Higher Serum Levels Of Creatinine Research Articles

The protective effects of Vitamin D against Cadmium-induced nephrotoxicity

BackgroundCadmium (Cd) is retained in the kidneys in large amounts thus inducing oxidative damage. Vitamin D (VD) is a potent antioxidant that is postulated to reverse the Cd-induced oxidative effects. AimThe present study aimed at investigating the effect of VD administration on reversing Cd-induced renal toxicity. Material and methodsTwenty-four male rats were assorted into three equal groups: Negative control (NC) group receiving drinking water only, Positive control (PC) group receiving Cadmium chloride (CdCl2) and VD group receiving VD injections in addition to CdCl2. The serum levels of creatinine, urea and 25-OH VD as well as renal tissue concentration of glutathione peroxidase (GPX) and malondialdehyde (MDA) were measured. Tissue sections were examined for signs of renal injury, immunostained for Vitamin D receptor (VDR), Cyp24a1 and Cyp27b1 and the apoptotic index was measured. ResultsCd administration resulted in higher serum levels of creatinine and urea as well as lower serum 25-OH VD level in addition to higher MDA and lower GPX renal concentration. VD supplementation showed improved renal functions, a remarkable improvement in the renal tissue with enhanced expression of VDR and Cyp27b1, lower Cyp24a1 expression and a lower apoptotic index. ConclusionVD administration can ameliorate Cd-induced nephrotoxicity.

Effects of Antioxidant Combinations on the Renal Toxicity Induced Rats by Gold Nanoparticles.

This study investigated some possible mechanisms underlying the nephrotoxic effect of gold nanoparticles (AuNPs) in rats and compared the protective effects of selected known antioxidants-namely, melanin, quercetin (QUR), and α-lipoic acid (α-LA). Rats were divided into five treatment groups (eight rats per group): control, AuNPs (50 nm), AuNPs + melanin (100 mg/kg), AuNPs + QUR (200 mg/kg), and AuNPs + α-LA (200 mg/kg). All treatments were administered i.p., daily, for 30 days. AuNPs promoted renal glomerular and tubular damage and impaired kidney function, as indicated by the higher serum levels of creatinine (Cr), urinary flow, and urea and albumin/Cr ratio. They also induced oxidative stress by promoting mitochondrial permeability transition pore (mtPTP) opening, the expression of NOX4, increasing levels of malondialdehyde (MDA), and suppressing glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT). In addition, AuNPs induced renal inflammation and apoptosis, as evidenced by the increase in the total mRNA and the cytoplasmic and nuclear levels of NF-κB, mRNA levels of Bax and caspase-3, and levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). Treatment with melanin, QUR, and α-lipoic acid (α-LA) prevented the majority of these renal damage effects of AuNPs and improved kidney structure and function, with QUR being the most powerful. In conclusion, in rats, AuNPs impair kidney function by provoking oxidative stress, inflammation, and apoptosis by suppressing antioxidants, promoting mitochondrial uncoupling, activating NF-κB, and upregulating NOX4. However, QUR remains the most powerful drug to alleviate this toxicity by reversing all of these mechanisms.

Hyperhomocysteinemia exacerbates acute kidney injury via increased mitochondrial damage.

Acute kidney injury (AKI) is a complex and common set of multifactorial clinical syndromes, and associated with increased in-hospital mortality. There is increasing evidence that Hyperhomocysteinemia (HHcy) is highly associated with the development of a variety of kidney diseases, including AKI. However, the pathogenesis of HHcy in AKI remains unclear. In this study, we investigated the effect and mechanism of HHcy on cisplatin-induced AKI in mice and NRK-52E cells cultured with HHcy. We confirmed that mice with HHcy had higher serum levels of creatinine and more severe renal tubule injury after cisplatin injection. We found that HHcy aggravated renal mitochondrial damage, mainly manifested as decreased ATP β, significantly increased cytoplasmic Cyt C expression and the ADP/ATP ratio, and a significantly decreased mitochondrial DNA (mtDNA) copy number. In addition, we found that HHcy accelerated cisplatin-induced renal DNA damage; culturing NRK-52E cells with homocysteine (Hcy) could significantly increase apoptosis and mitochondrial damage. Interestingly, we found that Mdivi-1 reduced Hcy-induced mitochondrial damage, thereby reducing the level of apoptosis. In conclusion, these results suggest that HHcy might aggravate the development of AKI by increasing mitochondrial damage and that reducing Hcy levels or inhibiting mitochondrial damage may be a potential therapeutic strategy to delay the development of AKI.

