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Background: Rabies disease continues to be most feared of all communicable diseases. Rabies is a zoonotic disease & transmitted by animal bites, mainly dogs. India accounts for 59.9% of rabies deaths in Asia and 35% of deaths globally. One of the important factors associated with successful treatment is the knowledge of the care giver in the correct management of animal bites and vaccination against rabies. Objectives: i) To assess the knowledge towards animal bite management, and (ii) To study the knowledge, attitude & practices regarding pre and post-exposure prophylaxis (PEP) of rabies amongst interns in a D. Y. Patil Medical College, & Hospital, Kolhapur, Maharashtra, a tertiary care teaching hospital. Material and Methods: i) Study design - An observational - cross sectional, knowledge, attitude & practices (KAP) study. ii) Tools used - Predesigned, pretested, structured questionnaire based survey in interns on animal bite wound management and pre & post-exposure prophylaxis for rabies. iii) Study population – Interns working in D. Y. Patil Hospital, Kolhapur during study period, iv) Statistical tests – mean, percentage and other statistical analysis was conducted by using Microsoft- Excel.

The increment in the usage of automobiles is resulting in increased greenhouse gases (GHG) emissions continuously and there is a substantial need to reduce them effectively. The present research work investigates the emission behavior of waste cooking oil biodiesel doped with CuO nanoparticles during testing in Compression Ignition (CI) engines. This investigation is based on the effective emission reduction analysis emitted by diesel fuel during experimentation on CI engines. It suggests a cost effective modification of biodiesel as a fuel prepared from waste cooking oil (WCO) by a novel hydrodynamic cavitation technique which includes the hydrodynamic cavitation reaction mixture composed of 1.28 L of methanol and 10 g KOH and 5 L of preheated WCO at 45 °C in the cavitation reactor for 40 min. These reactants are synthesized utilizing the principle of cavitation and the final manufactured esterified oil is authenticated with ASTM Standard property measurement for suitability check. In the research work, two different investigations are carried out. In the first one, WCO biodiesel-diesel blends of 0, 30, and 100% (B0, B30, B100) ratio are prepared and the emission characteristics have investigated at 1500 rpm constant speed with varying load and indicated mean effective pressure (IMEP). In the second investigation, the emission suitable blend B30 is doped with CuO nanoparticles, keeping other parameters as per the previous setup, the emission characteristics investigated for the second one. For precise results, more experimental trials are needed to achieve this decrease in the emission of harmful gases. Using an amalgamation of L9 Taguchi and response surface methodology (RSM) the maximum emission control with a minimum number of experimental trials is achieved. The first investigation includes the predefined predictors as A (blend), B (load), and C (IMEP), where blends (0 ≤ A ≤ 100%), load (0 ≤ B ≤ 12 kg), IMEP (3.5 ≤ C ≤ 7.5 bar) are controllable features. Optimization process resulted into a minimum emission of CO, CO2, and NOx by appertaining the condemnatory merger of inputs such as blend B0 (Diesel), load 12 kg, and IMEP 3.48 bar in the first investigation, which has resulted into 0.08 ppm CO, 0.6 ppm CO2 and 30 ppm NOx emission. Taguchi analysis-based second experimental investigation includes the predefined predictors as A (CuO), B (load), and C (IMEP), including nanoparticles CuO in blend B30, and the prognosticated results of optimization are 0.03 ppm CO, 0.3 ppm CO2 and 21 ppm NOx emission. In current investigation, the percentage reduction is found to be 92.3%, 94.82%, and 96% compared to the emission of diesel in CO, CO2 and NOx gases, respectively. The coefficient of determination is almost equal to 1, which reveals the chosen optimization technique is very accurate in prediction. The investigation has provided suitable minimum emission characteristics in a cost-effective way.

A new green synthetic approach of cobalt oxide (Co3O4) nanomaterial with cetyltrimethylammonium bromide (CTAB) using the sol–gel method was investigated. In this preparation, water is considered as a core solvent, and the synthetic approach is environmentally advantageous because of its low cost, easy preparation, and industrial viability due to this solvent. Investigation of nanomaterial have been done by X-ray diffraction (XRD), transmission electron microscopy (TEM), ultraviolet visible spectroscopy (UV-Visible), energy dispersive X-ray spectroscopy (EDX), and fourier transform Infrared spectroscopy (FTIR). Highly dispersed characterization results were shown by synthesized nanomaterial. This green approach proves an effective, eco-friendly, simple and valuable approach for the synthesis of Co3O4 nanomaterial.

