ANTI-GLOMERULAR BASEMENT MEMBRANE ANTIBODY DISEASE AND ITS OUTCOME

Anti-glomerular basement membrane (anti-GBM) disease is an aggressive autoimmune disease which affects glomerular capillaries, characterized by glomerular fibrinoid necrosis and crescent formation with or without pulmonary hemorrhage. Patients presenting with dialysis-dependent renal failure have poor renal outcomes. There is limited data regarding the clinical presentation and outcomes of antiGBM disease from India. Aim: To study the incidence, clinical, biochemical and pathological characteristics and outcome of patients with anti-glomerular basement membrane (anti-GBM) antibody disease. Methods and Material: This is a retrospective study conducted by screening renal biopsy reports of patients presented with rapidly progressing glomerulonephritis (RPGN) over a period of 45 months(JAN 2015-OCT 2018) Those patients who had histopathological features suggestive of ANTI GBM disease or those who had positive ANTI-GBM antibody titers were further analyzed. Their records were reviewed for the duration of symptoms before presentation, clinical features, and biochemical, pathology and serology reports. Follow up details were noted. Results: A total of 97 patients presented with RPGN during the period of 45 months (Jan 2015 to Oct 2018). Anti GBM disease (10/97) constituted 10.30% of rapidly progressive glomerular disease. Males and females were equally affected (M: F 5:5), males mean age; 43.6+ 6.9 yrs and females mean age 28.8+ 10.1 yrs. The presenting symptoms were pedal edema (80%), oliguria (60%), hematuria (40%) and hemoptysis (20%). Kidney biopsy was done after a mean period of 10.7+ 7.2 days after first presentation. Mean sr. creatinine was 7.7+ 3.3 mg/dl, Only 2 patients had a creatinine of <5 mg /dl. Eight patients screened for circulating anti-GBM antibodies were positive and one patient positive for p-ANCA. Mean crescents per biopsy specimen were 71 %, 3 had 100% crescents (30%). Conclusions: Anti GBM disease constituted 10.30% of rapidly progressive GN. Males and younger females were predominantly affected .All patients had >50% crescents and severe renal failure at presentation. Despite adequate immunosuppressive therapy all of them developed ESRD, due to delayed presentation

Unrecognized renal dysfunction in patients with acute stroke- Cross sectional study

Background and Objectives: Unrecognized renal insufficiency, defined as an estimated glomerular filtration rate <60 mL/min/l .73 m2 in the presence of normal serum creatinine levels, is a common comorbid condition among patients with various cardiovascular conditions. The current study was aimed to evaluate the prevalence and clinical significance of unrecognized renal dysfunction in patients admitted with acute stroke. Patients & Methods: This cross sectional study consisted of patients with acute stroke admitted in medical ward at Stanley medical college. Estimated glomerular filtration is estimated using MDRD and CKD — EPI formula. Study group is divided into three groups (Normal renal function, Unrecognized and Recognized renal dysfunction) as per eGFR. The two primary outcomes such as severe disability at hospital discharge and in-hospital mortality are compared in each group. Results: Of the 100 patients with stroke included in the study, 62% had a normal renal function, 31% had recognized renal insufficiency, and 7% had unrecognized renal insufficiency. Mortality rates are higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (29% and 28.5% and 9.6%) respectively, P <0.04053). Similarly, severe disability rates at discharge are also higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (72.27%, 80 %, and 32.14%) respectively. Conclusion: Unrecognized renal insufficiency is common among patients with acute stroke and is associated with adverse short-term outcomes

Identification and Characterization of RcMADS1, an AGL24 Ortholog from the Holoparasitic Plant Rafflesia cantleyi Solms-Laubach (Rafflesiaceae)

10.1371/journal.pone.0067243PLoS ONE86-POLN

DIARRHEA IN RENAL TRANSPLANT RECIPIENTS – A CROSS SECTIONAL STUDY

Background and Objectives: Post-transplant diarrhea is a frequent complication of renal transplantation. Post-transplant diarrhea is associated with reduced quality of life1, hastened decline of graft function and higher mortality2. Diarrhea is often neglected by patients and clinicians and considered as a side effect of immunosuppressive regimens. The aim of this study is to identify the etiology, clinical profile, and outcome of diarrhea in renal transplant recipients. Patients and Methods: Over 1-year period renal transplant recipients with diarrhea were analyzed. Diarrhea was defined as three or more semisolid or liquid stools per day for minimum of 3 days duration. After obtaining detailed history, patients were subjected to clinical examination. Blood samples were collected for biochemical investigations and stool samples for microbiological examination. We adopted DIDACT protocol for investigating the diarrheal episode in recipients3. Results: A total of 46 patients were enrolled in this study. Males were predominant in number 36 (78.2%). This included 33 live related renal transplant recipients (LRRTR) and 13 deceased donor renal transplant recipients (DDRTR). The mean age of the patients was 33.2±9.12 years. A majority of them had diarrhea after 1 year of transplantation (n= 29, 63.1%). Infective causes were identified in 6 patients and optimization of immunosuppression’s was done in 11 patients. Conclusion: In our study, most of the recipients (63.1%) had diarrhea after one year of renal transplantation. The cause of Diarrhea was unclear in a significant number (n=22) of the study population

