The use of lung ultrasound in evaluation of extravascular lung water in hemodialysis patients: Systematic review and meta-analysis.

RATIONALE AND OBJECTIVES: Determining dry weight is crucial for optimizing hemodialysis, influencing efficacy, cardiovascular outcomes, and overall survival. Traditional clinical assessment methods for dry weight, relying on factors such as blood pressure and edema, frequently lack reliability. Lung ultrasound stands out as a promising tool for assessing volume status, given its non-invasiveness and reproducibility. This study aims to explore the role of Lung ultrasound in evaluating the impact of hemodialysis and ultrafiltration on extravascular lung water, with a specific focus on changes in B-lines post-hemodialysis compared to pre-hemodialysis. MATERIALS AND METHODS: The research encompassed searches across PubMed, WOS, and Scopus databases for studies related to lung ultrasound and hemodialysis. A meta-analysis was then performed to determine the mean differences in various parameters before compared to after, hemodialysis, including the number of B-lines, indexed end-inspiratory and end-expiratory inferior vena cava diameters, inferior vena cava collapsibility index, weight, blood pressure, and serum levels of NT-pro-BNP. RESULTS: Our meta-analysis, included 33 studies with 2301 hemodialysis patients, revealed a significant decrease in the number of B-lines post-hemodialysis (mean difference = 8.30, 95% CI [3.55 to 13.05]). Furthermore, there was a noteworthy reduction in inspiratory and expiratory inferior vena cava diameters post-hemodialysis (mean difference = 2.32, 95% CI [0.31 to 4.33]; mean difference = 4.05, 95% CI [2.44 to 5.65], respectively). Additionally, a significant positive correlation was observed between B-lines and the maximum inferior vena cava diameter both pre- and post-hemodialysis (correlation coefficient = 0.39; correlation coefficient = 0.32, respectively). CONCLUSION: These findings indicate the effectiveness of lung ultrasound in detection of volume overload and assessment of response to ultrafiltration in hemodialysis patients.

Determination of immunological biomarkers in sarcoidosis and their relation to disease activity.

Sarcoidosis is a multisystem granulomatous disease of unknown origin. Ninety percent of patients with sarcoidosis have lung involvement. The onset can be acute or non-acute and the severity of sarcoidosis ranges widely from asymptomatic patients with accidental radiographic findings to patients with severe organ involvement. This case control analytic prospective study was conducted at the Chest Clinic, Al Zahraa hospital, to assess the diagnostic value of serum soluble interleukin 2 receptor (sIL-2R), cluster of differentiation 4 (CD4)/CD8 ratio and CD103 in sarcoidosis. We investigated the value of serum sIL-2R using ELISA and blood CD103, blood CD4/CD8 ratio using flow cytometry for 30 cases of sarcoidosis in different stages and 30 control persons to detect their use as a marker for diagnosis. We found a significant increase in sIL-2R in the sarcoidosis group as compared to the control group (p˂0.0001), while there was a significant decrease in CD103/CD4 in sarcoidosis group as compared to the control group (p < 0.001). In conclusion, sIL-2R and CD103 can be used as diagnostic markers for sarcoidosis.

Non-alcoholic fatty liver disease (NAFLD) and mental illness: Mechanisms linking mood, metabolism and medicines.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world and one of the leading indications for liver transplantation. It is one of the many manifestations of insulin resistance and metabolic syndrome as well as an independent risk factor for cardiovascular disease. There is growing evidence linking the incidence of NAFLD with psychiatric illnesses such as schizophrenia, bipolar disorder and depression mechanistically via genetic, metabolic, inflammatory and environmental factors including smoking and psychiatric medications. Indeed, patients prescribed antipsychotic medications, regardless of diagnosis, have higher incidence of NAFLD than population norms. The mechanistic pharmacology of antipsychotic-associated NAFLD is beginning to emerge. In this review, we aim to discuss the pathophysiology of NAFLD including its risk factors, insulin resistance and systemic inflammation as well as its intersection with psychiatric illnesses.

Mechanisms Underlying Antipsychotic-Induced NAFLD and Iron Dysregulation: A Multi-Omic Approach.

Atypical antipsychotic (AA) medications are widely prescribed for the treatment of psychiatric disorders, including schizophrenia, bipolar disorder and treatment-resistant depression. AA are associated with myriad metabolic and endocrine side effects, including systemic inflammation, weight gain, dyslipidemia and insulin resistance, all of which are associated with increased incidence of non-alcoholic fatty liver disease (NAFLD). NAFLD is highly prevalent in patients with mental illness, and AA have been shown to increase incidence of NAFLD pre-clinically and clinically. However, the underlying mechanisms have not been described. We mined multi-omic datasets from preclinical murine models of sub-chronic risperidone or olanzapine treatment, in vitro exposure of human cells to risperidone and psychiatric patients following onset of aripiprazole therapy focused on pathways associated with the pathophysiology of NAFLD, including iron accumulation, systemic inflammation and dyslipidemia. We identified numerous differentially expressed traits affecting these pathways conserved across study systems and AA medications. We used these findings to propose mechanisms for AA-associated development of NAFLD and dysregulated iron homeostasis.