The influence of different microbial inoculants and their combination for inducing rooting in hardwood cuttings of pomegranate cv. Ruby and Mrudula in greenhouse and open condition was studied. Shoot and root parameter such as days taken for first sprouting, length of sprouts, plant height number and length of roots, dry weight of shoot and root, percentage of rooting were analysed. Among various microbial cultures used Trichoderma + Azotobacter each at 2.5 ml/kg of potting mixture resulted in maximum number of branches, diameter of shoot and plant height, followed by IBA 2000 ppm + Azotobacter at 5 ml / kg of potting mixture and IBA 2000 ppm + Trichodermaat 5 ml / kg of potting mixture. Maximum number of sprouts per cutting recorded at weekly interval and length of shoot recorded on 30th day after planting till 90th day after planting were observed in cv. Ruby, when treated with microbial inoculants vi iz., Azotobacter + Trichoderma each at 2.5 ml /kg of potting mixture. High number of adventitious roots, secondary roots, length of longest adventitious root, length of longest secondary root and establishment after transplanting were also in cv. Ruby compared to cv. Mrudula. Cuttings under high cost greenhouse performed better with respect to both vegetative parameters and root parameters than those kept in open condition. The interaction effect of varieties, microbial inoculants and growing condition also influence various shoot and root parameters of hardwood cuttings. The combination of IBA @ 2000 ppm +Azotobacterat 5 ml /kg of potting mixture performed better in greenhouse condition. Therefore, it is advisable to use microbial consortia in place of IBA, since it is cheaper and provides other benefits apart from producing quality, planting material which will be cost effective. Further, treating the cutting with IBA @ 2000 ppm + Trichoderma@ 5 ml/ kg of potting mixture (T6) under greenhouse gave better results while under open condition the treatment with Azotobacter + Trichoderma each @ 2.5 ml/kg of potting mixture (T4) was economically feasible for propagation of pomegranate.

Introduction Pulmonary embolism (PE) is a relatively common cardiovascular emergency. It can lead to a variety of outcomes, from potentially reversible right ventricular failure (by occluding the pulmonary arterial bed) to eventual death. The diagnosis of PE is often missed due to its nonspecific clinical presentation. Materials and Methods This is a descriptive cross-sectional study conducted at tertiary care center in India from October 1, 2016 to September 30, 2018, which includes 36 cases of PE. Institutional ethics committee clearance was obtained before start of the study. Written and informed consent was obtained from all patients. Patients were informed regarding purpose, procedures, risks, and benefits of the study in their own vernacular language. Results The age-wise distribution of patients in this study showed that most patients were up to 40 years amounting to 58.4% of cases. Sex-wise distribution also showed that most patients were male (66.7%). Fifty percent of the patients had no thrombosis on Color Doppler findings of the involved limb, and 31.25% had superficial venous thrombosis. Blood investigation revealed that 94.4% patients had troponin negative and 94.4% had D-dimer positive. This study also attempted to correlate the D-dimer findings and Well's score. It can be seen that as per Well's score, 13 patients were with high probability, 18 with moderate probability, and 5 with low probability. Conclusion This study states that D-dimer assays are highly sensitive and have a low rate of false-negative results. The assays have been found safe and effective when the clinical probability of PE is low. When the D-dimer result is negative in patients with low clinical probability of having PE, the presence of acute PE can be safely ruled out without diagnostic imaging.

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Background: Swine flu (H1N1) is very infectious respiratory disease occurring in different parts of world showing pandemicity from time to time. Thorough knowledge about its epidemiology and clinical symptoms, attitude towards disease and practices to prevent its occurrence and spread are essential in all age groups especially in school children. To assess the awareness, practices, their attitude and myths regarding swine flu among adolescent school going children in Kolhapur district Maharashtra.Methods: A pre-tested questionnaire was designed emphasized on the demographic profile, knowledge and misconceptions about cause, transmission, prevention and cure of swine flu (H1N1) and social responsibility of every student about spreading awareness. The questionnaires were distributed to school students of 9th& 10th standard only. Maximum 15 minutes were allotted to participants. A power point presentation regarding swine flu was delivered to participants and staff members.Results: Total 210 study participants were included. 80.47% students knew cause of swine flu is viral and 69.04% knew it spreads through airborne route. 73.33% students correctly knew about symptoms of swine flu. 71.90% mentioned all the correct preventive methods as wearing face mask of appropriate size, vaccination against swine flu and maintaining hand hygiene. In reality only 32.38% students exclusively practicing hand hygiene.Conclusions: Although the term was well known, better recognition of pandemic influenza cases is needed. Children were not aware about certain important treatment and prevention aspects of the disease.

