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The world over energy resources are getting scarcer and increasingly exorbitant with time. In India bridging the ever- widening gap between energy demand and supply by increasing supply is an expensive option. The share of energy costs in total production costs can, therefore improve profit levels in all the industries. Thermal Power Plant is a major source of electricity production by coal. We will understand the overview of Thermal Power Plant i.e its parts such as boiler, turbine etc. Overview of Thermal Power Plant is very important for its better functioning and for its maintenance. The satisfactory design consist of selection of sites; estimation of cost; selection of Boiler, Turbine, Electrical Generator, Cooling System. The Transportation of electrical energy is more economical to the transportation of coal. So, we have to put greater efforts on thermal power plant as it is very economical for us. This reduction can be achieved by improving the efficiency of industrial operations and equipments. Energy plays an important role in identifying energy conservation opportunities in the industrial sector, while they do not provide the final answer to the problem; they do help to identify potential for energy conservation and induces the companies to concentrate their efforts in this area in a focused manner. [ABSTRACT FROM AUTHOR]

Technology evolves on a daily basis, resulting in a constant stream of fresh grounds for action. Due to the country's cost competitiveness and natural advantage, business has become global. The slogan of contemporary business is interdependence. E-commerce is a sort of business model in which the exchange of products and services, as well as the transmission of payments, data, and conditions of sale, takes place via an electronic network. Today, E-commerce offers huge prospects in a variety of industries. The widespread usage of ICT has paved the way for new corporate advancements. Due to its 24-hour accessibility, worldwide accessibility, and typically excellent customer service, e-business retail is undoubtedly handy. Its development would be heavily reliant on strong IT security systems, for which the required technical and legislative measures must be implemented on a continuous basis and reinforced as needed. Companies, organizations, and communities in India are starting to realize the promise of e-commerce; nevertheless, significant difficulties must be solved before e-commerce can become a useful tool for the general public. It is stated that e-Business is created by, by, and for the people. The intricacy of e-rising commerce's role and its numerous elements are discussed in this study. The study analyses contrasts conventional and electronic commerce. It recognizes the advantages while also recognizing the drawbacks. Discuss its influence, as well as the concerns and restrictions, challenges, and possibilities that it presents in the current e-world. [ABSTRACT FROM AUTHOR]

Introduction: In this paper, we introduce geographical information systems (GIS) as a tool to study trends in disease spread in time and space. Based on data gathered by the integrated disease surveillance programme (IDSP), we can see where outbreaks of Chickenpox have occurred. Objective: The aim of this study is to assess the trends in chickenpox diseases in India between January 2015 and April 2021 using GIS maps. Methods: For the collection of secondary data relating to chickenpox, a free app called collect 5 was used for collecting data weekly from the IDSP website and then storing them in an online server. In this project, variables that needed to be processed with QGIS were combined with table attributes of many shapefiles of India and presented as maps. Results: Between Jan 2015 and May 2021, 1269 chickenpox outbreaks (27,257 cases) have been recorded. Thirty-one deaths have been confirmed, with most occurring in Bihar and Uttar Pradesh. Nineteen states did not report any deaths. According to the seasonally adjusted trend, the number of cases was highest during the months of January and March. Conclusion: In summary, geographic information systems have become an invaluable tool for mapping the hotspots of acute epidemics and planning public health interventions to prevent the spread of these diseases. [ABSTRACT FROM AUTHOR]

Aim: To estimate the comprehensive healthcare costs of heart failure (HF) and determine the utilization of healthcare resources (HRU) for 2 years following index hospitalization. Subjects and methods: The Manipal Heart Failure Registry (MHFR) is a prospective registry analyzing the financial burden and HRU in 610 patients with HF. Costs incurred by patients during 2 years following index hospitalization were estimated, and their association with socio-demographic and clinical factors were calculated. After 54 (8.8%) in-hospital mortalities, 556 patients were followed up for 2 years. Results: The mean age of the study cohort was 65.08 ± 13.6 years, and 245 (40.2%) were females. Based on the ejection fraction (EF), 506 (82.9%) patients were diagnosed as having HF with reduced EF. Average hospital stay during index admission was 5.3 ± 2.9 days. Total expenditure during index hospitalization was INR 36.3 million and during 2-year follow-up was INR 45.2 million. Average total expenditure per patient was INR 133,663. The average out-of-pocket expense was INR 82,766 and average health insurance coverage was INR 50,896. Difference in expenditure was significant (P < 0.05) between specific groups, i.e., etiologies, genders, HF phenotypes, age groups, and healthcare insurance types. Conclusion: Healthcare expenditure of patients with HF in India is much lower than for the western counterparts. Higher utilization of healthcare resources in HF patients with ischemic etiology, non-compliant to medications, and elderly (age > 60 years) was associated with increased expenses. Interventional procedures and implantations account for the bulk of the expenses in ischemic HF patients. Trial registration number: Clinical Trial Registry of India: CTRI/2017/11/010395; National Institute of Health (NIH) clinical trial no.: NCT03157219. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. Methods: This is a prospective observational study conducted on patients with SARS-Co-V-2 infection, at a dedicated tertiary COVID-19 hospital in South India from April 1 to July 31, 2020. At the time of their admission to the COVID hospital, demographic data such as name, age, sex was recorded. A thorough history regarding the onset, duration, progression, nature of symptoms and its associated factors, medication history, treatment history were elicited and documented. Ocular examination was performed under torchlight by an ophthalmologist posted for COVID duty. Further investigations including imaging were sought for, depending on clinical indications. Serial follow-up examinations of all patients were carried out every 72 hours or when patients complained of any ocular symptoms whichever earlier, until discharge. All relevant data were compiled and statistically analyzed. Results: A total of 2742 patients were examined. Of them, 1461 (53.28%) were males and 1281 (46.72%) were females. The mean age (±SD) was 39.46 ± 17.63 years. None of the patients in our study had any ocular symptoms or signs as the presenting complaint at the time of their admission. On subsequent follow-up, only 20 (0.72%) developed ocular manifestations, of which 19 (95%) had features suggestive of Bilateral viral conjunctivitis. However, 1 (5%) patient had orbital cellulitis secondary to pansinusitis. Conclusion: Ophthalmic manifestations in the clinical spectrum of COVID-19 infection are uncommon and unlikely to be the presenting clinical impression. However, it has broadened our view to a wider spectrum of COVID-19 presentations enhancing our clinical acumen for staunch detection of COVID-19 suspects in our daily practice, augmenting early diagnosis and management and also break the chain of transmission for the greater good of humanity. [ABSTRACT FROM AUTHOR]

In the aftermath of resistance of Bt cotton to pink bollworm in many parts of India, alternative control strategies should be worked out apart from the traditional chemical control. Use of pheromones for mass trapping and mating disruption is gaining importance worldwide rather than monitoring for pink bollworm. In present study, the field efficacy of novel pheromone formulation against pink bollworm through mating disruption techniquein BG II cotton was evaluated in a large blocks of 12 ha each during summer 2016-17 at four different locations. The SPLAT formulation @ 125 g/acre was used thrice starting from 45 DAS onwards during crop growth period which was distributed uniformly on 200 plants/acre. The male moth catch, larval density and locule damage in green bolls was reduced by 86.72%, 62.03% and 74.21%, respectively and seed cotton yield was increased by 16.89% in SPLAT treated fields when compared to insecticide treated control fields. Results showed that the SPLAT, a novel slow and sustainable pheromone release formulation is effective in reducing the incidence and damage by pink bollworm through mating disruption technique in Bt cotton. [ABSTRACT FROM AUTHOR]

