Association of Estimated GFR (By MDRD) with the Carotid Intima Media Thickness (CIMT) in Different Stages of CKD among Patients with Type 2 Diabetes Mellitus.

Most of the mortalities among Diabetic Nephropathy patients are cardiovascular, if we identify the risk factor, measures can be taken to prevent it. Hence an objective was set to evaluate the association between carotid artery intima media thickness (CIMT) with eGFR in patients of CKD stage III, IV and V among patients with type 2 diabetes mellitus; also, correlation with age, BMI, lipid profile. This cross-sectional, observational study was performed in 70 patients in different stages of CKD in Diabetic Patients selected by Inclusion Criteria (Diabetic nephropathy patients with stages III, IV, V and exclusion Criteria (Acute kidney injury, History of carotid surgery, Patients of MI and stroke). This study was performed in Department of Nephrology, Dhaka Medical College in collaboration with the Department of Radiology and Imaging, laboratory of Department of Biochemistry and Department of Microbiology at Dhaka Medical College Hospital (By standard method in laboratory) from 1st January 2016 to 31st December 2016. eGFR was measured by MDRD formula and the CIMT was measured using an ultrasonographic examination. The mean CIMT was 0.9±0.21mm, and 62.9% of the subjects showed IMT thickening (≥1mm). The carotid IMT elevated significantly with the stage progression of CKD (Overall eGFR mean 28.8±14.5mL/min/1.73m² in CIMT<1mm with range from 6 to 54 and 9.1±9.0mL/min/1.73m² in CIMT ≥1mm with range from 3 to 32 (p=0.001). The eGFR was significantly lower in the patients with CIMT thickening than those without CIMT thickening. eGFR was also significantly associated with CKD stages (p=0.001), serum creatinine (p=0.001), BMI (r = -0.330, p=0.005), and negatively associated with age group, duration of hypertension, smoking. However, the CIMT was not significantly different among the patients at different stages of diabetic nephropathy (r = -0.172, p=156) and age group. It has been concluded that the mean CIMT was markedly high in patients with CKD compared to normal expected value. This study showed a relationship between the CIMT and the renal parameters as eGFR and the stages of diabetic nephropathy with a confirm association between the CIMT and diabetic macroangiopathy.

Hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh.

Hemoprotozoans are important pathogens of animals and humans, among which some species have zoonotic significance. The prevalence of different hemoprotozoa and Anaplasma spp. in larger mammals have been reported from different regions of the world. But, very few studies have been conducted to estimate the prevalence of hemoprotozoa in rodents and shrews of South-East Asia. The study assessed the prevalence of hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh. Blood samples (n=451) were collected from rodents and shrews between June 2011 and June 2013 and July-December 2015 from 4 land gradients of Bangladesh. Giemsa-stained blood smears revealed that 13% of animals were harboring hemoprotozoa (4.7% Babesia spp., 0.67% Plasmodium spp.), and Anaplasma spp. (7.5%). The study may serve as a guide for future hemoparasitic research of rodents and shrews.

Hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh

@#Hemoprotozoans are important pathogens of animals and humans, among which some species have zoonotic significance. The prevalence of different hemoprotozoa and Anaplasma spp. in larger mammals have been reported from different regions of the world. But, very few studies have been conducted to estimate the prevalence of hemoprotozoa in rodents and shrews of South-East Asia. The study assessed the prevalence of hemoprotozoa and Anaplasma spp. in rodents and shrews of Bangladesh. Blood samples (n=451) were collected from rodents and shrews between June 2011 and June 2013 and July-December 2015 from 4 land gradients of Bangladesh. Giemsa-stained blood smears revealed that 13% of animals were harboring hemoprotozoa (4.7% Babesia spp., 0.67% Plasmodium spp.), and Anaplasma spp. (7.5%). The study may serve as a guide for future hemoparasitic research of rodents and shrews.

The H3+ ionosphere of Uranus: decades-long cooling and local-time morphology.

