Blood Urea Nitrogen Values Research Articles

Hematological and biochemical effect of subcutaneous administration of robenacoxib in different goat breeds

Aim:This study aimedto investigate the effect of robenacoxibonhematological and biochemical parameters in healthy Alpine and Saanen goats 24 hours after subcutaneous administration. Materials and Methods: 12 healthy Alpine (n=6) and Saanen (n=6) breed goats were used. Robenacoxib was administered to Alpine and Saanen goats at a dose of 4 mg/kg once subcutaneously. Blood samples were collected before drug administration (0 hour) and then 24-hours. Hematological and biochemical parameters were analyzed using a hematology analyzer and biochemistry auto analyzer, respectively. Results: No change was observed in the clinical examination findings of both goat breeds. Statistical differences in hematological and biochemical parameters were determined within physiological limits in both goat breeds. The white blood cell, red blood cell and lymphocyte values were found to be low, and the monocyte% value was found to be high in Alpine goats. Decreases in red blood cell, hemoglobin and hematocrit levels and increases in the mean corpuscular volume and mean corpuscular hemoglobin values were observed at 24-hours in Saanen goats. Robenacoxib increases blood urea nitrogen value in both goat breeds, it decreases creatinine value in Saanen goats. Conclusion: There were no significant changes in hematological and biochemical parameters after robenacoxib administrations to Alpine and Saanen goats. Consequently, further studies are needed to investigate the effects of robenacoxib in high-dose and repeated administrations, liver and kidney dysfunctions, different age, breed, and physiological conditions. It was evaluated that robenacoxib could be used as an alternative NSAID to prevent pain and inflammation in goats, since no adverse effect was observed in the blood profile.

Clonal Hematopoiesis and Inflammation in the Vasculature (CHIVE), a Prospective, Longitudinal Clonal Hematopoiesis Cohort and Biorepository

Introduction Clonal hematopoiesis (CH), the expansion of a clonal population of hematopoietic cells, is an age-associated phenomenon leading to increased risk of both hematologic malignancy and non-malignant organ dysfunction. There have been significant advances in our understanding of the underlying pathophysiology of CH in recent years. However, additional studies are needed to better understand clinical trajectories and optimal care of patients with CH. To address this gap, the prospective, longitudinal CHIVE (Clonal Hematopoiesis and Inflammation in the VasculaturE) registry and biorepository was created to support multidisciplinary CH clinics. Methods Adults without active hematological malignancy who were clinically identified to have CH or who were at risk for CH were sequentially enrolled utilizing a multidisciplinary referral approach between October 2020 to April 2023 at Vanderbilt University Medical Center (VUMC). Research samples were procured at the time of routine clinical blood draws or bone marrow biopsies and stored in a newly established biorepository, equipped to store DNA, plasma, and viably cryopreserved cells to enable a spectrum of downstream applications. Specimens were sequenced on a highly cost efficient (~$6/sample) targeted next generation sequencing capture panel that identified mutations residing in the 24 most frequently mutated CHIP genes.The VUMC CH clinic, which serves as a referral pool, were included in Arm A of CHIVE (n=57). We also sought out a population at risk for CH which included patients over 18 years of age with a history of solid tumor, cardiovascular disease, renal disease, rheumatologic disease, or diabetes, who were included in Arm B (n=122). Patients from Arm A or B were included in the CH-positive (CH+) group if they met criteria for CH on the research assay at any time during their enrollment in the study. All other genotyped patients who were not found to have CH by the research assay, regardless of their clinical CH status at study enrollment, were included in the CH-negative (CH-) group.Anthropometric data and clinical assessments, including laboratories and cardiovascular studies obtained in the course of routine clinical care were extracted from the electronic health record, and recorded and maintained in the CHIVE database. Results 261 patients were approached for consent to enroll in CHIVE and 179 were ultimately enrolled. More than one half (54%) of all participants had a CH mutation (CH+) and of those, 49.5% were female. Median age of CH+ patients was 71.9 (IQR 64.0-77.5). DNMT3A (n=44) and TET2 (n=39) were the most commonly mutated genes, while variant allele fractions (VAF) ranged from 2.1 - 79.8% (Figure 1). 246 samples were serial samples collected from 89 patients at regular intervals. Significantly more CH+ patients had a diagnosis of coronary artery disease compared to CH- patients (55.7% vs 32.9%, p=0.004). CH+ patients also had increased rates of hypertension and heart failure compared to the CH- group (p<0.001, 0.035, respectively). Laboratory evaluation showed CH+ patients to have a lower median white blood cell count, hemoglobin, and platelets, and elevated blood urea nitrogen values compared to CH- patients, differences that did not meet statistical significance. 8.2% of the CH+ patients progressed to frank hematologic malignancy over the course of the 2.5-year study (Table 1). Eight of the 97 CH+ and 2 of the 82 CH- patients died over the course of the study period resulting in a trend toward decreased survival in CH+ patients (p=0.112). Conclusions We demonstrate the feasibility of a prospective, observational study of CH patients utilizing a robust referral network to support both clinical care and translational research. A well-genotyped and phenotyped cohort of CH patients will be critical to future translational research efforts and clinical trials - a key function of our study design. Early clinical findings from our cohort recapitulate large scale retrospective datasets where CH patients are at an increased risk of development of hematologic malignancy, end organ damage, and all-cause mortality. Scaling this resource in collaboration with other centers is underway and will ultimately enable the development of clinical guidelines and treatment strategies for this increasingly recognized patient population.

