استكشف المجموعة الواسعة من العناوين المتاحة.

ABSTRACT Background of the Study: Lupus is an autoimmune disease that affects multiple body systems and requires long-term treatment. The multisystem effect of this disease and long treatment may cause anxiety and depression in patients with lupus nephritis (LN) and ultimately deteriorate their quality of life and also affects the activity of the disease. Aim of the Study: This study aims to assess anxiety, depression, and quality of life in patients with LN and their relationship with disease activity. Material and Methods: A descriptive cross-sectional study was conducted to assess anxiety, depression, and quality of life among patients with LN. A total enumerative technique was used for the recruitment of 100 patients and data collected using standardized tools were analyzed. Results: The results of the study showed that the majority of patients (60.0%) with LN had moderate anxiety and most of them (61.0%) had moderate depression that affected their quality of life and impacted the disease activity index in lupus. Conclusion: LN patients experience significant levels of anxiety and depression, which deteriorates their quality of life and negatively impacts disease activity. Active surveillance for these conditions and early diagnosis might help in the improvement of health-related outcomes in such patients.

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.

Background Vitamin D deficiency has been examined as a risk factor for severity and progression of kidney disease due to its immunomodulatory effects. There is paucity of data about its impact in IgA nephropathy (IgAN). Methods In a retrospective cohort study, 25 (OH) vitamin D assay was performed in bio-banked baseline serum samples collected during kidney biopsy of 105 adult patients with primary IgAN diagnosed between 2015 and 2019. A level of < 10 ng/mL was defined as Vitamin D deficiency. Results Mean age of patients was 34 ± 10.6 years, 69.5% were males. Mean baseline 25(OH) Vitamin D levels was 15.9 ± 11.9 ng/mL and 41(39%) patients had vitamin D deficiency. Serum albumin level was lower in vitamin D deficient patients compared to those who had higher vitamin D levels (3.7 ± 0.9 vs 4.1 ± 0.7 g/dl, p  = 0.018)but there was no significant difference in baseline proteinuria and eGFR. Crescentic lesions were more frequent in vitamin D deficient group (19.5% vs 6.3%, p  = 0.022). At median follow up of 21.5 months (6 – 56 months), there was no difference in remission (68.3% vs 65.6%, p  = 0.777) and disease progression (12.5% vs 9.4%, p  = 0.614) in those with and without Vitamin D deficiency respectively. On multivariate cox proportional hazard analysis, vitamin D deficiency was not a significant risk factor for renal survival (HR-1.79, 95% confidence interval:0.50–6.34, p  = 0.368). Conclusion There was no association between vitamin D deficiency and disease profile as well as renal outcome in Indian patients with IgAN.

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.

Background: Coronavirus disease (COVID-19)-related scientific publications have increased exponentially during the present pandemic but their influence on biomedical literature is not known. The characteristics of highly cited articles help us to identify important advances and their scientific impact. Objectives: In the present study, we have identified and analyzed the top 100 most highly-cited articles of COVID-19 research published in the year 2020. Methods: A cross-sectional bibliometric analysis was using the search terms \"severe acute respiratory syndrome-coronavirus-2,\" \"COVID,\" \"nCoV,\" \"Coronavirus,\" and \"HCoV\" querying the Google Scholar database using the program \"Publish or Perish.\" The first 100 English language articles with the maximum number of citations were identified and evaluated in detail. Results: The top 100 COVID-19 articles in 2020 had citations ranging from 1147 to 20,440. The median (interquartile range [IQR]) number of citations was 1970 (1456-2939). The number of authors ranged from 1 to 79 (median 10; IQR 5.25-19). The majority of first authors was from China (58%), followed by the United States of America (16%) and the United Kingdom (7%). The top three journals in terms of the number of published articles (37%) were the New England Journal of Medicine, Journal of the American Medical Association, and The Lancet. Most of the top-cited COVID-19 literature were descriptive studies focusing on epidemiology (48%) and clinical course (60%) of COVID-19. Conclusion: Clinical course and epidemiology have been the predominant areas of research interest in COVID-19 in 2020. Citation analysis of COVID-19 literature helps us to map out the most important focus for research in this pandemic and to identify gaps in knowledge which would guide further research.

A 45-year-old man presented 4 months after ABOi renal transplantation with febrile illness and bicytopenia necessitating cessation of mycophenolate mofetil. Dengue non-structural protein 1 antigen (NS1 Ag) test was positive. Lowest total leucocyte count was 3.1×109/L and platelet count was 14×109/L. As fever subsided, patient became tachypneic with abdominal distention and hypotension. Ultrasonographic evaluation revealed ascites, gall bladder wall oedema and bilateral pleural effusion consistent with dengue capillary leak syndrome. He developed massive ascites with abrupt weight gain of 4 kg within 24 hours and worsening renal dysfunction. Patient was deteriorating rapidly in spite of adequate supportive care and we gave a trial of intravenous immunoglobulin (0.5 g/kg/day) for 5 days. Patient improved from day 2, and by day 3, he became haemodynamically stable and recovered completely. Patient was stable at discharge and is on regular follow-up.

Colovesical fistula per se is a rare condition and most commonly occurs secondary to diverticular disease in normal patients. Colovesical fistula in the setting of post-renal transplantation is even rarer and very few cases have been reported in literature. Patients with autosomal-dominant polycystic kidney disease (ADPKD) are predisposed to diverticulosis and hence are at a higher risk for fistula formation. Herein, we report a case of colovesical fistula in a renal allograft recipient with ADPKD in the absence of diverticulosis. The patient was successfully operated and is stable with no complications at 1-year follow-up.

