Determinants of dysphagia following stroke

Background:Swallowing is affected following stroke. Many studies focus on various aspects of swallowing difficulties (dysphagia) following stroke. However, there are not many studies on the determinants of dysphagia following stroke. The aim of the present study is to establish the association between various factors with the severity of dysphagia. Methods: After screening for Mann Assessment of Swallowing Ability (MASA),110 patients, post-stroke were selected using consecutive sampling to assess the common risk factors, namely the presence of diabetes mellitus, dyslipidemia, hypertension, alcohol usage and smoking habits. Additionally, other variables such as age, gender, type of lesion, side of lesion, tobacco chewing, speech disorders, arterial dysfunction, lobe involvement and Brunnstrom's stages, were also evaluated using a structured interview method. 2 (chi-squared) analysis was carried outto find out the association between the selected determinants and severity of dysphagia following stroke.Results: It was found that age and Brunnstrom's stages are the determinants of dysphagia, as analysis showed a strong association with a p value < 0.001. A marginal association between post-stroke dysphagia and type of lesion with a p value of 0.056 was also observed.Conclusions: Among15 factors evaluated, age, type of lesion and Brunnstrom's stages showed a significant association with the severity of dysphagia following stroke. This study advocates early dysphagia management for elderly patients with high Brunnstrom's grading, for those who are not expected to spontaneously recover following stroke, and for earlier and better community rehabilitation

Functional restructured meat: applications of ingredients derived from plants / Reestructurados cárnicos funcionales: aplicación de ingredientes derivados de plantas

Background: Meat is an important source of nutrients. However, in recent years their consumption is associated with chronic-degenerative diseases giving it the perception of "unhealthy food" Given that meat is an affordable source of quality protein; its improvement entails a huge challenge for the industry and science. Methods: The search and structured review of the literature in the last ten years in the scientific databases of articles related to the elaboration of restructured meat products with functional ingredients derived from plants. Objective: This work presents a general overview, as well as the most representative studies on the elaboration of restructured meat with ingredients from plants considered functional. Conclusions: The present review is intended to emphasize the use of plant natural ingredients in the elaboration of functional restructured meat products as an alternative for consumers allowing the inclusion of functional compounds beneficial to human health in their daily diet

Antecedentes: La carne es una fuente importante de nutrientes. Sin embargo, en los últimos años su consumo se asocia a enfermedades crónico-degenerativas dando la percepción de alimento poco saludable. Dado a que es una fuente accesible de proteína de calidad, su mejoramiento implica un enorme desafío para la industria y la ciencia de la carne. Método: La revisión estructurada de diversos artículos de investigación encontrados en bases de datos científicas, durante los últimos 10 años, relacionados a la elaboración de reestructurados cárnicos con derivados de plantas considerados funcionales. Objetivo: Este trabajo presenta una revisión general, de los estudios más representativos sobre la elaboración reestructurados cárnicos elaborados con derivados de plantas considerados como funcionales. Conclusión: La elaboración de productos reestructurados cárnicos funcionales con la utilización de derivados vegetales, puede considerarse una alternativa para los consumidores a fin de incluir compuestos funcionales beneficiosos para la salud humana en la dieta diaria

Modified Ashworth Scale and Alpha Motor Neuron Excitability Indicators of F-wave in Spastic Soleus Muscle Early after Stroke.

Aims: Plantar flexor spasticity affects walking ability after stroke. Spasticity is clinically tested by modified Ashworth Scale (MAS) and it is fairly reliable. The aim of this study was to test the correlation between MAS and alpha motor neuron excitability indicators of F-wave in spastic soleus muscles early after stroke. Place and Duration of Study: Neurophysiology laboratory, Kasturba Medical College, Mangalore, India and between June 2010- August 2012. Methodology: Twenty three people with post stroke duration of 2.26 (1.18) months and MAS score > 1 on soleus muscle participated in this cross-sectional study. Modified Ashworth Scale and F-wave procedures were administered on spastic soleus muscle and the relationship was tested by Spearman’s rank correlation coefficient. Results: The correlation of MAS to persistence of F-wave was high (r=0.842; p=<0.0001), but not with latency of F-wave (r= -0.264; p=0.223). A moderate correlation was found for post stoke duration to F-wave persistence (r=0.45; p=0.013) and the relation was nonlinear with latency of F-wave (r=0.016; p=0.950). Conclusion: Modified Ashworth scale may be a tool to measure the neural aspects of soleus muscle spasticity i.e. alpha motor neuron excitability in people with early stage stroke.

