High Urea Research Articles

Process development for cross-flow diafiltration-based VLP disassembly: A novel high-throughput screening approach.

Virus-like particles (VLPs) are particulate structures, which are applied as vaccines or delivery vehicles. VLPs assemble from subunits, named capsomeres, composed of recombinantly expressed viral structural proteins. During downstream processing, in vivo-assembled VLPs are typically dis- and reassembled to remove encapsulated impurities and to improve particle morphology. Disassembly is achieved in a high-pHsolution and by the addition of a denaturant or reducing agent. The optimal disassembly conditions depend on the VLP amino acid sequence and structure, thus requiring material-consuming disassembly experiments. To this end, we developed a low-volume and high-resolution disassembly screening that provides time-resolved insight into the VLP disassembly progress. In this study, two variants of C-terminally truncated hepatitis B core antigen were investigated showing different disassembly behaviors. For both VLPs, the best capsomere yield was achieved at moderately high urea concentration and pH. Nonetheless, their disassembly behaviors differed particularly with respect to disassembly rate and aggregation. Based on the high-throughput screening results, a diafiltration-based disassembly process step was developed. Compared with mixing-based disassembly, it resulted in higher yields of up to 0.84 and allowed for integrated purification. This process step was embedded in a filtration-based process sequence of disassembly, capsomere separation, and reassembly, considerably reducing high-molecular-weight species.

Serum biochemical reference ranges for pregnant sheep

Late pregnancy is accompanied by dramatic changes in the metabolism of sheep, in which the nutrient requirements increase and the metabolic capacity of ewes is under severe stress due to the rapid foetal growth and development of the mammary gland. The blood metabolic profile can be used to monitor these alterations, which can lead to metabolic disorders such as pregnancy toxaemia. However, data available on serum parameters in sheep do not consider physiological state. Therefore, the present study aimed to determine the biochemical reference ranges for pregnant ewes, including serum energy, protein and enzyme-related metabolites. Data from a variety of metabolites were obtained from experiments performed in several institutions and commercial farms using Santa Inês, Dorper, Lacaune, Morada Nova, Bergamacia and Suffolk ewes reared under different conditions (grazing, feedlot, semi-feedlot, collective and/or individual pens, and metabolic cages) from 2006 to 2017. All animals were healthy and without feed restriction. Data from ewes with any clinical manifestations were removed. The metabolic energy profile included data of glucose, cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein and very-low-density lipoprotein levels; the metabolic protein profile included the metabolites total protein, uric acid, urea, albumin, and creatinine; and the metabolic enzymatic profile included the enzymes aspartate aminotransferase, gamma-glutamyl transferase and alkaline phosphatase. The reference ranges were estimated using the software RefVal 4.11. Dixon’s test was used to identify and remove outliers. The confidence intervals and percentiles were estimated using the nonparametric method of bootstrap when data were not normally distributed. A 95% confidence level was used. The serum biochemical reference ranges for pregnant sheep determined in our study were strongly divergent from those established by one of the most cited books on the topic, especially considering the high serum urea and cholesterol concentrations and low levels of blood glucose observed. Therefore, it is essential to consider physiological status when evaluating the blood metabolic profile of pregnant ewes in order to maintain an adequate nutritional management and to prevent health disorders that may lead to productive and reproductive losses.

Cellulose-Based Hydrogels as Smart, Green and Controllable Nitrogenous Fertilizers Releasing Agents

Abstract A smart, green, and controllable-release hydrogel based on cellulose was prepared to avoid the problem of soil fertilizer abuse. A field-emission scanning electron microscope (FE-SEM) demonstrated a wrinkled, rough, lamellar structure with long microtubes. The effect of the cross-linker concentration, epichlorohydrin (ECH), on the physical and mechanical properties in addition to swelling and urea-release kinetics was thoroughly studied. A relatively high swelling ratio, urea entrapment, and proper flexibility were obtained for an ECH concentration of 3.33 %. The swelling kinetics of hydrogel was found to be a second-order process. The maximum swelling value and the initial swelling rate were dependent on cross-linker concentration. The hydrogel exhibited a dehydration shrinkage in saline solution. A significantly high urea release of 6.61 % at 3.33 ECH concentrations was estimated. The urea-release mechanism matches well with the Fickian model. Accordingly, the prepared hydrogel is potential as a smart, green, and controllable-release fertilizer for applications in agriculture and horticulture.

