Elevated Creatinine Levels Research Articles

The Clinical Significance and Prognostic Role of Whole-Blood Epstein-Barr Virus DNA in Lymphoma-Associated Hemophagocytic Lymphohistiocytosis.

To evaluate the role of circulating Epstein-Barr virus (EBV) DNA in lymphoma-associated hemophagocytic lymphohistiocytosis (HLH). We conducted a retrospective cohort study to explore the clinical and prognostic significance of EBV DNA in lymphoma-associated HLH. We included adult patients with combined diagnoses of lymphoma and HLH from January 2010 and November 2022 by retrieving the medical record system. A total of 281 patients with lymphoma-associated HLH were identified. Elevated whole-blood EBV DNA was observed in 54.4% (153/281) of patients, and the median copy number was significantly higher in the T/NK-cell malignancies (199,500, interquartile range, 30,000-1,390,000) than that in the B-cell non-Hodgkin lymphoma (5520, interquartile range, 1240-28,400, P < 0.001). The optimum cutoff for predicting survival was 16,100 copies/mL. Compared to the patients with EBV DNA ≤ 16,100 copies/mL, those with EBV DNA > 16,100 copies/mL were younger and had more T/NK-cell malignancies, lower levels of neutrophils and fibrinogen, and higher levels of hemoglobin, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, and β2-microglobulin. A higher load of EBV DNA (> 16,100 copies/mL), thrombocytopenia (< 100 × 109/L), neutropenia (< 1 × 109/L), hypofibrinogenemia (≤ 1.5g/L), and elevated levels of creatinine (> 133μmol/L) were independent adverse predictors of 60-day overall survival and overall survival. A prognostic index based on EBV DNA and the other four factors was established to categorize the patients into four groups with significantly different outcomes. Our study identified high EBV load as a risk factor for lymphoma-associated HLH and established a prognostic index to predict outcomes.

Megakaryoblasts in pleural fluid in neonate with transient leukaemia of Down's syndrome.

Twin baby boy born at 35+2 weeks gestation with a birth weight of 2070 grams via emergency cesarean section secondary to abnormal CTG and foetal distress. Full blood count obtained at birth showed haemoglobin 159 g/L, total white cell count 99.54 × 109/L platelet count 779 × 109/L. Manual differential showed an absolute neutrophil count of 2.01 × 109/L absolute lymphocyte count of 45.27 × 109/L and blast count of 50.3 × 109/L (50%). Initial peripheral blood smear morphology review revealed a thrombocytosis, platelet anisocytosis and micromegakaryocytes. It also demonstrated neutropenia, myeloid left shift, large blasts with a high N/C ratio and nucleoli. Additionally, numerous nucleated red blood cells were seen with marked red cell dysplasia including binucleate forms and abnormal haemoglobinisation. There was no prenatal diagnosis of Down's syndrome (DS). The above blood results along with the baby's clinical signs raised suspicion of DS and subsequently transient leukaemia of DS. This baby was then transferred to the regional neonatal intensive care unit on day 2 of life. On admission, he was noted to have bilateral pleural effusion, synthetic liver dysfunction with elevated creatinine and ammonia levels as well as ascites. He was intubated, and ventilated and required inotropic support. Due to adverse features of elevated white cell count, hepatosplenomegaly, pleural effusion as well as ascites [1] and following the multidisciplinary team (MDT) discussion and parental consent, the patient was commenced on low dose cytarabine for 7 days. He tolerated that well, however, did experience mild cytopenias and pyrexic episodes, followed by recovery during the following two weeks with a reduction in pleural effusions, hepatosplenomegaly and reduction in oxygen requirement which enabled successful extubation and commencement of continuous positive airway pressure. Unfortunately, on day 19 of life he was noted to have slowly increasing oxygen requirements with re-accumulation of pleural effusions and increasing hepatosplenomegaly as well as increasing blast count in peripheral blood. He proceeded to require intubation and ventilation again as well as placement of a chest drain to remove pleural fluid to improve respiratory compliance. A review of pleural fluid morphology had shown frequent ‘blast-like’ cells; these were medium-sized with a high N/C ratio with finely condensed chromatin nucleoli and budded basophilic cytoplasm thought to most likely represent megakaryoblasts [2]. As a result of the deterioration, a decision by MDT was made to give another cycle of low-dose cytarabine on days 1 through 5. Following the second cycle of cytarabine, the patient again experienced mild cytopenias and pyrexic episodes, was treated with antibiotics and supportive management and transfusions of packed red cells. He had complete count recovery and no blast population identified morphologically on peripheral blood film on day 26 of the second cycle of cytarabine. His GATA1 mutation was subsequently found to be positive. He continued to improve and was discharged home on day 67 of life Figures 1-3. Karolina Chmielowiec—wrote the manuscript, Gary Beattie—manuscript review, obtained image, obtained and analysed flow cytometry data, Kathryn Clarke—manuscript review, obtained and analysed flow cytometry, Ellen McCloy—manuscript review, morphology review, Bethany Mitchell—manuscript review, morphology review, Christine Macartney—manuscript review, supervising consultant. All authors discussed the results and commented on the manuscript. None. The authors declare no conflict of interest. No funding was required for this submission. Not applicable. Not Applicable. Not Applicable All authors have contributed to the acquisition, analysis and interpretation of data as well as either drafting the paper or revising it critically. All authors approved the submitted and final versions. For original data, please contact [email protected]

