Independent risk factors for depression in older adult patients receiving peritoneal dialysis for chronic kidney disease

BACKGROUND According to the trend of global population aging,the proportion of elderly patients with chronic kidney disease(CKD)is expected to increase.However,there are more than 20 million people in China with decompensated kidney function,of which 19.25%are elderly people.Therefore,special attention should be paid to the education years,sleep quality,anxiety status,comorbidities with diabetes,cardiovascular disease(CVD),and anemia as independent risk factors for depression in elderly CKD patients.This study explores the clinical management of elderly CKD patients that should address these risk factors to prevent depression and improve their prognosis.AIM To investigate depression risk factors in older patients receiving peritoneal dialysis,aiding future prevention of depression in these patients.METHODS This retrospective study included a primary study population of 170 patients with CKD who received peritoneal dialysis from January 2020 to December 2022.We assessed the patients’mental status using the Beck Depression Inventory Score-II(BDI-II),Self-Rating Anxiety Scale(SAS),Anxiety Inventory Score,and the Pittsburgh Sleep Quality Index(PSQI).Logistic regression was employed to identify depression independent risk factors among these patients.RESULTS The non-depressed group had a significantly longer education period than the depressed group(P<0.05).The depressed group exhibited significantly higher mental status scores than the non-depressed group(P<0.001).Patients with diabetes mellitus(DM)or CVD had a higher probability of developing depression.Patients with depression had significantly lower hemoglobin and albumin levels than patients without depression(P<0.05).Spearman correlation analysis of BDI-II scale scores,measuring depression,indicated positive correlations with BDI-II and SAS scores as risk factors for depression in patients with CKD.In contrast,years of education,hemoglobin levels,and peritoneal Kt/V were negatively correlated,serving as protective factors against depression.An analysis of variance for influences with significant differences in the univariate analysis revealed that years of schooling,BDI-II,SAS,PSQI,DM,CVD,and hemoglobin levels independently influenced depression in older patients with CKD.CONCLUSION Education,BDI-II,SAS,PSQI,DM,and CVD are independent risk factors for depression in older patients with CKD;therefore,post-treatment psychological monitoring of high-risk patients is crucial to prevent depression.

Prevalence, Risk Factors, and Awareness of Chronic Kidney Disease among Diabetes Mellitus and Hypertensive Individuals at the Buea Regional Hospital, Cameroon

Background: Kidney failure, cardiovascular disease, and early mortality are just a few of the major negative effects of chronic renal disease, a serious global health issue. The considerable financial and public health burden associated with chronic kidney disease can be lessened by raising awareness and adopting better practices for its impact, prevention, and early identification. Objective: In this study, individuals with hypertension and diabetes were evaluated for their knowledge of chronic kidney disease, its prevalence, and its risk factors. Method: It was a hospital-based cross-sectional study conducted on adult (>18 years) patients with diabetes mellitus and hypertension. Each participant provided written informed consent before having their data collected through interviews, medical information, and blood samples for CKD screening. The CKD epidemiology collaboration (CKD-EPI) equation was used to calculate the glomerular filtration rate (GFR) from serum creatinine, and CKD was determined using the estimated GFR (e-GFR). To find independent CKD factors, multivariate logistic regression was employed, with a p-value of 0.05 being regarded as statistically significant. This was accomplished using SPSS (Statistical Program for Social Sciences) version 22.0, IBM Corp., Armonk, NY. Result: A total of 156 participants took part in the study among which 95 (60.9%) were male, most of the participants 82 (52.6%) were aged between 51 - 70 years (mean 59.42 ± 11.007), 76 (48.7%) were unemployed and 97 (62.2%) were single. Overall, the knowledge score of participants on CKD was 65.4% for good knowledge and 34.6% for poor or inadequate knowledge of CKD. More than half of the participants (60%) had chronic kidney disease. Among these, the greatest proportion of CKD patients were those who were hypertensive (88.2%) followed by those who were both hypertensive and diabetic (70.7%). Conclusion: There is poor management of CKD in the South West Region of Cameroon which has contributed greatly to the progression of CKD and increases in the mortality rate.

