Light chain proximal tubulopathy with lambda restriction presenting as acute kidney injury

Monoclonal gammopathies can produce a variety of glomerular, tubular, vascular and interstitial lesions. The spectrums of renal lesions produced by these monoclonal gammopathies include AL/AH amyloidosis, light chain cast nephropathy or myeloma kidney and various proximal tubulopathies. Out of these, proximal tubule centered lesions are much less identified and diagnosed and light chain proximal tubulopathy (LCPT) is one among them. In LCPT the excess free light chains (mostly kappa type by immunofluorescence microscopy) in serum are filtered by the glomeruli and are reabsorbed by proximal tubules causing its damage. These monoclonal light chains when sequestered in the proximal tubules can give rise to crystalline and noncrystalline histological variants. Here we present a rare case of noncrystalline variant of LCPT with lambda light chain restriction who presented with renal insufficiency which on later investigations revealed to be multiple myeloma

Assessment of abdominal aortic calcification in predialysis chronic kidney disease and maintenance hemodialysis patients

Vascular calcification is associated with increased morbidity and mortality among chronic kidney disease (CKD) patients. The aim of the study was to assess the abdominal aortic calcification (AAC) in predialysis CKD patients and patients on hemodialysis (HD) and to study the risk factors associated with it. In this prospective study, 205 patients were including 104 patients with predialysis CKD and 101 patients were on maintenance hemodialysis. AAC was assessed using lateral lumbar radiography. Blood urea nitrogen, serum creatinine, albumin, calcium, phosphorus, highly sensitive C-reactive protein (hsCRP) and total cholesterol were analyzed. AAC was observed in 26 % of predialysis CKD patients and 34% in HD patients. Using multivariate analysis, the age (P = 0.001) was identified as independent predictor for the presence of AAC in predialysis patients, and for HD, the predictors were age (P = 0.025), time on dialysis (P = 0.001), hsCRP (P = 0.002), and corrected calcium (P = 0.030). In conclusion, the prevalence of AAC varies mainly with age and glomerular filtration rate levels in predialysis CKD patients. Advanced age, time on dialysis, and inflammation may be associated with presence and extent of AAC in HD patients. Further research into the risk factors and outcome for AAC is warranted

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020

Nanotechnology and Plant Extracts as a Future Control Strategy for Meat and Milk Products

Plant extracts, well known for their antibacterial and antioxidant activity, have potential to be widely used preservatives in the food industry as natural alternatives to numerous synthetic additives which have adverse impacts on health and the environment. Most plant compounds and extracts are generally recognized as safe (GRAS). The use of preservatives is of great importance for perishable foods such as meat and milk, which, along with their products, are commonly consumed food items globally. However, the bioavailability of plant compounds could be diminished by their interaction with food components, processing, and storage. Nanoencapsulation of plant extracts, especially essential oils, is an effective method for their application in food model systems. This technique increases the bioactivity of plant compounds by increasing their physical stability and reducing their size, without negative effects on organoleptic properties. Furthermore, a recent study showed that plant extracts act as good bioreductants for biosynthesis of nanoparticles. This so-called green synthesis method using plant extracts is a rapid, relatively inexpensive, safe, and efficient method for synthesis of nanoparticles including silver, gold, iron, lead, copper, cobalt, palladium, platinum, zinc, zinc oxide, titanium oxide, magnetite, and nickel. Some of these nanoparticles have antimicrobial potential which is why they are of great interest to the food industry. In this chapter, the nanoencapsulation of plant extracts and plant extract-mediated synthesis of nanoparticles and their potential application in order to improve the safety and quality and prolong the shelf life of meat and milk products are reviewed and discussed