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Background: Levamisole is a commonly used steroid-sparing agent (SSA), but the reported incidence of antineutrophil cytoplasmic antibody (ANCA) positivity has been concerning. Methods: Observational cross-sectional study wherein children aged 2 to 18 years with frequently relapsing/steroid dependent nephrotic syndrome (FRNS/SDNS) on levamisole for ≥ 12 months were tested for ANCA. Results: A total of 210 children (33% female), median age of 7.3 (IQR: 5.6–9.6) years, and a median duration of levamisole exposure of 21 (IQR: 15–30) months were tested. ANCA was positive in 18% (n = 37): 89% (n = 33) perinuclear ANCA (pANCA), 3% (n = 1) cytoplasmic ANCA (cANCA), and 8% (n = 3) both. Of ANCA-positive children, none had reduced eGFR or abnormal urinalysis. The majority of these children were asymptomatic (81%, n = 30). Rash was more common among ANCA-positive children [6/37 (16%) vs. 3/173 (2%), p = 0.0001]. On multivariate analysis, higher age (OR = 1.02, [95th CI: 1.01 to 1.03], p = 0.007) and longer duration of levamisole exposure (OR = 1.05, [95th CI: 1.02 to 1.08], p = 0.0007) were associated with ANCA positivity. Levamisole was stopped in ANCA-positive children with the resolution of any clinical manifestations if present. Repeat ANCA testing was performed in 54% (20/37), and all were ANCA negative by 18 months. Conclusions: Children with FRNS/SDNS on longer duration of levamisole were associated with increasing prevalence of ANCA positivity, but most of these children were clinically asymptomatic. Prospective studies are required to determine the chronology of ANCA positivity and its clinical implication. [ABSTRACT FROM AUTHOR]

Background: Levamisole is less expensive and has a better toxicity profile compared to other steroid sparing agents used in nephrotic syndrome. It has a plasma half-life of 2.0 to 5.6 hours, but is conventionally administered on alternate days. We aimed to assess whether daily levamisole is safe and more effective than standard alternate-day therapy in maintaining remission in children with frequently relapsing or steroid-dependent nephrotic syndrome (FR/SDNS). Methods: An open-label randomized controlled trial was conducted in children with FR/SDNS. Group A received daily while Group B received alternate-day levamisole (2–3 mg/kg/dose) for 12 months. Prednisolone was tapered off by 3 months. Patients were monitored for relapses, further steroid requirement, and adverse effects. Results: A total of 190 children with FR/SDNS (94 in Group A and 96 in Group B) were analyzed. Sustained remission for 12 months was observed in 36% of Group A and 27% of Group B patients (p = 0.18). Numbers completing 12 months in the study were 67% in Group A and 56% in Group B (p = 0.13). Time to first relapse, persistent FR/SDNS, and withdrawal due to poor compliance were statistically similar in both groups, while relapse rate and cumulative steroid dosage were significantly lower in Group A compared to Group B (p = 0.03 and p = 0.02, respectively). The incidence of adverse effects was comparable in both groups, with reversible leucopenia and hepatic transaminitis being the commonest. Conclusions: Daily levamisole therapy was not superior to alternate-day therapy in maintaining sustained remission over 12 months. Nevertheless, relapse rate and cumulative steroid dosage were significantly lower without increased adverse effects. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

