Impact of microfiber pollution on aquatic biota: A critical analysis of effects and preventive measures

The widespread use of Personal protective equipments (PPEs) by the healthcare professionals and public due to Corona Virus Disease (COVID-19) pandemic has become a new source for MFs pollution. Mismanaged plastic wastes and random dispose of used surgical face mask end up in large aquatic bodies via small waterways and waste water treatment plants (WWTPs). Microplastics/Microfibres (MPs/MFs) have recently been reported in a variety of aquatic and terrestrial ecosystems, including water, deep sea sediments, air and soil. Natural components like UV radiation and temperature play a major role in weathering of surgical masks. High loads of MPs/MFs emitted into the aquatic environment are easily consumed by organism's habitat in such ecosystem by disrupting the food chain and causing chronic health problems in the organisms including humans. The aim of this review article is to shed light on these issues and compile the most recent information available regarding the deterioration of surgical face masks in the environment as well as other contaminants and their presence in various environments, particularly with regard to methods that make use of exposure models, biomarkers of exposure, and their limitations. Along with this, the study focuses on identifying gaps in current understanding and highlighting prospective research directions. The literature on surgical face mask pollution and its effects on the biological and physiological systems of various organisms and ecosystems is critically analysed in this review. It also raises awareness of how to properly dispose of used surgical face masks and other PPEs.

Mental health of hypertensive patients and its association with their blood pressure in a rural area of Kancheepuram District, Tamil Nadu

Introduction:

Chronic diseases, such as type 2 diabetes mellitus and hypertension, are often associated with psychiatric comorbidities such as anxiety, depression, and somatization. Approximately, one-fourth of the adults were diagnosed with hypertension, and the proportion will reach about one-third by 2025. The prevalence of hypertension throughout India is 29.8% and the burden of hypertension in a rural area of Tamil Nadu is 25.2%. The compliance of drug intake depends on the mental health of the patient and this study intends to take care of patients with chronic illnesses. This study is designed to assess the mental health of hypertensive patients and its association with their blood pressure.

Materials and Methods:

A cross-sectional descriptive study was conducted among hypertensive patients in the field practice of a tertiary care medical college in the Kancheepuram district for a period of 3 months using a semi-structured validated schedule after obtaining the informed consent. The depression anxiety stress scale (DASS) scale was used to assess the mental health of hypertensive patients. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0.

Results:

Most hypertensive patients were found in the age group of 40 to 60 years. About 53.4% of hypertensive patients with normal blood pressure were suffering from depression. In addition, about 44.6% of pre-hypertensive patients and 44.6% of stage II hypertensive patients were found to have severe depression.

Conclusion:

Overall, pre-hypertensive patients were suffering from depression when compared to other hypertensive patients. Family history and tobacco and alcohol intake were other factors associated with depression in hypertensive patients.

Visual impairment among 10-14-year school children in Puducherry: A cross-sectional study

Introduction:

According to the 2010 estimates by the World Health Organization, nearly 285 million (4.24% of total population) people of all ages worldwide are visually impaired. Almost 18.9 million children under 15 years of age are visually impaired globally. In developing countries, 7%–31% of childhood blindness and visual impairment is avoidable.

Materials and Methods:

The study was conducted as a cross-sectional study among 1884 school students in Puducherry, in the age group of 10–14 years. A child with presenting maximum vision ≤6/12 Snellen equivalent in the better eye is considered visually impaired. Data were entered in Microsoft Excel 2013 and analyzed using the statistical software SPSS version 21.0. Chi-square test was applied for testing difference in proportion and a P < 0.05 was considered statistically significant.

Results:

The overall prevalence of visual impairment (vision ≤6/12) among the study participants was 6.37% (95% confidence interval = 5.27–7.47). The prevalence of visual impairment increased with age and it was found to be high among male students (6.6%) when compared to female students (6%). Presenting vision of 6/6 was observed in 79.8% of the children while with pinhole correction, the proportion increased to 94.6%.

