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Introduction: Diabetic nephropathy is the leading causeof End Stage Renal Disease in the world, accounting formore than one third of the cases. Micro albuminuria isa marker of wide spread micro vascular damage in Type 2Diabetes Mellitus and an earliest marker for nephropathy.The correlation between presence of overt proteinuria andproliferative diabetic retinopathy have been demonstrated inboth Type 1 and Type 2 diabetic patients. There is an increasingevidence that micro albuminuria could be used as a marker forearly diabetic retinopathy. However, this relationship has notbeen established in our setting. Hence, we planned to evaluatethe prevalence as well as correlation of micro albuminuria andretinopathy in patients of Type 2 Diabetes Mellitus.Material and Methods: 100 Type 2 diabetic patients willingto participate, were enrolled in the study after due approvalfrom the Institutional Ethical committee. Prevalence of microalbuminuria was checked using Micral test. Body Mass Indexand Glycosylated Hemoglobin were also measured. Patientswere evaluated by direct and indirect ophthalmoscopy to lookfor evidence of retinopathy.Results: 56% patients were male with majority of them(70%) were in the age group of 40-60 years. In 39%patients, duration of diabetes was less that 5 years and equalpercentage of patients had micro albuminuria. 45% patientsshowed signs of diabetic retinopathy, whereas, both microalbuminuria and retinopathy were observed in 32% ofpatients (p <0.001). Compared to overall prevalence of microalbuminuria and retinopathy, patients with age more than50 years showed higher prevalence of 51.61% and 56.45%(p=0.001) respectively. Micro albuminuria (52.45%) anddiabetic retinopathy (57.37%) were more likely with durationof diabetes above 6 years (p=0.001). Other factors whichwere statistically significant were Glycosylated Hemoglobin(HbA1c) more than 7% and Body Mass Index (BMI) >25kg/m2.Conclusion: The study showed that there is significantcorrelation between the presence of micro albuminuria anddiabetic retinopathy. Several factors like increase in age,duration of diabetes, HbA1c levels on admission and bodymass index are associated with increased prevalence of microalbuminuria and diabetic retinopathy
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Objective: To evaluate utility of XpertMTB/RIF in bronchoalveolar lavage fluid in childrenwith probable pulmonary tuberculosis. Methods: Children with probable pulmonarytuberculosis with negative smear and Xpert on induced sputum/gastric aspirate weresubjected to bronchoalveolar lavage (BAL) for Xpert assay and mycobacterial liquid culture.Data of children <14 y undergoing bronchoscopy for suspected MDR-TB (n=12) were alsoanalyzed. The sensitivity of Xpert in BAL fluid for diagnosis of probable and confirmedpulmonary tuberculosis was calculated with clinico-radiological diagnosis and culture as goldstandards, respectively. Results: Of 41 enrolled children, 24 (58.5%) had Xpert positive inBAL fluid and 11 (26.8%) had culture confirmed tuberculosis (BAL fluid;10; sputum,1). Thesensitivity of Xpert in BAL fluid among probable and culture confirmed tuberculosis caseswas 58.5% (24/41) and 81.8% (9/11), respectively. Conclusion: Xpert in bronchoalveolarlavage fluid has good sensitivity in both probable and confirmed pulmonary tuberculosis inchildren
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Objective: To determine the trough and two hour plasma levels of nevirapine, stavudine, and lamivudine when administered in fixed dose combinations (FDC). Design: Cross sectional Setting: Tertiary care hospital in Northern India. Participants: 79 HIV-infected children receiving antiretroviral therapy with FDCs for more than month. Intervention: Two-point sampling (0 and 2 hours after the morning dose). Outcome measures: Plasma concentrations of all three drugs were simultaneously assayed by liquid chromatography/mass spectroscopy. Results: Majority (77%) of children were receiving fixed dose combination of stavudine, lamivudine, nevirapine in the ratio of 6:30:50mg. The median (IQR) trough and 2-hour plasma levels (µg/mL) of nevirapine, stavudine and lamivudine were 5.2 (4.0, 6.3) and 7.9 (6.0, 9.7); 0.1 (0.06, 0.16) and 1.1 (0.59, 1.6); 0.1 (0.02, 0.2) and 2.5 (1.4, 3.1), respectively. Very few children had sub-therapeutic plasma drug levels of stavudine (2.5%), lamivudine (7.6%) and nevirapine (10%). Inadequate viral suppression at 6 months follow up was significantly associated with initial high viral load, low CD4 percentage at the time of enrolment in study, and lower doses of lamivudine and stavudine. Conclusion: The currently available generic pediatric fixed dose antiretroviral combinations in India provide adequate drug exposure in majority of children.