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

The path towards resource elasticity for 5G network architecture

Proceeding of: IEEE Wireless Communications and Networking Conference Workshops (WCNCW 2018)Vertical markets and industries are addressing a large diversity of heterogeneous services, use cases, and applications in 5G. It is currently common understanding that for networks to be able to satisfy those needs, a flexible, adaptable, and programmable architecture based on network slicing is required. Moreover, a softwarization and cloudification of the communications networks is already happening, where network functions (NFs) are transformed from monolithic pieces of equipment to programs running over a shared pool of computational and communication resources. However, this novel architecture paradigm requires new solutions to exploit its inherent flexibility. In this paper, we introduce the concept of resource elasticity as a key means to make an efficient use of the computational resources in 5G systems. Besides establishing a definition as well as a set of requirements and key performance indicators (KPIs), we propose mechanisms for the exploitation of elasticity in three different dimensions, namely computational elasticity in the design and scaling of NFs, orchestration-driven elasticity by flexible placement of NFs, and slice-aware elasticity via cross-slice resource provisioning mechanisms. Finally, we provide a succinct analysis of the architectural components that need to be enhanced to incorporate elasticity principles.Part of this work has been performed within the 5GMoNArch project, part of the Phase II of the 5th Generation Public Private Partnership (5G-PPP) program partially funded by the European Commission within the Horizon 2020 Framework Program

Multicenter registry and test bed for extended outpatient hemodynamic monitoring: the hemodynamic frontiers in heart failure (HF2) initiative

BackgroundHemodynamic Frontiers in Heart Failure (HF2) is a multicenter academic research consortium comprised of 14 US institutions with mature remote monitoring programs for ambulatory patients with heart failure (HF). The consortium developed a retrospective and prospective registry of patients implanted with a wireless pulmonary artery pressure (PAP) sensor.Goals/aimsHF2 registry collects demographic, clinical, laboratory, echocardiographic (ECHO), and hemodynamic data from patients with PAP sensors. The aims of HF2 are to advance understanding of HF and to accelerate development of novel diagnostic and therapeutic innovations.MethodsHF2 includes adult patients implanted with a PAP sensor as per FDA indications (New York Heart Association (NYHA) Class III HF functional class with a prior hospitalization, or patients with NYHA Class II or brain natriuretic peptide (BNP) elevation without hospitalization) at a HF2 member site between 1/1/19 to present. HF2 registry is maintained at University of Kansas Medical Center (KUMC). The registry was approved by the institutional review board (IRB) at all participating institutions with required data use agreements. Institutions report data into the electronic registry database using REDCap, housed at KUMC.ResultsThis initial data set includes 254 patients implanted from the start of 2019 until May 2023. At time of device implant, the cohort average age is 73 years old, 59.8% are male, 72% have NYHA Class III HF, 40% have left ventricular ejection fraction (LVEF) < 40%, 35% have LVEF > 50%, mean BNP is 560 pg/ml, mean N-Terminal pro-BNP (NTproBNP) is 5,490 pg/ml, mean creatinine is 1.65 mg/dl. Average baseline hemodynamics at device implant are right atrial pressure (RAP) of 11 mmHg, pulmonary artery systolic pressure (PASP) of 47 mmHg, pulmonary artery diastolic pressure (PADP) 21 mmHg, mean pulmonary artery pressure (mPAP) of 20 mmHg, pulmonary capillary wedge pressure (PCWP) of 19 mmHg, cardiac output (CO) of 5.3 L/min, and cardiac index (CI) of 2.5 L/min/m2.ConclusionA real-world registry of patients implanted with a PAP sensor enables long-term evaluation of hemodynamic and clinic outcomes in highly-phenotyped ambulatory HF patients, and creates a unique opportunity to validate and test novel diagnostic and therapeutic approaches to HF

C-Reactive protein and chest x-ray morphology in COVID-19 patients: Our single center experience

Background & Aims:  Coronavirus disease-2019 (COVID-19) is a newly discovered viral illness for which there is no proven cure at this time. We sought to establish the value of C-reactive protein (CRP) levels and chest X-ray morphology in determining the severity of COVID-19 disease and to correlate them with related mortality. Materials & Methods:  Data of COVID-19 patients with clinical outcomes in a small-designated hospital in Nadiad (Gujarat, India), collected retrospectively from March 15 to May 31, 2020. Patients with COVID-19 had their admission CRP's prognostic value, and chest X-ray morphology assessed. Results:  Out of 85 patients enrolled, 72 survived and 13 died. With an area under the curve (AUC) of 0.808 (95 percent CI, 0.708–0.885; P=0.001), the ROC curve analysis revealed moderate accuracy to identified mortality. Our model had an elevated CRP value of 0.105 units, which corresponded to an increased mortality rate of 1.11 times (Wald=12.73, 1.11(1.05, 1.18). Conclusion:  In contrast to the RT-PCR test, our investigation found that CRP and chest X-ray morphology were excellent predictors of earlier diagnosed COVID-19 patients. We want to require a larger sample size and to identify an additional biomarker that reduces mortality

Combination of integral and projected differential transform methods for time-fractional gas dynamics equations

