Serum Cystatin C for the diagnosis of acute Kidney Injury in Patients Admitted in the Emergency Department

BACKGROUND: Early diagnosis of acute kidney injury (AKI) at emergency department (ED) is a challenging issue. Current diagnostic criteria for AKI poorly recognize early renal dysfunction and may cause delayed diagnosis. We evaluated the use of serum cystatin C (CysC) for the early and accurate diagnosis of AKI in patients hospitalized from the ED. METHODS: In a total of 198 patients (105 males and 93 females), serum CysC, serum creatinine (sCr), and estimated glomerular filtration rate (eGFR) were calculated at 0, 6, 12, 24, 48, and 72 hours after presentation to the ED. We compared two groups according to the presence or absence of AKI. RESULTS: Serial assessment of CysC, sCr, and eGFR was not a strong, reliable tool to distinguish AKI from non-AKI. CysC > 1.44 mg/L at admission, both alone (Odds Ratio = 5.04; 95%CI 2.20-11.52; P < 0.0002) and in combination with sCr and eGFR (Odds Ratio = 5.71; 95%CI 1.86-17.55; P < 0.002), was a strong predictor for the risk of AKI. CONCLUSIONS: Serial assessment of CysC is not superior to sCr and eGFR in distinguishing AKI from non-AKI. Admission CysC, both alone and in combination with sCr and eGFR, could be considered a powerful tool for the prediction of AKI in ED patients

Meta-analysis of host response networks identifies a common core in tuberculosis

Tuberculosis remains a major global health challenge worldwide, causing more than a million deaths annually. To determine newer methods for detecting and combating the disease, it is necessary to characterise global host responses to infection. Several high throughput omics studies have provided a rich resource including a list of several genes differentially regulated in tuberculosis. An integrated analysis of these studies is necessary to identify a unified response to the infection. Such data integration is met with several challenges owing to platform dependency, patient heterogeneity, and variability in the extent of infection, resulting in little overlap among different datasets. Network-based approaches offer newer alternatives to integrate and compare diverse data. In this study, we describe a meta-analysis of host’s whole blood transcriptomic profiles that were integrated into a genome-scale protein–protein interaction network to generate response networks in active tuberculosis, and monitor their behaviour over treatment. We report the emergence of a highly active common core in disease, showing partial reversals upon treatment. The core comprises 380 genes in which STAT1, phospholipid scramblase 1 (PLSCR1), C1QB, OAS1, GBP2 and PSMB9 are prominent hubs. This network captures the interplay between several biological processes including pro-inflammatory responses, apoptosis, complement signalling, cytoskeletal rearrangement, and enhanced cytokine and chemokine signalling. The common core is specific to tuberculosis, and was validated on an independent dataset from an Indian cohort. A network-based approach thus enables the identification of common regulators that characterise the molecular response to infection, providing a platform-independent foundation to leverage maximum insights from available clinical data

Whole Genome Sequencing of Mycobacterium tuberculosis Clinical Isolates From India Reveals Genetic Heterogeneity and Region-Specific Variations That Might Affect Drug Susceptibility

Whole genome sequencing (WGS) of Mycobacterium tuberculosis has been constructive in understanding its evolution, genetic diversity and the mechanisms involved in drug resistance. A large number of sequencing efforts from across the globe have revealed genetic diversity among clinical isolates and the genetic determinants for their resistance to anti-tubercular drugs. Considering the high TB burden in India, the availability of WGS studies is limited. Here we present, WGS results of 200 clinical isolates of M. tuberculosis from North India which are categorized as sensitive to first-line drugs, mono-resistant, multi-drug resistant and pre-extensively drug resistant isolates. WGS revealed that 20% of the isolates were co-infected with M. tuberculosis and non-tuberculous mycobacteria species. We identified 12,802 novel genetic variations in M. tuberculosis isolates including 343 novel SNVs in 38 genes which are known to be associated with drug resistance and are not currently used in the diagnostic kits for detection of drug resistant TB. We also identified M. tuberculosis lineage 3 to be predominant in the northern region of India. Additionally, several novel SNVs, which may potentially confer drug resistance were found to be enriched in the drug resistant isolates sampled. This study highlights the significance of employing WGS in diagnosis and for monitoring further development of MDR-TB strains

