Background: L-arginine is the precursor for nitric oxide (NO) synthesis in vascular cells. The sources of L-arginine are endogenous and exogenous. Although macrophages and endothelial cells can generate L-arginine, most synthesis takes place in the liver and kidney. Level of L-arginine as of other amino acids is affected in malnourished patients; NO regulates platelet activation by inhibiting adhesion and aggregation. Objectives: The aim of the study is to evaluate the level of L-arginine in patients of end-stage kidney disease (ESKD) under regular hemodialysis and to determine its relation to platelet aggregation as a risk factor for vascular thrombosis which is a very important complication that affects the life span of those patients. In addition, we also tried to establish the relationship between L-arginine, platelet aggregation, and nutritional state of patients with ESKD. Subjects and Methods: Our study was "a case-control study", comparing data between 30 patients with ESKD under treatment with regular hemodialysis-group (A); group A1 (16)-patients with ESKD on regular hemodialysis with malnutrition, group A2 (14)-patients with ESKD on regular hemodialysis with normal nutrition state, and group B 10 subjects as healthy control group, each patient was evaluated for serum arginine level by high-performance liquid chromatography, and platelet aggregation, as well as other routine investigations. A thorough clinical history and examination were performed for all the patients. Results: Our study shows significant higher level of platelet aggregation to ADP in group A than group B (119±11.9% and 81.1±6.5% respectively, P < 0.05), a lower level of serum arginine in group A (71±45.3 μg/L) than in group B (120.5±14.6 μg/L) with P< 0.05. Also our study shows a lower level of serum arginine in group A1 (60.5±12.3 μg/L) than group A2 (83±27 μg/L) and a lower level in group A2 than group B (120.5±14.6 μg//l), and we found a negative correlation between serum arginine level and platelet aggregation expressing a more risk for thrombosis in patients with ESKD specially those with malnutrition. Conclusions: We concluded that patients with ESKD has a low level of L-arginine specially in those with malnutrition and this leads to increase in platelet aggregation and may increase the possibility of thrombus formation in malnourished patients with ESKD. We suggest the use of nutritional supplementation of L-arginine to suppress this process of atherothrombosis.

Background: The World Health Organization (WHO) describes Diabetes Mellitus (DM) as the most common endocrine disease in the world. The most common complication of DM is diabetic retinopathy. Diabetic retinopathy is increasingly becoming a major cause of blindness throughout the world in the age group of 20-60 years. Objectives: This study was conducted to assess the prevalence of diabetic retinopathy and its associated risk factors among diabetic patients attending Pravara Rural Hospital, Loni, Maharashtra. Materials and Methods: A cross-sectional study was carried out in the Department of Ophthalmology of Pravara Rural Hospital, Loni, Maharashtra from 1 ^st October 2011 to 31 ^st December 2011. A total of 88 diabetic patients who attended the Department of Ophthalmology of Pravara Rural Hospital, Loni during the study period were included and underwent pupil dilatation for fundus examination to screen retinopathy; after screening, it was classified according to the stages of diabetic retinopathy and associated history of hypertension, addictions and presence of family history was also noted. Data was analyzed by using Statistical Package of Social Sciences (SPSS) 16.0. Results: In the present study, the prevalence of diabetic retinopathy was 39 (44.4%). Of the 39 patients who had signs of diabetic retinopathy, 25 (64.10%) were males and 14 (35.89%) were females. Non-proliferative diabetic retinopathy was documented in 71.79%, while 5.12% had proliferative diabetic retinopathy. Conclusion: This study demonstrated that prevalence was 44.4% and poor control of diabetic retinopathy. This suggests the need for adequate prevention and treatment in patients with diabetes.

Purpose: This study was conducted to assess the knowledge of Revised National Tuberculosis Control Programme ( RNTCP) and attitude to tuberculosis (TB) among medical students and interns. Materials and Methods: This cross-sectional survey was carried out in a private medical college among 200 medical students. The students were asked to complete a written questionnaire. The answers were statistically analyzed using Statistical Package for the Social Sciences (SPSS) software program, IBM. In addition, item analysis was carried out for each question, wherever applicable. Results: Our analysis revealed that all students were aware of TB. They were also aware of RNTCP. In addition to the didactic lectures, students had gained information from different sources such as textbooks (168), case discussion (155), seminar (95), journals (75), and WHO publications (22). The average number of students with correct response was 122 (59.63%). Among the various categories of TB, the correct responses were highest for questions relating to diagnosis (146.25; 73.12%), followed by epidemiology (114; 62.16%), management (130.33; 61.75%), and risk perception (75.33; 28.5%). About 90% students feared the risk of transmission by inhalation from a TB patient with cough. Majority of the students were aware that all smear-positive patients should be isolated and treated. Item analysis of the multiple choice questions (MCQs) showed the areas that required more emphasis. Conclusions: Overall performance of III/I students was better than the rest of the study group. Students performed better in the epidemiology domain compared with the management and preventive aspects of TB. To ensure the successful control of TB and implementation of RNTCP, medical students need to be sensitized by conducting continuous medical education and orientation courses on RNTCP at regular intervals.

