Effect of hemodialysis on circulating cystatin c levels in patients with end stage renal disease

Plasma cystatin C is an emerging parameter to assess kidney function. Its utility in assessing the adequacy of hemodialysis in patients with end-stage-renal disease has however not been established with certainty. This study was therefore carried out to assess the usefulness of serum cystatin C estimation in patients undergoing low flux membrane hemodialysis. Serum creatinine and cystatin C were estimated in 20 patients before and after undergoing hemodialysis. The mean serum creatinine decreased from a pre-dialysis value of 7.72 mg/dL to a post-dialysis value of 2.90 mg/dL. On the contrary, the mean serum cystatin C levels were found to increase from a pre-dialysis value of 5.97 mg/L to a post-dialysis value of 8.25 mg/L. Therefore, serum cystatin C cannot be used to monitor dialysis adequacy. It however, serves as a surrogate marker of the inadequacy of low flux membrane bicarbonate hemodialysis in clearing low molecular weight proteins from the circulation.     

Serum Cystatin C Levels in Renal Transplant Recipients

Cystatin C is an emerging parameter for the assessment of renal allograft function. The objective of the study was to compare the efficacy of serum cystatin C (SCys) with the established parameter serum creatinine (SCr) in the assessment of renal function in renal transplant recipients (RTR). The glomerular filtration rate (GFR) of 30 renal transplant patients and 29 control subjects was determined using ^99mTc Diethylene-triamine-penta-acetate (DTPA) method. SCr was measured using an automated Jaffe’s assay and SCys was measured using latex particle enhanced turbidimetric immuno assay (PETIA). The modification of diet in renal disease (MDRD) formula was used to calculate GFR from SCr, while the Le Bricon formula was used to derive GFR based on SCys. Statistical analysis was performed using MedCalc software. SCr and SCys levels were significantly higher, while DTPA clearance was significantly lower in RTR (P < 0.0001) when compared with controls. The correlation coefficient (r value) between calculated GFR based on MDRD method and DTPA clearance was 0.343 (P = 0.06) while the calculated GFR based on Le Bricon formula was 0.694 (P < 0.001). The results have shown that SCys is a better parameter than SCr in assessing renal function in RTR. The inclusion of SCys as an additional parameter would certainly help in detection of even a marginal decline in renal function and also in adjusting the dosage of immunosuppressive drugs.     

Measuring transactional distance in web-based learning environments: an initial instrument development

This study was an initial attempt to operationalise Moore’s transactional distance theory by developing and validating an instrument measuring the related constructs: dialogue, structure, learner autonomy and transactional distance. Data were collected from 227 online students and analysed through an exploratory factor analysis. Results suggest that the instrument, in general, shows promise as a valid and reliable measure of the constructs related to transactional distance theory. Potential refinement of the instrument and future research directions are included at the end of the article.     

The impact of science content and professional learning communities on science teaching efficacy and standards‐based instruction

This study examines the impact of standards‐based professional development on teacher efficacy and instructional practice of elementary and middle school science teachers. Professional development activities were conducted over a period of 3 years and included content courses as well as teacher involvement in professional learning communities. Teacher efficacy was assessed at five time points using the Science Teacher Efficacy Beliefs Instrument (STEBI), and instructional practice was evaluated at four time points with classroom observations using the Reformed Teaching Observation Protocol (RTOP). Results indicate that there was significant growth in teacher self‐efficacy but not in outcome expectancy. There was also significant growth in the extent to which teachers implemented inquiry‐based instruction in the classroom. Additionally, a positive correlation was observed between changes in self‐efficacy and changes in the use of inquiry‐based instructional practice. These results are discussed in terms of a model of teacher learning wherein changes in teacher beliefs and changes in classroom practice mutually influence each other, and also in terms of the impact of collaboration on teacher efficacy and practice. © 2010 Wiley Periodicals, Inc., Inc. J Res Sci Teach 48: 534–551, 2011     

Schools and communities: An experience in rural India

When India became independent, primary education in the state of Rajasthan was made the responsibility of the Panchayats (Village Councils), and a number of village schools were opened. However they only drew around 40 per cent of the 6–11 age group, and the curricula, text books, and even the teachers themselves, recruited from the cities, were out of touch with the needs of the rural communities. A study conducted in 1974 showed that, to improve the situation, it would be necessary to make the school more relevant to village life, to involve the parents in planning, and to run it at times when the children could be spared from domestic or farm work; to select the teachers from village residents; and to adapt the curricula and teaching methods to the environment. An appropriate programme was worked out and introduced in three villages in 1975. It provided for morning classes for the regular pupils and evening school for children who worked during the day. The emphasis in the curricula was to be on agriculture and animal husbandry, and teaching methods were to be closely in keeping with the life of the village. Suitable local people were found and trained as teachers. The author describes the implementation of this programme in detail. It proved a success and has now been extended to ten villages with a total attendance at the schools of more than five hundred children.

