Significant role of permafrost in regional hydrology of the Upper Indus Basin, India.

Upper Indus Basin (UIB), being climatologically sensitive and socio-economically important, has emerged as a hotspot for eco-hydrological studies. Permafrost, one of the essential components of the regional hydrological cycle with a critical role in microclimate, is also an important water resource in the UIB. Despite being an important component of the cryospheric system, permafrost is least studied in the UIB. In present study, we used stable oxygen and hydrogen isotopic composition in supra-permafrost water (SPFW) and aufeis along with precipitation, snowpack, glacier and other groundwaters to assess their variability and estimate their contribution to regional hydrology. The sources are evolving isotopically, depending on physiographic and hydrometeorological factors, with each source attaining different (if not distinct) isotopic signatures. The isotopic signatures (with different ranges) of sources help in estimating the contribution from these sources. A significant altitude gradient of δ18O is observed in stream water, SPFW and other groundwaters. Isotopic composition in SPFW is differentially modulated by fractionation, resulting in isotopic variability from the source waters. The results suggest snowmelt and/or glacier melt as the source of SPFW. To stream flow, SPFW is the dominant contributor (43 ± 18 %) at higher elevations (> 4300 m a.m.s.l.) in July, followed by snowmelt (26 ± 10 %). In September, SPFW contribution decreases (14 ± 8 %), but the contribution from other groundwaters becomes dominant (39 ± 11 %) to stream flow. The results indicate the significant role of seasonal thawing and freezing of active layer on the contribution from SPFW. This study highlights the significant role of permafrost in the hydrological system of the basin. The study also emphasizes the need to understand the dynamics of permafrost, taliks of various types (e.g., supra-permafrost subaerial talik) and active layer under changing climate to define the subsequent implications to regional hydrology, eco-hydrological systems and micro-climate of permafrost regions.

Extreme local recycling of moisture via wetlands and forests in North-East Indian subcontinent: a Mini-Amazon.

Moisture recycling in precipitation is an important hydrological process, accounting for ~ 67% globally. North-east India, home to the world's wettest place, boasts vast wetlands and forest-cover. Despite its proximity to the coast, we find locally recycled moisture to be the primary annual source of rainfall (~ 45%). During the pre-monsoon season, the enriched δ18O (~ - 0.7 ‰) and high d-excess (~ 14 ‰) are ascribed to enhanced transpiration, owing to atmospheric instability which causes Nor'westers. During the Monsoon season, oceanic flux provides increased surficial moisture, enabling deep-localised convection via evaporation. Significant localised recycling, even during the Monsoon season is estimated (~ 38%), with predominantly high d-excess in precipitation during latter half of the monsoon with increased moisture contribution from floods in Brahmaputra (high d-excess). The increasing δ18O and d-excess during the post-monsoon season is associated with progressively lesser rainout history and increased localized recycling (~ 67%). In light of the dwindling wetlands and forest-cover, our study highlights their indispensable role in governing regional hydro-meteorology and water availability.

Disaster management in India: are we fully equipped?

Disasters occur with almost unpredictable probability, even though some ideas about the regions of incidence and likely impact on likelihood are available in the scientific literature. In this lecture, I have taken a full view of six disasters that include hydro-geological, meteorological, climate based like floods and droughts as well as the biological holocaust of Covid-19 pandemic. The approach followed in this lecture is to analyse the occurrences, incidence, history and devastation caused by the disaster. The impact and policies to alleviate the effects are also discussed. The culture of disaster reliance is discussed at the end.

Isotopic and hydrogeochemical tracking of dissolved nutrient dynamics in the Brahmaputra River System: A source delineation perspective.

