Higher Urea Levels Research Articles

Analysis of Serum Uric Acid Level in Patients with and without Diabetic Nephropathy

Diabetic nephropathy is one of the microvascular complications in type 2 Diabetes Mellitus (DM). Diagnosis of diabeticnephropathy is based on any history of DM, a decrease in Glomerular Estimation Filtrate Rate (eGFR) using the CKD-Epiformula, and albuminuria. The role of serum uric acid level in diabetic nephropathy remains an ongoing debate. Serum uricacid levels may be the cause or the result of diabetic nephropathy. This study aimed to analyze serum uric acid levels inpatients with and without diabetic nephropathy and determine its correlation with diabetic nephropathy. This study wasperformed at Dr. Wahidin Sudirohusodo Hospital, Makassar, by taking the data from the medical record of type 2 DMpatients from January to April 2018. Fifty-nine patients with diabetic nephropathy and 150 patients without diabeticnephropathy participated in this study. An independent T-test and Pearson's correlation test were used for statisticalanalysis. There was a significant difference in uric acid level between patients with and without diabetic nephropathy(9.57±3.42 mg/dL vs. 6.41±2.86 mg/dL, p < 0.001). There was significant correlation between uric acid serum levels with urea(p < 0.001, r=0.585), creatinine (p<0.001, r=0.413) and eGFR (p < 0.001, r=-0.525) in patients with diabetic nephropathy. Uricacid levels in patients with diabetic nephropathy were higher than patients without diabetic nephropathy. Higher levels ofurea and the serum creatinine led to higher levels of serum uric acid. Contrastingly, a lower eGFR rate led to higher levels ofuric acid.

Case report of severe seoul infection in peripartum period

Background: We present the case of severe Seoul orthohantavirus infection in 36 y old woman with onset of disease coincided with peripartum period. Case Description: The patient was admitted to the hospital for a period of 37–38 w of pregnancy with complaints for lower abdominal pain, backache, anuria, icterus, and fever 38.6 °C. Diagnosis at admission was: Pregnancy 37–38 w, first stage of labor. Severe preeclampsia, HELLP syndrome, multi-organ failure. Low level of platelets (40 x 109/l), a significant increase of serum aminotransferases, high serum levels of creatinine and urea, pathological findings of coagulation tests, slight neutrophilic leukocytosis and anemia partially supported preliminary diagnosis. Ultrasonic examination revealed diffuse changes in the liver and kidneys parenchyma, splenomegaly, effusion into the abdominal and pleural cavities and fluid in the lower pelvis. After spontaneous vaginal delivery the patient's condition worsened, anemia and thrombocytopenia persisted and due to indications of atonic postpartum hemorrhage the hysterectomy was performed. Discussion: Based on clinical symptoms and epidemiological data the orthohantavirus infection was supposed and confirmed by detection of specific IgM antibodies (titer 1:400) by ELISA. RNA isolated from patient blood was typing by reverse transcriptase PCR (RT-PCR) and subsequent sequencing of L-segment fragment (2969–3314 bp) and hantavirus Seoul (genotype Vladivostok) was identified as ethiological agent of this case. After 2 m of the patient's intensive care (including but not limited repetitive plasma exchanges and hemodialysis) her condition gradually improved. By the time of release, the coagulation system parameters were normal with moderate anemia (red blood cells 2.96 x 1012 g/l, hemoglobin 90 g/l, hematocrit 26.7%) and lymphocytosis. However, signs of renal failure (serum creatinine level 366 mmol / l, serum urea level 15.34 mmol / l, proteinuria 0.3 g /l) persisted. The final diagnosis: Severe hantavirus infection, renal-liver-failure. Acute renal damage stage 3 according to AKIN, class I by RIFLE. Symptomatic arterial hypertension. Secondary anemia with mixed causes. Conclusion: This case is a fascinating example of how difficult to recognize renal impairments associated with hantaviruses during past trimester of pregnancy in patient with different significant risks. The case also reinforces the fact that genotype Vladivostok of Seoul virus can cause severe, life threatening disease with multisystem failure.

