The initial experience of COVID-19 vaccination from a tertiary care centre of India.

To the Editor Drugs Controller General of India (DCGI) has approved the Bharat biotech vaccine against COVID-19, which is a locally manufactured inactivated vaccine named ''COVAXIN'' in collaboration with the Indian council of medical research (ICMR) on 3rd  January 2021 for emergency use along with the "Covishield" Oxford-AstraZeneca vaccine manufactured locally by the Serum Institute of India... *The Safdarjung COVID-19 Vaccination group: KR Meena (Professor, Paediatrics), U Venkatesh (Assistant Professor, Community Medicine), Pushpa Kumari (Associate Professor, Medicine), Sonal Burman (Specialist, Medicine), Neeraj Kumar Gupta (Professor and Head, Pulmonary Medicine), Nitesh Gupta (Assistant Professor, Pulmonary Medicine), Rohit Kumar (Assistant Professor, Pulmonary Medicine), Swetabh Purohit (Senior resident, Pulmonary Medicine), Arjun Ramaswamy (Senior resident, Pulmonary Medicine).

Quantification of nitrogen transformation and leaching response to agronomic management for maize crop under rainfed and irrigated condition.

Nitrogen (N) plays an important role in agriculture crop production but the increasing application of nitrogen increases the possibilities of groundwater contamination through nitrate leaching. Nitrate leaching is the inevitable part of agriculture production which occurs during nitrogen fertilization. Hence, the quantification of nitrogen fertilizer is required to reduce nitrate leaching. In this study, nitrogen transformation and transport such as ammonium (NH4+) and nitrate (NO3-) at different soil depths and maize crop growth stages were measured during field experiments for two sowing dates (timely and delay) and four N fertilization levels under irrigated (year 2013 and 2014) and rainfed (year 2012 and 2014) conditions for maize crop. NH4+, NO3- and total nitrogen concentrations were measured using spectrophotometer at 410 nm and Kjeldahl method at varying soil depths and maize crop growth stages. Thereafter, nitrogen balance approach was used to estimate the NO3- leaching. Results indicated that NO3- leaching in irrigated condition was higher 109% in N75, 179% in N100, and 292% in N125 level respectively in comparison to the N0 level in timely sowing date, while in delayed sowing date, leaching was higher 54% in N75, 123% in N100, and 184% in N125 level respectively in comparison to N0 level. In rainfed, the NO3- leaching was higher 30% in N60, 59% in N80, and 99% in N100 level respectively in comparison to N0 level for the timely sowing date, while in delayed sowing, leaching was higher 23% in N60, 44% in N80, and 78% in N100 level respectively in comparison to N0 level. The results indicate that leaching losses were less in timely sowing dates for both rainfed and irrigated maize. The study further reveals that sowing dates combination with N levels could be an effective management strategy to reduce NO3- leaching by minimizing the N fertilization.

Adsorptive removal of lead (Pb), copper (Cu), nickel (Ni) and mercury (Hg) ions from water using chitosan silica gel composite.

Silica gel chitosan composite was prepared to perform adsorptive experiment of different heavy metal ion solutions. The characterization of chitosan + silica gel (Ch + Sg) composite was done by FTIR and SEM-EDS to understand the presence of active sites and to have an insight on the surface morphology. The adsorption study of heavy metal ions by Ch + Sg composite gives maximum removal percent for Cu, Pb and Ni which were obtained at pH 5 and for Hg at pH 6.The trend of removal by Ch + Sg signifies that maximum removal percent was attained at 120 min. The surface of Ch + Sg is heterogeneous for the adsorption of Hg, Ni and Cu and homogeneous for Pb adsorption. The values obtained for Pb signify that its adsorption best fitted to pseudo first order with the R2 value of 0.986, whereas pseudo second order best fitted to the experimental data of Cu, Ni and Hg as R2 values which are 0.983, 0.819 and 0.957 respectively. The values of change in entropy (⊿S) obtained for Pb, Cu, Ni and Hg are - 69.33, - 118, - 63.33 and - 98.52 J/mol K respectively. Negative values of change in enthalpy, ⊿H in (kJ/mol) are in the range of - 18.2 to - 37.66 which indicates both physical and chemical adsorption involves in the process of adsorption.

