In Vitro and In Silico Studies on 4-Nitroacetophenone Thiosemicarbazone Potential Cytotoxicity Against A549 Cell Lines.

Lung malignancy is a major worldwide issue that occurs due to the dysregulation of various growth factors. Lung cancer has no apparent signs in the early stages, which makes it harder to catch it in time and leads to a higher fatality rate. So, the goal of this work was to create and analyze a novel chemical molecule called 4-nitro acetophenone thiosemicarbazone (4-NAPTSc) against the lung cancer cell line A549 and human non-tumorigenic lung epithelial cell line BAES-2B. The ligand was synthesized by refluxing the reaction mixture of 4-nitro acetophenone and thiosemicarbazide and was further characterized by UV, FTIR, and 1H and 13C NMR and Differential Scanning Calorimetry (DSC) study. Cytotoxicity assay/MTT (3-(4,5-dimethylthiazol-2-yl))2,5-diphenyltetrazolium bromide) was used to evaluate the cytotoxicity of the compound. Epidermal growth factor receptors (EGFR), polo-like kinase-1 (PLK1), and vascular endothelial growth factor receptors (VEGFR) were chosen as the target proteins for molecular docking to find potential ligand binding sites and inhibit their function. A novel yellow-colored crystalline solid has been synthesized. 4-NAPTSc had an IC50 of 2.93 µg/mL against the A549 lung cancer cells. When the dosage is increased from 5 to 15 µg/mL along with time, the cell viability falls. Docking results showed that the compound binds with the targeted proteins' amino acid residues, and the likeness profile of the compound is also favorable. This study reveals that the compound has the potential for further investigation and can be used in multitargeted cancer therapies.

The Clinical Spectrum and Occurrence of Major Infections in Hospitalized Children With Nephrotic Syndrome.

Background Nephrotic syndrome (NS) is one of the most common renal ailments in the pediatric population. The management of NS with major infections remains a challenge to pediatricians and pediatric nephrologists, as it is associated with increased morbidity and mortality. In this study, we aimed to know the clinical spectrum and occurrence of major infections in hospitalized children with NS. Methods This prospective, observational study was conducted over a period of two years among hospitalized NS children from one year to 18 years. The clinical spectrum and hospital course were studied in detail, and the data generated were analyzed to obtain valid results. Results A total of 101 hospitalizations of 66 children were assessed for the occurrence of infective complications. The incidence rate of infective complications among the hospitalized nephrotics was 29.7%. Urinary tract infection (UTI) was the commonest infective complication, followed by spontaneous bacterial peritonitis (SBP). Other infective complications observed were pneumonia, enteric fever, methicillin-resistant Staphylococcus aureus (MRSA) sepsis, tuberculosis, and varicella. Conclusion Infective complications are quite common among NS patients, where appropriate identification and prompt treatment could reduce morbidity and mortality.

Host-microbiota interactions and oncogenesis: Crosstalk and its implications in etiology.

A number of articles have discussed the potential of microbiota in oncogenesis. Several of these have evaluated the modulation of microbiota and its influence on cancer development. Even in recent past, a plethora of studies have gathered in order to understand the difference in microbiota population among different cancer and normal individuals. Although in majority of studies, microbiota mediated oncogenesis has been primarily attributed to the inflammatory mechanisms, there are several other ways through which microbiota can influence oncogenesis. These relatively less discussed aspects including the hormonal modulation through estrobolome and endobolome, production of cyclomodulins, and lateral gene transfer need more attention of scientific community. We prepared this article to discuss the role of microbiota in oncogenesis in order to provide concise information on these relatively less discussed microbiota mediated oncogenesis mechanisms.

Risk factors and occurrence of chronic kidney disease following acute kidney injury in Children.

