尿红细胞计数和形态在血尿鉴别诊断中的应用

尿液红细胞检测是诊断泌尿系统疾病,特别是肾脏疾病的重要实验指标之一.尿液有形成分的显微镜检查一直被肾内科医生认为是一种无创伤的"肾活检",尤其对尿液中红细胞的检测,能直接观察红细胞各种形态和数量.用观察血尿中红细胞形态及计数的方法来判断肾性血尿和非肾性血尿,对各种泌尿系统疾病的诊断和治疗具有十分重要的意义.     

《中国图书馆分类法》第四版“中国医学”类目设置质疑

从"食养、食疗"、"方剂学"、"气功"等类目设置和中西医结合类图书分类两方面详细列举了<中图法>"中国医学(R2)"类目设置重复交叉及仿分中出现的问题,并提出了具体的修订措施.     

杨霓芝论治慢性肾脏病特色

杨霓芝教授从事内科医疗、教学和科研工作近30年,临床经验丰富,对内科疾病尤在肾内科疾病的诊治方面造诣颇深.坚持以中医药防治肾内科疑难病,主张以益气活血法治疗慢性肾小球肾炎,益气温阳法治疗难治性肾病综合征,益气活血泻浊毒的中医综合疗法延缓慢性肾衰,中西医结合手段抢救肾内科急危重症;开展了中药全结肠透析、中药皮肤透析、中药血液透析、中药沐足等肾科特殊治疗技术.     

第四届全国心肾血管疾病临床进展研讨会通知

2009年7月10日至12日由中国医师协会心血管医师分会及中国老年学会心脑血管专业委员会主办、解放军总医院承办的国家级医学继续教育项目——“第四届全国心肾疾病临床与研究进展研讨会”将在首都北京举行。会议将特别邀请胡大一教授、陈香美院士等一大批国内心内科、肾内科著名临床专家进行有关专题学术报告、现场讨论和答疑，并组织进行相关心肾疾病的临床病例讨论，     

《中图法》R2中国医学类目问题概述

<中国图书馆分类法>第4版(简称<中图法>)自面世以来,受到了图书馆界同仁的极大关注.笔者对"R2中国医学"的类目设置中的存在一些问题总结归纳如下. 1 类目设置问题 1.1 设置不尽合理 <中图法>R大类,是按基础、临床、药学等顺序来设置的."R2中国医学"大体上也是按基础、临床、药学这一顺序来列类的.但是在"R28中药学"和"R29中国少数民族医学"的列类上,中国少数民族医学为中国医学的一部分,是中国少数民族所特有的医学,所以按照"R79外国民族医学"放在"R9药学"之前的列类顺序,把"R29中国少数民族医学"放在"R28中药学"之前为好,其类号应改为R28中国少数民族医学","R29中药学[1].     

肾实质性疾病患者血浆内皮素含量的临床观察

肾实质性疾病患者血浆内皮素含量的临床观察丁梅李忠实（第二临床学院肾内科，沈阳１１０００３）关键词血浆内皮素；肾实质性疾病；尿毒症内皮素是迄今所知人体内最强的缩血管物质［１］，是近几年日益受到人们重视的一种生物活性多肽。目前国外许多文献报道了内皮素与肾...     

肾组织磷脂酶A2受体和血清抗磷脂酶A2受体抗体在膜性肾病中的诊断价值

目的：检测特发性膜性肾病(idiopathic membranous nephropathy,IMN)、继发性膜性肾病(secondary membranous nephropathy,SMN)患者肾组织中磷脂酶A2受体(phospholipase A2 receptor,PLA2R)的表达及血清抗PLA2R 抗体滴度,分析其在诊断IMN中的价值。方法：2014年5月至2015年2月中南大学湘雅二医院肾内科肾活检患者73例, 分为IMN组(n=48)、SMN组(n=17)和微小病变性肾病组(n=8)。采用间接免疫荧光法检测各组肾组织PLA2R及血清抗 PLA2R抗体的表达。结果：IMN组肾组织PLA2R阳性率为91.7%,SMN组阳性率为29.4%,IMN组阳性率、荧光强度明 显高于SMN组(均P<0.05);IMN组血清PLA2R抗体阳性率为85.4%,SMN组阳性率为29.4%,IMN组抗体阳性率及滴度 明显高于SMN组(均P<0.05);微小病变性肾病组肾组织PLA2R抗原及血清抗体均呈阴性。IMN组血清PLA2R抗体滴度 与24 h尿蛋白呈正相关(r=0.432,P<0.01),与血清白蛋白呈负相关(r=–0.307,P<0.05)。结论：检测肾组织PLA2R和血 清PLA2R抗体的表达有助于IMN的诊断及鉴别诊断,监测血清PLA2R抗体滴度有助于评估疾病活跃程度和治疗效果。     

