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Double-filtration plasmapheresis (DFPP) has been utilized for immunomodulation in kidney transplantation. Anticoagulation is important to maintain circuit patency during DFPP. We aimed to compare the efficacy and safety of regional citrate anticoagulation (RCA) with systemic heparin anticoagulation during DFPP in kidney transplant recipients.A retrospective cohort study was conducted to compare the efficacy and safety of RCA (RCA-DFPP) to systemic heparin anticoagulation (Hep-DFPP) for DFPP among kidney transplant recipients in a single tertiary center.A total of 112 sessions of DFPP were performed for 23 subjects, of which 62 sessions were RCA-DFPP and 50 sessions were Hep-DFPP. There were 13 sessions (11.6%) of premature circuit clotting, 10 sessions (16.1%) for RCA-DFPP and 3 sessions (6.0%) for Hep-DFPP (P = .10). All premature circuit clotting episodes occurred in subjects who underwent DFPP through a vascular catheter. Premature circuit clotting was associated with the use of a vascular catheter (odds ratio [OR] 14.2, 95% confidence interval [CI] 2.7-73.7; P .01) and high postfilter ionized calcium (OR 12.7, 95% CI 1.4-112.5; P .01). There was no major bleeding event. Hep-DFPP was associated with higher occurrence of hypocalcemia (OR 1.1, 95% CI 1.0-1.2; P .01) and metabolic acidosis (OR 1.4, 95% CI 1.2-2.0; P = .04), while hypomagnesemia was more common for RCA-DFPP (OR 2.9, 95% CI 1.1-7.4; P = .03).Amongst kidney transplant patients who receive DFPP therapy, RCA-DFPP may be comparable to Hep-DFPP for the maintenance of circuit patency. Functioning vascular access is vital in avoiding premature clotting of the circuit. Close monitoring of electrolyte imbalances and coagulopathy related to DFPP is recommended.

Topical non-steroidal anti-inflammatory drugs (NSAIDs) have lower risks for cardiovascular disease and gastrointestinal adverse effects compared to oral NSAIDs, but there are little data regarding their kidney risks in chronic kidney disease (CKD). We evaluated the risk of adverse acute kidney outcomes in CKD according to route of NSAID administration.Retrospective cohort study of adults with CKD (eGFR less than 60 ml/min/1.73 mAmong 6298 adults with CKD (mean age 72.1 ± 13.3 years and eGFR 41.9 ± 12.2 ml/min/1.73 mAmong adults with CKD, both systemic and topical NSAIDs were independently associated with acute adverse kidney outcomes.

Abstract: Multi-drug resistance and its transmission is a ubiquitous health issue worldwide. The beta-lactamase AmpC resistance is a major concern among all health settings like hospitals and child care centers, etc. The clinical pipeline of the new antibiotics remains dry due to the production of AmpC beta-lactamases by the bacteria to develop resistance against antibiotics. According to the global antimicrobial resistance and use surveillance system, the rate of resistance to ciprofloxacin an antibiotic commonly used to treat urinary tract infections, varied from 8.4% to 92.9% for Escherichia coli and from 4.1% to 79.4% for Klebsiellapneumoniae in different countries. The lack of comprehensiveness within the data makes a choice problematic for the selection of appropriate βlactam antibiotic for the treatment of resistant microorganisms. Most experts agree it is prudent to avoid expanded-spectrum (i.e. third-generation) cephalosporins for the treatment of organisms posing the greatest risk of AmpC induction. Nonetheless, the development of specific inhibitors for the AmpC enzyme, either naturally or synthetically, is only unfolding. To date, there is no single and clinically active drug available that inhibits the AmpC enzyme and combats multidrug resistance and its transmission in individuals. The deficit of the enzyme inhibitor focused the researchers to work in the area. This present review will emphasize on the chemistry, and structure of clinically important and potent inhibitors against AmpC enzymes.

