Detection Of Overload Research Articles

Energy-efficient and quality-aware VM consolidation method

To improve resource utilization and energy efficiency, cloud data centers use virtual machine (VM) consolidation to consolidate VMs to fewer physical machines (PMs) through live VM migration. However, improper VM placement may cause frequent VM migrations and constant on–off switching of PMs, which results in lower service quality and increased energy consumption. In this paper, we address this problem by proposing an effective and efficient VM consolidation approach called EQ-VMC, which has the goal of optimizing energy efficiency and service quality. In our approach, a discrete differential evolution algorithm is developed to search for the global optimum solution for VM placement. By integrating this solution with a set of algorithms proposed for effective host overload detection, VM selection, and under-loaded host detection, EQ-VMC effectively reduces energy consumption and improves quality of service (QoS). Extensive simulation demonstrates its effectiveness and shows its superiority to previous VM consolidation methods.

Retrospective Evaluation of Remote Dielectric Sensing (ReDS) Vest Technology and its Impact on Heart Failure Readmission Rates and Diuretics Therapy

Purpose Early detection of fluid overload in CHF patients has previously shown to improve the quality and efficiency of care. ReDS vest is a non-invasive portable device that detects right lung fluid content. The purpose of this study was to assess if the use of ReDS technology was associated with decreased readmission rates, length of stay (LOS), and improvement in appropriateness of diuretic therapy in patients with CHF at our medical center. Methods An IRB approved retrospective chart review of 112 hospitalized adult patients with acute HF was conducted to evaluate the use of ReDS technology on patient outcomes. The ReDS vest readings were used at admission to aid the diagnosis of acute heart failure and adjust diuretics therapy. A two month time frame was used to assess the outcomes before and after device implementation. Eligible patients admitted June 1st to July 31st in 2017 without the guidance of ReDS vest served as the control group and patients admitted June 1st to July 31st in 2018 with the guidance of ReDS vest served as the study group. Baseline characteristics such as ejection fraction, BMP results, age, gender, and home and discharge diuretic regimens were reviewed. Each ReDS group patient was matched to a control patient based on all three criteria: age (±10 years), LVEF (≤ or >40%), and serum creatinine at admission (±0.3 mg/dL). The primary endpoint of this study was the rate of 30-day readmission. Secondary endpoints included LOS, changes in diuretic therapy based on ReDS reading, and changes in diuretics therapy between prior to admission and at discharge. The McNemar statistical test and the Wilcoxon signed rank test were used to analyze the endpoints. Results A total 56 patients in the ReDS group were matched to 56 patients in the control group. For the primary endpoint of 30 day heart failure readmission rates, there were 4 readmissions in the ReDS group and 10 readmissions in the control group [OR = 2.5 (95% CI: 0.78-7.97); P = 0.09]. For the secondary endpoint of LOS, ReDS group patients stayed an average of 5.2 days and control group patients stayed an average of 6.3 days (p = 0.02). Three patients out of the ReDS group had inpatient diuretics therapy changed due to their ReDS reading. Lastly, when the prior to admissions diuretics therapy was compared to discharge therapy, the ReDS group had 19 patients with new diuretic additions, 8 patients with dose increases of current diuretics, and one patient with both a new addition and increased dose. In the control group, 22 patients had new diuretic additions, 5 patients had dose increases of current diuretics, and one patient had both a new addition and increased dose. Conclusion The use of the technology decreased the LOS for patients admitted for ADHF and was able to augment the clinician's ability to guide therapy for some patients. However, future studies covering a longer time frame are warranted to further evaluate its role in preventing 30 day heart failure readmissions.