Prognostic potential of inflammatory markers, oxidative status, thrombocyte indices, and renal biochemical markers in neonatal calf diarrhoea-induced systemic inflammatory response syndrome

The study aimed to assess the prognostic value of inflammatory markers, indicators of oxidative stress, thrombocyte indices, and renal biochemical markers in neonatal calf diarrhoea (NCD) induced by systemic inflammatory response syndrome (SIRS) upon admission. A prospective, observational, and case-control study was conducted on 56 calves diagnosed with NCD. Mean concentrations of interleukin-6 (IL-6), malondialdehyde (MDA), glutathione (GSH), mean platelet volume (MPV), platelet distribution width (PDW), blood urea nitrogen (BUN), and creatinine (Crea) were measured. Furthermore, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were also calculated for SIRS survivors [SIRS (survivor)] and non-survivors [SIRS (non-survivor)] induced by NCD. A prognostic cut-off value for predicting the prognosis of the SIRS’s induced by NCD was obtained via receiver operating characteristic (ROC) curve analysis. Upon admission, the SIRS (non-survivor) calves had significantly higher (P < .001) average levels of IL-6, MDA, BUN, Crea, MPV, and PDW compared to the SIRS (survivor) calves and significantly lower (P < .001) average levels of GSH. Despite an apparent increase in the NLR and PLR values of calves diagnosed with SIRS, no significant difference was found between the survival and non-survivor SIRS cases. Positive predictive values (PPVs) for survival were determined as 100 %, 100 %, 80 %, 100 %, 80 %, and 80 %, respectively, using cut-off values of IL-6 (≤259.67 ng/L), MDA (≤2.87 nmol/mL), MPV (≤12.5 fL), PDW (≤34.25 %), BUN (≤168.3 mg/dL), and Crea (≤2.11 mg/dL). The determined threshold values are those obtained upon admission to the hospital. Based on the sensitivity, specificity, and PPVs derived from the ROC analysis, it has been concluded that IL-6, MDA, MPV, PDW, BUN, and Crea are the most relevant biomarkers used for predicting the prognosis of NCD-induced SIRS in calves. Furthermore, it is also noteworthy that IL-6 exhibited the highest effectiveness among all biomarkers.

Perubahan Status Energi Pada Proses Reproduksi Induk Domba Garut Yang Diberi Pakan Komplit Berbasis Hijauan Sorgum dan Indigofera

Blood urea nitrogen (BUN) is an indicator of the efficiency of protein use in metabolism which is correlated with energy adequacy status. This study aimed to analyze and measure differences in energy adequacy status of arrowroot ewes in the premating, pregnancy, and lactation phases that were fed a complete diet of sorghum indigofera. The method used experimentally with Completely Randomized Design (CRD). There were 2 feed treatments, namely field grass (RL) as control and complete feed based on forage sorghum indigofera with a composition of 50% sorghum silage + 40% indigofera hay + 10% fine bran (SI) and repeated 14 times. The data obtained were analyzed using a two sample t-test. The results showed that there was a decrease in BUN in both treatments in each phase, but overall the average BUN value did not show a significant difference (P&gt;0.05). Significant differences (P&lt;0.05) only occurred at the beginning of pregnancy, mid and late lactation with BUN values of 21.18±1.04; 13.25±0.60; 15.18±0.67 for RL and 18, respectively. ,61±1.10; 15.86±0.82; 12.43±0.56 for SI. So it can be concluded that complete feed based on sorghum indigofera has the same energy change status as field grass, and in SI it can be used as a substitute for field grass.

