Evaluation of dialysis adequacy in patients under hemodialysis and effectiveness of dialysers reuses

Reuse of dialysers is being practiced since the start of hemodialysis (HD) service in Nepal, which is cost effective as well as safe. A retrospective study was done in Nepal Medical College and Teaching Hospital. We reviewed case records of the year 2008 and retrieved required data such as pre and post urea, post dialysis weight and ultrafiltration volume from 186 sessions of dialysis of 60 patients. Dialysis sessions were divided into nine groups according to the number of use of dialyser. Out of 60 patients, 40 were male. Mean age of the study population was 45.82 +/- 15.42 yrs (range 18-78). Dialysers were reprocessed manually up to 9 times. Adequacy of dialysis was assessed using single pool Kt/v (spKt/v) and urea reduction rate (URR). Mean pre urea, post urea and spKt/v were 160 +/- 51.2 mg/dL, 71.8 +/- 28.5 mg/dL and 0.95 +/- 0.28 respectively. Mean URR was 54.82 +/- 11.24%. Out of total 186 sessions, spKt/v was > or = 1.2 in only 31 sessions (17.0%). There was no significant difference in mean spKt/v between the groups (p=0.87). When compared between the individual groups e.g. 1st vs. 7th, 1st vs. 8th and 1st vs. 9th, there was no significant difference in spKt/v. Dialysis is inadequate in most of our patients undergoing HD twice a week. Reuse of dialyser is effective in urea clearance and the practice of reuse is cost effective and safe.

In-center hemodialysis for end stage kidney disease at Nepal Medical College and Teaching Hospital

End stage kidney disease (ESKD) is defined by glomerular filtration rate (GFR) less than 5 ml/min. These patients need renal replacement therapy (RRT). Hemodialysis is an established form of RRT. Studies on incenter hemodialysis are very few. Here we would like to present our experience on in-center hemodialysis in Nepal Medical College and Teaching Hospital. Study period was one year (1st Baisakh 2065 to 31st Chaitra 2065). Total 33 patients (23 male, 10 female) were enrolled in the study. Average age was 42.33 +/- 15 years. Hypertension (55.0%), diabetes mellitus (24.0%), chronic glomerulonephritis (15.0%), rapidly progressive glomerulonephritis (3.0%) and others (3.0%) were the causes of ESKD requiring dialysis. Hypotension, hypertension, muscle cramps, chest pain were the common complications observed during dialysis. Average haemoglobin level was 9.44 +/- 1.88 g%. Majority of patients were physically inactive. Blood transfusion was the main modality for correction of anaemia. Approximate cost for one session of hemodialysis was Rs. 2000 (U.S. $.25) and average monthly income of study population was Rs.16312.5 (U.S. $.204) U.S. $1 = NRs.80, (4th May 2009).

Nutritional assessment of patients under hemodialysis in nepal medical college teaching hospital

Malnutrition is very common in hemodialysis patients and is predisposed by many factors. Malnutrition is associated with increased morbidity and mortality. Total of 26 patients (16 males and 10 females) who were under hemodialysis in our center were included in the study. With the help of Malnutrition Score (MS) developed by Kalanter-Zadeh, nutritional status of the patients was assessed. Patients also underwent different anthropometric measurements such as Body Mass Index (BMI), Triceps skin fold thickness (TSF), Mid Arm Circumlference (MAC) and Mid Arm Muscle Circumference (MAMC) and laboratory investigations. Mean age of the study population was 42.58 +/- 16.32 years (range 19 to 74 years). Females were older than males. MS of the study population was 15.82 +/- 3.76 (range 9-24). Female patients were having higher MS than males (16.5 +/- 4.11 vs. 15.06 +/- 3.55). Based on MS, 22 patients (84.6%) had mild to moderate malnutrition, 2 (7.7%) patients were having severe malnutrition and remaining 2 (7.7%) had normal nutrition score. Females were having lower BMI, MAC and MAMC but higher value of TSF. Significant negative correlation was present between MS and weight, BMI, MAC and MAMC. Calculated Urea Reduction Ratio (URR) of study population was 57.27 +/- 10.89. URR was higher in females than in males (61.77 +/- 12.74 vs. 54.45 +/- 8.85). Only 23.0% of the study population had URR of >65.0%. Protein Catabolic Rate (nPCR) in our study was 0.77 +/- 0.28 g/kg/day. Malnutrition is very common in our center which is >90% when MS was considered. In our study it negatively correlated with weight, BMI, MAC and MAMC. Dialysis inadequacy was present in around 75.0% of our study population.

A study on clinico-social factors for sexually transmitted diseases among urban males

This health center based study was conducted to find out the proportion and distribution of clinico-social factors for sexually transmitted diseases among male OPD attanders of urban health centre, Subharti Medical College, Meerut. Out of the total 150 male cases of genital diseases from January to June 2005, 42 were found to be symptomatic for STDs according to syndromic approach. The most common symptom was urethral discharge (35.7%). Illiteracy, trucker's occupation, multiple sex partners, extra marital relationship and non-usage of condom were found to be important socio-clinical factors for STDs.

Prenatal diagnosis of a neonate with fetus in fetu

Fetus in fetu is a rare condition not usually considered in the differential of a neonatal abdominal mass. This article illustrates the importance of prenatal ultrasound in the treatment of this condition as it facilitated the assembly of a multispecialty healthcare team that intervened within days of birth.

