Background: Early and accelerated atherosclerosis is a major cause of cardiovascular disease and often causes premature death in T1DM patients. In T1DM, atherosclerosis can be detected since adolescence. The initial association between urinary albumin to creatinine ratio (ACR) and c-reactive protein (hs-CRP) with subclinical cardiovascular disease in children and adolescents with T1DM supported findings from previous studies. Imaging tests using ultrasound can detect subclinical atherosclerosis in this patient population. Carotid artery intima-me- dia thickness (cIMT) and flow-mediated dilatation response (FMD) have been frequently used to detect subclini- cal atherosclerosis. Objectives: To find correlation between ACR and hsCRP on the thickness values of cIMT and FMD in children and adolescent T1DM patients at Dr Saiful Anwar Hospital Malang Methods: This is a cross-sectional study with 82 subjects of T1DM patients who routinely control the pediatric outpatient clinic of RSUD Dr. Saiful Anwar Malang, with the research period January – July 2019 and December 2021 – March 2022. Subjects were undergone valcuras ultrasound examination for measurements of cIMT and FMD. Blood sample from subjects were also collected to detect level of ACR and hsCRP. Associations between the study variables were estimated by calculating the Pearson’s rank correlation. Result: There was correlation between ACR with FMD and cIMT (r=-0.593; p=0.000 and r=0.339; p=0.002, respectively). ACR was negatively correlated with FMD and positively correlated with cIMT. There was also correlation between hsCRP with FMD and cIMT (p=-0.375; p=0.001 and r= 0.414; p=0.023, respectively). hsCRP was negatively correlated with FMD and positively correlated with cIMT. Conclusion: ACR and hsCRP have a correlation with increasing CIMT values and decreasing FMD values in children and adolescents with T1DM patients. Preadolescent children with T1DM displayed evidence of increased low-intensity vascular inflammation, increased cIMT and attenuated FMD measurements. These data suggest that endothelial dysfunction and systemic inflammation are present even in preadolescent children with T1DM
Background: Central vein stenosis (CVS) is common in hemodialysis patients and is caused by the implantation of cardiac intravascular devices, venous access, and limited vascular access. The effect may develop until an arteriovenous fistula (AVF) or graft is established in the ipsilateral arm or forearm for hemodialysis. Arm edema, significant venous dilatation, and recurring infections are common complications of having an ipsilateral arteriovenous fistula or graft Case Illustration: We present the case of a 50-year-old female who developed symptomatic CVS while being on regular hemodialysis. Venography using a catheter revealed significant stenosis of the subclavian vein. Due to central venous stenosis, this patient had substantial edema of her left arm after undergoing an ipsilateral arteriovenous graft. Multiple endovascular treatments have failed to alleviate the symptoms. Discussion: The incidence and danger of central vein stenosis in hemodialysis patients are discussed, as well as the success of endovascular therapies. The initial line of therapy should be percutaneous balloon angioplasty. Conclusion: Unfortunately, after angioplasty or stenting, primary patency is poor. If there is recurring stenosis, the procedure can be repeated.
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