Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients—A single centre cross-sectional study / Estudio de la disfunción sistólica ventricular izquierda, disfunción diastólica ventricular izquierda e hipertensión pulmonar en pacientes con ERC 3b-5ND – un estudio transversal en un solo centro

Introduction: Cardiovascular diseases are associated with increased morbidity and mortality among CKD (chronic kidney disease) population. Recent studies have found increasing prevalence of PH (pulmonary hypertension) in CKD population. Present study was done to determine prevalence and predictors of LV (left ventricular) systolic dysfunction, LVDD (left ventricular diastolic dysfunction) and PH in CKD 3b-5ND (non-dialysis) patients. Methods: A cross sectional observational study was done from Jan/2020 to April/2021. CKD 3b-5ND patients aged ≥15 yrs were included. Transthoracic 2D (2 dimensional) echocardiography was done in all patients. PH was defined as if PASP (pulmonary artery systolic pressure) value above 35mm Hg, LV systolic dysfunction was defined as LVEF (left ventricular ejection fraction)≤50% and LVDD as E/e′ ratio >14 respectively. Multivariate logistic regression model was done to determine the predictors. Results: A total of 378 patients were included in the study with 103 in stage 3b, 175 in stage 4 and 100 patients in stage 5ND. Prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. Predictors of PH were duration of CKD, haemoglobin, serum 25-OH vitamin D, serum iPTH (intact parathyroid hormone) and serum albumin. Predictors of LVDD were duration of CKD and presence of arterial hypertension. Predictors of LV systolic dysfunction were eGFR (estimated glomerular filtration rate), duration of CKD, serum albumin and urine protein. Conclusion: In our study of 378 CKD 3b-5ND patients prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. (AU)

Introducción: Las enfermedades cardiovasculares se asocian a un aumento de la morbilidad y la mortalidad entre la población con enfermedad renal crónica (ERC). Estudios recientes han encontrado un aumento de la prevalencia de la hipertensión pulmonar (HP) en la población con ERC. El presente estudio se llevó a cabo para determinar la prevalencia y los predictores de la disfunción sistólica del ventrículo izquierdo (VI), la disfunción diastólica del VI y la hipertensión pulmonar en pacientes con ERC 3b -5ND (sin diálisis). Métodos: Se realizó un estudio observacional transversal desde enero/2020 hasta abril/2021. Se incluyeron pacientes con ERC 3b -5ND de edad ≥15 años. Se realizó una ecocardiografía transtorácica 2D (bidimensional) a todos los pacientes. La HP se definió como un valor de presión sistólica de la arteria pulmonar superior a 35mm Hg, la disfunción sistólica del VI se definió como una fracción de eyección del ventrículo izquierdo ≤ 50% y la DVL como una relación E/e′>14 respectivamente. Se realizó un modelo de regresión logística multivariante para determinar los predictores. Resultados: Un total de 378 pacientes fueron incluidos en el estudio con 103 en estadio 3b, 175 en estadio 4 y 100 pacientes en estadio 5ND. La prevalencia de la HP fue del 12,2%, la disfunción sistólica del VI fue del 15,6% y la DVL fue del 43,65%. Los predictores de la HP fueron la duración de la ERC, la hemoglobina, la vitamina D 25-OH en suero, la iPTH en suero (hormona paratiroidea intacta) y la albúmina en suero. Los predictores de la EVL fueron la duración de la ERC y la presencia de hipertensión arterial. Los predictores de la disfunción sistólica del VI fueron la tasa de filtración glomerular estimada, la duración de la ERC, la albúmina sérica y las proteínas en orina. Conclusión: En nuestro estudio de 378 pacientes con ERC 3b-5ND la prevalencia de la HP fue del 12,2%, la disfunción sistólica del VI fue del 15,6% y la DVL fue del 43,65%. (AU)

Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients-A single centre cross-sectional study.

