The effects in correction of anaemia in chronic kidney disease with erythropoietin therapy--preference to cardiovascular, neurologic and general well-being of patients from a tertiary care centre.

Anaemia, the major sequelae of chronic renal disease (CRD) needs to be investigated because it acts as an independent risk factor for worsening of cardiovascular survival, cognitive impairment and poor quality of life. In this prospective tertiary care hospital-based study we have followed up 100 randomly assigned CRD patients who were not on dialysis for at least 6 months. Left ventricular mass index (LVMI), ejection fraction (EF), mini-mental status examination (MMSE) and general well-being of these patients were assessed quantitatively on admission and at 3rd and 6th months of follow-up after receiving recombinant human erythropoietin (rHuEPO) and aggressive intravenous iron therapy for anaemia correction. The median study duration was 6 years. Statistical analysis also showed the positive impact of anaemia correction which, even when partial, caused significant improvement in cardiovascular function as evidenced by increase in EF (p = 0.004) and decrease in LVMI (p = 0.016) along with substantial enhancement of general well-being (p < 0.001). Cognition did not show significant change within a short spell of 6 months. This study thus emphasises on earliest detection and correction of anaemia in CRD population to enhance both short-term and long-term survival as a whole.

Etiology of anemia in primary hypothyroid subjects in a tertiary care center in Eastern India.

INTRODUCTION: The association of anemia with primary hypothyroidism has been common knowledge for many years. However; its pathogenesis is far from clear in many cases. Often the causes of anemia are manifold. AIMS AND OBJECTIVES: In this study, we evaluated the causes of anemia in patients with primary hypothyroidism. MATERIALS AND METHODS: Sixty adult nonpregnant untreated primary hypothyroid patients with anemia without any obvious cause were included. All patients were subjected to full medical history, clinical examination, biochemical and imaging studies. Serum iron profile, vitamin B12, folic acid, anti parietal cell antibody, anti TPO antibody, bone marrow study, and stool for occult blood, Coomb's test, HPLC for hemoglobinopathies and complete hemogram with reticulocyte count were done and analyzed. RESULTS: Normocytic, normochromic anemia was present in 31 patients (51.6%) followed by microcytic anemia in 26 patients (43.3%). Six patients (10%) had megaloblastic anemia with vitamin B12 deficiency including 3 cases of pernicious anemia. Two patients had combined deficiency of iron and vitamin B12. CONCLUSION: Normocytic normochromic anemia with normal bone marrow was commonest type of anemia in this study, followed by iron deficiency anemia.

Benefits of leptin therapy in HIV patients.

Leptin therapy in human recombinant form has recently been used in HIV-associated lipodystrophy syndrome on experimental basis in some small short-term clinical trials. It has shown its beneficial effects only in hypoleptinemic HIV-infected patients by causing definite improvement in their insulin sensitivity, glucose tolerance, lipid status, and truncal obesity. Leptin prevents lipotoxicity and activates insulin signaling pathways through several postulated mechanisms. Central leptin insufficiency with peripheral hyperleptinemia has come out to be a significant contributor to the development of obesity and metabolic syndrome. In this article, we will review the basis of leptin therapy in HIV patients, with its promises. However, further larger clinical trials are needed to prove its long-term efficacy in the control of metabolic complications related to HIV therapy.

Human immunodeficiency virus endocrinopathy.

Human immunodeficiency virus (HIV) endocrinopathy encompasses a broad spectrum of disorders. Almost all the endocrine organs are virtually affected by HIV infection. HIV can directly alter glandular function. More commonly secondary endocrine dysfunction occurs due to opportunistic infections and neoplasms in immunocompromised state. The complex interaction between HIV infection and endocrine system may be manifested as subtle biochemical and hormonal perturbation to overt glandular failure. Antiretroviral therapy as well as other essential medications often result in adverse endocrinal consequences. Apart from adrenal insufficiency, hypogonadism, diabetes and bone loss, AIDS wasting syndrome and HIV lipodystrophy need special reference. Endocrinal evaluation should proceed as in other patients with suspected endocrine dysfunction. Available treatment options have been shown to improve quality of life and long-term mortality in AIDS patients.

Isolated ascites in hypothyroidism: medical and ethical issues.

Hypothyroidism presenting as ascites is one of the rarest clinical scenarios encountered in medical practice. A case of a 65-year-old woman, presenting with progressive onset ascites, secondary to underlying hypothyroidism, which responded to thyroid hormone replacement therapy is reported. A feature of hypothyroidism Induced ascites is the high protein content of the ascitic fluid (> 2.5 g/dl), a high serum albumin ascites gradient (SAAG) and the consistent drastic response of ascites to thyroid hormone replacement. Hypothyroid ascites is thus a very rare manifestation of the primary disease, but should be borne in mind when other causes of ascites are ruled out and the ascitic fluid shows typical features.

Heterotransplantation of kidney: medical and legal issues.

Since 1905, various attempts were made to transplant kidney from rabbit, pig or goat. But the attempts failed due to strong immune reaction-response. Heterotransplantation or xenotransplantation is a process to transplant kidney between various species. Allotransplantation is costly and needs lifelong immunosuppression associated with high risk rate of infection and other complications. Moreover legal and social issues involved in the process should be taken into account. So xenotransplantation is definitely an improved process.

Atypical hepatic pathology associated with diabetes mellitus--report of two cases.

Generalised oedema of short onset without evidences of cardiac or renal failure in two diabetic patients, irrespective of diabetes type with common features of non-hepatomegaly, without altered liver enzymes, absence of viral markers, absence of diabetic angiopathy, poor glycaemic control and improvement with glycaemic care are reported. Both the patients had certain biochemical and hepatic histologic features in common.