Fall related self-efficacy among elderly: a comparison of resistance training with balance exercise.

Aims: To evaluate the effectiveness of individualized progressive resistance strength training (PRT) program in improving the confidence level among the institutionalized elderly with balance impairment, in comparison with traditional balance exercise (TBE), and combination of both (COMBI). Place and Duration of Study: The study was conducted between June 2008 and December 2012 in the geriatric care homes, Mangalore, India. Methodology: The eligible subjects were assigned to 3 groups (TBE, PRT and COMBI) using block randomization technique and allocation concealment was done. PRT group received strength training for the key muscles (hip flexors, extensors and abductors, knee flexors and extensors, ankle dorsiflexors and plantar flexors) essential for maintenance of balance. TBE group received conventional balance training and the participants of the COMBI group received TBE and PRT interventions alternately. All the three groups received their respective interventions 4 times a week for 6 months. The data was collected at baseline, 3rd and 6th month and the analysis was performed using Statistical Package for Social Sciences (SPSS) version 15. Both per-protocol and intention to treat methods of analyses were used. Results: Mean age of the 54 elderly participants (18 in each group) was 75.17 years and the comparison of the baseline variables revealed homogeneity between the groups. Between the baseline and six months, all the three groups showed notable reduction in Falls Efficacy Scale (FES) scores. The change scores (pre-post intervention) of FES were notable for all the three groups, but the statistical test did not reveal any significant differences between the groups. Conclusion: Individualized structured PRT intervention targeting the key muscles of lower limbs for balance maintenance, for a period of 6 months, is comparable to TBE in improving the falls efficacy. This in turn reduces self-induced functional restrictions among the non-frail elderly people living in geriatric homes.

Predictors of Esophageal Stricture Formation Post Endoscopic Mucosal Resection

BACKGROUND/AIMS: Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formation have not been well studied. METHODS: We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection database in a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophageal strictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyze the association between the primary outcome and predictors. RESULTS: Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia (median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increased odds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablative modalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007). CONCLUSIONS: Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation include large mucosal resections and the resection of multiple lesions on the initial procedure.

Substitution levels of fish meal by Arthrospira (=Spirulina) maxima meal in experimental diets for red tilapia fingerlings (Oreochromis sp.) / Niveles de sustitución de harina de pescado por harina de Arthrospira (=Spirulina) maxima, en dietas experimentales para alevines de tilapia roja (Oreochromis sp.) / Níveis de substituição da farinha de peixe por farinha de Arthrospira (= Spirulina) maxima, em dietas experimentais para alevinos de tilapia vermelha (Oreochromis sp.)

The high international demand and cost of protein ingredients have led to the increasing need to meet nutritional requirements of animals with national resources. Objective: the objective of th is study was to evaluate three levels of substitution (10, 20, and 30%) of fish meal with Spirulina maxima meal as a protein source in experimental diets for red tilapia fingerlings (Oreochromis sp.). Methods: masculinized fry (average weight: 2.5 ± 0.10 g) were randomly distributed in aerated aquaria with daily water exchange. Four diets were formulated replacing increasing levels of fish meal with Spirulina maxima meal, as follows: 10 (A), 20 (B), 30 (C) and 0% (D, control diet). A commercial diet (E) was also used. All diets were isoproteic (28%) and isocaloric (400 kcal/100 g). Fish were fed two daily rations during 90 days. Weight gain (GP), feed efficiency (EA), protein-efficiency ratio (REP), and feed conversion (FCA) were measured every two weeks. Results were assesses by ANOVA at the end of the test. Results: no significant differences (p>0.05) were observed for GP, EA and REP, indicating a similar efficiency in all diets (A, B, C, D, and E). Treatment C had the best FCA (p<0.05). Conclusions: fish meal can be substituted with up to 30% Spirulina maxima meal in the preparation of diets for red tilapia fry.

