SARS-CoV-2 in dialysis patients and the impact of vaccination.

BACKGROUND: In centre haemodialysis (ICHD) patients have been identified as high risk of contracting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection due to frequent healthcare contact and poor innate and adaptive immunity. Our ICHD patients were offered immunisation from January 2021. We aimed to assess outcomes following SARS-CoV-2 infection and report on the effect of vaccination in our ICHD patients. METHODS: Demographics, SARS-CoV-2 status, hospitalisation, mortality and vaccination status were analysed. From 11th March 2020 to 31st March 2021, 662 ICHD patients were included in the study and these patients were then followed up until 31st August 2021. RESULTS: SARS-CoV-2 infection occurred in 28.4% with 51.1% of them requiring hospitalisation in contrast to community infection rates of 13.9% and hospitalisation of 9.0%. 28-day mortality was 19.2% in comparison to 1.9% of the community. Mortality increased to 34.0% over the study period. Mortality over the study period was 1.8 times in infected patients (HR 1.81 (1.32-2.49) P < 0.001) despite adjustment for age, gender and ethnicity. 91.3% of ICHD patients have now received both doses of SARS-CoV-2 vaccinations. CONCLUSIONS: ICHD patients are at increased risk of acquiring SARS-CoV-2, with increased rates of hospitalisation and mortality. The increased mortality extends well beyond the 28 days post-infection and persists in those who have recovered. Peaks and troughs in infection rates mirrored community trends. Preliminary data indicates that the SARS-CoV-2 vaccination provides protection to ICHD patients, with ICHD case rates now comparable to that of the local population.

Case Study: Extreme Weight Making Causes Relative Energy Deficiency, Dehydration, and Acute Kidney Injury in a Male Mixed Martial Arts Athlete.

The aim of the present case study was to quantify the physiological and metabolic impact of extreme weight cutting by an elite male mixed martial arts athlete. Throughout an 8-week period, we obtained regular assessments of body composition, resting metabolic rate, peak oxygen uptake, and blood clinical chemistry to assess endocrine status, lipid profiles, hydration, and kidney function. The athlete adhered to a "phased" weight loss plan consisting of 7 weeks of reduced energy (ranging from 1,300 to 1,900 kcal/day) intake (Phase 1), 5 days of water loading with 8 L/day for 4 days followed by 250 ml on Day 5 (Phase 2), 20 hr of fasting and dehydration (Phase 3), and 32 hr of rehydration and refueling prior to competition (Phase 4). Body mass declined by 18.1% (80.2 to 65.7 kg) corresponding to changes of 4.4, 2.8, and 7.3 kg in Phases 1, 2, and 3, respectively. We observed clear indices of relative energy deficiency, as evidenced by reduced resting metabolic rate (-331 kcal), inability to complete performance tests, alterations to endocrine hormones (testosterone: <3 nmol/L), and hypercholesterolemia (>6 mmol/L). Moreover, severe dehydration (reducing body mass by 9.3%) in the final 24 hr prior to weigh-in-induced hypernatremia (plasma sodium: 148 mmol/L) and acute kidney injury (serum creatinine: 177 µmol/L). These data, therefore, support publicized reports of the harmful (and potentially fatal) effects of extreme weight cutting in mixed martial arts athletes and represent a call for action to governing bodies to safeguard the welfare of mixed martial arts athletes.

Development of a traffic noise prediction model for an urban environment.

The objective of this study is to develop a traffic noise model under diverse traffic conditions in metropolitan cities. The model has been developed to calculate equivalent traffic noise based on four input variables i.e. equivalent traffic flow (Q e ), equivalent vehicle speed (S e ) and distance (d) and honking (h). The traffic data is collected and statistically analyzed in three different cases for 15-min during morning and evening rush hours. Case I represents congested traffic where equivalent vehicle speed is <30 km/h while case II represents free-flowing traffic where equivalent vehicle speed is >30 km/h and case III represents calm traffic where no honking is recorded. The noise model showed better results than earlier developed noise model for Indian traffic conditions. A comparative assessment between present and earlier developed noise model has also been presented in the study. The model is validated with measured noise levels and the correlation coefficients between measured and predicted noise levels were found to be 0.75, 0.83 and 0.86 for case I, II and III respectively. The noise model performs reasonably well under different traffic conditions and could be implemented for traffic noise prediction at other region as well.

Intensified seed spices-based cropping systems for higher productivity, resource-use efficiency, soil fertility and profitability in arid and semi-arid regions of India.

