ß-Endosulfan-mediated induction of pro-fibrotic markers in renal (HK-2) cells in vitro: A new insight in the pathogenesis of chronic kidney disease of unknown etiology.

Chronic kidney disease of unknown etiology (CKDu), manifested clinically as tubulo interstitial fibrosis, has emerged as the second major cause of chronic kidney disease (CKD) in the Indian subcontinent and various agrochemicals have been implicated in its occurance. Among the agrochemicals organochlorine pesticides particularly endosulfan is well known for its toxicity and recent residue analysis have shown its presence in the blood samples of general population. In this present study, we have investigated the consequences of endosulfan exposure at a concentration (0.01 µM) equivalent to their highest reported presence in human blood sample of some CKDu patients, to human renal proximal tubular epithelial (HK-2) cell line with regard to ROS generation and expression of profibrotic and epithelial to mesenchymal (EMT) markers in order to find out endosulfan's ability to induce profibrotic changes in renal cell. We demonstrated a significant increase in intracellular ROS generation and increased expression of TGF-ß1 when cells were incubated with ß-endosulfan (0.01 µM) indicating occurrence of oxidative stress and fibrotic process. Again, decreased expression of epithelial marker E-cadherin and increase in the expression of mesenchymal marker α-smooth muscle actin (α-SMA) suggest possible onset of EMT process. Pre-treatment with 5 mM concentration of anti-oxidant N-acetyl cysteine partially attenuated the above process. In conclusion, these findings suggest possible involvement of ß-endosulfan in the development of CKDu through oxidative stress and profibrotic signaling.

Organochlorine pesticide level in patients with chronic kidney disease of unknown etiology and its association with renal function.

BACKGROUND: Involvement of agrochemicals have been suggested in the development of chronic kidney disease of unknown etiology (CKDu). The association between CKDu and blood level of organochlorine pesticides (OCPs) in CKDu patients has been examined in the present study. METHODS: All the recruited study subjects (n = 300) were divided in three groups, namely, healthy control (n = 100), patients with chronic kidney disease of unknown etiology (n = 100), and patients with chronic kidney disease of known etiology (CKDk) (n = 100). Blood OCP levels of all three study groups were analyzed by gas chromatography. RESULTS: Increased level of OCPs, namely α-HCH, aldrin, and ß-endosulfan, were observed in CKDu patients as compared to healthy control and CKD patients of known etiology. The levels of these pesticides significantly correlated negatively with the estimated glomerular filtration rate (eGFR) and positively with urinary albumin of CKD patients. Logistic regression analysis revealed association of γ-HCH, p, p'-DDE, and ß-endosulfan with CKDu on adjustment of age, sex, BMI, and total lipid content. CONCLUSIONS: Increased blood level of certain organochlorine pesticides is associated with the development of chronic kidney disease of unknown etiology.

Role of advanced glycation end product (AGE)-induced receptor (RAGE) expression in diabetic vascular complications.

AIMS: Vascular complications are the major causes of morbidity and mortality in diabetic subjects. Interaction of advanced glycation end products (AGEs) with their receptor (RAGE) induces signal transduction that culminates in vascular complications. Therefore, in the present study we investigated the dependence of RAGE expression on circulating AGEs and evaluated the outcome of AGE-RAGE interaction by the oxidative stress and nature of vascular complications in type 2 diabetes mellitus (T2DM) patients. METHODS: RAGE expression was determined by quantitative real-time PCR and western blotting, serum AGEs were estimated by ELISA and spectrofluorometry and oxidative stress markers namely protein carbonyl (PCO), advanced oxidation protein products (AOPP) and lipid peroxidation (MDA) were assayed spectrophotometerically in 75 T2DM patients (DM without vascular complication n=25; DM with microvascular complications n=25; DM with macrovascular complications n=25) and 25 healthy controls. RESULTS: Serum AGE level was significantly higher in diabetic patients having vascular complications as compared to T2DM without complications (p<0.01). RAGE m-RNA expression level in PBMCs assayed by quantitative real time PCR was four times higher in diabetic subjects without vascular complications while DM patients having microvascular and macrovascular complications showed 12 fold and 8 fold higher RAGE m-RNA expression respectively compared to healthy controls. Circulating AGE level showed significant positive correlation with RAGE m-RNA expression and oxidative stress markers. CONCLUSION: AGE-mediated exacerbation of RAGE expression may contribute to oxidative stress generation that plays a key role in pathogenesis of vascular complications in diabetes.