Prognostic Value of Blood Urea Nitrogen for Short-Term Mortality in Patients with Infective Endocarditis.

Blood urea nitrogen (BUN) is a metabolic product validated to be an independent risk factor in the prognosis of several diseases. However, the prognostic value of BUN in patients with infective endocarditis (IE) remains unevaluated. A total of 1371 patients with a diagnosis of IE were included and divided into four groups according to BUN (mmol/L) at admission: < 3.5 (n = 343), 3.5-4.8 (n = 343), 4.8-6.8 (n = 341), and ≥ 6.8 (n = 344). Restricted cubic spline was used to assess the association of BUN with in-hospital mortality. Multivariate analysis was performed to identify the independent risk factors for adverse outcomes. The in-hospital mortality reached 7.4%, while the 6-month mortality was 9.8%. The restricted cubic spline plot exhibited an approximately linear relationship between BUN and in-hospital mortality. Receiver operating characteristics curve analysis showed that the optimal cut-off of BUN for predicting in-hospital death was 6.8mmol/L. Kaplan-Meier analysis showed that patients with BUN > 6.8mmol/L had a higher 6-month mortality than other groups (log rank = 97.9, P < 0.001). Multivariate analysis indicated that BUN>6.8mmol/L was an independent predictor indicator for both in-hospital [adjusted odds ratio (aOR) = 2.365, 95% confidence interval (CI) 1.292-4.328, P = 0.005] and 6-month mortality [adjusted hazard ratio (aHR) = 2.171, 95% CI 1.355-3.479, P = 0.001]. BUN is suitable for independently predicting short-term mortality in patients with IE.

Evaluation of factors affecting treatment and mortality in patients over 65 years of age and without chronic disease, followed in the Intensive Care Unit due to COVID-19.

In this study, demographic, clinical, and laboratory data of patients aged 65 and over who are followed on mechanical ventilators due to COVID-19 in intensive care clinics will be useful in terms of strategies to be developed in the fight against COVID-19 and other infectious agents. Our study included 299 patients aged 65 years and older, who were not chronically ill, and who were followed up on mechanical ventilators due to COVID-19 in intensive care clinics in the period between 2020 and 2022. Our study was designed as a retrospective cross-sectional study. The demographic characteristics of the patients included in the study, their complaints during hospitalization, the time between the beginning of the complaint and the admission to the hospital, the vital signs at the time of admission to the hospital, the lung computed tomography findings during hospitalization, and the treatments given were examined. 55.9% of all patients were males, and the mean age was 75.45±7.47 years. While there was no significant difference in terms of mean age between the groups of patients with/without a higher risk of mortality, there was a significant difference in gender (p=0.025). There was a statistically significant difference between the COVID-19 intensive care (p=0.001) and renal failure (p=0.014) and mortality groups. The mean nutric score, Procalcitonin (PCT), Lactate Dehydrogenase (LDH), Blood Urea Nitrogen (BUN), Phosphorus, and lactate values, which are important parameters, were statistically higher in the group with a higher risk of mortality (p<0.001). In addition, there was a statistically significant difference in terms of sepsis, neuromuscular blocker (Nmb), vasopressor, and intubation between the groups of patients with/without a higher risk of mortality (p<0.001). In the group with high mortality, 34.2% (n=55) had plasmapheresis treatment, and 14.2% had hemodiafiltration treatment (p<0.001). According to the results of the multivariate logistic regression model in determining the factors associated with a higher risk of mortality, those who were males (p=0.001), those with kidney failure (p<0.001), those with organ failure (p=0.006), increased in alanine aminotransferase (ALT) values (p=0.019), those with sedation (p=0.001) and those with vasopressors (p<0.001) were found to have an increased risk of mortality. We think that our study is valuable in terms of determining the most appropriate treatment strategies by following the patients in terms of parameters that are significant in the findings during their follow-up period in the Intensive Care Unit.

