Higher Creatinine Research Articles

Prognostic impact and predictors of persistent renal dysfunction in acute kidney injury after percutaneous coronary intervention for acute myocardial infarction.

This study aimed to evaluate the prognostic impact and predictors of persistent renal dysfunction in acute kidney injury (AKI) after an emergency percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). A total of 877 patients who underwent emergency PCI for AMI were examined. AKI was defined as serum creatinine (SCr) ≥ 0.3mg/dL or ≥ 50% from baseline within 48h after PCI. Persistent AKI was defined as residual impairment of SCr ≥ 0.3mg/dL or ≥ 50% from baseline 1month after the procedure. The primary outcome was the composite endpoints of death, myocardial infarction, hospitalization for heart failure, stroke, and dialysis. AKI and persistent AKI were observed in 82 (9.4%) and 25 (2.9%) patients, respectively. Multivariate Cox proportional hazards analysis demonstrated that persistent AKI, but not transient AKI, was an independent predictor of primary outcome (hazard ratio, 4.99; 95% confidence interval, 2.30-10.8; P < 0.001). Age > 75years, left ventricular ejection fraction < 40%, a high maximum creatinine phosphokinase MB level, and bleeding after PCI were independently associated with persistent AKI. Persistent AKI was independently associated with worse clinical outcomes in patients who underwent emergency PCI for AMI. Advanced age, poor cardiac function, large myocardial necrosis, and bleeding were predictors of persistent AKI.

Which Laboratory and Clinical Feature are different in Pregnant and Non-pregnant Women with COVID-19? A Cross-sectional Study in the West of Iran

Background: This study aimed to determine the differences in laboratory and clinical characteristics of pregnant and non-pregnant women with COVID-19 in Hamadan, the west of Iran. Material &amp; Methods: This cross-sectional study compared 135 pregnant with 135 non-pregnant women without underlying diseases and matched by age with COVID-19 from March 2020 to June 2021 in Hamadan, a western city in Iran. Their demographic characteristics, clinical symptoms, vital signs, and laboratory findings were evaluated using a preset checklist and contrasted between the two groups. The adjusted odds ratios (ORs) for the outcomes of illness were presented. A considerable amount of analysis was performed on all data using the SPSS version 26 software. Results: In general, there was a significant association between most clinical symptoms and status of pregnancy. Although the Peripheral oxygen saturation with a pulse oximeter (SPO2) mean was significantly lower among non-pregnant compared to the pregnant women (89.19±4.52 versus 94.91±3.12; p &lt; 0.001), the mean of heart rate was significantly lower among pregnant women compared to non-pregnant women (90.59±11.80 versus 96.50±15.02; p = 0.001). The percentage of low hemoglobin (Hb), abnormal Blood Urea Nitrogen, high Creatinine (CR), high Erythrocyte Sedimentation Rate and high Lactate Dehydrogenase was significantly higher in non-pregnant women compared to the pregnant women. Women with pregnancy compared to non-pregnant women and women with low Hb compared to normal Hb had a considerably increased chance of intensive care unit /death. Each unit increase in SPO2 and pulse rate resulted in a considerable reduction in this risk. In addition, women with high CR, shortness of breath and per unit rise in temperature had a considerably higher chance of staying in the hospital for a longer period of time. Conclusion: The clinical and para-clinical manifestations of pregnant women with COVID-19 are different from non-pregnant women. Although there was a significant difference between the two groups due to mortality, the percentage of admission to the intensive care unit in pregnant women with COVID-19 is higher than in non-pregnant women. To avoid these adverse outcomes, pregnant women should take precautions to avoid COVID-19 infection.

