Tracheobronchial compression by right-sided aortic arch in a middle aged male.

Exertional dyspnoea is a common symptom among middle-aged population. Diagnostic evaluation of such patients is often challenging and confusing. We report a patient presenting with exertional dyspnoea and an obstructive ventilatory defect on spirometry that was refractory to bronchodilator therapy. Careful review of the chest radiograph and spirometry pointed towards variable intra-thoracic airways obstruction as a cause of dyspnoea. Contrast enhanced computed tomography (CECT) of the thorax and bronchoscopy established the diagnosis of a right-sided aortic arch resulting in tracheobronchial compression and tracheomalacia.

Etiology and outcome of acute renal failure in pregnancy

To determine the etiology and outcome of Acute Renal Failure [ARF] in pregnancy. A case series. Nephrology Department of the Jinnah Postgraduate Medical Centre, Karachi, from August 2007 to July 2008. Pregnant women who were healthy previously and had developed ARF, diagnosed on oliguria [urine output <400 ml/day] and mounting azotemia [serum creatinine > 2 mg%] were included in the study. Percutaneous renal biopsy was performed for delayed recovery, i.e. after three weeks. Patients were followed up for a period of 6 months. Percentages were calculated for qualitative variables i.e. causes of ARF, mortality, morbidity and outcome in form of complete recovery, partial recovery, demise and non-recovery. A total of 43 patients with pregnancy-related ARF were included in the study. The puerperal group comprised 36 patients [83.7%]. Haemorrhage was the etiology for ARF in 25 [58.1%], antepartum haemorrhage APH in 8 [18.6%] and postpartum haemorrhage PPH in 16 [37.2%] of patients. In 12 [27.9%], puerperal sepsis was the etiological factor, while 4 [9.3%] patients had DIC on presentation. Pre-eclampsia, eclampsia and HELLP syndrome accounted for 5 [11.6%]. While 1 [2.3%] was diagnosed with hemolytic uremic syndrome and another one was diagnosed as ARF secondary to hypotension produced by hyperemesis gravidarum. Renal biopsy was performed in 31 patients showing that 10 had acute cortical necrosis and 21 had acute tubular necrosis. Maternal mortality was 16.2% [n=7]. Of the 36 [83.7%] surviving patients, 18 [41.4%] had complete recovery of renal function; 12 [27.9%] had partial recovery; and 6 [13.9%] required chronic dialysis. Pregnancy-related ARF was associated with poor outcome. Antepartum and postpartum haemorrhage were the most common cause of ARF in pregnancy

Rate of decrease in hemoglobin/hematocrit levels among male patients with various degrees of chronic renal insufficiency

To correlate the rate of decrease in hemoglobin/ hematocrit levels with decrease in creatinine- clearance among male patients with various degrees of chronic renal insufficiency. A cross sectional analytical study. Department of Physiology, BMSI, JPMC, Karachi, in collaboration with Department of Nephrology, JPMC, Karachi. The study included 75 subjects, distributed into five groups of 15 subjects each. First group [control] comprising of normal subjects with Creatinine clearance [Cr. C1] above 90 ml/min, and remaining four groups i.e, group II [Cr. C1 60-90 ml/min], group III [Cr. C1 30-59 ml/min], group IV [Cr. C1 15-29 ml/min and group V [Cr C1 < 15 ml/min], comprising of patients with increasing severity of the renal insufficiency. All the subjects were males. Their hemoglobin and hematocrit levels were analyzed and statistically compared. As compared to control group, there was a 6.85%. 11.46%, 29.09% and 49.93% decrease in hemoglobin levels when subjects or group II, III, IV and V were taken into consideration. Similarly there was 8.45%, 18.13%, 29.47% and 54.00% decrease in hematocrit levels, in the same order. The rate of decrease in hemoglobin and hematocrit levels goes higher as the renal excretory function falls lower

Acute renal failure associated with malaria

Malaria has protean clinical manifestations and acute renal failure [ARF] is one of its serious complications and could be life threatening. This study was carried out to describe the clinical characteristics and factors associated with adverse out come in patients with malarial acute renal failure. Data of 46 Patients with ARF and smear positive malaria was analyzed further among all cases of ARF presented to us at Nephrology department of Jinnah Postgraduate Medical Centre, Karachi from January 2003 to December 2004.Results were expressed as mean, standard deviation and range. Among 237 patients with ARF of diverse etiology, 46[19.4%] developed ARF due to falciparum malaria. The male to female ratio was 3.6:1. Oliguria was seen in 76.09% on admission, and 78.26% required dialysis. In addition to ARF, most of the patients had at least one other manifestation of severe malaria. 35[76.06%] patients recovered completely while 11[23.91%] died in early dialysis. Prolonged disease duration, severe ARF, cerebral malaria, hyperbilirubinaemia, and disseminated intravascular coagulopathy [DIC] were poor prognostic factors. Falciparum malaria associated with ARF is a life threatening condition, but early presentation and intervention with appropriate anti-malarial and dialysis therapy is associated with improved survival and recovery of renal function. Early dialysis treatment in patients with severe falcipaum malaria and signs of deteriorating renal function is recommended

Gender difference in hemoglobin/hematocrit levels among patients with various degrees of chronic renal insufficiency

To observe the gender difference in hemoglobin/hematocrit levels among patients with various degrees of chronic renal insufficiency. A cross-sectional analytical study. Department of Physiology, BMSI, JPMC, Karachi, in collaboration with Department of Nephrology, JPMC, Karachi. The study included 150 subjects, distributed into five groups of 30 subjects each. First group [control] comprising of normal subjects [Cr.Cl >90 ml/min] and remaining four groups [group II [CrCl 60-90 ml/min], group III [CrCl 30-59 ml/min, group IV [CrCl 15-29 ml/min] and group IV [CrCl <15 ml/min]], comprising of patients with increasing severity of the renal insufficiency. Half of the subjects in each group were males. Their hemoglobin and hematocrit levels were analyzed and were statistically compared. As compared to control group, there was a 6.85%, 11.46%, 29.09% and 49.93% decrease in hemoglobin levels in case of males versus 5.15%, 9.24%, 24.24% and 49.0% decrease in case of females when subjects o -group II, III, iv and V were taken into consideration. Similarly, there was 8.45%, 18.13%, 29.47% and 54.0% decrease in hematocrit levels in case of males versus 4.71%, 11.31%, 22.58% and 50.98% decrease in case of females, in the same order. There is a slight gender difference in hemoglobin and hematocrit levels among patients with various degrees of chronic renal insufficiency