Study on pattern of drug utilization in the treatment of congestive cardiac failure in a tertiary care hospital

Background: Congestive cardiac failure/congestive heart failure (CCF/CHF) is one of the major public health problem seen in more than 23 million people worldwide. Drug utilization studies were stood as a powerful exploratory tool to ascertain the role of drugs in determining the therapeutic efficacy, cost effectiveness and also in minimizing the adverse effects due to it during the treatment of a disease. Aims and Objectives: The present study undertaken to describe the drug utilization pattern in patients of CHF in a tertiary care hospital. Materials and Methods: This is a Prospective, Observational, and Non-interventional study. The study was undertaken after obtaining the ethical committee approval in the in-patient department of Medicine. Case records of 100 patients were obtained and treatments were noted. Results: The present study had 60 male and 40 female patients admitted and undergoing treatment for CCF. Most of them were above 50 years of age and the most common comorbidity among them were hypertension (25%) followed by diabetes mellitus (19%). The most commonly used drugs were diuretics and antihypertensives. Conclusion: In our study, patients use of more than 2 ?3 drugs (Polytherapy) was found very common than use of one drug (Monotherapy).

Neutrophil gelatinase-associated lipocalin: a biochemical marker for acute kidney injury and long-term outcomes in patients presenting to the emergency department

INTRODUCTION@#Creatinine has limitations in identifying and predicting acute kidney injury (AKI). Our study examined the utility of neutrophil gelatinase-associated lipocalin (NGAL) in predicting AKI in patients presenting to the emergency department (ED), and in predicting the need for renal replacement therapy (RRT), occurrence of major adverse cardiac events (MACE) and all-cause mortality at three months post visit.@*METHODS@#This is a single-centre prospective cohort study conducted at Singapore General Hospital (SGH). Patients presenting to SGH ED from July 2011 to August 2012 were recruited. They were aged ≥21 years, with an estimated glomerular filtration rate <60 mL/min/1.73 m2, and had congestive cardiac failure, systemic inflammatory response syndrome or required hospital admission. AKI was diagnosed by researchers blinded to experimental measurements. Serum NGAL was measured as a point-of-care test.@*RESULTS@#A total of 784 patients were enrolled, of whom 107 (13.6%) had AKI. Mean serum NGAL levels were raised (P < 0.001) in patients with AKI (670.0 ± 431.9 ng/dL) compared with patients without AKI (490.3 ± 391.6 ng/dL). The sensitivity and specificity of NGAL levels >490 ng/dL for AKI were 59% (95% confidence interval [CI] 49%-68%) and 65% (95% CI 61%-68%), respectively. Need for RRT increased 21% per 100 ng/dL increase in NGAL (P < 0.001), whereas odds of death in three months increased 10% per 100 ng/dL increase in NGAL (P = 0.028). No clear relationship was observed between NGAL levels and MACE.@*CONCLUSION@#Serum NGAL identifies AKI and predicts three-month mortality.

Early outcomes of heart transplantation in critical patients: single center experience of Fuwai Hospital / 器官移植

Objective To analyze the early outcomes of heart transplantation in critical patients and its significance in donor allocation decision. Methods Clinical data of 449 recipients undergoing heart transplantation were retrospectively analyzed. According to preoperative status, all patients were divided into the critical status group (n=64) and general status group (n=385). The incidence of critical status was summarized. Clinical data of recipients were statistically compared between two groups. Postoperative survival and causes of death in recipients between two groups were analyzed. Perioperative results of critical recipients undergoing different mechanical circulation support as a bridge to heart transplantation were compared. Results Critical patients accounted for 14.3% of the total number of transplant recipients. The proportion of critical patients gradually increased in recent 5 years. Compared with the general status group, the recipients in critical status group had a lower proportion of smoking history, a higher proportion of cardiac surgery history, a higher serum level of creatinine, and a higher proportion of primary diseases of heart failure before heart transplantation(all P≤0.01). The proportion of undergoing mechanical circulation support was higher, the incidence of complications was higher, the stay time in intensive care unit (ICU) was longer and the in-hospital fatality was higher after heart transplantation in the critical status group (all P≤0.01). The 1-year survival rate of recipients in critical status group was significantly lower than that in general status group (83% vs. 95%, P < 0.01). The fatality of recipients due to infection and multiple organ failure in critical status group was higher than that in general status group. Among 64 critical recipients, 1 recipient received ventilator alone, and 63 recipients underwent mechanical circulation support devices as a bridge to heart transplantation. Among them, intra-aortic balloon pump (IABP) alone was applied in 49 cases (77%), 8 cases (13%) of extracorporeal membrane oxygenation (ECMO) combined with IABP, 4 cases (6%) of ECMO alone, and 2 cases (3%) of left ventricular assist device (LVAD) alone. Critical patients who received preoperative ECMO and ECMO combined with IABP bridging to heart transplantation have a higher proportion of postoperative complications, a longer ICU stay time, a longer mechanical ventilation time, and a higher proportion of hospital deaths. Conclusions The overall prognosis of critical patients undergoing heart transplantation is relatively poor. Effective preoperative management may reverse the high-risk status of critical patients in a certain extent. The limited quantity of donor heart should be allocated to the most urgent patients who can obtain the greatest benefit from heart transplantation.

