Postrenal transplant hemolytic uremic syndrome/thrombotic microangiopathy: Ahmedabad experience.

BACKGROUND: Hemolytic uremic syndrome (HUS)/thrombotic microangiopathy (TMA) (tissue-limited HUS) is a well-recognized serious complication of renal transplantation, affecting 3% to 14% patients who are administered calcineurin inhibitor-based immunosuppression. We performed a retrospective study to examine the incidence, etiology, course, and outcome of HUS/TMA in our experience. PATIENTS AND METHODS: This retrospective study of 1540 renal allograft biopsies performed between January 2000 and October 2007 was performed to assess the incidence of HUS/TMA. Institute Transplant Registry records were reviewed for clinical history, laboratory findings, medications, and outcome. The offending drug was substituted in all subjects and plasmapheresis was added as an adjuvant until recovery of allograft function. RESULTS: TMA was observed in 17 (1.1%) biopsies. Two of 17 patients experienced recurrent HUS; 15 were drug-induced (12 with cyclosporine, three with Sirolimus); 10 were TMA; and five HUS. Nine patients developed HUS/TMA within 3 months of transplantation with eight developing it within 1 year posttransplantation. Graft function recovered in 12, while five did not recover. The HUS group showed 60% recovery compared with 80% among the TMA group. Two patients were lost; both displayed HCV seropositivity and one also showed anti-cardiolipin antibody. CONCLUSION: Early allograft biopsy with prompt diagnosis and management by drug substitution +/- plasmapheresis in posttransplant HUS/TMA plays an important role in allograft outcome. TMA showed better recovery than HUS.

Cost-effectiveness of bariatric surgery in adolescents with severe obesity in the UK.

Evidence shows that surgery for severe obesity in adults improves health and psychological functioning, and is cost-effective. Data on bariatric surgery for adolescents with severe obesity are extremely limited, with no evidence on cost-effectiveness. We evaluated the lifetime cost-effectiveness of bariatric surgery compared with no surgery in adolescents with severe obesity from the UK's National Health Service perspective. Eighteen adolescents with body mass index ≥40 kg m-2 who underwent bariatric surgery (laparoscopic Roux en Y Gastric Bypass [RYGB] [N = 9], and laparoscopic Sleeve Gastrectomy [SG] [N = 9]) at University College London Hospitals between January 2008 and December 2013 were included. We used a Markov cohort model to compare the lifetime expected costs and quality-adjusted life years (QALYs) between bariatric surgery and no surgery. Mean cost of RYGB and SG procedures were £7100 and £7312, respectively. For RYGB vs. no surgery, the incremental cost/QALY was £2018 (95% CI £1942 - £2042) for males and £2005 (95% CI £1974 - £2031) for females. For SG vs. no surgery, the incremental cost/QALY was £1978 (95% CI £1954 - £2002) for males and £1941 (95% CI £1915 - £1969) for females. Bariatric surgery in adolescents with severe obesity is cost-effective; it is more costly than no surgery however it markedly improved quality of life.

Quantitative structure activity relationship studies of diaryl furanones as selective COX-2 inhibitors.

Selective COX-2 inhibitors have attracted much attention in recent times in the design of non-steroidal anti-inflammatory agents (NSAID), which are devoid of the common side effects of classical NSAIDs. QSAR studies have been performed on a series of diaryl furanones that acts as selective COX-2 inhibitor using Molecular Operating Environment (MOE). The studies were carried out on 43 analogs. These studies produced good predictive models and give statistically significant correlations of selective COX-2 inhibitory with physical property, connectivity and conformation of molecule. Also when available COX-1 inhibitory data was analyzed with descriptors obtained from MOE, partial charge descriptor, van der Waal's surface area and solvation energy gave statistically significant results.

Quantitative structure activity relationship studies of diaryl furanones as selective COX-2 inhibitors.