Conclusion:

The prevalence of visual impairment in our study population was found to be 6.37% and the prevalence was even higher among children who belonged to schools of urban region or private schools. Children with a positive family history of spectacle use were more likely to have visual impairment.

Chromium Accumulation in Medicinal Plants Growing Naturally on Tannery Contaminated and Non-contaminated Soils

Herbal preparations used to treat human ailments globally can be contaminated with various heavy metals (HMs) originating from the raw materials or from the manufacturing processes. Therefore, we assessed 22 medicinal plants growing naturally on tannery pollutant contaminated (Site-C) and non-contaminated (Site-NC) sites for their ability to accumulate chromium (Cr). The Cr contents in soil and various plant parts were estimated using an atomic absorption spectrophotometer. Translocation and bioconcentration factors were calculated. The soil at Site-C had 27-fold higher concentration of total Cr than at Site-NC. Chromium accumulation is reported for the first time in 50 % of the medicinal plants examined and varied significantly among the sites. Shoots of Ricinus communis and Amaranthus viridis had maximum concentrations of Cr at Site-C, whereas in Site-NC, none of the plants had Cr accumulation >30 ppm. Ricinus communis, Amaranthus viridis, and Amaranthus spinosus had translocation factor (TF) greater than the one in the Site-C and Lantana camara had TF >1 in Site-NC. The bioconcentration factor (BCF) was >1 only for Ricinus communis at both the sites. The majority of the medicinal plants at Site-NC had Cr content exceeding the permissible limit of 2 ppm suggested for herbal raw material. The results of the study clearly emphasize the need for screening plants of therapeutic value for the presence of HMs even when collected from non-contaminated soils. Moreover, proportional allocation of Cr in different plant parts provided an insight on the safety of these parts when specifically used in herbal preparations.

The Banff 2015 Kidney Meeting Report: Current Challenges in Rejection Classification and Prospects for Adopting Molecular Pathology

The XIII Banff meeting, held in conjunction the Canadian Society of Transplantation in Vancouver, Canada, reviewed the clinical impact of updates of C4d-negative antibody-mediated rejection (ABMR) from the 2013 meeting, reports from active Banff Working Groups, the relationships of donor-specific antibody tests (anti-HLA and non-HLA) with transplant histopathology, and questions of molecular transplant diagnostics. The use of transcriptome gene sets, their resultant diagnostic classifiers, or common key genes to supplement the diagnosis and classification of rejection requires further consensus agreement and validation in biopsies. Newly introduced concepts include the i-IFTA score, comprising inflammation within areas of fibrosis and atrophy and acceptance of transplant arteriolopathy within the descriptions of chronic active T cell-mediated rejection (TCMR) or chronic ABMR. The pattern of mixed TCMR and ABMR was increasingly recognized. This report also includes improved definitions of TCMR and ABMR in pancreas transplants with specification of vascular lesions and prospects for defining a vascularized composite allograft rejection classification. The goal of the Banff process is ongoing integration of advances in histologic, serologic, and molecular diagnostic techniques to produce a consensus-based reporting system that offers precise composite scores, accurate routine diagnostics, and applicability to next-generation clinical trials.

Comparative study of the effects of organic selenium on hen performance and productivity of broiler breeders