Geriatric Medicine concepts: Trajectory of illness, Life course approach and comprehensive Geriatric assessment

@#Globally, there is an increase in older people. Clinicians, particularly primary care physicians, will need to equip themselves with knowledge and have a general approach for management of older people. In this paper, the following geriatric principles and concepts are covered: the trajectory of illness and the life course approach, multifactorial diagnoses and attributable risk, and comprehensive geriatric assessment. The illness trajectory concept enables clinicians to recognize where the patient is at, predict their likely prognosis and offer appropriate treatment decisions, balanced between aggressive curative intent and symptomatic management. The life course approach provides a model for planning intervention, which usually needs cooperation with other specialties. It is a worthwhile reminder for clinicians that older people tend to present with atypical symptoms, with multiple contributing factors towards their illness. Comprehensive geriatric assessment enables the clinician to gather sufficient information to complete clinical decision making for older people.

Diagnostic and Prognostic Value of N-Terminal Brain Natriuretic Peptide in Patients of Heart Failure.

Heart failure is a clinical condition in which a deviation in normal cardiac structure or function is accountable for the incapability of the heart to eject or fill with blood at a proportion proportionate to the requirements of the metabolizing tissues. The detection of heart failure is based on clinical symptoms, signs, chest x rays and reaction to the treatment. BNPs are released by the heart ventricles in reaction to volume load or pressure load physiologically and they function to counteract rennin angiotensin system, cause vasodilatation and natriuresis. The BNP evaluation has gained approval already in the recommendations of European Society of Cardiology for the detection of heart failure. We wanted to study the potential of a new unconventional assay plasma N-Terminal pro BNP in detecting cardiac failure, and correlate the levels of plasma N-Terminal pro BNP with the severity of the cardiac failure and levels of plasma N-Terminal Pro BNP with systolic and diastolic dysfunction. MethodsIt was an analytical cross-sectional study conducted among 50 patients with clinical features of cardiac failure attending medicine OPD and emergency department of the hospital for the duration of 18 months and an equal number of age and sex equivalent fit controls. In subjects with clinical features of heart failure, and in healthy controls, 2 mL of blood sample is drawn for assay of plasma N-Terminal pro BNP within half an hour of presentation. Using biomedical kit plasma N-T pro BNP concentration was measured. The entire period of the assay is 18 min. Detectability range by this method of N-T proBNP is 5 pg/mL to 35,000 pg/mL. ResultsCases comprised of 28 males and 22 females with a mean age 50.80 (13.11) years while controls comprised of 28 males and 22 females with a mean age 50.86 (12.7) years. There was a statistically noteworthy difference in Mean N-T pro BNP between case and control groups, NYHA Class, and age group. Mean N-T pro-BNP is not significantly different at discharge and on 2nd follow-up. For the rest of the diagnoses, there is a notable difference in Mean N-T pro BNP at discharge and on 2nd follow-up. ConclusionsPlasma N-Terminal pro BNP levels are useful from therapeutic point of view (aggressive therapy if needed e.g. Heart transplantation / bilateral pacemaker or invasive therapy may be planned by N-T pro BNP levels).

Evidence related to sodium restriction in patients with heart failure / Pruebas relacionadas con la restricción de sodio en pacientes con insuficiencia cardíaca / Evidências relacionadas à restrição de sódio em pacientes com insuficiência cardíaca

ABSTRACT Objectives: to analyze the scientific production about sodium restriction in patients with heart failure. Methods: integrative literature review from articles published from 2007 to 2017, located in the CINAHL and Scopus databases. Results: thirteen studies were analyzed. Sodium intake restriction was associated with lower unfavorable clinical outcomes in patients with marked symptomatology. The 24-hour urine sodium dosage was the main tool to assess adherence to the low sodium diet. Conclusions: based on the studies included in this review, in symptomatic patients, dietary sodium restriction should be encouraged in clinical practice as a protective measure for health. However, in asymptomatic patients, it should be well studied.

RESUMEN Objetivo: analizar la producción científica sobre la restricción de sodio en pacientes con insuficiencia cardíaca. Métodos: revisión integral de la literatura de artículos publicados de 2007 a 2017, ubicados en las bases de datos CINAHL y Scopus. Resultados: se analizaron trece estudios. La restricción en la ingesta de sodio se asoció con resultados clínicos desfavorables más bajos en pacientes con marcada sintomatología. La dosis de sodio en orina de 24 horas fue la herramienta principal para evaluar el cumplimiento de la dieta baja en sodio. Conclusión: según los estudios incluidos en esta revisión, en pacientes sintomáticos, se debe fomentar la restricción de sodio en la dieta en la práctica clínica como medida de protección para la salud. Sin embargo, en pacientes asintomáticos, debe estudiarse bien.

