Midterm eGFR Predicts Pregnancy Outcomes: An Observational Study

Introduction: The hemodynamic adjustments during pregnancy play a pivotal role in sustaining the gestation, however, its clinical connotation on midterm renal hyperfiltration and its consequence on maternal and fetal outcomes need a greater appraisal. The present retrospective study looked into the midterm estimated glomerular filtration rate (eGFR) among pregnant females without overt pieces of evidence of chronic kidney disease (CKD) as a surrogate marker for midterm hyperfiltration and its implication on maternal and fetal outcomes. Materials and methods: All pregnancies among females aged 18–50 years with available pregestational baseline serum creatinine were included in the study. Maternal renal hyperfiltration was expressed as the highest eGFR, using the creatinine clearance method. Its association with adverse maternal and fetal outcomes was assessed. Results: A total of 1,045 pregnancies were assessed during the study. According to midterm eGFR, among them, 65% of pregnancies showed midterm eGFR between 120 and 150, however, 4.3% of pregnancies had values more than 150 mL/min per 1.73 m2 . The risk of poor pregnancy outcome was observed for eGFR levels below and above the reference level of 120–150 mL/min per 1.73 m2 (1.97 for values ?150 mL/min per 1.73 m2 , and 1.72 for 90–120 mL/min per 1.73 m2 ). Pregnancies with eGFR between 60 and 90 mL/min per 1.73 m2 had odds ratios (ORs) of 5.64. Conclusion: A distinctive relationship was observed between the midterm eGFR and adverse pregnancy outcomes with the best outcomes for midterm eGFR levels between 120 and 150 mL/min per 1.73 m2 . Despite no apparent functional renal deterioration, a poor maternal hyperfiltration response may play a crucial impact on poor pregnancy outcomes.

Seronegative invasive gastro‑intestinal cytomegalovirus disease in renal allograft recipients a diagnostic dilemma! – Tissue PCR the saviour.

Seronegative Invasive Gastro-intestinal cytomegalovirus disease in renal allograft recipients Background –CMV as oppurtunistic infection affecting the gastrointerstinal tract is the most common cause for tissue invasive CMV disease occuring in 10–30% of organ transplant recepients. Gastrointerstinal CMV disease can be diagnosed in presence of clinical suspecion along with histopathological findings (CMV inclusions) and presence of mucosal lesion(s) on endoscopic examination with collaborative evidences via molecular technique. Aims-Few cases of CMV infection affecting the gastrointerstinal tract show no evidences of dissemintion despite use of highly sensitive molecular techniques. We encountered 6 cases where in despite strong clinical suspecion of Gastrointerstinal CMV disease there were seronegative and endoscopic negative evidences for CMV, blind tissue biopsy yeilded positive results for CMV disease with excellent improvement with antiviral therapy. Conclusions-Blind biopsy specimen for tissue PCR could serve as saviour in an immunocompromised individiual who has a strong clinical symptomatology for GI-CMV disease in absence of viremia, normal endoscopy and histopathology, so that the early therapeutic interventions could help in excellent patient and graft survival.

Initial experience with day case laparoscopic cholecystectomy at a tertiary care hospital in India.

BACKGROUND: Cholecystectomy is one of the commonest general surgical operations. Laparoscopic cholecystectomy is currently the most favoured approach. As it is associated with less postoperative pain and ileus, it allows early discharge of patients from the hospital. Studies from the West have reported that 'day case laparoscopic cholecystectomy' is feasible and safe. In India, the current practice is to admit patients for laparoscopic cholecystectomy 24-48 hours prior to surgery and to discharge most patients within one to two days of surgery. There is no report from any Indian centre describing 'day case laparoscopic cholecystectomy'. We conducted a prospective study to assess the feasibility, safety and patients' acceptance of 'day case laparoscopic cholecystectomy' in a tertiary care hospital. METHODS: Eighty-four patients with symptomatic cholelithiasis, aged less than 65 years with ASA grade I and II, were offered day case laparoscopic cholecystectomy. Seventy-four patients consented to be included in the study. The nature of operation and likely postoperative course were explained in detail to the patients. Conventional 4-port laparoscopic cholecystectomy was attempted in all patients. The main outcome measures assessed were successful management of patients on day case basis and its acceptance by the patients. RESULTS: Sixty-eight (92%) patients underwent successful laparoscopic cholecystectomy. Fifty-five of these (81%) were successfully managed as day case procedures. There were no major complications. Three of the 55 patients (5.4%) needed re-admission and could be managed conservatively. Fifty-three (96%) patients described their experience as 'pleasant'. None of them described their experience to be 'unpleasant' or 'bad'. Fifty-four (98%) patients stated that they would recommend day case laparoscopic cholecystectomy to close friends and relatives. CONCLUSION: In selected patients, day case laparoscopic cholecystectomy is safe and feasible in a developing country.