Introduction: Tacrolimus blood levels are influenced by polymorphisms involving Cytochrome 3A subfamily (CYP3A5) and P-Glycoprotein (ABCB-1) genes. However, their role in transplant outcomes was less studied in South Indian population. We studied the prevalence and impact of these polymorphisms in renal transplant recipients from South India. Methods: An analysis of CYP3A5, ABCB1 genotype done in 101 renal transplant recipients by polymerase chain reaction was correlated with blood tacrolimus trough levels (CLIA method), weight, concentration/dose (L/D) ratio, incidence of biopsy proven early acute rejections, and tacrolimus toxicity. Results: Prevalence of CYP3A5*1/*1, *1/*3 and *3/*3 and ABCB1 (3435C>T) TT, CT, CC genotypes were 12 (11.9%), 48 (47.5%), 41 (40.6%) and 16 (15.8%), 45 (44.6%), 40 (39.6%), respectively. Mean tacrolimus level, median concentration/dose (L/D) ratio were significantly lower in homozygous (CYP3A5*1/*1-6.01 ng/mL; 48.99 ng/mL/mg/kg/day) and heterozygous expresser group (CYP3A5*1/*3-5.84 ng/mL; 68.93 ng/mL/mg/kg/day) when compared with nonexpresser group [CYP3A5*3/*3-7.46 ng/mL (P < 0.001);181.3 ng/mL/mg/kg/day (P < 0.05]. No significant differences observed between the ABCB1 genotypic groups. Incidence of early acute rejections (30% vs. 9.76%; P 0.016) and tacrolimus-related toxicity (14.6% vs. 5%; P 0.039) were significantly higher in CYP3A5 expressers and nonexpressers, respectively. No correlation observed between the ABCB1 polymorphisms between rejection episodes or tacrolimus renal toxicity. Among 101 patients, 40.6% were non-expressers (poor metabolizers) (*3/*3). Conclusions: CYP3A5 polymorphisms correlated with tacrolimus dose requirements and blood levels, incidence of early acute rejection, and tacrolimus nephrotoxicity. CYP3A5 polymorphism analysis prior to renal transplant will aid more precise early tacrolimus dose calculation to balance between rejection and toxicity. [ABSTRACT FROM AUTHOR]

Natural gas hydrates are considered as a strategic unconventional clean hydrocarbon resource in the energy sector. This paper analyzes the spatiotemporal effectiveness of the depressurization technique for producing methane gas from an unconfined Class 4 clayey setting in the Krishna Godavari (KG) basin, east coast of India. The production potential of a well by depressurization based on the borehole-based pumping technique is modeled using the newly developed spatiotemporal numerical tool, IndHyd 1.0, built using MATLAB for a constant borehole ΔP. The model is aided by TOUGH+HYDRATE reservoir production simulation software. From the IndHyd 1.0 simulation results, it is identified that a vertical well in the location NGHP-01-10D could have a lateral well reach, longevity, and a cumulative methane gas production potential of 145 m, 1.2 years, and ∼0.6 billion m3, respectively. For the formation with a postdissociation permeability of 200 mD, a possible scenario in the fractured settings, the well reach, longevity, and gas production potential could be 340 m, 3.6 years, and ∼9 billion m3, respectively. [ABSTRACT FROM AUTHOR]

The large-scale land conversions to urban impervious surfaces, loss of lakes and occupation of floodplains, have resulted in many problems like urban heat island, depletion of the ground water and more importantly flash floods. The impervious surfaces of urbanization led to accelerated run-off and reduced recharge. Currently, around 280 locations are vulnerable to flash floods in the Bangalore city of India. The dumping of solid waste, laying of cables in the channels, under-potential culverts and allotment of the floodplain for housing purposes has developed vulnerability to frequent flooding. Increased urbanization with intensified vertical growth of the city has led to the liquid waste disposal along the storm water drains making the run-off models unpredictable. The breach of lake embankments and overflowing lakes at the initial monsoon rains is the popular phenomenon as the lakes are silted and saturated with sewage. Efforts of revival of some lakes and desilting storm water drains have not improved the overall circumstance. Floods are reported even in short rainfall of 30 mm per hour. Adoption of the dual piping system to carry the wastewater and the rainwater would make restoration more meaningful. Multiple criteria evaluation of spatial layers in GIS environs provides a better assessment of vulnerable flash flood regions. For strategic plans, results from this investigation intuit in building a self-sufficient eco-friendly sustainable smart city that conserves the rainwater and avoid flooding in low-lying regions. The outcomes of the study guide in developing proper structures to the present urban situation, thereby implementing sustainable alternative development. [ABSTRACT FROM AUTHOR]

This paper analyses the effectiveness of the depressurization technique for methane gas production from an unconfined gas hydrate setting in the Krishna Godavari Basin of India. TOUGH + HYDRATE reservoir modeling and production simulation software is used for identifying the depressurization range for sustained dissociation. For the identified depressurization range, a borehole based pumping technique is modeled using MATLAB software, to identify the effectiveness of the technique in dissociating the reservoir with post-dissociation permeability (PDP) ranging between 1 and 500 mD, the likely scenario for the KG basin. The results indicate that the depressurization technique shall be effective for reservoirs with higher PDP, while the reach of the bore well depends on the capacity of the pump and hydrate zone well perforation area. The simulation results indicate that a bore well with 50 m 2 of hydrate zone surface area could be effective in dissociating the reservoir up to a distance of 1000 m, with a pump of 128 kW electric capacities in formations with PDP of 500 mD. The results could serve as a basis for the economic planning of production wells in gas hydrate reservoirs. [ABSTRACT FROM AUTHOR]

Pregnancy-associated acute kidney injury (PAKI) is encountered frequently in developing countries. We evaluated the maternal, fetal and renal outcomes in women with PAKI who needed at least one session of dialysis. Of the total of 98 cases (mean age 28.85 ± 5.13 years; mean parity 2.65 ± 1.28) of PAKI, the most common cause of PAKI was postabortal sepsis. Eighteen patients died; those with oligoanuria, sepsis and central nervous system (CNS) involvement were at greater risk of mortality. The relative risk (RR) of neonatal mortality was lower after with full‑term delivery (RR: 0.17, 95% confidence interval (CI): 0.03-0.96, P = 0.02) compared to preterm delivery. Of the 80 surviving patients, 60 (75%) patients achieved complete recovery of renal function at the end of 3 months; and of the remaining 14 had presumed (n = 4) or, biopsy-proven (n = 10) acute patchy cortical necrosis. The RR of non-recovery of renal function was high (RR: 24.7, 95% CI: 3.4- 179.5) in patients who did not recover at 6 weeks. Of the 14 patients with cortical necrosis, 3 (21.42%) became independent of dialysis at 6 months. PAKI patients should be watched for dialysis independency for 6 months. [ABSTRACT FROM AUTHOR]

We evaluated whether polymorphisms in interleukin (IL‑1) gene cluster (IL‑1 alpha [IL‑1A], IL‑1 beta [IL‑1B], and IL‑1 receptor antagonist [IL‑1RN]) are associated with end stage renal disease (ESRD). A total of 258 ESRD patients and 569 ethnicity matched controls were examined for IL‑1 gene cluster. These were genotyped for five single‑nucleotide gene polymorphisms in the IL‑1A, IL‑1B and IL‑1RN genes and a variable number of tandem repeats (VNTR) in the IL‑1RN. The IL‑1B − 3953 and IL‑1RN + 8006 polymorphism frequencies were significantly different between the two groups. At IL‑1B, the T allele of − 3953C/T was increased among ESRD (P = 0.0001). A logistic regression model demonstrated that two repeat (240 base pair [bp]) of the IL‑1Ra VNTR polymorphism was associated with ESRD (P = 0.0001). The C/C/C/C/C/1 haplotype was more prevalent in ESRD = 0.007). No linkage disequilibrium (LD) was observed between six loci of IL‑1 gene. We further conducted a meta‑analysis of existing studies and found that there is a strong association of IL‑1 RN VNTR 86 bp repeat polymorphism with susceptibility to ESRD (odds ratio = 2.04, 95% confidence interval = 1.48-2.82; P = 0.000). IL‑1B − 5887, +8006 and the IL‑1RN VNTR polymorphisms have been implicated as potential risk factors for ESRD. The meta‑analysis showed a strong association of IL‑1RN 86 bp VNTR polymorphism with susceptibility to ESRD. [ABSTRACT FROM AUTHOR]

