scholarly journals Nephro protection property of double blockade versus single blocked of RAAS in delaying the progression of CKD

2018 ◽  
Vol 5 (3) ◽  
pp. 748
Author(s):  
Arvind Gupta ◽  
Upma Narain ◽  
Romar Dabu
Keyword(s):  
Blood Pressure ◽  
Phase Iii ◽  
P Value ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii ◽  
Protection Property

Background: Dual renin angiotensin aldosterone system blockade using angiotensin receptor blockers in combination with angiotensin converting enzyme inhibitors is reported to improve proteinuria in non-diabetic patients.Methods: A prospective observational study was done on 810 non-diabetic chronic kidney disease patients during July 2012 to August 2014 to compare the nephro protection property of double blockade and single blocked of renin angiotensin aldosterone system in delaying the progression of chronic kidney disease.Results: At the end of 24 months urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0001) was found significant. Similarly, on comparing group II and group III, p value (0.003) was again significant. Mean arterial blood pressure of group I and group III were statistically significant (<0.0496) while comparing group II and group III, p value (0.0419) was again significant.Conclusions: The study concludes that the use of double renin angiotensin aldosterone system blockade therapy is more effective than monotherapy at reducing albuminuria and proteinuiria, and in decreasing blood pressure at the same time not causing significant deterioration in glomerular filtration rate. Newer potassium lowering therapies can effectively and safely correct hyperkalemia and maintain normokalemia in patients receiving background treatment with renin angiotensin aldosterone system blockade. However, the use of new potassium binders for cardiovascular and renal risk reduction with combined renin angiotensin aldosterone system blockade therapy will require phase III trials.

scholarly journals Comparison between the efficacy of double blockade and single blockade of RAAS in diabetic kidney disease

2018 ◽  
Vol 5 (4) ◽  
pp. 931
Author(s):  
Arvind Gupta ◽  
Upma Narain
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
P Value ◽  
Renin Angiotensin Aldosterone System ◽  
Diabetic Kidney ◽  
Renin Angiotensin ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Background: Diabetic kidney disease is associated with high morbidity and cardiovascular mortality. A number of guidelines and recommendations have been issued over the years recommending the use of renin angiotensin aldosterone system blockade in the management of diabetic kidney disease.Methods: A prospective observational study was done on 750 diabetic chronic kidney disease patients during July 2012 to August 2014 to compare the efficacy of double blockade and single blocked of renin angiotensin aldosterone system in diabetic kidney disease.Results: At the end of 24 months urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0268) was found significant. Similarly, on comparing group II and group III, p value (0.0278) was again significant. Mean arterial blood pressure of group I and group III were statistically significant (0.0496) while comparing group II and group III, p value (0.0419) was again significant.Conclusions: The study concludes that the use of double renin angiotensin aldosterone system blockade therapy is more effective than mono-therapy at reducing albuminuria and proteinuiria, and in decreasing blood pressure at the same time not causing significant deterioration in glomerular filtration rate in diabetic kidney disease patients. Novel potassium-lowering therapies are shown to effective compensate the hyperkalemia risk associated with renin angiotensin aldosterone system blockade use in people with diabetic kidney disease, offering promise for more adequate therapy and greater renal and cardiovascular risk protection in the future.

scholarly journals Effects of weight loss on the cardiac parameters of obese dogs

2010 ◽  
Vol 30 (2) ◽  
pp. 167-171 ◽  
Author(s):  
Gláucia B.P. Neto ◽  
Márcio A. Brunetto ◽  
Marlos G. Sousa ◽  
Aulus C. Carciofi ◽  
Aparecido A. Camacho
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Body Weight ◽  
Companion Animals ◽  
Left Ventricular ◽  
Weight Loss Program ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii

Obesity is one of the most frequent nutritional problems in companion animals and can lead to severe health problems in dogs and cats, such as cardiovascular diseases. This research aimed to evaluate the structural and functional cardiac changes after weight loss in obese dogs. Eighteen obese healthy dogs were assigned into three different groups, according with their initial body weight: Group I (dogs up to 15 kg), Group II (dogs weighing between 15.1 and 30 kg), and Group III (dogs weighing over 30 kg). The animals were submitted to a caloric restriction weight-loss program until they lose 15% of the body weight. The M-mode echocardiogram, electrocardiogram, and blood pressure evaluations were performed before the diet has started and after the dogs have reached the target weight. Data showed a decrease in left ventricular free wall thickness during diastole and systole in Group III, decrease in the systolic blood pressure in Group III, and also in the mean blood pressure in Group II. It was possible to conclude that the weight loss program can reverse structural cardiac changes such as left ventricle eccentric hypertrophy in dogs weighing more than 30 kg, and decrease the arterial blood pressure in obese dogs.

scholarly journals Comparison of the efficacy of triple blockade, double blockade and single blockade of RAAS in non diabetic chronic kidney disease

2018 ◽  
Vol 5 (4) ◽  
pp. 941
Author(s):  
Arvind Gupta ◽  
Upma Narain ◽  
Aditya Sachan
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Urinary Protein ◽  
P Value ◽  
Angiotensin Ii Receptor Blocker ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Group Iii ◽  
Group I ◽  
Dual Blockade

Background: Although dual blockade of the renin-angiotensin-aldosterone system with the combination of an angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker is generally well established as a treatment for nephropathy, this treatment is not fully effective in some patients.Methods: A prospective observational study was done on 600 chronic kidney disease patients during July 2012 to August 2014 to compare the efficacy of triple blockade, double blockade and single blockade of renin-angiotensin-aldosterone system in non diabetic chronic kidney disease.Results: At the end of the study, 24 hours urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0268) was found significant. Similarly, on comparing group II and group III, p value (0.0160) was again found significant.Conclusions: Triple blockade of the renin-angiotensin-aldosterone system was effective for the treatment of proteinuria in patients with non-diabetic nephropathy whose increased urinary protein had not responded sufficiently to a dual blockade.

Oxygen Fraction Adjustment According to Body Surface Area during Extracorporeal Circulation

2015 ◽  
Vol 18 (3) ◽  
pp. 098
Author(s):  
Cem Arıtürk ◽  
Serpil Ustalar Özgen ◽  
Behiç Danışan ◽  
Hasan Karabulut ◽  
Fevzi Toraman
Keyword(s):  
Body Temperature ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Extracorporeal Circulation ◽  
Group Iii ◽  
Oxygen Fraction ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii

<p class="p1"><span class="s1"><strong>Background:</strong> The inspiratory oxygen fraction (FiO<sub>2</sub>) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO<sub>2</sub>) to reach hyperoxemic levels (&gt;180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO<sub>2</sub> levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO<sub>2</sub> levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO<sub>2</sub> during cardiac surgery.</span></p><p class="p1"><span class="s1"><strong>Methods:</strong> After approval from the Ethics Committee of the University of Acıbadem, informed consent was given from 60 patients. FiO<sub>2</sub> adjustment strategies applied to the patients in the groups were as follows: FiO<sub>2</sub> levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5).</span></p><p class="p1"><span class="s1"><strong>Results:</strong> Mean PaO<sub>2</sub> was significantly higher in Group I than in Group II at T2 and T3 (<em>P</em> = .0001 and <em>P</em> = .0001, respectively); in Group I than in Group III at T1 (<em>P</em> = .02); and in Group II than in Group III at T2, T3, and T4 <br /> (<em>P</em> = .0001 for all). </span></p><p class="p1"><span class="s1"><strong>Conclusion: </strong>Adjustment of FiO<sub>2</sub> according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO<sub>2</sub> between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO<sub>2</sub> levels in concordance with the body temperature in the <br /> rewarming period.</span></p>

Functional adaptation to reduced renal mass in early development

1982 ◽  
Vol 242 (2) ◽  
pp. F190-F196 ◽  
Author(s):  
R. L. Chevalier
Keyword(s):  
Renal Mass ◽  
Left Kidney ◽  
Extracellular Fluid ◽  
Functional Adaptation ◽  
Fluid Loss ◽  
Group Iii ◽  
Arterial Blood ◽  
India Ink ◽  
Group I ◽  
Group Ii