Prognostic factors in real-world elective supported high risk percutaneous coronary intervention with pLVAD or ECMO

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): University Hospital of Salamanca - contract (CM19/00055) supported by the Instituto de Salud Carlos III in Spain (Co-funded by European Social Fund "Investing in your future"). Background/Introduction Percutaneous coronary intervention (PCI) is the last remaining revascularization option in high risk (HR) patients affected by complex coronary artery disease not suitable for surgery. Elective mechanical circulatory support (MCS) could be necessary to keep hemodynamics during these procedures. In this context, selection of the patients balancing the risk-benefit is a challenge. Purpose Analyse the factors related to mortality in patients who underwent elective HR-PCI with MCS: veno-arterial extracorporeal membrane oxygenation (VA-ECMO), Impella CP® or percutaneous heart pump (PHP). Methods The study is a retrospective single centre registry, including all elective MCS implants for HR-PCI in a referral hospital. All of them were previously discussed in clinical session, deciding this modality of intervention by the Heart Team. Univariate analysis of variables related to discharge survival was performed using SPSS Statistics. Results Twenty-seven patients underwent supported elective HR-PCI from 2013 to Sep-2021 (Figure 1). They were patients with low LVEF, high percentage of admission for ACS or HF, high coronary anatomy complexity (mean syntax score 31.4±9.5), and high surgical risk (mean STS morbidity-mortality score 24.17±16.0). In 88.9% of the patients, the circulatory support device was removed after completing the procedure, remaining in the rest due to persistent instability. The main access site was femoral, using axillary arterial access when the iliofemoral arteries were not suitable. Endotracheal intubation was needed in 29.6% of patients. Deaths during the admission (14.8%) were not directly related with the procedure but with posterior complications (alveolar haemorrhage, multiorgan failure, refractory heart failure and sepsis). Variables related to mortality were concomitant more than mild valvular heart disease; higher creatinine serum levels and lower pH before the procedure; axillary access and need for endotracheal intubation during or after the intervention; periprocedural mayor and minor bleeding and postprocedural critical care infections (Figure 1). We did not find other differences in terms of baseline characteristics, complexity of revascularization, type of support or development of complications. In the follow-up (median 4.8 [29.7] months) 70.4% of patients remain alive after the intervention (Figure 2). Conclusion Temporary MCS used prophylactically in elective high-risk PCI appeared feasible and safe in the real-world setting and could be an alternative for patients dismissed for surgery because of high-risk. Moreover, we found some prognostic variables related to discharge survival to help clinicians with the selection of the most appropriate patients. Randomized studies are required to determine a better selection of cases according to risk-benefit

Inflammatory biomarkers and severity of COVID-19: Cross sectional study among Egyptian patients

The newly emerging coronavirus disease 2019 (COVID-19) is characterized by multisystem inflammatory syndrome. The development of SARS-CoV-2 complications usually starts within few days following infection, and the severity of the disease determines its outcome. Vitamin D insufficiency is associated with risk of lung infections, also cell-based studies reported the ability of vitamin D to control enveloped virus growth. We aimed to investigate the relationship between the most eminent inflammatory biomarkers and the level of vitamin D aiming to provide a tool for early diagnosis and prediction of disease progression. The current study was approved by Research Ethics Committee (REC), Kasr Al-Ainy. After confirmation of being COVID-19 by PCR, the admitted patients were categorized as mild-moderate, and severe-critically ill based on clinical and radiologic data. The total levels of serum 25(OH)D, as well as other pro-inflammatory biomarkers were measured and were analyzed by receiver operating characteristic curve (ROC) analysis for detection of their association with COVID-19 disease severity and to determine their sensitivity and specificity at optimum cutoff points. The area under the curve (AUC) ROC for predicting COVID-19 disease severity was the highest (of 0.97) for vitamin D, inflammatory cytokines, liver enzymes, ferritin, and D-Dimer. In addition, high serum levels of creatinine, and elevated liver enzymes associated with severe-critical COVID-19. The low 25(OH)D was associated with the disease severity.

