Asymptomatic cardiac manifestations in CKD

Background: Chronic kidney disease is recognised as health concern globally with more than 40 percent of morbididty and mortality. CKD is one of the independent risk factor for cardiovascular diseases and its unfavourable health outcomes. The risk factors like smoking, hypertension, dyslipidemia and diabetes which are highly prevalent in CKD. The therapeutic interventions in CKD patients to reduce CVD events does not hold a desired effect and has bad prognosis in end stage renal disease. The initial evidence indicating a relationship between CKD and CVD is more apparent in patient with dialysis. The aim of the study was to evaluate the asymptomatic cardiac manifestations in 2-4 stages of CKD through non-invasive methods like ECG and Echocardiography.Methods: It is a cross sectional study investigated on 250 CKD patients receiving care in JSS hospital, Mysore. For the primary objective, correlational analysis were performed to evaluate the association of renalfunctional parameters like serum creatinine, urine albumin, eGFR with cardiac parameters through ECG and Echocardiographic changes.Results: ECG revealed LVH with pressure overload pattern in 36%. 25% patients had ST-T changes. Echocardiography revealed LVH and diastolic dysfunction as abnormalities. LVH has significant p value.Conclusions: CVD is a leading cause of morbidity and mortality in patients of CKD who succumb to Cardio vascular deaths before reaching the end stage renal disease. Thus, focus of patient care in early CKD stages should be directed to prevention of cardiovascular complications through early ECG and Echocardiography

IN VITRO ANTIBACTERIAL AND ANTIFUNGAL ACTIVITIES OF AQUEOUS AND ETHANOLIC LEAF EXTRACTS OF ACACIA AURICULIFORMIS

Objective: The present study focuses on in vitro antimicrobial properties of aqueous and ethanol leaf extract of Acacia auriculiformis tested on Gram-positive cocci, Gram-negative bacilli, multidrug-resistant (MDR) Gram-negative bacilli, and fungus.Methods: Ethanol and aqueous extracts of the leaves of A. auriculiformis were prepared. Agar well diffusion was the method for antimicrobial susceptibility. Freshly grown standard strains of Staphylococcus aureus, Enterococcus faecalis, Klebsiella pneumoniae (K. pneumoniae) , Escherchia coli (E.coli) and Pseudomonas aeruginosa, clinical strains of Streptococcus pneumoniae, Candida albicans (C. ailbicans), and MDR E. coli, and MDR Klebsiella pnuemoniae were used. Ampicillin disc (10 μg) was used as control.Results: The zone of inhibition was measured to determine the antimicrobial activity. Ethanolic extract of A. auriculiformis exhibited antibacterial activity against all the strains including MDR strains of K. pneumoniae and E. coli. Antifungal activity was exhibited by both aqueous and ethanol leaf extracts of A. auriculiformis.Conclusion: Ethanol extract could be used against MDR K. pneumoniae and MDR E. coli. Similarly, aqueous and ethanol extract can be the drug of choice for C. albicans infection. Further study is necessary to evaluate the accurate compound responsible for antibacterial and antifungal activity for pharmaceutical applications

Role of CYP1B1, MYOC, OPTN and OPTC genes in adult-onset primary open-angle glaucoma: predominance of CYP1B1 mutations in Indian patients

Mutations in the CYP1B1, MYOC, OPTN, and WDR36 genes result in glaucoma. Given its expression in the optic nerve, it is likely a mutation in the OPTC gene is also involved in initiating glaucoma. This study was designed to evaluate the involvement of the CYP1B1, MYOC, OPTN, and OPTC genes in the etiology of adult-onset primary open-angle glaucoma (POAG) found in 251 Indian patients

Experimental study of the influence of glass cover cooling using evaporative cooling process on the thermal performance of single basin solar still

Acute shortage of drinking water has been on the rise owing to increasing population as well as shortage of drinkable water. Generation of potable water using passive solar stills is among the simplest and easier devices which make use of solar heat energy. However, the output of solar still is generally low owing to greater heat loss and needs improvement. In this paper, an experimental analysis is carried out to determine the performance of passive solar still with glass cover cooling using cold water generated using passive evaporative cooling process. The cold water required for cooling the glass cover is obtained using evaporative cooling process in the water tank which is wound with wet cotton cloth wick. The cold water thus obtained is sprayed onto the top surface of glass cover. The experiment is carried out in the outdoor conditions of Dubai from 10:00h to 14:00h and the temperature recordings of basin plate, glass cover, basin water, ambient air and cooling water are noted for every 30 minutes. The results reveal that the average increase in condensation heat transfer coefficient is found to be about 20.8% higher in the presence of glass cover cooling and the distillate output is found to increase by about 3.32 times. The average still efficiency is found to be relatively higher in the presence of cooling which is about 7.3% higher in the presence of cooling. The cold water temperature generated through evaporative cooling process is about 20.4% lower as compared to ambient temperature. Thus, the cooling of glass cover using cold water obtained through evaporative cooling process is found to be effective in enhancing the thermal performance of single basin solar still system

Effects of the WHO Labour Care Guide on cesarean section in India: a pragmatic, stepped-wedge, cluster-randomized pilot trial

