Anemia Of Chronic Disease And Kidney Failure

Anemia is a disease that caused due to inflammation, autoimmune disease, or chronic disease as cancer, kidney failure, heart failure, diabetes, but the main reason of anemia is iron deficiency. Breathlessness, weakness, and exhaustion are all possible effects of anemia. Anemia comes in a variety of types. Everyone has a unique reason. Anemia may be chronic or transient. It could be minor or really serious. Anemia may indicate a more serious medical condition.  In this research we will explain the anemia due to chronic disease especially kidney failure. Anemia occurs when decreasing the number of red blood cells that carry oxygen to the body. According to world health organization (WHO), the person has anemia when hemoglobin (which is present in red blood cells, transports oxygen from the lungs to every other organ in the body), (Hb) levels <12.0 g/dl in women and <13.0 g/dl in men. We can treat anemia by iron supplement, medications, blood transfusion, vitB12, blood and bone transplant but it occur in hospital and by healthy diet. If anemia remained untreated it will be a risk of irregular heartbeat, heart failure, infection, and in children it may cause developmental delay. We can diagnosis anemia by blood tests which are used by medical practitioners to look for indications of inflammation-related anemia, other anemias, or other health issues. You will give blood to a medical professional who will then submit the sample to a lab for analysis. The National institutes of health (NIH) approved that we can examine a variety of components and characteristics of your blood, such as how many red blood cells ,the dimensions of red blood cells ,how much hemoglobin is present in your blood and red blood cells ,the quantity of reticulocytes, or growing red blood cells, in your blood. Blood tests are another tool that a medical expert may use to measure how much iron is stored in blood, transferrin, and ferritin. If the results of a blood test indicate that you have anemia low blood iron levels will appear, determining the amount of iron in low and normal range. Adults who suffer from severe anemia may become vulnerable to heart or lung issues. For instance, you might experience heart failure, in which the heart is unable to pump enough blood throughout your body at the proper pressure or tachycardia, which is an unusually rapid heartbeat. Anemia  can also come from obesity unlike exception of some people so we should follow health diet has iron supplement such as meat, sugar beet

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Design and Synthesis of Polyimides Based on Carbocyclic Pseudo-Tröger’s Base-Derived Dianhydrides for Membrane Gas Separation Applications

Two novel carbocyclic pseudo-Tröger’s base-derived dianhydrides, 5,6,11,12-tetrahydro-5,11-methanodibenzo­[<i>a,e</i>]­[8]­annulene-2,3,8,9-tetracarboxylic anhydride (CTB1) and its dione-substituted analogue 6,12-dioxo-5,6,11,12-tetrahydro-5,11-methano­dibenzo­[<i>a,e</i>]­[8]­annulene-2,3,8,9-tetra­carboxylic dianhydride (CTB2), were made and used for the synthesis of soluble polyimides of intrinsic microporosity with 3,3′-dimethyl­naphthidine (DMN). The polyimides CTB1-DMN and CTB2-DMN exhibited excellent thermal stability of ∼500 °C and high BET surface areas of 580 and 469 m² g^–1, respectively. A freshly made dione-substituted CTB2-DMN membrane demonstrated promising gas separation performance with O₂ permeability of 206 barrer and O₂/N₂ selectivity of 5.2. A higher O₂ permeability of 320 barrer and lower O₂/N₂ selectivity of 4.2 were observed for a fresh CTB1-DMN film due to its higher surface area and less tightly packed structure as indicated by weaker charge-transfer complex interactions. Physical aging over 60 days resulted in reduction in gas permeability and moderately enhanced selectivity. CTB2-DMN exhibited notable performance with gas permeation data located between the 2008 and 2015 permeability/selectivity upper bounds for O₂/N₂ and H₂/CH₄

Early markers of renal damage in obstructive sleep apnea syndrome (OSAS) patients with or without diabetes mellitus

Background: Although obstructive sleep apnea syndrome (OSAS) has been associated with chronic kidney disease CKD, there are little data about early screening of renal affection in OSAS patients. Aim of the work: To evaluate renal function in OSAS patients with or without diabetes mellitus (DM) using blood indices [mean platelet volume (MPV) and red cell distribution width (RDW)] and serum neutrophil gelatinase associated lipocalin (NGAL) as early markers of kidney injury. Patients and methods: This case control analytic study was designed to enroll 20 OSAS patients with DM, 20 OSAS patients without DM, and 20 non OSAS diabetic patients as control group. All patients underwent full over-night attended diagnostic polysomnography. Those with AHI ≥5 were considered to have OSAS. Laboratory parameters including complete blood count with MPV and RDW, serum glucose, urea, creatinine, Hemoglobin A1c, urine albumin creatinine ratio UACR and serum NGAL were done to all enrolled participants. Results: Urine albumin creatinine ratio UACR ≥ 3 mg/mmol was found in 11 (55%) of OSAS diabetic group, 6 (30%) of non diabetic OSAS group and in 11 (55%) of D.M group. Both diabetic and non diabetic OSAS patients had significantly higher RDW and NGAL compared to non OSAS diabetic. The diabetic OSAS group had also significantly higher serum urea and creatinine compared to DM group. In OSAS patients, RDW had significant positive correlation with UACR. Meanwhile both RDW and NGAL were determined to have significant positive correlation with desaturation index during sleep, but not correlated to AHI. Conclusion: Renal impairment is common in OSAS patients but more frequent if associated with diabetes mellitus. RDW% can be used as simple screening test for early detection of renal injury in OSAS patients with or without diabetes mellitus

Precision Face Milling of Maraging Steel 350: An Experimental Investigation and Optimization Using Different Machine Learning Techniques

Maraging steel, characterized by its superior strength-to-weight ratio, wear resistance, and pressure tolerance, is a material of choice in critical applications, including aerospace and automotive components. However, the machining of this material presents significant challenges due to its inherent properties. This study comprehensively examines the impacts of face milling variables on maraging steel’s surface quality, cutting temperature, energy consumption, and material removal rate (MRR). An experimental analysis was conducted, and the gathered data were utilized for training and testing five machine learning (ML) models: support vector machine (SVM), K-nearest neighbor (KNN), artificial neural network (ANN), random forest, and XGBoost. Each model aimed to predict the outcomes of different machining parameters efficiently. XGBoost emerged as the most effective, delivering an impressive 98% prediction accuracy across small datasets. The study extended into applying a genetic algorithm (GA) for optimizing XGBoost’s hyperparameters, further enhancing the model’s predictive accuracy. The GA was instrumental in multi-objective optimization, considering various responses, including surface roughness and energy consumption. The optimization process evaluated different weighting methods, including equal weights and weights derived from the analytic hierarchy process (AHP) based on expert insights. The findings indicate that the refined XGBoost model, augmented by GA-optimized hyperparameters, provides highly accurate predictions for machining parameters. This outcome holds significant implications for industries engaged in the machining of maraging steel, offering a pathway to optimized operational efficiency, reduced costs, and enhanced product quality amid the material’s machining challenges

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (&gt; 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72&nbsp;h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) &lt; 60&nbsp;ml/min/1.73&nbsp;m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72&nbsp;h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7&nbsp;days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7&nbsp;days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P &lt; 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P &lt; 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7&nbsp;days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019Research in context

Summary: Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding: The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences &amp; Sichuan Provincial People's Hospital (2022QN38)