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The differential diagnosis of acute onset flank pain include renal colic, papillary necrosis, pyelonephritis and renal infarction from renal artery thrombosis or embolism. Here, we describe a case of acute onset flank pain caused by unilateral renal vein thrombosis (RVT) in a previously healthy

In endemic areas, histoplasmosis should always be considered as a differential diagnosis in a patient presenting with fever of unknown origin, chronic fatigue, adrenomegaly and hyperpigmentation. Early diagnosis and prompt institution of antifungal therapy is imperative to prevent mortality as

Background Chronic kidney disease (CKD) is an important cause of morbidity and mortality worldwide. There is a lack of information on epidemiology and progression of CKD in low–middle income countries. The Indian Chronic Kidney Disease (ICKD) study aims to identify factors that associate with CKD progression, and development of kidney failure and cardiovascular disease (CVD) in Indian patients with CKD. Methods ICKD study is prospective, multicentric cohort study enrolling patients with estimated glomerular filtration rate (eGFR) 15–60 mL/min/1.73 m2, or >60 mL/min/1.73 m2 with proteinuria. Clinical details and biological samples are collected at annual visits. We analysed the baseline characteristics including socio-demographic details, risk factors, disease characteristics and laboratory measurements. In addition, we compared characteristics between urban and rural participants. Results A total of 4056 patients have been enrolled up to 31 March 2020. The mean ± SD age was 50.3 ± 11.8 years, 67.2% were males, two-thirds of patients lived in rural areas and the median eGFR was 40 mL/min/1.73 m2. About 87% were hypertensive, 37% had diabetes, 22% had CVD, 6.7% had past history of acute kidney injury and 23% reported prior use of alternative drugs. Diabetic kidney disease, chronic interstitial nephritis (CIN) and CKD-cause unknown (CKDu) were the leading causes. Rural participants had more occupational exposure and tobacco use but lower educational status and income. CIN and unknown categories were leading causes in rural participants. Conclusions The ICKD study is the only large cohort study of patients with mild-to-moderate CKD in a lower middle income country. Baseline characteristics of study population reveal differences as compared with other cohorts from high-income countries.

Tunneled femoral vein hemodialysis catheters are used when all other options for permanent vascular access or jugular central vein catheter are exhausted. There is little published literature on the outcome and survival of tunneled femoral vein catheters.Using a retrospective database, we identified all tunneled femoral dialysis catheters placed in the Nephrology department of our institute over a one-and-half year period. The outcomes, complications, and patency of these procedures was retrospectively evaluated.Out of total 21 patients, 14 were female and 7 males with a mean age of 45 (range 17-73 years) and about one-fourth had diabetes mellitus (26%). Right-sided femoral catheter insertion was performed in 18 patients (85.7%) and 3 patients underwent left-sided insertion. Technical success of placement was 100% with no immediate complications. Median follow up period was 24 days. Primary catheter patency at 30, 60, 90, and 180 days were 81, 29, 18, and 12.5%, respectively. Three patients (15.7%) developed catheter-related deep venous thrombosis. Three catheters (14.2%) were removed for catheter-related infection and seven (33.3%) were removed because of absent blood flow.Our experience with tunneled femoral catheters revealed low catheter survival and significant complications (deep venous thrombosis and malfunction/occlusion).

Deranged coagulogram is a common problem, which a nephrologist faces before doing a renal biopsy. We describe a rare cause of coagulopathy in a patient with rapidly progressive renal failure due to acquired factor X deficiency caused by systemic light chain amyloidosis (AL). The patient had prolonged prothrombin and activated partial thromboplastin time, which got corrected on mixing with normal plasma, and factor X activity was markedly reduced at 5%. Rectal biopsy and immunofixation electrophoresis established the diagnosis of AL and the patient was started on bortezomib-based chemotherapy. Hence, appropriate coagulation work-up should be conducted in patients with renal dysfunction with prolonged coagulation times, as it can sometimes reveal the underlying diagnosis in situations where renal biopsy could not be done due to high risk of bleeding.

The present study investigated the detection of severe acute respiratory syndrome– coronavirus 2 (SARS-CoV-2) genomes at each treatment stage of 14 aerobic wastewater treatment plants (WWTPs) serving the major municipalities in two states of Rajasthan and Uttarakhand in Northern India. The untreated, primary, secondary and tertiary treated wastewater samples were collected over a time frame ranging from under-lockdown to post-lockdown conditions. The results showed that SARS-CoV-2 RNA was detected in 13 out of 40 wastewater samples in Jaipur district, Rajasthan and in 5 out of 14 wastewater samples in the Haridwar District, Uttarakhand with the E gene predominantly observed as compared to the N and RdRp target genes in later time-points of sampling. The Ct values of genes present in wastewater samples were correlated with the incidence of patient and community cases of COVID-19. This study further indicates that the viral RNA could be detected after the primary treatment but was not present in secondary or tertiary treated samples. This study implies that aerobic biological wastewater treatment systems such as moving bed biofilm reactor (MBBR) technology and sequencing batch reactor (SBR) are effective in virus removal from the wastewater. This work might present a new indication that there is little to no risk in relation to SARS-CoV-2 while reusing the treated wastewater for non-potable applications. In contrast, untreated wastewater might present a potential route of viral transmission through WWTPs to sanitation workers and the public. However, there is a need to investigate the survival and infection rates of SARS-CoV-2 in wastewater. Published version This research was funded by research grants from the Department of Biotechnology-GoI [Grant No. BT/RLF/Re-entry/12/2016].

