Plasma Neutrophil Gelatinase Associated Lipocalin (pNGAL) Level to Identify AKI Early in Patients Undergoing Cardiac Valve Surgery.

Cardiac valve surgery is considered one of the most frequent surgical procedures in which AKI is a common & serious complication. Although serum creatinine is routinely used as a marker of renal function, it poorly reflects the immediate post operative period renal function. Within minutes to few hours after a renal insult, plasma neutrophil gelatinase associated lipocalin (pNGAL) is released. The aim of this study was to assess the superiority of pNGAL over serum creatinine in detecting AKI in early post operative period. This prospective observational study was carried out in the Department of Nephrology of National Institute of Kidney Diseases & Urology in collaboration with National Institute of Cardiovascular Diseases (NICVD) & Dhaka Shisu Hospital (DSH) from January 2015 to December 2016. Total 120 patients were selected from inpatient ward of cardiovascular surgery department. According to inclusion & exclusion criteria total 80 patients were included who was undergone cardiac valve surgery. Serum samples for pNGAL were collected from study population 6 hours after completion of surgery & stored at -80°C, serum samples were also collected for serum creatinine day before surgery, in 1st post operative day (POD1) & 2nd post operative day (POD2). Total 79 patients undergoing cardiac surgery, who met the inclusion & exclusion criteria, were consecutively included. There were 44 male (55.69%) and 35 female (40.31%) ranged from 15-60 years, with mean age of 36 years. pNGAL level in the blood of AKI patients (244.19±59.61ng/ml) 6 hours after completion of surgery was significantly higher from the non AKI patients (171.73±68.63ng/ml). A positive significant correlation was found between pNGAL 6 hours after completion of surgery & serum creatinine at POD1, POD2. This study demonstrated that level of pNGAL concentration 6 hours after completion of cardiac valve surgery increased before the rise of serum creatinine level & can thus AKI can be detected earlier by pNGAL.

Chronic kidney disease specific cardiovascular risk factors among non dialytic patients with chronic kidney disease stage-V--an experience of a specialized hospital.

The study was carried out to see prevalence of Chronic Kidney Disease (CKD) specific cardiovascular risk factors and cardiovascular events among patients with Chronic Kidney Disease stage-V (CKD-V) before starting dialysis therapy in the department of Nephrology of National Institute of Kidney Diseases & Urology (NIKDU), Dhaka, Bangladesh. Among CKD specific cardiovascular risk factors, anemia showed the highest prevalence (96.7%) in study population. More than fifty percent of CKD-V patients had both hypocalcaemia and hyperphosphataemia. Calcium-Phosphate Product (CaXP) was elevated among 23 percent of the population. C-reactive protein, an acute phase protein was positive in 78% of CKD-V patients. Besides, among traditional risk factors, Hypertension and Diabetes Mellitus were present in 83.3% and 23% of the study population respectively. The prevalence of cardiovascular events among CKD-V patients showed that 18.3% had ischemic heart disease, 38% heart failure, 4.7% arrhythmia and 9% left ventricular hypertrophy. Females were significantly prone to develop cardiovascular events than their male counterpart (p=0.028). Diabetes was significantly higher in patients with cardiovascular complications than in patients without cardiovascular complications (p=0.021).

Awareness about organ donation among school girls.

Prevalence of organ failure is high through out the world. Organ transplantation, the definitive treatment option of organ failure keeps very low due to scarcity of organ. Most of the people are not aware about organ donation. Adolescent girls will be the mother of future nation and they can motivate family members for organ donation. This study was carried out to see attitudes towards organ donation and determine the negative factors of organ donation prevailing among school girls. One hundred sixty eight girls from class VIII to class X of a higher secondary school were participated. A structured questionnaire was filled up by the girls. The data were processed from questionnaire and analyzed. Among study population, most of them (64%) had no idea about on going organ donation and transplantation. The positive attitude of the girls towards organ donation was low when they are live (16%) and their attitudes also kept low even after their death (14%). The girls who did not agree to donate organ were further asked to mention the reasons. The reasons of negative attitude were religious belief, fear of illness and social and familial reservation. The result of this study suggests that among girls, awareness and attitudes about organ donation is poor. There were several reasons identified for low consent rates. Multidisciplinary actions should be taken to improve the awareness of the people about organ donation and motivate them for donation.