多器官功能障碍综合征ICD-10编码解析

多器官功能障碍综合征（MODS）在全国各地医院疾病分类中没有一个明确的、合理的编码。ICD-10有全身炎症反应综合征（SIRS）是根据病因和是否伴有器官功能衰竭分类,而没有文字上的对MODS分类,但实质上MODS符合类目R65（SIRS）中对器官功能衰竭的描述。类目R65中infectious origin的中文翻译为传染性病因是不恰当的,应翻译为感染性病因。临床诊断多器官功能衰竭与MODS不是一个疾病,不要混淆。为了规范疾病编码,达到全国疾病分类代码统一[1],应给予MODS一个正确的、较为合理的编码,以解决此疾病编码混乱和错误的问题。     

法医学文献归类问题分析探讨

1 归类存在问题的分析 近几年法医学发展迅速,有关文献也呈上升趋势.但<中国图书馆分类法>(以下简称<中图法>)第4版仍然将法医学文献归入D919或DF795,只在医学类目列出一个交替类目"[R89]法医学宜入D919或DF795".而D919和DF795都下设6个完全相同的子类目:法医学基础科学、法医物证检验学、司法精神医学、法医鉴定学、妇婴法医学、法医人类学[1].对于设有法医学专业的医学院校或法医学院图书馆来说,这样的类目设置就显得过于粗略和简单.<中图法>未对一些需要细分的大类进行细分,只在类目注释中说明它的内容范围,例如:"D919.1法医基础科学 "注释:" 法医物理学、法医化学、法医毒物学、法医病理学、法医放射线学等入此."其类目包括的范围过大,给法医专业的读者检索与利用带来困难.     

肾复康系列胶囊治疗肾小球肾炎的临床观察

原发性肾小球肾炎(下称肾炎)是肾内科疾病中一组常见而又难治的疾病,为了探索其治疗效果,自1997年5月至2000年6月,笔者应用河南同济肾病研究中心提供的肾复康系列中药,进行前瞻性临床治疗观察,取得了较为满意的疗效,现将结果报告如下.     

Histopathological and immune alterations in autopsied kidneys

Objectives:

To collect data on all detectable histologic and immune alterations from the kidneys of 55 autopsy cases.

Methods:

This prospective study was carried out at the Department of Pathology, Medical Faculty, Trakya University, Edirne, Turkey. Fifty-five cases were subjected to the study among 248 autopsies that were performed in 2011 and 2012. All kidney samples were evaluated under a light microscope and fresh tissue samples were used for immunofluorescence microscopy. Immunohistochemically kappa (κ) and lambda (λ) antibodies were applied to the tissue sections. The glomerular, tubulo-interstitial, and vascular alterations, as well as immune depositions were noted.

Results:

The microscopic morphology was close to normal histology in only 23 cases, and 23 cases had glomerular alterations. Nineteen cases had at least one immune deposition. There was immunoglobulin A deposition in 13 cases, and 9 cases showed positivity for both κ and λ immunohistochemically, and there was no clonal positivity.

Conclusion:

The most striking outcome of our study is the high rate of immune depositions. There was also a significant number of glomerular and non-glomerular renal alterations.End stage kidney disease (ESKD) is one of the leading health problems worldwide with high morbidity, and mortality rates.1,2 Biopsy proven data shows that glomerulonephritis (GN) is the most important cause of chronic renal insufficiency, in which primary GN comprises the biggest proportion, especially in Western and Eastern Europe.3,4 Vascular diseases (VDs) and tubulointerstitial diseases (TIDs) seem to be less frequent diseases leading to chronic renal insufficiency. However, biopsy policies and biopsy indications are changing from country to country, and in daily practice kidneys prone to VDs and TIDs are rarely biopsied in most regions. Regarding the daily clinical practice, although they are not proven by biopsies, VDs, and TIDs seem to be the leading cause of chronic renal insufficiency worldwide, where the former is a more important reason when compared with the latter. Among acute lesions developing renal insufficiency, tubular injury takes place after crescentic GN and necrotizing vasculitis.4,5 Incidence and prevalence studies of chronic renal diseases are mostly based on native renal biopsies, which usually depends on single center studies along with a retrospective review of the diagnostic criteria obtained from the files of patient registries.6-12 There are rarely regional multicenter or national studies, in which the diagnostic data are obtained from the national registry system for renal biopsies.1-5,13,14 These types of studies are of importance as they investigate the incidence of the categorized renal diseases to determine the leading causes of ESKD. However, it should be kept in mind that they are providing data only from a symptomatic population. Population based studies are needed to obtain the real incidence of renal lesions in an asymptomatic population. Although there are some retrospective studies on kidneys of patients that underwent nephrectomy due to kidney masses,15 it is not assumable that the data of those studies can reflect the real incidence of alterations in otherwise normal kidneys of the population. Thus, autopsy studies play an important role in achieving the closest information towards this target. There are a few autopsy studies related to renal diseases in the literature. Two of those studies16,17 aimed to investigate GN due to hepatitis C virus infection retrospectively in autopsy cases with prior known hepatitis C virus infection, thus, they did not provide any data regarding other possible causes of kidney diseases related to primary or secondary GN, VDs, or TIDs. The Hisayama study18 was a large retrospective autopsy study with 839 subjects, and the risk factors for glomerular sclerosis and vascular changes were sought without assistance of immunofluorescence or immunohistochemistry and lacked detailed data for possible reasons of glomerular sclerosis, except for the reasons of glomerular sclerosis based on vascular disorders of the kidneys. In a prospective autopsy kidney study,19 which was conducted on a West African urban community, the authors investigated the glomerular numbers and volumes, as well as renal pathology in 81 subjects. In this study,19 the histopathological changes were assessed with histochemical methods without guidance of immunofluorescence microscopy. In Turkey, there is very limited information regarding the epidemiology of kidney diseases, and it is mainly based on a few single center studies, concerned with retrospective evaluation of the data obtained from previous renal biopsies.20-22 Very recently a national registry system was created in Turkey for medical kidney biopsies, but we still need time to receive the first reliable data from this system. In the present study, we aimed to collect data obtained from the kidneys of 55 autopsy cases, regarding all detectable histologic and immune alterations. Likewise, we aimed to provide a regional data regarding kidney lesions in an asymptomatic population.     

INITIAL EXPERIENCE WITH SHOCK WAVE LITHOTRIPSY AT ARMY HOSPITAL (R & R) DELHI CANTT

Army Hospital (R & R) has acquired an Electrohydraulic Lithotripter (DIREX NOVA), the first of its kind in the Armed Forces for the treatment of stone diseases. The first 200 patients who underwent Extracorporeal Shock Wave Lithotripsy (ESWL) have been analysed in this study. This being a pilot study would serve as a beginning of an ongoing experience with this non-invasive procedure and its benefits for the stone population in the Armed Forces.KEY WORDS: ESWL, Lithotripsy     

Pro-angiogenic Activity of Notoginsenoside R1 in Human Umbilical Vein Endothelial Cells in vitro and in a Chemical-Induced Blood Vessel Loss Model of Zebrafish in vivo