Attention and information processing in end stage renal disease and effect of hemodialysis: a bedside study.

The neurobehavioral syndrome of uremia in chronic kidney disease affects the functioning of the central nervous system. Cognitive impairment is one of the most important manifestations of this dysfunction. The process of hemodialysis is known to bring about conflicting changes in the cognitive status of patients. In the present study an assessment of cognitive status of patients with end stage renal disease was done in comparison to controls before and after a session of hemodialysis using simple bedside paper-pencil tests. Thirty patients of end stage renal disease on maintenance dialysis for at least one month with MMSE score >24 were assessed one hour before and one hour after hemodialysis using Digit Symbol Substitution Test, One Letter and Three Letter Cancellations tasks. Their results were compared to age and sex matched healthy controls. The patients with end stage renal disease had significantly lower performance in cognitive tests in comparison to controls. The performance improved 1 hour after hemodialysis in comparison to pre-dialysis values. However, the values after dialysis were significantly lower than in controls, thereby indicating that though the cognitive functions improved after hemodialysis, they did not reach the control levels. There was also a significant change in the biochemical parameters after dialysis. We conclude that patients with end stage renal disease suffered from cognitive impairment which improved on hemodialysis due to removal of metabolic waste products.

Diabetes self-efficacy strongly influences actual control of diabetes in patients attending a tertiary hospital in India.

A cross-sectional survey of 507 in- and out-patients, with diagnosed Type 2 diabetes mellitus (T2DM) was undertaken to study the relationships between personal, disease and treatment-related factors and diabetes control in a tertiary care hospital. On multivariate logistic regression analysis, self-efficacy (odds ratio (OR) =2.94; 95% confidence interval (CI) =1.92-4.54); P<0.001) was the single most important determinant of current diabetes control (HbA1c ≤7%), along with absence of hyperglycemic symptoms in the past year (OR=1.83; 95% CI=1.15-2.93, P<0.01), current treatment with oral medication (OR=1.77; 95% CI=1.17-2.66; P<0.007), and adherence to dietary restrictions (OR=2.7; 95% CI=1.28-5.88; P<0.009). Self-efficacy was itself influenced by educational status, employment, availability of family support, and positive mental attitudes. Our findings suggest that health care delivery inputs, patients' personal characteristics including education and attitude, and family support for care are complexly processed to determine patients' ability to manage their disease, which ultimately influences disease outcomes.

Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis.

PURPOSE: To study and compare dermatological manifestations in patients with various stages of chronic kidney disease (CKD) and end stage renal disease (ESRD), undialysed and dialysed, in a developing country. STUDY DESIGN: 200 patients were recruited, 50 each in stages 3, 4 and 5 CKD (undialysed) and 50 in stage 5 undergoing maintenance haemodialysis (MHD) for at least 1 month. Patients in stages 3 and 4 constituted pre-ESRD while stage 5 (both dialysed and undialysed) formed the ESRD group. Detailed cutaneous examination was done for all patients and dermatological manifestations were compared among various study groups. RESULTS: 96% of patients had at least one dermatological manifestation. Xerosis was most common and was observed in 72% of patients, followed by pigmentation (50%), pruritus (36%), infections (29%), markers of skin ageing (13%), half-and-half nail (28%), and absent lunula (22%). Perforating disorders (3%), bullous disorders (2%), and nephrogenic systemic fibrosis (1%) were encountered less often. Local complications of dialysis occurred in 64% patients on MHD. Diffuse pigmentation and skin pallor were seen more commonly as compared to findings reported in the west. The frequency of most cutaneous manifestations was similar between dialysed and undialysed patients with ESRD. Xerosis, pigmentation, and pruritus were more frequent in patients with severe disease, and mean duration of disease was significantly higher for patients with pigmentation, pruritus, and half-and-half nail. Longer duration on MHD was associated with greater pigmentation and pruritus. CONCLUSION: Dermatological manifestations increase with increasing duration and severity of renal disease. Dialysis may in turn often perpetuate many of these cutaneous complaints. Recognition and management of some of these dermatological manifestations may vastly reduce the morbidity and improve the cutaneous outcome in these patients.

