Objective - To study thyroid function abnormalities in patients with CKD. To correlate the thyroid function abnormalities with stage and duration of CKD. Methods - The cross-sectional study was ...carried out on 53 patients above the age of 18 years presenting with CKD in OPD/wards of medicine department at Tertiary Care Center, South Gujarat. Result- Most common abnormality in thyroid hormones found in our study was low T3. Female cases were equally affected with thyroid hormone abnormalities as male cases. No statistically significant difference in T3, T4 and TSH hormone levels was noted with respect to duration of CKD. Conclusion - There are no considerable variations in T3 and TSH hormone levels with respect to stage and duration of CKD, however there is statistically significant decline T4 hormone levels with increasing severity of renal failure.
Persistent infection with the hepatitis B virus (HBV) as indicated by chronic HBV surface antigenemia (HBsAg) continues to be an important problem in end‐stage renal disease (ESRD) patients and ...specifically in those receiving maintenance hemodialysis (HD). Patients on HD who are HBsAg‐positive for a year have little chance of ever eliminating the virus; hence, clearance of HBsAg is a rare event in long‐term HD patients. We report the case of a 62‐year‐old diabetic woman who was HBsAg‐positive at the time she started HD and remained so until 10 years later when she became HBsAg‐negative followed by the development of hepatitis B surface antibody (anti‐HBs). Prior to her seroconversion, she suffered a persistent infection of her HD arteriovenous graft (AVG) that required prolonged antibiotics and several surgical procedures. We speculate that this immune stimulation contributed to her seroconversion.
Abstract only
Atrial fibrillation is the most common sustained arrhythmia affecting more than 2 million people annually in USA. Previous studies have shown that left ventricular hypertrophy (LVH) ...results in an increase in the late I
Na
that plays an important role in genesis of ventricular arrhythmias. We tested the hypothesis that LVH, which is associated with elevated pressure in the left atrium, could enhance the late I
Na
in left atrial (LA) myocytes, leading to increased trigger activities. Rabbit LVH, which exhibited a significantly greater left ventricle to body mass ratio, was induced using the renovascular hypertension model. Interestingly, early afterdepolarizations (EADs) at action potential phase 2 and 3 occurred in 6 of 10 LA myocytes isolated from 5 LVH rabbits at a pacing cycle length of 2000 ms, whereas EADs were elicited in none of 10 cells isolated from 5 control rabbits (
p
<0.01). Spontaneously activities (SA) were observed in 6 of 10 LA myocytes from five LVH rabbits at the pacing rate of 8000 ms. The density of the late I
Na
was significantly larger in LA myocytes of LVH rabbits than that recorded in control rabbits (0.59±0.02 pA/pF in LVH versus 0.42±0.05 pA/pF in control, n=6,
p
<0.01). Ranolazine, a late I
Na
blocker, exerted a concentration-dependent blocking effect on the late I
Na
in LA myocytes of the rabbits (IC
50
=15.7±0.6 μM) and abolished all of atrial EADs and SA of the LVH rabbits at 30 μM. Our results demonstrate that LVH results in a significant increase in the late I
Na
in the LA myocytes that may render these cells susceptible to genesis of EADs. The late I
Na
is a potentially useful ionic target by antiarrhythmic drugs for the treatment of atrial fibrillation in the setting of LVH.
This research has received full or partial funding support from the American Heart Association, AHA National Center.
BACKGROUND AND PURPOSE Drug‐induced torsades de pointes (TdP) often occurs during bradycardia due to reverse use‐dependence. We tested the hypothesis that inhibition or enhancement of late sodium ...current (INa,L) could modulate the drug‐induced reverse use‐dependence in QT and Tp‐e (an index of dispersion of repolarization), and therefore the liability for TdP.
EXPERIMENTAL APPROACH Arterially perfused rabbit left ventricular wedge preparations were used. Action potentials from the endocardium were recorded simultaneously with a transmural ECG. The effects of Anemonia sulcata toxin (ATX‐II) (an INa,L enhancer), d,l‐sotalol, clarithromycin and ranolazine (an INa,L blocker) on rate‐dependent changes in QT, Tp‐e and proarrhythmic events were tested, either alone or in combination. Rate‐dependent QT and Tp‐e slopes and TdP score (a combined index of TdP liability) were calculated at control and during drug infusion.
KEY RESULTS ATX‐II (30 nM) and sotalol (300 µM) caused a marked increase in QT and Tp‐e intervals, steeper QT‐basic cycle length (BCL) and Tp‐e‐BCL slopes (i.e. reverse use‐dependence), and TdP. Addition of ranolazine (15 µM) to ATX‐II or sotalol significantly attenuated QT‐BCL, Tp‐e‐BCL slopes and the increased TdP scores. In contrast, clarithromycin (100 µM) moderately prolonged QT and Tp‐e without causing R‐on‐T extrasystole or TdP, but addition of ATX‐II (1 nM) to clarithromycin markedly amplified the QT‐BCL and Tp‐e‐BCL slopes and further increased TdP score.
CONCLUSION AND IMPLICATIONS Modulation of INa,L altered drug‐induced reverse use‐dependence related to QT as well as Tp‐e, indicating that inhibition of INa,L can markedly reduce the TdP liability of agents that prolong QT intervals.
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