Case series on herbal medication induced acute kidney injury in central India

Around 60 to 70 percent of the people from India reside in rural areas and usually opt for herbal medicine for illness from local traditional medicine practitioners before seeking allopathic advice. Kidneys play a central role in excretion of the metabolites of these substances or the substances themselves. Renal injury happens in the form of acute tubular necrosis, interstitial nephritis, rhabdomyolysis, nephrolithiasis, urothelial cancers and rarely renal cortical necrosis and progressive interstitial fibrosis. Physicians and patients may ignore the potential nephrotoxicity caused by certain herbal medicines, assuming them to be harmless. Adverse event reporting is usually done on a voluntary basis, and toxicity has been reported through case reports and series. It is important for clinicians to factor in the use of herbal medicines when treating patients with unexplained acute kidney injury or progressive chronic kidney disease.  We hereby present a case series of renal injury mediated by herbal medications with different mechanism of injury to kidney. This article is first of its type reported from central India

Spectrum of acute kidney injury in patients of tropical acute febrile illness in a tertiary hospital

Background: Tropical acute febrile illnesses (TAFI) such as malaria, typhoid, leptospirosis, dengue are major causes of AKI in the tropics. The spectrum of AKI due to TAFI in developing countries like India is still underestimated. Hence, we conducted a study to know the spectrum of AKI in patients of TAFI. Methods: The prospective study was conducted in Yashoda hospital, Secunderabad a tertiary care hospital in India from April 2019 to March 2020. AKI was defined as per KDIGO. The clinical history, physical examination and laboratory investigations were recorded in a standard proforma. Results: Hundred patients suffering from TAFI were admitted during the study period. Mean age of the study population was 43.12±14.33 years. Twenty-six (60.5%) were males. Most common presenting feature was fever (100%), chills (81.4%) and vomiting (67.4%). The most common cause of TAFI was dengue (n=49, 49%), leptospirosis (n=20, 20%), followed by malaria (n=10, 10%), scrub typhus (n=10, 10%) and undifferentiated fever (n=6, 6%). 43 patients (43%) had AKI as per KDIGO definition. 23 patients (53.5%) had stage 1, 11 (25.6%) had stage 2 and 9 (20.9%) had stage 3 AKI. RRT was required in 16.3% of patients. Dengue and leptospirosis were the most common causes for requirement of RRT. SLED was the most common modality of dialysis. Mortality was observed in 6.98% patients and Dengue was the most common cause of mortality. Conclusions: AKI is common in tropical acute febrile illness. However, RRT was required only in 16.3% and mortality was observed in 6.98% patients

Whole-genome resequencing of 292 pigeonpea accessions identifies genomic regions associated with domestication and agronomic traits

Pigeonpea (Cajanus cajan), a tropical grain legume with low input requirements, is expected to continue to have an important role in supplying food and nutritional security in developing countries in Asia, Africa and the tropical Americas. From whole-genome resequencing of 292 Cajanus accessions encompassing breeding lines, landraces and wild species, we characterize genome-wide variation. On the basis of a scan for selective sweeps, we find several genomic regions that were likely targets of domestication and breeding. Using genome-wide association analysis, we identify associations between several candidate genes and agronomically important traits. Candidate genes for these traits in pigeonpea have sequence similarity to genes functionally characterized in other plants for flowering time control, seed development and pod dehiscence. Our findings will allow acceleration of genetic gains for key traits to improve yield and sustainability in pigeonpea

Living kidney donor with monoclonal gammopathy of undetermined significance: Is it a contraindication for kidney donation?

Kidney transplantation is the treatment of choice for patients suffering from end-stage renal disease. We report a case of living kidney transplantation in which the donor had monoclonal gammopathy of undetermined significance, a condition having possible implication for both donor and recipient. Both donor and recipient had an uneventful course in short-term follow-up of 1 year following kidney transplantation

Health equity in dialysis care: Time for action

The development of chronic kidney disease and its progression to End Stage Renal Disease requiring renal replacement therapy remains a significant source of reduced quality of life and premature mortality. The global dialysis population and treatment gap is growing, especially in low- and middle- income countries. In India, 70% of those starting dialysis, die or discontinue treatment in the initial period due to the high cost of treatment and lack of access to dialysis therapy. Achieving health equity requires ensuring access to the resources that needs to be healthy, and addressing social determinants of health involves needs factors that influence the health outcomes. Universal Health Coverage requires an alternate model to address the substantial Out-Of-Pocket-Expenditure borne by these patients for traveling and medications

DYNAMIC SPECTRUM SHARING IN WIRELESS COMMUNICATION

Wireless technology is proliferating rapidly and the vision of pervasive wireless computing and Communications offers the promise of many societal and individual benefits. While consumer devices such as cell phones and laptops receive a lot of attention, the impact of wireless technology is much broader. This explosion of wireless applications creates an ever-increasing demand for more radio spectrum, but the radio spectrum has a fixed range that is not much larger and this limited range of the spectrum is major problem in the wireless networks. Spectrum sharing is one method which gives the solution of this problem by shared the limited band of spectrum between the different users. This increases the spectral efficiency of the wireless networks.Dynamic spectrum access is one method of spectrum sharing in which spectrum should be shared by two users i.e. licensed and unlicensed user. The request of unlicensed would be blocked if the spectrum should occupied by the licensees. In this paper we simulated the dynamic spectrum access approach by using hierarchical access model. We also analyzed the blocking probability of secondary users(unlicensed).Blocking should be reduced by applying queueing process and based on queuing model i.e. Erlang model we analyzed the delay probability waiting time waiting probability for secondary user