Los altos precios de los ingredientes proteicos, así como su demanda, han ocasionado la necesidad cada vez mayor de cubrir los requerimientos nutricionales de los animales con recursos nacionales que proporcionen una fuente de proteína a bajo costo. Objetivo: el objetivo de la presente investigación fue evaluar tres niveles de sustitución (10, 20 y 30%) de harina de pescado por harina de Spirulina maxima como fuente de proteína en dietas experimentales para alevines de tilapia roja (Oreochromis sp.). Métodos: se emplearon alevines masculinizados con peso promedio de 2.5 ± 0.10 g., distribuidos al azar en acuarios con aireación permanente y recambios diarios de agua. Se formularon tres dietas experimentales y una dieta control, con niveles de sustitución de harina de pescado por harina de Spirulina maxima, así: 10 (A), 20 (B), 30 (C) y 0 % (D, dieta control). Todas las dietas fueron isoproteicas (28%) e isocalóricas (400 Kcal/100 g.) y en conjunto con la dieta comercial (E) fueron suministradas a los peces en dos raciones diarias durante 90 días. Se realizaron muestreos quincenales donde se determinaron: ganancia de peso (G.P.), eficiencia alimenticia (E.A.), relación eficiencia-proteína (R.E.P.) y el factor de conversión alimenticia (F.C.A). Al final del ensayo, se compararon entre sí los resultados de cada parámetro mediante un ANOVA a un nivel de significancia del 5 %. Resultados: el análisis no reveló diferencias significativas (p>0.05) entre la G.P., E.A. y R.E.P., indicando una eficiencia similar en todas las dietas (A, B, C, D y E). Para el F.C.A., se observaron diferencias significativas (p<0.05), resultando el tratamiento C el de mejor relación alimento consumido – ganancia de peso. Conclusiones: la harina de pescado puede ser substituida por la harina de Spirulina maxima hasta en un 30% en la elaboración de dietas para la alimentación de alevines de tilapia roja.

Os altos preços dos ingredientes proteicos, assim como sua demanda, tem ocasionado uma necessidade cada vez maior de cobrir os requerimentos nutricionais dos animais com recursos nacionais que proporcionem uma fonte de proteína de baixo custo. Objetivo: o objetivo da presente pesquisa foi avaliar três níveis de substituição (10, 20 e 30%) de farinha de peixe por farinha de Spirulina maxima como fonte de proteína em dietas experimentais para alevinos de tilápia vermelha (Oreochromis sp.). Métodos: Utilizaram-se alevinos masculinizados com peso médio de 2.5 ± 0.10 g, distribuídos ao acaso num aquário com aeração permanente e mudanças diárias de água. Formularam-se três dietas experimentais e a dieta controle, com níveis de substituição de farinha de peixe por farinha de Spirulina maxima de 10 (A), 20(B), 30 (C) e 0 % (D, dieta controle), todas isoproteicas (28%) e isocalóricas (400 Kcal/100 g.) que em conjunto com a dieta comercial (E), foram subministradas aos peixes em dois rações diárias, durante 90 dias. Realizaram-se amostragens a cada 15 dias onde se determinaram: ganho de peso (G.P), eficiência alimentícia (E.A), relação eficiência proteína (R.E.P) e o fator de conversão alimentícia (F.C.A). Ao final do ensaio compararam-se entre sim os resultados de cada parâmetro mediante um ANOVA com um nível de significância de 5%. Resultados: Este analise não revelou diferenças significativas (p>0.05) entre a G.P, E.A e R.E.P, indicando uma eficiência similar em todas as dietas (A, B, C, D e E). Para o F.C.A encontraram-se diferencias significativas (p<0.05), resultando o tratamento C o de melhor relação entre alimento consumido e o ganho de peso. Conclusões: a farinha de peixe pode ser substituída por farinha de Spirulina máxima até um 30% na elaboração de dietas para a alimentação de alevinos de tilápia vermelha.

Approaches to Effectively Documenting Prior Single Dose Nevirapine Exposure among Women in Africa