The Cox model of predicting mortality among melioidosis patients in Northern Malaysia: A retrospective study.

Melioidosis is an infectious disease that is initiated by a bacteria recognized as Burkholderia pseudomallei. Despite the high fatality rate from melioidosis, there is a minimal published study about the disease in Malaysia.This study aimed to identify the prognostic factors of mortality among melioidosis patients in northern Malaysia.All inpatient patients who were admitted to Hospital Sultanah Bahiyah, Kedah and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis during the period 2014 to 2017 were included in the study. The study retrospectively collected 510 melioidosis patients from the Melioidosis Registry. Hazard ratio (HR) used in advanced multiple Cox regression was used to obtain the final model of prognostic factors of melioidosis. The analysis was performed using STATA/SE 14.0 for Windows software.From the results, among the admitted patients, 50.1% died at the hospital. The mean age for those who died was 55 years old, and they were mostly male. The most common underlying disease was diabetes mellitus (69.8%), followed by hypertension (32.7%). The majority of cases (86.8%) were bacteremic. The final Cox model identified 5 prognostic factors of mortality among melioidosis patients. The factors were diabetes mellitus, type of melioidosis, platelet count, white blood cell count, and urea value. The results showed that bacteremic melioidosis increased the risk of dying by 3.47 (HR: 3.47, 95% confidence intervals [CI]: 1.67–7.23, P = .001) compared to non-bacteremic melioidosis. Based on the blood investigations, the adjusted HRs from the final model showed that all 3 blood investigations were included as the prognostic factors for the disease (low platelet: HR = 1.76, 95% CI: 1.22–2.54, P = .003; high white blood cell: HR = 1.49, 95% CI 1.06–2.11, P = .023; high urea: HR = 2.92, 95% CI: 1.76–4.85, P < .001; and low level of urea: HR = 2.69, 95% CI: 1.69–4.29, P < .001). By contrast, melioidosis patients with diabetic had 30.0% lower risk of dying from melioidosis compared to those with non-diabetic (HR = 0.70, 95% CI: 0.52–0.94, P = .016).Identifying the prognostic factors of mortality in patients with melioidosis allows a guideline of early management in these patients, which may improve patient's survival.

Factors Associated with Prolonged Hospital Stay during Induction Chemotherapy for High Risk Pediatric Acute Lymphoblastic Leukemia

IntroductionPediatric patients with High Risk (HR) or Very High Risk (VHR) acute lymphoblastic leukemia (ALL) receiving intensive induction chemotherapy often have a complicated and prolonged hospital stay. The aim of this study was to identify risk factors that are associated with a complicated hospital course or prolonged inpatient admission during induction chemotherapy, and investigate if these factors influence disease-free or overall survival.MethodsAll patients (N=73) (age<21 years) diagnosed from 2009-2016 with de novo HR (leukocyte count at presentation≥50,000/mm3 or age≥10 years, T cell ALL) or VHR (≥13 years old, presence of Philadelphia chromosome, hypodiploidy, MLL rearrangement, intrachromosomal amplification of chromosome 21, high minimal residual disease, or induction failure) ALL, treated at Riley Children's Hospital, Indianapolis, were included for chart review. Univariate and multivariate logistic regression was used to test for statistical significance. A P-value<0.05 was considered to be statistically significant. Variables with significance in the univariate models were considered for multivariate analysis. The overall survival (OS) and disease (leukemia)-free survival (LFS) were analyzed using the Kaplan-Meier method and log-rank test.ResultsN=42 (57%) patients (group A) had an uncomplicated course (discharged at day 4 after receiving pegylated-asparaginase, no readmission or ICU stay) during induction chemotherapy. N=31 (43%) patients (group B) experienced a prolonged admission (median hospital stay=8 days vs 4 days (group A), P=0.02) or an ICU stay (N=13 (18%)), due to infectious or metabolic complications. Only 2 patients (3%) died during induction chemotherapy.In univariate logistic regression, patients with a platelet count<20,000 /mm3 (P=0.04), low serum bicarbonate (P=0.002), and a high blood urea nitrogen (BUN) (P=0.03) on day 4 were more likely to have a prolonged admission (OR=4.52, 8.21, and 3.02, respectively). Age, Hispanic ethnicity, or severity of anemia or neutropenia were not associated with a prolonged hospital stay or ICU stay. Multivariate stepwise logistic regression identified low serum bicarbonate (P=0.002) and a platelet count<20,000/mm3 (P=0.02) on day 4 of admission to be predictive of a prolonged hospital stay. LFS was significantly worse in group B compared to group A (5 year LFS=58% vs 89%, respectively, P=0.03). No difference in the OS was observed in the two groups (A and B) (5 year OS=67% (group B) vs 83% (group A), P=0.9).ConclusionA significant proportion of HR or VHR pediatric ALL patients experience a prolonged inpatient hospital stay during induction chemotherapy. We identified factors that may be predictive of a prolonged length of hospitalization due to complications, and noted an inferior leukemia-free survival in this group of patients. DisclosuresNo relevant conflicts of interest to declare.