Introduction: Double-filtration plasmapheresis (DFPP) may be used for immunomodulation in kidney transplant (KTx). While DFPP reduces plasma product exposure, risk of circuit clotting merits adequate anticoagulation. Regional citrate anticoagulation (RCA) avoids the risks of systemic anticoagulation, but a protocol for RCA-DFPP is not previously widely described. Methods: We conducted a single-center retrospective cohort study involving adult (≥21 years old) KTx recipients who underwent RCA-DFPP from 2018 to 2020 to investigate efficacy and safety for an RCA protocol during DFPP in KTx recipients. Results: Fifty-one (85%) of 60 RCA-DFPP sessions in 17 patients completed without circuit clotting. Circuit clotting was associated with high post-filter ionized calcium (28 vs. 3.7%, odds ratio 10.1, 95% CI 1.1–89.4, p = 0.037). Hypo- and hypercalcemia developed in 5 (8.3%) and 8 (13.3%) sessions, respectively, but no adverse effects were noted despite severe hypocalcemia in one. There was no significant change in pre- and post-RCA-DFPP sodium, bicarbonate, albumin, and platelet levels. With regards DFPP procedure, prolongation of prothrombin time (PT) and activated partial thromboplastin time (aPTT) was observed following 38 (64.4%) and 12 (20.3%) sessions, respectively. Severely prolonged (>1.5 × upper limit normal) PT and aPTT were recorded in 2 sessions each. Expectedly, hypofibrinogenemia developed after 31 (51.7%) sessions: including 4 (6.7%) severe hypofibrinogenemia (Discussion/Conclusion: Protocol-based RCA for DFPP is feasible and safe in KTx recipients. However, DFPP-related coagulopathy can develop consequent to treatment; caution should be exercised for patients with bleeding risk. Close monitoring and management of the patients’ electrolytes, especially hypocalcemia and hypomagnesemia, and fluid status is recommended.

Abstract: Diabetes mellitus is a ubiquitous metabolic syndrome with increased rates of mortality from the past few decades. It is a biochemical disorder with a complex pathophysiology and has disturbed glucose homeostasis maintained by the insulin hormone. The current medications for diabetes mellitus have serious adverse effects after long treatments. Thus, Ayurveda based phytoconstitutents are a new and well-accepted path for the possible discovery of newer drugs for the better management of diabetes and associated complications. The plant phytoconstitutents are more affordable and clinically effective with less adverse effects than the modern allophatic medications. The literature has shown the efficacy and clinical safety of the traditional medicine system. These natural products act by inhibiting alpha amylase and alpha glucosidase enzymes, some act by regulating the insulin secretion and activation of PRARγ pathway for maintaining glucose concentration. These natural treatments were found to be remarkably potent and safe as no adverse effects have been clinically outlined during medical therapy. This review briefly describes the various secondary plant metabolites, their structures and proposed mechanism of action for treating diabetes mellitus and associated complications.

Immunoglobin-G4 related disease (IgG4-RD) is an auto-immune inflammatory condition where patients present with a tumour-like mass that shows infiltration by plasma cell and subsequent fibrosis. It is a systemic condition that primarily involves the salivary glands, pancreas, kidneys, aorta, and retroperitoneum amongst other organs. Testicular involvement is a rare occurrence in this disease entity. A 55-year old male patient presented with the complaints of pain and swelling in the right scrotal region. Right-sided orchidectomy was carried out which on histopathology showed features suggestive of IgG4-RD which was later confirmed on immunohistochemistry. Whole body MRI revealed that no other organ was involved in the disease process in this patient. IgG4-RD has a variable clinical course and considerable overlap with its differentials. Imaging studies and serum IgG4 levels are neither confirmatory nor customarily diagnostic in every case. The only confirmatory diagnostic investigation is histopathological examination, which shows infiltration of IgG4+ plasma cells and fibrosis in the involved tissue. Whenever a mass-forming lesion with typical histomorphological features is encountered with involvement of multiple organs/anatomic sites, IgG4-related disease should be considered among the differentials, and clinicians of all disciplines should be familiar with this disease entity.