Experience with various reconstructive techniques for meningomyelocele defect closure in India.

BACKGROUND: The estimated incidence of spina bifida is 1-2 cases per 1000 population. In earlier literature, the global prevalence of meningomyelocele (MMC) is reported as 0.8-1.0 per 1000 live births. This retrospective study analyses the outcome of various surgical procedures performed for the closure of MMC defects. METHOD: A total of 22 patients with MMC defects who underwent repair at our institute from July 2016 to August 2018 were included in the study. A retrospective review of all the cases operated was completed to analyse patient demography including defect size, defect location, surgical procedures, complications and the final outcome. RESULTS: Out of 22 cases, wherein the neurosurgery department sought help from the plastic surgery department, 11 defects were closed using the Limberg flap technique, 4 defects were closed with either primary closure or the double flap rotation flaps, one defect was closed using the triple rotation flap and 2 defects were closed using the local transposition flap cover technique. Complications were noted in only three cases. One patient had a local wound infection, while in two other cases, wound dehiscence was observed. All 3 cases were managed conservatively. On average, it takes approximately 70 days in India to close such defects. CONCLUSION: MMC defects can be effectively managed with local flap options such as Limberg flap, local transposition flap or rotation flaps. Various reasons for the delay in closure were reported in patients late to our centre, when the first point of contact was with other departments.

Tuberculosis diagnostic and treatment practices in private sector: Implementation study in an Indian city.

SETTING: Implementation study in private health facilities in an Indian metropolis. OBJECTIVES: Improve Tuberculosis (TB) care by private practitioners (PPs). METHODS: PPs from a defined city area were imparted short training in TB care and linkages made with public facilities; subsequent practices were recorded. RESULTS: Of 364 presumptive TB patient records, 70 (19.3%) did not conform to its definition. Of the conforming, 174 (59.2%) had presumptive pulmonary TB (PTB), 53 (18%) presumptive extra-pulmonary (EPTB) and 67 (24%) had both. Of conforming presumptive PTB, most underwent Chest X-ray and sputum examination in private laboratories. Tissue based diagnostics were not advised for most presumptive EPTB patients. Of 101 cases diagnosed with TB, 82% were new, 23% known diabetic and 4.7% human immune deficiency virus (HIV) reactive out of 64 tested. Most were notified and initiated treatment within 15 days of diagnosis. One-fourth was prescribed standard treatment regimen and treatment was not directly observed for most. One third was initial defaulters or lost during treatment; 62% of PTB and 46% EPTB cases initiated on treatment in private were successfully treated. Of successfully treated PTB cases, 61% had undergone follow-up sputum examination. CONCLUSION: Much intensified support mechanisms are needed to improve TB care in private sector.

Knowledge of private practitioners of Bangalore city in diagnosis, treatment of pulmonary tuberculosis and compliance with case notification.

One hundred and twenty-nine qualified private practitioners (PPs) were assessed on their knowledge in diagnosis of pulmonary tuberculosis (PTB), treatment of a new drug sensitive PTB case and practices of case notification, using semi-structured questionnaire. About 20% had adequate knowledge of diagnosis, 29% of treatment regimen, 54% the need for Direct Observation Treatment and 57% about role of sputum smear examination in monitoring treatment response. Of 85 (68%) PPs who had diagnosed any TB case during last two years, 54 (64%) had practised notification. These findings suggest the need for upgrading knowledge of PPs in TB diagnosis, treatment and notification.

A review on sustainable yeast biotechnological processes and applications.

