Effect of Oral Nutrition Supplement on Hemodialysis Patients- An Observational Study

Introduction: PEW (Protein Energy Wasting) is a well-known phenomenon observed among Hemodialysis (HD) patients. This study was conducted to evaluate the nutrition status of HD patients receiving oral nutrition supplement (ONS) on Dialysis days along with a high protein diet. Material and Methods: The outpatients who visited Hemodialysis unit were nutritionally assessed using the Subjective Global Assessment (SGA). Malnourished patients were selected for the study. Diet advice was given on a high protein diet as per the standard renal guidelines. Patients were given ONS on dialysis days for 6 months along with a high protein diet. ONS provided 200 Kcal and 9 g protein. Patients were nutritionally assessed pre and post supplementation at 0- 6month gap using SGA, MIS (Malnutrition Inflammation Score), BIA (Bioelectrical Impedance Analysis), hand grip strength, C- Reactive protein, Serum Albumin & Total Iron Binding Capacity. The data were collected and analysed. Results:  A significant improvement (p < 0.05) was observed in the ICW (Intra cellular water), BCM (Body Cell Mass), SMM (Skeletal Muscle Mass) & Protein Mass. An improvement in the mean Hand grip strength, SGA and MIS scores were also observed.   Conclusion: Providing ONS on Dialysis days would be an ideal way to reduce PEW.&nbsp

Etiology and Outcomes of ARDS in a Rural-Urban Fringe Hospital of South India

Objectives. Etiology and outcomes of acute lung injury in tropical countries may be different from those of western nations. We describe the etiology and outcomes of illnesses causing acute lung injury in a rural populace. Study Design. A prospective observational study. Setting. Medical ICU of a teaching hospital in a rural-urban fringe location. Patients. Patients ≥13 years, admitted between December 2011 and May 2013, satisfying AECC criteria for ALI/ARDS. Results. Study had 61 patients; 46 had acute lung injury at admission. Scrub typhus was the commonest cause (7/61) and tropical infections contributed to 26% of total cases. Increasing ARDS severity was associated with older age, higher FiO 2 and APACHE/SOFA scores, and longer duration of ventilation. Nonsurvivors were generally older, had shorter duration of illness, a nontropical infection, and higher total WBC counts, required longer duration of ventilation, and had other organ dysfunction and higher mean APACHE scores. The mortality rate of ARDS was 36.6% (22/61) in our study. Conclusion. Tropical infections form a major etiological component of acute lung injury in a developing country like India. Etiology and outcomes of ARDS may vary depending upon the geographic location and seasonal illnesses

An effective field theory approach to the electroweak corrections at LEP energies

In the framework of the effective field theory (EFT) we discuss the electroweak (EW) corrections at LEP energies. We obtain the effective Lagrangian in the large m_t limit, and reproduce analytically the dominant EW corrections to the LEP2 processes e+ e- --> gamma Z and e+ e- --> Z Z. To include effects of finite top-quark and Higgs masses, we use the effective Lagrangian at tree level and fit LEP1/SLD observables with four arbitrary parameters, plus alpha_s(m_Z). The EFT approach works remarkably well. Using the effective couplings determined from the fit, and tree-level EFT formulae, we predict the cross sections for e+ e- --> Z Z, gamma Z at a level better than 1%.Comment: 17 pages incl. 2 eps figures, REVTeX. New references added and few misprints correcte