PREDICTORS OF IRON OVERLOAD TOXICITY IN MULTI-TRANSFUSED BETA-THALASSEMIC CHILDREN

Introduction: There are certain risk factors or predictors that can be used for early detection of cardiac iron overload to improve the long-term gains in beta-thalassemic children. Objective: The aim of the study was to consider the predictive abilities of some of the clinical attributes of the beta-thalassemia patients regarding cardiac iron overload to identify at risk patients. Materials and Methods: This current observational study was conducted in the Department of Pediatrics, VIMSAR, Burla from November 2016 to October 2018. A total of 105 thalassemic children were enrolled in the study after satisfying the inclusion criteria (multi-transfused beta-thalassemia children in the age group of 6–14 years). All the relevant data were collected and correlation-regression statistics were done using computer-based software. Results: Serum ferritin has weak negative correlation with left ventricular end diastolic diameter (LVEDD) (r=–0.511, p=0.000), good negative correlation with ejection fraction (EF) (r=–0.604, p=0.000), and weak positive correlation with left ventricular end systolic diameter (LVESD) (r=0.084, p=0.393). Number of units of packed red cell transfusion has strong negative correlation with EF (r=–0.785, p=0.000), weak negative correlation with LVEDD (r=–0.297, p=0.005), and weak positive correlation with LVESD (r=0.413, p=0.000). Corrected logistic regression equation, i.e., cardiac iron overload=1.997 (age in years) –3.119 (gender) –0.078 (units of packed red blood cells [PRBC]) +0.003 (serum ferritin in ng/ml) –0.149 (LVEDD in mm) –0.235 (weight in kg) –10.928 with prediction of 94.3%. Conclusions: Age of the patient, serum ferritin level, and number of units of PRBCs transfused, LVEDD and weight of the child are good predictors of myocardial iron overload among childhood beta-thalassemic and hence can be used as indices for monitoring of onset of cardiac iron overload.

Effective method of evaluating myocardial iron concentration in pediatric patients with thalassemia major.

BackgroundThe use of T2* magnetic resonance imaging (MRI) has been promoted by recent studies as a noninvasive method for the detection of iron overload in thalassemia major patients. This study aims to estimate the iron load in the heart and liver of thalassemia major patients using T2* MRI and to determine its correlation with the left ventricle ejection fraction and serum ferritin level.MethodsForty β-Thalassemia major patients were included in the study. We evaluated the serum ferritin level, echocardiography, cardiac T2*, myocardial iron concentration (MIC), liver iron concentration (LIC) and hepatic T2* in all patients. CMR T2* findings were categorized as normal cardiac T2* (T2* >20 ms) or abnormal cardiac T2* (T2* <20 ms).ResultsThe study found that 85% of patients had a normal cardiac T2* value. The median serum ferritin level was 2189. A significant inverse correlation was found between the serum ferritin level and the cardiac T2* (r=−0.381, =0.015); however, the correlations between serum ferritin and the hepatic T2* and liver iron concentration were statistically non-significant (P=0.539 and P=0.637, respectively). Additionally, the LVEF correlation was statistically non-significant with SF, hepatic T2* and cardiac T2*.ConclusionRegardless of the serum ferritin level or left ventricle function, a cardiac T2* MRI should be done for all patients with β-Thalassemia major in order to estimate the myocardial iron concentration.

Multi-Dimensional Regression Host Utilization algorithm (MDRHU) for Host Overload Detection in Cloud Computing

The use of cloud computing data centers is growing rapidly to meet the tremendous increase in demand for high-performance computing (HPC), storage and networking resources for business and scientific applications. Virtual machine (VM) consolidation involves the live migration of VMs to run on fewer physical servers, and thus allowing more servers to be switched off or run on low-power mode, as to improve the energy consumption efficiency, operating cost and CO2 emission. A crucial step in VM consolidation is host overload detection, which attempts to predict whether or not a physical server will be oversubscribed with VMs. In contrast to the majority of previous work which use CPU utilization as the sole indicator for host overload, a recent study has proposed a multiple regression host overload detection algorithm, which takes multiple factors into consideration: CPU, memory and network BW utilization. This paper provides further improvement along two directions. First, we provide Multi-Dimensional Regression Host Utilization (MDRHU) algorithms that combine CPU, memory and network BW utilization via Euclidean Distance (MDRHU-ED) and absolute summation (MDRHU-AS), respectively. This leads to improved results in terms of energy consumption and service level agreement violation. Second, the study explicitly takes real-world HPC workloads into consideration. Our extensive simulation study further illustrates the superiority of our proposed algorithms over existing methods. In particular, as compared to the most recently proposed multiple regression algorithm that is based on Geometric Relation (GR), our proposed algorithms provide an improvement of at least 12% in energy consumption, and an improvement of at least 80% in a metric that combines energy consumption, service-level-violation, and number of VM migrations.

