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Developing applications for the by-products obtained from waste processing is vital for resource recovery. The synthesis of ZnCl2-activated biochar with high electrocatalytic activity was carried out by the microwave-assisted pyrolysis of pineapple peel and subsequent chemical activation process. Activated biochar is employed in the electrochemical sensing of nitrite by drop casting in a glassy carbon electrode (GCE). The activated biochar exhibited a stacked carbon sheet, 254 m2 g−1 Brunauer, Emmett and Teller (BET) surface area, 0.076 cm3 g−1 pore volume, 189.53 m2 g−1 micropore area and oxygen-containing functional groups. The electrochemical impedance spectroscopy of the modified GCE showed a reduced charge transfer resistance of 61%. This is crucial to determine the electrochemical properties of biochar. The sensor showed a significant current response and an excellent limit of detection of 0.97 µmol L−1. The modified-activated biochar electrochemical sensor demonstrated high selectivity, reproducibility (RSD=2.4%), and stability (RSD=2.6%). Graphical abstract

Considering present shortage of fossil fuels and discharges of ozone harming substances, power developed from Renewable Energy Sources (RES) is identified as the excellent choice for producing the electricity. The characteristic of an inverter is to transform the dc power into ac power to fulfill out the requirements of load. Despite its advantage, the presence of harmonics in the output voltage reduces both the efficiency and the performance of the inverter. Several researches have been carried out since last three decades for eliminating the harmonics. Based upon several researches, it reveals that the Selective Harmonic Elimination Pulse-width Elimination technique (SHEPWM) has proven to be the best in eliminating lower order harmonics. But when calculus based methods are used for solving the non-linear transcendental equations, this technique has shown some complications. Artificial Intelligence (AI) techniques appear to be better in solving the above said equations. This review paper provides the performance of some AI techniques used for eliminating the harmonics in inverters. Based upon the information collected from various literatures and its results, conclusion has been made.

The benefits of large-scale genetic studies for healthcare of the populations studied are well documented, but these genetic studies have traditionally ignored people from some parts of the world, such as South Asia. Here we describe whole genome sequence (WGS) data from 4806 individuals recruited from the healthcare delivery systems of Pakistan, India and Bangladesh, combined with WGS from 927 individuals from isolated South Asian populations. We characterize population structure in South Asia and describe a genotyping array (SARGAM) and imputation reference panel that are optimized for South Asian genomes. We find evidence for high rates of reproductive isolation, endogamy and consanguinity that vary across the subcontinent and that lead to levels of rare homozygotes that reach 100 times that seen in outbred populations. Founder effects increase the power to associate functional variants with disease processes and make South Asia a uniquely powerful place for population-scale genetic studies.

Multilevel inverters play a vital role in the industrial and renewable energy sectors due to their flexibility in synthesizing sinusoidal waveforms using a low-pass filter with a medium voltage range. It has several drawbacks, such as a higher number of power component requirements and voltage balancing problems. In this study, a new structure for multilevel inverters has been developed to offer good power quality with minimum number of switching devices and gate driver circuits. The proposed structure is configured to operate in symmetrical and asymmetrical configurations for single/three-phase versions. A simulation study using MATLAB/Simulink has been utilized to study the operating characteristics under both configurations. A laboratory prototype has been built to check the feasibility of the proposed structure for real-time applications.

