Delhi Model: A New Tool for Predicting Response to Terlipressin in Hepatorenal Syndrome-Acute Kidney Injury.

Background and objectives: International club of ascites (ICA) has introduced revised criteria for hepatorenal syndrome-acute kidney injury (HRS-AKI) with an aim to improve the response rate to treatment. We lack prospective trials to assess its positive impact on the response rate and factors influencing response rate. Thus, we conducted this study with the primary aim of identifying independent factors that predict treatment response to terlipressin. Methods: We prospectively included patients of HRS-AKI as per the revised ICA criteria. All were treated with terlipressin and albumin according to the defined protocol and were followed for 90 days, death or liver transplantation. Baseline parameters, as well as delta serum creatinine (sCr) at day 4 (DCD4), were investigated as predictive factors influencing response to terlipressin (primary endpoint). Secondary endpoints were the overall response rate to terlipressin, response in various subgroups of acute-on-chronic liver failure (ACLF) patients, need for readmission, and 90 days survival. Results: The study included 114 patients with a median age of 52 years (83% males). 70 (61%) patients responded to terlipressin. Response rate among ACLF1, ACLF2, and ACLF3 were 62%, 48%, and 35%, respectively. On multivariate analysis, baseline creatinine (odds ratio [OR] 7.889, 95% confidence interval [CI] 3.335, 18.664), Child Turcotte Pugh (CTP) score (OR 1.470, 95% CI 1.026, 2.106), and the DCD4 (OR 0.048, 95% CI 0.015, 0.158) were independently predicting response. We also created a Delhi Model (DM) with an excellent predictive ability for response prediction at day 4 with an AUROC of 0.940 (95% CI 0.897, 0.982). Among responder group, 50% of patients required readmission within three months. The 90-days survival among responder and non-responder groups were 68.5% and 9% (P value < 0.01), respectively. Conclusions: Baseline creatinine, CTP score, and DCD4 independently predict response to terlipressin in HRS-AKI. The DM may guide terlipressin treatment in HRS-AKI but need further validation.

A Prospective Study of Prevalence and Impact of Sarcopenia on Short-term Mortality in Hospitalized Patients with Liver Cirrhosis.

Background: Sarcopenia is common in chronic advanced liver disease and is associated with poor prognosis. There is paucity of Indian data regarding sarcopenia in chronic advanced liver disease & its impact on prognosis. The aim of this study was to study the prevalence of sarcopenia in Indian patients with chronic advanced liver disease and its impact on morbidity and short-term mortality. Methods: Patients with chronic advanced liver disease were prospectively evaluated for the presence of sarcopenia using computerized tomography (CT) abdomen. The cross-sectional area of the right psoas muscle was measured at the third lumbar vertebra (L3) and the Psoas muscle index (PMI) was calculated. Sarcopenia was defined as PMI <295 mm2/m2 for females and <356 mm2/m2 for males. The normative values of PMI were obtained from patients undergoing CT scan for non-specific abdominal pain who had no confounding factor which could result in sarcopenia. All patients were followed up for 6 months or until death, whichever was earlier. The impact of sarcopenia on mortality and rate of readmission has been assessed at the end of 6 months. Results: Of the 156 patients with chronic advanced liver disease, 74 (47.4%) patients had sarcopenia. Sarcopenia was more commonly seen in males (M: F = 61:13) and in patients with alcohol-related liver disease. There was a linear correlation (negative) between the PMI and severity of liver disease as assessed by Child-Pugh and model for end-stage liver disease (MELD) scores (r = -0.591 and -0.465, respectively). Patients with encephalopathy, ascites, and coagulopathy had higher prevalence of sarcopenia. On six months follow-up, sarcopenic patients had higher readmission rates (74.3% vs. 22%; P = 0.0001) and higher mortality (24.3% vs. 3.7%; P = 0.002). MELD score and PMI were independent predictors of mortality. The cut-off value of PMI 305.9 mm2/m2 predicted mortality with a sensitivity of 76.2% and a false positivity of 22.2% (area under curve was 0.805; 95% confidence interval: 0.69-0.91, P = 0.001). Conclusion: Sarcopenia is seen in about half of the patients with chronic advanced liver disease. It is commoner in males, patients with alcoholic liver disease, and those with advanced liver disease. Patients with sarcopenia have worse prognosis, require more frequent hospitalization and it negatively impacts short-term survival.

