Predictive factors for extracorporeal shockwave lithotripsy success in ureteric stones, does skin-stone distance and hounsfield unit matter?

OBJECTIVE: To evaluate the usefulness of measuring stone skin distance and stone attenuation values by non-contrast computed tomography for predicting treatment outcome of ureteric stones by extracorporeal shockwave lithotripsy (ESWL). PATIENT AND METHOD : Retrospective review of 66 patients who underwent ESWL for ureteric stones with pre-ESWL NCCT in 2010–2012. Subjects were stratified into 2 groups, successful ESWL and failed ESWL, with ESWL success defined as stone fragment less than 4 mm at 6 weeks after ESWL. Patient age, sex, stone size, stone location, laterality, shockwave energy, number of shockwave administered, Hounsfield unit (HU), skin to stone distance (SSD), presence of hydronephrosis, pre-ESWL JJ stent or PCN were studied as predictive factors. RESULTS : Patient demographics and stone characteristics were similar between the 2 groups. On univariate analysis, the mean stone size for successful ESWL was 7.9 mm compared with 10.2 mm in the failure group (P = 0.02). For the skin-stone distance, the mean distance for the successful group was 95 mm compared with 104 mm in the failure group (P = 0.04). Concerning the Hounsfield Unit, a mean of 1034 HU was found in the successful compared with 1129 HU in the failure group (P = 0.16) CONCLUSION : Skin to stone distance on non-contrast CT scan is a useful predictive factors for ESWL success for ureteric stones.postprin

Prevalence of Microalbuminuria among Diabetic Patients in Usmanu Danfodiyo University Teaching Hospital, Sokoto

Diabetic nephropathy is a common phenomenon in patients with diabetes. Its prevalence risk factors have not been fully  described in black African patients. This study determined the prevalence of microalbuminuria (mal) among diabetic patients in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto. It involved 100 diabetics and 50 healthy controls.  Mal was  estimated by BCG-dye binding method, while fasting blood glucose (FBG) by glucose oxidation method. The prevalence of mal varied between males (24.3%) and females (16.6%). The duration of the disease ranged from < 5 years (42.0%) with   8(14.5%) having abnormal mal, (58%) >5 years with (31%) having abnormal mal, (30%) < 30 years having (17.1%) having abnormal mal and (70%) >30 years having (24%) with abnormal mal. The prevalence of mal was 22% (17% males and 5% females). FBG differed significantly (p<0.05) between patients (11.01±1.03mmol/l) and control subjects (4.38±0.07 mmol/l). Urinary albumin excretion was significantly higher in diabetics than in control (57.65±18.92 versus 24.16±1.48mg/24hrs respectively). Mal significantly (p<0.05) increased with duration of diagnosis of diabetes (108.6±14 versus 214.6±9.1  mg/24hrs in <5 years and >5years group respectively). Poor glycaemic control was the only modifiable predictor for the  development of mal. Other non-modifiable risk factors related to progression of mal are sex and duration of disease. Early diagnosis of mal and aggressive glycaemic control is hereby recommended.Keywords: Microalbuminuria, Diabetic nephropathy, Fasting blood glucos

Percutaneous nephrostomy, nephrolithotomy and combined ureteroscopic lithotripsy using the supine approach

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Cytotoxic Effect of Crude Aqueous Extract of Pistia Stratiotes Leaves (water lettuce) on Body Weight and Renal Cells of Albino Rats

Pistia stratiotes is a medicinal plant used traditionally to treat a various diseases such as skin infections, worm infections, tuberculosis, ulcer, diabetes etc. The present study was designed to investigate the effect this crude aqueous extract may have on body weight and renal cells function in albino rats. Twelve white Albino rats divided into 4 groups of 3 rats each were used. Groups 2, 3 and 4 were administered orally of 100, 200 and 300mgkg-1 body weight of the aqueous leaves extract of pistia stratiotes respectively, while group 1 served as control and was given the vehicle. Body weight and renal indices were significantly (p<0.05) altered at higher doses of the extract when compared to control. The study shows that aqueous extract of p. stratiotes leaves may have effect on body weight and renal cells of albino rats after 5 days. At the end of the study, body weight of the animals was 156.27±1.91g (group 1), 141.32±0.82g (group 2), 140.38±1.77g (group 3), and 161.29±0.97g (group 4) as against the body weight of 150.32±2.27g, 146.37±1.73g, 145.71±2.20g, and 165.32±1.75g, correspondingly before administration of the extract. There were significant differences (based on T-test and p-values 141.32±0.82g and 140.38±1.77g) in the body weight of group 3 and 4 before and after administration of the extract. Serum urea concentrations were 6.71±1.19 mmol/L, 18.57±2.98 mmol/L, 27.27±2.37 mmol/L in extract treated groups 2, 3 and 4 respectively, as against the concentration of 7.11±1.19 mmol/L before the administration of the extract. There were significant differences (p<0.05) (based on T-test and p-values 7.11±1.19 mmol/L, 18.57 mmol/L and 27.27±2.37 mmol/L) between urea concentration of group 1, 2 and 3 before and after the administration of the extract. Serum creatinine concentration was found to be 108.51±3.21 mmol/L in controls, before the administration of the extract as against the concentration of 102.21±7.67 mmol/L, 123.80±2.15 mmol/L, 129.20±7.15 mmol/L in treated groups 2, 3 and 4 after the administration of the extract respectively. There were significant differences (based on 108.51±3.21 mmol/L and 102.21±7.67mmol/L) between serum creatinine concentration of group 1 and 2 before and after the administration of the extract. Hence, results from this finding revealed that the aqueous extract of pitia stratiotes leaves could be associated with some levels of kidney toxicity.Keywords: Pistia stratiotes, body weight, renal indices, extract, administration

