Dimethylarginines in Children after Anti-Neoplastic Treatment

Background and Objectives: According to a recent Cochrane systematic review, renal impairment can develop in 0–84% of childhood cancer survivors in the future. The renal function impairment in this patient group can be related to nephrectomy, nephrotoxic agents therapy, abdominal radiotherapy, and combinations of these treatment methods. In this study, in a population of patients after anti-neoplastic therapy, with particular emphasis on patients after Wilms’ tumour treatment, we compared new substances which play role in the chronic kidney disease (CKD) pathogenesis (asymmetric dimethylarginine—ADMA, symmetric dimethylarginine—SDMA) with standard renal function markers (e.g., creatinine and cystatin C in serum, creatinine in urine, etc.) to assess the usefulness of the former. Materials and Methods: Eighty-four children, without CKD, bilateral kidney tumours, congenital kidney defects, or urinary tract infections, with a minimum time of 1 year after ending anti-neoplastic treatment, aged between 17 and 215 months, were divided into three groups: group 1—patients after nephroblastoma treatment (n = 21), group 2—after other solid tumours treatment (n = 44), and group 3—after lymphoproliferative neoplasms treatment (n = 19). The patients’ medical histories were taken and physical examinations were performed. Concentrations of blood urea nitrogen (BUN), creatinine, cystatin C, C-reactive protein (CRP), ADMA, and SDMA in blood and albumin in urine were measured, and a general urine analysis was performed. The SDMA/ADMA ratio, albumin–creatine ratio, and estimated glomerular filtration rate (eGFR) were calculated. eGFR was estimated by three equations recommended to the paediatric population by the KDIGO from 2012: the Schwartz equation (eGFR1), equation with creatinine and urea nitrogen (eGFR2), and equation with cystatin C (eGFR3). Results: Both the eGFR1 and eGFR2 values were significantly lower in group 1 than in group 3 (eGFR1: 93.3 (83.1–102.3) vs. 116.5 (96.8–126.9) mL/min/1.73 m2, p = 0.02; eGFR2: 82.7 (±14.4) vs. 94.4 (±11.9) mL/min/1.73 m2, p = 0.02). Additionally, there were weak positive correlations between SDMA and creatinine (p < 0.05, r = 0.24), and cystatin C (p < 0.05, r = 0.32) and weak negative correlations between SDMA and eGFR1 (p < 0.05, r = −0.25), eGFR2 (p < 0.05, r = −0.24), and eGFR3 (p < 0.05, r = −0.32). Conclusions: The usefulness of ADMA and SDMA in the diagnosis of renal functional impairment should be assessed in further studies. eGFR, calculated according to equations recommended for children, should be used in routine paediatric practice.

Pathological and radiological irregularities in patients with chronic kidney disease - An observational study

Background: Chronic kidney disease (CKD) encompasses a spectrum of different pathophysiologic processes associated with abnormal renal function and progressive decline in glomerular filtration rate (GFR). Aims and Objectives: The objectives of the study are 1) to assess basic tests and kidney function tests in patients with CKD, (2) to assess coagulation profile, sugar levels, and platelets levels in patients of CKD, (3) to do the urine analysis in patients with CKD, and (4) to assess GFR among the study population. Materials and Methods: After taking the informed consent, detailed history was taken and clinical examination of patient was done. Pathological tests such as hemogram, renal function tests, liver function tests, coagulation profile, blood sugar levels, urine routine, and microscopy were performed. Ultrasonography of abdomen and pelvis was done. Correlation was done between severity of sepsis and mortality in patients. Results: Anemia was moderate (7–8.9 g/dl) in 38%, mild (9–10.9 g/dl) in 31%, while severe (<6.9) in 29 patients, that is, 29%. Thrombocytopenia was present in 58% of patients. Mean serum albumin in patients was 2.67±0.551 mg/dl; serum globulin was 3.89±0.345 mg/dl. Mean blood sugar of study subjects was 127.41±61.387 mg/dl fasting, 199.67±114.827 mg/dl post-prandial, and mean glycated hemoglobin was 5.63 ± 1.668. On ultrasound acute pyelonephritis, 25 (25%) was the most common finding. Conclusion: Correlation of clinical findings with pathological and radiological findings is very important in patients with CKD. Severity of sepsis directly correlates with mortality of patients.

