miR-155, miR-125a-5p, miR-151a-3p and miR-22-3p, miR-199a-5p could be involved in the different clinical presentation of SpA, as well as disease activity. In addition, association with non−response to TNFi treatment and presence of IRAK3 and CHUCK genes in SpA patients was recently detected. Finally, polymorphisms in genes involved in IL-23/IL-17 pathway, such as in drug pharmacodynamics and pharmacokinetics may have a role in response to TNFi, IL17i, and IL23i. A major understanding of genomic variability could help in the development of new therapeutic targets or in taking advantages of different mechanisms of action of biological drugs. Moving from the multifactorial etiology of disease, the present review aims at evaluating genetic and epigenetic factors and their relationship with sex and bDMARDs response, helping to investigate the different expression among males and females of genes on X- and other chromosomes, as well as mi-RNA, to highlight relationships between sex and occurrence of specific phenotypes and symptoms of the disease. Moreover, the role of the epigenetic modification in relation to immune-regulatory mechanisms will be evaluated.

Soluble HLA-G is upregulated in serum of patients with severe COVID-19

Soluble HLA-G (sHLA-G) molecules are considered potent immunomodulators, and their dysregulated expression has been implicated in several pathological conditions, including coronavirus disease 19 (COVID-19). Therefore, a case-control study (103 COVID-19 patients and 105 controls) was performed to determine sHLA-G role in severity of COVID-19. Results revealed that median levels of sHLA-G were significantly increased in serum of patients compared to controls (19.3 vs. 12.7 ng/mL; p <0.001). When patients and controls were stratified by age group, gender, body mass index, chronic disease, or ABO and Rh blood groups, the sHLA-G level did not show a significant difference in each stratum. Logistic regression analysis demonstrated that the up-regulated expression of sHLA-G was associated with an elevated risk of developing COVID-19. Receiver operating characteristic curve analysis showed that sHLA-G was a very good predictor of COVID-19, and at a cut-off value of 15.4 ng/mL, the sensitivity and specificity of sHLA-G were 79.6 and 79.0%, respectively. Spearman rank correlation analysis revealed that sHLA-G was positively correlated with age, erythrocyte sedimentation rate, white blood cell count, and random blood glucose, while a negative correlation was recorded with vitamin D. In conclusion, up-regulated expression of sHLA-G was indicated in patients with severe COVID-19.

The very elderly followed at a nephrology center: metabolic acidosis as a predictor of progressive chronic kidney disease

Chronic kidney disease is an increasingly common diagnosis in the very elderly and identifying the patients who benefit from a nephrologist’s intervention and the ones who would not might avoid wasteful or harmful interventions. The aim of this study is to identify the risk factors for progressive versus non -progressive chronic kidney disease in a population aged over 80 years old. We performed a cohort single -center retrospective study including 101 patients over 80 years old with chronic kidney disease diagnosed for at least five years and followed regularly by a nephrologist. Progressive disease was defined as glomerular filtration rate declines greater than 5 mL/min/1.73 m2/year. Of the 101 patients, 33.7% had progressive chronic kidney disease. The median glomerular filtration progression rate was 3.0 [2.1 -6.0] mL/ min/1.73m2/year. Hypertension and diabetes mellitus prevalence was similar between groups. Nephrology follow -up time was longer in the progressive group (5.0 vs 2.0 years, p=0.01). Regarding chronic kidney disease complications, 37.6% had anemia and half of these needed erythropoiesis -stimulating agents. None of the patients had hyperphosphatemia. About 18.8% presented metabolic acidosis. In multivariable analysis, after adjusting for covariables such as age, hypertension, and diabetes mellitus only the presence of metabolic acidosis (OR 0.4, CI: 0.1 -0.8) was associated with the development of progressive chronic kidney disease. Progressive chronic kidney disease group presented higher mortality (log rank 4.5, p=0.03). Ischemic cardiomyopathy (OR: 0.5, CI: 0.2 -0.9) and progressive chronic kidney disease (OR: 0.6, CI:0.3 -0.8) were associated with all -cause mortality. Our results showed that most elderly patients have non -progressive chronic kidney disease. Patients with metabolic acidosis seem to be at an increased risk for developing progressive disease. Most elderly patients die before reaching end -stage kidney disease, so it is important to look at progressive kidney disease in those patients as an important marker of comorbidity and privilege cardioprotective measures.

