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Hada R.,National Academy of Medical science | Poudyal B.,Civil Service Hospital and Blue Cross Hospital | Sharma A.,Dr Lal Path Labs Pvt Ltd | Khatri R.,Shree Birendra Hospital and Blue Cross Hospital
Journal of the Nepal Medical Association | Year: 2012

Cast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent in spite of treatment. We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no "M spike" but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy.

Mishra M.N.,Dr Lal Path Labs Pvt Ltd | Sharma A.,Army Hospital Research and Referral
Indian Journal of Human Genetics | Year: 2012

Background: Recombination (crossing over) may generate novel haplotypes that can be beneficial to a population against recently introduced pathogens. It may lead to the generation of new alleles. Settings and Design: A prospective study at a tertiary care centre. Aim :0 To report two rare cases of crossing over in HLA region. Materials and Methods: Tissue-typing was done by sequence specific primers (SSP) for DR locus and by both SSP and serology for Class I which was reconfirmed on fresh samples. Results: In one patient crossing over had taken place in the region of A locus resulting in inheritance of AFNx0101 instead of expected AFNx0111. In second family crossing over had taken place in region of DRB1 locus and the sibling inherited DRB1FNx0108 instead of DRB1FNx0110. Conclusions: Possibility of recombination must be considered when interpreting implausible tissue-typing results of families worked up for BMT.

Bhattacharya S.K.,Vellore Institute of Technology | Bhattacharya S.K.,Dr Lal Path Labs Pvt Ltd | Sarkar A.,Vellore Institute of Technology | Sengupta S.,Vellore Institute of Technology
Journal of Microbial and Biochemical Technology | Year: 2014

Poliovirus (PV) has been implicated in the etiology of poliomyelitis. Post-polio syndrome (PPS) is a condition that affects polio survivor years after recovery from an initial acute attack of the polio virus. DNA polymorphisms in the poliovirus receptor gene (PVR) are associated with persistent poliovirus infection. In the present study we have presented clinical and demographic characteristics of the PPS individuals who were affected initially by poliomyelitis and later developed PPS. We have also attempted to find out whether mutation in the PVR gene allows poliomyelitis patients to progress for PPS. PVR mutation was studied in 110 cases of PPS and 200 normal controls. In PVR exon 2, the Ala67Thr mutation was detected in 45.46% of progressive PPS and 10% of control subjects. The frequency of the mutation was significantly higher in patients with PPS than in controls. Changes in the PVR gene may result in slowly progressive cytopathic effects that may lead to progression of PPS. © 2014 Bhattacharya SK, et al.

Sharma A.,Dr Lal Path Labs Pvt Ltd | Hada R.,National Academy of Medical science | Agrawal R.K.,National Academy of Medical science | Baral A.,National Academy of Medical science
Indian Journal of Nephrology | Year: 2012

Atheroembolic renal disease is characterized by renal failure secondary to occlusion of renal vasculature by cholesterol containing atheromatous plaques. Clinical presentations of this disease entity are myriad, with limited therapeutic options and unfavorable outcomes. This report describes an elderly male patient with peripheral vascular disease who developed acute renal failure during hospital admission for rectal bleed, and was diagnosed with atheroembolic renal disease on renal biopsy. The patient was managed with pulse steroid therapy and had a favorable outcome.

Mishra M.N.,Indian Naval Hospital Ship Asvini | Mishra M.N.,Dr Lal Path Labs Pvt Ltd | Kalra R.,Indian Naval Hospital Ship Asvini | Rohatgi S.,Indian Naval Hospital Ship Asvini
Sao Paulo Medical Journal | Year: 2013

Context and Objective: Arterial thrombosis may occur consequent to hereditary thrombophilia and increased lipoprotein(a) [Lp(a)] and fibrinogen. Our aim was to study the prevalence of common thrombophilia markers in 85 consecutive cases of arterial thrombosis. Design and Setting: A retrospective study was conducted from 85 consecutive young patients treated as outpatients or admitted due to stroke or myocardial infarction at a tertiary care hospital. Methods: Eighty-five Indian patients (age < 45 years) presenting ischemic stroke (n = 48) or myocardial infarction (n = 37) and 50 controls were studied for seven thrombophilia markers including antithrombin (AT), factor V, protein C, protein S, activated protein C resistance (APC-R), fibrinogen and Lp(a). Functional assays for protein C, protein S, factor V and APC-R were performed using clotting-based methods. Semiquantitative estimation of fibrinogen was done using Clauss's method and Lp(a) using immunoturbidimetry. Statistical analysis was done using the Epi Info 6 software. Results: Thirty-three samples (38.8%) tested positive for one or more thrombophilia markers. The three commonest abnormalities were elevated Lp(a) (20%), fibrinogen (17.6%) and low APC-R (14.2%). Low levels of protein C, protein S and AT were present in 4.7, 9.4 and 7% of the patients, respectively. Overall, the risk factor profile was: smoking (33%), positive family history (15.3%), hyperlipidemia (7%), hypertension, diabetes mellitus and obesity (2.3% each). Conclusions: An association was found between low levels of protein C, protein S and AT and arterial thrombosis, but only elevated fibrinogen levels, smoking, positive family history and hyperlipidemia showed statistical significance.

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