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"Mahajan, Sandeep"
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Vacuum rhexis - A novel capsulorhexis technique for white cataracts
Capsulorhexis in white intumescent cataract is often associated with extension leading to radial tears or biradial extension \"Argentinian flag sign\" and associated complications. We describe a novel technique of managing this situation. Vacuum rhexis is performed with a 24 G bent cannula attached to a 10-ml syringe. The flap is lifted and then caught using 24 G cannula. The suction is manually controlled by the surgeon, and the rhexis is completed using circumferential movement. The chamber stability is well maintained as there is no leakage, and the bent tip gives excellent fulcrum for movement. The advantage of this technique is that a single port is used for maintaining the chamber stability and it needs no special surgical instruments. Vacuum rhexis is a novel surgical technique used for performing successful continuous curvilinear capsulorhexis (CCC) of adequate size in white and intumescent cataracts, with a consistent and predictable outcome.
Journal Article
Serum IgA/C3 ratio as a diagnostic and prognostic biomarker for IgA nephropathy
IgA nephropathy (IgAN) is a common glomerular disease in adults with a smoldering course and high risk of progression to end-stage kidney disease (ESKD) in South Asians. We investigated serum IgA/C3 ratio as a potential biomarker for IgAN. We measured serum levels of IgA and C3 in 258 patients with IgAN and 90 controls with non-IgAN primary glomerular disease and examined if serum IgA/C3 ratio differentiates IgAN from other glomerular diseases and if it predicts renal survival in IgAN. The primary outcome was lack of renal survival, defined as irreversible decline in eGFR > 50% from baseline or progression to ESKD. Median serum IgA/C3 ratio was higher in IgAN patients compared to controls (2.4, IQR: 1.9-3.0 vs. 1.8, IQR: 1.3–2.5, p < 0.001). The AUC for the receiver operating curve of IgA/C3 ratio was 0.6760 (95% CI: 0.6074–0.7446). The sensitivity and specificity of IgA/C3 ratio > 2.0 were 70.5% and 62.2% respectively, for differentiating IgAN from other non-IgAN glomerular diseases. With a median duration of follow-up of 35.0(IQR 16-56.8) months, 26.7% patients reached the primary outcome. Compared to patients with a low IgA/C3 ratio(≤ 2.0), those with a high ratio(> 2.0) were significantly older [median age 34 vs. 29 years, p = 0.003], more likely to have hypertension (70.6% vs. 50.5%, p = 0.001), had lower median eGFR [47.7 mL/min/1.73 m² vs. 77.7 mL/min/1.73 m², p < 0.001], lower urine protein creatinine ratio [2.0 g/g vs. 2.5 g/g, p = 0.015] and a significantly higher proportion of segmental glomerulosclerosis (S1 lesions) (80.4% vs. 62.1%, p = 0.005). Renal disease progression was comparable (26.3% vs. 27.0%, p = 0.906) between the low and high IgA/C3 ratio groups respectively. High IgA/C3 ratio (> 2.0) was not a significant predictor of primary outcome (HR = 1.32 95% CI: 0.80–2.2, p = 0.278). Serum IgA/C3 ratio is elevated in IgAN compared to other glomerular diseases but has limited diagnostic and prognostic utility in our patients.
Journal Article
Editorial: Case reports in nephrology
Community-acquired AKI has a varied etiology and milder course compared to hospital-acquired AKI (3). Though there are a limited number of studies showing the concurrent presentation of RAVT and overt AKI in patients following ingestion of nephrotoxic agents, this case illustrates the necessity of the early evaluation of etiology and appropriate management to prevent progression to CKD. Gastrointestinal (GI) injury associated with sevelamer use is a documented adverse effect but is underrecognized as a cause of life-threatening GI complications.Fistrek Prlic et al.reported the case of a 74-year-old woman taking low-dose sevelamer with serious GI adverse effects causing colon rupture and severe GI bleeding. Rituximab has been used successfully in patients with autoimmune hemolytic anemia (4).Zhuang et al.reported the case of an adult patient with refractory MCD complicated with β-thalassemia minor and accompanied by autoimmune hemolytic anemia. [...]anemia due to mild β-thalassemia also recovered to normal.