Background The incidence of orthopedic disorders amongst patients with Prader–Willi Syndrome (PWS) is high when compared to the general pediatric population. The purpose of this retrospective study was to define the most commonly performed orthopedic procedures in pediatric patients with PWS and to characterize the peri-operative outcomes of these patients. Methods The Kids Inpatient Database (KID) was queried to collect data and identify all pediatric patients with PWS who underwent orthopedic procedures from 2001 to 2012. A total of 3684 patients with PWS were identified, 334 of who underwent an orthopedic procedure. Population demographics, comorbidities, and specific procedures undergone were defined. The incidences of postoperative complications and length of associated hospital stay were additionally evaluated. Results Mean age of patients in this sample was 10.33 years (SD 4.5). The most common comorbidities included obesity (18.1%), chronic pulmonary disease (14.1%), hypothyroidism (5.1%), hypertension (5.1%), and uncomplicated diabetes (4%). Common procedures were spinal fusion (165/334, 49%) and lower extremity procedures (50/334, 15%). Complications included acute blood loss anemia, device related complications, pneumonia, sepsis, and urinary tract infections. The overall complication rate was 35.6%. Average hospital lengths of stay for patients undergoing spinal fusion was 6.68 days (SD 4.13), lower extremity orthopedic procedure was 5.65 days (SD 7.4), and all other orthopedic procedures was 7.74 days (SD 16.3). Conclusions Orthopedic disorders are common in patients with PWS. Consequently, spinal fusions and lower extremity procedures are commonly performed in this patient population. Associated comorbid conditions may negatively impact surgical outcomes in these patients. This information should prove useful in the peri-operative management of patients with PWS undergoing orthopedic surgery and for shared decision making with families.

In closing a long time, renewable power means have entered lesser hobbyhorse as the choice for of strength is growing. Solar power is truly the maximum functional salutary useful resource in the fineness of renewable powers as it's long hauls to be had transnational. Solar energy can be converted into energy in approaches; via CSP energy factory life or Photovoltaic structures. The solar energy is converted to lukewarmness and also this energy is converted to energy in CSP energy shops. Still, this revision of power can be finished in an unattached- step system by the use of sun panels and PV period. This generation is fantastically trusted sun irradiance and temperature. For every particular 2d, there can be a maximum electricity aspect (MPP) and its charge is reckoned on irradiance and temperature. The conventional strategies cannot perform sufficiently. Metaheuristic optimization algorithms may be used to song MPP in every normal circumstance and partial shading script. The pivotal gain of the use of them is that they will be speedy in operation, and they don't trap in near optimums. This oil uses Honey Badger Optimization set of rules in Maximum Power Tracking (MPPT) in PV systems.

Background Uremic pruritus has an impact on the quality of life and sleep of hemodialysis patients, but the majority of cases go unreported and untreated unless severe, due to a lack of awareness. The purpose of this study is to determine the prevalence, associated factors, and impact on health-related quality of life (HR-QOL) and sleep in hemodialysis patients. Methodology A single-center observational study of 3 months wherein 120 adults on maintenance hemodialysis were included. Baseline characteristics, dialysis-related factors, and lab parameters influencing uremic pruritus were recorded. Those with uremic pruritus completed “12-item pruritus severity scale (12-PSS)”, “SKINDEX10”, and “Itch-MOS” questionnaires to evaluate severity, impact on HR-QOL, and sleep respectively. Results Sixty seven over one hundred twenty (55.83%) patients had pruritus and majority were mild (40.83%) as per 12-PSS. Those with pruritus (n=67) had a mean age of 56.5±11.3 years, most were males (82%), chronic glomerulonephritis (29.1%) was the commonest cause of end-stage kidney disease, 3 active smokers, and 4 seropositive. 65(97%) patients were on twice-weekly dialysis, 36/67 had Conclusion The majority of patients on maintenance hemodialysis experience uremic pruritus. None of the clinical characteristics, dialysis-related factors, and laboratory parameters affected uremic pruritus. Uremic pruritus patients had the worst HR-QOL & their sleep quality significantly declined as pruritus severity escalated. Trial registration number and date of registration Study approval was obtained from Institutional Research Committee and Institutional Ethical Committee (IEC 642/2021). Clinical Trial Registry of India (CTRI) registration (CTRI/2022/01/039143) was also obtained.