Background: Chronic kidney disease (CKD) is an irreversible progressive condition with diverse etiologies among which acute kidney injury (AKI) is increasingly being recognized as an important one. Methods: This was a prospective observational study of pediatric intensive care unit (PICU) patients admitted with different etiologies, at a tertiary care hospital for children in Kashmir India, between October 2018 and September 2020. AKI was defined as an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr 50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 hours (h). Besides analysis of AKI and associated PICU mortality, post-AKI patients after discharge were kept on follow-up for complete 1 year. Results: From 119 enrolled patients with AKI with no preexisting risk factors, 5.6% (n = 8/119) developed CKD. The AKI-associated mortality rate after 48 h of PICU stay was 13.4% (n = 16/119). At time of discharge from hospital, elevated blood pressure (BP) (n = 5/8) and subnephrotic proteinuria (n = 3/8) were the statistically significant sequels of AKI (P value <0.001) for progression to CKD. After 3 months of follow-up, elevated BP (n = 7/8) and subnephrotic proteinuria (n = 3/8) were significantly associated with progression to CKD at 1 year (P < 0.005). Conclusions: Occurrence of CKD after an attack of AKI was not uncommon and the risk of long-term consequences in the form of hypertension, proteinuria, and CKD is significant, which may be much higher than observed. It is prudent that all post-AKI PICU discharged patients must be monitored for the long-term consequences of AKI.

Résumé Contexte: La maladie rénale chronique (CKD) est une condition progressive irréversible avec diverses étiologies parmi lesquelles une lésion rénale aiguë (AKI) est de plus en plus reconnue comme importante. Méthodes: Il s'agissait d'une étude observationnelle prospective des patients de l'unité de soins intensifs pédiatriques (USIC) admis avec différentes étiologies, dans un hôpital de soins tertiaires pour les enfants du Cachemire, entre octobre 2018 et septembre 2020. L'AKI a été défini comme une augmentation de la créatinine sérique absolue (SCR) ≥ 0,3 mg / dL ou par un pourcentage d'augmentation du SCR 50% et / ou par une diminution de la production d'urine à <0,5 ml / kg / h pendant> 6 heures (H). Outre l'analyse de l'AKI et de la mortalité par USIC associée, les patients post-AKI après libération ont été maintenus sur le suivi pendant 1 an. Résultats: De 119 patients inscrits atteints d'AKI sans facteurs de risque préexistants, 5,6% (n = 8/119) ont développé une CKD. Le taux de mortalité associé à l'AKI après 48 h de séjour PICU était de 13,4% (n = 16/119). Au moment de la sortie de l'hôpital, une pression artérielle élevée (BP) (n = 5/8) et une protéinurie subnéphrotique (n = 3/8) étaient les suites statistiquement significatives de AKI (valeur p <0,001) pour la progression vers CKD. Après 3 mois de suivi - UP, une BP élevée (n = 7/8) et une protéinurie subnéphrotique (n = 3/8) ont été significativement associées à la progression vers la CKD à 1 an (p <0,005). Conclusions: La présence de CKD après une attaque d'AKI n'était pas rare et le risque de conséquences à long terme sous forme d'hypertension, de protéinurie et de CKD est significatif, ce qui peut être beaucoup plus élevé que celle observée. Il est prudent que tous les patients inscrits post-AKI PUCU doivent être surveillés pour les conséquences à long terme de l'AKI. Mots-clés: Blessures rénales aiguës, enfants, soins intensifs, mortalité, résultats.

Biomedical Microscopic Imaging in Computational Intelligence Using Deep Learning Ensemble Convolution Learning-Based Feature Extraction and Classification.

Microscopy image analysis gives quantitative support for enhancing the characterizations of various diseases, including breast cancer, lung cancer, and brain tumors. As a result, it is crucial in computer-assisted diagnosis and prognosis. Understanding the biological principles underlying these dynamic image sequences often necessitates precise analysis and statistical quantification, a major discipline issue. Deep learning methods are increasingly used in bioimage processing as they grow rapidly. This research proposes novel biomedical microscopic image analysis techniques using deep learning architectures based on feature extraction and classification. Here, the input image has been taken as microscopic image, and it has been processed and analyzed for noise removal, edge smoothening, and normalization. The processed image has been extracted based on their features in microscopic image analysis using ConVol_NN architecture with AlexNet model. Then, the features have been classified using ensemble of Inception-ResNet and VGG-16 (EN_InResNet_VGG-16) architectures. The experimental results show various dataset analyses in terms of accuracy of 98%, precision of 90%, computational time of 79%, SNR of 89%, and MSE of 62%.

Deciphering the involvement of iron targets in colorectal cancer: a network biology approach.

Several studies suggested the role of heme iron, but not non-heme iron in colorectal cancer. A network and system biology-based approach was used to understand the role of heme and non-heme iron on colorectal cancer etiology. Heme and non-heme iron targets were screened in addition to CRC targets. The protein-protein interaction map of both iron targets was prepared with CRC targets. Moreover, functional enrichment analysis was performed in order to understand their role in cancer etiology. The heme iron is predicted to modulate several cancer-associated pathways. Our results indicate several targets and pathways, including IL-4/IL-13, ACE, and HIF-1 signaling, that may have an important role in heme iron-mediated CRC and must be given consideration for understanding their role in colorectal cancer.

