Association Between Admission Serum Phosphate and Risk of Acute Kidney Injury in Critically Ill Patients with Rhabdomyolysis: A Retrospective Study Based on MIMIC-III

Background The incidence of acute kidney injury(AKI) is high in critically ill patients with rhabdomyolysis. Limited evidence was proved of the association between serum phosphate levels at intensive care unit(ICU) admission and the subsequent risk of AKI. Our study aims to assess if serum phosphate level at admission was independently associated with AKI risk in these patients. Methods This study extracted and analyzed data from Medical Information Mart for Intensive Care-Ⅲ(MIMIC-Ⅲ,version1.4). Rhabdomyolysis was defined as a peak creatine kinase(CK) level higher than 1000 U/L. Serum phosphate was measured within the first day into the ICU and was categorized to 4 groups(<2.6, 2.6-3.4, 3.5-4.5, >4.5mg/dl). AKI was defined according to the Kidney Disease Improving Global Outcome (KDIGO) guidelines. Adjusted smoothing spline plots and multivariate logistic regressions were carried out to explode the association between serum phosphate and risk of AKI. Subgroup analyse was applied to verify the consistency of the association.Results Three hundred and twenty-one patients(67.8% male) diagnosed as rhabdomyolysis were eligible for this analysis. AKI occurred in 204(63.6%) patients of total. Incidence of AKI with admission serum phosphate groups<2.6, 2.6-3.4, 3.5-4.5 and>4.5mg/dl were 52.6%, 56.8%, 68.4% and 75.9%, respectively. Smoothing spline curve showed that there was a positive curve between the elevated phosphate values and increasing risk of AKI, and there was no threshold saturation effect. In multivariate logistic regression, OR was 1.3(95%CI 1.1-1.6, P=0.012, P trend=0.034) after adjusting confounders. Subgroup analyses proved the consistency of the relationship in these patients except in the strata of creatine kinase.Conclusion In rhabdomyolysis patients admitted to ICU, serum phosphate level at admission was independently associated with an increased risk of AKI. As phosphate levels rise, the risk of AKI increased.

Torus Mandibularis in Patients Receiving Hemodialysis

Reports on the prevalence of torus mandibularis among dialysis patients have been limited and inconclusive. A wide variety of oral manifestations has been found in patients with hyperparathyroidism. Furthermore, uremia-related changes in facial bone structures have been described in the literature. This prospective observational study examined 322 hemodialysis patients treated at the Chang Gung Memorial Hospital from 1 August to 31 December 2016. Two subgroups were identified: patients with torus mandibularis (n = 25) and those without (n = 297). Clinical oral examinations including inspection and palpation were employed. Our study found that most mandibular tori were symmetric (84.0%), nodular (96.0%), less than 2 cm in size (96.0%), and located in the premolar area (92.0%). Poor oral hygiene was observed among these patients, with 49.7% and 24.5% scoring 3 and 4, respectively, on the Quigley-Hein plaque index. More than half (55.0%) of patients lost their first molars. Multivariate logistic regression analysis revealed that blood phosphate level (odds ratio = 1.494, p = 0.029) and younger age (odds ratio = 0.954, p = 0.009) correlated significantly with torus mandibularis. The prevalence of torus mandibularis in patients receiving hemodialysis in this study was 7.8%. Younger age and a higher blood phosphate level were predictors for torus mandibularis in these patients.

Genotype and Phenotype Analysis in X-Linked Hypophosphatemia

Background: X-linked hypophosphatemia (XLH) is the most frequent form of hypophosphatemic rickets and is caused by mutations in the PHEX gene. We analyzed genotype-phenotype correlations in XLH patients with proven PHEX mutations.Methods:PHEX mutations were detected in 55 out of 81 patients who clinically presented with hypophosphatemic rickets. The patients were grouped into nontruncating (n = 9) and truncating (n = 46) mutation groups; their initial presentation as well as long-term clinical findings were evaluated according to these groups.Results: Initial findings, including presenting symptoms, onset age, height standard deviation scores (SDS), and laboratory tests, including serum phosphate level and tubular resorption of phosphate, were not significantly different between the two groups (onset age: nontruncating mutation group, 2.0 years, truncating mutation group, 2.2 years; height SDS: nontruncating mutation group, −1.9, truncating mutation group, −1.7; serum phosphate: nontruncating mutation group, 2.5 mg/dL, truncating mutation group, 2.6 mg/dL). However, at their last follow-up, the serum phosphate level was significantly lower in patients with truncating mutations (nontruncating mutation group: 3.2 mg/dl, truncating mutation group: 2.3 mg/dl; P = 0.006). Additionally, 62.5% of patients with truncating mutations developed nephrocalcinosis at their last follow-up, while none of the patients with nontruncating mutations developed nephrocalcinosis (P = 0.015). Orthopedic surgery due to bony deformations was performed significantly more often in patients with truncating mutations (52.3 vs. 10.0%, P = 0.019).Conclusion: Although considerable inconsistency exists regarding the correlation of truncating mutations and their disease phenotype in several other studies, we cautiously suggest that there would be genotype-phenotype correlation in some aspects of disease manifestation after long-term follow-up. This information can be used when consulting patients with confirmed XLH regarding their disease prognosis.