Identification of risk factors and construction of a nomogram predictive model for post-stroke infection in patients with acute ischemic stroke

BACKGROUND Post-stroke infection is the most common complication of stroke and poses a huge threat to patients.In addition to prolonging the hospitalization time and increasing the medical burden,post-stroke infection also significantly increases the risk of disease and death.Clarifying the risk factors for post-stroke infection in patients with acute ischemic stroke(AIS)is of great significance.It can guide clinical practice to perform corresponding prevention and control work early,minimizing the risk of stroke-related infections and ensuring favorable disease outcomes.AIM To explore the risk factors for post-stroke infection in patients with AIS and to construct a nomogram predictive model.METHODS The clinical data of 206 patients with AIS admitted to our hospital between April 2020 and April 2023 were retrospectively collected.Baseline data and post-stroke infection status of all study subjects were assessed,and the risk factors for poststroke infection in patients with AIS were analyzed.RESULTS Totally,48 patients with AIS developed stroke,with an infection rate of 23.3%.Age,diabetes,disturbance of consciousness,high National Institutes of Health Stroke Scale(NIHSS)score at admission,invasive operation,and chronic obstructive pulmonary disease(COPD)were risk factors for post-stroke infection in patients with AIS(P<0.05).A nomogram prediction model was constructed with a C-index of 0.891,reflecting the good potential clinical efficacy of the nomogram prediction model.The calibration curve also showed good consistency between the actual observations and nomogram predictions.The area under the receiver operating characteristic curve was 0.891(95%confidence interval:0.839–0.942),showing predictive value for post-stroke infection.When the optimal cutoff value was selected,the sensitivity and specificity were 87.5%and 79.7%,respectively.CONCLUSION Age,diabetes,disturbance of consciousness,NIHSS score at admission,invasive surgery,and COPD are risk factors for post-stroke infection following AIS.The nomogram prediction model established based on these factors exhibits high discrimination and accuracy.

Risk factors for depression in patients with chronic obstructive pulmonary disease

BACKGROUND The prevalence of depression in patients with chronic obstructive pulmonary disease(COPD)ranges from 10%to 42%,but the diagnosis of depression in patients with COPD is often unrecognized and untreated.Unrecognized depression has major implications for compliance with medical treatment,prolonged lengths of stay,increased frequency of hospital admissions,and increased consultations with primary care physicians.Many studies have attempted to identify risk factors for progression,prognosis and response to therapy in patients with depression.However,few studies have examined the risk factors for depression in patients with COPD,and some results remain controversial.AIM To identify the potential risk factors to define patients with COPD who are at“high risk”of depression.METHODS The clinical data of 293 patients with COPD were reviewed from January 2017 to December 2018.The correlations between demographics,clinical characteristics and depression were analyzed.The risk factors for depression in patients with COPD were identified by multivariate logistic regression analysis.The cutoff value,sensitivity and specificity of the independent correlation factors were calculated with a receiver operating characteristic curve.RESULTS Of the 293 patients included,65(22.18%)individuals were identified to have depression.Significant differences were detected between patients with and without depression in terms of body mass index(BMI),forced expiratory volume in 1 s(FEV1),and COPD assessment test(CAT)score(all P<0.05).Low BMI,low FEV1,and high CAT were independent risk factors for depression in patients with COPD and the cutoff values of BMI,FEV1,and CAT scores were 21.373 kg/m2,0.855 L and 12.5,respectively.CONCLUSION Low BMI,low FEV1,and high CAT score were identified as independent risk factors for depression in patients with COPD.

The risk factors for chronic obstructive pulmonary disease in Li and Han ethnic groups in Hainan, China

Objective: To investigate the risk factors of chronic obstructive pulmonary disease(COPD) in Li and Han ethnic group in Hainan, China. Methods: All subjects were randomly selected from various regions in Hainan. General characteristics were compared between COPD cases and healthy control cases in both Li and Han ethnic groups. The odds ratio(OR), the corresponding 95% confidence interval(CI) of COPD were calculated by logistic regression.Results: A total of 277 Li COPD cases, 307 Li healthy control subjects, 290 Han COPD cases and 301 Han healthy control were included in this study. In both the Li and Han groups, the average age exceeded 65 years, and the cigarette number smoked per day and the smoking duration were correlated with risk of COPD. In the Li COPD subjects, low weight, smoking, and recurrent infection of respiratory tract were mainly risk factors; while the mainly risk factor of Han COPD subjects was family history of respiratory disease. Conclusions: The risk factors are different in COPD subjects of Han and Li nationalities in Hainan of China. The age and smoking are strongly correlated with COPD risk.