Are we expecting too much for too long from the vaccinators? A qualitative study on perceived challenges of COVID-19 vaccinators of district Shahdol, India.

Background: There is a paucity of knowledge regarding challenges faced by the coronavirus disease 2019 (COVID-19) vaccinators in resource constraint settings like district Shahdol, Central India. Hence, the present study was planned to explore the perceived challenges of vaccinators regarding COVID-19 vaccination. Methods: In October 2021, district health authorities conducted a one-day workshop with the auxiliary nurse midwives, staff nurses, and lady health visitors who work as vaccinators. It had three distinct but mutually connected phases. In the first phase, a free listing exercise was performed to list out their perceived challenges that are prominent and representative of their cultural domain. In the second phase, the pile-sorting exercise with the challenges mentioned in the above step was performed to produce similar data in the form of a matrix, based on a perceived similarity between them by multi-dimensional scaling analysis. In the final phase, the transcripts generated during the discussion on the free listing and pile sorting exercises was used for the thematic analysis to find plausible explanations for the findings. Result: A total of 15 vaccinators took part in the workshop. In the free listing exercise, a total of 14 items were identified as perceived challenges for COVID-19 vaccinators. The three items with the highest Smith's S value were overtime duty, no holidays, and lack of monetary incentive. The analysis of pile-sorting suggested that participants clustered their 14 perceived challenges into five groups; 1) beneficiaries related, 2) vaccination schedule related, 3) lack of facilities at vaccination site, 4) lack of monetary incentive, and 5) issues related to digital data handling. Thematic analysis suggested that their main challenges were overtime duty, no monetary incentive, and lack of toilet, food, and transport facility at the session site. Conclusion: Vaccinators perceive overtime duty and lack of holidays as their top two challenges and expect monetary incentives for this. The study recommends better basic amenities like toilet facility, sustained and effective community engagement, a monetary incentive, and a better ecosystem for digital data handling for the vaccinators.

Microbiota, probiotics and respiratory infections: the three musketeers can tip off potential management of COVID-19.

Rapid infectivity of SARS-CoV2 with recent viral variants is posing a challenge in the development of robust therapeutic strategies. On the other hand, microbiota is debated for its involvement in SARS-CoV2 infection with varied opinions. Although ample data about the role of microbiota and probiotics in respiratory viral infections are available, their role in COVID-19 is limited albeit emerging rapidly. The utilization of probiotics for the management of COVID-19 is still under investigation in many clinical trials. Existing information coupled with recent COVID-19 related studies can suggest various ways to use microbiota modulation and probiotics for managing this pandemic. Present article indicates the role of microbiota modulation and probiotics in respiratory infections. In addition, scattered evidence was gathered to understand the potential of microbiota and probiotics in the management of SARS-CoV2. Gut-airway microbiota connection is already apparent in respiratory tract viral infections, including SARS-CoV2. Though few clinical trials are evaluating microbiota and probiotics for COVID-19 management, the safety evaluation must be given more serious consideration because of the possibility of opportunistic infections among COVID-19 patients. Nevertheless, the information about microbiota modulation using probiotics and prebiotics can be helpful to manage this outbreak and this review presents different aspects of this idea.

Natural Bioactive as a Potential Therapeutic Approach for the Management of Cyclophosphamide-induced Cardiotoxicity.