1. A 10-week experiment was conducted with Ross 308 broiler breeder chickens in cages to evaluate the influence of organic and inorganic sources of selenium (Se) supplementation. A total of 600 birds at 29 weeks of age were divided at random into 4 groups and fed on a maize-soya basal diet supplemented with different forms of Se. 2. The first (control) group was given the basal diet without Se supplementation, whereas the second, third and fourth groups were given, respectively, the basal diet with 0.3 mg/kg of inorganic Se in the form of sodium selenite or 0.3 and 0.5 mg/kg of organic Se in the form of Se enriched yeast (Se-yeast). 3. The experiment was carried out for 10 weeks to compare and evaluate the influence of Se supplementation on breeder performance, egg production, hatchability and the quality of eggs. Samples were collected for analysis at weeks 0, 5 and 10 of the experimental period. 4. At the end of the experiment (39 weeks), there was a reduction in mortality in breeders given diets supplemented with 0.5 mg/kg of Se-yeast. Supplementation of feed with 0.5 mg/kg organic Se increased egg production, percentage of settable eggs and hatchability. 5. Selenium supplementation increased egg weight and specific gravity compared to the control diet. However, no significant variation was found in albumen or yolk protein content at the end of week 10. 6. Selenium accumulation and glutathione peroxidase (GSHPx) activity were lower in the egg albumen and yolk of control compared with Se-supplemented treatments. Se accumulation and GSHPx activity were higher in the group given 0.3 mg/kg organic compared to 0.3 mg/kg of inorganic Se. 7. The results favour the use of Se-yeast at the dose of 0.5 mg/kg in broiler breeder diets for better productivity of eggs, settable eggs, hatchability and higher Se accumulation and antioxidant status in eggs.

Anticancer activity of fungal L-asparaginase conjugated with zinc oxide nanoparticles

Demand for developing novel delivery system for cancer treatment has increased due to the side effects present in intravenous injection of L-asparaginase. Nanoparticles are used for delivering the drugs to its destination in cancer cure. Nanobiocomposite of zinc oxide nanoparticles conjugated with L-asparaginase was produced by Aspergillus terreus and was confirmed using maximum UV-Vis absorption at 340 nm in the present work. The presence of functional groups like OH, C-H, -C=N and C=O on the surface of nanobiocomposite was found from Fourier transform infrared spectrum analysis. Size of the produced nanocomposite was found in the range of 28-63 nm using scanning electron microscope. The crystalline nature of the synthesized nanobiocomposites was confirmed by X-ray diffraction analysis. The presence of zinc oxide on synthesized nanobiocomposite was confirmed by energy dispersive spectrum analysis. The anti-cancerous nature of the synthesized zinc oxide conjugated L-asparaginase nanobiocomposite on MCF-7 cell line was studied using MTT assay. The viability of the MCF-7 cells was decreased to 35.02 % when it was treated with L-asparaginase conjugated zinc oxide nanobiocomposite. Hence it is proved that the synthesized nanobiocomposites of zinc oxide conjugated L-asparaginase has good anti-cancerous activity.

Biomimetic mineralization of novel silane crosslinked collagen

Studies on the mechanisms of mineralization of connective tissues, have gained momentum in the recent past. In the present study, Biomimetic mineralization of modified fish scale collagen in vitro is reported. The fish scale collagen was crosslinked with 3-Aminopropyl triethoxysilane and the crosslinked collagen (FCSi) was characterized using conventional methods. The biomimetic mineralization capacity of FCSi was evaluated in SBF solution for 7 days. Formation of hydroxyapatite crystals on the matrix in vitro has been confirmed by FTIR, XRD and SEM-EDAX techniques. The FCSi may be used as a scaffold in bone tissue engineering and as an osteoinductive material in experimental animal models before applying clinically.

Cauda equina syndrome presentation of sacral insufficiency fractures

INTRODUCTION

Sacral insufficiency fractures are a well recognised cause for low back, buttock and groin pain in the elderly. However, over a 4 year period, four patients have presented with symptoms of cauda equina syndrome, who were found on investigation to have acute sacral insufficiency fracture without any other aetiological spinal abnormality.

PATIENTS AND METHOD

Four patients who presented to the spinal surgeons of our institution with symptoms of cauda equina syndrome were referred for spinal MR. Sagittal and axial T1 and T2 weighted turbo spin echo sequences of the lower thoracic and lumbar spine were performed on all patients. Subsequent studies included MR of the sacrum supplemented where appropriate by CT and technetium MDP bone scintigraphy.