Diagnostic Accuracy of Urine Analysis (DR) in Suspicious Cases of Urinary Tract Infections by Taking Urine Culture as Gold Standard

Background: Urinary tract infections (UTI) are one of common clinical condition encountered in various clinical settings. This the most common infection, typically diagnosed on the basis history and clinical examination endorsed by urine analysis and culture sensitivity. Timely diagnosis and treatment are crucial in management. For diagnosis of UTI, Urine culture is standard, as it provide detail information for urinary pathogens, but it has certain disadvantages e.g. urine culture is costly, takes longer time, and up to 60-80% of the results are negative. Objective: To determine the diagnostic accuracy of urinalysis (Urine DR) in detection of urinary tract infection (UTI) among suspected cases of UTI by taking urine culture as gold standard. Materials And Methods: This cross sectional study was conducted at study was conducted at Department of Urology, Jinnah Postgraduate Medical Centre (JPMC) Karachi, from march 2021 to September 2021. All patients who visited to JPMC Karachi and fulfilled the inclusion criteria and were included in the study after getting Informed consent. All patients were evaluated by urinalysis and urine culture. The results of urinalyses were recorded and compared with the results obtained on subsequent urine cultures. All of the specimens were obtained by the “clean-catch” method. All data and results were recorded on proforma and used electronically for research purpose. Results: Mean ± SD of age was 52.6±8.5 years. In distribution of gender, 60 (53.1%) patients were male while 53 (46.9%) were female patients. Diagnostic accuracy of urinalysis was 73.45% in diagnosis of urinary tract infection with sensitivity 76.47%, specificity 72.15% PPV 54.17% and NPV was found to be 87.69% by using urine culture findings as gold standard. Conclusion: It is to be concluded that evaluating of urinary tract infection (UTI) with urinalysis (Urine DR) did not prove helpful and comparable to urine culture. Urine culture should be done in each and every suspected case of UTI. Keywords: Bacteriuria, Diagnostic Accuracy, Sensitivity, Specificity, Urinalysis

Experimental Evaluation of Furosemide and/or Tadalafil in Conventional and Nanoparticle Forms in Prevention of Chronic Renal Failure Induced in Rats

Introduction: Chronic renal failure (CRF) is a progressive loss of renal function that lead to reduced sodium filtration and inappropriate suppression of tubular reabsorption that ultimately leads to volume expansion. To improve treatment outcomes, the aim of this study was to evaluate the possible renoprotective effect of tadalafil and furosemide, individually and in combination, in both conventional and nanoforms in adenine-induced CRF rat-model. Methods: Addition of 0.75% adenine to the diet of rats for 4 weeks gained general acceptance as a model to study kidney damage as this intervention mimicked most of the structural and functional changes seen in human chronic kidney disease Urine analysis, histopathological changes and immunohistochemical expression of caspase-3 and interleukin-1β (IL-1β) in renal tissues were performed.Results: Our results showed that the combination of tadalafil and furosemide using conventional and nanoparticle formulations revealed a beneficial therapeutic effect in the treatment of CRF. This was demonstrated by improvement of urinary, serum and renal tissue markers as indicative of organ damage. This was also reflected on the reduction of tubular expression of KIM-1 and NGAL. Immunohistochemical studies showed that significant increase in the number of apoptotic tubular cells indicated by increased expression of caspase-3 in CRF. These deteriorated renal cellular changes were improved by the treatment of rats with the investigated drugs. Results from ELISA showed that IL-1β was reduced by such treatment in kidney tissue. Conclusion: Tadalafil and furosemide improved the biochemical, histopathological and immunohistochemistry changes in adenine-induced CRF which strongly support the renopreventive effects of investigated drugs in particular the nanoparticle forms.

Impact of Heavy Metals in Ambient Air on Insulin Resistance of Shipyard Welders in Northern Taiwan