Clinical Features and Etiology of Musculoskeletal Infection with or without Sepsis in the Emergency Department.

BackgroundMusculoskeletal infection (MSKI) is a common reason to seek medical care in the emergency department (ED). We aimed to determine the clinical characteristics and etiology of patients with MSKI in our ED, the characteristics of MSKI with sepsis, and the predictors of death in sepsis patients.MethodsThe study retrospectively analyzed patients with MSKI from April 1, 2017, to March 31, 2021. The patients were divided into non-sepsis and sepsis groups. Clinical data of these patients including their basic information, laboratory results, diagnostic results, and outcomes were collected. Statistical analysis was carried out using GraphPad Prism 5.ResultsIn all, 106 patients (70 male, 36 female) were enrolled in this study: 43 MSKI patients with sepsis and 63 MSKI patients without sepsis. Five patients with sepsis died. The patients’ age and sex ratio were no significantly different between the sepsis and non-sepsis groups. In the sepsis group, the ratio of rheumatic diseases, diabetes, coronary heart disease, and deep vein thrombosis was significantly different than that in the non-sepsis group (all p<0.05). Fifty-six patients (54.37%) had positive etiology results. Staphylococcus, streptococcus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli were the most common bacteria found in both groups, but sepsis patients had more Candida albicans infections than non-sepsis patients (p=0.0331, p<0.05). The five patients who died in the sepsis group had higher serum levels of creatinine and procalcitonin (PCT). Multivariate logistic regression analyses showed that PCT (p=0.026; odds ratio, 1.038) was significantly related to mortality.ConclusionIn MSKI patients, rheumatic diseases, diabetes, coronary heart disease, and deep vein thrombosis are the risk factors for sepsis. Staphylococcus, streptococcus, K. pneumoniae, P. aeruginosa, and E. coli were the most common bacteria in MSKI patients, while MSKI patients with sepsis had more C. albicans infections. Elevated PCT was significantly related to death in sepsis patients.

Serum netrin and VCAM-1 as biomarker for Egyptian patients with type IΙ diabetes mellitus

ObjectiveThis study aimed to evaluate the serum level of netrin and soluble vascular cell adhesion molecule 1 (VCAM-I) in patients with type IΙ diabetes mellitus (T2DM) and evaluate the association of their levels with the development of a diabetic complication. Patients and methodsThis study was carried out on type II diabetic patients with and without complications and healthy individuals served as controls. All subjects were submitted to the estimation of serum lipid profile, serum creatinine, urinary albumin/creatinine ratio (ACR), fasting blood glucose (FBG), glycated hemoglobin (HbA1c), visceral adiposity index (VAI), atherogenic index of plasma (AIP), lipid accumulation product (LAP) and detection of serum level of netrin1 and VCAM1. ResultsDiabetic patients with complications had significantly higher serum levels of creatinine, ACR, cholesterol, Triglyceride, low-density lipoprotein, netrin1, and VCAM1 than diabetic patients without complications. Likewise, the level of VAI and LAP as markers of excessive body fat were significantly higher in diabetic patients with complications than diabetic patients without complications. The netrin1 and VCAM1 were a significant discriminator of T2DM renal complications with a sensitivity of 96%, 90%, and specificity of 82.7%, 91.3% respectively. ConclusionIt can be concluded that serum netrin1 and VCAM1 correlated significantly with markers of excessive body fat, a renal complication in the patient with type 2 diabetes mellitus.

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.

Biochemical and Hematological Correlates of Elevated Homocysteine in National Surveys and a Longitudinal Study of Urban Adults.