HUBUNGAN LAMA HEMODIALISIS DENGAN NAFSU MAKAN PADA PASIEN GAGAL GINJAL KRONIK DI UNIT HEMODIALISIS RUMAH SAKIT GRANDMED LUBUK PAKAM TAHUN 2019

Hemodialysis patients are susceptible to malnutrition caused by components in hemodialysis, such as Dialyzer (Kidney Artificial), blood line, AV fistula, bicarbonate fluid, acidic liquid. Patients who have long been undergoing hemodialysis have high urea and creatinine levels. Increased levels of urea and creatinine can stimulate acid production such as stomach ulcers (gastritis), namely nausea, vomiting, heartburn, bloating and no appetite. This research aims to knowing long standing relationship of hemodialysis with appetite in patients chronic renal failure in the unit hemodialysis of Grandmed Lubuk Pakam Hospital in 2019. This type of research is quantitative research, using analytical survey method with cross sectional approach. The population in this study were all patients with chronic renal failure who were in the hemodialysis unit of Grandmed Lubuk Pakam Hospital with a sample of 49 people, using a purposive sampling technique. Data collection was using a questionnaire. The analysis in this study used Chi Square test with a degree of confidence of 5% = 0,05. The results of the study stated that the majority of respondents were in the old category (2 years-3 years) as many as 31 people (63.3%) with decreased appetite by 21 people (42.9%), fixed appetite of 7 people (14.3 %), appetite increased by 3 people (6.1%). There is a long standing relationship of hemodialysis with appetite in patients chronic renal failure in the unit hemodialysis of Grandmed Lubuk Pakam Hospital in 2019 with p value < α = 0,05.

Left Ventricular Diastolic and Systolic Functions in Patients with Hypothyroidism.

Background and objectives: Long standing hypothyroidism may impair myocardial relaxation, but its effect on systolic myocardial function is still controversial. The aim of this study was to investigate left ventricular (LV) systolic and diastolic function in patients with hypothyroidism. Materials and Methods: This study included 81 (age 42 ± 13 years, 92% female) patients with hypothyroidism, and 22 age and gender matched controls. All subjects underwent a detailed clinical examination followed by a complete biochemical blood analysis including thyroid function assessment and anthropometric parameters measurements. LV function was assessed by 2-dimensional, M-mode and Tissue-Doppler Doppler echocardiographic examination performed in the same day. Results: Patients had lower waist/hip ratio (p< 0.001), higher urea level (p = 0.002), and lower white blood cells (p = 0.011), compared with controls. All other clinical, biochemical, and anthropometric data did not differ between the two groups. Patients had impaired LV diastolic function (lower E wave [p< 0.001], higher A wave [p = 0.028], lower E/A ratio [p< 0.001], longer E wave deceleration time [p = 0.01], and higher E/e’ ratio [p< 0.001]), compared with controls. Although LV global systolic function did not differ between groups, LV longitudinal systolic function was compromised in patients (lateral mitral annular plane systolic excursion—MAPSE [p = 0.005], as were lateral and septal s’ [p< 0.001 for both]). Conclusions: In patients with hypothyroidism, in addition to compromised LV diastolic function, LV longitudinal systolic function is also impaired compared to healthy subjects of the same age and gender. These findings suggest significant subendocardial function impairment, reflecting potentially micro-circulation disease that requires optimum management.

Renal changes in COVID-19 infection.

The COVID-19 (SARS-CoV-2) infection started in China, Wuhan City, Hubei Province, in December 2019, and it was declared a pandemic in mid-March 2020, caused by a new coronavirus strain called SARS-CoV-2. The pathogenesis of kidney injury attributed to SARS- CoV-2 is not well defined yet. Observations show that the kidney damage caused by the new virus mutation is mainly tubular, with impairment of glomerular filtration and high levels of urea and creatinine. A study with seriously ill patients with COVID-19 showed that acute kidney injury was present in 29%. In the face of this evidence, based on recent studies, we can see the great renal contribution as an impact factor in the evolution of COVID-19, not just as a complicator of severity, but maybe part of the initial cascade of the process, requiring a deeper analysis using conventional biomarkers of kidney injury and more aggressive clinical intervention in patients at risk, in an attempt to reduce mortality.

Prevalence of cerebral edema among diabetic ketoacidosis patients.

