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Of the more than 20 studies published on SLE patients with COVID-19, none of the studies focused on lupus nephritis. We report the outcomes of renal biopsy-proven systemic lupus erythematosus (SLE) nephritis patients after COVID-19 disease. Our institute has been declared as a state COVID-19 hospital in the last week of March 2020. From then till now, we have admitted and managed COVID-19 patients from several districts of Andhra Pradesh and neighbouring states. We collected the data of patients with SLE nephritis contemporaneously from admission to the outcomes on a computerised proforma. We had identified sixteen patients with SLE nephritis who were admitted with COVID-19 disease. Of them, fourteen were females and two were males. The mean age was 29.3 years. Out of sixteen patients, seven required a mechanical ventilator and dialysis and eventually succumbed. One more patient died due to disseminated tuberculosis. Our results suggested that with an approximately 50% mortality rate, the COVID-19 disease had a calamitous effect on SLE nephritis patients. Key Points • We identified the significant risk factors for mortality: younger age, higher serum creatinine at presentation, higher CT severity score and lower serum albumin. • After the analysis done for this article, we decided to reduce the medications for SLE nephritis to prednisolone 10 mg/day when COVID-19 disease is contracted. [ABSTRACT FROM AUTHOR]

A 20-year-old male patient presented with an alleged history of consumption of 80 mL of paraphenylenediamine (PPD) hair dye. At initial presentation, throat pain, anasarca and reduced urine output were evident. On general physical examination, tachycardia and tachypnoea were evident; blood pressure was 130/80 mm Hg. Oxygen saturation measured with a pulse oximeter (SpO2) on ambient air was 98%. Laboratory investigations revealed haemoglobin (Hb) 14.7 g/dL, platelets 250,000/mm3, neutrophilic leucocytosis, total leucocyte count 23,600/mm3, 86% neutrophils) elevated serum creatinine (6.8 mg/dL), creatine phosphokinase levels (1466 IU/L), hyperkalaemia (6.2 mEq/L) and myoglobinuria. Abdominal ultrasonography revealed normal-sized kidneys and grade 2 renal parenchymal disease changes with maintained corticomedullary differentiation indicating acute kidney injury. Laboratory investigations done on day 7 of admission revealed anaemia Hb 9 g/dL, thrombocytopenia platelets 73,000/mm3, haemoglobinuria and elevated serum lactate dehydrogenase levels (3005 IU/L) with a negative direct and indirect Coombs test and schistocytes (5%) on peripheral smear suggesting microangiopathic haemolytic anaemia. Serum calcium, magnesium and phosphorous were within normal limits. Urinalysis showed plenty of red blood cells with dysmorphia. Haemolytic uraemic syndrome (HUS) was diagnosed and 15 sessions of haemodialysis as well as 7 sessions of plasma exchange were instituted. Clinical improvement was noted with improvement in urinary output; normalisation of laboratory parameters occurred over the next 3 weeks. He was discharged in a haemodynamically stable state. The present case highlights the unusual occurrence of HUS secondary to a hair dye (PPD) poisoning which responded to plasma exchange treatment. [ABSTRACT FROM AUTHOR]

Burkitt's lymphoma (BL) is a highly aggressive type of B-cell non-Hodgkin lymphoma. BL commonly occurs in children of age 4-7 years and is uncommon in adults, with a worse prognosis. Patients often present with a rapidly growing mass typically involving the abdomen (liver and spleen) and head and neck (nodes, jaw, and facial bones). Pancreas involvement is very rare and very few case reports have been documented so far. Fluorine-18 positron emission tomography/ computed tomography (F-18 PET/CT) is a whole-body survey commonly used for initial staging evaluation. Here, we present an interesting case of BL in an adult female of 43 years, who presented with swelling in the left submandibular region after tooth extraction with multiorgan involvement found on F-18 fluorodeoxyglucose PET/CT. [ABSTRACT FROM AUTHOR]

The multiorgan deleterious effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) are now well known. Although COVID-19 disease is a hypercoagulable state and thrombotic complications occur in about one-third of critically ill patients with COVID-19, thrombosis is not typically a presenting symptom. We report the case of a patient presented with the complaints of abdominal pain due to renal vein thrombosis as the first feature of the COVID-19. [ABSTRACT FROM AUTHOR]