Prognostic value of blood urea nitrogen to serum albumin ratio for acute kidney injury and in-hospital mortality in intensive care unit patients with intracerebral haemorrhage: a retrospective cohort study using the MIMIC-IV database

ObjectiveWe sought to evaluate the prognostic ability of blood urea nitrogen to serum albumin ratio (BAR) for acute kidney injury (AKI) and in-hospital mortality in patients with intracerebral haemorrhage (ICH)...

Predictive value of blood urea nitrogen in heart failure: a systematic review and meta-analysis.

The mortality rate of patients with heart failure (HF) remains high, and when heart failure occurs, blood urea nitrogen (BUN) is involved in the perfusion of renal blood flow. Some studies have shown an association between heart failure prognosis and blood urea nitrogen, but the results of some other studies were inconsistent. Therefore, we conducted a comprehensive meta-analysis to investigate the value of BUN on the prognosis of patients with heart failure. A computerized systematic search of all English literature was performed in four databases, PubMed, Cochrane, Embase and Web of Science, from their inception to May 2022. The data of BUN were classified into continuous and categorical variables after passing the inclusion and exclusion criteria. The BUN data of both types were extracted separately into stata15.0 for statistical analysis. A total of 19 cohort studies involving 56,003 patients were included. When BUN was used as a categorical variable, the risk of death in heart failure was 2.29 times higher for high levels of BUN than for low levels of BUN (RR = 2.29, 95% CI:1.42-3.70, P < 0.001). The results showed statistical significance in multifactorial and univariate groups, the prospective cohort, and European and Asian groups. When BUN was used as a continuous variable, the risk of death in heart failure was 1.02 times higher for each unit increase in BUN (RR = 1.02, 95% CI:1.01-1.03, p < 0.001). Subgroup analysis showed statistical significance in retrospective cohort, American and Asian. High BUN is an independent predictor of all-cause mortality in heart failure. Lower BUN was associated with better prognosis in patients with heart failure.

Reproductive Success Rate and Blood Urea Nitrogen Status of Garut Ewes Fed Sorghum-Indigofera in Majalengka District - West Java

The body's Blood Urea Nitrogen (BUN) concentration could be used as diagnostic information for interpreting animal nutritional status, improving nutritional management, and preventing metabolic disorders in ewes during the reproductive phase. This study aimed to evaluate the reproductive success rate and changes in the BUN status of Garut ewes fed sorghum-Indigofera in Majalengka District – West Java, Indonesia. Twenty-eight multiparous Garut ewes with an average body weight of 30 kg, aged 2-3 years or parity from 3rd to 4th, and non-pregnant were separated into two feed treatment groups; divided field grass (FG) and sorghum-Indigofera (SI) mixed feed. This study was designed using a Complete Randomized Design (CRD). After one month of feed acclimatization, all ewes were served an estrus synchronization protocol and mated naturally. A pregnancy test was carried out on the 28th day after mating using ultrasonography (USG). Seven blood samples were taken (1 time in the pre-mating phase and three times each in the pregnancy and lactation phases), and the BUN parameter was analyzed. The results showed that SI feed increased the number of ewes pregnant and giving birth compared to FG (10 vs. 9 and 9 vs. 6, respectively). Meanwhile, the average value of the BUN content of ewes in both FG and SI treatments during the premating, pregnancy, and lactation phases did not show any differences (p&gt;0.05). The concentration of BUN is still in normal condition even though it has decreased from pre-mating until the lactation phase. It can be concluded that Sorghum-Indigofera mixed feed could increase reproductive success. However, the average value of BUN in the two types of feed treatment experienced the same status change in all reproductive phases. Both can overcome the energy deficit problem if they have sufficient feed.

Analyses of Kidney Biomarkers in Patients With SARS-CoV-2 (COVID-19)

