Chronic kidney disease; study on patterns of anemia in relation to glomerular filtration rate [GFR] in patients

Chronic kidney disease is usually related with anemia and the level of anemia correlates with the severity of renal failure. A chronic kidney disease is complicated by anemia and anemia may contribute to adverse clinical outcomes. No large-scale population data are available for patients with chronic kidney disease regarding prevalence of anemia, subpopulations at risk, and relationships between anemia and renal dysfunction

Objectives: The objective of this study is to determine the frequency of different patterns of anemia in relation to glomerular filtration rate in patients suffering from chronic kidney disease stage II and above Patients

Material and Methods: Study Design: Cross sectional study

Setting: Medical and Nephrology wards of Liaquat University Hospital Hyderabad / Jamshoro

Period: 20[th] January 2013 to 19[th] December 2013

Results: During the study period, total 339 patients of chronic kidney disease with stage II and above patients were enrolled. The mean age +/- Standard Deviation and range] of patients was 50.65 +/- 11.86 [16 to 80 years, n = 339]. 211[62.2%] were male and 128[37.8%] were female. [Male to Female Ratio 1: 6]. Mean Hemoglobin +/- SD was 7.16 +/- 3.89 [3.0 to 17.0 g/dL]. The frequency of anemia was present in 285[84.1%] patients with mean Hb +/- SD 6.02 +/- 2.1 [g/dL]. The mean weight +/- SD was 56.50 +/- 9.84 [40 to 81 kg]. The mean serum creatinine +/- SD was 5.63 +/- 2.48 [0.9 to 12.0 mg/dL] and we observed that most frequent pattern of anemia was normocytic-normochromic anemia in 216[77.0%] patients, hypochromic-microcytic in 61[18.0%] and macroyctic in 17[5.0%] patients. We also found that as anemia increased progressively with declining GFR with mean hemoglobin concentration of 11.78 +/- 2.8 g/dL in CKD stage 2, 10.14 +/- 3.6 g/dL in CKD stage 3, 6.8 +/- 3.6 g/dL in CKD stage 4, 7.44 +/- 4.0 g/dL in CKD stage 5

Conclusion: Frequency of anemia increases with the progression of stage of chronic kidney disease [decreased GFR] and anemia was most common in stage 5 patients of chronic kidney disease. Most frequent pattern of anemia is normocytic normochromic anemia

Essential hypertension; [evaluation of serum uric acid at tertiary care hospital hyderabad/jaivishoro]

Little and sparse information is present in our population on association between serum uric acid and essential hypertension .Increased serum uric acid is related with elevated blood pressure in different research studies. The relationship between serum uric acid level and high blood pressure can be difficult to assess because drugs for high blood pressure usually affect uric acid level. The objective of our study is to evaluate the association of serum uric acid to severity and duration of essential hypertension at Liaquat University Hospital [tertiary care] Hyderabad / Jamshoro. Case control and prospective study. Medical wards and Out Patient Medicine Department of Liaquat University Hospital Hyderabad /Jamshoro. One year i.e. from 20[th] March 2013 to 19[th] February 2014. A total of 75 high blood pressure subjects aged 35 years and above were included as cases with same number[75] of age and sex matched normal blood pressure subjects as controls after excluding, Secondary hypertension, metabolic syndrome ,Diabetes Mellitus, age <40 ;>70 years, hypothyroidism, hyperparathyroidism, Ischemic heart disease, congestive cardiac failure, Alcohol abuse, Renal Insufficiency, glomerulonephritis, pyelonephritis, hereditary nephropathy, patients on drugs -, ethambutol levodopa pyrazinamide, low dose asprin, Cytotoxic drugs, nicotinic acid ,thiazide diuretics.. Qualitative and quantitative data were evaluated in SPSS version 16.0. The mean serum uric acid level was 6.3 +/- 1.4 mg/dl vs 4.5 +/- 1.2 mg/dl in case [n = 75] and control patients [n = 75] respectively. A total of 23 [30.6%, n = 75] patients in cases and 8 [10.6%] subjects in control had high serum uric acid [Odds Ratio 2.13, p <0.05]. Therefore, the frequency of increased serum uric acid level subjects and mean serum uric acid level were significantly greater in hypertensive cases, as compared to those of healthy normal blood pressure Controls. Serum uric acid correlated positively with both systolic blood pressure [r=0.132, p<0.01] and diastolic blood pressure [r=0.214; p<0.01]. High serum uric acid is frequent in our populace with essential hypertension and there is relationship between serum uric acid level and blood pressure. Further large scale research studies on the pathophysiologic significance of high serum uric acid in these high blood pressure patients are in further need

Helicobacter pylori and hepatic encephalopathy; do they represent two sides of the same coin?

