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Abstract Introduction: A high incidence of cardiovascular disease (CVD) events and premature mortality is observed in patients with chronic kidney disease (CKD). Thus, new biomarkers that may help predict the development of CVD in early stages of CKD are being investigated along with other traditional risk factors. Objective: To investigate cathepsin S as an early biomarker for CVD in patients with CKD. Methods: A total of 64 patients with CKD were included and classified into 2 groups: CKD patients with established CVD and CKD patients with non-established CVD. All patients were submitted to routine investigations including complete blood count, random blood sugar, glycated hemoglobin (HbA1c), serum electrolytes, urea, creatinine, total protein, total albumin, calcium total, phosphorous, uric acid, vitamin D, parathormone, lipid profile, liver function test, measurement of serum cathepsin S (Cat S), and 2D Echo of the heart. Results: The level of serum Cat S was increased in CKD patients with CVD (p <0.05) as well as in later stages of CKD (p <0.05). CVD was also more common in patients in early stage CKD. In early stages CKD, Cat S and CVD were positively correlated. Conclusion: These findings suggest that serum Cat S might be useful as an early biomarker for CVD in CKD patients.
Resumo Introdução: Uma alta incidência de eventos de doença cardiovascular (DCV) e mortalidade prematura é observada em pacientes com doença renal crônica (DRC). Assim, novos biomarcadores que podem ajudar a prever o desenvolvimento de DCV nos estágios iniciais da DRC estão sendo investigados juntamente com outros fatores de risco tradicionais. Objetivo: Investigar a catepsina S como um biomarcador precoce para DCV em pacientes com DRC. Métodos: Um total de 64 pacientes com DRC foram incluídos e classificados em 2 grupos: pacientes com DRC com DCV estabelecida e pacientes com DRC com DCV não estabelecida. Todos os pacientes foram submetidos a investigações de rotina incluindo hemograma completo, glicemia aleatória, hemoglobina glicada (HbA1C), eletrólitos séricos, ureia, creatinina, proteína total, albumina total, cálcio total, fósforo, ácido úrico, vitamina D, paratormônio, perfil lipídico, teste de função hepática, medição da catepsina S sérica (Cat S), e Eco 2D do coração. Resultados: O nível de Cat S sérica esteve aumentado em pacientes com DRC com DCV (p <0,05), bem como em estágios posteriores da DRC (p <0,05). A DCV também foi mais comum em pacientes com DRC em estágio inicial. Em estágios iniciais da DRC, a Cat S e a DCV foram positivamente correlacionadas. Conclusão: Estes achados sugerem que a Cat S sérica pode ser útil como um biomarcador precoce para DCV em pacientes com DRC.
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Background: Spinal anesthesia is the preferred modality of anesthesia for lower segment cesarean section, but it is complicatedwith hypotension and bradycardia, which may be harmful to both parturient and baby. Bezold–Jarisch reflex plays an importantrole through 5HT3 receptors located in intracardiac vagal nerve endings in causing hypotension and bradycardia. In this study, weevaluated the effect of ondansetron, as a 5HT3 receptor antagonist, on the hemodynamic response following spinal anesthesiain parturients undergoing elective lower segment cesarean section.Methodology: Sixty parturients who were scheduled for lower segment elective cesarean section were randomly allocated intotwo groups. Before giving the spinal injection, Group O (n = 30) received intravenous ondansetron 4 mg and Group S (n = 30)received normal saline. Blood pressure, heart rate, and vasopressor requirements were assessed.Results: Total dose of vasopressor (mephentermine) used in Group “O” was 78 mg (mean±SD = 2.60 ± 4.36) and in Group “S,”it was 168 mg (mean ± SD = 5.6 ± 4.43 (P = 0.010). In Group O, the incidence of hypotension was 9 out of 30 patients whilein Group S, 21 out of 30 patients developed hypotension at any point of surgery (χ2=9.6 and P = 0.002).Conclusion: Ondansetron 4 mg, given intravenously 5 min before spinal anesthesia, causes reduction in hypotension andvasopressor use in parturients undergoing elective lower segment cesarean section.
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Background: HbA1C a marker of chronic hyperglycemia, is associated with diabetes and its complications and has been recommended as a diagnostic test. It is an indicator of average blood glucose concentration over the period of 2-3 months. Objectives: The main objective of this study was to compare the efficiency of HbA1C, fasting & post prandial blood glucose levels, in the diagnosis of type- 2 diabetes mellitus. Material and Methods: This study was conducted in Career Institute of Medical Sciences and Hospital, a tertiary care referral hospital over a period of 6 months (July 2017-December 2017). Total 300 subjects included in this study were divided into 2 groups. Results: The study and control group were almost of the similar ages. FBS & 2 hour PP of control groups are 95.5 ± 9.8 & 168.45 ± 22.8 (mg/dl) respectively & that of type 2DM is 198.5 ± 25.6 & 295.8 ± 32.6 respectively. The HbA1C % of all the 30 cases of DR & all the cases with microalbuminuria was >7.5%. Conclusion: HbA1C can be used effectively for the diagnosis of type 2 DM & it can be used for predicting the complications of type 2 DM. It shows a direct & linear correlation with the diabetic retinopathy and micro-albuminuria. It is very safe to say that HbA1C is better parameter than FBS & 2 hour PPBS level in diagnosing & predicting the complications of diabetes.
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Foregut cystic developmental malformations are rare developmental anomalies. The problems inherent to these malformations are their presentation across specialties that include embryology, anatomy, pathology, thoracic foregut surgery, pediatric surgery and general abdominal surgery. The direct consequence of this variation has resulted in diverse terminology, classification and a failure to identify the correlation. The article aims to summarize and unify the embryological concepts of foregut cystic malformation, to suggest a generic title to the various groups of these interrelated disorders and a uniform use of nomenclature on the basis of unifying concepts of embryopathogeneis.
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Spontaneous perforation of the biliary tract is rare in infants & children with less than 100 cases reported in English Literature till date. We report two cases of this rare clinical entity in a 9-month-old boy and other of a 2-year old boy. Both patients presented with clinical features of acute peritonitis. Laparotomy revealed sterile biliary peritonitis with a normal cholangiogram in the infant and biliary perforation in other child. Simple drainage in the former and cholecystostomy with external biliary drainage in later resulted in a satisfactory outcome.