Idiopathic minimal change disease is a disorder of T‑cell dysfunction. The relative predominance of regulatory T cells (Tregs), Th1, and Th2 cells in nephrotic syndrome (NS) remains controversial. Imbalance in peripheral blood regulatory and effector T cells (Teff) are linked to cell mediated immune response and may be associated with steroid response in NS. Peripheral blood CD4 + CD25 + FoxP3 + (Tregs), CD4 + IFN‑γ+ (Th1), and CD4 + IL‑4 + (Th2) lymphocytes were analyzed in 22 steroid‑sensitive NS (SSNS) patients in sustained remission, 21 steroid‑resistant NS (SRNS) and 14 healthy controls. The absolute percentage values and ratio of Th1/Tregs, Th2/Tregs, and Th1/Th2 were compared between SSNS, SRNS and control subjects. The percentage of Tregs was lower in SRNS patients (P = 0.001) compared with that of SSNS and healthy control. The percentage of Th1 cells was higher in SRNS (P = 0.001) compared to that of SSNS patients; however, it was similar to healthy controls (P = 1.00). The percentage of Th2 cells in SRNS (P = 0.001) was higher as compared to SSNS and controls. The ratio of Th1/Treg cells in SRNS (P = 0.001) was higher as compared to SSNS patients and controls. The ratio of Th2/Treg was also higher in SRNS as compared to SSNS and controls. The ratio of Th1/Th2 cells in SSNS, SRNS, and healthy controls were similar. The cytokines secretion complemented the change in different T‑cell subtypes in SSNS, SRNS and healthy controls. However, the IFN-γ secretion in healthy controles was low inspite of similar percentage of Th1 cells among SRNS cases. We conclude that greater ratio of Tregs compared to that Th1 and Th2 favor steroid sensitivity and reverse ratio results in to SRNS. The difference in ratio is related to pathogenesis or it can be used as marker to predict steroid responsiveness needs further evaluation. [ABSTRACT FROM AUTHOR]

Background Radiofrequency-induced heat therapy (RFHT) has been found to be safe and effective against cutaneous leishmaniasis (CL) in the short term, but its long-term efficacy is unclear. Objectives To compare the long-term efficacy of RFHT vs. intralesional sodium stibogluconate (SSG) injections in the treatment of CL in India. Methods One hundred patients with a confirmed diagnosis of CL were randomly assigned in a 1 : 1 ratio to receive topical RFHT for 30-60 s or seven intralesional injections of SSG (50 mg cm−2 of lesion). Improvement and recurrence were monitored every 15 days after the initiation of treatment for 4 months and then at 5, 6, 9, 12 and 18 months post-treatment; the rates of complete cure were compared. Results Lesions were healed in 47 out of 50 patients (94%) in the RFHT group and in 46 out of 50 patients (92%) in the SSG group at week 12. Time to complete healing was comparable in the two groups. At 6 months post-treatment, cure rates in the RFHT and SSG groups were 98% [95% confidence interval (CI) 94-100%] and 94% (95% CI 86-100%), respectively. Age, sex and lesion size or number had no effect on cure rates. No relapse of infection was recorded in cured patients in either group up to 12-18 months after initiation of treatment. Skin biopsies of cured lesions in eight out of eight (100%) patients from the RFHT group and three of three from the SSG group at 12 months showed minimal fibrosis and were negative for Leishmania tropica by polymerase chain reaction test. Conclusions A single application of RFHT is safe, cosmetically acceptable and effective in inducing a long-term cure of CL. [ABSTRACT FROM AUTHOR]

The genus Poecilotheria is known to occur only in India and Sri Lanka. The genus is represented by 8 species in India and 7 in Sri Lanka. Since August 2011 onwards, we are carrying out a detailed biodiversity inventory of the Seshachalam Biosphere Reserve in Chittoor and Kadapa districts, Andhra Pradesh. During one of our biodiversity surveys we sighted a dead specimen of Theraphosid spider in Kapilatheertham, forest complex (13°34'N; 79°21' E) of Seshachalam Biosphere Reserve on 29th January 2013. Poecilotheria metallica is ranked by the IUCN as Critically Endangered. Further research with reference to ecology, threats and conservation of biodiversity in the area is in progress. So far many rare species recorded in this area, the present record reveal that the area is very rich in biodiversity and there is an urgent need to adapt conservation policies. [ABSTRACT FROM AUTHOR]

The results of radon concentration measurements carried out in dwellings with natural ventilation for 1 y in Bangalore are reported. Measurements, covering three sessions of the day (morning, afternoon, night) were performed two times in a month for 1 y at a fixed place of each dwelling at a height of 1 m above the ground surface in selected dwellings. The low-level radon detection system (LLRDS), an active method, was used for the estimation of radon concentration. The measurements were aimed to understand the diurnal variation and the effect of ventilation rate and flooring type on indoor radon concentration. The geometric mean (± geometric standard deviation) of indoor radon concentration from about 500 measurements carried out in 20 dwellings is found to be 25.4 ± 1.54 Bq m−3. The morning, afternoon and night averages were found to be 42.6 ± 2.05, 15.3 ± 2.18 and 28.5 ± 2.2 Bq m−3, respectively. The approximate natural ventilation rates of the dwellings were calculated using the PHPAIDA—the on-line natural ventilation, mixed mode and air infiltration rate calculation algorithm and their effects on indoor radon concentrations were studied. The inhalation dose and the lung cancer risk due to indoor radon exposure were found to be 0.66 mSv y−1 and 11.9 per 106 persons, respectively. The gamma exposure rate was also measured in all the dwellings and its correlation with the inhalation dose rate was studied. [ABSTRACT FROM PUBLISHER]

Background Cutaneous leishmaniasis (CL) is caused by Leishmania major and L. tropica in the old world. Bikaner, the 'Thar Desert', situated in the north-western corner of India, is an endemic pocket for CL caused by L. tropica. Skin lesions of CL heal slowly, causing disfiguring scars if remaining untreated. Current recommended treatment for CL comprises systemic administration of sodium stibogluconate (SSG) for 2-3 weeks. Five to seven injections of SSG intralesionally have also been found to be effective. Objectives To determine the efficacy of a short-duration, twice-weekly intralesional SSG treatment for CL. Methods Two hundred and twenty patients with CL having 298 lesions were included in the present study. They were divided into groups A and B (110 patients each). Patients were treated with five to seven intralesional injections of SSG in doses of 50 mg cm−2 of lesion either once (group A) or twice (group B) weekly. Improvement was recorded at 6, 8, 10, 12, 16, 20 and 24 weeks and the rate of complete cure was compared. Results Complete cure rate at 6, 8 and 10 weeks was higher (20%, 57% and 73%, respectively) in group B as compared with group A (12%, 36% and 62%, respectively). The differences in cure rates at these time points were statistically significant ( P < 0·05). The complete cure rate at 24 weeks was similar in both groups (96% in group B and 92% in group A). The remaining 4% and 8% of patients in groups B and A were 'nonresponders', respectively. No major side-effects were observed in either group. In all cured cases, there were no relapses reported up to 2 years after treatment. Conclusions A short-duration, twice-weekly intralesional SSG treatment for CL accelerates cure and is highly effective and well tolerated. [ABSTRACT FROM AUTHOR]

