Review on diagnosis and molecular characterization of Toxoplasma gondii in humans and animals

@#Toxoplasma gondii is an obligate intracellular protozoon which causes toxoplasmosis, an important zoonotic disease that is endemic worldwide. Common sources of T. gondii infection in humans are food or water contaminated with oocysts and raw or undercooked meat with cysts. In animals, common sources of infection include feed, water, or litter contaminated with oocysts. The diagnosis and molecular characterization of T. gondii infection in humans and animals is crucial due to public and veterinary health importance. Various traditional and serological methods have been used in clinical practice for toxoplasmosis diagnosis, but interpreting the results remains a challenge. Several molecular techniques have also been used for the detection and genetic characterization of T. gondii, but primarily in research settings. In this paper, we review the techniques that are currently used for the diagnosis and genetic characterization of T. gondii in humans and animals, along with their advantages and disadvantages. The techniques reviewed have laid the groundwork for the future development of more effective and precise detection and characterization of T. gondii. These advances will contribute to a better understanding of epidemiology, prevention and control of toxoplasmosis. Thus, this review would be of particular interest to clinical physicians, veterinarians and researchers.

Isolation and characterisation of human gingival margin-derived STRO-1/MACS(+) and MACS(-) cell populations / 国际口腔科学杂志·英文版

Recently, gingival margin-derived stem/progenitor cells isolated via STRO-1/magnetic activated cell sorting (MACS) showed remarkable periodontal regenerative potential in vivo. As a second-stage investigation, the present study's aim was to perform in vitro characterisation and comparison of the stem/progenitor cell characteristics of sorted STRO-1-positive (MACS⁺) and STRO-1-negative (MACS⁻) cell populations from the human free gingival margin. Cells were isolated from the free gingiva using a minimally invasive technique and were magnetically sorted using anti-STRO-1 antibodies. Subsequently, the MACS⁺ and MACS⁻ cell fractions were characterized by flow cytometry for expression of CD14, CD34, CD45, CD73, CD90, CD105, CD146/MUC18 and STRO-1. Colony-forming unit (CFU) and multilineage differentiation potential were assayed for both cell fractions. Mineralisation marker expression was examined using real-time polymerase chain reaction (PCR). MACS⁺ and MACS(-) cell fractions showed plastic adherence. MACS⁺ cells, in contrast to MACS⁻ cells, showed all of the predefined mesenchymal stem/progenitor cell characteristics and a significantly higher number of CFUs (P<0.01). More than 95% of MACS⁺ cells expressed CD105, CD90 and CD73; lacked the haematopoietic markers CD45, CD34 and CD14, and expressed STRO-1 and CD146/MUC18. MACS⁻ cells showed a different surface marker expression profile, with almost no expression of CD14 or STRO-1, and more than 95% of these cells expressed CD73, CD90 and CD146/MUC18, as well as the haematopoietic markers CD34 and CD45 and CD105. MACS⁺ cells could be differentiated along osteoblastic, adipocytic and chondroblastic lineages. In contrast, MACS⁻ cells demonstrated slight osteogenic potential. Unstimulated MACS⁺ cells showed significantly higher expression of collagen I (P<0.05) and collagen III (P<0.01), whereas MACS⁻ cells demonstrated higher expression of osteonectin (P<0.05; Mann-Whitney). The present study is the first to compare gingival MACS⁺ and MACS⁻ cell populations demonstrating that MACS⁺ cells, in contrast to MACS⁻ cells, harbour stem/progenitor cell characteristics. This study also validates the effectiveness of the STRO-1/MACS⁺ technique for the isolation of gingival stem/progenitor cells. Human free gingival margin-derived STRO-1/MACS⁺ cells are a unique renewable source of multipotent stem/progenitor cells.

Intravascular catheter related infections and antimicrobial susceptibility pattern of isolated bacteria in a tertiary care hospital of Bangladesh.

The aim of this study was to evaluate the rate of bacterial colonisation and catheter related blood stream infections (CRBSI) together with the antibiotic susceptibility patterns in a tertiary care hospital. CRBSI was detected with semi-quantitative and quantitative methods. The antimicrobial susceptible patterns of the isolated organisms were performed by Kirby Bauer disk diffusion method. The rate of catheter colonisation and CRBSI were 42.1% and 14% (16.1/1000 catheter days) respectively. The most common causative pathogens were Pseudomonas sp. (23.7%), Acinetobacter sp. (18.4%), Staphylococcus aureus (13.2%) and Enterobacteriaceae (10.5%). The rate of isolation of methicillin resistance S. aureus, imipenem resistant Pseudomonas sp. and extended spectrum β lactamase producing Enterobacteriaceae were 60%, 44.0% and 100%. The result of this study would be useful for control and treatment of CRBSI.