Clinical Profile and Risk Factors for Severe Disease in 402 Children Hospitalized with SARS-CoV-2 from India: Collaborative Indian Pediatric COVID Study Group.

IntroductionThere is a lack of large multicentric studies in children with COVID-19 from developing countries. We aimed to describe the clinical profile and risk factors for severe disease in children hospitalized with COVID-19 from India.MethodsIn this multicentric retrospective study, we retrieved data related to demographic details, clinical features, including the severity of disease, laboratory investigations and outcome.ResultsWe included 402 children with a median (IQR) age of 7 (2–11) years. Fever was the most common symptom, present in 38.2% of children. About 44% had underlying comorbidity. The majority were asymptomatic (144, 35.8%) or mildly symptomatic (219, 54.5%). There were 39 (9.7%) moderate-severe cases and 13 (3.2%) deaths. The laboratory abnormalities included lymphopenia 25.4%, thrombocytopenia 22.1%, transaminitis 26.4%, low total serum protein 34.7%, low serum albumin 37.9% and low alkaline phosphatase 40%. Out of those who were tested, raised inflammatory markers were ferritin 58.9% (56/95), c-reactive protein 33.3% (41/123), procalcitonin 53.5% (46/86) and interleukin-6 (IL-6) 76%. The presence of fever, rash, vomiting, underlying comorbidity, increased total leucocyte count, thrombocytopenia, high urea, low total serum protein and raised c-reactive protein was factors associated with moderate to severe disease.ConclusionFever was the commonest symptom. We identified additional laboratory abnormalities, namely lymphopenia, low total serum protein and albumin and low alkaline phosphatase. The majority of the children were asymptomatic or mildly symptomatic. We found high urea and low total serum protein as risk factors for moderate to severe disease for the first time.

Impact of Dialysis Vintage and Renal Biomarkers on Mortality in Dialysis-Dependent Patients With Critical Limb Ischemia Undergoing Revascularization

Purpose: Revascularization of both endovascular therapy (EVT) and surgical reconstruction improve clinical outcomes of patients with critical limb ischemia (CLI); however, treatment of dialysis-dependent patients with CLI is still challenging. This study aimed to investigate the impact of dialysis-related parameters on the risk of mortality in dialysis-dependent patients undergoing revascularization for CLI. Materials and Methods: We retrospectively identified 274 dialysis-dependent patients with CLI (196 males; mean age 71 years), who underwent revascularization, from the clinical database of the surgical reconstruction vs peripheral intervention in patients with critical limb ischemia (SPINACH) study, which was a prospective, multicenter, observational study. Of these patients, 175 patients underwent EVT and 99 patients received surgical reconstruction. The current study evaluated the impact of dialysis vintage and renal biomarkers on the mortality rate of dialysis-dependent patients with CLI undergoing revascularization. Results: During a mean follow-up period of 1.7 ± 1.1 years, 147 deaths were observed. The 3-year overall survival rate and its standard error were estimated to be 40.5% ± 8.1% using the Kaplan-Meier method. A Cox proportional hazard analysis revealed that dialysis vintage ≥4 years, serum creatinine levels <4.7 mg/dL, serum urea nitrogen ≥88 mg/dL, and calcium-phosphate product ≥62.6 mg2/dL2 were independent risk factors for mortality after adjustment for the detailed mortality risk score developed in the SPINACH study. Adding these parameters to the original mortality risk score slightly, but not significantly, increased the area under the time-dependent receiver operating characteristics curve from 0.74 (95% CI, 0.67 to 0.81) to 0.77 (0.71 to 0.84) (p=0.084), whereas continuous net reclassification improvement reached 0.75 (0.12 to 0.90) (p=0.027). Conclusion: We found that long dialysis vintage, low serum creatinine, high serum urea nitrogen, and high calcium-phosphate product were independently associated with the increased risk of mortality in dialysis-dependent patients with CLI undergoing revascularization.