The new coronavirus was first reported in China and caused a widespread global outbreak of pneumonia that spread rapidly across this country and many other countries. Acute kidney injury is one of the important complications of COVID-19, which has been shown in some cases. Exploring the diagnostic features of biomarkers of kidney function in COVID-19 patients may lead to better patient management. We collected laboratory data from 206 people with confirmed COVID-19 disease and evaluated their renal biomarkers, Blood Urea Nitrogen (BUN), and creatinine. The age range of the patients was almost 62 years old. The mean age in the dead patients and recovered patients was 71 and 54 years old, respectively. The average LDH value was 755 U/L, and creatine phosphokinase (CPK) was 267 U/L in the patients. The average BUN was 59.1 U/L, and creatinine was 1.5 U/L in COVID-2019 patients. Among all 193 patients, laboratory results revealed that 163 (85.4 %) patients had an elevated BUN level. Based on creatinine levels for total patients, laboratory results revealed that 49 (25.4 %) patients had an elevated value. The average BUN value in dead patients was 85 mg/dL, while in recovered patients was 40.5 mg/dL (P&lt;0.0001). Also, the average creatinine level in dead patients was 1.86 mg/dL, while in recovered patients was 1.24 mg/dL (P=0.0004). Inflammation following COVID-19 disease causes kidney damage and elevated urea and creatinine levels, which may increase the risk of death in these patients.

Urolithiasis pada Kucing Snow di K and P Clinic Surabaya

Urolithiasis is a disorder in the form of crystals or stones in the urinary tract such as the urinary bladder that occurs in both male and female animals. The condition of the formation of calculi due to supersaturation in urine consisting of one or several types of minerals. A case of urolithiasis in a Persian cat named Snow, female, 40 months old, 3.76 Kg, solid white hair color, came to the K and P Clinic and a physical examination was performed by palpation of the bladder which was filled with urine but not distended. Complete blood count (CBC) examination using blood samples showed leukocytosis, lymphocytosis, monocytosis, and thrombocytosis. The results of blood chemistry tests using blood serum samples showed hypoglycemic conditions and an increase in blood urea nitrogen (BUN) values. Calcium phosphate crystals are found on microscopic examination of the urine. Urinalysis test showed abnormal values ​​for ascorbic acid, microalbumin, protein, calcium, leukocytes, creatinine, blood, and protein to creatinine ratio. The formation of calculi looks like a hyperechoic mass and the presence of an acoustic shadow can be seen on ultrasonography (USG) examination of the urinary bladder. The handler given is cystotomy surgery.&#x0D; Keywords: Urolithiasis, calcium phosphate, ultrasound.

Evaluation of Serum Uric Acid and its Correlation with Decline in Estimated Glomerular Filtration Rate among the Chronic Kidney Disease Patients

Background: Chronic kidney disease is one of the most serious public health burdens globally, with significant morbidity, mortality, and reduced patient life expectancy. Many sub-Saharan African countries face double-burden challenges in the treatment of chronic kidney disease and its complications. This study aims to evaluate serum uric acid and its correlation with estimated glomerular filtration rate, as well as other risk factors among chronic kidney disease patients on follow-up at Jimma University specialised referral hospital. Method: A hospital-based cross-sectional study was conducted at Jimma University Medical Centre from August 6, 2022, to November 13, 2022. Using a consecutive sampling technique, a total of 140 CKD follow-up patients were recruited into the current study. Data were collected using interviewer-based structured questionnaires, record reviews, and physical examinations. The collected data were analysed by SPSS version 25.0. The correlation between eGFR and uric acid concentrations was examined by Pearson’s correlation analyses. Univariate and multivariate linear regression were used to test predictors of serum uric acid in the study participants. Result: A total of 140 study participants were recruited for this study. Subjects included (54.3% [n=76]) men and (45.7% [n=64]) women, respectively. The mean (SD) age of the study subjects was 51.04±9.02 years. The mean value of serum uric acid was 7.2±2.1mg/dl, whereas the mean of estimated glomerular filtration rate (eGFR) was 54.2±31 mL/min/1.73m2. Furthermore, the mean values of serum creatinine and blood urea nitrogen among participants in this study were 3.2±1.4 and 67.8±35.8 mg/dL. In the current study, estimated glomerular filtration rate (eGFR) value was negatively correlated (r=-0.912, P&lt;0.001) with uric acid. However, systolic blood pressure was positively correlated (r=0.584, P&lt;0.001) with uric acid. Moreover, the eGFR value was negatively associated (β=-0.060, P=&lt;0.001) with uric acid among study participants. Conclusion: Based on the current study findings, an increase in serum uric acid was associated with a decrease in eGFR value. Increased serum uric acid, increased body mass index (BMI) and high blood pressure are independent risk factors for disease progression in patients with CKD.

Acute kidney injury early after left ventricular assist device implantation: incidence, risk factors and clinical consequences.