Exposure to metals poses potential health risks, including insulin resistance (IR), to those exposed to them in excess. Limited studies have examined such risks in occupational workers, including welders, and these have yielded inconsistent results. Thus, we examined the associations between exposure to welding metals and IR in welders. We recruited 78 welders and 75 administrative staff from a shipyard located in northern Taiwan. Personal exposure to heavy metals, including chromium (Cr), manganese (Mn), iron (Fe), nickel (Ni), copper (Cu), zinc (Zn), and cadmium (Cd), was monitored through particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5) and urine analysis by inductively coupled plasma mass spectrometry (ICP–MS). After each participant fasted overnight, blood samples were collected and analyzed for IR assessment through updated homeostasis model assessment (HOMA2) modeling. Air sampling in the personal breathing zone was performed during a Monday shift prior to the blood and urine sample collection the following morning. The welders’ median personal Cr, Mn, Fe, Ni, Cu, and Zn airborne PM2.5 levels and urinary Cd levels were significantly higher than those of the administrative staff. After adjustment for covariates, logarithmic PM2.5-Mn, PM2.5-Fe, PM2.5-Cu, and PM2.5-Zn levels were positively correlated with logarithmic fasting plasma glucose (P-FGAC) levels (PM2.5-Mn: β = 0.0105, 95% C.I.: 0.0027–0.0183; PM2.5-Fe: β = 0.0127, 95% C.I.: 0.0027–0.0227; PM2.5-Cu: β = 0.0193, 95% C.I.: 0.0032–0.0355; PM2.5-Zn: β = 0.0132, 95% C.I.: 0.0005–0.0260). Logarithmic urinary Zn was positively correlated with logarithmic serum insulin and HOMA2-IR levels and negatively correlated with logarithmic HOMA2-insulin sensitivity (%S; βinsulin = 0.2171, 95% C.I.: 0.0025–0.4318; βIR = 0.2179, 95% C.I.: 0.0027–0.4330; β%S = −0.2180, 95% C.I.: −0.4334 to −0.0026). We observed that glucose homeostasis was disrupted by Mn, Fe, Cu, and Zn exposure through increasing P-FGAC and IR levels in shipyard welders.

Prevalence of urinary tract infection in febrile children of less than five years of age

To determine the prevalence of urinary tract infection in febrile children, less than 5 years of age. To assess the validity of microscopic urine analysis and urine culture in the diagnosis of urinary tract infection.Prospective study. Children attending the department of paediatrics, Dr.V.R.K. Women’s Medical College, Teaching Hospital & Research Centre, with febrile illness during June 2019-June 2020.370 children between 1 month to 5 years of age.Data related to age, sex, nutritional status, socioeconomic status and predisposing risk factors like urethral instrumentation, bowel habits etc, were noted. A thorough physical examination with relevant investigations were carried out in all these patients. Routine urinary microscopy was done in all patients and urine culture was done in those who showed pyuria of &#62;5 pus cells/HPF in centrifuged urine sample.In our study, overall prevalence of UTI was 3.5% in children between 1 month to 5 yrs and 4.1% in children &#60;2yrs and 7% in Children &#60;1 year of age with M:F ratio of 1:1in children &#60;2yrs. Prevalence of culture positivity was 44% in those who showed &#62;10 pus cells/HPF in centrifuged sample of urine and 2.5% in those who showed &#62;5pus cells/HPF.The presence of obvious source of fever such as upper respiratory tract infection or otitis media is not reliable in excluding urinary tract infection. Overall prevalence of UTI in our study was low (3.5%) and prevalence among children &#60;2yrs was 4.1% and &#60;1 year of age was 7%. Pyuria of &#62;5pus cells/HPF (centrifuged urine sample) should be considered as significant and further evaluation should be done to initiate prompt treatment.

Is the Urine Analysis, a Diagnostic Value in COVID-19 Patients?

Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), a novel coronavirus causing Coronavirus disease 19 (COVID-19) in December 2019, is now a pandemic infectious disease, primarily affecting the respiratory tract. To date, many investigations are available for the diagnosis of SARS-CoV-2. A viral nucleic acid test has been used for the diagnosis of COVID-19, and some hematological indicators have been used in the auxiliary diagnosis and identification of the severity of COVID-19. There are very few studies available in routine urine biochemical parameters and their relation with Covid-19 patients. Aim: This study is aimed to study the changes in urine parameter values in COVID-19 disease and to predict the severity of the disease with the changes in urine parameters. Materials and Methods: A total of 150 patients with COVID-19 were admitted at Saveetha Medical College and Hospital during the study period. All cases tested positive for SARS-CoV-2 by RT-PCR test done on nasopharyngeal swabs during the study period were included. Patients who tested negative by RT-PCR test were considered as controls. The relationship between the results of urine biochemical parameters and the severity of COVID-19 were analysed by Descriptive statistics, Chi-squared test. Results: The positive rates of proteinuria (PRO) and leucocytes were more significant in COVID-19 patients than in healthy controls. The urine specific gravity (SG) value was highly significant (p <0.001) while the blood, nitrites in urine, and potential of hydrogen (pH) value was insignificant. Conclusion: There were some considerable changes in few urine biochemical parameters between patients with the SARS-CoV-2 and healthy controls. So from this study we conclude, proteinuria is helpful for predicting COVID-19 severity and kidney function.