Sensitivity of splenic and bone marrow aspirate study for diagnosis of kala-azar.

Fifty adult patients of kala-azar were included in this prospective study from Medicine Unit-I of Mymensingh Medical College Hospital. Splenic and bone marrow aspiration were done simultaneously to compare the sensitivity and other related merits and demerits of each procedure. Splenic aspiration appeared to be more sensitive procedure than bone marrow aspiration. Leishman - Donovan (LD) bodies were found in 90 percent and 72 percent of the spleen and bone marrow aspirates respectively. Splenic aspiration was found more acceptable to patients (96%) as it was less painful. Both the procedures were hazardless. There was no major complication except mild pain after splenic aspiration; even a few patients had history of epistaxis. Splenic aspiration was also more acceptable by the physicians because of an easy and reliable diagnostic procedure.

Thoracic actinomycosis.

Thoracic actinomycosis represents about one-fourth of all cases of the disease. Isolated pleural effusion due to Actinomycosis is rare. We report a case of right sided pleural effusion with discharging sinus in the right anterior chest wall. Actinomycosis was suspected and confirmed by microscopic identification of "sulfur granules" in the discharge of the sinus tract and also identification of gram-positive filamentous bacteria in the specimen of discharging sinus. The patient improved clinically and radiologically after treatment with intravenous penicillin G followed by oral penicillin and aspiration of pleural fluid.

Clinical profile of Kala-azar in adults: as seen in Mymensingh Medical College Hospital, Mymensingh, Bangladesh.

A total of eighty-one consecutive cases of Kala-azar admitted in all four medicine units of Mymensingh Medical College Hospital during the period from January 2002 to mid August 2002 were included in this study. The number of the patients clearly indicates that the burden of Kala-azar in this region is significant and expanding, which constituted 1.90% of total admission in all 4 medicine units during this period. Majority of the patients were of 20-29 years of age. Male to female ratio was 1.38:1. Maximum number of the patients were of poor socio-economic group with history of housing made up of mud and having close proximity with cattle house. Fever and splenomegaly (100%) were the predominant features. Hepatomegaly was found in 91.36% of the cases. Other clinical manifestations were weight loss (79.01%), normal or increased appetite (65.43%), generalized weakness (72.84%), pallor (69.13%), cough (25.92%), jaundice (17.28%), abdominal Pain (12.34%), hyperpigmentation (9.88%), ascites (4.94%) and bleeding manifestations (4.94%). Notable concomitant illnesses were urinary tract infection (7.40%), pulmonary tuberculosis (3.70%), malaria (1.23%), scabies (4.94%), heart failure (3.70%) and chronic liver disease (2.47%). Due to wide diversity of clinical presentations, clinical features of kala-azar should be evaluated in details which will pave the hidden cases into light.

Risk factors & clinical presentations--a study of eighty-five hospital admitted stroke cases.

Stroke is the commonest neurological cause of morbidity and mortality. Changes in risk factors may influence stroke incidence. Definitive diagnosis of the type of stroke is necessary for management and it has a strong impact on stroke outcome. A total of eighty-five consecutive stroke patients irrespective of age and sex admitted during the period of August 2000 to June 2001 were studied. They were asked about occupation, area of habitat, smoking habit, family history of ischaemic heart disease and/or stroke, any febrile illness, recent history of productive cough, dysuria and diarrhoea. They were searched for hypertension, diabetes mellitus, ischaemic heart disease, valvular heart disease and dislipidaemia. In every patient complete blood count, urine examination, fasting blood glucose and serum lipids, ECG, x-ray chest were performed. CT scan of brain was performed in 68 cases. Male was found 81.18% of cases with age 62.54 +/- 13.08 (m +/- SD) years. Female were 18.82% of cases with age 58.81 +/- 12.77 (m +/- SD). 75.29% of patients were belongs to middle class family. 51.76% of patients came from rural area and 48.24% of patients came from urban area. 78.82% of patients were hypertensive. Infection was associated with 37.65% of cases. Hemiplegia was commonest presentation (88.24%). Though altered consciousness was found more in haemorrhagic stroke (54.84%) but it was not significantly. High from ischaemic cases (p > 0.10) Male suffer more from stroke. Hypertension is the commonest risk factor. Infection is a common association of stroke. Altered consciousness is not a reliable guide to differentiate between ischaemic and haemorrhagic stroke is hospitalized cases.