Incidence and Predictors of Worsening Renal Function in Edoxaban-Treated Atrial Fibrillation Patients Within ETNA-AF-Europe Registry

BackgroundManaging patients with atrial fibrillation (AF) and worsening renal function (WRF) remains a clinical challenge due to the need of dose adjustment of non-vitamin K antagonist oral anticoagulants. ObjectivesTo determine the incidence of WRF in patients with AF treated with edoxaban, the association of WRF with clinical outcomes, and predictors of WRF and clinical outcomes in these patients. MethodsThis is a subanalysis of the Edoxaban Treatment in routiNe clinical prActice for patients with non-valvular Atrial Fibrillation in Europe study (NCT02944019), an observational study of edoxaban-treated patients with AF. WRF was defined as a ≥25% reduction in creatinine clearance between baseline and 2 years. ResultsOf the 9,054 patients included (69% of the total 13,133 enrolled), most did not experience WRF (90.3%) during the first 2 years of follow-up. WRF occurred in 9.7% of patients. Patients with WRF had significantly higher rates of all-cause death (3.88%/y vs 1.88%/y; P < 0.0001), cardiovascular death (2.09%/y vs 0.92%/y; P < 0.0001), and major bleeding (1.51%/y vs 0.98%/y; P = 0.0463) compared with those without WRF. Rates of intracranial hemorrhage (0.18%/y vs 0.18%/y) and of any stroke/systemic embolic events were low (0.90%/y vs 0.69%/y; P = 0.3161) in both subgroups. The strongest predictors of WRF were a high CHA2DS2-VASc score, high baseline creatinine clearance, low body weight, and older age. Most predictors of WRF were also predictors of clinical outcomes. ConclusionsWRF occurred in approximately 10% of edoxaban-treated AF patients. Rates of death and major bleeding were significantly higher in patients with WRF than without. Stroke events were low in both subgroups.

Postoperative Outcomes After Emergency Surgery in COVID-19 Patients: An Ambispective Matched Cohort Study.

Purpose There is limited data from the Indian subcontinent regarding the surgical outcomes of coronavirus disease (COVID-19) patients. In this observational study, we aimed to evaluate the postoperative outcomesafter emergency surgery in COVID-19 patients compared to concurrent age and gender-matched controls. We also sought to analyze the possible predictors of postoperative mortality in COVID-19 patients. Methods This matched cohort study was conductedin a tertiary care teaching hospital in central India, between 1st July 2021 and 30th June 2022. COVID-19-positive patients undergoing emergency surgery under anesthesia were recruited as cases. Age and gender-matched COVID-19-negative patients undergoing a similar nature of surgery in the same period served as concurrent controls. The cases and controls were compared for the 30-day mortality and perioperative complications. Results The COVID-19-positive surgical cohort had a 12.3 times greater 30-day postoperative overall mortality risk as compared to a matched cohort of patients with a negative COVID-19 test. A positive COVID-19 status was associated with more postoperative complications of acute respiratory distress syndrome (ARDS), sepsis, shock, and persistent hyperglycemia. On analysis of predictors of mortality, the presence of preoperative dyspnea, ARDS, American Society of Anesthesiologists Physical Status (ASA-PS) Class IIIE/IVE, increase in sequential organ failure assessment (SOFA) score, Quick SOFA>1, higher creatinine, bilirubin, and lower albumin were observed to be associated with increased mortality. Conclusions Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients undergoing emergency surgery is significantly associated with higher postoperative complications and increased 30-day postoperative mortality.

A cross-sectional study determining prevalence and factors associated with ST-segment elevation myocardial infarction and non-ST segment elevation myocardial infarction in Iran: results from fasa registry on acute myocardial infarction (FaRMI)