Selective COX-2 inhibitors have attracted much attention in recent times in the design of non-steroidal anti-inflammatory agents (NSAID), which are devoid of the common side effects of classical NSAIDs. QSAR studies have been performed on a series of diaryl furanones that acts as selective COX-2 inhibitor using Molecular Operating Environment (MOE). The studies were carried out on 43 analogs. These studies produced good predictive models and give statistically significant correlations of selective COX-2 inhibitory with physical property, connectivity and conformation of molecule. Also when available COX-1 inhibitory data was analyzed with descriptors obtained from MOE, partial charge descriptor, van der Waal's surface area and solvation energy gave statistically significant results.

Measurement of gradient index profiles by Babinet fringe analysis.

A theory for determining one-dimensional ray deflections with the help of distorted Babinet fringes has been developed. An approach for investigating two-dimensional ray deflections has been presented. Applications of the techniques for the study of gradient index glass have been described.

Optical technique for the study of convective diffusion from falling drops.

A recently developed deflection mapping technique has been exploited for measurement of rate of mass transfer from a liquid drop falling freely in another liquid medium. Results have been found to be in good agreement with theory. Simultaneously, measurement of the diffusion coefficient is also reported.

Pharmacognostic study of Lepidium sativum Linn (Chandrashura).

Pharmacognosy is the study of naturally occurring biological substances, principally those derived from plants that find use in medicine. The word "Pharmacognosy" is derived from the Greek "Pharmacon," "a drug" and "gignosco," to acquire knowledge of. It is closely related to both botany and plant chemistry and both originated from the earlier scientific studies on medicinal plant. The plant kingdom still holds many species of plants containing substances of medicinal value which have yet to be discovered large number of plants constantly being screened for their possible pharmacological value. The plant Chandrashura is being used for the treatment of Amavata, Sandhivata, and Katishula successfully. Here, an attempt is made to study the plant pharmacognostically; the part taken for study is the seed. Diagnostic features of seed and seed powder were also worked out and the details were presented.

Transplantation with kidney paired donation to increase the donor pool: a single-center experience.

BACKGROUND: A living either related or unrelated donor transplant leads to a better outcome in terms of patient and graft survivals compared with one from a deceased donor. Desensitization protocols are expensive and labor intensive. The use of unrelated living donors has the greatest potential to increase the number of donors in the future, when no willing living donor is available due to blood group and/or human leukocyte antigen incompatibility. Herein, we have reported our results with a living donor exchange program. AIMS: To determine the feasibility and effectiveness of kidney paired donation (KPD) to manage patients with incompatible donors as well as present patient and graft survivals, serum creatinine (S.Cr) levels, and rejection episodes. RESULTS: Between June 2000 and December 2009, we performed KPD transplants in 36 recipients to avoid blood group incompatibility (n = 28) or to avoid a positive crossmatch (n = 8). At a median follow-up of 27.7 months (range, 5.83-119.8). The patient survival rate was 88.9% and the graft survival rate was 94.4%. Four patients developed acute cellular rejection episodes (11.1%) and 3 (8.3%) acute antibody-mediated rejection. At 1, 3, and 5 years, the mean S.Cr values were 1.42 ± 0.28 mg% (n = 28) 1.61 ± 0.51 (n = 22) and 1.24 ± 0.15 (n = 8), respectively. CONCLUSIONS: The incidence of acute rejection episodes and patient/graft survivals were acceptable in our KPD program. The use of unrelated living donors has great potential to increase the number of donors in the future; a national KPD program should be encouraged in India.

3-D QSAR studies of triazolinone based balanced AT1/AT2 receptor antagonists.

Essential structural and physicochemical requirements in terms of common biophoric sites (pharmacophore) and secondary sites for binding and interacting with AT1 and AT2 receptors have been identified using APEX-3-D expert system on 16 N2- aryl triazolinone biphenyl sulphonamides. Among several biophoric 3-D QSAR models two models (Nos. 1 and 2) having R2 > 0.7, chance <0.05 and match >0.5 and two models (Nos. 3 and 4) having R2 > 0.89, chance <0.03 and match >0.5 with three biophoric sites and two secondary sites (except model No. 4 with three secondary sites) describe the variation in AT1 and AT2 antagonistic activities, respectively.