Achievements of Mesoporous Carbon Solution and Single-Walled Carbon Nanotube Composite on the Sensitive Electrochemical Assay of Ivabradine

In this study, the electrochemical determination of Ivabradine hydrochloride (IH) was studied in detail using a glassy carbon electrode (GCE) modified with mesoporous carbon solution (MCS) and carboxylated group linked single-walled carbon nanotube (SWCNT-COOH). The developed nanosensor showed a significant effect by remarkably increasing the IH signal compared with the bare GCE. Cyclic (CV) and differential pulse voltammetric (DPV) methods were applied to perform electrochemical analysis of IH in pH 3.0 BRB solutions. The calibration plot for IH with a detection limit of 1.47 × 10−7 M was obtained using the DPV technique in the range of 1–10 µM under optimum experimental conditions. The proposed method has been validated and applied for the detection of the IH tablet. The produced nanosensor was also performed for the determination of IH in serum and urine. Excellent recoveries of 98.4%, 98.0%, and 100.2% were achieved for tablet, serum, and urine analysis, respectively.

A case report on asymptomatic and biochemically silent pheochromocytoma in adrenal incidentaloma

Pheochromocytoma are rare tumours originating from the chromaffin tissue. The clinical manifestations are variable and are not specific as pheochromocytoma and often imitate other diseases. The diagnosis is established by measurement of catecholamines and their metabolites in urine or plasma and by radiographic studies for localisation. Surgical removal of the tumour is the preferred treatment. 45 years old female presented with adrenal incidentaloma of about 6.1×6.2×5.4 cm well defined heterogenous lesion with internal cystic areas seen in right adrenal region abutting upper pole of right kidney. Biochemical investigations for adrenal hormones including plasma aldosterones, cortisols, plasma metanephrines, 24 hrs urinary metanephrines and VMA were found to be normal. Proceeded with adrenelectomy and histopathology of the specimen revealed pheochromocytoma as diagnosis. Pheochromocytoma leads to high mortality and morbidity rates if untreated. Fractionised metanephrines and catecholamines in a 24 hrs urine analysis is the preferred biochemical test. In a biochemically silent pheochromocytoma imaging modalities are used to identify and locate the tumour. Adequete alpha and beta blockade should be ensured before tumour removal. Surgery is recommenced irrespective of size and normal biochemical study to prevent complications.

Lipidomic and Metabolomic Signature of Progression of Chronic Kidney Disease in Patients with Severe Obesity

Severe obesity is a major risk for chronic kidney disease (CKD). Early detection and careful monitoring of renal function are critical for the prevention of CKD during obesity, since biopsies are not performed in patients with CKD and diagnosis is dependent on the assessment of clinical parameters. To explore whether distinct lipid and metabolic signatures in obesity may signify early stages of pathogenesis toward CKD, liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-high resolution accurate mass-mass spectrometry (GC-HRAM-MS) analyses were performed in the serum and the urine of severely obese patients with and without CKD. Moreover, the impact of bariatric surgery (BS) in lipid and metabolic signature was also studied, through LC-MS and GC-HRAM-MS analyses in the serum and urine of patients with severe obesity and CKD before and after undergoing BS. Regarding patients with severe obesity and CKD compared to severely obese patients without CKD, serum lipidome analysis revealed significant differences in lipid signature. Furthermore, serum metabolomics profile revealed significant changes in specific amino acids, with isoleucine and tyrosine, increased in CKD patients compared with patients without CKD. LC-MS and GC-HRAM-MS analysis in serum of patients with severe obesity and CKD after BS showed downregulation of levels of triglycerides (TGs) and diglycerides (DGs) as well as a decrease in branched-chain amino acid (BCAA), lysine, threonine, proline, and serine. In addition, BS removed most of the correlations in CKD patients against biochemical parameters related to kidney dysfunction. Concerning urine analysis, hippuric acid, valine and glutamine were significantly decreased in urine from CKD patients after surgery. Interestingly, bariatric surgery did not restore all the lipid species, some of them decreased, hence drawing attention to them as potential targets for early diagnosis or therapeutic intervention. Results obtained in this study would justify the use of comprehensive mass spectrometry-based lipidomics to measure other lipids aside from conventional lipid profiles and to validate possible early markers of risk of CKD in patients with severe obesity.