Novel Urinary Biomarkers and Chronic Kidney Disease After Coronary Angiography: A Prospective Case-Controlled Study

BACKGROUND: Novel urinary biomarkers may have potential for early detection of acute kidney injury. AIM: The aim of the study was to test two urinary biomarkers: Kidney injury molecule-1(KIM-1) and liver-type fatty acid binding protein (L-FABP) as markers of kidney injury following coronary angiography. METHODS: This is a prospective non-randomized controlled trial, performed in two large teaching hospitals. Patients were recruited from the catheter lab or form nephrology outpatient clinics. In group (A), 100 patients with AKI on top of CKD after coronary angiography and Group B: Thirty-one patients with stable CKD as a control. KIM-1 and L-FABP were measured at base line and after 3 months. RESULTS: In group (A), 100 patients who had acute on top of CKD after coronary angiography, stage progression occurred in 15 patients in group (A) compared to two patients in group (B) (p = 0.28). The median change in eGFR after 3 months was not statistically significant between both groups (p = 0.8). Median baseline urinary liver-type fatty acid binding protein was higher in Group A compared to Group B (3.7 μg/g vs. 1.82μg/g). The change in L-FABP from baseline to 3 months was significant between both groups (p < 0.001). The median urinary concentrations of KIM-1 and L-FABP were higher at the end of the follow-up compared to base line values in both groups, (p < 0.000). CONCLUSION: Urinary L-FABP correlates with kidney function decline in patients with acute on top of CKD after coronary angiography. Urinary levels of KIM-1 and L-FABP at 3 months increase significantly compared to baseline in patients with progressive CKD

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Impact of Enterobacteriaceae bacteremia on survival in patients with hepatorenal failure

Enterobacteriaceae are now the predominant pathogens isolated in patients with liver cell failure associated with bloodstream infections. We conducted a retrospective cohort study of patients who were admitted for the diagnosis of hepatorenal failure (HRF) between June 1999 and May 2008 to investigate the risk factors of Enterobacteriaceae bacteremia (EB). EB was defined as the isolation of an EB species from at least one blood culture within three months following diagnosis of HRF. Variables were collected from the medical records and analyzed in relation to EB. Twenty-four (32.5%) of the 73 patients developed EB. The origin of EB was abdominal in 21% of the patients, urinary in 12.5%, pulmonary in 16.5%, and primary in the remaining patients (50%). Two-thirds of EB occurred within 10 days following the development of HRF. The main pathogens were Escherichia coli (44%), Enterobacter species (20%) and Klebsiella pneumoniae (22%). Eighteen patients (75%) with EB died. Variables significantly associated with EB after multivariate analysis were a model for end-stage liver disease score >20 [odds ratio (OR): 2.84, P <0.02], posthepatitis B liver cirrhosis (OR: 4.72, P <0.05), posthepatitis C liver cirrhosis (OR: 3.48, P <0.05), and initial level of serum creatinine on admission to intensive care unit (OR: 2.56, P <0.02). EB is a frequent and severe complication of HRF. Patients with posthepatitis cirrhosis B and C, higher serum creatinine, and severe liver cell failure score have a high risk of developing EB

The effect of co-infection with hepatitis B and hepatitis C viruses on the prevalence of proteinuria and loss of renal function: a single-center experience

Introduction and aim of the work Patients infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) are at increased risk of renal disease. This study compares factors associated with proteinuria and doubling of serum creatinine level in patients who were infected with HCV or HBV alone with those who were coinfected with HCV and HBV. Materials and methods The study was performed on 1243 patients who were diagnosed with HBV and/or HCV at the Cairo University Hospitals. All the included subjects underwent urine analysis for proteinuria and serum creatinine level. Clinical characteristics were recorded at baseline and at last follow-up. Results Of 1243 patients, 293 (23.6%) patients had proteinuria. Subset analysis of the patients with proteinuria showed that 10.6% were HBV infected, 63.8% were HCV infected, and the remaining 25.6% were coinfected with both HBV and HCV. Overall, coinfection with both viruses (P=0.01), lower serum albumin (P=0.001), hypertension (P=0.01), and diabetes (P=0.001) were associated with an increase in risk of proteinuria. Coinfection (P=0.001), presence of HBV (P=0.001), and increasing HCV RNA level in patients with HCV and in coinfected patients (P=0.05) was associated with doubling of serum creatinine level. Conclusion The patients coinfected with HBV and HCV are at greater risk of clinically significant proteinuria and loss of renal function owing to complex virological profile. Progressive loss of renal function in that population is associated with markers of viral activity such as proteinuria and increasing HCV RNA levels among HCV-infected patients