BackgroundAcute myocardial infarction is still a leading cause of death worldwide, accounting for roughly three million deaths yearly. This study aimed to investigate the prevalence and factors associated with ST-Segment Elevation Myocardial Infarction and Non-ST Segment Elevation Myocardial Infarction in Iran.MethodsThis cross-sectional study was conducted using the databases of the Fasa Registry on Acute Myocardial Infarction (FaRMI) and the Fasa Adult Cohort Study (FACS). chi-squared and one-way ANOVA tests were utilized to calculate the unadjusted associations between the study variables. A multivariate multinomial logistic regression model was also employed to determine the adjusted association of each independent variable with the risk of ST-elevation myocardial infarction (STEMI).ResultsThe prevalence of STEMI and non-STEMI was 31.60% and 11.80%, respectively. Multinomial logistic regression showed that older age, anemia, high WBC, and high creatinine levels were associated with higher odds of STEMI and non-STEMI compared to healthy individuals. In addition, based on the analysis being a woman(OR = 0.63,95%CI:0.51–0.78), anemia(OR = 0.67,95%CI:0.54–0.63)and hypertension (OR = 0.80,95%CI:0.65–0.97)decreased the likelihood of STEMI occurrence compared to non-STEMI, while high WBC(OR = 1.19,95%CI:1.15–1.23)increased the odds.ConclusionIn this study, significant predictors of MI risk included age, gender, anemia, lipid profile, inflammation, and renal function. Subsequent investigations ought to prioritize the comprehensive understanding of the underlying mechanisms that drive these connections and assess the effectiveness of specific interventions aimed at diminishing the occurrence of MI and improving patient outcomes.

Intra-arterial PRRT with Lu-177 DOTATATE in Liver-dominant Metastatic Neuroendocrine Tumors: Early Assessment of Efficacy and Toxicity.

We proposed to administer Lu-177-DOTATATE in intra-arterial (IA) mode for higher first-pass localization to somatostatin receptors, higher residence time in liver metastases, and more radiation to tumor. This study aimed at assessing early hematological, renal and hepatotoxicity; and objective response to IA peptide receptor radionuclide therapy (PRRT). Fourteen patients (4 females and 10 males) were prospectively assessed. 5/14 patients underwent 2 cycles, whereas 3/14 underwent 3 cycles, and 6/14 received 1 cycle of IA PRRT. 200 mCi of Lu-177-DOTATATE was administered in 15-20 min by IA route under angiographic guidance. Patients were asked to follow-up at 4 and 8 weeks with hematological, liver, and renal functional parameters, and Ga-68 DOTATATE positron emission tomography/computed tomography (PET/CT) after 8 weeks. Response was assessed using RECIST 1.1 and EORTC PET criteria. Safety: 2/14 patients had high total and direct bilirubin, which reverted to normal after IA PRRT. Three patients had low albumin, which improved after 1 cycle. Nine patients showed no worsening of liver function. Two patients showed Grade 1 hematotoxicity which reverted to normal. Five patients showed high creatinine, but preserved glomerular filtration rate and EC clearance. On follow-up at 8 weeks, serum creatinine reverted to normal. Efficacy: In five patients who underwent 2 cycles of IA PRRT, 3 showed partial response (PR) on RECIST 1.1 and partial metabolic response (PMR) on EORTC criteria, whereas 2 showed stable disease (SD). In patients who underwent 3 cycles, 1 showed SD, whereas other patient showed PMR on DOTANOC PET/CT, with PR in size. Among the remaining seven patients, 5 showed PMR, whereas the other 2 showed SD. Thus 9/14 patients showed PR, whereas 5 showed SD on metabolic and size criteria. IA PRRT is a safe and efficacious approach for the treatment of liver dominant metastatic neuroendocrine tumors.

Description of Urea and Creatinine Levels in Dyspepsia Patients Taking Proton Pump Inhibitor Drugs at the Indonesian Christian University Hospital in 2018

