Mean Creatinine Research Articles

Detection of Creatinine in Vaginal Fluid for Diagnosis of Preterm Premature Rupture of Membranes

Background: to evaluate the role of vaginal fluid creatinine level in diagnosis of preterm prelabour rupture of membranes among patients giving history of amniotic fluid leak. Objectives: the aim of this study was to evaluate the reliability of vaginal fluid creatinine level in the vaginal fluid for diagnosis of prelabour premature rupture of membranes. Patients and Methods: 100 pregnant women with gestational age 24: 37 weeks gestation participated in the present study divided into 2 groups. Group I (confirmed PROM group) & group II (control non-PROM group). All patients underwent a sterile speculum examination for detection of amniotic fluid pooling in the posterior vaginal fornix followed by taking 3ml from vaginal fluid. Creatinine measurement was done using ELISA. Results: The mean creatinine levels in vaginal fluid in group (I) & group (II) were.70 ± 0.88 and.04 ± 0.18 mIU/mL respectively. The difference was statistically significant (P value < 0.001). With creatinine cut-off value of 0.25 mIU/ml, the sensitivity & specificity in confirming PROM were 72 and 94% respectively. Conclusion: Creatinine level was significantly higher in pregnant women with definite PROM. Therefore, vaginal fluid creatinine can be used as an easy, rapid, reliable and non-invasive test for confirming the diagnosis of PROM and can be used as an adjunctive test in equivocal cases.

Detection of Creatinine in Vaginal Fluid for Diagnosis of Preterm Premature Rupture of Membranes

Background: to evaluate the role of vaginal fluid creatinine level in diagnosis of preterm prelabour rupture of membranes among patients giving history of amniotic fluid leak. Objectives: the aim of this study was to evaluate the reliability of vaginal fluid creatinine level in the vaginal fluid for diagnosis of prelabour premature rupture of membranes. Patients and Methods: 100 pregnant women with gestational age 24: 37 weeks gestation participated in the present study divided into 2 groups. Group I (confirmed PROM group) & group II (control non-PROM group). All patients underwent a sterile speculum examination for detection of amniotic fluid pooling in the posterior vaginal fornix followed by taking 3ml from vaginal fluid. Creatinine measurement was done using ELISA. Results: The mean creatinine levels in vaginal fluid in group (I) & group (II) were.70 ± 0.88 and.04 ± 0.18 mIU/mL respectively. The difference was statistically significant (P value < 0.001). With creatinine cut-off value of 0.25 mIU/ml, the sensitivity & specificity in confirming PROM were 72 and 94% respectively. Conclusion: Creatinine level was significantly higher in pregnant women with definite PROM. Therefore, vaginal fluid creatinine can be used as an easy, rapid, reliable and non-invasive test for confirming the diagnosis of PROM and can be used as an adjunctive test in equivocal cases.

Renal Replacement Therapy in Intensive Care Unit at a Tertiary Care Center in Nepal

Acute kidney injury is a major complication in intensive care unit patients. It is associated with increased in-hospital mortality and length of stay. The provision of renal replacement therapy in intensive care is not widely available in resource poor countries like Nepal. The study aims to look into clinical profile and outcome of patients who received renal replacement therapy in intensive care unit. It was an observational study done from 1st October 2016 till 30th September 2017. Patient’s demographic data, indications, biochemical tests, outcomes, modality of renal replacement therapy were recorded. Statistical package for the social sciences version 17 was used for statistical analysis. There were total of 649 admissions in intensive care, among which 148 had kidney related complications. Of 148 patients, 69 (47%) received renal replacement therapy. Mean age, urea and creatinine on admission were 50.17 ± 18.42 years, 174.54 ± 63.46 mg/dl and 8.05 ± 3.49 mg/ dl respectively. They underwent 4.32 ± 3.09 sessions and 14.94 ± 10.88 hours of renal replacement therapy. Total 42 (61%) had septic shock on admission and underwent sustained low efficiency dialysis as the modality of renal replacement therapy. In-hospital mortality was 19 (28%). Presence of septic shock on admission and mean number of ionotropes required 2.05 ± 1.12 was statistically significant for in-hospital mortality (p=0.01). About half of the patients were on mechanical ventilation which was statistically significant for in-hospital mortality (p&lt;0.001). Sustained low efficiency dialysis can be done in patients on ionotropes and patients can be switched over to intermittent hemodialysis.