Renal dysfunction or renal failure is a common complication in patients undergoing a left ventricular assist device (LVAD). Measurement of serum creatinine and estimated glomerular filtration rate (eGFR) is the most commonly used inexpensive and easy method for the evaluation of kidney function. In studies, the development of acute kidney injury (AKI) after LVAD has generally been studied at 1, 3 months and 1 year, but there are almost no studies with 1-week data. We retrospectively analyzed the incidence of AKI, risk factors, length of stay in hospital and intensive care unit (ICU), and postoperative complications of 138 patients who underwent LVAD implantation in our center between 2012 and 2021, according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the preoperative, postoperative 1st day, 2nd day, 1st week, 1st month, 3rd month and 1st year serum creatinine, eGFR and blood urea nitrogen (BUN) values. The mean age of 138 patients who underwent LVAD implantation and evaluated the development of AKI was 50.4 (±10.86) and 119 (86.2%) were males. The incidence of AKI, the need for renal replacement therapy (RRT) and dialysis after LVAD implant were respectively 25.4%, 25.3% and 12.3%. According to the KDIGO criteria, in the AKI (+) patient group, 21 (15.2%) cases were identified as stage 1, 9 (6.5%) as stage 2 and 5 (3.6%) as stage 3. The incidence of AKI was found to be high in cases with diabetes mellitus (DM), age, preoperative creatinine level ≥1.2, and eGFR ≤60 ml/min/m2. There is a statistically significant relationship between having AKI and right ventricular (RV) failure (p=0.0033). Right ventricular failure developed in 10 (28.6%) of 35 patients who developed AKI. If perioperative AKI is recognized early, the development of advanced stages of AKI and mortality can be reduced with nephroprotective measures.

Association of age with perioperative morbidity among patients undergoing surgical management of minor burns.

Burn injuries are associated with significant morbidity, often necessitating surgical management. Older patients are more prone to burns and more vulnerable to complications following major burns. While the relationship between senescence and major burns has already been thoroughly investigated, the role of age in minor burns remains unclear. To better understand differences between elderly and younger patients with predominantly minor burns, we analyzed a multi-institutional database. We reviewed the 2008-2020 ACS-NSQIP database to identify patients who had suffered burns according to ICD coding and underwent initial burn surgery. We found 460 patients, of which 283 (62%) were male and 177 (38%) were female. The mean age of the study cohort was 46 ± 17 years, with nearly one-fourth (n = 108; 23%) of all patients being aged ≥60 years. While the majority (n= 293; 64%) suffered from third-degree burns, 22% (n = 99) and 15% (n = 68) were diagnosed with second-degree burns and unspecified burns, respectively. An average operation time of 46 min, a low mortality rate of 0.2% (n = 1), a short mean length of hospital stay (1 day), and an equal distribution of in- and outpatient care (51%, n = 234 and 49%, n = 226, respectively) indicated that the vast majority of patients suffered from minor burns. Patients aged ≥60 years showed a significantly prolonged length of hospital stay (p<0.0001) and were significantly more prone to non-home discharge (p<0.0001). In univariate analysis, advanced age was found to be a predictor of surgical complications (p= 0.001) and medical complications (p = 0.0007). Elevated levels of blood urea nitrogen (p>0.0001), creatinine (p>0.0001), white blood cell count (p=0.02), partial thromboplastin time (p = 0.004), and lower levels of albumin (p= 0.0009) and hematocrit (p>0.0001) were identified as risk factors for the occurrence of any complication. Further, complications were more frequent among patients with lower body burns. In conclusion, patients ≥60 years undergoing surgery for predominantly minor burns experienced significantly more complications. Minor lower body burns correlated with worse outcomes and a higher incidence of adverse events. Decreased levels of serum albumin and hematocrit and elevated values of blood urea nitrogen, creatinine, white blood count, and partial thromboplastin time were identified as predictive risk factors for complications.

Clinical Features, Inflammatory Markers, and Limb Salvage in Older Adults with Diabetes-Related Foot Infections.