Elevated blood homocysteine (Hcy) among middle-aged adults can increase age-related disease risk, possibly through other biochemical and hematological markers. We selected markers for hyperhomocysteinemia among middle-aged adults, studied time-dependent Hcy-marker associations and computed highly predictive indices of hyperhomocysteinemia, with cross-sectional and longitudinal validations. We used data from the National Health and Nutrition Examination Survey (NHANES III, phase 2, nmax = 4000), the NHANES 1999–2006 (nmax = 10,151) and pooled NHANES (cross-sectional validation). Longitudinal validation consisted of mixed-effects linear regression models (Hcy predicting markers’ annual rates of change), applied to the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS, n = 227–244 participants, k = 2.4 repeats/participant, Agebase: 30–65 years) data. Machine learning detected nine independent markers for Hcy > 14 µmol/L (NHANES III, phase 2): older age; lower folate and B-12 status; higher serum levels of creatinine, uric acid, alkaline phosphatase, and cotinine; mean cell hemoglobin and red cell distribution widths (RDW); results replicated in the 1999–2006 NHANES [AUC = 0.60–0.80]. Indices combining binary markers increased elevated Hcy odds by 6.9–7.5-fold. In HANDLS, first-visit Hcy predicted annual increase in creatinine, RDW and alkaline phosphatase, with third-visit index (2013–2018) directly predicting Hcy (2004–2009). We provide evidence of the internal and external validity of indices composed of several biomarkers that are strongly associated with elevated Hcy.

ToleRability of BevacizUmab in elderly Ovarian cancer patients (TURBO study): a case-control study of a real-life experience.

ObjectiveBevacizumab maintenance following platinum-based chemotherapy is an effective treatment for epithelial ovarian cancer (EOC), both in primary and recurrent disease. Our aim was to identify criteria to select elderly patients who can safely benefit from bevacizumab addition.MethodsThis is a case-control study on patients with primary or recurrent EOC who received platinum-based chemotherapy plus bevacizumab, between January 2015 and December 2016. Patient characteristics, treatment details and adverse events were reviewed and analyzed in 2 settings: younger (<65 years, group 1) and elderly (≥65 years, group 2). A binary logistic model was applied to correlate clinical variables and severe (grade ≥3) toxicity risk.ResultsOverall, 283 patients with EOC were included, with 72 (25.4%) older patients compared with 211 (74.6%) younger women. Bevacizumab had been administered to 234 patients (82.7%) as first-line treatment and in 49 (17.3%) with recurrent disease. At diagnosis, elderly patients presented with at least one comorbidity and were taking at least 1 medication in 84.7% and 80.6% of the cases respectively, compared with correspondingly 47.4% and 37.4% in group 1 (p<0.001). Nonetheless, the occurrence of serious (grade ≥3) adverse events did not increase among the older group. Creatinine serum levels >1.1 g/dL, estimated glomerular filtration rate (eGFR) ≤60 mL/min, ≥3 comorbidities were independently associated with a higher severe toxicity.ConclusionsElderly patients with EOC can safely be treated with bevacizumab; factors other than age, as higher creatinine serum levels, eGFR and number of comorbidities should be considered to better estimate bevacizumab-related toxicity risk.

Thyroid endocrine status and biochemical stress responses in adult male Wistar rats chronically exposed to pristine polystyrene nanoplastics.

