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Background: CCL2 is a chemoattractant for monocytes/macrophages, T cells, and natural killer cells. It is shown to be involved in the immunological responses against renal allograft. This study was conducted to access the role of urinary CCL2 expression in predicting the rejection episodes in renal transplant patients. Method: A total of 409 urine samples included in this study. The samples were consisted of (a) biopsy-proven graft rejection (n= 165); (b) non-rejection (n= 93); (c) non-biopsy stable-graft (n= 42), and (d) healthy renal donors (n= 109). The samples were quantified for the CCL2 using the MCP-1/CCL2 ELISA kit. The data were analyzed using the Statistical Package for Social Sciences (SPSS®) and MedCalc®statistical software. Results: Results showed that the CCL2 levels were significantly increased in rejection group when compared with the non-rejection, stable-graft, and control,P< 0.05. The receiver operating curve’s characteristics illustrated that the urinary CCL2 level is a good predictor for graft rejection, with an area under the curve of 0.81 ± 0.03 with optimum sensitivity and specificity of 87% and 62%, respectively, at a cut-off value of 198 pg/mL. Kaplan–Meier curve also showed better cumulative rejection-free graft survival time in group with less than 198 pg/mL of CCL2 as compared to those with expression levels of more than 198 pg/mL (30 weeks vs. 3 weeks; log-rank test,P< 0.001). Conclusion: In our study, noninvasive investigation of CCL2 levels in urine has showed potential to predict rejection episodes. It is suggested that the CCL2, with others markers, may help in early detection and monitoring of graft rejection episodes. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate the impact of haemodialysis on plasma carnitine levels., Methods: The cross-sectional study was conducted from April 20, 2020 to May 10, 2022, at the dialysis unit of the nephrology ward of Jinnah Postgraduate Medical Centre, Karachi, and the Pakistan Navy Ship Shifa Hospital, Karachi, in collaboration with the Department of Biochemistry, University of Karachi, and comprised patients of either gender aged >18 years. They were divided into chronic kidney disease group A and end-stage renal disease group B. Control group C included subjects from the general population. Free carnitine and total carnitine values were detected using enzyme-linked immunosorbent assay. Acyl carnitine was estimated by applying the standard formula, and the ratio between acyl carnitine and free carnitine was calculated for accurate assessment of the carnitine status. Data was analysed using SPSS 23., Results: Of the 203 subjects, 143(70.44%) were cases and 60(29.55%) were controls. Among the cases, 120(84%) were recruited from Jinnah Postgraduate Medical Centre and 23(16%) from Pakistan Navy Ship Shifa Hospital. There were 60(29.55%) patients in group A, 83(40.88%) in group B and 60(29.55%) in group C. The mean age in group A was 47.90 5.±65 years, it was 44.10 ±8.92 years in group B and 40.90 ± 6.73 years in group C. There was a significant difference related to free carnitine, total carnitine, acyl carnitine values and the ratio between acyl carnitine and free carnitine values in groups A and B compared to control group C (p<0.05)., Conclusion: Patients on maintenance haemodialysis developed were found to have developed carnitine deficiency.

Spinal cord injury without any radiographic abnormality (SCIWORA) is rare in adults. We describe here two case reports of adult patients, who presented to us with quadriplegia, following a road traffic accident. Plain radiography and computed tomography (CT) of cervical spine were normal. Hence the patients were diagnosed as cases of adult SCIWORA. However, subsequent magnetic resonance imaging (MRI) of the two patients revealed cervical cord injury in the form of cord contusion and disc protrusion, respectively. Patient with cord contusion was managed medically, whereas the patient with disc lesion was treated with discectomy. Patient treated with discectomy showed marked improvement. Therefore, patients having no osseous injury on X ray and CT scan should have an MRI study done to look for surgically correctable pathology. As in such rare patients of SCIOWRA an early diagnosis and timely intervention is crucial; with MRI playing a pivotal role.

Spontaneous regression (SR) of hepatocellular carcinoma (HCC) is a rare event. Several factors have been suggested as the underlying mechanism but the exact pathogenesis is not understood. The role of sofosbuvir in HCC regression has not been established yet. We report here a case of a 59 years old male who developed HCC secondary to chronic HCV infection. He failed treatment with interferon but the tumour regressed completely after treatment of hepatitis C with sofosbuvir and ribavirin for 48 weeks.

Background: Malnutrition is a serious child health issue throughout the developing world. Pakistan has the second highest infant and child mortality rate in South Asia. This study was carried out to assess the nutritional status of children under 5 years of age and to determine the frequency and association of malnutrition with various demographic variables in the study group., Methods: A multi-centre, cross sectional study was conducted at the immunization centres of the 3 allied hospitals of Rawalpindi Medical College during March-May 2014. Healthy children of under 5 years of age without confirmed diagnosis of any disease/ailment were included. Guardians of 100 children were interviewed using a structured questionnaire. Demographic variables include age, gender, family size, family income, breastfeeding, maternal education, presence of a family member with special needs and presence of siblings under 5 years in family. Weight (kg) was measured and malnutrition was assessed by weight for age., Results: Malnutrition was found to be present in 32% of children. Adequately nourished children were 68%, while moderately and severely malnourished children were 14% and 18% respectively. Our study indicated malnutrition to be significantly associated with maternal illiteracy (p = 0.01) and presence of a family member with special needs (p = 0.05). No significant association was found between malnutrition and gender, family size, family income, breast feeding and presence of siblings under 5 years of age., Conclusion: There is a need to plan composite interventions to elucidate the factors that place children at greater risk for malnutrition.