Correlation of fibroblast growth factor 23 and malnutrition in chronic kidney disease patients on maintenance hemodialysis.

Chronic Kidney Disease (CKD) is a major health problem that causes death and disability worldwide. Fibroblast growth factor - 23 (FGF 23), is a novel hormone, which is secreted primarily by the osteoblasts. CKD patients are at an increased risk of malnutrition, characterized by micronutrient deficiencies and protein-energy wasting. The mechanisms of malnutrition in CKD are complicated and involve multiple pathophysiologic alterations. Serum FGF 23 levels may be used as a marker of malnutrition in such patients. MATERIAL: 50 CKD patients on maintenance hemodialysis were selected after fulfilling inclusion and exclusion criteria and their anthropometric measurements and Subjective Global Assessment-Dialysis Malnutrition Score (SGA-DMS) score calculated, Serum FGF 23 levels and various other baseline characteristics and demographic information were collected from August 1, 2020 to March 31, 2021 in this cross-sectional observational study, which was done in the medicine wards of a tertiary care hospital in Delhi. OBSERVATION: The mean age of the study population was 42.44 ± 14.35 years. The mean Body Weight was 58.06 kg. The mean height was 1.72 m. The mean BMI was 19.73 kg/m2. The mean SGA-DMS Score was 30.12. The mean FGF 23 levels were 650.46 pg/mL. There was a strong negative correlation between SGA-DMS Score and FGF-23 (pg/ mL), and this correlation was statistically significant (rho = -0.72, p = <0.001). CONCLUSION: FGF 23 levels showed negative correlation with nutrition status of the patient and it can be used as a marker for malnutrition in CKD patients on maintenance hemodialysis.

Nephron index [urinary phosphate: serum fibroblast growth factor 23 ratio]- a marker for atherosclerosis in diabetic predialysis chronic kidney disease patients.

Chronic kidney disease (CKD) is a global health problem, a leading cause of death and disability worldwide, estimated to affect more than 10% of the population Fibroblast growth factor - 23 (FGF 23), is a novel hormone, which is secreted primarily by the osteoblasts. It has been proposed that the ratio of Urinary phosphate (U-P) excretion (mg/day) to FGF23 as an index that theoretically represents the number of nephrons (nephron index)1. In this study, an attempt was made to establish the relationship between the Nephron index and degree of atherosclerosis (CIMT-Carotid intimal medial thickness) in predialysis CKD patients. MATERIAL: 110 predialysis CKD patients were selected after fulfilling the inclusion and exclusion criteria and their CIMT, Serum FGF 23 levels and various other baseline characteristics and demographic information were collected from August 1, 2020 to March 31, 2021 in this cross-sectional observational study, which was done in the medicine wards of a tertiary care hospital in Delhi. OBSERVATION: The mean Age was 43.80 ± 15.08 years. The mean Body Weight (Kg) was 63.36 ± 8.37. The mean Nephron Index in the study population was 2.80 ± 3.55. The mean 24 hr urinary phosphate was 1026.03 ± 784.83 mg and the mean FGF-23 levels were 564.60 ± 194.16pg/ml. There was a moderate negative correlation between CIMT (mm) and Nephron Index (r = -0.39, p = <0.001). CONCLUSION: Nephron Index was found to have an association with age, S. Creatinine, S.Calcium, S.Phosphate, iPTH, 24-Hour Urinary PO4, FGF-23, CIMT, eGFR, CKD stage, and CIMT. Nephron index may be used as a marker for atherosclerosis in predialysis CKD patients.

Giant Cell Arteritis Masquerading as Tooth Pain: A Case Report.

Giant cell arteritis (GCA) is a form of vasculitis characterized by symptoms that often lead a patient to consult a general dentist. Its rarity in the dental setting and serious life-altering effects make it a formidable diagnosis. We discuss a case of a 60-year-old female with GCA presenting with primary symptoms of excruciating tooth and jaw pain on the left side. We also report secondary symptoms of headache and partial vision loss and engage in a review of the relevant literature. Jaw pain, unexplained toothache, or tissue necrosis in patients aged over 50 years can be misdiagnosed as joint arthritis or temporomandibular disease (TMD), which could lead to severe consequences. Accurately diagnosing this ophthalmic emergency is critical for implementing therapy promptly and preventing ischemic complications. Dentists should maintain a high index of suspicion about its signs and symptoms, which will aid in making an early diagnosis and prompt referral.

Study of association of severity of sleep disordered breathing and functional outcome in stroke patients.

OBJECTIVE: Sleep disordered breathing (SDB) is a prevalent yet underrecognized condition that may have major adverse consequences for those affected by it. We performed a prospective observational study to seek a correlation of severity of SDB with the severity of stroke and its functional outcome. METHODS: Patients with history of recent-onset stroke were recruited and underwent overnight polysomnography (PSG) after the acute phase of the stroke was over; for defining hypopneas, 3% and 4% desaturation limits were used, and the apnea-hypopnea index was respectively calculated as AHI3% and AHI4%. Stroke severity was graded using the Scandinavian Stroke Scale. Functional disability and neurological impairment was evaluated six weeks after the PSG using the Barthel Index (<80 = functional dependence; ≥80 = functional independence) and modified Rankins Scale (>2 = poor outcome; ≤2 = good outcome). RESULTS: A total of 50 patients were enrolled, 30 (60%) with ischemic stroke and 20 (40%) with hemorrhagic strokes. Of the patients, 39 (78%) had an AHI4% of >5/h, 23 (46%) had an AHI4% of >15/h, and 9 (18%) had an AHI4% of >30/h. Multivariate analysis showed that body mass index (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.04-1.54, p = 0.019) and Scandinavian Stroke Scale score (stroke severity) (OR = 0.86; 95% CI = 0.76-0.96, p = 0.009) were significant risk factors for predicting SDB (AHI4% > 15) in patients of stroke. When we looked for factors predicting outcomes, only AHI4% (OR = 1.20; 95% CI 1.01-1.43, p value 0.041) was predictive of the functional dependence (based on Barthel Index) of the patient and AHI4% (OR = 1.14; 95% CI 1.03-1.25, p = 0.008) and body mass index (OR = 0.75; 95% CI 0.59-0.96, p = 0.024) were found to be predictive of poor outcome (based on modified Rankins Scale). We obtained similar results, regardless of the hypopnea definition used. CONCLUSION: In conclusion, given the high frequency of SDB in stroke patients and its correlation with poor outcome, screening for obstructive sleep apnea in all stroke and transient ischemic attack patients may be warranted.