Patients with multiple myeloma and high serum levels of circulating free light chains (FLC) have increased risk of acute kidney injury (AKI) secondary to cast nephropathy and is associated with poor survival. Despite removal of FLC by medium cutoff (MCO) dialyzer, the role of MCO hemodialysis (HD) in the treatment of cast nephropathy and its clinical benefits remain unknown.A systematic review was conducted to establish the effectiveness of MCO dialyzer and clinical outcomes, compared to other forms of dialyzers in the removal of FLC, in myeloma patients with AKI. The primary outcome was effectiveness of MCO-HD in reducing serum FLC. The secondary outcomes were HD independence, estimated glomerular filtrate rate, mortality rates, length of hospitalization, rebound of serum FLC before the next dialysis, removal of other molecules during dialysis, and adverse events.We identified three case series, with a total of 17 patients. There were no randomized controlled trials (RCTs) or cohort studies. These case series showed that MCO dialyzer was effective in the removal of FLC and led to a reduction in FLC concentration post-dialysis. The majority of the case series did not have comparator arm and renal and/or other clinical outcomes.MCO dialyzer appeared to be effective in the removal of FLC based on the existing limited data. However, more data, particularly large-scale RCTs, are needed to assess the use of MCO dialyzer in reducing serum FLC and its effect on clinical outcomes in patients with multiple myeloma and AKI.

Therapeutic plasma exchange (TPE) and continuous kidney replacement therapy (CKRT) are extracorporeal therapeutic procedures often implemented in management of patients. Critically ill patients may be afflicted with disease processes that require both TPE and CKRT. Performing TPE discontinuous with CKRT is technically easier, however, it disrupts CKRT and may compromise with CKRT efficiency or hemofilter life. Concurrent TPE with CKRT offers several advantages including simultaneous control of disease process and correction of electrolyte, fluid, and acid-base disturbances that may accompany TPE. Additionally, TPE may be performed by either centrifugation method or membrane plasma separation method. The technical specifications of these methods may influence the methodology of concurrent connections. This report describes and reviews two different approaches to circuit arrangements when establishing concurrent TPE and CKRT.

Background WHO has recommended personal hygiene (respiratory hygiene, using face masks, washing hands with warm water and soap, use of alcohol-based hand sanitizers, avoid touching mouth, eyes & nose, cleanliness), social distancing and careful handling of purchased products as an effective preventive measure for COVID-19 disease. The growing pandemic of COVID-19 disease requires social distancing and personal hygiene measures to protect public health. But this message is not clear and well understood among people. The aim of this study is to determine the awareness, knowledge and attitude about COVID-19 and relate the behaviour of Indian society, especially when the country is restarting all its economic activities, after the complete lockdown. Method The present paper is based on an extensive survey among 21 406 adult participants of various sections of Indian society with different age groups between 18 and 80 years to introspect the level of public awareness with respect to cause, spread, prevention and treatment of disease caused by spread of COVID-19 viral outbreak, which will be automatically reflected in the societal behavioural response of rigorous precautionary measures. Conclusions There is a need to extend the knowledge base among individuals to enhance their active participation in the prevention mechanisms with respect to the spread of the pandemic. There is a need to elaborate the Indian socio-cultural aspects, so that society starts appreciating and voluntarily following social distancing. This should improve the adaptability of people with livelihood resilience to let them protect themselves not only from the present pandemic but also from all other unforeseen infections, and to provide care to patients.

Background Burned patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) have exceedingly high mortality rates of 73% to 100%. Since January 2011, we have been adopting an early RRT approach in managing burned patients with AKI. Our hypothesis was that early initiation of RRT leads to improved outcome and survival among burned patients with AKI. Methodology We conducted a retrospective analysis of Burns Database in Singapore General Hospital from January 2011 to February 2016. Indications for dialysis included serum creatinine of greater than 1.5 times baseline or urine output of less than 0.5 mL/kg per hour for at least 6 consecutive hours. Patients with similar condition from January 2006 to December 2010 were recruited for comparison. Result A total of 27 patients with burns and AKI were recruited from January 2011 to February 2016. The mean age was 45.4 years and 88.9% were male. The mean total burn surface area (TBSA) was 54.8%. The total volume of fluid resuscitation was 2.7 mL/kg per TBSA. The time from onset of burn to RRT was 6.4 days. Most patients presented with stage 1 AKI (51.9%), whereas 22.2% and 25.9% had stage 2 and stage 3 AKI, respectively. Most patients (74.1%) received CRRT and 18.5% received SLED. The mortality rate was 37.0% with majority of death (70%) due to sepsis/multiorgan failure. Only 1 patient required long-term RRT after discharge, and there was no occurrence of abdominal compartment syndrome. The mean age of 15 patients from 2006 to 2010 was 47.8 years. The mean TBSA was 49.5%. Only 26.7% of patients were started on RRT. The mortality rate was 66.7%, which was higher than that of subjects from 2011 to 2016 (37.0%) (P = 0.039). Conclusions Optimal timing of RRT for burned patients with AKI has not been established and data on early RRT approach are scarce. The findings of our study suggested that early RRT was associated with lower mortality rates among burned victims with AKI.