The Brahmaputra river system (BRS) produces the largest discharge in India, supplying water to more than 62 million inhabitants. The present study aims to quantify the environmental elements that affect the spatio-temporal variation of nutrients in the Brahmaputra river system (BRS). The association of physico-chemical characteristics of floodplain sediments with the distribution pattern of P during wet and dry periods in different depths were also studied. The seasonal variation suggest that the average dissolved inorganic nitrogen and dissolve inorganic phosphorus are found higher in monsoon while the average dissolve silica were higher in post-monsoon. The spatial variation of dissolve inorganic phosphate and nitrate concentration suggests both the nutrient are higher in upstream sites. The DiS concentrations tended to be higher in downstream. In 70% of the sampled tributaries, the average molar ratio for dissolved inorganic nitrogen/dissolved inorganic phosphorous (DIN/DIP) was greater than 16:1, which indicates phosphate limited biological productivity. In contrast, an average molar ratio of dissolved inorganic silica/DIN (DSi/DIN) of 3.8 ± 3.0 favoured diatom growth in those tributaries where DSi/DIN molar ratio was lower than 1, indicating eutrophication. The BRS transported 24.7, 5.93, and 312 × 104 tons/year-1 of DIN, PO4-P and SiO2-Si, respectively. The depth-wise variation of P-fraction during monsoon suggests that the authigenic phosphorus was most abundant followed by Fe-bound, exchangeable, detrital and organic. In the post-monsoon, Fe-bound P was found at a higher concentration followed by authigenic phosphorus. High nutrient concentrations with more δ18O depleted water implied precipitation being the major source of nutrients in the BRS.

Identifying and estimating the sources of river flow in the cold arid desert environment of Upper Indus River Basin (UIRB), western Himalayas.

A reliable water supply in different Himalayan River basins is increasingly important for domestic, agriculture, and hydropower generation. These water resources are under serious threat due to climate change, with the potential to alter the economic stability of 237 million people living in the Indus River Basin alone. In the present study, we used new stable water isotope data set to identify and estimate the different sources of streamflow and their controlling factors in the Upper Indus River Basin (UIRB), India. The data set presented wide spatial and temporal variability without the distinct isotopic signature of various sources of river flow. However, variable but distinct signatures of sources of river/stream flow exist at the sub-basin or catchment scale. These variabilities are ascribed to changing physiographical, meteorological, and local climatic conditions. Further, the distinct microclimatic conditions including altitudinal variability, aspect slope, etc. govern the spatio-temporal variability of sources and streamflow, hence different lapse rates at sub-basin/catchment scale. The study suggested that the contribution of snowmelt and glacier melt to river flow varies spatially and temporally. The Bayesian mixing model results suggested that snowmelt contribution is higher in Indus (63 ± 1.2%) and Shyok (58 ± 1.7%) while as, glacier melt contribution is higher in Nubra 64 ± 2.3% and Suru 60 ± 2.7% sub-basins/catchments. The groundwater contribution (baseflow) sustains and regulates the flow in rivers/streams during winter and spring, which is very vital for the local water supply. The study suggests that the spatially diverse rugged topography and microclimate in UIRB dominantly control the differential contribution from various sources of river flow. The warming climate, which has resulted in a decrease in solid precipitation, continuous glacier mass loss, early melting of snow cover, etc., would have an inconsistent impact on the perennial flow of rivers with the potential to alter the economic and political stability in the region.

Skull base chondrosarcoma presenting with parenchymal hemorrhage: A case report.

Chondrosarcoma (CS) is a locally invasive, slow growing malignant neoplasm. Intracranial chondrosarcoma are extradural osseous lesions and intradural location with intratumoral hemorrhage is very rare. We report a rare case of 65-year-old male presenting with a small mass in left posterior skull base and later, suddenly deteriorating due to large cerebellar hemorrhage. A brief review of literature of such cases is also presented.

Sources, controls, and probabilistic health risk assessment of fluoride contamination in groundwater from a semi-arid region in Gujarat, Western India: An isotope-hydrogeochemical perspective.

