Measurement of Glomerular Filtration Rate by Exogenous and Endogenous Filtration Markers.

The National Kidney Foundation (NKF), through its Kidney Disease Outcomes Quality Initiative (K/DOQI), and other National institutions proposed glomerular filtration rate (GFR) to describe, classify, screen and examine chronic kidney disease (CKD). GFR is the standard measure of renal function but cannot be practically measured for clinical and research purposes, so serum creatinine (Scr) is used to calculate estimated GFR (eGFR) which is affected by age, weight, muscle mass, race, various medications and extra-glomerular elimination. To overcome this Cystatin C (CysC) is new and reliable marker for renal function due to its low molecular weight it is freely filtered through glomerulus, completely reabsorbed and catabolized, but not secreted, by tubular cells. Various equations used for GFR estimation such as the Modification of Diet in Renal Disease (MDRD) Study equation, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Cockcroft–Gault (CG) equation based on Scr , Grubb and Hoek equation based on CysC and Stevens equation based on both SCr and CysC are used. CKD–EPI is preferred for identifying patients with CKD and for staging the disease. The risk of underestimation of kidney function with MDRD is highest when the GFR is 30 mL/minute/1.73 m2 so GFR is calculated by CKD–EPI equation for these persons. CKD–EPI is recommended for diagnosis and staging when the addition of appropriate prophylactic drugs or avoidance of certain nephrotoxic drugs should occur. The aim of this review is to evaluate from recent literature available different exogenous and endogenous markers used for the determination of GFR and which marker found suitable for the determination of GFR according to literature available on PubMed and determine their reliability in the detection and monitoring of CKD and its stages. Key words: Glomerular filtration rate, chronic kidney disease, Creatinine, Cystatin C, Measurement of GFR Abbreviations - Glomerular filtration rate (GFR), chronic kidney disease (CKD), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Cockcroft–Gault (CG), Serum creatinine (Scr), serum cystatin C (CysC), National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI), Cardiovascular disease (CVD), Food and drug administration (FDA), Diethylene triamine pentaacetic acid (DTPA), Ethylene diamine tetra acetic acid (EDTA)

To Study the Effect of Fertilizer and Organic Manure on Dynamic Changes of Potassium Under Cropping Sequence.

A field experiment was conducted in a farmer’s field in the Red and Laterite zone of West Bengal to evaluate the effect of integrated use of FYM and concentrated organic manures and chemical fertiliser on dynamics of potassium in soil in relation to growth and yield of component crops viz., Potato, Sesame and Rice. Three levels of chemical fertilisers viz., (i) 75% of the RDF, (ii) 100% of the RDF, and (iii) 150% of the RDF and three levels of organic manures (i) Control- applying no 0rganic manure; (ii) FYM at 20 ton/ha, and (iii) a consortium of concentrated organic manure were applied in potato after which sesame and rice were grown with the residual nutrients. Under all the three crops, application of higher doses of chemical fertilizer resulted in greater decrease in soil pH and increase in soil EC, soil OC, exchangeable, water soluble and non-exchangeable K contents of the soil. Among the two organic manures applied, the values of these parameters of the soil under all the three component crops were the highest under application of FYM. The highest pooled mean value of soil pH and lowest EC, OC, exchangeable, water soluble and non-exchangeable K contents of the soil, irrespective of the component crop in the cropping sequence, was observed under RDF75 without any organic manure and the highest under RDF150 with application of FYM. Pearson correlation co-efficient among different soil and plant parameters suggested strong relationship among themselves and K content of rice shoots, and straw of the component crops. Under limited availability of FYM, commercially available sea weed extract based concentrated organic manures could be handy and effective.

Spontaneous Pneumomediastinum in H1N1 Infection.

Spontaneous pneumomediastinum is an uncommon pediatric emergency which usually occurs secondary to bronchial asthma in children. We report a case of spontaneous pneumomediastinum in a 7 year child following Swine Flu (H1N1) infection.

Nosocomial pneumonia in a pediatric intensive care unit.

BACKGROUND: Nosocomial pneumonia (NP) is the second most common hospital acquired infection. Understanding the pattern of occurrence, risk factors and etiological agents of NP in a PICU, is essential for developing effective infection control measures. This prospective observational study was conducted in a PICU of a tertiary care teaching hospital, to determine the incidence, etiology and risk factors for NP. MATERIALS AND METHODS: Patients admitted to the PICU, over a period of 1 year who had endotracheal (ET) intubation, were enrolled consecutively into the study. Demographic details were recorded at the time of inclusion. Diagnosis of NP was based on CDC criteria (1988).Semiquantiative assay of endotracheal aspirate (ETA) with a colony count of > 10(5) cfu/mL was taken as evidence of infection. Colonisation was defined as isolation of organism with <10(5) cfu/mL. Age, nutritional status, number and duration of intubations, duration of mechanical ventilation, sedation, nasogastric feeding were the risk factors studied for development of NP. Intubation attempts of more than one were defined as reintubation. Risk factors found significant on univariate analysis, were subjected to multiple regression analysis to determine the most important predictors of NP. RESULTS: The study group comprised of 72 children with a median age of 3.7 years and boys: girls ratio of 1.9:1.Twenty two of 72 (30.5%) developed NP; the predominant isolates from ETA were Acinetobacter anitratus(12), Pseudomonas aeruginosa (5), Klebsiella sp(3) and Staphylococcus aureus and E.coli(1) each. Additionally 18(39%) had evidence of ET colonization, with Acinetobacter sp being the commonest 9(50%). Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP.On multiple regression analysis, reintubation was the only independent risk factor for NP(OR 0.72, 95%CI 0.55-0.94).Overall mortality was 21%(15/72);7(47%)of these deaths were secondary to NP. CONCLUSIONS: NP developed in nearly one third of the intubated patients; Gram negative organisms were the predominant etiological agents and associated with high mortality. Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis, reintubation was the only independent risk factor for NP.

Serum adenosine deaminase levels in reactional and non-reactional leprosy.

BACKGROUND AND AIMS: Altered serum adenosine deaminase (ADA) levels have been recorded in various diseases involving lymphocytes and/or lymphoreticular system including leprosy. The study was planned to evaluate alterations in serum ADA levels, if any, in reactional and non-reactional leprosy. METHODS: Eighty patients of leprosy, comprising 60 patients of non-reactional leprosy and 20 patients of reactional leprosy were studied along with 20 normal healthy controls. Five milliliters of venous blood was collected and ADA levels were estimated by the method of Giusti (1974). RESULTS: There were 54 males and 26 females. The age of the patients ranged from 5 years to 62 years. The duration of leprosy ranged from 15 days to 3 years. The mean serum ADA level in normal controls was 10.31 +/- 0.58 u/L. The serum ADA levels were raised in leprosy patients, significantly so in multibacillary patients. The serum ADA levels were higher in patients of leprosy with reaction. CONCLUSIONS: The study showed significantly high serum ADA levels in multibacillary leprosy and this was further increased in patients of leprosy with reaction. This may be because of increased lymphoreticular activity during the reactional phases.