Yeast is very well known eukaryotic organism for its remarkable biodiversity and extensive industrial applications. Saccharomyces cerevisiae is one of the most widely used microorganisms in biotechnology with successful applications in the biochemical production. Biological conversion with the focus on the different utilization of renewable feedstocks into fuels and chemicals has been intensively investigated due to increasing concerns on sustainability issues worldwide. Compared with its counterparts, Saccharomyces cerevisiae, the baker's yeast, is more industrially relevant due to known genetic and physiological background, the availability of a large collection of genetic tools, the compatibility of high-density and large-scale fermentation, and optimize the pathway for variety of products. Therefore, S. cerevisiae is one of the most popular cell factories and has been successfully used in the modern biotech industry to produce a wide variety of products such as ethanol, organic acids, amino acids, enzymes, and therapeutic proteins. This study explores how different sustainable solutions used to overcome various environmental effects on yeast. This work targets a broad matrix of current advances and future prospect in yeast biotechnology and discusses their application and potential in general.

Characterization and pollutant removal efficiency of biochar derived from baggase, bamboo and tyre.

Conversion of broad-spectrum organic waste into carbonaceous biochar has gained enormous interest in past few years. The present study aims to characterize feedstock (FS), i.e. bagasse (Bg), bamboo (Bm) and biochar (BC), i.e. baggase biochar (BBg), bamboo biochar (BBm) and tyre biochar (Ty). Significant changes in elemental composition, atomic ratio, proximate analyses, mineral content and heavy metal content were observed which was well supported by Fourier transform infrared (FTIR) spectroscopy and X-ray diffraction (XRD) analysis. Impregnation with ferric hydroxide was done, and resultant modified biochars (MBC), i.e. iron-impregnated baggase biochar (FeBBg), iron-impregnated bamboo biochar (FeBBm) and iron-impregnated tyre biochar (FeTy), along feedstock and biochar were used for PO4 (3-), Pb, Hg and Cu adsorption. In general, BBg, FeBBg, BBm, FeBBm, Ty and FeTy were found to adsorb PO4 (3-), Pb, Hg and Cu better than Bg and Bm, except in few cases. Results from adsorption experiments were fitted into Langmuir, Freundlich and Temkin models of isotherms and pseudo-first-order, pseudo-second-order and Elovich models of kinetics. Result of batch study adsorption revealed that maximum adsorption of PO4 (3-), Pb, Hg and Cu was done by FeBBg (adsorption mechanism explained by Freundlich model), FeTy (Temkin model), Ty (Langmuir model) and BBm (Langmuir model) respectively. According to R (2) values, pseudo-first-order reaction was well suited to PO4 (3-), Pb, Hg and Cu adsorption. The optimum pH for maximum adsorption was observed to be 7.4 for PO4 (3-), 5 for Cu and 6 for Pb and Hg respectively.

Domestic liquefied petroleum gas: are we using a kitchen bomb?

The aim of this study is to understand the aetiological factors and pattern of burns caused by the use of liquefied petroleum gas (LPG). This hospital based study was conducted on consecutive patients admitted with major burns from September 2011 to August 2012. The data was recorded on predesigned data sheet. Age, gender, mode of injury, its exact mechanism, place of incidence, extent of burn and inhalation injury were recorded for every patient. 182 patients with LPG related burn injury were admitted in one year. This is 11% of total burn patients received during the same period (182/1656). 147 incidents caused these burns due to gas leak from various parts of the LPG cooking system. Leakage was either from the cylinder, pipe or stove in 52%, 36% and 2% incidents respectively. Human error accounted for 3% incidents while in 7% the mechanism could not be ascertained. Leakage from 5kg cylinder with pipe was the commonest aetiological factor. There were 14 group casualties with more than one victim involved. LPG related burns are preventable to a large extent. There is a need to improve the safety standards in the LPG stove system. Public awareness needs to be improved.

NVP-LDE-225 (Erismodegib) inhibits epithelial-mesenchymal transition and human prostate cancer stem cell growth in NOD/SCID IL2Rγ null mice by regulating Bmi-1 and microRNA-128.