Degree of convexity calculated from expiratory flow-volume curves for identifying airway obstruction in nonsedated and nonparalyzed ventilated patients

The predictive performance of applying the degree of convexity in expiratory flow-volume (EFV) curves to detect airway obstruction in ventilated patients has yet to be investigated. We enrolled 33 nonsedated and nonparalyzed mechanically ventilated patients and found that the degree of convexity had a significant negative correlation with FEV1% predicted. The mean degree of convexity in EFV curves in the chronic obstructive pulmonary disease (COPD) group (n = 18) was significantly higher than that in the non-COPD group (n = 15; 26.37 % ± 11.94 % vs. 17.24 % ± 10.98 %, p = 0.030) at a tidal volume of 12 mL/kg IBW. A degree of convexity in the EFV curve > 16.75 at a tidal volume of 12 mL/kg IBW effectively differentiated COPD from non-COPD (AUC = 0.700, sensitivity = 77.8 %, specificity = 53.3 %, p = 0.051). The degree of convexity calculated from EFV curves may help physicians to identify ventilated patients with airway obstruction.

Total Sleep Time in the Taiwan Obstructive Lung Disease Cohort.

Patients with chronic obstructive pulmonary disease (COPD) have been reported to have poor sleep quality. However, total sleep time has not been evaluated in detail among patients with COPD. This retrospective, observational, multicenter research study was performed across six participating hospitals in Taiwan, with a total of 421 adult patients enrolled. Pulmonary function, the Modified British Medical Research Council Dyspnea Scale, the COPD Assessment Test and basic clinical data were assessed. The Pittsburgh Sleep Quality Index was also administered to patients, and the total sleep time was extracted for further analysis. The patients whose total sleep time was between 6 and 7 h had better pulmonary function, and the patients who slept less than 5 h had worse comorbidities. There was a significant higher total sleep time in Global Initiatives for Chronic Obstructive Lung Disease (GOLD) group B compared to GOLD group A. COPD patients who sleep between 5 and 6 h used fewer oral steroids and were less likely to use triple therapy (long-acting beta-agonist, long-acting muscarinic antagonist, inhaled cortical steroid). COPD patients sleeping from 5 to 7 h had better clinical features than those sleeping less than 5 h in terms of pulmonary function, comorbidities and medication usage.

Evaluation of Corona Virus Disease-19 Related Fear and Anxiety in Patients Admitted to Neurology Outpatient Clinic

SARS-CoV-2, quickly spread and became a threat to public health. The majority of the people are affected psychologically, socially, economically by the pandemic. We aimed to investigate the level of anxiety and fear about coronavirus disease 19 (COVID-19) and related factors in patients with chronic neurological disease We evaluated the patients with chronic neurological disease who have been followed up at our outpatient clinic before the pandemic. Demographical data, information about social media use, change of hospital admission during the pandemic and status of the patients' or family members' whether they had the COVID-19 disease were recorded. We investigated the fear of COVID-19 and coronavirus anxiety of the study population with Fear of COVID-19 and The Coronavirus Anxiety Scale. The study population was consisted of 247 patients (158 women, 89 men). The distribution of the patient groups was as follow: 28.34 % headache, 12.5 % stroke, 5.6% Parkinson's disease, multiple sclerosis 34.8%, epilepsy 13.36%, others 5.26%. Mean scores of FC-19 S, CAS of the study group were 18±6.76 and 1.31±2.42, respectively. There was no statically significant difference in the FC-19 S and CAS scores between chronic neurological disease groups (p>0.05) but females reported higher FC-19 S scores (p= 0.001). Rate of social media users was 67.6 % and 45.67 % of the patients reported that they were affected by the COVID-19 related news. Often enough, communication with chronic disease patients by healthcare professionals is a key to the patients to be adherence to the medications and follow up visits. During the pandemic, the health system needs new solutions. We think that legal regulations regarding using technological tools such as telemedicine and video consultancy should be completed in our country.

