Relation between Calcium, Phosphorus, Calcium-Phosphorus Index and iPTH in Chronic Kidney Disease Patients.

BACKGROUND: The disturbance in homeostasis of calcium, phosphorus, vitamin D, and parathyroid hormone are frequently seen in chronic kidney disease patients. It is vital for physician to know the relation among them to treat chronic kidney disease patients. The main objective of the study is to 1) gather and analyze the data from chronic kidney disease patients undergoing dialysis to find out intact parathyroid hormone status 2) the relation between level of serum calcium, serum phosphorus, calcium-phosphorus index and serum intact parathyroid hormone in Nepalese population. METHODS: Verbal consent was taken from all the participants. Eighty participants between the age of 29 and 70 years with chronic kidney disease having indication of emergency hemodialysis were included in this study. Serum calcium, and phosphorus were measured by Fully Automatic Biochemistry Analyzer, and serum intact parathyroid hormone (iPTH) was measured using Chemi Luminescence Immuno Assay (CLIA) method. RESULTS: There is positive correlation between high calcium - phosphorus index and raised serum intact parathyroid hormone (r= 0.30).The relation is also true for serum calcium level and serum intact parathyroid hormone (r= 0.38). There is weak negative correlation between serum phosphorus and serum intact parathyroid hormone (r= -0.03). CONCLUSIONS: In Chronic kidney disease patients, high serum calcium or calcium - phosphorus index associated with raised level of serum intact parathyroid hormone and reverse is true for increased serum phosphate level. The relation may guide physician to suspect hyperparathyroidism in chronic kidney disease patients and manage the complications related to hyperparathyroidism like renal mineral bone disease, anemia resistant to erythropoietin.

Relation between Serum Intact Parathyroid Hormone Level and Hematocrit in Chronic Kidney Disease Patients.

Background Anemia is a common complication of chronic kidney disease. There are various causes of anemia in chronic kidney disease patients on hemodialysis. Secondary hyperparathyroidism is one of the less recognized causes of anemia in chronic kidney disease patients. Objectives The main objective of the study is to find the correlation between intact parathyroid hormone and hematocrit level in chronic kidney disease (CKD) patients undergoing hemodialysis. Method Verbal consent was taken from all the participants. Eighty participants between the age of 29 and 70 years with chronic kidney disease having indication of hemodialysis were included in this study. Hematocrit was measured by bioelectrical impedance method and serum intact parathyroid hormone was by using Chemi Luminescence Immuno Assay (CLIA) method. Result A weak reverse correlation was found between serum intact parathyroid level and hematocrit (r= -0.33). Conclusion In chronic kidney disease patient, there is reverse correlation between level of serum intact parathyroid and hematocrit level. This association may have clinical relevance in assessing the cause of unexplained low hemoglobin level in CKD patients.

Prevalence of Gall Stones in Liver Cirrhosis.

INTRODUCTION: Increased incidence and prevalence of gallstones in liver cirrhosis has already been reported by many studies. This study aimed to investigate the prevalence of gallstone disease in Nepali patients with LC and to identify risk factors for gallstone formation. METHOD: Consecutive patients of LC presenting to liver clinic from January, 2010 to December, 2012 were evaluated for GS by ultrasonography at their first visit. Liver cirrhosis was diagnosed on the basis of clinical features, laboratory parameters, ultrasonography, and/or histopathology. RESULT: Two hundred and twenty four LC patients were studied. Male to female ratio was 2.3:1. Alcohol was the major etiological factor for LC followed by hepatitis B, alone or in conjunction with alcohol. Seventy-four patients (33%) were found to have GS. Incidence of GS was more in advance stage of cirrhosis. There was no significant correlation between formation of GS and etiology of LC, except for the HCV related liver cirrhosis, in which it was present in 39% of the patients. More the advance disease,more was the incidence as 57% of Child-C patients had GS. Portal vein diameter was also associated with GS formation. When portal vein diameter was more than 13 mm, there was more GS formation. CONCLUSIONS: One third of the patients of LC showed GS at the presentation. Patients with HCV related cirrhosis are more prone to develop GS than other. Severity of the disease and portal vein diameter was found to be associated with GS formation.