The upper atmosphere of Uranus has been observed to be slowly cooling between 1993 and 2011. New analysis of near-infrared observations of emission from H3+ obtained between 2012 and 2018 reveals that this cooling trend has continued, showing that the upper atmosphere has cooled for 27 years, longer than the length of a nominal season of 21 years. The new observations have offered greater spatial resolution and higher sensitivity than previous ones, enabling the characterization of the H3+ intensity as a function of local time. These profiles peak between 13 and 15 h local time, later than models suggest. The NASA Infrared Telescope Facility iSHELL instrument also provides the detection of a bright H3+ signal on 16 October 2016, rotating into view from the dawn sector. This feature is consistent with an auroral signal, but is the only of its kind present in this comprehensive dataset. This article is part of a discussion meeting issue 'Advances in hydrogen molecular ions: H3+, H5+ and beyond'.

Response of Proliferative Lupus Nephritis with Pulse Cyclophosphamide Therapy during Induction Period: A Single Centre Study in Bangladesh.

This prospective study was conducted to assess the response of proliferative lupus nephritis with pulse cyclophosphamide therapy during induction period in the department of Nephrology of Dhaka Medical College, Dhaka, Bangladesh from December 2012 to November 2013. A total of 35 clinically diagnosed SLE patients of class III/IV lupus nephritis were included. But 3 patients were dropped out during follow-up, therefore finally 32 patients (class III = 4, class IV = 28) were studied. The patients were evaluated for response on the basis of proteinuria, serum creatinine & active sediment in urine after 6th cycle of cyclophosphamide and 62.5% patients achieved complete response, 25% patients achieved partial response & 12.5% patients achieved no response. The factors favored complete response was early clinical presentation (7 months duration), proteinuria ≤3gm/day& normal renal function during their initial presentation. And higher anti ds DNA titre was an independent predictor for partial response/no response.

Clinical consequences of upfront pathology review in the randomised PORTEC-3 trial for high-risk endometrial cancer.

Background: In the PORTEC-3 trial, women with high-risk endometrial cancer (HR-EC) were randomised to receive pelvic radiotherapy (RT) with or without concurrent and adjuvant chemotherapy (two cycles of cisplatin 50 mg/m2 in weeks 1 and 4 of RT, followed by four cycles of carboplatin AUC5 and paclitaxel 175 mg/m2). Pathology review was required before patient enrolment. The aim of this analysis was to evaluate the role of central pathology review before randomisation. Patients and methods: A total of 1295 cases underwent pathology review to confirm HR-EC in the Netherlands (n = 395) and the UK (n = 900), and for 1226/1295 (95%) matching review and original reports were available. In total, 329 of these patients were enrolled in the PORTEC-3 trial: 145 in the Netherlands and 184 in the UK, comprising 48% of the total PORTEC-3 cohort of 686 participants. Areas of discrepancies were evaluated, and inter-observer agreement between original and review opinion was evaluated by calculating the kappa value (κ). Results: In the 1226 pathology reviews, 6356 selected items were evaluable for both original and review pathology. In 43% of cases at least one pathology item changed after review. For 102 patients (8%), this discrepancy led to ineligibility for the PORTEC-3 trial, most frequently due to differences in the assessment of histological type (34%), endocervical stromal involvement (27%) and histological grade (19%). Lowest inter-observer agreement was found for histological type (κ = 0.72), lymph-vascular space invasion (κ = 0.72) and histological grade (κ = 0.70). Conclusion: Central pathology review by expert gynaeco-pathologists changed histological type, grade or other items in 43% of women with HR-EC, leading to ineligibility for the PORTEC-3 trial in 8%. Upfront pathology review is essential to ensure enrolment of the target trial-population, and to avoid over- or undertreatment, especially when treatment modalities with substantial toxicity are involved. This study is registered with ISRCTN (ISRCTN14387080, www.controlled-trials.com) and with ClinicalTrials.gov (NCT00411138).

Factors responsible for increased percent recirculation in arterio-venous fistula among the haemodialysis patients.

Recirculation is an important issue in haemodialysis (HD) patients as increased percent recirculation causes decreased dialysis delivery of the patients. The purpose of the study was to determine the amount and factors of recirculation in those patients. The study was a cross sectional one carried in the Department of Nephrology, Dhaka Medical College and Hospital during October 2010 to September 2011. A total of 118 end stage renal disease patients with arterio-venous fistula who were on HD for more than 3 months were purposively selected. The degree of recirculation was measured with urea based two needle technique method. For each patient distances between arterial and venous and distances of needles from fistula and its directions were recorded. Echocardiography and A-V fistula Colour Doppler Ultrasound were also performed. The mean A-V fistula recirculation was 8.1 +/- 5.5% with a range 0-66%. The most common factors were close proximity and improper arterial and venous needles placement. No difference was observed between diabetic and non diabetic also between hypertensive and normotensive. A-V fistula recirculation is common occurrence in HD patients and the most common factors of recirculation are misplacement and close proximity of needles therefore emphasis should be given on education and training of HD staffs.