Background: Single dose nevirapine (sdNVP) is widely used in resource-limited settings for the prevention of mother to child transmission of HIV; but can result in NVP resistance that negatively impacts the subsequent efficacy of maternal antiretroviral therapy (ART). It is important to determine prior sdNVP exposure status to help guide treatment decisions; but systematic data on approaches to documenting previous sdNVP ingestion are lacking. Aim: With the growing body of evidence of the effects of sdNVP exposure on subsequent choices of ART; we aim to highlight some of the practical challenges that exist in documenting prior sdNVP exposure or lack thereof. Materials and Methods: ACTG A5208 Optimized Combination Therapy after Nevirapine Exposure (OCTANE) is a randomized treatment trial of protease inhibitor vs. NVP-based ART that enrolled 745 HIV-infected women in 7 African countries. Documentation of previous exposure to sdNVP (or lack thereof) was collected prospectively and intensively; as were locally-available sources of such data. Results: All 243 women who were exposed to sdNVP recalled having taken sdNVP; written documentation of sdNVP exposure was found for 73 and an additional 20 identified having ingested a NVP tablet when the tablet was shown to them. Among 502 women not exposed to sdNVP; only 10 (2) had written documentation of lack of sdNVP exposure. NVP resistance was detected in 33 (13.8) of sdNVP-exposed and 1 of non-exposed women. Conclusion: Maternal self-report of prior sdNVP exposure was corroborated by supporting evidence in the majority of women participating in the trial

Effect of cigarette smoking and 3.2% ethanol alone or together on RBC and platelet counts in rats.

The present study was conducted on 32 rats divided into four groups. Group C served as control, Group S rats were exposed to cigarette smoke alone, Group SE to cigarette smoke and ethanol (3.2%) and Group E to ethanol alone for twelve weeks. The basal RBC and platelet count were determined and compared with the values obtained at the end of 12 weeks. A significant increase in RBC and platelet counts was seen in Groups S (P < 0.001 and P < 0.01 respectively) and SE (P < 0.01 for both counts). The increase in group SE is less than that seen in Group S. Ethanol consumption alone has shown a significant decrease (P < 0.01) in RBC count and apparent decrease in platelet count as compared to control. This study indicates that cigarette smoke is damaging to health alone or when combined with ethanol.

Tumoural cysticercosis.

The unusual occurrence of very large cysticerci presenting as tumour-like lesions prompted this search of the pathology records of a south Indian hospital, to find similar cases. The maximum diameter of 187 consecutively diagnosed extraneural cysticerci, was recorded and those cases exceeding the mean by two standard deviations reviewed. Six biopsies showing cysticerci with a maximum diameter ranging from 4 to 11 cm, were identified, and hospital records and all pathological material available, were reexamined. The clinical differential diagnosis included benign and malignant tumours, hydatid cyst and haematoma. All the cysts were confirmed to be cysticerci, but species diagnosis was not possible by examining archival material. In an appropriate geographical setting, large cysticerci should form part of the differential diagnosis of cystic tumour-like lesions. An attemp can then be made, while the specimen is still fresh, to identify the species.

SSPE - The continuing challenge: A study based on serological evidence from a teritary care centre in India.

PURPOSE: To assess the prevalence of subacute sclerosing panencephalitis (SSPE). METHODS: In the period June 96 to December' 98 an analysis for measles virus (MV) antibody was carried out on 103 serum-CSF pairs received from patients clinically suspected of SSPE. Measles antibody was detected in an indirect immunofluorescent assay (IIF) test. RESULTS: Antibody to measles was detectable in 49 (48%) of the serum-CSF pairs tested, a diagnostic criterion for SSPE. Antibody titers ranged from 20 to 1280 in serum and neat to 32 in CSF. The serum: CSF ratio ranged from 5:1 to 80:1. Of the 49 patients diagnosed to have SSPE, 36 were males and 13 females, and the age of the patients at the time of diagnosis of SSPE ranged from 5 to 26 years. Ten of the SSPE patients gave a history of measles vaccination. CONCLUSIONS: Inadequate vaccine coverage and quality of vaccine used continue to have an impact on occurrence of SSPE.

A pilot study on the role of cytomegalovirus & human herpesvirus-6 infections in Indian bone marrow transplant recipients.