Quality of antenatal care in primary health care centers of Bangladesh

To find out the quality of ANC in the Upazila Health Complexes [PHC centres] of Bangladesh. This cross sectional study was done in purposively selected three upazilas among the clients receiving antenatal care [ANC]. Data were collected with questionnaire cum checklist in the context of two aspects of quality issues, namely assessment of physical arrangements for ANC [input] and services rendered by the providers [process]. The mean age of respondents was 24.6 +/- 4.5 years. Majority of the respondents were with primary level education [60.3%]. About half [52.8%] of the families had monthly income ranging from 3000-5000 taka [38-64 US$]. Nearly half [48.9%] had no child, little more than one third [42.3%] were primigravida and 528 [57.7%] were multigravida. Out of 528 multigravid respondents 360 [68.2%] took ANC in their previous pregnancy whereas 168 [31.8%] did not take ANC Pregnancy outcome was found to be associated with receiving ANC [? [2] =73.599; p=0.000]. Respondents receiving ANC had more good pregnancy outcome. The mean waiting time for receiving ANC was 0.77 +/- .49 hours. Out of the 13 centers, only 3 [23.1%] have sufficient instruments to render ANC services. Findings showed that where the modes of ANC service delivery in the ANC centers are fairly satisfactory. Though some of the points of standard operation procedures [SOPs] on ANC are not covered by some ANC centers, those were not considered necessary. But, regarding the physical facilities available for rendering ANC services, it is seen that facilities are not quite satisfactory. Number of doctors and nurses are not very satisfactory. One of the centers under this study has no doctor, where ANC services are given by nurses. It can be concluded that the ANC services at the primary health care level is not adequate in Bangladesh. To ensure further improvement of the quality of ANC services, instruments used in logistics and supplies should be enhanced

Gender Differentials In Nutritional Status of Elderly People In Selected Rural Areas of Bangladesh.

Background: The present cross sectional study was undertaken to assess the food habits and nutritional status among elderly people in rural Bangladesh and to compare the same between male and female. A simple random sampling and geographical re-conciliation method was used to select the study population. All the patients in a pre-publicized medical camp were approached and a total of 186 male and 237 female participated in the study. Data were collected through face to face interview with a semi-structured questionnaire and anthropometric measures were collected using instruments. Associations between dietary intake and World Health Organization (WHO) referred Body Mass Index (BMI) range was done using cross tabulation. Results: The mean age of male was 67.69 years and that of female was 65.46 years. The female subjects were higher than males in number in this study. The rate of male literacy was found to be 39.8% where literacy among the female was 13.9%. Among all, 79.6% males were found to be living with their spouse where the rate of living with spouse among the female amounted 53.2%. About half of elderly people were found to be living under poor and 32% in low middle class socio-economic condition. Study revealed that 80.6% male and 78.9% female got no opportunity to take protein-rich food more than three days per week. Again 95.7% male and 97.5% female had no opportunity take more than two servings of protein rich food per week. The similar case occurred in case of taking fatty food, vegetable and fruits per week. Similarly 100 % male and 99.6% female reported that they were taking more than two servings of fatty food per week. No significant association was found between BMI and food intake. The significance was tested by Pearson chi-square. In this test the p –value for protein rich food was 0.234 (p?0.05), while fatty food (0.712), vegetable (0.502) and fruits (0.274) which was more than referred significance p-value ?0.05. Hence, the study confirmed that malnutrition remains a common problem among older people living in rural Bangladesh though there is no significant association was found between food intake and nutrition. Conclusion: Management of malnutrition in case of elderly population requires a multidisciplinary approach that treats pathology and uses both social and dietary forms of intervention.

