Purpose:
To investigate the peripapillary retinal nerve fiber layer thickness (RNFLT), macular RNFLT, ganglion cell layer (GCL), and inner plexiform layer (IPL) thickness in recovered COVID-19 ...patients compared to controls.
Methods:
Patients previously diagnosed with COVID-19 were included, while healthy patients formed the historic control group. All patients underwent an ophthalmological examination, including macular and optic nerve optical coherence tomography. In the case group, socio-demographic data, medical history, and neurological symptoms were collected.
Results:
One hundred sixty patients were included; 90 recovered COVID-19 patients and 70 controls. COVID-19 patients presented increases in global RNFLT (mean difference 4.3; CI95% 0.8 to 7.7), nasal superior (mean difference 6.9; CI95% 0.4 to 13.4), and nasal inferior (mean difference 10.2; CI95% 2.4 to 18.1) sectors of peripapillary RNFLT. Macular RNFL showed decreases in COVID-19 patients in volume (mean difference −0.05; CI95% −0.08 to −0.02), superior inner (mean difference −1.4; CI95% −2.5 to −0.4), nasal inner (mean difference −1.1; CI95% −1.8 to −0.3), and nasal outer (mean difference −4.7; CI95% −7.0 to −2.4) quadrants. COVID-19 patients presented increased GCL thickness in volume (mean difference 0.04; CI95% 0.01 to 0.07), superior outer (mean difference 2.1; CI95% 0.8 to 3.3), nasal outer (mean difference 2.5; CI95% 1.1 to 4.0), and inferior outer (mean difference1.2; CI95% 0.1 to 2.4) quadrants. COVID-19 patients with anosmia and ageusia presented an increase in peripapillary RNFLT and macular GCL compared to patients without these symptoms.
Conclusions:
SARS-CoV-2 may affect the optic nerve and cause changes in the retinal layers once the infection has resolved.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Abstract
Background and Aims
The vascular access of choice for hemodialysis patients is the arteriovenous fistula (AVF). There is a high rate of early primary failure and loss of primary AVF patency. ...Monitoring of vascular access is essential for early diagnosis of complications and prolonging survival. Models based on Artificial Intelligence (AI) and Machine Learning (ML) can be used for this.
Method
Retrospective descriptive study of the Vascular Doppler Ultrasound (VDU) in adults carried out since January 2019 to January 2022 in our AVF follow-up nephrology clinic. We analyze the results and create AI-based AVF underdevelopment prediction models. We included clinical, demographic and ultrasound variables. Patients were undergoing AVF post-surgery follow-up (VDU by protocol at 3-4 weeks after AVF surgery) or were referred to the clinic with signs of AVF dysfunction. The insufficient development of the vascular access is established as an objective variable. SPSS 20 Statistical Package. Automated Learning Analysis (ML) with Orange ML and BigML.
Results
243 VDU were performed. Of the total, 139 (57%) were follow-up post-surgical VDU per protocol and 104 (43%) were AVF dysfunction VDU. Using supervised ML Analysis techniques with random sampling of 80% of the instances for Training and 20% for Test, we obtain prediction models for the underdevelopment (UD) attribute of FAV: Decision tree algorithm, Area under the curve (AUC) 89%, Classification accuracy (CA) 90%, Precision 90%. Random Forest Algorithm (RF) (AUC) 95%, (CA) 86%, Accuracy 81%. Near Neighbor Algorithm (K-NN) (AUC) 88%, CA 82%, Accuracy 78%. Convolutional Neural Networks (NNC) (AUC) 82%, CA 74%, Accuracy 60%. Algorithm with unsupervised technique of clustering in k-Means 3 clusters are obtained. The variables that best correlate with the objective variable are access flow, vein diameter, resistance index (RI) proximal, (RI) distal, and diameter of the anastomosis.
Conclusion
The vascular ultrasound systematized by the nephrologist facilitates the early diagnosis of complications that lead to early intervention. Analysis of the data with techniques (ML) can facilitate early diagnosis AVF poor development requiring close monitoring or intervention. The development of a nephrology clinic for monitoring vascular access could avoid invasive and unnecessary procedures for the patient.
Abstract
BACKGROUND AND AIMS
The main vascular access for haemodialysis patients is the arteriovenous fistula (AVF). There is a high rate of early primary failure and loss of primary patency, ...therefore, vascular access monitoring is essential for the early diagnosis of complications and prolonging their survival.
Our objective is to analyse the results of a consultation for the review and follow-up of AVFs using colour-Doppler ultrasound, performed by the nephrologist.