A Novel Physical Machine Overload Detection Algorithm Combined with Quiescing for Dynamic Virtual Machine Consolidation in Cloud Data Centers

Further growth of computing performance has been started to be limited due to increasing energy consumption of cloud data centers. Therefore, it is important to pay attention to the resource management. Dynamic virtual machines consolidation is a successful approach to improve the utilization of resources and energy efficiency in cloud environments. Consequently, optimizing the online energy-performance trade off directly influences Quality of Service (QoS). In this paper, a novel approach known as Percentage of Overload Time Fraction Threshold (POTFT) is proposed that decides to migrate a Virtual Machine (VM) if the current Overload Time Fraction (OTF) value of Physical Machine (PM) exceeds the defined percentage of maximum allowed OTF value to avoid exceeding the maximum allowed resulting OTF value after a decision of VM migration or during VM migration. The proposed POTFT algorithm is also combined with VM quiescing to maximize the time until migration, while meeting QoS goal. A number of benchmark PM overload detection algorithms is implemented using different parameters to compare with POTFT with and without VM quiescing. We evaluate the algorithms through simulations with real world workload traces and results show that the proposed approaches outperform the benchmark PM overload detection algorithms. The results also show that proposed approaches lead to better time until migration by keeping average resulting OTF values less than allowed values. Moreover, POTFT algorithm with VM quiescing is able to minimize number of migrations according to QoS requirements and meet OTF constraint with a few quiescings.

Clinical Implementation of a Focused MRI Protocol for Hepatic Fat and Iron Quantification.

OBJECTIVE. The purpose of this article is to describe our institutional experience with the clinical implementation of a novel focused rapid chemical shift-encoded MRI protocol specifically intended to detect and quantify hepatic steatosis and iron overload, highlighting usage statistics and issues related to cost. CONCLUSION. Focused MRI examinations for specific clinical indications, such as this protocol for detection and quantification of hepatic steatosis and iron overload, are feasible in a busy clinical practice and add value for patients and referring providers.

Cost-effective telemetry for energy network of an electricity distribution company: part I

We present a novel application of radio frequency wireless mesh network and general packet radio service technologies in a telemetry solution to measure power flow in the energy network of an electricity distribution company. The telemetry solution utilizes some selected circuits of grid stations and calculates total power consumed, total power imported, and total power exported by the distribution company. The selection of circuits for sensors installation is the key for reducing solution cost as compared to the case when sensors are installed on all the power output points. The framework involves installation of specially developed energy sensors (smart energy meters) and data concentrator units at the selected grid stations for measurement of energy data that include active energy, reactive energy, active power, apparent power, current, voltage, and power factor. The measured data reach the data concentrator unit using a 433-MHz wireless mesh network and are transmitted to a remote power control center using general packet radio service. Energy data from different grid stations across the energy network are collected at the power control center and utilized in calculation of total power consumed, total power imported, and total power exported. The approach has been tested on two electricity distribution companies of Pakistan: the Islamabad Electric Supply Company and Peshawar Electric Supply Company. Also in this work, the result of overload detection based on a generalized likelihood ratio test for an industrial feeder of the Islamabad Electric Supply Company is included. Detection probability of 0.96 with a false alarm probability of 0.04 has been achieved for a 30-min data interval.

Pregnancy in Thalassemia.

Therapeutic advances, including the availability of oral iron chelators and new non-invasive methods for early detection and treatment of iron overload, have significantly improved the life expectancy and quality of thalassemia patients, with a consequent increase in their reproductive potential and desire to have children. Hundreds of pregnancies have been reported so far, highlighting that women carefully managed in the preconception phase usually carry out a successful gestation and labor, both in case of spontaneous conception and assisted reproductive techniques. A multidisciplinary team including a cardiologist, an endocrinologist, and a gynecologist, under the supervision of an expert in beta-thalassemia, should be involved.During pregnancy, a close follow-up of maternal disorders and of the baby’s status is recommended. Hemoglobin should be maintained over 10 g/dL to allow normal fetal growth. Chelators are not recommended; nevertheless, it may be reasonable to consider restarting chelation therapy with desferrioxamine towards the end of the second trimester when the potential benefits outweigh the potential fetal risk.Women with non-transfusion-dependent thalassemia who have never previously been transfused or who have received only minimal transfusion therapy are at risk of severe alloimmune anemia if blood transfusions are required during pregnancy. Since pregnancy increases the risk of thrombosis three-fold to four-fold and thalassemia is also a hypercoagulable state, the recommendation is to keep women who are at higher risk -such as those who are not regularly transfused and those splenectomised- on prophylaxis during pregnancy and the postpartum period.