Hypomagnesemia is Associated with New-Onset Diabetes Mellitus Following Heart Transplantation

Purpose Diabetes mellitus (DM) is a major cause of morbidity and mortality following heart transplantation (HT), with 21% and 35% of survivors being affected within 1 and 5 years following HT, respectively. Magnesium (Mg) deficiency is common among HT patients treated with calcineurin inhibitors and is a known risk factor for DM in non-HT patients. We therefore investigated the association between serum Mg (s-Mg) levels and new-onset diabetes after transplantation (NODAT). Methods Between 2002 and 2017 we assessed 101 non-DM HT patients. S-Mg levels were reviewed during the first year post-HT. In accordance with the mean value of all s-Mg levels recorded during the first year, patients were divided into high s-Mg (≥1.8 mg/dL) and low s-Mg ( hemoglobin A1c ≥6.5%; fasting plasma glucose ≥126 mg/dL; or random plasma glucose ≥200 mg/ dL. Results Baseline clinical and demographic characteristics for the high s-Mg (n=42) and low s-Mg (n=59) groups were similar. Kaplan-Meier survival analysis showed that 15-year freedom from NODAT was significantly higher among patients with high s-Mg vs low s-Mg (84% vs 22% log-rank test, p=0.003, Figure). Consistently, multivariate analysis adjusted for age, gender, immunosuppression therapies and mean creatinine values of the first year post-HT, showed that low s-Mg was independently associated with a significant >5-fold increased risk for NODAT (95% CI 1.35-21.04, p=0.02). Patients with low s-Mg levels had a significantly higher rate of cerebrovascular events than patients with high s-Mg (15.5% vs 0, p=0.02). Conclusion Low post-HT s-Mg level is an independent risk factor for NODAT in HT patients. The implications of interventions, focusing on preventing or correcting low s-Mg, on the risk for NODAT and on clinical outcomes should be evaluated.

Augmented Renal Clearance.

Augmented renal clearance (ARC) is a phenomenon in critically ill patients characterized by increased creatinine clearance and elimination of renally eliminated medications. Patients with severe neurologic injury, sepsis, trauma, and burns have been consistently identified as at risk of ARC, with mean creatinine clearances ranging from 170ml/minute to more than 300ml/minute. Several potential mechanisms may contribute to the occurrence of ARC including endogenous responses to increased metabolism and solute production, alterations in neurohormonal balance, and therapeutic maneuvers such as fluid resuscitation. Augmented renal clearance is associated with suboptimal exposure to critical medications, including β-lactams and vancomycin, increasing the risk of treatment failure. Although definitive screening tools are not yet known, critical care pharmacists must be vigilant in recognizing when ARC may be a contributing factor affecting expected treatment outcomes in individual patients. Optimizing dosing strategies in critically ill patients with ARC remains a goal of continued research. The current review discusses the clinical characteristics and methods of identifying patients at risk of ARC, potential mechanisms for ARC, and describes pharmacotherapy dosing considerations in patients with ARC.

Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience

ObjectiveThis study aimed to determine if superselective renal artery embolization is a safe and effective method of treating bleeding complications after percutaneous renal biopsy.MethodsFrom January 2006 to December 2017, 43 patients (22 men and 21 women, mean age: 44.5 ± 14.0 years) underwent angiography for post-biopsy bleeding complications following percutaneous biopsy. Patients underwent angiography and superselective artery embolization. We recorded serum creatinine and hemoglobin values to assess the effect of embolization.ResultsSuccessful embolization was achieved in all patients. There was a pseudoaneurysm in 10 cases, arteriovenous fistula in eight, contrast media extravasation in 16, arteriovenous fistula combined with contrast media extravasation in five, and pseudoaneurysm combined with arteriovenous fistula in four. The embolic substance was a microcoil only or combined with a gelatin sponge. The mean creatinine value was not different at 1 day and 1 week after embolization compared with before embolization. Mean hemoglobin values were significantly higher at 1 day and 1 week after embolization than before embolization.ConclusionsSuperselective renal artery embolization is a safe and effective treatment for post-biopsy bleeding complications after percutaneous renal biopsy. Lumbar or iliolumbar artery angiography is necessary if renal arteriography shows no signs of hemorrhage.

Persistent hyperlactataemia is related to high rates of in-hospital adverse events and poor outcome in acute heart failure.