Cerebral edema (CE) is the most severe complication of diabetic ketoacidosis (DKA) in children. There is no accurate knowledge of CE pathogenesis and its onset has been related to intravenous rehydration therapy during the initial treatment. To estimate the prevalence of CE among DKA patients treated at Hospital General de Niños Pedro de Elizalde with intravenous rehydration and analyze potential risk factors for the development of CE. Cross-sectional prevalence study and exploratory analysis to compare clinical and laboratory characteristics between patients with and without CE. Patients aged 1-18 years hospitalized with the diagnosis of DKA between January 1st, 2005 and December 31st, 2014 were included. A total of 693 DKA events from 561 medical records were analyzed. Ten patients had evidence of CE (1.44 %; 95 % confidence interval: 0.8-2.6). Patients with CE had higher serum urea levels (p &#60; 0.001), lower carbon dioxide pressure (p &#60; 0.001), and lower serum sodium levels (p &#60; 0.001) than those without CE. The prevalence of CE among DKA patients was 1.44 %, smaller than that reported in our country (1.8 %). The risk factors at admission associated with CE development were high serum urea levels, hyponatremia, and hypocapnia.

Probiotics-addicted low-protein diet for microbiota modulation in patients with advanced chronic kidney disease (ProLowCKD): A protocol of placebo-controlled randomized trial

Microbiota is a term coined to describe the population of bacteria, viruses and fungi that inhabit in symbiosis within a living host. A connection between unbalanced microbiota and chronic kidney disease has been established. In these patients, high levels of urea reach the intestine promoting the overgrowth of bacterial species that are prone to generate uremic toxins. Due to the high morbidity and mortality of this condition, a large number of therapeutic approaches to reduce inflammation and microbial uremic toxins have been proposed, with controversial results. A low protein diet, with a protein intake of 0.6–0.8 g/kg of body weight, is a useful and historically pursued option with this regard. The aim of our study is to evaluate, among patients with advanced renal failure not on dialysis, the synergic beneficial effects of this diet and the selected probiotics Bifidobacterium longum (mix DLBL) and Lactobacillus reuteri LRE02 (DSM 23878).

Biochemical and histomorphological findings in Swiss Wistar rats treated with potential boron-containing therapeutic - K2[B3O3F4OH

BackgroundBoron and boron containing compounds are known for their biological and protective roles being non-toxic and non-mutagenic in low concentrations. Male rats were exposed to halogenated boroxine (HB), dipotassium-trioxohydroxytetrafluorotriborate K2[B3O3F4OH], a potential new boron-containing therapeutic, aiming to determine concentrations with no adverse effects on selected serum biochemical parameters and histomorphological features. MethodsHB was prepared by reacting potassium hydrofluoride (KHF2) with boric acid in molar ratios 2:3 at room temperature and its primary structure contains 4 fluorine atoms substituted in 6-membered ring. In concentrations of 10, 25, 35 and 45 mg/kg, HB was administered intraperitoneally as a single dose. Biochemical parameters were observed 24 and 96 h following the treatment. Effects of HB on biochemical blood parameters were also observed 24 h following continuous nine days application in concentrations of 10 mg/kg intraperitoneally and 50 mg/kg per os. Histomorphological observation of kidneys, liver, spleen, lungs and heart was performed for all treated animals. ResultsAdministration of single high dose of HB (35 mg/kg–45 mg/kg) effected high levels of urea and creatinine, which indicated renal injury that appeared to be temporary. Possible cause of concern is pancreatic injury indicated by elevated levels of serum amylase in the groups of animals that received the highest dosages of the substance. Histopathological examination of selected tissues revealed mild to moderate lesions in the kidneys and livers associated with administration of HB. ConclusionObservation of biochemical serum parameters or histopathology of examined tissues revealed no adverse effects of HB either after the administration of single dose lower than 35 mg/kg or following repeated administration at 10 mg/kg. These dosages should be further considered for potential therapeutic applications.

Clinical impact of type 2 diabetes mellitus on outcomes after one-lung ventilation during thoracic surgery: a retrospective cohort study.