In past few decades, solar energy plays a vital role in energy production among the different renewable energy resources. In shaded/unshaded photovoltaic (PV) systems, tracking of maximum power under different environmental conditions is provided by maximum power point tracking (MPPT). In recent years many works available on different types of MPPT techniques to track maximum power from PV systems with own pros and cons. This article comprehensively reviews the different traditional methods like perturb and observation (P&O), open circuit voltage (OCV), short circuit current (SCC), hill climbing (HC), incremental conductance (IC). Also recall the advanced MPPT techniques like particle swarm optimization (PSO), grey wolf optimization (GWO), cuckoo search (CS), artificial neural networks (ANN), fuzzy logic controller (FLC) available in literature. This review is conducted based on implementation, accuracy, tracking speed, cost, merits, and demerits of each technique. Traditional MPPT methods can’t able to track global maximum power point under partial shaded conditions and exhibits less efficiency when compared with advanced soft computing methods. Hybrid methods provide good efficiency and performance than traditional and advanced methods. Authors powerfully confirm that this article offers convenient information’s to enthusiastic engineers and new researchers those who are all working in solar PV systems.

Everlasting increase of connected devices and users in communication networks carry out enormous traffic volumes. This reason places the network in a position to fine tune the energy consumption in proposal and attentive operations. Optical transmission technologies are a momentous paradigm which brings down the overall energy consumption in communication networks. This advantage increases an interest on research to improve the energy saving opportunities of optical networks. Regardless of this most vibrant research few unanswered questions direct the researchers to set effort on resolving the issues in energy efficient optical networks. Shannon limit and parallelism to support higher capacities is essential in approaching optical systems also without reducing the network performance parameters such as latency, reliability and survivability, energy consumption of optical networks must be laid out as it affects quality of services. New generation network services like optical cloud and fixed mobile convergence have necessity to meet out the end-to-end energy optimization. All these factors enlighten research area towards energy efficiency in optical network transmission. This special research work reconnoiters and consolidates the earlier research models related to energy efficient transmission in optical networks

Background: The World Health Organisation recommends prioritised use of recently prequalified typhoid conjugate vaccines in countries with the highest incidence of typhoid fever. However, representative typhoid surveillance data are lacking in many low-income countries because of the costs and challenges of diagnostic clinical microbiology. Environmental surveillance (ES) of Salmonella Typhi in sewage and wastewater using molecular methods may offer a low-cost alternative, but its performance in comparison with clinical surveillance has not been assessed. Methods: We developed a harmonised protocol for typhoid ES and its implementation in communities in India and Malawi where it will be compared with findings from hospital-based surveillance for typhoid fever. The protocol includes methods for ES site selection based on geospatial analysis, grab and trap sample collection at sewage and wastewater sites, and laboratory methods for sample processing, concentration and quantitative polymerase chain reaction (PCR) to detect Salmonella Typhi. The optimal locations for ES sites based on digital elevation models and mapping of sewage and river networks are described for each community and their suitability confirmed through field investigation. We will compare the prevalence and abundance of Salmonella Typhi in ES samples collected each month over a 12-month period to the incidence of blood culture confirmed typhoid cases recorded at referral hospitals serving the study areas. Conclusions: If environmental detection of Salmonella Typhi correlates with the incidence of typhoid fever estimated through clinical surveillance, typhoid ES may be a powerful and low-cost tool to estimate the local burden of typhoid fever and support the introduction of typhoid conjugate vaccines. Typhoid ES could also allow the impact of vaccination to be assessed and rapidly identify circulation of drug resistant strains.

Chronic kidney disease (CKD) is extremely common all over the world and is strongly linked to cardiovascular disease (CVD). The great majority of CKD patients have hypertension, which raises the risk of cardiovascular disease (CVD), end-stage kidney disease, and mortality. Controlling hypertension in patients with CKD is critical in our clinical practice since it slows the course of the disease and lowers the risk of CVD. As a result, accurate blood pressure (BP) monitoring is crucial for CKD diagnosis and therapy. Three important guidelines on BP thresholds and targets for antihypertensive medication therapy have been published in the recent decade emphasizing the way we measure BP. For both office BP and out-of-office BP measuring techniques, their clinical importance in the management of hypertension has been well defined. Although BP measurement is widely disseminated and routinely performed in most clinical settings, it remains unstandardized, and practitioners frequently fail to follow the basic recommendations to avoid measurement errors. This may lead to misdiagnosis and wrong management of hypertension, especially in CKD patients. Here, we review presently available all BP measuring techniques and their use in clinical practice and the recommendations from various guidelines and research gaps emphasizing CKD patients.