Toxicity evaluations of micro- or nano-sized plastics in rodent species commonly employed for toxicity analyses based on which risk assessment for humans could be performed are still largely lacking. Given this knowledge gap, the present work was aimed at determining the potential impact of chronic exposure to polystyrene nanoplastics (PS NPs) on the thyroid endocrine status and biochemical stress in a rat model. Young adult male rats were orally administered with PS NPs (1, 3, 6 and 10 mg kg-1 day-1) for five weeks. Thyroid hormones (THs) l-thyroxine (T4), l-triiodothyronine (T3), l-free triiodothyronine (FT3), and l-free thyroxine (FT4) as well as thyroid stimulating hormone (TSH) serum levels of normal rats and those exposed to PS NPs were compared. Serum levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, and creatinine, as well as glutamic oxaloacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) enzymes were also measured. Exposure to PS NPs suppressed the serum levels of T3 and circulating levels of THs, whereas TSH increased significantly. Though exposure to PS NPs did not affect the molar ratios of T3/T4, it induced a slight, but significant, increase in FT3/FT4. In addition, exposure to plastic nanoparticles showed signs of nephrotoxicity induction and kidney injury in exposed organisms as can be inferred from the significantly higher serum levels of creatinine in exposed groups. Our results provide clear evidence of an association between exposure to plastic NPs and thyroid endocrine disruption as well as metabolic deficit, and generate new leads for future research efforts.

The Experience of Using a Combination of Febuxostat and Canakinumab in Tophaceous Gout Complicated by Chronic Kidney Disease in a Teenage Patient: A Case Study

Background . Gout is extremely rare in childhood and is genetically determined in almost all cases. Late initiation of urate-lowering therapy in children with gout increases the risk of severe disability due to the state of the musculoskeletal system and kidney function. Description of a Clinical Case . At the age of 13 years and 9 months, the boy first experienced acute pain, hyperthermia, and restriction of movement in the right elbow joint. Acute haematogenous osteomyelitis was excluded. Further, repeated recurrences of arthritis of the 1st metatarsophalangeal joint of the left foot, distal interphalangeal joints of the 3rd and 5th fingers of the right hand were noted. After 8 months, a diagnosis of 'Rheumatoid arthritis, polyarticular type' was established at his place of residence. Hyperuricemia (0.99 μ mol/L), high serum levels of creatinine (127 μ mol/L) and urea (7.2 μ mol/L), hypoisostenuria (1,008–1,009) were detected for the first time. Nephrological examinations were not conducted. He received non-steroidal anti-inflammatory drugs and sulfasalazine without effect, with increasing deformity in the affected joints. At the age of 15 years and 7 months, gout was diagnosed with damage to the joints and kidneys, allopurinol therapy was initiated. Normalization of serum uric acid levels was not reached, repeated attacks of gouty arthritis were noted. Direct automated sequencing of the coding sequence of the HPRT1 gene, including exon-intron regions, revealed a mutation of c.481G&gt; А (p.Aia161Thr)CM088136 NM 000194.1 in the hemizygous state. Genetically determined tophaceous gout, stage 2–3 chronic kidney disease were diagnosed. The patient was administered the interleukin-1 inhibitor canakinumab (single injection), urate-lowering therapy with a non-purine inhibitor of xanthine oxidase febuxostat was prescribed. As a result, the target serum uric acid level was reached a week later. Over the next 7 months, there were no repeated gouty attacks. Conclusion . Late initiation of treatment for tophaceous gout in the teenage patient caused chronic kidney disease. The successful experience of using a combination of canakinumab and febuxostat in a patient under 18 years old has been described for the first time.

Predictors of major adverse cardiac events following elective stenting of large coronary arteries

ObjectiveDiameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries. MethodsWe reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter. ResultsData of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio=5.23, P=0.030) and use of DES (odds ratio=0.048, P=0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting. ConclusionThis study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.

Late graft failure in heart transplant recipients: incidence, risk factors and clinical outcomes.

