Renal Allograft Cortical Necrosis in a COVID-19 Positive Patient.

The incidence of acute kidney injury (AKI) has been reported to be higher in kidney transplant recipients infected with SARS-CoV-2 compared with the general population. Here, we report a case of cortical necrosis in the graft kidney due to COVID infection in a patient with stable graft function over the years. The patient was started on hemodialysis and treated with steroids, and anticoagulants for COVID infection. Later, he had gradual improvement in his graft function and became dialysis independent on follow up.

Identification of Fibre Content in Edible Flours Using Microwave Dielectric Cell: Concise Review and Experimental Insights.

The quality of edible intake decides the health of the human body and is also responsible for building a healthy immune system in the body. A healthy immune system can protect the body even from invisible attacks of viral or bacterial infections. The assessment of the quality of edible items is not well defined and standardized in many developing countries due to quality assessment difficulties in practice. An alternative well-defined quality assessment approach for edible flours is presented in this paper. Every edible substance has dielectric properties, and it varies from material to material in nature. Edible flours and liquid have different microwave absorption capabilities, based on their natural molecular structure. Based on the microwave energy absorption characteristics of materials, the attenuation constant of edible flours is derived by the waveguide method in this work. In this approach, microwave energy absorption of the edible samples of different types of wheat, rice and millets are observed, and the attenuation constant factors of the samples are then calculated from the tabulated values. The work focuses on the identification of fibre content present in the edible flours. Inferences are made based on the attenuation and its variations with the number of samples, dielectric loss and dielectric constant of the samples. A systematic and concise review of the topic is also included for the benefit of future researchers.

A study of Factors Affecting Dialysis Recovery Time in Haemodialysis Patients in India.

BACKGROUND: Patients on maintenance haemodialysis (MHD) often complain of fatigue and tiredness following haemodialysis sessions leading to poor compliance with the dialysis schedule. There is limited Indian data on dialysis recovery time (DRT). The present study was designed to assess the factors affecting DRT in our haemodialysis population. METHODS: We recorded self-reported patient recovery times of 120 patients who satisfied the inclusion criteria, over three consecutive dialysis sessions by asking the question, 'How long does it take to recover from a dialysis session'? Data recorded included patient factors like age, sex, co-morbidities, Charlson comorbidity index score (CCI), dialysis vintage, duration of kidney disease, interdialytic weight gain (IDWG), treatment factors like ultrafiltration rate (UFR), SpKt/V, blood pump speed, dialysate sodium, session length, pre and post HD blood pressure and laboratory parameters. Health-related quality of life (HRQoL) was assessed with the KDQOL-SF v. 1.3 questionnaire. Results from the SF-36 score were summarised into the physical composite score (PCS), mental composite score (MCS) and kidney disease composite score (KDCS). RESULTS: The mean age of the study population was 50.6 ± 12.6 years. Among the 120 patients, 77 (64.2%) were males. Thirty-nine patients (32.5%) were diabetic and 95 (79.1%) patients were hypertensive. The mean dialysis vintage of the study population was 26.1 ± 18.6 months, 41 (34.2%) patients reported DRT <2 h; 48 (40%) reported DRT between 2-6 h and 31 (25.8%) reported DRT >6 h. On multivariate regression analysis, higher IDWG, CCI score and UFR were associated with prolonged DRT. Reported DRT also inversely correlated with PCS (r = - 0.66), MCS (r = - 0.65) and KDCS (r = - 0.59) scores which was statistically significant. CONCLUSION: The present study showed that higher CCI scores, IDWG and UFR were associated with prolonged DRT in Indian haemodialysis patients and patients with longer recovery time had poor HRQoL. Interventions to reduce DRT need to be assessed in further trials in Indian MHD patients.

Stiffness After Total Knee Arthroplasty: Prevalence and Treatment Outcome.

