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The study was aimed at evaluating various biological actions of widely consumed Areca catechu nut. The nut's ethanolic extract exhibited cytotoxicity [lung cancer cell line], embryotoxicity [chick embryo], phytotoxicity [Lemna minor], insecticidal [Rhyzopertha dominica], anti-bacterial [Pseudomonas aeruginosa], anti-fungal [Microsporum canis] and mitogenic [human blood lymphocytes] actions. The standardization results revealed presence of 1.7 microg arecoline per mg of extract. In conclusion, the Areca nut is endowed with both harmful and beneficial biological actions. Keeping in view its wide consumption and ease of availability, the aforesaid information should be channelized for health and agricultural benefits
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Omeprazole is a widely prescribed proton pump inhibitor to treat various gastric acid hyper secretion disorders. The present study was designed to evaluate the renal clearance and urinary excretion of omeprazole in eight healthy female volunteers to increase the understanding of the contributing factors such as demographics variability in the renal clearance and urinary excretion of omeprazole under indigenous conditions. The urine and blood samples were collected 0.5, 1, 1.5, 2, 3, 4, 6, 8 hours after oral administration of enteric coated omeprazole [20 mg] and drug concentration in the samples was determined by High Performance Liquid Chromatography [HPLC] with C18 column and UV detector. Urinary excretion and renal clearance of omeprazole was calculated and data was statistically analyzed by using regression/correlation technique. Endogenous creatinine was also measured by reagent kit available in the market. The results indicate that mean diuresis was 0.0172+/-0.0029 ml/min/kg. While the mean values of renal clearance of creatinine and omeprazole were 1.315+/-0.103 and 0.066+/-0.0042 ml/min. kg, respectively. Whereas, clearance ratio was 0.055+/-0.007 which indicates back diffusion. The cumulative percentage of dose excreted was 6.71+/-0.358. A significant [p<0.05] negative correlation [r= -0.457] between clearance ratio and urine pH of omeprazole reflecting glomerular filtration reabsorption of drug at kidney tubular level while significant [p<0.05] negative correlation [r= - 0.681] between clearance ratio and plasma concentration of omeprazole indicates the involvement of active tubular secretion of drug. It can be concluded that during glomerular filtration, omeprazole diffuse back/reabsorption. Therefore, Urinary excretion of omeprazole in indigenous healthy female subjects was observed to be lower than given in the literature values
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Objective: To assess health-related quality of life and co-morbidity pattern in hemodialysis patients
tudy Design: Observational / cross sectional study
Place and Duration of Study: This study was carried out in the Department of Nephrology Department, Nishtar Medical Hospital, Multan from February 2015 to January 2016
Materials and Methods: By a non probability purposive sampling procedure, 123 hemodialysis patients from our hemodialysis center in Nishtar Hospital Multan[Pakistan] were interviewed by resident doctor according to the SF-36 Scales. The means and standard deviations for each of eight scales were calculated, each domain ranges from 0-100, the highest scores indicating better quality of life. Comorbidities like DM, Hypertension ,ischemic heart disease lung disease etc were also recorded
Results: The scores of the eight scales in the hemodialysis patients were 49.92 +/- 0.90, 38.82 +/- 41.39, 46.73 +/- 26.54, 40.52 +/- 21.65, 43.98 +/- 21.82, 49.43 +/- 27.76, 49.85 +/- 40.59 and 59.93 +/- 17.36. Co-morbidities pattern were hypertension in 104[84.6%],DM 59[48%],ischemic heart disease 23[18.7%] and other co morbidities were less common. The scores of most of the scale in the patients with co morbidities were lower as compared to patients without co morbidities. Data obtained was entered by a doctor in SPSS version 20 and was analyzed to compute descriptive statistics of the numerical variables while frequencies and their percentages for categorical variables of the study
Conclusion: The results of our study indicate that quality of life was poor among patients on hemodialysis particularly those having co-morbidities. Hypertension and diabetes were major co-morbidities in our study. Quality of life score was lower in female patients than that of male patients. Proper management of co-morbidities can improve quality of life of these patients which will decrease disease morbidity and mortality. This will also provide psychological and financial relief to the suffering families and also be cost effective for hospital authorities in terms of availability of space