Dyspepsia is a health problem often encountered by doctors in daily practice. Many people complain of symptoms of dyspepsia but do not seek help for treatment. Proton pump inhibitors are the drugs for the treatment of dyspepsia, such as omeprazol, lansoprazol, esomeprazol, rabeprazol, and pantoprazol. Some studies have explained that proton pump inhibitor drugs can interfere with kidney function due to acute interstitial nephritis due to the consumption of proton pump inhibitors, and this condition can end with chronic kidney disease that occurs due to undiagnosed acute interstitial nephritis. This study aimed to see how urea and creatinine levels in dyspepsia patients at Universitas Kristen Indonesia Hospital were taking proton pump inhibitors. This research is a descriptive research content analysis, hospital-based. Based on medical records at Universitas Kristen Indonesia Hospital in 2018, 80.3% high ureum levels and 19.7% normal ureum levels were found. In creatinine levels, it was found that men had more normal creatinine levels of 57.7% and high ureum levels of 42.3%, and women found more normal creatinine levels of 62.5% and high creatinine levels of 37.5%. Keywords: Dyspepsia, Proton Pump Inhibitor, Creatinine, Ureum

Machine learning-based prediction of in-hospital mortality for critically ill patients with sepsis-associated acute kidney injury

Objectives This study aims to develop and validate a prediction model in-hospital mortality in critically ill patients with sepsis-associated acute kidney injury (SA-AKI) based on machine learning algorithms. Methods Patients who met the criteria for inclusion were identified in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and divided according to the validation (n = 2440) and development (n = 9756, 80%) queues. Ensemble stepwise feature selection method was used to screen for effective features. The prediction models of short-term mortality were developed by seven machine learning algorithms. Ten-fold cross-validation was used to verify the performance of the algorithm in the development queue. The area under the receiver operating characteristic curve (ROC-AUC) was used to evaluate the differentiation accuracy and performance of the prediction model in the validation queue. The best-performing model was interpreted by Shapley additive explanations (SHAP). Results A total of 12,196 patients were enrolled in this study. Eleven variables were finally chosen to develop the prediction model. The AUC of the random forest (RF) model was the highest value both in the Ten-fold cross-validation and evaluation (AUC: 0.798, 95% CI: 0.774–0.821). According to the SHAP plots, old age, low Glasgow Coma Scale (GCS) score, high AKI stage, reduced urine output, high Simplified Acute Physiology Score (SAPS II), high respiratory rate, low temperature, low absolute lymphocyte count, high creatinine level, dysnatremia, and low body mass index (BMI) increased the risk of poor prognosis. Conclusions The RF model developed in this study is a good predictor of in-hospital mortality for patients with SA-AKI in the intensive care unit (ICU), which may have potential applications in mortality prediction.

Case Report: 18 Year Old Male Patient with Lupus Nephritis

Systemic lupus erythematosus is a chronic autoimmune disease that can affect various organs of the body, one of the most commonly affected complications is the kidneys and results in lupus nephritis, the percentage of disease occurrence is more than 50% of patients in the first 5 years. Male patients tend to have more aggressive disease with renal, vascular, and cardiac involvement. Based on the criteria of Systemic Lupus International Collaborating Clinics in 2012 defines lupus nephritis if there is proteinuria in 24 hours ≥ 0.5 g / day, there is urine sediment, and there is a decrease in renal filtration function. Although the disease can be diagnosed based on these three things kidney biopsy remains the gold standard of diagnosis. In this case report, an 18-year-old male with lupus history came to the emergency room with the main complaint of fever accompanied by shortness of breath, from the results of supporting examinations obtained anemia, thrombocytopenia, high creatinine, and eGFR of 4 mL/minute, complete urine showed proteinuria, cylinders, and erythrocytes, AP thorax photos showed cardiomegaly, bronchopneumonia, and bilateral pleural effusions. Based on history, physical examination, lab, and imaging, the patient was diagnosed with systemic lupus erythematosus, lupus nephritis, chronic kidney disease, normocytic normochromic anemia, and community acquired pneumonia. The patient received glucocorticoids, immunosuppressants, diuretic, antihypertensives, antibiotics, and other supportive therapy, The patient also received renal replacement therapy in the form of hemodialysis and a kidney biopsy will be done after the condition improves

Novel Pathogenic Mutation of P209L in TRPC6 Gene Causes Adult Focal Segmental Glomerulosclerosis.