Introduction Stiffness following total knee arthroplasty (TKA) is an incapacitating complication. The prevalence and causes leading to stiffness are not clearly determined. The aim of the study was to ascertain the prevalence, determine the influencing factors, and evaluate the efficacy of manipulation under anaesthesia (MUA) as a treatment option. Method Retrospective review of consecutive series of 1350 primary TKA over a 28-month period. For the purpose of the study, stiffness was defined as flexion contracture of >15 degrees and/or flexion of <75 degrees. Demographic data included co-morbidities, previous knee surgery, pre-operative and post-operative range of movement, anaesthetic techniques and use of nerve blocks, type of prosthesis, ligament balancing including release, mobility post-surgery, patient motivation, physiotherapy, complications, and final range of motion post-MUA. Results Of the 1350 patients evaluated, 33 (2.44%) had stiffness defined by the above-outlined criteria and required intervention. Thirty-one patients (2.29%) underwent MUA as a first-line treatment. No complications arose following MUA. One patient (0.07%) required arthroscopic arthrolysis while another patient (0.07%) required revision arthroplasty due to patellar mal-tracking. Following manipulation, mean flexion contracture decreased from 8 degrees to 3.6 degrees, and mean flexion improved from 51.8 degrees to 93.2 degrees. Arc of motion improved in 100% of patients but it is important to note that multiple manipulations were performed in seven patients. Conclusion Stiffness after TKA can be difficult to treat and can result in prolonged morbidity and dissatisfaction. This retrospective study highlights the effectiveness of manipulation under anaesthesia as a first-line treatment option leading to improved outcomes especially if done early.

Effect of low dialysate sodium in the management of intradialytic hypertension in maintenance hemodialysis patients: A single-center Indian experience.

BACKGROUND: High dialysate sodium is a significant contributor to intradialytic hypertension (IDH) in maintenance hemodialysis patients. In this study, we aimed to study the effect of low dialysate sodium on IDH in Indian hemodialysis patients. MATERIALS AND METHODS: Fifty patients on maintenance hemodialysis for atleast 3 months with episodes of IDH were enrolled in this study. The study was performed in two different stages. In the first phase, patients were dialyzed with standard dialysate sodium (140 mEq/L) for eight consecutive sessions and in the second phase, they were dialyzed with low sodium dialysate (136 mEq/L) for eight consecutive sessions. Differences in pre, intradialytic, and post-HD blood pressure, interdialytic weight gain, mean serum sodium, intradialytic adverse events, and number of IDH episodes requiring intervention between the two phases were assessed. RESULTS: The mean age of the study population was 52 years (36 males,14 females). The mean post-HD systolic and diastolic BP was 163.26 ± 9.58 mmHg and 88.60 ± 5.27 mmHg in the standard dialysate phase and 142.38 ± 14.09 mmHg and 84.58 ± 4.276 mmHg, respectively, in the low dialysate phase (p < 0.01). Interdialytic weight gain was 3.34 ± 0.9 and 3.11 ± 0.86 in the standard and low sodium dialysate phases, respectively (p = 0.19).The mean pre-HD plasma sodium level was 138.48 ± 3.69 and 135.80 ± 1.35 mEq/dl, respectively, in standard and low dialysate phases (p = 0.01). There was significant reduction in number of IDH episodes requiring intervention. There was no difference in hypotensive episodes, adverse events between the two phases. CONCLUSION: In patients with intradialytic hypertension, low dialysate sodium significantly reduces the post-HD blood pressure and intradialytic hypertensive episodes, when compared with standard sodium dialysate.

Giant lipoma of the hand causing median nerve compression.

Lipomas are benign neoplasms derived from adipose tissue composed of mature adipocytes. They account for almost 50% of all soft-tissue neoplasms and occur in up to 2% of the population. They usually present asymptomatically as solitary discrete mobile lumps found most commonly on the neck, upper back, proximal limbs and chest. In less than 1% of cases, they can be found in the distal extremities.We discuss the case of a 65-year-old man who presented with a 2-year history of a slowly enlarging left palm swelling, with recent-onset numbness and loss of power in the distribution of the median nerve. MRI studies showed that the 5×4×2.7 cm lipoma had a component extending into the distal aspect of the carpal tunnel, compressing the median nerve. It was successfully excised, and at follow-up the patient reported complete resolution of his symptoms.