To determine whether reduced renal mass in the newborn results in acceleration of normal renal development, the response to unilateral nephrectomy (N) before 36 h of age was compared with sham-operated (S) guinea pigs during the period of most rapid nephron maturation. Studies were performed at 7-13 days (group I) and 19-25 days (group II). Mean arterial blood pressure (AP), left kidney glomerular filtration rate (LKGFR), and urine sodium excretion (UNaV) were measured. Superficial single nephron GFR (sSNGFR) and proximal fractional water reabsorption (FRH2O) were measured by micropuncture, and the number of glomeruli (NG) was determined by India ink perfusion. In view of the susceptibility of the neonate to extracellular fluid loss, groups I and II were plasma infused to maintain euvolemia and group II was compared with 19- to 25-day-old hydropenic animals (group III). Increase in body weight with age was unaffected by neonatal N. In group IN, the compensatory increase in sSNGFR was greater than SNGFR for deeper nephrons, which normally contribute most to GFR at this age. In group IIN there was an 80% adaptive increase in LKGFR that could not be entirely explained by the rise in SNGFR. Since NG in group IIN was greater than in group IIS and similar to that in adulthood, the enhanced adaptation in LKGFR in group IIN may be due in part to earlier recruitment of a population of underperfused glomeruli. FRH2O did not change significantly with age and did not differ in N and S groups. Animals in group III developed a rise in hematocrit during the experiment, and AP, LKGFR, and UNaV were lower in group IIIN than in group IIN. It is concluded that following N at birth, the sequence of renal functional maturation is accelerated while glomerulotubular balance is preserved. As a result of these adaptative changes, homeostasis is maintained and body growth proceeds without impairment.

scholarly journals The prognostic role of inflammatory markers in COVID 19 patients – A retrospective analysis.

2021 ◽  
Author(s):  
Shivkumar Gopalakrishnan ◽  
sangeetha kandasamy ◽  
S.Malini ◽  
S.Peer Mohamed ◽  
k.velmurugan
Keyword(s):  
Inflammatory Markers ◽  
Severe Disease ◽  
Radiation Hazard ◽  
P Value ◽  
Binary Logistic Regression Analysis ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
D Dimer

Abstract Background. Approximately 5% of COVID-19 patients suffer near fatal disease. Clinical and radiologic features may predict severe disease albeit with limited specificity and radiation hazard. Laboratory biomarkers are eyed as simple, specific and point of care triage tools to optimize management decisions.This study aimed to study the role of inflammatory markers in prognosticating COVID-19 patients.Methodology. A hospital based retrospective study was conducted on COVID-19 adult inpatients classified into three groups as mild disease-recovered [Group I], severe disease-recovered [Group II] and dead [Group III]. Categorical outcomes were compared using Chi square test. Univariate binary logistic regression analysis was performed to test the association between the explanatory and outcome variables. Unadjusted OR along with 95% CI was calculated. The utility of lab parameters (Ferritin, LDH, D dimer, N/L ratio and PLT/L ratio) in predicting severity of COVID-19 was assessed by Receiver Operative Curve (ROC) analysis. P value < 0.05 was considered statistically significant.Results. The mean age was 49.32 +/- 17.1 years. Among study population, 378 were Group I, 66 Group II, and 56 Group III. Median levels of Ferritin among the 3 groups were 62ng/mL, 388.50 ng/mL and 1199.50 ng/mL. Median value of LDH were 95U/L, 720 and 982.50(p <0.001). D-dimer values of 3 groups were 23.20ng/mL, 104.30 ng/mL and 197.10 ng/mL (p <0.001). CRP done qualitatively was positive in 2 (0.53%), 30 (45.45%) and 53 (94.64%) of patients. The odds of patients suffering severe COVID-19 rose with rising values of ferritin, LDH and D-dimer [unadjusted OR 1.007, 1.004 &1.020]Conclusion. One time measurement of serum ferritin, LDH, D-dimer and CRP is promising to predict outcomes for COVID 19 inpatients. Single qualitative CRP was equally good but more cost effective than quantitative CRP. The most specific combination was NLR, Lymphocyte percentage and D-dimer levels done between 7th – 10th day of symptoms.