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Zusammenfassung Als Indien unabhängig wurde, übertrug man im Staat Rajasthan die Grundschulbildung der Verantwortung den Panchayats (Dorf-Räten) und eine Reihe von Dorfschulen wurde eröffnet. Aber diese erfaßten nur etwa 40% der Altersgruppe von 6–11 Jahren, und die Lehrpläne, die Textbücher, ja sogar die aus den Städten rekrutierten Lehrer selbst hatten keinerlei Berührung mit den Bedürfnissen der ländlichen Gemeinwesen. Aus einer 1974 durchgeführten Untersuchung ergab sich, daß es zur Verbesserung der Lage notwendig sein würde, der Schule mehr Bedeutung für das dörfliche Leben zu verleihen; die Eltern in die Planung einzubeziehen; zu den Zeiten Schule zu halten, da die Kinder bei der häuslichen und bäuerlichen Arbeit entbehrt werden konnten; die Lehrer unter den Dorfbewohnern auszuwählen, sowie Lehrpläne und Unterrichtsmethoden der Umwelt anzupassen. Nach Ausarbeitung eines geeigneten Programms wurde dieses 1975 in drei Dörfern eingeführt. Den regulären Schülern bot es Vormittagsunterricht und den tagsüber arbeitenden Kindern eine Abendschule. In den Curricula sollte das Hauptgewicht auf Landwirtschaft und Viehzucht liegen, und die Unterrichtsmethoden sollten genau auf das Leben des Dorfes abgestimmt werden. Geeignete Einheimische wurden gefunden und zu Lehrern ausgebildet. Der Verfasser beschreibt im einzelnen die Einführung dieses Programms. Es erwies sich als wirksam und wurde nun auf zehn Dörfer übertragen, so daß jetzt ingesamt mehr als fünfhundert Kinder die Schulen besuchen.

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Résumé Lorsque l'Inde est devenue indépendante, l'enseignement primaire, dans l'état de Rajasthan, a été placé sous la responsabilité des Panchayats (Conseils de village), et un grand nombre d'écoles ont été ouvertes dans les villages. Toutefois, elles ne furent fréquentées que par 40% environ des enfants appartenant au groupe d'âge de 6 à 11 ans, car les curricula, les manuels scolaires et même les enseignants qui étaient recrutés dans les villes, ne tenaient pas compte des besoins des communautés rurales. Une enquête menée en 1974 a montré que pour améliorer la situation il faudrait que l'école ait davantage de rapports avec la vie du village, qu'elle fasse participer les parents à la planification et que les classes fonctionnent quand les parents peuvent se passer de l'aide des enfants pour les travaux domestiques ou ceux de la ferme. L'enquête a révélé également qu'il fallait choisir les enseignants parmi les habitants du village; enfin que les curricula et les méthodes d'enseignement soient adaptés à l'environnement. Un programme approprié a alors été élaboré et appliqué expérimentalement dans trois villages en 1975. Ce programme assurait des classes matinales pour les élèves réguliers et des classes vespérales pour les enfants travaillant dans la journée. L'accent des curricula était mis sur l'agriculture et l'élevage, et les méthodes d'enseignement étaient en harmonie avec la vie du village. Des gens du cru, répondant à certains critères, étaient formés pour devenir des enseignants. L'auteur décrit en détail la mise en application de ce programme qui s'est révélé un succès. Il est maintenant étendu à dix villages et plus de cinq cents enfants fréquentent l'école.

     

Status of Vitamin D Receptor Gene Polymorphism and 25-Hydroxy Vitamin D Deficiency with Essential Hypertension

Essential hypertension (EH) is a multifactorial and complex disease with high rate of incidence and associated co-morbidities. Previous studies do not provide unanimous results for the risk of hypertension and association with Fok I genotype frequency and serum vitamin D levels. Hence, this study was undertaken to determine the status of Fok I vitamin D receptor (VDR) gene polymorphism along with vitamin D levels and blood pressure in patients with EH. Four hundred (200 controls and 200 cases of essential hypertension) participants from general Indian population were enrolled in this study. Peripheral blood samples were collected for genotyping Fok I-VDR gene polymorphism using PCR–RFLP method whereas 25-OH vitamin D levels in serum were quantified using high performance liquid chromatography (HPLC). Significantly reduced 25-OH vitamin D levels were observed in patients with EH (24.04 ± 8.62 vs 50.46 ± 15.46) compared to control subjects (p = 0.0001). Homozygous recessive genotype ‘ff’ frequency was increased by 8.06 fold (CI: 3.71–17.47, p = 0.0001) in patients with EH compared to dominant ‘FF’ genotype frequency. In conclusion, recessive ‘ff’ genotype frequency correlates with reduced serum vitamin D levels and results in significantly increased systolic and diastolic blood pressures leading to predisposition of EH.     

Association between plasma homocysteine and riboflavin status in Acute Lymphoblastic Leukemia in children

Remethylation of homocysteine to methionine is dependent on an adequate supply of one or more of the B vitamins like folate, vitamin B₁₂ and vitamin B₆. Plasma total homocysteine (tHcy) is also influenced by genetic factors such as polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene. MTHFR is a flavo enzyme and a key player in folate metabolism and changes in its activity could modify the susceptibility to Acute Lymphoblastic Leukemia (ALL). In this case — control study we have examined the effect of riboflavin status as measured by erythrocyte glutathione reductase activation coefficient (EGRAC) on homocysteine levels along with vitamin B₁₂ and folate in pediatric ALL. Folate and B₁₂ levels were significantly lower among cases as compared to controls while EGRAC and tHcy did not differ significantly among the groups. The multivariate regression analysis revealed that in the ALL group EGRAC significantly influences tHcy levels suggesting that riboflavin availability may be a predictor of tHcy levels in patients with ALL. This finding may have implications for tHcy lowering therapy.     

Analysis of Bcl I and Xba I polymorphism in factor VIII gene to detect carriers of haemophilia a in Andhra Pradesh

The efficacy of two intragenic polymorphic markers of factor VIII gene has been examined in Andhra Pradesh population with a view to confirm/revise the strategy for carrier detection that would be precise and economical. The haemophilia A carrier was detected using Bcl I and Xba I polymorphic sites in intron 18 and 22 respectively. The cumulative efficiency of these two sites for detection of carriers is 100% since all 15 families tested were informative for one of these polymorphisms, thus confirming their usefulness for factor VIII gene mutations found in Andhra Pradesh.