Prostate cancer stem cells (CSCs) are defined by their extensive self-renewal, differentiation and tumor initiation properties. It is now clear that CSCs are involved in tumor growth and recurrence, and resistance to conventional treatments. The sonic hedgehog (Shh) pathway has a crucial role in stemness and tumorigenesis. Thus, the strategy that suppresses stemness and consequently tumorigenic potential of CSCs could be considered for the management of prostate cancer. The objectives of this study were to examine the molecular mechanisms, by which NVP-LDE-225/Erismodegib (smoothened inhibitor) regulates stem cell characteristics and tumor growth in prostate cancer. The effects of NVP-LDE-225 on CSC's viability, sphere formation, apoptosis, epithelial-mesenchymal transition (EMT) and tumor growth in NOD/SCID IL2Rγ null mice were examined. NVP-LDE-225 inhibited cell viability and spheroid formation, and induced apoptosis by activation of caspase-3 and cleavage of poly-ADP ribose polymerase (PARP). NVP-LDE-225 induced expression of Bax and Bak, and inhibited the expression of Bcl-2, Bcl-XL, XIAP, cIAP1, cIAP2 and survivin. NVP-LDE-225 inhibited Gli transcriptional activity, Gli-DNA interaction and the expression of Gli1, Gli2, Patched1 and Patched-2 in prostate CSCs. Interestingly, NVP-LDE-225 induced PDCD4 and apoptosis and inhibited cell viability by suppressing miR-21. Furthermore, NVP-LDE-225 inhibited pluripotency-maintaining factors Nanog, Oct-4, c-Myc and Sox-2. The inhibition of Bmi-1 by NVP-LDE-225 was regulated by upregulation of miR-128. NVP-LDE-225 suppressed EMT by upregulating E-cadherin and inhibiting N-cadherin, Snail, Slug and Zeb1 by regulating the miR-200 family. Finally, NVP-LDE-225 inhibited CSC tumor growth, which was associated with the suppression of Gli1, Gli2, Patched-1, Patched-2, Cyclin D1, Bmi-1 and PCNA and cleavage of caspase-3 and PARP in tumor tissues derived from NOD/SCID IL2Rγ null mice. Overall, our findings suggest that inhibition of the Shh signaling pathway could therefore be a novel therapeutic option in treating prostate cancer.

Nano-titanium dioxide induces genotoxicity and apoptosis in human lung cancer cell line, A549.

The increased inhaled application of titanium dioxide nanoparticles (TiO(2) NPs) increases the potential pulmonary health risks. The present investigations were carried out to study the TiO(2) NPs-induced apoptosis, oxidative stress and genotoxicity in the human lung cancer cell line, A549, a widely used cell system for pulmonary toxicity studies. Tetrazolium bromide salt and lactate dehydrogenase release assays were used to study the cytotoxicity. The genotoxicity studies were carried out using cytokinesis block micronucleus assay. Apoptosis was confirmed by the formation of apoptotic bodies and altered expression (messenger RNA (mRNA) and protein) of markers such as P(53), P(21), Bax, Bcl(2) and cleaved caspase-3. Cells exposed to TiO(2) NPs (10 and 50 µg/ml) for 6-24 h shows significant induction in oxidative stress, that is, the production of reactive oxygen species and malondialdehyde and decrease in the activity of catalase and glutathione. TiO(2) NPs exposure also induces the formation of apoptotic bodies and micronucleus as marker of genotoxicity. A significant up-regulation in the expression of apoptosis markers such as P(53), P(21) and cleaved caspase-3 was observed, while the levels were down-regulated for Bcl(2) at both mRNA and protein levels. TiO(2) NPs exposure could not pose significant effects on Bax expression. Data indicate that nano-TiO(2) induces oxidative stress, genotoxicity and apoptosis in human lung cancer cell line, A549. Our result also identifies the mechanisms involved in TiO(2) NP-induced changes in A549 cells. Perhaps, reporting for the first time, the association of TiO(2) NPs-induced genotoxicity and apoptosis at transcriptional and translational level in the human lung cancer cell line, A549 cells.

Application of air pollution dispersion modeling for source-contribution assessment and model performance evaluation at integrated industrial estate-Pantnagar.