Focal segmental glomerulosclerosis (FSGS) is a leading kidney disease, clinically associated with proteinuria and progressive renal failure. The occurrence of this disease is partly related to gene mutations. We describe a single affected family member who presented with FSGS. We used high-throughput sequencing, sanger sequencing to identify the pathogenic mutations, and a systems genetics analysis in the BXD mice was conducted to explore the genetic regulatory mechanismsof pathogenic genes in the development of FSGS. We identified high urinary protein (++++) and creatinine levels (149μmol/L) in a 29-year-old male diagnosed with a 5-year history of grade 2 hypertension. Histopathology of the kidney biopsy showed stromal hyperplasia at the glomerular segmental sclerosis and endothelial cell vacuolation degeneration. Whole-exome sequencing followed by Sanger sequencing revealed a heterozygous missense mutation (c.643C > T) in exon 2 of TRPC6, leading to the substitution of arginine with tryptophan at position 215 (p.Arg215Trp). Systems genetics analysis of the 53 BXD mice kidney transcriptomes identified Pygm as the upstream regulator of Trpc6. Those two genes are jointly involved in the regulation of FSGS mainly via Wnt and Hippo signaling pathways. We present a novel variant in the TRPC6 gene that causes FSGS. Moreover, our data suggested TRPC6 works with PYGM, as well as Wnt and Hippo signaling pathways to regulate renal function, which could guide future clinical prevention and targeted treatment for FSGS outcomes.

Combination of Binary Particle Swarm Optimization (BPSO) and Multilayer Perceptron (MLP) for Survival Prediction of Heart Failure Patients

Heart failure is a dangerous condition in which the heart cannot pump blood effectively and can lead to death. To improve this treatment, it needs methods to predict patient survival. This paper proposed combining wrapping features, namely Binary particle swarm optimization (BPSO) and a multilayer perceptron (MLP) classifier called BPSO-MLP. BPSO is used to determine the most relevant feature subset, and MLP is used to calculate its fitness. The experiment used a public dataset containing the medical records of 299 heart failure patients. This dataset comprises 13 features: age, anemia, high blood pressure, creatinine phosphokinase (CPK), diabetes, ejection fraction, platelets, gender, serum creatinine, serum sodium, smoking, time, and death events. The experiment results showed that the proposed method could produce an accuracy of up to 91.11%. The proposed method can increase accuracy by 8.89% compared to MLP (without BPSO). The addition of this wrapping feature has a significant influence on the accuracy results.

Evaluation of therapeutic and toxic levels of serum digoxin concentration: a cross-sectional study from a tertiary hospital.

Digoxin is a cardiac glycoside for treating heart failure and atrial fibrillation. Despite its limited therapeutic range and complex pharmacokinetic properties, this medication continues to be frequently prescribed. This study aimed to evaluate the serum digoxin concentration (SDC) at therapeutic, subtherapeutic, and toxic levels and explore the factors affecting these levels in patients receiving digoxin therapy for heart failure. In this descriptive and cross-sectional study, the data were obtained from the electronic system of patients who presented to Afyonkarahisar Health Sciences University. For the SDC, the reference range was accepted as 0.5-0.9 ng/mL, and the upper limit was 2.0 ng/mL. The patient's demographic characteristics, comorbidities, and laboratory findings were evaluated. The Mann-Whitney U test, Chi-square test, and logistic regression analysis were used. p<0.05 was considered statistically significant. The data of 419 patients (mean age: 65.9±16.1 years, 68.5% women) were evaluated. The mean SDC was 1.11±1.01 ng/mL, and it was below 0.5 ng/mL in 24.3% of the patients, 0.5-0.9 ng/mL in 23.4%, 0.9-2 ng/mL in 41.3%, and over 2 ng/mL in 11.1%. Age, male gender, the presence of diabetes mellitus, and high HbA1c values were found to be associated with greater SDC levels, but this was not statistically significant. The presence of renal failure, elevated creatinine and magnesium levels, and potassium, sodium, and calcium levels outside the normal limits significantly increased the SDC. High creatinine and low/high potassium values significantly affected the detection of SDC at the toxic level. The measurement of SDC levels holds significance not only in the monitoring of toxicity but also in ensuring adherence to the recommended therapeutic range during therapy. It is recommended to exercise caution in terms of risk factors such as age, kidney function test results, and blood electrolyte levels.