Assessing the Diagnostic Performance of CT in Suspected Urinary Stones: A Retrospective Analysis

Background Urinary stone disease is a common reason for emergency department (ED) visits, and a computed tomography scan of the kidneys, ureters, and bladder (CT-KUB) is frequently used for diagnosis. The objective of this study was to estimate the positive rate of CT-KUB and identify predictors of emergency interventions for patients with ureteric stones. Methods A retrospective study was conducted to investigate the positive rate of CT-KUB for urinary stone disease and to explore the factors that determine the need for emergency urologic interventions. The study population included adult patients who underwent CT-KUB to rule out urinary stones at King Fahd University Hospital. Results The study included 364 patients, of whom 245 (67.3%) were men and 119 (32.7%) were women. CT-KUB revealed stones in 243 (66.8%) patients, including 32.4% with renal stones and 54.4% with ureteric stones. Female patients were more likely to have normal results than male patients. Approximately 26.8% of patients with ureteric stones required emergency urologic intervention. Multivariable analysis found that the size and location of ureteric stones were independent predictors for emergency intervention. Patients with distal ureteric stones were 35% less likely to need emergency interventions than those with proximal stones. Conclusion The positive rate of CT-KUB was acceptable for patients with suspected urinary stone disease. Most demographic and clinical characteristics were not predictors for emergency interventions, but the size and location of ureteric stones and elevated creatinine levels were significantly associated.

Survival of community-acquired Bacillus cereus sepsis with venous sinus thrombosis in an immunocompetent adult man – a case report and literature review

BackgroundBacillus cereus infections in immunocompetent patients are uncommon and mainly observed in fragile patients. It can cause lethal infections with multiple organ dysfunction syndrome (MODS). However, a patient presenting as venous sinus thrombosis and survival without sequela has not been reported.Case presentationA 20-year-old previously healthy male developed gastroenteritis after a meal, followed by fever, convulsions, and severe disturbance of consciousness. The patient had significant leukocytosis with a mildly elevated D-dimer, creatinine level, and respiratory failure. The CT(computed tomography) revealed fatal brain edema and subarachnoid hemorrhage. Previous blood culture in a local hospital revealed B. cereus, which was confirmed by mNGS(metagenomic next-generation sequencing) using blood and urine in our hospital. Accordingly, B. cereus sepsis with MODS were considered. Later, cerebral venous sinus thrombosis was proved. After anti-infection (linezolid 0.6 g, Q12h; and meropenem 1.0 g, Q8h), anti-coagulant (enoxaparin 6000U, Q12h), and other symptomatic treatments, the patient recovered completely without sequela at the 6-month follow-up.ConclusionsThis case suggests that in immunocompetent adults, there is still a risk of infection with B. cereus, causing severe MODS. Special attention should be paid to venous sinus thrombosis and subarachnoid hemorrhage in such cases, while, anti-coagulant is essential therapy.

Gallic acid and/or cerium oxide nanoparticles synthesized by gamma-irradiation protect cisplatin-induced nephrotoxicity via modulating oxidative stress, inflammation and apoptosis

