Urea is generated by the urea cycle enzymes, which are mainly in the liver but are also ubiquitously expressed at low levels in other tissues. The metabolic process is altered in several conditions such as by diets, hormones, and diseases. Urea is then eliminated through fluids, especially urine. Blood urea nitrogen (BUN) has been utilized to evaluate renal function for decades. New roles for urea in the urinary system, circulation system, respiratory system, digestive system, nervous system, etc., were reported lately, which suggests clinical significance of urea. 

Urea

We describe a case report of a young girl, who presented with symptoms and signs of acute decompensated heart failure not responding to decongestive therapy. Routine 2D echocardiography revealed a diagnosis of constrictive pericarditis. She underwent pericardiectomy, and etiology of it turned out to be CD20 negative B-cell lymphoblastic primary cardiac lymphoma (PCL). Despite intensive medical and surgical management, it was fatal. PCL is uncommon among cardiac tumors and extremely rare in immunocompetent patients. Constrictive pericarditis is a rare clinical diagnosis and manifestation of pericardial involvement in PCL.

CD20 negative B-cell lymphoma presenting as constrictive pericarditis: Rare etiology of acute heart failure

Constrictive pericarditis (CP) is an uncommon post inflammatory disorder. It is described as pericardial thickening, myocardial constriction, and impaired diastolic filling. The most common etiologies are idiopathy, mediastinal radiotherapy, and prior cardiac surgery. Less common etiologies include viral infections, collagen vascular disorders, renal failure, sarcoidosis, tuberculosis, and blunt chest trauma. CP can less commonly be caused by malignancy. We report a very rare case of non-Hodgkin's lymphoma (NHL) presenting twice with attacks of decompensated heart failure. Echocardiography revealed that CP was responsible for the patient's symptoms as the first manifestation of NHL. Chest computed tomography scan and biopsy findings were compatible with the diagnosis of NHL. The patient received R-CHOP (cyclophosphamide, hydroxydaunorubicin, Oncovin®, and prednisone or prednisolone, combined with the monoclonal antibody rituximab) chemotherapy. Three months later, there was significant improvement in the patient's symptoms and considerable decrease in pericardial thickness.

/pdf/non-hodgkin-s-lymphoma-presenting-as-constrictive-1s60rxt4iy.pdf

Non-Hodgkin's Lymphoma Presenting as Constrictive Pericarditis: A Rare Case Report.

Abstract Background Cardiac lymphoma is a rare disease. Effusive–constrictive pericarditis can be a characteristic of pericardial involvement in patients with this disease. Conversely, a phenotype with electrocardiogram changes similar to those of Brugada syndrome is called Brugada phenocopy, and these changes improve after treatment. Case summary A 71-year-old man was transported to our hospital with chest pain, hypotension, and ST-segment elevation in V1 and V2 leads during maintenance dialysis for renal failure. After arrival at the hospital, his ST-segment elevation disappeared, and emergency coronary angiography scan revealed no significant coronary artery stenoses or obstructions. His computed tomography and echocardiography scans revealed pericardial effusion and an intrapericardial mass. Further, his blood pressure dropped and ST-segment elevation recurred during dialysis after 7 days. Thus, pericardiocentesis was performed, but haemodynamic improvement was insufficient, and right catheterization findings suggested effusive–constrictive pericarditis. Meanwhile, flow cytometry of the pericardial fluid suggested the diagnosis of B-cell lymphoma; however, radical chemoradiotherapy was impossible because of cardiogenic shock. The patient died on Day 17. Further, autopsy revealed diffuse large B-cell lymphoma with pericardial and myocardial infiltration. Discussion Cardiac lymphoma is rare but can be associated with effusive–constrictive pericarditis, which may be difficult to manage even with pericardial drainage. In such cases, radical treatment, including chemotherapy, should be promptly considered, if possible. Our patient presented with Brugada-type electrocardiogram but no syncope or family history, suggesting Brugada phenocopy and not true Brugada syndrome due to cardiac lymphoma. Notably, temporary improvement in ST-segment elevation was observed despite the absence of treatment.