Unmet needs of family planning and practice of family planning in a selected urban to rural migrated population of Dhaka city

To ascertain the unmet needs of family planning and identify the practice of family planning among the urban to rural migrated slum dwellers. A cross-sectional descriptive study was done randomly among selected 600 slum dwellers residing in two selected slums of Dhaka city. Data collected by face to face interview using pretested semi structured questionnaire. Among the respondents 87.7% of were females, illiterate was 60% and most [79.9%] of the houses were katcha and [37.3%] of the families had 5-7 persons in each family. Most families [70%] had monthly income of less than 5000 [app.US$70] taka per month. Majority [89.3%] of the families lived in the villages before coming to Dhaka. About 31.34% were living in present slum for 5-10 years and 80% came for search for better work. It was also found that 33.7% of the couples were not using any contraceptive method. About 29% of these couples did not mention any specific cause for not using family planning method. Only 3.5% of the respondents said of any sort of difficulty in collecting contraceptives and the main difficulty was shyness. As regards knowledge of above consequence of not using contraceptive method 97.7% opined that it would cause unplanned pregnancy, which indicated their awareness towards family planning. The study found that the respondents were aware about the needs of family planning but a great number of them were not using any contraceptive method without any specific reason. Some behavior change communication activities can be run within these areas to bring them under the family planning methods which eventually enhance the population control activity of the country

Plant stature of aromatic rice genotypes in the environment of Bangladesh.

Plant stature of a rice crop is an important selection criterion. As plant height is a quantitative trait it is influenced by environmental conditions. A field experiment was conducted with 40 rice genotypes to assess the fluctuation and stability of plant height in a series of 16 environmental situations. The effects of genotype (G), environment (E) and all the components of G×E interaction were highly significant. Among the genotypes, Jamai sohagi was extremely sensitive (bi = 1.37) to environmental changes, and indicating lowest adaptability over the environments. Plant height of seven genotypes viz. Basmati PNR346, Benaful, BRRIdhan28, BRRIdhan38, BRRIdhan39, Gandho kasturi and Neimat, having the bi values between 0.59 and 0.72, showed high stability against environmental changes. The other seven genotypes viz. Badshabhog, Basmati Tapl-90, Kamini soru, Khazar, Laljira, Sarwati and Ukni madhu expressed only nonlinear sensitivity (S2 di = 90 – 181)) and thus unpredictable fluctuation. Twenty one genotypes indicated their average stability (bi = 0.91 -1.15) over the environments.

Rare Case of Ruptured Sinus of Valsalva: Ruptured Into Left Ventricular Cavity.

Rupture sinus of Valsalva is a relatively rare condition. We report a rare case of ruptured left sinus of valsalva with aneurysm, presenting with acute left ventricular failure. Transthoracic echocardiography showed an aneurysmal dilatation of the base of interventricular septum and part of the aortic root and a marked turbulent flow from the aortic root to the left ventricle with a continuous systolodiastolic shunting. The patient underwent successful repair of ruptured sinus of valsulva with closure of fistula. During Ventriculotomy the defect was repaired using pledgeted 5/ 0 prolene interrupted sutures and pericardial patch.

Risk factor Analysis and Angiographic Profiles in First 228 Cases Undergone Coronary Angiography in Cardiac Cath Lab of Dhaka Medical College Hospital.

Background: Coronary artery diseases are one of the major challenges faced by cardiologists. Control of certain risk factors for CAD is associated with decrease in mortality and morbidity from myocardial infarction and unstable angina. So, identification and taking appropriate measures for primary and secondary prevention of such risk factors is, therefore, of great importance. This retrospective study was carried at the newly set up cath lab in Dhaka Medical college. Materials and Methods: Total 228 consecutive case undergone diagnostic coronary angiogram from 10th January 2007 to31st January 2009 out of which 194(80%) were male and 34 (20%) were female. In both sexes most of the patients were between 41 to 60 years of age. Risk factors of the patients were evaluated. Results: In females commonest risk factor was Diabetes (58.8%) followed by dyslipidaemia (35.3%). In males commonest risk factor was hypertension (30.9%) followed by smoking (29.9%) and diabetes (28.3%). In males 44.3% patients presented with acute myocardial infarction followed by stable angina (43.3%); but in females stable angina was the commonest presentation (50.0%) followed by myocardial infarction (38.2%).CAG findings revealed that in males 33.5% had double vessel disease 26.8% followed by single vessel 26.8% and multivessel disease 25.3%. In females normal CAG was found in 35.5% followed by double vessel 23.5%, multivessel 20.6% and single vessel 20.6%. On the basis of CAG findings; in males 41.8% patients were recommended for CABG, followed by PTCA & stenting 26.3% and medical therapy 30.0%; where as in females 55.9% were recommended for medical therapy , followed by CABG 32.4% and PTCA & stenting11.8%. Conclusion: The commonest presentation of CAD was 4th and 5th decades in both sexes. Diabetes and dyslipidaemia were more common in females whereas hypertension and smoking were more common in males. Myocardial infarction and stable angina were most common presentation in both sexes though in males myocardial infarction was more common. In males the angiographic severity of CAD was more and they were more subjected for CABG in comparison to females.