Although lactate is a well-established marker in intensive care, our understanding of its utility in acute heart failure (AHF) is modest and based on studies with a single measurement of this marker. We aimed to investigate whether persistent elevation of lactate during hospitalisation is related to a higher risk of ad- verse events. We conducted a prospective study to assess AHF patients hospitalised in one cardiac centre. The diagnosis of persistent hyperlactataemia was based on two measurements of the marker (on admission and at 24 h of hospitalisation) and it was defined as lactate elevation (≥ 2 mmol/L) at both time points. The population consisted of 222 patients at a mean age of 70 ± 13 years. Mean ejection fraction and creatinine level on admission were 37% ± 16% and 1.36 ± 0.51 mg/dL, respectively. The percentage of patients with elevated lactates on admission, at 24 h of hospitalisation, and persistent hyperlactataemia were 47%, 35%, and 24%, respectively. The group with persistent hyperlactataemia did not differ in most clinical and laboratory variables from the rest of the population. Patients with persistent hyperlactataemia had higher rate of adverse events during hospitalisation: worsening of heart failure (22.6% vs. 6.5%, p < 0.05), inotrope use (22.6% vs. 5.3%, p < 0.05), and increase of N-terminal pro-B-type natriuretic peptide at 48 h of hospitalisation (30% vs. 18%, p < 0.05). Persistent hyperlactataemia was an independent predictor of one-year mortality (hazard ratio 2.5, 95% confidence interval 1.5-4.3, p < 0.001). Persistent hyperlactataemia within the first 24 h of hospitalisation is a predictor of a worse outcome in AHF and is related to higher rates of in-hospital adverse events and one-year mortality.

Severity of Mucositis Determines Cyclosporine Levels after Allogeneic Transplantation

Introduction Intestinal mucosal injury is a common complication following allogeneic stem cell transplant (alloHSCT), especially with myeloablative and TBI-based (total body irradiation) conditioning regimens. Prospective evaluation studies have shown that intestinal malabsorption persists for several weeks following conditioning, beyond visible resolution of mucositis and bowel integrity. Serum cyclosporine levels in the early to intermediate post-transplant period (when patients are taking oral cyclosporine) may be affected by reduced gut absorption and could influence early transplant related outcomes. Objective To determine the relationship between mucositis severity, cyclosporine levels, and post-transplant outcomes. Methods 169 patients who received myeloablative (BuCy, CyTBI, EtoTBI) or reduced-intensity (FluMel) allo-HSCT at the Royal Melbourne Hospital were studied. Serum cyclosporine levels were measured at 2 hours post oral dosing. Days of post-transplant total parental nutrition (TPN) were used as a surrogate for severity of gastrointestinal mucositis. To determine degree of renal impairment, creatinine values were recorded at baseline, D+30, D+60 and D+100. Percentage increase of mean creatinine above baseline was taken as an index of renal impairment. The incidence and severity of acute graft-versus-host disease (aGVHD) was recorded before D+100. The incidence of CMV viraemia before D+100 was recorded and analysed according to serum viral load. Patients with recurrence of disease were compared with patients without recurrence ( 6 months). Results Linear regression analysis showed an inverse correlation between days requiring TPN with the post SCT 100-day median cyclosporine level (p Higher median cyclosporine level was associated with a greater percentage increase of creatinine above baseline (p=0.004, R2= 0.051). There was no significant correlation between incidence (p=0.05) and severity (p=0.47) of aGVHD with lower cyclosporine levels. CMV reactivation was associated with higher cyclosporine levels (p Conclusion Our data suggest that patients who have significant mucositis have lower serum cyclosporine levels with oral cyclosporine dosing, which in turn impact upon post-transplant outcomes, in particular renal impairment and CMV reactivation.

Stent Placement Across the Renal Vein Inflow in Patients Undergoing Venous Reconstruction Preserves Renal Function and Renal Vein Patency: Experience in 93 Patients