RESUMO Objetivos: analisar a produção científica acerca da restrição de sódio em pacientes com insuficiência cardíaca. Métodos: revisão integrativa da literatura, a partir de artigos publicados no período de 2007 a 2017, localizados nas bases de dados CINAHL e Scopus. Resultados: foram analisados 13 estudos. A restrição no consumo de sódio se mostrou associada a menores desfechos clínicos desfavoráveis em pacientes com sintomatologia acentuada. A dosagem de sódio na urina coletada em 24 horas foi a ferramenta principal para avaliar adesão à dieta com baixo teor de sódio. Conclusões: com base nos estudos incluídos nesta revisão, em pacientes sintomáticos, a restrição de sódio na dieta deve ser encorajada na prática clínica como medida protetora à saúde. No entanto, em pacientes assintomáticos, deve ser bem estudada.

Application of essential oil components of aromatic Chinese materia medica in cardiovascular diseases / 中草药

Aromatic Chinese materia medica (CMM) have special aromatic odor, in which essential oils are widely present. It is reported that some essential oil components can significantly improve cardiovascular diseases by scavenging oxygen free radicals, relaxing blood vessels, improving lipid metabolism, reducing heart rate, and antiplatelet aggregation. Several mechanisms have been proposed for the role of essential oils in promoting cardiovascular health in aromatic CMM. The purpose of this review is to highlight and summarize the role of essential oils from aromatic CMM in reducing the risk of cardiovascular disease and their mechanisms. The research on essential oil components of aromatic CMM could discover new bioactive compounds and provide ideas for the development of new functional products for the treatment of cardiovascular diseases such as arterial hypertension, angina, heart failure, and myocardial infarction.

Study of etiology of pleural effusion in Telangana population

Background: Among 86 patients aged between 18 to 65 of both sexes having pleural effusion due to various clinical etiologies were studied.Methods: Chest x-ray PA. was studied, 20 ml of pleural fluid was aspirated to study bio-chemically, microbiologically and pathological. Echo-cardiography, USG abdomen and biopsy of pleura was also done in same patients in whom diagnosis or etiology was unclear.Results: Among 59(68.6%) had fever, 68(79%) had cough, 40(46.5%) had breathlessness, 20(23.2%) had pedal edema, 42(48.8%) had chest pain, 5(5.8%) had abdominal distention. 52(60.4%) had tubercular pleural effusion 34(39.5%) had non- tubercular pleural types of non-tubercular PE effusion (PE) included 8(23.5%) synpneumonic, 5(14.7%) had CCF, 11(32.3%) had malignancy, 2(5.88%) had RA, 2(5.88%) had dengue fever, 2(5.88%) had pancreatitis, 4(11.7%) had Hypoproteinaemia.Conclusions: This pragmatic approach to pleural effusion for patients with different clinical manifestations as pleural fluid analysis is gold standard method in evaluation pleural effusion of different etiology.Background: Among 86 patients aged between 18 to 65 of both sexes having pleural effusion due to various clinical etiologies were studied.Methods: Chest x-ray PA. was studied, 20 ml of pleural fluid was aspirated to study bio-chemically, microbiologically and pathological. Echo-cardiography, USG abdomen and biopsy of pleura was also done in same patients in whom diagnosis or etiology was unclear.Results: Among 59(68.6%) had fever, 68(79%) had cough, 40(46.5%) had breathlessness, 20(23.2%) had pedal edema, 42(48.8%) had chest pain, 5(5.8%) had abdominal distention. 52(60.4%) had tubercular pleural effusion 34(39.5%) had non- tubercular pleural types of non-tubercular PE effusion (PE) included 8(23.5%) synpneumonic, 5(14.7%) had CCF, 11(32.3%) had malignancy, 2(5.88%) had RA, 2(5.88%) had dengue fever, 2(5.88%) had pancreatitis, 4(11.7%) had Hypoproteinaemia.Conclusions: This pragmatic approach to pleural effusion for patients with different clinical manifestations as pleural fluid analysis is gold standard method in evaluation pleural effusion of different etiology.

Chronic kidney disease in pregnancy and fetomaternal outcome

Background: Chronic kidney disease is a heterogeneous group of renal dysfunctions with complex and varied presentations in pregnancy. With a long asymptomatic course, timely diagnosis and management is crucial for fetomaternal wellbeing.Methods: A retrospective cohort study over a period of 3 years and 4 months included all obstetric in patients with known or newly diagnosed renal disorders. Maternal outcome was measured with regard to biochemical parameters presence /absence of proteinuria, hypertension, mode of pregnancy termination and complications. Fetal outcome was noted with respect to antenatal complications, weight, Apgar, NICU stay. Computation of results was done using percentages, mean and proportions.Results: Out of 13 women studied, 53.8% were pre-diagnosed cases of renal dysfunction and 46.2% were diagnosed during pregnancy. 38% had proteinuria at first visit and 50% remained so even after delivery. 60% had history of pregnancy induced hypertension in their previous pregnancies. Secondary hypertension and superimposed preeclampsia were seen in 30% and 38% cases respectively, with only one patient requiring magnesium sulphate prophylaxis in post-partum. Cardiac dysfunction was found to be coexisting in 15.3% cases with pre-existing renal leision. Intrauterine growth restriction was seen in 61.5% cases Average fetal weight was 2. 26kg with 30% having NICU stay. 30.6% had preterm delivery. Mode of delivery was caesarean section in 46% cases.Conclusions: Pregnancy with CKD is a high-risk pregnancy with adverse fetomaternal outcomes. For optimal pregnancy outcomes, an expert multidisciplinary team is required. With limited studies in south Asian population, there needs to be an upgradation in registry system.