Pheochromocytoma with hypertensive crisis due to glucocorticoid administration: a case report and review of the literature.

We report a patient who presented with single episode of severe hypertension after intramuscular injection of betamethasone which was given to treat acute exacerbation of bronchial asthma. Episode of severe arterial hypertension was associated with pulmonary edema, acute renal failure and hyperkalemia. Further evaluation by appropriate diagnostic tests revealed that the patient is a case of phaechoromocytoma. This neoplasm was excised successfully and the patient is presently asymptomatic.We believe that this episode was initiated by glucocorticoid injection.

Study of Association of C- Reactive Protein with Coronary Collateral Development.

Background: In vitro studies have shown that C-reactive protein ( CRP ) attenuates nitric oxide production and inhibits angiogenesis, which may result in impaired collateral development. The aim of this study was to investigate the association between CRP levels and the extent of coronary collaterals. Materials and methods: A total of 100 patients who had a stenosis of >95% in any major coronary artery in angiograms were included in the study. The CRP was measured from a venous blood sample with a high- sensitivity assay. Collaterals of the epicardial coronary arteries were then studied and graded in a scale of 0 - 3 according to Rentrop classification. Results: Mean age was 49.6 years and 86% were male. The mean CRP level was found 15.57 ±12.85 mg/L in grade 0 (n =25 ), 11.38± 11.11 mg/L in grade I( n=20 ), 9.22± 10.15 mg/L in grade II ( n=34 ) and 8.97±8.44 mg/L in grade III ( n =21 ) collateral group. The mean CRP values reduced significantly (p<0.05) as the Rentrop collateral grade increased which indicated that patients with a higher grade of collaterals significantly had less CRP. Subjects with a higher grade of collaterals were significantly less likely to have diabetes mellitus [odds ratio (OR): 0.53, 95%; CI: 0.13, 0.91] or acute coronary syndrome [ odds ratio (OR) :0.67 , 95%; CL 0.43, 0.95] or higher CRP values [odds ratio (OR) 0.56 per 10 unit increase, 95%; CL 0.22, 0.92] but they were more likely to have higher number of vessels with significant stenosis [odds ratio (OR) : 1.59 ; 95% CI: 1.34, 1.87]. After adjusting for age, gender, clinical presentation with acute coronary syndrome, diabetes mellitus and the number of vessels with significant stenosis, each 10-unit increase in CRP values corresponded to 39% reduced- odds of having a higher collateral grade ( OR: 0.61, 95%: CL0.1 1,0.68). Conclusion: It may be concluded that elevated levels of CRP are significantly and inversely associated with angiographically visible coronary collateral development assessed by Rentrop classification.

Hypertension in Yemeni patients with type II diabetes and its association with vascular complications

Diabetes Mellitus [DM] and its complications are a common problem among Yemeni population. Hypertension is commonly associated with type II DM. Both are risk factors for vascular complications. This study was designed to assess the prevalence of hypertension in Yemeni patients with Type II DM, and its association with macrovascular and microvascular complications. The aim of this study is to determine the prevalence of hypertension among Yemeni patients with diabetic Type II, and its association with vascular complications of DM. A Cross Sectional Study was carried out in Al-Thawra Hospital, between June to December 2007. A total of one hundred eighty-nine adult patients with Type II DM were included in the study. The diagnosis of Diabetes was based on the WHO criteria, while the diagnosis of hypertension was based on the criteria of the fifth Joint National Committee [JNC-5]. The patients were divided into two groups: with and without hypertension, and their clinico-laboratory parameters were studied and analyzed. The mean age was 55.6 +/- 10.2 years, and mean BMI was 22.61 +/- 3.6 kg/m[2]. The mean time duration of DM was 8.9 +/- 6.3 years. The prevalence of hypertension in Type II diabetic patients was 55% [N = 104 patients]. No significant differences were observed in the duration, sex and BMI of both groups. Hypertension was significant in the elderly, low HDL cholesterol, and poor glycemic control group. The hypertensive diabetic groups were observed to have more ischemic heart disease [IHD], diabetic nephropathy, diabetic retinopathy and peripheral neuropathy than the normotensive diabetics. Hypertension is common among Yemeni patients with Type II DM. It's associated with increased prevalence of both micro-and macro-vascular complications

Sporadic creutzfeldt Jacob disease

We report a 65-year-old lady who presented with rapidly progressive dementia and was found to have Creutzfeldt-Jacob disease [CJD]. On reviewing the literature, there have been only 3 case reports of CJD from Saudi Arabia. Our aim is to report this rare disease and to include it in the differential diagnosis of rapidly progressive dementia in our practice

Wilson's disease with hepatic presentation in childhood.

