Clinical Characteristics, Outcomes, and Risk Factors of Disease Severity in Patients With COVID-19 and With a History of Cerebrovascular Disease in Wuhan, China: A Retrospective Study

Background and Purpose: Coronavirus disease 2019 (COVID-19) rapidly resulted in a pandemic. Information on patients with a history of cerebrovascular disease (CVD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is limited. This study investigated the clinical features and the risk factors of developing adverse outcomes in patients with COVID-19 and with previous CVD.Methods: This was a single-center retrospective clinical study including all the confirmed cases of COVID-19 at Wuhan Huoshenshan Hospital from February 4 to April 7, 2020. Differences in clinical characteristics were compared between patients with and without a history of CVD. The incidences of severe events comprising all-cause death, intensive care unit admission, shock, and mechanical ventilation usage during hospitalization in two groups were compared using propensity score matching analysis and multivariate logistic regression analyses. Besides, the risk factors of developing severe events in patients with COVID-19 who also have history of CVD were analyzed.Results: A total of 2,554 consecutive patients were included in our study, of whom 109 (4.27%) had a medical history of CVD. Patients with CVD tend to be older and with more comorbidities, including hypertension, diabetes, coronary heart disease, and chronic obstructive pulmonary disease. The levels of white blood cell, neutrophil, C-reactive protein, creatine kinase isoenzymes, and lactate dehydrogenase were higher, whereas the levels of lymphocyte and albumin were lower in the CVD group. Compared to those without CVD, patients with CVD were more likely to have severe events after age matching (12.8 vs. 5.7%, P = 0.012). After adjusting for the confounding effects of age, sex, smoking, and comorbidities, the odds ratio for developing severe events with a history of CVD was 2.326 (95% CI, 1.168–4.630; P = 0.016). Besides, patients with CVD, either with decreased lymphocyte count (OR 9.192, 95% CI, 1.410–59.902, P = 0.020) or increased blood urea nitrogen (OR 5.916, 95% CI, 1.072–32.641, P = 0.041), had a higher risk of developing severe events during hospitalization.Conclusions: Patients with CVD history tend to have adverse clinical outcomes after being infected with SARS-COV-2. Decreased lymphocyte counts and increased blood urea nitrogen levels may be risk factors for adverse outcomes in patients with COVID-19, and had CVD.

The effect of rose hip on experimental anti-GBM glomerulonephritis in systemic lupus erythematosus murine models

Background: Systemic lupus erythematosus (SLE or lupus) is a chronic autoimmune disease with ominous end organ manifestations significantly affecting the kidneys and joints. One of the most frequent manifestations is glomerulonephritis (GN), a renal disease distinguished by inflammation of the glomeruli that often leads to end stage kidney failure. Treatments often have severe side effects. Rose hip (RH) is derived from Rosa canina L. and has been used as a medicinal plant for centuries; it contains numerous beneficial constituents, and has the capacity to counter lipid peroxidation, oxidative stress, and inflammation. Methods: Nephritis was induced in 129/svJ strain mice using anti-glomerular basement membrane antibodies (anti-GBM). The experimental group was fed whole RH preparation (100mg/kg body weight per day) by oral gavage from D5 to D10; the control group was fed the diluent used to dissolve RH (10 mice per group). Mice were sacrificed on D11 and phenotyped for disease. Blood urea nitrogen (BUN) and proteinuria were measured; flow cytometry of kidneys was performed on both groups. Results: RH treatment decreased proteinuria, blood urea nitrogen, CD4+, CD8+, CD11b+Gr-1+ (neutrophil), and CD11b+CD11c+ (myeloid cells) compared with nephritis control. The presence of vitamin C was confirmed. RH largely maintained its total antioxidant capacity and some vitamin C content for 24 hours, as well as at least 7 days after preparation. Conclusion: Our preliminary results confirmed that RH has antioxidative properties, significant anti-inflammatory effects, and may be useful in managing glomerulonephritisKeywords: Rose hip, glomerulonephritis, systemic lupus erythematosus, lupus, proteinuria, blood urea nitrogen, CD4+, CD8+, CD11b+Gr-1+(neutrophil), and CD11b+CD11c+ (myeloid cells)

Correlation between C-Reactive Protein Level and Blood Urea Nitrogen-Creatinine Ratio in COVID-19 Patients

Coronavirus Disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2).C-Reactive Protein (CRP) is an inflammation marker that increases significantly in COVID-19 patients. SARS-CoV-2 can affectkidney function and increase the Blood Urea Nitrogen (BUN)-creatinine ratio. The previous study showed that CRP andBUN-creatinine ratios could be used as predictors of the severity and survival of COVID-19 patients. This study aimed todetermine the correlation between CRP levels and the BUN-creatinine ratio in COVID-19 patients. A retrospectivecross-sectional study was conducted on 34 COVID-19 patients who were diagnosed by PCR test at Dr. Kariadi Hospital,Semarang from March to September 2020. The Spearman correlation test was used for statistical analysis. The median CRPvalue was 4.59 (0.36-27.48) mg/L and BUN-creatinine ratio was 15.06 (5.79-37.04), while the correlation between CRP andBUN-creatinine ratio showed p=0.003 and r=0.502. There was a moderate positive correlation between CRP level andBUN-creatinine ratio. C-reactive protein plays a role in the infiltration process of inflammatory cells and increases adhesionmolecules, which can directly or indirectly damage kidney function. SARS-CoV-2 can enter the kidney directly through theACE-2 receptor and activate the renin-angiotensin-aldosterone system, which will increase water and sodium absorption inthe renal tubules, passive reabsorption of BUN, and creatinine filtration in the glomerulus resulting in increasedBUN-creatinine ratio.