A 54-year-old man with hypertension, end-stage renal disease (ESRD) who was receiving thrice-weekly haemodialysis for the past 3 years, developed breathlessness after a session of haemodialysis. Oxygen saturation by pulse oximetry (SpO2) was 88% and he was admitted for evaluation. Nasopharyngeal swab real time-polymerase chain reaction (RT-PCR) had tested positive for SARS-CoV-2. He was started on intravenous azithromycin, dexamethasone 8 mg, and subcutaneous heparin. On the 8th day after admission, he had painful swelling, redness and watering of the left eye. Within hours, he also complained swelling of the left half of the face, diminished vision and reduced eye movements of the left eye. Magnetic resonance imaging (MRI) and magnetic resonance angiography of the brain revealed left orbital cellulitis. angioinvasive fungal sinusitis. Laboratory testing confirmed the diagnosis. The patient was treated with intravenous ammphotericin B and surgery. [ABSTRACT FROM AUTHOR]

The study helps in the derivation of a new closed form analytical solution, based on the Maxwell's equations for conductors for the electric field distribution inside a metallic cylindrical disk specimen for the case of an ideal two-probe impedance measurement. The results show that the skin effect term of the solution becomes significant at high frequencies near the end regions of the disk, though the constriction term only dominates the regions near the electrode contacts.

Drugs associated with gingival overgrowth fall into three broad categories - anticonvulsants, immune suppressants and calcium channel blockers. Amlodipine is a third-generation dihydropyridine. The prevalence of amlodipine-induced gingival hyperplasia is 4.2%. We report two patients with the amlodipine-induced gingival hyperplasia. [ABSTRACT FROM AUTHOR]

Even though a small number of published single patient reports have more recently reported pulmonary cavitation in COVID-19 disease, it is still considered a rare radiology feature. We report a 45-year-old man with COVID 19 disease and a pulmonary cavity. [ABSTRACT FROM AUTHOR]

Background: The Incidence of Poisoning Is Constantly On The Rise In The Modern World With A Gradual Shift Towards The Use of Agricultural Poisons In Suicides With Majority of Cases Using Organophosphate Compounds And In India The Incidence of Ingested Suicidal Poisoning Is High Especially In The Southern States. This Study Is Undertaken With A View To Asses If There Is Any Correlation Between Plasma Levels of Pseudocholinesterase and mortality in cases of acute organophosphate poisoning. Method: The study was conducted on patients of organophosphate poisoning admitted to Bapuji Hospital (J.J.M. Medical College), Davangere during a period of October 2011 to March 2013. Total number of cases studied were 150. Detailed history was obtained regarding the amount of poison, type of poison, quantity of poison, etc from the patient and his/her relatives as well from the police. Clinical examination of each patient was carried out and according to signs and symptoms, the patients were grouped into 3 grades, mild, moderate and severe according to Dreisbach's criteria. At the time of admission pseudocholinesterase was measured. All patients were followed-up for 3 days to know the outcome and results were compared and analysed. Conclusion: Our study concludes that there is a very good correlation between the levels of plasma pseudocholinesterase and mortality as well as morbidity [ABSTRACT FROM AUTHOR]

Background: Compared to the developed world, the pattern of acute kidney injury (AKI) is different in tropics. The present study was undertaken to study the epidemiological profile and outcomes in AKI. Methods: This prospective observational study was conducted in a tertiary care teaching hospital in South India. Demographic details, detailed medical history, aetiological factors, comorbid conditions, prognostic factors and outcomes were studied. Acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated at admission for every patient to know the prognosis. Results: A total of 193 patients who fulfilled the inclusion criteria were enrolled in the study. Majority of the patients were in their sixth decade of life. The mean age was 52.1 ± 14.8 years (male:female = 1.7:1). Hypertension (41.5%; n = 80) and diabetes mellitus (33.7%; n = 65) were the most common comorbid illnesses in our patients. The average duration of hospital stay was 8 days. AKI was secondary to medical causes in 69.4% (134/193), surgical causes in 25.4% (49/193) and obstetric is 5.18% (10/193). Renal replacement therapy was required in 56.4% (n = 109) of the study population. The mortality rate observed in our study was 21.8% (n = 42). The mean APACHE II score and mean SOFA score were found to be significantly higher in the non survivors compared to the survivors. Conclusions: Patients with AKI who have higher APACHE II or SOFA score should be carefully monitored and aggressively treated to reduce mortality. [ABSTRACT FROM AUTHOR]