N-terminal-pro-b-type natriuretic peptide levels and cardiac hemosiderosis in adolescent β-thalassemia major patients.

Background:Iron-induced cardiomyopathy remains the leading cause of mortality in patients with β-thalassemia major. Iron overload cardiomyopathy, which may be reversible through iron chelation, is characterized by early diastolic dysfunction. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive biomarker of diastolic dysfunction.Aim:The aim of the study is to evaluate the diagnostic value of NT-proBNP as a surrogate marker of iron overload examined with magnetic resonance imaging T2-star (MRI T2*).Methods:Sixty-eight β-thalassemia major patients (10–18 years) with no signs of heart failure underwent NT-proBNP measurement before routine transfusion. All participants prospectively underwent cardiac MRI T2* examination within 3 months (median 19 days). Patients were divided as cardiac hemosiderosis (cardiac MRI T2* <20 ms) and nonhemosiderosis (cardiac MRI T2* >20 ms).Results:Of 68 patients, the male-to-female ratio was 1:1.1 and the median age was 14.1 years (range: 10–17.8 years). NT-proBNP levels were not different between hemosiderosis and nonhemosiderosis patients (P = 0.233). Further receiver operating characteristic analysis resulted in no significant correlation of NT-proBNP and MRI T2* (area under the curve 0.393, P = 0.233).Conclusion:Measurement of NT-proBNP levels cannot be used for early detection of cardiac iron overload in adolescent with β-thalassemia major.

Energy-efficient fuzzy-based approach for dynamic virtual machine consolidation

In cloud environments, the overload leads to performance degradation and Service Level Agreement (SLA) violation while underload results in inefficient utilisation of resources and needless energy consumption. Dynamic Virtual Machine (VM) consolidation is considered as an effective solution to deal with both overload and underload problems. However, dynamic VM consolidation is not a trivial solution as it can also lead to violation of negotiated SLA due to runtime overheads in VM migration. Further, dynamic VM consolidation approaches need to answer many questions such as (i) when to migrate a VM? (ii) which VM is to be migrated? and (iii) where to migrate the selected VM? In this work, efforts are made to develop a comprehensive approach to achieve better solution to above discussed problems. In the proposed approach, future forecasting methods for host overload detection are explored; a fuzzy logic based VM selection approach that enhances the performance of VM selection strategy is developed; and a VM placement algorithm based on destination CPU utilisation is also developed. The performance evaluation of the proposed approaches is carried out on CloudSim toolkit using PlanetLab data set. The simulation results have exhibited significant improvement in the number of VM migrations, energy consumption, and SLA violations.

Hepatocellular Carcinoma in β-Thalassemia Patients: Review of the Literature with Molecular Insight into Liver Carcinogenesis.

With the continuing progress in managing patients with thalassemia, especially in the setting of iron overload and iron chelation, the life span of these patients is increasing, while concomitantly increasing incidences of many diseases that were less likely to show when survival was rather limited. Hepatocellular carcinoma (HCC) is a major life-threatening cancer that is becoming more frequently identified in this population of patients. The two established risk factors for the development of HCC in thalassemia include iron overload and viral hepatitis with or without cirrhosis. Increased iron burden is becoming a major HCC risk factor in this patient population, especially in those in the older age group. As such, screening thalassemia patients using liver iron concentration (LIC) measurement by means of magnetic resonance imaging (MRI) and liver ultrasound is strongly recommended for the early detection of iron overload and for implementation of early iron chelation in an attempt to prevent organ-damaging iron overload and possibly HCC. There remain lacking data on HCC treatment outcomes in patients who have thalassemia. However, a personalized approach tailored to each patient’s comorbidities is essential to treatment success. Multicenter studies investigating the long-term outcomes of currently available therapeutic options in the thalassemia realm, in addition to novel HCC therapeutic targets, are needed to further improve the prognosis of these patients.

