B-type natriuretic peptide versus amino terminal pro-B type natriuretic peptide: selecting the optimal heart failure marker in patients with impaired kidney function

Background: The effect of impaired kidney function on B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) is vague. This study was performed to examine the effect of kidney dysfunction on the afore-mentioned markers and determine appropriate cutoffs for systolic heart failure (SHF). Methods: In this cross sectional study adults with estimated glomerular filtration rate (eGFR)/min for ≥3 months were identified in consulting clinics from June 2009 to March 2010. SHF was defined as documented by a cardiologist with ejection fraction of \u3c 40% and assessed by New York Heart Association classification (NYHA). Plasma was assayed for creatinine (Cr), BNP and NT-proBNP. Results: A total of 190 subjects were enrolled in the study, 95 with and 95 without SHF. The mean age of patients was 58 (±15) years, 67.4% being males. Mean BNP levels showed a 2.5 fold and 1.5 fold increase from chronic kidney disease (CKD) stage 3 to stage 5 in patients with and without SHF respectively. NT-proBNP levels in non-heart failure group were 3 fold higher in CKD stage 5 compared to stage 3. Mean NT-proBNP levels were 4 fold higher in CKD stage 5 compared to stage 3 in patients with SHF. Optimal BNP and NT-proBNP cutoffs of SHF diagnosis for the entire CKD group were 300 pg/ml and 4502 pg/ml respectively. Conclusion: BNP and NT-proBNP were elevated in kidney dysfunction even in the absence of SHF; however the magnitude of increase in NT-proBNP was greater than that of BNP. BNP and NT-proBNP can be useful in diagnosing SHF, nonetheless, by using higher cutoffs stratified according to kidney dysfunction. NT-proBNP appears to predict heart failure better than BNP

Prevalence of gastric varices and results of sclerotherapy with N-butyl 2 cyanoacrylate for controlling acute gastric variceal bleeding.

Aim: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV). Methods: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed. Results: The prevalence of GV in patients with portal hypertension was 15% (220/1436) and the incidence of bleeding was 22.7% (50/220). Out of the 50 bleeding GV patients, isolated gastric varices (IGV-I) were seen in 22 (44%), gastro-oesophageal varices (GOV) on lesser curvature (GOV-Ⅰ) in 16 (32%), and GOV on greater curvature (GOV-Ⅱ) in 15 (30%). IGV-Ⅰ was seen in 44% (22/50) patients who had bleeding as compared to 23% (39/170) who did not have bleeding (P \u3c 0.003). Primary hemostasis was achieved with NBC in all patients. Re-bleeding occurred in 7 (14%) patients after 48 h of initial sclerotherapy. Secondary hemostasis was achieved with repeat NBC sclerotherapy in 4/7 (57%). Three patients died after repeat sclerotherapy, one during transjugular intrahepatic portosystemic stem shunt (TIPSS), one during surgery and one due to uncontrolled bleeding. Treatment failure-related mortality rate was 6% (3/50). Conclusion: GV can be seen in 15% of patients with f patients with using the tissue adhesive agent butyl cyanoacrylate. Since then several authors have used different sclerosing agents to achieve hemostasis in bleeding gastric varices, including N-butyl-2 cyanoacrylate (histoacryl)[4,8], 2-octyl cyanoacrylate[9], ethanolamine oleate injection[10], gastric variceal banding[11], thrombin[12], sodium tetradecyl sulfate[13]. However, N-butyl 2 cyanoacrylate (NBC) is the only promising agent. Most reports on endoscopic treatment of bleeding gastric varices are small series, case reports, or retrospective reviews[14,15]. Not more than 1000 patients with bleeding GV have been treated with different sclerosing and coagulating agents. Cyanoacrylate injection can achieve primary hemostasis in 70% to 95% of patients with acute GV bleeding, with an early rebleeding rate ranging from 0% to 28% within 48 h[5,7,16]. Different doses of cyanoacrylate are used by different gastroenterologis ts[16,17]. Moreover, dilution ratio of NBC to lipoidal is different[18,19]. However, there is no consensus regarding effective dose and dilution of sclerosing agents. This study was to analyze patients with GV in order to establish predictors of bleeding GV, and the efficacy and safety of NBC in treatment of bleeding GV

Role of rapid urease test and histopathology in the diagnosis of Helicobacter pylori infection in a developing country