RESULTS

No evidence of a compressive lesion of the lower thoracic or lumbar spine was present in any of the four patients. Dedicated MR examination of the sacrum in these patients revealed unilateral acute insufficiency fractures involving zone 1 from S1 to S3 extending from the sacro-iliac joint to the lateral margin of the sacral foramen. There was no evidence of compression of the sacral nerve roots. The possible mechanism for the symptomatic presentation is discussed.

CONCLUSION

Sacral insufficiency fractures should be excluded in elderly or osteoporotic patients presenting with cauda equina syndrome who have no evidence of compression in the thoraco-lumbar MR studies.

Arbuscular mycorrhizal morphology and dark septate fungal associations in medicinal and aromatic plants of Western Ghats, Southern India

We investigated roots of 107 medicinal and aromatic plants (MAPs) in the Western Ghats region of Southern India for arbuscular mycorrhizal (AM) and dark septate endophyte (DSE) associations. Of the 107 MAPs belonging to 98 genera in 52 families examined, 79 were AM and 38 harbored a DSE association. Typical Arum- and Paris-type mycorrhizas are first reported in the presumed nonmycorrhizal family Amaranthaceae. Similarly, DSE associations are recorded for the first time in nine plant families and 37 plant species. Thirty MAPs had both AM and DSE associations. The number of MAPs having Arum-type mycorrhiza was greater than those having Paris-type. This was more prominent among herbaceous plants than in trees where the Paris-type was predominant. Similarly, the Arum-type was more prevalent in annuals than in perennials. DSE associations were more frequent in herbs and perennials compared to other MAPs.

Primary synovial osteochondromatosis presenting as constrictive capsulitis

Primary synovial chondromatosis of the joints can present as capsular constriction with peri-articular osteopenia. This rare presentation is highlighted in three cases (two hips and one shoulder). The diagnosis in all the patients was made on arthrography and/or MRI/CT and was confirmed histologically. Synovial chondromatosis should be considered in patients with this presentation. Arthrography is the best imaging modality to confirm the cause (synovial chondromatosis) and effect (constrictive capsulitis).

Subperiosteal ganglion associated with Paget's disease of bone

Tumoral lesions related to Paget's disease may be classified as malignant, benign or pseudotumoral. While sarcomatous degeneration is the most feared complication, awareness of benign and pseudotumoral lesions is essential for assisting in accurate histological interpretation of the biopsy sample, which may avoid unnecessary repeat biopsies. We present the first case of a juxta-articular subperiosteal ganglion associated with Paget's disease, with classic imaging characteristics, especially on CT examination. The well-defined soft tissue mass at the medial aspect of the obturator rim, adjacent to a small fracture in pagetic quadrilateral plate, showed an ossified rim and internal gas lucencies, these being the hallmarks of a juxta-articular subperiosteal ganglion. On MRI, the lesion was of intermediate signal intensity on T1-weighted sequences, increased signal intensity on T2-weighted sequences, with rim enhancement after gadolinium contrast injection and preservation of fatty marrow signal of the underlying pagetic bone. Identification of the entity avoided an unnecessary biopsy or surgical intervention.

Stress-induced Salter-Harris I growth plate injury of the proximal tibia: first report

We describe a case of chronic Salter-Harris I injury of the proximal tibial epiphysis. To our knowledge such an injury has not been described in the English language literature. The radiological appearance can mimic chronic infection. The possibility of chronic athletic stress-related change should be considered in such scenarios to avoid a misdiagnosis.

Mycorrhiza in sedges--an overview

Most terrestrial plants associate with root-colonising mycorrhizal fungi, which improve the fitness of both the fungal and plant associates. However, exceptions exist both between and within plant families failing to associate with mycorrhizal fungi or in the incidence and the extent of mycotrophy, which may vary greatly. Sedges are important pioneers of disturbed habitats and often dominate vegetations like wetlands, and arctic and alpine vegetations, in which the mycorrhizal inoculum in the soil is often low or absent. In the past, sedges were often designated as non-mycorrhizal, though limited reports indicated the presence of mycorrhiza in certain species. However, studies since 1987 indicate widespread occurrence of mycorrhiza in sedges. Based on these studies, the family Cyperaceae is no longer a non-mycorrhizal family, but the mycorrhizal status of its members is greatly influenced by environmental conditions. Further, sedges appear to have several morphological adaptations to thrive in the absence of mycorrhizal association. Though mycorrhizal associations have been noted in many sedge species, the ecological role of this association is not well documented and no clear generalisation can be drawn. Similarly, the role of mycorrhizal fungi on sedge growth and nutrient uptake or non-nutritional benefits has yet to be fully ascertained. This paper reviews the current information available on the incidence of mycorrhiza in sedges and the possible reasons for low mycotrophy observed in this family.