A biphasic regulation of receptor mRNA expressions for growth hormone, glucocorticoid and mineralocorticoid in the rat dentate gyrus during acute stress.

Acute stress increases circulating ACTH and glucocorticoid levels. The hippocampus (HIP) is a target of such stress hormones as glucocorticoid and it also expresses receptors for growth hormone (GH), particularly in the dentate gyms (DG). In order to understand the interactions between glucocorticoids and functions of GH in HIP during acute stress, the mRNA levels for GH receptor (GHR), glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) were investigated in DG in rats exposed to restraint stress in the water (RSW). Using in situ hybridization histochemistry (ISHH), high level expressions of GHR mRNA were detected in DG. These were down-regulated by 14% after 0.5 h of RSW and then up-regulated by 38% over the initial level after 4 h of RSW. This biphasic enhancement of GHR mRNA expression in DG followed the elevation of plasma glucocorticoid levels and paralleled with biphasic expressions of mRNAs for GR and MR in DG. Although circulating GH levels did not show any correlation with the hippocampal GHR mRNA expression, adrenalectomy (ADX) decreased GHR mRNA expression in DG, and the dexamethasone treatment (DEX; 20 microg/100 microl, i.p.) of ADX rats rapidly increased the GHR mRNA expression in DG. These results have suggested that the GHR mRNA expression in the DG is regulated, at least in part, by glucocorticoids and that GH may be involved in responses of the DG to acute stress.

Subcutaneously administered prolactin and 20K hGH, but not rGH or 22K hGH, prevent restraint stress-induced gastric ulcers in rats.

Stress causes gastric ulcer in vertebrates. In humans, growth hormone (hGH) and prolactin (hRPL) are promptly released into the circulation under the stress conditions, while in rats exposed to stress, the circulating levels of GH (rGH) are decreased and the circulating PRL (rPRL) levels are rapidly increased as in humans during stress. However, the roles of the circulating rGH and rPRL during stress are still unclear. Here we analyzed whether 22K hGH, 20K hGH or rGH, when compared to rPRL, can affect restraint stress in water (RSW)-induced gastric ulcers. Pretreatments of rats with subcutaneously (s.c.) administered rPRL or 20K hGH clearly prevented the development of the gastric injuries in rats subjected to 7 h RSW. The s.c. pretreatment with 22K hGH resulted in little cytoprotection in the rats exposed to RSW, while s.c. pretreatment with rGH showed no such protective effect against RSW-induced gastric injuries. Results suggested that rPRL and 20K hGH were acting on PRL receptor, but not on GH receptor, to prevent RSW-induced gastric injuries.

Synthesis and purification of a deleted human growth hormone, hGH delta 135-146: sensitivity to plasmin cleavage and in vitro and in vivo bioactivities.