Fungal infections account for 5% of all infections in renal transplant recipients. Mucormycosis has emerged as an important invasive fungal infection in transplant recipients associated with aggressive clinical course and substantial rates of death. A 28-year-old male with chronic kidney disease underwent renal transplantation from a deceased brain-dead donor. Implantation kidney biopsy showed features of acute tubular necrosis. On follow-up, the patient had progressive renal failure. The patient expired 3 months after transplantation due to sepsis with refractory shock. Postmortem needle biopsy done on the liver showed areas of necrosis with broad, aseptate filamentous fungal hyphae stained positive with Gomori methenamine silver stain favoring mucormycosis. Mucormycosis is a fatal mycosis in transplant recipient due to its angiophilic and thrombosis/hemorrhage-oriented characteristics. The overall mortality rate among solid-organ transplant recipients with mucormycosis is 38%-48%. Early detection and appropriate timely management of fungal infections play a decisive role in improving the survival and reducing the mortality. [ABSTRACT FROM AUTHOR]

The pleiotropic cytokine osteopontin (OPN) is found to be involved in the pathogenesis of both kidney and cardiovascular disease (CVD). We evaluated the relationship between OPN, other cardiovascular risk factors and carotid intima-media thickness (CIMT) in chronic kidney disease (CKD) (predialysis) patients. This is a 2-year cross-sectional prospective study involving 75 patients with CKD from stage 1 to stage 5 attending the nephrology outpatient department and 25 healthy controls. Routine biochemical parameters were analyzed on clinical chemistry Autoanalyzer Beckman Coulter DXC 600 Synchron, USA. OPN was estimated by ELISA method. Carotid intima-media wall thickness was estimated by Doppler of carotid vessels. Serum OPN and other nontraditional cardiovascular risk factors such as CIMT, lipoprotein (a) Lp(a), fibrinogen, and homocysteine were significantly increased in patients of CKD compared to controls. OPN, Lp(a), fibrinogen, CIMT, parathyroid hormone, and homocysteine progressively increased from early stages of CKD and increased further with progression of the disease, but nitric oxide (NO) level progressively decreased with progression of CKD. OPN showed a positive correlation with CIMT, Lp(a), fibrinogen, and homocysteine and negative correlation with estimated glomerular filtration rate and NO. There was a close direct association between circulating levels of OPN and the presence of atherosclerotic plaques in carotid arteries of patients with CKD. Osteopontin and nontraditional CVD risk factors are altered in early stages of CKD and might predict adverse outcomes in these patients. [ABSTRACT FROM AUTHOR]

Scrub typhus caused by organism Orientia tsutsugamushi and transmitted to humans by the bite of a leptotrombidium mite (chigger). Although eschar formation is one of the important signs that aid in diagnosis, multiple eschar formation is a rare presentation. Although scrub typhus causes multiple organ dysfunction, the pancreas involvement is rare. Here, we describe a patient with scrub typhus with multiple eschars complicated with acute pancreatitis and acute kidney injury. [ABSTRACT FROM AUTHOR]

Fungal infections are a common cause of morbidity and mortality among patients on continuous ambulatory peritoneal dialysis (CAPD). We present the clinical manifestations, and management of five CAPD patients with fungal peritonitis seen during the last seven years. Microscopy and culture of the peritoneal fluid tested positive for fungus in all patients. Filamentous fungi were identified as the causative fungi among four patients and Candida nonalbicans was the cause in one patient. Catheter was removed and appropriate antifungal therapy was given to all the patients. Four patients recovered and one died due to ventilator associated infection. Previously treated bacterial infections, old age more than 50 years, diabetes and hypertension were recognised as the risk factors leading to fungal infection among CAPD patients. [ABSTRACT FROM AUTHOR]

In the ISN/RPS 2003 classification of lupus nephritis (LN) renal vascular lesions are not mentioned. We present a patient with postpartum lupus vasculopathy. The renal biopsy in our patient showed concentric intimal thickening with narrowed lumen. No inflammatory changes were found. It also revealed immunoglobulin and complement deposition on the wall of the arteriole. These changes indicate lupus vasculopathy. The glomeruli revealed diffuse proliferative glomerulonephritis, with wire loops and cellular crescent in one glomerulus. The patient showed improvement with immunosuppression. [ABSTRACT FROM AUTHOR]

Strongyloides stercoralis, an intestinal parasitic nematode, infects more than 100 million people worldwide. Strongyloides are unique in their ability to exist as a free-living and autoinfective cycle. Strongyloidiasis infection usually remains asymptomatic, but in immunocompromised hosts hyperinfection and dissemination can occur, which has a high mortality. We report a 30-year-old male patient with membranous nephropathy who was receiving oral corticosteroids and cyclophosphamide who presented with disseminated strongyloidiasis. Larvae of S. stercoralis were isolated from the stool and the sputum specimens. Seven days later despite anti-helminthic therapy and intensive care support the patient died. Early detection and diagnosis of this condition is based on a high index of clinical suspicion, especially in immunocompromised hosts. Screening for Strongyloidiasis infection before the initiation of immunosuppressive therapy can be considered. [ABSTRACT FROM AUTHOR]