Renal abscess after the Fontan procedure: a case report

<p>Abstract</p> <p>Introduction</p> <p>The Fontan procedure is an intervention that helps to correct single ventricle physiology. There are many known long-term complications of 'Fontan physiology'. However, the occurrence of renal abscess in such patients has not yet been reported in the literature. The first generation of adults has now undergone the procedure and it is necessary to be aware of the long-term outcomes and complications associated with it.</p> <p>Case presentation</p> <p>We report the case of a 22-year-old South Indian man who had developed a staphylococcal renal abscess against a background of xanthogranulomatous pyelonephritis, nine years after Fontan surgery. He presented to our hospital with a high-grade fever of 25-days duration but with no other symptoms. Physical examination identified costovertebral angle tenderness and pedal edema. An ultrasound scan revealed a mass in his left kidney. The results of a computed tomography scan were consistent with a renal abscess. Despite treatment with the appropriate parenteral antibiotics, there was no change in the size of the abscess and a left nephrectomy was performed as a curative procedure.</p> <p>Conclusions</p> <p>The learning points here are manifold. It is important to be aware of the possibility of renal abscess in a post-procedural patient. The early diagnosis of a septic focus in the kidneymay help to prevent the rare outcome of nephrectomy.</p

Constraints on Unparticle Physics from Solar and KamLAND Neutrinos

Interest has been directed recently towards low energy implications of a non-trivial conformal sector of an effective field theory with an IR fixed point (\Lambda), manifest in terms of ``unparticles'' with bizarre properties. We re-examine the implications of the limits on decay lifetimes of solar neutrinos for unparticle interactions. We study in detail the fundamental parameter space (\Lambda, M) and derive bounds on the energy scale M characterizing the new physics. We work strictly within the framework where conformal invariance holds down to low energies. We first assume that couplings of the unparticle sector to the Higgs field are suppressed and derive bounds with \Lambda in the TeV region from neutrino decay into scalar unparticles. These bounds are significant for values of the anomalous dimension of the unparticle operator 1.0 < d < 1.2. For a region of the parameter space, we show that the bounds are comparable to those arising from production rates at high energy colliders. We then relax our assumption, by considering a more natural framework which does not require a priori restrictions on couplings of Higgs-unparticle operators, and derive bounds with \Lambda in meV region from neutrino decay into vector unparticles. Such low scales for the IR fixed point are relevant in gauge theories with many flavors.Comment: To be published in Phys. Lett.

Semilocal Topological Defects

Semilocal defects are those formed in field theories with spontaneously broken symmetries, where the vacuum manifold $M$ is fibred by the action of the gauge group in a non-trivial way. Studied in this paper is the simplest such class of theories, in which $M\simeq S^{2N-1}$, fibred by the action of a local $U(1)$ symmetry. Despite $M$ having trivial homotopy groups up to $\pi_{2N-2}$, this theory exhibits a fascinating variety of defects: vortices, or semilocal strings; monopoles (on which the strings terminate); and (when $N=2$) textures, which may be stabilised by their associated magnetic field to produce a skyrmion.Comment: 28pp, DAMTP-HEP-92-2

Top-Charm Associated Production in High Energy e+e−e^+e^- Collisions

The possibility of exploring the flavor changing neutral current $tcZ/tc\gamma$ couplings in the production vertex for the reaction \epem\to t\bar c + \bar tc is examined. Using a model independent parameterization for the effective Lagrangian to describe the most general three-point interactions, production cross sections are found to be relatively small at LEP II, but potentially sizeable at higher energy \epem colliders. The kinematic characteristics of the signal are studied and a set of cuts are devised for clean separation of the signal from background. The resulting sensitivity to anomalous flavor changing couplings at LEP II with an integrated luminosity of $4\times 500$ pb$^{-1}$ is found to be comparable to their present indirect constraints from loop processes, while at higher energy colliders with $0.5-1$ TeV center-of-mass energy and 50-200 fb$^{-1}$ luminosity, one expects to reach a sensitivity at or below the percentage level.Comment: Latex, 22 page