Radio frequency (RF) plasma polymerization of plant extracts offers an effective large scale encapsulation method for organic photovoltaics (OPVs).

Dielectric properties of any particular material will determine the level of microwave (MW) heating. Therefore, measurement of the dielectric properties of MW treatment subject materials is necessary. This study investigated the dielectric properties of six roughages and three concentrate animal feeds across the microwave frequency range of 1 × 109 to 5 × 109 Hz. Six treatment groups, named control (at equilibrium moisture constant), oven dried (0% moisture), 25% moisture added, 50% moisture added, 75% moisture added, and 100% moisture added groups were prepared for the study. Three separate replications and five observations for each replication were used to assess the dielectric properties of these materials. The results showed that for increasing moisture content, from oven-dried, though the control status, to 100% added moisture, both the dielectric constant (real part) and the dielectric loss factor (imaginary part) increased for both the roughages and concentrates. However, the responses were not linear. The oven-dried plant samples' dielectric properties were very low compared with those of the higher moisture content samples. Thus, the sample's moisture content was the dominant contributor to the feed samples' dielectric behavior. Among all the feed samples, faba bean and wheat grain showed the highest response to added moisture. Mathematical models were developed to explain the dielectric properties of feeds as a function of frequency and moisture content. The goodness of fit (r2) for these models' real part varied between 0.85–0.99 for roughage and 0.98–0.99 for concentrate feed type. On the other hand, the goodness of fit for the imaginary part varied between 0.59–0.78 for roughage, and 0.81–0.93 for concentrate feeds.

We present a case of Klippel-Feil Syndrome, a congenital skeletal defect where multiple cervical vertebral bodies are fused. Klippel-Feil Syndrome has multiple associated anomalies, with a notable one being Sprengel's deformity. In this case, the patient was given a diagnosis of Klippel-Feil Syndrome prenatally after suspected cervical vertebrae fusion and Sprengel's deformity were seen on both fetal magnetic resonance imaging (MRI) and ultrasound. Prenatal diagnosis of Sprengel's deformity has been reported once in the literature. In this report, we present imaging findings of Sprengel's deformity seen in association with Klippel-Feil Syndrome using a combination of fetal ultrasound and MRI.

Graphene is a highly sought-after material for a wide range of applications, particularly in areas such as energy harvesting and storage, electronics, electrochemical sensors, biomedical, composites, and coatings. The synthesis of high-quality graphene is a precondition for its real-time application. However, conventional synthesis methods have certain drawbacks including laborious procedures and structural defects in graphene nanosheets. Plasma-based synthesis techniques such as plasma-enhanced chemical vapor deposition and atmospheric pressure microwave plasma are high-tech synthesis practices that can produce graphene without any solvents in a few seconds. This article reviews these state-of-the-art techniques emphasizing mainly their process parameters for the synthesis of high-grade graphene, which is defect-free, and comprises mono to few layers, great carrier mobility, and high purity. The applications of as-synthesized graphene in various fields are also provided. Moreover, the potential breakthroughs and the prospect of these techniques are also discussed in this work.

PurposeThis paper aims to look into the role of transformational leadership and transactional leadership as predictors of employee creativity and organisational innovation. Employee creativity is examined as a potential mediator in the leadership styles–organisational innovation relationships.Design/methodology/approachA cross-sectional, quantitative design was adopted and structural equation modelling (SEM) techniques were used to analyse data collected from 369 employees working in 39 public coffee enterprises in Vietnam.FindingsTransformational leadership and transactional leadership were significant predictors of employee creativity and organisational innovation. Specifically, transformational leadership was instrumental to employee creativity and organisational innovation while transactional leadership was detrimental to these two variables. Additionally, employee creativity partially mediated the relationships between the two leadership styles and organisational innovation.Practical implicationsResults of this study benefit the management of organisations and policy makers by providing an insight of which leadership style will effectively suit public enterprises to promote employee creativity and foster organisational innovation.Originality/valueWhile there is a lack of studies investigating organisational innovation in organisational methods and that the interrelationships between leadership styles, employee creativity and organisational innovation are not fully understood, this study pioneers in examining relationships between leadership styles and organisational innovation that is being mediated by employee creativity. Figuring out that organisational innovation is more likely to be fostered by the positive influence of leadership behaviours and the improvement of employee creativity, in particular, the significant role of employee creativity represents important contributions of the current study.