Cisplatin is one of the most significant anticancer. However, its use is associated with numerous toxicities especially nephrotoxicity. The main aim of this work was to examine the protective effect of Gallic acid (GA) and/or cerium oxide nanoparticles (CONPs) synthesized by gamma-irradiation on cisplatin-induced nephrotoxicity in rats. To do that, 48 adult male albino rats were separated into eight groups and received GA (100 mg/kg orally) and/or CONPs (15 mg/kg i. p.) for 10 days before injection with a single dose of cisplatin (7.5 mg/kg i. p.). The findings showed that cisplatin treatment impaired kidney functioning as shown by elevated serum levels of urea and creatinine. Additionally, the oxidative stress indicators (MDA and NO), levels of NF-kB, pro-inflammatory cytokines (IL1-and TNF-) and pro-apoptotic proteins (BAX and caspase-3) were raised after cisplatin injection, while levels of intrinsic anti-oxidants (CAT, SOD, and GSH) and anti-apoptotic protein (Bcl-2) were reduced. Moreover, renal toxicity was confirmed by alteration in normal histological architecture of the kidneys. On the other hand, pretreatment with CONPs and/or GA ameliorated cisplatin-induced nephrotoxicity as evidenced by improvement of renal function parameters and levels of oxidative stress, inflammatory and apoptotic markers in renal tissue along with the renal histopathological changes. This study clarifies how GA and CONPs protect against cisplatin-induced nephrotoxicity and demonstrates any potential synergism between them. Therefore, they can be considered as promising nephroprotective agents during chemotherapy.

Dietary patterns among chronic kidney disease patients and their impact on their clinical course: A longitudinal study from rural Kanyakumari

ABSTRACT Background: Nonpharmacological management of chronic kidney disease (CKD) by dietary modifications is an integral part in preventing the disease progression into renal failure. Fish has been recommended as a substitute protein instead of meat in renal diets. However, sardines and dried fish which are a staple diet in coastal areas may cause more harm than benefit. Hence, this study was designed to analyze dietary patterns of sardines, dried fish, meat and salt consumption and its impact among CKD patients. Materials and Methods: This longitudinal study was carried out among 100 CKD patients in Nephrology department, excluding seriously ill patients or those on hemodialysis. Dietary patterns were assessed using food frequency questionnaire. Renal parameters and clinical staging were estimated at the beginning of the study and after 2 months. Results: The mean age of the CKD patients was 55.29 years. The mean quantities of sardines, dried fish, meat, and salt consumed per week were 375 g, 70.1 g, 115.7 g, and 39.54 g, respectively. There was a statistically significant increase in the mean values of all renal parameters. Patients who had elevated creatinine and potassium levels had a statistically significant higher mean consumption of sardines and salt, respectively. Conclusion: The consumption of sardines, meat and salt was very high among the CKD patients. Worsening of disease was seen in almost half the study population. Culturally appropriate dietary guidelines are required for diet modifications in CKD patients.

Предикторы успеха выполнения уретеролитотрипсии.

Urolithiasis is one of the most common diseases seen by urologists. In 28% of patients with kidney stones, the disease is symptomatic. The benefits of ureteral stone extraction include minimal invasiveness, a shorter postoperative recovery time, and a favourable safety profile. Aim: to compare and evaluate the relationship between the density of the ureter, the density of the calculus, its localization and the value of the creatinine level and predicting the success of ureterolithoextraction. Materials and methods. In total, 125 ureteral lithotripsy procedures were performed (42 in women and 83 in men). Initially, the patients were divided into two groups. In the first group, ureteral stone extraction was performed in 97 patients. The second group included 28 patients with ureteral stent placement, without ureteral lithotripsy. In percentage terms, the increase in mean calculus size in the groups (10%) was less significant than the increase in ureter density under the calculus (65%). Results. There was no relationship between the ureter density under the calculus and the residence time of the calculus in the ureter. However, there is a relationship between the residence time of the calculus and the anatomical narrowing of the ureter, which may affect the success of the procedure. Elevated creatinine levels in the group with initial ureteral stent placement may indicate impaired urine passage from the kidney. Conclusions. Routine measurement of the ureter density under the calculus during MSCT may be an additional parameter in determining the surgical treatment method.

Elevated Levels of Plasma Collagen Triple Helix Repeat Containing 1 (CTHRC1) Are Strongly Associated with eGFR and Albuminuria in Chronic Kidney Disease.

Background: Chronic kidney disease (CKD) has various etiologies, making it impossible to fully understand its complex pathophysiology. Elevated levels of plasma creatinine, proteinuria, and albuminuria and declined eGFR are traits observed in CKD patients. The current study attempts to highlight the collagen triple helix repeat containing 1 (CTHRC1) protein as a putative blood biomarker for CKD in addition to existing recognized indicators of CKD progression. Methods: A total of 26 CKD patients and 18 healthy controls were enrolled in this study. Clinical characteristics and complete blood and biochemical analyses were collected, and human ELISA kits were used to detect possible CKD biomarkers. Results: The study's findings showed that CTHRC1 correlates with key clinical markers of kidney function such as 24 h urine total protein, creatinine, urea, and uric acid. In addition, CTHRC1 demonstrated a strong significant difference (p ≤ 0.0001) between the CKD and control group. Conclusions: Our research demonstrates that the plasma level of CTHRC1 can distinguish between those with CKD and healthy patients. Plasma CTHRC1 levels may aid in the diagnosis of CKD given the current state of knowledge, and these results call for further investigation in a wider, more diverse patient group.