Effect of GSTM1 and GSTT1 double deletions in the development of oxidative stress in diabetic nephropathy patients.

Association of diabetic nephropathy (DN) with the deletion of GSTT1 and GSTM1 genes is well reported. Oxidative stress (OS) has also been associated with the development of DN. The present study was conducted to find out, whether these deletions had any contributory role in the development of OS in patients with DN. Pre-dialysis venous blood samples were obtained from 60 patients with diabetic end-stage renal disease (stages 4 and 5). Reduced-glutathione (GSH), glutathione S-transferase (GST) activity and malondialdehyde (MDA) levels were measured for the assessment of OS. Genetic polymorphism analysis of DN patients revealed the following distribution pattern: GSTM1 null 46.7%; GSTT1 null 55%; both null 30% and both positive 28.3%. Patients with both null genotypes were found to have significantly increased levels of MDA and low GST activity as compared to other genotypic groups. Lower GSH levels were observed in all the genotypic groups as compared to both positives. Double deletions involving GSTT1 and GSTM1 may result in decreased GST levels, leading to increased OS as reflected by increased MDA levels. As GST is a multi-functional enzyme involved in xenobiotic metabolism, this double null genotype population has a greater risk of development of DN. Further studies using increased sample size to find out the allelic distribution and their role in the development of DN are in progress.

Pilot Study of Chronic Obstructive Pulmonary Disease in an Industrial Town in India.

BACKGROUND: The burden of chronic obstructive pulmonary disease (COPD) in India is not well understood. Due to geographical and environmental heterogeneity, the epidemiological profile of COPD may not be uniform across the country. Studies carried out in small geographical areas can help to determine the prevalence and risk factors of COPD. OBJECTIVES: The present study was conducted in one city in northwest India in order to calculate prevalence in small geographically determined areas within the city as well as across socio-economic strata and adjoining neighborhoods. METHODS: The present study was conducted in Ludhiana, an industrial town in Punjab, India. Residential colonies were identified in an industrial and nonindustrial area and all households were screened for COPD using the Global Initiative for Chronic Obstructive Lung Disease criteria and confirmed by spirometry. Information about exposure to possible risk factors was also collected from suspected cases of COPD. Cases were mapped on a digital map of the city and hotspots were identified. RESULTS: Fifty-six cases of COPD were detected. More than half (71%) were in the industrial area. The overall prevalence rate of COPD in the city was 3.17 per 1 000. The highest prevalence (5.6-9.4 per thousand) was observed in the colonies of the industrial area. All surveyed colonies in the nonindustrial area showed a low prevalence (0.0 to 0.9 per thousand). CONCLUSIONS: Hotspots were located in the industrial area and there was no such aggregation in the nonindustrial area. This suggests a potential association of industrial air pollutants with COPD. A strength of the present study is that it provides important baseline data. However, the study was limited, as it did not show a temporal association of exposure to air pollution and smoking with COPD. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: The study was approved by the Institutional Ethics Committee for Human Research of the University College of Medical Sciences, Delhi, India. INFORMED CONSENT: Obtained. COMPETING INTERESTS: The authors declare no competing financial interests.

Effect of aspirin on lipoprotein(a) in patients with ischemic stroke.