A five-year-old girl child presented to us with a history of two weeks high grade fever treated outside with intensive antibiotic therapy for an ultrasound abdomen finding of hypoechoic lesion in the midpole of the left kidney. As fever and sonographic findings persisted, a CT abdomen was done, which showed features of lobar nephronia but reported as Wilm's tumor. Child underwent open biopsy and the diagnosis of lobar nephronia was confirmed. Child was continued on antibiotics and fever and sonographic findings improved. [ABSTRACT FROM AUTHOR]

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The concentration of radon daughters in outdoor air was measured continuously from January 2006 to December 2006 near the Department of Physics, Bangalore University campus, Bangalore. The concentration was measured by collecting air samples at a height of 1 m above the ground level on a glass micro fibre filter paper with a known air flow rate. The results show that the radon progeny concentration exhibits distinct seasonal and diurnal variations that are predominantly caused by changes in the temperature gradient at the soil-atmosphere interface. The concentration was found to be high from 20.00 to 8.00 hrs, when the turbulence mixing was minimum and low during the rest of the time. In terms of the monthly concentration, January was found to be the highest with September/August being the lowest. The diurnal variations in the concentrations of radon progeny were found to exhibit positive correlation with the relative humidity and anti-correlation with the atmospheric temperature. From the measured concentration, an attempt was made to establish the annual effective dose to the general public of the region and was found to be 0.085 mSv/a. In addition, an attempt was also made for the first time to study the variation of inhalation dose with respect to the physical activity levels. Results show that in the light of both the effect of chemical pollutants and radiation dose due to inhalation of radon daughters, evening jogging is advisable. [ABSTRACT FROM AUTHOR]

This paper discusses the concentrations of natural radionuclides in soil in Bangalore, India. The authors measured the concentrations of Radium, Thorium and Potassium isotopes by gamma ray spectrometry. They also measure the absorbed dose rates in air and estimated radium equivalent activity, annual effective dose rate, external and internal hazard indices. They compared these levels with published worldwide values and found that the overall mean values were similar. They concluded that the annual effective dose to the general population and hazard indices were comparable to other normal background regions of India and the world.

Over half of the people affected by leprosy worldwide are in India, many of whom are severely disabled when they present for care. Changes in policy and the integration of the leprosy programme with general health services has given rise to new challenges for the control of blinding eye disease in leprosy patients. This paper looks at the challenges posed: management, materials, manpower, money, and mobility – all of which are common barriers to the availability, access, and utilization of services – and to monitoring existing programmes. We consider strategies to overcome these challenges and fulfill the goal of VISION 2020 – eliminating avoidable blindness – through the provision of comprehensive eye care and strengthening the existing infrastructure. Formal cooperation between national governments, non-governmental organisations, and International Development Agencies will need to continue, although possibly, in different roles and with plans modified to be relevant to the local needs of leprosy patients.Journal of Public Health Policy (2007) 28, 456–464. doi:10.1057/palgrave.jphp.3200149 [ABSTRACT FROM AUTHOR]

Potable waters from various locations of the Bangalore environment were investigated for their 222Rn concentrations by the emanometry method. About 94 groundwater (borewell) samples were analysed for 222Rn concentrations and found to vary in the range 5.3–283.4 Bq L-1 with a mean value of 87 Bq L-1. Frequency distribution showed the 222Rn concentration in a large number of samples in the range of 0–50 Bq L-1. From the measured concentrations, the effective doses (lung and stomach) for the population of the region were estimated. The effective dose was found to vary from 42.6 to 2280.2 µSv y-1 with a mean value 702.5 µSv y-1. The effect of boiling of water showed a drastic reduction in the 222Rn concentration. The results of the present investigation are systematically analysed, compared with the literature values and discussed. [ABSTRACT FROM AUTHOR]

Describes the organization of farmers' markets that the state government initiated in Tamil Nadu, South India in 1999. Background on the vegetable markets in the region; Impact of the markets on stakeholder groups; Role of the markets in farmers' marketing strategies.

Introduction: Living kidney donation is a complex psychological experience for donors. The present study examined the psychosocial impact of kidney donation on donors. Methods: The retrospective study included 506 donors who donated a kidney between 2010 and 2018 at a transplant centre in India. These donors responded via a donor insight questionnaire about their hospital anxiety, and their possible level of depression. The information included socio-demographic form with multiple information. The health survey was used periodically evaluate the psychosocial impact among donors following donation, including the transplant outcomes. Results: The majority of donors were females (79.4%). There was a significant improvement in the quality of life among donors (SF-36) following the donation of a kidney, especially among those donors who maintained good graft functions themselves as well as those who were informed about good kidney function in transplanted recipients. These donors showed a lesser degree of depressive and anxiety scores (HAD score 3.5 and BDI II 4.8) than donors who had problems themselves and/or whose donated kidneys did not function well. Most living donors (89.1%) felt that the act of donation had a positive impact on their lives and those donors would encourage others to donate a kidney. Overall, the graft outcomes impacted the donor's state of mind. Conclusion: The study showed a very positive impact of the acknowledgment of the donor by the recipient, especially those donors whose kidney transplants were well functioning. The state of depression, anxiety, and psycho-social outcomes correlated with the graft outcomes. Donors showed positive insight towards donation, with inner conscience still conclusively willing to donate and encourage others. [ABSTRACT FROM AUTHOR]

Gas hydrates are considered to be potential sources of clean energy. Various methods of gas hydrates extraction such as thermal stimulation, depressurization and inhibitor injection have been proposed, but each of them has some advantages and disadvantages depending upon reservoir conditions. This study deals with a production method applicable to the fine-grained clay-rich reservoir conditions in the Krishna–Godhavari (KG) Basin of India, by means of introducing an electrode into a gas hydrate reservoir to confine the energy delivery for dissociation and continue with depressurization for sustained production. The simulation of electrical heating using MATLAB and hydrate dissociation quantification using TOUGH + HYDRATE modeling programs, supported by laboratory studies, indicate that the reservoir temperature can be raised to 21.5 °C in one hour at a distance of 1 m from the electrode. Results indicate that 20.1 m 3 of hydrate-bearing reservoir section with 90% hydrate saturation can be dissociated in 72 h at a given power of 90 kW. The energy balance calculations show that the energy supplied to produce is at the ratio of 1:3.5. To enhance the energy efficiency after 15 h of heating either the input power is increased in incremental stages or thermal stimulation is stopped and extraction is continued with the depressurization technique by pumping out dissociated freshwater from the zone of dissociation within the reservoir at a rate of 144 m 3 /h with a perforated borehole area of 2 m 2 in the reservoir. [ABSTRACT FROM AUTHOR]

Context.-The bones of the hands and feet constitute more than half of the bones in the human skeleton (106/206), but lesions occurring in them are infrequently reported. Although many of the lesions that occur in the rest of the skeletal bones can occur in bones of the hands or feet, their distribution and frequency differ. Objective.-To study lesions involving bones of the hands or feet. Design.-Retrospective study of all lesions involving bones of the hands or feet during the period from January 2000 to September 2006 from a university hospital in southern India. Clinical, radiologic, and pathologic features were reviewed. Results.-The 50 lesions encountered included 23 (46.0%) infections/inflammatory lesions, 16 (32.0%) benign tumors, 6 (12.0%) malignant tumors, and 5 (10.0%) tumorlike lesions. Giant cell tumor was the most common benign tumor. Malignant tumors involved the nonphalangeal bones, with chondrosarcoma the most common. Conclusions.-Lesions of the bones of the hands or feet are uncommon. Awareness and correlation of clinical, radiologic, and pathologic features help in making correct diagnoses. [ABSTRACT FROM AUTHOR]