Spectrum of Biochemical Alterations in Patients with Covid-19

Background and objective: Millions of people worldwide have died from COVID-19, which has caused the failure of the lungs and other organs. The research assessed biochemical anomalies in COVID-19 patients to comprehend the illness and its effect better. Study Design: Retrospective longitudinal cohort analysis Place of study: ABWA Medical College Faisalabad Methods: A total of 150 adult patients (n=150) who tested positive for COVID-19 via RT-PCR were included in the study. A Roche Diagnostics Cobas C501 used spectrophotometry to measure calcium, magnesium, phosphate, lactate dehydrogenase (LDH), urea, creatinine, ferritin, and chloride in the blood. A NOVA electrolytic analyzer used Ion-selective electrodes to measure sodium, chloride, potassium, and bicarbonate. Results: In the study, 33.6% of patients had elevated urea levels, and 22.4% had elevated creatinine levels. Furthermore, 88.8% of patients had elevated ferritin levels, and 93.5% had elevated LDH levels. After 44 weeks, there was a drop in sodium-containing electrolytes, with 9% of patients experiencing a decrease in sodium, 22.4% in potassium, 53.3% in bicarbonate, 48.6% in calcium, and 23.4% in phosphorus. These changes in electrolyte levels suggest a long-term trend in electrolyte depletion among the patient population. There was no significant difference in biochemical anomalies between age groups (p &gt; 0.05). Conclusion: These results suggest that COVID-19 patients have lung illness and multi-organ involvement, which should be considered when managing these patients. These biochemical alterations warrant careful monitoring for organ failure by healthcare practitioners. More study is required to comprehend the processes causing these biochemical anomalies in COVID-19 patients. Keywords: Covid-19, Biochemical alterations, Outcomes

Demographics and Characteristics of Acutely Decompensated Heart Failure (ADHF) Patients in a Tertiary Care Center in Saudi Arabia.

Acute decompensated heart failure (ADHF) has been defined as the gradual or rapid change in heart failure (HF) signs and symptoms resulting in a need for urgent therapy. Patients with ADHF usually have multiple comorbidities that contribute to the severity of exacerbation at admission, including diabetes mellitus and chronic kidney disease. The prognosis for these individuals is generally poor, with a high risk of readmission and death after discharge. Unfortunately, there are limited studies in Saudi Arabia reporting the characteristics of such patients. We aim to study the demographics and characteristics of ADHF patients admitted to King Abdulaziz University Hospital (KAUH) and analyze gender discrepancies and in-hospital mortality. This retrospective record review was conducted at KAUH. The study included 425 patients diagnosed with ADHF. The New York Heart Association (NYHA) classification, underlying etiology of HF, comorbidities, left ventricular ejection fraction (LVEF), vital signs, comprehensive metabolic panel at admission, and in-hospital mortalitywere evaluated and analyzed. The majority of the patients were males (52.5%), and the average age was 63 ± 13.75years. The most prevalent etiology of HF was hypertensive heart disease (51.8%), followed by ischemic heart disease (42.8%). The most common comorbidity was diabetes mellitus (73.6%), and the most common medication administered was diuretics (95.5%). The mean LVEF was 37.9% ± 16.0. In-hospital mortality occurred in 10.4%of patients. The mean length of hospitalization was 16.7 ± 86.2days. The mean blood urea nitrogen (BUN) (17.18 ± 11.16) and creatinine (243.34 ± 222.27) were higher in patients with in-hospital mortality. The mean difference was statistically significant (P = 0.003and P = 0.014). A higher length of hospitalization was significantly associated with in-hospital mortality (P = 0.036). We found more than half of our sample to be malesand diabetes mellitus to be common among ADHF patients. Elevated BUN and creatinine levels at the time of presentation, as well as patients who had been in the hospital for a more extended period of time, were found to be associated with an increased risk of in-hospital mortality.

Identification and functional characterization of a novel truncating splicing variant in COL4A5 gene causes X-linked Alport syndrome with astigmatism.

Identification and functional characterization of a novel truncating splicing variant in COL4A5 gene causes X-linked Alport syndrome with astigmatism.

Analysis of the impact of eliminating bolus 5-fluorouracil in metastatic colorectal cancer.