Understanding the spatiotemporal dynamics of river water chemistry from its source to sinks is critical for constraining the origin, transformation, and "hotspots" of contaminants in a river basin. To provide new spatiotemporal constraints on river chemistry, dissolved trace element concentrations were measured at 17 targeted locations across the Ramganga River catchment. River water samples were collected across three seasons: pre-monsoon, monsoon, and post-monsoon between 2019 and 2021. To remove the dependency of trace element concentrations on discharge, we used molar ratios, as discharge data on Indian transboundary rivers are not publicly available. The dataset reveals significant spatiotemporal variability in dissolved trace element concentrations of the Ramganga River. Samples collected upstream of Moradabad, a major industrial city in western Uttar Pradesh, are characterized by ~ 1.2–2.5 times higher average concentrations of most of the trace elements except Sc, V, Cr, Rb, and Pb, likely due to intense water–rock interactions in the headwaters. Such kind of enrichment in trace metal concentrations was also observed at sites downstream of large cities and industrial centers. However, such enrichment was not enough to bring a major change in the River Ganga chemistry, as the signals got diluted downstream of the Ramganga-Ganga confluence. The average river water composition of the Ramganga River was comparable to worldwide river water composition, albeit a few sites were characterized by very high concentrations of dissolved trace elements. Finally, we provide an outlook that calls for an assessment of stable non-traditional isotopes that are ideally suited to track the origin and transformation of elements such as Li, Mg, Ca, Ti, V, Cr, Fe, Ni, Cu, Zn, Sr, Ag, Cd, Sn, Pt, and Hg in Indian rivers. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a known independent risk factor for morbidity/mortality but there is scarcity of robust data on it among childhood nephrotic syndrome (NS). We assessed the incidence of AKI among hospitalized children with NS as well as looked for any significant risk factors. Prospective observational study conducted across two tertiary pediatric hospitals in Eastern India from September 2020 to August 2021. Children aged 1–18 years admitted with NS and without any nephritic features or pre-existing chronic kidney disease (CKD) were included. In 200 admissions (n = 176; 63% female, median age 4 years [IQR: 3–7]), AKI occurred in 36 (18%; 95% CI 13 to 36%). Two children required kidney replacement therapy and one death was recorded. In 27/36 (75%), AKI resolved within 48 h, 4 had persistent AKI, 3 acute kidney disease, and two progressed to CKD. On multivariate regression analysis: fractional excretion of sodium ≤ 0.2% (OR 12.77; 95% CI 3.5–46.4), male gender (OR 6.38; 95% CI 2.76–14.74), underlying infection (OR 5.44; 95% CI 2.4–11.86), nephrotoxic drugs (OR 4.83; 95% CI 2.21–10.54), and albumin ≤ 1.4 g/dl (OR 4.35; 95% CI 1.55–12.8) were associated with AKI. A predictive equation using these five variables on admission had high AUC (0.86) in correctly identifying 17 children who subsequently developed AKI. Conclusion: In a low resource setting, AKI is common among hospitalized children with NS. Larger multi-center prospective studies are needed to refine prediction equations and test its utility in preventing AKI development. What is Known: • Acute Kidney Injury is a known independent risk factor for increased morbidity and mortality. • There are few studies to assess the incidence of Acute kidney injury in hospitalised cases of childhood nephrotic syndrome.. What is New: • This is the largest prospective cohort of children suffering from nephrotic syndrome, in India, proposing a novel algorithm for predicting the risk of AKI among hospitalised cases of childhood nephrotic syndrome. [ABSTRACT FROM AUTHOR]

Background: Despite its utility, uncertainty exists on the feasibility of acute peritoneal dialysis (PD) and optimal PD catheter type for very low birth weight (VLBW < 1500 g) and extremely low birth weight (ELBW < 1000 g) infants. We hereby report our experience of acute PD among these high-risk infants and compare the outcome between stylet-based rigid catheter (SRC) and Cook Mac-Loc Multipurpose Drainage catheters® (CMMDC). Methods: Case notes of infants < 1500 g undergoing PD between 2012 and 2021 in a network of five participating neonatal units supported by a tertiary paediatric nephrology centre in Kolkata, India, were retrospectively reviewed. PD was conducted either with SRC or after 2018 with CMMDC. Outcome parameters included complications, survival during PD, and survival to discharge. Results: 24 infants (VLBW: n = 13 and ELBW: n = 11) underwent PD at median age 4.5 days (IQR 3–6) with either CMMDC (n = 14) or SRC (n = 10). Significant improvement in biochemical parameters and fluid removal was seen in both ELBW and VLBW infants. CMMDC was associated with significantly fewer PD-related complications 7/14 (50%) vs. 9/10 (90%) (p = 0.04) and higher survival during PD 13/14 (93%) vs. 5/10 (50%) (p = 0.02), without significant difference in survival to hospital discharge 8/14 (57%) vs. 3/10 (30%) (p = 0.25). CMMDC also enabled longer duration of PD, higher ultrafiltration, and better control of acidosis. Consumable cost was higher for CMMDC (USD$60) than SRC (USD$14). Conclusions: In a low resource setting, CMMDC had lower PD complications and superior short-term survival among ELBW/VLBW infants. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

The wetland cover is defined as the spatially homogenous region of a wetland attributed to the underlying biophysical conditions such as vegetation, turbidity, hydric soil, and the amount of water. Here, we present a novel method to derive the wetland-cover types (WCTs) combining three commonly used multispectral indices, NDVI, MNDWI, and NDTI, in three large Ramsar wetlands located in different geomorphic and climatic settings across India. These wetlands include the Kaabar Tal, a floodplain wetland in east Ganga Plains, Chilika Lagoon, a coastal wetland in eastern India, and Nal Sarovar in semi-arid western India. The novelty of our approach is that the derived WCTs are stable in space and time, and therefore, a given WCT across different wetlands or within different zones of a large wetland will imply similar underlying biophysical attributes. The WCTs can therefore provide a novel tool for monitoring and change detection of wetland cover types. We have automated the proposed WCT algorithm using the Google Earth Engine (GEE) environment and by developing ArcGIS tools. The method can be implemented on any wetland and using any multispectral imagery dataset with visible and NIR bands. The proposed methodology is simple yet robust and easy to implement and, therefore, holds significant importance in wetland monitoring and management. [ABSTRACT FROM AUTHOR]

The article discusses a case of a child with abdominal pain, arthralgia, palpable skin rash, hepatosplenomegaly, and pancytopenia. It mentions the etiology of the child's symptoms, which initially presented as Henoch-Schonlein purpura (HSP)/IgA vasculitis but was later diagnosed as Wilson disease. It also delves into the possible pathogenesis of IgA vasculitis and discusses the treatment approach for this condition in the context of Wilson disease.