The preoperative presence of diabetes mellitus (DM) has been recently demonstrated to be a risk factor for adverse events after thoracic surgery. However, the specific effects of presence of DM preoperatively on thoracic surgery is not known. This study aimed to investigate the association between preoperative DM and clinical outcomes and the short-term survival rates after thoracic surgery. In this retrospective, observational, and matched-pair analysis study, patients receiving thoracic surgery from a tertiary university hospital in 2 consecutive years were grouped as either type 2 DM (T2DM) or controlled within the first 24 hours after surgery. Multivariate Cox regression was conducted to investigate the impact of T2DM within the first 24 hours of admission on in-intensive care unit (ICU) and hospital survival. Among the included thoracic patients, 41 (8.4%) had T2DM and 450 (91.6%) did not have T2DM. In the single-factor analyses, T2DM patients were shown to have a higher preoperative white blood cells (WBCs) count, increased release of immunoglobulin A, complement C3 and C4, impaired kidney function with high level of urea, and low expression of alanine aminotransferase (ALT) and monoamine oxidase (MAO). In multivariate analyses, the preoperative urea level was associated with a low-grade risk of dying for the ICU survival time. In contrast, preoperative complement C3 level favored a positive contribution in-ICU survival. Besides the complement C3 level, immunoglobulin A level remained a positive contribution in regression models of hospital survival. Pre-admission T2DM was not associated with an increased in-ICU and hospital mortality among patients with thoracic surgery. Furthermore, they were accompanied by impaired kidney function, activated inflammation and liver function.

High HIV prevalence in an early cohort of hospital admissions with COVID-19 in Cape Town, South Africa.

South Africa (SA) has a high prevalence of HIV and tuberculosis. Cape Town was the SA metropole most affected in the early stages of the COVID-19 pandemic. Early observational data from Africa may provide valuable insight into what can be expected as the pandemic expands across the continent. To describe the prevalence, clinical features, comorbidities and outcome of an early cohort of HIV-positive and HIV-negative patients admitted with COVID-19. This was a descriptive observational study of an early cohort of adults with COVID-19 pneumonia admitted from 25 March to 11 May 2020. Of 116 patients (mean age 48 years, 61% female) admitted, 24 were HIV-positive (21%). The most common symptoms reported were cough (n=88; 73%), shortness of breath (n=78; 69%), fever (n=67; 59%), myalgia (n=29; 25%) and chest pain (n=22; 20%). The most common comorbidities were hypertension (n=46; 41%), diabetes mellitus (n=43; 38%), obesity (n=32; 28%) and HIV (n=24; 21%). Mortality was associated with older age (mean (standard deviation) 55 (12) years v. 46 (14) years; p&lt;0.01); the presence of hypertension or hypertension along with diabetes and/or obesity; lower partial pressure of arterial oxygen to fraction of inspired oxygen ratio; and higher urea level, white cell count, neutrophil count, and C-reactive protein, lactate dehydrogenase and ferritin levels, and high neutrophil to lymphocyte ratio. The overall survival rate for all hospital admissions was 86/116 (73%). In this early cohort, survival was similar in patients with HIV (n=18; 75%) compared with those without HIV (n=67; 75%) (p=1). Of the 74 patients admitted to the wards, 63 (85%) survived, whereas 22 of 42 (52%) admitted to the intensive care unit survived. Patients with HIV infection represented a large proportion of all COVID-19 admissions. The presentation and outcome of patients with HIV did not differ significantly from those of patients without HIV.

Quality of donkey mammary secretion during the first ten days of lactation

The physico-chemical characteristics and somatic cell count of donkey mammary secretion during the first ten days after foaling were analysed. During this period, a decreasing trend was observed for protein, dry matter and ash levels. The lowest values for lactose and pH were detected in the first hours (4.01 g 100 mL−1 of milk and 6.69 pH units), while the fat showed a peak (3.42 g 100 mL−1 of milk) at 6 h. The highest urea level was at 6 and 12 h (56.18 and 51.55 mg dL−1). Mineral levels changed during the experimental period, except for calcium, zinc and iron. Mean diameter of the fat globules and classes of fatty acids did not show significant differences; however, the n6/n3 ratio was influenced by day of lactation. In conclusion, the colostrum phase in donkeys lasts about 12–24 h, after which the secretion can be considered as transitional milk.