Objective: This study aimed at investigating whether notoginsenoside R1(R1), a unique saponin found in Panax notoginseng could promote angiogenic activity on human umbilical vein endothelial cells(HUVECs) and elucidate their potential molecular mechanisms. In addition, vascular restorative activities of R1 was assessed in a chemically-induced blood vessel loss model in zebrafish. Methods: The in vitro angiogenic effect of R1 was compared with other previously reported angiogenic saponins Rg1 and Re. The HUVECs proliferation in the presence of R1 was determined by cell proliferation kit Ⅱ(XTT) assay. R1, Rg1 and Re-induced HUVECs invasion across polycarbonate membrane was stained with Hoechst-33342 and quantified microscopically. Tube formation assay using matrigelcoated wells was performed to evaluate the pro-angiogenic actions of R1. In order to understand the mechanism underlying the pro-angiogenic effect, various pathway inhibitors such as SU5416, wortmannin(wort) or L-Nω-nitroL-arginine methyl ester hydrochloride(L-NAME), SH-6 were used to probe the possible involvement of signaling pathway in the R1 mediated HUVECs proliferation. In in vivo assays, zebrafish embryos at 21 hpf were pre-treated with vascular endothelial growth factor(VEGF) receptor kinase inhibitor Ⅱ(VRI) for 3 h only and subsequently post-treated with R1 for 48 h, respectively. The intersegmental vessels(ISVs) in zebrafish were assessed for the restorative effect of R1 on defective blood vessels. Results: R1 could stimulate the proliferation of HUVECs. In the chemoinvasion assay, R1 significantly increased the number of cross-membrane HUVECs. In addition, R1 markedly enhanced the tube formation ability of HUVECs. The proliferative effects of these saponins on HUVECs were effectively blocked by the addition of SU5416(a VEGF-KDR/Flk-1 inhibitor). Similarly, pre-treatment with wort [a phosphatidylinositol 3-kinase(PI3K)-kinase inhibitor], L-NAME [an endothelial nitric oxide synthase(eN OS) inhibitor] or SH-6(an Akt pathway inhibitor) significantly abrogated the R1 induced proliferation of HUVECs. In chemicallyinduced blood vessel loss model in zebrafish, R1 significantly rescue the damaged ISVs. Conclusion: R1, similar to Rg1 and Re, had been showed pro-angiogenic action, possibly via the activation of the VEGF-KDR/Flk-1 and PI3KAkt-eN OS signaling pathways. Our findings also shed light on intriguing pro-angiogenic effect of R1 under deficient angiogenesis condition in a pharmacologic-induced blood vessels loss model in zebrafish. The present study in vivo and in vitro provided scientific evidence to explain the ethnomedical use of Panax notoginseng in the treatmentof cardiovascular diseases, traumatic injuries and wound healing.     

Experimental Study on Effect of Cordyceps Sinensis on Renal Protection,Urinary Enzymes and Nephrotox icity of Cyclosporine A in Rats

Ｅｘｐｅｒｉｍｅｎｔａｌ　Ｓｔｕｄｙ　ｏｎ　Ｅｆｆｅｃｔ　ｏｆ　Ｃｏｒｄｙｃｅｐｓ　Ｓｉｎｅｎｓｉｓ　ｏｎ　Ｒｅｎａｌ　Ｐｒｏｔｅｃｔｉｏｎ,Ｕｒｉｎａｒｙ　Ｅｎｚｙｍｅｓ　ａｎｄ　Ｎｅｐｈｒｏｔｏｘｉｃｉｔｙ　Ｏｆ　Ｃｙｃｌｏｓｐｏｒｉｎｅ　Ａ　ｉ...     

Protective effect of Shengmai Injection on rats with contrast medium-associated acute renal failure) on rats with contrast medium-associated acute renal failure

Objective: Radiographic contrast media can induce renal failure and it may serve as an experimental model of acute renal failure (ARF). The study was aimed to determine the protective effect of Shengmai Injection (SMI) on contrast medium-associated ARF in Sprague-Dawley (SD) rats.Methods: Twenty healthy SD rats of both sex were randomly divided into two groups, Group A (control group) treated with glycerin+0. 9% saline+meglucamine diatrizoate, and group B (preventive group) with glycerin+SMI+meglucamine diatrizoate.Results: In Group B, the levels of blood urea nitrogen, serum creatinine, renal phospholipase A₂ (PLA₂) and calcium were all significantly lower than those in Group A,P < 0.01. The results indicated the renal injury induced by meglucamine diatrizoate was alleviated by SMI.Conclusion: SMI could prevent renal tissue from contrast media induced nephropathy in SD rats. The effect may partially owe to its preventing intracellular calcium accumulation, inhibiting PLA₂ activity and dilating renal vessels.     

Screening for urine abnormalities among preschool children in western Saudi Arabia

Objectives:

To estimate the frequency of urinary problems among preschool children.

Methods:

In this cross-sectional study, 1000 preschool asymptomatic children attending the outpatient clinics of the Children’s Hospital, Taif, Kingdom of Saudi Arabia between August 2013 and December 2013 were subjected to dipstick urine analysis. Microscopic examination was performed for the abnormal dipstick samples, and children with hematuria were investigated for kidney function.