Journal Article
LPG gas sensing performance of the SnO2 thin films influenced by the dielectric and conducting properties
This study presents a comprehensive investigation of the dielectric properties and DC conductivity of three tin (IV) oxide (SnO2) thin films with varying thicknesses 30 nm, 90 nm, and 150 nm and explores their influence on gas sensing performance. The gas sensing response of the three SnO2 sensor structures were evaluated for detecting 300 ppm of liquefied petroleum gas (LPG). X-ray diffraction (XRD) and atomic force microscopy (AFM) were used to study the structural and morphological properties of SnO2 thin films. The results of these studies were subsequently correlated to achieve a deeper insight into the gas sensing phenomenon. The dielectric analysis revealed that the SnO2 thin film of 90 nm thickness exhibited the lowest value of dielectric constant ε′(ω), measuring 2.7 at 1 kHz. To gain deeper insights, the capacitance (Cp) of the 90 nm SnO2 thin film was analyzed across a frequency range from 100 Hz to 1 MHz. Pronounced frequency dispersion was observed at elevated temperatures, which was attributed to the presence of a surface barrier. The DC conductivity (σdc) of all the SnO2 thin films was found to be relatively low, approximately 1.7 × 10⁻⁷ Ω⁻1 cm⁻1. The decreased conductivity indicates a high concentration of adsorbed oxygen on the surface and grain boundaries, which traps free electrons and lowers the number of charge carriers. Such characteristics are significant for gas sensing applications, as they can enhance the sensitivity of the sensor by facilitating a pronounced change in conductivity upon exposure to target gases.Article HighlightsThis study offers an in-depth analysis of the dielectric properties and DC conductivity of three tin (IV) oxide (SnO2) thin films with thicknesses of 30 nm, 90 nm, and 150 nm, while also examining their impact on gas sensing performance.The dielectric constant, ε′, was observed to be lowest for the 90 nm SnO2 thin film. This decrease is likely due to the presence of numerous voids within the film's microstructure, which enhance its gas sensing properties by increasing the surface area and improving gas interaction. Dielectric studies revealed the presence of surface barrier, a key factor in improving the response characteristics of gas sensors.Relatively low DC conductivity was observed indicating high concentration of adsorbed oxygen.
Journal Article
Pim protein kinases regulate energy metabolism and cell growth
The serine/threonine Pim kinases are overexpressed in solid cancers and hematologic malignancies and promote cell growth and survival. Here, we find that a novel Pim kinase inhibitor, SMI-4a, or Pim-1 siRNA blocked the rapamycin-sensitive mammalian target of rapamycin (mTORC1) activity by stimulating the phosphorylation and thus activating the mTORC1 negative regulator AMP-dependent protein kinase (AMPK). Mouse embryonic fibroblasts (MEFs) deficient for all three Pim kinases [triple knockout (TKO) MEFs] demonstrated activated AMPK driven by elevated ratios of AMP:ATP relative to wild-type MEFs. Consistent with these findings, TKO MEFs were found to grow slowly in culture and have decreased rates of protein synthesis secondary to a diminished amount of 5'-cap-dependent translation. Pim-3 expression alone in TKO MEFs was sufficient to reverse AMPK activation, increase protein synthesis, and drive MEF growth similar to wild type. Pim-3 expression was found to markedly increase the protein levels of both c-Myc and the peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α), enzymes capable of regulating glycolysis and mitochondrial biogenesis, which were diminished in TKO MEFs. Overexpression of PGC-1α in TKO MEFs elevated ATP levels and inhibited the activation of AMPK. These results demonstrate the Pim kinase-mediated control of energy metabolism and thus regulation of AMPK activity. We identify an important role for Pim-3 in modulating c-Myc and PGC-1α protein levels and cell growth.
Journal Article
MRI Insights in Chiari Malformation Type 1 and Variations With Hydrosyringomyelia
Chiari malformation (CM) type 1 is a complex neurological disorder characterized by the displacement of the cerebellar tonsils into the upper spinal canal. Hydrosyringomyelia (HSM), which frequently coexists with this condition, presents diagnostic and treatment problems due to its broad spectrum of symptoms. There are various forms of CMs, with CM type 1 (CM1) being the most common type. Magnetic resonance imaging (MRI) is the best imaging technique to properly identify and diagnose CM1 and HSM. Important imaging findings include downward displacement of the cerebellar tonsils across the foramen magnum, the appearance of the syrinx in the spinal cord, and the alteration of the flow dynamics of the cerebrospinal fluid. This study was conducted at Datta Meghe Medical College, Nagpur, and Government Medical College & Super Speciality Hospital, Nagpur, India. It focuses on the diagnostic use of MRI in CM1 and its variations associated with HSM. Individuals who are asymptomatic may not need any treatment; however, those who are symptomatic or have HSM may require surgical decompression and restoration of the flow. We discuss the findings of MRI of six cases of CM1 and its variants with HSM and search for possible underlying causes. We conclude that magnetic resonance imaging is an imaging modality for the identification and evaluation of CM1 in cases of HSM.