Zinc-methionine supplementation prevents the live weight loss in the early lactation of Ongole-Crossbred cows in the reproduction cycle

This research aimed to investigate the reproductive performance of Ongole crossbred (PO) cows offered zinc methionine (ZincMeth) during the late gestation and early lactation. Thirty-two PO pregnant cows, 400 kg live weight (LW) were weighed and measured body condition score (BCS) before the experiment. The experimental design was a 2 x 2 factorial with two nutritional and two ZincMeth treatments, with eight cows in each nutrition x ZincMeth group. All cows were offered elephant grass (EG), 16 cows offered a concentrate diet (CONS) containing 15% crude protein (CP) and 16 cows offered a CONS containing 11% CP at 3% LW on a DM basis, the ratio of EG: CONS was 40:60. Five grams of ZincMeth was added to the CONS prepared for individual cows. The parameters observed were LW gain, BCS, post-partum anestrus period, luteinizing hormone, volatile fatty acid, and blood metabolite concentrations. The results showed that the BCS change was greater in cows fed a high CP diet, they also had high plasma glucose, urea, and total protein concentrations. ZincMeth prevented LW loss in the early lactation and increased plasma urea concentration. Thus, the ZincMeth maintained the LWG during the critical period but did not affect any reproductive parameters.

Effect of Sevelamer and Nicotinamide on Albumin Carbamylation in Patients with End-Stage Kidney Disease.

Background and ObjectiveIn end-stage kidney disease, high urea levels promote the carbamylation of lysine side chains on a variety of proteins, including albumin. Albumin carbamylation has been identified as a risk factor for mortality and sevelamer led to a decrease in urea levels in dialysis patients. In the present secondary analysis of the NICOREN trial, we investigated the putative impacts of sevelamer and nicotinamide on albumin carbamylation, and the potential correlation between carbamylation and vascular calcifications.MethodsAll possible carbamylation of circulating albumin were screened for with high-resolution liquid chromatography-tandem mass spectrometry. Levels of three carbamylated peptides were then measured as a guide to the extent of albumin carbamylation. Carbamylation was measured at baseline in 55 patients included in the NICOREN trial and 29 patients at 24 weeks of treatment. Calcifications on plain radiographs were quantified as the Kauppila score and the Adragao score.ResultsBaseline albumin carbamylation was present at three different sites in subjects with end-stage kidney disease. At baseline, we observed only a correlation between urea and the KQTA carbamylation site in these patients. Albumin carbamylation levels did not decrease after 24 weeks of treatment with either sevelamer or nicotinamide. Furthermore, the proportion of carbamylated serum albumin was not correlated with vascular calcification scores in this population.ConclusionsOur results confirmed the presence of carbamylated albumin in patients with end-stage kidney disease and demonstrated the presence of carbamylation beyond the LRVP residues. The results also demonstrated the lack of impact of sevelamer or nicotinamide on albumin carbamylation levels. Therapeutic strategies to lower carbamylation load should probably be focused on direct anti-carbamylation processes and/or potentially anti-inflammatory therapies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40268-021-00350-7.