Cyclophosphamide (CP) is an extensively used anticancer drug, but its cardiotoxic manifestation is a major concern for its widespread clinical use. The observed cardiotoxic attributes have been reported at the therapeutic dose and often result into a high mortality rate and poor clinical outcome. Fall in the level of antioxidant enzymes catalase (CAT), reduced glutathione (GSH), superoxide dismutase (SOD) generation of reactive oxygen species (ROS), inflammatory cytokines nuclear factor kappa-light-chain enhancer of activated B cells (NF-kB), tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL- 1ß), apoptotic proteins (caspases) and direct damage to myocardial tissue (histological and ultrastructural damage) are some of the reported manifestations of cardiotoxicity. The observed clinical attributes of CP-induced cardiotoxicity are myocarditis, hemorrhage, thrombosis, myocardial infarction (MI), reduced ejection fraction, altered electrocardiogram (ECG) reading and heart failure. However, unlike Daxarazasone (an adjuvant to reduce doxorubicin-induced cardiotoxicity), no approved adjuvant is available to mitigate CPinduced cardiotoxicity. Thus, various natural bioactives have been explored for the possible cardioprotective effect against CP-induced cardiotoxicity. In the current manuscript, we have discussed the clinical and preclinical aspects of CP-induced cardiotoxicity, its clinically used combination with other anticancer drugs, and the available therapeutic regimen to mitigate this cardiotoxicity. Further, we discussed the limitations of available synthetic drugs used as an adjuvant and discussed various natural bioactive and their experimental details. This manuscript's overall goal is to throw light on CP-induced cardiotoxicity and summarize all the experimental data so that researchers working in this field may scientifically get up-to-date information in one place.

Sustainability of Palm Biodiesel in Transportation: a Review on Biofuel Standard, Policy and International Collaboration Between Malaysia and Colombia.

Biodiesel is gaining prominence as a superior alternative source of energy to replace petroleum-based fuel in transportation. As of today, the biodiesel market continuous to rise up as the biofuel has been introduced to more than 60 countries worldwide. The aim of the present review is to highlight on the scenario of the biofuel implementation in transportation sector towards sustainable development in Colombia and Malaysia. Colombia serves as an ideal comparative case for Malaysia in terms of biodiesel development since the country is the main palm oil producer in Latin America region and the pioneer in bioethanol industry. The first section shows an overview on the biodiesel as an alternative fuel in transportation. The next section will focus on a comparative study between Malaysia and Colombia biodiesel sector in terms of energy supply, resource, production and consumption, standards, techno-economic cost and their biodiesel policies. A comprehensive review was studied to discuss on the sustainability of palm cultivation and biodiesel, impact of palm industry and biodiesel policy in transportation sector and potential international collaboration between Malaysia and Colombia to improve their existing policies, strategies and blueprints related to the palm biodiesel industry, thus overcoming the challenges when dealing with global energy issue.

Pediatric hypertension: an updated review.

Globally hypertension in adults is among the leading preventable cause of premature death, where a graded association from the childhood hypertension is well recognised. With the concurrent rise in obesity and pediatric hypertension (HTN) during the past decade in developed countries, a parallel trend is emerging in developing countries that has a potential for exponential rise in cardiovascular, cerebrovascular and renal tragedies. A cumulative incidence of pediatric HTN in China and India is 50-70 and 23% respectively, is quite disturbing. New guidelines for the detection, evaluation and management of hypertension in children and adolescents published in 2017, where a jump in prevalence of pediatric HTN is observed, rings a call to address this under-attended burning problem; for which a review in pediatric hypertension and its management is warranted.

Protein-protein interactions of HPV-Chlamydia trachomatis-human and their potential in cervical cancer.

Aim: HPV is an important cause of cervical cancer, but Chlamydia trachomatis (CT) is suspiciously involved in this disease ranging from direct to its involvement as a cofactor with HPV. We performed this study to understand the interaction of HPV and C. trachomatis with humans and its contribution to cervical cancer. Materials & methods: Host-pathogen and pathogen-pathogen protein-protein interaction maps of HPV/CT/human were prepared and compared to analyze interactions during single/coinfection of C. trachomatis and HPV. The interacting human proteins were detected by their involvement in cervical cancer. Results:C. trachomatis may interact with several cancer associated proteins while HPV and C. trachomatis largely interact with different human proteins, suggesting different pathogenesis. Conclusion:C. trachomatis coinfection with HPV may modulate cervical cancer development.

Colorectal cancer-inflammatory bowel disease nexus and felony of Escherichia coli.

Colorectal cancer (CRC) has a multifactorial etiology. Although the exact cause of CRC is still elusive, recent studies have indicated microbial involvement in its etiology. Escherichia coli has emerged as an important factor in CRC development since the bacterium can cause changes in the gut that lead to cancerous transformation. A number of studies indicate that chronic inflammation induced by microorganisms, including E. coli, during inflammatory bowel disease (IBD) predisposes an individual to CRC. The evidence that support the role of E. coli in the etiology of CRC, through IBD, is not limited only to chronic inflammation. The growth of E. coli as an intracellular pathogen during IBD and CRC enable the bacteria to modulate the host cell cycle, induce DNA damage and accumulate mutations. These are some of the contributing factors behind the etiology of CRC. The present article considers the current status of the involvement of E. coli, through IBD, in the etiology of CRC. We discuss how intracellular E. coli infection can cause changes in the gut that can eventually lead to cellular transformation. In addition, the recent management strategies that target E. coli for prevention of CRC are also discussed.