Normal limits of 14C-urea breath test.

BACKGROUND/AIMS: 14C-urea breath test has been widely used for diagnosis of Helicobacter pylori (H. pylori) infection. There is no general agreement on the cutoff values for determination of H. pylori negative subjects. We studied baseline values in subjects who were proved to be H. pylori negative and calculated the cutoff value of normalcy. A comparison of this test with other tests for diagnosis of H. pylori infection was also done. PATIENTS AND METHODS: 12 patients (mean age 34 +/- 14, range 22-65 years; 8 men) of non-ulcer dyspepsia were studied, who were proved to be H. pylori negative by rapid urease test, Gram's staining, histopathology and culture of gastric mucosal biopsies obtained four each from the antrum, body and fundus of the stomach. The controls included 12 patients (mean age 40 +/- 13, range 22-65 years, 9 men), who were positive for H. pylori on culture or combination of rapid urease test and histopathology or rapid urease test and Gram's stain. 14C-urea breath test was performed using 5 uCi of 14C-urea dissolved in 300 ml of water. Breath samples were collected once before ingestion of 14C urea and subsequently at 5, 15 and 30 minutes after ingestion and 14C-contents in the breath samples measured. Results were expressed as 14 CO2/mmol CO2 exhaled as percent of administered urea. RESULTS: The mean +/- SD 14-C value in H. pylori negative vs H. pylori positive patients at 5 minutes, 15 minutes and 30 minutes were found to be 0.003 +/- 0.003 vs 0.064 +/- 0.042 (p < 0.001), 0.002 +/- 0.001 vs 0.056 +/- 0.039 (p < 0.001) and 0.001 +/- 0.002 vs 0.041 +/- 0.026 (p < 0.001) respectively. The mean values of 14C-urea breath test were significantly lower in H. pylori negative patients as compared to H. pylori positive patients. Using receiver operating characteristic (ROC) analysis of the data, the cutoff values obtained were 0.01, 0.007 and 0.009 at 5 minutes, 15 minutes and 30 minutes respectively. CONCLUSIONS: 14C-urea breath test levels at 5, 15 and 30 minutes intervals are significantly lower in H. pylori negative patients as compared to H. pylori positive patients. This test has high sensitivity and specificity in detecting H. pylori infection.

Dexamethasone in bacterial meningitis: to use or not to use?

Permanent neurologic disabilities are seen in up to a quarter of survivors of bacterial meningitis despite major improvements in therapy. Experimental studies have demonstrated that most of the pathology in meningitis is mediated by inflammatory cytokines such as tumor necrosis factor (TNF) and interleukin-1 (IL-1), which are produced by host cells in response to bacterial invasion of the meninges. Dexamethasone has been used in a number of clinical trials to moderate the host response and to improve neurologic outcome of meningitis. Results of six randomized, placebo controlled trials are summarized in this review. Dexamethasone treatment did not lower mortality. Only a moderate, but not a significant reduction in the neurologic and audiologic sequelae was seen in dexamethasone recipients when Haemophilus influenzae type b (Hib) was the causative agent of meningitis. Following routine use of Hib vaccine, meningitis caused by this agent has virtually disappeared in the USA. Hence, findings from these trials may no longer be applicable in countries with high rates of immunization against Hib. Presently, there is little or no evidence showing a benefit of dexamethasone therapy in meningitis caused by S. pneumoniae or N. meningitidis. Global emergence of penicillin and cephalosporin resistant S. pneumoniae has raised new concerns about the use of dexamethasone in pneumococcal meningitis. Since dexamethasone significantly decreases the penetration and concentration of vancomycin and ceftriaxone in the CSF and delays CSF sterilization, adjunctive dexamethasone therapy may increase the risk of treatment failure in meningitis caused by antibiotic resistant pneumococci. An antibiotic combination should be used in the treatment of meningitis caused by antibiotic resistant pneumococci, particularly if dexamethasone is also being administered concurrently.

