World Kidney Day 2023: Kidney Health for All –Preparing for the Unexpected, Supporting the Vulnerable: Are We Well Prepared?

Guest Editoria

Combined congenital aortic stenosis and coarctation of aorta with severe left ventricle dysfunction and pulmonary hypertension in an infant-one case, multiple challenges

Aortic stenosis (AS) is commonly associated with coarctation of aorta (COA). Due to chronic increase in afterload, it can lead to left ventricle (LV) dysfunction and ultimately LV failure. We present a case of 10-month-old infant with combined AS and COA, complicated by severe LV dysfunction and severe Pulmonary hypertension (PH). There are no guidelines as to which condition should be treated first although both staged and combined procedure have been reported. It poses multiple challenges in the perioperative management. Although performing a balloon aortic valvuloplasty first would reduce the surgical risk for COA repair significantly, but due to lack of facilities for same in this age group, we proceeded with a high-risk COA repair via thoracotomy, avoiding the need for cardiopulmonary bypass (CPB). Application of Aortic cross clamp was associated with a further increase in afterload and hypotension owing to severe LV dysfunction in contrast to the expected increase in proximal pressures, and required high inotrope support to manage hemodynamics. Postoperative course was challenging as well owing to severe pulmonary hypertension. Very few similar cases have been reported in literature

A Security Solution for Wireless Local Area Network (WLAN) Using Firewall and VPN

In the era of internet millions of users share resource for different purpose. The chances of security risks are more when a user connected with internet. Internet technology plays an important role in every aspect of human life. We can create virtual connectivity with-in seconds with anyone in the world and can exchange or share the information through internet. Sometimes these information is very useful for Defense, and personal use. Sometimes this information is stolen on the internet or we can say destroyed so that receiver cannot receive that information, so for successful communication on internet our connection should be protected. For this protection we can use Firewall protection, VPN Network. These Networks is much more protected than normal Network. Network with VPN and Firewall is faster and efficient rather than normal connection. In normal Network user may faces unexpected delay due to malware and virus. In this paper we have described and analyze impact of Virtual Private Network technology and firewall with normal network. We have simulated three scenarios without firewall, with firewall and Firewall_VPN. The simulation results of three scenarios are compared over WLAN and analyze the impact of Firewall and VPN on network performance. OPNET 14.5 is used for simulator work. Keywords: VPN, Firewall, Security, WLAN, OPNET 14.5

Optimizing Finerenone Therapy: A Comprehensive Review Using the “Finerenone Pentad”

Chronic kidney disease (CKD) is a pressing global health concern, often intertwined with comorbid conditions such as type 2diabetes mellitus (T2DM) and cardiovascular complications. Managing CKD in T2DM patients requires a multifaceted approach,and emerging therapeutic options are increasingly essential. Finerenone, a selective nonsteroidal mineralocorticoid receptorantagonist, has shown considerable promise in addressing the intricate cardiorenal needs of these patients. To maximize theeffectiveness of this therapy, we propose the approach of “Finerenone Pentad” which can be utilized as a checklist while startingand subsequently monitoring the finerenone therapy. This structured approach offers guidance on patient selection, monitoringand outcome evaluation, ensuring a holistic approach to the care of individuals with T2DM and CKD.&nbsp

Rational Renometrics

The precise evaluation of renal function and structure is indispensable clinical medicine. This is required not only to screen,diagnose and monitor kidney disease, but also to allow accurate choice of drugs and their dosages while treating individuals.Traditional methods, exemplified by glomerular filtration rate (GFR) calculations and urinalysis, have long served as pillarsof nephrology. However, their inherent limitations introduce diagnostic ambiguities, raising concerns for both health careproviders and patients. This comprehensive review introduces the concept of "Rational Renometrics", a transformativeapproach that harmonizes various tests and factors to provide a holistic assessment of renal health. It focuses on correcturine sample collection, mitigates false positives in urinalysis and embraces the concept of permissive hypercreatinemia.The evidence-based, data-driven perspective of rational renometrics empowers health care providers and patients, leadingto more accurate diagnoses, individualized treatment strategies and improved therapeutic outcomes. Rational renometricsallows accurate risk assessment and institution of preventive interventions, reinforcing its pivotal role in preserving renalhealth and optimizing patient care. We describe the principles, advantages, challenges and potential clinical applications ofrational renometrics, emphasizing the need for continued research and validation of this concept

Vascular Calcification in Chronic Kidney Disease

Cardiovascular disease (CVD) is the major cause of death in chronic kidney disease (CKD). Of the various risk factors, vascular calcification has only recently come into prominence. CKD is associated with an increased risk of vascular calcification. In routine practice, clinicians usually overlook this finding. Screening for vascular calcification is often missed during first contact with nephrologists. With this article, we would like to reiterate the importance of preventing vascular calcification in early stages of CKD and once it starts appearing, its progression needs to be halted early with individualized treatment. The prevalence, sites of involvement, detection, quantification, pathogenesis, risk factors, clinical manifestations and management options have been discussed

A rare presentation of snake bite

In India, doctor’s in casualty frequently get confronted with snake bite. A wide range of complications occur in snake bite. Intracerebral haemorrhage (ICH) is an unusual presentation following snake bite. Here authors discuss a patient presents with ICH after snake bite. Venom induced consumption coagulopathy is the most accepted theory behind intracerebral haemorrhage