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Objective: The objective of the study is to evaluate the outcomes of live‑donor renal allografts with multiple and single renal arteries taking into consideration ischemia times, graft function, and other complications including vascular and urological. Materials and Methods: We conducted a retrospective study by analyzing a prospectively maintained database from January 2021 to December 2021 of all patients undergoing live‑related renal allograft transplants at a tertiary care center in North India. A total of 239 live donor kidney transplants were performed during this period. Patients were divided into two groups – Group 1: Single artery single anastomosis and Group 2: Multiple arteries with two or more anastomoses. Duplex imaging of the graft was done at 6 months. Recipients were followed up for possible graft dysfunction, arterial insufficiency, and major urological complications. Results: Mean ischemia times in the two groups were 20.62 ± 1.05 and 30.45 ± 1.77 min, respectively. Failure to normalize creatinine (<1.2 mg/dl) within 72 h was seen in 6/183 and 3/56 (P > 0.05). Slow graft function was encountered in 6 cases in Group 1 and 3 cases in Group 2. Delayed graft function occurred in two patients in both groups. One‑year graft survival among the groups was 5/183 and 2/56, respectively (P > 0.05). One patient from Group 1 developed transplant renal artery stenosis. Six patients from Group 1 developed ureteric complications. Conclusion: Donor grafts with multiple renal arteries may be accepted safely with careful surgical reconstruction and close surveillance posttransplant. [ABSTRACT FROM AUTHOR]

The triglyceride-synthesizing enzyme acyl CoA:diacylglycerol acyltransferase 1 (DGAT1) plays a critical role in hepatitis C virus (HCV) infection by recruiting the HCV capsid protein core onto the surface of cellular lipid droplets (LDs). Here we find a new interaction between the non-structural protein NS5A and DGAT1 and show that the trafficking of NS5A to LDs depends on DGAT1 activity. DGAT1 forms a complex with NS5A and core and facilitates the interaction between both viral proteins. A catalytically inactive mutant of DGAT1 (H426A) blocks the localization of NS5A, but not core, to LDs in a dominant-negative manner and impairs the release of infectious viral particles, underscoring the importance of DGAT1-mediated translocation of NS5A to LDs in viral particle production. We propose a model whereby DGAT1 serves as a cellular hub for HCV core and NS5A proteins, guiding both onto the surface of the same subset of LDs, those generated by DGAT1. These results highlight the critical role of DGAT1 as a host factor for HCV infection and as a potential drug target for antiviral therapy.

Objective: The objective of the study was to evaluate the patients undergoing renal transplants for urological complications and their management. Materials and Methods: A total of 239 renal transplant surgeries were done at our center between January 2021 and December 2021. Out of these 239 transplants, 196, 14, and 29 were ABO-compatible, swap, and ABO-incompatible, respectively. Clinical signs and symptoms, kidney function tests, ultrasound whole abdomen, computed tomography (CT) abdomen/CT urography, magnetic resonance imaging pelvis, and retrograde pyelography helped to diagnose and assess the severity of ureteric complications. These complications that occurred either in the early postoperative period or in follow-up were analyzed retrospectively. The severity of symptoms, patient status and grading, and type of complication determined the modality that would be used to treat the patients. Results: Out of 239 patients who underwent a kidney transplant, 10 (4.18%) cases developed ureteric complications. The variables that showed a significant statistical difference for the development of ureteric stenosis were older female donors, inferior polar artery, diabetic donors, and prolonged cold ischemia time. Conclusion: Ureteric complications can occur following renal transplantation. This can be reduced by minimally handling the ureter during graft removal and carefully anastomosing it to the bladder. Early diagnosis and prompt intervention increase the chances of graft and patient survival. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has distorted the health-care system at a global level. Organ donation being a life-saving procedure, it continued even in the COVID era, although at a slow pace. Irrespective of the increase in renal transplants in the later era of COVID-19, the scarcity of literature for a review article in this context resulted in the genesis of this study. A retrospective data collection was conducted over various databases in the English language. The databases were thoroughly searched with keywords COVID-19, Coronavirus, SARS-CoV-2, and renal transplant. The data from various sources including original articles comprising single- and multicenter studies were collected, analyzed, and compiled over various parameters. The data were framed as mean, median, percentage, and standard deviation. We analyzed 10 single-centered studies and 4 multicenter studies conducting renal transplantation during the COVID era. The mean age of donor and recipient in the analysis was 47.6 ± 6.01 years and 47.8 ± 6.65 years, respectively. Two transplant centers used deceased renal donors only and one centre was doing transplant only on live donors and the remaining of the centres were taking both live and deceased donors. We observed that four studies had no COVID-positive recipient in their follow-up and the maximum COVID-positivity rate was 50%. Among reviewed 14 studies, 8 studies had no mortality in recipients who were COVID positive and the maximum mortality was 54%. To reduce morbidity and mortality, strict criteria for COVID-19 workup in donor and recipient patients should be followed. The type of donor has no direct relation to the risk of acquiring COVID-19 infection. The vaccination program has been accepted worldwide to reduce the severity of COVID-19 infection even in transplant patients. [ABSTRACT FROM AUTHOR]