To analyse the incidence, risk factors and clinical outcomes of late graft failure after heart transplantation. We conducted an observational, single-centre study based on 547 patients who underwent cardiac transplantation from 1991 to 2014 and who survived the in-hospital postoperative period. Late graft failure was defined as the first hospitalization due to this condition after discharge. Over a mean follow-up of 8.4 ± 6 years, 178 (32.5%) patients were hospitalized due to late graft failure [incidence rate: 3.6 cases per 100 patient-years, 95% confidence interval (CI) 3.1-4.2]. Pre-transplant diabetes, higher pre-transplant transpulmonary pressure gradient and lower donor-recipient weight ratio were independently associated with higher risk of graft failure. Cardiac allograft vasculopathy, cellular rejection grade ≥1R, and antibody-mediated rejection grade ≥1 were detected in 50.6%, 44.9% and 19.2% patients, respectively, admitted due to graft failure. Left ventricular ejection fraction was ≥50% in 60.1% of these patients. Re-transplant free survival 1, 5, 10 and 15 years after the diagnosis of late graft failure was 72.2%, 38.4%, 18.4%, and 7.5%, respectively; the incidence rate of re-hospitalization due to decompensated heart failure was 40.9 episodes per 100 patient-years (95% CI 36.6-46.1). The need for inotropes, the presence of cardiac allograft vasculopathy, higher creatinine serum levels, lower ejection fraction and lower sodium serum levels were independent predictors of worse outcomes. Late graft failure is frequent after heart transplantation, as it is associated with poor outcomes. Rejection and cardiac allograft vasculopathy are the most frequent underlying causes.

Cystatin C Based Evaluation of Renal Function in Hypertensive Patients in Ubth, Benin City

Background: Hypertension is a recognized cause of chronic kidney disease. Hypertension in blacks is most important because it is volume dependent and its ensuing renal complication. The widely accepted marker to assess renal function is creatinine and its estimated glomerular filtration rate. However, this is limited in assessing early renal impairment. This necessitate a need to evaluate other renal markers such as cystatin C. Objective: To measure and compare serum cystatin C and creatinine for early renal impairment among hypertensive patients on treatment. Methodology: A total of 48 hypertensive patients attending cardiology clinic for follow up were recruited in this study. Serum specimen were collected and assayed for creatinine and cystatin C. estimated glomerular filtration (eGFR) rate was calculated for the analytes. The two eGFR were compared in assessing renal function. Results: The BMI, Blood pressure and Abdominal circumference of the subjects were significantly higher than the controls (31.5±7.5kg/m 2 , 144/82mmHg and 102.3cm vs 26.1±4.3kg/m 2 , 116/80mmHg and 93cm) respectively Table 1. The hypertensives had a significantly higher serum levels of creatinine and cystatin C when compared with the controls (105µmol/L vs 88µmol/L and 2.9mg/L vs 1.1mg/L) respectively Table 2. Calculated estimated GFR for both serum creatinine and cystatin C were significantly lower among the subjects (89.1ml/min/1.73m 2 vs 110ml/min/1.73m 2 and 67.7ml/min/1.73m 2 vs 118ml/min/1.73m 2 ). Estimated GFR based on cystatin C was significantly lower than eGFR-Cr among the subjects (67.7ml/min/1.73m 2 vs 89.1ml/min/1.73m 2 ). There was a significant correlation between BMI and eGFR-Cr, abdominal circumference also had a significant correlation with fasting plasma glucose among the subjects and controls. Conclusion: serum levels of cystatin C appears to be a better predictor of GFR among hypertensive patients.

Left Ventricular Ejection Time in Acute Heart Failure Complicating Precapillary Pulmonary Hypertension

Novel noninvasive tools may improve the management of patients with pulmonary hypertension (PH) experiencing heart failure. Major right ventricle overload leads to decreased stroke volume, which shortens left ventricular ejection time (LVET). Our arterial tonometry study tested the hypothesis that LVET carries prognostic value in patients with precapillary PH with heart failure. Clinical, biologic, and radial artery tonometry variables were prospectively obtained at admission and at day 3 to 5 in 53 consecutive patients with PH admitted to our ICU for clinical deterioration. LVET was measured from the reconstructed aortic pressure curve. Overall ICU mortality (median stay, 5 days) was 17%. At admission, the LVET was shorter in patients with unfavorable outcome (median, 228 milliseconds [25th-75th percentiles, 212-278 milliseconds] vs 257 milliseconds [237-277 milliseconds], P = .032), whereas other tonometric indices were similar. The LVET at entry (237 milliseconds) had 73% sensitivity and 89% specificity for identifying death in the ICU. Other prognostic factors at admission were higher serum levels of brain natriuretic peptide (BNP) and creatinine and lower natremia. Dobutamine requirement, higher furosemide dose, and higher oxygen flow were associated with unfavorable outcome. At the second evaluation, higher serum levels of creatinine and BNP, higher furosemide dose and oxygen flow, and dobutamine or norepinephrine requirement were associated with poor outcome. The change in LVET between admission and follow-up measurement was not associated with outcome. The 90-day mortality was 28%. Shortened LVET at ICU admission was a prognostic factor in patients with precapillary PH with heart failure. Previously documented prognostic factors were also confirmed in this cohort.