Source-contribution assessment of ambient NO2 concentration was performed at Pantnagar, India through simulation of two urban mathematical dispersive models namely Gaussian Finite Line Source Model (GFLSM) and Industrial Source Complex Model (ISCST-3) and model performances were evaluated. Principal approaches were development of comprehensive emission inventory, monitoring of traffic density and regional air quality and conclusively simulation of urban dispersive models. Initially, 18 industries were found responsible for emission of 39.11 kg/h of NO2 through 43 elevated stacks. Further, vehicular emission potential in terms of NO2 was computed as 7.1 kg/h. Air quality monitoring delineates an annual average NO2 concentration of 32.6 µg/m³. Finally, GFLSM and ISCST-3 were simulated in conjunction with developed emission inventories and existing meteorological conditions. Models simulation indicated that contribution of NO2 from industrial and vehicular source was in a range of 45-70% and 9-39%, respectively. Further, statistical analysis revealed satisfactory model performance with an aggregate accuracy of 61.9%.

Integration of tobacco cessation in general medical practice: need of the hour.

Tobacco use is the single most preventable cause of death and disability. Tobacco use causes almost one million deaths annually in India, which is much more than the combined mortality due to malaria/TB and HIV/AIDS. It is estimated to cause one billion deaths in the 21st century, eighty per cent of which will occur in the developing countries like India. Tobacco use is increasing in the country. Global Adult Tobacco Survey, 2010, estimated that more than one-third of adults (35%) in the country use tobacco, out of which 21% use smokeless tobacco, 9% smoke and 5% use both. The prevalence of overall tobacco use among men was 47.9% and among women was 20.2%. Global Youth Tobacco Survey, India, 2009, estimate 14.6% of 13-15 years school going children use tobacco. There is urgent need for addressing the tobacco epidemic in India. Though effective interventions for tobacco cessation such as brief counselling, nicotine replacement therapy, non-nicotine pharmacotherapy are available, their use by general practitioners is restricted due to lack of adequate dissemination of information in their use. Use of these simple assessment tools and practice of these effective interventions by general medical and healthcare practitioners will go a long way in addressing the rising tobacco epidemic in India and making general healthcare more comprehensive.

Burden of NCDs, Policies and Programme for Prevention and Control of NCDs in India.

Noncommunicable diseases and injuries account for 52% of deaths in India. Burden of noncommunicable diseases and resultant mortality is expected to increase unless massive efforts are made to prevent and control NCDs and their risk factors. Based on available evidence, cancer, diabetes, hypertension, cardiovascular diseases, stroke, chronic obstructive pulmonary disease, chronic kidney disease, mental disorders and trauma are the leading causes of morbidity, disability and mortality in India. Government of India had supported the States in prevention and control of NCDs through several vertical programs since 1980s. However, during the 11(th) plan, there was considerable upsurge to prevent and control NCDs. New programs were started on a low scale in limited number of districts. However, there has not been any considerable change in the burden of NCDs. Based on experiences in the past, there is need to emphasize on health promotion and preventive measures to reduce exposure to risk factors. Facilities and capacity for screening, early diagnosis and effective management are required within the public health care system. Public awareness program, integrated management and strong monitoring system would be required for successful implementation of the program and making services universally accessible in the country.

Pigeonpea genomics initiative (PGI): an international effort to improve crop productivity of pigeonpea (Cajanus cajan L.).