Miocardiopatía no compactada asociada a Defectos cardiacos congénitos. Reporte de caso Hnerm-Essalud / Non compacted miocardiopathy associated with congenital heart Defects. Case report Hnerm-Essalud

El presente caso corresponde a un paciente de un mes de vida, sexo masculino con diagnóstico de miocardiopatía no compactada asociada a defectos cardiacos congénitos. La miocardiopatía no compactada recién es incluida por la American Heart Association (AHA) como entidad propia a partir de la segunda mitad de la década pasada. El diagnóstico principalmente es ecocardiográfico. La sintomatología en menores de un año puede empezar con falla cardiaca. La evolución es variable con tendencia a la mejoría en algunos casos para finalmente en décadas posteriores se hace más pronunciada la falla cardiaca, eventos tromboembólicos, arritmias malignas y muerte súbita. El manejo esta en medicamentos para falla cardiaca, evitar arritmias malignas y eventos tromboembólicos.

The present case corresponds to a 1-month-old male patient with a diagnosis of non-compacted cardiomyopathy associated with congenital heart defects. Noncompacted cardiomyopathy is newly included by the AHA as its own since the second half of the last decade. The diagnosis is mainly echocardiographic. Symptoms in children under one year may start with heart failure. The evolution is variable and tends to improve in some cases. Finally, in later decades, heart failure, thromboembolic events, malignant arrhythmias and sudden death become more pronounced. The management is in medicines for heart failure, to avoid malignant arrhythmias and thromboembolic events.

Acceso venoso para hemodiálisis y repercusión crónica en el sistema cardiovascular / Hemodialysis venous access and chronic impact on cardiovascular system

En el tratamiento de enfermos renales en fase terminal, se realizan accesos vasculares para hemodiálisis. Son hechos habitualmente, en las venas de los miembros superiores, especialmente la técnica de Brecia y Cimino (fístula arteriovenosa latero lateral de la cefálica y la radial en la muñeca). La mayor complicación, directamente relacionada con un flujo excesivo por la fístula arteriovenosa, es la insuficiencia cardíaca congestiva. Se presenta el caso de un paciente con una fístula arteriovenosa (iatrogénica) que causó una insuficiencia cardiaca congestiva. El paciente, hipertenso conocido, tuvo un acceso venoso de más de 10 años de evolución (por un aparente diagnóstico y para una futura hemodiálisis que nunca fue efectuada). Acudió a consulta con disnea y edemas periféricos. Al examen físico se encontró la tensión arterial en 160 y 100 mm Hg, signos clínicos de cardiomegalia, edemas periféricos, ingurgitación yugular y hepatomegalia. Se palpó un thrill sistodiastólico en la muñeca izquierda, donde presentaba una cicatriz. Pudo observarse marcada dilatación y endurecimiento de todas las venas superficiales del plexo braquial de ese lado, (arterialización del árbol venoso del miembro superior izquierdo hasta las venas superficiales del hemitórax). Se diagnosticó una insuficiencia cardiaca de gasto alto, mejoró con el tratamiento habitual, pero continuó con la malformación venosa adquirida. Fue un caso muy llamativo, que muestra una complicación poco frecuente de los accesos venosos para hemodiálisis y también una causa mencionada, pero escasamente vista, de insuficiencia cardiaca de gasto elevado(AU)

In the treatment of renal patients in terminal phase. Vascular accesses are used for hemodialysis. They are usually performed in the veins of the upper limbs, especially using Brecia and Cimino technique (lateral arteriovenous fistula of the cephalic and radial at the wrist). The major complication, directly related to an excessive flow of arteriovenous fistula, is congestive heart failure. We present the case of a patient with an arteriovenous (iatrogenic) fistula that caused a congestive heart failure. He is hypertensive and had venous access for over 10 years of evolution (for an apparent diagnosis and for future hemodialysis, which was never performed). He went to the clinic with dyspnea and peripheral edema. Physical examination revealed blood pressure of 160 and 100 mm Hg, clinical signs of cardiomegaly, peripheral edema, jugular engorgement and hepatomegaly. We found a systodiastolic thrill on his left wrist, where there is a scar. A marked dilation and hardening of all the superficial veins of the brachial plexus on that side was observed, that is arterialization of the venous tree of the left upper limb to the superficial veins of hemitorax. The diagnosis was high output heart failure. He improved with the usual treatment, but the acquired venous malformation continued in an iatrogenic manner. It was a very striking case because of the infrequent complication of venous accesses for hemodialysis and because for rarely seen elevated heart failure(AU)