INTRODUCTION: Cardiovascular diseases are associated with increased morbidity and mortality among CKD (chronic kidney disease) population. Recent studies have found increasing prevalence of PH (pulmonary hypertension) in CKD population. Present study was done to determine prevalence and predictors of LV (left ventricular) systolic dysfunction, LVDD (left ventricular diastolic dysfunction) and PH in CKD 3b-5ND (non-dialysis) patients. METHODS: A cross sectional observational study was done from Jan/2020 to April/2021. CKD 3b-5ND patients aged ≥15 yrs were included. Transthoracic 2D (2 dimensional) echocardiography was done in all patients. PH was defined as if PASP (pulmonary artery systolic pressure) value above 35mm Hg, LV systolic dysfunction was defined as LVEF (left ventricular ejection fraction)≤50% and LVDD as E/e' ratio >14 respectively. Multivariate logistic regression model was done to determine the predictors. RESULTS: A total of 378 patients were included in the study with 103 in stage 3b, 175 in stage 4 and 100 patients in stage 5ND. Prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%. Predictors of PH were duration of CKD, haemoglobin, serum 25-OH vitamin D, serum iPTH (intact parathyroid hormone) and serum albumin. Predictors of LVDD were duration of CKD and presence of arterial hypertension. Predictors of LV systolic dysfunction were eGFR (estimated glomerular filtration rate), duration of CKD, serum albumin and urine protein. CONCLUSION: In our study of 378 CKD 3b-5ND patients prevalence of PH was 12.2%, LV systolic dysfunction was 15.6% and LVDD was 43.65%.

Design, Synthesis, and Temperature-Driven Molecular Conformation-Dependent Delayed Fluorescence Characteristics of Dianthrylboron-Based Donor-Acceptor Systems.

We report a simple and novel molecular design strategy to enhance rISC in boron-based donor-acceptor systems to achieve improved delayed fluorescence characteristics. Dianthrylboryl ((An)2B)-based aryl aminoboranes 1 (donor: phenothiazine) and 2 (donor: N,N-diphenylamine) were synthesized by a simple one-pot procedure. The energy of the electronic excited states in 1 and 2 were modulated by varying the arylamine donor strength and electronic coupling between D and A moieties. The presence of a large π-system (anthryl moiety) on boron enhances the electronic communication between donor arylamine and acceptor boryl moieties, and hence, both 1 and 2 exhibit delayed fluorescence characteristics in a broad range of temperatures (80-300 K). Single crystal X-ray analysis and temperature-dependent photophysical studies together with theoretical studies were carried out to rationalize the observed intriguing optical signatures of 1 and 2.

Intertissue differences for the role of glutamate dehydrogenase in metabolism.

The enzyme glutamate dehydrogenase (GDH) plays an important role in integrating mitochondrial metabolism of amino acids and ammonia. Glutamate may function as a respiratory substrate in the oxidative deamination direction of GDH, which also yields α-ketoglutarate. In the reductive amination direction GDH produces glutamate, which can then be used for other cellular needs such as amino acid synthesis via transamination. The production or removal of ammonia by GDH is also an important consequence of flux through this enzyme. However, the abundance and role of GDH in cellular metabolism varies by tissue. Here we discuss the different roles the house-keeping form of GDH has in major organs of the body and how GDH may be important to regulating aspects of intermediary metabolism. The near-equilibrium poise of GDH in liver and controversy over cofactor specificity and regulation is discussed, as well as, the role of GDH in regulation of renal ammoniagenesis, and the possible importance of GDH activity in the release of nitrogen carriers by the small intestine.

A case of adult onset Still's disease with flare of arthritis.

Adult onset Still's disease is a febrile illness of unknown aetiology, accounting for about 6% cases of fever of unknown origin. It was first described by Eric GL Bywater in 1971, and since then few case series have been reported from India and other parts of the globe. A case of adult onset Still's disease who presented with fever and polyarthralgia of 18 months duration with flare of joint symptoms during fever spikes has been reported.

Radiation exposure of ventilated trauma patients in intensive care: a retrospective study comparing two time periods.

OBJECTIVE: To describe the cumulative effective dose of radiation that was received during the initial Emergency Department assessment and ICU stay of patients admitted with trauma, who required mechanical ventilation, during two time periods. METHOD: A retrospective analysis of radiological and clinical data, set in a regional nonurban ICU. Two cohorts (starting 1 January 2004 and 1 January 2009), each comprising 45 adult patients admitted with trauma who were mechanically ventilated in intensive care, were studied. Frequency and type of radiological examinations, demographic information, and clinical data were collated from the radiological database, hospital admission record and Australian Outcomes Research Tool for Intensive Care database. Cumulative effective doses were calculated and expressed as a total dose and average daily dose for each cohort. RESULTS: The median cumulative effective dose per patient (in milliSieverts) increased from 34.59 [interquartile range (IQR) 9.08-43.91] in 2004 to 40.51 (IQR 22.01-48.87) in 2009, P=0.045. An increased number of computed tomography examinations per patient was also observed over the same interval from an average of 2.11 (median 2, IQR 1-3) in 2004 to an average of 2.62 (2, 2-4) in 2009, P=0.046. CONCLUSION: The radiation exposure of mechanically ventilated trauma patients in intensive care has increased over time. Radiation exposure should be prospectively monitored and staff should be aware of the increased risk resulting from this change in practice.