Introduction: Kidney transplant recipients are at increased risk of opportunistic infections, including Nocardia. The incidence of nocardiosis in kidney transplant recipients is 0.4-1.3%. The data regarding its epidemiology and outcomes is limited., Methods: This was a 10-year retrospective observational study from January 2012 to December 2021 at a tertiary care center in northern India, in which all kidney transplant recipients with Nocardia infection were included and followed., Results: 12 (1.1%) patients had a Nocardia infection among the 1108 kidney transplant recipients. All were living donor kidney transplant recipients, and the mean age at diagnosis was 48.67 ± 12.60 years. Nocardia infection occurred at a median of 26 months (range 4-235) post-transplantation, with 4 (33.1%) of the cases occurring within a year of transplant. Breakthrough infection occurred in 7 (58.3%) patients on cotrimoxazole prophylaxis. 41.7% (n = 5) cases had an episode of rejection in the preceding year of Nocardia diagnosis. Concurrent cytomegalovirus (CMV) infection was present in one (8.3%) case. The lung was the most frequently involved organ. Microscopy was positive in all the cases; while culture was positive in 10 cases, and antimicrobial susceptibility testing (AST) were performed for these isolates. The majority (60%) of isolates were resistant to cotrimoxazole. All tested isolates remained susceptible to Amikacin, Imipenem, and Linezolid. No patients experienced Nocardia recurrence after completion of antibiotic therapy. The mortality at 12 months was 66.7% (n = 4), and only one death was Nocardia-related., Conclusion: Nocardia may cause a late-manifesting infection beyond the traditional window. The cotrimoxazole prophylaxis may not be sufficient for Nocardia prevention., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Rapidly progressive renal failure (RPRF) is not typical of diabetic nephropathy and suggests non-diabetic kidney disease (NDKD). We conducted an analysis of the data of RPRF patients (28 diabetic and 88 non-diabetic patients) with doubled creatinine over 2 weeks to 3 months and/or presented with >4 mg serum creatinine without prior renal disease to ascertain the types of lesions and compare the patients' histopathology. The primary outcome was dependence on dialysis at 1 year. Anti-neutrophilic cytoplasmic antibody-associated pauci-immune glomerulonephritis was the most common cause of RPRF in both groups. No particular lesion was more frequent in either group. Dependence on dialysis at 1 year was similar in both groups and was associated with dependence on dialysis at presentation but not diabetes. Crescentic glomerulonephritis was the most common in non-diabetic patients (57.9 vs. 25%, P = 0.002), and acute tubular necrosis (ATN) was seen in diabetic patients (21.4 vs. 11.4%, P = 0.179). Both factors were associated with adverse renal outcomes. Diffuse global glomerulosclerosis at presentation suggested a poor outcome in both groups. Diabetic nephropathy was seen in 14.29%, and its presence did not affect the outcome. The etiology of RPRF in diabetic patients has changed and is similar to that in non-diabetic patients, with no specific lesions predominating. Diabetic nephropathy does not alter the outcome for those with RPRF. Diffuse global glomerulosclerosis, being on dialysis at presentation, and ATN in a diabetic patient indicate a poor outcome and need close follow-up. Diabetic retinopathy should not prevent us from investigating for NDKD., (Copyright © 2023 Copyright: © 2023 Saudi Journal of Kidney Diseases and Transplantation.)

Introduction: The corticosteroid dosing modulation in renal transplant recipients (RTRs) with coronavirus disease-19 (COVID-19) is not well defined. We aimed to analyze the outcomes and infectious and non-infectious sequelae in RTR with COVID-19 with reference to corticosteroid dosing and the first and second pandemic waves of COVID-19., Materials and Methods: This study included RTRs admitted during two pandemic waves between March 25, 2020, and July 31, 2021. Patients were categorized into mild, moderate, and severe COVID-19. The outcomes and predictors of survival at 4 weeks were analyzed. The survivors were also followed for 6 months and were studied for mortality, readmission rates, and infectious and non-infectious sequelae with reference to high-dose and standard-dose corticosteroids., Results: A total of 251 RTRs, 104 during the first wave and 147 during the second wave, were treated. Overall mortality was 15.1% (11.5% in the first wave vs. 17.5% in the second wave, p = .23). The use of high-dose steroids was also significantly high in non-survivors (85.8% vs. 11.3%, p = .001). On multivariate analysis, the severity of COVID-19, graft dysfunction, and high dose of corticosteroid therapy were associated with increased odds of mortality. Among survivors, 6-month mortality (17.3% vs. 0.5%, p = .001), readmission rate (91.3% vs. 23.7%, p = .001), fungal infection (30.4% vs. 2.2%, p < .001), and post-COVID lung sequelae (21.7% vs. 4.4%, p = .008) were significantly higher in the high-dose corticosteroid group than in the standard-dose group., Conclusion: High-dose corticosteroid dosing in RTRs with COVID-19 was associated with increased infections, particularly fungal infections, and non-infectious sequelae with higher mortality on subsequent follow-up., (© 2022 Wiley Periodicals LLC.)

With increasing urbanisation, the dengue disease burden is on the rise in India, especially in large cities such as Mumbai. Current dengue surveillance in Mumbai includes municipal corporation carrying out specific activities to reduce mosquito breeding sites and the use of insecticides to suppress the adult mosquito populations. Clinical cases remain either underreported or misreported due to the restriction to government clinics, missing the large private health care sector. There is a need for an integrated approach to manage dengue outbreaks in Mumbai. There are various novel strategies available for use that can be utilised to improve disease detection, mosquito surveillance, and control of mosquito-borne diseases. These novel technologies are discussed in this manuscript. Given the complex ecosystem of mosquito-borne diseases in Mumbai, integrating data obtained from these technologies would support the ongoing mosquito control measures in Mumbai.

Introduction: Asymptomatic maintenance hemodialysis patients with acute respiratory corona virus-2 (SARS-COV-2) are missed with pre-dialysis screening without testing. The possible ideal strategy of testing each patient before each shift with reverse transcription polymerase chain reaction (RT-PCR) is not feasible. We aimed to study the effectiveness of fortnightly screening with RT-PCR for SARS-CoV-2 in curbing transmission., Methods: Between July 1, 2020 and September 30, 2020, all 273 patients receiving hemodialysis were subjected to fortnightly testing for SARS-Cov-2 in the unit to detect asymptomatic patients. The cost and effectiveness of universal testing in preventing transmission were analyzed using susceptible-infectious-removed (SIR) modeling assuming R 0 of 2.2., Results: Of 273 MHD patients, 55 (20.1%) found infected with SARS-CoV-2 over 3 months. Six (10.9%) were symptomatic, and 49 (89.1%) asymptomatic at the time of testing. Six (10.9%) asymptomatic patients develop symptoms later, and 43 (78.2%) remained asymptomatic. A total of seven (6.1%) HCWs also tested positive for the virus. Fortnightly universal testing is cost-effective, and SIR modeling proved effective in preventing person-to-person transmission., Conclusions: Repeated universal testing in maintenance hemodialysis patients detected 89% of asymptomatic SARS-CoV-2 patients over 3 months and appeared to be an effective strategy to prevent person-to-person transmission in the dialysis unit., (© 2021 Wiley Periodicals LLC.)