Mycorrhiza of plants in different vegetation types in tropical ecosystems of Xishuangbanna, southwest China

We examined plants growing in four tropical vegetation types (primary forest, secondary forest, limestone forest and a slash and burn field) in Xishuangbanna, southwest China for mycorrhizal associations. Of the 103 plant species examined (belonging to 47 families), 81 had arbuscular mycorrhizal (AM) associations, while three species possessed orchid mycorrhiza. AM colonization levels ranged between 6% and 91% and spore numbers ranged between 1.36 spores and 25.71 spores per 10 g soil. Mean AM colonization level was higher in primary and secondary forest species than in plant species from limestone forests and a slash and burn field. In contrast, mean AM fungal spore numbers of the primary and limestone forest were lower than in the secondary forest or the slash and burn field. AM fungal spores belonging to Glomus and Acaulospora were the most frequent in soils of Xishuangbanna. AM fungal colonization and spore numbers were significantly correlated to each other and were significantly influenced by vegetation type.

Optimization of RNA yield, purity and mRNA copy number by treatment of urine cell pellets with RNAlater

BACKGROUND

We have shown that measurement of mRNA for cytotoxic attack proteins perforin and granzyme B in urinary cells is a noninvasive means of diagnosing acute rejection of human renal allografts. Urinary cell mRNA studies have yielded useful information in other patient populations such as patients with cancer. The isolation of sufficient and high quality ribonucleic acid (RNA) from urinary cells however is problematic. RNAlater, an RNA stabilization solution, has been reported to optimize RNA isolation from tumor tissues stored at room temperature and from pigment-rich ocular tissues.

METHODS

We explored whether the addition of RNAlater to urine cell pellets improves RNA yield, enhances purity and facilitates measurement of low abundance mRNAs. We measured, with the use of real-time quantitative polymerase chain reaction (PCR) assay, levels of expression of a constitutively expressed gene 18S rRNA and mRNA for granzyme B and transforming growth factor-beta(1) (TGF-beta(1)) in urine specimens and renal biopsies obtained from renal allograft recipients.

RESULTS

RNA yield (P<0.01, Wilcoxon signed rank test) and the A260/A280 ratio (P<0.01) were both higher with urine cell pellets treated with RNAlater prior to snap freezing compared to cell pellets that were not treated with RNAlater prior to snap freezing. Levels (copy number per 1 microg of total RNA) of 18S rRNA (P<0.02), granzyme B mRNA (P=0.002) and TGF-beta(1) (P=0.02) were all higher with treated urine cell pellets compared to untreated cell pellets. Kruskall-Wallis one way analysis of variance and pair-wise comparisons with Student-Newman-Keuls test showed that the levels of mRNA for granzyme B (P<0.05) and TGF-beta(1) (P<0.05) are significantly different between renal allograft biopsies and untreated urine cell pellets but not between the biopsy specimens and RNAlater-treated urine cell pellets.

CONCLUSIONS

The addition of RNAlater to urine cell pellets improves RNA isolation from urinary cells and facilitates measurement of low abundance mRNAs.

Prognostic factors in immunoglobulin-A nephropathy

AIM

To study the course, identify prognostic factors and a model predictive for development of end stage renal failure (ESRF) in adults with immunoglobulin-A nephropathy (IgA-N).

DESIGN

Retrospective cohort.