Risk factors and urinary biomarkers of non-albuminuric and albuminuric chronic kidney disease in patients with type 2 diabetes

BACKGROUND A number of recent studies indicate a transformation in the natural course of chronic kidney disease(CKD)in type 2 diabetes(T2D)patients:an increasing prevalence of declined renal function without proceeding to the accompanying elevation of albuminuria.It has been suggested that albuminuric and nonalbuminuric CKD patterns could be different in their phenotypes and pathogenic mechanisms.AIM To identify the risk factors and biomarkers of albuminuric and non-albuminuric patterns of CKD in patients with T2D.METHODS Three hundred sixty patients with T2D duration≥10 years were included in this observational cross-sectional study.The associations of a panel of demographic and clinical characteristics,complications,comorbidities,and metabolic and hematology parameters with albuminuric and non-albuminuric CKD patterns were analyzed.The urinary excretion of nephrin and podocin,two podocytespecific markers,and WAP-four-disulfide core domain protein 2(WFDC-2),a marker of tubulointerstitial fibrosis,was determined by ELISA in comparison with healthy controls.RESULTS Non-albuminuric CKD was associated with age≥65 years(P=0.0001),female sex(P=0.04),diabetes duration≥15 years(P=0.0009),and the use of diuretics(P=0.0005).Male sex(P=0.01),smoking(P=0.01),waist-to-hip ratio>1.0(P=0.01)and hemoglobin A1c(HbA1c)>8.0%(P=0.005)were risk factors for elevated albuminuria not accompanied by a decrease in estimated glomerular filtration rate(eGFR).Duration of diabetes≥15 years and the use of calcium channel blockers were risk factors for albuminuria with decreased eGFR(both P=0.01).In multivariate logistic regression analysis,age,HbA1c,female sex and diuretics were significant predictors for reduced eGFR,while waist-to-hip ratio,HbA1c and male sex were associated with elevated urinary albumin-to-creatinine ratio(UACR).Excretion of nephrin and podocin was increased in patients with albuminuria,regardless of decline in renal function(P<0.001),correlating positively with UACR.The urinary excretion of WFDC-2 was markedly higher in men than in women(P<0.000001).Men with T2D demonstrated increased WFDC-2 levels independently of the CKD pattern(all P<0.05).In T2D women,WFDC-2 excretion was increased in those with reduced renal function(P≤0.01),correlating negatively with eGFR.CONCLUSION The data provide further evidence that albuminuric and non-albuminuric CKD phenotypes correspond to different pathways of diabetic kidney disease progression.

Behavioral Risk Factors for Chronic Non-Communicable Diseases in Adults and Elderly People in the City of Ribeirão Preto—SP

Aims: to analyze the presence and simultaneity of behavioral risk factors for chronic non-communicable disease (NCD) in adults and the elderly. Methods: quantitative, cross-sectional and observational study. Healthy and unhealthy eating are classified according to the frequency of food consumption. Smoking is expressed by the percentage of smokers. Harmful alcohol consumption by the percentage of individuals who consumed alcoholic beverages at least once in the last 30 days. Classification of the level of physical inactivity required to practice at least 150 minutes of physical activity. Results: the sample constituted 719 people, 535 adults and 184 elderly. The behavioral risk factor reported by most adults 499 (93.3%) and elderly 156 (84.8%) was unhealthy eating. Frequency 72% higher of smoking, four times higher of harmful alcohol consumption and 10% higher of unhealthy food among adults when compared to the elderly. The simultaneity between risk factors was 39% greater in adults than in the elderly. Discussion: risk factors evaluated in this study are key aspects of the development of NCDs. Adults have 2.43 times the chance of presenting two risk factors and 7.73 times the chance of presenting three in relation to the elderly. Conclusion: To achieve more effective and differentiated results, knowing and directing measures to control behavioral risk factors, whether isolated or concurrent, requires specific knowledge.