Serum Uric Acid in Acute Coronary Syndromes

Introduction: Uric acid (urate), an organic compound ofcarbon, nitrogen, oxygen and hydrogen has been thought to beprotective against ageing, oxidative stress and oxidative cellinjury owing to its oxidant property. Recent epidemiologicaland clinical evidences suggest that hyperuricaemia might be arisk factor for cardiovascular disease where enhanced oxidativestress plays an important pathophysiological role. The studyis taken up to determine serum uric acid levels in AcuteCoronary Syndromes (ACS) and to compare the incidence ofcomplications in hyperuricaemic and normouricaemic acutecoronary syndrome patients.Material and Methods: A prospective cohort study wasconducted in the Department of Medicine in collaborationwith Department of Biochemistry, RIMS, Imphal fromOctober 2014 to September 2016, among 73 normouricaemicACS patients and 73 hyperuricaemic ACS patients. Clinicaland anthropometric data were taken from each subject.Laboratory evaluation involves serum uric acid by enzymaticcolorimetric method.Results: The mean serum uric acid level in the studypopulation was 5.96 ± 1.88 mg/dl. Arrhythmias occurred in27.4% of hyperuricemic patients and 5.5% of normouricemicpatients. It is observed that 27 patients developed congestivecardiac failure (CCF), out of which 17 patients (22.3%)were hyperuricaemic and 10 patients (13.7%) werenormouricaemic. Pulmonary edema (PE) was observed in 35hyperuricaemic and 28 normouricaemic patients (47.9% and38.4% respectively).Conclusions: Complications of ACS such as arrhythmias,CCF and PE occurred more frequently in hyperuricaemicindividuals. Thus, it can be concluded that serum uric acidlevel can be considered a suitable marker for predicting ACSrelated future adverse events.

Study of cardiac disease and its outcome in pregnancy

Background: Pregnancy comes as a temporary complication in the disease process of a patient with a cardiac lesion. It is the 4th common cause of maternal mortality and one of the most important non-obstetrical causes of maternal death. Previously most women with diagnosed heart disease were advised to avoid pregnancy and labor and termination was advised. But in modern obstetrical practice, pregnancy in a patient with a heart disease is no longer an unacceptable hazard. The objective of this study is to find out incidence of cardiac diseases in pregnancy, to evaluate their management and to find out maternal and fetal outcome in pregnancy with cardiac disease.Methods: This study is a prospective cohort study in which an analysis of maternal and fetal outcome in 30 cases of cardiac diseases in pregnancy was carried out in the department of Obstetrics and Gynaecology in our institute at Civil hospital Ahmadabad from 01/01/2017 to 31/12/2017.The study included all known case of RHD, CHD, or newly diagnosed case or surgically corrected case with prosthetic heart valves during current pregnancy.Results: Majority of women having pregnancy with cardiac disease were in the age group of 20-30 years. Majority of them were primigravida and suffered from rheumatic heart diseases with grade 1 NYHA severity. Majority of women got delivered by normal vaginal delivery with healthy fetal outcome. Most of the babies born to cardiac mother had their baby weight ranging between 2.0-2.5kg.Conclusions: The results of present study indicate that heart disease forms a considerable proportion of medical illness complicating pregnancy. Cardiac disease presents problems both to the obstetrician and as well as to the physician, cardiologist and to the neonatologist. But the majority of pregnancies complicated by heart disease are uneventful with a favorably good outcome for both the mother and the fetus.

Study on clinical presentation and etiological profile of atrial fibrillation patients

Background: Atrial fibrillation is one of most common arrhythmias observed in general practice. Atrial fibrillation may occur paroxysmal or may become established as permanent condition. The aim of the treatment of atrial fibrillation is either normalization of rhythm by cardioversion or control of ventricular rate by drugs. The present work was undertaken to study, clinical presentation, aetiology and complications in patients developing atrial fibrillation.Methods: A prospective study carried out at Department of Medicine V.M. Medical college and Shri Chhatrapati Shivaji Maharaj Sarvopachar Rungnalaya, Solapur, over the study period of two years. 100 patients of atrial fibrillation diagnosed by following clinical and ECG criteria were included. Detail study of aetiology complication and clinical presentation of atrial fibrillation was done in present study.Results: Commonest presenting symptom was breathlessness (70%) followed by palpitation (58%). Common signs elicited were irregular pulse, apex pulse deficit (92%). Congestive cardiac failure was present in 46% patient among those raised JVP was seen in 100% cases, oedema in 60.8% hepatomegaly 63.04% basal crepitations in 86.9% cases. ECG revealed coarse fibrillary waves (81.8%) in patients with rheumatic heart disease whereas fine fibrillary waves were seen in patients with IHD as cause of AF.Conclusions: Size of fibrillary was may be predicted etiology of AF as coarse waves are common in rheumatic and fine waves in non- rheumatic AF. The present paper would help in early diagnosis and prompt treatment of AF.