SETTING

Madras Medical College and Government General Hospital, Chennai, Tamil Nadu.

PARTICIPANTS

Ninety eight adult patients with diagnosis of primary IgA nephropathy.

RESULTS

Out of 98 patient 64 (65.3%) were men. Mean age of presentation was 25.7 years. The predominant renal lesions included nephrotic syndrome in 25 (25.5%), rapidly progressive renal failure and accelerated malignant hypertension in 21 (21.4%) each, chronic renal failure in 13 (13.3%), hypertension in nine (9.2%) haematuria in five (5.1%) and acute renal failure in four (4.1%). Sixty (61%) had renal failure at diagnosis. Age > 25 years, glomerular histology of Hass subclass V and interstitial fibrosis were significant factors. Forty (48.2%) (IR) patients developed ESRF during follow up. Serum creatinine > 5 mg/dl (hazard ratio: 5.37, 95% confidence interval CI 2.49-11.58) Hass-V (3.74, 1.60-8.76), crescents (4.08, 1.52-10.94) and IF (6.15, 2.0-19.0) were associated with disease progression in the multivariate analysis. Five years renal survival (CI) was 38.5% (24.6%-52.3%). Among those with no risk factor, 95% had not reached ESRF by 42 months. The median ESRF-free survival with one, two and three or four risk factors was 65, 16 and four months, respectively.

CONCLUSIONS

Serum creatinine > 5 mg/dl, crescents: Hass-V histology and interstitial fibrosis predict the progression to ESRF. Renal biopsies should include a detailed assessment of the tubulointerstitium.

Arbuscular mycorrhizas in cycads of southern India

Root and soil samples of three potted or ground-grown cycads ( Cycas circinalis, C. revoluta, Zamiasp.) were collected between November 1999 and June 2000 and surveyed for arbuscular mycorrhizal (AM) colonization and spore populations. AM fungi were associated with all root systems and rhizosphere samples examined. Root colonization was of a typical Arum type and AM colonization levels differed significantly between species and between potted and ground-grown cycads. Mycorrhizal colonization levels were inversely related to root hair number and length. Spores of nine morphotypes belonging to three genera ( Acaulospora, Glomus, Scutellospora) were extracted from soil. The percentage root length colonized by AM fungi was not related to soil factors, but total AM fungal spore numbers in the rhizosphere soil were inversely related to soil nitrogen and phosphorus levels. AM fungal spore numbers in the soil were linearly related to root length colonized. The co-occurrence of septate non-mycorrhizal fungi was recorded for the first time in cycads. These observations and the relationship between plant mycorrhizal status and soil nutrients are discussed.

Impact of cyclosporine withdrawal on living related renal transplants: a single-center experience

High treatment costs force the discontinuation of cyclosporine (CSA) in a vast majority of renal transplant recipients in India. The impact of CSA withdrawal among 108 living related renal transplant recipients 12.54 +/- 4.2 months after transplantation was studied retrospectively. In 83 patients, CSA was withdrawn over a 12-week period (group I). Azathioprine dosage was increased to 2 to 2.5 mg/kg/d, and prednisolone, to 30 mg/d 2 weeks and 1 week before starting CSA withdrawal, respectively. In the other 25 patients, CSA had to be withdrawn faster (mean, 28.52 +/- 14.18 days; group II). Twenty-nine rejection episodes (26.9%) were noted in 22 patients (20.4%; 19% in group I and 52% in group II; P: = 0.008). Fifteen group-I patients (18%) and 11 group-II patients (44%) died or lost their grafts (P: = 0.017). There was no difference in age, donor source, HLA matches, pretransplantation cross-match positivity, delayed graft function, immunosuppressive drug doses, rejection episodes, or prewithdrawal serum creatinine levels between the patients who did or did not develop acute rejection after CSA withdrawal. On follow-up, 10 patients (50%) died or returned to dialysis among the rejection group compared with 16 patients (18%) in the nonrejection group (P: = 0.007). The mean creatinine level at last follow-up was greater in the rejection group (3.97 +/- 2.54 versus 1.65 +/- 1.1 mg/dL; P: < 0.001). CSA withdrawal because of economic constraints carries a significant risk for acute rejection and death and/or graft loss in Indian living donor renal transplant recipients, even after 12 months.