Knowledge, attitudes and beliefs about menarche of adolescent girls in Anand district, Gujarat

A questionnaire survey of knowledge, attitudes and beliefs towards menstruation was made in 22 schools in Anand district, Gujarat state. Of 900 schoolgirls aged 11-17 years, only 38.5% felt comfortable about menarche and only 31.0% believed that menstruation was a normal physiological process. Many (37.2%) had not been informed about menarche before its onset and 48.2% felt they were not mentally prepared. The major sources of information were the mother (60.7%) or an elder sister (15.8%); teachers and others relatives played a small role. In this area of India, many families continue the custom of celebrating the first menarche and observing social restrictions.

QTL analysis of resistance to Fusarium head blight in Swiss winter wheat (Triticum aestivum L.)

Fusarium head blight (FHB) of wheat is a widespread and destructive disease which occurs in humid and semi-humid areas. FHB epidemics can cause serious yield and quality losses under favorable climatic conditions, but the major concern is the contamination of grains with mycotoxins. Resistance to FHB is quantitatively inherited and greatly influenced by the environment. Its evaluation is costly and time-consuming. The genetic basis of FHB resistance has mainly been studied in spring wheat. The objective of this study was to map quantitative trait loci (QTLs) for resistance to FHB in a population of 240 recombinant inbred lines (RILs) derived from a cross between the two Swiss winter wheat cultivars Arina (resistant) and Forno (susceptible). The RILs were genotyped with microsatellite and RFLP markers. The resulting genetic map comprises 380 loci and spans 3,086 cM. The 240 RILs were evaluated for resistance to FHB in six field trials over 3 years. Composite interval mapping (CIM) analyses carried out on FHB AUDPC (i.e. mean values across six environments) revealed eight QTLs which altogether explained 47% of the phenotypic variance. The three main QTLs were mapped on the long arms of chromosomes 6D ( R(2)=22%), 5B ( R(2)=14%) and 4A ( R(2)=10%). The QTL detected on 5B originated from the susceptible parent Forno. Other QTLs with smaller effects on FHB resistance were detected on chromosomes 2AL, 3AL, 3BL, 3DS and 5AL.

Prevalence of extended spectrum -lactamase producing Klebsiella pneumoniae in a tertiary care hospital

PURPOSE

The purpose of this study was to know prevalence of extended spectrum -lactamase (ESBL) in multi drug resistant (MDR) strains of Klebsiella pneumoniae isolated from different clinical samples.

METHODS

A total of 120 MDR strain of K. pneumoniae were selected for the study, 106 of which were resistant to at least one of the third generation cephalosporins (3GC). They were studied for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) and by double disc synergy test (DDST).

RESULTS

88.3% (106) of the isolates were found to be resistant to at least one of the 3GC tested (cefotaxime, ceftazidime and ceftriaxone) and 72% of the isolates were resistant to all the 3GC tested. ESBL was detected in 30.18% (32) of the K. pneumoniae by PCDDT and in 27.3% (29) by DDST. Among the ESBL producers 6 (18.75%) were sensitive to cefotaxime, 2 (6.25%) to ceftazidime and 3 (9.37%) to ceftriaxone by disc diffusion test. The minimum inhibitory concentrations (MICs) of 3GC for these strains ranged from 2-8 microg/mL while for non ESBL producer sensitive counterparts it ranged from 0.03-1 microg/mL. Resistance to cefotaxime was transferred to recipient E. coli K12 strains J62-1. All the K. pneumoniae isolates were sensitive to imipenem. Resistance against amoxicillin, gentamicin, ciprofloxacin and amikacin was found in 93.28, 70, 10.37 and 26.14% of the isolates respectively.

CONCLUSIONS

Our study shows presence of ESBL producer K. pneumoniae in clinical isolates. The routine antimicrobial sensitivity test may fail to detect ESBL mediated resistance against 3GC and detection of ESBL production should be carried out as a routine in diagnostic laboratories by PCDDT as it is a simple and cost effective test.

Implantation in vitro: co-culture of rat blastocyst and epithelial cell vesicles

Implantation of blastocysts involves conversion of maternal and embryonic cell surfaces from a nonadhesive to an adhesive state in response to the internally driven developmental program or to externally generated factors. However, the intricacies of the cellular and subcellular changes that promote the attachment are not known, because these changes are difficult to determine in situ because of the nonaccessibility of the site. To overcome this, an in vitro model of implantation was developed by co-culturing rat blastocysts and uterine epithelial cells of the same gestational age (day 5 postcoitum; plug day as day 1) in drops hanging from the lid of a Petri dish. The system was used to study the changes on the surface membranes of the cells of the trophectoderm and uterine epithelium and to evaluate the antiadhesive activity of the newly designed test substances. The isolated epithelial cell vesicles were co-cultured with zona-free blastocysts in the microdrops (40-50 microl) hanging from the lid of a 60-mm Petri dish. The lid was placed over the lower dish, which was presaturated with the medium. The culture was examined 48 h later to determine the site of adhesion of epithelial cell vesicles with the trophoblasts lining the blastocyst. The cell-cell adhesion was monitored on a computerized image analyzer. To validate the adhesion of blastocysts and epithelial cell vesicles in co-culture, the expression of a cell adhesion molecule, uvomorulin, was studied using immunocytochemical technique after incubating with antiuvomorulin antibody. Intense staining was noted on the membrane surfaces at the site of attachment of the blastocyst and cell vesicles.

Modified iridoid glycosides as anti-implantation agents: inhibition of cell adhesion as an approach for developing pregnancy interceptive agents

Structural modifications in iridoid glycosides and evaluation of their efficacy on adhering capability (in vitro) of immature hamster uterine epithelial cells to the substratum have been studied. Out of 31, eight compounds in vitro, five compounds in utero and two in vivo showed adhesion/implantation preventing activity, respectively. The results provide an indication for further exploration in the line of development of anti-adhesive agents.