WHY MUCORMYCOSIS(BLACK FUNGUS) CAN NOT BE DECLARED AS EPIDEMIC IN INDIA

WHY MUCORMYCOSIS(BLACK FUNGUS) CAN NOT BE DECLARED AS EPIDEMIC IN INDIA

MO390THE RISK FACTORS AND CLINICAL OUTCOMES ASSOCIATED WITH ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19

Background and AimsKidney involvement, ranging from mild hematuria and proteinuria to acute kidney injury (AKI) in patients with coronavirus disease-2019 (COVID-19), is a recent finding with various incidence rates reported among hospitalized patients with COVID-19. Current evidence on AKI rate in patients hospitalized with COVID-19 and its associated risk factors is limited, especially in Iran.MethodIn this retrospective cohort study, we enrolled adult patients referred to the Sina hospital, Iran, from 20 February to 14 May 2020, with either a positive PCR test or a highly susceptible chest computed tomography features (CT) consistent with COVID-19 diagnosis. AKI was defined according to the kidney disease improving global outcomes (KDIGO) criteria, and patients were stratified based on their AKI staging. We evaluated the risk indicators associated with AKI during hospitalization besides in-hospital outcomes and recovery rate at the time of discharge.Results: We evaluated 516 patients with a mean age of 57.6±16.1 years and a male to female ratio of 1.69 who were admitted with the COVID-19 diagnosis. AKI development was observed among 194 (37.6%) patients, comprised of 61.9% patients in stage 1, 18.0% in stage 2, and 20.1% in stage 3. Out of all patients, AKI occurred in 58 (11.2%) patients during the hospital course, and 136 (26.3%) patients arrived with AKI upon admission. AKI development was positively associated with all of the in-hospital outcomes, including intensive care unit admissions, need for invasive ventilation, acute respiratory distress syndrome (ARDS), acute cardiac injury, acute liver injury, multi-organ damage, and mortality. Patients with stage 3 AKI showed a significantly higher mortality rate, ARDS, and need for invasive ventilation than other stages. After multivariable analysis, male sex (odds ratio (OR):11.27), chronic kidney disease (OR: 6.89), history of hypertension (OR:1.69), disease severity (OR; 2.27), and high urea levels (OR: 1.04) on admission were independent risk indicators of AKI development. Among 117 (28.1%) patients who experienced AKI and survived, only 33 (28.2%) patients made a recovery from the AKI, and 84 (71.8%) patients did not exhibit full recovery at the time of discharge.ConclusionWe found that male sex, history of chronic kidney disease, hypertension, disease severity, and high serum urea were independent risk factors associated with AKI in patients with COVID-19. Also, higher stages of AKI were associated with increased risk of mortality and in-hospital complications. Our results indicate a necessity for more precise care and monitoring for AKI during hospitalization in patients with COVID-19, and lack of AKI recovery at the time of discharge is a common complication in such patients.

MO639THE ASSOCICATION BETWEEN SERUM INTERLEUKIN 1 BETA AND HEPARAN SULFATE IN DIABETIC NEPHROPATHY PATIENTS

Abstract Background and Aims The global diabetes mellitus (DM) prevalence in 2019 is estimated to be 9.3%. Approximately 20% to 40% of patients with DM develop diabetic nephropathy (DN). DN is the leading cause of end stage renal disease (ESRD). Inflammation is considered to be an important mechanism in the development of DM and persists for a long time before the occurrence of DN. Many studies demonstrated that decrease of endothelium glycocalyx (EG) was negatively correlated with proteinuria. Whether EG damage induced by inflammasome in DM patients leads to the occurrence of micro albuminuria (MA) and accelerating the progress of DKD is rarely studied. Method: This prospective, observational cohort study screened 300 diagnosed diabetic patients from departments of nephrology and endocrinology of our hospital. The exclusion criteria were: type 1 diabetes; acute infections; usage antibiotics within 3 months; kidney disease before; heart failure; malignancy. Finally 70 patients were invited to this study and were divided into type 2 DM (T2DM) group and type 2 diabetic nephropathy (T2DN) group. T2DM group were defined as patients with normal MA and without diabetic retinopathy (n=35). T2DN group were defined as patients with increased MA and diabetic retinopathy (n=35). Laboratory data were measured via routine laboratory methods. Heparan sulfate (HS) and interleukin 1 beta (IL-1β) were noted as EG biomarker and inflammasome biomarker respectively. Serum samples of patients were collected, and serum IL-1β and HS were measured by ELISA. SPSS 18.0 was used for all statistical analyses. Results: T2DN patients had higher serum IL-1β (27.85 vs. 21.35 pg/ml), higher HS (2.17 vs. 1.47 ng/ml), higher urea nitrogen (6.30 vs. 5.33 umol/L), higher CRP (2.03 vs. 0.81 mg/L), higher hemoglobin (128 vs. 141 g/L), higher neutrophil (4.1 vs. 3.4 × 109/L) and higher neutrophilic granulocyte percentage (63% vs. 56%) compared with T2DM patients (all P&amp;lt;0.05). Logistic regression analyses demonstrated serum HS was independently associated with T2DN. Furthermore in T2DN patients, serum IL-1β was positively correlated with HS (r = 0.6, P&amp;lt;0.01) and was and independent associated factor. The relationship of HS and IL-1β was not significant in T2DM patients. Conclusion T2DN patients had higher serum IL-1β and HS than T2DM patients in our study. In T2DN patients IL-1β was an independent associated factor of HS. The results suggested that the inflammasome may damage the EG in diabetic patients, which induced the occurrence of MA and accelerating the progress of DN.