Assessing glomerular filtration rate in healthy adult potential kidney donors in Bangladesh: a comparison of various prediction equations with measured glomerular filtration rate by diethylentriamine pentaacetic acid renogram.

To ensure that potential kidney donors in Bangladesh have no renal impairment, it is extremely important to have accurate methods for evaluating the glomerular filtration rate (GFR). We evaluated the performance of serum creatinine based GFR in healthy adult potential kidney donors in Bangladesh to compare GFR determined by DTPA with that determined by various prediction equations. In this study GFR in 61 healthy adult potential kidney donors were measured with 99mTc-diethylenetriamine penta-acetic acid (DTPA) renogram. We also estimated GFR using a four variable equation modification of diet in renal disease (MDRD), Cockcroft-Gault creatinine clearance (CGCrCl), Cockcroft-Gault glomerular filtration rate (CG-GFR). The mean age of study population was 34.31 +/- 9.46 years and out of them 65.6% was male. In this study mean mGFR was 85.4 +/- 14.8. Correlation of estimated GFR calculated by CG-CrCl, CG-GFR and MDRD were done with measured GFR DTPA using quartile. Kappa values were also estimated which was found to be 0.104 for (p = 0.151), 0.336 for (p = 0.001) and 0.125 for (p = 0.091) respectively. This indicates there is no association between estimated GFR calculated by CG-CrCl, CG-GFR, MDRD with measured GFR DTPA. These results show poor performance of these equations in evaluation of renal function among healthy population and also raise question regarding validity of these equations for assessment of renal function in chronic kidney disease in our population.

Radiation processed hydrogel of poly (vinyl alcohol) with biodegradable polysaccharides.

Poly(vinyl alcohol) (PVA) can be modified to polymer hydrogels by radiation crosslinking and can be used in different biomedical applications. A study was done on the optimization of ingredients concentration for preparing good quality PVA hydrogels with natural polysaccharides. The synthesized hydrogels were also characterized by measuring the different physical properties e.g. gel fraction, swelling and absorption rate. Besides these, sterility test were also performed. Good quality hydrogels were obtained from PVA and natural polysaccharides solutions with 27 kGy radiation dose. There is an influence of natural polysaccharides on the gel fraction of hydrogel. The increase in the amount of polysaccharide causes a decrease in gel fraction that is decrease in the crosslinking density of PVA hydrogel network. The prepared hydrogels were found to be sterile.

Non-group A streptococci: are they pathogens in the throat?

A total of 3,184 paediatric patients with sporadic pharyngitis was studied at King Khalid University Hospital in Riyadh, Saudi Arabia. In addition, 478 children without pharyngitis who were matched for age and sex were included as controls. Group A beta-haemolytic streptococci (beta HS) were detected significantly more often among the children with pharyngitis than among the controls (8.4% vs 2.3%; p < 0.0001). In contrast, total non-group A and group C beta HS were isolated at lower frequency from the sick than control children (0.9% vs 2.5% and 0.2% vs 1.2% respectively; p < 0.01) while other non-group A beta HS such as groups B, G and F were each isolated in similar frequency from both the sick and control children. We conclude that non-group A beta HS appear not to be as important as aetiological agents of sporadic pharyngitis in these children.

Spectrum of Haemophilus influenzae type b disease in children at a university hospital in Riyadh, Saudi Arabia.

During a period of 5 years, 42 cases of invasive Haemophilus influenzae type b (Hib) disease were studied. An outstanding finding in our patients was occult bacteraemia, which was detected in 13 (31 per cent) patients. Other clinical conditions encountered were nine (21 per cent) patients with pneumonia, nine (21 per cent) with meningitis, six (14 per cent) with cellulitis, three (7 per cent) with arthritis, one (2 per cent) with epiglottitis, and one (2 per cent) with urinary tract infection. The mean age of children was 21 months (range 1-156 months); the majority (62 per cent) belonged to the age group 7-18 months. There were 24 females and 18 males. Eighty-one per cent of these patients were Saudi nationals. Five isolates (12 per cent) of Hib were resistant to ampicillin and similar numbers were resistant to chlorampenicol. Twenty-five children (60 per cent) were treated with ampicillin, nine (21 per cent) with chlorampenicol and eight (19 per cent) with ceftriaxone. All patients made complete recovery.

