Comparison of calcium acetate with calcium carbonate as phosphate binder in patients on maintenance haemodialysis

Hyperphosphatemia is common in end-stage renal disease patients. Objective of this study is to compare the hypercalcaemic effect and phosphate binding power of calcium acetate and calcium carbonate in end-stage renal disease patients on maintenance haemodialysis. This randomised control trial was conducted in four phases with calcium acetate or calcium carbonate. Sixty-four patients on haemodialysis were randomly divided into 2 groups. After a washout period of 2 weeks, each group was given calcium acetate or calcium carbonate for 2 months. After another washout period the patients were crossed over and again received these drugs for 2 months. Serum Calcium, phosphate, and albumin were analysed on Selectra E auto analyser at completion of each phase of study. Hypercalcaemic effect was defined as serum calcium >2.54 mmol/l, and phosphate binding power as serum phosphate <1.61 mmol/l. Forty-one patients completed the study. Though lower dose of calcium acetate was used, it resulted in equally good control of hyperphosphatemia as compared with calcium carbonate therapy [1.37 mmol/l [SD 0.33] vs. 1.46 mmol/l [SD 0.34], p=0.16]. Incidence of hypercalcaemia was higher with calcium carbonate therapy [2.73 +/- 0.67 mmol/l vs. 2.32 +/- 0.28 mmol/l, p < 0.01]. Both drugs were well tolerated, but patients more frequently complained of muscle cramps while taking calcium acetate. It is concluded that calcium acetate has similar effect on serum phosphate levels as compared to calcium carbonate in patients on maintenance haemodialysis. However, calcium acetate results in lesser frequency of hypercalcaemia as compared to calcium carbonate. Tolerance to both drugs was similar, though patients complained of more muscle cramps while taking calcium acetate

Assessment of lipid dysfunction in patients on maintenance haemodialysis

Dyslipidaemia is a major risk factor of cardiovascular disease in patients on maintenance haemodialysis. Both increased and decreased levels of cholesterol are associated with increased cardiovascular mortality in haemodialysis patients. To assess the lipid dysfunction among patients on maintenance haemodialysis in a nephrology unit at Rawalpindi as compared with healthy individuals. A descriptive comparative study was carried out in a nephrology unit at Rawalpindi, Pakistan. A total of 140 subjects were included consisting of 70 patients on maintenance haemodialysis [MHD] and 70 healthy controls. Body mass index [BMI] was measured according to WHO guidelines. Serum total cholesterol [TC], triglycerides [TG] and high-density lipoprotein cholesterol [HDL-C] were assayed on chemistry analyser. Low-density lipoprotein cholesterol [LDL-C] was calculated by Friedwald equation. MHD patients had significantly lower BMI, mean [SD] 20.07[3.66] as compared with the controls 22.88[3.97] kg/m2 [p < 0.001]. The lipid profile among MHD patients and controls are given as mean [SD]: [a] Total Cholesterol 3.84[1.06] vs 4.65[0.97] [p < 0.001], [b] LDL-C 2.21[0.77] vs 2.93[0.71] [p < 0.001], [c] HDL-C 0.95[0.166] vs 0.97[0.138] [p=NS], [d] Non HDL 2.88[0.95] vs 3.67[0.88] [p < 0.0001], [e] Triglycerides 1.68[1.09] vs 1.69[0.86] [p=NS]. The most common abnormality observed in haemodialysis patients was low HDL-C [81%] followed by increased Non-HDL-C [23%] and increased serum triglycerides [19%]. It is concluded that our patients on maintenance haemodialysis have significantly low BMI, total Cholesterol, LDL-C and Non-HDL-C depicting malnutrition leading to inflammation, accelerated atherosclerosis process and cardiovascular complications

Stress hyperglycemia and mortality in patients with acute ischemic stroke

The objective of the study was to compare mortality and morbidity in patients of acute ischemic stroke presenting with and without stress hyperglycemia. A high proportion of patients suffering an acute stress such as stroke or myocardial infarction may develop hyperglycemia, even in the absence of a preexisting diagnosis of diabetes. This study was carried out in neurology units of Military Hospital Rawalpindi, and in Combined Military Hospital Rawalpindi, both are tertiary referral hospitals. The duration of study was from 1st March to 25th August, 2004. In the hyperglycemic group, out of 50 patients, 22 [44%] died within 04 weeks of stroke. In the control group, 10 [20%] out of 50 patients expired. The study showed a statistically significant relative risk of 2.2 in case of hyperglycemics as compared to normoglycemics. In the study group, mortality rate was higher in males, 14 [63%] out of 22 as compared to females of 8 [36.36%]. Even in survivors, functional outcome at 01 month was worse in the hyperglycemic group. Patients with stress hyperglycemia were 0.4 times less likely to improve as compared to normoglycemics. In non-diabetic patients suffering from an ischemic stroke, moderately elevated glucose levels were associated with a more than 2-fold higher risk of short-term mortality compared with lower glucose levels. Even in survivors, stress hyperglycemia was associated with a poor functional outcome after acute ischemic strokes

Emergence of metallo-beta-lactamase producing Pseudomonas aeruginosa in Pakistan

We report a case of urinary tract infection due to metallo-beta-lactamase producing Pseudomonas aeruginosa resistant to carbapenems. This report signals an ominous development. Unless curbed by judicious use of antibiotics and early detection by screening tests, spread of this plasmid-mediated resistance can render the carbapenems ineffective