Histological Spectrum of Clinical Kidney Disease in Type 2 Diabetes Mellitus Patients with special Reference to nonalbuminuric Diabetic Nephropathy: A Kidney Biopsy-based Study

Background: Diabetic nephropathy (DN) is an important and catastrophic complication of diabetes mellitus (DM). Kidney disease has heterogeneity in histology in diabetes patients and includes both diabetic kidney disease (DKD) (albuminuric or nonalbuminuric) and nondiabetic kidney disease (NDKD) either in isolation or in coexistence with DN. Diabetic nephropathy is hard to overturn. While NDKD is treatable and reversible. Materials and methods: We enrolled a total of 50 type 2 diabetes mellitus (T2DM) patients with clinical kidney disease, of both genders and age >18 years, who underwent kidney biopsy from October 2016 to October 2018. Patients with proteinuria <30 mg per day were excluded from the study. The indications of the renal biopsy were nephrotic syndrome (NS), active urinary sediment, rapid decline in renal function, asymptomatic proteinuria, and hematuria. Result: A total of 50 (males: 42 and females: eight) patients with T2DM who underwent kidney biopsy were enrolled. The clinical presentation was: NS 26 (52%), chronic kidney disease (CKD) 11 (22%), asymptomatic proteinuria and hematuria six (12%), acute kidney injury (AKI) four (8%), and acute nephritic syndrome (ANS) three (6%). Diabetic retinopathy (DR) was noted in 19 (38%) cases. Kidney biopsy revealed isolated DN, isolated NDKD, and NDKD superimposed on DN in 26 (52%), 14 (28%), and 10 (20%) cases, respectively. Idiopathic membranous nephropathy (MN) (4) and amyloidosis (2) were the most common forms of NDKD, whereas diffuse proliferative glomerulonephritis (DPGN) was the main form of NDKD superimposed on DN. Diabetic nephropathy was observed in 15 (79%) cases in presence of DR and also in 11 (35.5%) cases even in absence of DR. Of eight patients with microalbuminuria four (50%) cases have biopsy-proven DN. Conclusion: About 48% of patients had NDKD either in isolation or in coexistence with DN. Diabetic nephropathy was found in absence of DR and in patients with a low level of proteinuria. The level of proteinuria and presence of DR does not help to distinguish DN vs NDKD. Hence, renal biopsy may be useful in selected T2DM patients with clinical kidney disease to diagnose NDKD.

Quality of Services in a Tertiary Care Hospital of Northern India: Geriatric Patient Perspective.

This study was planned with the objectives of studying the bio-social and morbidity pattern of elderly and to assess the quality of medical and non-medical services as perceived by elderly patients along with the health worker-patient relation.A Cross-Sectional Descriptive Study was conducted on elderly patients (>60 years) attending outpatient department of a tertiary hospital and residing in Lucknow. Total 242 subjects were selected from the entry gate of outpatient department. Most common morbidity in this age group is hypertension and eye related morbidity in urban area, while in rural area it was musculoskeletal and eye related morbidity. Elderly from Non Peri-urban area mostly perceived that the services rendered were average while majority of those living in Peri-urban area (51.5%) opined that the services rendered were good. Nearly half (44%) of urban elderly patients rated quality of services as average. While among rural elderly patients 42.6% rated quality of services as poor. However those from peri-urban area, 57.1% rated it as poor. Relation of quality of services of hospital with residence of elderly patients was statistically significant (p <0.05).Among elderly of urban area, most frequent morbidity was hypertension. total elderly patient from urban area one third perceived poor quality of services. While elderly patient of rural areas, majority had felt poor quality of service. About 57.1 percent of elderly patient of non peri-urban area had perceived poor quality of service followed by 28.6 percent of very poor quality of services. While of peri-urban area 40.9 percent had felt average quality of services followed by 34.8 percent with poor quality of services.

Factors Associated with the Preference for Delivery at the Government Hospitals in Rural Areas of Lucknow District in Uttar Pradesh.

For assuring safe maternal and newborn health, institutional delivery was given paramount importance. In India, in spite of several efforts, lesser than 40% deliveries are conducted at health facilities, mostly at private sector. The present cross-sectional study aimed to fi nd out the determinants of preference for delivery at government hospitals in rural areas of Lucknow, a district in Uttar Pradesh. Multistage random sampling was used for selecting villages. From them, 352 recently delivered women were selected, following systematic random sampling. Overall, 84.9% of deliveries were conducted at health institutions. Out of them, 79.3% were at government hospitals. Applying multivariate logistic regression, Hindu women (odd’s ratio [OR] = 3.205), women belonging to lower socio-economic class (OR = 4.630) and late registered women (OR = 2.320) were found to be more likely to deliver at government hospitals. Attention should be given to religion, social status and timing of registration for ensuring higher fraction of deliveries at government set-up.

