Rapid detection of acute kidney injury by urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass surgery

To determine the accuracy of neutrophil gelatinase-associated lipocalin [NGAL] in early detection of acute kidney injury [AKI] after cardiopulmonary bypass [CPB] surgery by comparing with serum creatinine. Descriptive study. Department of Chemical Pathology and Endocrinology, AFIP in collaboration with AFIC/ NIHD, Rawalpindi, from April to December 2011. Eighty eight patients undergoing CPB surgery in AFIC/NIHD were included by consecutive sampling. Blood samples of subjects for serum creatinine analysis were drawn pre-operatively, 4 h, 24 h and 48 h after CPB surgery. Spot urine samples for NGAL were collected at 4 h after CPB surgery. Urine samples were analyzed on Abbott ARCHITECT i2000SR analyzer whereas serum creatinine samples were measured on Beckman UniCel DxC 600 Synchron Clinical System. Out of 88 patients, 11 [13%] cases developed AKI 4 h postoperatively. Urinary NGAL increased markedly at 4 h postoperatively as compared to serum creatinine which showed rise at 24 - 48 h after cardiac surgery. Analysis of urine NGAL at a cutoff value of 87 ng/ml showed area under the curve of 0.91 [95% confidence interval [Cl] 0.83 - 0.96] with sensitivity of 90.9% [95% Cl 58.7 - 98.5] and specificity of 98.7% [95% Cl 92.9-99.8]. There was a positive correlation of 4 h urine NGAL and serum delta creatinine at 48 h, which was statistically significant [r[s] = 0.33, p = 0.001]. The study demonstrated that levels of urine NGAL in patients suffering from AKI increased significantly at 4 has compared to serum creatinine levels. Urine NGAL is an early predictive biomarker of AKI after CPB

Comparison of urine with plasma neutrophil gelatinase-associated lipocalin in detecting acute kidney injury after cardiopulmonary bypass surgery

To compare the accuracy of urine with plasma neutrophil gelatinase-associated lipocalin [NGAL] in early detection of acute kidney injury [AKI] following cardiopulmonary bypass [CPB] surgery. A prospective cohort study. Department of Chemical Pathology and Endocrinology, AFIP from December 2011 to July 2012. Ninety three adult patients planned for CPB surgery in AFIC/NIHD were consecutively included. Blood for serum creatinine were collected preoperatively, 4, 24 and 48 hours [h] after CPB surgery. Blood and urine samples for NGAL analysis were collected only at 4 h. Serum creatinine, plasma and urine NGAL samples were analyzed on UniCel[R] DxC 600 [Beckman], TRIAGE meter pro [Biosite] and ARCHITECT i2000SR analyzer [Abbott] respectively. Out of 93 patients undergoing CPB surgery, 12 [13%] developed AKI. AKI patients had significantly higher median interquartile range [IQR] urine NGAL of 180 ng/ml [105-277 ng/ml] as compared to control of 6 ng/ml [2-15 ng/ml] and median plasma NGAL of 170 ng/ml [126-274 ng/ml] as compared to control of 75 ng/ml [61-131 ng/ml]. The patients had increased urine vs plasma NGAL area under curve [AUC] [0.91 vs 0.70 [p = <0.001]], better sensitivity [91% vs 82%] and specificity [98% vs 65%]. Plasma and urine NGAL values increased significantly in AKI patients as compared to serum creatinine values. Urine in comparison to plasma NGAL revealed more sensitivity and specificity in detecting AKI following CPB surgery

Role of cephalometery in evaluation of vertical dimension

The objective of the present study was to determine the vertical dimension by comparing hard and soft tissues through lateral cephalographs. To show that these measures are compatible with the routinely used methods plus records for future complete denture fabrications. It is a descriptive study and was carried out at the Prosthodontic Department of Lahore Medical and Dental College, Lahore from July 2011 to January 2012. A total of twenty completely edentulous patients of both genders were selected and age range was 40 years and above. Demographic data and informed consent of all the patients were obtained. The exclusion criteria included any facial asymmetry, congenital and acquired orofacial deformity and patients not willing to undergo radiography. The cephalographs of each patient was carried out at 2 stages, before and after the insertion of the complete dentures. With the help of lateral cephalographs the hard and the soft tissues were compared. The Rickets cephalometric analysis was to analyze the hard tissues from both the first and second lateral cephalographs for measuring the vertical dimension. The Burstone analysis was used to analyze the soft tissues. The results of the present study showed that the pre and post difference of the skeletal proportions when compared from both the cephalographs was insignificant .Furthermore the stability in the skeletal vertical dimension was observed in Pakistani population. In addition the soft tissue proportions remained near 1 [G-Sn/Sn-Me]. It was concluded that the lateral cephalographic method can be used to evaluate the vertical dimension in the Pakistani population and is complementary to the routinely used methods for the complete denture fabrication

Compliance, frequency of target INR achievement and complications in patients on long term oral anticoagulant therapy

To assess compliance and achievement of target international normalized ratio [INR] in patients with a broad range of indications for long term oral anticoagulant therapy [OAT] with warfarin. Case-review of 50 patients on long term OAT. Department of Cardiology, Shifa International Hospital, July 2004-Dec 2004. Medical records of 50 patients on long term OAT for at least six months and being followed in the cardiology outpatient department [OPD] were reviewed. Data was collected and analyzed for indication for OAT, frequency of INR check, target INR achievement and subsequent complications. Descriptive statistics were used to detect frequencies. Out of a total of 50 patients, 30 [60%] were male and 20 [40%] were female. Majority of the patients [61%] belonged to the cities of Islamabad and Rawalpindi. 40.9% of the patients were getting their INR checked every 1-2 months. 20.5% were getting it checked every 2-4 months and a third [38.6%] was having their INR checked more than 4 months apart. Commonest indications for OAT were atrial fibrillation alone [25%], prosthetic heart valve alone [29.5%] or both [20%]. Average INR values were between 1-2 in 17 [38.6%], between 2-3 in 22 [50%] and more than 3 in 5 [11.4%] patients. Major complications occurred in 2 [4.6%] patients only. Majority of the patients on long term OAT were getting their INR checked latter than recommended with a third of the patients with INR checks more than 4 months apart. More than a third of the patients did not achieve their target INR. However, despite these suboptimal results, major complications occurred very infrequently