Background: Maintenance hemodialysis (MHD) patients face disadvantages with higher risk of acquiring SARS-CoV-2 infection, atypical manifestations, and associated multiple comorbidities. We describe patients' outcomes with symptomatic COVID-19 on MHD in a large cohort of patients from India., Methods: Data were collected prospectively from hemodialysis units in 11 public and private hospitals between March 15, 2020, and July 31, 2020. The survival determinants were analyzed using stepwise backward elimination cox-regression analysis., Results: Of the 263 total patients (mean age 51.76 ± 13.63 years and males 173) on MHD with symptomatic COVID-19, 35 (13.3%) died. Those who died were older (p = 0.01), had higher frequency of diabetic kidney disease (p = 0.001), comorbidities (p = 0.04), and severe COVID-19 (p = 0.001). Mortality was higher among patients on twice-weekly MHD than thrice-weekly (p = 0.001) and dialysis through central venous catheter (CVC) as compared to arteriovenous fistula (p = 0.001). On multivariate analysis, CVC use (HR 2.53, 95% CI 1.26-5.07, p = 0.009), disease severity (HR = 3.54, 95% CI 1.52-8.26, p = 0.003), and noninvasive ventilatory support (HR 0.59, 95% CI 0.25-0.99, p = 0.049) had significant effect on mortality., Conclusion: The adjusted mortality risk of COVID-19 in MHD patients is high in patients associated with severe COVID-19 and patients having CVC as vascular access., (© 2021 Wiley Periodicals LLC.)

Aims: To assess the staining efficacy of the innovative "Pravara" stain on ground sections of human teeth under a stereomicroscope. In this study, the ground sections were stained with the innovative stain. The stain is obtained from a leafless tree called Terminalia chebula. Terminalia chebula , commonly known as Harad, is found in South Asia from India. Few species are found in the Pravara region of Maharashtra, India., Materials and Methods: A total of 40 extracted teeth were collected and ground sections of each tooth were prepared. The samples were randomly divided into two groups: group I-control (without stain), group II-study group (the samples in this group were stained with the help of innovative "Pravara" stain). The sections were graded from I to III according to the differentiation and contrast of tissues., Results: The ground sections in group II stained with Pravara stain demonstrated better contrast for structures within sections under a microscope in comparison with group I (control group)., Conclusion: The study demonstrates the efficacy of a new innovative Pravara stain, which is a simple, economical, quick, and effective staining method for the ground sections of the teeth., Clinical Significance: This innovative Pravara stain is cost-effective, saves time, ecofriendly, and highlights the anatomical structures more effectively and does not fade easily with time.

Background: Late-night salivary cortisol (LNSC) is used as a screening test for Cushing syndrome (CS), but there is no community-derived normative data for the normal upper limit in the South Asian population. This study aimed to determine the upper limit of normal (97.5th percentile) for LNSC in an Asian Indian population using a commercially available second-generation electrochemiluminiscence immunoassay (ECLIA)., Methods: LNSC in apparently healthy community-dwelling individuals was assessed by multistage cluster sampling. Healthy individuals age 18 to 60 years from 8 urban and 8 rural clusters of Thiruvananthapuram district were studied. Thirty people from an approximate population of 1000 individuals from each cluster participated in the study. A saliva sample was collected between 11 PM and 12 midnight and analyzed using Roche COBAS-e-411 and ultrasensitive Cortisol II kits the next day., Results: Cortisol values from 474 salivary samples were available for final analysis after exclusion of improperly collected samples. The 97.5th percentile of the LNSC concentrations was 0.25 μg/dL (6.89 nmol/L) (90% CI, 0.23-0.27 μg/dL; ie, 6.34-7.45 nmol/L). In postmenopausal women, median LNSC was significantly higher but the 90% CI for the upper limit of their LNSC (0.28μg/dL or 7.72 nmol/L) overlapped with that of premenopausal women., Conclusions: This study establishes the normal value of LNSC estimated by second-generation ECLIA in healthy community-dwelling Asian Indian individuals for the first time. Salivary cortisol at 11 pm to 12 am is less than 0.25μg/dL (6.89 nmol/L) in the general Asian Indian population. Menopause causes a significant increase in LNSC and may lead to overdiagnosis of CS if not interpreted carefully., (© Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Lupus nephritis (LN) has a considerable impact on the morbidity and mortality of systemic lupus erythematosus (SLE) patients. Long-term comparative outcome data from the Indian subcontinent on treatment regimens with cyclophosphamide (CYP) and mycophenolate mofetil (MMF) are sparse. We assessed renal and patient survival for these patients in terms of the types of induction - CYP or MMF - and the two maintenance therapies - MMF or azathioprine (AZA)., Methods: We retrospectively analysed outcomes of 100 LN patients, 67 treated with CYP (26 class III, 25 class IV, 6 class III + V and 10 class IV + V; 40 Euro lupus regimen and 27 National Institutes of Health regimen) and 33 treated with a MMF-based regimen with steroids between July 2008 and June 2018. Data regarding demographic, clinical and histopathological features and the treatment given to all patients were extracted. Outcomes between the two regimens CYP and MMF were compared in terms of remission, dialysis and patient survival., Results: The clinical characteristics were similar in both groups, except that the activity index was higher in CYP patients (6.13 ± 4.48 vs. 4.61 ± 2.80). However, the chronicity index was similar. The overall remission rate was 70% at the end of induction. The rates of complete remission, partial remission and non-responders in the CYP group were 46.2%, 23.9% and 29.9%, respectively. However, in the MMF group, the corresponding rates were 57.6%, 12.1% and 30.3%, respectively. The 1-, 2-, 3-, 4-, 5- and 10-year patient survival rates in the CYP group were 89.5%, 86.2%, 86.2%, 83.8%, 83.8% and 83.8%, respectively. In the MMF induction group, the corresponding rates were 93.9%, 93.9%, 89%, 89%, 89% and 89%, respectively. At the end of the study, rates of end-stage renal disease in the MMF group and CYP group were 7.5% and 12.1%, respectively. The death-censored and non-censored renal survival rates were also similar in the long term. With regard to maintenance therapy, 3/56 (5.3%) in the MMF group and 7/34 (20.5%) in the AZA group experienced doubling of serum creatinine ( p  = 0.03)., Conclusions: Long-term outcomes in terms of patient and renal survival of LN patients treated with CYP and MMF induction are similar. Doubling of serum creatinine occurred more with AZA-based maintenance therapy than with MMF-based maintenance therapy. Most deaths occurred during induction, and sepsis was the most common cause of death.

Background and Objectives: Patient-reported outcomes have gained prominence in the management of chronic noncommunicable diseases. Measurement of health-related quality of life is being increasingly incorporated into medical decision making and health care delivery processes., Design, Setting, Participants, & Measurements: The Indian Chronic Kidney Disease Study is a prospective cohort of participants with mild to moderate CKD. Baseline health-related quality of life scores, determined by the standardized Kidney Disease Quality of Life 36 item instrument, are presented for the inception cohort ( n =2919). Scores are presented on five subscales: mental component summary, physical component summary, burden, effect of kidney disease, and symptom and problems; each is scored 0-100. The associations of socioeconomic and clinical parameters with the five subscale scores and lower quality of life (defined as subscale score <1 SD of the sample mean) were examined. The main socioeconomic factors studied were sex, education, occupation, and income. The key medical factors studied were age, eGFR, diabetes, hypertension, and albuminuria., Results: The mean (SD) subscale scores were physical component summary score, 43±9; mental component summary score, 48±10; burden, 61±33; effects, 87±13; and symptoms, 90±20. Among the socioeconomic variables, women, lower education, and lower income were negatively associated with reduced scores across all subscales. For instance, the respective β -coefficients (SD) for association with the physical component summary subscale were -2.6 (-3.4 to -1.8), -1.5 (-2.2 to -0.7), and -1.6 (-2.7 to -0.5). Medical factors had inconsistent or no association with subscale scores. The quality of life scores also displayed regional variations., Conclusions: In this first of its kind analysis from India, predominantly socioeconomic factors were associated with quality of life scores in patients with CKD., (Copyright © 2020 by the American Society of Nephrology.)