A distributed file system is used to store and share files in a peer-to-peer network using the InterPlanetary File System (IPFS) protocol. In a distributed file system, multiple central servers can save the files which will be accessed by various remote clients with proper authorization rights within the network. Nowadays, the amount of data getting generated each minute is huge and can be accessed by multiple users. This creates a problem in managing, accessing and executing data and finally leading to concurrency control issues. Concurrency control is a process of simultaneously managing the execution of data in a shared database and ensures the serializability of data for multiple users. Thus, in the context of Hadoop, if multiple clients want to write an updated data in the HDFS file system then the protocol that needs to be followed to make sure that the write done by one client does not influence the computation performed by the other client. This paper elaborates how multiple users can access the same file without getting any distortion in the content of that file. It also provides a theoretical solution to handle the concurrency control problem in Hadoop. The solution discussed in this paper is to implement Hadoop’s Java-based Filesystem interface for the decentralised, peer-to-peer file system using IPFS. The proposed interface will allow the Hadoop MapReduce functions to be directly performed on data files hosted on IPFS.

In the recent decades, the role of wastewater treatment plants has been entrenched for the dissemination of antibiotic resistant bacteria into the environment. The present study explores the dynamics of earthworms-microorganisms interactions involved in the high treatment efficacy of vermifiltration technology along with reduction of antibiotic resistant bacteria (ARB). This study is the first of its kind to investigate the performance efficacy of vermifilter (VF) for clinical laboratory wastewater treatment. The results of the study showed that earthworms and VF associated microbial community had a significant effect on Biochemical Oxygen Demand (BOD) and Chemical Oxygen Demand (COD) reduction (78–85%), coliforms and pathogen removal (>99.9%) and caused a significant shift in the prevalence pattern of ARB. Molecular profiling of resistance causing genes such as ESBL (blaSHV, blaTEM and blaCTX-M), MRSA (mec-A) and Colistin (mcr-1) confirmed the probable mechanisms behind the resistance pattern. The microbial community diversity in the influent, earthworm's coelomic fluid and gut and filter media layers associated with the VF assists in the formation of biofilm, which helps in the removal of pathogens from the wastewater. This biofilm formation further results in a paradigm shift in the resistance profile of ARB and ARG, specifically most effective against drugs, targeting cell wall and protein synthesis inhibition such as Ampicillin, Ticarcillin, Gentamicin and Chloramphenicol. These findings further validate vermifiltration technology as a sustainable and natural treatment technology for clinical laboratory wastewater, specifically for the removal of pathogens and antibiotic resistance.

We investigated the presence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA at different treatment stages of 15 wastewater treatment plants (WWTPs) in two North Indian states of Rajasthan and Uttarakhand. Untreated (influent), biologically treated, and disinfected wastewater samples were collected from May to August 2020. The qualitative analysis of the wastewater for the presence of SARS-CoV-2 RNA was done using different pre-processing methods. SARS-CoV-2 RNA was detected in 11 out of 39 wastewater samples in Jaipur district and 5 out of 17 wastewater samples in Haridwar District using Reverse-Transcriptase Quantitative Polymerase Chain Reaction (RT-qPCR) for qualitative detection. None of the 56 samples tested for post-secondary or tertiary treatment were found positive for SARS-CoV-2 RNA. The findings indicate that there are no SARS-CoV-2 related risks involved with using the treated effluent for non-potable applications. In contrast, untreated wastewater may be a potential route of viral transmission to the WWTP and sanitation workers. Future studies are imperative to understand the survival rates of these viruses in wastewater.Graphical AbstractHighlightsMild to moderate genome load observed in the municipal wastewater samples.Increased patient numbers post-lockdown correspond to a decrease in the CTvalue of genes.Presence of SARS-CoV-2 genome load was observed in untreated wastewater.E gene was present in abundance in wastewaters as compared to the N gene and RdRp gene.SARS-CoV-2 genome load was absent in secondary and tertiary treated effluent.