Background: Inherited tubulopathies are a heterogeneous group of genetic disorders making whole-exome sequencing (WES) the preferred diagnostic methodology. Methods: This was a multicenter descriptive study wherein children (< 18 years) with clinically suspected tubular disorders were recruited for molecular testing through WES. Multiplex ligation-dependent probe amplification (MLPA) and Sanger sequencing were done when required. Variants were classified as per American College of Medical Genetics 2015 guidelines and pathogenic (P)/likely pathogenic (LP) variants were considered causative. Results: There were 77 index cases (male =73%). Median age at diagnosis was 48 months (IQR 18.5 to 108 months). At recruitment, the number of children in each clinical group was as follows: distal renal tubular acidosis (dRTA) = 25; Bartter syndrome = 18; isolated hypophosphatemic rickets (HP) = 6; proximal tubular dysfunction (pTD) = 12; nephrogenic diabetes insipidus (NDI) = 6; kidney stone/nephrocalcinosis (NC) = 6; others = 4. We detected 55 (24 novel) P/LP variants, providing genetic diagnoses in 54 children (70%). The diagnostic yield of WES was highest for NDI (100%), followed by HP (83%; all X-linked HP), Bartter syndrome (78%), pTD (75%), dRTA (64%), and NC (33%). Molecular testing had a definite impact on clinical management in 24 (31%) children. This included revising clinical diagnosis among 14 children (26% of those with a confirmed genetic diagnosis and 18% of the overall cohort), detection of previously unrecognized co-morbidities among 8 children (sensorineural deafness n = 5, hemolytic anemia n = 2, and dental changes n = 1) and facilitating specific medical treatment for 7 children (primary hyperoxaluria n = 1, cystinosis n = 4, tyrosinemia n = 2). Conclusion: WES is a powerful tool in the diagnosis and management of children with inherited tubulopathies in the Indian population. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

The article describes the case of a six-year old girl with e Beta thalassemia on regular blood transfusion and iron chelation therapy. Further investigations on the patient included evaluation of metabolic acidosis, conformation on the underlying cause of acute kidney injury and acute liver failure as well as indications of underlying tubulopathy of proximal variant. The patient was treated with oral deferiprone after deferasirox was withdrawn. Adverse effects of deferasirox were identified.

Summary: PREDNOS 2 was a double blind placebo controlled trial done to investigate the use of daily low-dose prednisolone for the treatment of upper respiratory tract infection—related relapses. It evaluated 365 children with relapsing steroid-sensitive nephrotic syndrome with and without background immunosuppressive treatment at 122 pediatric departments in the UK from February 1, 2013, to January 31, 2020. At the beginning of an upper respiratory tract infection, children received 6 days of prednisolone, 15 mg/m2 daily, or matching placebo preparation. Those already taking alternate-day prednisolone rounded their daily dose using trial medication to the equivalent of 15 mg/m2 daily or their alternate-day dose, whichever was greater. The primary outcome was the incidence of first upper respi-ratory tract infection-related relapse. The modified intention-to-treat analysis population comprised 271 children (mean (SD) age, 7.6 (3.5) years; 64.2% male), with 134 in the prednisolone arm and 137 in the placebo arm. The number of patients experiencing an upper respiratory tract infection-related relapse was 56 (42.7%) in the predniso-lone arm and 58 (44.3%) in the placebo arm (adjusted risk difference, 0.02; 95% CI, 0.14 to 0.10; P =0.70). No evidence was found that the treatment effect differed according to background immuno-suppressive treatment. A post hoc subgroup analysis assessing the primary outcome in 54 children of South Asian ethnicity (risk ratio, 0.66; 95% CI, 0.40–1.10) vs 208 children of other ethnicity (risk ratio, 1.11; 95% CI, 0.81–1.54) found no difference in efficacy of intervention in those of South Asian ethnicity (test for interaction P=0.09). The authors concluded that, results of PREDNOS 2 suggest that administering 6 days of daily low-dose prednisolone at the time of an upper respiratory tract infection does not reduce the risk of relapse of nephrotic syndrome in children in the UK and further work is needed to study the inter-ethnic differences in the study response. [ABSTRACT FROM AUTHOR]