Brugada phenocopy with altered ST-segment elevation in pericardial diffuse large B-cell lymphoma and effusive–constrictive pericarditis: a case report

Medicinal plants have been used as traditional medicines for treatment of diseases such as diabetes mellitus. However, scientific information to support the claims of herbal medicine practitioners based on Use Value (UV) and Informant Consensus Factor (ICF) is largely unexplored. The aim of this study is to screen common medicinal plants and to evaluate their traditional use through an ethnopharmacological survey at Kangkar Pulai, Johor, Malaysia. Data were collected from the community through open interviews, determining the relative importance of the species surveyed and calculating the UV and ICF in relation to the medicinal plant uses. A total of 38 plant species belongs to 28 families were documented. Based on the results of ethnopharmacological survey, Orthosiphon stamineus Benth and Momordica charantia L recorded the highest Use Values (0.32 and 0.24) to treat diabetes. The results of antioxidant tests revealed that the total phenolic content (TPC) of O. stamineus is 71.70 ± 0.85 mg (GAE)/g and total flavonoid content (TFC) is 44.71 ± 0.75 mg (CE)/g. Further study was carried out to examine the effects of oral administration of O. stamineus extract in the treatment of diabetes in normal and alloxan-induced diabetic rats. Forty rats were divided into four groups of 10 each. Group A (control) consisted of normal rats receiving 2 mL (10 mL/kg bwt) of normal saline on daily basis, whereas group B consisted of diabetic rats treated with 1 mL (120 mg/kg bwt) of O. stamineus extract. Group C consisted of diabetic rats treated with 1 mL (150 mg/kg bwt) of Metformin. Group D consisted of untreated diabetic rats acted as negative control. Group B, C and D were injected intrapertonially with alloxan (150 mg /kg bwt). Diabetic group B rats treated with O. stamineus extract showed significantly (p <0.05) low blood glucose level compared to group D (untreated diabetic rats). Similarly diabetic group B rats consumed significantly lower daily food and water intake at significant level p <0.05 compared to group D (untreated diabetic rats). Diabetic group B rats treated with O. stamineus extract showed significantly higher body weight at significant level p <0.05 compared to group D (untreated diabetic rats). Diabetic group B rats treated with O. stamineus extract showed lower serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and higher high-density lipoprotein cholesterol (HDL-C) at significant value (p < 0.05) compared with group D (untreated diabetic rats). A significant decrease of total protein, albumin and creatinine was observed in the plasma of group B rats after being treated with O. stamineus extract compared with group D. Additionally, immunohistochemistry results showed that the levels of heat shock protein 70 (HSP70) and inducible nitric oxide synthase (iNOS) of group B diabetic rats were brought back to near normal range after being treated with O. stamineus extract at significant value (p < 0.05) compared with group D (untreated diabetic rats). In conclusion, O. stamineus extract exhibited antidiabetic activity in alloxan-induced diabetic rats. Thus, the present findings also support the potential use of O. stamineus extract as a remedy for hyperglycemia.

Identification of commonly used medicinal plants in Kangkar Pulai and their therapeutic evaluation as anti-diabetic

Few cases of primary cardiac lymphoma (PCL) are found in the literature. We report the case of an 85 year-old male who presented with cardiac tamponade and effusive-constrictive pericarditis secondary to primary cardiac lymphoma involving only the pericardium. There have been no prior published cases with these rare scenarios.

/pdf/effusive-constrictive-pericarditis-secondary-to-primary-x29d3binw4.pdf

Effusive-Constrictive Pericarditis Secondary to Primary Pericardial Lymphoma: A Case Report

Prognostic Importance of Serial Evaluation of Blood Urea Nitrogen in Ambulatory Patients with Chronic Systolic Heart Failure and Preserved Renal Function

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Effusive-Constrictive Pericarditis Secondary to Primary Pericardial Lymphoma: A Case Report

Prognostic Importance of Serial Evaluation of Blood Urea Nitrogen in Ambulatory Patients with Chronic Systolic Heart Failure and Preserved Renal Function