Role of prescribers in the level of patient satisfaction: A study in public health care settings.

Aims: To assess the level of patient satisfaction with the various aspects of interaction of the health provider with the patient such as communication, examination and information regarding prescription in the allopathic public health facilities of Lucknow district. Settings and Design: Public health facilities of Lucknow district, India. Introduction: Satisfaction in service provision is increasingly being used as a measure of health system performance. The satisfaction with the service provider i.e., the prescriber is a vital component of the whole process of consultation and largely determines the compliance of the patient to the treatment prescribed. Apart from this, satisfaction also varies according to the sociodemographic characteristics of the beneficiaries. We have therefore tried to study these factors in the present study. Materials and Methods: Multistage stratified random sampling was used to select the health facilities while the patients were selected by systematic random sampling for the interview. Statistical Analysis: Number and percentages, mean and c2 test. Results: The overall satisfaction regarding the doctor patient communication and certain aspects of examination was highest for the residents (75.4%) followed by the super specialists (71.5%) and specialists (69.1%). Conclusions: The findings of the study will help us educate the prescribers about the various neglected areas of the consultation which will go a long way to develop a consistent relationship between the providers and the beneficiaries for the attainment of the "Health for All".

Molecular mechanisms and targets of cancer chemoprevention by garlic-derived bioactive compound diallyl trisulfide.

Health benefits of garlic and other Allium vegetables (e.g., onions), such as lipid lowering and anticancer effects, are credited to metabolic byproducts, including diallyl trisulfide (DATS). Evidence for anticancer effects of garlic derives from both population-based case-control studies, and clinical and laboratory investigations using purified garlic constituents such as DATS. Studies have shown that DATS can offer protection against chemically-induced neoplasia as well as oncogene-driven spontaneous cancer development in experimental rodents. Mechanisms underlying cancer chemopreventive effects of DATS are not completely understood, but known pharmacological responses to this natural product include alteration in carcinogen-metabolizing enzymes, cell cycle arrest, induction of apoptotic cell death, suppression of oncogenic signal transduction pathways, and inhibition of neoangiogenesis. This article reviews mechanisms and targets of cancer chemoprevention by DATS.

Client satisfaction with immunization services in urban slums of Lucknow District.

Objective. To assess the satisfaction of parents with the immunization services and its association with their sociodemographic characteristics. Methods. The study was a part of the coverage evaluation survey conducted using the WHO 30 cluster sampling methodology in the Urban slums of Lucknow district, north India. Analysis for a total of 388 respondents of completely or partially immunized children, was done to assess the level of satisfaction and its determinants. Results.The overall satisfaction was more than 90% in the respondents of both the categories of the children, however the difference between the satisfaction rates was found to be significant. Also the satisfaction with accessibility (p<0.04) and information given by the health worker (p<0.00) differed significantly between completely and partially immunized. Most of the sociodemographic factors were not found to have a significant association with the satisfaction related to different parameters of the immunization services. Conclusion. The dissatisfaction regarding the various aspects of immunization services emphasizes the imperative need to intervene, for the achieving the goal of universal immunization.

Non-familial juvenile polyposis with histological evidence of adenomatous transformation.

A 14-year-old male presented with abdominal pain, diarrhoea and a sensation of something prolapsing through the anus during defecation, and was found to have diffuse colonic polyposis. There was no evidence of mucocutaneous hyperpigmentation and family history was negative, suggesting a diagnosis of non-familial juvenile polyposis. Histological analysis of multiple endoscopic biopsies showed features typical of juvenile or retention type (hamartomatous) lesions: dilated cystic glands lined by mucocus-secreting epithelium and prominent, inflamed and congested lamina propria. However, admixed with these features, focal areas of atypical adenomatous changes were recognized. Even the intervening normal-looking colonic mucosa showed some dysplastic changes. These findings indicate that hamartomatous and atypical adenomatous epithelial changes can co exist in non-familial juvenile polyposis and the latter may confer a risk of malignant transformation in this otherwise non-neoplastic disease.