The therapeutic options for preventing or slowing the progression of chronic kidney disease (CKD) have been thus far limited. While angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are, without a doubt, safe and effective drugs, a significant proportion of patients with CKD still progress to end-stage kidney disease. After decades of negative trials, nephrologists have finally found cause for optimism with the introduction of sodium-glucose cotransporter-2 (SGLT2) inhibitors and non-steroidal mineralocorticoid receptor antagonists (MRAs). Recent trials such as EMPA-REG OUTCOME and CREDENCE have provided evidence of the renal benefits of SGLT2 inhibitors, which have now found widespread acceptance as first-line agents for diabetic CKD, in addition to ACEi/ARBs. Considering results from the DAPA-CKD study, it is expected that their use will soon be expanded to other causes of albuminuric CKD as well, although confirmation from further trials, such as the EMPA-KIDNEY study is awaited. Likewise, although the role of mineralocorticoid receptor overactivation in CKD progression has been known for decades, it is only now with the FIDELIO-DKD study that we have evidence of benefits of MRAs on hard renal endpoints, specifically in patients with diabetic CKD. While further research is ongoing, given the evidence of synergism between the three drug classes, it is foreseeable that a combination of two or more of these drugs may soon become the standard of care for CKD, regardless of underlying aetiology. This review describes pathophysiologic mechanisms, current evidence and future perspectives on the use of SGLT2 inhibitors and novel MRAs in CKD.

Background Aneurysmal Subarachnoid Haemorrhage (aSAH) is a complex and critical neurological condition associated with significant mortality and morbidity. Apart from the initial insult due to the aneurysmal rupture itself, re-bleeding and severe cerebral vasospasm are some of the complications of aSAH that result in overall poor outcomes. Cerebral vasospasm in post-aSAH can result in delayed ischaemic neurological deficits. In the absence of timely interventions, it can lead to grave consequences for the patient. Management of cerebral vasospasm has been evolving over the years to prevent mortality and morbidity in aSAH patients. Materials and methods During 36 months from January 2018 to December 2020, 164 patients were admitted with aSAH in multiple Indian centres. Endovascular methods were used to treat all the aneurysms. Patients were observed for clinically symptomatic cerebral vasospasm. Patients with suspected vasospasm were further evaluated with a transcranial Doppler (TCD), brain computed tomography (CT) or magnetic resonance imaging (MRI) scan. In addition, digital subtraction angiography (DSA) of cerebral vessels was performed to evaluate vasospasm further. Twenty-two patients had clinically and angiographically significant vasospasm, and 20 patients were treated with transluminal balloon angioplasty (TBA). Results Satisfactory lumen dilation was achieved in 79 out of the 91 (86.81%) vasospastic segments, namely, distal internal carotid arteries (ICAs) 100%; middle cerebral arteries (MCA) 97.56% (M1=100%, M2=100%, M3=87.5%); vertebral arteries-100%; basilar arteries-100%; anterior cerebral arteries (ACA) 67.64% (A1=75%, A2=57.14%). The mean Modified Rankin Scale (mRS) score at 90 days was 0.75. 17 patients (85%) had an overall good outcome with no new neurological deficits. There were no cases of vessel rupture, dissection or thromboembolic complications. Conclusion TBA is a valuable, safe and effective option for managing clinically significant vasospasm caused by aSAH, adjuvant to medical management.