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The current study was aimed at exploring the folkloric use of Cuscuta reflexa dodder a parasitic plant [family convolulaceae] against depression. Briefly, the methanolic extract of C. reflexa vine was assessed for antidepressant action using various behavioral paradigms such as tail suspension test [TST], forced swim test [FST] and locomotor activity test. The serotonergic and noradrenergic changes were evaluated using 5-hydroxytryptophan [5-HTP] induced head twitches and yohimbine potentiation tests, respectively. The fluoxetine and phenelzine were used as positive controls in the study. Our data demonstrated that the C. reflexa extract significantly declined the immobility time in TST [EC[50] 50 mg/kg] and FST without affecting the locomotor counts
The extract also significantly increased the 5-HTP induced head twitches and yohimbine induced lethality. The aforesaid behavioral outcomes were similar to that caused by standard drug phenelzine [monoamine oxidase inhibitor, MAOI]. It is known that quercetin is an inhibitor of MAO and also the constituent of C. reflexa. Our HPLC data confirmed the presence of quercetin [0.156 mg/25 mg of extract; retention time = 2.1 minutes] in the extract and was used in present study. In conclusion, the present study validate the folkloric use of C. reflexa as an antidepressant and this effect can be attributed to quercetin mediated rise in neuronal serotonin and noradrenaline levels possibly via MAO inhibition
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Oxidative stress and glycation processes have a combined effect on diabetes related complications. Crude plant extracts and plant derived compounds possessing both antiglycation and antioxidant activities have a high therapeutic potential for treating these complications. Antioxidant, antiglycation, anti-lipid per oxidation and cytotoxic activities of crude methanol extract and solvent fractions of Hypericum androsaemum L. [Hypericaceae] were evaluated and correlated with total content of phenolics and flavonoids. Significant radical scavenging activity was observed for the methanol extract against 2,2-diphenyl-1-picrylhydrazyl [DPPH] free radical used as a basis for antioxidant activity with IC50 value of 92.70 +/- 2.85 micro gmL-1 [96.20 +/- 2.34% inhibition at 500 micro gmL-1]. In case of anion scavenging activity the results were not very significant [33.20 +/- 1.22% inhibition at 500 micro gmL-1]. Anti-lipid per oxidation activity was highest for n-hexane fraction [67.83 +/- 1.33% inhibition at 500 micro gmL-1] while the ethyl acetate fraction had the highest antiglycation activity [62.77 +/- 2.54% inhibition at 500 micro gmL-1]. Statistically significant correlation was determined for antioxidant and antiglycation activity and phenolic and flavonoid contents. In cytotoxicity assay all the extracts had IC50 values >30 microg mL-1 as compared to the standard cycloheximide [IC50 value 0.084 +/- 0.1 micro gmL-1]. The polar extracts of H. androsaemum can be a good source of non-toxic compounds with antioxidant, anti-lipid per oxidation and antiglycation activities
Subject(s)
Plant Extracts , Antioxidants , Lipid Peroxidation , Glycosylation , Cytotoxins , Free Radical Scavengers , AnionsABSTRACT
In the present study, two species Hypericum x moserianum and Hypericum ericoides which belong to genus Hypericum were evaluated for their potential antiglycation, antioxidant, anti lipid peroxidation and cytotoxic activities. These species are widely used in folk medicine and to the best of our knowledge there were no previous reports regarding antioxidant, anti-glycation and cytotoxicity studies of these species. Among the crude methanol extracts and fractions of both the species, the ethyl acetate fraction of H. x moserianum exhibited promising antioxidant activity against 1, 1-diphenyl-2-picrylhydrazyl [DPPH] with IC50 129.084+/-1.215µg/ml, followed by methanol extract [IC50=232.083+/-1.215µg/ml] and aqueous fraction [IC50=266.962+/-2.213µg/ml]. The ethyl acetate fraction of Hericoides exhibited IC50 value of 295.088+/-2.320µg/ml. In antiglycation assay, the ethyl acetate fraction of H.x moserianum showed 52.096% inhibition at 500µg/ml. For lipid peroxidation assay, the dichloromethane, aqueous and n-hexane fractions of H. x moserianum showed 67.241, 66.147 and 64.213% inhibition respectively, while aqueous fraction of H. ericoides exhibited 67.404% inhibition at 500µg/ml. In cytotoxicity assay, all fractions of both the species were found to be non-toxic on mouse fibroblast 3T3 cells with IC50 value greater than 30µg/ml as compared to cycloheximide with IC50 value 0.073+/-0.1µg/ml used as a st and ard. It was concluded from the study that among the two species, crude methanolic and ethyl acetate fractions were more active regarding the antioxidant, anti-glycation activities while dichloromethane, aqueous and n-hexane fractions possessed anti-lipid peroxidation activity