Leukocyte esterase reagent strip as a bedside tool to detect peritonitis in patients undergoing acute peritoneal dialysis

Peritonitis is a common and life-threatening complication of acute peritoneal dialysis (PD). Diagnosis requires the presence of clinical signs of peritonitis which are nonspecific and laboratory investigations [total leukocyte count (TLC), Gram-stain, and culture of PD effluent fluid] which are time-consuming and not available at the bedside. In this study, we evaluated the use of leukocyte esterase reagent strip (LERS) as a bedside test to diagnose peritonitis in patients undergoing acute PD. Patients who underwent acute PD were monitored for signs and symptoms of peritonitis. PD effluent fluid analysis included TLC, absolute neutrophil count, Gram-stain, and culture for the diagnosis of peritonitis. LERS (Multistix 10SG) was simultaneously dipped in PD effluent fluid and read at two minutes. Reading of + was considered as indicative of peritonitis. Twenty-one out of 166 (12.6%) patients undergoing acute PD developed peritonitis. LERS detected peritonitis in 20 patients. The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of LERS were 95.2%, 95.2%, 74.1%, and 99.3%, respectively. LERS has very high sensitivity and NPV and can be used as a rapid bedside tool to exclude peritonitis in patients undergoing acute PD

Spectrum of asymptomatic bacteriuria in renal allograft recipients and its short-term effect on graft outcome: Experience of a Tertiary Care Center from Northwest India

Introduction: Asymptomatic bacteriuria (AB) is not uncommon after renal transplantation with limited data from developing countries; we did this study to assess the microbiological spectrum and its short-term graft outcome in our tertiary care center. Materials and Methods: It is a prospective observational study. We included all the patients who underwent renal transplantation over a period of 18 months, from January 2016 to June 2017. Patients who had indwelling urinary catheter beyond 5 days posttransplant and those with persistent graft dysfunction within 6 months of transplant were excluded from the study. Results: A total of 67 patients were included in the study with a mean age of 33.78 ± 8.91 years and a male-to-female ratio of 7:1; live-related donors were 36 (53.73%), live unrelated were 19 (28.35%), and 12 (17.91%) were cadaveric renal allograft recipients (RARs). Twenty-eight (41.79%) patients had 42 episodes of AB over 6 months of follow-up. The maximum episodes occurred within 1 month of postrenal transplantation, and 42 out of 67 (62.68%) RARs had bacterial growth in their double-J ureteral stents (USs). The most frequently isolated pathogen from urine was Escherichia coli (n = 14, 33.33%), whereas Pseudomonas aeruginosa (n = 10, 23.80%) was in US culture (USC). The prevalence of AB was higher in cadaveric RARs compared to live RARs (83.33% vs. 32.72%, P = 0.001) and with bacterial growth in the USC compared to those who did not show any growth in USs (57.14% vs. 16.0%, P = 0.001). However, the estimated glomerular filtration rate between those with AB and those without at 6 months of follow-up (66.36 ± 14.98 vs. 66.10 ± 13.83 ml/min/1.73 m2, P = 0.943) was not different. Conclusion: AB is not uncommon in RARs and it is more common in cadaveric RARs and those with growth in US culture without compromise in allograft function at 6 months postrenal transplant

A leap toward brighter future – deceased-donor renal transplantation: Three years of experience in Sawai Man Singh Hospital, Jaipur, India

Background: With an increase in the prevalence of risk factors for chronic kidney disease, the prevalence of end-stage renal disease (ESRD) is increasing in India, adding 1.75 lakh ESRD patients each year. Renal transplant is one of the best modalities of renal replacement therapy; however, it is available only in a few centers. Despite an increase in trend, deceased-donor renal transplant (DDRT) rate is only 0.34/million populations, one of the lowest rates in the world. Materials and Methods: We analyzed 25 DDRT recipients transplanted in the last 3 years. The patients were followed till death or graft loss whichever was earlier. Posttransplant outcome and complications were evaluated. Results: The patient survival was 84% (21/25), and death-censored graft survival was 84% (21/25). 16% (4/25) had the second renal transplant with a history of failed previous live renal transplant. Delayed graft function (DGF) and biopsy-proven acute rejection were seen in 16% and 12%, respectively. The mean posttransplant creatinine in recipients with functioning graft on the last follow-up was 1.14 ± 0.2 mg/dl. The most common medical complication was sepsis (40%, 10/25). Conclusion: The short-term outcome of DDRT in our center is comparable to other centers in India. DGF was the most important determinant of graft survival

Multiple brain abscesses due to Enterobacter cloacae in an immune-competent child

Brain abscesses due to Enterobacteriaceae in immune-competent children are rare, and those due to Enterobacter cloacae are even rarer. We report an interesting case of community-acquired E. cloacae neuroinfection resulting in multiple brain abscesses in a young child with no underlying risk-factors. A 10 year-old-boy presented with low-grade fever, headache, neck pain and progressive deterioration of sensorium. On examination, he was conscious but drowsy with photophobia, normal fundii, meningeal signs, mild hypertonia, brisk muscle stretch reflexes and extensor plantar responses. Magnetic resonance imaging of brain showed bilateral, multiple pyogenic abscesses. Culture of the abscess material aspirated at the time of surgical drainage showed growth of E. cloacae. He received intravenous imipenem for 18 weeks guided by clinical and radiological response. A pragmatic approach combining early surgical drainage, targeted antimicrobial therapy and patient-tailored duration based on the clinico-radiological response is needed in such difficult cases. Keywords: Neuroinfection, Enterobacter, Brain abscess, Pyogenic, Carbapenem