Little information exists about diabetic foot infections (DFIs) in older patients. We hypothesize that older patients with DFIs have different clinical features and worse outcomes than younger patients. We conducted a prospective observational study consisting of a cohort of patients with diabetes and moderate to severe DFIs. Patients included in the cohort were dichotomized into two groups using percentile 75 (P75) of age as the cut-off value. Patients aged > P75 presented with more comorbidities and foot-related complications, a higher rate of peripheral arterial disease (PAD), worse renal function (higher values of blood urea nitrogen and creatinine, and lower values of estimated glomerular filtration rate), and lower values of HbA1c compared with younger patients. Infection severity, microbiological features, and inflammatory markers were similar in both groups. In the multivariate analysis, minor amputations were associated with age > P75 (OR = 2.8, 95% CI 1.3-5.9, p <0.01), necrosis (OR = 4.2, 95% CI 1.8-10.1, p < 0.01), and CRP values (OR = 1.045, 95% CI 1.018-1.073, p < 0.01). Major amputations were associated with a history of amputation (OR = 4.7, 95% CI 1.3-16.7, p = 0.01), PAD (OR = 4.3, 95% CI 1.2-14.6, p = 0.01), and albumin values (OR = 0.344, 95% CI 0.130-0.913, p = 0.03). In conclusion, limb salvage can be achieved in older patients with diabetes-related foot infections at the same rate as in younger patients, despite the fact that they have more comorbidities and foot-related complications, a higher rate of PAD, and worse renal function.

Evaluation of Uric Acid and Its Correlation with Decline in Estimated Glomerular Filtration Rate among the Chronic Kidney Disease Patients

Chronic kidney disease is one of the most serious public health burdens globally, with significant morbidity, mortality, and compromise patient life expectancy. Many sub-Saharan African countries face double-burden challenges in the treating of chronic kidney disease and its associated complications. The current study aims to evaluate serum uric acid, and its correlation with estimated glomerular filtration rate as well as other risk factors among the chronic kidney disease patients on follow-up at renal clinic of Jimma University specialized referral hospital. An Institution-based cross-sectional study was conducted at Jimma University referral from August 6, 2022, to November 13, 2022. A consecutive sampling technique was employed to recruit the study participants into the current study. Data were collected using interviewer-based structured questionnaires and patient’s record reviews. The collected data were analyzed by SPSS version 25.0. Pearson’s correlation analyses was used to check the correlation between estimated glomerular filtration rate and uric acid. Univariate and multivariate linear regression model was used to test predictors of serum uric acid in the study participants. The total study participants were 140 individuals. Subjects included (54.3% [n=76]) men and (45.7% [n=64]) women, respectively. The mean (SD) age of study subjects was 51.04±9.02 years. The mean value of serum uric acid was 7.2±2.1mg/dl whereas the mean of estimated glomerular filtration rate (eGFR) was 54.2±31 mL/min/1.73m². Furthermore, the mean values of serum creatinine and blood urea nitrogen among participants in this study were 3.2±1.4 and 67.8±35.8 mg/dL respectively. In the current study, estimated glomerular filtration rate (eGFR) value was negatively correlated (r=-0.912, P<0.001) with uric acid. However, systolic blood pressure was positively correlated (r=0.584, P<0.001) with uric acid. Moreover, the eGFR value was negatively associated (β=-0.060, P=<0.001) with uric acid among study participants. Based on the current study finding, an increase in serum uric acid was associated with a decrease in eGFR value. Increased serum uric acid, increased body mass index and high blood pressure are independent risk factors for disease progression in patients with CKD.

Are bacterial coinfections really rare in COVID-19 intensive care units?

ObjectivesThere are limited data about nosocomial coinfections of COVID-19 cases monitored in the intensive care unit. This study aims to investigate coinfections in COVID-19 patients followed in an intensive care unit of a university hospital.MethodsThis study analyzed retrospectively the data of coinfections of 351 COVID-19 patients in the period 28.02.2020–15.01.2021 in a tertiary care intensive care unit in a university hospital.ResultsBacterial coinfections were present in 216 of the 351 cases. One hundred and thirty of these cases were evaluated as nosocomial infections. On the third day the Sequential Organ Failure Assessment Score, usage of invasive mechanical ventilation and presence of septic shock were significantly higher in the coinfected group. The neutrophil/lymphocyte ratio, polymorphonuclear leukocyte count, procalcitonin, ferritin, and blood urea nitrogen values were significantly higher in the coinfection group. White blood cells (WBC) (OR: 1.075, 95% CI 1.032–1.121, p = 0.001) and ICU hospitalization day (OR: 1.114, 95% CI 1.063–1.167, p < 0.001) were found to be independent risk factors for coinfection in the multivariate logistic regression analysis. The rates of hospitalization day on the day of arrival, the 21st day, as well as total mortality (p = 0.004), were significantly higher in the coinfected group.ConclusionBacterial coinfections of COVID-19 patients in the intensive care unit remain a problem. Identifying the infectious agent, classifying colonizations and infections, and using the proper treatment of antibiotics are of great importance in the case management of COVID-19 patients in the intensive care unit.