Coriander, fenugreek, nigella etc. are collectively known as seed spices. They are "High value and low volume crops" and considered cash crops for the growers of arid and semi-arid regions of India. Coriander, fenugreek and nigella are grown during the rabi season and take hardly 130-140 days to attain full maturity. In this context, farmers are not able to develop income from available arable land round the year, even though they have sufficient resources as well as manpower. Therefore, coriander, fenugreek and nigella-based cropping systems, four of each (total 12) were evaluated during 3 consecutive years (2019-20 to 2021-22) for their productivity, resource-use efficiency, economics and soil fertility. The results showed that among the seed spices-based cropping systems, maximum system productivity (5193 kg ha-1), production efficiency (18.81 kg ha-1 day-1), water-use efficiency (2.31 kg ha-1 mm-1), economic efficiency (11.85 US $ ha-1 day-1), net return (3270 US $ ha-1), benefit:cost ratio (3.27) and available N (165.6 kg ha-1) were observed under nigella-green coriander-mungbean cropping system. Hence, seed spices growers are recommended to adopt nigella-green coriander-mungbean cropping system in order to realize better productivity, resource-use efficiency, soil fertility and profitability.

Nephrotic syndrome with minimal change disease after the Pfizer-BioNTech COVID-19 vaccine: two cases.

We present two cases of nephrotic syndrome with minimal change disease after the Pfizer-BioNTech COVID-19 vaccine. We discuss the initial presentation, investigation and management of these patients along with a discussion around the current evidence base for vaccine-induced nephrotic syndrome.

High-output cardiac failure secondary to high-output arteriovenous fistula: investigations, management and definitive treatment.

A 32 year-old woman was admitted to our institution with progressive dyspnoea. Her medical history was notable for end-stage renal failure secondary to chronic pyelonephritis, and she had undergone a cadaveric renal transplant in 2010. This had been preceded by haemodialysis treatment via a radiocephalic arteriovenous fistula. Her diagnostic evaluation was remarkable for pulmonary hypertension. A subsequent doppler ultrasound of her arteriovenous fistula revealed a blood flow of 3 L/min. This is consistent with a high output fistula. Echocardiography demonstrated an improvement in pulmonary artery pressure with occlusion of the fistula. After multidisciplinary discussion, a decision was made to surgically tie off her fistula. The patient experienced immediate improvement in her shortness of breath along with resolution of pulmonary hypertension on echocardiography. This case highlights the rare complication of high output cardiac failure from a dialysis fistula and its successful surgical management.

Colistin-induced nephrotoxicity and the role of N-acetylcysteine: a retrospective cohort study.

INTRODUCTION: Colistin is associated with dose-dependent nephrotoxicity. N-acetylcycteine (NAC) may reduce the risk of concomitant acute kidney injury (AKI) due to its antioxidant properties. We report a retrospective cohort study evaluating the role of N-acetylcysteine (NAC) in the development of colistin (COL) associated nephrotoxicity. METHODOLOGY: A single centre retrospective cohort study was conducted in a university hospital between January 2014 and June 2015. Nephrotoxicity was defined and staged per the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. We evaluated the association between NAC use and COL-related nephrotoxicity by comparing the incidence of nephrotoxicity in patients receiving colistin with or without adjunctive NAC. RESULTS: Forty-six patients received intravenous (IV) COL and 46 patients received IV NAC+COL. The cumulative COL doses did not differ between the two groups (p = 0.802). The initial creatinine value doubled in 29 (63%) patients undergoing NAC+COL therapy and in 27 (58.7%) patients in the COL group (p = 0.669). The median doubling time of baseline creatinine was 6 and 7 days in the NAC+COL and COL groups, respectively. The mean hospital stay, potentially nephrotoxic agent use, and mortality rates were statistically higher for the patients receiving NAC+COL (p < 0.005). CONCLUSIONS: The present study was not able to reveal any beneficial effect of NAC for patients undergoing COL therapy. The NAC+COL group had a higher baseline risk for development of AKI. However, the incidence of AKI was comparable between the groups. The results of the study would not solely exhibit the protective effect of adjunctive NAC therapy.

Muscle glycogen utilisation during Rugby match play: Effects of pre-game carbohydrate.

OBJECTIVES: Although the physical demands of Rugby League (RL) match-play are well-known, the fuel sources supporting energy-production are poorly understood. We therefore assessed muscle glycogen utilisation and plasma metabolite responses to RL match-play after a relatively high (HCHO) or relatively low CHO (LCHO) diet. DESIGN: Sixteen (mean±SD age; 18±1 years, body-mass; 88±12kg, height 180±8cm) professional players completed a RL match after 36-h consuming a non-isocaloric high carbohydrate (n=8; 6gkgday-1) or low carbohydrate (n=8; 3gkgday-1) diet. METHODS: Muscle biopsies and blood samples were obtained pre- and post-match, alongside external and internal loads quantified using Global Positioning System technology and heart rate, respectively. Data were analysed using effects sizes ±90% CI and magnitude-based inferences. RESULTS: Differences in pre-match muscle glycogen between high and low carbohydrate conditions (449±51 and 444±81mmolkg-1d.w.) were unclear. High (243±43mmolkg-1d.w.) and low carbohydrate groups (298±130mmolkg-1d.w.) were most and very likely reduced post-match, respectively. For both groups, differences in pre-match NEFA and glycerol were unclear, with a most likely increase in NEFA and glycerol post-match. NEFA was likely lower in the high compared with low carbohydrate group post-match (0.95±0.39mmoll-1 and 1.45±0.51mmoll-1, respectively), whereas differences between the 2 groups for glycerol were unclear (98.1±33.6mmoll-1 and 123.1±39.6mmoll-1) in the high and low carbohydrate groups, respectively. CONCLUSIONS: Professional RL players can utilise ∼40% of their muscle glycogen during a competitive match regardless of their carbohydrate consumption in the preceding 36-h.