Efficacy of Computer-Assisted Management of Respiratory Failure in Neonates

PEDIATRICS ◽  
1986 ◽  
Vol 78 (1) ◽  
pp. 139-143 ◽  
Author(s):  
Waldemar A. Carlo ◽  
Lucia Pacifico ◽  
Robert L. Chatburn ◽  
Avroy A. Fanaroff
Keyword(s):  
Respiratory Failure ◽  
Computer Program ◽  
Computer Assisted ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Group Ii ◽  
Assisted Management

We modified an algorithm for mechanical ventilation of infants with respiratory distress syndrome to create an interactive user-friendly computer program. To determine the effectiveness of this computer program, we evaluated the correction of deranged arterial blood gases in three groups of neonates: group I, treated before the introduction of the computer into the nursery; group II, managed by pediatric residents with the guidance of the computer program; group III, treated after the introduction of the computer into the nursery but managed without consideration of the computer output. Arterial blood gas values improved more frequently in the neonates managed with computer consultation (group II, 65/75, 87%) than in both control groups (group I, 37/57, 65%, P &lt; .005; and group III, 46/63, 73%, P &lt; .05). Furthermore, increases in ventilatory support in the presence of normal arterial blood gas values occurred only in patients managed without computer guidance. In a teaching institution, more effective care of neonates with respiratory failure may be facilitated by computer-assisted management of mechanical ventilators.

scholarly journals COMPARATIVE EFFICACY OF BLOCKADE OF THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM WITH COMBINATIONS OF ALISKIREN AND AMLODIPINE, RAMIPRIL AND AMLODIPINE IN PATIENTS WITH ESSENTIAL HYPERTENSION

2017 ◽  
pp. 24-29
Author(s):  
E. Krutikov ◽  
S. Chistyakova ◽  
V. Gorbatuk
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Combined Therapy ◽  
Control Group ◽  
Common Disease ◽  
Angiotensin I ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Daily Average ◽  
Group I

Hypertension is one of the most common disease of the cardiovascular system. Important components of a rational antihypertensive therapy are drugs that block the RAAS. The aim of the study was to conduct a comparative evaluation of the effectiveness of blockade of the renin-angiotensin-aldosterone system with drug combinations – aliskiren and amlodipine and combination of ramipril and amlodipine in patients with hypertension and increased body weight. 50 patients with hypertension of stage II, II degree, high and very high risk were involved in the study. Patients were randomized into two groups depending on the received treatment. The first group (25 patients) consisted of patients treated with combined therapy including ramipril and amlodipine, the second group (25 patients) consisted of patients receiving a combination of aliskiren and amlodipine. The control group (25 people) included apparently healthy people. By the 12th week of the study the daily average systolic blood pressure in the first group was 146 (145; 150) mm Hg and 131 (130; 137) mm Hg in the second group, respectively, the daily average diastolic blood pressure was equal to 94 (91; 96) mm Hg in the first group and 81 (80; 82) mm Hg in the second group . By the 12th week of treatment plasma renin levels in the first group was equal to 73 (50; 78) and 15 (14; 27) in the second group, respectively, the level of angiotensin-I in the first group was 6 (4; 7) and 1,4 (1,1; 1,9) in the second group, aldosterone levels in the first group was equal to 134 (132; 145) and 130 (123; 132) in the second group, respectively. It is found that combination of aliskiren and amlodipine have the advantage over the combination of ramipril and amlodipine in achieving of purposeful level of systolic and diastolic blood pressure in patients with hypertension and overweight. The purposeful level of blood pressure reached to 56,6% of patients in group I and 80% of patients in group II to 12th week of the study. Receiving both combinations equally reduces plasma aldosterone levels at the same time receiving a combination of aliskiren and amlodipine accompanied by a decrease in plasma rennin level of 69% and angiotensin-I of 67%, while the combination of ramipril and amlodipine increases of these hormones on 68% and 65% respectively. Thus, using combination of ramipril and amlodipine more effective in patients with low rennin hypertension , patients with normal and high rennin hypertension necessary combination of aliskiren and amlodipine.