An 11-year-old male child who presented with increased frequency of urination, thirst and feeling of incomplete void was initially diagnosed with diabetes mellitus (DM) based on elevated blood sugar. Polyuria and polydipsia were confirmed even after normalisation of blood sugar. A standardised water deprivation test showed presence of central diabetes insipidus (DI) and patient was started on desmopressin. Presence of DM and DI led to suspicion of DIDMOAD/Wolfram syndrome and ophthalmic examination confirmed bilateral optic atrophy. Despite treatment for DM and DI the urinary complaints persisted, and ultrasound showed persistent bilateral hydronephroureterosis. Bladder workup including voiding cystourethrography (VCUG) and urodynamic study reported thickened trabeculated bladder wall along with overactivity, poor compliance and high bladder pressure. Bladder dysfunction has been documented to be associated with Wolfram syndrome and often may lead to chronic kidney disease which can be prevented by early diagnosis and appropriate management. The case highlights the need for comprehensive evaluation of children with urinary symptoms. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a well-known life-threatening systemic effect of snake envenomation which commonly happens secondary to snake bites from families of Viperidae and Elapidae. Enzymatic toxins in snake venom result in injuries to all kidney cell types including glomerular, tubulo-interstitial and kidney vasculature. Pathogenesis of kidney injury due to snake envenomation includes ischaemia secondary to decreased kidney blood flow caused by systemic bleeding and vascular leakage, proteolytic degradation of the glomerular basement membrane by snake venom metalloproteinases (SVMPs), deposition of microthrombi in the kidney microvasculature (thrombotic microangiopathy), direct cytotoxic action of venom, systemic myotoxicity (rhabdomyolysis) and accumulation of large amounts of myoglobin in kidney tubules. Clinical features of AKI include fatigue, loss of appetite, headache, nausea, vomiting, oliguria and anuria. Monitoring of blood pressure, fluid balance, serum creatinine, blood urea nitrogen and serum electrolytes is useful in managing AKI induced by snake envenomation. Early initiation of anti-snake venom and early diagnosis of AKI are always desirable. Biomarkers which will help in early prediction of AKI are being explored, and current studies suggest that urinary clusterin, urinary neutrophil gelatinase-associated lipocalin, and serum cystatin C may play an important clinical role in the future. Apart from fluid and electrolyte management, kidney support including early and prompt initiation of kidney replacement therapy when indicated forms the bedrock in managing snake bite-associated AKI. Long-term follow-up is important because of chances of progression towards CKD. [ABSTRACT FROM AUTHOR]

The groundwater crisis in northwestern India is the result of over-exploitation of groundwater resources for irrigation. The Government of India has targeted a 20 percent improvement in irrigation groundwater use efficiency. In this perspective, and using a regional-scale calibrated and validated three-dimensional groundwater flow model, this article provides the first forecasts of water levels in the study area up to the year 2028, both with and without this improvement in use efficiency. Future water levels without any mitigation efforts are anticipated to decline by up to 2.8 m/year in some areas. A simulation with a 20 percent reduction in groundwater abstraction shows spatially varied aquifer responses. Tangible results are visible in a decade, and the water-level decline rates decrease by 36–67 percent in over-exploited areas. Although increasing irrigation use efficiency provides tangible benefits, an integrated approach to agricultural water management practice that incorporates use efficiency along with other measures like water-efficient cropping patterns and rainwater harvesting may yield better results in a shorter period. [ABSTRACT FROM AUTHOR]

Introduction: Body stores of vitamin D are measured as "total" serum 25-hydroxy vitamin D (25(OH)D). Its largest component is protein bound and lost in urine in nephrotic syndrome (NS). Our study investigates whether "free" 25(OH)D levels are a better guide to bone health and need for vitamin D supplementation in patients with steroid-sensitive NS (SSNS). Methods: A cross-sectional study was performed in children with SSNS and healthy controls. Blood was tested for albumin, creatinine, calcium, phosphate, ALP, total and free (by direct ELISA) 25(OH)D, iPTH, and urine for protein–creatinine ratio. Results: Seventy-nine NS patients (48 in relapse, 31 in remission) and 60 healthy controls were included. The levels of total 25(OH)D were significantly different (lowest in NS relapse and highest in controls) (p < 0.001). Corrected calcium and phosphate levels were normal, and there were no differences in free 25(OH)D, ALP, or iPTH levels between groups. Only total and not free 25(OH)D correlated significantly and negatively with urinary protein creatinine ratios (rs = − 0.42 vs. 0.04). Free 25(OH)D values of 3.75 and 2.85 pg/ml corresponded to total 25(OH)D levels of 20 and 12 ng/ml, respectively, in healthy controls. Conclusion: These results confirm that total 25(OH)D levels are low in NS and related to degree of proteinuria. However levels of free 25(OH)D, ALP, and iPTH did not change in relapse or remission in comparison with healthy controls. Our results suggest that in proteinuric renal diseases, free 25(OH)D rather than total 25(OH)D levels should be used to diagnose vitamin D deficiency and guide therapy. [ABSTRACT FROM AUTHOR]

The article reports a case of a 10-year-old boy with fever, body swelling, painless gross hematuria, abdominal and knee joint pain, and rashes on both lower limbs. It is reported that the child was diagnosed with glomerulonephritis with mesangial depositions of IgA and C3, despite treatment with corticosteroids showing no significant improvement in kidney parameters.

