and medication non-adherence in patients with AF was examined. Methods: Studies published between 2005 and 2015 on medication non-adherence and depression in patients with AF were examined. The key terms for screening were atrial fibrillation, medication adherence, stroke risk and depression. They were used in Medline, PubMed and Google Scholar. Results: Only 7 epidemiological studies of about 1500 patients assessed depression in patients with atrial fibrillation with 50% having depression. 5 studies assessed medication adherence in AF patients (depression was not measured in these studies). Persistence at 18 months was noted in fewer than 25% of patients. Unfortunately, depression was not assessed in these persistence trials. The recent trials of the new anticoagulant drugs (NOACs) vs. Warfarin included almost 100,000 patients. High discontinuation rates were noted of about 10% / year. Depression was not measured in these trials either. Depression is known to be a major risk factor in patients with CHD and heart failure and depressed patients are three times more likely to be non-adherent. Conclusion: Depression is a major factor for poor adherence and highly prevalent in AF patients. Treatment of depression improves adherence per se and is likely to decrease complications of AF. Screening for depression ought to be included in guidelines for management of AF.
Aim:To estimate the day to day variability of spot protein creatinine ratio (spotPCR). Background: Accurate measurement of proteinuria is central in the diagnosis and management of chronic kidney disease (CKD). The gold standard test, 24-hour urinary protein excretion (24hrUP), is cumbersome, subject to errors and delays in obtaining results. Spot urine PCR is a convenient alternative, however day to day variability remains undefined. Methods: 190 outpatients from a CKD clinic were prospectively studied between July 2007 and April 2010. There were 112 males and 78 females. The median age was 56 yr and median creatinine-clearance 55 mls/min. The mean 24hUP excretion was 0.69 grams/day (range = 0.07-25 grams/day). Spot urine PCRs were collected at 9am (day1) & 9am (day2) and results compared with a 24hrUP done concurrently. Urine protein and creatinine were measured on the Roche Hitachi modular analyzer using the Roche Hitachi reagent and kinetic Jaffe method respectively The variability between log-spotPCRs was determined. Spearmans correlation and Bland-Altman limits of agreement of log-spPCR vs log-24hUP and log-24hrPCR were determined respectively. Results: 158 paired results were analysed. There was no significant difference between the mean log-spotPCR1 vs. the mean log-spotPCR2 (−2.74 ± 1.31 vs. −2.73 ± 1.31, mean difference −0.01 [95% CI = −0.09 to 0.08], p = 0.89). The median log-spotPCR intraassay coefficient of variation (cv) was −6.05% There was good correlation between log-spotPCR1 and log-TP, Spearman's correlation r = 0.92. and between log-24hrPCR and log-24hUP r = 0.93. There was also good agreement between log-spotPCR1 and log-24hrPCR. Conclusion: There was no significant day to day variability between spotPCRs among this CKD clinic population. SpotPCR can be used to predict 24hrUP with a high degree of accuracy suggesting spotPCR is an appropriate test for use in the diagnosis and management of patients with kidney disease.Aim: We hypothesised that use of liposomal curcumin would provide targeted drug delivery and improve ischaemia-reperfusion injury (IRI). Background: IRI is a major cause of acute renal failure in native and transplanted kidneys. Curcumin is a lipophilic extract of turmeric with immunomodulatory and anti-oxidant properties. Methods: Fluorescent-labelled liposomes were injected into mice to assess systemic distribution and cellular uptake. Liposomes with or without curcumin were injected into male C57BL/6 mice (n = 10/group) 24 hours prior to bilateral renal ischaemia. Biochemistry, histology, apoptosis and markers of oxidative stress were measured at 4 and 24 hours. Results: Liposomes were endocytosed by renal tubular and antigen-presenting cells (APC), including CD11b+F480+macrophages, CD11c+ myeloid and PDCA-1+ plasmacytoid dendritic cells. APC exposed in vivo to liposomal curcumin, isolated and incubated ex vivo with lipopolysaccharide showed decreased NFκB nuclear translocation (immunofluorescence) compared to controls. Liposomal curcumin pre-treatment improved serum urea and...
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