A 34-year-old woman was admitted with symptoms of easy fatiguability, decreased urine output and jaundice for 1 week. She had similar history of weakness and jaundice 3 months ago that lasted for a week for which she consumed herbal medicines. Laboratory evaluation revealed anaemia with

The present study points to the relevance of the earthworms-microorganism’s symbiotic and synergistic interactions that drive the wastewater treatment by identifying the most essential mechanisms underlying the removal of contaminants during vermifiltration technology. Previous studies have showed the presence of earthworms improves treatment performance of vermifilter (VF), but earthworm microbial community dynamics, their structure and functional characteristics in VF were not fully investigated. To investigate the effects of earthworms on the inherent microbial community of the VF, the present study envisages the dynamics of the complex symbiosis of earthworms & microorganisms associated to the treatment mechanisms. In this study, the design, operations and performance evaluation and influent, effluent and filter media layer were investigated for microbial diversity inside the earthworm population, along with the antimicrobial activity, enzymatic activity, and protein profiling assays. The results showed that earthworm gut microbial communities were dominated by Gammaproteobacteria, and the percentages arrived to 59–60% of the microbial species detected, while filter media layer showed presence of Firmicutes and Actinobacteria. The protein profiling of the microbiota associated with the VF showed that earthworms feeding and earthworm–microorganism interaction were responsible for enhanced treatment performance. The finding provides an insight into the complex earthworm microbial dynamics and mechanisms for wastewater treatment in VF. Furthermore, earthworm predation strongly regulated microbial biomass while improving microbial activity, and is deciphered as the possible mechanisms behind the vermifiltration technology.

Carfilzomib is an irreversible proteasome inhibitor currently approved for the treatment of relapsed multiple myeloma. It has been implicated as a cause of thrombotic microangiopathy (TMA) in several case reports. The incidence, risk factors, and treatment of carfilzomib-related TMA remain unclear. Here we describe the clinical presentation and outcome of a 58-year-old man with biopsy-proven TMA that occurred following treatment with carfilzomib-based therapy. We also reviewed the published literature with regard to the incidence, risk factors, treatment options, and outcome of carfilzomib-related TMA.

The infection with SARS-CoV-2 is reported to be accompanied by the shedding of the virus in stool samples of infected patients. Earlier reports have suggested that COVID-19 agents can be present in the fecal and sewage samples and thus it can be a good indication of the pandemic extent in a community. However, no such studies have been reported in the Indian context so far. Since, several factors like local population physiology, the climatic conditions, sewage composition, and processing of samples could possibly affect the detection of the viral genome, it becomes absolutely necessary to check for the presence of the SARS-CoV-2 in the wastewater samples from wastewater treatment plants (WWTPs) serving different localities of Jaipur city, which has been under red zone (pandemic hotspots) since early April 2020. Samples from different local municipal WWTPs and hospital wastewater samples were collected and wastewater based epidemiology (WBE) studies for the presence of SARS-CoV-2 were carried out using the RT-PCR technique to confirm the presence of different COVID-19 target genes namely S gene, E gene, ORF1ab gene, RdRp gene and N gene in the viral load of wastewater samples. In the present study, the untreated wastewater samples from the municipal WWTPs and hospital wastewater samples showed the presence of SARS-CoV-2 viral genome, which was correlated with the increased number of COVID-19 positive patients from the concerned areas, as per reported in the publically available health data. This is the first study that investigated the presence of SARS-CoV-2 viral genome in wastewater, at higher ambient temperature (above 40°C), further validating WBE as a potential tool in predicting and mitigating outbreaks.HighlightsThe study reports detection of SARS-CoV-2 in sewage in India.The presence of SARS-CoV-2 was confirmed by RT-PCR.The presence of viral genome was detected at high ambient temperatures of 40-45° C.Corroborates trends in the WWTPs showing viral genome with public health data.Treated effluent from WWTPs appears safe for reuse with low public health concern.Graphical Abstract

Histoplasmosis is a rare disease in nonendemic areas. We report a case of a 23-year-old male patient who presented with fever of unknown origin, cytopenias, organomegaly, and allograft dysfunction 4 months after renal transplant with father as donor. Bone marrow examination showed intracellular budding yeast cells, which was confirmed as histoplasmosis by culture of bone marrow biopsy sample. The patient was treated with intravenous liposomal amphotericin and responded well.

Histoplasma knee infection in a renal transplant recipient has not been reported in the literature. The present case illustrates an interesting case of unilateral Histoplasma monoarthritis in a patient 3 years after renal transplantation who presented with pain and swelling of the right knee. The diagnosis was established by tissue aspiration from a focal lesion in lateral femur condyle. The patient was successfully managed with amphotericin followed by itraconazole with complete resolution of the symptoms. It is important to consider such rare differentials in an immunocompromised patient to avoid delays in treatment.

The study brings insight to earthworms-microorganism's symbiotic interactions for wastewater treatment for the most essential mechanisms (antimicrobial and enzymatic activity) during vermifiltration. The results showed that vermifilter (VF) resulted in effluent with biochemical oxygen demand (BOD)