Suchergebnisse

Background: Chronic kidney disease encompasses a spectrum of different pathophysiological processes associated with abnormal renal function and a progressive decline in glomerular filtration rate. Duplex ultrasonography is widely available and important imaging investigation required in the work?up of chronic kidney disease. The objective of the study was to assess correlation of renal duplex ultrasonographic parameters with decreased glomerular filtration rate in patients with chronic kidney disease.Methods: This was a crosssectional hospital-based study. A total of sixty-two patients with chronic kidney disease referred for ultrasonography were included in the study. Patients were evaluated by duplex ultrasonography. Correlation of renal length, parenchymal thickness, cortical thickness, cortical echogenicity, peak systolic velocity, end diastolic velocity pulsatility index and resistive index with glomerular filtration rate was evaluated by using Pearson's correlation coefficient.Results: Chronic kidney disease was seen more prevalent in 41-50 years of age group. The major risk factors associated with Chronic kidney disease was Hypertension and Diabetes Mellitus. A significant positive correlation of renal length, parenchymal thickness, cortical thickness (p value < 0.01) and end diastolic velocity (p value < 0.05) with eGFR and significant negative correlation of cortical echogenicity, resistive index and pulsatility index (p value < 0.01) with eGFR was derived.Conclusions: Duplex sonographic findings of renal length, parenchymal thickness, cortical thickness, cortical echogenicity, end diastolic velocity, pulsatility index and resistive index are found to be useful parameters in evaluation of chronic kidney disease.Keywords: Chronic kidney disease; duplex ultrasonography; glomerular filtration rate.

Background: The diagnosis of acute coronary syndrome remains challenging, as cardiac troponins and creatine kinase-MB do not detect myocardial ischemia. Ischemia modified albumin is biomarker positive within 6-10 minutes following ischemic onset, where oxygen free radicals leads to reduction in binding capacity of human serum albumin to transitional metal-cobalt. The objective of this study was to compare ischemia modified albumin between acute coronary syndrome patients and healthy controls, and evaluate diagnostic performance of ischemia modified albumin compared to cardiac troponins, creatine kinase-MB and electrocardiogram in acute coronary syndrome patients.Methods: Fifty ACS patients and 50 healthy controls were enrolled in this cross-sectional study. Ischemia modified albumin was measured after addition of known amount of cobalt to human serum albumin, followed by spectrophotometric determination of unbound cobalt fraction at 470 nm using dithiothreitol as coloring agent. Independent student t-test and One-way ANOVA to compare differences of mean between groups; diagnostic sensitivity and specificity of ischemia modified albumin was determined by receiver operating characteristic curve; McNemar-test was used to assess diagnostic performance of entire test parameters, when used alone and in combinations.Results: Ischemia modified albumin was significantly higher in acute coronary syndrome patients compared to controls (0.823±0.191 vs 0.410±0.081)(p<0.001). Receiver operating characteristic curve derived optimal cutoff of 0.475 Absorbance unit had sensitivity and specificity of 92% and 82% respectively (area under curve- 0.96). However, no significant differences in mean ischemia modified albumin values between three categories of acute coronary syndrome were seen. Sensitivity of ischemia modified albumin assay (92%) was significantly higher compared to electrocardiogram (72%), cardiac troponin I (18%), and creatine kinase-MB(42%).Conclusions: Ischemia modified albumin is elevated in acute coronary syndrome patients with better diagnostic performance compared to electrocardiogram, cardiac troponin I, and creatine kinase-MB for early diagnosis, however, with limited ability to discriminate between ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina.

IMPORTANCE Although rheumatic heart disease has been nearly eradicated in high-income countries, 3 in 4 children grow up in parts of the world where it is still endemic. OBJECTIVES To determine the prevalence of clinically silent and manifest rheumatic heart disease as a function of age, sex, and socioeconomic status and to estimate age-specific incidence. DESIGN, SETTING, AND PARTICIPANTS In this school-based cross-sectional study with cluster sampling, 26 schools in the Sunsari district in Eastern Nepal with 5467 eligible children 5 to 15 years of age were randomly selected from 595 registered schools. After exclusion of 289 children, 5178 children were enrolled in the present study from December 12, 2012, through September 12, 2014. Data analysis was performed from October 1, 2014, to April 15, 2015. EXPOSURES Demographic and socioeconomic characteristics were acquired in a standardized interview by means of a questionnaire customized to the age of the children. A focused medical history was followed by a brief physical examination. Cardiac auscultation and transthoracic echocardiography were performed by 2 independent physicians. MAIN OUTCOMES AND MEASURES Rheumatic heart disease according to the World Heart Federation criteria. RESULTS The median age of the 5178 children enrolled in the study was 10 years (interquartile range, 8-13 years), and 2503 (48.3%) were female. The prevalence of borderline or definite rheumatic heart disease was 10.2 (95% CI, 7.5-13.0) per 1000 children and increased with advancing age from 5.5 (95% CI, 3.5-7.5) per 1000 children 5 years of age to 16.0 (95% CI, 14.9-17.0) in children 15 years of age, whereas the mean incidence remained stable at 1.1 per 1000 children per year. Children with rheumatic heart disease were older than children without rheumatic heart disease (median age [interquartile range], 11 [9-14] years vs 10 [8-13] years; P = .03), more commonly female (34 [64.2%] vs 2469 [48.2%]; P = .02), and more frequently went to governmental schools (40 [75.5%] vs 2792 [54.5%]; P = .002). Silent disease (n = 44) was 5 times more common than manifest disease (n = 9). CONCLUSIONS AND RELEVANCE Rheumatic heart disease affects 1 in 100 schoolchildren in Eastern Nepal, is primarily clinically silent, and may be more common among girls. The overall prevalence and the ratio of manifest to subclinical disease increase with advancing age, whereas the incidence remains stable at 1.1 per 1000 children per year. Early detection of silent disease may help prevent progression to severe valvular damage.