Purpose: To determine if stent placement across the renal vein inflow affects kidney function and renal vein patency. Methods: Between June 2008 and September 2016, 93 patients (mean age 39 years, range 15–70; 54 women) with iliocaval occlusion underwent venous stent placement and were retrospectively reviewed. For this analysis, the patients were separated into treatment and control groups: 51 (55%) patients had suprarenal and infrarenal iliocaval venous disease requiring inferior vena cava stent reconstruction across the renal vein inflow (treatment group) and 42 (45%) patients had iliac vein stenting sparing the renal veins (control group). Treatment group patients received Wallstents (n=15), Gianturco Z-stents (n=24), or suprarenal and infrarenal Wallstents such that the renal veins were bracketed with a “renal gap” (n=12). Stenting technical success, stent type, glomerular filtration rate (GFR), and creatinine before and after stent placement were recorded, along with renal vein patency and complications. Results: All procedures were technically successful. In the 51-patient treatment group, 15 (29%) patients received Wallstents and 24 (47%) received Gianturco Z-stents across the renal veins, while 12 (24%) were given a “renal gap” with no stent placement directly across the renal vein inflow. In the control group, 42 patients received iliac vein Wallstents only. Mean prestent GFR was 59±1.8 mL/min/1.73 m2 and mean prestent creatinine was 0.8±0.2 mg/dL for the entire cohort. Mean prestent GFR and creatinine values in the Wallstent, Gianturco Z-stent, and “renal gap” subgroups did not differ from the iliac vein stent group. Mean poststent GFR and creatinine values were 59±3.3 mL/min/1.73 m2 and 0.8±0.3 mg/dL, respectively. There were no differences between mean pre- and poststent GFR (p=0.32) or creatinine (p=0.41) values when considering all patients or when comparing the treatment subgroups and the control group. There were no differences in the poststent mean GFR or creatinine values between the Wallstent (p=0.21 and p=0.34, respectively) and Gianturco Z-stent (p=0.43 and p=0.41, respectively) groups and the “renal gap” group. One patient with a Wallstent across the renal veins developed right renal vein thrombosis 7 days after the procedure. Conclusion: Stent placement across the renal vein inflow did not compromise renal function. A very small risk of renal vein thrombosis was seen.

Elevated lactate in acute heart failure patients with intracellular iron deficiency as identifier of poor outcome.

We believe that there is a physiological link between intracellular iron status (assessed by soluble transferrin receptor [sTfR]) and efficiency of energy production/consumption (assessed by lactate, a product of anaerobic cell metabolism), which may further impact the outcome of patients with acute heart failure (AHF). To examine if elevated levels of lactate (> 2 mmol/L) accompanied by unmet cellular iron requirements (defined as sTfR > 1.59 mg/L) identify AHF patients with an unfavourable outcome. The study is a single-centre, retrospective analysis of AHF patients in whom lactate and iron status were assessed on admission. The endpoint of the study was one-year mortality. The study population consisted of 89 patients at a mean age of 65 ± 13 years. Mean systolic blood pressure and creatinine level were 135 ± 36 mmHg and 1.3 ± 0.6 mg/dL, respectively, and median [25th-75th quartiles] lactate level on admission was 2.0 [1.6-2.6] mmol/L. In 17 (19%) patients, both lactate and sTfR were below the cut-off values (group 1). In 38 (43%) individuals one of the markers was elevated (group 2) and in the remaining 34 (38%) patients both markers were above the predefined cut-off values (group 3). There was no difference in clinical and laboratory characteristics between the groups. During one-year follow-up 23 (26%) patients died. Mortality risk in group 3 was higher compared to the rest of the population (hazard ratio 5.6, 95% confidence interval 2.2-14, p = 0.0003), even after adjustments for well-defined prognostic factors. Patients with unmet iron cell requirements and hyperlactataemia on admission have significantly higher mortality risk compared to individuals without those pathologies.

Serious central nervous system side effects of cephalosporins: A national analysis of serious reports registered in the French Pharmacovigilance Database

IntroductionAmong antibiotics, Central Nervous System (CNS) adverse drug reactions (ADRs) are often under-suspected and overlooked. Cephalosporins are an important cause of drug-induced CNS ADRs but the characteristics of such ADR have not been fully explored. We aimed to characterize the profile of cephalosporins serious CNS ADRs. MethodWe performed an analysis of serious reports recorded in the French Pharmacovigilance database from 1987 to 2017. ResultsA total of 511 serious ADRs reports was analyzed. Patients had a mean age of 67.1 years and were mainly men (52.5%), with a mean creatinine clearance of 32.9 ml/min. The most involved molecules were cefepime (33.1%), ceftriaxone (29.7%), ceftazidime (19.6%), cefotaxime (9%) and cefazoline (2.9%), mostly administered intravenously (87.3%). A CNS history was observed in 25% of the reports (n = 128). Patients exhibited encephalopathy (30.3%), confusional state (19.4%), convulsion (15.1%), myoclonia (9.4%), status epilepticus (9.2%), coma (6.3%) and hallucination (4.3%). The mean time of onset was 7.7 days and the mean duration was 6 days. Cephalosporin plasma levels were recorded for 153 patients (29.9%) and 107 were above the standards including 62 (57.9%) related to renal impairment. Electroencephalograms were performed in 38.2% (n = 195) of the patients and 81% (n = 158) were abnormal. ConclusionThis study characterizes an off-target CNS ADRs of several cephalosporins. Ceftriaxone represented a large part of our reports after cefepime and it would be relevant to warn healthcare professionals. Investigations (EEG, though plasma levels and renal function) can be precious tools for clinicians to make a prompt diagnosis and improve patients' outcomes.