Results:

Dipstick urine analysis revealed abnormal findings in 25.1% of the screened children. The most common dipstick abnormalities were positive nitrite test in 18.1%, hematuria in 16.9%, and positive leukocyte esterase test in 14.3% of the cases. The most common abnormality in microscopic urine examination was crystals in 13% of the cases. Pyuria were evident in 5% of cases and hematuria in 2.5%. The most common bacteria in positive urine culture samples was Escherichia coli in 62.6%.

Conclusion:

In view of these important findings, dipstick screening should be implemented in preschool children.Chronic kidney disease (CKD) is a global public health problem, its incidence is steadily increasing among children.1 The Kingdom of Saudi Arabia (KSA) is a large country (26.9 million) populated with a high percentage of children; children aged 0-14 years represent 28.2% of the population.2 The Kingdom of Saudi Arabia is similar to other developing countries in that there is no current national epidemiologic data on pediatric chronic renal failure (CRF) and its risks.3 Detection and management of renal problems in children are of major importance for CKD prevention; this in turn will decrease the burden of CKD in the pediatric population.4 Urinalysis is recognized as the simplest and least expensive method for screening healthy children and dipstick method is the most commonly implemented procedure.5 Moreover, dipstick has proven effective in prediction of rapidly declining kidney function.6 It must be recognized that not all abnormal results are clinically significant, and that false positive and false negative results can exist.7 Moreover, there is uncertainty as to whether early detection of renal disorders in children will lead to prevention of development of end-stage renal disease (ESRD). However, there is a clear consensus among Japanese, Taiwanese, and Korean investigators that the screening programs currently in place in these counties have led to early detection and effective intervention.8 Proteinuria and hematuria are among the early manifestations of renal disease.9 The presence of a dipstick test 1+ or ≥2+ for proteinuria was strongly associated with renal risk.10 Hematuria can be caused by several conditions, including infections, stone disease of the urinary tract, glomerular, and tubular disorders.11 Nitrite in urine has also been used to diagnose urinary tract infection; a common condition in childhood with serious complications.12 The treatment of persistent proteinuria should be directed toward the underlying cause. Steroid therapy may be used. Other therapies may be required in patients with renal dysfunction (namely, cyclophosphamide, chlorambucil, cyclosporine). Additionally, angiotensin-converting enzyme inhibitor and/or angiotensin-II receptor blocker can be used to the slow progression of renal disease and decreasing proteinuria. Referral to a pediatric nephrologist may be needed for further management.13 The aim of the current study was to screen for hematuria and other urine abnormalities among children in Taif city, as early detection could aid in preventing the progression of renal diseases.     

Can pre-implantation biopsies predict renal allograft function in pediatric renal transplant recipients?

Objectives:

To determine the utility of pre-implantation renal biopsy (PIB) to predict renal allograft outcomes.

Methods:

This is a retrospective review of all patients that underwent PIB from January 2003 to December 2011 at the Great Ormond Street Hospital for Children in London, United Kingdom. Thirty-two male patients (56%) aged 1.5-16 years (median: 10.2) at the time of transplantation were included in the study and followed-up for 33 (6-78) months. The results were compared with 33 controls.

Results:

The PIB showed normal histopathological findings in 13 patients (41%), mild chronic vascular changes in 8 (25%), focal tubular atrophy in one, moderate to severe chronic vascular change in 3, mild to moderate acute tubular damage in 6, and tissue was inadequate in one subject. Delayed graft function (DGF) was observed in 3 patients; 2 with vascular changes in PIB, and one with normal histopathological findings. Two subjects with PIB changes lost their grafts. The estimated glomerular filtration rate at 3-, and 6-months post-transplantation was lower in children with abnormal PIB changes compared with those with normal PIB. There was one case of DGF in the control group, and 4 children lost their grafts including the one with DGF.