Suboptimal dialysis initiation is associated with comorbidities and uraemia progression rate but not with estimated glomerular filtration rate.

BackgroundDespite early referral of uraemic patients to nephrological care, suboptimal dialysis initiation (SDI) remains a common problem associated with increased morbimortality. We hypothesized that SDI is related to pre-dialysis care.MethodsIn the ‘Peridialysis’ study, time and reasons for dialysis initiation (DI), clinical and biochemical data and centre characteristics were registered during the pre- and peri-dialytic period for 1583 end-stage kidney disease patients starting dialysis over a 3-year period at 15 nephrology departments in the Nordic and Baltic countries to identify factors associated with SDI.ResultsSDI occurred in 42%. Risk factors for SDI were late referral, cachexia, comorbidity (particularly cardiovascular), hypoalbuminaemia and rapid uraemia progression. Patients with polycystic renal disease had a lower incidence of SDI. High urea and C-reactive protein levels, acidosis and other electrolyte disorders were markers of SDI, independently of estimated glomerular filtration rate (eGFR). SDI patients had higher eGFR than non-SDI patients during the pre-dialysis period, but lower eGFR at DI. eGFR as such did not predict SDI. Patients with comorbidities had higher eGFR at DI. Centre practice and policy did not associate with the incidence of SDI.ConclusionsSDI occurred in 42% of all DIs. SDI was associated with hypoalbuminaemia, comorbidity and rate of eGFR loss, but not with the degree of renal failure as assessed by eGFR.

Empagliflozin Prevents Renal Dysfunction and Inhibits Proximal Tubule NHE3 Activity in Nondiabetic Heart Failure Rats

Sodium‐glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control by suppressing glucose reuptake in the renal proximal tubule (PT). Primarily designed as antidiabetic agents, these drugs also reduce cardiovascular death and hospitalization for heart failure (HF), regardless of the presence or absence of type 2 diabetes. However, the mechanisms underlying the cardioprotective effects of SGLT2 inhibitors remain unknown. Given the importance of the cardiorenal axis in HF care, this study aimed to test the hypothesis that the SGLT2 inhibitor empagliflozin (EMPA) is capable of exerting renoprotective effects in the setting of nondiabetic HF. To this end, male Wistar rats were subjected to ligation of the anterior descending coronary artery or sham operation. Four weeks after surgery, rats were fed normal chow, with or without EMPA, for an additional 4 weeks. Compared with sham‐groups, HF rats treated with EMPA had similar serum BNP levels, whereas cardiac dysfunction deteriorated it further in HF rats (Sham: 0.5 ± 0.1; Sham+EMPA: 0.5 ± 0.1; HF: 2.1 ± 0.3; HF+EMPA: 0.9 ± 0.1 ng/mL). Additionally, HF rats exhibited an increase in lung (Sham: 3.2 ± 1.5; Sham+EMPA: 31.8 ± 1.1; HF: 44.7 ± 3.3; HF+EMPA: 32.7 ± 1.7 mg/mm) and right ventricle (Sham: 6.3 ± 0.2; Sham+EMPA: 5.2 ± 0.2; HF: 8.9 ± 1.0; HF+EMPA: 6.4 ± 0.3 mg/mm) mass. Renal function was impaired in HF rats as evidenced by low glomerular filtration rate (GFR) and high levels of plasma urea and urinary protein excretion. However, EMPA treatment restored these parameters to sham rats levels [(GFR, Sham: 6.5 ± 0.2; Sham+EMPA: 7.7 ± 0.6; HF: 4.5 ± 0.4; HF+EMPA: 7.7 ± 0.4 mL/min/kg) (Plasma urea, Sham: 37 ± 1; Sham+EMPA: 38 ± 2; HF: 48 ± 2; HF+EMPA: 39 ± 1 mg/dL) (Urine protein to creatinine ratio, Sham: 1.2 ± 0.1; Sham+EMPA: 1.0 ± 0.1; HF: 1.8 ± 0.1; HF+EMPA: 1.3 ± 0.1)]. Furthermore, EMPA prevented reduction of hematocrit in HF rats (Sham: 48.7 ± 0.3; Sham+EMPA: 49.5 ± 0.7; HF: 45.8 ± 0.5; HF+EMPA: 49.7 ± 0.4 %). In vivo stationary microperfusion showed that EMPA reduced Na+/H+ exchanger isoform 3 (NHE3) activity in HF rats, similar to sham‐groups (Sham: 2.05 ± 0.04; Sham+EMPA: 1.40 ± 0.05; HF: 4.36 ± 0.08; HF+EMPA: 1.54 ± 0.05 nmol/cm2). Collectively, these findings demonstrate that SGLT2 inhibition ameliorates renal dysfunction and improves the volemic status of nondiabetic HF rats.Support or Funding InformationSupported by FAPESP and CAPES.