The present study is aimed to analyze the combustion, performance, and emission characteristics of water-emulsified soybean biodiesel fueled diesel engine with alumina nanoadditive and the results compared with conventional diesel fuel (BD). Experiments were conducted in a single-cylinder, four-stroke, variable compression ratio, and natural aspirated diesel engine with an eddy current dynamometer at a constant speed of 1500 rpm. Water-soybean biodiesel emulsion fuel was prepared using a mechanical agitator, in which the water concentration was limited to 10%, whereas soybean biodiesel (SB) and surfactant concentrations were 89% and 1% by volume respectively. Alumina (Al) was chosen as a nanoadditive, and the mass fractions of 50 ppm and 100 ppm were blended with emulsion fuel using ultrasonicator and the physicochemical properties were measured. The physicochemical properties of water-emulsified biodiesel and nanoadditive included emulsified biodiesel are at par with EN14214 limits. The in-cylinder pressure (ICP) and net heat release rate (NHR) values of SB are 5.3% and 7.2% lower than BD respectively, whereas the water inclusion significantly increases the ICP and NHR values by 6.9% and 15.9% compared to SB. Brake-specific fuel consumption (BSFC) of SB is higher than BD, and brake-specific energy consumption (BSEC) is lower than BD. An inclusion of 10% water in SB improves the BSFC and BSEC by 4% and 10.6% respectively compared to SB. The Al nanoparticle inclusion in water-emulsified soybean biodiesel further improves the combustion and performance parameters. The exhaust gas temperature (EGT) of sample fuels seems to be lesser than BD due to efficient combustion. As far as the emission characteristics are concerned, the SB promotes lower level of hydrocarbon (HC), carbon monoxide (CO), and smoke emissions with notable increases in oxides of nitrogen (NOx) and carbon dioxide (CO2) emissions. An inclusion of 10% water in SB reduces the NOx, HC, CO, and smoke emission by 21.2%, 16.7%, 16.9%, and 11.8% respectively under peak brake mean effective pressure (BMEP) condition. The addition of Al nanoparticle in biodiesel emulsion fuel further reduce NOx, HC, CO, and smoke emissions and marginally increases the CO2 emission.

The present study aims to investigate the optimum condition of stationary diesel engine’s operating parameters to obtain better performance and emission level, where the diesel engine is fueled with different concentrations of soybean biodiesel (SB), water, and alumina (Al) nanoadditive. Taguchi method coupled with gray relational analysis has been implemented in this study to obtain the optimum concentration of SB, water, and Al nanoparticle, and statistical analysis of variance (ANOVA) is applied to obtain the individual response of operating parameters on overall engine performance and emission level. Various concentration of SB (10%, 20%, and 30%), water (10%, 20%, and 30%), and Al nanoparticle (50 ppm, 100 ppm, and 150 ppm) are mixed with base diesel (BD) by mechanical agitation and followed by an ultra-sonication process. The fuel properties are measured based on EN590 standards, and the experiments are conducted in a single-cylinder, four-stroke, natural aspirated stationary diesel engine based on an L 9 orthogonal array fuel combination. From the obtained gray relational co-efficient (GRC) and signal-to-noise (S/N) ratio, the optimum concentration of SB, water, and nanoadditive are identified as 20%, 10%, and 100 ppm, respectively, and a confirmation experiment has also been carried out to confirm the improvements at optimum condition. The ANOVA results imply that water concentration (WC) has the maximum influence on overall diesel engine’s performance and emission level followed by nanoparticle and SB concentrations. Overall, it can be concluded that the engine exhibits better performance and greener emissions at optimal condition.

This study aimed to determine the prevalence of immediate posttransplant hyperglycemia and new onset diabetes after renal transplantation (NODAT). It also aims at answering whether posttransplant hyperglycemia is a risk factor for future development of NODAT. A retrospective study was conducted among patients undergoing kidney transplantation under a single surgical unit in a tertiary care hospital in the past 5 years. All known patients with diabetes were excluded from the study. Immediate postoperative hyperglycemia was defined as random blood sugar (RBS) ≥200 mg/dl or requirement of insulin. NODAT was defined as fasting plasma glucose ≥126 mg/dl or RBS ≥200 mg/dl or if the patient is receiving therapy for glycemic control at 6 weeks or 3 months posttransplantation. The study population included 191 patients. The overall prevalence of posttransplant hyperglycemia and NODAT was 31.4% and 26.7%, respectively. NODAT developed in 28 patients (46.7%) of those who had posttransplant hyperglycemia. Thus, posttransplant hyperglycemia was associated with a fourfold increased risk of NODAT ( = 0.000). Posttransplant hyperglycemia was associated with increased infections ( = 0.04) and prolonged hospital stay ( = 0.0001). Increased age was a significant risk factor for NODAT ( = 0.000), whereas gender, acute rejection episodes, cadaveric transplant, hepatitis C virus status, human leukocyte antigen mismatch, and high calcineurin levels were not significantly associated with the future development of NODAT. The significant risk of NODAT posed by posttransplant hyperglycemia makes it prudent to follow up these patients more diligently in a resource-limited setting wherein routine monitoring in all patients is cumbersome.