Absolute Lymphocyte Count as a Predictor of Mortality in Emergency Department Patients with Paraquat Poisoning

BackgroundParaquat (PQ) is a potent, highly toxic and widely used herbicide. The major medical problems associated with PQ are accidental or suicidal ingestion. There are several prognostic markers of PQ poisoning, with the serum PQ concentration considered to be the best indicator of outcome. However, the measurement of such markers is limited in many hospitals.ObjectiveThe present study was conducted to investigate the association of absolute lymphocyte count (ALC) and the 30-day mortality rate in patients with PQ poisoning.MethodsWe performed a retrospective analysis of patients admitted to the emergency department after paraquat poisoning between January 2010 and April 2013. Independent risk factors including ALC for 30-day mortality were determined. The ALC was categorized in quartiles as ≤1700, 1700 to 3200, 3200 to 5000, and >5000. Univariate and multivariate Cox proportional hazard analysis were performed to determine the independent risk factors for mortality.ResultsA total of 136 patients were included in the study, and the 30-day mortality was 73.5%. ALC was significantly higher in nonsurvivors than in survivors. The highest ALC quartile (ALC>5000; hazard ratio, 2.58; 95% CI, 1.08–6.21) was associated with increased mortality in multivariate analysis. In addition, old age, lower arterial PaCO2, increased peripheral neutrophil count, and high serum levels of creatinine were associated with mortality.ConclusionThe absolute lymphocyte count is associated with the 30-day mortality rate in patients with paraquat poisoning.

Prognostic significance of serum cystatin C in multiple myeloma

Multiple myeloma (MM) is frequently complicated by renal insufficiency, which is associated with an unfavorable prognosis. Serum cystatin C is a new and accurate marker of glomerular filtration rate. Global gene expression analysis has revealed serum cystatin C as one of the most highly upregulated genes in MM. Recent data have shown serum cystatin C as an independent prognostic marker in MM. To further elucidate the prognostic significance of serum cystatin C, we investigated pretreatment serum cystatin C levels in 68 newly diagnosed patients homogeneously treated with high-dose melphalan followed by autologous stem cell transplantation. Median serum cystatin C level in MM patients was significantly higher than in the 66 healthy controls (1.07 vs. 0.74 mg/L [p = 0.002]). Median serum cystatin C levels significantly increased with higher International Staging System (ISS) stages (stage I 0.72 mg/L; stage II 0.89 mg/L; stage III 1.28 mg/L; p < 0.0001). Higher serum cystatin C was positively correlated with higher serum levels of creatinine (r = 0.84; p < 0.0001), β2-microglobulin (r = 0.72; p < 0.0001), LDH (r = 0.43; p = 0.0003), white blood cell counts (r = 0.61; p < 0.0001) and calcium (r = 0.29; p = 0.016), and negatively correlated with lower serum albumin levels (r = 0.44; p < 0.0001) and hemoglobin levels (r = 0.31; p = 0.01). Using ROC analysis, patients with serum cystatin C levels ≥0.95 mg/L (n = 24) had a significantly shorter event-free survival (EFS) and overall survival (OS) than patients with serum cystatin C levels <0.95 mg/L (median EFS: 26 vs. 44 months, p < 0.0001; median OS: 54 vs. 68 months, p = 0.05). Moreover, the combination of serum cystatin C level and genomic aberrations further refined the prognostic information (EFS and OS) provided by either one of the factors. The level of serum cystatin C is not only a sensitive marker of renal function, but also reflects tumor burden and delivers prognostic information in MM.