Diagnosis of Wilson's disease with hepatic presentation in childhood using clinical and common laboratory parameters is still challenging and is often missed or delayed. The aim of the study was to document the clinical and laboratory parameters of hepatic presentation of Wilson's disease in children. The study was conducted at a tertiary-care hospital in a developing country. Clinical and common laboratory parameters were recorded in 32 Wilson's disease children with hepatic presentation. The diagnosis was based on positive family history, Kayser-Fleischer ring, low serum ceruloplasmin level, elevated basal urinary copper excretion and favorable response to therapy with D-penicillamine. Mean age+/-SD at presentation was 9+/-2.97 years and 21 (65.6%) were boys. Chronic liver disease (21; 65.6%) followed by fulminant hepatic failure 1(6; 18.8%) were the commonest presentation. In the whole group, Kayser-Fleischer ring was found in 21 (65.6%), low serum ceruloplasmin in 16 (50%) and elevated basal urinary copper excretion in all 32 (100%) children. Diagnosis of Wilson's disease was made at presentation on the basis of i) Kayser-Fleischer ring, low serum ceruloplasmin, elevated basal urinary copper excretion and favorable response to D-penicillamine therapy in 11 (34.4%), ii) Kayser-Fleischer ring, elevated basal urinary copper excretion and favorable response to D-penicillamine therapy in 10 (31.2%), iii) elevated basal urinary copper excretion and favorable response to D-penicillamine therapy in 6 (18.8%) and iv) low ceruloplasmin, elevated basal urinary copper excretion and favorable response to D-penicillamine therapy in 5 (15.6%) children. Wilson's disease can not be excluded in children presenting with hepatic involvement using the commonly practiced clinical and laboratory parameters. A combination of various clinical and laboratory parameters were used for the diagnosis of Wilson's disease in the studied children with hepatic presentation.

Male urethral cancer.

A 55 years old man presented with long standing voiding obstructive symptoms like poor stream, frequency of micturition, straining at micturition and a sense of incomplete evaluation since 2002. He was clinically diagnosed a case of stricture urethra. Later he developed a swelling in the penoscrotal region with retention of urine in March 2005 and was treated by dilatation. But on removal of the catheter he developed retention again for several times and ultimately for gross periurethral sepsis, urinary diversion was required in May 2005. In October 2005, biopsy from the scrotal abscess wall established the diagnosis of urethral carcinoma. In November 2005 extensive penoscrotectomy was done followed by chemo-radiotherapy. But the prognosis was so bad that the patient died in November 2006. Urethral carcinoma is a rare disease diagnosed in the department of urology, Mymensingh Medical College Hospital, the prognosis of which is also poor even after extensive operations.

Management of external hernias: analysis of 1020 [corrected] cases.

A prospective study was done to find out the incidence of different external hernias, identify the predisposing factors and type of repair performed. Over a period of 8 years, 1020 patients were admitted with different varieties of external hernias in Chittagong Medical College Hospital. Among them 743 patients had inguinal hernia, 130 had incisional hernia, 58% had indirect inguinal hernia, 29% had direct inguinal hernia, Bilateral inguinal hernia was present in 13% cases. 272 (32.08%) presented with complications like, irreducibility, obstruction, strangulation, 576 (67.92%) was admitted from out-patient department for elective operation. 97.04% of patients with inguinal hernia were male, 2.96% of patients were female. But among incisional hernia 77.70% are female and 22.30% are male patients. The highest incidence of both inguinal hernia and incisional hernia were found in 4th decade of life. Predisposing factors could be identified in 42.06% cases. 90.76% patients approached doctors for advice after 6 months of noticing hernia only 36.37% could mention the cause of delay. Out of 1020 patients (812) 72.18% patients underwent different operations. 2.5% patients were inoperable due to associated disease like Ca-liver, IHD, renal transplant, CLD, uncontrolled DM. Others refused or absconded, being afraid of operation. Effort for post operative follow up was not very satisfactory as only a small number could be followed for a limited period.