Pathway of psychiatric care in Hong Kong

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Seasonal Influenza Vaccine Effectiveness among Children Aged 6 to 59 Months in Southern China

In China the protective effect of seasonal influenza vaccine has only been assessed in controlled clinical trials and proven to be highly effective. However, the post-licensure effectiveness of influenza vaccine has not been examined. In our study all influenza cases from the 19 surveillance sites in Guangzhou were laboratory confirmed during 2009 and 2010. Controls were randomly selected from children aged 6 to 59 months in the Children's Expanded Programmed Immunization Administrative Computerized System. 2529 cases and 4539 controls were finally enrolled. After adjusting for gender, age and area of residence, the vaccine effectiveness of full vaccination was 51.79% and 57.78% in the 2009 and 2010 influenza season, respectively. Partial vaccination provided 39.38% and 35.98% protection to children aged 24 to 59 months in 2009 and 2010, respectively, and no protective effect was observed among younger children. Full vaccination is highly protective and partial vaccination is protective for older children. Influenza vaccination in general should be encouraged, and full vaccination should be particularly encouraged because its protective effect is much stronger than that of partial vaccination

Long Isoforms of NRF1 Contribute to Arsenic-Induced Antioxidant Response in Human Keratinocytes

BACKGROUND: Human exposure to inorganic arsenic (iAs), a potent oxidative stressor, causes various dermal disorders, including hyperkeratosis and skin cancer. Nuclear factor-erythroid 2-related factor 1 (NRF1, also called NFE2L1) plays a critical role in regulating the expression of many antioxidant response element (ARE)-dependent genes. OBJECTIVES: We investigated the role of NRF1 in arsenic-induced antioxidant response and cytotoxicity in human keratinocytes. RESULTS: In cultured human keratinocyte HaCaT cells, inorganic arsenite (iAs(3+)) enhanced the protein accumulation of long isoforms (120-140 kDa) of NRF1 in a dose-and time-dependent fashion. These isoforms accumulated mainly in the nuclei of HaCaT cells. Selective deficiency of NRF1 by lentiviral short-hairpin RNAs in HaCaT cells [NRF1-knockdown (KD)] led to decreased expression of gamma-glutamate cysteine ligase catalytic subunit (GCLC) and regulatory subunit (GCLM) and a reduced level of intra-cellular glutathione. In response to acute iAs(3+) exposure, induction of some ARE-dependent genes, including NAD(P)H:quinone oxidoreductase 1 (NQO1), GCLC, and GCLM, was significantly attenuated in NRF1-KD cells. However, the iAs(3)-induced expression of heme oxygenase 1 (HMOX-1) was unaltered by silencing NRF1, suggesting that HMOX-1 is not regulated by NRF1. In addition, the lack of NRF1 in HaCaT cells did not disturb iAs(3+)-induced NRF2 accumulation but noticeably decreased Kelch-like ECH-associated protein 1 (KEAP1) levels under basal and iAs(3+)-exposed conditions, suggesting a potential interaction between NRF1 and KEAP1. Consistent with the critical role of NRF1 in the transcriptional regulation of some ARE-bearing genes, knockdown of NRF1 significantly increased iAs(3+)-induced cytotoxicity and apoptosis. CONCLUSIONS: Here, we demonstrate for the first time that long isoforms of NRF1 contribute to arsenic-induced antioxidant response in human keratinocytes and protect the cells from acute arsenic cytotoxicity

Mitochondrial phylogeography and demographic history of the Vicuña: implications for conservation

The vicuña (Vicugna vicugna; Miller, 1924) is a conservation success story, having recovered from near extinction in the 1960s to current population levels estimated at 275 000. However, lack of information about its demographic history and genetic diversity has limited both our understanding of its recovery and the development of science-based conservation measures. To examine the evolution and recent demographic history of the vicuña across its current range and to assess its genetic variation and population structure, we sequenced mitochondrial DNA from the control region (CR) for 261 individuals from 29 populations across Peru, Chile and Argentina. Our results suggest that populations currently designated as Vicugna vicugna vicugna and Vicugna vicugna mensalis comprise separate mitochondrial lineages. The current population distribution appears to be the result of a recent demographic expansion associated with the last major glacial event of the Pleistocene in the northern (18 to 22°S) dry Andes 14–12 000 years ago and the establishment of an extremely arid belt known as the 'Dry Diagonal' to 29°S. Within the Dry Diagonal, small populations of V. v. vicugna appear to have survived showing the genetic signature of demographic isolation, whereas to the north V. v. mensalis populations underwent a rapid demographic expansion before recent anthropogenic impacts