Susceptibility to chronic mucus hypersecretion, a genome wide association study

Background: Chronic mucus hypersecretion (CMH) is associated with an increased frequency of respiratory infections, excess lung function decline, and increased hospitalisation and mortality rates in the general population. It is associated with smoking, but it is unknown why only a minority of smokers develops CMH. A plausible explanation for this phenomenon is a predisposing genetic constitution. Therefore, we performed a genome wide association (GWA) study of CMH in Caucasian populations. Methods: GWA analysis was performed in the NELSON-study using the Illumina 610 array, followed by replication and meta-analysis in 11 additional cohorts. In total 2,704 subjects with, and 7,624 subjects without CMH were included, all current or former heavy smokers (≥20 pack-years). Additional studies were performed to test the functional relevance of the most significant single nucleotide polymorphism (SNP). Results: A strong association with CMH, consistent across all cohorts, was observed with rs6577641 (p = 4.25x10-6, OR = 1.17), located in intron 9 of the special AT-rich sequence-binding protein 1 locus (SATB1) on chromosome 3. The risk allele (G) was associated with higher mRNA expression of SATB1 (4.3x10 -9) in lung tissue. Presence of CMH was associated with increased SATB1 mRNA expression in bronchial biopsies from COPD patients. SATB1 expression was induced during differentiation of primary human bronchial epithelial cells in culture. Conclusions: Our findings, that SNP rs6577641 is associated with CMH in multiple cohorts and is a cis-eQTL for SATB1, together with our additional observation that SATB1 expression increases during epithelial differentiation provide suggestive evidence that SATB1 is a gene that affects CMH

MINERAL BONE DISORDERS IN NAÏVE CHRONIC KIDNEY DISEASE PATIENTS – A COHORT STUDY FROM A TERTIARY CENTRE IN SOUTH INDIA

Background: Highest rates of morbidity and mortality in chronic kidney disease (CKD) are encountered with its cardiovascular complications and Mineral Bone Disorders (MBD). MBD is now being recognized as a systemic disorder with far-reaching consequences on the quality of life and is no longer merely restricted to the histomorphometric findings in the bone biopsy. Objective: Few studies to date are available on the pattern of mineral bone disorders in Indian CKD population. Our primary aim was to study the varied patterns of CKD mineral bone disorders in our center based on biochemical parameters. Patients & Methods: Cross-sectional study involving 75 newly diagnosed patients with CKD stages G3, G4 & G5D. Patients were categorized into two groups based on their KDIGO CKD staging- Group A – CKD stages G3a, G3b, G4; Group B – CKD stage G5D. The biochemical markers of CKD-MBD, namely, serum calcium, phosphorus, alkaline phosphatase, intact parathyroid hormone (PTH), and 25-hydroxyvitamin Vitamin D were measured. Results: 24 patients were included in group A and 51 patients in group B. The most common underlying native kidney disease was chronic glomerulonephritis (41.3%), followed by diabetic nephropathy (37.3%) and chronic interstitial nephritis (21.3%). The mean age of our study population was 49.5 ± 22.9 years in group A and 54.1 ± 15.77 years in group B. Conclusions: A higher prevalence of hyperphosphatemia, hypocalcemia and vitamin D deficiency was observed in our CKD cohort. Early identification and treatment of these mineral bone disorders are of paramount importance to prevent complications, retard disease progression and improve quality of life