Prevalence of Risk Factors for Chronic Non-Communicable Diseases to the National Teaching Hospital “HKM” of Cotonou

Background: In 2008 Non-communicable diseases (NCDs) were responsible for 63% of deaths worldwide and 80% of these deaths occurred in developing countries. Four of them were responsible for more than 80% of mortality from NCDs, which were cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. They shared the same risk factors. Objective: To determine the prevalence of NCD risk factors in patients admitted to consult in the outpatient unit of the National Teaching Hospital of Cotonou. Patients and Methods: This was a transversal, descriptive and analytical study which took place from 15 June 2011 to 16 September 2011. It focused on 1000 subjects found after a recruitment of all patients coming to consult during the study period. The collection technique was a questionnaire followed by physical measures (weight, height, blood pressure and waist) and biological measures (fasting glucose and cholesterol). The data were analyzed with the software Epi-3.3.2 info. Results: The mainly prevalent behavioural risk factors were smoking (10.2%), alcohol consumption (60.3%), insufficient intake of fruits and vegetables (84.2%), and physical inactivity (57.6%). The prevalent physical risk factors were hypertension (47.4%), obesity (27.5%), and overweight (35.3%). The prevalent biological risk factors were diabetes (28.5%), and hypercholesterolemia (10.4%). The level of cardiovascular risk was higher than 40% in 81 people (8.1%). Conclusion: This study shows the importance of risk factors for NCDs in outpatient Unit in the National Teaching Hospital of Cotonou.

Associated Risk Factors of Non-Communicable Disease in Three Sites across Ivory Coast: An Urban (Cocody), Peri-Urban (Abobo) and Rural (Yocoboué) Area

Introduction: The prevalence of Non-communicable diseases (NCDs) has increased so it’s becoming a global public health problem. This problem is also threatening in Sub-Sahara Africa (SSA) country including Ivory Coast. Ivory Coast is a country of 22.6 million people experiencing rapid economic development and social change. All development is typically associated with an increase in non-communicable disease (NCD) risk factors. Our study aimed to determine the prevalence and associated factors of the major risk factors of NCDs among the population of Cocody, Abobo and Yocoboué in the Ivory Coast. Methods: A descriptive and analytical cross-sectional study was conducted and involved 1146 adults of 19 to 60 years from general population in Cocody (urban), Abob (peri-urban) and Yocoboué (rural). The WHO STEPS risk factor survey has been changed a bit and was administered. it contains anthropometric and biochemical measures. Results: The prevalence of NCD risk factors was markedly different across the three sites particularly between urban (Cocody) and rural (Yocoboué) areas. The overall prevalence estimates of the risk factors were 15.2% for current smoking, 57.71% for harmful use of alcohol, 58.84% for low physical activity, 24.71% for sedentariness (sitting at least 7 h), 69.45% for skipping breakfast, 61% for having late dinner and 36% for snacking. Concerning biological risk factor we noticed 40.95% for Overweight/obesity, 52.96% for abdominal obesity, 14.61% for raised blood pressure, 23.37% for raised blood sugar and 18.51 low HDL-C. Being female has an important associated with an increased risk for having abdominal obesity (OR: 25.7) and being overweight or obese (OR: 11.3), suffering from hypertension increased with age, 30 - 39 years (OR 8.45), 40 - 49 years (OR 13.4) and 50 years and above (OR 24.6). Conclusion: Adult residents in the two (Urban and peri-urban) of three different areas are developing high-risk NCDs, particularly Cocody’s population. At the end, we observed among participants that the female gender, living in urban areas and clustering are the most concerned by non-communicable disease risk factors. To reach the goal, preventive and therapeutic interventions are needed among the targeted population.

