Comparison of awareness about nephrology and kidney diseases amongst doctors in institutes with and without nephrology departments

To compare the awareness about nephrology and kidney diseases in medical officers and postgraduate trainee doctors working in institutes with and without nephrology departments. This cross sectional study was conducted at Nephrology Department, Shalamar Hospital Lahore from 1[st] Jan to 31[st] Mar 2013. Doctors working on medical floor with more than one year experience after house job were included in the study. Each doctor was given questionnaire comprising of 28 questions. Two hundred and eleven doctors fulfilling the criteria were included in the study. Most of the doctors were male 150[71.1%]. Knowledge had strong correlation with practice [p= 0.001]. Knowledge regarding nephrology and chronic kidney disease [CKD] was found significantly different among doctors of different hospitals [[F=36.09, p=0.000]. Practice regarding nephrology and chronic kidney disease [CKD] was found significantly different [F= 7.222, p=0.000]] among doctors of different hospitals of Lahore. Doctors working in the Shaikh Zayed Hospital [SZH], Lahore were having maximum score in the components of the knowledge and practice than other hospitals. Awareness of the Medical Officers and postgraduate doctors is poor regarding nephrology and kidney diseases. Doctors working in institutes with established nephrology services have better knowledge than other units. Working experience of doctors improve the practice significantly

Parathyroid hormone and magnesium levels in vitamin D deficient females

Vitamin D deficiency is a major health problem worldwide. In healthy subjects, vitamin D deficiency causes an increase in serum parathyroid hormone [PDH] level in response to hypocalcemia that in turn effectively restores serum calcium and phosphorus levels. However, the response in adult female in vitamin D deficient population in particular has not been studied especially in our set up. The objectives of this study were to determine the levels of iPTH and magnesium in vitamin D deficient adult females, among a sector of population living in a suburban area of Lahore. A total of 125 asymptomatic apparently healthy women [aged 20 - 60 years] were included in this study. Subjects were randomly selected from the Shalamar / Mughalpura area in Lahore. The research was started after taking permission from ethical committee of UHS. In a total of 125 subjects, 59 [47%] had deficient, 41 [33%] had insufficient and 25 [20%] had sufficient levels of vitamin D. The serum iPTH level in vitamin D deficient women was significantly higher and an inverse correlation existed between vitamin D and iPTH. Magnesium levels, on the other hand deteriorated only with severe deficiency of vitamin D. This study indicates that serum iPTH is a better marker of detection of low vitamin D states, as compared to serum calcium and phosphorus levels which remain normal. Furthermore, magnesium levels must be monitored in vitamin D deficiency because of its implications in bone metabolism, muscular and cardiac activity

Comparison of action exchange HPLC and immunoturbidimetric method for determination of HbA1c

The objective of this study was to compare and correlate the analytical performance of D10 Hemoglobin Testing System based on Cation Exchange HPLC and Roche Hitachi 902 Immunoturbidimetric method. Subjects and Methods: A total of 110 patients of Type 2 Diabetes Mellitus were included in the study. HbA1c was determined using D-10 Hemoglobin Testing system and Roche Hitachi 902 Analyzer. Both methods showed good correlation with the correlation coefficient [r] of 0.95. Between run Coefficient of variance was found to be lower for HPLC system compared to immunoturbidimtric method. HPLC method also produces a chromatogram that shows the different hemoglobin fractions, allowing identification of different hemoglobin variants. In the present study both methods showed good correlation but the D10 HPLC system provided adequate throughput and improved precision as compared to immunoturbidimetric method

Importance of polymerase chain reaction in diagnosis of pulmonary and extra-pulmonary tuberculosis