Yield and Yield Components of Potato (Solanum tuberosum) as Affected by Rock Phosphate in Standoff Soil, Southern Alberta Canada

An experiment was conducted in Standoff, Southern Alberta in April, 2020. The object of the experiment was to investigate effect of rock phosphate organic fertilizer on growth and yield of potato crop grown in Standoff. The varying levels of rock phosphate were broadcasted into the soil at control (0 P Kg ha-1), Low P level (50 P Kg ha-1) and High P level (100 P Kg ha-1). The basal application of urea inform of nitrogen fertilizer was applied at 280 N Kg ha-1. Potato seeds were planted at a distance of 30 by 90 cm. The three treatments were replicated three times, resulting into nine plants. One plant was taken out of uniformly grown tallest plant in each of the treatment to measure yield parameters. The yield parameters collected were subjected to analysis of variance (ANOVA) using Duncan&rsquo;s Multiple Range Test (DMRT) for separation of means. Results of the experiment indicated that High P and Low P rock phosphate fertilizer levels positively influenced weight of potatoes at 76 and 112 Days after sowing (DAS), respectively while High P rock phosphate fertilizer level got highest number of potatoes than Low P and control at 76 DAS. Furthermore, High P rock phosphate fertilizer level and control plots supported marketable number of potatoes at 76 DAS while High P rock phosphate fertilizer level favoured unmarketable number of potatoes at 112 DAS. It was quite obvious from the results that marketable weight of potatoes was positively influenced by High P rock phosphate level and Low P rock phosphate level at 76 and 112 DAS, respectively whereas unmarketable weight of potatoes was affected by High P rock phosphate fertilizer level at 112 DAS. These results revealed the beneficial use of rock phosphate for potato crop production

Bone metabolic disorder and its contributing factors in patients with chronic kidney disease; a three-year cohort study

Introduction: The prevalence of bone mineral disorder is best known in end-stage renal disease (ESRD) patients, but less data is available for the earlier stages. Objectives: We aimed to compare the prevalence of bone metabolic disorder at all stages of chronic kidney disease (CKD) and assess its contribution to CKD progression and patients’ outcome. Patients and Methods: In a retrospective cohort study, CKD patients who were under treatment for three years were selected from a nephrology clinic in Tehran, Iran. Patients’ demographic and laboratory data, as well as the outcome of their treatment were gathered and analyzed. Results: In 473 patients with an average age of 61.5, 60.1% were at stage III, 35.8% were at stage IV, and 4.1% were at stage V of CKD. There was a significant relationship between CKD stage and serum phosphate, calcium-phosphate product, and systolic blood pressure (SBP). Furthermore, the patients’ outcome was significantly related to advanced stages of CKD, higher first phosphate level, diabetes mellitus in medical history, and higher stages of SBP. By multiple Cox regression analysis, after adjustment for glomerular filtration rate (GFR), the first serum phosphate level, and the calcium-phosphate product did not contribute to the undesirable outcome. Conclusion: Although bone metabolic disorder is more frequently seen in advanced stages of chronic kidney disease, these changes can be seen even in earlier stages of the disease. The influence of phosphate abnormality in the patients’ outcome should be studied more in earlier stages for better control.

Effect chewing tapioca pearls in the bubble tea drinks on the salivary α-amylase and phosphate level

Bubble tea drinks contained tapioca pearls, that can stimulate mastication. Chewing tapioca pearls may stimulate saliva production. Increased salivary secretion is thought to be correlated with an increase in inorganic components and salivary α-amylase (SAA). This study aimed to evaluate the effect of bubble tea on SAA and salivary phosphate (PO43-) levels. Subjects were 15 people with a total sample of 60. Each subject drank bubble tea with tapioca pearl for 3 days in the first week as the intervention group. In the second week the subjects drank tea without bubble for 3 days as a control group. Saliva samples were taken on day 1 before treatment and day 3 after treatment. Saliva was collected in the morning 09:00 am–12:00 pm for 1 minute. SAA levels were measured using an ELISA kit with Optical Density (OD) at 405 nm. Phosphate levels were measured using a semi-quantitative test kit. Data were analyzed using ANOVA, Kruskal Wallis, t-test, and Pearson test (p < 0.05). The results of ANOVA and Kruskall-Wallis showed that there was a significant difference in the effect of consumption of bubble tea and tea without bubble (p < 0.005) on SAA and phosphate levels. SAA and phosphate levels increased significantly after drinking bubble tea and tea without bubble (p < 0.05). SAA levels after drinking bubble tea were significantly higher than after drinking tea without bubble. Comparison between phosphate levels after drinking bubble tea and tea without bubble were not significantly different (p > 0.05). Correlation between SAA and phosphate level was a significant different (p < 0.05) and r was moderate category. It was concluded that the consumption of drinking bubble tea and tea without bubbles could increase salivary α-amylase (SAA) also phosphate level and may improve quality of saliva through a salivary buffer mechanism.