Diagnostic challenge of tuberculosis of the elderly in hospital: experience at a university hospital in Saudi Arabia.

We studied retrospectively 80 elderly patients who had been admitted to hospital with tuberculosis (TB) between January 1988 and June 1993. There were 64 with pulmonary TB and 16 with miliary tuberculosis (MTB). The mean age was 70+/-7.5 years (range 60-88 years) with 56% over 70 years of age. Underlying disease preceding TB was present in 86.3% patients. In the majority of patients clinical manifestations were subtle. Chest X-ray showed involvement of lower lung fields and miliary shadowing in 71.2% (33/80) and 20% (16/80) patients, respectively. The organism was detected in expectorated sputum specimens in 62.5% (50/80). Of the specimens obtained by flexible fibreoptic bronchoscopy (FOB), 61% were positive for acid-fast bacilli (AFB) by films and culture. Drug-induced adverse effects were observed in 17.6% (6/34). In 18 patients (22.5%), the diagnosis of TB was delayed or missed. The overall mortality of 21% (9/43) included seven patients with MTB and two with pulmonary TB. TB was the direct cause of death in the former and a significant contributory cause in the latter.

Penicillin-resistant Streptococcus pneumoniae in Riyadh, Saudi Arabia.

During a period of ten months, minimum inhibitory concentrations (MICs) to seven antimicrobial agents of 150 clinical isolates of Streptococcus pneumoniae were determined at a teaching hospital in Riyadh, Saudi Arabia. Twenty-two (14.7%) isolates showed relative resistance to penicillin. High-level resistance to penicillin was not observed in any of the isolate. Seventeen (11.3%) isolates were resistant to erythromycin, and 31 (20.7%) to tetracycline. Multiple resistance was observed in 21 (14%) isolates. Decreased resistance to ceftriaxone was also found in two (1.3%) isolates. Isolates with relative resistance to penicillin were significantly associated with higher rates of resistance to other antibiotics than were penicillin-susceptible isolates. This was also true for multiple resistance encountered in both groups.

Coagulase-negative staphylococcal bacteraemia with special reference to septic shock: experience in an intensive care unit.

During a period of 4.5 years, 48 patients with bacteraemia due to coagulase-negative staphylococci were studied prospectively in order to evaluate their clinical profile, management and outcome. There were 25 males and 23 females with ages ranging between 13 and 100 years. Over 60% of patients belonged to the age group 30 to 69 years. Shock was recorded in 23 (48%) of the 48 patients. Of the shocked patients, 16 were immunocompromised and also had abnormal coagulation. Their mortality was 44%. By contrast, none of the immunocompromised patients without shock died. Abnormal coagulation was found in 17 patients without septic shock. Their mortality was 5.9%. The commonest underlying disease was respiratory failure especially in shocked patients. The source of infection was identified in the majority of cases. In addition, most patients had an indwelling intravascular catheter especially an arterial one. The overall mortality was 16.7% (8/48). It was significantly higher in patients with shock than in those without shock (30.4% vs. 4.0%, P < 0.05).

Infections in critically ill patients: experience in MICU at a major teaching hospital.

During a one-year period 105 patients suffering a total of 134 infectious episodes were studied prospectively in the medical intensive care unit (MICU). These patients included 54 male and 51 female patients, age ranging from 14 to 100 years (median = 54 years). The overall incidence of infection was 46.7%. Infections acquired in medical wards accounted for 47.8% of the total, followed by community-acquired infections in 27.0%, and MICU-acquired infections in 25.2% of the cases. The most frequent infections were pneumonia and septicaemia accounting for 88% of the total, whereas urinary tract (4.4%), gastrointestinal tract (5.0%), skin and wound infections (2.5%) constituted only 11.5%. The pathogens mainly involved were gram-negative rods, Staphylococcus spp. and Streptococcus pneumoniae. However, in community-acquired pneumonia, the major pathogens were gram-negative rods. In addition, Mycobacterium tuberculosis was an important cause of pneumonia in these patients. The majority of patients had a monoinfection; multiple pathogens were isolated in 11.9% of the episodes. The overall mortality was 46.7%. Several factors that influenced the mortality in these patients were analyzed. Early recognition of these factors may reduce morbidity and mortality.