Isoniazid does not affect bioavailability of cyclosporine in renal transplant recipients

Transplant recipients are predisposed to develop opportunistic infections such as tuberculosis, and isoniazid (INH) is used in most antitubercular therapeutic and prophylactic protocols. Cyclosporine (CyA) bioavailability increases with the concomitant use of drugs that inhibit hepatic cytochrome P-450 enzymes. There are conflicting reports on a possible interaction between the two drugs. Seven renal transplant recipients on CyA (Sandimmun Neoral) with slow acetylation status and also requiring concomitant INH prophylaxis (300 mg/day) against tuberculosis were studied. There were no significant changes in CyA pharmacokinetic parameters including CyA trough levels, total CyA exposure and CyA clearance before and 2 weeks after instituting INH prophylaxis. There was also no statistically significant correlation between INH levels and changes in CyA pharmacokinetic parameters before and after administration of INH. Even after all post-INH pharmacokinetic parameters were adjusted for INH levels, the differences in the above pre- and post-INH parameters did not reach statistical significance. Renal function during the study period remained constant and there were no episodes of CyA toxicity or acute rejection during and up to 4 weeks of INH treatment. We conclude that concomitant administration of INH and CyA is safe and is not associated with any appreciable alterations in the bioavailability of CyA.

Treatment-related acute renal failure in the elderly: a hospital-based prospective study

BACKGROUND

Elderly individuals need a host of diagnostic procedures and therapeutic interventions to take care of ailments. This prospective study was carried out to determine the magnitude of treatment-related acute renal failure (ARF) in the elderly in a hospital setting, to know about pathogenetic factors and to study the factors that could predict an adverse outcome.

METHODS

All elderly patients (>60 years) admitted over a 12-month period were screened prospectively throughout their hospital stay for the development of ARF.

RESULTS

Of 31860 patients admitted, 4176 (13%) were elderly. Of these 59 (1.4%) developed ARF in the hospital. Nephrotoxic drugs contributed towards development of ARF in 39 (66%), sepsis and hypoperfusion in 27 (45.7%) each, contrast medium in 10 (16.9%) and postoperative ARF occurred in 15 (25.4%) patients. These pathogenetic factors were responsible for ARF in different combinations. Amongst these combination of pathogenetic factors, radiocontrast administration (partial chi(2) 28.1, P<0.0001), surgery (partial chi(2) 14.89, P=0.001), and drugs (partial chi(2) 6. 22, P=0.0126) predicted ARF on their own. Nine patients (15.23%) needed dialytic support. Of 59 patients, 15 (25.4%) died, of those who survived, 38 (86.3%) recovered renal function completely and six (13.6%) partially. Mortality in the elderly with ARF was significantly higher than in those without ARF (25.4 vs 12.5%; chi(2) 8.3, P=0.03). Sepsis (odds ratio 43), oliguria (odds ratio 64), and hypotension (odds ratio 15) were independent predictors of poor patient outcome on logistic regression analysis.

CONCLUSION

Incidence of treatment-related ARF in the elderly was 1.4%, with more than one pathogenetic factor playing a role in the development of ARF in the majority. Sepsis, hypotension, and oliguria were the independent predictors of poor patient outcome.

Acute renal failure due to nontraumatic rhabdomyolysis following binge drinking

Nontraumatic rhabdomyolysis is an important but under-recognized cause of acute renal failure. In alcoholics, rhabdomyolysis most frequently develop following muscle necrosis during alcohol-induced coma, but has also been described rarely in those without prolonged coma or seizures. We describe a patient who developed myoglobinuric acute renal failure requiring dialysis following binge drinking in the absence of convulsions or coma. The renal biopsy showed acute tubular necrosis with pigment casts.