BACKGROUND & OBJECTIVES: Studies from Western transplant centers have shown the importance of cytomegalovirus (CMV) in infections among immunosuppressed post-transplant patients (both solid and bone marrow transplant recipients). Human herpesvirus-6 (HHV-6) infection is also important. Since such data are lacking from India, we carried out a pilot study to investigate the role of these two viruses in infections among Indian allogeneic bone marrow transplant (BMT) recipients. METHODS: A total of 21 BMT patients who developed acute graft versus host disease (GVHD), two patients who developed chronic GVHD, and eight recipients who did not develop GVHD but had skin rash/elevated liver enzymes, persistent cytopaenia or interstitial pneumonitis with a high clinical suspicion of possible CMV association were studied for markers of CMV and HHV-6 infections. RESULTS: CMV DNAemia was documented in 9 (42.8%) and CMV IgM in 4(19%) of the 21 patients with acute GVHD. HHV-6 DNAemia was not seen in any patient with acute GVHD but 2 (9.5%) had HHV-6 IgM. Of the 2 patients with chronic GVHD, 1 was positive for CMV DNA and IgM, and both were negative for HHV-6 markers. The lower incidence of CMV DNAemia in our recipients may be attributable to the presence of neutralizing antibody (anti gB/AD-1) among the 17 CMV and HHV-6 DNAemia negative recipients, 4(23.5%) had neutralizing antibodies (S/N ratio > or = 5). Of the 13 CMV DNAemia positive recipients, only one (7.7%) was positive for neutralizing antibodies. Among the 5 neutralizing antibody (S/N ratio > or = 5) positive recipients, 4 (80%) were negative for CMV DNAemia. The one nPCR positive was revealed only at high DNA (> 0.1 microgram) input indicating low CMV signal strength. INTERPRETATION & CONCLUSION: The present study shows the use of DNAemia in detecting CMV infections among BMT recipients. All recipients had high avidity CMV IgG (AI > 50%) confirming CMV reactivation or reinfection in these patients. There was evidence from this study suggesting that neutralizing antibodies may play a role in controlling CMV reactivation. We found no significant HHV-6 association with GVHD in Indian allogeneic BMT recipients.

Characterization of antibody response to human cytomegalovirus in Indian renal transplant patients.

BACKGROUND & OBJECTIVES: Cytomegalovirus (CMV) disease in seroendemic transplant populations is due to reactivation of the virus, or reinfection. In this context, the antibody response is likely to influence presentation, clinical severity and outcome of the disease, and may provide a diagnostic and prognostic marker. This study was carried out in Indian renal transplant patients and healthy adults to characterize the antibody response to cytomegalovirus. METHODS: Thirty three transplant recipients with CMV illness (symptomatology with IgM and/or nPCR positive status), 20 recipients who were asymptomatic in the 6 months of follow up after transplantation and 62 healthy controls were investigated for markers of CMV infection. These individuals were tested for IgG avidity and neutralizing antibody by ELISA techniques. RESULTS: All 53 transplant recipients were found to have an IgG avidity index of > 50 per cent. Antibody to a CMV envelope glycoprotein gB/AD-1 (putative neutralizing antibody) was expressed as S/N ratio and was > or = 5 in asymptomatic (65%) and symptomatic (27%) immunosuppressed renal transplant recipients. However, none of the 53 CMV IgG positive healthy controls were positive for neutralizing antibodies S/N ratio > or = 5 (S/N ratio = sample mean OD/mean OD of 3 negative controls in each run). We observed the simultaneous presence of CMV PCR signal in leukocytes and neutralizing antibody (S/N ratio > or = 5) in the plasma in 22 (41.5%) of the 53 renal transplant recipients. INTERPRETATION & CONCLUSIONS: In this study among the immunosuppressed transplant patients we observed an association between symptomatic disease and the relative absence of neutralizing antibodies. The neutralizing antibodies are less frequently demonstrable among controls; while appearance in a higher proportion of asymptomatic recipients especially in association with high IgG avidity (> 90%) is suggestive of its role in control of CMV disease despite reactivation as evidenced by DNAemia while on immunosuppressive therapy.

A randomized study of the safety and efficacy of reused angioplasty balloon catheters.

BACKGROUND: To lower costs, many centers around the world utilize previously used, resterilized balloon catheters to perform coronary angioplasty There are no controlled trials regarding their safety and efficacy. METHODS AND RESULTS: We performed the first randomized, double-blind, controlled, single-center clinical trial comparing the safety (clinical success) and efficacy (angiographic success) of reused versus new coronary angioplasty balloon catheters. A total of 377 procedures were included, 178 in the reused catheter arm and 199 in the new catheter arm. There were no significant differences in clinical or lesion characteristics among the two arms. The incidence of first balloon failure in the reused catheter arm was similar to that of the new catheter arm (12 cases [7%] v. 10 cases [5%], respectively). The angiographic success rate was also similar-176 cases (98.9%) in the reused catheter arm and 196 cases (98.5%) in the new catheter arm. The number of balloon catheters used per lesion, amount of contrast, and procedural and fluoroscopy time were similar in the two arms. At 30 days, the incidence of major adverse cardiac events was similar in both arms, 8 cases (4.5%) in the reused catheter arm and 10 cases (5%) in the new catheter arm. The incidence of fever was also similar. CONCLUSIONS: When performing coronary angioplasty, reused catheters are as effective (similar angiographic success) and safe (similar clinical success) as new catheters.

