Upper Zone of Growth Plate and Cartilage Matrix (UCMA) Levels in Patients with Chronic Kidney Disease

Abstract Chronic kidney disease (CKD) is an important health problem across the world affecting the adult population with an enormous social and economic burden. Calcium regulation is also affected in patients with CKD, and related to several disorders including vascular calcifications, mineral bone disorders, and cardiovascular diseases (CVD). Upper zone of growth plate and cartilage matrix (UCMA) is vitamin K-dependent protein (VKDP) and acts as a calcification inhibitor in the cardiovascular system. The molecular mechanism of UCMA action remains unclear in CKD. In the current study, we aimed to investigate serum total UCMA levels and its association with calcium metabolism parameters in CKD patients including hemodialysis (HD) patients. Thirty-seven patients with CKD stage 3-5, 41 HD patients, and 34 healthy individuals were enrolled in this cross-sectional study. Serum UCMA and calcification related protein levels (Matrix Gla Protein (MGP), Osteocalcin (OC), and Fetuin-A) were analyzed with enzyme-linked immunosorbent assay (ELISA). Calcium mineral disorder parameters (Serum Ca, P, iPTH) were quantified with routine techniques. We, for the first time, report the potential biomarker role of UCMA in CKD including HD. Serum total UCMA levels were significantly higher in patients with CKD including HD patients than the healthy controls. Also, serum UCMA levels showed negative correlations with serum calcium, and eGFR, while showed positive relationships with P, iPTH, MGP, OC. Increased total UCMA levels may have a role in the Ca metabolism disorder and related to the pathogenesis of Vascular Calcification in patients with CKD.

Comparison of Paramedian with Midline technique of Spinal Anaesthesia in elderly

Objective: To compare the technique of paramedian with midline approach of subarachnoid block in terms of number of attempts and frequency of success rate in elderly patients undergoing elective lower body surgeries

Study Design: Randomized controlled trial

Place and Duration of Study: This study was carried out at Anaesthesia department of Combined Military Hospital Lahore. Six months from Jan 2014 to Jun 2014

Material and Methods: One hundred and seventy elderly patients were scheduled for lower body surgery, using spinal anaesthesia. They were randomized to either Midline approach [n=85] or Paramedian approach [n=85] by lottery method. The outcome measures number of attempts and success rate were noted in both groups and analyzed using SPSS version 18

Results: The successful block in first attempt was 95.3 percent in Paramedian group and 58.8 percent in Midline group. Mean number of attempts in paramedian group was 1.24 +/- 0.52 as compared to 1.95 +/- 0.97 in midline group. A p-value <0.05 was taken significant

Conclusion: The Paramedian technique was found associated with higher success rate, lesser possibility of repeated number of attempts in elderly patients as compared to Midline approach

Childhood primary angiitis of the central nervous system

To analyze the clinical course and magnetic resonance angiographic [MRA] abnormalities in children with primary angiitis of the central nervous system [cPACNS]. Cohort study. Neurosciences and Neuroradiology Department of the Children's Hospital, Lahore, from January 2009 to December 2010. The cohort comprised consecutive patients diagnosed as having cPACNS based on clinical findings and identification of arterial stenosis on magnetic resonance angiography [MRA] in the absence of an underlying condition that could cause these findings. The treatment protocol for ischaemic infarcts consisted of induction therapy with intravenous steroids pulses and intravenous immunoglobulin followed by maintenance therapy with azathioprine and low dose aspirin. When indicated, they were treated with anticoagulants at least for 4 weeks along with induction therapy. Patients were followed at a single centre and systemically assessed for clinical presentation, classification of disease as progressive or non-progressive, adverse effects of anticoagulants, aspirin, azathioprine and their hospital course. Sixty-eight children with medium-large vessel cPACNS [62% boys, 38% girls] with mean age of 8.5 +/- 3.5 years were enrolled in this study. Motor deficit [70%]; headache [64%] and fever [20%] were the commonest symptoms; whereas hemiparesis [60%]; seizures 55% [focal 35%, generalized 20%] and decreased conscious level [30%], were the commonest neurological findings. Neuroradiological findings were ischaemic strokes in 50 [73.5%], haemorrhagic strokes in 10 [14.7%] and ischaemic haemorrhagic lesions in 8 cases [11.8%]. Angiographically 51 [51/68, 75%] of the cohort had non-progressive [obliterative] and 17 [17/68, 25%] had evidence of progressive arteriopathy at the time of admission. No secondary haemorrhagic lesions were documented among infarcts strokes, which were treated with heparin and oral anticoagulants. Outcome was survival in 56 cases [81.5%] and death in 12 cases [18.5%]. All survivors were discharged on long-term oral aspirin; 15 of them were also commenced on azathioprine. Neurological findings among the 56 survivors were; normal 20%, minor disabilities in 25%, moderate disabilities in 20% and severe disabilities in 35%. The spectrum of cPACNS includes both progressive and non-progressive forms with significant morbidity and mortality. This treatment protocol of immunosuppressive therapy may improve long-term neurological outcome in children with medium-large vessel childhood primary angiitis of the CNS

Comparison between angiographic findings of the coronary artrey involved in acute myocardial infarction between military and civilian sectors

Objective: Comparison between involvement of different coronary arteries in acute myocardial infarction among military and civilian population

Place: Combined military hospital Lahore and Punjab institute of cardiology Lahore

Time Duration: From 15th March to 15th April 2010

Study Design: Comparative cross-sectional study

Patients And Methods: 50 civilians patients admitted in PIC Lahore and 50 patients admitted in CMH Lahore with confirmed acute myocardial infarction on angiography were selected in the study by consecutive sampling

Results: Involvement of left circumflex coronary artery was documented only in military personnel [p=.003], whereas left anterior descending artery was predominantly [64%] involved in civilian population [p=.091]. Military personnel had more [42%] triple vessel coronary artery disease [p=.003] and double vessel coronary artery disease [p= 0.001] in contrast to civilian population

Conclusion: Involvement of coronary arteries varies significantly [p=.000] among the different sectors of the same society