Conclusion:

Pre-implantation renal biopsy can provide important baseline information of the graft with implications on subsequent medical treatment for pediatric renal transplant recipients.Pre-implantation or implantation biopsies (PIB) have been used in adult renal transplantation for the last 2 decades.1 The PIB of the donor kidney was initially suggested by Gaber et al2 in 1992 as they found that pathological changes correlated with subsequent renal allograft rejection and loss. They reported that the presence of polymorphonuclear (PMN) leucocytes marginating in the peritubular capillaries is related to the subsequent occurrence of cellular rejection, and an elevated mean glomerular PMN leucocyte count in conjunction with an elevated peritubular PMN leucocyte count was always associated with hyperacute rejection.2 Many adult renal transplant recipients have PIB performed on a routine basis, or as part of clinical studies as it is believed that major histological injuries are the leading causes of long-term chronic allograft dysfunction.3 This includes glomerular injury, vascular injury, and tubulointerstitial injury, such as interstitial fibrosis (IF), and tubular atrophy (TA).1 Pre-implantation or implantation biopsies is particularly useful when using marginal kidneys from deceased donors (DD), such as donation after cardiac death (DCD) as it is more likely to show donor pathology, such as glomerulosclerosis (GS), IF, hypertensive vascular changes and TA, which predict a subsequent worse renal allograft survival.1,4-6 It was reported that baseline biopsies with severe vascular disease correlated with delayed graft function (DGF), acute rejection episodes, and renal allograft dysfunction with increased serum creatinine levels at 18 months post-transplantation.6 Eapen et al7 reported that the percentage of acute rejections episode with normal PIB was 48% compared with 75% of patients with abnormal PIB. Furthermore, the quality of the donor organ at implantation was strongly predictive of subsequent renal histology in allografts functioning at 3 months.8 The GS percentage is directly correlated to renal allograft survival, DGF, and primary non-function.9 There is evidence that early transplant damage occurs in the tubulointerstitial compartment from pre-existing donor kidney injury and subsequent chronic damage, and renal allograft failure reflect accumulated previous injury.10 There is a lack of studies in the pediatric populations regarding the use of PIB and its correlation with renal allograft function. In this study, we investigated the utility of PIB to predict early- and long-term renal allograft outcome in pediatric renal transplant recipients (PRTR).     

Renal artery stenosis in association with congenital anomalies of the kidney and urinary tract

Objectives:

To describe 8 cases of renal artery stenosis (RAS) in children with congenital anomalies of the renal tract.

Methods:

We conducted a retrospective chart review of 78 children with RAS who were followed up at Great Ormond Street Hospital, London, United Kingdom between 2003 and 2012. We used an interventional radiology database to identify all patients who had RAS confirmed by digital subtraction angiography and examined all cases of congenital anomaly of the renal tract that had been diagnosed during childhood.

Results:

We documented the following renal anomalies: multicystic dysplastic kidney (n=2), renal hypoplasia (n=1), congenital solitary kidney with hydronephrosis (n=1), and unilateral vesicoureteric reflux with poorly functioning kidneys (n=2). The anomaly was unknown in 2 cases. Seven children had unilateral nephrectomy at a median age of 2.5 years (range, 0.4-10 years) for various urological abnormalities. All children were confirmed to have RAS after presentation with hypertension at a median age of 10 (3.5-16.2) years. Angioplasty was performed in 7 children, of which 6 achieved control of their blood pressure on reduced medications.

Conclusion:

We highlight the association between RAS and other renal anomalies, which indicates that they could share a common genetic background.Renovascular disease (RVD) is an important cause of severe hypertension in children.1 It is caused by impairment of blood flow to a part or all one or both kidneys as a result of narrowing of renal arteries.2 It has several different etiologies, but the most common is fibromuscular dysplasia (FMD), in Western countries, and Takayasu arteritis (TA) in the developing world.1 The underlying diagnosis of children with RVH is not always well defined as some children experience renal artery stenosis (RAS) as part of a genetic syndrome, such as neurofibromatosis types 1 or Williams syndrome.1 It could also occur secondary to other conditions such as tumor surgery, radiation therapy, or rarely following neonatal umbilical artery catheterization.1 There is no known relationship between congenital abnormalities in the renal tract (CAKUT) and RVD. However, RVD has previously been reported in a few subjects in association with renal anomalies such as solitary kidneys, multicystic dysplastic kidney, and polycystic disease.3-13 In this study, we report a series of 8 patients with RAS after being diagnosed earlier in life with CAKUT.     