Pre-transplant risk factors for renal allograft dysfunction at one year in Indian patients.

BACKGROUND: Only a few patients with end-stage renal disease in the Indian subcontinent receive optimal treatment. Of these only a minority can afford a second renal transplant. Awareness of modifiable pre-transplant risk factors that influence allograft function is crucial before embarking on the first transplant. There are no reports from the Asian subcontinent describing the pre-transplant risk factors. METHODS: We studied the effect of donor age, gender, and relation with the recipient, patient age, gender, HLA matching, native kidney disease and immunosuppression on one-year allograft function using data from 1177 consecutive primary living related donor renal transplants at the Christian Medical College Hospital, Vellore. We performed a univariate followed by a multivariate analysis using a logistic regression model to calculate the odds ratio for the effect of the above factors on two levels of graft function (serum creatinine > 1.4 mg/dl and > 2 mg/dl) at one year. RESULTS: On univariate analysis, older donors, women donors, mother being the donor, men recipients, < 1 HLA antigen match, cyclosporine-based immunosuppression and patient age between 16 and 40 years were associated with serum creatinine levels > 1.4 mg/dl at one year. Multivariate analysis showed that donor-related factors, namely mother as donor, older donors, and a < or = 1 HLA antigen match, were risk factors for graft dysfunction (serum creatinine level > 1.4 mg/dl) at one year. Recipient-related risk factors were male patients and those between the age of 16 and 40 years. CONCLUSION: In patients undergoing living related donor renal transplants from large extended families, a younger haplomatched donor, for instance, a brother, is a better choice than an older haplomatched donor, for instance, the mother, particularly in young male recipients at a higher risk of renal dysfunction.

Unusual association of Kikuchi's disease and dengue virus infection evolving into systemic lupus erythematosus.

Kikuchi's disease is a histologically alarming self-limiting condition typically affecting the lymph nodes of young females. A 13-year-old girl was presented with fever, skin rash and cervical lymphadenopathy. On examination she was found febrile, mild pallor was present and she had lymphadenopathy. Liver was palpable. Cervical lymph node biopsy showed histiocytic necrotising lymphadenitis (Kikuchi's disease). Dengue virus serology for IgG blot showed evidence of seroconversion in serial samples. She was treated with antibiotics and fluconazole and cyclosporin A. During hospitalisation she developed retinal vasculitis. She was reviewed after one month and showed rashes of subacute cutaneous lupus erythematosus. This case can be described to be a triggering event by dengue viral infection causing abnormal immune response leading initially to Kikuchi's disease and later on to systemic lupus erythematosus.

Prognostic factors in diffuse proliferative lupus nephritis.

BACKGROUND: Patients with diffuse proliferative lupus nephritis (DPLN) can have variable clinical course. Identification of the predictors of outcome would help to improve the management. We have studied the prognostic significance of clinical, laboratory and histological parameters in patients with DPLN. METHODS: Twenty nine patients diagnosed to be having DPLN seen between 1987 and 1991 were followed up for over 57 months. Parameters assessed for prognostic significance included serum creatinine, urine protein at the time of biopsy, blood pressure, type of immunosuppression, composite scores and individual components of activity index (AI) and chronicity index (CI). Kaplan-Meier survival curves were plotted and the results were compared using log rank test. Fishers' exact test was used to study the risk factors. RESULTS: End stage renal failure developed in 7/29 (24.1%) patients; 7/19 (36.8%) who had hypertension and 7/16 (43.8%) who had nephrotic proteinuria developed renal failure, while none who had normal blood pressure or nonnephrotic proteinuria, developed renal failure (p < 0.01). Three patients had high activity index (> 12) and all three developed renal failure. Other parameters such as age, gender, serum creatinine, type of immunosuppression, CI and individual components of AI failed to predict the outcome (p > 0.05). CONCLUSION: Hypertension, nephrotic proteinuria and high AI were predictive of progression to end stage renal failure in patients with diffuse proliferative lupus nephritis.