A multicenter retrospective study was conducted to assess the clinical spectrum of 30 severe acute respiratory syndrome coronavirus (SARS-CoV-2)-positive children with idiopathic nephrotic syndrome. Difficult to treat nephrotic syndrome was found to be a high-risk group with a high incidence of acute kidney injury and mortality. [ABSTRACT FROM AUTHOR]

Objectives: To assess the efficacy of cyclosporine (CsA) in patients of oral steroid unresponsive or steroid dependent systemic juvenile idiopathic arthritis (sJIA); to evaluate the optimum dosage and blood level of CsA to achieve and maintain remission and to observe for side-effects on prolonged usage. Methods: This prospective observational study was conducted on children with steroid dependent /refractory sJIA admitted at the Institute of Child Health, Kolkata from July 2009 through November 2014. A total of 82 sJIA was diagnosed; 15 were steroid dependent /refractory and were included as candidates for cyclosporine therapy. Results: CsA was used in 15 patients; 13 showed a favourable response with significant steroid sparing effect and minimal toxicity. Conclusion: CsA was found to be effective in almost 75% of frequently relapsing steroid dependent sJIA to achieve and maintain remission. The average cost of therapy for a 20 kg patient on CsA was found to be 10,000 INR (132 EURO)/ patient over a 6 mo period; which would amount to 100,000 INR (1318 EURO)/patient with Tocilizumab for the same duration. [ABSTRACT FROM AUTHOR]

Childhood hypertension has become a significant health concern. There have been a slew of important new findings in this field over the last decade. This has led to an update by the American Academy of Pediatrics of the original recommendation of United States Fourth Working Group on blood pressure. We herein describe the important changes in the guideline, which include an updated normative data, change in blood pressure classification, strong endorsement of ambulatory blood pressure measurement and the reduction in the blood pressure target for both chronic kidney disease and non-chronic kidney disease hypertensive children. [ABSTRACT FROM AUTHOR]

Wide ranges of age and weight in pediatric patients makes renal replacement therapy (RRT) in acute kidney injury (AKI) challenging, particularly in the pediatric intensive care unit (PICU), wherein children are often hemodynamically unstable. Standard hemodialysis (HD) is difficult in this group of children and continuous veno-venous hemofiltration/dialysis (CVVH/D) has been the accepted modality in the developed world. Unfortunately, due to cost constraints, CVVH/D is often not available and peritoneal dialysis (PD) remains the common mode of RRT in resource-poor facilities. Acute PD has its drawbacks, and intermittent HD (IHD) done slowly over a prolonged period has been explored as an alternative. Various modes of slow sustained IHD have been described in the literature with the recently introduced term prolonged intermittent RRT (PIRRT) serving as an umbrella terminology for all of these modes. PIRRT has been widely accepted in adults with studies showing it to be as effective as CVVH/D but with an added advantage of being more cost-effective. Pediatric data, though scanty, has been promising. In this current review, we elaborate on the practical aspects of undertaking PIRRT in children as well as summarize its current status. [ABSTRACT FROM AUTHOR]

Urbanism in the Bronze-age Indus Civilisation (~4.6–3.9 thousand years before the present, ka) has been linked to water resources provided by large Himalayan river systems, although the largest concentrations of urban-scale Indus settlements are located far from extant Himalayan rivers. Here we analyse the sedimentary architecture, chronology and provenance of a major palaeochannel associated with many of these settlements. We show that the palaeochannel is a former course of the Sutlej River, the third largest of the present-day Himalayan rivers. Using optically stimulated luminescence dating of sand grains, we demonstrate that flow of the Sutlej in this course terminated considerably earlier than Indus occupation, with diversion to its present course complete shortly after ~8 ka. Indus urban settlements thus developed along an abandoned river valley rather than an active Himalayan river. Confinement of the Sutlej to its present incised course after ~8 ka likely reduced its propensity to re-route frequently thus enabling long-term stability for Indus settlements sited along the relict palaeochannel. [ABSTRACT FROM AUTHOR]

The article describes the case of a six-year old girl with e Beta thalassemia on regular blood transfusion and iron chelation therapy. Results of initial laboratory blood investigations including arterial blood gas, serum sodium and serum potassium, Glasgow Coma Scale, as well as urinary protein creatinine ratio are presented. The patient was administered with antibiotics, acyclovir and ammonia-scavenging therapy with sodium benzoate.

Background: Nephrogenic diabetes insipidus (DI) can be primary or secondary to various causes. Case Characteristics: One child with Fanconi syndrome with proximal renal tubular acidosis (RTA) due to nephropathic cystinosis, and other with Distal RTA with hearing loss. Observation: Both cases showed features of nephrogenic DI, which resolved after treating the primary pathology. Message: Renal Tubular acidosis may cause nephrogenic DI. [ABSTRACT FROM AUTHOR]

The article discusses the resistance of pathogens to antimicrobials in urinary tract infection (UTI) using logistic regression models and study of patients enrolled with Careful Urinary Tract Infection Evaluation (CUTIE) or Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) studies.