Acute kidney injury (AKI) is a frequent complication of severe burn injury and is associated with a high mortality rate of up to 80%. We aimed to establish the incidence, mortality rate, and factors related to mortality in adult patients with severe burn injury and AKI with renal replacement therapy (RRT) in Singapore.We performed a retrospective cohort study of severely burned patients who were admitted to the Burns Intensive Care Unit (BICU) at the Singapore General Hospital (SGH) from January 2008 to December 2016. We compared patients with AKI with RRT who survived with those who did not survive. As there were changes in the protocol for burns management after 2013, we also compared patients with AKI with RRT who survived with non-survivors in each of the 2008-2012 and 2013-2016 cohorts.Data of 201 patients were studied. The incidence of AKI with RRT use in severe burn injury was 21.9% and their mortality rate was 50.0%. The non-survivors had significantly higher median burned total body surface area (p = 0.043), earlier AKI (p = 0.046), earlier use of RRT (p = 0.035), lower rate of renal recovery (p = 0.0001), higher rates of adult respiratory distress syndrome (ARDS) (p = 0.005) and shock with vasopressors (p = 0.009) compared to the survivors. The survival rate was 36.8% in the 2008-2012 cohort, but improved to 60.0% in the 2013-2016 cohort. In the 2008-2012 cohort, the non-survivors developed AKI earlier (day 0 admission vs. day 3 admission, p = 0.039), and were initiated on RRT at lower serum creatinine level (173.5 μmol/L vs. 254.0 μmol/L, p = 0.042), when compared to the survivors in this same cohort. On the other hand, there were no significant differences in the renal status and fluid balance parameters between the non-survivors and survivors in the 2013-2016 cohort.The incidence of AKI with RRT in the Singapore study cohort was high, but their mortality rate was relatively lower compared to other study cohorts. Severity of AKI and use of RRT were associated with poor prognosis. Large scale study is required to further study the risk factors for mortality in this group of patients and establish cause-and-effect relationship.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used analgesics among older adults. Adverse effects may be avoided by careful patient selection. We aimed to evaluate the incidence of acute kidney injury (AKI) and/or hyperkalemia, risk factors, and the accuracy of an NSAID risk prediction model in a cohort of Asian older adults.We conducted a retrospective cohort study of older adults, age 65 years and above, who received prescriptions between March 2015 and December 2017 from Singapore's largest cluster of public healthcare institutions. Factors associated with 30-day incident acute kidney injury and/or hyperkalemia were evaluated with multivariable regression analysis. Calibration and discrimination of the Nash prediction model were assessed using the Hosmer-Lemeshow goodness-of-fit test and C-statistic, respectively.The primary outcome occurred in 16.7% of 12,798 older adults. Topical NSAIDs (adjusted OR 1.29, 95% CI 1.15-1.45), systemic NSAIDs of 1-14 days' duration (adjusted OR 1.43, 95% CI 1.27-1.62), and systemic NSAIDs 14 days (adjusted OR 1.84, 95% CI 1.37-2.49) were independently associated with the primary outcome, compared with no NSAID. Diabetes mellitus, cardiovascular disease, lower estimated glomerular filtration rate (eGFR), and diuretics were also independently associated with increased incident AKI and/or hyperkalemia. When applied to older adults with systemic NSAIDs 14 days (n = 305), the Nash risk model had poor calibration (p 0.001) and poor discrimination with C-statistic 0.527 (0.438, 0.616).Longer NSAID duration and systemic compared with topical route were associated with incremental odds for acute renal events. Further studies are required to improve the available risk model to guide NSAID prescriptions in older adults.

Metaplastic carcinoma is a rare but heterogeneous group of neoplasm of breast, accounting for about 1% of all breast carcinomas. Metaplastic carcinomas may be either low-grade tumors (e.g., adenosquamous carcinoma or spindle cell carcinoma), or high-grade tumors (e.g., squamous cell carcinoma, or spindle cell carcinoma). We report a case of metaplastic breast carcinoma in a 72-year-old lady. The clinical, radiological and histological characteristics are discussed.