Fluoride contamination in groundwaters of a rural region in semi-arid Western India has been studied using combination of geochemical-and-isotopic techniques, in conjunction with Health Quotient assessment approach. The objective of this study is to determine the sources and controls on fluoride content and to evaluate probabilistic non-carcinogenic risk associated with its long-term consumption. F- ranges from 0.3 to 12 mg L-1, shows high spatial variability, and ~ 35% of the samples have F- > 1.5 mg L-1 (WHO maximum limit for drinking). Two sources are identified: high F- results from water-rock interaction of F-bearing minerals in granites and gneisses, while phosphate fertilizers can contribute up to ~ 0.46 mg L-1 of groundwater F- that can be significant for low F- samples. High F- samples are characterized by high pH, Na and alkalinity, and low Ca. Calcite precipitation drives the solubility of F-bearing minerals. Kinetic fractionation of water isotopes (18O and 2H) demonstrates that evaporation plays role in enriching groundwater F-. Non-carcinogenic risk, estimated by Hazard Quotient ([Formula: see text]), ranges from 0.13-5.72 to 0.26-11.86 for adult and children, respectively. Conservative estimate shows that ~ 0.467 million of adults and~0.073 million of children in four sub-districts are under the risk of fluorosis-while the residents of other five sub-districts remain safe from it. Finally, we suggest stakeholders to install F- treatment plants to ensure the health safety of local residents in the high-risk zones, create awareness in farmers for optimum use of fertilizers, and promote rainwater harvesting, for better management of groundwater resources and quality in the region.

Diagnosis and Management of Osteoarticular Tuberculosis: A Drastic Change in Mind Set Needed-It is Not Enough to Simply Diagnose TB.

BACKGROUND: In the era of increasing drug resistance in pulmonary tuberculosis (TB), it is prudent to assess causes of poor response to anti tubercular therapy (ATT) and drug sensitivity pattern (DSP) in osteoarticular TB. MATERIALS AND METHODS: As a part of Bombay Orthopaedic society's research project, members were asked to refer non responders to ATT to our institute. Cases were enrolled from October 2010 to March 2014. Deep tissue samples were obtained in all but five cases and subjected to a battery of tests including histopathology (HPE) and TB culture and sensitivity. The DSP was compared with the study performed by the principle author from 2004 to 2007 and published in 2009. RESULTS: 39 male and 50 female patients with a mean age of 24.85 years (2-66) were included and classified in four groups after results. (1) Culture and HPE positive-36. 24 had MDR and three XDR TB. Primary resistance to even second line drugs and deterioration of DSP since last study was noted, (2) culture negative and HPE positive-21. The cause of poor response was surgical in more than half cases, (3) non representative samples or lost to follow-up-15, (4) TB mimics-16. CONCLUSION: There is increasing incidence of primary resistance to second line drugs, primary resistance in children and worsening of resistance patterns as compared to older studies. ATT initiation is a fateful decision and every attempt should be made to rule out TB mimics and establish DSP before initiation.

Lymphorrhea: An Unusual Complication of Jugular Venous Catheterization for Hemodialysis.

A considerable number of end-stage renal disease patients undergo tunneled cuffed catheter insertion for hemodialysis under ultrasonographic guidance while awaiting arteriovenous fistula creation. We report a case of a 62-year-old female who underwent tunneled catheter insertion in the left internal jugular vein under ultrasound and fluoroscopic guidance, which was followed by pericatheter serous discharge. Fluid examination confirmed the diagnosis of lymphorrhea, and lymphoscintigraphy facilitated its localization. This case is reported for its rarity and with a discussion on literature review, complications of lymphorrhea, and their management.

Efficacy of C.E.R.A. in Routine Clinical Practice for Correction of Anaemia and Maintenance of the Haemoglobin Levels in CKD Patients not on Dialysis.