Pakistan ranks 8[th] on the list of 22 high-burden tuberculosis [TB] countries in the world according to the World Health Organization's [WHO] Global Tuberculosis Control 2009. Including other reasons the main cause is improper and late diagnosis of the disease. PCR may play an important role to control the disease with its rapid, sensitive and specific diagnosis. But in Pakistan due to lake of knowledge about this latest technique we are not using this technique appropriately. Clinicians still trust on conventional methods of TB diagnosis, which are time consuming or insensitive. The present study was arranged to highlight the importance of PCR in TB diagnosis in pulmonary and extra-pulmonary cases and its comparison with conventional methods. Samples obtained from 290 patients of suspected TB [pulmonary or extra-pulmonary] were subjected to ZN smear examination, LJ medium culture and PCR test by amplifying 541bp fragment of Mycobacterium tuberculosis complex genome. The present prospective study is performed at Shalamar Hospital Lahore from November 2008 to November 2010. A distinctly difference was observed in the test results done by PCR and other conventional techniques in pulmonary or extra-pulmonary tuberculosis samples [p<0.001]. The sensitivity of different tests was 68.62% for PCR, 26.90% for LJ medium culture, and 14.14% for ZN smear examination [p<0.05]. However, there was no significant difference between different tests as for as specificity was concerned. PCR test sensitivity in pulmonary and extra-pulmonary clinical samples was 78.34 and 61.76% respectively, being significantly higher [p<0.05] when compared with sensitivity of other tests. The mean detection time for M. tuberculosis was 25 days by LJ medium culture and less than 1 day by smear examination and PCR test. PCR test is more sensitive than ZN smear examination and LJ medium culture for the diagnosis of TB in pulmonary and extrapulmonary clinical samples

Percentage of CD4[+] and CD8[+] T-lymphocytes in blood of tuberculosis patients

Tuberculosis is a fatal infectious disease, mainly caused by Mycobacterium tuberculosis. Spread of TB is controlled by cell-mediated immunity. Purpose of this study was to determine CD4[+] and CD8[+] T cell percentages in TB patients. 77 subjects consisted of 39 patients of active tuberculosis and 37 normal healthy individuals were recruited for the study. Among patients, 27 were at different stages of anti-tuberculous therapy while rests of the patients were not taking treatment. Sixteen patients were sputum positive for AFB while other patients were sputum negative for AFB. T cells percentages were determined by flow cytometer. In TB patients CD4[+] and CD8[+] T cells percentages were 34.4 +/- 9.8 and 32.0 +/- 9.8 while in controls these were 37.1 +/- 6.9 and 30.2 +/- 7.2 respectively but the difference was statistically insignificant. CD4[+] T cell percentage in newly diagnosed TB patients was 28.8 +/- 8.7 while it was 37.9 +/- 8.9 in TB patients who were on therapy and difference was statistically significant whereas difference in CD8[+] T-cell percentages was statistically insignificant. A negative correlation between CD8[+] Tcells percentage and the duration of ATT was found. CD4[+] and CD8[+] T-cells percentages may help to find out the immune status of TB patients before and after the completion of ATT

Level of interferon gamma in the blood of tuberculosis patients

Interferon gamma [IFN- gamma], a cytokine produced by a variety of cells is involved in the immune response against M. tuberculosis. It activates the production of other cytokines and molecules that kill mycobacterium. IFN- gamma also has diagnostic role in identification of active and latent tuberculosis. To determine the level of IFN- gamma in the blood of TB patients. Ninety-one subjects were selected, including 54 active TB patients and 37 healthy controls. Among 54 TB patients, 27 had confirmed TB and 27 were clinically diagnosed as having TB. IFN- gamma concentration was determined in their blood by an ELISA technique. In TB patients, Mean +/- SD of IFN- gamma was 48.69 +/- 28.78 pg/ml while it was 12.99 +/- 5.70pg/ml in the control group [p <0.001]. Significant differences in the level of IFN- gamma were observed among confirmed TB patients, clinically diagnosed TB patients and the control group [Mean +/- SD 59.68 +/- 28.78, 36.85 +/- 24.76 and 12.99 +/- 5.70 pg/ml, respectively]. Furthermore, a significant negative correlation was observed between the concentration of IFN- gamma in TB patients and the duration of anti-tuberculosis therapy. IFN- gamma level was high in both clinically diagnosed and confirmed TB patients as compared to a control group. Measurement of IFN- gamma production is helpful to diagnose active tuberculosis, but further research is required