Urea level is an independent predictor of mortality in patients with severe aortic valve stenosis.

IntroductionSevere aortic stenosis (AS) is the most common valvular heart disease in the western world. Various factors are related to severe AS prognosis, including chronic kidney disease. The aim of this study was to evaluate the prognostic value of urea level in patients with severe AS.MethodsWe prospectively enrolled 142 patients (79.1±9.4 years, 88 women) with severe AS (mean valve area 0.67± 0.17 cm2). Clinical assessment, blood tests and echocardiography were performed at enrollment and follow up. The patient population was divided into low and high urea level groups, according to the median urea level at enrollment (72 patients, mean urea 35.5±6.2 mg/dL and 70 patients, mean urea 61.1±17.8 mg/dL, respectively). Hundred and twelve patients (79%) underwent aortic valve intervention. The primary endpoint was all-cause and cardiovascular mortality.OutcomesDuring follow-up of 37±19.5 months, 56 (37.1%) patients died, 39 due to cardiovascular causes. In univariate analysis, age, urea level, creatinine, New York Heart Association (NYHA) class and aortic valve intervention were associated with all-cause mortality. However, in multivariate analysis only aortic valve intervention and blood urea were independent predictors of all-cause mortality (HR 0.494; 95% CI 0.226–0.918, P = 0.026 and HR 1.015; 95% CI 1.003–1.029, P = 0.046 respectively). Urea level, NYHA class and age were also significant predictors of cardiovascular mortality. Whereas, in multivariate analysis, only urea level predicted cardiovascular mortality in these patients (HR 1.017; CI 1.003–1.031 P = 0.019).ConclusionsBlood urea, a generally readily available and routinely determined marker of renal function, is an independent prognostic factor in patients with severe AS.

Kidney-Detrimental Factors and Estimated Glomerular Filtration Rate in Preterm Newborns: The Role of Nutrition.

Background: Kidney function in preterm newborns may be impaired by many factors. Methods: 71 newborns with gestational age (GA) < 32 weeks were enrolled. Serum creatinine (sCr), cystatin C (CysC), beta-trace protein (BTP) and urea were measured at T0 (3rd day of life) and T36 (GA 36 weeks), and estimated glomerular filtration rate (eGFR) was calculated according to different formulas at T36. Pre-natal and post-natal kidney injury risk scores were calculated. Results: Newborns with GA ≤ 28 weeks had higher sCr at T0, and lower sCr, BTP and higher urea levels at T36 (p = 0.007, p = 0.005 and p = 0.029, respectively). eGFR values were not different according to GA when calculated by the formulas using only CysC, but were higher in subjects with GA ≤ 28 weeks according to the other formulas. The post-natal score was positively correlated with eGFR according to sCr-based formulas, but the correlations did not persist when adjusted for urea levels and GA. Conclusions: CysC-based eGFR values are not influenced by GA. Post-natal score shows a direct correlation with eGFR according to sCr-based formulas, not persisting after adjustment for GA and urea levels, implying the importance of the nutritional status, since more premature subjects receive a more aggressive nutritional regimen, testified by higher urea levels.

Changes in the Solid-, Liquid-, and Epithelium-Associated Bacterial Communities in the Rumen of Hu Lambs in Response to Dietary Urea Supplementation.