Quantum Gravity from Noncommutative Spacetime

We review a novel and authentic way to quantize gravity. This novel approach is based on the fact that Einstein gravity can be formulated in terms of a symplectic geometry rather than a Riemannian geometry in the context of emergent gravity. An essential step for emergent gravity is to realize the equivalence principle, the most important property in the theory of gravity (general relativity), from U(1) gauge theory on a symplectic or Poisson manifold. Through the realization of the equivalence principle, which is an intrinsic property in symplectic geometry known as the Darboux theorem or the Moser lemma, one can understand how diffeomorphism symmetry arises from noncommutative U(1) gauge theory; thus, gravity can emerge from the noncommutative electromagnetism, which is also an interacting theory. As a consequence, a background-independent quantum gravity in which the prior existence of any spacetime structure is not a priori assumed but is defined by using the fundamental ingredients in quantum gravity theory can be formulated. This scheme for quantum gravity can be used to resolve many notorious problems in theoretical physics, such as the cosmological constant problem, to understand the nature of dark energy, and to explain why gravity is so weak compared to other forces. In particular, it leads to a remarkable picture of what matter is. A matter field, such as leptons and quarks, simply arises as a stable localized geometry, which is a topological object in the defining algebra (noncommutative $\star$-algebra) of quantum gravity.Comment: 97 pages, to be published in J. Korean Phys. So

Establishing a core outcome set for peritoneal dialysis : report of the SONG-PD (standardized outcomes in nephrology-peritoneal dialysis) consensus workshop

Outcomes reported in randomized controlled trials in peritoneal dialysis (PD) are diverse, are measured inconsistently, and may not be important to patients, families, and clinicians. The Standardized Outcomes in Nephrology-Peritoneal Dialysis (SONG-PD) initiative aims to establish a core outcome set for trials in PD based on the shared priorities of all stakeholders. We convened an international SONG-PD stakeholder consensus workshop in May 2018 in Vancouver, Canada. Nineteen patients/caregivers and 51 health professionals attended. Participants discussed core outcome domains and implementation in trials in PD. Four themes relating to the formation of core outcome domains were identified: life participation as a main goal of PD, impact of fatigue, empowerment for preparation and planning, and separation of contributing factors from core factors. Considerations for implementation were identified: standardizing patient-reported outcomes, requiring a validated and feasible measure, simplicity of binary outcomes, responsiveness to interventions, and using positive terminology. All stakeholders supported inclusion of PD-related infection, cardiovascular disease, mortality, technique survival, and life participation as the core outcome domains for PD

Rhabdomyolysis in Community Acquired Bacterial Sepsis – A Retrospective Cohort Study

BACKGROUND AND OBJECTIVES:Rhabdomyolysis is often associated with sepsis and gram positive bacterial pathogens are reported to be the most frequent cause of sepsis induced rhabdomyolysis. We report the pattern of infecting bacterial pathogens and associated causal factors in a South-Indian cohort. DESIGN, SETTING, PARTICIPANTS #ENTITYSTARTX00026; MEASUREMENTS:Retrospective cohort study of adult patients with community acquired bacterial sepsis complicated by rhabdomyolysis from March 2003--August 2008. Rhabdomyolysis was defined as serum creatine kinase >2000 IU/L. The study population was divided into group-I (sepsis with gram positive pathogens), group-II (sepsis with gram negative pathogens) and group-III (culture negative sepsis). RESULTS:103 patients (group I -15, group II- 34 and group III- 54) formed the study cohort. Mean age was 55 years and two-third had diabetes. Mean creatine kinase was 7114 IU/L and mean serum creatinine on admission was 2.4 mg/dl. Causative pathogen of sepsis was identified in 47.5%. Gram negative pathogens were more frequently (33%) associated with rhabdomyolysis than gram positive pathogens (14.5%). Lung was the commonest foci of sepsis (38.8%). 78.6% of the study population had one or more additional causal factor for rhabdomyolysis like statin intake, chronic alcoholism, hypokalemia, hypernatremia and hypophosphatemia. Mortality was 59%. CONCLUSIONS:Gram negative bacterial pathogens were more frequently associated with rhabdomyolysis than gram positive pathogens. Rhabdomyolysis in patients with sepsis is multifactorial and is associated with high mortality