In this work, we have selected three number of stepped type solar stills of the same overall dimensions 620 mm (W) × 808 mm (L) but with different absorber surface areas due to the variation in the shape of the basin surface. The other design parameters like depth of water, thickness of glass cover, insulation thickness, type of condensing cover, absorbing material provided over the basin, and angle of inclination of the still were kept constant to study the effect of shape of the absorber surface over the distillate yield obtained. The shape of the absorber surface provided in the basins of solar stills A, E and F was flat, convex and concave respectively. When the convex and concave type stepped solar stills are used, the average daily water production has been found to be 56.60% and 29.24% higher than that of flat type stepped solar still respectively. Also an economic analysis was made. The payback period of flat type, convex type and concave type stepped solar still is 823 days, 525 days and 637 days respectively. Thus, the convex type solar still gives the returns within the least possible time as compared to other two types of stepped solar stills. The laboratory tests were conducted to test the quality of water after distillation. The tests indicate that the quality of water in terms of pH, electrical conductivity, total hardness, TDS, Alkalinity, Nitrates etc. is well within the desirable limits as prescribed by WHO for Indian specific conditions.

Background: Obstructive lung diseases as asthma and Chronic Obstructive Pulmonary Disease (COPD) have considerable morbidity and mortality globally. Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is projected to rank fifth in 2020 in burden of disease worldwide, according to the WHO study. Aim and objectives was to evaluate clinical profiles of obstructive lung diseases patients attending tertiary care hospital.Methods: The data was collected from 112 obstructive lung diseases patients presenting to OPD of pulmonary medicine department from January 2009 to August 2010. Research tool comprised of questions about demographic characteristics, past or presenting symptoms, general and systemic examinations. For statistical analysis MS Excel and SPSS 16 were used.Results: Overall 72 (64.28%) were smokers. 63 (56.25%) were suffering from COPD and 49 (43.75%) were asthmatic. Breathlessness was found as most common symptom in 53 (84.12%) COPD and in 45 (91.83%) asthma patients. Among COPD patients, 26 (41.26%) were of moderate obstruction whereas in asthma patients, 17 (34.69%) were of moderate obstruction and 16 (32.65%) were of severe obstruction as per Pulmonary Function Tests (PFT).Conclusions: Males were most commonly affected in obstructive lung diseases. COPD was common after 35 years of age where as asthma occurs mostly before 35 years of age. Smoking was most common etiological factor. Breathlessness was the most common presenting symptom. Family history of asthma was most common risk factor for asthma patients. Most of the patients with both COPD as well as asthma had moderate type of obstructions.

Background: There is an increase in prevalence of childhood obesity and its chronic health effects especially in developing countries like India in last 2-3 decades. This study is small effort to know prevalence and risk factors causing obesity. Aim of the study was to estimate prevalence of obesity and its risk factors in school students of age group 11 to 16 years.Methods: About 207 adolescent school children from selected school were enrolled in the study. Research tool comprised of questions about demographic characteristics, daily physical activity, frequency of having junk food intake etc. Height and weight were measured on calibrated scales. For statistical analysis MS Excel and SPSS 16 were used.Results: Among participants 58.9% were boys. 66.7% students were in the 13 to 14 years of age group. As per body mass index, 46.9% children were underweight and 8.7% were obese. 77.3% participants were eating junk food more than once in a week.Conclusions: Health education on dietary habits and physical activity is needed for adolescent children to prevent development of obesity and complications related to it.

Background: Menstrual disorders affect half of all female adolescents and represent leading cause of periodic college absenteeism but awareness regarding health seeking behaviour is less. Objective was to study association between common menstrual disorders and college absenteeism in first and second year medical students in Mumbai . Methods: 150 female students from first and second year MBBS were included in the study. Research tool comprised of questions about demographic characteristics, age at menarche, menstrual cycle pattern, complaints and its impact on daily activities including college absenteeism. Behaviour towards health and knowledge about menstrual cycle was observed. Percentage and chi square values were calculated using SPSS 16. The study was conducted in period between August to October 2012. Results: 150 first and second year female medical students participated in the study. Their mean age was 19.5 yrs. Mean age of menarche was 13-14 years in 78%. Menstrual cycle was regular in 72.6%. Menstrual flow was average in 73.3% of respondents and 88% reported duration as 3-5 days. 92% respondents had painful menses especially reporting moderate pain in 78% while in 70% of those pain resolved on its own. 67.4% reported mother as source of menstrual cycle information. Although menstrual disorder was cause of college absenteeism of 1-2 days in 44% students, 88% students didn’t seek medical advice for menstrual disorders . Conclusions: Improving health seeking behaviour towards common menstrual problems can reduce college absenteeism.