Study on effect of Baoyuan Qiangshen Capsule No. II on tubular interstitial injury in chronic renal failure patientsCapsule No. II on tubular interstitial injury in chronic renal failure patients

Objective: To explore the protective effect of Baoyuan Qiangshen Capsule No. II (BYQS) and its mechanism in treating chronic renal failure (CRF).Methods: Sixty CRF patients were divided into 2 groups randomly, the treated group used BYQS combined with Lotensin and the control group administered with essential amino acid combined with Lotensin. Changes of renal functions and tubular labelled proteins were observed.Results: The markedly effective rate and total effective rate of the treated group were 63.3% and 93.3% respectively, and those of the control group were 30.0% and 56.7% respectively, the effect of the treated group was obviously better than that of the control group (P < 0.01). In the treated group after medication, blood urea nitrogen, serum creatinine and clearance rate of creatinine were improved significantly (P < 0.01), while Tamm-Horfau protein increased significantly (P < 0.01).Conclusion: BYQS could alleviate tubular interstitial injury significantly so as to improve the renal function and enhance the effective rate in treating CRF.     

Vaccines or Latrines? Debating spending on health

The final session of the 1st year Environmental Health module took the form of a class debate.“This class believes that the recent trend of increasing investment in health care in low income countries at the expense of environmental health measures will be detrimental to health outcomes overall.”A few days prior to the debate, each student was asked to prepare a short paper arguing either for or against the motion. Students could not choose which side of the debate to argue for, but voting was free choice. We took a vote at the start on the motion. Three people from each side of the debate presented their case before the debate was opened up to the floor. A spokes-person from each side summed up, then there was a second vote on the motion.Interestingly, most of the class agreed with the title of the debate at the outset. But those arguing for the relative merits of health care spending, particularly in relation to reducing mortality in under-five''s, had managed to convince more skeptics by the end of the morning.Two of the best papers are given here.

• Malawi Med J. 2003; 15(1): 18–19.
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• Bridget Msolomba: Arguing in favour of the motion

Malawi Med J. 2003; 15(1): 18–19.

Bridget Msolomba: Arguing in favour of the motion

Copyright and License information DisclaimerCopyright © 2003, Malawi Medical JournalLow-income countries have always faced infectious disease epidemics. Rather than focusing on prevention, the trend has been to react to crises as they arise, such as the cholera outbreak in Malawi 2001. In this way resources are spent on treating the condition in an emergency where access to affected areas is often difficult due to poor transport and roads. In my opinion governments should not focus narrowly on cure after the event, but should broaden their policies to include mass prevention through environmental health measures, which will prove more cost effective in the long run.Most developing countries are caught in a dilemma over how best to invest in health. Worldwide, annually 400 million people are infected with malaria, 200 million with bilharzia and 9 million with TB. Deaths from these diseases are not only a burden to the families and communities but have socioeconomic effects as well. One estimate suggested that AIDS deaths by the year 2000 would cost Asian countries $50 billion in lost productivity alone¹. Methods of prevention and treatment for many of these diseases are known. However, growing pressure of budget cuts and population growth overwhelms governments'' ability to control these diseases. Also there has been a vast disparity in provision of preventive measures between the rich and the poor, for example water supply typically is to urban landowners leaving out the rural majority.Sixteen percent of the world''s population (∼ 1.1 billion people) has no access to a safe water supply and 40% are living without adequate sanitation. Eighty percent of all diseases in the developing world are associated with a lack of clean water, accounting for 24 million deaths each year. Several studies however have shown that by simply providing piped water to homes, disease occurrence can drop by as much as 25%. Furthermore, the quantity of water available appears to be a more important determinant of disease reduction than quality, with sanitation and hygiene also playing a role².In the early 80''s, governments aimed to provide water pumps and boreholes to their populations, but maintaining these proved expensive and difficult. More recently there has been a shift in emphasis to treatment, for example promoting Oral Rehydration therapy. Earlier interventions were focusing on governments'' being the sole provider, but increasingly the private sector is the provider under monitored surveillance by government officials. I agree with this ideology in which governments merely provide incentives and a fraction of financial support for projects whilst encouraging communities to raise funds, provide labour and committees. In Malawi where there is a high demand for new boreholes with only 15,000 boreholes for a rural population of 9 million³, this policy will ensure that demand is met without excessive government spending.In conclusion, I believe that whilst short-term investment should be directed at epidemics there should be equal investment now in environmental health. Regardless of the effort spent on treatment, if the root of the problem like clean water supply is not solved in the long run the problem will keep on recurring and resources will continue to be poured into the same problem instead of focusing on development.