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Health care is the crucial and fundamental right of every human being. Quality health care is the strong desire of every human being. Quality is considered as one of the prime pillar of differentiation in services. Service quality is lifeline of organizational success. This paper throws a public eye on patient's expectations and the satisfaction level pertaining to quality of service provided by public hospitals. [1] To dig out the quality of service in public teaching hospitals of Lahore, Pakistan by using SERVQUAL model. Quantitative Study. Sep 2014 to Oct 2014. Five Teaching Hospital, Jinnah Hospital, Mayo Hospital, Services Hospital, General Hospital, Sir Ganga Ram Hospital, Lahore which are the Medical Giants of Pakistan. The research is carried out on primary data, recording 250 responses from target audience by using structure questionnaire. Regression and correlation analysis were performed to confirm a relationship between Service Quality dimensions and patient satisfaction. Study shows that empathy is the most important factor that brings happiness and satisfaction to the patients. Research findings are fruitful for health department and hospital administration to plan strategies in order to improve service quality and become benchmark for others in industry
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Objective: To assess the magnitude of flood related rise in the frequency of malaria, diagnosed at a secondary care hospital, during 2007-2011
Study Design: Cross sectional descriptive study
Place and Duration of Study: Pakistan Air Force hospital Mianwali, from 1[st] Jan 2007 to 31[st] Dec 2011
Patients and Methods: Monthly records of hospital laboratory patients with peripheral blood smears, positive for malarial parasites, were counted from 1[st] Jan 2007 to 31[st] Dec 2011. Frequencies of vivax and falciparum malarial cases diagnosed each year during 2007-2009 were compared with the corresponding frequencies during the year of floods i.e. 2010, and the following year i.e. 2011
Results: When compared with the mean of the annual frequencies during 2007-2009, there was a rise in the total number of malaria cases by 1.3 times in 2010; while next year, i.e. during 2011, the rise was 3.0 times. During the period 2007-2011, vivax malaria cases always peaked during the months of September each year while falciparum malaria cases had a spike in the months of November
Conclusion: Massive floods resulted in a rise in the frequency of malaria cases during flood season and as an after math during the next malarial season. Planning for prevention and control should be done accordingly. Spread of falciparum malaria following the floods demands more efforts towards halting its possible rise in Mianwali district
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Soft tissues analysis in Orthodontics, not only plays important role to assess facial esthetics, rather it is also one of the crucial steps in determining the stability and success of treatment outcome. This cross sectional study was carried out in sample of local Karachi population with esthetically pleasing faces having Class I skeletal base with fully erupted permanent teeth and no history of previous orthodontic treatment. Cephalometric soft tissue analysis was done using the Nasolabial angle, E-Line and S-Line for 91 subjects [68 females and 23 males] who met the inclusion criterion. Mean value ofnasolabial angle was found to be 101.6° +/- 14.5°. Upper and lower lip prominence in accordance to E-Line was 2.91+/-2.45mm and1.25 +/- 2.67mm respectively. Upper and lower lips were found to be slightly protrusive with reference to the norms of E-Plane proposed by Rickets. The anteroposterior position of upper and lower lip in relation to S-Line was 0.0+/- 2.5 mm and- 0.71 +/- 2.5 mm respectively. Both the lips were found to lie close to the norms of S-Line proposed by Steiner's. Thickness of soft tissues varies from one patient to other, which is one of the major factors in determining the profile of patients. This study was conducted in a sample of Karachi population and these results do not necessarily exhibit the trend of entire Pakistani population as soft tissue thickness varies in different ethnic groups