Ameliorative effects of Si-SNP synergy to mitigate chromium induced stress in Brassica juncea.

Hyperaccumulation of heavy metal in agricultural land has hampered yield of important crops globally. It has consequently deepened concerns regarding the burning issue of food security in the world. Among heavy metals, Chromium (Cr) is not needed for plant growth and found to pose detrimental effects on plants. Present study highlights the role of exogenous application of sodium nitroprusside (SNP, exogenous donor of NO) and silicon (Si) in alleviating detrimental ramification of Cr toxicity in Brassica juncea. The exposure of B. juncea to Cr (100 µM) under hydroponic system hampered the morphological parameters of plant growth like length and biomass and physiological parameters like carotenoid and chlorophyll contents. It also resulted in oxidative stress by disrupting the equilibrium between ROS production and antioxidant quenching leading to accumulation of ROS such as hydrogen peroxide (H2O2) and superoxide (O2•‾) radicle which causes lipid peroxidation. However, application of Si and SNP both individually and in combination counteracted oxidative stress due to Cr by regulating ROS accumulation and enhancing antioxidant metabolism by upregulation of antioxidant genes of DHAR, MDHAR, APX and GR. As the alleviatory effects were more pronounced in plants treated with combined application of Si and SNP; therefore, our findings suggest that dual application of these two alleviators can be used to mitigate Cr stress.

Iron oxide nanoparticles impart cross tolerance to arsenate stress in rice roots through involvement of nitric oxide.

The growth and development patterns of crop plants are being seriously threatened by arsenic (As) contamination in the soil, and it also acts as a major hurdle in crop productivity. This study focuses on arsenate As(V) mediated toxicity in rice plants. Further, among the different type of NPs, iron oxide nanoparticles (FeO NPs) display a dose-dependent effect but their potential role in mitigating As(V) stress is still elusive. FeO NPs (500 µM) play a role in imparting cross-tolerance against As(V) induced toxicity in rice. Growth attributes, photosynthetic performance, nutrient contents and biochemical parameters were significantly altered by As(V). But FeO NPs rescued the negative consequences of As(V) by restricting its entry with the possible involvement of NO in rice roots. Moreover, results related with gene expression of NO(OsNoA1 and OsNIA1) and proline metabolism were greatly inhibited by As(V) toxicity. But, FeO NPs reversed the toxic effect of As(V) by improving proline metabolism and stimulating NO mediated up-regulation of antioxidant enzymes particularly glutathione-S-transferase which may be possible reasons for the reduction of As(V) toxicity in rice roots. Overall, it can be stated that FeO NPs may act as an As(V) barrier to restrict the As(V) uptake by roots and have the ability to confer cross tolerance by modulating various morphological, biochemical and molecular characteristics with possible intrinsic involvement of NO.

Refractory Seizure in Childhood: Dyke-Davidoff-Masson Syndrome Revisited.

Dyke-Davidoff-Masson syndrome (DDMS) is a rare disorder characterized by recurrent seizures, facial asymmetry, contralateral hemiplegia, radiologic features of cerebral hemiatrophy, and ipsilateral compensatory hypertrophy of the skull bone and sinuses. We describe three cases of children with DDMS, who initially presented with refractory seizure to the pediatric department of North Bengal Medical College and Hospital, India. In each case, the clinical features noted along with computed tomography or magnetic resonance imaging helped confirm the diagnosis of DDMS. DDMS should be considered as a differential diagnosis of refractory seizures in children. We seek to emphasize the importance of thorough clinical and neuroimaging workup of seizure disorder in children for the proper management of the condition.