Hyperlipidemia and increased serum lipoprotein (Lp)(a) are independent risk factors for atherosclerosis and its complications. Serum Lp(a) concentration is not influenced by most lipid-lowering therapies other than niacin. Recently aspirin also has been reported to decrease its levels. In the current study, we evaluated the serum levels of Lp(a) and lipids in 25 patients with first-ever diagnosed ischemic stroke, aged 21 to 60 years, and compared their levels with an equal number of age- and sex-matched healthy control subjects. In addition, the effect of aspirin on Lp(a) levels was studied by estimating its levels after 4 weeks of daily treatment with 150 mg of aspirin. Both groups were comparable regarding their anthropometric measurements and routine laboratory parameters except that erythrocyte sedimentation rate was higher in the patients. Serum lipids were not significantly different between the two groups, although Lp(a) levels were significantly higher in the patients (27.40 +/- 22.30 mg/dL) as compared with the control subjects (14.68 +/- 11.75 mg/dL) (P = .005). Twenty of 25 patients (80%) had serum Lp(a) levels of more than 10 mg/dL, whereas only 11 of 25 control subjects (44%) had serum Lp(a) levels of more than 10 mg/dL (P = .009). After 4 weeks of treatment with aspirin, Lp(a) levels declined significantly (46.24%) from baseline 27.40 +/- 22.30 mg/dL to 14.73 +/- 10.47 mg/dL (P < .001). Patients with baseline levels greater than 25 mg/dL showed greater decline (55.63%) compared with those with levels less than 25 mg/dL (26.63%) (P = .008). Results of our study confirm that aspirin lowers the increased Lp(a) levels in patients with ischemic stroke.

Role of angiotensin converting enzyme and angiotensinogen gene polymorphisms in angiotensin converting enzyme inhibitor-mediated antiproteinuric action in type 2 diabetic nephropathy patients.

AIM: To investigate the role of genetic variants of angiotensin converting enzyme (ACE) and angiotensinogen (AGT) genes in the antiproteinuric efficacy of ACE inhibitor therapy in diabetic nephropathy (DN) patients. METHODS: In the present study, 270 type 2 diabetes mellitus patients with nephropathy were enrolled and treated with ACE inhibitor (ramipril) and followed at 6 mo for renal function and albumin excretion by estimating serum creatinine, end stage renal disease, and albumin/creatinine ratio (ACR) in urine. Genotyping of ACE I/D and AGT M235T polymorphisms were performed by using primer specific polymerase chain reaction (PCR) and PCR-RFLP techniques, respectively. RESULTS: Forty-eight percent of DN patients (responders) benefited with respect to proteinuria from ACE inhibitor therapy at 6 mo follow-up. A significant reduction in ACR was observed after 6 mo treatment with ACE inhibitor irrespective of whether DN patients were micro-albuminuric (≥ 30 and < 300 mg/g creatinine) or macro-albuminuric (≥ 300 mg/g creatinine) at the time of enrollment. However, macro-albuminuric patients (55%) showed better response to therapy. A reduction in urinary ACR was found independent of genotypes of ACE I/D and AGT M235T polymorphisms although macro-albuminuric patients having TT genotype showed statistically insignificant increased response (72%). CONCLUSION: ACE inhibitor therapy reduced urinary ACR by ≥ 30% in 50% of DN patients and the response is independent of ACE I/D and AGT M235T polymorphisms.

Profile of Patients Hospitalized through the Emergency Room to the Medicine Ward and their Short-term Outcome at a Tertiary Care Hospital in Delhi.

INTRODUCTION: With an increasing number of sicker patients, limited hospital beds, and an emphasis on day care, the profile of patients hospitalized to medicine wards has undergone a radical re-definition. The increasing share of patients hospitalized through the emergency department for acute care to medicine wards has left little space for hospitalization through the outpatient department (OPD). There are some global data available on the profile of patients presenting to the emergency rooms (ERs) and their subsequent outcome. Data from developing countries, especially India, in this regard are lacking. METHODS: This cross-sectional study included all patients hospitalized to the medicine ward through the medical emergency services, provided by the Department of Medicine, each Wednesday and every sixth Sunday for the entire year (a total of 62 days), from November 2010 through October 2011, and followed their outcome up to seven days after hospitalization. RESULTS: Of the 3,618 cases presenting to medicine emergency on these days, 1,547 (42.3%) were advised admission. Nine hundred sixty-seven reported to the medicine wards. One hundred eleven (7.73%) expired within 24 hours; others absconded, were lost in transit, did not consent to participation, or were discharged. During the next seven days, 452 (46.7%) recovered sufficiently and were discharged to go home. Two hundred thirty (23.8%) left the hospital without informing the medical staff. Fourteen (1.4%) patients were transferred to other departments. One hundred thirty-seven (8.8%) patients died during the next six days of hospitalization. After Multivariate Logistic Regression analysis, abnormal Glasgow Coma Scale (GCS) score, high systolic blood pressure (BP), age, increased total leucocyte count, increased globulin, low bicarbonate in arterial blood, low Mini Mental Status Examination (MMSE) score, and a raised urea >40 mg/dL were found to be associated significantly with mortality. CONCLUSION: Of the 1,547 patients who needed urgent hospitalization, 248 (16%) died within the first week, one-half of them within the first 24 hours. An advanced age, abnormal GCS score, low MMSE score, increased systolic BP, leukocytosis, acidosis, and uremia were found to be associated with a fatal outcome. Therefore, nearly one-half of the patients who would have a fatal short-term outcome were likely to do so within the first 24 hours, making the first day of presentation "the golden day" period.