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OBJECTIVE@#To evaluate the antimicrobial potential of extracts of the endophytic fungi Plectophomella sp., Physalospora sp., and Crataegus monogyna (C. monogyna) and study the tentative identification of their active constituents.@*METHODS@#Crude extracts and isolated compounds were screened for antimicrobial activity using the agar well diffusion method. Four compounds were purified from three endophytic fungi using column chromatography and their structures have been assigned based on their (1)H and (13)C nuclear magnetic resonance spectra.@*RESULTS@#Plectophomella sp., Physalospora sp., and C. monogyna extracts showed promising antifungal, antibacterial and herbicidal properties. (-)-Mycorrhizin A was isolated from Plectophomella sp. while cytochalasins E and K were isolated from Physalospora sp. Similarly radicinin was purified from the endophytic fungus C. monogyna. The ethyl acetate extract of Plectophomella sp. showed significant antifungal activity towards Ustilago violacea (U. violacea) and Eurotium repens (E. repens) and significant antibacterial activity against Bacillus megaterium. Interestingly, the ethyl acetate extracts of Physalospora sp. and C. monogyna showed strong herbicidal and antifungal activities towards Chlorella fusca, U. violacea, E. repens, Mycotypha microspora (M. microspora), Fusarium oxysporum, Escherichia coli, and Bacillus megaterium. (-)-Mycorrhizin A showed significant antifungal activity towards U. violacea and E. repens. Cytochalasins E and K showed strong antifungal activity against E. repens and M. microspora especially towards fungal Mycotypha microspora. Similarly cytochalasins E and K showed good herbicidal activity towards Chlorella fusca. Radicinin showed strong antifungal activity against E. repens and M. microspora.@*CONCLUSIONS@#Antimicrobial activities demonstrated by the extracts of the endophytic fungi Plectophomella sp., Physalospora sp., and C. monogyna and four isolated compounds clearly demonstrate that these fungi extracts and active compounds present a great potential use in the food, cosmetic and pharmaceutical industries.
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Objective: To evaluate the antimicrobial potential of extracts of the endophytic fungi Plectophomella sp., Physalospora sp., and Crataegus monogyna (C. monogyna) and study the tentative identification of their active constituents. Methods: Crude extracts and isolated compounds were screened for antimicrobial activity using the agar well diffusion method. Four compounds were purified from three endophytic fungi using column chromatography and their structures have been assigned based on their
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The current study was aimed at investigating the effect of Areca catechu nut dichloromethane fraction [7 mg/kg] on monoamines [serotonin and dopamine] modulation [5-hydroxytryptophan-induced tremors and phenylethylamine-induced stereotypes] and its interaction with tyramine [cheese effect]. The dichloromethane fraction caused pronounced increase in 5-HTP-induced tremors [50%] with negligible PEA-induced stereotypes [20%]. Additionally, it did not produce a significant increase in the tyramine pressor effects. These results suggest that the dichloromethane fraction of A. catechu nut primarily elevates serotonin levels [probably via monoamine oxidase A inhibition] and does not induce cheese effect
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To establish reference intervals for Free Triiodothyronine [FT[3]] and Free Thyroxine [FT[4]] in euthyroid subjects and to assess the effect of age and gender on FT[3] and FT[4]. Cross-sectional, analytical study. Institute of Nuclear Medicine and Oncology [INMOL], Lahore, from January 2009 to April 2011. FT[3] and FT[4] were measured in 852 euthyroid patients. Those with previous thyroid surgery, on thyroidrelated medication and severe non-thyroid illness were excluded. There were 215 males and 637 females with mean age of 46 years. The reference intervals, revealed by this study, for FT[3] and FT[4] were 2.80 - 5.39 pmol/L and 11.9 - 22.2 pmol/L respectively. The mean difference between gender groups and age groups was found statistically significant for FT[3] [gender: p < 0.001; age: p < 0.001] but statistically insignificant for FT[4] [gender: p=0.147; age: p=0.201]. There was no effect of gender and age on FT[3] and FT[4]. The age with serum FT[3] and FT[4] significantly negatively correlated but this correlation was stronger for FT[3] as compared to FT[4] levels. Reference intervals of FT[3] and FT[4] for male [2.99 - 5.63 pmol/L, 12.3 - 22.6 pmol/L] and female [2.77 - 5.29 pmol/L, 11.7 - 22.1 pmol/L] respectively are suggested
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Introduction: Early detection of silent myocardial ischemia plays an important role in prevention of sudden cardiac death and acute myocardial infarction. The studies regarding the frequency of silent myocardial ischemia in diabetic patients having cardiovascular autonomic neuropathy are few so we planned this study to determine the frequency of silent myocardial ischemia among patients with diabetic cardiovascular autonomic neuropathy in our population