Incidence of pediatric acute kidney injury in hospitalized patients.

Pediatric acute kidney injury (pAKI) is a common complication associated with high mortality in children. The objective of this study was to determine the incidence of acute kidney injury (AKI) and mortality in hospitalized (critically ill and non-critically ill) patients. This was a retrospective study conducted during the period of June 1, 2013, to May 31, 2014, at the Postgraduate Department of Pediatrics, G. B. Pant Hospital, an Associated Hospital of Government Medical College, Srinagar, Jammu and Kashmir, India. All patients between the ages of one month and 18 years were included in the study, who had AKI. In general, out of 23,794 patients, 197 developed AKI (0.8%). On subgroup analysis, 2460 were critically ill and had Intensive Care Unit (ICU) admission among whom 99 developed AKI (4%), whereas 21,334 had general pediatric ward admissions and 98 developed AKI (0.5%). Infantile age group was the most commonly 91 (46.2%) affected. The common causes of AKI were renal in 73 (37%), neurologic in 38 (19%), septicemia in 35 (18%), and inborn errors of metabolism in 30 (15.2%). Out of 197 pAKI patients, 42 (21.3%) died and all of them were critically sick (ICU admissions). The incidence of pAKI in general was 0.8%, whereas it was 4% in critically ill children and 0.5% in general ward admissions implying an eight-fold increased risk of pAKI in critically ill patients.

Paediatric Urinary Tract Infection: A Hospital Based Experience.

INTRODUCTION: Paediatric Urinary Tract Infection (UTI) is one of the commonly encountered entities by paediatricians. Studies have shown easy vulnerability of paediatric urinary tract in any acute febrile illness and a miss in diagnosis could have long term consequences like renal scaring with its adverse effects. Bearing these evidence based preludes in view we designed our study to know the prevalence of UTI in Kashmir province. AIM: Aim of the present study was to know the prevalence of UTI in febrile children and to know the sensitivity of different imaging modalities like Renal and Urinary Bladder Ultrasonography (RUS), Voiding Cystourethrography (VCUG) and Dimercaptosuccinic Acid (DMSA) scan in diagnosing UTI. MATERIALS AND METHODS: A total of 304 patients, between 2 months to 10 years, with axillary temperature of ≥ 100.4oF (38oC), who did not have a definite source for their fever and who were not on antibiotics were included in the study. Detailed history and through clinical examination was done to rule out any potential or definite focus of infection as per the predesigned proforma. Routine urine examination with culture and sensitivity, followed by RUS and VCUG was done in all patients where routine urine examination was suggestive of UTI. DMSA was done in only culture proven cases after 6 months to document the renal scarring. RESULTS: Out of 304 children, 140 were males and 164 were females, UTI was present in 40 patients who had fever without any apparent cause giving a prevalence of 13.2%. Escherichia coli (E. coli) were the commonest isolated organism, followed by Klebsiella and Citrobacter species. Renal and Urinary Bladder Ultrasonography (RUS) detected Vesicoureteral Reflux (VUR) in 25% (10/40) while VCUG showed VUR in 55% (22/40) giving a RUS sensitivity of 45% for detecting VUR. DMSA done only after 6 months in UTI diagnosed patients showed a renal scarring in 25% (10/40) patients. CONCLUSION: Missing a febrile paediatric UTI, can prove a future catastrophe if not timely diagnosed and treated.

The other side of vitamin D therapy: a case series of acute kidney injury due to malpractice-related vitamin D intoxication
.

