Clinicopathological Spectrum and Treatment Outcome of Clinically Suspected Rapidly Progressive Glomerulonephritis: An Analysis of 35 Cases in a Tertiary Care Center, Bangladesh

Background and Aim: Rapidly progressive glomerulonephritis (RPGN) is characterized by a rapid decline in the renal function and urinary abnormalities. There is limited information on epidemiological factors and clinical and histopathological patterns of RPGN from developing countries. Therefore, the objective of this study was to identify the etiology, clinical features, histopathological patterns, and treatment outcomes of patients with clinically suspected RPGN. Methods: This retrospective study was conducted in the Pediatric Nephrology Department of Bangabandhu Sheikh Mujib Medical University from January 2014 to January 2019. Patients with clinically suspected RPGN that underwent renal biopsy were enrolled in this study. Results: Thirty-five patients were recruited in this study. Macroscopic hematuria, edema, hypertension, uremia, and oliguria were common clinical presentations. Diffuse proliferative GN (28.5%) and crescentic GN (22.8%) were the most common histological diagnoses in this study. Immune mediated GN (62%) followed by idiopathic GN (25%) were found to be the most frequent cause of crescentic GN. Renal replacement therapy was required in 45% of the cases and 11.4% of the patients developed end-stage renal disease.Conclusion: Renal histology is an integral part of the investigation of patients with suspected RPGN for both diagnostic and prognostic purposes. Diffuse proliferative GN was the most common histopathological diagnosis in patients with clinical RPGN in our population. Preservation of renal function depends on early intervention and detection of RPGN in pediatric patients.Keywords: Nephritis; Glomerulonephritis; ESRD; End-Stage Kidney Disease; Child.

Real Exchange Rates and Productivity

This paper examines the impact of productivity shocks on real exchange rate fluctuations in a dynamic international general equilibrium model with nontraded goods. The model predicts a close association between relative technology shocks and bilateral real exchange rate movements. Empirical results based on the data for Group of Seven countries are consistent with the predicted theoretical correlations. Using Johansen and Juselius (1990) multivariate cointegration tests the study finds that a statistically significant relationship exists between bilateral real exchange rates and international productivity differentials in the traded and nontraded sectors.Real effective exchange rates;Productivity;Economic models;exchange rate, real exchange rate, exchange rates, real exchange rates, equation, statistics, exchange rate movements, cointegration, equations, nominal exchange rate, real exchange rate movements, financial statistics, predictions, correlations, correlation, standard deviation, nominal exchange rates, real variables, exchange rate fluctuations, real exchange rate fluctuations, exchange rate determination, general equilibrium model, equilibrium exchange rate, optimization, autocorrelation, logarithms, statistic, floating exchange rates, flexible exchange rate, floating exchange rate, exchange rate dynamics, analytical method, exchange rate regimes, bilateral real exchange rate, bilateral exchange rate, exchange rate theories, exchange rate volatility, depreciation of exchange rates, fluctuations in exchange rates, floating exchange rate regime, effective exchange rate, standard errors, significance level, foreign exchange rates, dollar exchange rate, effective exchange rates, exchange rate behavior, exchange rate regime, econometrics, foreign exchange, time series, maximum likelihood estimation, real effective exchange rate, exchange rate variability, home currency, real exchange rate dynamics, exchange rate data, forecasting, statistical analysis

Correlations Between Real Interest Rates and Output in a Dynamic International Model-Evidence From G-7 Countries

This paper examines the extent to which a dynamic international general equilibrium model can account for observed movements in real interest rates and interest rate differentials. Using data for Group of Seven, the study finds that measured real interest rates are countercyclical in a single country and that the contemporaneous cross-correlations between international real interest differentials and output growth spreads are negative. Predictions of the baseline model are, however, inconsistent with the data. Extending the benchmark model to include habit persistence in consumption improves the match between theory and data.