International audience; Advances in our understanding of uremic retention solutes, and improvements in hemodialysis membranes and other techniques designed to remove uremic retention solutes, offer opportunities to readdress the definition and classification of uremic toxins. A consensus conference was held to develop recommendations for an updated definition and classification scheme on the basis of a holistic approach that incorporates physicochemical characteristics and dialytic removal patterns of uremic retention solutes and their linkage to clinical symptoms and outcomes. The major focus is on the removal of uremic retention solutes by hemodialysis. The identification of representative biomarkers for different classes of uremic retention solutes and their correlation to clinical symptoms and outcomes may facilitate personalized and targeted dialysis prescriptions to improve quality of life, morbidity, and mortality. Recommendations for areas of future research were also formulated, aimed at improving understanding of uremic solutes and improving outcomes in patients with CKD.

Background Acute kidney injury (AKI) is a major global health problem. We aim to evaluate the epidemiology, risk factors and outcomes of AKI episodes in our single centre. Methodology We prospectively identified 422 AKI and acute on chronic kidney disease episodes in 404 patients meeting KDIGO definitions using electronic medical records and clinical data from 15th July to 22nd October 2016, excluding patients with baseline estimated GFR (eGFR) of

An emerging crisis of antibiotic resistance for microbial pathogens is alarming all the nations, posing a global threat to human health. The production of the metallo-β-lactamase enzyme is the most powerful strategy of bacteria to produce resistance. An efficient way to combat this global health threat is the development of broad/non-specific type of metallo-β-lactamase inhibitors, which can inhibit the different isoforms of the enzyme. Till date, there are no clinically active drugs against metallo- β-lactamase. The lack of efficient drug molecules against MBLs carrying bacteria requires continuous research efforts to overcome the problem of multidrug-resistance bacteria. The present review will discuss the clinically potent molecules against different variants of B1 metallo-β-lactamase.

Introduction: The impairment of glucose metabolism leads to hyperglycemia and type-2 diabetes mellitus. Glucokinase enzyme is the key regulator of glucose homeostasis that catalyzes the conversion of glucose to glucose-6-phosphate in liver and pancreatic cells. In hepatocytes, GK controls the glucose uptake and glycogen synthesis. The action of liver GK is controlled by Glucokinase Regulatory Protein (GKRP) partially. In fasting conditions the GKRP binds with GK and inactivate it from carbohydrate metabolism and serve as new target for treatment of diabetes mellitus. However, the GK activators as potential antidiabetic agents but results in increased risks of hypoglycemia.Conclusion:The allosteric inhibitors of the GK-GKRP interaction are coming as alternative agents that can mitigate the risk associated with GK activators. This review discusses the recent advances and current status of potential molecules targeted to GK activators and GK-GKRP disrupters.

Summary Gestational hypertriglyceridemia-induced pancreatitis is associated with significant maternal and fetal morbidity and mortality. We report a case of gestational hypertriglyceridemia-induced pancreatitis in a primigravida at 31-weeks gestation, complicated by impending preterm labor and metabolic acidosis requiring hemodialysis. This was successfully managed with therapeutic plasma exchange (TPE), followed by i.v. insulin, low-fat diet, and omega-3. Triglyceride levels stabilized after TPE and the patient underwent an uncomplicated term delivery. In pregnancy, elevated estrogen and insulin resistance exacerbate hypertriglyceridemia. Management is challenging as risks and benefits of treatment options need to be weighed against fetal wellbeing. We discuss management options including a review of previous case reports detailing TPE use, dietary optimization, and delivery timing. This case emphasizes the importance of multidisciplinary care to optimize maternal and fetal outcomes. Learning points Gestational hypertriglyceridemia-induced pancreatitis has high morbidity. A multidisciplinary team approach is a key as maternal and fetal needs must be addressed. Rapid lowering of triglycerides is crucial and can be achieved successfully and safely with plasma exchange. A low-fat diet while ensuring adequate nutrition in pregnancy is important. Timing of delivery requires consideration of fetal maturity and risk of recurrent pancreatitis.