Long-term improvement in cardiac magnetic resonance in β-thalassemia major patients treated with deferasirox extends to patients with abnormal baseline cardiac function.

The management of iron overload in thalassemia has changed dramatically since the implementation of magnetic resonance imaging, which allows detection of preclinical iron overload and prevention of clinical complications. This study evaluated the effect of deferasirox (DFX), the newest once-daily oral chelator, on cardiac function, iron overload and cardiovascular events over a longer follow up in a "real world" setting. Longitudinal changes in cardiac magnetic resonance T2*, cardiac function parameters and cardiovascular clinical events were assessed in a cohort of 98 TM patients exposed to DFX for a mean of 6.9 years (range 1.8-11.6 years). No cardiac death or incident heart failure occurred. Cardiac T2* significantly increased (+2.6 ± 11.9 msec; P = 0.035) in the whole population, with a significantly greater increase (+11.6 ± 15.5 msec, P = 0.019) in patients with cardiac iron overload (T2* <20 ms). A significant improvement in left-ventricular ejection fraction (LVEF) (from 50.6 ± 6 to 60.2 ± 5; P = 0.001) was observed in 11 (84.6%) out of 13 patients who normalized cardiac function (LVEF >56%). Arrhythmias were the most frequent cardiac adverse event noted but none led to DFX discontinuation. Our data indicate that DFX is effective in maintaining cardiac iron level in the normal range and in improving cardiac iron overload. No heart failure or cardiac death was reported over this longer observation up to 12 years. For the first time, a DFX-induced improvement in LVEF was observed in a subgroup of patients with abnormal cardiac function at baseline, a preliminary observation which deserves further evaluation.

MRI Evaluation of Hepatic Iron Overload in b-Thalassemic Children

AbstractBackground: b-Thalassaemia major is a hereditary hemo-lytic anemia that have amajor complication iron overload. Assessment of Liver Iron Concentration (LIC) is necessary for detection and quantitative staging of iron overload and monitoring of iron-reducing treatments. MRI represents the most available noninvasive technique to assess LIC.The aim of this study was to assess LIC by MRI in multitransfused b-Thalassemic children.Patients and Methods: Forty multi-transfused b-thalassemic children were subjected to clinical evaluation, appropriate laboratory assessment and assessment of LIC by MRI.T2* weighted gradient echosequence MRI was performed with 1.5T scanner.Results:- Significant reduction in signal intensity ratio of the liver was show in all patients.- Highly significant correlation between MRI parameter (R2* and T2*) and LIC (p 0.05).- Splenectomizied patients had significant lower SIR of liver (decrease R2* and increase T2*) compared to non splenec-tomized patients (p<0.007).Conclusion: In conclusion based on results of our study MRI is the best noninvasive method for assessment and evaluation of hepatic iron overload and determine its severity in multi-transfused b-thalassemic patients.

Detection of Myocardial Iron Overload with Magnetic Resonance By Native T1 and T2* Mapping Using a Segmental Approach