Steroid resistant focal segmental glomerulosclerosis: effect of arterial hyalinosis on outcome: single center study

Background. Few data with adequate evidence exists as regards the effect of Cyclosporine (CsA) and mycophenolate mofetil (MMF) on pathological prognostic parameters in patients with steroid resistant focal segmental glomerulosclerosis (FSGS). The purpose of the present study is to compare the effect of cyclosporin and mycophenolate mofetil in addition to steroids on functional and histopathologic renal parameters in patients with steroid resistant FSGS one year after treatment

Evaluation of left ventricular function in patients with chronic obstructive pulmonary disease with or without pulmonary hypertension

Background: Chronic obstructive pulmonary disease (COPD) is a common entity in clinical practice. Development of right ventricular hypertrophy and eventual right side heart failure is also common in such patients. However, some disturbance in left ventricular (LV) function has been observed among such patients. Objectives: The aim of this study was to evaluate LV function in patients with chronic obstructive pulmonary disease (COPD) with or without pulmonary hypertension. Patients and methods: Thirty-six patients with COPD without additional cardiac diseases and 12 age and sex-matched healthy subjects were enrolled into the study. All patients underwent spirometry, standard and tissue Doppler echocardiography. Results: 20 COPD patients (55.6%) had pulmonary hypertension. Left ventricular systolic function did not differ between patient and control groups. However the difference between both groups was significant regarding left ventricular diastolic function and left ventricular global function. Left ventricular diastolic function and global function differed significantly between different COPD grades. Patients with pulmonary hypertension had significantly higher heart rate, less E wave peak velocity (measured by DTI) (P ⩽ 0.05), less E/A ratio (measured by DTI) (P ⩽ 0.01) and E/A ratio (measured by flow) and higher myocardial performance index (P ⩽ 0.05) than normal pulmonary pressure patients. Conclusion: Left ventricular diastolic function and LV global function are affected in COPD patients especially with progression of the disease. COPD patients with pulmonary hypertension are more liable to LV diastolic and global dysfunction than normal pulmonary pressure COPD patients. Doppler tissue echocardiography is a better tool in the assessment of left ventricular function

Designing and validating an evaluation tool for nurse educators regarding core competencies

Using standardized evaluation tool for core competencies of nurse educator is essential to prepare faculty member. This study was aimed to design and validate an evaluation tool for nurse educators core competencies based on literature review. Also, Assessing the validity of the proposed tool by panel of experts and assessing the reliability of the proposed tool. Methodological design was used to carry out this study on two group "Jury group" was recruited for testing the face and content validity of the preliminary tool, this group consists of (35) members selected from different fields in nursing and "nurse educators" group working at two selected technical institutes of nursing Which affiliated to Ain-Shams Specialized Hospital and Ain-Shams University Hospitals. Data collection tool included Opinionnaire sheet for validity of the proposed tool, questionnaire sheet for eliciting the importance of preliminary tool from the viewpoint of nurse educator and developed evaluation tool. The results revealed that a majority agreement of jury group regarding face and content validity. Also a majority agreement of nurse educator regarding importance of proposed tool items of. Construct validity is measured by exploratory factor analysis (EFA) and Eigen value. It proved to be high reliability through intra-rater and inter-rater testing

Efficacy of 4-hour rescue therapeutic plasma exchange in severe septic shock patients

Background.Early intervention for septic shock is crucial to reduce mortality and improve outcome. There is still a great debate over the exact time of therapeutic plasma exchange (TPE) administration in septic shock patients. This study aims to investigate the effect of early initiation (within 4 hours) of TPE in severe septic shock on hemodynamics & outcome