The rumen bacteria in the solid, liquid, and epithelial fractions are distinct and play important roles in the degradation of urea nitrogen. However, the effects of urea on rumen bacteria from the three fractions remain unclear. In this study, 42 Hu lambs were fed a total mixed ration based on concentrate and roughage (55:45, dry matter basis) and randomly assigned to one of three experimental diets: a basal diet with no urea (UC, 0 g/kg), a basal diet supplemented with low urea levels (LU, 10 g/kg DM), and a basal diet supplemented with high urea levels (HU, 30 g/kg DM). After an 11-week feeding trial, six animals from each treatment were harvested. Rumen metabolites levels were measured, and bacteria of the rumen solid, liquid, and epithelial fractions were examined based on 16S rRNA gene sequencing. Under urea supplementation, the concentrations of ammonia and butyrate in the rumen increased, whereas the concentration of propionate decreased. The population of total protozoa was the highest in the LU treatment. Prevotella 1 was the most abundant genus in all samples. The unclassified Muribaculaceae, bacteria within the families Lachnospiraceae and Ruminococcaceae, and Christensenellaceae R7 were abundant in the solid and liquid fractions. Butyrivibrio 2 and Treponema 2 were the abundant bacteria in the epithelial fraction. Principal coordinate analysis showed separation of the solid, liquid and epithelial bacteria regardless of diet, suggesting that rumen fraction had stronger influences on the bacterial community than did urea supplementation. However, the influences on the bacterial community differed among the three fractions. In the solid and liquid fractions, Succinivibrionaceae UCG 001 and Prevotella 1 showed decreased abundance with dietary urea supplementation, whereas the abundance of Oscillospira spp. was increased. Howardella spp. and Desulfobulbus spp. were higher in the epithelial fraction of the UC and LU treatments relative to HU treatment. Comparisons of predictive function in the rumen solid, liquid, and epithelial fractions among the three treatments also revealed differences. Collectively, these results reveal the change of the rumen bacterial community to dietary urea supplementation.

Early HIV infection is associated with reduced proportions of gamma delta T subsets as well as high creatinine and urea levels.

Renal dysfunctions are major predictors of co-morbidities and mortality in HIV-infected individuals. Unconventional T cells have been shown to regulate kidney functions. However, there is dearth of information on the effect of HIV-associated nephropathies on γδ and DN T cells. It is also not clear whether γδ T cell perturbations observed during the early stages of HIV infection occur before immune activation. In this study, we investigated the relationship between creatinine and urea on the number of unconventional T cells in HIV-infected individuals at the early and chronic stages of infection. Persons in the chronic stage of infection were divided into treatment naïve and exposed groups. Treatment exposed individuals were further subdivided into groups with undetectable and detectable HIV-1RNA in their blood. Creatinine and urea levels were significantly higher among persons in the early HIV infection compared with the other groups. Proportions of γδ T, γδ+CD8, γδ+CD16 cells were also significantly reduced in the early stage of HIV infection (P<.01). Markers of immune activation, CD4+HLA-DR and CD8+HLA-DR, were also significantly reduced during early HIV infection (P<.01). Taken together, our findings suggest that high levels of renal markers as well as reduced proportions of gamma delta T cells are associated with the early stages of HIV infection. This event likely occurs before systemic immune activation reaches peak levels. This study provides evidence for the need for early HIV infection diagnosis and treatment.

Effects of fucoidan on the hematic indicators and antioxidative responses of Nile tilapia (Oreochromis niloticus) fed diets contaminated with aflatoxin B1.

Fucoidan is a rich source of medicinally active immunostimulants that possess various pharmacological properties. This study examined the potential impact of fucoidan on the hematic indicators and antioxidative responses of Nile tilapia fed diets contaminated with aflatoxin B1 (AFB1). Fish (60 ± 6.1g) were allocated to five groups; the first (control) and second groups were fed 0% or 1% fucoidan-supplemented diets without AFB1 contamination, while the third, fourth, and fifth groups were fed diets contaminated with AFB1 and supplemented with 0%, 0.5%, and 1% fucoidan, respectively. After 30days, fish fed AFB1 showed high ALT, AST, ALP, cholesterol, urea, and creatinine levels; furthermore, total blood protein and tissue (liver, kidney, and gill) glutathione (GSH), glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) activity significantly (P ≤ 0.05) decreased in fish fed AFB1, while tissue malondialdehyde significantly increased (P ≤ 0.05). Interestingly, fish fed fucoidan showed decreased ALT, AST, ALP, cholesterol, urea, and creatinine, as well as increased blood protein, GSH, GPx, SOD, and CAT activity. The results suggested that fucoidan is capable of inducing protective activity against AFB1 toxicity in Nile tilapia by enhancing the serum biochemical and tissue antioxidant responses of fish.