THE EFFECT OF GIVING NATURAL GUARD ESSENTIAL OIL IN DRINKING WATER ON BLOOD UREA NITROGEN LEVELS, CREATININE, AND AMINOTRANSFERASE IN BROILERS

To increase growth and feed efficiency, we can use feed additives through feed or drinking water, one of which is the use of essential oils. NATURALGUARD is a mixture of natural oils, namely pine oil (Pinus sp.), lavender (Lavandula sp.), and eucalyptus oil (Eucalyptus sp.) which contains active compounds as immunomodulators, antibacterials, antioxidants, anti-inflammatory, antifungal and antiviral. This study aims to determine the level of Blood Urea Nitrogen (BUN), Creatinine, Aspartate Aminotransferase (AST), and Alanine Aminotransferase (ALT) in broilers after being given NATURALGUARD via drinking water. This study used a completely randomized design with a total sample of 24 broiler CP-707 strain, with four treatments and six replications. The treatment applied was P0 as a control without giving NATURALGUARD, P1 P2, and P3 were given NATURALGUARD at doses of 1, 2, and 4 g/L respectively, adlibitum for 30 days. At the end of the study, 3 mL of blood sample was taken via the pectoral vein aseptically, and then a blood serum examination was carried out. The research results showed that the highest mean BUN level was at P0 (8.9 mg/dL) and the lowest was at P1 (5.2 mg/dL), the highest creatinine was at P3 (1.08 mg/dL) and the lowest was at P0 and P1 (1, 0 mg/dL), AST was highest at P0 (273 µ/L) and lowest at P2 (220 µ/L), and ALT was highest at P0 (7.5 µ/L) and lowest at P3 (5.48 µ/ L). Statistical results showed no significant differences in BUN, creatinine, AST, and ALT levels in all treatment groups. It was concluded that NATURALGUARD as feed additive at doses of 1, 2, and 4 g/L via drinking water is safe to be used in broilers.

Abstract TP182: Vessel Wall MRI in Diagnosis and Prognosis of Intracranial Vasculopathy

Introduction: High resolution vessel wall MRI (VWMRI) has been increasingly used in stroke patients to evaluate the arterial pathologies and underlying cause of stroke. We aimed to explore VWMRI features of intracranial vasculopathies in ischemic stroke patients and assess their associations with stroke mechanism and with clinical outcome. Methods: Ischemic stroke or TIA patients with intracranial vasculopathy as the potential cause of stroke were included if they underwent VWMRI (3D T1-weighted, pre- &amp; post- contrast, resolution isotropic 0.625 mm). The VWMRI features including the number of arterial lesions with thickened wall, presence of T1 hyperintensity, degree of enhancement [absent (0), mild (1), significant (2 =similar to infundibulum)], pattern of enhancement [eccentric, concentric, and mixed (both)] were evaluated by board certified neuroradiologists. Primary outcome was defined as recurrent stroke or other cardiovascular events. The association between clinical characteristic VWMRI features &amp; clinical outcome were examined. Results: A total of 46 patients [29 (63%) males; mean age (SD) 55.7 (15) years] were included. Among 41 patients (89%) had at least one lesion with thickened wall, 21 patients (51.2%) had multiple lesions, 28 (68.3%) had T1 hyperintensity, 39 (95%) had contrast enhancement (eccentric n=24, concentric n=10, mixed n=5 ) and 27 (66%) had significant enhancement. Overall, VWMRI suggested a different pathological mechanism of stroke in 16 patients comparing with the original impression. Higher creatinine and lower HDL levels were significantly (p&lt;0.05) associated with presence of multiple vs single lesion on VWMRI. LDL was significantly (p=0.04) higher in those with eccentric vs concentric enhancement. The median follow-up was 28.4 (IQR 13- 47) months, and primary outcome occurred in 6 (13.3%) patients. VWMRI features were not associated with the primary outcome. Conclusions: Presence of some degree of enhancement is common (95%) in patients with ischemic stroke attributed to intracranial vasculopathies. The VWMRI features were not associated with the primary clinical outcome. VWMRI may help to clarify the etiology of the stroke mechanisms. These findings warrant further evaluation in larger studies.