P. falciparum Malaria induced Renal impairment

Introduction: The involvement of the kidney in falciparum malaria has been known for decades. In 1944, Spitz observed acute renal failure due to falciparum infection in soldiers during World War II. This observation was later supported by other workers who detected oliguria developing in patients with black water fever. The initial clinical pattern is that of reversible renal dysfunction or pre-renal azotemia, which rapidly progresses to acute tubular necrosis if treatment is not started early. Patients with malaria induced renal failure are hypercatabolic with blood urea and serum creatinine levels rising rapidly.Oliguric as well non-oliguric renal failure are observed and duration of oliguric renal failure ranges from a few days to several weeks depending on the severity of renal dysfunction. Acute renal failure in falciparum malaria is usually associated either with acute intravascular haemolysis or heavy parasitemia. Acute renal failure in falciparum malaria is also observed in patients with severe intravascular haemolysis resulting in haemoglobinuria. It may be induced by malarial fever or by anti-malarial drugs in a patient with or without G6-PD deficiency. Materials and Methods: This is a hospital based cross sectional study carried out in a total of 50 cases of acute renal failure who were selected from diagnosed patients of P. falciparum malaria. Cases were confirmed either by P. falciparum antigen test and/or peripheral blood smear test(both thick and thin smear).Malarial ARF (MARF) is diagnosed when serum creatinine level &gt; 3 mg/dl, and/or urine output &lt; 400 ml/24hrs despite adequate rehydration. Result: Out of 174 cases of falciparum malaria 50 patients (28.7%) had acute renal failure in falciparum malaria. 36 (72%) cases were males and 14 (28%) were females, indicating a much higher incidence in males. Approximately 78% of the cases in the present study were below the age of 40 years. The youngest was 15 years old and the oldest was 61 years old (Mean age – 32 ± 11.6 years). All were febrile (100%) and a majority had oliguria or anuria (72%); jaundice was detected in 30 (60%) patients on presentation. Hepatomegaly &amp; Splenomegaly were found in 76% &amp; 66% of the cases respectively. Out of the total 50 cases of malaria induced ARF, 14 cases (28%) had pre-renal ARF while in the majority, 72% the clinical course was that of ATN. The pathogenesis of ATN in the 36 cases was found to be heavy parasitaemia in 40% of the cases, IV hemolysis with haemoglobinuria in 3 (6%) of cases; and cholestatic jaundice in 26% of falciparum patients. Examination of the urinary sediments revealed that albumin was present in urine in 40 cases (80%). Majority of the patients had significant rise in blood urea level with a mean value of 177 mg. S. creatinine levels ranged between 3.2 - 13.6 mg with a mean value of 7.83 mg. The mean creatinine clearance rate was 11.71 ml/min. The overall mortality rate was 26%. Conclusion: AKI is common in Falciparum malaria. The pathogenesis of AKI is largely unknown but may be related to the erythrocyte sequestration and agglutination within the renal microcirculation interfering with flow and metabolism. Clinically and pathologically, this syndrome manifests as Pre-renal azotemia and acute tubular necrosis. Acute renal failure may occur simultaneously with other vital-organ dysfunction (in which case the mortality risk is high) or may progress as other disease manifestations resolve. Early dialysis or hemofiltration considerably enhances the likelihood of a patient’s survival, particularly in acute hypercatabolic renal failure. Severity of oliguria and presence of one or more associated complications like pulmonary oedema, acidosis, and altered sensorium have considerable influence on the outcome of the patients.

Short-Term Outcomes of Treatment of Boys with Posterior Urethral Valves.