59 Background: 5-Fluorouracil (5-FU) is a component of first-line treatment regimens for metastatic colorectal cancer (mCRC). Historically, 5-FU is administered as a bolus followed by an infusion. However, the bolus dose adds substantial toxicity and is often withheld in patients with limited functional status or high-risk comorbidities, but its impact on treatment outcomes remains unclear. Small studies suggest that it may be omitted. The aim of this study was to determine whether omission of the 5-FU bolus is associated with a difference in overall survival (OS). Methods: An electronic health record-derived national multicenter oncology database from Flatiron Health was queried to select patients with mCRC who received a first-line 5-FU-containing regimen. Demographics, relevant labs, treatment details, and survival outcomes were collected. Propensity score (PrS) matching and OS analysis were performed incorporating age, race, sex, ECOG score, combination drug regimen, and baseline creatinine and bilirubin. Variables with p &lt; 0.10 in univariable Cox proportional hazards models were included in the multivariable analysis. Results: We included 9741 patients with mCRC who received 5-FU-based regimens. All individuals received a 5-FU infusion, and 7901 (81%) also received a 5-FU bolus. Among our entire cohort, 43% were female, 23% were &gt; 70 years, 66% were white, and 89% had ECOG ≤ 1. Over a median follow-up time of 19 months, 5847 patients (60%) died. In the unmatched univariable (HR 0.94, 95% CI 0.88-1.00, p = 0.06) and multivariable (aHR 0.85, 95% CI 0.93-1.06, p = 0.85) analyses, there was no association between the use of bolus 5-FU and OS. A number of factors were associated with an increased risk of death, including older age, high ECOG scores, and elevated bilirubin or creatinine levels. Similarly, in our PrS-matched dataset (n = 6126), the use of a 5-FU bolus was not associated with OS (HR 0.98; 95% CI 0.91-1.06; p = 0.64). Conclusions: The findings of our PrS-matched multicenter cohort study indicate that, after adjusting for host and treatment factors, 5-FU bolus dosing was not associated with an overall survival benefit among patients with mCRC. These results suggest that, in mCRC, the addition of a 5-FU bolus does not appear to add efficacy to regimens utilizing infusional 5-FU. Future work is necessary to determine the role of bolus dosing in the adjuvant setting and its impact on other clinically-relevant outcomes.

Ameliorative potential of Acalypha wilkesiana leaf extract (subsp. macrophylla) on cyanide-induced renal damaged Wister rats

BackgroundRecently, phytomedicine have been applied in the management of various diseases related to toxicity. In addition, attention has been on cyanide toxicity due to its harmful effects on man and animals. Thus, this research was carried out to determine the effect of Acalypha wilkesiana methanol leaf extract on cyanide induced renal damage in rats. Methods45 female Wister rats randomly divided into 7 groups were used for this study. Group 1:received neither cyanide nor methanol fraction of Acalypha wilkesiana (MFAW), 2 and 3 received different doses of MFAW respectively, 4 received cyanide only, 5 Rats received cyanide and sodium thiosulphate. 6 and 7 received cyanide and different doses of MFAW respectively. Renal markers (urea, creatinine, sodium, bicarbonate, potassium and chloride electrolytes) and antioxidant status (superoxide dismutase, malonaldehyde, catalase, gluthathione peroxidase) were assessed in the kidneys using standard biochemical procedures. ResultsRenal markers showed significant elevated levels of creatinine, urea and serum electrolytes in the untreated rats. However, treatment with methanol leaf extract of Acalypha wilkesiana significantly (p<0.05) reduced the cyanide-induced increase of creatinine, urea, serum electrolytes levels of sodium ion, potassium ion, bicarbonate and chlorine ion irrespective of the dose. Additionally, antioxidant status indicated a significant increase in lipid peroxidation and glutathione peroxidase with a concomitant decrease in catalase, superoxide dismutase as well as reduced glutathione and glutathione S-transferase, in untreated rats. However, treatment using the leaf extract modulated the cyanide induced mop up of these antioxidants and the rising glutathione peroxidase and lipid peroxidation in the kidney of rats exposed to cyanide irrespective of the dose of the extract. ConclusionsThe present study indicated that methanolic leaf extract of Acalypha wilkesiana conferred protection to the kidney of rats against chronic cyanide toxicity by ameliorating renal indices and up regulating antioxidant response.