METHOD
Retrospective descriptive study of vascular ultrasounds performed from January 2019 to January 2021. Including clinical and demographic variables of the patients, as well as ultrasound parameters. Data from the Review group were compared; ultrasounds performed 3–4 weeks after performing vascular access; versus Dysfunction group; whose patients were referred from the advanced chronic kidney disease (ACKD) consultations or from the different dialysis centres upon detecting any data of suspected vascular access dysfunction.
RESULTS
A total of 166 vascular ultrasounds were performed: 106 (64%) in the Review group and 60 (36%) in the Dysfunction of the AVF group.
A higher proportion of women was found in the Dysfunction group and upper mean age, close to the significance, P = 0.06 and P = 0.059 respectively. No significant differences were found with respect to other demographic characteristics in both groups (hypertension, diabetes, anticoagulant treatment and aetiology of kidney disease).
Regarding the type of vascular access, a lower proportion of radiocephalic AVFs was observed in the Revision group (65% versus 50%) and a greater number of elbow AVFs (humero cephalic, humero basilic and humero median) in the Dysfunction group (35% versus 50%) with differences close to significance, P = 0.057.
In the Review group, in 70.8% the findings were normal, in 24.5% lack of development was found, thrombosis in 9.4%, stenosis 6.6%, aneurysm 6%, oedema 17% and haematoma 6.6%. A 43% of the patients did not require to implement measures, in 42% exercise was recommended, in 6% repose of the AVF and 6 patients were requested fistulography and 3 were referred to cardiovascular surgery (CCV).
In the Access Dysfunction group, the ultrasound diagnosis was normal in 28%, thrombosis was objective in 25%, stenosis 37%, aneurysm 42%, oedema 17%, haematoma 22%. 37% were referred for fistulography and 15% for revision by CCV.
Regarding the ultrasound parameters, significant differences (P > 0.05) were found in terms of AVF flow, proximal and distal resistance index and vein calibre, but not in terms of vein depth and anastomosis diameter.
A total of 28 fistulograms were performed, finding 86% agreement with the ultrasound findings. And in 93% the intervention was successful. Only 24% of the patients referred to the consultation required some type of intervention, and up to 65% were able to save the AVF, avoiding the realization of a new vascular access.
CONCLUSION
The systematic review after performing the vascular access made it possible to diagnose complications early and allow early intervention. It might be necessary to establish predictive criteria for vascular access dysfunction to individualize the follow-up for each patient, such as age, sex, or type of vascular access.
Systematized vascular ultrasound by the nephrologist is very useful to preserve the functionality of the vascular access. On the other hand, the Vascular Nephrodiagnosis Consultation can avoid performing invasive and unnecessary procedures for the patient.
Abstract
BACKGROUND AND AIMS
The incidence of acute renal failure (ARF) is frequent and has an implication in the morbidity and mortality of SARS-CoV-2 infection.
METHOD
A retrospective descriptive ...study of patients admitted for SARS-CoV-2 infection during the first (G1) and second (G2) waves who presented with ARF. They correspond to the period from March to May 2020 (G1) and from August to December 2020 (G2). We compare populations, outcomes and treatments.
RESULTS
A total of 73 patients in the first wave (G1), with a cumulative incidence (CI) of 28.3% (G1), compared with 58 patients in the second wave (G2), with a CI of 8% (G2). The mean age was higher in G2 65.8 ± 15 years (G1); 75.3 ± 14 (G2); P <.05, with no difference regarding sex 63% (G1); 54% (G2). In G2, there was a higher proportion of patients with cardiovascular disease 23% (G1); 57% (G2), hypertension 56% (G1); 83% (G2). The baseline glomerular filtration rate (GFR) being similar for both groups (CKD EPI: 69 mL/min/1.73² (G1); P = .27). In the first wave, the mean days from admission to ARF was 3.1 days ± 4.2, and 42% of the patients were diagnosed at admission (31 patients). In the second, it was 2.9 days ± 5.7, of which 60% at admission (35 patients). The most prevalent cause was prerenal in both. Higher proportion in G1 of KDIGO stage 3 (G1: 30% versus G2: 17%) and renal replacement therapy (RRT) (G1: 9 versusG2: 2 patients). Only 3 patients remained in RRT in G1 and 1 patient in G2. In G1, 64% recovered their GFR mean time (MT): 7.5 ± 8 days, and the percentage of deaths was 34%. In G2, 72% recovered GFR (MT: 16 ± 25 days), and 19% of patients died.
CONCLUSION
Despite a lower age and comorbidity of the first wave patients, the severity and lethality was higher. There were no differences in the proportion of patients who recovered their baseline renal function, although the recovery time was longer in the second wave.
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