A novel predictive marker for placental abruption with composite adverse outcomes: creatinine-fibrinogen ratio.

To develop a new cost-effective marker named creatinine-fibrinogen ratio (CFR) for the prediction of composite adverse outcomes (CAO) in placental abruption cases. A total of 109 placental abruption patients (30 with adverse outcomes, 79 without adverse outcomes) were enrolled in this retrospective cohort study. Patients with at least one of the features listed below were included in the abruption with CAO group: requirement of blood product transfusion (erythrocyte suspension, fresh frozen plasma, pooled thrombocyte, thrombocyte apheresis), development of acute kidney injury or disseminated intravascular coagulation, and need for intensive care unit. Laboratory parameters and CFR values at admission to the hospital were compared between the two groups. Higher creatinine and lower fibrinogen levels were found in the CAO group (p = 0.007 and p < 0.001 respectively). The CFR value of the CAO group was significantly higher (p < 0.001). In the ROC curve analysis performed to investigate the value of CFR in CAO prediction, the area under the curve (AUC) was calculated as 0,802 (95% CI 0.709-0.895, 77% sensitivity, 65% specificity). CFR seems to be a practical marker for the prediction of CAOs in pregnant women with ablatio placenta.

CORRELATIONS BETWEEN FERRITIN LEVELS AND CREATININE IN PEDIATRIC THALASSEMIA PATIENTS PRODIA CILEGON

Thalassemia is a blood disorder that is passed down genetically from parents to their children. The body cannot form normal red blood cells resulting in them being damaged easily and having a short life of less than 120 days and anemia, requiring continuous blood transfusions to maintain hemoglobin levels in the body. A history of repeated blood transfusions can cause excess iron in the body which is characterized by an increase in serum ferritin levels which can cause damage to kidney function by looking at creatinine levels. The purpose of this study was to determine whether there is a relationship between ferritin and creatinine levels in children with thalassemia. This study used a quantitative method with a cross sectional approach. The sampling technique used in this study was the total sampling technique. The sample used was 12 samples. Data processing in this study used the Shapiro-Wilk Normality test and the Pearson Correlation test in bivariate analysis. The results of the analysis of this study indicate that there is no significant relationship between the ferritin and creatinine levels in children with thalassemia where the value of Sig. 0.212 &gt; 0.05 (p&gt; 0.05), and shows a significant negative correlation of -0.389. This study in thalassemia children had high ferrtin levels but creatinine levels were still within normal limits.

Inpatient Rehabilitation of a Patient with Anti-signal Recognition Antibody-positive Myositis with Persistently High Creatinine Kinase Levels at a Kaifukuki Rehabilitation Ward

Inpatient Rehabilitation of a Patient with Anti-signal Recognition Antibody-positive Myositis with Persistently High Creatinine Kinase Levels at a Kaifukuki Rehabilitation Ward

Real-World Data Study on Risk Factors Associated with Acute Kidney Damage in Patients Treated with Anti-MRSA Antibiotics