EFFECT OF DIFFERENT PLANS OF NUTRITION ON GROWTH, FEED EFFICIENCY, BLOOD METABOLITES AND RELATIVE ECONOMICS IN SAHIWAL HEIFERS

This trial was designed with the objectives to select best and economical feedingstrategies to accelerate growth pattern for reducing age at maturity in buffalo heifers. Twenty Sahiwalheifers (Age = 24 ± 2-month and wt. = 200 ± 30 kg) were divided into four equal groups(n-5) on thebasis completely randomized design, Control group (D) of heifers was fed on green fodder only and noration was offered while test diets were comprised on TMR based on wheat straw (A), fodder(B) andsilage(C) with crude protein 10-11 percent. Feed intake of each experimental animal were recordeddaily. Animals were weighed at the start of experiment and fortnightly thereafter. Animals of group Cgained higher body weight (averaged 580 grams daily) comparing with other groups while animals ofgroup (D)fed on fodder only yielded very poorly growth. Dry Matter Intakes of all groups were similarand there was no effect of treatment of different plans of diet fed to animals. Dry matter, Crude proteinand crude fiber digestibility values were higher in animals fed total mixed ration based on corn silageand dry ration as compared to those fed other diets. Blood urea nitrogen values were higher in group Afed on TMR wheat straw based diet while blood glucose values were higher in animals of group B andC fed corn silage or green fodder based diet as indicator for availability of nutrients for growth.

Bleeding Complications in Uremic Patients After Ultrasound-Guided Central Venous Catheter Placement.

Bleeding associated with elevated blood urea nitrogen (BUN) is a known complication. Patients with uremia require a central venous catheter insertion by dialysis. The relation between BUN and bleeding complications during central venous catheter insertion is not yet clear. We described the frequency of complications associated with central venous catheter implantation in uremic patients and evaluated the statistical relationship between bleeding complications and catheter type, number of punctures, and catheter insertion site. Also, we determined if any value of BUN is associated with bleeding complications. We included patients with a serum value of BUN >70 mg/dl that required insertion of a central venous catheter. The quantitative variables were expressed through the measure of central tendency. A bivariate analysis and a ROC curve were performed. A total of 273 catheters were included in this study. Bleeding complications were detected in 69 cases (25.3%), and local bleeding was the most frequent complication in 51/69 cases. Statistically significant association was not established. We did not find a specific cut-off value directly related to BUN levels and the rate of complications. Bleeding complications associated with the insertion of central venous catheter and the suspected disorder of hemostasis given by BUN levels >70 mg/dl are common. It was not possible to determine a BUN cut-off value to predict complications. The association analysis was not conclusive. High BUN levels should not be considered a high-risk condition for central venous cannulation under ultrasound guidance performed by trained personnel.

Research of mortality risk prediction based on hospital admission data for COVID-19 patients.

As COVID-19 continues to spread across the world and causes hundreds of millions of infections and millions of deaths, medical institutions around the world keep facing a crisis of medical runs and shortages of medical resources. In order to study how to effectively predict whether there are risks of death in patients, a variety of machine learning models have been used to learn and predict the clinical demographics and physiological indicators of COVID-19 patients in the United States of America. The results show that the random forest model has the best performance in predicting the risk of death in hospitalized patients with COVID-19, as the COVID-19 patients' mean arterial pressures, ages, C-reactive protein tests' values, values of blood urea nitrogen and their clinical troponin values are the most important implications for their risk of death. Healthcare organizations can use the random forest model to predict the risks of death based on data from patients admitted to a hospital due to COVID-19, or to stratify patients admitted to a hospital due to COVID-19 based on the five key factors this can optimize the diagnosis and treatment process by appropriately arranging ventilators, the intensive care unit and doctors, thus promoting the efficient use of limited medical resources during the COVID-19 pandemic. Healthcare organizations can also establish databases of patient physiological indicators and use similar strategies to deal with other pandemics that may occur in the future, as well as save more lives threatened by infectious diseases. Governments and people also need to take action to prevent possible future pandemics.