PENGARUH DEBT TO EQUITY RATIO (DER), RETURN ON ASSETS (ROA), EARNING PER SHARE (EPS), RETURN ON EQUITY (ROE), DEBT TO ASSET RATIO (DAR) DAN PRICE BOOK VALUE (PBV) TERHADAP HARGA SAHAM PADA PERUSAHAAN SUBSEKTOR MAKANAN DAN MINUMAN DI BURSA EFEK INDONESIA (BEI) PERIODE 2018 - 2022

Harga saham pada dasarnya akan mengalami perubahan secara alami mengikuti besarnya permintaan dan penawaran. Jika permintaan besar, maka harga saham akan naik pula. Sebaliknya, jika penawaran lebih besar, maka harga saham cenderung turun. Perubahan ini sesuai dengan hukum mekanisme pasar. Besarnya permintaan dan penawaran di pasar saham sangat bergantung pada persepsi investor terhadap kondisi fundamental saham dan informasi yang beredar berkaitan dengan kinerja emiten. Informasi yang beredar di pasar tersebut dibedakan dalam dua golongan besar, yakni informasi resmi yang berasal dari perusahaan (emiten) dan informasi tidak resmi yang sumber beritanya tidak berasal dari perusahaan. Penelitian ini mencakup dalam ruang lingkup akuntansi, khususnya terkait pengaruh debt to equity ratio (DER), return on asset (ROA), earning per share (EPS), return on equity (ROE), debt to asset ratio (DAR), dan price book value (PBV) secara simultan terhadap harga saham pada perusahaan subsektor makanan dan minuman di BEI tahun 2018-2022. Hasil uji regresi data panel dapat diketahui bahwa variabel Debt to Equity Ratio (DER), Return on Asset (ROA), Earning Per Share (EPS), Return on Equity (ROE), Debt to Asset Ratio (DAR), dan Price Book Value (PBV) secara simultan berpengaruh terhadap harga sahampada perusahaan subsektor makanan dan minuman di BEI tahun 2018-2022. Hasil uji regresi data panel secara parsial dapat diketahui bahwa: 1) Debt to Equity Ratio (DER) secara parsial tidak berpengaruh terhadap harga saham pada perusahaan subsektor makanan dan minuman di BEI tahun 2018-2022., 2) Return on Asset (ROA) secara parsial berpengaruh terhadap harga saham pada perusahaan subsektor makanan dan minuman di BEI tahun 2018-2022.3) Earning Per Share (EPS) secara parsial tidak berpengaruh terhadap harga saham perusahaan subsektor makanan dan minuman di BEI tahun 2018-2022., 4) Return on Equity (ROE) secara parsial tidak berpengaruhterhadap harga saham pada perusahaan subsektor makanan dan minuman di BEI tahun 2018- 2022. 5) Debt to Asset Ratio (DAR) secara parsial tidak berpengaruh terhadap harga saham perusahaan subsektor makanan dan minuman di BEI tahun 2018-2022. 6) Price Book Value (PBV) secara parsial berpengaruh terhadap harga saham perusahaan subsektor makanan dan minuman di BEI tahun 2018-2022

UXO Detection by Multiscale Potential Field Methods

The choice of an effective interpretative methodology in terms of management costs, timing, reliability, safety and efficiency is a key issue for the identification of unexploded ordnance (UXO). Among geophysical methods, magnetometry plays an important role in detection and interpretation of UXO objects. We present a study aimed at the identification and characterization of buried UXO in Rohoznik, Slovakia, by a multiscale analysis on high-resolution magnetic data. The area is located close to a former army shooting range and is characterized by several buried UXO. When a UXO hits the ground but does not explode, the impact causes a re-organization of the magnetic domains within the armature (shock demagnetization). Due to shock demagnetization the object gets a magnetization oriented in the direction of the actual Earth magnetic field. Furthermore, the elongated shape of the UXO of Rohoznik causes their anomalies to be oriented along the longitudinal axis of the projectiles. Our multiscale analysis was performed through methods such as depth from extreme points (DEXP) and the multi-ridge method. The upward continuation employed by these two methods allowed reducing the influence of the high-frequency noise related to non-UXO buried iron objects. Also, the use of high-order derivatives in the multiscale approach decreased interference effects related to close-by sources and avoided any pre-filtering. Our approach was first validated on a test site located close to Rohoznik, where unexplored projectiles were buried with different orientations at a known depth. Then we focused on the real data of the former army shooting range. For all our analyses we employed a structural index value of 2.5, which was estimated through the scaling function analysis and the derivative euler deconvolution algorithm. Both the (DEXP) and multi-ridge depth-estimation methods proved to be effective and rapid with respect to more expensive and time-consuming methods such as inversion. Our analysis revealed average depths for the analysed UXOs matching rather well with what was found by subsequent excavations, with a maximum discrepancy of a few decimetres

