A study of chronic kidney disease patients with no known risk factors coming to tertiary care hospital

Background: Chronic kidney disease (CKD) has become a major cause of morbidity and. in some parts of the world CKD incidence has increased regardless of hypertension, diabetes mellitus or metabolic syndrome. This study was done to identify the unknown factors which can be contributing to the increased incidence of CKD.Methods: It was a case control study. There were 61 cases and 50 controls. A detailed history regarding residence, occupation, addiction, drug intake, family history, diet and environmental factors was taken. The data was analysed to identify a common factor amongst the CKD patients who did not have history of any known risk factors of CKD.Results: Age of onset of CKD in 48% of cases was 5 years (30%) as compared to controls. Much more cases as compared to controls gave history of mixed diet (46% vs 26%). Much higher proportion of cases had history of heat exposure, excessive heating and sugarcane exposure (72%, 70% and 48% respectively) as compared to controls.Conclusions: This study supports the association of sugarcane exposure, heat exposure and excessive sweating with CKD and reports a changing trend of renal involvement starting at an earlier age. It highlights need of study with sufficient sample size and greater emphasis on family history, smoking, extent of heat exposure and sugarcane exposure to help identifying area of further research and guide policy making

Interaction of nitrogen doses and establishment methods in lowland rice at Parwanipur, Bara, Nepal

The experiment was laid out in split plot design: three establishment methods were designed (Puddled transplanted rice, Non- puddled transplanted rice, Conventional dry tillage +DSR) as a main plot and four levels of nitrogen rate (0, 60, 120, 180) as sub plot and replicated three times during summer season of 2015 and 2016 at RARS, Parwanipur. Grain yield and other yield attributes like plant height, penicle length and number of tiller per m2 of rice was observed significantly differed (p<0.05) between different establishment methods and nitrogen levels. In 2015 there was not significant effect of establishment practices on grain yield but significantly highest grain yield (4603 kg/ha) was obtained from application of nitrogen@120 kg/ha and grain yield decreased with increased of nitrogen application @ 180 kg/ha (4365 kg/ha). Results reveled that significantly higher grain yield was obtained under non puddled transplanted rice (3314 kg/ha) than puddle transplanted rice (3280 kg/ha) which were at par with conventional tillage plus DSR (2123 kg/ha) and significantly highest grain yield (3424 kg/ha) was obtained from application of nitrogen@180 kg/ha during 2016. In both years the highest grain yield was obtained from puddled transplanted rice with the nitrogen application @ 120 kg/ha. Based on two years results, it can be concluded that N is limiting factor for the productivity of rice in Parwanipur. Therefore 120 kg/ha nitrogen could be optimum dose for puddled transplanting and direct seeded rice at Parwanipur condition

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

TECHNOLOGY Integrated Approach towards Grey Water Management

India is facing a water crisis and by 2025 it is estimated that India's population will be suffering from severe water scarcity. With increased population growth and development, there is a need to critically look at alternative approaches to ensure water availability. These alternative resources include rainwater and bulk of water used in household will emerge as grey water and contain some minerals, organic waste materials dissolved and suspended in it. The main goal of this paper is to propose some efficient, cheap and sustainable grey water treatment systems for households. The treated grey water can be used for non-potable use purposes such as irrigation, toilet flushing, car washing and dust control as well as to recharge the aquifers. The imbalance between water demand and supply has become a significant concern of human life as demand is increasing exponentially. So implementation of alternative water supply options has become an inevitable need for urban water management. There are various kinds of grey water treatment systems around the world. A review of those processes has been done to identify the best suited processes at household and community level. Septic tank, constructed wetland and intermittent sand filter are identified as the most suitable processes for decentralized treatment due to the simple operation and maintenance facilities as well as cost effectiveness of these systems. The use of gray water is becoming more and more common, especially in areas where water resources are scarce. The use of grey water is, therefore, the last option for the water conservation. Grey water use is important because it restricts fresh water demand and reduces stress on treatment system

Vaccines in dermatology

A vaccine is a biological preparation that improves immunity to a specific disease. More than two centuries have passed since the first successful vaccine for smallpox was developed. We′ve come a long way since. Today′s vaccines are among the 21 st century′s most successful and cost-effective public health tools for preventing diseases

Causes, epidemiology, and long-term outcome of traumatic cataracts in children in rural India

Purpose : To describe preoperative factors, long-term (>3 years) postoperative outcome and cost of traumatic cataracts in children in predominantly rural districts of western India. Subjects : Eighty-two traumatic cataracts in 81 children in a pediatric ophthalmology department of a tertiary eye-care center. Materials and Methods : Traumatic cataracts operated in 2004-2008 were reexamined prospectively in 2010-2011 using standardized technique. Cause and type of trauma, demographic factors, surgical intervention, complications, and visual acuity was recorded. Statistical Analysis : Data analysis done by using SPSS (Statistical package for social sciences) version 17.0 We have used Chi-square test, Fisher′s exact test, paired t-test to find the association between the final vision and various parameters at 5% level of significance; binary logistic regression was performed for visual outcome ≥6/18 and ≥6/60. Results : The children were examined in a 3-7 year follow-up (4.35 ± 1.54). Average age at time of surgery was 10.4 ± 4.43 years (1.03 to 18). Fifty (61.7%) were boys. Forty (48.8%) were blunt and 32 (39%) were sharp trauma. The most common cause was wooden stick 23 (28.0%) and sharp thorn 14 (17.1%). Delay between trauma and presentation to hospital ranged from same day to 12 years after the injury with median of 4 days. The mean preoperative visual acuity by decimal notation was 0.059 ± 0.073 and mean postoperative visual acuity was 0.483 ± 0.417 (P < 0.001). Thirty-eight (46.3%) had best corrected visual acuity (BCVA) ≥6/18 and 51 (62.2%) had BCVA ≥ 6/60. In univariable analysis, visual outcome (≥6/18) depended on type of surgery (P = 0.002), gender (P = 0.028), and type of injury (P = 0.07)-sharp trauma and open globe injury had poorer outcomes; but not on age of child, preoperative vision, and type of surgeon. On multivariable binary logistic regression, only gender was significant variable. Of the 82 eyes, 18 (22%) needed more than one surgery. The parents spent an average of Rs. 2250 ($45) for the surgery and 55 (66.4%) were from lower socio-economic class. Conclusion : The postoperative visual outcomes varied and less than half achieved ≥ 6/18