The 2015 Academic College of Emergency Experts in Indias INDO-US Joint Working Group White Paper on Establishing an Academic Department and Training Pediatric Emergency Medicine Specialists in India.

The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine in Emergency Medicine as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3 year superspeciality course after completion of MD Diplomate of National Board (DNB) Pediatrics or MD DNB in EM. The National Board of Examinations that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG ACEE India) gives its recommendations for starting 3 year DM DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.

The 2015 Academic College of Emergency Experts in India's INDO-US Joint Working Group White Paper on Establishing an Academic Department and Training Pediatric Emergency Medicine Specialists in India.

The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally, organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine (MD) in Emergency Medicine (EM) as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3-year superspeciality course (in PEM) after completion of MD/Diplomate of National Board (DNB) Pediatrics or MD/DNB in EM. The National Board of Examinations (NBE) that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program - DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG-ACEE-India) gives its recommendations for starting 3-year DM/DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.

Lipoprotein (a) in chronic renal failure: effect of maintenance hemodialysis.

BACKGROUND: Coronary artery disease accounts for significant morbidity and mortality in patients with chronic kidney disease (CKD). Besides the higher prevalence of traditional risk factors, several uremia-related factors may play a role in accelerated atherosclerosis, such as elevated levels of lipoprotein (a) (Lp(a)). The effect of maintenance hemodialysis (MHD) on Lp(a) levels is not well understood. The present work was carried out to study the Lp(a) levels in Stage 4 and Stage 5 CKD patients as well as the effect of MHD on Lp(a) levels in patients with Stage 5 CKD. METHODS: The study subjects included 15 patients with Stage 4 CKD, 15 patients with Stage 5 CKD, and 15 age- and sex-matched healthy controls. Plasma Lp(a) was measured by ELISA in all the subjects at the time of entry into the study and after 4 weeks of MHD in patients with Stage 5 CKD. Patients on MHD were dialyzed two to three times weekly for 4 hr during each session. RESULTS: Mean Lp(a) levels were significantly higher in patients with CKD than in control patients. In patients with Stage 4 CKD, the Lp(a) level was 34.0 +/- 19.5 mg/dL, whereas in Stage 5 CKD the level was 49.0 +/- 30.9 and in healthy controls it was 22.2 +/- 16.4. In patients with Stage 5 CKD, 4 weeks of MHD led to a significant fall in Lp(a) levels by 23.6% (P < 0.001). CONCLUSIONS: The results of this study show that increases in Lp(a) levels start early during the course of CKD and become more pronounced with increased severity of disease. Initiation of MHD lowers Lp(a) levels and may have a long-term beneficial effect on cardiovascular morbidity and mortality.

Role of neutrophil gelatinase-associated lipocalin for early detection of acute kidney injury.

Acute kidney injury (AKI) is characterized by abrupt or rapid decline of renal function and is usually associated with the development of serious complications as well as an independent risk of mortality in hospitalized patients. Emergency physicians play a critical role in recognizing early AKI, preventing iatrogenic injury, and reversing the course of AKI. Among the various available biomarkers for AKI, reliable and automated assay methods are commercially available for only cystatin-C and neutrophil gelatinase-associated lipocalin (NGAL). NGAL appears to be a promising marker for early detection of AKI and is likely to be adapted for wide-scale clinical use in patient management as a point-of-care test. Use of NGAL along with panel of other renal biomarkers can improve the rate of early detection of AKI. Large, multicenter studies demonstrate the association between biomarkers and hard end points such as need for renal replacement therapy (RRT), cardiovascular events, hospital stay, and death, independent of serum creatinine concentrations.

