Given the high prevalence of chronic venous diseases (CVD), defining criteria to screen patients who are in need for intervention is attaining primacy. An important clinical criterion for treating CVD is incompetence of larger veins. We have assessed the association of size of afflicted veins with disease severity in patients with CVD to define an acceptable criterion to identify patients who need intervention. Demographic characteristics and risk factors were recorded from 6350 patients. Based on physical examination and venous duplex ultrasound study, patients were classified into clinical severity, etiology, anatomy, and pathophysiology (CEAP) classes and grouped according to the size of the veins which had varicosities. Patients with reflux in smaller veins (vein size <4 mm diameter) were considered as type I and those with varicosities in truncal veins (>4 mm diameter) as type II. Risk ratio was determined by multivariate regression analysis. About 47.67% of patients in this study were found to have CEAP class 3 disease. Compared with varicose veins of large truncal veins, patients with varicosities in smaller superficial veins had 2.85-fold (p < 0.01) more risk of edema and 5.71-fold (p < 0.01) higher prevalence of hyperpigmentation. Varicosities in small superficial veins were associated with higher risk of ulceration (odds ratio 3.93, 95% confidence interval 2.51–6.18) compared with truncal vein reflux. Our study reveals that presence of small varicose veins in patients without truncal saphenous reflux involvement is associated with severe manifestations of venous insufficiency such as edema and skin lesions even in the absence of varicosities in truncal saphenous veins.
Introduction: Klotho is a single-pass transmembrane protein with a long extracellular domain and short cytoplasmic tail that appears to modulate aging. Objectives: This cross-sectional investigation was conducted at a tertiary care centre to find the possible correlation of serum Klotho with various biochemical parameters in Indian chronic kidney disease (CKD) patients. Patients and Methods: The study was conducted in 80 CKD patients (58 males, 22 females). Mean age was 54.21 ± 14.08 years (25-90 years). Participants included 55 CKD- hemodialysis (HD), 10 CKD- peritoneal dialysis (PD) and 15 CKD-non-dialysis (ND) patients. Results: Serum Klotho (sKlotho) in CKD-HD patients ranged from 0 to 374.36 ng/mL with a mean of 13.76±4.3 ng/mL (median: 0.0174 ng/mL). In PD patients, sKlotho ranged from 0 to 374.36 ng/ mL with a mean of 37.58 ± 6.56 ng/mL (median of 0.0087 ng/mL). In ND population, sKlotho ranged from 0 to 7.01 ng/mL, with a mean of 0.73 ± 0.01 ng/mL (median of 0.1687ng/mL). In CKDHD and CKD-PD patients, sKlotho was positively correlated with the fibroblast growth factor 23 (pg/mL) (P<0.001). Conclusion: Serum Klotho levels show significant positive correlation with FGF23 levels in HD and PD patients. The findings of the study indicate that high Klotho and fibroblast growth factor 23 levels may be associated with worse outcomes in chronic renal failure patients.
A 51-year-old female, with non-alcoholic liver cirrhosis, portal hypertension, type 2 diabetes mellitus, autosomal dominant polycystic kidney disease with a clipped cerebral aneurysm and chronic kidney disease stage 5 was on continuous ambulatory peritoneal dialysis (CAPD) for 6.5 years elsewhere. She came for opinion on continuation of CAPD as she had 21 episodes of peritonitis in 76 months. Her blood pressure was 80/50 mmHg. She was on haemodialysis with a temporary central access for 2 weeks. She had no abdominal tenderness, and exit site looked normal. Fluid was negative for Mycobacterium tuberculosis. Laparoscopically, we replaced the catheter with a new swan-neck Tenckhoff double-cuff catheter through a different exit site in the same sitting. Catheter-tip biofilm culture isolated Enterococcus casseliflavus. Peritoneal sampling biopsy showed evidence of fibrosis. She has adequate ultrafiltration and is currently on automated peritoneal dialysis for 5 months.
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