Background:Posterior urethral valve (PUV) is a significant cause of morbidity and mortality among male children resulting in renal failure in 25%–30% before adolescence irrespective of initial treatment. This study aimed at evaluating the early outcomes of children managed for PUV.Materials and Methods:This was a prospective study of all children who were treated for PUV between 2012 and 2016 at a single referral institution. Information reviewed included demographic and clinical data, imaging findings, pre- and post-operative serum electrolytes, and postoperative renal outcomes.Results:Twenty-nine male children were managed for PUV at a median age of 6 months including 7 (24.1%) neonates. Two (6.9%) patients had antenatal diagnosis. Micturating cystourethrogram confirmed PUV in all patients. Fourteen (48.3%) patients had impaired renal function (IRF) at presentation and 8 (57%) had improved renal function (RF) after initial catheter drainage. The mean creatinine at presentation was 1.86 ± 1.69 mg/dl and the mean serum creatinine following initial catheter drainage was 0. 93 ± 0.49 mg/dl (P = 0.003). For those patients with normal RF, the mean creatinine at presentation was 0.81 ± 0.22 mg/dl versus 0.74 ± 0.21 mg/dl (P = 0.012), following initial catheter drainage. Children with IRF on admission had mean creatinine at presentation of 2.61 ± 2.00 mg/dl compared to 1.17 ± 0.53 mg/dl (P = 0.002) after initial catheter drainage. Valve ablation was achieved with Mohan's valvotome in 26 (96.3%) patients. All patients had good urine stream at a median follow-up of 5 months. Four (13.8%) patients developed IRF at follow-up. Renal outcomes of patients presenting before 1 year and those presenting after 1 year were similar. Two children died preoperative of urosepsis and one out of hospital death given an overall mortality of 10.3% (n = 3).Conclusion:There was significant improvement in RF after initial catheter drainage. The incidence of IRF at follow-up was 13.8%. Long-term follow-up is necessary to identify patients at risk of end-stage renal disease.

Computed Tomography with Intravenous Contrast is Not Associated with Development of Acute Kidney Injury in Severely Injured Pediatric Patients

Data for the incidence of acute kidney injury (AKI) related to intravenous contrast administration in the pediatric trauma population are limited. Obtaining a creatinine value before elective CT scans is a relatively accepted standard of care. We sought to determine whether there was any significant difference in the incidence of AKI between severely injured patients who received IV contrast and those who did not. We reviewed data from the trauma registry at our Level I pediatric trauma center. We limited the patients to severely injured pediatric traumas (<15 years old) directly transported from the scene of injury with a creatinine level measured on arrival. Two hundred and eleven patients were included in the study. AKI was defined by the criteria of the AKI Network. We then compared incidence of AKI in those who received a CT scan with IV contrast with those who did not receive IV contrast. The two groups were comparable in age, gender, Glasgow Coma Scale, Injury Severity Score, mean creatinine on arrival, and mean creatinine post-CT scan/arrival. There was no significant difference in AKI between the two. In a subgroup analysis of patients presenting in shock, there was no significant difference in AKI. Our study suggests that IV contrast is not associated with the development of AKI in severely injured pediatric trauma patients. Although obtaining a creatinine value before exposure is ideal, a CT scan with IV contrast in severely injured children should not be delayed to obtain a creatinine value.

Nutritional and phytogenic properties of pawpaw (Carica papaya) leaf meal on blood characteristics of growing rabbits

Nutritional and phytogenic properties of pawpaw (Carica papaya) leaf meal on blood characteristics of growing rabbits

Effect of genotype on haematology and serum biochemistry of Nigerian indigenous roosters (cockerels)

An experiment was conducted to determine the haematology and serum biochemistry of three genotypes of Nigerian indigenous roosters. A total of twenty-seven roosters aged 8 months were used. They were divided into 3 treatment groups as T1, T2 and T3, representing frizzled, naked neck and normal feathered roosters respectively. Each of the treatment group consisted of Nine (9) roosters, replicated 3 times with 3 roosters per replicate in a completely randomized design (CRD). They were fed grower mash for 35 days after which blood samples were collected for haematological and serum biochemical evaluation. The parameters measured included haemoglobin (Hb), red blood cell (RBC), white blood cell (WBC), packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular heamoglobin concentration (MCHC), total protein, albumin, urea, globulin, glucose, creatinine and cholesterol. The results of the study revealed that all the parameters measured showed no significant differences (P&gt;0.05) among the treatment groups although variations were observed among the different genotypes. More so, almost all the parameters measured are within the normal ranges for chicken.

Postmarketing surveillance on clinical use of edoxaban in patients with nonvalvular atrial fibrillation (ETNA-AF-Japan): Three-month interim analysis results.