The objective was to evaluate the incidence of nephrotoxicity related to vancomycin and other anti-MRSA antibiotics (linezolid and daptomycin). Patients receiving any of these drugs between July 2014 and December 2020 at a tertiary hospital were included. Renal failure was evaluated using the acute renal injury (AKIN) system. Univariate analysis was conducted on the 5806 patients who were included. Among them, 1023 patients (17.62%) developed renal failure. The renal damage incidence was 14.74% (496/3365) for vancomycin, 19.13% (367/1918) for linezolid, and 30.59% (160/523) for daptomycin. Patients with lower basal glomerular filtration had a higher risk of AKIN. In the vancomycin group, the risk factors were high creatinine and urea serum basal values, duration of treatment (DOT), body mass index (BMI), ICU stay, age, and low CKDEPI and albumin levels. In the linezolid group, AKIN was linked to high creatinine and urea levels, BMI, age, and ICU stay and to low CKDEPI levels; for daptomycin, AKIN was associated with low CKDEPI and albumin levels and a long DOT. Patients with AKIN showed higher mortality rates. Vancomycin-associated nephrotoxicity remains a great concern. However, linezolid and daptomycin could also cause nephrotoxicity. Bearing in mind risk factors that may prompt nephrotoxicity in hospitalized patients taking anti-staphylococcal antibiotics will result in better pharmacotherapeutic management.

Allostatic load in early pregnancy and sleep-disordered breathing.

To assess the association between allostatic load in early pregnancy and sleep-disordered breathing (SDB) during pregnancy. High allostatic load in the first trimester was defined as ≥ 4 of 12 biomarkers (systolic blood pressure, diastolic blood pressure, body mass index, cholesterol, low-density lipoprotein, high-density lipoprotein, high sensitivity C-reactive protein, triglycerides, insulin, glucose, creatinine, and albumin) in the unfavorable quartile. SDB was objectively measured using the Embletta-Gold device and operationalized as "SDB ever" in early (6-15 weeks) or mid-pregnancy (22-31 weeks); SDB at each time point was analyzed as secondary outcomes. Multivariable logistic regression was used to test the association between high allostatic load and SDB, adjusted for confounders. Moderation and sensitivity analyses were conducted to assess the role of allostatic load in racial disparities of SDB and obesity affected the relationship between allostatic load and SDB. High allostatic load was present in 35.0% of the nuMoM2b cohort. The prevalence of SDB ever occurred among 8.3% during pregnancy. After adjustment, allostatic load remained significantly associated with SDB ever (aOR= 5.3; 3.6-7.9), in early-pregnancy (aOR= 7.0; 3.8-12.8), and in mid-pregnancy (aOR= 5.8; 3.7-9.1). The association between allostatic load and SDB was not significantly different for people with and without obesity. After excluding BMI from the allostatic load score, the association decreased in magnitude (aOR= 2.6; 1.8-3.9). The association between allostatic load and SDB was independent of confounders including BMI. The complex and likely bidirectional relationship between chronic stress and SDB deserves further study in reducing SDB.

Clinical Characteristics, Pathological Features and Treatment Outcomes of Children With Nephrotic Syndrome at Princess Marina Hospital, Botswana.

Objective. Despite the remarkable progress made in the understanding and treatment of childhood nephrotic syndrome (NS), a lot is still unknown about its epidemiology in many African countries. This study sought to determine the clinicopathological features and treatment outcomes of children with NS at the largest tertiary hospital in Botswana. Methods. A retrospective study of 26 children with NS treated from 2009 to 2014 was conducted. Results. Mean age at presentation was 5.96 ± 3.06. Hematuria was found in 92.3%, low C3 in 26.7%, high creatinine in 19.2% and hypertension in 46.2% of the patients. 92.3% had primary NS out of which 23.1% had familial NS. HIV, tuberculosis and hepatitis B infections were diagnosed in 3.85%, 9.09% and 4.16% respectively. 69.2% had steroid-resistant nephrotic syndrome, focal segmental glomerulosclerosis (SRNS-FSGS). Conclusion. The frequency of primary SRNS-FSGS and familial SRNS appears to be much higher in Botswana highlighting the possibility of genetic causes.