Introduction: Arteriovenous fistula is considered as gold standard access for maintenance hemodialysis. Due to increasing burden of end-stage renal disease requiring dialysis, it is important for nephrologists to complement creation of arteriovenous fistula to meet the demand., Methods: This retrospective study was designed to assess the outcomes of arteriovenous fistula made by nephrologists at a tertiary care center from North India. The study included all radiocephalic arteriovenous fistula performed by nephrologists between November 2015 and January 2017. All arteriovenous fistulas were performed in patients whose duplex ultrasonography revealed both arterial and venous diameter of at least 2 mm. Data were collected with regard to age, gender, dialysis status, basic diseases, co-morbidities, and mineral bone disease parameters. The predictors of the primary and secondary patency rates were analyzed., Results: Five hundred patients (age 39.3 ± 14.4 years; 82.4% males; 21.6% diabetics) were included. In total, 83 (16.6%) patients had primary failure and 31 (7%) patients had secondary failure. Diabetes was associated with poor primary and secondary patency rates. Mean survival among the patients without primary failure was 11 months. The primary patency rates at 3, 6, 12, 18, and 21 months were 82%, 78%, 73%, 70%, and 70%, respectively., Conclusion: To conclude, the outcomes of radiocephalic arteriovenous fistulas created by nephrologists are at par with historic outcomes.

Background: Peritoneal dialysis (PD) is the preferred modality of dialysis among children with end-stage renal disease., Methods: To study the incidence of technique failure and survival among children with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), we included children younger than 18 years of age who commenced and continued PD for more than 3 months as their primary form of dialysis between 1st January 2005 and 31st December 2016. Kaplan-Meier survival analysis was applied to analyze the CAPD outcomes., Results: A total of 68 Tenckhoff (58 double cuffs, and ten single cuffs) catheters were inserted in 66 patients (mean age 12.3 ± 3.91 years) during the study period. Of the 66 children, 31 (47%) experienced 45 episodes of peritonitis. The total duration on CAPD was 107.58 years with a peritonitis rate of 0.42 episodes per year. Overall, the mean patient survival was 41 (95% confidence interval (CI) 29-54) months, with mean patient survival of 72% at 12 months, declining to 30% at 36 months and then remaining stable until the end of follow-up (106 months). The overall mean technique survival was 55 (95% CI 40-69) months, with mean technique survival of 69% at 12 months, declining to 44% at 36 months and then remaining stable until the end of follow-up (106 months)., Conclusion: CAPD is a viable option for end-stage renal disease in children from developing countries with a lack of access to automated PD and pediatric hemodialysis centers.

The objectives of this review were to understand the epidemiology and outbreak of NiV infection and to discuss the preventive and control measures across different regions. We searched PubMed and Scopus for relevant articles from January 1999 to July 2018 and identified 927 articles which were screened for titles, abstracts and full texts by two review authors independently. The screening process resulted in 44 articles which were used to extract relevant information. Information on epidemiology of NiV, outbreaks in Malaysia, Singapore, Bangladesh, India and Philippines, including diagnosis, prevention, treatment, vaccines, control, surveillance and economic burden due to NiV were discussed. Interdisciplinary and multi sectoral approach is vital in preventing the emergence of NiV. It is necessary to undertake rigorous research for developing vaccines and medicines to prevent and treat NiV., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Despite the advancement in diagnostic modalities of sepsis, it is still a leading cause of morbidity and mortality. Differentiation between sepsis and non-infectious disease states remains a diagnostic challenge. Procalcitonin (PCT) is useful for the diagnosis of sepsis but it varies in cut-off ranges at different clinical settings. The aim of this study was to correlate serum PCT levels with cultures and to evaluate the best cut-off values with high sensitivity and specificity for PCT., Methodology: This prospective study included 305 patients from different medical wards; the patients were classified into group I: controls (n=46), group II: culture-negative sepsis (n=76) and group III: culture-positive sepsis (n=196). Mean p value <0.05 was considered significant., Results: PCT levels were significantly higher in group II and group III as compared with group I. In group II, the best cut-off point for PCT was 1.3ng/ml with 87.30% sensitivity and 78.26% specificity (area under curve 0.86). In group III, the best cut-off value of 2.20ng/ml with 98.47% sensitivity and 89.13% specificity was found (AUC 0.96)., Conclusion: Procalcitonin can accurately differentiate culture-negative and culture-positive sepsis from non-infectious diseases, thus making it a promising biomarker in diagnosis of bacterial sepsis., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Renal cortical necrosis (RCN) is a serious complication of acute kidney injury (AKI) and pregnancy is a clinical state closely associated with it with poor renal outcomes. The incidence is much higher in obstetrical AKI compared to other causes of RCN. Despite better medical care facilities available, this continues to be an important cause of morbidity and mortality in developing countries. This is a retrospective analysis among all pregnant females presenting with AKI from January 1999 to December 2014 at a tertiary care center in the northern part of India. We looked for the incidence of obstetrical-related RCN in our renal biopsies performed in the last 15 years and to evaluate precipitating factors responsible for RCN. RCN constituted 8.3% of pregnancy-related AKI cases in our institution. The overall incidence has been declining which was 9.09% from 1999 to 2008 to 7.8% from 2009 to 2014. The patient's median age was 29.3 ± 5.2 years. The average time to presentation from the day of delivery was 8.7 ±2.1 days. The mortality was observed in 11.7% of them with sepsis and multiorgan dysfunction present in all of them. The most common etiology for RCN was found to be septic abortion and puerperal sepsis accounting for - 15.3% each. Postpartum hemorrhage was a cause in 9.09% of patients. The most important cause of RCN was postpartum thrombotic microangiopathy which was observed in 48.7% of patients. Kidney biopsy was helpful in diagnosis in 31 patients while computed tomography scan abdomen alone helped in diagnosis in five patients. Patchy cortical necrosis in histology was seen in 35.4% of patients and morbidity in terms of prolonged hospitalization was seen in 22.7% while dialysis dependency in 61.5% of the study population. In conclusion, strategies need to be implemented in reducing the preventable causes for RCN which is not only catastrophic in terms of renal outcomes but also for social and psychological perspectives as well., Competing Interests: None

Background: Refractory peritonitis is defined as failure of clearance of peritoneal fluid despite 5 days of appropriate antibiotic therapy. Catheter removal decreases morbidity and mortality. Data on the outcomes of refractory peritonitis and of reinitiation of peritoneal dialysis (PD) in this group of patients are sparse. The present study analyzed etiology, outcomes, and prognostic factors of refractory peritonitis as well as survival of the reinitiation of the technique., Methods: This was a single-center retrospective study that included 90 patients of refractory continuous ambulatory PD (CAPD) peritonitis at a tertiary care center in North India. We collected information regarding symptomatology, causes, prognostic factors, and outcomes of refractory peritonitis., Results: Ninety patients suffered 93 episodes of refractory peritonitis. Fungal peritonitis was the most common cause of refractory peritonitis. Twenty nine (31%) episodes were culture-negative. We observed no difference between culture-positive and culture-negative peritonitis. Out of 90 patients, 54 (60%) recovered while 36 (40%) died. Septic shock at presentation alone was significantly associated with mortality in our study. The immediate mortality of refractory peritonitis is high. Even in patients who were shifted to permanent hemodialysis, 33% died in the first 3 months. Mean duration of technique survival after reinitiation was 23 months (1 - 85 months). Among the 12 patients who were reinitiated on CAPD, 5 patients had technique failure due to refractory peritonitis or ultrafiltration (UF) failure., Conclusion: Refractory peritonitis is associated with significant morbidity and mortality despite catheter removal. Reinitiation is confounded by residual infection, which is a concern for poor technique survival, and high immediate mortality., (Copyright © 2018 International Society for Peritoneal Dialysis.)