Introduction. T2* measurement of myocardial iron overload (MIO) is presently the gold standard for monitoring and tailoring the chelation in thalassemia patients. Native T1 mapping has been proposed also for the MIO quantification because it is known that iron can reduce native T1 values. No data are available in literature comparing T1 and T2* mapping using a segmental approach including the whole left ventricle. The goal of our study was to assess the relationship between T1 and T2* values using a segmental approach.Methods. 29 patients with hemoglopinopathies (18 females, 45.39±13.49 years) enrolled in the Extension Myocardial Iron Overload in Thalassemia (eMIOT) Network were considered.Native T1 and T2* images were acquired, respectively, with the Modified Look-Locker Inversion recovery (MOLLI) and with the multi-echo gradient-echo techniques. Three parallel short-axis views (basal, medium and apical) of the left ventricle (LV) were acquired with ECG-gating. The myocardial T1 and T2* distribution was mapped into a 16-segment LV model, according to the AHA/ACC model.The lower limit of normal for each segment was established as mean±2 standard deviations on data acquired on 14 healthy volunteers.In 25 patients also post-contrastografic images were acquired.Results. T1 images showed more pronounced motion artifacts and lower contrast-to-noise-ratio, determining the exclusion of 18/464 segments. No segments were excluded by T2* mapping. So, globally, 446 segmental T1 and T2* values were considered. The mean of all segmental T2* and T1 values were, respectively, 37.83±11.30 ms and 982.72±118.24 ms.Normal T2* and T1 values were found in 374 segments (83.9%) while 29 (6.5%) segments had pathologic T2* and T1 values. For 33 segments (7.4%) (13 patients) a pathologic T1 value was detected in presence of a normal T2* value. For 10 segments (2.2%) a pathologic T2* value was detected in presence of a normal T1 value. Out of the 9 patients with pathologic T2* values in presence of normal T1, in 7 patients post-contrastografic images were acquired; in all segments with pathologic T2* value macroscopic fibrosis by late gadolinium enhancement technique and/or microscopic fibrosis by T1 mapping were found. The relation between segmental T1 and T2* values is shown in the figure. For patients with pathologic segmental T2* values there was a linear relationship between T1 and T2* values (R=0.735, P<0.0001) while the whole data was fitted with a quadratic curve.Conclusion. T2* and T1 mapping showed a good correlation in identifying iron by a segmental approach. However, we found a scatter between results. In 9 patients T1 mapping was not able to detect iron probably due to the presence of macroscopic and/or microscopic fibrosis that it is known to increase the native T1 . Conversely, in 13 patients T1 mapping seems to be more sensitive than T2* (sensitive to different iron chemistry or error measurements?). Further studies on larger population and correlation with clinical outcome are need. [Display omitted] DisclosuresPepe:Chiesi Farmaceutici S.p.A., ApoPharma Inc., and Bayer: Other: No profit support.

Bioimpedance vector analysis for the detection of extracellular volume overload and sarcopenia in systemic AL amyloidosis.

Bioimpedance vector analysis for the detection of extracellular volume overload and sarcopenia in systemic AL amyloidosis.

The Interdialytic Creatinine Rise is a novel marker of volume overload and mortality risk in hemodialysis patients

BackgroundVolume overload poses a major risk in hemodialysis patients but simple detection methods are lacking. We propose a novel marker, the Interdialytic Creatinine Rise (IDCR), readily calculated as the change in serum creatinine over time (in mg/dL/h), to assess volume overload and predict mortality risk in hemodialysis patients.MethodsFirst, we calculated IDCR changes with volume in a prospective cohort of 35 hospitalized hemodialysis patients awaiting hemodialysis and 33 hospitalized patients undergoing hemodialysis every other day. Second, in a prospective cohort of 25 outpatients, IDCR cutoff values associated with hypervolemia were determined between two treatments and compared with simultaneous volume assessments by their nephrologist. Third, IDCR as a mortality predictor was studied using survival analysis in a longitudinal retrospective cohort study of 39 maintenance hemodialysis patients followed from 2012 until death or 2017.ResultsIDCR decreased by − 0.014 mg/dL/h each day (95%CI − 0.017,− 0.010; p < 0.001) without dialysis due to fluid volume gain and increased by 0.013 mg/dL/h (95%CI 0.008,0.017; p < 0.001) from before to after each successive hemodialysis due to fluid removal.Choosing an IDCR cutoff value of ≤0.1 had sensitivity of 82% and specificity of 79% in diagnosing volume overload with the area under the ROC curve of 0.78 (95%CI 0.59,0.97).The hazard ratio of death for each 0.01 decrease in IDCR was 1.64 (95%CI 1.31,2.07; p < 0.001). If IDCR decreased to less than 0.05 mg/dL/h, the median survival was 32 days and the odds ratio of death within 2 months was 38 (95%CI 8, 131; p < 0.001).ConclusionsIn this pilot study, IDCR is shown to be a novel metric that decreases with fluid retention and increases after fluid removal. IDCR can assist clinicians in detection or exclusion of volume overload in hemodialysis patients and provide prognostic value in identifying those at high risk for death.