BACKGROUND: The aim of this study was to determine the effect of commonly self-prescribed proton pump inhibitors (PPI) on the results of rapid urease test and histology for the diagnosis of H. pylori infection. METHODS: One hundred-nine consecutive patients with dyspeptic symptoms attending the endoscopy suite were enrolled in this study. Antrum biopsy specimens were collected at endoscopy for the rapid urease test (Pronto Dry, Medical Instrument Corp, France) and histopathology. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and like-hood ratio of a positive and negative of Pronto Dry test were compared against histology. The gold standard test for the diagnosis of H. pylori infection was histopathology. RESULTS: Sixty-one percent (66/109) patients were males with mean age of 43 ± 14.1 years and age range 17–80 years. Fifty-two percent (57/109) were not on any medications while 48% (52/109) used PPI before presentation to the outpatients. Pronto Dry was positive in 40% (44/109) and negative in 60% (65/109). Histopathology was positive for H. pylori in 57% (62/109) and negative in 43% (47/109). The sensitivity, specificity, PPV, NPV and like-hood ratio of a positive and negative Pronto Dry test with and without PPI were 43.3%, 86.4%, 81.3%, 3.18, 0.656 and 52.8% vs 71.9%, 80%, 82.1%, 69%, 3.59 and 0.35. CONCLUSION: This study shows that the sensitivity, specificity, NPV and PPV of rapid urease test was reduced in patients who are on PPI. The exclusive use of the rapid urease test for the diagnosis of Helicobacter pylori cannot be recommended in patients with prior PPI use

Protective Effect of Solanum nigrum

The prophylactic or curative antioxidant efficacy of crude extract and the active constituent of S. nigrum leaves were evaluated in modulating inherent antioxidant system altered due to immobilization stress in rat brain tissues, in terms of measurement of glutathione (GSH), lipid peroxidation (thiobarbituric acid reactive substances, TBARS), and free radical scavenging enzymes activities. Rats were treated with single dose of crude extract of S. nigrum prior to and after 6 h of immobilization stress exposure. Exposure to immobilization stress resulted in a decrease in the brain levels of glutathione, SOD, GST, and catalase, with an increase in thiobarbituric acid reactive substances (TBARS) levels. Treatment of S. nigrum extract and its active constituents to both pre- and poststressed rats resulted in significant modulation in the above mentioned parameters towards their control values with a relative dominance by the latter. Brain is vulnerable to stress induced prooxidant insult due to high levels of fat content. Thus, as a safe herbal medication the S. nigrum leaves extract or its isolated constituents can be used as nutritional supplement for scavenging free radicals generated in the brain due to physical or psychological stress or any neuronal diseases per se

B-type natriuretic peptide versus amino terminal pro-B type natriuretic peptide: choosing the optimal heart failure marker in patients with impaired kidney function

Introduction: B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are novel HF markers but the effect of renal disease on these markers is not fully understood. Objective: To compare the levels of serum BNP and NT-proBNP in patients with compromised kidney function with and without HF. Study Design: Cross sectional. Place and Period: Consulting Clinics and Chemical Pathology Unit of Department of Pathology and Microbiology at Aga Khan University Hospital Karachi. From June 2009 to March 2010. Material and Method: Blood sample from adults with impaired kidney function for ≥3 months was obtained. Patients with documented HF with EF \u3c 40% were in the HF group. The demographic and clinical details of the patients were noted. Plasm was assayed for creatinine (Cr), BNP and NT-proBNP. Estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft Gault formula. Results: The mean age of patients (n=190) was 58 years (±15 years), majority being males (67.4 %). BNP (r=-0.3) and NT-proBNP (r = - 0.5) rose with declining eGFR. Log mean BNP levels in the group with HF and impaired kidney function (n=95) was 2.4 ± 0.6 pg/ml as compared to those with impaired kidney function but no HF (n=95) 2.0 ±. 0.4 pg/ml (p\u3c0.01). Log mean NT-proBNP levels in the HF group was 3.9 ± 0.6 pg/ml as compared to those with no HF 2.9 ±. 0.6 pg/ml (p \u3c0.01). Conclusion: Plasma NT-proBNP was much higher as compared to BNP in the HF group and concentrations of BNP and NT-proBNP are not interchangeable. NT-proBNP appears to be affected more by declining eGFR, in keeping with the hypothesis that its clearance is predominantly renal. Keywords: heart failure, kidney, chronic, biomarke