Risk Factors for Nontyphi Salmonella Bacteremia Over 10 Years in Fort-de-France, Martinique, West Indies.

Nontyphoidal Salmonella infections can result in bacteremia. This study was undertaken to determine the predictive factors for bacteremia in children aged less than 16 years. Medical data were collected for every child with positive nontyphoidal Salmonella cultures in blood or stools at the University hospital of Martinique, French West Indies, between January 2005 and December 2015. Among 454 patients, 333 were included; 156 cases had confirmed bacteremia, and 177 were included as control group with nontyphoidal Salmonella only isolated in stools. Age at diagnosis, delay before consulting, prematurity, immunosuppression, or hyperthermic seizures were not significantly associated with bacteremia. C-reactive protein was higher in cases of bacteremia (P = 0.01); however, after adjusting to the threshold of 30 mg/L, there was no longer any difference. There were also significant relations for electrolytes such as hyponatremia (odds ratio (OR) = 2.08 [95% CI = 1.31-3.95]; P < 0.01), high urea level (OR = 0.53 [95% CI = 0.32-0.88], P < 0.01). The infecting serotype was the most discriminant risk factor (P < 10-4). Among 28 serotypes isolated between 2005 and 2015, Salmonella panama was the most common serotype: 122 strains (78.2%) were isolated from bacteremic patients versus 60 (33.9%) from nonbacteremic patients (P < 10-4). Salmonella panama was the most important risk factor for bacteremia (OR = 7.37 [95% CI = 3.18-17.1], P < 10-4) even after multivariate analysis (OR = 13.09 [95% CI = 5.42-31.59], P < 10-4). After adjusting for bacteremia, S. panama was associated with a significantly higher body temperature than other Salmonella: 39°C (standard deviation [SD] = 0.92) versus 38.2°C [SD = 1.1], linear regression P < 10-3. Children with Salmonella serotype panama infection were at higher risk of bacteremia than children infected with other Salmonella serotypes.

P901 Left ventricular diastolic and systolic functions are compromised in patients with hypothyroidism

Abstract Background and Aim Long standing hypothyroidism may impair myocardial relaxation, but its effect on systolic myocardial function is still controversial. The aim of this study was to investigate left ventricular (LV) systolic and diastolic function in patients with hypothyroidism. Methods This study included 81 (age 42 ± 13 years, 92% female) patients with hypothyroidism, and 22 age and gender matched controls. All subjects underwent a detailed clinical examination followed by a complete biochemical blood analysis including thyroid function assessment and anthropometric parameters measurements. LV function was assessed by 2 dimensional, M-mode and Tissue-Doppler Doppler echocardiographic examination performed in the same day. Results Patients had lower waist/hip ratio (p &amp;lt; 0.001), higher urea level (p = 0.002) and lower white blood cells (p = 0.011), compared to controls. All other clinical, biochemical and anthropometric data did not differ between the two groups. Patients had impaired LV diastolic function (lower E wave [p &amp;lt; 0.001], higher A wave [p = 0.028], lower E/A ratio [p &amp;lt; 0.001], longer E wave deceleration time [p = 0.01], and higher E/e’ ratio [p &amp;lt; 0.001]), compared with controls. Although LV global systolic function did not differ between groups, LV longitudinal systolic function was compromised in patients (lateral mitral annular plane systolic excursion - MAPSE [p = 0.005], as were lateral and septal TDI s’ [p &amp;lt; 0.001 for both]). Conclusion In patients with hypothyroidism, in addition to compromised LV diastolic function, LV longitudinal systolic function is also impaired compared to healthy subjects of the same age and gender. These findings suggest significant subendocardial function impairment, reflecting potentially micro-circulation disease, that requires optimum management.