Role of blood urea nitrogen and serum albumin ratio in predicting severity of community acquired pneumonia (CAP)

Blood urea nitrogen and serum albumin levels are independent risk factors for poor clinical outcome in CAP. However, there is a paucity in the literature on the role of Blood urea nitrogen and albumin ratio(B/A) in CAP. This was a prospective observational study in which 112 admitted patients with the diagnosis of CAP underwent routine blood examinations, ABG, procalcitonin and Chest X-ray. Univariate analysis among various risk factors, CURB-65 scores, blood parameters including B/A ratios and clinical outcomes were carried out followed by multiple logistic regression. Cox regression was done to look at B/A values and time to mortality. In the logistic regression, age, CURB -65 score, B/A ratio and procalcitonin came out to be independent risk factors for ICU admission and mortality. Odds ratio of B/A in predicting mortality and ICU admission came out to be 67.8 (49.2-95.4) and 11.2 (8.4-14), respectively. Cox regression showed B/A values were also found to have a statistically significant relationship with time to mortality (p=0.001). B/A ratio has the potential to become a veritable predictor of poor clinical outcomes in patients with CAP.

PSXII-16 Fertility affects in yearling beef heifers grazing triticale before artificial insemination

Our objective was to compare two systems of pre-breeding heifer development, drylot (D) or grazing winter triticale (T) on heifer fertility. In each of 4 years (yr), Black Angus heifers (n = 168, 86, 97 and 103, respectively) were allotted to treatment (trt) 32 to 50 days (d) prior to artificial insemination (AI). Each year a 14-d CIDR PG protocol was used to synchronize estrus (d-30 to d-16: 1.38 g progesterone intravaginal insert, CIDR; d 0: 25 mg dinoprost tromethamine injection; + 66 hours: 100 µg gonadorelin hydrochloride injection, and AI). Starting body weight and body condition were similar between treatments but differed by year (P < 0.01). After CIDR removal, 83% were in estrus by d -10 and did not differ with trt or yr. Weight at AI was greater (P < 0.01) for T (384 kg ± 2) than D (378 kg ± 2) with a trt by yr interaction. Body condition change between start of treatment and AI was greater (P < 0.01) for T (0.44 ± 0.03) than D (-0.02 ± 0.04) with a trt by yr interaction (P < 0.01) due to the magnitude of difference. A trt by yr interaction occurred for estrous response before AI (P < 0.01). Treatment means for AIPR were 59.1% (143/242) for D and 42.1% (101/240) for T (trt; P < 0.01). AIPR was similar between treatments in yr 1 and higher for D than T in subsequent yr (trt x yr, P < 0.05). Blood urea nitrogen was greater (P < 0.05) in T than D on d 0 and at AI. At the time of AI, triticale was more mature in yr 1 when there was no difference in AIPR. Grazing triticale during estrus synchronization and AI resulted in acceptable gains but decreased fertility in yearling beef heifers.

The Efficacy of Triptolide in Preventing Diabetic Kidney Diseases: A Systematic Review and Meta-Analysis

Ethnopharmacological Relevance: Triptolide (TP), the primary biologically active ingredient of Tripterygium wilfordii Hook F (TWHF), possesses the potential to solve the shortcomings of TWHF in treating diabetic kidney disease (DKD) in the clinic.Aim of the Study: We conducted a meta-analysis to evaluate the efficacy of TP in treating DKD and offer solid evidence for further clinical applications of TP.Materials and Methods: Eight databases (CNKI, VIP, CBM, WanFang, PubMed, Web of Science, EMBASE, and Cochrane library) were electronically searched for eligible studies until October 17, 2020. We selected animal experimental studies using TP versus renin–angiotensin system inhibitors or nonfunctional liquids to treat DKD by following the inclusion and exclusion criteria. Two researchers independently extracted data from the included studies and assessed the risk of bias with the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias tool. Fixed-effects meta-analyses, subgroup analyses, and meta-regression were conducted using RevMan 5.3 software. Inplasy registration number: INPLASY2020100042.Results: Twenty-six studies were included. Meta-analysis showed that TP significantly reduced albuminuria (14 studies; standardized mean difference SMD: −1.44 [−1.65, −1.23], I2 = 87%), urine albumin/urine creatinine ratio (UACR) (8 studies; SMD: –5.03 [–5.74, −4.33], I2 = 84%), total proteinuria (4 studies; SMD: –3.12 [–3.75, −2.49], I2 = 0%), serum creatinine (18 studies; SMD: –0.30 [–0.49, −0.12], I2 = 76%), and blood urea nitrogen (12 studies; SMD: –0.40 [–0.60, −0.20], I2 value = 55%) in DKD animals, compared to the vehicle control. However, on comparing TP to the renin–angiotensin system (RAS) inhibitors in DKD treatment, there was no marked difference in ameliorating albuminuria (3 studies; SMD: –0.35 [–0.72, 0.02], I2 = 41%), serum creatinine (3 studies; SMD: –0.07 [–0.62, 0.48], I2 = 10%), and blood urea nitrogen (2 studies; SMD: –0.35 [–0.97, 0.28], I2 = 0%). Of note, TP exhibited higher capacities in reducing UACR (2 studies; SMD: –0.66 [–1.31, −0.01], I2 = 0%) and total proteinuria (2 studies; SMD: –1.18 [–1.86, −2049], I2 = 0%). Meta-regression implicated that the efficacy of TP in reducing DKD albuminuria was associated with applied dosages. In addition, publication bias has not been detected on attenuating albuminuria between TP and RAS inhibitors after the diagnosis of DKD.Systematic Review Registration:https://clinicaltrials.gov/, identifier INPLASY2020100042