Nd: Yag laser treatment for sub-hyaloid hemorrhage in childhood acute leukemia.

INTRODUCTION: Sub-hyaloid haemorrhage is common in acute leukemia. OBJECTIVE: To investigate the effects of Nd: YAG Laser hyaloidotomy in 11 eyes of 8 patients with pre-macular haemorrhage in acute childhood leukemia. MATERIALS AND METHODS: Premacular sub-hyaloid haemorrhage is one of the leading causes of visual disability in children with acute leukemia. Eleven eyes of 8 patients attending Kanti Children Hospital and BP Koirala Lions Centre for Ophthalmic Studies from January 2006 to July 2007 with premacular subhyaloid haemorrhage were included in the study and treated with Nd: YAG Laser. The haemorrhage originated from acute myeloid leukemia (AML) in 4 cases (6 eyes) and acute lymphoblastic leukemia (ALL) in 4 cases (5 eyes). RESULTS: Drainage of premacular sub-hyaloid haemorrhage into the vitreous cavity within 3 months succeeded in 9 eyes out of 11 eyes treated. One eye had a dense clotted haemorrhage and the other had a re-bleed. Overall visual improvement was equal in both AML and ALL cases. No obvious epiretinal membrane, retinal breaks and tractional retinal detachment occurred in any eye. CONCLUSION: Nd: Yag laser hyaloidotomy is a relatively safe, simple and alternative treatment for eyes with a dense premacular sub-hyaloid haemorrhage in acute childhood leukemia. The risks and benefits have to be weighed in randomized clinical trials to establish Nd: YAG hyaloidotomy treatment as a routine procedure in leukemic children.

Physiologically based biokinetic (PBBK) model for safrole bioactivation and detoxification in rats.

A physiologically based biokinetic (PBBK) model for alkenylbenzene safrole in rats was developed using in vitro metabolic parameters determined using relevant tissue fractions. The performance of the model was evaluated by comparison of the predicted levels of 1,2-dihydroxy-4-allylbenzene and 1'-hydroxysafrole glucuronide to levels of these metabolites reported in the literature to be excreted in the urine of rats exposed to safrole and by comparison of the predicted amount of total urinary safrole metabolites to the reported levels of safrole metabolites in the urine of safrole exposed rats. These comparisons revealed that the predictions adequately match observed experimental values. Next, the model was used to predict the relative extent of bioactivation and detoxification of safrole at different oral doses. At low as well as high doses, P450 mediated oxidation of safrole mainly occurs in the liver in which 1,2-dihydroxy-4-allylbenzene was predicted to be the major P450 metabolite of safrole. A dose dependent shift in P450 mediated oxidation leading to a relative increase in bioactivation at high doses was not observed. Comparison of the results obtained for safrole with the results previously obtained with PBBK models for the related alkenylbenzenes estragole and methyleugenol revealed that the overall differences in bioactivation of the three alkenylbenzenes to their ultimate carcinogenic 1'-sulfooxy metabolites are limited. This is in line with the generally less than 4-fold difference in their level of DNA binding in in vitro and in vivo studies and their almost similar BMDL(10) values (lower confidence limit of the benchmark dose that gives 10% increase in tumor incidence over background level) obtained in in vivo carcinogenicity studies. It is concluded that in spite of differences in the rates of specific metabolic conversions, overall the levels of bioactivation of the three alkenylbenzenes are comparable which is in line with their comparable carcinogenic potential.

Retinal vasculitis.

Retinal vasculitis is an idiopathic inflammatory venous occlusion primarily affecting the peripheral retina of otherwise healthy young adults. Eales' disease is recognized as primary vasculitis of unknown etiology occurring in young adults. This article aims at the overall review of the etiopathogenesis, clinical presentations, pathology, management and prognosis of retinal vasculitis.