BACKGROUND: Vitamin D deficiency is highly prevalent in Indian Kashmir. Many people get injectable vitamin D (600,000 IU/injection). At times, the dose prescribed is far above the permissible limit. We report 62 patients with malpractice-related vitamin D intoxication, presenting with hypercalcemia and acute kidney injury (AKI). METHODS: The diagnosis was made on basis of (1) history of multiple intramuscular vitamin D injections (2) toxic serum levels of 25-OH vitamin D and (3) exclusion of common causes of hypercalcemia (malignancy and hyperparathyroidism). Their presentation was either de novo AKI in 51 (group 1) or acute on top of chronic kidney disease in 11 (group 2). RESULTS: The mean age was 60 ± 14 vs. 62 ± 13 years, approximate number of vitamin D injections received ranged from 4 to 28 (2.4 - 16.8 million units) vs. 3 to 24 (1.8 - 14.4 million units), mean creatinine at presentation was 3.2 ± 0.9 vs. 4.5 ± 1.1 mg/dL, which decreased to 1.2 ± 0.2 vs. 3.3 ± 1.0 mg/dL, mean serum calcium on admission was 13.7 ± 1.4 vs. 13.6 ± 2.0 mg/dL which decreased to 10.7 ± 1.2 vs. 11.0 ± 1.0 mg/dL on follow-up of 7.2 ± 0.6 months, mean vitamin D level was 313.3 ± 54.8 (range 235 - 375) vs. 303.7 ± 48.4 (range 210 - 375) nmol/L and mean PTH was 18.1 ± 9.6 (range 6.2 - 32) vs. 52.3 ± 12.6 (range 28 - 88) pg/mL in group 1 vs. group 2, respectively. The clinical presentation was weakness, constipation, abdominal pain, nausea, vomiting, anorexia, altered sensorium, and oliguria. The treatment received was intravenous fluids (normal saline) in all in group 1 and in 8/11 in group 2, short course of steroids (prednisolone) in 44, and bisphosphonate in 6. CONCLUSION: This is the largest case series of AKI secondary to vitamin D toxicity ever reported.
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Spectrum of Renal and Urinary Tract Diseases in Kashmiri Children.

INTRODUCTION: Definite paucity of data pertaining to spectrum of renal and urinary tract diseases in our state and in various parts of India forms the basis of this study. Available data has emphasized more on specific clinical syndromes and chronic renal diseases rather than over all spectrums of renal and urinary tract diseases, that too in adult population. AIM: The present study a retrospective analysis, forms one of the basic data of paediatric nephrology and urology related disorders in our state. MATERIALS AND METHODS: Retrospective analysis of the case records of all the hospitalized patients with renal and urinary tract diseases between 2012 and 2013 were performed. Case records were analysed and categorized into various groups like; Urinary Tract Infections (UTI), Acute Kidney Injury (AKI), Acute Glomerulonephritis (AGN), Nephrotic Syndrome (NS), haematuria, Polycystic Kidney Disease (PCKD), Posterior Urethral Valve (PUV), Vesicoureteric Reflux (VUR), Chronic Kidney Disease (CKD), Congenital Anomalies of Kidney and Urinary Iract (CAKUT) and others. These groups were divided into subgroups to get more insight about the pattern of these diseases. RESULTS: Out of 28114 patients hospitalized between 2012 and 2013 years, 447 (232 males and 215 females) patients were diagnosed of renal and urinary tract diseases which forms 1.58% the total admitted patients. Among these patients 32.9% (147/447) were diagnosed Acute Kidney Injury (AKI); 24.1% (108/447): Urinary Tract Infection (UTI); 9.6% (43/447): Acute Glomerulonephritis (AGN); 5.6% (25/447): bilateral hydronephrosis with UTI; 4.47% (20/447): nephrotic syndrome (NS); 3.5% (16/447): haematuria; and 4% (18/447) were having CAKUT (Congenital Anomalies Of Kidney And Urinary Tract). In addition to this there were 17 cases of Renal Tubular Acidosis (RTA), 3 cases of Barter syndrome and one case of Liddle syndrome. CONCLUSION: A substantial number of children are hospitalized with renal and urinary tract diseases with delayed ages of presentation, which at times have suffered irreversible renal damage that could have been prevented or treated if diagnosed earlier. Our study indicates that majority of these renal and urinary tract diseases are preventable and treatable. Henceforth, there is a need to develop a comprehensive service for the children with renal and urinary tract diseases in Jammu & Kashmir (J&K) India.

Drug reaction with eosinophilia and systemic symptoms: manifestations, treatment, and outcome in 17 patients.