Study of progesterone production in humanm pregnancy by early placental explants

Little is known about the factors stimulating placental progesterone (P4) production at the time of the luteo-placental shift (6-8 weeks post-conception). To explore the regulatory mechanism, the effects of various steroids and peptides on the production of P4 by placental explants were studied.In early placental explant culture P4 production was stimulated by 19-nortestosterone (19-NT), androstenedione (A-dione), 5$alpha$-androstane-3$alpha,$17$beta$ diol (3$alpha$-diol) and 5$alpha$-androstane-3$beta,$17$beta$ diol (3$beta$-diol). Of all the compounds tested, 19-NT had maximal effect. At term, P4 production was stimulated only by 3$beta$-diol. 19-NT and A-dione were poorly aromatized in early placental explants compared to another androgen (Androst-5-ene-3$beta,$17$beta$ diol).In accord with the above observations, placental levels of 19-NT and A-dione were higher in early gestation while the diols were higher in late gestation.19-NT stimulated P4 production in early placenta by effects on the conversion of P4 both from 25-hydroxycholesterol and from pregnenolone. The stimulatory influences of A-dione and 3$alpha$-diol were mediated by increasing the P450scc activity. The specific increase of the conversion of P4 from pregnenolone accounted for the P4 stimulation observed by 3$beta$- diol treatment of culture.Cyloheximide (CH) treatment abolished the stimulatory influences of the aforementioned steroids on P4 production except for the initial phase of P4 stimulation by 19-NT, suggesting that all but the latter are dependent on protein synthesis.P4 production was also stimulated and prolonged to 30 days in the presence of human maternal serum (HMS); a good correlation (r = 0.74, P $<$ 0.05) was seen between the histological appearance of the explants and P4 production. The stimulatory activity of HMS was heat labile, non-dialyzable and non-extractable into an organic solvent, suggesting that it is protein in nature.In conclusion, this study suggests that 19-NT and A-dione are important for placental P4 production at the time of the luteo-placental shift. For in vitro study of placental hormonal regulation, HMS is a better nutrient supplement than fetal bovine serum

Fuzzy Metric Space: A Study on Level Sets Notion

Abstract. In this paper, the Level sets concept of fuzzy numbers is considered to study fuzzy metric space. Some properties of metric space along with contraction mapping are revised in terms of the notion of level sets

Morphometrical and Topographical Anatomy of Position of Nutrient Foramen on Fully Ossified Left Femur

Background: The femur is the typical long bone of lower limb which extends from the pelvis to the knee. It forms the skeleton of the thigh, bears body weight, supports movement of legs; provide attachment to muscles, form blood cells and acts as a store house for calcium and phosphate. The nutrient foramina are cavities that conduct the nutrient arteries and the peripheral nerves. The majority blood supply for femur originates from the nutrient arteries, mainly during the growing period and during the early phase of ossification. In bone grafts the nutrient blood supply is crucial and it should be preserved in order to promote the fracture healing.Objective: The anatomy of nutrient foramen of femur is very essential for orthopedic & vascular surgeons as well as to radiologists for planning of treatment.Materials and method: This cross sectional study was carried out in the department of Anatomy, Sir Salimullah Medical College, Dhaka, Bangladesh from July 2011 to June 2012. The study comprised 199 fully ossified left sided dry femur of both sex (n=89 male, n=110 female). Sampling technique was purposive. Morphometric and topographic study was carried out on all samples by direct physical and photographic methods.Results: The most common position of nutrient foramen on the shaft of femur was found on the middle 1/5th in both male and female femur (50.78% in male and 56.86% in female respectively).Conclusion: The anatomical knowledge about this study might be useful in certain surgical procedures as well as micro vascular bone transfer to preserve the circulation

Histopathological Pattern of Difficult Childhood Nephrotic Syndrome in A Tertiary Care Centre, Bangladesh

BackgroundThe aim of this study was to know the spectrum of histopathology in children who underwent a renal biopsy for difficult NS in a tertiary care pediatric nephrology center.MethodThis prospective observational study took place in Pediatric Nephrology department of Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh, from January 2011 to July 2018. Patients presented with difficult pattern of nephrotic syndrome and underwent renal biopsy were enrolled in this study.ResultsTotal 140 patients were recruited in this study. Patients with SRNS &amp; nephrotic syndrome with atypical presentation had renal biopsy ; a good number of atypical NS were SDNS. They were grouped into Group A: SRNS, Group B: SDNS, Group C:Nephrotic Syndrome with atypical presentation. Comparison among 3 groups were done. Regarding lab parameters, serum creatinine was raised in 40.6% patients in  nephrotic syndrome with atypical presentation and 16.2%in SRNS. In patients with SDNS, MCD (51.3%) was the most common histological pattern followed by MesPGN (33.3%); whereas MesPGN was the commonest histological pattern in SRNS (56.8%) and atypical presentation (54.7%) followed by MCD and FSGS.Most of the patients response to immunosuppressive therapy. In SRNS partial response achieved in 18.9% and CKD  developed in 16.2% cases. In comparison, nephrotic syndrome atypical presentation 10.9% patients achieved partial response and 7.8% developed CKD but these are not statistically significant. 5.4% patients of SRNS died.ConclusionMesangioproliferative glomerulonephritis was the most common histopathological diagnosis in patients with SRNS &amp; nephrotic syndrome atypical presentation  in our population. MCD is predominant among SDNS