Purpose: This study aims to describe the incidence of postoperative urinary retention among pediatric patients undergoing orthopedic surgery and identify risk factors. Methods: The Pediatric Health Information System was used to identify children aged 1–18 years who underwent orthopedic surgery. Collected from each patient’s record were demographic information, principal procedure during hospitalization, the presence of neurologic/neuromuscular conditions and other complex chronic medical conditions, the total postoperative length of stay, and the presence of postoperative urinary retention. Results: The overall incidence of postoperative urinary retention was 0.38%. Children with complex chronic neuromuscular conditions (OR 11.54 (95% CI 9.60–13.88), p = < 0.001) and complex chronic non-neuromuscular medical conditions (OR 5.07 (95% CI 4.11–6.25), p ≤ 0.001) had a substantially increased incidence of urinary retention. Surgeries on the spine (OR 3.98 (95% CI 3.28–4.82, p ≤ 0.001) and femur/hip (OR 3.63 (95% CI 3.03–4.36), p ≤ 0.001) were also associated with an increased incidence. Conclusions: Children with complex chronic neuromuscular conditions have a substantially increased risk of experiencing postoperative urinary retention. Complex chronic non-neuromuscular medical conditions and surgeries to the spine, hip, and femur also carry a notably increased risk.

The predictive torque control (PTC) is researched extensively for control of electrical drives because of its fast-dynamic response and robust control. In multiphase motors, it is mandatory to design a multiobjective cost function with more than two terms for controlling $x\!y$ -subspace current and common-mode voltage (CMV). However, selecting the weighting factor for multiple control variables is time penalizing and increases the computational burden. Using a noisy speed input from the speed sensor in the prediction model reduces the steady-state performance in terms of higher torque ripple, flux ripple, and phase current total harmonic distortion (THD), especially during low speeds. In this article, PTC for a five-phase induction motor (IM) drive without speed sensor [sensorless PTC (PTC-S)] is presented. The adaptive full observer is incorporated to estimate the stator flux, stator resistance, and rotor speed. The proposed algorithm is capable to eliminate CMV and $x\!y$ -current harmonics having advantages over the conventional PTC (PTC-C) algorithm. The elimination of CMV is achieved by the selection of set of voltage vectors from available 243 voltage vectors. The proposed speed sensor-less control is implemented with a three-level neutral-point clamped (NPC) inverter using synthetic voltage vectors. The use of a synthetic voltage vector eliminates the $x\!y$ -subspace current and reduces the computational burden. The PTC-S is implemented with a seven-level hysteresis torque comparator, which reduces the torque ripple significantly. To further improve the effectiveness of the control algorithm, two-step delay compensation is implemented. The discussed algorithms are tested on a laboratory prototype for experimental evaluation. The proposed study also highlights the effect of torque ripple reduction on the speed adaptive flux observer for sensor-less operation. The experimental results show the effectiveness and applicability by comparing the steady-state and dynamic performances of PTC.

The purpose of this study was to evaluate the peri-operative outcomes of patients with Prader–Willi Syndrome (PWS) undergoing spinal deformity correction and compare the outcomes to patients with adolescent idiopathic scoliosis (AIS). A retrospective review of the Kid’s Inpatient Database was performed from 2000 to 2012 to identify all pediatric patients with scoliosis undergoing spinal fusion. Cohorts were created on the basis of PWS diagnosis and adolescent idiopathic scoliosis. Statistical analysis was performed for differences in post-operative outcomes between these two patient cohorts. Between 2000 and 2012, the number of spinal fusions performed increased by 24.6 and 32.2% in the PWS and adolescent idiopathic scoliosis populations, respectively. There was no difference between the incidence of major complications in PWS patients when compared to AIS (1.7% vs. 1.0% in idiopathic scoliosis; p = 0.362). Although there was no significant difference in the rate of overall minor complications, PWS patients were demonstrated to be more likely to experience post-operative pneumonia (p

Introduction: In hemodialysis (HD) patients, catheter-related bloodstream infections (CRBSI) cause significant morbidity and mortality. Objectives: We analyzed dialysis CRBSI incidence, associated factors, and the spectrum of the causative organisms. Patients and Methods: Patients aged ≥18 years either on maintenance HD or with acute kidney injury having CRBSI (NKF-KDOQI criteria) were included in this prospective observational study and patients with other infections were excluded. Blood, catheter tip culture, and antibiogram were analyzed. All patients were initially treated with antibiotics covering both gram-positive and gram-negative pathogens. Results: Of 921 catheters (882 patients) included, 212 (23%) had CRBSI, of which 69(32.5%) and 143 (67.5%) had culture-positive probable CRBSI and culture-negative possible CRBSI respectively. 131 (61.8%) were