Journal Article
Characterizing predictors of non-diabetic kidney disease (NDKD) in diabetic patients
BackgroundDiabetic kidney disease (DKD) is the chief cause of renal involvement in diabetic patients. It is primarily a clinical diagnosis. Non-diabetic kidney disease (NDKD) may be missed if they are not biopsied. In this study, we describe the spectrum of NDKD and evaluate the predictors considered for planning a biopsy in diabetic patients with kidney disease.MethodsIn a retrospective cohort study, diabetic patients who underwent kidney biopsy at our centre between May 2006 and July 2019 were evaluated for NDKD.Results321 diabetic patients who underwent kidney biopsy were analyzed. Mean age was 49.3 ± 12.4 years and 71% were males. 75.8% patients had hypertension and 25.2% had diabetic retinopathy. Based on the kidney biopsy, patients were classified as DKD-127 (39.6%), NDKD—179(55.8%) and combined DKD + NDKD—15(4.7%). Overall, the most commonly diagnosed pathology was membranous nephropathy-MN (17%), followed by IgA nephropathy (16.0%) and focal segmental glomerulosclerosis-FSGS (14.9%). In patients with DKD + NDKD, IgA nephropathy (53.3%) was predominant. 165 (51.4%) patients had a diagnosis potentially amenable to a specific therapy. On multivariate analysis, female gender [OR 2.07 (1.08–3.97), p = 0.02], absence of diabetic retinopathy [OR 7.47 (3.71–15), p < 0.001] absence of hypertension [OR 3.17 (1.56–6.45), p = 0.001] and duration of diabetes ≤ 24 months [OR 3.67(1.97–6.84), p < 0.001], were independent predictors for NDKD while the absence of nephrotic range proteinuria [OR 1.73 (0.98–3.05), p 0.05] showed a trend towards significance.ConclusionAstute use of kidney biopsy can detect potentially treatable NDKD in a large number of diabetic patients with glomerular diseases being the predominant diagnosis. A combination of risk factors needs to be considered to guide the need for kidney biopsy in diabetic patients.
Journal Article
Effect of Zr on dielectric, ferroelectric and impedance properties of BaTiO3 ceramic
A polycrystalline sample of Zr-doped barium titanate (BaTiO3) was prepared by conventional solid state reaction method. The effect of Zr (0·15) on the structural and microstructural properties of BaTiO3 was investigated by XRD and SEM. The electrical properties (dielectric, ferroelectric and impedance spectroscopy) were measured in wide range of frequency and temperature. With substitutions of Zr, the structure of BaTiO3 changes from tetragonal to rhombohedral. Lattice parameters were found to increase with substitution. The room temperature dielectric constant increases from ∼ 1675 to ∼ 10586 and peak dielectric constant value increases from ∼ 13626 to ∼ 21023 with diffuse phase transition. Impedance spectroscopy reveals the formation of grain and grain boundary in the material and found to decrease with increase in temperature.
Journal Article
Clinical profile of nonproteinuric kidney disease in type 2 diabetic patients in India
Background: Diabetic kidney disease (DKD) is the commonest cause of end-stage renal disease (ESRD) across the world. Development of microalbuminuria is the earliest marker of DKD and predicts progressive decline in estimated glomerular filtration rate (eGFR). However, recent evidence has suggested that a significant proportion of type 2 diabetic patients have chronic kidney disease (CKD) without proteinuria. Methods: In this single-center, prospective observational study, 400 consecutive type 2 diabetic patients with either overt proteinuria (>500 mg/day) and/or renal dysfunction eGFR <60 ml/min/1.73 m2) were recruited. Baseline demographic and clinical data were recorded. eGFR and proteinuria were recorded at 6 months and 1 year. Patients with proteinuric (proteinuria >0.5 g/day) and nonproteinuric phenotypes were compared for progression of renal dysfunction in terms of doubling of serum creatinine and need for dialysis. Results: In our study cohort, 106 (26.5%) were nonproteinuric. Both the groups were similar in terms of gender, duration of diabetes, comorbidities, body mass index (BMI), blood pressure control, and glycemic control. The nonproteinuric group was older (56.5 ± 2.1 vs. 54.7 ± 11.6 years, P = 0.012), had lesser prevalence of diabetic retinopathy (49 [46.2%] vs. 218 [74.1%], P < 0.001), higher hemoglobin levels (11.3 ± 1.7 vs. 10.5 ± 2.0 g/dl, P < 0.001), and higher cholesterol levels (169.3 ± 43.3 vs 157.1 ± 58.1 mg/dl, P = 0.025). The nonproteinuric phenotype had higher eGFR at baseline, 6 months, and 1 year. However, doubling of serum creatinine (10 [9.4%] vs. 48 [16.3%]) and progression to ESRD (5 [4.7%] vs. 19 [6.5%], P = 0.159) were not different between the two phenotypes. Conclusion: Nonproteinuric DKD is common. Patients with nonproteinuric DKD tend to be older with a slower decline in eGFR.
Journal Article