UXO Detection by Multiscale Potential Field Methods

The choice of an effective interpretative methodology in terms of management costs, timing, reliability, safety and efficiency is a key issue for the identification of Unexploded Ordnance (UXO). We present a study aimed at the identification and characterization of buried UXO in Rohoznik-Studienka, Slovakia, by a multiscale analysis on high-resolution magnetic data. The area is located close to a former army shooting range and is characterized by several buried UXO. When a UXO hits the ground but does not explode, the impact causes a re-organization of the magnetic domains within the armature (shock demagnetization). Due to shock demagnetization the object gets a remanent magnetization oriented in the direction of the actual Earth magnetic field. Furthermore, the elongated shape of the UXO of Studienka causes their anomalies to be oriented along the longitudinal axis of the projectiles. Our multiscale analysis was performed through methods such as Depth from Extreme Points (DEXP) and the Multi-ridge method. The upward continuation employed by these two methods allowed reducing the influence of the high-frequency noise related to non-UXO buried iron objects. Also, the use of high-order derivatives in the multiscale approach decreased interference effects related to close-by sources and avoided any pre-filtering. For our analyses we employed a structural index value of 2.5, which was estimated through the Derivative Euler Deconvolution algorithm. Both depth-estimation methods proved to be effective and rapid with respect to more expensive methods such as inversion. Our analysis revealed average depths for the analyzed UXOs matching rather well with what was found by subsequent excavations, with a maximum discrepancy of a few centimeters

Traumatic diaphragmatic hernia-our experience

AbstractObjectiveTo review our experience in the management of traumatic diaphragmatic hernia.Materials and methodsThe records of all patients operated for diaphragmatic hernia between January 1998 and October 2008 at S.D.S Sanitorium and Rajiv Gandhi Institute of Chest Diseases, Bangalore, India were reviewed. Details of their clinical presentation, mode of diagnosis, operative findings and postoperative outcome were analysed.ResultsTwenty nine patients underwent surgery for traumatic diaphragmatic hernia. The cause of rupture was blunt trauma in 24(83%) patients and penetrating trauma in 5(17%) patients. In 21 (72%) patients the diagnosis was made within 24hrs and in 8(28%) patients the diagnosis was made after 24hrs. Thoracotomy was the most common surgical approach used in 20(69%) patients. Post operative morbidity was 24% and mortality was 13.8%.ConclusionX-ray chest is still very useful in the diagnosis of diaphragmatic ruptures. Right sided ruptures are difficult to diagnose. Diaphragmatic hernia repair can be done through a thoracotomy with acceptable results in patients without concomitant intra abdominal injuries

Hypothyroidism in MDR-TB treatment – Rare occurrence but a major concern

Context: To achieve good cure rate during treatment of MDR-TB, strict adherence to treatment regimen is a must. As the second line drugs have great potential to cause adverse drug reactions (ADR), identifying these adverse reactions and treating them early is major factor in preventing default. Hypothyroidism is one such ADR caused by thioamides (ethionamide, prothionamide) and paraamino salicylic acid. Aims: To study the frequency of occurrence of hypothyroidism and its implication in MDR-TB treatment. Settings and design: Retrospective analysis of 488 patients enrolled in our institute for MDR-TB treatment treated with standardised Cat IV treatment, as per RNTCP-PMDT guidelines. Methods and material: Retrospective analysis of 484 (4 had hypothyroidism before treatment initiation) patients treated in our institute was done. Thyroid function test was done at baseline and repeated when indicated by symptoms during clinical follow up. Patients developing hypothyroidism (defined as TSH > 10 microIU/ml) during treatment and the reasons for same are analysed. Its implication in treatment outcome is studied. Results: Out of the 484 study population, 19 (3.9%) had at least one documented record of TSH > 10.0 microIU/ml after treatment initiation. Median time from initiation of MDR-TB treatment to development of hypothyroidism was 153 days (range 32–441 days). Conclusions: Occurrence of hypothyroidism is rare in MDRTB treatment. But symptomatic hypothyroidism is a major factor influencing the patient compliance towards the treatment regimen. As the drugs in regimen are effective in disease treatment, the major hindrance in achieving good cure-rate is to prevent defaulters. Identifying hypothyroidism early helps to prevent default