Pigeonpea (Cajanus cajan), an important food legume crop in the semi-arid regions of the world and the second most important pulse crop in India, has an average crop productivity of 780 kg/ha. The relatively low crop yields may be attributed to non-availability of improved cultivars, poor crop husbandry and exposure to a number of biotic and abiotic stresses in pigeonpea growing regions. Narrow genetic diversity in cultivated germplasm has further hampered the effective utilization of conventional breeding as well as development and utilization of genomic tools, resulting in pigeonpea being often referred to as an 'orphan crop legume'. To enable genomics-assisted breeding in this crop, the pigeonpea genomics initiative (PGI) was initiated in late 2006 with funding from Indian Council of Agricultural Research under the umbrella of Indo-US agricultural knowledge initiative, which was further expanded with financial support from the US National Science Foundation's Plant Genome Research Program and the Generation Challenge Program. As a result of the PGI, the last 3 years have witnessed significant progress in development of both genetic as well as genomic resources in this crop through effective collaborations and coordination of genomics activities across several institutes and countries. For instance, 25 mapping populations segregating for a number of biotic and abiotic stresses have been developed or are under development. An 11X-genome coverage bacterial artificial chromosome (BAC) library comprising of 69,120 clones have been developed of which 50,000 clones were end sequenced to generate 87,590 BAC-end sequences (BESs). About 10,000 expressed sequence tags (ESTs) from Sanger sequencing and ca. 2 million short ESTs by 454/FLX sequencing have been generated. A variety of molecular markers have been developed from BESs, microsatellite or simple sequence repeat (SSR)-enriched libraries and mining of ESTs and genomic amplicon sequencing. Of about 21,000 SSRs identified, 6,698 SSRs are under analysis along with 670 orthologous genes using a GoldenGate SNP (single nucleotide polymorphism) genotyping platform, with large scale SNP discovery using Solexa, a next generation sequencing technology, is in progress. Similarly a diversity array technology array comprising of ca. 15,000 features has been developed. In addition, >600 unique nucleotide binding site (NBS) domain containing members of the NBS-leucine rich repeat disease resistance homologs were cloned in pigeonpea; 960 BACs containing these sequences were identified by filter hybridization, BES physical maps developed using high information content fingerprinting. To enrich the genomic resources further, sequenced soybean genome is being analyzed to establish the anchor points between pigeonpea and soybean genomes. In addition, Solexa sequencing is being used to explore the feasibility of generating whole genome sequence. In summary, the collaborative efforts of several research groups under the umbrella of PGI are making significant progress in improving molecular tools in pigeonpea and should significantly benefit pigeonpea genetics and breeding. As these efforts come to fruition, and expanded (depending on funding), pigeonpea would move from an 'orphan legume crop' to one where genomics-assisted breeding approaches for a sustainable crop improvement are routine.

In vitro effect of fluoroquinolones against Mycobacterium tuberculosis isolates from Agra & Kanpur region of north India.

BACKGROUND & OBJECTIVE: Fluoroquinolones (FQs) are important drugs used for treatment of drug resistant tuberculosis and are also now being considered as first line drugs to shorten the duration of treatment of tuberculosis (TB). In order to find out useful FQs for treatment of tuberculosis, the comparative efficacy of five FQs, namely, ofloxacin (OFL), ciprofloxacin (CIP), sparfloxacin (SPX), gatifloxacin (GAT) and levofloxacin (LEVX) was studied against Mycobacterium tuberculosis (MTB) isolates obtained from both treated and untreated patients from Agra and Kanpur regions of north India. METHODS: A total of 162 MTB isolates [including 110 MTB isolates obtained from untreated patients (Cat-I) and 52 isolates from treated patients (Cat-II)] were tested for their susceptibilities to FQs using standard minimum inhibitory concentration (MIC) method on Löwenstein-Jensen medium. RESULTS: Keeping in view the therapeutically achievable drug levels, it was found that in Cat-I 97.2 per cent (107/110) isolates were sensitive to GAT, 89 per cent (98/110) to LEVX at 1 microg/ml whereas 92.7 per cent (102/110) isolates were inhibited by OFL at 2 microg/ml and 73.6 per cent (81/110) to SPX at 0.5 microg/ml. Only 63.6 per cent (70/110) isolates were found to be sensitive to CIP at 2 microg/ml which increased to 89 per cent (98/110) at 4 microg/ml (higher than achievable peak serum level). On the other hand, among 52 isolates for Cat-II, 37 (71.2%) were found to be sensitive to GAT and 33 (63.5%) to LEVX at 1 microg/ml concentration, 28 (53.8%) to SPX at 0.5 microg/ml whereas 33 (63.5%) and 24 (46.2%) isolates were found to be sensitive to OFL and CIP at 2 microg/ml, respectively. INTERPRETATION & CONCLUSION: It appears that GAT has higher activity against MTB isolates followed by OFL, LEVX and SPX whereas CIP showed the lowest activity. GAT was also found to be the most effective FQ against multi-drug resistant (MDR) isolates both from Cat-I and Cat-II patients. Thus, except CIP, other FQs showed potential to be included in the treatment regimens of tuberculosis including MDR-TB.