Background and Objectives: The emergence of methicillin-resistant Staphylococcus aureus (MRSA) has led to the use of Macrolide-Lincosamide-Streptogramin B (MLS _B ) antibiotics to treat MRSA infections. Clinical failures can result if resistance to these drugs is inadequately tested. This study was carried out to detect MLS _B phenotypes and inducible clindamycin resistance among Staphylococcus aureus (S. aureus). Materials and Methods: A total of 250 non-duplicate S. aureus isolates were subjected to D-test by placing an erythromycin (15 μg) disc at a distance of 15mm from a clindamycin (2 μg) disc. Results were interpreted using Clinical and Laboratory Standards Institute (CLSI) guidelines. Methicillin resistance was detected by the oxacillin agar dilution method. Results were analyzed using the Chi-square test. Results: Among 250 isolates of S. aureus, 84 (33.6%) were MRSA and 166 (66.4%) were methicillin-susceptible Staphylococcus aureus (MSSA). Thirty one (36.9%) MRSA and 75 (45.2%) MSSA were sensitive to both erythromycin and clindamycin. Macrolide and Streptogramin B (MS _B ) phenotype were observed in 20 (23.8%) of MRSA and 64 (38.6%) of MSSA isolates. Constitutive MLS _B resistance and inducible MLS _B resistance were observed in 22 (26.2%) and 11 (13.1%) of MRSA, and 17 (10.2%) and 10 (6%) of MSSA isolates, respectively. Conclusion : D-test should be included as a part of routine antibiotic susceptibility testing to detect inducible clindamycin resistance to prevent treatment failure.

Malignancies are sometimes associated with the development of proteinuria and the nephrotic syndrome. A 59-year-old Caucasian male university professor was referred for evaluation of renal insufficiency to the nephrologist three months after unilateral radical nephrectomy for clear cell renal carcinoma. Post nephrectomy, he was found to have significant proteinuria with a 24-hour urine collection revealing 1.38 g of glomerular protein. Histological sections of the noncancerous areas of the resected kidney were then examined which revealed focal segmental glomerulosclerosis. The patient was given angiotensin-converting enzyme inhibitor therapy. Six years later, the 24-hour urine protein excretion was 0.32 g and there has been no recurrence of his renal carcinoma. Patients undergoing nephrectomy for renal carcinoma should have routine urinalysis and a 24-hour urine collection ordered if protein is detected. Noncancerous portions of renal tissue can be reviewed at tumor resection or nephrectomy, so that biopsy of the remaining kidney is not necessary.

Colonic lipomas are uncommon neoplasms. These tumors rarely produce symptoms. However, we encountered a middle-aged man presenting with features of acute intestinal obstruction. On laparotomy, a hard, irregular mass was identified at splenic flexure. Histological evaluation proved the mass to be a submucosal lipoma. We are presenting this case along with relevant discussions to underscore the fact that colonic lipomas can present as acute abdomen.

Hemichorea-hemiballismus (HC-HB) is a rare, but dramatic complication of nonketotic hyperglycemia specially in elderly Asian females. We report a case of HC-HB syndrome with emotional lability in a poorly-controlled diabetic female. MRI brain showed T1 and FLAIR hyperintensities in the right caudate and hippocampus.

Acute Necrotizing Pancreatitis is not uncommon but pancreatic encephalopathy, which is a complication and a very rare as sparse are the published reports, linking the risk of continuous ambulatory peritoneal dialysis (CAPD) to acute necrotizing pancreatitis, especially in India. We report a rare case of pancreatic encephalopathy in a patient who was on long-term CAPD for end stage renal disease (ESRD) and developed acute necrotizing pancreatitis. This case suggests that the risk of acute necrotizing pancreatitis increases in patients on long-term peritoneal dialysis. It is also been seen in other studies, that the risk of acute necrotizing pancreatitis is significantly high in patients undergoing CAPD, when compared with the general population.