Multiple myeloma is the most common indication for high-dose chemotherapy with autologous stem cell support (ASCT) in North America today. Stem cell procurement for ASCT has most commonly been performed with stem cell mobilization using colony-stimulating factors with or without prior chemotherapy. The target CD34+ cell dose to be collected as well as the number of apheresis performed varies throughout the country, but a minimum of 2 million CD34+ cells/kg has been traditionally used for the support of one cycle of high-dose therapy. With the advent of plerixafor (AMD3100) (a novel stem cell mobilization agent), it is pertinent to review the current status of stem cell mobilization for myeloma as well as the role of autologous stem cell transplantation in this disease. On June 1, 2008, a panel of experts was convened by the International Myeloma Foundation to address issues regarding stem cell mobilization and autologous transplantation in myeloma in the context of new therapies. The panel was asked to discuss a variety of issues regarding stem cell collection and transplantation in myeloma especially with the arrival of plerixafor. Herein, is a summary of their deliberations and conclusions.

It is essential that there be consistency in the conduct, analysis, and reporting of clinical trial results in myeloma. The goal of the International Myeloma Workshop Consensus Panel 1 was to develop a set of guidelines for the uniform reporting of clinical trial results in myeloma. This paper provides a summary of the current response criteria in myeloma, detailed definitions for patient populations, lines of therapy, and specific endpoints. We propose that future clinical trials in myeloma follow the guidelines for reporting results proposed in this manuscript. (Blood. 2011; 117(18): 4691-4695)

Despite the widespread use of email, electronic communication between physicians and patients is not part of the standard physician-patient relationship in the United States. Increased use of email may improve physician-patient communication, which is associated with improved patient satisfaction and health status. Evaluating email communication in this context is vital to minimizing potential risks and maximizing benefit to physicians and patients. We evaluated email use between physicians and patients, and physicians perceptions of the value and issues surrounding this form of communication in order to identify issues that would facilitate and improve electronic communication.

Grammaxone (paraquat) is trade name for N,N′-dimethyl-4,4′bipyridinium dichloride. It is most widely used as herbicide. It came into disrepute because of accidental or intentional ingestion leading to a high mortality. Paraquat is commonly preferred for suicide by farmers because of easy availability, low cost, low toxic dose. Here we are reporting a case of paraquat poisoning with pulmonary fibrosis developing over 2 weeks.

When we talk about severe malaria, we usually think of Plasmodium falciparum. However, in recent times, Plasmodium vivax has also been reported to cause severe multi-organ dysfunction and life-threatening disease similar to P. falciparum. We report here a case of P. vivax malaria in a young boy from an endemic zone, who developed acute renal failure, severe thrombocytopenia, and anemia and later developed spontaneous subarachnoid hemorrhage. Multisystem involvement in a patient with P. vivax is rare, and subarachnoid hemorrhage is an unusual presentation.

Plasma exchange after hematopoietic stem cell transplantation in multiple myeloma to reduce renal insufficiency

The type I melanoma antigen gene (MAGE) proteins CT7 (MAGE-C1) and MAGE-A3 are commonly expressed in multiple myeloma (MM), and their expression correlates with increased plasma cell proliferation and poor clinical outcome. They belong to the cancer-testis antigen (CTAg) group of tumor-associated proteins, some of which elicit spontaneous immune responses in cancer patients. CT7 and MAGE-A3 are promising antigenic targets for therapeutic tumor vaccines in myeloma; therefore, it is critical to determine if they are immunogenic in MM patients. We analyzed cellular and humoral immune responses against CTAgs in patients with plasma cell dyscrasias: MM, monoclonal gammopathy of undetermined significance (MGUS), and Waldenström's macroglobulinemia (WM). Bone marrow lymphocytes from two of four untreated MM patients exhibited CT7-specific cellular immune responses as measured by an autologous cellular immunity assay, the first such immune response to CT7 to be reported in cancer patients. Sera from 24 patients were screened by ELISA for humoral immune responses to CTAgs. Two patients with MM demonstrated positive titers, one for MAGE-A1 and the other for SSX1. These data demonstrate that CTAgs, particularly CT7, are immunogenic in MM patients and merit further exploration as targets of immunological therapy in MM.

