A rare case report on primary sjogren’s syndrome complicating as osteomalacia with renal tubular acidosis in a tertiary care teaching hospital tirupathi

Renal involvement in Sjogren’s syndrome (SS) is not uncommon and may precede other complaints. Tubulointerstitial nephritis is the most common renal disease in SS and may lead to, renal tubular acidosis (RTA), which in turn may cause osteomalacia. Nevertheless, osteomalacia rarely occurs as the first manifestation of a renal tubule connective tissue disorder due to SS. Here we are presenting a female patient of age 41 yrs was admitted in our hospital with chief complaints of bilateral thigh pain which restrict her walking with weakness. x-ray of long bone shows that extensive demineralization of the bone. Laboratory investigations revealed hypokalemia (3.2 mmol/L), hypophosphatemia (0.4 mmol/L), hypocalcemia (2.14 mmol/L) and hyperchloremic metabolic acidosis (chlorine: 214 mmol/L; alkaline reserve: 14 mmol/L). The serum alkaline phosphatase levels were elevated. The serum levels of 25-hydroxyvitamin D and 1,25-dihydroxy vitamin D were low and borderline low, respectively, and the parathyroid hormone level was 90 pg/L. Urinalysis showed inappropriate alkaline urine (urinary PH: 7), glycosuria. These values indicated the presence of both distal and proximal RTA. Our patient reported dryness of the mouth and eyes and Schirmer’s test showed xerophthalmia

Correlation, Path Analysis and Genetic Divergence of Various Agro-morphological Traits and Traits Suitable for Mechanical Harvesting of Chickpea (Cicer arietinum L.) Germplasm

Five hundred and forty germplasm lines of chickpea were evaluated along with five checks (RLBGK-1, BG 3062, RVG 204, Phule Vikram, NBeG 47) in augmented design during rabi, 2021–2022 at Rani Lakshmi Bai Central Agricultural University, Jhansi, Uttar Pradesh, India to study the agro-morphological features and traits appropriate for mechanical harvesting. Correlation, path coefficient analysis and genetic divergence were estimated to find out the extent of association and genetic divergence among chickpea germplasm.  Plant height, growth habit, the height of the initial podding node, and the angle of the primary branch are characteristics that have been researched to identify lines that are suited for mechanical harvesting. Peduncle length, number of primary branches, number of secondary branches, number of pods per plant, chlorophyll content, leaf area index, chlorophyll fluorescence showed positive correlation with seed yield per plant. Plant height and height of first podding node were showing positive high indirect effects through number of secondary branches on seed yield per plant. Cluster 1 was the largest with 399 germplasm while two clusters number 24 and 37 were smallest with 1 genotype each.  Plant height and height of first podding node were exhibiting maximum mean in cluster 32, whereas seed yield per plant was having maximum mean in cluster 14. According to percent contribution of different characters to total divergence obtained, the most significant contributors to the divergence were number of pods per plant and plant height. Correlation analysis indicated that traits suitable for mechanical harvesting are not directly correlated with seed yield, while path coefficient analysis indicated that they have indirect effects on seed yield through number of primary and secondary branches per plant

Risk of Acute Liver Injury With Antiretroviral Therapy by Viral Hepatitis Status.

BackgroundThe risk of hepatotoxicity with antiretroviral therapy (ART) remains unknown. We determined the comparative risk of acute liver injury (ALI) for antiretroviral drugs, classes, and regimens, by viral hepatitis status.MethodsWe followed a cohort of 10 083 human immunodeficiency virus (HIV)-infected persons in Kaiser Permanente Northern California (n = 2099) from 2004 to 2010 and the Veterans Aging Cohort Study (n = 7984) from 2004 to 2012. Within the first year of ART, we determined occurrence of (1) liver aminotransferases >200 U/L and (2) severe ALI (coagulopathy with hyperbilirubinemia). We used Cox regression to determine hazard ratios (HRs) with 95% confidence intervals (CIs) of endpoints among initiators of nucleos(t)ide analogue combinations, antiretroviral classes, and ART regimens, all stratified by viral hepatitis status.ResultsLiver aminotransferases >200 U/L developed in 206 (2%) persons and occurred more frequently among HIV/viral hepatitis-coinfected than HIV-monoinfected persons (116.1 vs 20.7 events/1000 person-years; P < .001). No evidence of differential risk was found between initiators of abacavir/lamivudine versus tenofovir/emtricitabine among coinfected (HR, 0.68; 95% CI, .29-1.57) or HIV-monoinfected (HR, 1.19; 95% CI, .47-2.97) groups. Coinfected patients had a higher risk of aminotransferases >200 U/L after initiation with a protease inhibitor than nonnucleoside reverse-transcriptase inhibitor (HR, 2.01; 95% CI, 1.36-2.96). Severe ALI (30 events; 0.3%) occurred more frequently in coinfected persons (15.9 vs 3.1 events/1000 person-years; P < .001) but was too uncommon to evaluate in adjusted analyses.ConclusionsWithin the year after ART initiation, aminotransferase elevations were infrequently observed and rarely led to severe ALI. Protease inhibitor use was associated with a higher risk of aminotransferase elevations among viral hepatitis-coinfected patients