Cardiovascular Disease Risk Associated to Chronic Inflammatory Rheumatic Diseases in Patients Seen in Rheumatology Unit in Yaounde, Cameroon

Introduction: Even though there is a huge burden of both chronic inflammatory rheumatic diseases (CIRD) and cardiovascular diseases in Sub-Saharan Africa, no published study from this region has yet addressed the issue of cardiovascular diseases in a group including different CIRD to the best of our knowledge. Objective: We conducted this research with the aim to explore the association between CIRD and cardiovascular risk in a Cameroonian population based on the World Health Organization (WHO) and International Society for Hypertension (ISH) risk charts. Methods: This cross-sectional study included CIRD patients, followed at the rheumatology unit of the Yaounde Central Hospital, and, who were matched to non-CIRD subjects for sex, age and race. Cardiovascular risk factors were studied and subsequently the cardiovascular risk was estimated using the WHO/ISH risk charts. Analyses were performed in Epi-info and SPSS software and results were considered statistically significant for a p-value less than 0.05. Results: In total, 109 CIRD patients and 111 non-CIRD subjects were included. Their respective mean ages were 44.4 ± 15.2 years and 44.2 ± 15.1 years. Odds ratio 2.09, 95% confidence interval (CI) (1.07 - 4.08);high BMI OR 1.89, 95% CI (1.1 - 3.24);diabetes mellitus (p = 0.03) and physical inactivity (p < 0.001) were all markedly found in CIRD patients compared with controls. Ten (9.2%) CIRD patients had a past history of atherosclerotic cardiovascular events compared with no control (p < 0.001). The cardiovascular risk estimated with the WHO/ISH risk charts was low in 43 (79.6%) patients with CIRD versus 52 (88.1%) non-CIRD subjects. Conclusions: CIRD were associated with hypertension, excess overall adiposity, diabetes mellitus, and physical inactivity. A substantially increased proportion of CIRD patients with a past history of atherosclerotic cardiovascular events were noted. But the WHO/ISH risk charts broadly found a similar and globally decremented cardiovascular risk in both study groups, highlighting the need to pursue research for definite conclusions on their reliability.

Risk factors and outcome of bacterial infections in cirrhosis

Viable and non-viable pathological bacterial translocation promote a self-perpetuating circle of dysfunctional immune activation and systemic inflammation facilitating infections and organ failure in advanced cirrhosis.Bacterial infections and sepsis are now recognized as a distinct stage in the natural progression of chronic liver disease as they accelerate organ failure and contribute to the high mortality observed in decompensated cirrhosis.The increasing knowledge of structural,immunological and hemodynamic pathophysiology in advanced cirrhosis has not yet translated into significantly improved outcomes of bacterial infections over the last decades.Therefore,early identification of patients at the highest risk for developing infections and infectionrelated complications is required to tailor the currently available measures of surveillance,prophylaxis and therapy to the patients in need in order to improve the detrimental outcome of bacterial infections in cirrhosis.

Gender-specific associations between coronary heart disease and other chronic diseases: cross-sectional evaluation of national survey data from adult residents of Germany

Background Combinations of coronary heart disease(CHD) and other chronic conditions complicate clinical management and increase healthcare costs. The aim of this study was to evaluate gender-specific relationships between CHD and other comorbidities. Methods We analyzed data from the German Health Interview and Examination Survey(DEGS1), a national survey of 8152 adults aged 18-79 years. Female and male participants with self-reported CHD were compared for 23 chronic medical conditions. Regression models were applied to determine potential associations between CHD and these 23 conditions. Results The prevalence of CHD was 9%(547 participants): 34%(185) were female CHD participants and 66%(362) male. In women, CHD was associated with hypertension(OR = 3.28(1.81-5.9)), lipid disorders(OR = 2.40(1.50-3.83)), diabetes mellitus(OR = 2.08(1.24-3.50)), kidney disease(OR = 2.66(1.101-6.99)), thyroid disease(OR = 1.81(1.18-2.79)), gout/high uric acid levels(OR = 2.08(1.22-3.56)) and osteoporosis(OR = 1.69(1.01-2.84)). In men, CHD patients were more likely to have hypertension(OR = 2.80(1.94-4.04)), diabetes mellitus(OR = 1.87(1.29-2.71)), lipid disorder(OR = 1.82(1.34-2.47)), and chronic kidney disease(OR = 3.28(1.81-5.9)). Conclusion Our analysis revealed two sets of chronic conditions associated with CHD. The first set occurred in both women and men, and comprised known risk factors: hypertension, lipid disorders, kidney disease, and diabetes mellitus. The second set appeared unique to women: thyroid disease, osteoporosis, and gout/high uric acid. Identification of shared and unique gender-related associations between CHD and other conditions provides potential to tailor screening, preventive, and therapeutic options.

Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency

BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed.The data of 321 patients with no acute respiratory insufficiency as controls were also collected.Clinical variables of the first 24 hours after admission to intensive care unit were collected,including age,sex,comorbid disease,type of surgery,admission type,presence of shock,presence of acute kidney injury,presence of acute lung injury/acute respiratory distress syndrome,acute physiologic and chronic health evaluation(APACHE Ⅱ) score,sepsis-related organ failure assessment(SOFA),and PaO_2/FiO_2 ratio.Duration of mechanical ventilation,length of intensive care unit stay,intensive care unit death,length of hospitalization,hospital death and one-year survival were calculated.RESULTS:The incidence of acute respiratory insufficiency was 37.2%(190/321).Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases(P=0.001),surgeryrelated infection(P=0.004),hypo-volemic shock(P<0.001),and emergency surgery(P=0.018),were independent risk factors of postoperative acute respiratory insufficiency.Compared with the patients without acute respiratory insufficiency,the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay(P<0.001),a prolonged length of hospitalization(P=0.006),increased intensive care unit mortality(P=0.001),and hospital mortality(P<0.001).Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency(P=0.029,RR:8.522,95%CI:1.243-58.437,B=2.143,SE=0.982,Wald=4.758).Compared with the patients without acute respiratory insufficiency,those with acute respiratory insufficiency had a shortened one-year survival rate(78.7%vs.97.1%,P<0.001).CONCLUSION:A history of chronic obstructive pulmonary diseases,surgery-related infection,hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency.Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency.Compared with patients without acute respiratory insufficiency,those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.

Infectious, atopic and inflammatory diseases, childhood adversities and familial aggregation are independently associated with the risk for mental disorders: Results from a large Swiss epidemiological study

AIM To examine the associations between mental disorders and infectious, atopic, inflammatory diseases while adjusting for other risk factors.METHODS We used data from PsyC oL aus, a large Swiss Population Cohort Study(n = 3720; age range 35-66). Lifetime diagnoses of mental disorders were grouped into the following categories: Neurodevelopmental, anxiety(early and late onset), mood and substance disorders. They were regressed on infectious, atopic and other inflammatory diseases adjusting for sex, educational level, familial aggregation, childhood adversities and traumatic experiences in childhood. A multivariate logistic regression was applied to each group of disorders. In a complementary analysis interactions with sex were introduced via nested effects. RESULTS Associations with infectious, atopic and other chronic inflammatory diseases were observable together with consistent effects of childhood adversities and familial aggregation, and less consistent effects of trauma in each group of mental disorders. Streptococcal infections were associated with neurodevelopmental disorders(men), and measles/mumps/rubella-infections with early and late anxiety disorders(women). Gastric inflammatory diseases took effect in mood disorders(both sexes) and in early disorders(men). Similarly, irritable bowel syndrome was prominent in a sex-specific way in mood disorders in women, and, moreover, was associated with early and late anxiety disorders. Atopic diseases were associated with late anxiety disorders. Acne(associations with mood disorders in men) and psoriasis(associations with early anxiety disorders in men and mood disorders in women) contributed sex-specific results. Urinary tract infections were associated with mood disorders and, in addition, in a sex-specific way with late anxiety disorders(men), and neurodevelopmental and early anxiety disorders(women).CONCLUSION Infectious, atopic and inflammatory diseases areimportant risk factors for all groups of mental disorders. The sexual dimorphism of the associations is pronounced.

Cardiovascular co-morbidity in chronic kidney disease:Current knowledge and future research needs

Chronic kidney disease(CKD) is recognised as a health concern globally and leads to high rates of morbidity,mortality and healthcare expenditure.CKD is itself an independent risk factor for unfavorable health outcomes that include cardiovascular disease(CVD).Coronary artery disease is the primary type of CVD in CKD patients and a significant cause of death among renal transplant patients.Traditional and non-traditional risk factors for CVD exist in patients with CKD.Traditional factors include smoking,hypertension,dyslipidemia and diabetes which are highly prevalent in CKD patients.Non-traditional risk factors of CKD are mainly uraemiaspecific and increase in prevalence as kidney function declines.Some examples of uraemia-specific risk factors that have been well documented include low levels of haemoglobin,albuminuria,and abnormal bone and mineral metabolism.Therapeutic interventions targeted at more traditional risk factors which contribute to CVD,have not had the desired effect on lowering CVD events and mortality in those suffering with CKD.Future research is warranted to delineate clear evidence to the benefit of modifying non-traditional risk factors.