Perplexing mortality data from triple therapy trials in COPD

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, which has resulted in several large trials studying the impact of COPD-associated treatments on mortality. 1 Rabe KF Hurd S Anzueto A et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007; 176: 532-555 Crossref PubMed Scopus (4256) Google Scholar The Global Initiative for Chronic Obstructive Lung Disease group recognises the inconsistent results of the data on mortality and the need for evidence on the escalation from dual bronchodilator therapy to triple therapy. 2 Vogelmeier CF Criner GJ Martinez FJ et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J. 2017; 491700214 Crossref PubMed Scopus (411) Google Scholar , 3 Rodriguez-Roisin R Rabe KF Vestbo J Vogelmeier C Agustí A Global Initiative for Chronic Obstructive Lung Disease (GOLD) 20th Anniversary: a brief history of time. Eur Respir J. 2017; 501700671 Crossref PubMed Scopus (29) Google Scholar

MO026CLINICAL AND MUTATIONAL SPECTRUM OF CHILDREN WITH AUTOSOMAL RECESSIVE AND AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE

Abstract Background and Aims Cystic kidney diseases are a heterogeneous group of chronic renal disease. Autosomal recessive polycystic kidney disease (ARPKD) is generally diagnosed in utero or at birth due to mutations in PKHD1 gene. Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease commonly associated with mutations in PKD1 or PKD2. In this study, we aimed to investigate clinical and genetic features of ARPKD and ADPKD in a group of Turkish patients. Method A total of 69 children with genetically confirmed ARPKD (10 females, 11 males) or ADPKD (28 females, 20 males) from seven pediatric nephrology centers were included in this study. Demographic features, family history, clinical and laboratory findings at presentation and during 12 months intervals were collected. Results For ARPKD patients, the median age at diagnosis was 10.5 (IQR; 0.75-58.5) months. Consanguinity between parents was present in 11 patients (52.4%). At the time of diagnosis, 14 (66.7%) patients had eGFR&amp;lt;90 ml/min/1.73 m2. Mean duration of follow-up was 4.1±3,7 years. At the last visit, median eGFR was 74 (IQR; 43-126) ml/min/1.73m2. A total of 6 patients (28,6%) underwent a renal replacement therapy (RRT), 3 of them died in infancy and 2 of them had renal transplantation during follow up. All patients had bi-allelic PKHD1 mutation. For ADPKD patients, the mean age at diagnosis was 5.5±4.6 years. At the time of diagnosis 11 (22.9%) patients had eGFR&amp;lt;90 ml/min/1.73m2. Mean duration of follow-up was 2,7±2.3 years. At the last visit, median eGFR was 114 (IQR; 98-135) ml/min/1.73m2. Only one patient underwent a renal transplantation. A total of 42 patients (87.5%) had a heterozygous PKD1 mutation while 6 (12.5%) had a heterozygous PKD2 mutation. The rate of growth retardation, hypertension at diagnosis and progression to chronic kidney disease (CKD) were higher in patients with PKHD1 mutation than the patients with PKD1 or PKD2 mutation (p &amp;lt; 0.001, p &amp;lt; 0.001 and p = 0.001, respectively). In kidney survival analysis, mutation type, growth retardation at presentation, increased renal echogenity in ultrasonography were found as independent risk factors for progression to CKD. Conclusion Cystic kidney diseases are one of the most clinically and genetically heterogenous diseases. Differentiating them and establishing the predictors for CKD development is important to provide appropriate management including choosing appropriate donor in renal transplantation.

How to Address Physical Activity Participation After Stroke in Research and Clinical Practice.

How to Address Physical Activity Participation After Stroke in Research and Clinical Practice.

Pain as a significant symptom in patients with periodic paralysis—A cross‐sectional survey