English

BACKGROUND Sickle cell disease is the commonest haemoglobinopathy. Recent advanced therapeutic approaches are enabling the sickle cell patients to survive beyond adulthood. METHODS The study provides important data on cardiovascular abnormalities in sickle cell disorder in Chhattisgarh by employing a non-invasive method of two-dimensional colour Doppler echocardiography. RESULTS The present study suggests that sickle cell disease has association with left ventricular diastolic dysfunction and pulmonary artery hypertension and no association with other echocardiographic findings including left ventricular dimensions and functions. The association is further affected by the presence of moderate to severe anaemia (haemoglobin &lt; 8.9 gm %), higher urea (&gt; 19 mg / dL), creatinine (0.8 mg / dL) and diastolic blood pressures (&lt; 69 mmHg). The age, gender and systolic blood pressures of the subject were not found to impact echocardiographic parameters. CONCLUSIONS The present study suggests that sickle cell disease affects left ventricular diastolic dysfunction and pulmonary artery hypertension but does not affect the other echocardiographic dimensions and functions. The association is further affected by the presence of moderate to severe anaemia, higher urea, creatinine and diastolic blood pressures. The age, gender and systolic blood pressure do not influence echocardiographic parameters. KEY WORDS Adult, Sickle Cell Disease, Echocardiography, Ventricular Function, Anaemia

The Value of Blood Urea Nitrogen in the Prediction of Risks of Cardiovascular Disease in an Older Population.

Background: High blood urea nitrogen (BUN) is associated with adverse outcomes in patients with cardiac disease risks. However, no study has explored whether BUN can predict the risk of cardiovascular disease (CVD) in the healthy older population. This study aims to explore the incidence and risk factors of CVD among a healthy older population community in China.Design and Methods: This study was designed as a cohort study with a 4-year follow-up. We recruited 5,000 older people among 137,625 residents of the Gaohang community. In the baseline, subjects were asked to participate in medical screening and biological tests, and answered survey questions. During the follow-up period (2014–2017), the researchers regularly tested the subjects' indicators and assessment scales. We monitored the occurrence of CVD and explored the relationship between BUN and CVD via a Cox regression analysis.Results: During the follow-up, subjects were newly diagnosed with CVD including heart failure (HF), heart disease events, atrial fibrillation, diabetes, hypertension, metabolic syndrome, and kidney disease. The Cox regression analysis found an association between baseline BUN and incident CVD in female subjects, with higher BUN associated with increased risk of AF in females and kidney disease in both male and females. No association was found between BUN and CVD in male subjects.Conclusions: Current results indicate that BUN is a valuable predictive biomarker of CVD. A higher BUN level (>13.51 mg/dL) is associated with an increased occurrence of HF but a decreased occurrence of diabetes and metabolic symptoms in normal older females.

Studying Resistance of Some Dairy Cattle Breeds to Heat Stress in Relation to Milk Yield