Weaknesses in Experimental Design and Reporting Decrease the Likelihood of Reproducibility and Generalization of Recent Cardiovascular Research.

Recent evidence indicates that many clinical and preclinical studies are not reproducible. Prominent causes include design and implementation issues, low statistical power, unintentional bias, and incomplete reporting in the published literature. The primary goal of this study was to assess the quality of published research in three prominent cardiovascular research journals by examining statistical power and assessing the adherence to augmented ARRIVE guidelines (Animal Research: Reporting of In Vivo Experiments). For unpaired t-tests, the average median power for a 20% and 50% change was 0.27 ± 0.06 and 0.88 ± 0.08, respectively. For analysis of guidelines, 40 categories were assessed with a 0-2 scale. Although many strengths were observed, several key elements that were needed for reproducibility were inadequate, including differentiation of primary and secondary outcomes, power calculations for group size, allocation methods, use of randomization and blinding, checks for normality, reports of attrition, and adverse events of subjects, and assessment of bias. A secondary goal was to examine whether a required checklist improved the quality of reporting; those results indicated that a checklist improved compliance and quality of reporting, but adequacy levels in key categories were still too low. Overall, the findings of this study indicated that the probability for reproducibility of many clinical and preclinical cardiovascular research studies was low because of incomplete reporting, low statistical power, and lack of research practices that decrease experimental bias. Expansion of group sizes to increase power, use of detailed checklists, and closer monitoring for checklist adherence by editors and journals should remediate many of these deficits and increase the likelihood of reproducibility.

Can Ethanolic Leaf Extract of Olive or Black Mulberry Substitute Sodium Hypochlorite as a Root Canal Irrigant? An In Vitro Study.

AIM: This study aimed to evaluate Olea europaea (olive) leaves and Morus nigra (black mulberry) leaves as potential natural alternatives to sodium hypochlorite (NaOCl) endodontic irrigant. Their antimicrobial activity against Enterococcus faecalis (E. faecalis) and their effects on both root dentin microhardness and push-out bond strength of resin sealer/root dentin were assessed. METHODOLOGY: Fifty-four extracted teeth were selected. Samples were grouped according to the irrigant used: group I (control): 2.5% NaOCl, group II: 8% ethanolic extract of Olea europaea, and group III: 2% ethanolic extract of Morus nigra. Antibacterial activity (n = 6) was evaluated after each canal was autoclaved, inoculated with E. faecalis, and incubated. Canals were sampled before and after chemicomechanical canal preparation with 2 mL of irrigant. The colony-forming units (CFUs) were counted at 1/10 and 1/100 broth concentrations. Vickers hardness number (VHN) of root dentin (n = 6) was measured before and after root canal preparation and irrigation. Push-out bond strength testing (n = 9) was carried out following preparation, irrigation, obturation, and thermocycling. Results were considered statistically significant at p ≤0.05. RESULTS: Following irrigation, the CFUs of E. faecalis were significantly reduced with no significant difference in the CFU count between all groups at both broth concentrations. A significant reduction in root dentin microhardness resulted in all groups following irrigation, with Morus nigra resulting in the lowest percentage reduction (26.42 ± 1.12). The lowest significant mean push-out bond strength was revealed in the Olea europaea group (3.372 ± 1.513 MPa). CONCLUSION: The use of 2% mulberry (Morus nigra) leaf extract and 8% olive (Olea europaea) leaf extract as alternatives to NaOCl provides promising antimicrobial action against E. faecalis. CLINICAL SIGNIFICANCE: 2% Morus nigra extract may represent a promising natural endodontic irrigant.

Myocardial dysfunction in relation to serum thiamine levels in children with diabetic ketoacidosis.

Background Thiamine deficiency is commonly reported in patients with diabetes especially during diabetic ketoacidosis (DKA) that could attribute to myocardial dysfunction in those patients. However, there is limited data regarding its relation to myocardial function among those patients. This study aimed to explore the association between myocardial function and serum thiamine levels in children with type 1 diabetes mellitus (DM). Methods This cross-sectional comparative study included 25 patients with DKA. Clinical data assessment, echocardiographic examination and measurement of serum high-sensitive troponin T (hs-cTnT) and thiamine levels were done. We also assessed the association between troponin levels, echocardiographic ventricular systolic and diastolic function and serum thiamine. Results Twenty-four percent of children with DKA had thiamine deficiency. DKA children with thiamine deficiency had significant acidosis and higher serum troponin levels and significant impairment of diastolic function than those without thiamine deficiency. The serum thiamine level had a significant positive correlation with the echocardiographic indices of diastolic function but negative correlation with troponin levels. Conclusions Thiamine deficiency is a common finding during the treatment of children with DKA, and this deficiency may be associated with myocardial dysfunction.