Periodic paralysis (PP) is thought to be limited to episodes of muscle weakness, but there are reports of fibromyalgia-like pain in PP. We aimed to evaluate pain and comorbid sleep, fatigue, and mood disorders in PP patients. We administered a cross-sectional survey to PP patients at the 2019 Periodic Paralysis Conference. The survey consisted of the Brief Pain Inventory, Widespread Pain Index, Pittsburgh Sleep Quality Index, Modified Fatigue Impact Scale, and ten-question Center for Epidemiologic Studies Depression Scale (CESD-10). Descriptive statistics for PP patients were calculated and compared with earlier studies. Forty-four individuals with PP took the survey. Of these patients, 52.3% reported a moderate to severe interference of pain on their lives, and 45.5% met the study criteria for fibromyalgia. Patients with SCN4A mutations had higher rates of fibromyalgia than the next most prevalent gene mutation, CACNA1S. In patients with pain, there were increased rates of comorbid fatigue, depression, and poor sleep quality. Pain, akin to fibromyalgia, is a significant symptom of PP and can affect quality of life. Pain in PP was more prevalent than in the general population, at a rate comparable with other chronic neuromuscular disease groups. PP patients could benefit from a multidisciplinary approach to assess their pain, sleep, fatigue, and mood.

Risk factors and severity of acute liver injury in non-chronic liver disease and chronic liver disease patients

Objectives To study factors related to acute liver injury and compare the severity and risk of those factors in patients with and without chronic liver disease. Methods This cross-sectional study of 323 patients admitted to Somdejphrajaotaksin Maharaj Hospital between 1 January and 30 September 2019, analyzing data collected on the clinical background, signs and symptoms, and laboratory results of those patients. Results Of the 323 patients in the study, 188 did not have chronic liver disease (58.2%) and 135 had chronic liver disease (41.8%). Risk factors for acute liver injury in the chronic liver disease group included bacterial infection (33.3%) and spontaneous bacterial peritonitis (4.4%), much significantly higher than the rates in the no chronic disease group. However, the risk factors excessive consumption of alcohol (30.3%) and dengue infection (11.2%) in the no chronic liver disease group were significantly higher than in the chronic disease group. Both groups had a high incidence of disease severity as well as a high incidence of complications and mortality, although the mortality rate was higher in the chronic liver disease group (15.0% vs. 6.9%). Conclusions The types and frequencies of risk factors for acute liver injury in patients with chronic liver disease and those with no chronic liver disease groups are different. The incidence of bacterial infection and spontaneous bacterial peritonitis is higher in patients with chronic liver disease. The incidence of excessive alcohol consumption and dengue infection is much higher in patients without chronic liver disease. Both groups have high levels of disease severity, complications and mortality. Sepsis is the major cause of mortality, especially in patients with chronic liver disease.

Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups

ObjectiveFor eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life.DesignRetrospective cohort study using administrative...

A cross-sectional study on metabolic syndrome and its abnormal components in cancer patients

From December 2017 to December 2018, 3 509 subjects who had regular physical examination in Health Management Center, Tianjin Medical University General Hospital were enrolled in our study, including 399 cancer patients, 1 555 chronic disease patients, and 1 555 healthy control, respectively. The mean age was (55.87±11.98) years, and 31.38% were men. The prevalence of MS among chronic disease group (42.44%) was higher than that of cancer group (34.59%) and healthy control group (18.65%) (P<0.001). Compared with healthy control group, the OR (95%CI) values of MS risk in cancer group and chronic disease group were 2.13 (1.61-2.83) and 2.85 (2.23-3.66), respectively; the OR (95%CI) values of MS risk were 3.56 (2.04-6.21) and 2.77 (1.46-5.25) in breast cancer and thyroid cancer, respectively.

Effect of Serotonin Concentration and Some Variables in the Sera 6 hours before and after Dialysis on Chronic Kidney Patients with Different Ages in Iraqi Population