Proteolytically cleaved human 22 kDa growth hormone (22K hGH) between the amino acid residues 134 and 150 by plasmin or other proteases in vitro has been reported to be most active in growth promoting activity. In this study a deleted mutant hGH lacking amino acid residues from 135 to 146 and having more sensitivity to plasmin digestion was produced using the inverse polymerase chain reaction method and the Escherichia coli expression system. The mutant, hGH delta 135-146, was folded and purified effectively and found to be more sensitive to plasmin cleavage to form the two-chain form in vitro. The biological activities of this plasmin sensitive hGH delta 135-146 were tested by in vitro cell proliferation assays and in vivo growth promoting assay. In Ba/F3-hGHR cells, which express receptors for hGH, hGH delta 135-146 showed 10-20% less growth promoting activity than 22K hGH, but expressed comparable quantities of IGF-I mRNA to that of 22K hGH. In Nb2 rat lymphoma cells, which proliferate in response to hGH via the lactogenic receptors, hGH delta 135-146 showed equivalent activities to those of 22K hGH at lower concentrations. By the body weight gain test using hypophysectomized rats, a lower dose (2.5 nmol kg-1) of hGH delta 135-146 exhibited an equivalent activity to that of wild type 22K hGH, but a higher dose (25 nmol kg-1) of the mutant showed less growth promoting activity than 22K hGH. These results indicated that the plasmin sensitive recombinant hGH delta 135-146 failed to show higher biological activity than the 22K hGH in vivo, suggesting the unsuccessful formation of the active two-chain form in vivo.

Inverse effects of 20K and 22K human growth hormones on the growth of T-47D human breast cancer cells in culture and in nude mice.

The major form of human growth hormone (22K hGH) stimulates the growth of T-47D human breast cancer cells in culture and in nude mice by binding to their receptors for growth hormone and prolactin. Another isoform of hGH having a smaller molecular mass (20K hGH) is known to show different binding affinities to these receptors. In this study, we have analyzed the effects of 20K hGH on the growth of T-47D cells in vitro and in vivo. 20K hGH (50 ng/ml) inhibited the proliferation and DNA synthesis of T-47D cells cultured in the presence and absence of 17 beta-estradiol (100 ng/ml), while 22K hGH (50 ng/ml) promoted the cellular growth. In estradiol-treated nude mice, 22K hGH (100 micrograms) remarkably promoted the growth of T-47D tumor, but 20K hGH again suppressed the tumor growth significantly. The results suggest the presence of different signal pathways for these two hGH isoforms and imply a possible clinical application for 20K hGH.

Cooperative and differential effects of estrogen, prolactin, 22K and 20K human growth hormones on cyclin D1/PRAD1 gene expression in T-47D human breast cancer cells.

The cyclin D1/PRAD1 gene is correlated with carcinogenesis of human breast cancer. In this study, we have analyzed effects of breast cancer-related hormones on the cyclin D1 gene expression in T-47D human breast cancer cells. Estradiol (E2) and human prolactin (hPRL) equally enhanced the cyclin D1 gene expression in the cells, and 22 and 20 kDa human growth hormones (22K and 20K hGHs) showed less stimulatory effects. In the presence of E2, however, hPRL or 22K hGH showed additive stimulations of the cyclin D1 gene expression to that by E2 alone, while 20K hGH did not show any additive stimulation of the gene expression. The results suggest that the signal pathways through estrogen and hPRL receptors are important for cyclin D1 gene expression in breast cancer cells, and that 20K hGH has little effect on the cyclin D1 gene expression in these cells because of its lower affinity to PRL receptor.

Expression and purification of a mutant human growth hormone that is resistant to proteolytic cleavage by thrombin, plasmin and human plasma in vitro.

The region having a sequence from amino acid 134 to 150 in human growth hormone (hGH) is known to be cleaved by proteases in human plasma, plasmin and thrombin. In this study, oligonucleotide primer-directed mutagenesis was used to produce recombinant mutant hGHs resistant to limited proteolysis by these proteases. Substitution of Arg134 and Thr135 of hGH with Asp134 and Pro135 yielded a thrombin-resistant hGH mutant, and substitution of Arg134, Thr135 and Lys140 with Asp134, Pro135 and Ala140 yielded a plasmin-resistant hGH mutant. The latter mutant hGH was also insensitive to in vitro proteolysis by human plasma incubated for 7 days. These alterations in amino acid residues of hGH did not disrupt its biological conformation and retained full growth promoting activities on rat Nb2 cells and human T-47D breast cancer cells.