Endothelial injury and inflammation in patients with hyperuricemic nephropathy at chronic kidney disease stages 1-2 and 3-4

BACKGROUND Endothelial injury and inflammation are the main pathological changes in hyperuricemic nephropathy(HN);however,they have not been assessed in patients in the early,middle,and late phases of HN.AIM To investigate endothelial injury and inflammatory conditions between patients with HN at chronic kidney disease(CKD)stages 3-4 and CKD 1-2.METHODS This study enrolled 80 patients(49 and 31 with HN at CKD stage 1-2 and 3-4,respectively)from the Department of Nephrology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between July 2021 and January 2022.Plasma levels of heparan sulfate,endocan,oxidized low-density lipoprotein(Ox-LDL),E-selectin,soluble intercellular adhesion molecule-1(slCAM1),interleukin(IL)-1β,and IL-6 and urine levels of lipocalin-type prostaglandin D synthase(L-PGDS),IL-1β,and IL-6 were measured using enzyme-linked immunosorbnent assay.RESULTS Comparison between patients with HN at CKD 1-2 and those with HN at CKD 3-4 showed that age and disease course were significant factors(P<0.001 and P<0.010,respectively).There were no statistical differences in sex,heart rate,body mass index,and systolic and diastolic blood pressures.The incidence of hypertension was also significant(P=0.03).Plasma levels of heparin sulfate(P<0.001),endocan(P=0.034),E-selectin(P<0.001),slCAM1(P<0.001),IL-1β(P=0.006),and IL-6(P=0.004)and the urine levels of L-PGDS(P<0.001),IL-1β(P=0.003),and IL-6(P<0.001)were high in patients with HN at CKD 3-4 than in those with HN at CKD 1-2.The difference in plasma Ox-LDL levels was not significant(P=0.078).CONCLUSION Vascular endothelial injury and inflammation were higher in patients with HN at CKD3-4 than at CKD 1-2.Plasma heparin sulfate and slCAM1 levels are synergistic factors for CKD staging in HN.

Risk Factors among Greenhouse Farmers in Gaza Strip

Greenhouse farmers are exposed to many risk factors during work. This paper characterized the risk factors and discussed their health impacts among greenhouse farmers. Risk factors under greenhouse conditions emerged from pesticide application and greenhouse gas emission from soil during day. Risk factors among farmers were determined by recording toxicity symptoms, acute and chronic obstructive pulmonary disease (COPD). This study targeted 67 greenhouses in Gaza Strip and found 169 farmers doing many agricultural activities without protective clothes. We documented nine highly toxic insecticides and five moderately toxic fungicides being applied for insect and fungal control. A large number of farmers (55%) revealed that they visited respiratory health clinic quite two to three times a month immediately after insecticide application. About 8.88% (n = 15) of farmers stated that they had unrecoverable lung disease due to working in greenhouses during winter season. Personal health records of farmers showed variety of cholinergic symptoms, severe reduction on acetyl choline esterase activity (ACHE), many cases of COPD and some pneumonia cases. Classification of farmers according to risk factors indicates that 18% of farmers are at high risk due to extreme to insecticides. It is recommended to seasonally investigate the activity of ACHE of greenhouse farmers and to routinely check their chests and lungs to avoid any potential health risk factors due to works in greenhouse environment.