SPECTRUM OF ORAL AND DENTAL MANIFESTATIONS IN CHRONIC KIDNEY DISEASE PATIENTS – A SINGLE CENTER EXPERIENCE

Background: Increased survival among Chronic Kidney Disease (CKD) patients have led to new problems including concerns for oral health. Periodontitis is a potential proinflammatory state associated with protein energy malnutrition and accelerated atherosclerosis. As supported by literature, patients with periodontitis have higher odds and risks of developing cardiovascular diseases. In our work, we aimed to look into the spectrum of oral and dental manifestations in CKD patients and compare the prevalence of periodontal disease with that of age and gender matched controls. Study design & population: This was an observational, case control cross sectional study where 100 patients with CKD and 100 age and sex matched controls were involved. Patients were asked about symptoms of unpleasant taste, dry mouth and burning tongue and were examined for oral lesions such as pale mucosa, dry fissured lips, Saburral tongue, Candidiasis, petechiae, ecchymosis, smooth tongue, ulcerative stomatitis and angular cheilitis by a trained dental surgeon with appropriate armamentarium. The Periodontal disease index using the plaque component, calculus component, gingival and periodontal components were scored for each patient. Statistical analysis: Student t-test & Chi-square test were used to determine the difference in clinical parameters between the patients and controls. SPSS version 16.0 was used for data analysis. Results: Most common symptoms in CKD patients were xerostomia (45%) and unpleasant taste (42%) while the most common signs were pale mucosa and smooth tongue (28%). Prevalence of uremic fetor, xerostomia, pale mucosa, dry fissured lips, suboral tongue, smooth tongue in diabetic CKD patients was higher than in non-diabetic CKD patients. Periodontal disease index scoring revealed a significantly higher plaque index, calculus index and gingival and periodontal index in CKD patients compared to controls. Conclusions: Periodontitis is an ignored source of systemic inflammation in patients with CKD. Our study highlights the rampant prevalence of oral lesions and periodontitis in CKD particularly in diabetic CKD and End stage renal disease (ESRD) patients. Recognising and managing periodontitis at an early stage may help in decreasing the pro inflammatory state and increasing the nutritional status of CKD patients. Periodic oral cavity and periodontal assessment should be made a part of routine standard of care in CKD patients

Point-of-care ultrasound in acute kidney injury: A single-center study

Background: Acute kidney injury (AKI) is a serious condition with a high mortality rate, necessitating prompt radiological assessment for effective management. Delays in radiologist evaluation can impede the initiation of treatment. Nephrologists are increasingly utilizing point-of-care ultrasound (POCUS) for bedside evaluations, expediting treatment decisions. POCUS enhances physical examinations and is valuable in nephrology for guiding procedures and diagnosing kidney disease. Aims and Objectives: This study aimed to use POCUS to assess kidney echogenicity, size in various AKI causes, post-renal obstructions, volume status through the inferior vena cava (IVC), and lung ultrasonography (USG) findings and to compare these findings with clinical assessments. Materials and Methods: In this prospective observational study, 50 patients with AKI were clinically categorized upon admission into euvolemic, hypervolemic, or hypovolemic groups based on physical examination. POCUS was used to assess renal cortical echogenicity, bladder outlet obstruction, and volume status using IVC size and lung USG. Correlations between clinical and POCUS-assessed volume status were compared. Results: The mean age was 48.8 years, with 64% male (n=32). POCUS revealed increased renal echogenicity in three patients (6%) and obstructive nephropathy in six patients (12%). Clinical assessments correlated with POCUS findings in 69.2% of euvolemic, 93.3% of hypervolemic, and 88.9% of hypovolemic patients (P<0.0001). Conclusion: The strong correlation between POCUS findings and clinical assessments underscores its reliability as a rapid, non-invasive tool for evaluating volume status in patients with AKI, supporting treatment decisions such as dialysis and hydration

Agile process systems engineering education:What to teach, and how to teach

peer reviewedThis paper investigates the current and future trends in the teaching of Process Systems Engineering (PSE) topics, addressing what should be taught and how these topics should be taught effectively in a classroom setting. It addresses which key PSE topics should constitute the core requirement of chemical engineering education and which application areas should be included. We surveyed existing courses on novel aspects of PSE applications, as well as polling PSE stakeholders to ascertain their opinion of what is taught and the degree to which graduates skills match their expectations. Existing gaps and interesting prospects have been revealed by the surveys leading to suggestions for the future. The second part of the contribution addresses how best the PSE content should be taught, so that our graduates are equipped to effectively apply their knowledge, given the availability of teaching technologies and the time available to effectively educate our students

Narcissism and the strategic pursuit of short-term mating : universal links across 11 world regions of the International Sexuality Description Project-2.

Previous studies have documented links between sub-clinical narcissism and the active pursuit of short-term mating strategies (e.g., unrestricted sociosexuality, marital infidelity, mate poaching). Nearly all of these investigations have relied solely on samples from Western cultures. In the current study, responses from a cross-cultural survey of 30,470 people across 53 nations spanning 11 world regions (North America, Central/South America, Northern Europe, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, Southeast Asia, and East Asia) were used to evaluate whether narcissism (as measured by the Narcissistic Personality Inventory; NPI) was universally associated with short-term mating. Results revealed narcissism scores (including two broad factors and seven traditional facets as measured by the NPI) were functionally equivalent across cultures, reliably associating with key sexual outcomes (e.g., more active pursuit of short-term mating, intimate partner violence, and sexual aggression) and sex-related personality traits (e.g., higher extraversion and openness to experience). Whereas some features of personality (e.g., subjective well-being) were universally associated with socially adaptive facets of Narcissism (e.g., self-sufficiency), most indicators of short-term mating (e.g., unrestricted sociosexuality and marital infidelity) were universally associated with the socially maladaptive facets of narcissism (e.g., exploitativeness). Discussion addresses limitations of these cross-culturally universal findings and presents suggestions for future research into revealing the precise psychological features of narcissism that facilitate the strategic pursuit of short-term mating