BACKGROUND AND AIMS An arteriovenous (AV) fistula is preferred for long-term haemodialysis vascular access. AV fistula creation requires adequate arterial and venous anatomy to support its creation and a sufficient time interval to allow the AV fistula to mature prior to its use. Failure to mature remains a problem highlighting the importance of the perioperative evaluation of the fistula. Ultrasound and colour doppler are a rapid, non-invasive and repeatable tools that can be used for the early diagnosis of vascular complications. METHOD A prospective, observational study was conducted at a tertiary hospital in South India. All the patients with arteriovenous fistulas made in the upper limb between the time period of June 2021–August 2021 were included. A preoperative doppler mapping and assessment of the upper lime was done by the nephrology team and two DUS exams in the post-operative period. RESULTS In our study, a total of 134 patients were evaluated with a mean age of 51.89 ± 13.7 years. The total number of males in the study was 115 (85.8%). The aetiology of end-stage renal disease (ESRD) was predominantly nondiabetic in origin seen in 56.7% of the patients. Ischaemic heart disease was seen in 36 patients. There were 116 brachiocephalic,18 radiocephalic AV fistulas in our group of patients. The overall success rate of the fistula was 79.9%. The average vein diameter in patients with successful AV fistula was 3.03 ± 1.05 mm and was 2.25 ± 0.9 mm in those who had a failed fistula. The average blood flow measurement in the proximal artery supplying the fistula was 479.42 ± 113.1 mL/min in the immediate post-op period and 1055.88 ± 227.6 mL/min at 6 weeks. There was a significant difference (P CONCLUSION It is essential for a practicing nephrologist to be acquainted with the technique of doppler to assess AV fistula to assess for maturity and to see for.

BACKGROUND AND AIMS The risk of developing tuberculosis (TB) is 10–25% in chronic kidney disease (CKD) patients. TB in CKD patients may have a mortality of 16–37%. Standard treatment with four drugs (Isoniazid, Rifampin, Pyrazinamide and Ethambutol) predisposes to side effects, drug interactions and incomplete adherence in this population. We studied adverse drug reactions and potential drug–drug interactions in CKD patients with TB. METHOD Consecutive patients with CKD and TB attending tertiary care hospitals in South India were included over a period of 12 months. CKD was diagnosed based on estimated GFR using CKD EPI and TB using standard methodology. Data on demographic details and adverse drug reactions were collected from case records. Potential drug–drug interactions were checked using Micromedex Drug-Reax® (Truven Health Analytics, Greenwood Village, Colorado, USA). Statistical analysis was done using SPSS version 20. RESULTS Of 1300 TB patients, 59 had CKD. The demographic details are as per Table 1. CONCLUSION In CKD with TB, adverse drug reactions were seen in 45.5% and potential drug–drug interactions were seen mostly with rifampin (28.81% in CKD).