Re-evaluation of pneumonia requiring admission to an intensive care unit: a prospective study.

BACKGROUND: Appropriate treatment of severe community and hospital acquired pneumonias requiring admission to a medical intensive care unit depends on knowledge of the likely aetiological agents in any community. Little is known about the pattern and outcome of patients with such pneumonias in Saudi Arabia. METHODS: In a prospective study 113 patients with pneumonia were investigated in the medical intensive care unit at King Khalid University Hospital, Riyadh, Saudi Arabia between September 1991 and December 1992. The diagnosis was established by microscopy and culture of sputum, blood culture, or serological examination. A standard proforma was used to collect demographic, clinical, and laboratory data. RESULTS: A microbiological diagnosis was made in 80% of the cases with a single pathogen accounting for 69% of the isolates and multiple pathogens for 11%. Pseudomonas aeruginosa was the most common infecting agent (16%), followed by Streptococcus pneumoniae (12%), Staphylococcus aureus (9%), and Mycobacterium tuberculosis (8%). Pneumonia due to Legionella pneumophilia was diagnosed in three patients and infection due to Mycoplasma pneumoniae in two. These five cases were identified by serological examination. Gram negative rods were the predominant pathogens in both community and hospital acquired pneumonia. The aetiology of pneumonia was not identified in 20% of cases. The overall mortality was 37%. Patients with hospital acquired pneumonia had a higher mortality than those with a community acquired pneumonia. Similarly, a high mortality was found in patients who had a serious underlying disease, abnormal mental state, diastolic blood pressure < 60 mm Hg, blood urea > 7 mmol/l, abnormal liver function tests, serum albumin < 30 g/l, those who required mechanical ventilatory support, and those with APACHE II scores > 20. CONCLUSIONS: This study highlights two major findings which differ from previous reports on the aetiology of pneumonia. Firstly, Gram negative rods were the predominant pathogens in community acquired pneumonia and secondly, M tuberculosis was an important cause of pneumonia in these patients, indicating that tuberculous pneumonia should be considered in the differential diagnosis of pneumonia in Saudi Arabia.

Nationwide community survey of tuberculosis epidemiology in Saudi Arabia.

In the first nationwide community-based survey of the epidemiology of tuberculosis in Saudi Arabia, 7721 subjects were screened in the 5 provinces (using an equal proportional allocation formula) for 2 parameters: (1) prevalence of positive Mantoux test in non BCG vaccinated subjects; (2) prevalence of bacillary cases on sputum culture. The prevalence of positive Mantoux reaction in children aged 5-14 years was 6% +/- 1.8; higher in urban areas (10%), and lower in rural areas (2%), thus classifying Saudi Arabia among the middle prevalence countries. These relatively good results (by Third World standards) could reflect the rise of the standard of living and wide availability of free treatment for active cases with a lowered risk of infection in the community. This view is supported by the fact that in our survey, only one subject grew Mycobacterium tuberculosis in the sputum. However, there were foci of high prevalence of Mantoux reaction in the urban communities in the Western province (20% +/- 8.7 urban; 1% +/- 1.9 rural). The problem may be caused by the fact that the province receives every year over a million pilgrims, some of whom are known to settle illegally and escape the usual screening for tuberculosis imposed on foreign labourers. In conclusion, even in the absence of an enforceable national programme for the eradication of tuberculosis, the economic standard and wide availability of free treatment for active cases has resulted in relatively low rates of prevalence of tuberculin sensitivity in children. The foci of high prevalence in the Western Province require special screening arrangements.

An outbreak of infection due to Staphylococcus aureus phage type 52 in a neonatal intensive care unit.

An outbreak of infection due to Staphylococcus aureus phage-type 52, resistant only to penicillin, occurred in children's wards primarily in a neonatal intensive care unit. The outbreak involved 86 infants; the majority presented with conjunctivitis, wound infections, boils, omphalitis and otitis externa. Seven per cent of these infants (six of 86) also had septicaemia. In addition, 6% (five of 86) were colonized by this phage type and the most common site of carriage was the umbilicus. The outbreak was contained by eradication of nasal carriage among the staff members and also by standard infection control measures.