Nanomaterials are currently in hot demand for industrial development all over the world. The textile industry is also among those highly involved with the evolution of nanomaterials and nanotechnology. From coloration of textiles, to functionalities such as antimicrobial, UV protection, and water repellency, almost everywhere nanomaterials utilization. Textile effluent remediation is another side of the textile industry which is also of high concern. Nanotechnology-based effluent treatments are among the most popular methods of wastewater treatment in recent times. This chapter discusses the synthesis and characterization of nanomaterials for textile finishing. Functionalities achieved on textiles via nanomaterials are critically discussed. The mechanism of textile industry effluent treatment with the help of nanomaterials is summarized including the side effects of nanotechnology on the ecosystem.

Food waste is complex which consists of both liquid and solid waste. Solid waste from food processing units includes both organic waste and packaging waste. The food processing sector includes milk and milk products, fruits, vegetables and juices, grain and flour processing, poultry and meat, alcoholic beverages, fisheries, and many consumer-predicated products like chocolates, coffee, tea, confectionaries, soya-based products, mineral water, soft-drink, etc. Food waste from each type of food industry has specific characteristic and hence need treatments, e.g., aerobic and anaerobic lagoons, vermicomposting accordingly. Along with this the use of food waste could significantly reduce food waste levels and create new opportunities and benefits for all those involved in the food production system. Reducing food waste through the recovery of its valuable components is therefore an important way to increase sustainability. The need for a sustainable approach can no longer be overlooked by food production companies and other stackholders of food production system. Sustainable food waste management system is the only way to reduce the developed waste.

Background End stage renal disease (ESRD)/ end stage renal failure (ESRF) is on the rise globally and especially in Singapore. Varicella or chickenpox is not uncommon among adults especially ESRD/ESRF patients. It has been reported to cause complications and even death among immunocompetent adults. Methods A retrospective data collection on patients with varicella infection and ESRD in Singapore General Hospital (SGH) from the year 2005 to 2016 was performed. Continuous data and categorical data were summarized as median (range) and count (%) respectively. The association of health care utilization (total length of hospital stay, readmission related to varicella, intensive care unit admission) and mortality with complication due to varicella were tested using chi-square and Mann-Whitney test for categorical and continuous outcomes respectively. Results Sixty-six patients with ESRD developed varicella during the study period (2005–2016). The case incidence rates for varicella among ESRD ranges from 97 to 267 per 100,000 populations with ESRD yearly. There were 9 deaths (13.6%). Mortality was higher among the ESRD patients with one or more varicella complications compared to patients without complications ((25% vs 7.1%, 95% CI for difference: − 1.1%, 36.9%, p = .063). Likewise, utilisation of intensive or high dependency units were higher among patients with complications compared to those without (20.8% vs 2.4%, 95% CI for difference: 1.6%, 35.3%, p = .012). Length of stay was twice as long in the group with complications compared to patients without (median (IQR) days: 14 (8, 21) vs 7 (5, 14), p = .065), although it did not reach statistical significance. Conclusions Varicella is associated with high morbidity and significant mortality rate in ESRD patients. Varicella vaccination is recommended for seronegative ESRD patients.

Present system relates to the designing of an energy conservation system that uses a Passive Infrared Radio sensor(PIR) for controlling light and fan when classroom is vacant. When anyone (human being) make an entry into the classroom, then the Infrared energy released by the human body is concentrated by a Fresnel lens section which triggers the ‘PIR’ sensors and the signal is transmitted to a microcontroller associated within the system. Once motion is sensed the relays comes into action and on the fan and light. The condition to turn on the operation fan is only the classroom reaches a value of temperature of 25 degree C-30 degree C.

Retraction notice to “The chemistry of group-VIb metal carbonyls” [Eur. J. Chem. 2012, 3(3), 367-394, doi: 10.5155/eurjchem.3.3.367-394.604]