The literature, particularly from India, is scarce on the renal effects of glyphosate poisoning. Glyphosate causes toxicity not only after its ingestion but also after dermal exposure by inhalation route and on eye exposure. We present a patient report of glyphosate consumption which resulted in toxic epidermal necrolysis - the first report after glyphosate consumption and acute kidney injury. [ABSTRACT FROM AUTHOR]

The article offers information on the chemical protective clothing for individuals who deal with chemicals. It is stated that industries should provide chemical protective clothing to ensure the safety of employers who work with potentially hazardous chemicals. It discusses various levels chemical protective clothing and the chemical protective fabrics containing electrometric barriers.

Nephropathy is an important and a frequent complication of long-term type II diabetic nephropathy. Strong evidence exists that genetic predisposition plays a major role in the development of diabetic nephropathy. Recent studies have implicated association between angiotensin converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and nephropathy. The deletion gene polymorphism of ACE gene has been shown to be associated with increased activity of this enzyme. This study examines the association of ACE I/D polymorphism with type II diabetes without nephropathy in 30 patients and type II diabetes with nephropathy in 30 patients. The results of the study suggest the association between the DD polymorphism and type II diabetes with nephropathy. [ABSTRACT FROM AUTHOR]

Granular piles can resist only compressive and shear loads owing to their inherent nature. By a simple modification of providing a pedestal/geogrid at the bottom and attaching a cable to the same, they are made to resist pullout/uplift forces. This paper presents an analysis of granular pile anchor (GPA), considering it and the in situ soil to behave linearly and the in situ ground to be semi-infinite. A parametric study presents results in the form of variations of normalised shear stress, displacement influence coefficient and axial uplift force with depth with relative stiffness factor. Two methods for the estimation of deformation moduli of the GPA and the in situ soil are proposed. Based on the estimated values of the moduli, the displacements of GPA were estimated and the results compared with test results of Kumar (2002). The predicted displacements compare well with the measured ones. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is associated with a higher risk for stroke in studies from developed countries. This prospective study was conducted to study the clinical profile, management, and outcome of stroke in patients of chronic kidney disease who had been admitted in our institute during the period from December 2004 to December 2006. A higher incidence of stroke was found in men and in the fifth decade of life. Hypertension and diabetes were found in 88.8 and 48.1% of the patients respectively. CKD was detected for the first time during stroke evaluation in 55.5% of the patients. Stroke was due to cerebral infarction in 48.14% and due to cerebral hemorrhage in 40.7% of the patients. Surgical intervention was needed in 14.8% of all patients while stroke was managed medically in the rest. Over 70% of the patients were discharged after they showed improvement in the symptoms. [ABSTRACT FROM AUTHOR]

The author discuss a case of a 15-year-old girl who presented with weakness of both lower limbs, sensory loss below costal margin, and bladder disturbances, and loss of vision in the left eye for 3 months with past history of similar illness. On examination she was diagnosed with Devic's neuromyelitis optica (NMO), an inflammatory disease characterized by severe attacks of optic neuritis and myelitis. She was given five sessions of plasma exchange on alternate days after which she recovered.

Accelerated atherosclerosis and cardiovascular disease are major causes of morbidity and mortality in patients of end-stage renal disease. Carotid intima media thickness is taken as a useful surrogate marker of atherosclerosis. Thirty end-stage renal disease (ESRD) patients were subjected to ultrasonography to study CIMT before the initiation of dialysis. CIMT was found to be higher in ESRD patients than in controls. Levels of a serum marker of oxidative stress were also found to be higher in patients than in the controls. CIMT is an easy, noninvasive, reproducible, and cost-effective investigation in patients with chronic renal failure. [ABSTRACT FROM AUTHOR]

Leptospirosis is an important zoonosis with a worldwide distribution that is characterized by a broad spectrum of clinical manifestations ranging from inapparent infection to fulminant disease. The presentation of paraparesis in combination with acute renal failure is rare. [ABSTRACT FROM AUTHOR]

Fournier's gangrene is an uncommon infection of the genital, perineal and perianal regions. The infection is both dramatic in nature and highly lethal in course. The mortality of the disease is high, despite the advancements in management. Multiorgan dysfunction is one of the predictors of severity and mortality of the disease. The association of acute renal failure and Fournier's gangrene is not often discussed; hence, this study is being presented. This study comprised of six patients presented with Fournier gangrene and associated acute renal failure. [ABSTRACT FROM AUTHOR]