Aneurysmal bone cyst of sphenoid bone--a case report.

Aneurysmal bone cysts of the skull are rare and involvement of sphenoid bone is even less frequent. We present X-ray, CT, MR imaging and histopathologic findings of an aneurismal bone cyst of the sphenoid in a 15-years old female adolescent. Radiological findings of the aneurysmal bone cyst of the skull were highly suggestive of the diagnosis and that were confirmed by histopathologic analysis.

Chronic renal failure in children.

The study was carried out to see the etiology and outcome of chronic renal failure in children. It is a prospective study, carried out to evaluate all new cases of CRF in children < 15 years in nephrology unit of BSMMU from May 2000 to May 2002. Diagnosis of CRF was based on Ccr < 75 ml/min/m(2) along with other features of CRF with no evidence of recovery over ensuing three months. A total of 44 children with CRF having mean age of 8.73 3.56 years were diagnosed during study period, among them, 30 cases (68.19%) were male and 14 cases (31.81%) were female. Causes of CRF were obstructive uropathy in 24 cases (54.55%) followed by glomerular diseases in 15 cases (34.9%), hereditary disorders in 3 cases (6.81%), and reflux nephropathy in 2 cases (4.54%). At presentation, 13 (29.55%) children had mild to moderate CRF and 31 (70.45%) children had severe CRF and ESRD. Mean follow up period was 32.3 weeks. At the end of the study period, 8 patients of mild to moderate CRF were on conservative treatment, 6 patients of severe CRF and ESRD group attended for maintenance dialysis irregularly of which 3 died at hospital and rest of the patients did not attend at follow up due to financial reason or opted against IPD. In the present study, majority of the children with CRF is due to treatable obstructive uropathy; mostly PUV and most of them presented with advanced renal disease.

A study of effects of acid activated saw dust on the removal of different dissolved tannery dyes (acid dye) from aqueous solutions.

The effectiveness of acid activated sawdust in absorbing D-Brown EGP and Lurazol Brown PM dyes from aqueous solutions was studied as a function of agitation time and initial dye concentration. The experimental data were fitted to Langmuir and Freundlich isotherm and found that adsorption process follows both the isotherms. The values of Langmuir and Freundlich constants indicate favorable and beneficial adsorption. Saw dust is an excellent low cost adsorbent of colored organic anions and may have significant potential as a color removal from tannery wastewater.

Correlation of serum parathormone level with biochemical parameters in chronic renal failure.

A prospective study was carried out to assay the level of serum intact parathormone and its correlation with biochemical parameters in patients with chronic renal failure (CRF). The study included 64 children (44 with CRF, and 20 age and sex matched controls). Serum intact parathormone (iPTH), serum creatinine, urea, calcium, inorganic phosphate and alkaline phosphatase were estimated. Creatinine clearance (Ccr) was estimated by Schwartz formula. Patients with CRF were divided into four groups based on their Ccr (mild CRF with mean Ccr 59.17 +/- 1:18.53 mL/min/1.73 m2 (n = 6) moderate CRF with mean Ccr 34.98 +/- 7.75 mL/min/1.73 m2 (n = 7); severe CRF with mean Ccr 17.71 +/- 5.40 mL/min/1.73 m2 (n = 15); and end-stage renal disease with mean Ccr 6.46 +/- 1.71 mL/min/1.73 m2 (n = 16). Mean serum iPTH levels were 93.00 +/- 46.62 pg/mL in CRF and 16.52 +/- 9.35 pg/mL in controls. Groupwise mean serum (iPTH) levels were 48.50 +/- 4.76, 67.29 +/- 7.91, 82.42 +/- 9.67 and 130.66 +/- 58.74 pg/mL in mild, moderate, severe CRF and endstage renal failure respectively. Mean serum iPTH level of CRF (93.00 +/- 46.42 pg/mL) negatively correlated with mean Ccr (22.02 +/- 18.53 mL/min/l.73 m2) (P < 0.001) and mean serum calcium (7.30 +/- 1.02 mg/dL) (P < 0.001) and positively correlated with mean inorganic phosphate (5.76 +/- 1.1 mg/dL) (P < 0.05) and mean alkaline phosphatase (355.14 +/- 185.53 UL) (P < 0.001). We conclude that increased iPTH level occur even early in the course of CRF and progressive hypocalcemia and hyperphosphatemia are the initiating factors for the development of hyperparathyroidism.