Thyroid storm with multi-organ failure limits the use of conventional treatment. A 44-year-old male presented with thyroid storm and experienced cardiovascular collapse after beta-blocker administration, with resultant fulminant multi-organ failure requiring inotropic support, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy. Hepatic and renal failure precluded the use of conventional thyroid storm treatment and early plasma exchange was instituted. The patient underwent emergency thyroidectomy after four effective exchanges, with subsequent rapid reversal of multi-organ failure. The challenges of institution of plasma exchanges with ongoing ECMO support, dialysis and timing of thyroidectomy are discussed. This case highlights the important role of early therapeutic plasma exchange (TPE) as an effective salvage therapy for lowering circulating hormones and stabilization of patients in preparation for emergency thyroidectomy in patients with thyroid storm and fulminant multi-organ failure. Learning points: Administration of beta-blockers in thyroid storm presenting with congestive cardiac failure may precipitate cardiovascular collapse due to inhibition of thyroid-induced hyperadrenergic compensation which maintains cardiac output. TPE can be an effective bridging therapy to emergency total thyroidectomy when conventional thyroid storm treatment is contraindicated. End-organ support using ECMO and CRRT can be combined with TPE effectively in the management of critically ill cases of thyroid storm. The effectiveness of plasma exchange in lowering thyroid hormones appears to wane after 44–48 h of therapy in this case, highlighting the importance early thyroidectomy. Background Thyroid storm with multi-organ failure confers very high mortality and management is challenging. When conventional treatment cannot be used, therapeutic plasma exchange (TPE) may be a salvage bridging therapy to emergency thyroidectomy. The combined use of TPE, CRRT and ECMO has not been described in the setting of thyroid storm management. This report described in detail the various treatment strategies employed in the management of a critically ill case of thyroid storm, providing guidance to physicians managing such complex cases.

The use of the oXiris® haemofilter during continuous veno-venous haemodiafiltration (CVVHDF) for acute kidney injury (AKI) and severe sepsis is not completely understood. Although this filter has in vitro adsorptive properties for blood-borne cytokines and other humoural mediators of sepsis, its clinical usefulness is uncertain. Given its inherent adsorptive limitation for septic mediators, we developed a CVVHDF protocol in which the oXiris haemofilter was electively changed every 12 h even though there was no clotting or adverse circuit pressures. Augmented filter membrane adsorption was conducted for 3 consecutive days. We treated a critically ill patient with severe sepsis secondary to a gram-negative bacterial infection and sepsis-associated acute kidney injury (SA- AKI) in this way. The patient required high-dose vasopressor support, required mechanical ventilation, had received 12 h of CVVHDF with conventional M100 haemofilter, was on broad spectrum antibiotics and other conventional intensive care unit (ICU) care, prior to institution of the frequent oXiris haemofilter change protocol. Following the start of elective 12 hourly oXiris filter change, the patient showed reduction in the need for vasopressor and by Day 4 of this SA- AKI frequent filter change protocol, vasopressor requirement ceased, he was extubated. He survived ICU and but not hospital stay. To this end, more clinical studies are needed.

Recent experimental observation of magicity in $^{78}$Ni has infused the interest to examine the persistence of the magic character across the N$=$50 shell gap in extremely neutron rich exotic nucleus $^{78}$Ni in ground as well as excited states. A systematic study of Ni isotopes and N$=$50 isotones in ground state is performed within the microscopic framework of relativistic mean-field (RMF) and the triaxially deformed Nilson Strutinsky model (NSM). Ground state density distributions, charge form factors, radii, separation energies, pairing energies, single particle energies and the shell corrections show strong magicity in $^{78}$Ni. Excited nuclei are treated within the statistical theory of hot rotating nuclei where the variation of level density parameter and entropy shows significant magicity with a deep minima at N$=$50, which, persists up to the temperatures $\approx$ 1.5$-$2 MeV and then slowly disappear with increasing temperature. Rotational states are evaluated and effect of rotation on N$=$50 (Z$=$20$-$30) isotones are studied. Our results agree very well with the available experimental data and few other theoretical calculations., Comment: Submitted to IJMPE

Aim Optimal timing for acute renal replacement therapy (ARRT) initiation in critically ill patients with acute kidney injury (AKI) is unclear. We aimed to evaluate outcomes in patients who initiated ARRT for traditional indications versus those who met Acute Kidney Injury Network (AKIN) criteria without traditional indications. Methods This was a single-centre prospective cohort study of medical and surgical intensive care patients with AKI. Traditional indications for ARRT initiation included: serum potassium ≥6.0 mmol/L, serum urea ≥30 mmol/L, arterial pH