Objectives: To determine the frequency of silent myocardial ischemia in type 2 diabetic patients having cardiovascular autonomic neuropathy
Study Design: Cross-Sectional study
Place and Duration of Study: Medical Departments of Allied Hospital and Aziz Fatimah Hospital Faisalabad from 01-08-2013 to 31-01-2014
Methods: This study included 91 type 2 diabetic patients with cardiovascular autonomic neuropathy. All the patients had ECG done. Those who had normal ECG underwent ETT, to determine if there was any silent myocardial ischemia which was described as frequency distribution table. The data was collected on specially designed performa
Results: Total 91 patients were included in the study. Silent myocardial ischemia was present among 35 [38.5%] patients while 56 [61.5%] did not have silent myocardial ischemia. The mean age of the patients was 52.99 + 7.00 years [range 41-71years]. 57 [62.6%] patients were male and 34 [37.4%] patients were female. ECG was positive for ischemia among 25 [27.5%] patients and ETT was positive for ischemia among 10 [11%] patients
Conclusion: The frequency of the silent myocardial ischemia is high among patients with diabetic cardiovascular autonomic neuropathy, so every diabetic patient with cardiovascular autonomic neuropathy should be screened for ischemic heart disease
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Introduction: Left ventricular hypertrophy, common in hypertension, is an adaptive state of the heart to increase in wall stress. LVH has important prognostic implications for patients with hypertension. In detection of LVH, Echocardiography is considered to be superior to electrocardiography in patients with hypertension
Objectives: To compare the findings of electrocardiography with echocardiography in terms of concurrence of results in the diagnosis of left ventricular hypertrophy
Study Design: Cross - sectional study
Place and Duration of Study: Medical Department of Allied Hospital and PINUM Faisalabad from 14-02-2014 to 13-08-2014
Material and Methods: A total of 88 patients were included in this study. After detailed history and examination, all patients had first ECG and then echocardiography
Results: Mean age of the patients was 50.85+6.3 year. Out of 88 cases, 55 patients [62.5%] were male while remaining 33 patients [37.5%] were female. Mean height of the patients was 1.69+0.10 meter, mean weight was 66.1+9.86 kg and mean BMI was 23.38+1.20. Out of 88 cases, 67 cases were positive on echocardiography and 39 cases were positive on electrocardiography [ECG]. Out of these 39 cases 37 cases were true positive, 2 cases were false positive
Conclusion: The results show that electrocardiogram has low sensitivity and low NPV for detecting LVH as compare to echocardiography. These findings are relevant for physiological LVH and should not be extrapolated to detection of hypertrophic cardiomyopathy. In clinical practice, echocardiography alone should be used to exclude LVH
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To determine the frequency of demyelinating pattern on electrophysiological study in patients with diabetic peripheral polyneuropathy. Cross sectional study. This study was performed at Department of Neurology, Mayo Hospital, Lahore and Medical Unit II, Allied Hospital, Faisalabad from 01-Jan-2012 to 30-Sep-2012. In this study non-probability purposive sampling technique was used. The calculated sample size was 100 cases. All patients with diabetic peripheral neuropathy and of both gender and age between 15-65 y were included in the study. Whereas Diabetic patients in whom history, clinical examination or medical record showing renal failure, hereditary neuropathies, thyroid disease, alcohol intake and toxic drug intake like anti tuberculous treatment, anti-cancer medicine etc were excluded from the study. Nerve conduction studies and electromyography were performed. Patients were labeled as having demyelinating, axonal or mixed pattern. The collected information was entered into SPSS version 15. Among the enrolled 100 patients, 56 [56%] patients were male and 44 [44%] patients were female. On electrophysiological examination, demyelinating pattern was found in 18[18%] patients, axonal pattern in 54[54%] patients and mixed pattern in 28[28%] patients. Mean duration of diabetes mellitus was 82 months + 56 S.D. The duration of diabetes ranged from 8-264 months. Our study indicates that there is high frequency of demyelinating neuropathy in patients of diabetic peripheral polyneuropathy in our local population
Subject(s)