BackgroundDirect oral anticoagulants are the first‐line drugs for anticoagulation therapy in nonvalvular atrial fibrillation (NVAF). However, a real‐world, large‐scale, clinical study on edoxaban has not been performed. Our ongoing postmarketing surveillance, ETNA‐AF‐Japan (Edoxaban Treatment in routiNe clinical prActice in patients with non‐valvular Atrial Fibrillation; UMIN000017011), was designed to collect such data.MethodsEnrollment started on 13 April 2015 and ended on 30 September 2017. Eligible patients were those diagnosed with NVAF who were to receive edoxaban for the first time and provided written consent for study participation. Baseline patient characteristics and adverse events (AEs) were collected.ResultsA total of 11 569 patients were enrolled. Data for 8157 patients in the first 3 months were analyzed. Mean age, body weight, creatinine clearance (CLcr), and CHADS 2 score were 74.2 ± 10.0 years, 60.0 ± 12.6 kg, 64.0 ± 25.6 mL/min, and 2.2 ± 1.3, respectively. Female patients, and patients with age ≥75 years, body weight ≤60 kg, and CLcr <30 mL/min constituted 40.7%, 52.4%, 54.6%, and 4.7%, respectively. Patients with paroxysmal, persistent, and permanent AF constituted 46.1%, 38.7%, and 15.1%, respectively. Most patients (85.3%) received dosages according to the prescribing information, and 90.8% continued the medication for 3 months. Bleeding AEs occurred in 3.29%, including major bleeding in 0.29%.ConclusionsThe majority (90.8%) of patients continued medication and no significant safety concerns related to edoxaban were reported during the first 3 months of treatment. Clearer safety and efficacy profiles of edoxaban await data analyses after the 2‐year follow‐up period.

Thirty-day clinical outcomes after an atrial flutter ablation in patients on dabigatran: The Flutter French prospective study

To evaluate the clinical management and 30-day outcomes of patients taking dabigatran and undergoing atrial flutter ablation in everyday clinical practice. Study Flutter is a multicentre, observational, prospective study of patients undergoing an atrial flutter ablation. Eligible patients had been taking dabigatran (150 or 110 mg twice daily) for ≥ 3 weeks before the procedure and were followed for 30 days afterwards. A total of 90 patients (71 ± 12 years, 81% male, mean CHA2DS2-VASc score 2.2 ± 1.3) were enrolled at 10 academic/non-academic centers in France. The most prevalent concomitant disorders were hypertension (31% of patients), diabetes (15%) and vascular disease (11%). Only 6 patients (6.7%) had a history of stroke. Mean creatinine value was 88 ± 22 mmol/L, mean creatinine clearance (Cockroft − Gault) was 85 ± 35 mL/min, and median weight was 83 ± 19 kg. Sixty-five patients (73%) were receiving dabigatran 300 mg/day and 25 (27%) 220 mg/day. The patients were receiving dabigatran at 220 mg/day because of an age ≥ 80 year old for 24 patients (26.7%), an age between 75 and 80 years old and an aspirin treatment (1 patient). Dabigatran was not or shortly discontinued before flutter catheter ablation, with a median duration of interruption of 5 ± 8 hours. Preprocedural bridging with therapeutic LMWH was performed in only one patient with enoxaparin twice daily. Among the patients, 19 (21%) had a TEE before the procedure. No thromboembolic event, major bleeding complications or death were recorded within 30 days of the procedure. These preliminary observational data of patients on dabigatran undergoing atrial flutter ablation procedures in everyday practice show a good safety at 30 days.

Effects of iso-osmolar contrast media on renal function in elderly patients

Objective To investigate the effect of iso-osmolar contrast media (IOCM) on renal function in elderly patients. Methods The clinical data of 77 patients aged over 65 years undergoing vascular angiography and interventional therapy using IOCM with a dose>100 ml from September 2016 to May 2017 were retrospectively analyzed. Serum creatinine (CRE), urea and uric acid were measured before angiography, within 48 h and 3-7 d after angiography. The incidence of contrast-induced nephropathy (CIN) and the renal function before and after angiography were compared. Results Among the 77 patients, 58 were males and 19 were females, with an average age of (73.8±7.2) years. The mean serum CRE values before and 3-7 days after angiography were (84.55±39.92) μmol/L and (83.87±38.45) μmol/L respectively (t=0.140, P=0.889); the mean serum urea levels were (5.64±2.36) mmol/L and (6.44±3.15) mmol/L (t=3.041, P=0.003); the mean serum uric acid levels were (281.39±85.30) μmol/L and (333.29±89.89) μmol/L (t=7.297, P<0.001), respectively. CIN occurred in 7 patients with an incidence of 9.1%. In 7 patients with CIN, the mean CRE values increased from (135.71±102.41) μmol/L before angiography, to (180.00±100.45) μmol/L within 48 h and (142.86±92.97) μmol/L 3-7 d after angiography (F=9.876, P=0.011); and the uric acid levels progressively decreased from (353.43±86.73) μmol/L before angiography, to (339.14±85.69) μmol/L within 48 h after angiography and (299.57±95.71) μmol/L 3-7 d after angiography (F=5.713, P=0.029). Conclusion In elderly patients, IOCM has relatively mild effect on renal function during vascular angiography or interventional therapy. Key words: Contrast media; Aged; Acute kidney injury

