Sonal Pruthi

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.

End-of-Life Care Attitudes, Values, and Practices Among Health Care Workers

Introduction: This study aims to ascertain attitudes of health care workers on end-of-life care (EOLC) issues and to highlight the disparity that exists in countries with different backgrounds. Methods: It is a cross-sectional questionnaire survey across heterogeneous health care providers in India, Chile, the United Kingdom, and the Netherlands using an indigenously prepared questionnaire considering regional variations, covering different areas of EOLC. Results: Of the 109 participants, 68 (62.4%) felt that cardiopulmonary resuscitation should be done selectively, 25 (22.9%) had come in contact with at least 1 patient who had asked them to hasten death, and 36 (33%) felt that training was insufficient to prepare them for skills in issues of EOLC. Conclusion: To avoid cumbersome through well-meant interventions, it is important that the caregiving team is aware of the patient’s own wishes with respect to EOLC issues.

To ascertain the utility of urinary methyl malonic Acid as a potential marker of ischemic heart failure.

BACKGROUND Methyl Malonic Acid (MMA) is known to be an integral component of the cascade of events in mitochondrial energy metabolism and since heart failure involves energy pathways, it is probable that levels of MMA could be used as a reliable biomarker to objectively identify the disease during the early stages and help in prognostication. MATERIALS AND METHODS The present study was envisaged to evaluate the relation between urinary MMA levels in patients with Ischemic heart disease and in those progressing to failure. The relationship between the severity of the disease and the level of MMA in urine were also evaluated. Analysis of urinary MMA was done by Gas Chromatography-Mass Spectrometry (GC-MS) using stable isotope dilution. Twenty patients each with Ischemic Heart Disease, heart failure and controls were recruited in this pilot study. RESULTS The mean value of MMA in patients with IHD was 126.71(±66.3) pmol/L and those with IHF was 390.76 (±97.99) pmol/L with the difference being statistically significant (p<0.001). Co-existing B12 deficiency was excluded as that was a potential confounder. CONCLUSION Levels of MMA were significantly higher in patients with heart failure compared to those with IHF, which were significantly higher than controls. Evaluation of the correlation between MMA levels and the stage of the disease did not reach statistical significance; but this requires adequately powered studies to support this preliminary finding.

Disaster management in India: a road ahead.

Correspondence: Sonal Pruthi University College of Medical Sciences Dilshad Garden Delhi, India E-mail: sonalpruthi@hotmail.com Heartbeats taken too soon amongst silent prayers, debris scattered for miles, houses unrecognizable, treasures lost amidst the trampled smell of mud, where broken chairs and teddy bears lieyan apocalyptic nightmare meets the eye after a disaster. The great Indian Ocean tsunami of 2004, with a death toll of 300,000, wiped out civilization in many parts of Southeast Asia. Where at the start of the day, people were going about their normal lives, at the end of the day millions were struggling with reality of tens of thousands of dead or missing relatives, destroyed homes, and shattered lives. The thousands of corpses hanging on trees or washed up on beaches immediately started to rot in the tropical heat, and exposed the pitiful, ragged state of disaster management system in India. At a time of global changes, it is vital that India pays attention to its disaster management facilities. Disaster management is a continuous process by which individuals, groups and communities manage hazards in an effort to ameliorate the impact of disaster. Due to the country’s unique geoclimatic location, 60% of the landmass is prone to earthquakes; 68% to drought; eight percent to cyclones and 12% to floods. India has experienced many major natural disasters in the past few years, which has made us realize that the need of the hour is to adopt a multi-dimensional, multi-disciplinary and multi-sectoral approach to create a robust system which can create awareness, efficiently prevent disaster and manage once the disaster has taken place. Though government has taken baby steps in that direction, there is a yawning gap between what is planned and what is implemented. The need of the hour is an integrated effort to collect and compile data, including information and local knowledge on disaster history and response patterns. Another need is an Early Warning System to provide timely information, targeting the important minutes before disasters when measures can be taken to minimize damage. Another requirement is a reliable and cost-efficient telecommunications link for humanitarian relief and assistance agencies, along with a portable telemedicine system with satellite connectivity. Equally important is to keep in mind the vulnerability of critical infrastructure. Hence, agencies should be equipped with electrical and solar generators, lighting equipment, fuel, solar cookers and other technologies to take care of power supply and basic needs. Safe water availability with low-cost, local treatment facilities is important during post-disaster situations for sanitation and to avoid outbreak of other epidemics. Manpower is of vital importance. It is imperative to train personnel for effective triage and first aid—the lack of training is a prime concern. Equally relevant is to have regular practice drills to train the population to assist in relief activities in the event of a disaster. Sustainability of efforts is critical. Unless the systems are maintained in good condition, all efforts are futile. To summarize, we must take an integrated approach to create a Culture of Disaster Preparedness and Prevention, in which people at risk receive, understand, and act upon the warning information conveyed. We realize that though the unexpected can happen at any time and we cannot control the unexpected, we can control how we plan and respond. If sufficient number of management layers are superimposed, it can be assured that disaster is not left to chance. doi:10.1017/S1049023X12001616