Humans , Male , Female , Demyelinating Diseases/physiopathology , Diabetic Neuropathies/complications , Electrophysiological Phenomena , Cross-Sectional Studies , Neural Conduction/physiologyABSTRACT
To demonstrate the spectrum of MR imaging findings in patients with suspected spinal dysraphism in a Military Hospital. Descriptive study. Department of Radiology, Military Hospital Rawalpindi from September 2005 to October 2007. Patients were referred from neurology, neurosurgery and general surgery departments of Military Hospital and Combined Military Hospital Rawalpindi who presented with various neurological problems and skin stigmata having suspicion of spinal dysraphism. A total of 74 patients were evaluated over a period of two years. All 74 [100%] patients suspected of spinal dysraphism showed one or multiple abnormalities out of the whole spectrum on plain MRI spine. Mean age was 6.4 years with the youngest patient sixteen days old and the eldest being 37 years old. Majority of the patients were under six years of age. A wide range of abnormalities were seen with Myelomeningocele found in 29 [39.2%] and along with lipomatous component in 9 [12.2%]. Thirty three [44.6%] patients had diastometomyelia, 10 [13.5%] having associated lipoma of filum terminale while syringomyelia was noted in 36 [48.6%] patients. Moreover, in the majority of patients, dysraphism was at the lower lumbar and upper sacral region. It was concluded that plain MRI spine is a single safe, non-invasive and quick method of describing the gamut of findings in patients of spinal dysraphism
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The current study was aimed at comparing the behavioral and biochemical [5-hydroxytryptamine and 5-hydroxyindoleacetic acid levels] effects of monoamine reuptake inhibitors [fluoxetine, venlafaxine and imipramine] in sub-chronically forced swim stressed rats. At the given doses of 10, 20 and 30 mg/kg, among aforesaid antidepressants, the imipramine treatment alone caused significant decline in the immobility time of rats [IC[50] - 20 mg/kg]. In the hippocampus of rats, the imipramine treatment caused significant elevation of 5-hydroxytryptamine [5-HT] whereas, the fluoxetine and venlafaxine elicited significant increase in 5-hydroxyindoleacetic acid [5-HIAA] levels. Likewise, in the plasma of rats, the imipramine treatment significantly increased the 5-HIAA levels whereas, the fluoxetine and venlafaxine treatment significantly elevate the 5-HT levels. It can therefore be inferred that the imipramine did not act like other monoamine reuptake inhibitors in biochemical study, which could possibly underlie its ability to be detected in forced swim test [behavioral study]. Moreover, the re-uptake inhibition of 5-HT is not accountable for the antidepressant action exhibited in forced swim test
Subject(s)
Male , Animals, Laboratory , Hippocampus , Serotonin , Hydroxyindoleacetic Acid , Fluoxetine , Imipramine , Rats, Sprague-Dawley , CyclohexanolsABSTRACT
Haemoptysis has a long list of causes, but pulmonary varices are amongst the rare causes. Pulmonary varices are rare abnormalities of pulmonary veins that may exist either as an isolated malformation or in association with pulmonary venous hypertension. This case report describes pulmonary varices as a cause of hemoptysis in an adolescent boy, which was diagnosed on multislice CT and confirmed on angiography
Subject(s)
Humans , Male , Adolescent , Varicose Veins/complications , Pulmonary Veins/diagnostic imaging , Lung , Angiography , Diagnosis, Differential , Hemoptysis/diagnostic imaging , Tomography, X-Ray Computed , Varicose Veins/diagnostic imagingABSTRACT
To measure recirculation by Urea based Method in double lumen catheters in patients undergoing hemodialysis. Cross sectional study. Hemodialysis unit of Nephrology department of Shaikh Zayed Hospital, Lahore, and Quaid- i-Azam Medical College Bahawalpur for period of eight months from October 2007 to May 2008. Total 125 adult patients selected with Non probability purposive sampling technique in which hemodialysis were done through double lumen catheter, were studied for recirculation. Access recirculation by urea based method with three sample technique was calculated from following formula; Percentage Recirculation= Systemic [S] - Arterial [A]/ systemic - Venous [V] x 100. Out of 125 patients 53 [42%] were males, whereas 72 [58%] were females. Their mean age was 43.4 +/- 15.7 years. Percentage recirculation by urea based method was 10.3 +/- 6.64 with range from 3.6 to 24.8. Our results have shown the upper limit of acceptable recirculation [10.3 +/- 6.6] through double lumen catheter. Central venous catheter remains an important temporary access and in some cases the only achievable access for the patients. This recirculation should be considered when measuring adequacy level in these patients