The article reports that urine and sputum failed to confirm evidence of tuberculosis, omental biopsy was undertaken which revealed lymph nodes with necrotizing granulomatous lesions and cartridgebased nucleic acid amplification test (CBNAAT) positive for Mycobacterium tuberculosis. Topics include unifying diagnosis is Granulomatous disease secondary to tuberculosis leading to hypercalcemia; and renal vascular resistance as well as increased catecholamine production.

A case study of a 12-year-old male presented with intermittent low-grade fever with anorexia, fatigue, muscle aches, and increased frequency of urination for a couple of months. Topics include noted to have high blood pressure classified as stage II hypertension, and fundoscopy showed retinal arterial attenuation; and Polyuria was documented and urine analysis showed pus cells and 6–8 red blood cells per high power field with early morning urinary specific gravity.

This study conducted among 302 infants aimed to determine the most suitable mid-upper arm circumference cut-off to diagnose severe acute malnutrition (weight-for-length <-3 SD) in infants aged between 1 and 6 months. The cut-off of ≤11.0 cm had the best performance (Youden index 0.63, sensitivity 82.5%, specificity 80.3%). [ABSTRACT FROM AUTHOR]

Paleoclimate studies in lakes typically use oxygen isotopic ratios in samples that consist of multiple ostracod specimens, to obtain an average δO value that reflects the mean temperature and δO of lake water over the life spans of the combined individuals measured. This approach overlooks potential information on seasonal climate variability that is recorded in the single valves of short-lived ostracods. Here we estimate seasonal variability in ostracod δO by measuring 10-30 individual carapaces of Cyprideis torosa in selected stratigraphic levels of a sediment core from paleolake Riwasa in Haryana, India. The mean δO values of ostracod populations show a general decrease from 9.6 to 8.3 kyr BP, which was interpreted previously as resulting from strengthening of the Indian summer monsoon during the early Holocene. The δO measurements of single ostracods within samples show a large range (up to ~15 ‰) and standard deviation (up to ±3.3), suggesting high seasonal variability in the hydrology of this playa lake. The great variability is ascribed to changes in both seasonal temperature (16 °C) and δO of lake water in a drying water body. The latter is attributable to the Rayleigh distillation process, described using a Craig-Gordon model for isotopic fractionation during evaporation from an open water body. Our results suggest that the range of δO values measured in single ostracod carapaces is useful to evaluate seasonal changes in lake temperature and hydrology. Even with great intra-sample δO variability, however, the mean δO of multiple (more than 10) ostracods can be used to infer long-term climate trends. [ABSTRACT FROM AUTHOR]

Objectives: To assess yield of imaging performed as per Indian Society of Pediatric Nephrology (ISPN) urinary tract infection (UTI) guideline. Methods: Ultrasonography (USG), voiding cystourethrography (VCUG) and dimercaptosuccinic-acid (DMSA) scintigraphy were performed in 183 children (age 0-5y) with first episode (age 0-1y) of UTI or recurrent (age <5y) UTI, as per ISPN recommendations. Results: Significant abnormalities were detected in 110 (63%), with vesicoureteric reflux (VUR) grades 3-5 in 31% and renal scars in 43%. Combined USG and DMSA had a negative predictive value of 94% for significant VUR. Conclusion: ISPN guideline resulted in a high yield of detection of significant abnormalities. [ABSTRACT FROM AUTHOR]

The article presents questions and answers related to pediatrics including the differential diagnoses of milky/whitish urine, nephrotic syndrome, and etiology.

Haemophagocytic lymphohistiocytosis (HLH) is a heterogeneous group of clinical syndromes characterised by activation and subsequent uncontrolled non-malignant proliferation of T lymphocytes and macrophages, leading to a cytokine storm that accounts for most of its clinical features such as acute febrile illness, hepatosplenomegaly, multi-organ dysfunction and fulminant pancytopenia-resembling severe sepsis. Here, we present a series of 23 cases of infection-associated HLH diagnosed in our hospital within a time period of last three and half years. Though the presentation and progression of disease was variable, the patients shared some common features like prolonged fever unresponsive to broad spectrum antibiotics, organomegaly and cytopenias. In most of the cases, however, the triggering infectious agent could not be identified. They were treated using a steroid only protocol along with supportive measures and showed an excellent response. [ABSTRACT FROM AUTHOR]