The present paper discusses the solution of nonlinear homogeneous and nonhomogeneous time-fractional gas dynamic equations arising in shock fronts by a new combination of new integral and projected differential transform method. The new integral projected differential transform method (NIPDTM) makes the calculation very simpler and in this method the nonlinear term can be easily handled by projected differential transform without using Adomian’s polynomial and He’s polynomial, which can be taken as a big advantage of this method. This method is more exertive and easy to handle such fractional differential equation in comparison to other methods. The results obtain from illustrative examples shows the competency and accordance of the proposed method. Keywords: New integral transform method, Projected differential transform method, Time-fractional gas dynamic equation, Caputo fractional derivative, Mittag-Leffler functio

Role of Diagnostic Hysterolaparoscopy in Evaluation of Primary and Secondary Infertility

ABSTRACT Introduction: It is widely accepted that infertility is a life crisis and the number of couples seeking medical help for infertility is increasing dramatically. Aims and Objective is to assess etiological factors in infertility by hysterolaparoscopy. Study design is Cross-sectional study. Place and duration of study is NIMS Infertility and Research centre, Jaipur, over a period of one and half years fro

Formulation, Development and Evaluation of Uncoated Bilayer Tablet of Anti-Hypertensive Agents

The present research work was carried out to Formulate and evaluation of bilayer tablet dosage form for the treatment of Hypertension.The objective of this study to compare the specific characteristics of Metoprolol [beta selective (cardio selective) adrenoreceptor blocking agent] and Hydrochlorothiazide (Thiazide Diuretics]) in order to design stable formulation. It can be concluded that bilayer tablet were successfully formulated to achieve immediate release of Hydrochlorothiazide (HCTZ)  and tailored release of Metoprolol (MPL)by using Dual Release Drug Absorption System(DUREDAS technology).Both drugs were found to be stable in Bilayer tablet formulation and were found to be stable for few months. This bilayer tablet dosage form increases the stability which may reduce loss and cost of formulation. It improves the benefits of producer, retailer, and patients. Recently, greater attention has been focused on development of bilayer tablet formulations. Over the past 30 years, the expenses and complications involved in marketing new drug entities have increased with concomitant recognition of therapeutic advantages of conventional drug delivery system. Several pharmaceutical companies are currently developing bi-layer tablets, for a variety of reasons: patent extension, efficient pharmacological effect, better patient compliance, etc. Bilayer tablet is becoming new approach for the successful drug delivery system and for better stability in combination. Bilayer tablets can be primary option to avoid chemical incompatibilities between APIs by physical separation. Keywords: Bilayer tablet, DUREDAS Technology, Antihypertensive, Metoprolol, Hydrochlorthiazid

A comparative study in acute pancreatitis to find out the effectiveness of early addition of ulinastatin to current standard care in Indian subjects

Background: Acute pancreatitis is an inflammatory condition of the pancreas which begins in pancreatic acinar cells and triggers local inflammation that may progress to systemic inflammatory response (SIRS) causing distant organ involvement and hampering its function and ending up with multiple organ dysfunction syndrome (MODS). It remains a common disorder with devastating consequences .Although most episodes are mild and self-limiting, up to a one-fifth of patients develop a severe attack that can be fatal. Inspite of technical advances in medical and surgical field’s acute pancreatitis remains a major cause of morbidity and mortality. Aims and Objectives: Our aim is to find out the effectiveness of early addition of Ulinastatin to current standard care in Indian subjects with acute pancreatitis. The aim of this study is to compare effectiveness of with or without injection Ulinastatin in acute pancreatitis with respect to: 1) Duration of analgesic requirement, 2) Prevention of early sepsis and complication, 3) Duration of hospital stay. Material and methods: This prospective study was conducted between December 2018 to December 2019 on patients admitted to Dhiraj Hospital Piparia Vadodara. 60 patients with episodes of acute pancreatitis were enrolled for the study

Racial Differences in the Prevalence and Outcomes of Atrial Fibrillation in Patients Hospitalized With Heart Failure

Previous research has shown that roughly 15% to 30% of those with heart failure (HF) develop atrial fibrillation (AF). Although studies have shown variations in the incidence of AF in patients with HF, there has been no evidence of mortality differences by race. The purpose of this study was to assess AF prevalence and inhospital mortality in patients with HF among different racial groups in the United States. Using the National Inpatient Sample registry, the largest publicly available all-payer inpatient care database representing >95% of the US inpatient population, we analyzed subjects hospitalized with a primary diagnosis of HF from 2001 to 2011 (n = 11,485,673) using the International Classification of Diseases, Ninth Edition (ICD 9) codes 428.0-0.1, 428.20-0.23, 428.30-0.33, 428.40-0.43, and 428.9; patients with AF were identified using the ICD 9 code 427.31. We assessed prevalence and mortality among racial groups. Using logistic regression, we examined odds of mortality adjusted for demographics and co-morbidity using Elixhauser co-morbidity index. We also examined utilization of procedures by race. Of the 11,485,673 patients hospitalized with HF in our study, 3,939,129 (34%) had AF. Patients with HF and AF had greater inhospital mortality compared with those without AF (4.6% vs 3.3% respectively, p <0.0001). Additionally, black, Hispanic, Asian, and white patients with HF and AF had a 24%, 17%, 13%, and 6% higher mortality, respectively, than if they did not have AF. Among patients with HF and AF, minority racial groups had underutilization of catheter ablation and cardioversion compared with white patients. In conclusion, minority patients with HF and AF had a disproportionately higher risk of inpatient death compared with white patients with HF. We also found a significant underutilization of cardioversion and catheter ablation in minority racial groups compared with white patients