Role of diffusion weighted MRI in characterization of renal diseases

Background: MRI has the unique ability to show both structure and function objectively without any radiation exposure to the patient. Apparent diffusion coefficient (ADC) is a quantitative parameter that combines the effects of capillary perfusion and water diffusion. Renal parameters have shown inverse relationship with the ADC values in these studies. So, ADC values have a potential to serve as a marker of renal function. The aim of the present endeavor was to study the role of DW MRI in characterization of renal function and to find out the clinical use of DW MRI in renal diseases; and establish the relationship between renal function assessed by eGFR and that by DW MRI calculated in terms of ADC values in various renal diseasesMethods: Total 30 patients were included in the study. The study was carried out in department of radiodiagnosis at Dr. RPMGC Kangra. 1.5 Tesla MRI machine was used. The ADC value was calculated at upper, mid and lower pole of each kidney and the mean was taken. Then the mean of right and left kidneys was taken to calculate the mean ADC of the patient.Results: Serum creatinine in present study ranged from 0.67 to 13.9mg/dl, with mean value of 7.28mg/d. Serum urea ranged from 22 to 293mg/dl with the mean of 119.6mg/dl. There was significant inverse correlation occurred between ADC values and serum urea (r=-0.43, p=0.02). There was significant inverse correlation between ADC values and serum creatinine (p=0.01) and a positive correlation between eGFR and ADC values (r=0.14, p=0.47).Conclusions: ADC values consistently decreased with increasing stage of renal failure, so these can be used as an indirect maker of renal function. Authors conclude that lower would be the ADC value more advanced would be the stage of renal failure. DW MRI can also be detect early stages of renal failure even when the serum maker are within normal range.

Dexamethasone therapy for bacterial meningitis in adults: a double blind placebo control study.

Routine use of steroids in the treatment of bacterial meningitis remains controversial. A prospective placebo controlled double blind study of dexamethasone was carried out in 40 patients (age>10 years) of acute bacterial meningitis. The patients were randomly assigned to receive either placebo (n=20) or dexamethasone (n=20) in addition to injection ceftriaxone 100 mg/kg/day (maximum 4 gm/day) for 14 days. Dexamethasone sodium phosphate was given in dose of 0.6 mg/kg/day in 4 divided doses, for first 4 days of therapy. First dose of dexamethasone was given 15 minutes prior to first dose of ceftriaxone. Baseline demographics, clinical and laboratory features of the two groups were similar. Clinical improvement of signs of meningeal irritation was rapid in dexamethasone group than in the placebo group, but no significant difference was observed regarding resolution of fever, headache and vomiting. Secondary fever (mean+/-SD 15.00), gastrointestinal tract bleeding (mean+/-SD 15.00) and psychiatric manifestations (mean+/-SD 10.00) were more common in dexamethasone group. Neurological complications and hearing loss were more common and severe in placebo group as compared to the dexamethasone group (p<0.05). It is concluded that dexamethasone may be beneficial in some aspects of bacterial meningitis, in adults. A study with a larger number of cases in each group is recommended.

Stressful family life events and nonspecific somatic complaints in school children.

The relationship between stressful family life events and somatic complaints in 477 school children was studied. There was a significant association between life events and somatic complaints, with a general trend for somatic complaints to increase in almost direct proportion to the number of family life events. Overall occurrence of these nonspecific symptoms was more in girls. The somatic complaints were significantly more in children from nuclear families and of illiterate or poorly educated mothers. No significant association was observed between somatic complaints and number of children in the family or socio-economic status. Assessment of psychodevelopmental tasks and family environment during routine check up of children by the school health teams and their appropriate training in this field should be stressed upon.