Contralateral suppression of aldosterone at adrenal venous sampling predicts hyperkalemia following adrenalectomy for primary aldosteronism.

BACKGROUND: We aimed to determine whether a greater degree of contralateral suppression of aldosterone secretion at adrenal venous sampling predicted the development of postoperative hyperkalemia after unilateral adrenalectomy for primary aldosteronism. METHODS: A retrospective analysis of patients undergoing unilateral adrenalectomy for primary aldosteronism between 2004-2015 was performed. Clinical and biochemical parameters of patients who developed hyperkalemia (≥5.2 mmol/L) after unilateral adreanlectomy were compared with those who remained normokalemic. The contralateral suppression index was defined as the aldosterone-to-cortisol ratio from the nondominant adrenal vein divided by the aldosterone-to-cortisol ratio from the external iliac vein. RESULTS: Of 192 patients who met criteria for inclusion, 12 (6.3%) developed hyperkalemia (median serum potassium 5.5 mmol/L, range 5.2-6.2 mmol/L), with a median time to onset of 13.5 days (range 7-55 days). Five patients had transiently increased serum potassium concentrations that normalized spontaneously. Four patients received mineralocorticoid replacement therapy with fludrocortisone. On univariate analysis, hyperkalemic patients had slightly greater preoperative serum creatinine levels (1.2 vs 1.0 mg/dL, P = .01), higher postoperative creatinine (1.3 vs 1.0 mg/dL, P = .02), lesser median contralateral suppression index (0.14 vs 0.27, P = .03), and larger adenomas (1.9 vs 1.4 cm, P = .02). On multivariable logistic regression, the contralateral suppression index remained the only significant predictor of postoperative hyperkalemia (P = .04) with an optimal cut-off of <0.47. CONCLUSION: Hyperkalemia after unilateral adrenalectomy for primary aldosteronism is uncommon and usually transient, but may require mineralocorticoid supplementation. Patients with a contralateral suppression index of <0.47 require meticulous follow-up and monitoring of serum potassium concentrations after unilateral adrenalectomy.

Quantitative determination of organochlorine pesticides in sewage sludges using soxtec, soxhlet and pressurized liquid extractions and ion trap mass-mass spectrometric detection.

A new analytical method is described for the determination of organochlorine pesticides (OCPs) in sewage sludges using GC-ion trap-MS-MS. In this work, 16 organo-chlorine pesticides (OCPs) listed by the US Environmental Protection Agency (US EPA) as priority pollutants were separated and quantified. Sludge samples from three of Kuwait's wastewater treatment plants (WWTPs) were analyzed for organochlorine pesticides (OCPs). Spiked sludge samples were extracted with a mixture of (1:1 v/v) dichloromethane (DCM)/hexane. The extracts were cleaned on a silica/aluminum oxide column, then transferred to a gel permeation chromatography (GPC) column, before undergoing further silica/aluminum oxide clean-up; the presence of OCPs was then confirmed by GC-ion trap-MS-MS. Three extraction techniques, soxtec, soxhlet, and pressurized liquid extractions were utilized, compared and validated using the spiked sludge samples. The methods were validated in term of accuracy (recovery) and precision (RSD). The method recovery values varied from 76.1 to 92.9% for the three extraction techniques.

Maternal health care in a rural area of Pakistan.

OBJECTIVE: The need for effective strategies for delivery of healthcare to rural women is paramount and requires a study of maternal perceptions and experiences of the healthcare system. METHOD: This article describes knowledge, attitudes and practices regarding obstetric healthcare in a rural area of Pakistan. This is a cross sectional survey of a rural area of district Hyderabad, Pakistan. A multistage sample of 1,150 households was drawn from a population of 247,257 living in 30,653 households. Structured KAP questionnaires regarding maternal health were administered to male and female respondents in study household. RESULTS: A total of 1,178 married women and 1,146 married men were interviewed. The mean age of female respondents was 29 +/- 6 years. At the time of the interview 20% women were pregnant. Sixty-one percent women received antenatal care during their last pregnancy. The most frequent antenatal care providers were female doctors (55%). Majority (67%) of women had delivered at home with the assistance of traditional birth attendants (TBAs). Overall less than 40% of respondents could correctly identify signs of obstetric complications. Thirty-eight percent women experienced obstetric complications during their last pregnancy. Estimated annual maternal mortality ratio (MMR) was 689/100,000 live births. CONCLUSION: Women have inadequate access to obstetric care due to limited healthcare options and poor knowledge of obstetric complications. This can be corrected by improving services and increasing overall maternal health awareness in the community.

Evaluation of vitamin A supplementation in Gulshan-e-Sikandarabad.

INTRODUCTION: Vitamin A deficiency (VAD) causes blindness of 250,000 to 500,000 children annually, around the world. It also increases the risk of morbidity and mortality due to other diseases. Pakistan is categorized in the 'Severe Sub-Clinical Deficiency' group. A mass supplementation program has been started in 1999. AIM: To determine the coverage of vitamin A supplements in children under five years of age, and to assess the incidence of symptoms related to hypervitaminosis A. SETTING: Block I-A of Gulshan-e-Sikanderabad. METHODOLOGY: A survey was conducted, using the fourth year MBBS students of Ziauddin Medical University (ZMU), under faculty supervision. A pre-tested structured questionnaire was used to assess coverage and symptoms of toxicity. RESULTS: Data was obtained on 489 children. The coverage of polio and vitamin A supplementation was 88% and 74.8%, respectively. In all 15 children (4.4%) experienced symptoms of toxicity related to vitamin A supplementation. CONCLUSION: Although vitamin A supplementation can save lives, it is only a short term measure. What is needed is a multi-strategy approach including short and long term strategies.