INTRODUCTION: C.E.R.A. reported effective correction of anaemia and was well tolerated in International studies on CKD patients not on dialysis. OBJECTIVE: The study aimed to describe the management of renal anaemia in CKD patients not on dialysis with C.E.R.A. in routine clinical practice in India. METHODS: This was a prospective, single-arm, open-label, multi-centre, non-interventional, Phase IV study which followed 108 CKD Stage III-IV patients, not on dialysis with Hb < 10 g/dL for correction of anaemia with C.E.R.A. RESULTS: Of the 108 patients with Hb < 10 g/dL at baseline, 83 (90.2%) patients achieved target Hb of 10-12 g/dL and the time taken to achieve correction of anaemia was 9.6 weeks ± 6.13 weeks in the Intent-to-treat population. Haemoglobin concentration increased from 8.59 ± 0.808 g/dL pre-therapy to 10.91 ± 0.634 g/dL post-therapy. The change in mean ± SD Hb value was 2.32 ± 0.174 g/dL. Maintenance of Hb levels within the target range of Hb 10 - 12 g/dL was observed in 78.2% of ITT and 80.8% of the PP population for mean duration of 16.69 weeks. Four patients (3.7%) experienced 5 AEs and 2 patients (1.9%) experienced 3 SAEs in the safety population. As per the treating physician none of the AEs or SAEs was considered related to study drug. There were no deaths reported. CONCLUSIONS: This study demonstrated successful correction of anaemia in Indian patients with C.E.R.A. treatment as well as maintenance of Hb levels within the target range. C.E.R.A. was well tolerated with no new safety concerns specific to the Indian population. The less frequent up to monthly dosing schedule of C.E.R.A. may offer clinicians and patients a simplified regimen of anaemia management as compared to traditional frequently administered (thrice weekly to once weekly) ESAs.

Liquid biopsy: A potential and promising diagnostic tool for advanced stage non-small cell lung cancer patients.

More than 50% of non-small cell lung cancer (NSCLC) cases harbor an actionable mutation, and molecular testing at different intervals can help in personalized and targeted treatment. Core tissue biopsy and needle biopsy done at the time of diagnosis/disease progression are interventional, time-consuming and can affect the patients adversely. Noninterventional biomarker testing by liquid biopsy promises to revolutionize advanced stage cancer screening. The present report was formulated based on an expert panel meeting of renowned oncologists who gave their opinions for minimally invasive liquid biopsy to detect targetable molecular biomarkers in advanced NSCLC cases. An exhaustive literature search was done to support their recommendations. Clinical utility of minimally invasive liquid biopsy, for detection of molecular biomarkers in advanced stage NSCLC patients, was broadly discussed by the key opinion leaders.

Oxygen isotope in archaeological bioapatites from India: Implications to climate change and decline of Bronze Age Harappan civilization.

The antiquity and decline of the Bronze Age Harappan civilization in the Indus-Ghaggar-Hakra river valleys is an enigma in archaeology. Weakening of the monsoon after ~5 ka BP (and droughts throughout the Asia) is a strong contender for the Harappan collapse, although controversy exists about the synchroneity of climate change and collapse of civilization. One reason for this controversy is lack of a continuous record of cultural levels and palaeomonsoon change in close proximity. We report a high resolution oxygen isotope (δ(18)O) record of animal teeth-bone phosphates from an archaeological trench itself at Bhirrana, NW India, preserving all cultural levels of this civilization. Bhirrana was part of a high concentration of settlements along the dried up mythical Vedic river valley 'Saraswati', an extension of Ghaggar river in the Thar desert. Isotope and archaeological data suggest that the pre-Harappans started inhabiting this area along the mighty Ghaggar-Hakra rivers fed by intensified monsoon from 9 to 7 ka BP. The monsoon monotonically declined after 7 ka yet the settlements continued to survive from early to mature Harappan time. Our study suggests that other cause like change in subsistence strategy by shifting crop patterns rather than climate change was responsible for Harappan collapse.

Lipoid Pneumonia After Prolonged Inhalation of Clarified Butter Made from the Milk of a Buffalo or Cow (Ghee).

Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat containing substances. It can present acutely or more commonly presents as an insidious onset chronic respiratory illness. It requires a high degree of suspicion with great emphasis on history. It can mimic tuberculosis, malignancy or interstitial lung disease. We report the case of a 31-year-old male with a history of sniffing hydrogenated oil, presenting with a non-resolving pneumonia.

Digital histology quantification of intra-hepatic fat in patients undergoing liver resection.

BACKGROUND: High intra-hepatic fat (IHF) content is associated with insulin resistance, visceral adiposity, and increased morbidity and mortality following liver resection. However, in clinical practice, IHF is assessed indirectly by pre-operative imaging [for example, chemical-shift magnetic resonance (CS-MR)]. We used the opportunity in patients undergoing liver resection to quantify IHF by digital histology (D-IHF) and relate this to CT-derived anthropometrics, insulin-related serum biomarkers, and IHF estimated by CS-MR. METHODS: A reproducible method for quantification of D-IHF using 7 histology slides (inter- and intra-rater concordance: 0.97 and 0.98) was developed. In 35 patients undergoing resection for colorectal cancer metastases, we measured: CT-derived subcutaneous and visceral adipose tissue volumes, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), fasting serum adiponectin, leptin and fetuin-A. We estimated relative IHF using CS-MR and developed prediction models for IHF using a factor-clustered approach. RESULTS: The multivariate linear regression models showed that D-IHF was best predicted by HOMA-IR (Beta coefficient(per doubling): 2.410, 95% CI: 1.093, 5.313) and adiponectin (ß(per doubling): 0.197, 95% CI: 0.058, 0.667), but not by anthropometrics. MR-derived IHF correlated with D-IHF (rho: 0.626; p = 0.0001), but levels of agreement deviated in upper range values (CS-MR over-estimated IHF: regression versus zero, p = 0.009); this could be adjusted for by a correction factor (CF: 0.7816). CONCLUSIONS: Our findings show IHF is associated with measures of insulin resistance, but not measures of visceral adiposity. CS-MR over-estimated IHF in the upper range. Larger studies are indicated to test whether a correction of imaging-derived IHF estimates is valid.

A comparison of diagnostic imaging modalities for colorectal liver metastases.

AIMS: The aims of this study were to compare the diagnostic performance of CT scan, MR liver, PET-CT and intra-operative ultrasound (IOUS) for the detection of liver metastases against the histopathological findings, and to compare PET-CT with CT for the detection of distant disease in metastatic colorectal cancer patients eligible for surgical treatment. METHODS: A prospective study was performed that measured concordance between the number and stage of metastatic lesions identified with various preoperative imaging modalities and histology of patients undergoing surgical treatment for CRLM. RESULTS: Compared with histopathology, concordance for the number of metastatic liver lesions was moderate for CT scan (K = 0.477, 95% CI: 0.28-0.66), moderate for MR scan (K = 0.574, 95% CI: 0.39-0.75), good for FDG PET-CT (K = 0.703, 95% CI: 0.52-0.87) and very good for IOUS (K = 0.904, 95% CI: 0.81-0.99). Additional CRLM were identified intraoperatively in six patients (9.1%) with IOUS and in 7.5% of the cases surgical strategy was changed according to the new intraoperative findings. The diagnosis of intra abdominal lymph node metastatic disease was made with PET-CT only in nine patients (13.6%) DISCUSSION: Our study supports the recent recommendations of the Oncosurg Multidisciplinary International Consensus regarding the importance of high quality CT and MR in the staging of CRLM but provides further evidence for the added value of PET-CT, especially in detecting extrahepatic intra-abdominal metastatic disease that may be amenable to potentially curative resection. Despite these advances in preoperative staging, there still remains a role for IOUS in detecting additional metastases at the time of surgery.