The objective for our work was to estimate the milk yield and blood biochemical constituents of and weight daily gain of calves recently born from imported cows under hot summer conditions in Egypt. Thirty late- pregnant cows, aged 22-24 months, chosen randomly were used in this study. Experiment was carried out during the period from third stage of pregnancy and continued to 8 weeks postpartum. Imported late-pregnant cows divided into three groups, each group was 10 cows. 1st group was Brown Swiss (BS) cows, 2nd group was Simmental (S) cows and 3rd group was Holstein (H). Results showed that H cows have a lowest rectal temperature (RT) and respiration rate (RR) in compare with BS and S cows. Results showed that H cows have a highest daily milk yield while S cows have lowest values. BS and H cows have significantly higher total protein, albumin and urea concentrations than S cows. While, globulin and glucose concentrations were significantly higher in BS than its concentrations in S and H cows, respectively. Total cholesterol, phospholipids and creatinine concentrations showed the lowest values in BS cows as compare with S and H cows. Otherwise, BS cows have the highest triglycerides concentration as compare with H and S cows. About liver function showed the highest activity for AST in S cows and for ALT in H cows as compared of other groups. BS cows have significantly higher T4 and Estradiol17β levels than its levels in S and H cows, respectively. Birth weight of newborn both male and female calves as well as daily body weight gain of calves produced from the three imported cows were not differs Significantly. Two months weight of calves produced from S cows was significantly higher than BS and H cows, respectively. In conclusion, the three imported breed cows appears good resistance to heat stress effects under hot summer conditions in Egypt with extremely resistance for H cows.

Clinical features and risk factors for severe influenza in children: A study from multiple hospitals in Shanghai

The incidence and mortality of influenza in children had risen, but data are limited on children with severe influenza virus infection in China. We conducted a retrospective case-control study and collected the patients' clinical data. Clinical data including demography, clinical presentation, laboratory findings, radiologic findings, treatment and outcomes were collected. Children were clinically confirmed to have virus infection in Shanghai in three hospitals from June 2014 to June 2019. During the study, 36,047 children were enrolled. Among them, 118 met the criteria for severe flu. Clinical symptoms such as fever, cough, gastrointestinal symptoms, coma and epilepsy were higher in the severe group. Complications such as pneumorrhagia, heart failure, septic shock, acute renal failure and influenza-associated encephalitis were higher in the severe influenza group than the death group. The laboratory findings including decreased hemoglobin, high alanine aminotransferase, high urea nitrogen and high lactate levels were risk factors for death in children with influenza. Influenza-associated encephalopathy (IAE), acute respiratory distress syndrome (ARDS) were the common clinical manifestations and complications for the severe influenza, and delayed use of oseltamivir was found to be associated with fatality.

Acute heart failure: is ACTION-ICU useful?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (pts) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes. Objective To validate ACTION-ICU score in AHF as predictor of in-hospital M (IHM), post discharge early M [1-month mortality (1mM)] and 1-month readmission (1mRA), in our center population, using real-life data. Methods Based on a single-center retrospective study, data collected from pts admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used non-parametric tests, logistic regression analysis and ROC curve analysis. Results We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. Mean heart rate was 95.5 ± 27.5bpm, mean systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, mean urea level at admission was 68.8 ± 40.7mg/dL, mean sodium was 137.6 ± 4.7mmol/L, mean glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean ACTION-ICU score was 10.4 ± 2.3. Inotropes’ usage was necessary in 32.7% of the pts, 11.3% of the pts needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the pts were readmitted 1 month after discharge. Older age (p &amp;lt; 0.001), lower SBP (p = 0,035), presenting in KKC 4 (p &amp;lt; 0.001, OR 8.13) and need of inotropes (p &amp;lt; 0.001) were predictors of IHM in our population. Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p &amp;lt; 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the studied variables were predictive of need of IV. LVEF (OR 0.924, p &amp;lt; 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p &amp;lt; 0.001, CI 0.971-0.988), higher urea (OR 1.01, p &amp;lt; 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors inotropes’ usage. ACTION-ICU was able to predict IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed ACTION-ICU performs well when predicting IHM (Area under curve (AUC) 0.729, confidence interval (CI) 0.59-0.87), inotropes’ usage (AUC 0.619, CI 0.54-0.70) and 1mM (AUC 0.705, CI 0.58-0.84). Conclusion In our population, ACTION-ICU score was able to predict IHM, 1mM and inotropes’s usage.

Acute heart failure: predicting early in-hospital outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes. Objective To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), using real-life data. Methods Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis. Results Among the 300 P admitted with AHF included, mean age was 67.4 ± 12.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4 ± 2.3 and GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge. Older age (p &amp;lt; 0.001), lower SBP (p = 0,035) and need of inotropes (p &amp;lt; 0.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p &amp;lt; 0.001). Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p &amp;lt; 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p &amp;lt; 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p &amp;lt; 0.001, CI 0.971-0.988), higher urea (OR 1.01, p &amp;lt; 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors of inotropes’ usage. Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p &amp;lt; 0.001, CI 1.05-1.19), 1mM (OR 1.10, p = 1.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p &amp;lt; 0.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84). Conclusion In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.

