ABSTRACT
Background: Chronic Kidney Disease (CKD) is a growing public health problem affecting millions of people worldwide. Along with its well-known systemic effects, CKD has been associated with various ocular abnormalities, including uveitis, macular edema, and retinal vascular changes. Early detection and management of these ocular complications can prevent significant visual loss and improve the quality of life of patients with CKD. This highlights the importance of regular ophthalmic examinations as part of the comprehensive management of CKD. The aim of this study was to evaluate the ocular status of chronic kidney disease. Material & Methods: This was an observational study. The present study was conducted on 150 Patients attending the Department of Ophthalmology at Dr. Sirajul Islam Medical College and Hospital Ltd, Dhaka, Bangladesh. The duration of the study was 2 years. All collected data was entered in MS Excel and Statistical analysis was done using the SPSS-24 version. Results: The study analyzed a population between the ages of 40-59 years, with a slight majority of women (52.67%) and moderate CKD (64.00%). The most common cause of CKD in the population was hypertension and diabetes (52.00%). 66.67% of 300 eyes had good vision (6/18 or better), while the remainder had impaired or legally blind vision (increasing as the severity of CKD increases). Ocular anterior segment findings showed that lid oedema and conjunctival pallor were present in 3.5% and 56.9% of the eyes, respectively. Dry eyes and cataract were present in 5.6% and 11.1% of the eyes, respectively. Hypertensive retinopathy was present in 48.00% of eyes in the moderate CKD group, and diabetic retinopathy was present in 32.00% of eyes in the severe and end-stage CKD groups. Maculopathy and vitreous hemorrhage were present in 12.67% and 6.33% of eyes in the end-stage CKD group. Of the 100 eyes with poor or blind visual acuity, 24 (24%) were affected by Maculopathy and 21 (21%) by Cystoid Macular Edema. The causes of visual impairment were also listed with their corresponding percentage. Conclusion: In CRF patients, eye exams can detect ocular problems. Early treatment prevents negative outcomes and those with a history of abnormal renal function need close monitoring due to increased risk of vision loss. Awareness of ocular complications is important, as well as thorough eye exams and control of diabetes and hypertension for maintaining eye health.
ABSTRACT
Background: Mitral stenosis (MS) is a common valvular heart disease. Thromboembolism is one of the most serious consequences of mitral stenosis, particularly when it is accompanied with atrial fibrillation (AF). When linked with Left atrial appendage inactivity (LAAI), patients with sinus rhythm (SR) are also at risk for this condition. In mitral stenosis, LAA inactivity determined by S-wave is an independent predictor of thromboembolism. The aim of the study was to evaluate the Prevalence and Echocardiographic Predictors of Left Atrial Appendage inactivity in patients of Mitral Stenosis.Material & Methods:Sixty MS patients were evaluated by transthoracic echocardiography (TTE) and all patients underwent transesophageal echocardiography (TEE). The annular systolic (S-wave) and diastolic (Em- and Am-waves) velocities were recorded by tissue Doppler imaging (TDI). LAA inactivity was defined as LAA emptying velocity <25 cm/second determined by pulse wave Doppler at the junction of LA & LAA (TEE). Patients were divided into three groups; group A I (n = 18). Sinus rhythm (SR) and LAA emptying velocity ?25 cm/sec, group A II (n -22): SR and LAA emptying velocity <25cm/sec and group B (n = 20): atrial fibrillation.Results:Thrombus was detected in 14 patients and spontaneous echo contrast (SEC) was detected in 43 patients. Both S-wave and peak LAA emptying velocities were decreasing, while SEC frequency and density were increasing from group A to group B. There was a positive correlation between LAA emptying vs. S-wave and LAA emptying vs. Am velocities (p < 0.001, r= 0.708 and p<0.001, r=0.495). Multivariate regression analysis showed that only S-wave is the independent predictor of inactive LAA (p = 0.001, odds ratio = 0.133, 95% Cl =0.032-0.556). In patients with SR, the cutoff value of S-wave was 10 cm/sec for the prediction of the presence of inactive LAA (sensitivity: 92.3%, specificity: 95.3%).Conclusions:In individuals with severe mitral stenosis in sinus rhythm, there is a significant prevalence of left atrial appendage inactivity. The mean pressure gradient across the mitral valve, as well as S-wave are independent predictors of left atrial appendage inactivity. Inactivity of the left atrial appendage is an independent predictor of left atrial/left atrial appendage smoke and associated thrombus.