This study is concerned with chronic kidney disease and control group . The determine patients from (alsederhospital ) in Najaf city during the period between January 2019 to July 2019. The CKD patient and controlgroup consisted of sixty with age mean of (80 ±20) years. The blood samples were drawn from all patients 6hours before and after dialysis to measurement serotonin , blood Urea, Creatinine , uric acid and hemoglobinand control group. Also the patients classified into two groups according to age . This variables measured byusing assay (ELISA) technique and colorimetric methods. The higher mean value of serotonin was shownin CKD patients before dialysis ( 0.0257± 0.00224 ng /ml) compared with patients after dialysis ( 0.1894 ±0.05189 ng/ml) compared with control group( 0.0059 ± 0.00139 ng/ml). Also the higher value of blood Ureaand Creatinine reversibly in CKD patients before dialysis was (126.25± 4.869 mg/dL), (10.041± 0.3019mg/dL) compared in blood Urea and Creatinine in CKD patients after dialysis was (48.183± 2.262 mg/dL),(3.28± 0.201 mg/dL) and control group was (28.105 ± 1.896 mg/dL), (1. 095 ± 0.0961 mg/dL).Also the higher value of uric acid and hemoglobin reversibly in CKD patients before dialysis was (8.0623±0.1478 mg/dL), (13.800 ± 0.16519 g/dL) compared in uric acid and hemoglobin in CKD patients afterdialysis was (5.5361± 0.16055 mg/dL), (12.383 ± 0.15872 g/dL) and control group was (2.6789 ± 0.2977 mg/dL), (13.742 ± 0.18954 g/dL) , all above results there was a significant difference and correlation (p?0.05).Aim of study: Study the effect of serotonin, blood Urea, Creatinine , uric acid and hemoglobin 6 hoursbefore and after dialysis on CKD patients and compared with control group .Study the effect of variableson CKD patients with different age and study the relation between CKD patients after and before dialysis.

Oral Health Status of Children Undergoing Hemodialysis and Kidney Transplantation in Mansoura City, Egypt

Purpose: Evaluation of oral health status in children undergoing hemodialysis sessions and kidney transplantation and compared them with healthy children. Materials and Methods: This descriptive study was conducted on 250 children aged 6-18 years old (100 children undergoing hemodialysis, 50 children undergoing kidney transplantation and 100 healthy children as a control group). The oral health status was evaluated regarding to caries experience, gingivitis using PMA index, developmental defects using modified DDE index. Un-stimulated salivary flow rate and pH were also measured. Results: caries experience was significantly lower in both chronic kidney disease (CKD) groups compared to control group. Median PMA was significantly higher in hemodialysis and in transplantation groups compared to control group. The prevalence of developmental enamel defects was 41% in hemodialysis group and 58% in transplantation group compared to 11% in control group (P-value < 0.001). Regarding to saliva analysis, the flow rate was higher among healthy children while the salivary PH was higher among children with CKD. Conclusions: chronic kidney disease may decrease caries experience, increase gingival inflammation, in addition to increase prevalence of developmental defects. Furthermore, children with chronickidney disease have lower salivary flow rate and higher buffering capacity than healthy children.

Gallbladder condition in patients with rheumatic fever and acquired valve defects of rheumatic origin

Gallbladder (GB) and heart are linked by viscero-visceral reflexes, but little is known about the connections between GB and heart in patients with acute and chronic rheumatic heart disease.&#x0D; Purpose of the study. To assess the GB condition in patients with acute and chronic rheumatic disease and the difference in structural and functional sonographic parameters of heart in dependence of GB condition.&#x0D; Materials and methods. We examined 136 patients including 58 patients with active rheumatism (mean age 36,72 ± 3,00 years), 44 patients with chronic rheumatic heart disease (CRHD), who underwent surgical correction of the valvular defect (mean age 54,00 ± 3,69 years), and 34 patients with CHD, who were treated as inpatients withour surgery (mean age 61,48 ± 4,50 years).&#x0D; Results. Among 136 patients with acute and chronic forms of rheumatic heart disease, GB changes were significantly more common than intact GB (62,5 ± 4,1% vs. 37,5 ± 4,1%, p &lt; 0,05). The incidence of GB disorders was the highest in patients with CRHD, who underwent drug treatment (76,5 ± 7,3% vs. 58,7 ± 6,5% and 50,0 ± 7,5%, both p &lt; 0,05), which were characterized by older age. No significant differences in the incidence of various pathological conditions of GB were revealed between acute and chronic rheumatic heart disease groups. The most common pathological GB changes included signs of cholecystitis, biliary sludge and cholesterosis, cholelithiasis, the least common – GB removal due to cholelithiasis. Patients with biliary autonomic viscero-visceral cardioneuropathy differed from those with intact GB by the thickening of the interventricular septum and posterior wall of the left ventricle, which correlated with the increased duration of inpatient treatment, diastolic hypertension and lower alanine aminotransferase.&#x0D; Conclusions. In patients with acute and chronic forms of rheumatic heart disease, the GB condition is often changed. These changes affect heart condition, blood pressure and carbohydrate metabolism.