Earthworms are justifying the beliefs of Great Russian scientist Dr. Anatoly Igonin who said they are-' disinfecting, detoxifying, neutralizing, protective and productive'. Studies indicate that some species of earthworms can 'bio-accumulate, biodegrade or bio-transform' any toxic chemicals including 'heavy metals', 'organochlorine pesticide', 'herbicides', and the lipophilic organic micro-pollutants like 'polycyclic aromatic hydrocarbons' (PAHs). Worm vermicasts, due to the presence of 'hydrophilic' groups in the 'lignin contents' and 'humus', also provide wonderful sites for 'adsorption' of heavy metals and chemical pollutants in wastewater. Vermifiltration of wastewater using waste-eater earthworms is a newly conceived novel technology with several economic and environmental advantages. The earthworm's body and the their 'vermicast' work as a 'biofilter' removing BOD by over 90 %, COD by 60-80 %, TDSS by 90-95 %, and toxic chemicals and pathogens from wastewater. This was a pioneering work done on an extremely 'toxic wastewater' from the petroleum industry. It contained mixture of 'aliphatic' and 'aromatic' volatile petroleum hydrocarbons (C 10-C 36) and 'organochlorines' originating from the cooling liquids, waste engine and gear oil, waste transmission and brake fluid, grease, spilled petrol, and diesel oil. The aliphatic fraction contained cycloalkanes as well as a complex mixture of saturated toxic hydrocarbons. The aromatic fraction mainly consisted of PAHs, which are more toxic and persistent than the aliphatic part. The chemicals of concern were the total petroleum hydrocarbons (TPH), dichloromethane (DCM), dichloroethane (DCE), and t-butyl methyl ether (tBME). The tBME compound has raised global concern recently due to its high mobility and persistence in the environment and possible carcinogenicity. About 1,000 earthworms (species Eisenia fetida) were released in the soil of vermifilter bed. They not only tolerated and survived in the toxic petroleum environment but also bio-filtered and bio-remediated the dark-brown petroleum wastewater with a pungent smell into pale-yellow and odorless water indicating disappearance of all toxic hydrocarbons. The hydrocarbons C 10-C 14 were reduced by 99.9 %, the C 15-C 28 by 99.8 %, and the C 29-C 36 by 99.7 % by earthworms. [ABSTRACT FROM AUTHOR]

Although sleep disorders are common in adults with chronic kidney disease, little is known about the prevalence of sleep problems in children and adolescents with chronic kidney disease and their relationship to health-related quality of life measurements. We performed a clinic-based survey of sleep habits and common symptoms of sleep disturbances in 159 school-aged patients with chronic kidney disease. Three patient groups of chronic kidney disease were assessed: group 1, those not on dialysis and not transplanted; group 2, those on dialysis; and group 3, those with a functioning renal allograft. Four symptom domains for sleep disorders were assessed: excessive daytime sleepiness; sleep disordered breathing; restless legs syndrome symptoms; and insufficient sleep. Patients and the parent-proxy also completed the Pediatric Quality of Life Inventory Version 4.0 Generic Core Scales questionnaire. Ninety-three (93) patients (58.5%) had symptoms of a sleep disturbance. The presence of a sleep disturbance correlated with a decrease in health-related quality of life scores that was independent of the chronic kidney disease study group or estimated glomerular filtration rate. We conclude that sleep disturbances are common throughout the spectrum of chronic kidney disease in children and adolescents and are associated with diminished health-related quality of life scores. [ABSTRACT FROM AUTHOR]

Recently there have been great advances in the use of ambulatory blood pressure monitoring (ABPM) in children. A major boost has been the publication of normative data for blood pressure in children. ABPM has been able to detect significant differences in blood pressure in many disease states including chronic renal failure, polycystic kidney disease and post renal transplantation and has helped in identifying both white coat hypertension and masked hypertension. Current evidence does suggest that sole reliance on clinic blood pressure might not be always appropriate and ABPM has a definite role in pediatric hypertension. [ABSTRACT FROM AUTHOR]

Earthworms in general are tolerant to many chemical contaminants including heavy metals and organic pollutants in soil and can bio-accumulate them in their tissues. Earthworms species like Eisenia fetida, Eisenia tetraedra, Lumbricus terrestris, Lumbricus rubellus and Allobophora chlorotica have been found to remove heavy metals (Cd, Pb, Cu, Hg, etc.) pesticides and lipophilic organic micropollutants like the polycyclic aromatic hydrocarbons (PAH) from the soil. They ‘absorb’ the dissolved chemicals through the moist ‘body wall’ in the interstitial water and also ‘ingest’ by mouth while the soil passes through the gut. They either ‘bio-transform’ or ‘biodegrade’ the chemical contaminants rendering them harmless in their bodies. Meanwhile the quality of the soil is improved significantly in terms of physical, chemical and biological properties as the worms thoroughly upturn and disperse the soil, ingest large volumes of soil and excrete nutritive materials (NKP and micronutrients) in the form of ‘vermicasts’ along with millions of beneficial soil microbes including nitrogen fixers. [ABSTRACT FROM AUTHOR]

