Renal hypoxia in kidney disease: Cause or consequence?

Tissue hypoxia has been proposed as an important factor in the pathophysiology of both chronic kidney disease (CKD) and acute kidney injury (AKI), initiating and propagating a vicious cycle of tubular injury, vascular rarefaction, and fibrosis and thus exacerbation of hypoxia. Here, we critically evaluate this proposition by systematically reviewing the literature relevant to the following six questions: (i) Is kidney disease always associated with tissue hypoxia? (ii) Does tissue hypoxia drive signalling cascades that lead to tissue damage and dysfunction? (iii) Does tissue hypoxia per se lead to kidney disease? (iv) Does tissue hypoxia precede pathology? (v) Does tissue hypoxia colocalize with pathology? (vi) Does prevention of tissue hypoxia prevent kidney disease? We conclude that tissue hypoxia is a common feature of both AKI and CKD. Furthermore, at least under in vitro conditions, renal tissue hypoxia drives signalling cascades that lead to tissue damage and dysfunction. Tissue hypoxia itself can lead to renal pathology, independent of other known risk factors for kidney disease. There is also some evidence that tissue hypoxia precedes renal pathology, at least in some forms of kidney disease. However, we have made relatively little progress in determining the spatial relationships between tissue hypoxia and pathological processes (i.e. colocalization) or whether therapies targeted to reduce tissue hypoxia can prevent or delay the progression of renal disease. Thus, the hypothesis that tissue hypoxia is a "common pathway" to both AKI and CKD still remains to be adequately tested.

A Comparative Study of Magnetic Resonance Imaging and Transabdominal Ultrasonography for the Diagnosis and Evaluation of Uterine Fibroids.

Uterine fibroids often cause symptoms of pelvic pain, pressure, and bleeding and a significant cause of morbidity for women of reproductive age. A new, Food and Drug Administration approved noninvasive treatment option is magnetic resonance guided focused ultrasound surgery, which has the potential to become a treatment of choice for selected patients. The purpose of the study was to compare and evaluate the usefulness of MRI and transabdominal ultrasonography for the diagnosis of uterine fibroids. A cross sectional study was carried out in the department of Radiology & Imaging of Mymensingh Medical College Hospital, during the period of January' 2010 to December 2011. A total number of 40 consecutive patients having suspected uterine fibroids underwent MRI and transabdominal ultrasonography and they were followed up from the admission upto the tissue diagnosis of uterine fibroids for histopathological correlation were included in this study. The test of validity of MRI and transabdominal ultrasonography in diagnosis of uterine fibroids was calculated. In the diagnosis of uterine fibroids, USG was 88.2% sensitive, 66.7% specific, 85.0% accurate, 93.8% positive predictive values and 50% negative predictive values. However MRI was 97.1% sensitive, 83.3% specific, 95.0% accurate, 97.1% positive predictive values and 83.3% negative predictive values for prediction of uterine fibroids. The study shows that the MRI is more efficient diagnostic modality than transabdominal ultrasonography in detecting uterine fibroid presence and evaluation.

Role of Computed Tomography in the Evaluation of Nasopharyngeal Mass.

In Indian subcontinent, all types of nasopharyngeal masses are rare. However, Nasopharyngeal carcinoma is not uncommon in Bangladesh. It is very important to differentiate malignant from benign lesions early in the disease process. In recent years, CT is the primary diagnostic screening modality for the detection of nasopharyngeal pathology. This cross sectional study was carried out in the Department of Radiology & Imaging, BSMMU in collaboration with Department of otolaryngology of the same hospital from July 2012 to June 2014. Sensitivity of CT scan in diagnosis of nasopharyngeal carcinoma was 100%, specificity was 93.10%, positive predictive value (PPV) was 93.94%, negative predictive value (NPV) was 100% and accuracy was 96.67%. Sensitivity of CT scan in diagnosis of benign angiofibroma was 78.26 %, specificity was 89.19%, positive predictive value (PPV) was 81.82%, negative predictive value (NPV) was 86.84% and accuracy was 85% of CT scan. CT scan findings of the present study correlated well in most of the cases with the histopathological evaluations. Considering the high validity parameter it can come to a conclusion that CT scan is as highly effective as histopathology in diagnosis of nasopharyngeal mass.

Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol.

BACKGROUND: Severely malnourished children have high mortality rates. Death commonly occurs during the first 48 h after hospital admission, and has been attributed to faulty case-management. We developed a standardised protocol for acute-phase treatment of children with severe malnutrition and diarrhoea, with the aim of reducing mortality. METHODS: We compared severely malnourished children with diarrhoea aged 0-5 years managed by non-protocol conventional treatment, and those treated by our standardised protocol that included slow rehydration with an emphasis on oral rehydration. The standardised-protocol group included children admitted to the ICDDR,B Hospital, Dhaka between Jan 1, 1997, and June 30, 1997, while those admitted between Jan 1, 1996, and June 30, 1996, before the protocol was implemented, were the non-protocol group. FINDINGS: Characteristics on admission of children on standardised protocol (n=334) and non-protocol children (n=293) were similar except that more children on standardised protocol had oedema, acidosis, and Vibrio cholerae isolated from stools. 199 (59.9%) of children on standardised protocol were successfully rehydrated with oral rehydration solution, compared with 85 (29%) in the non-protocol group (p<0.0001). Use of expensive antibiotics was less frequent in children on standardised protocol than in the other group (p<0.0001). Children on standardised protocol had fewer episodes of hypoglycaemia than non-protocol children (15 vs 30, p=0.005). 49 (17%) of children on non-protocol treatment died, compared with 30 (9%) children on standardised protocol (odds ratio for mortality, 0.49, 95% CI 0.3-0.8, p=0.003). INTERPRETATION: Compared with non-protocol management, our standardised protocol resulted in fewer episodes of hypoglycaemia, less need for intravenous fluids, and a 47% reduction in mortality. This standardised protocol should be considered in all children with diarrhoea and severe malnutrition.

PIP: Severely malnourished children have high mortality rates, with death commonly occurring during the first 48 hours after hospital admission. Such mortality has been attributed to faulty case management. The authors therefore developed a standardized protocol for the acute-phase treatment of children with severe malnutrition and diarrhea, with the aim of reducing mortality. This paper compares severely malnourished children with diarrhea aged 0-5 years managed by nonprotocol conventional treatment to those treated by the authors' standardized protocol, which included slow rehydration with an emphasis upon oral rehydration. The characteristics on admission of the 334 children on the standardized protocol and the 293 nonprotocol children were similar, except that more children on the standardized protocol had edema, acidosis, and Vibrio cholerae isolated from stools. 59.9% of the children on the standardized protocol were successfully rehydrated with oral rehydration solution, compared with 29% of those in the nonprotocol group. The use of expensive antibiotics was less frequent in children on the standardized protocol than in the other group, and children on the standardized protocol had fewer episodes of hypoglycemia than nonprotocol children. 17% of nonprotocol and 9% of standardized protocol children died. These findings suggest that the standardized protocol should be considered for all children with diarrhea and severe malnutrition.