Prevalence of and clinicopathologic findings associated with ascites in dogs in Enugu State, Nigeria

This study investigated the prevalence of and clinicopathologic findings associated with grade 3 ascites in dogs presented at three major veterinary clinics in Enugu State, Nigeria between January and December 2010. Blood samples were collected from reported cases for haematology and serum chemistry tests, while the ascites fluid was collected for cytological and relevant clinical chemistry determinations. Blood samples were also collected from 12 apparently healthy non-ascitic dogs from the study population to serve as control. All haematology, cytology and clinical chemistry tests were carried out following standard procedures. Results showed that out of a total of 1,788 dogs presented in the three clinics during the study period, 14 had grade 3 ascites (0.78%), and there were no significant differences (p > 0.05) between the prevalence obtained from the different clinics. There were also no significant association (p > 0.05) between sex and prevalence. However, the prevalence was significantly higher (p < 0.05) in dogs 3 years and above (71.4%) than in those 1 to 2.9 years of age (21.4%) and those less than 1 year of age (7.1%). Alsatian–Rottweiler crosses had a significantly (p < 0.05) higher prevalence (50%) than all other breeds. The 14 ascites cases were classified into four causative types: cirrhotic liver disease (CLD)—14.3%; chronic active hepatitis (CAH)—21.4%; congestive heart failure (CHF)—50%; and kidney damage (KD)—14.3%. Each of these types presented certain characteristic serum chemistry and haematological findings. Dogs with CLD had a significantly (p < 0.05) very low serum activity of alanine amino transferase (ALT) and aspartate amino transferase (AST) and very low serum urea levels, and also significantly (p < 0.05) very high serum activity of alkaline phosphatase (ALP), while dogs with CAH had a contrasting significantly (p < 0.05) very high serum activity of ALT, AST and ALP when compared to the controls. Dogs with CHF were characterised by significantly (p < 0.05) very high serum AST activity, while dogs with KD were characterised by significantly (p < 0.05) very high serum levels of creatinine and urea, significantly (p < 0.05) very low packed cell volume, red blood cell counts and haemoglobin concentration. The ascites fluid was a transudate in all cases. It was concluded that the prevalence of grade 3 ascites in dogs in the study area was low, and that most of the cases were due to CHF, followed by CLD, CAH and KD, each of which was characterised by some specific serum chemistry and haematological abnormalities that could be of diagnostic importance.

Comparison of outcomes of white versus black patients hospitalized with heart failure and preserved ejection fraction

Black patients who have heart failure (HF) may have a larger proportion of HF with preserved ejection fraction (PEF) than white patients because of the greater prevalence and severity of hypertension and left ventricular hypertrophy in blacks. However, studies have not systematically evaluated differences by race in patients who have HF-PEF compared with those who have systolic HF (SHF). Therefore, we examined baseline characteristics and long-term outcomes in patients who had HF-PEF compared with those who had SHF, with an emphasis on variation by race, in a biracial cohort of patients treated within the Veterans Health Administration health care system. In a cohort of 448 patients (192 blacks and 256 whites) hospitalized with HF, 27% had HF-PEF. The proportion of HF-PEF was similar in black (25%) and white (29%) patients (p = 0.4). Among patients who had SHF, black patients were younger, had lower prevalences of atrial fibrillation and diabetes, and had less co-morbidities than white patients, whereas there were no significant differences in these variables by race in patients who had HF-PEF. However, among patients who had SHF or HF-PEF, blacks had a lower prevalence of coronary disease, higher systolic and diastolic blood pressures, and higher serum levels of creatinine than white patients. In addition, mortality and readmission rates for HF did not differ by race among patients who had HF-PEF. Overall, patients who had HF-PEF had a high morbidity rate (30% patients were readmitted for HF in </=6 months) and a high mortality rate (44% at 3 years), despite the use of angiotensin-converting enzyme inhibitors by 66% of patients at discharge. This underscores the importance of evaluating other agents for the treatment of patients who have HF-PEF.