Renal echography and cystatin C for prediction of acute kidney injury: very different in patients with cardiac failure or sepsis / 中华危重病急救医学

Objective@#To explore the predicting performance of renal resistive index (RRI), semi quantitative power Doppler ultrasound (PDU) score and serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with cardiac failure or sepsis.@*Methods@#A prospective, observational study was conducted. Critically ill patients with acute cardiac failure or sepsis admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 1st to December 31st in 2018 were enrolled. In addition to the demographic data, serum Cys C, RRI, and PDU score were measured within 6 hours after admission to ICU. Renal function was assessed on day 5 according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients who proceeded to AKI stage 2 or 3 within 5 days from admission were defined as the AKI 2-3 group; other patients were classified into the AKI 0-1 group. The differences of each index were compared in all patients, cardiac failure patients and sepsis patients between the two groups. Multivariate binary Logistic regression was carried out to identify the independent risk predictors of AKI 2-3. Receiver operator characteristic (ROC) curves were plotted to examine the values of Cys C, RRI, PDU score, and RRI+PDU in predicting AKI 2-3.@*Results@#Thirty-seven patients with cardiac failure (11 with no AKI, 10 with AKI stage 1, 3 with AKI stage 2, and 13 with AKI stage 3) and 26 patients with sepsis (8 with no AKI, 2 with AKI stage 1, 7 with AKI stage 2, and 9 with AKI stage 3) were recruited. In all patients as well as the subgroup of cardiac failure, compared with the AKI 0-1 group, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score, rate of continuous renal replacement therapy (CRRT), 28-day mortality, serum creatinine (SCr), Cys C and RRI were higher in AKI 2-3 group, and urine output, PDU score were lower; in the subgroup of sepsis, rate of CRRT, SCr, and Cys C were higher in AKI 2-3 group, and urine output was lower. Multivariate Logistic regression analysis found that Cys C and PDU score were independent risk factors for AKI 2-3 in all patients [Cys C: odds ratio (OR) = 11.294, 95% confidence interval (95%CI) was 2.801-45.541, P = 0.001; PDU score: OR = 0.187, 95%CI was 0.056-0.627, P = 0.007]; RRI and PDU score were independent risk factors for AKI 2-3 in patients with cardiac failure [RRI (×10): OR = 6.172, 95%CI was 0.883-43.153, P = 0.067; PDU score: OR = 0.063, 95%CI was 0.007-0.584, P = 0.015]; Cys C was the independent risk factor for AKI 2-3 in patients with sepsis (OR = 22.830, 95%CI was 1.345-387.623, P = 0.030). It was shown by ROC curve analysis that: in the subgroup of cardiac failure, the predictive values of RRI, PDU score and Cys C were well [area under the curve (AUC) and 95%CI was 0.839 (0.673-0.942), 0.894 (0.749-0.971), 0.777 (0.610-0.897), all P < 0.01]. RRI+PDU performed best in predicting AKI (AUC = 0.956, 95%CI was 0.825-0.997, P < 0.01), and the predictive value was higher than Cys C [AUC (95%CI): 0.956 (0.825-0.997) vs. 0.777 (0.610-0.897), P = 0.034]. In the subgroup of sepsis, the predictive value of Cys C was well (AUC = 0.913, 95%CI was 0.735-0.987, P < 0.01), however, the predictive value of RRI, PDU, RRI+PDU were poor.@*Conclusions@#RRI and PDU score effectively predict AKI stage 2 or 3 in cardiac failure patients, but not in patients with sepsis. The predictive values of Cys C for AKI are similar in patients with cardiac failure or sepsis.

Renal echography and cystatin C for prediction of acute kidney injury: very different in patients with cardiac failure or sepsis / 中华危重病急救医学