The 2014 Academic College of Emergency Experts in India's Education Development Committee (EDC) White Paper on establishing an academic department of Emergency Medicine in India - Guidelines for Staffing, Infrastructure, Resources, Curriculum and Training.

Emergency medicine services and training in Emergency Medicine (EM) has developed to a large extent in developed countries but its establishment is far from optimal in developing countries. In India, Medical Council of India (MCI) has taken great steps by notifying EM as a separate specialty and so far 20 medical colleges have already initiated 3-year training program in EM. However, there has been shortage of trained faculty, and ambiguity regarding curriculum, rotation policy, infrastructure, teachers' eligibility qualifications and scheme of examination. Academic College of Emergency Experts in India (ACEE-India) has been a powerful advocate for developing Academic EM in India. The ACEE's Education Development Committee (EDC) was created to chalk out guidelines for staffing, infrastructure, resources, curriculum, and training which may be of help to the MCI and the National Board of Examinations (NBE) to set standards for starting 3-year training program in EM and develop the departments of EM as centers of quality education, research, and treatment across India. This paper has made an attempt to give recommendations so as to provide a uniform framework to the institutions, thus guiding them towards establishing an academic Department of EM for starting the 3-year training program in the specialty of EM.

Association of RAGE gene polymorphism with vascular complications in Indian type 2 diabetes mellitus patients.

AIMS: The study was designed to evaluate the association of -374T/A and -429T/C polymorphism in the promoter region and Gly82Ser polymorphism in exon 3 region of RAGE gene with diabetic vascular complications in Indian population. METHODS: We screened 603 subjects which includes 176 healthy controls, 140 type 2 diabetes mellitus (T2DM) subjects without any vascular complications (DM), 152 T2DM subjects with microvascular complications (DM-micro) and 135 T2DM subjects with macrovascular complications (DM-macro) for -374T/A, -429T/C and Gly82Ser polymorphisms of RAGE gene. DNA isolated from the enrolled subjects were genotyped by PCR-RFLP. Logistic regression analysis was used to evaluate the association of single nucleotide polymorphisms (SNPs). RESULTS: The -429 T/C and Gly82Ser RAGE polymorphisms were found to be significantly associated with the development of macrovascular and microvascular complications, respectively, in T2DM subjects while -374A allele showed reduced risk towards the development of macrovascular complications. Further, -429T/C, -374T/A and Gly82Ser haplotype analysis revealed association of CTG haplotype with development of macrovascular complications while haplotype TAG was observed to be significantly protective towards development of macrovascular complications in T2DM subjects (OR=0.617, p=0.0202). CONCLUSIONS: Our data indicates significant association of RAGE SNPs and haplotypes with vascular complications in North Indian T2DM subjects.

Profile of hospital admissions following acute poisoning from a major teaching hospital in North India.

A retrospective analysis of 584 cases of acute poisoning admitted with a medical emergency to the Department of Medicine, GTB Hospital, Delhi, over a three-year period. The patients were analysed with respect to the age, sex, mode of poisoning, type of poison consumed and mortality. Of these, 42.63% were aged 20-30 years. Poisoning was used as a suicidal agent by 63.8% of the patients. The nature of the poison could not be ascertained in 15.92% of patients. Sedatives were involved in 13.36%. Aluminium phosphide poisoning was found in 11.82%. The overall mortality was estimated to be 13.18% with 53.2% being caused by the consumption of aluminium phosphide. There has been a change in the nature of poisons consumed and the number of cases of aluminium phosphide poisoning is declining. However, aluminium phosphide poisoning still remains a major threat as it carries a high mortality rate.

Approach to a patient with urosepsis.

Urinary tract infections can occur in all age groups and produce an exceptionally broad range of clinical syndromes ranging from asymptomatic bacteriuria to acute pyelonephritis with Gram negative sepsis to septic shock. In approximately one-quarter of all patients with sepsis, the focus of infection is localized to the urogenital tract. This may lead to substantial morbidity and significant economic implications. We present a review of the current approaches to managing urospesis.