Effect of norepinephrine on diaphragm contractility and blood flow

1990 ◽  
Vol 69 (6) ◽  
pp. 2019-2028 ◽  
Author(s):  
G. S. Supinski ◽  
A. F. DiMarco ◽  
J. Gonzalez ◽  
M. D. Altose
Keyword(s):  
Blood Flow ◽  
Group Iv ◽  
Arterial Flow ◽  
Force Frequency ◽  
Group Iii ◽  
Arterial Blood ◽  
Group I ◽  
Intramuscular Electrodes ◽  
Phrenic Artery ◽  
Group Ii

Recent studies have shown that diaphragm fatigue can be reversed by mechanical augmentation of phrenic arterial flow. The purpose of the present experiment was to determine whether it was possible to pharmacologically augment diaphragm blood flow and reverse fatigue by the administration of norepinephrine. Four groups of studies were performed, all employing our previously described in situ isometric canine diaphragm strip preparation (Supinski et al., J. Appl. Physiol. 60: 1789-1796, 1986). Group I studies examined the effects of norepinephrine on the contractility of the nonfatigued diaphragm in normotensive dogs, group II studies examined the effects of this drug on the contractility of the fatigued diaphragm in normotensive animals, and group III studies examined the effect of this drug on the contractility of the fatigued diaphragm in hypotensive animals. Group IV studies examined the effect of norepinephrine in normotensive animals in which the phrenic artery was cannulated and pump perfused at constant flow. Fatigue was induced in group II, III, and IV studies by rhythmically stimulating the diaphragm via intramuscular electrodes. Norepinephrine had no effect on the contractility of the nonfatigued diaphragm (group I). In normotensive (group II) and hypotensive animals (group III), norepinephrine elicited dramatic increases in arterial blood pressure and phrenic arterial flow and produced a significant upshift in the force-frequency curve of the fatigued diaphragm. However, when phrenic flow was held constant (group IV experiments), norepinephrine failed to augment the contractility of the fatigued diaphragm. These results indicate that 1) norepinephrine can increase phrenic blood flow and augment the contractility of the fatigued diaphragm in both normotensive and hypotensive conditions and 2) this effect of norepinephrine to partially reverse fatigue is secondary to its action to augment diaphragmatic blood flow.

Abstract P147: Office Blood Pressure: An Inadequate Guide to the Diagnosis and Treatment of Hypertension

Hypertension ◽  
2015 ◽  
Vol 66 (suppl_1) ◽  
Author(s):  
Jay Cohn ◽  
Sue Duval ◽  
Natalia Florea ◽  
Lynn Hoke ◽  
Daniel Duprez
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Invasive Disease ◽  
Office Blood Pressure ◽  
Group Iii ◽  
Non Invasive ◽  
Group I ◽  
Group Ii ◽  
Cv Disease ◽  
Asymptomatic Individuals

Hypertension is a cardiovascular (CV) disease with high risk for CV morbid events (ME) that benefits from anti-hypertensive therapy. Resting blood pressure (BP) >140/90 mmHg serves as the diagnostic criterion for hypertension, and management has been aimed at BP reduction. Progression of CV disease in the absence of elevated blood pressure identifies individuals who might benefit from CV-protective therapy but are not currently being recognized as in need of treatment. In 2017 asymptomatic individuals evaluated for early functional and structural CV abnormalities, 1534 not taking anti-hypertensive drugs were available to determine the relationship between office blood pressure and the severity of CV abnormalities, as defined by a 10-test non-invasive disease score (DS) of 0-20. Previous studies have documented the high predictive value of DS for future CVME. The population was 53% male, average age 50±11 years, BP 122/77mmHg, LDL cholesterol 129±38 mg/dL, HDL 52±17mg/dL, triglycerides 109 mg/dL. DS was adjusted by eliminating the score for BP, but 9-test DS was still directly related to BP: 2.3 in those (n=550) <120/80 mmHg (Group I), 3.2 in those 120-129/80-85 mmHg (n=600) (Group II), 4.1 in those 130-139/85-89 mmHg (n=236) (Group III), and 5.7 in those 140+/90+mmHg (n=148) (Group IV). Nonetheless, DS of >6 indicative of high risk was present in 10% of Group I, 20% of Group II and 30% of Group III. BP was largely overlapping in individuals with no CV disease (DS 0-2), early disease (DS 3-5) and advanced disease (DS 6+). Therefore, reliance on resting BP leaves many at-risk individuals undiagnosed and untreated for early CV disease likely to progress. The hypertensive state exists in the absence of elevated BP and should be recognized and treated to prevent CVME.

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