A B-spline based heterogeneous modeling and analysis of proximal femur with graded element.

Bone is a complex biological tissue and natural heterogeneous object. The main objective of this study is to simulate quasi-static loading of bio-objects like human femur with B-spline based modeling and its 3D finite element analysis with graded element. B-spline surface representation method is extended to represent material composition to develop heterogeneous solid model of proximal femur. Lagrangian graded element is used to assign inhomogeneous isotropic elastic properties in finite element model to improve the performance. Convergence study is carried out with finite element model in single leg stance load condition. To test the feasibility of the model, sensitivity of simulation is investigated. To validate the model, numerical results are compared with those of an experimental work for the same specimen in simple stance load condition obtained from one of the reference paper. Good agreement is achieved for vertical displacement and strains in most of the locations.

Chronic kidney disease in India: challenges and solutions.

Chronic diseases have become a major cause of global morbidity and mortality even in developing countries. The burden of chronic kidney disease (CKD) in India cannot be assessed accurately. The approximate prevalence of CKD is 800 per million population (pmp), and the incidence of end-stage renal disease (ESRD) is 150-200 pmp. The most common cause of CKD in population-based studies is diabetic nephropathy. India currently has 820+ nephrologists, 710+ hemodialysis units with 2,500+ dialysis stations and 4,800+ patients on CAPD. There are 172+ transplant centers, two-thirds of which are in South India and mostly privately run. Nearly 3,500 transplants are done annually, the total number of cadaver donors being approximately 700 till now. Thus, taken together, nearly 18,000-20,000 patients (10% of new ESRD cases) in India get renal replacement therapy. The cost of single hemodialysis varies between USD 15 and 40 with an additional cost of erythropoietin being USD 150-200/month. The cost of CAPD using a 'Y' set with 3 exchanges/week is USD 400/month. The cost of the transplant procedure in a state-run hospital is USD 800-1,000, and the cost of immunosuppression using tacrolimus, steroid and mycophenolate is USD 350-400/month. Until recently, the government did not recognize CKD/ESRD as a significant problem in India. However, some illustrious activities in relation to CKD brought attention of the media and policymakers to this very common but till now deprived group of diseases. On the one side the government has initiated a process by which it is planning to establish stand-alone hemodialysis units in the country to increase the facilities at an affordable cost, and on the transplant side it had launched a National Organ Transplant Program to facilitate transplantation on a national scale. Hemodialysis program is halfway to being implemented. Thus, in India there is still a long way to go with respect to CKD. Until then, in a country like India, screening of high-risk individuals for CKD and the risk factors is the best bet.

Treatment of rayon grade pulp drain effluent by upflow anaerobic fixed packed bed reactor (UAFPBR).

The Rayon grade pulp (RGP) drain effluent of pulp and paper mill was studied to find out pollutant loading and its control measures by low cost and efficient treatment method. Upflow anaerobic fixed packed bed reactor (UAFPBR) with brick ballasts as packing material was used for this purpose. This was compared with conventional anaerobic treatment method. The digested slurry was taken as inoculum from the active cow dung biogas plant. After stabilization of the reactors the reduction in pollutant loading was found to be higher in UAFPBR than conventional anaerobic reactor (CAR). Hydraulic retention time (HRT) of 12 hr was optimum for the treatment of effluent when 74.5% COD and 81% BOD reduction was obtained. 30% inoculum concentration was best for the anaerobic treatment of RGP colour drain effluent. The maximum biogas production (1.37 l l(-1) of effluent) was when the effluent was inoculated with 30% seeding material. Thus, UAFPBR system was very efficient in terms of BOD, COD, TSS and TDS removal from RGP drain of paper mills in ambient environmental conditions.