Gene-therapy of blood-borne disorders may be best achieved using hematopoietic stem cells (HSC) which have extensive self renewal potential as well as multilineage repopulating potential as a cellular target. The human HSC, which is CD34+Thy-1+Lin- has been isolated from fetal, adult bone marrow and cytokine-mobilized peripheral blood (MPB) (1-3). Results presented in this study show that the degree of mobilization of HSC into peripheral blood of cancer patients is highly variable and that the combined use of high dose chemotherapy and GM-CSF as a mobilization strategy is superior to the use of G-CSF with regard to the mobilization of true HSC. A multistep cell isolation procedure has been developed which utilizes high speed flow-cytometric cell sorting and allows the isolation of sufficient numbers of HSC from MPB to permit their use as an hematopoietic graft for clinical transplantation. Hematopoietic stem cells isolated from MPB are capable of self-renewal and differentiation into multiple hematopoietic lineages as shown by their behavior in both in vitro and in vivo assays. Mobilized PB mononuclear cells isolated from cancer patients are frequently contaminated with tumor cells. Using this cell isolation procedure, HSC preparations from patients with multiple myeloma have been created with greatly reduced tumor cell burdens. These CD34+Thy-1+Lin- cells are capable of being stably transduced at high efficiency (32-75%) by co-culture on a cell line producing recombinant retroviruses containing the neomycin-resistant gene. These HSC cell populations are likely ideal targets for hematopoietic cell-based gene therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Summary Background Selinexor combined with dexamethasone has shown activity in patients with heavily pre-treated multiple myeloma. In a phase 1b/2 study, the combination of oral selinexor with bortezomib (a proteasome inhibitor) and dexamethasone induced high response rates with low rates of peripheral neuropathy, the main dose-limiting toxicity of bortezomib. We aimed to evaluate the clinical benefit of weekly selinexor, bortezomib, and dexamethasone versus standard bortezomib and dexamethasone in patients with previously treated multiple myeloma. Methods This phase 3, randomised, open-label trial was done at 123 sites in 21 countries. Patients aged 18 years or older, who had multiple myeloma, and who had previously been treated with one to three lines of therapy, including proteasome inhibitors, were randomly allocated (1:1) to receive selinexor (100 mg once per week), bortezomib (1·3 mg/m2 once per week), and dexamethasone (20 mg twice per week), or bortezomib (1·3 mg/m2 twice per week for the first 24 weeks and once per week thereafter) and dexamethasone (20 mg four times per week for the first 24 weeks and twice per week thereafter). Randomisation was done using interactive response technology and stratified by previous proteasome inhibitor therapy, lines of treatment, and multiple myeloma stage. The primary endpoint was progression-free survival in the intention-to-treat population. Patients who received at least one dose of study treatment were included in the safety population. This trial is registered at ClinicalTrials.gov , NCT03110562 . The trial is ongoing, with 55 patients remaining on randomised therapy as of Feb 20, 2020. Findings Of 457 patients screened for eligibility, 402 were randomly allocated—195 (49%) to the selinexor, bortezomib, and dexamethasone group and 207 (51%) to the bortezomib and dexamethasone group—and the first dose of study medication was given between June 6, 2017, and Feb 5, 2019. Median follow-up durations were 13·2 months [IQR 6·2–19·8] for the selinexor, bortezomib, and dexamethasone group and 16·5 months [9·4–19·8] for the bortezomib and dexamethasone group. Median progression-free survival was 13·93 months (95% CI 11·73–not evaluable) with selinexor, bortezomib, and dexamethasone and 9·46 months (8·11–10·78) with bortezomib and dexamethasone (hazard ratio 0·70 [95% CI 0·53–0·93], p=0·0075). The most frequent grade 3–4 adverse events were thrombocytopenia (77 [39%] of 195 patients in the selinexor, bortezomib, and dexamethasone group vs 35 [17%] of 204 in the bortezomib and dexamethasone group), fatigue (26 [13%] vs two [1%]), anaemia (31 [16%] vs 20 [10%]), and pneumonia (22 [11%] vs 22 [11%]). Peripheral neuropathy of grade 2 or above was less frequent with selinexor, bortezomib, and dexamethasone (41 [21%] patients) than with bortezomib and dexamethasone (70 [34%] patients; odds ratio 0·50 [95% CI 0·32–0·79], p=0·0013). 47 (24%) patients in the selinexor, bortezomib, and dexamethasone group and 62 (30%) in the bortezomib and dexamethasone group died. Interpretation A once-per-week regimen of selinexor, bortezomib, and dexamethasone is a novel, effective, and convenient treatment option for patients with multiple myeloma who have received one to three previous lines of therapy. Funding Karyopharm Therapeutics.

