ABSTRACT
Aims: The aim of this study was to find out the involvement of renal dysfunction in people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLHA) in India. Study Design: Observational study. Place and Duration of Study: Total (n=150) consecutive HIV positive patients between November 2012 - April 2014, who were attending the ART Clinic or were admitted in Department of Medicine at University College of Medical Sciences and Guru TegBahadur Hospital, Delhi, India were recruited for the study. Methodology: Estimated glomerular filtration rate (eGFR) was calculated by using Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Morning spot urine samples were collected for urine albumin and urine creatinine test. Albumin/creatinine ratio (ACR) was calculated by using urine albumin and urine creatinine and were expressed in mg/g creatinine. Results: The mean eGFR (MDRD) of the study subjects was found 106.8±20.72 mL/min/1.73 m2 and a statistically significant difference was observed between male and female subjects (p = 0.039). The mean eGFR (CKD-EPI) of the study subjects was found 107.53±18.50 mL/min/1.73 m2, however, no significant difference was observed between male and female subjects (p = 0.745). The micro/macro-albuminuria (urinary ACR ≥ 30 mg/g creatinine) was found in 18 (12%) patients and leucocyturia and hematuria was found in 12.7% and 5% patients respectively. The median CD4 counts of the study subjects was 341 (222-467) cells/ mm3 and 141 (94%) were taking highly active anti-retroviral therapy (HAART). The most common HAART regimens were zidovudin/ lamivudine/nevirapine (ZLN) and tenofovir/ lamivudine/ nevirapine (TLN); 60.7% & 26.0% respectively. Hepatitis B and C co-infection rate found among subjects was 4% and 3.3% respectively. Conclusions: In conclusion, the prevalence of deranged renal functions as indicated by eGFR and urinary ACR is common in PLHA in North India. All HIV infected patients must undergo renal function tests including urinary ACR to detect the renal involvement at early stage.
ABSTRACT
PRASHANT MAHAJAN, PRERNA BATRA1, BINITA R SHAH2, ABHIJEET SAHA3, SAGAR GALWANKAR4, PRAVEEN AGGRAWAL5, AMEER HASSOUN2, BIPIN BATRA6, SANJEEV BHOI5, OM PRAKASH KALRA7 AND DHEERAJ SHAH1 From Department of Pediatrics and Emergency Medicine, Wayne State School of Medicine, Michigan, 2Department of Emergency Medicine, SUNY Downstate Medical Center, New York, 4University of Florida, Department of Emergency Medicine, Jacksonville, Florida, USA; Departments of 1Pediatrics and 7Medicine, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, 3Department of Pediatrics, Post Graduate Institute of Medical Education and Research and Ram Manohar Lohia Hospital, 5Department of Emergency Medicine, All India Institute of Medical Sciences, and 6National Board of Examinations, New Delhi, India. Correspondence to: Dr Prerna Batra, Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Dilshad Garden, Delhi 110 095, India. drprernabatra@yahoo.com W H I T E P A P E R The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine (MD) in Emergency Medicine (EM) as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3- year superspeciality course (in PEM) after completion of MD/Diplomate of National Board (DNB) Pediatrics or MD/DNB in EM. The National Board of Examinations (NBE) that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program – DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG-ACEE-India) gives its recommendations for starting 3-year DM/DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.
ABSTRACT
Association of diabetic nephropathy (DN) with the deletion of GSTT1 and GSTM1 genes is well reported. Oxidative stress (OS) has also been associated with the development of DN. The present study was conducted to find out, whether these deletions had any contributory role in the development of OS in patients with DN. Pre-dialysis venous blood samples were obtained from 60 patients with diabetic end-stage renal disease (stages 4 and 5). Reduced-glutathione (GSH), glutathione S-transferase (GST) activity and malondialdehyde (MDA) levels were measured for the assessment of OS. Genetic polymorphism analysis of DN patients revealed the following distribution pattern: GSTM1 null 46.7%; GSTT1 null 55%; both null 30% and both positive 28.3%. Patients with both null genotypes were found to have significantly increased levels of MDA and low GST activity as compared to other genotypic groups. Lower GSH levels were observed in all the genotypic groups as compared to both positives. Double deletions involving GSTT1 and GSTM1 may result in decreased GST levels, leading to increased OS as reflected by increased MDA levels. As GST is a multi-functional enzyme involved in xenobiotic metabolism, this double null genotype population has a greater risk of development of DN. Further studies using increased sample size to find out the allelic distribution and their role in the development of DN are in progress.