Comparing the Liver Function of Children with Acute Lymphoblastic Leukemia (ALL) Receiving Standard or High Intensity Treatment during the Interim Maintenance I Phase of Therapy: A Study of 658 Patients

Introduction: Hepatotoxicity is a challenging adverse event associated with acute lymphoblastic leukemia (ALL) therapy. Due to a lack of large, diverse, and well-characterized cohorts in pediatric ALL, factors predictive of therapy-related adverse events such as hepatotoxicity are not well understood. Here, we leveraged a data repository jointly developed between two large pediatric oncology treatment centers to assess the impact of host and disease-related factors on risk for liver dysfunction. Our aim was to better understand risk determinants of hepatotoxicity in patients risk-stratified to receive one of two potentially hepatotoxic regimens during their first interim maintenance (IM1) therapy phase.Methods: All patients were treated for ALL between 2006-2014 at either Children's Hospital of Philadelphia (CHOP) or Texas Children's Hospital (TCH). We collected patient data by combining targeted manual abstraction and extensive semi-automated extraction of patient electronic medical record (EMR) data. Demographic information, disease-related data, and all laboratory values collected during treatment (along with age-related normal values) were obtained and stored in REDCap™ databases. To reduce cohort heterogeneity and better address our objective of understanding hepatotoxicity risk with standard ALL regimens, we removed patients who received non-standard ALL therapies. We separated the remaining patients into those who received more intensive IM1 therapy with high dose methotrexate (‘HDMTX’: 5grams/m2 intravenously over 24hrs q2 weeks x 4) vs. those who received less intensive therapy with Capizzi methotrexate (‘Capizzi’: dose escalation by 50 mg/m2 every 10 days x 5, starting at 100mg/m2). We restricted our analysis to liver-relevant labs obtained during this phase: AST (SGOT), ALT (SGPT), total bilirubin, conjugated bilirubin, and creatinine. Each was normalized as a ratio of the age-related upper limit of normal (ULN), and then each lab obtained throughout the phase was averaged across all patients within the two treatment groups. Multivariate mixed-effects linear regression with random effects was used to identify differences in each averaged lab value during IM1 related to the following covariates: race/ethnicity, sex, age, treating center, and overweight/obesity (yes/no). Significance cutoff: p <0.05Results: Out of 923 ALL patients, 658 received IM1 as their third block of ALL therapy and were included for analysis. Mean age was 7.1 years, with those receiving HDMTX older than those receiving Capizzi, as expected (4.91 years vs. 10.03 years, p <0.0001). Non-Hispanic white patients comprised nearly 50% of patients, followed by Hispanic patients (35%), and the remaining Non-Hispanic black, Asian, and other each <10%. There was no difference between sex, treating center, or being overweight/obese between the Capizzi and HDMTX groups (Table 1). Both treatment intensity groups had mildly elevated mean transaminases (ALT, AST) during IM1 (Table 2), however the HDMTX group slightly higher transaminase averages than the Capizzi group (ALT: 2.72 vs. 2.42; AST: 1.70 vs. 1.22). For all patients, both mean bilirubin (total and conjugated) and mean creatinine were below the ULN. Analysis of all potential covariates identified that both race and age were significantly associated with higher ALT and AST, but only in the Capizzi group (Tables 3 and 4). Markedly, Hispanic patients treated with Capizzi were 2.5x more likely than non-Hispanic white patients to have higher ALT. There was no effect on bilirubin by any of the covariates.Conclusions: This is the first comprehensive study of factors related to hepatotoxicity in a large and uniformly-treated cohort of pediatric patients of ALL. A wide distribution of liver function laboratory values was seen in IM1 for both Capizzi and HDMTX groups, with modest ALT and AST elevations noted but not bilirubin. Not surprisingly, HDMTX patients (who received both high-dose methotrexate and 6-mercaptopurine in IM1) did have slightly higher ALT/AST on average than those who received Capizzi. Race and/or age influence ALT and AST during IM1 for the Capizzi group only. Further studies are needed to delineate the temporal correlation of liver function changes in IM1 and, more broadly, all phases of therapy to predict toxicities, guide dose modifications, and help guide the incorporation of investigational agents into existing ALL regimens. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.