Three Year Community Based Intervention for Chronic Disease Prevention in Epidemiological and Political Transition Context: Example of Tunisia

Objective: Our aim was to determine the effectiveness, feasibility, and necessary cultural adaptations of evidence-based interventions directed at tobacco use, unhealthy diet, and physical inactivity in adults and children in three different sectors: workplace, neighborhood and schools. Materials and Methods: We conducted in Sousse, Tunisia an interventional study through a quasi-experimental design (pre-post with intervention and control groups) to prevent non communicable disease risk factors. The intervention group included different settings and pre and post assessment concerned independent groups (schools with 1929 and 2170 participants, workplaces with 914 and 1098 participants and community with 940 and 1001 participants respectively at pre and post assessment). It was located in the delegation of Sousse Jawhara and Sousse Erriadh. The control group with similar settings (schools with 2074 and 2105 participants, workplaces with 861 and 1015 and community with 940 and 976 participants respectively at pre and post assessment) was located in the delegation of Msaken from the region of Sousse. Results: Tobacco use decreased among neighborhood (26.2% to 23.2%, p = 0.13) workplace (39.2% to 37.5%, p = 0.43) and schools (5.7% to 4.8%, p = 0.19) participants. In control group, it increased significantly in schools and neighborhood. Participants who consumed five fruits and vegetables daily increased significantly in all settings in intervention group (from 30% to 33.2% in schools, 47.5% to 52.1% in workplace and 39.4% to 58.4% in neighborhood). However in control group it increased only in schools and neighborhood. An improvement in physical activity practice was seen both in intervention and control group among adults participants but not in schools. Conclusion: The “Together in Health” project for the prevention of risk factors for NCD is an example of a loco-regional initiative. Such initiatives can only be beneficial with a structure organized by the government.

Cardiovascular Disease Burden in Patients with Non-Dialysis Dependent Chronic Kidney Disease in Cameroon: Case of the Douala General Hospital

Introduction: Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). Objective: To evaluate the burden of CVD and audit the management of cardiovascular risk factors (CVRF) in patients with non-dialysis (ND) dependent CKD in Cameroon. Patients and Methods: A cross-sectional study in the Douala general hospital was conducted from January to March 2016, including CKD patients’ stages 3 - 5 ND. Socio-demographic data, comorbidities, medications and biological data were extracted from patient’s records. For each participant, lipid profile and urinary protein excretion were measured;a resting electrocardiogram was done. Hypertension, diabetes, dyslipidemia, obesity, smoking, alcohol consumption, anemia, hyperuricemia, proteinuria and high calcium-phosphorus product were considered as CVRF. CVD was defined as a history of stroke, peripheral artery disease, coronary heart disease (CHD), left ventricular hypertrophy (LVH), heart failure (HF) and arrhythmia. We used KDOQI 2003, KDIGO 2012 and JNC 8 guidelines for definition and evaluation of the management of lipid abnormalities, proteinuria and hypertension respectively. Results: A total of 83 patients (45 males) were included;mean age was 56 ± 15 years. Mean number of CVRFs per patient was 5.19 ± 1.64;hypertension (90.3%), obesity (79.5%), anemia (78.3%), dyslipidemia (69.8%) and hyperuricemia (69.8%) were the most frequent. Mean number of CVD per patient was 1.5 ± 0.63 with an overall prevalence of 69.8%;LVH (48.2%) and CHD (30.1%), were the most frequent and prevalence increased significantly with CKD stage. Treatment rate of hypertension was 100%, 53.4% for dyslipidemia and 75.3% for anemia. Target values were achieved in 50% of participants for LDL-cholesterol and phosphorus levels, 26.6% for blood pressure and 6% for hemoglobin levels. Conclusion: CVRF are highly prevalent in non-dialyzed CKD populations in this setting. This may contribute to the burden of CVD implying strict control of these factors.

COVID-19 pandemic:Its impact on liver disease and liver transplantation

Severe pulmonary disease caused by the novel coronavirus[severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)],has devastated many countries around the world.It has overwhelmed the medical system.The priorities of many institutions have changed to manage critically ill corona virus infectious disease-2019(COVID-19)patients,which affected the working style of many departments.Hepatologists and transplant surgeons look after a very sensitive patient group.Patients with liver disease need special attention and continuous follow-up.Similarly,transplant candidates also need special care.Healthcare professionals in the field of hepatology face the overwhelming task of taking care of COVID-19 patients with hepatic complications,liver disease or transplant patients who are SARS-CoV-2 positive,and the patients on routine surveillance who do not have COVID-19.This review will evaluate COVID-19 from the perspective of its effect on the liver and its possible effects on patients with liver disease.Furthermore,the level of care for liver transplant recipients during the pandemic will be discussed.