Ashok Kirpalani’s research while affiliated with Bombay Hospital & Medical Research Centre and other places

Objective Our study aims to compare novel ABPM parameters between CKD and non-CKD patients and also within various subgroups of CKD. Design and method 100 consecutive hypertensive patients-{Group A with CKD Stage 1 to 4 (n=50) and Group B - without CKD (n=50)}; underwent measurement of single clinic BP (SOBP, by Omron 7113), averaged automated clinic BP (AOBP, by Omron HEM 907) and 24 hours ABPM (by SunTech Oscar 2). Results When compared with daytime ABPM, mean AOBP (136.8/78.5 mm Hg) correlated significantly better than mean single clinic BP (141.2/81.6 mm Hg); (r=0.75 versus 0.59). Group A had significantly higher (p<0.05) awake, asleep and 24 hour mean systolic BP {144.8, 133.4, 141.9} than Group B {139.6, 125.3, 136.7 mm Hg respectively}. Group A had significantly higher (p=0.03) masked hypertension (38% vs. 20% in Group B). Group A had EMBS (36% vs. 22%, p=0.04) and higher non dipping of BP (60% vs. 46%, p=0.04) as well as nocturnal heart rate (14% vs. 12%, p=0.06) than Group B. BP variability was significantly higher (p<0.05) in Group A (Average real variability: 12.9+4.18 vs. 11.6+3.63; Variability independent of the mean: 24.74+16.25 vs. 22.2+13.3). Conclusions As compared to non-CKD population, CKD patients have higher prevalence of ABPM phenotypes such as masked hypertension, nocturnal hypertension, EMBS and BP variability irrespective of age, stage of CKD and level of control of office BP. Utilization of novel ABPM parameters can guide towards holistic management of hypertension in CKD.

A retrospective observational study was undertaken to evaluate the clinical profile of recurrent urinary tract infections (UTIs) in a tertiary care hospital. Patients <18 years, kidney-transplant recipients, those on immunosuppressive agents and pregnant patients were excluded. Patients with ≥2 episodes of culture positive UTIs were included. Demographic details, investigations and treatment were recorded. Out of total 48 patients, 18 were female and 30 male. The common manifestations were acute pyelonephritis (52%), emphysematous pyelonephritis (20%) and cystitis (25%). Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (48%) was the most frequent organism isolated followed by Klebsiella spp. (29%) and Pseudomonas spp. (23%). Recurrent episodes of UTI with same organisms were noted in 62% patients. Death occurred in 12.5% patients due to septic shock. Renal calculi (24%) and double J (DJ) stent placement (30%) were associated with recurrent UTIs, though this was not statistically significant. Resistance to higher antibiotics (colistin, carbapenems, piperacillin-tazobactam, cefoperazone-sulbactam, third-generation cephalosporins) (65.4%, r = 0.81), diabetes (62.5%, r = 0.79), urological procedure (39.5%, r = 0.68), prior hospitalization (75%, r = 0.84), history of UTI prior to the study period (44%, r = 0.72) and need for per urethral catheter (PUC) beyond 7 days (35%, r = 0.74) had significant correlation with recurrent UTIs.

Objective: High daily salt consumption amongst adolescents is one of the most relevant etiological factors for future risk of hypertension and other lifestyle diseases. The aim of this study is to evaluate and compare the amount and pattern of sodium (Na) consumption in urban and rural school-going adolescents and identify high risk groups for conducting awareness and intervention programs. Design and method: Subjects aged 12 - 15 years from 3 schools in and around Mumbai were given a questionnaire detailing their demographic, anthropometric data and eating habits. A self-administered semi-quantitative Food Frequency Questionnaire was used to record consumption pattern of 22 high salt containing food items, divided into 5 categories (bakery, fried, packed, preserved and fast foods). Each participant`s sodium consumption from these food items was calculated. Additional sodium consumption from regular meals was excluded.Data analysed with MS Excel. Results: 1141 (urban- 565; rural- 576; Males-612,Females -524) participated. 13 % subjects added table salt while 62 % ate frozen foods < twice a month .Median Sodium consumption of the study population was 473 mg/day (~ 1 g salt) (Q1-Q3: 254 - 851 mg/day). Daily Median Na consumption was significantly higher (p < 0.05) in urban students (724 mg/day) as compared to rural (292 mg/day). Bakery and fried foods comprised 51% of sodium consumption amongst rural, whereas all five food categories had equal representation in the urban population. An alarming 54 % subjects' BMI (34 % urban, 20 % rural) was above the normal range. Higher BMI values correlated significantly with higher daily Na consumption (p = 0.001, Mann-whitney test). Conclusions: The salt intake over and above the usual dietary salt consumption was high (~ 2 g per day for urban and ~1 g/day for rural adolescents). More than half the study population was found to be either overweight or obese .This double whammy has a singular potential for producing future hypertensives .Thus targeted awareness, counselling and intervention programs for salt reduction in adolescents is the urgent need of the hour.