Objective To explore the predicting performance of renal resistive index (RRI), semi quantitative power Doppler ultrasound (PDU) score and serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with cardiac failure or sepsis. Methods A prospective, observational study was conducted. Critically ill patients with acute cardiac failure or sepsis admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 1st to December 31st in 2018 were enrolled. In addition to the demographic data, serum Cys C, RRI, and PDU score were measured within 6 hours after admission to ICU. Renal function was assessed on day 5 according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria. Patients who proceeded to AKI stage 2 or 3 within 5 days from admission were defined as the AKI 2-3 group; other patients were classified into the AKI 0-1 group. The differences of each index were compared in all patients, cardiac failure patients and sepsis patients between the two groups. Multivariate binary Logistic regression was carried out to identify the independent risk predictors of AKI 2-3. Receiver operator characteristic (ROC) curves were plotted to examine the values of Cys C, RRI, PDU score, and RRI+PDU in predicting AKI 2-3. Results Thirty-seven patients with cardiac failure (11 with no AKI, 10 with AKI stage 1, 3 with AKI stage 2, and 13 with AKI stage 3) and 26 patients with sepsis (8 with no AKI, 2 with AKI stage 1, 7 with AKI stage 2, and 9 with AKI stage 3) were recruited. In all patients as well as the subgroup of cardiac failure, compared with the AKI 0-1 group, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score, rate of continuous renal replacement therapy (CRRT), 28-day mortality, serum creatinine (SCr), Cys C and RRI were higher in AKI 2-3 group, and urine output, PDU score were lower; in the subgroup of sepsis, rate of CRRT, SCr, and Cys C were higher in AKI 2-3 group, and urine output was lower. Multivariate Logistic regression analysis found that Cys C and PDU score were independent risk factors for AKI 2-3 in all patients [Cys C: odds ratio (OR) = 11.294, 95% confidence interval (95%CI) was 2.801-45.541, P = 0.001; PDU score: OR = 0.187, 95%CI was 0.056-0.627, P = 0.007]; RRI and PDU score were independent risk factors for AKI 2-3 in patients with cardiac failure [RRI (×10): OR = 6.172, 95%CI was 0.883-43.153, P = 0.067; PDU score: OR = 0.063, 95%CI was 0.007-0.584, P = 0.015]; Cys C was the independent risk factor for AKI 2-3 in patients with sepsis (OR = 22.830, 95%CI was 1.345-387.623, P = 0.030). It was shown by ROC curve analysis that: in the subgroup of cardiac failure, the predictive values of RRI, PDU score and Cys C were well [area under the curve (AUC) and 95%CI was 0.839 (0.673-0.942), 0.894 (0.749-0.971), 0.777 (0.610-0.897), all P < 0.01]. RRI+PDU performed best in predicting AKI (AUC = 0.956, 95%CI was 0.825-0.997, P < 0.01), and the predictive value was higher than Cys C [AUC (95%CI): 0.956 (0.825-0.997) vs. 0.777 (0.610-0.897), P = 0.034]. In the subgroup of sepsis, the predictive value of Cys C was well (AUC = 0.913, 95%CI was 0.735-0.987, P < 0.01), however, the predictive value of RRI, PDU, RRI+PDU were poor. Conclusions RRI and PDU score effectively predict AKI stage 2 or 3 in cardiac failure patients, but not in patients with sepsis. The predictive values of Cys C for AKI are similar in patients with cardiac failure or sepsis.

Renal echography and cystatin C for prediction of acute kidney injury: very different in patients with cardiac failure or sepsis / 中华危重病急救医学

Objective To explore the predicting performance of renal resistive index (RRI), semi quantitative power Doppler ultrasound (PDU) score and serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with cardiac failure or sepsis. Methods A prospective, observational study was conducted. Critically ill patients with acute cardiac failure or sepsis admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 1st to December 31st in 2018 were enrolled. In addition to the demographic data, serum Cys C, RRI, and PDU score were measured within 6 hours after admission to ICU. Renal function was assessed on day 5 according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria. Patients who proceeded to AKI stage 2 or 3 within 5 days from admission were defined as the AKI 2-3 group; other patients were classified into the AKI 0-1 group. The differences of each index were compared in all patients, cardiac failure patients and sepsis patients between the two groups. Multivariate binary Logistic regression was carried out to identify the independent risk predictors of AKI 2-3. Receiver operator characteristic (ROC) curves were plotted to examine the values of Cys C, RRI, PDU score, and RRI+PDU in predicting AKI 2-3. Results Thirty-seven patients with cardiac failure (11 with no AKI, 10 with AKI stage 1, 3 with AKI stage 2, and 13 with AKI stage 3) and 26 patients with sepsis (8 with no AKI, 2 with AKI stage 1, 7 with AKI stage 2, and 9 with AKI stage 3) were recruited. In all patients as well as the subgroup of cardiac failure, compared with the AKI 0-1 group, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score, rate of continuous renal replacement therapy (CRRT), 28-day mortality, serum creatinine (SCr), Cys C and RRI were higher in AKI 2-3 group, and urine output, PDU score were lower; in the subgroup of sepsis, rate of CRRT, SCr, and Cys C were higher in AKI 2-3 group, and urine output was lower. Multivariate Logistic regression analysis found that Cys C and PDU score were independent risk factors for AKI 2-3 in all patients [Cys C: odds ratio (OR) = 11.294, 95% confidence interval (95%CI) was 2.801-45.541, P = 0.001; PDU score: OR = 0.187, 95%CI was 0.056-0.627, P = 0.007]; RRI and PDU score were independent risk factors for AKI 2-3 in patients with cardiac failure [RRI (×10): OR = 6.172, 95%CI was 0.883-43.153, P = 0.067; PDU score: OR = 0.063, 95%CI was 0.007-0.584, P = 0.015]; Cys C was the independent risk factor for AKI 2-3 in patients with sepsis (OR = 22.830, 95%CI was 1.345-387.623, P = 0.030). It was shown by ROC curve analysis that: in the subgroup of cardiac failure, the predictive values of RRI, PDU score and Cys C were well [area under the curve (AUC) and 95%CI was 0.839 (0.673-0.942), 0.894 (0.749-0.971), 0.777 (0.610-0.897), all P < 0.01]. RRI+PDU performed best in predicting AKI (AUC = 0.956, 95%CI was 0.825-0.997, P < 0.01), and the predictive value was higher than Cys C [AUC (95%CI): 0.956 (0.825-0.997) vs. 0.777 (0.610-0.897), P = 0.034]. In the subgroup of sepsis, the predictive value of Cys C was well (AUC = 0.913, 95%CI was 0.735-0.987, P < 0.01), however, the predictive value of RRI, PDU, RRI+PDU were poor. Conclusions RRI and PDU score effectively predict AKI stage 2 or 3 in cardiac failure patients, but not in patients with sepsis. The predictive values of Cys C for AKI are similar in patients with cardiac failure or sepsis.