Maternal Exposure to Acephate Caused Nephrotoxicity in Adult Offspring Rats Mediated by Excessive Autophagy Activation, Oxidative Stress Induction, and Altered Epithelial Sodium Channel and Na+/K+-ATPase Gene Expression

This study examined how maternal exposure to acephate-an organophosphate-based insecticide-affected the renal development in rat offspring during adulthood. Virgin female Wistar rats were randomly allocated to three groups: group 1 (control) received sterile water; groups 2 and 3 were intragastrically exposed to low (14 mg/kg) and high (28 mg/kg) doses of acephate from day 6 of pregnancy until delivery, respectively. Further, the offspring of the adult female rats were euthanized in postnatal week 8. Compared with the controls, the adult rat offspring with exposure to low and high doses of acephate exhibited elevated plasma creatinine and blood urea nitrogen levels. Additionally, immunofluorescence analysis revealed the upregulation of autophagic marker genes (Beclin-1 and LC-3) in the acephate-treated rat offspring, thereby suggesting the induction of an autophagic mechanism. Notably, the increased malondialdehyde level, decreased glutathione level, and decreased superoxide dismutase and catalase activities confirmed the ability of acephate to induce oxidative stress and apoptosis in the kidneys of the rat offspring. This may explain the renal histopathological injury detected using hematoxylin and eosin staining. Furthermore, a reverse transcription polymerase chain reaction revealed that the mRNA expression levels of the Na+/K+-ATPase and the epithelial sodium channel (ENaC) genes were significantly higher in the kidney of female offspring than that of controls owing to acephate toxicity. However, there was no significant effect of acephate on the expression of NHE3 in the treatment group compared with the control group. Overall, the present findings suggest that oxidative stress caused by prenatal exposure to acephate causes nephrotoxicity and histopathological alterations in adult rat offspring, likely by actions on renal ENaC and Na+/K+-ATPase genes as well as the autophagic markers Beclin-1 and LC-3.

Risk factors of maternal and failed maternal mortality, prediction of severe obstetric conditions

Objective. To determine the priority risk factors for maternal mortality (MM) and failed maternal mortality (FMM) on the basis of clinical and epidemiological features and to develop scientifically based patient-centered models for predicting severe obstetric conditions.&#x0D; Materials and methods. Primary documentation of successful and dysfunctional maternal outcomes that occurred at the levels I, II, III of medical organizations in Perm and the territories of Perm Krai from 2007 to 2018. Using random sampling, two observation groups were formed: women with failed maternal mortality, deceased women and the control group. Analytical epidemiological "case-control" studies were carried out, which included the determination of confidence intervals, etiological accuracy using Epi Info and Excel 2016 MSO programs, a package of applied electronic tables Stat2015 of the author ( V.S. Sheludko, 20012016), the MedCalc 15.8 Portable program.&#x0D; Results. Socio-behavioral, general somatic, obstetric-gynecological risk factors, the frequency of occurrence of which among women with failed maternal mortality was 1,44,3; 1,225,5; 1,17,6 times more often, and in the group of deceased mothers 1,99,0; 1,729,5; 2,89,0 times higher than in the group of healthy participants. The "indicators of maternal death" have been identified, which increase the risk of a failed maternal death turning into maternal death. Early clinical and laboratory signs of severe obstetric conditions are the following: high leukocyte intoxication index (LII), elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea and creatinine, decreased levels of fibrinogen, prothrombin index (PTI), prolongation of thrombin time (TT). Infectious-inflammatory, hypertensive complications, comorbidity, a high percentage of premature births and, accordingly, severe perinatal conditions are significantly more common in groups with unfavorable outcomes.&#x0D; Conclusions. In the course of the study, reliably significant risk factors were identified, on the basis of which scientifically based models for assessing the probability of developing critical obstetric conditions were worked out.

Rutin and Hesperidin Alleviate Paclitaxel-Induced Nephrocardiotoxicity in Wistar Rats via Suppressing the Oxidative Stress and Enhancing the Antioxidant Defense Mechanisms.

Paclitaxel is a primary chemotherapy agent that displays antitumor activity against a variety of solid tumors. However, the clinical effectiveness of the drug is hampered by its nephrotoxic and cardiotoxic side effects. Thus, this investigation aimed at assessing the protective effects of rutin, hesperidin, and their combination to alleviate nephrotoxicity caused by paclitaxel (Taxol), cardiotoxicity in male Wistar rats, as well as oxidative stress. Rutin (10 mg/kg body weight), hesperidin (10 mg/kg body weight), and their mixture were given orally every other day for six weeks. Rats received intraperitoneal injections of paclitaxel twice weekly, on the second and fifth days of the week, at a dose of 2 mg/kg body weight. In paclitaxel-treated rats, the treatment of rutin and hesperidin decreased the elevated serum levels of creatinine, urea, and uric acid, indicating a recovery of kidney functions. The cardiac dysfunction in paclitaxel-treated rats that got rutin and hesperidin treatment also diminished, as shown by a substantial reduction in elevated CK-MB and LDH activity. Following paclitaxel administration, the severity of the kidney and the heart's histopathological findings and lesion scores were markedly decreased by rutin and hesperidin administration. Moreover, these treatments significantly reduced renal and cardiac lipid peroxidation while markedly increased GSH content and SOD and GPx activities. Thus, paclitaxel likely induces toxicity in the kidney and the heart by producing oxidative stress. The treatments likely countered renal and cardiac dysfunction and histopathological changes by suppressing oxidative stress and augmenting the antioxidant defenses. Rutin and hesperidin combination was most efficacious in rescuing renal and cardiac function as well as histological integrity in paclitaxel-administered rats.