BACKGROUND: Drug-induced hypersensitivity syndrome (DIHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare type of adverse drug reaction with complex clinical features involving multiple systems of the body. OBJECTIVES: This study was designed to evaluate the clinical features, course, response to treatment, and outcome of DRESS. METHODS: The study involved a retrospective analysis of data collected over a period of four years in 17 patients with DRESS. Clinical features, laboratory findings, responses to treatment, and outcomes were investigated. RESULTS: The study population included 17 patients, of whom eight (47.1%) were male and nine (52.9%) were female. The most common (64.7%) culprit drugs were anticonvulsants (phenytoin, phenobarbitone, carbamazepine, oxcarbazepine, and lamotrigine). Other causative drugs included allopurinol, dapsone, vancomycin, leflunomide, and nitrofurantoin. The latency period varied from 11 days to 34 days, with a mean of 22.35 ± 5.83 days. The mean latency period of anticonvulsant drugs was longer than that of other drugs. Multisystem involvement was present in all patients. Systemic corticosteroids, injectable followed by oral, were administered to all patients. Thirteen (76.5%) patients recovered completely, two (11.7%) developed post-inflammatory hyperpigmentation, and one (5.9%) patient developed renal failure. One patient with liver failure had a poor outcome. CONCLUSIONS: A variety of drugs can cause DRESS, the most common being anticonvulsants. Patients show diverse presentations with varied organ involvement. Systemic corticosteroids are an effective management option and are associated with a good clinical outcome if started early.

(99m)Tc Diethylenetriaminepentacetic Acid Angiotension-coverting Enzyme Inhibitor Renography as Screening Test for Renovascular Hypertension in Unilateral Small Kidney: A Prospective Study.

To know the probability of renal artery stenosis (RAS) in unilateral small kidney and function of the unilateral small kidney, which includes glomerular filtration rate, differential function, uptake, Tmax by (99m)Tc diethylenetriaminepentacetic acid (DTPA) base and (99m)Tc DTPA angiotensin converting enzyme (ACE) inhibition scan. All our patients were subjected to (99m)Tc DTPA ACE inhibition renal scintigraphy. All the patients underwent either computed tomography (CT) angiography and magnetic resonance (MR) angiography was done in those patients in which kidney function test was deranged. Renal angiography was subsequently performed in cases with the suggestion of RAS on CT or MR angiography. The quantitative data was expressed as the arithmetic mean, standard deviation and percentages. The intergroup comparisons for parametric data were done by Student's t-test, whereas non-parametric data was compared with Mann-Whitney U-test. The intergroup comparisons were made by paired t-test and Wilcoxon sign rank test. P <0.05 was considered to be significant, and data was analyzed by Statistical package for social sciences(SPSS-20) software. Out of 47 patients, 25 patients were in the low probability group out of which none was positive for RAS on CT/MR angiography. Out of 47 patients, 12 were in the intermediate group out of which none was positive for RAS. Ten, out of 47 patients were suspected of high probability for RAS by ACE inhibition scan out of which 4 were positive for RAS by CT/MR angiography including one with bilateral RAS. (99m)Tc DTPA angiotension-coverting enzyme inhibitor renography is a safe, non-invasive, sensitive, specific, and cost-effective test for excluding renovascular hypertension in patients who have normal or nearly normal renal function in unilateral small kidney.

Non-Hyperammonemic valproate encephalopathy.

A 21-year-old male known case of primary hypothyroidism, Seizure disorder sequelae of an old trauma receiving sodium valproate, clobazam and phenobarbitone for control of Generalized tonic clonic seizures reported to neurology OPD with history of altered sensorium and gait unsteadiness for 1 week with history of hike in valproate dose 2 weeks before. On examination he was drowsy. Neurological examination was unremarkable except for gait unsteadiness and ataxia. Patient was admitted and evaluated for acute worsening. All (the) biochemical parameters including complete blood count, liver function tests, kidney function tests, routine urine examination, arterial blood gas analysis, blood and urine culture tests were normal. CSF analysis was also normal. Repeat MRI brain was also done which depicted all old changes with no fresh changes which will account for worsening of his sensorium. EEG was suggestive of diffuse encephalopathy. Thyroid function tests were also normal. Valproate encephalopathy was suspected and Valproate was empirically stopped and he was put on levetiracetam and phenytoin. His sensorium improved rapidly after stoppage of valproate with normalization of EEG. Serum valproate Levels were high with serum ammonia levels were in the normal range. We made the inference of nonhyperammoneamic valproate encephalopathy. This case highlights the existence of non-hyperammonemic valproate induced encephalopathy, suggesting mechanisms other than hyperammonemia responsible for this encephalopathy.