Aim: Few studies have evaluated patients after cardiac surgery for subsequent chronic kidney disease (CKD) which increases cardiovascular morbidity and mortality. This study aimed to ascertain the long-term renal outcome in adult patients with severe acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery. Methods: This is a single-center retrospective cohort study of consecutive adult patients who received acute dialysis for AKI after CABG between February 8, 2009 and January 30, 2011. Data on pre- and intra-operative factors were retrieved from electronic medical records. The primary endpoint was CKD progression as defined by dialysis dependence or doubling of serum creatinine from the pre-operative level. Secondary endpoints included in-hospital mortality and renal function at 3 months and 1 year. Results: Fifty-five patients required acute dialysis after CABG. The median age was 67 years (IQR: 61, 75), and 70.9% were male. Median pre-operative serum creatinine was 157 µmol/l (IQR: 122, 203). A total of 19 patients (34.5%) died. The median follow-up time for hospital survivors was 44.2 months (IQR: 25.0, 49.4) after surgery. Among the 36 survivors, 14 patients (38.9%) reached the primary endpoint. Patients with CKD progression had higher pre-operative serum creatinine [median 214 µmol/l (IQR: 159, 399) vs. 155 µmol/l (112, 187), p = 0.015] and lower eGFR [median 20.4 ml/min/1.73 m2 (IQR: 11.9, 38.2) vs. 39.9 ml/min/1.73 m2 (25.9, 55.5), p = 0.027] compared to those who did not have CKD progression. Conclusion: Patients with severe AKI after CABG are at high risk of long-term renal dysfunction and should be monitored regularly for deterioration.

The payments infrastructure in banking has seen a rapid development in India over the last few years. With the ever-increasing smartphone penetration in India (over 220 million in Feb 2016—Counterpoint Research) and the growth of Internet, there has been a focus to take banking to the mobile phone. There has seen a rapid growth of digital payment systems—National Electronic Funds Transfer (NEFT), Real-Time Gross Settlement (RTGS), Immediate Payments Service (IMPS), and mobile application transfer compared to the manual payment methods. The latest addition to the list is UPI (Unified Payments Interface). This paper covers the basic model of UPI, how it can be used in different business transactions and usage scenarios have been analyzed.

In recent years there has been an increasing research emphasis on complex macromolecular systems. These include polymers and coordination compounds with precise control of structures, multicomponent systems with higher degrees of organization, they involved in confined environments, nanochemistry and nanostructures, biopolymers and bio-inspired chemistry. Successful Spectroscopic studies of these complexes require judicious applications of existing techniques and development of new or improved strategies and methodologies. In this article various Chemical drawing and Spectra prediction computer software are compared and analyzed for their role in research in complex macromolecular systems. We have compared various software like Accelrys (Symyx) Draw, ChemDraw (ChemBioDraw), DrawIt, ChemSketch, ChemDoodle, Chemistry 4-D Draw, MarvinSketch and MestreNova NMR Predict.

We intended to develop a desired ointment for treat ment of wound. Main objective of this study was to formulate the ointment with different ointment base s having good consistency, better diffusion and antiseptic properties. To assess the efficacy of un iformity, viscosity, diffusivity, rheology, stabili ty, spreadability, permeability and other physical char acteristics were evaluated. Two Formulations, formulation A (Aq. extract of Ficus racemosa ) and B (Aqueous extract of Ficus benghalensis ) were prepared with same bases. Both the Formulation A and B contains hard paraffin, cetostearyl alcohol, Li ght liquid paraffin and microcrystalline wax. Formulati on B was found better than formulation A in all asp ects like spreadability, viscosity, consistency, stabili ty, diffusibility. In conclusion, it was clearly observed that Formulation B was better than formulation A.

To establish the wound healing activity of aqueous and ethanolic extract of roots of Morus alba. Two models were performed to evaluate the wound healing activity i.e., Incision and Excision model. In inc ision model the parameter which was carried out was breaking strength of wounded skin. In excision model percentage wound contraction and period of epitheli alization was established for both the extracts. Reference standard drug was Aloe vera ointment for comparison with other groups. From th e observation in both the models, Aq. extract of Morus alba was found to have greater wound healing activity i n terms of breaking strength in incision model and percentage wound contraction, period of epithelialization was highest in excision model compared with other groups. In conclusion, our findings suggest that aq. ext ract of Morus alba possess better healing ability than the ethanolic extract.