Intraperitoneal hepato-renal toxicity of zinc oxide and nickel oxide nanoparticles in male rats: biochemical, hematological and histopathological studies.

In recent years, zinc oxide (ZnO) and nickel oxide (NiO) nanoparticles (NPs) have become more prevalent in commercial and industrial products. However, questions have been raised regarding their potential harm to human health. Limited studies have been conducted on their intraperitoneal toxicity in rats, and their co-exposure effects remain uncertain. Therefore, this study aimed to investigate some biological responses induced by a single intraperitoneal injection of ZnO-NPs (200 mg/kg) and/or NiO-NPs (50 mg/kg) in rats over time intervals. Blood and organ samples were collected from 36 male rats for hematological, biochemical, oxidative stress, and histological analysis. Results showed that the administration of NPs reduced the body and organ weights as well as red blood cell (RBC) indices and altered white blood cell (WBC) and platelet (PLT) counts. The experimental groups exhibited elevated levels of aspartate aminotransferase (AST), alanine transaminase (ALT), creatinine (CREA), urea, lipid profile, glucose (GLU), total protein (TP), albumin (ALB) and malondialdehyde (MDA), and decreased uric acid (UA), superoxide dismutase (SOD), and glutathione (GSH). Histological observations also revealed architectural damages in liver and kidneys. These alterations were time-dependent and varied in their degree of toxicity. Co-exposure of NPs initially lessened the damage but increased it afterwards compared to individual exposure. In conclusion, intraperitoneal injection of ZnO-NPs and/or NiO-NPs alters biological processes and induces oxidative stress in rats' liver and kidneys in a time-dependent manner, with NiO-NPs being more potent than ZnO-NPs. Furthermore, co-exposed NPs initially appeared to be antagonistic to one another while further aiming toward synergism.

Predictors of Length of Hospital Stay in Patients with COVID-19: A Retrospective Study

Introduction: Known independent predictors of extended Length Of Stay (LOS) in Coronavirus Disease 2019 (COVID-19) included older age, chronic kidney disease, elevated maximum temperature, and low minimum oxygen saturation. Additional known predictors of prolonged hospitalisation included male sex, chronic obstructive pulmonary disease, hypertension, and diabetes. Elevated levels of C-Reactive Protein (CRP), creatinine, and ferritin are proven determinants of hospitalisation and LOS. Determining predictors of LOS will aid in triaging and management of COVID-19 patients. Aim: To assess the clinical, biochemical and radiological profile of admitted COVID-19 patients and determine the predictors of prolonged length of stay at hospital. Materials and Methods: It was a retrospective, cross-sectional observational, record-based study included hospital records of 544 confirmed COVID-19 patients, above age of 18 years admitted at Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India, during February 2021 to June 2021. Possible determinants of LOS were studied including their demographic, epidemiological, clinical and radiological characteristics. The patients were divided into two groups as per median LOS i.e, group I with LOS &lt;10 days (n=277) and group II with LOS ≥10 days (n=267). Statistical analysis was done using Chi-square test, proportion test, Z test, MannWhitney U test, regression analysis by Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: Mean age in group I and II was 47.83±16.34 years and 53.21±15.63 years (p-value &lt;0.0001), respectively. The fatigue was significantly more in group II than group I (p-value=0.018). Diabetes mellitus was more (p-value=0.026) and severity of illness (p-value&lt;0.0001) was significantly higher in group II than group I. In univariate analysis, mean Neutrophil/Lymphocyte ratio (p-value&lt;0.0001), serum LDH (p-value&lt;0.018), blood urea level (p-value&lt;0.0001), random blood sugar (p-value=0.003), glycated haemoglobin (HbA1c) (p-value=0.072) and serum creatinine (p-value=0.41) were significantly more in group II. Median CRP (p-value&lt;0.0001), D-dimer (p-value&lt;0.0001), serum ferritin (p-value&lt;0.0001), procalcitonin (p-value&lt;0.0001), Serum Glutamic Oxaloacetic Transaminase (SGOT) (p-value=0.002) was significantly higher in group II. Lung involvement {chest radiograph or High-Resolution Computed Tomography (HRCT) chest} was significantly (p-value&lt;0.0001) more in group II. Conclusion: Fatigue, older age, diabetes mellitus, severity of illness, mean neutrophil/lymphocyte ratio, CRP, D-dimer, serum ferritin, serum Lactate Dehydrogenase (LDH), procalcitonin, blood urea, SGOT were associated with prolonged LOS among hospitalised COVID-19 patients.