Fractional volume of placental vessels in women with diabetes using a novel stereological 3D power Doppler technique.

OBJECTIVES: In maternal diabetes the placenta is large with abnormal vascular development and increased villous volume. We used a novel stereological 3D power Doppler ultrasound technique to investigate differences in-vivo in the placental fractional volume of power Doppler signal (FrVol-PD) between women with and without diabetes. METHODS: We recruited 17 pregnant women with pre-gestational diabetes and 20 controls, all with anterior placentae. Each subject had ultrasound scans (Voluson 730 Expert) every 4 weeks between 12 and 32 weeks gestation. 3D power Doppler data were acquired and the placenta manually outlined using VOCAL (4D View). Power Doppler signal within the resultant volume was counted in a 3D manner adapting the random but systematic techniques used in stereology. RESULTS: Subjects were of similar age, BMI and parity. From 16 weeks the mean (SD) placental FrVol-PD was higher in the non-diabetic than in the diabetic group: 16 weeks - 0.125 (0.03) versus 0.108 (0.03), 20 weeks - 0.144 (0.05) versus 0.104 (0.03), 24 weeks - 0.145 (0.05) versus 0.128 (0.03), 28 weeks - 0.159 (0.05) versus 0.133 (0.02) and 32 weeks - 0.154 (0.03) versus 0.123 (0.04). These differences were significant between control and diabetic subjects [F(1,35) = 4.737, p = 0.036] and across gestation [F(3,140) = 8.294, p < 0.001]. CONCLUSION: Using a novel stereological-based ultrasound technique we have demonstrated the reliability of this application in the placenta. This technique shows promise for non-invasive assessment of placental function: further studies are required to identify if structural changes in a diabetic placenta are accompanied by altered function, manifest as reduced perfusion demonstrable in-vivo.

Rarer in a rare.

Though moya moya disease is a disease of Asian origin, it is one of the very rare causes of stroke in India. It is a rare disease mainly characterized by progressive cerebrovascular episode due to the slowly progressive stenosis of supraclinoid segment of bilateral internal carotid arteries, the anterior and the middle cerebral arteries, and very rarely, posterior cerebral arteries. We hereby report a case of a young female who presented to us with the psychiatric complaints and refractory headache since her childhood. Therefore, we are reporting rarer (headache and neuropsychiatric) manifestations in the rare (moya moya) disease.

Measurement of fetal fat in utero in normal and diabetic pregnancies using magnetic resonance imaging.

OBJECTIVES: To assess the reliability of magnetic resonance imaging (MRI) to measure fetal fat volume in utero, and to study fetal growth in women with and without diabetes in view of the increased prevalence of macrosomia in the former. METHODS: We studied 26 pregnant women, 14 with pre-gestational diabetes and 12 non-diabetic controls. Fetal assessment took place at 24 weeks' gestation and again at 34 weeks by standard ultrasound biometry followed by MRI at 1.5 T. Fetal fat volume was determined from T1-weighted water-suppressed images using a semi-automated approach based on pixel intensity and taking into account partial volume effects. Fetal volume was also determined from the MRI images. Fetal weight was calculated using published fat and lean tissue densities. RESULTS: There was little fetal fat at 24 weeks' gestation, but at 34 weeks the fetal fat content was considerably higher in the women with diabetes, with a mean fat content of 1090 ± 417 cm(3) compared with 541 ± 348 cm(3) in the controls (P = 0.006). Measurements of fetal fat volume showed low intra- and interobserver variability at 34 weeks, with intraclass correlation coefficients consistently above 0.99. Birth-weight centile correlated with fetal fat volume (R(2) = 0.496, P < 0.001), percentage of fetal fat (R(2) = 0.362, P = 0.008) and calculated fetal weight (R(2) = 0.492, P < 0.001) at 34 weeks. CONCLUSIONS: MRI appears to be a promising tool for the determination of fetal fat, body composition and weight in utero during the third trimester of pregnancy.