Anti-inflammatory properties of 3-methylpyrazolin-5-(4 H)-one-4-[3'-methoxy-4' (2'',3'',4'',6''-tetra-O-acetyl-beta-D-glycopyranosyl]benzylidene (compound IIIA).

Oral treatment of compound IIIA exhibited dose related inhibitory action in acute tests of carrageenan, histamine and dextran-induced oedema in rats. Marked inhibitory action of the compound was found when it was administered intraperitoneally in animals. It displayed prominent anti-arthritic activity in chronic tests of adjuvant and formaldehyde-induced arthritis in rats. It prevented the arthritis associated rise in total leucocyte count and erythrocyte sedimentation rate. It also lowered the levels of exudate volume and migration of leucocytes in carrageenan induced pleurisy in rats. It did not exhibit any analgesic, antipyretic or ulcerogenic effect. No mortality was recorded up to 2 g/kg in mice on oral or intraperitoneal treatment over a period of 72 hr.

Childhood appendicitis. A clinical profile.

A study to assess the reliability of clinical symptoms and signs in 50 patients with a presumptive diagnosis of acute appendicitis is presented. The male to female ratio was 3: 2, with age ranging from 2 to 15 years. Abdominal pain was present in 42; tenderness was localized in 35, generalized in 11 and diffuse in 4 patients. Total leucocyte count was above 11,000/cu mm in 31, below 11,000/cu mm in 17 and above 18,000/cu mm in 2. Of the 48 operated patients, 8 had normal appendices and the diagnosis in them was Meckel's diverticulitis 3, ruptured ovarian follicle 2, mesenteric adenitis 2, and salpingo-oophoritis 1. Abdominal pain and right iliac fossa tenderness with contributory investigations are the most reliable indicators of acute appendicitis with a false positive rate of 16.66% only.

Blalock Taussig type shunt palliation for cyanotic infants and children.

In a period of ten years from January 1, 1979 to December 31, 1988, 54 cyanotic patients weighing less than 10 kg underwent shunt operations of Blalock Taussig type. The indications were hypercyanotic spells, failure to thrive and pulmonary arteries being too small for safe total collection. The commonest diagnosis was tetralogy of Fallot (63%). Thirty-three (64%) patients were older than 1 year but still weighed less than ten kg. Mortality was 16.67% (70% C.L. 8.94-26.60). During follow-up, there were 4(7%) late deaths. During the same period, 134 patients less than 5 years age came to autopsy without having any cardiological or surgical intervention. Ninety-seven (72.4%) of these deaths were due to cardiac causes. In order to save their lives, early identification is necessary which highlights the importance of parent and primary physician education.

Changes in phosphatases and lipids following scrotal gamma irradiation in adult rat testis.

Effects of localized low (2.5 Gy) and high (10 Gy) levels of gamma irradiation on the testis of albino rats were studied. A marked increase in the testicular total lipid, phospholipid and cholesterol content was observed at all post-treatment intervals except at 16 weeks where the contents decreased. A significant decrease in the activity of acid phosphatase/g of testis was seen at both the doses, the minimum value being at 4 weeks. The decrease in acid phosphatase activity is correlated with the state of germ cell population in seminiferous tubule which is found to be depleted at 4 week interval. The alkaline phosphatase activity/g testis however, showed a significant increase, the maximum being at 4 weeks post-treatment. Thereafter, the values of the enzyme activity showed a slight recovery at 16 weeks post-irradiation. ATPase activity increased initially followed by a significant decrease at all post-treatment intervals.