Hepatic encephalopathy is a common and serious complication affecting patients with liver disease. Helicobacter pylori bacterium is postulated to be involved in worsening of this condition via its potential to create ammonia within the gastrointestinal tract. The objective of this study was to determine the frequency of H pylori infection in cirrhotic patients who were suffering from hepatic encephalopathy. Case series study. Medical Unit-IV of Liaquat University Hospital, Hyderabad. Period: January to July 2010. Every confirmed case of cirrhosis of liver who presented with acute confusional state, and loss of consciousness to the emergency department of hospital was considered for enrollment in the study. The presence of hepatic encephalopathy was confirmed and its severity grading was done clinically. Subsequently H pylori serological tests were done on every patient and a cut off value of 200:1 antibody titer was considered as positive. Primary outcome variable was presence or absence of H pylori antibody titer. A total of 115 patients were selected, 69 [60%] were males and 46 [40%] were females. The mean age of patients was 49.36 years with a SD of 7.8. Antibody to H pylori was present in 83 [72.17%] patients, whereas it was absent in 32 [27.83%]. Two out of ten patients [20%] who were in Grade I hepatic encephalopathy showed a positive test for H pylori antibody. In Grade II hepatic encephalopathy 17 out of 19 patients [89.47%] were having positive H pylori antibody, in grade III 29 out of 34 [85.29%] and grade IV 35 out of 52 patients [67.3%] were having the antibody to H pylori. Further studies are warranted to evaluate the arguments for and against the role of H pylori in the pathogenesis of hepatic encephalopathy

Interobserver and intraobserver agreement in radiographic diagnosis of osteoporosis

Osteoporosis is a common bone disorder which means paucity of bone particularly of trabecular bone. This leads to increased tendency to fractures and bone pains. The radiological diagnostic workup usually starts from plain x-rays followed by bone mass measurement techniques. To determine the inter- and intra-observer agreement in plain x-ray diagnosis of osteoporosis using a standardized grading system. It was a cross-sectional analytical study conducted from May 2004 to June 2005 at Radiology department Dow University of Health Sciences and Civil Hospital, Karachi and Osteoporosis Diagnostic Clinic Karachi. Plain non digital x-rays of femur of post menopausal females [a group known to be at risk of and clinically suspected with osteoporosis] were independently read by three qualified professionals-two radiologists and a nuclear physician specialized in osteoporosis diagnosis. Standardized radiological grades of osteoporosis [Singh Index] were assigned to plain x-rays of pelvis and femur. Kappa statistics were used to determine inter- and intra-observer agreement by computing k-value. A total of 98 patients were included in the study. All were post menopausal females with age of 59 +/- 6.5 years Kappa [k-] value for inter-observer agreement ranged from 0.21 to 0.44. For intra-observer agreement, it was 0.69 to 0.78. The inter- and intra-observer agreement for diagnosis of osteoporosis on plain x-rays alone is markedly low, necessitating the use of multiple and sensitive techniques rather than plain x-rays alone

Radiographic morphometry of the osteoporotic femur: comparison with densitometry

To determine the accuracy of radiographic morphometry i.e. grading of osteoporosis on plain x-rays of femur [Singh index] compared with bone densitometry by dual energy x-ray absorptiometry [DEXA] in post menopausal females. From May 2004 to June 2005 at Radiology Department, Dow University of Health Sciences [DUHS], and Civil Hospital Karachi [CHK] in collaboration with Osteoporosis Diagnostic Clinic, Karachi. Post menopausal females referred for evaluation of clinically suspected osteoporosis by both plain x-rays and DEXA were included in the study. Those with history of previous trauma or radiation, other systemic disease with bony component, advanced degenerative disease, metastatic disease and bony metallic implants or prosthesis, were excluded. A standardized system of grading skeletal osteoporosis on plain x-rays of femur/pelvis [Singh index grades 1-6] was exercised. Bone mineral density and T-score were determined on DEXA. Sensitivity and specificity of each assessed was determined against the gold standard T-score. There were 98 patients in all with mean age of 59 +/- 6.5 years and mean post menopausal interval of 9.66 +/- 6.52 years. The predominant distribution was, 26.5% in grade 6 and 31% in grade 3. Nineteen had normal T-score [>-1], 49 were osteopenic [T- score between -1.00 and -2.5] and 30 were osteoporotic with T-score below -2.5. For grade 3 and below, the sensitivity and specificity of Singh index [SI] were 55% and 84% respectively. For SI grades 4 and above, the values were 44% and 97% respectively. Singh index or radiographic morphometry grading of osteoporosis is fairly accurate for advanced osteoporosis with high specificity. The sensitivity is low requiring use of bone densitometry for early detection

Situs ambiguous

The case of a female child is described who presented with recurrent respiratory infections and 'recurrent right subphrenic abscess". Detailed radiological work-up identified situs ambiguous abdominis with bronchiectasis, duodenal malrotation, umbilical hernia and spina bifida