BACKGROUND AND AIMS The involvement of kidney in plasma cell dyscrasias is widespread, often referred to as myeloma kidney. At the time of presentation, nearly 50% of patients have renal involvement which is associated with higher mortality [1, 2]. Multiple myeloma is more common in African Americans, with male predilection and median age about 65–70 years [3]. Two major causes of renal insufficiency are light chain cast nephropathy and hyperkalcaemia [4]. Flow cytometry plays an important role in diagnosis of plasma cell dyscrasias. Myeloma cells infrequently express CD19 and variable CD45 in contrast to normal plasma cells. Approximately 70% of myeloma cells will express CD56, which is typically negative in normal plasma cells and in plasma cell leukaemia [5]. Studies addressing the relation of flow cytometry parameters with respect to prognosis and outcome in plasma cell dyscrasias are sparse in Asian population. Hence, this research was conducted to study the clinical profile and correlation of flow cytometry parameters with renal outcomes in patients with plasma cell dyscrasias. METHOD All consecutive patients, aged above 18 years and diagnosed with plasma cell dyscrasias from January 2016 to June 2021 were included. RESULTS Of 165 patients, 115 were males (69.7%), with mean age 58.2 ± 6.4 years. Pallor was seen in 126 (76.4%), bone pains in 90 (54.5%), lytic lesions in 63 (38.2%) and fractures in 37 (22.4%) patients. Severe anaemia ( Remission was attained with chemotherapy in 139 patients (64.3%), and bone marrow transplantation was done in 27 patients (16.4%). Relapse of disease was seen in 31 patients (18.8%) and worsening of renal parameters at relapse was seen in 15 (48.4%) patients. A total of 35 (21.2%) patients expired. Correlation of flow cytometry parameters with renal outcomes showed presence of CD56 with worse renal outcomes (P = .032), and presence of CD117 with favourable renal outcomes (P = .003) with statistical significance. Presence of CD56 and CD138 had increased risk of mortality with significant P value (P = .04, P = .01, respectively). CONCLUSION Flow cytometry parameters may play a role in predicting the prognosis and renal outcomes in patients of plasma cell dyscrasias. Our study showed presence of CD56 with worse renal outcome and mortality, while CD117 presence with favourable renal outcome. Table 1. Flow cytometry parameters in patients with plasma cell dyscrasias CD markers (n = 165) Present Absent CD19 21/165 (12.7%) 144/165 (87.3%) CD38 53/165 (32.1%) 112/165 (67.9%) CD45 46/165 (27.9%) 119/165 (73.9%) CD56 134/165 (81.2%) 31/165 (18.8%) CD117 86/165 (52.1%) 79/165 (48.9%) CD138 46/165 (27.9%) 119/165 (73.9%) KAPPA 93/165 (56.4%) 72/165 (44.6%) LAMBDA 71/165 (43%) 94/165 (57%)

Empathy is the cornerstone of the patient–physician relationship and is consistently ranked by patients as one of the most important factors in the quality of their care. In this paper we examine the degree to which perceived physician empathy is associated with the characteristics of the caregiver (parent or legal guardian) and physician in pediatric orthopedic surgery. This was a cross-sectional survey study of 200 English-speaking caregivers of pediatric patients at a large children's hospital. The Consultation and Relational Empathy (CARE) Measure was used to measure perceived physician empathy. Only if the caregiver felt carefully listened to by the physician ( p-value < 0.001), and if the physician showed respect for what the caregiver had to say ( p-value = 0.007) were statistically significant and positively associated with perceived physician empathy. The most significant determinant of perceived physician empathy is whether the caregiver felt listened to during the encounter. Other factors such as caregiver demographics, health literacy, self-rated mental health, wait time, and time spent with the physician do not significantly affect perceived physician empathy.

Pediatric acute hematogenous osteomyelitis (AHO) outcomes are highly dependent on the disease severity. Recently, the A-SCORE and C-SCORE, were proposed as predictors of an acute complicated course and chronic morbidity, respectively. The purpose of this study was to externally validate the A-SCORE and C-SCORE at a single institution.This IRB-approved retrospective chart review included AHO patients admitted at a tertiary referral hospital between October 1, 2015 and December 31, 2019. The inclusion criteria were ages 0 to 18 and clinical response to treatment. The exclusion criteria were immunocompromised status or penetrating inoculation.The A-SCORE demonstrated an area under the receiver operator curve (ROC area) of86% with regards to all acute complications. It also demonstrated sensitivities85% and specificities92% at the cut-off of 4 (Youden index) for all acute complications. The C-SCORE demonstrated an ROC area of 100% with regards to chronic osteomyelitis. It also demonstrated sensitivities70% and specificities93% for the chronic morbidity variables seen in our population at the cut-off of 3 (Youden index.).These novel composite clinical scores, in combination with clinical judgment, could help guide early care decisions. The A-SCORE and C-SCORE are useful risk stratification tools in the management of pediatric AHO and in predicting acute complicated courses or chronic sequelae of AHO, respectively. These scoring systems, if integrated into standardized pediatric AHO guidelines, can allow clinicians to stratify the AHO population and guide clinical decision making.Level III (prognostic study, retrospective chart review).