The baseflow index is a crucial parameter in basin-scale water balance studies. However, it has frequently been neglected for various reasons, viz. near-impossible direct measurement, simplification of the model, and non-existence of the hydro-meteorological data. Hence, baseflow is computed for the Ramganga river basin in the present study, for which a scientific assessment had not been done previously. The classified-archived-observed river discharge data are obtained from Central Water Commission (CWC) and are applied in an analytical filter to assess the baseflow index (BFI) at all exiting CWC hydro-meteorological sites in the Ramganga river basin. The average values of BFIs for the CWC sites vary between 27% and 38%. The results are found to be consistent and showed significance with the hydrological characteristics of the basin. The results have also been discussed to account for various possible anthropogenic effects, which are assessed as having no significant impact. [ABSTRACT FROM AUTHOR]

Objective: The choice of lithotripter is an important part of planning in mini-percutaneous nephrolithotomy (mini perc) as the operating time is prolonged due to reduced sheath size and smaller working channel. Previous studies mostly reported the use of laser lithotripter for stone fragmentation while the literature on pneumatic lithotripter use in miniperc is scant., Methods: In this study, we compared the efficacy and safety of the laser lithotripter (LL) vs pneumatic lithotripter (PL) in miniperc for small to medium-sized renal/upper ureteric stones (size: 1-2 cm). All consecutive patients who underwent miniperc from September 2020 to August 2022 were included in the study. Laser lithotripter was used in 81 patients (group LL), while pneumatic was used in 75 patients (group PL). The preoperative, operative, and postoperative findings were compared., Results: Baseline patient characteristics (age, sex, body mass index, and co-morbid illness) and stone characteristics (size, stone number, laterality, presence of staghorn calculi, presence of hydronephrosis, Guy's stone scores) were comparable between the two groups (P>0.05). The mean operative time was comparable (P=0.38) while the mean fragmentation time was significantly higher in the PL group (35.42±6.34 vs 28.96±2.82 minutes; P<0.01). 29.3% required forceps/basket for stone removal in PL group as compared to 7.4% in LL group (P=0.02). Mean VAS (Visual Analog Scale) score on the first post-operative day, stone clearance, drop in hemoglobin, average hospital stay, stone clearance at 3 months postoperative, and complications were comparable (P>0.05)., Conclusion: Lithotripsy with pneumatic lithotripter can be used as an equally effective and safe alternative to laser lithotripter in mini-perc for treatment of small-medium sized renal/upper ureteric calculi., Competing Interests: None., (AJCEU Copyright © 2023.)

Background: Infections caused by ceftazidime-resistant Pseudomonas and extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria are increasing worldwide. Meropenem and piperacillin/tazobactam (PIP/TZB) are recommended for the treatment of peritoneal dialysis-associated peritonitis (PDAP) caused by ceftazidime-resistant Pseudomonas and other resistant gram-negative bacteria. Patients may also receive intraperitoneal heparin to prevent occlusion of their catheters. However, the stability of meropenem or PIP/TZB, in combination with heparin, in different types of peritoneal dialysis (PD) solutions used in clinical practice is currently unknown. Therefore, we investigated the stability of meropenem and PIP/TZB, each in combination with heparin, in different PD solutions., Methods: A total of 15 PD bags (3 bags for each type of PD solution) containing meropenem and heparin and 24 PD bags (3 bags for each type of PD solution) containing PIP/TZB and heparin were prepared and stored at 4°C for 168 hours. The same bags were stored at 25°C for 3 hours followed by 10 hours at 37°C. An aliquot withdrawn before storage and at defined time points was analyzed for the concentration of meropenem, PIP, TZB, and heparin using high-performance liquid chromatography. Samples were also analysed for particle content, pH and color change, and the anticoagulant activity of heparin., Results: Meropenem and heparin retained more than 90% of their initial concentration in 4 out of 5 types of PD solutions when stored at 4°C for 168 hours, followed by storage at 25°C for 3 hours and then at 37°C for 10 hours. Piperacillin/tazobactam and heparin were found to be stable in all 8 types of PD solutions when stored under the same conditions. Heparin retained more than 98% of its initial anticoagulant activity throughout the study period. No evidence of particle formation, color change, or pH change was observed at any time under the storage conditions employed in the study., Conclusions: This study provides clinically important information on the stability of meropenem and PIP/TZB, each in combination with heparin, in different PD solutions. The use of meropenem-heparin admixed in pH-neutral PD solutions for the treatment of PDAP should be avoided, given the observed suboptimal stability of meropenem., (Copyright © 2018 International Society for Peritoneal Dialysis.)