Hepatic and Cardiac Iron-load in Children on Long-term Chelation with Deferiprone for Thalassemia Major

Objective: To evaluate the efficacy of prolonged deferiprone monotherapy in patients with ?-thalassemia major. Methods: This cross-sectional study included 40 patients (age range 9 to38 years) with thalassemia major receiving deferiprone for ?5 years. Serum ferritin, andmyocardial iron concentration (MIC) and liver iron concentration (LIC) assessed by T2*MRIwere recorded. Results: The patients were receiving deferiprone for a mean (SD) duration of12.1 (4.7) years. The median (IQR) dose of deferiprone was 85 (74.3, 95) mg/kg/day. TheMIC was normal or had a mild, moderate or severe elevation in 29 (72.5%), 3 (7.5%), 3(7.5%), and 5 (12.5%) patients. The LIC was normal or had a mild, moderate or severeelevation in 2 (5%), 4 (10%), 11 (27.5%) and 23 (57.5%) patients. Conclusions: The majorityof patients receiving deferiprone had a moderate/severe hepatic but normal cardiac iron load.Prolonged deferiprone monotherapy was suboptimal for hepatic iron load in the majority.

Clinical analysis of cardiac failure in post-myocardial infarction patients

Background: Cardiac failure is one of the common complications of Acute Myocardial Infarction. As CAD is the leading cause of death and post MI Cardiac failure also causing increase in rate of Mortality. It directs us to assess the complications of MI and to evaluate the precautionary & preventive steps of cardiac failure.Methods: The present study comprises of 50 cardiac failure patients with history of MI in the past and who presented with myocardial infarction with cardiac failure were included in this study. We excluded the patients who presented with Cardiac failure without Prior history of MI. This hospital based cross sectional study was conducted at Rajiv Gandhi Institute of Medical Sciences (RIMS), Ongole, Prakasam District, Andhra Pradesh. The study was carried out for a period of 1 year with informed consent.Results: In present study majority number of patients (33) show hypokinesia and 10 are found to have dyskinesia and only 4 are akinesia. In this study More than 50% patients are with history of anterior wall involvement. 36(72%) patients have elevated JVP, 34(68%) have cardiomegaly, 38 patients presented with PND. 29(58%) patients are DM and 35(70%) are HTN and only 6(12%) patients are neither DM, nor HTN.Conclusions: Cardiac failure is a common complication after MI. Most common presentations are breathlessness, chest pain, PND, JVP etc. Anterior wall MI on ECG either isolated or associated with other walls is the leading cause of post MI cardiac failure.

White muscle disease in three selenium deficient beef and dairy calves in Argentina and Uruguay / Doença do músculo branco em três bezerros para carne e leite deficientes em selênio na Argentina e Uruguai

ABSTRACT: White muscle disease (WMD), nutritional myodegeneration or enzootic muscular dystrophy, is a nutritional condition associated with selenium and/or vitamin E deficiency in ruminants. These elements are constituents of the major body antioxidant systems. Depletion of selenium results in oxidative damage to cardiac and skeletal muscle cells, resulting in myodegeneration and myonecrosis, typical lesions of WMD. Selenium deficiency is common in South America, but WMD is underreported. This research describes clinical, biochemical and pathological findings in two episodes of WMD associated with selenium deficiency in beef and dairy calves in Argentina and Uruguay with concurrent copper deficiency in one of them, which resulted in spontaneous calf mortality. Further studies are necessary to estimate the true incidence and economic impact of clinical and subclinical mineral deficiencies in livestock production systems in the southern cone of South America.

RESUMO: Doença do músculo branco (DMB), miodegeneração nutricional ou distrofia muscular enzoótica é uma condição nutricional associada à deficiência de selênio e/ou vitamina E em ruminantes. Esses elementos são constituintes dos principais sistemas antioxidantes do corpo. O esgotamento de selênio resulta em dano oxidativo às células musculares cardíacas e esqueléticas, resultando em miodegeneração e mionecrose, lesões típicas da DMB. A deficiência de selênio é comum na América do Sul, mas a DMB está subnotificada. Este trabalho descreve os achados clínicos, bioquímicos e patológicos em dois surtos de DMB associados à deficiência de selênio em bezerros para carne e leite na Argentina e Uruguai com concomitante deficiência de cobre em um surto, que resultaram em mortalidade espontânea de bezerros. São necessários mais estudos para estimar a verdadeira incidência e impacto econômico das deficiências minerais clínicas e subclínicas nos sistemas de produção pecuária no sul da América do Sul.