Assessment of honking impact on traffic noise in urban traffic environment of Nagpur, India.

BACKGROUND: In context of increasing traffic noise in urban India, the objective of the research study is to assess noise due to heterogeneous traffic conditions and the impact of honking on it. METHOD: Traffic volume, noise levels, honking, road geometry and vehicular speed were measured on national highway, major and minor roads in Nagpur, India. RESULTS: Initial study showed lack of correlation between traffic volume and equivalent noise due to some factors, later identified as honking, road geometry and vehicular speed. Further, frequency analysis of traffic noise showed that honking contributed an additional 2 to 5 dB (A) noise, which is quite significant. Vehicular speed was also found to increase traffic noise. Statistical method of analysis of variance (ANOVA) confirms that frequent honking (p < 0.01) and vehicular speed (p < 0.05) have substantial impact on traffic noise apart from traffic volume and type of road. CONCLUSIONS: The study suggests that honking must also be a component in traffic noise assessment and to identify and monitor "No Honking" zones in urban agglomerations.

Evaluation and analysis of noise levels at traffic intersections of Nagpur city, India.

The objective of the present study was to monitor and assess the noise levels at traffic intersections in Napgur city under heterogenic traffic activities. For this, traffic volume and noise level were measured at intersections on highways, major roads andring road during morning and evening peak hours. Traffic volume was categorized in light, medium and heavy vehicles while noise levels were measured for Lmin, Lmax, Leq , L10 and L90. Equivalent noise was observed in the range of 71.3 to 79.3 dB(A) at the traffic intersections. Due to heterogenic traffic conditions and activities at the intersection like honking, idling, gear noise, bearing noise, breaking noise, tyre-road noise and exhaust noise, no correlation was established between traffic volume and observed noise levels except West High Court road. A strong correlation was found at West High Court road due to controlled traffic flow and less impact of heavy vehicles. Impact of noisy vehicles on general traffic was also assessed at the traffic intersections based on noise pollution levels and traffic noise index. The study suggests that control measures are required at the traffic intersections to minimize noise pollution levels.

Randomized controlled trial: lisinopril reduces proteinuria, ammonia, and renal polypeptide tubular catabolism in patients with chronic allograft nephropathy.

BACKGROUND: Angiotensin-converting enzyme inhibitors in native nephropathies reduce proteinuria and delay progression to renal failure. Data in renal transplantation remain limited. A negative effect on glomerular filtration rate was concluded in a recent systematic review. METHODS: In this novel randomized controlled trial, 47 patients with chronic allograft nephropathy, severe renal impairment, and more than or equal to 1 g/24 hr proteinuria were randomized to lisinopril (group A) or other hypotensives (group B) for 1 year. Sodium bicarbonate was given to all patients to treat metabolic acidosis prophylactically (acidosis increases significantly with lisinopril). The annual rate of decline of graft function was measured isotopically (primary outcome) and 24 hr proteinuria, genotyping, radiolabeled polypeptide aprotinin proximal tubular catabolic studies (in group A only) as secondary outcome measurements were undertaken. RESULTS: At baseline, groups were comparable except for greater proteinuria in group A. After 1 year, the rate of decline of graft function and graft survival were comparable in both groups. Proteinuria decreased significantly in group A patients only. Lisinopril also significantly reduced radiolabeled aprotinin uptake and metabolism, plasma aldosterone, and ammonia excretion. Plasma potassium, bicarbonate, and mean arterial pressures were comparable in both groups. Patients with more than or equal to 30% reduction in proteinuria had a significant association with rs699 polymorphism in the angiotensinogen gene. CONCLUSIONS: The rate of decline of renal graft function in patients with chronic allograft nephropathy was not adversely affected by lisinopril therapy given for 1 year. Lisinopril significantly reduced proteinuria, renal proximal tubular polypeptide catabolism, plasma aldosterone, and ammonia excretion suggesting relative preservation of graft function. Treating metabolic acidosis allowed safe and prolonged use of angiotensinogen-converting enzyme inhibitors.