Background: To assess the cardiac functions in patients with chronic kidney disease (CKD).Methods: 150 patients with CKD were randomly selected. 12 lead ECG were performed to detect CVD. All Patients were diagnosed with CKD. The left ventricular ejection fraction (LVEF) and fractional shortening (FS) were taken as measures of LV systolic function. Diastolic function was determined by measuring early to late peak velocities (E/A) ratio by spectral Doppler LV inflow velocity. Results: Male: female 95 and 55, hypertension 67% was leading cause of CKD. Diastolic dysfunction as denoted by E/A ratio of less than 0.75 or more than 1.8 was present in 64% of patients. Regional wall motion abnormality (RWMA) was present in 14%. LVH was present in 74%. Systolic dysfunction as measured by reduced fractional shortening (<25%) and decreased LVEF (<52%) was present in 8% and 12% respectively. PE was noted in 15% of patients. Valvular calcification in 8% of CKD patients. Mean LV internal diameter in diastole was 41±6 mm. Mean Interventricular septum diameters in systole was11.9±1.21 mm. Mean LA diameter was 29±4 mm. Statistically significant difference was noted in LVH and E/A ratio in hypertensive group as compared to normotensive group.Conclusions: LV diastolic dysfunction also happens in patients who having the early stage of CKD. Hypertensive patients along with CKD had found higher widespread presence of diastolic and systolic dysfunction as compared to normotensive.

Aim and Objective: To explore risk factors associated with mortality in COVID-19 patients and assess the use of D-dimer as a first line biomarker for disease severity and clinical outcome. Materials and Methods: We retrospectively analysed the pathological and radiological characteristics of 2087 consecutive cases of COVID-19 in PSH, Vadodara, Gujarat, from March 2021 to July 2022. Graphically, MS-Excel with median values were used. Correlations of D-dimer upon admission with disease severity and in-hospital mortality were analysed accordingly. Data were collected in MS-Excel with median values. Results: 2087 patients having positive RT-PCR and confirm diagnosis of Covid-19 were included upon hospital admission. Whereas, 65.78% (n= 1373) were male and 34.21% (n= 714) were female. Mean age was 52± 4 year. D-dimer level > 250 ng/mL at the time of hospital admission was the only fluctuating value accompanying with increased mortality [(95% CI), P = 0.025]. D-dimer elevation (≥250 ng/mL) was seen in 81.31% patients. Pericardial effusion and Deep vein thrombosis were ruled out in probability of thrombosis based on 2-D echo, X-ray chest and USG. This recommend that hyper-coagulopathy of the fibrin plays a significant role in the occurrence of thromboembolic complications with COVID-19 patients. D-dimer levels was crucially escalated with increasing severity of COVID-19 as determined by clinical improvement (within 5 days of hospital stay) and chest CT staging (CO-RADS score out of 25, P = 0.000). 319 patient were died during above said period and overall in-hospital mortality rate was 15.28%. Additionally, 6.08 % (n=127) patient were on BIPEP and all are died with 100% death ratio. Median D-dimer level in non-survivors (15.29%) was significantly higher than in survivors (84.71%, n = 1768, RR 24.69%). Median elevated D-dimer level was 600.5 ng/ml. Furthermore, the disease activity were higher in the overhead D-dimer level group demonstrated to have anticipating value in differentiating disease severity along with high ESR level and hs-CRP and the fibrinogen level was also upraised indicated seriousness of disease. Conclusion: We concluded that D-dimer level was routinely uplifted in patients with COVID-19 disease. D-dimer levels match up with severity of the disease and are a significant definitive prognostic first line marker for in-hospital mortality for COVID-19 disease. Furthermore, a significant association between the high D-dimer level and severity of COVID-19 disease was noted among comorbid patients. Additionally, raced D-dimer level demonstrated with high ESR level and hs-CRP and the fibrinogen level indicated seriousness of disease in comorbid patients.