L-Arginine is a precursor of polyamine, nitric oxide (NO), creatine, and agmatine and is essential for the differentiation and proliferation of blood cells, although the precise biological role of L-arginine is unclear. We have recently reported that the depletion of L-arginine in cultured medium prevented both proliferation and differentiation of blood cells (Shima et al., Blood First Edition Paper, October 6, 2005; DOI 10.1182). Since one of metabolic products of L-arginine in the cells is polyamine that associates with cell differentiation and proliferation, the effects of L-arginine on the human K562 cell line and human cord blood-derived CD34 positive cells were investigated by focusing on polyamines such as putrescine, spermidine, and spermine in the present study. When polyamines were added to the culture medium in the absence of L-arginine, the cells did not grow or differentiate well. However, when intracellular polyamines were depleted using ornithine decarboxylase inhibitor, alpha-difluoromethylornithine (DFMO), the proliferation and differentiation of K562 cells to erythrocytes were reduced even in the presence of L-arginine. Moreover, in the presence of DFMO, cell differentiation and proliferation were recovered by the addition of putrescine or spermidine in the presence of L-arginine. Accordingly, it was demonstrated that polyamines are essential for the proliferation and differentiation of the blood cells as the metabolites of L-arginine and the externally added polyamines are also effective by being taken up through polyamine transporter.

12 páginas, 3 tablas.-- et al., The role of high-dose therapy followed by autologous stem cell transplantation (ASCT) in the treatment of multiple myeloma (MM) continues to evolve in the novel agent era. The choice of induction therapy has moved from conventional chemotherapy to newer regimens incorporating the immunomodulatory derivatives thalidomide or lenalidomide and the proteasome inhibitor bortezomib. These drugs combine well with traditional therapies and with one another to form various doublet, triplet, and quadruplet regimens. Up-front use of these induction treatments, in particular 3-drug combinations, has affected unprecedented rates of complete response that rival those previously seen with conventional chemotherapy and subsequent ASCT. Autotransplantation applied after novel-agent-based induction regimens provides further improvement in the depth of response, a gain that translates into extended progression-free survival and, potentially, overall survival. High activity shown by immunomodulatory derivatives and bortezomib before ASCT has recently led to their use as consolidation and maintenance therapies after autotransplantation. Novel agents and ASCT are complementary treatment strategies for MM. This article reviews the current literature and provides important perspectives and guidance on the major issues surrounding the optimal current management of younger, transplantation-eligible MM patients.

Renal impairment is a common complication of multiple myeloma (MM). The estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula is the recommended method for the assessment of renal function in patients with MM with stabilized serum creatinine. In acute renal injury, the RIFLE (risk, injury, failure, loss and end-stage kidney disease) and Acute Renal Injury Network criteria seem to be appropriate to define the severity of renal impairment. Novel criteria based on eGFR measurements are recommended for the definition of the reversibility of renal impairment. Rapid intervention to reverse renal dysfunction is critical for the management of these patients, especially for those with light chain cast nephropathy. Bortezomib with high-dose dexamethasone is considered as the treatment of choice for such patients. There is limited experience with thalidomide in patients with myeloma with renal impairment. Thus, thalidomide can be carefully administered, mainly in the context of well-designed clinical trials, to evaluate if it can improve the rapidity and probability of response that is produced by the combination with bortezomib and high-dose dexamethasone. Lenalidomide is effective in this setting and can reverse renal insufficiency in a significant subset of patients, when it is given at reduced doses, according to renal function. The role of plasma exchange in patients with suspected light chain cast nephropathy and renal impairment is controversial. High-dose melphalan (140 mg/m(2)) and autologous stem-cell transplantation should be limited to younger patients with chemosensitive disease. J Clin Oncol 28:4976-4984. (C) 2010 by American Society of Clinical Oncology