Evaluation of electrocardiographic and serum biochemical changes in arrhythmias associated with renal diseases of dogs

The present study was conducted to investigate electrocardiographical (ECG) and haemato-biochemical changes in arrhythmia associated with renal diseases in dogs. The dogs with renal affections confirmed through appropriate diagnostic methods were selected and screened for arrhythmia. The ECG and haemato-biochemical parameters of twenty dogs with arrhythmia were compared with that of the control group and ECG parameters were statistically correlated with the haemato-biochemical parameters for correlation studies. It was found that the occurrence of arrhythmia was 51.2 per cent in renal diseases. Arrhythmia was more predominant in dogs with chronic kidney disease (CKD) followed by acute kidney injury (AKI). Sinus arrhythmia followed by first-degree AV block and wandering pacemaker were the common types of arrhythmias observed. A significant increase in R-R interval and a decrease in heart rate was noticed in comparison. The haemato-biochemical analysis revealed anaemia, leukocytosis with neutrophilia, elevated blood urea nitrogen (BUN), creatinine and magnesium level. A significant positive correlation was noticed between haemoglobin, volume of packed red cells (VPRC) and red blood cell count (RBC) with T amplitude and, creatinine and BUN levels with corrected Q-T interval. A significant negative correlation was noticed between VPRC, RBC and haemoglobin with the corrected QT interval. The present study revealed ECG and haemato-biochemical parameters had a significant role in renal diseases in dogs which might help in the early diagnosis and proper management of arrhythmia associated with renal diseases.

PS-C16-3: HYPERTENSION AND RISK FACTORS ASSOCIATED WITH IN-HOSPITAL DEATH IN PATIENTS WITH COVID-19

Objective: To explore the prevalence of hypertension and the common risk factors associated with increased death rate among (Covid-19) patients. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of patients from two COVID 19 isolation centers. Medical history, demographic data, self-reported comorbidities, symptoms, disease complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID 19 hospitalized patients between Feb 2020 and July 2021. The outcomes of interest were death or discharge from the hospital. Logistic regression analysis was used to assess the impact of age, gender, associated comorbidities and some laboratory abnormalities on increased death rate among in-hospital (Covid-19) patients. Results: The prevalence of hypertension, was 59.6%, followed by diabetes (47.3%). COVID-19 patients with hypertension were older (67.0 ± 10.7vs 65.0 ± 13.0 P = 0.001). 70.4% were males. Undiagnosed high blood pressure was detected among 14.5%. Overall mortality was 46.2%, while mortality among normotensives, known hypertensives and undiagnosed hypertension was 47.7%, 54.7% and 37.6%, respectively (p &lt; 0.005). Death was significantly higher among the age group &gt; 65 years compared to ≦ 65 years old (53.6% % vs 39.0% (P = 0.005) irrespective of their blood pressure. Severe respiratory and gastrointestinal symptoms were significantly higher among hypertensives. Type I Respiratory failure 22.1%, and acute kidney injury 11.8% were the most typical complications among hypertensives. Leucocytosis (24.2%), Lymphopenia (56.8%) and higher levels of D-Dimer (47.7%) and C-reactive protein (49.7%) were mainly observed among hypertensive patients. Logistic Regression analysis after adjusting for age significantly showed age OR: 1.81, 95% CI: (1.12: 2.73, p = 0.01), undiagnosed HTN OR: 5.65, 95% CI: (2.04:15.67, p = 0.00), low platelets count OR: 6.53, 95% CI, (1.23:35.23, p = 0.02), higher levels of urea OR:1.67, 95% CI, (1.04:2.63, p = 0.03) and creatinine OR:1.71, 95% CI, (1.063:2.70, p = 0.02), were associated with worse prognosis and in-hospital death among Covid- 19 patients. Conclusion: The age group, more than 65 years with undiagnosed BP of more than 140/90, is significantly associated with higher in-hospital death. Thrombocytopenia and elevated urea and creatinine levels were the most prominent laboratory markers and may be used as a potential indicator for prognosis and outcome among Covid 19 hypertensives.