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Introduction: Association between Chronic kidney disease(CKD) and increased risk of cardiovascular disease (CVD)is well established. Relationships of carotid intima-mediathickness (CIMT) as a measure of subclinical atherosclerosisin CKD patients is a matter of debate. Current research aimedto study the role of CIMT in CKD patients and its associationwith the CKD staging.Material and Methods: Hundred CKD patients werestudied and compared with 50 subjects without CKD in theDepartment of Medicine, G.R. Medical College & J.A. Groupof Hospitals, Gwalior (M.P.) India. GFR was determined byMDRD (Modification of diet in renal study) equation. Studypopulations were subjected for high resolution B - modeCarotid ultrasonography.Results: In case group, majority were males (68%) havingage between 30-60 years (62%). Majority had stage V CKD(67%), 21% had stage III and 14% had stage IV CKD.Majority of the cases had CIMT between 0.9-1.0 mm (42%)followed by 0.7-0.8 mm (17%) as compared to 0.5-0.6 mm(42%) in control. Mean CIMT was significantly higher incases (0.87±0.24) as compared to control (0.61±0.34) group(p<0.001). No significant difference in mean CIMT was foundbetween different stages of CKD (p=0.649).Conclusion: CKD patients have significantly more carotidarterial wall thickness in comparison to age matched controls.The CIMT does not differ in different stages of CKD.
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Background: Patients with Chronic Kidney Disease (CKD) are at high risk for developing cardiovascular disease (CVD). Carotid intima media thickness (CIMT) has been found to correlate with coronary artery atherosclerosis. Methodology: This was a prospective study of carotid intima media thickness in patients of CKD, done in the Department of Medicine, G.R. Medical College & J.A. Group of Hospitals, Gwalior (M.P.), India. A total of 70 patients of CKD and 35 age and sex matched controls were enrolled. Bilateral assessment of intima media thickness was done in common carotid artery and higher value of CIMT of any one carotid artery was recorded. Results: Out of total 70 patients of CKD, 42 were males. Clinical findings in CKD patients were anemia (92.5%), edema (71.4%), decreased urine output (41.42%), obesity (12.5%). Proteinuria (>300mg/24 hrs) was seen in 91.4% patients. CIMT in CKD patients was between 0.9-1.0mm whereas in controls was between 0.5-0.6mm. 62.5% of total patients (CIMT 0.91±0.24 to 1.15±0.24) were having mean BP between 90 to 130 mmHg, 12.7% of total patients (CIMT 1.00±0.26) were having mean BP>130 mmHg. CKD patients with dyslipidemia were having mean CIMT 1.08±0.19 in comparison to controls with dyslipidemia having mean CIMT 0.67±0.22. Conclusion: CIMT was increased in CKD patients with increased age, progression of stage of CKD and proteinuria. Mean CIMT was increased in all stages of CKD and there was no significant difference in CIMT in different stages of CKD. Patients having high mean blood pressure was having higher mean CIMT in comparison to patients having lower mean blood pressure, patient with dyslipidemia had high mean CIMT as compared to mean CIMT of controls having dyslipidemia.
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Background: Adenosine deaminase has been proposed to be a useful surrogate marker for tuberculosis in pleural, pericardial and peritoneal fluids. Studies have confirmed high sensitivity and specificity of Adenosine deaminase for early diagnosis of extra pulmonary tuberculosis. Aim: To assess the diagnostic level of ADA in tubercular serosal effusion and to determine its sensitivity and specificity. Methods: The study was carried out on 120 patients suffering from serosal effusion (50 pleural, 50 peritoneal, and 20 cases of pericardial effusion) . Detailed clinical history, physical examination and routine and relevant investigation of all patients including ADA estimation by GALANTI AND GIUSTI method was done. Results: ADA Level in tuberculous pleural effusion ranged from 45-160 U/L with a mean level of 100U/L and sensitivity and specificity of 100% (p<0.001, highly significant). ADA level in tuberculous peritoneal effusion ranged from 35-135 U/L with a mean level of 92U/L and sensitivity and specificity of 100% and 95% respectively (p<0.001, highly significant). ADA level in tubercular pericardial effusion ranged from 63-117 U/L with a mean level of 90U/L and sensitivity and specificity of 100% and 83.3% respectively (p<0.005, very significant).In toto serosal fluid ADA level estimation offers high degree of sensitivity and specificity of about 100% and 94.6% respectively, Conclusion: ADA was found positive with a mean value of 100U/L, 92U/L and 90 U/L in tubercular pleural, peritoneal and pericardial effusion respectively with overall 100% sensitivity and 94.6% specificity and cutoff value of 40 U/L.