Cesarean section rates worldwide are rising, driven by medically unnecessary cesarean use. The new World Health Organization Labour Care Guide (LCG) aims to improve the quality of care for women during labor and childbirth. Using the LCG might reduce overuse of cesarean; however, its effects have not been evaluated in randomized trials. We conducted a stepped-wedge, cluster-randomized pilot trial in four hospitals in India to evaluate the implementation of an LCG strategy intervention, compared with routine care. We performed this trial to pilot the intervention and obtain preliminary effectiveness data, informing future research. Eligible clusters were four hospitals with >4,000 births annually and cesarean rates ≥30%. Eligible women were those giving birth at ≥20 weeks' gestation. One hospital transitioned to intervention every 2 months, according to a random sequence. The primary outcome was the cesarean rate among women in Robson Group 1 (that is, those who were nulliparous and gave birth to a singleton, term pregnancy in cephalic presentation and in spontaneous labor). A total of 26,331 participants gave birth. A 5.5% crude absolute reduction in the primary outcome was observed (45.2% versus 39.7%; relative risk 0.85, 95% confidence interval 0.54-1.33). Maternal process-of-care outcomes were not significantly different, though labor augmentation with oxytocin was 18.0% lower with the LCG strategy. No differences were observed for other health outcomes or women's birth experiences. These findings can guide future definitive effectiveness trials, particularly in settings where urgent reversal of rising cesarean section rates is needed. Clinical Trials Registry India number: CTRI/2021/01/03069

Mechanisms of T cell organotropism

F.M.M.-B. is supported by the British Heart Foundation, the Medical Research Council of the UK and the Gates Foundation

Effect of nutritional intervention on malnutrition indicators in patients on haemodialysis

SUMMARY Objective To formulate a nutrient supplement using low cost, commonly available food ingredients and test its efficacy on various nutritional parameters in haemodialysis (HD) subjects. Design Prospective intervention study. Subjects 15 subjects who did not have diabetes were recruited for the study. The subjects served as self controls. Approach The subjects received a multi-nutrient formulation for a period of 3 months. Somatic status weight, mid upper arm circumference (MUAC), mid upper arm muscle circumference (MUAMC), waist and hip measurements, biochemical parameters blood urea nitrogen (BUN), total iron binding capacity (TIBC),serum levels of creatinine, albumin, triglycerides, sodium, potassium, calcium, phosphorus and high sensitive C-reactive protein(HsCRP), dietary intake and malnutrition inflammation score (MIS) were assessed. Results Significant increments (P ≤ 0.01) in anthropometric measurements. Significant increases (P ≤ 0.01) in Hb, BUN, serum creatinine, albumin and total protein and a significant decrease (P ≤ 0.01) in HsCRP and MIS were observed at the end of the study. An increase in baseline food/nutrient intake was also observed. Conclusion Nutritional supplementation designed for haemodialysis, improved their nutritional status in the short term study

Asymptomatic cardiac manifestations in CKD

Background: Chronic kidney disease is recognised as health concern globally with more than 40 percent of morbididty and mortality. CKD is one of the independent risk factor for cardiovascular diseases and its unfavourable health outcomes. The risk factors like smoking, hypertension, dyslipidemia and diabetes which are highly prevalent in CKD. The therapeutic interventions in CKD patients to reduce CVD events does not hold a desired effect and has bad prognosis in end stage renal disease. The initial evidence indicating a relationship between CKD and CVD is more apparent in patient with dialysis. The aim of the study was to evaluate the asymptomatic cardiac manifestations in 2-4 stages of CKD through non-invasive methods like ECG and Echocardiography.Methods: It is a cross sectional study investigated on 250 CKD patients receiving care in JSS hospital, Mysore. For the primary objective, correlational analysis were performed to evaluate the association of renalfunctional parameters like serum creatinine, urine albumin, eGFR with cardiac parameters through ECG and Echocardiographic changes.Results: ECG revealed LVH with pressure overload pattern in 36%. 25% patients had ST-T changes. Echocardiography revealed LVH and diastolic dysfunction as abnormalities. LVH has significant p value.Conclusions: CVD is a leading cause of morbidity and mortality in patients of CKD who succumb to Cardio vascular deaths before reaching the end stage renal disease. Thus, focus of patient care in early CKD stages should be directed to prevention of cardiovascular complications through early ECG and Echocardiography

Correlation of carotid intimal-medial thickness with estimated glomerular filtration rate and cardiovascular risk factors in chronic kidney disease

Carotid intimal-medial thickness (CIMT) predicts future vascular events in the general population. However, the correlation of traditional cardiovascular risk factors and stages of chronic kidney disease (CKD) with CIMT is not studied extensively. To determine the correlation of CIMT with traditional cardiovascular risk factors like age, body mass index (BMI), dyslipidemia and various stages of CKD patients, CIMT was measured by means of high-resolution B-mode ultrasonography in 70 CKD patients and compared with the 30 healthy controls. The mean CIMT in patients was 0.86 ± 0.21 mm vs 0.63 ± 0.17 mm in healthy age- and sex-matched controls (P <0.001). There was a significant univariate positive correlation between CIMT and age (r = 0.605, P <0.001), BMI (r = 0.377, P = 0.001), total cholesterol (r = 0.236, P ≤0.018) and serum triglyceride (r = 0.387, P ≤0.001). No statistically significant correlation was found between mean CIMT and estimated glomerular filtration rate (eGFR) (r = -0.02, P = 0.30), very low-density lipoprotein and high-density lipoprotein-cholesterol. Atherosclerotic changes very well correlate with the traditional cardiovascular risk factors like age, BMI, serum total cholesterol and serum triglyceride level in CKD patients. Even though CIMT was marginally more in the late stages of CKD patients, no statistically significant correlation was found with CIMT and eGFR