Cardiac Iron Overload: Correlation between MRI T2* &amp; Two Dimensional Strain Echocardiography in Children with b-Thalassemia Major

AbstractBackground: b-thalassemia is a group of inherited blood disorders that causes iron overload in the heart. Development of overt heart failure is delayed till the second decade of life. Early detection of cardiac iron overload is necessary before development of heart failure.Aim of the Study: Was to evaluate cardiac function in children with b-thalassemia major having iron overload and to Compare MRI T2* and doppler echocardiography in dem-onstration of iron deposition in cardiac muscles in those patients.Patients and Methods: Fifty children with thalassemia major were subjected to history taking, clinical assessment, laboratory assessment, Doppler echocardiography and MRI for cardiac iron load assessment.Results: There is a negative correlation between cardiac MRI T2* with age, ferritin and serum iron level. As regard correltion between MRI and doppler echocardiography there is a positive correlation between MRI T2* and diastolic echocardiographic parameters Tei index in patients with thalassemia Major.Conclusion: There is a significant correlation between MRI T2* and Doppler echocardiography in patients with b thalassemia major.

Association between OH/ECW and echocardiographic parameters in CKD5 patients not undergoing dialysis.

BackgroundEchocardiography is the most valuable tool for assessing cardiac abnormalities of chronic kidney disease (CKD) patients even though it has its limitations, including high equipment cost and the need for specialized personnel. Assessment of volume status is important not only for volume management, but also for prevention of cardiovascular disease of the CKD patients. Recently, bioimpedance is gaining acceptance as a way to quantitatively assess patient hydration status at bedside.Methods127 patients who were admitted for planning their first dialysis treatment were enrolled. The echocardiography and bioimpedance spectroscopy (BIS) were performed. The association between echocardiographic data and clinical values such as NT-proBNP and OH/ECW was examined.ResultsOH/ECW, which indicates relative fluid overload, was positively associated with LA dimension (r = 0.25, P = 0.007), LAVI (r = 0.32, P < 0.001), and E/e´ ratio (r = 0.38, P < 0.001). While OH/ECW was not significantly associated with echocardiographic values such as LVEDD, LVEDV, LVMI, and LVEF, NT-proBNP were significantly associated with all echocardiographic parameters. Multivariate logistic regression analysis showed E/e´ ratio (odds ratio, 1.14 [95% confidence interval (CI), 1.01 to 1.29]; P = 0.031), NT-proBNP (odds ratio, 4.78 [95% CI, 1.51 to 15.11]; P = 0.008), and albumin (odds ratio, 0.22 [95% CI, 0.08 to 0.66]; P = 0.007) were significantly associated with OH/ECW.ConclusionsSince OH/ECW measured by BIS is associated with echocardiographic parameters related to diastolic dysfunction, preliminary screening through laboratory findings, including serum albumin in conjunction with OH/ECW and NT-proBNP, may find patient with risk of diastolic dysfunction. Our study suggests that a timely detection of fluid overload in patients with CKD as well as their proper treatment may help reduce diastolic dysfunction. Further research may be needed to validate the consistency of this association across other stages of CKD.

Hepatocellular Carcinoma in a β-Thalassemia Intermedia Patient: Yet Another Case in the Expanding Epidemic

The incidence of hepatocellular carcinoma (HCC) in patients with thalassemia is increasing, the two well recognized HCC risk factors in thalassemia being iron overload and chronic hepatitis C. The carcinogenicity of iron is related to its induction of oxidative damage, whereas chronic hepatitis leads to necroinflammation that can accelerate progression to HCC. We hereby report the case of a non transfused, hepatitis C-negative, β-thalassemia intermedia (β-TI) patient from our practice who had evidence of significant iron overload, suggesting the importance of increased iron burden as a HCC risk factor in this patient population. As such, screening thalassemia patients using magnetic resonance imaging (MRI)-based liver iron concentration (LIC) measurement and liver ultrasound is strongly recommended for early detection of iron overload and HCC, respectively. Data appears to be lacking on HCC treatment outcomes in patients who have thalassemia, but an approach tailored to each patient’s comorbidities is key to treatment success. The prognosis of these patients can be improved by multicenter studies investigating novel HCC therapeutic targets in the thalassemia realm.