COMPARISON OF HBA1C LEVEL MEASURED BY HPLC AND CAPILLARY ELECTROPHORESIS AMONG PATIENT WITH HIGH UREA

Utilization of glycated haemoglobin (HbA1c) in diagnosis and monitoring of diabetes mellitus is accepted and validated worldwide. Standardisation between various methods available is no longer an issue. However, knowledge of HbA1c interference by various haemoglobin (Hb) fractions presence in the patient’s sample must be taken into account during HbA1c analysis and interpretation. Carbamylated Hb (cHb) is one of Hb fractions, formed when Hb condensed at the N-terminal valine by cyanate derived from spontaneous decomposition of urea which usually raised in patients with renal impairment. This study aimed to compare the level of HbA1c in patient with high urea measured using High Performance Liquid Chromatography (HPLC) and Capillary Electrophoresis (CE). After analysis using the laboratory’s routine method, or HPLC, the patient’s samples with concurrent urea level of &gt;25 mmol/L were re-analyzed within 2 hours using the comparative method or CE. A cut off cHb of 2% on HPLC considered as no interference. The mean level of urea was 31.37±5.09 mmol/L (range 25.2-43.1mmol/L). Out of 68 samples, only 24 cHb were detected by HPLC but only less than 2% and none cHb detected on CE. Correlation between HPLC and CE showed no significant different in HbA1c measurement (r= p&gt;0.05). Therefore, we propose that both HPLC and CE can be used to determine HbA1c level in patient with high urea.

Epidemiological, clinical, and laboratory findings for patients of different age groups with confirmed coronavirus disease 2019 (COVID-19) in a hospital in Saudi Arabia.

BackgroundAlthough the coronavirus disease 2019 (COVID-19) pandemic continues to rage worldwide, clinical and laboratory studies of this disease have been limited in many countries. We investigated the epidemiologic, clinical, and laboratory findings of COVID-19 infected patients to identify the effective indicators correlated with the disease.MethodsA retrospective study was conducted at King Abdullah Hospital in Bisha Province, Saudi Arabia, from March 20 to June 30, 2020. Patients of different age groups were confirmed as having COVID-19 infection using a real-time polymerase chain reaction. The demographic, clinical, and laboratory data of the patients were statistically analyzed.ResultsOf the 132 patients, 85 were male and 47 were female, with a mean age of 50.9 years (SD±16.7). The patients were elderly (n = 29) and adults (n = 103). Of these, 54 (40.9%) had comorbidities, (25%) were admitted to the intensive care unit (ICU), and 12 (9.1%) died. On admission, the main clinical manifestations were fever (84.1%), cough (64.4%), shortness of breath (25%), chest pain (20.5%), and fatigue (18.2%). In all patients, increased neutrophils and decreased lymphocytes were observed. Patients’ lactate dehydrogenase (LDH) was elevated. C-reactive protein (CRP) was elevated in 48.5%, D-dimer in 43.2%, and the erythrocyte sedimentation rate (ESR) in 40.9% of patients. The elderly showed higher neutrophil (p = 0.011) and lower lymphocyte (p = 0.009) counts than adults. Glucose, creatine kinase-MB, LDH, bilirubin, D-dimer, and ESR were significantly higher in the elderly than in the adults. The COVID-19 death group had a higher leucocyte count (p = 0.036), and higher urea (p = 0.029) and potassium (p = 0.022) than the recovered group but had a lower hemoglobin concentration (p = 0.018). A significant association was determined between COVID-19 death and the presence of cardiovascular disease (χ2(1) = 16.297, p<0.001), hypertension (χ2(1) = 12.034, p = 0.001), renal failure (χ2(1) = 3.843, p = 0. 05), old age (t (130) = 4.9, p <0.001), and ICU admission (χ2(1) = 17.6 (1), p<0.001).ConclusionsInvestigating some of the laboratory and clinical parameters could help assess the disease progression, risk of mortality, and follow up patients who could progress to a fatal condition.