Lymphatic filariasis is caused by nematode filariae Wuchereria bancrofti , Brugia malayi or Brugia timori. It is commonly seen in tropical and subtropical regions of the world and affects the lymphatic system of humans, who are the definitive host while mosquito is the intermediate host. The most common manifestation of the disease is hydrocele followed by lower limb lymphoedema and elephantiasis. Although filariasis is much more common entity in north India, its presentation as retroperitoneal cyst is very rare with reported incidence rate of 1/105 000. We present a case of primary retroperitoneal filariasis in a 52-year-old man, without any classic signsandsymptoms, diagnosed postoperatively after surgical resection following diagnostic uncertaintyandfailure of other medical therapies., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Acute kidney injury (AKI) is now an established and preventable cause for chronic Kidney disease. Poor outcome of Acute Kidney Injury is influenced by severity and duration of AKI. We hypothesize that recurrent episodes of acute kidney injury are associated with adverse renal and patient related outcome., Methods: Study was undertaken to look into etiological risk factors for recurrent AKI and its effect on renal and patient related outcome. This retrospective analytical study was conducted at tertiary care health care centre from northern part of India from January 2003 to December 2013. All patients with the diagnosis of "acute renal failure" or "acute kidney injury" as their hospital admission diagnosis was identified and individuals with recurrent Acute Injury were included in the study., Results: Recurrent acute kidney injury was found in 21 (0.56%) of 3698 patients who presented with acute kidney injury during the 10 years period. Topical infections were the most common etiology of recurrent AKI followed by rhabdomyolysis and intravascular hemolysis leading to pigment nephropathy. Acute tubular necrosis was the most common histopathological diagnosis among patients biopsied. As the episodes of AKI increased from 2 to >2 episodes, there was poor immediate as well as late renal outcome. 50% were protienuric and 87.5% were hypertensive at 1 year among patients who had >2 episodes of AKI while it was 15.3% and 7.69% among patients having < 2 episodes respectively., Conclusion: Recurrent episodes of AKI are associated with poor patient and renal outcome suggesting that each episode of acute kidney injury needs close evaluation and follow up following hospital discharge with particular attention to renal outcomes., (© Journal of the Association of Physicians of India 2011.)

Aim: This study evaluates the safety and efficacy of direct-acting antivirals (DAAs) including sofosbuvir, ledipasvir and daclatasvir in patients with hepatitis C viraemia who were on maintenance haemodialysis., Methods: Data on patients who received sofosbuvir and ribavirin were analysed. Patients who experienced treatment failure with the above regimen received sofosbuvir and ledipasvir for infection with hepatitis C virus (HCV) genotype 1. Those having HCV genotype 3 infection received sofosbuvir and daclatasvir. All treatment regimens were of 12 weeks duration. Side-effects were investigated. The HCV viral load was determined by RT-PCR at 4,16 and 24 weeks after the initiation of therapy; haemoglobin levels and liver function tests were monitored at regular intervals during therapy., Results: Of the 22 subjects initially treated with sofosbuvir and ribavirin, 72.72% attained sustained virologic response at 12 weeks (SVR12). Four patients experienced treatment failure and received genotype specific therapy. Patients with HCV genotype one received sofosbuvir with ledipasvir. One patient with HCV genotype 3 infection received sofosbuvir and daclatasvir. All of them attained SVR12. A statistically significant reduction in the median serum glutamic-oxaloacetic transaminase (SGOT) and Serum glutamic pyruvic transaminase (SGPT) were observed from the baseline until the end of treatment. Anaemia was observed in 45% of patients receiving ribavirin., Conclusions: Our study demonstrates that sofosbuvir-based therapy is efficacious for HCV viraemia in patients on maintenance haemodialysis. The therapy was found to be reasonably safe with no major adverse effects noted with the use of sofosbuvir, ledipasvir or daclatasvir. However, larger studies are needed to validate our results., (© 2017 Asian Pacific Society of Nephrology.)

In recent past, direct-acting anti-viral drugs (DAAs) have become the standard of care for the treatment of hepatitis C virus (HCV) infection. However, the experience with the use of these drugs in Indian renal transplant recipients is limited. We retrospectively reviewed our experience with DAA-based treatment for HCV infection in such patients. Between April 2015 and December 2016, six adults (median age 41 [range 34-52] years, male 5; GT1 2, GT3 3, and GT4 1; including three with prior failed interferon-based treatment) had received genotype-guided, DAA-based anti-HCV treatment 1 to 158 (median 15) months after renal transplantation. Of them, four completed the planned 24-week treatment without any significant adverse event. One of them had increase in serum creatinine after 16 weeks of treatment with sofosbuvir and daclatasvir, with acute interstitial nephritis on kidney biopsy; his renal function improved on stopping the drugs. The other patient had preexisting mild renal dysfunction, which worsened after 8 weeks of sofosbuvir-ledipasvir treatment; this did not reverse on stopping treatment. All the six patients achieved undetectable HCV RNA after 4 weeks of treatment and also achieved sustained virologic response, i.e. lack of detectable HCV RNA in serum 12 weeks after stopping treatment. Overall, DAA-based treatment was effective in treating HCV infection in our renal transplant recipients; however, caution and monitoring of renal function during such treatment is advisable in patients who have additional factors that predispose to renal injury.

Introduction: Guillain-Barré syndrome (GBS) is a fulminant polyradiculoneuropathy that is acute, frequently severe and autoimmune in nature. Etiology of GBS is incompletely understood, prognosis is usually good with early detection and prompt treatment. This retrospective study was done to evaluate clinical profile, epidemiological, laboratory, and electrodiagnostic features of patients with GBS and mode of management, complications and prognostic factors., Methods: Data of 1,166 patients admitted with GBS or presented to outpatient department (previous medical records) with GBS between January 2003 and January 2014 were analyzed., Results: No difference in genders noted. Around 35% of patients are above 50 years of age. Poor control of diabetes with mean HbA1c of 8.1 ± 2.11 is found on analysis. Seasonal occurrence in GBS is prominent in winter 484 (41.50%) and mechanically ventilated were 449 (38.50%) patients. 48 (4.11%) deaths were attributed to GBS. Neurological analysis revealed cranial nerve involvement in 407 (34.90%) patients, facial palsy in 401 (34.39%) and ataxia in 88 (7.54%) patients. Most patients in plasma exchange group belonged to the lower socio-economic status. Mean cerebrospinal fluid (CSF) protein levels was (n=962) 113.8 ± 11.8 mg/dl. Conduction block determined indirectly by absent H-reflex was noted in 891 (90.64%) patients. No difference in complications and outcome is found in treatment regimens of intravenous immunoglobulin (IVIG) and plasma exchange., Conclusion: Seasonal occurrence predominantly in winter is noted. Peak flow test may be a predictor of assessing requirement of mechanical ventilation and prognosis. Conduction block is the major abnormality noted in electrophysiological studies and proximal nerve segment assessing with Erb's point stimulation has high predictive value. IVIG treatment is more expensive but is associated with less duration of hospital stay.