Earthworms’ body works as a ‘biofilter’ and they have been found to remove the 5 days’ BOD (BOD5) by over 90%, COD by 80–90%, total dissolved solids (TDS) by 90–92%, and the total suspended solids (TSS) by 90–95% from wastewater by the general mechanism of ‘ingestion’ and biodegradation of organic wastes, heavy metals, and solids from wastewater and also by their ‘absorption’ through body walls. Earthworms increase the hydraulic conductivity and natural aeration by granulating the clay particles. They also grind the silt and sand particles, increasing the total specific surface area, which enhances the ability to ‘adsorb’ the organics and inorganic from the wastewater. Intensification of soil processes and aeration by the earthworms enable the soil stabilization and filtration system to become effective and smaller in size. Suspended solids are trapped on top of the vermifilter and processed by earthworms and fed to the soil microbes immobilized in the vermifilter. There is no sludge formation in the process which requires additional expenditure on landfill disposal. This is also an odor-free process and the resulting vermifiltered water is clean and disinfected enough to be reused for farm irrigation and in parks and gardens [ABSTRACT FROM AUTHOR]

A 3.5-year-old girl with fever had a pancytopenic blood smear that also showed schistocytes and blast cells. Bone marrow examination resulted in a diagnosis of acute lymphoblastic leukemia (ALL). Although creatinine on admission was normal, she had mild hematuria and moderate proteinuria. Chemotherapy was started, but she was initially given only steroids (dexamethasone) due to high liver enzymes. Her renal parameters worsened, and her creatinine doubled. She also developed nephrotic-range proteinuria and hypertension. Renal biopsy showed thrombotic microangiopathy that was clinically consistent with hemolytic uremic syndrome (HUS). Some reports of HUS preceding ALL do exist. However, to the best of our knowledge, this is the first case that describes ALL and HUS presenting simultaneously. [ABSTRACT FROM AUTHOR]

Examines the earthworm action on the biodegradation of community wastes. Secretion of enzymes for the biochemical conversion of cellulosic and proteinaceous materials; Reduction in the composting time; Efficacy of earthworm action in the natural biodegradation and decomposition of wastes.

Focuses on the availability of the commercial composting slurry technology in India. Role of microbes in the technology; Process of composting; Range of the composting.

Presents a case study on the impact of mining on the human ecosystem from Bijolia quarrying area in Rajasthan, India. Hazards caused to nature by the extraction and processing of ores; Significance of scientific mining and judicious use of geological resources in providing ecological security and economic prosperity.

Pediatric hypertension is usually secondary to an underlying identifiable cause, most often renal. Hypertension with low Plasma Rennin Activity (PRA), although rare, is important as it is often familial and is associated with single gene disorders (monogenic). It hence carries greater genetic implications for the family. The authors' hereby report a case of low PRA hypertension which was diagnosed as Liddle Syndrome, an autosomal dominant form of hereditary hypertension. Early detection and appropriate treatment may help to improve the long term morbidity and mortality in children with this condition. [ABSTRACT FROM AUTHOR]

Hereditary spherocytosis (HS) and distal renal tubular acidosis (dRTA), although distinct entities, share the same protein i.e. the anion exchanger1 (AE1) protein. Despite this, their coexistence has been rarely reported. We hereby describe the largest family to date with coexistence of dRTA and HS and discuss the molecular basis for the co-inheritance of these conditions. [ABSTRACT FROM AUTHOR]

Fanconi -Bickel Syndrome (FBS) is described as an autosomal recessive Glycogen Storage Disorder type XI. The underlying enzyme defect is unknown. The gene GLUT2 maps to 3q26.1-q26.3; encodes a facultative glucose transporter gene. A 6-y-old girl presented with the characteristic facial gestalt, glucose and galactose intolerance, proximal renal tubular dysfunction, hepatomegaly, and altered liver function. To confirm the diagnosis, mutation analysis was performed. Patient showed homozygous mutation in exon 9 of GLUT2 gene 1093 C>T, the mutation causing transition from arginine to stop codon at position 365 and causing premature termination of protein. The mutation was found to be causative as previously described. To the best of authors' knowledge this is first Indian patient ever reported with a mutation. Genetic testing can be employed as a method of confirming diagnosis, especially where definitive mutation can be useful for prenatal diagnosis and prognostication. [ABSTRACT FROM AUTHOR]

The Ganga River is facing mounting environmental pressures due to rapidly increasing human population, urbanisation, industrialisation and agricultural intensification, resulting in worsening water quality, ecological status and impacts on human health. A combined inorganic chemical, algal and bacterial survey (using flow cytometry and 16S rRNA gene sequencing) along the upper and middle Ganga (from the Himalayan foothills to Kanpur) was conducted under pre-monsoon conditions. The upper Ganga had total phosphorus (TP) and total dissolved nitrogen concentrations of less than 100 μg l−1 and 1.0 mg l−1, but water quality declined at Kannauj (TP = 420 μg l−1) due to major nutrient pollution inputs from human-impacted tributaries (principally the Ramganga and Kali Rivers). The phosphorus and nitrogen loads in these two tributaries and the Yamuna were dominated by soluble reactive phosphorus and ammonium, with high bacterial loads and large numbers of taxa indicative of pathogen and faecal organisms, strongly suggesting sewage pollution sources. The high nutrient concentrations, low flows, warm water and high solar radiation resulted in major algal blooms in the Kali and Ramganga, which greatly impacted the Ganga. Microbial communities were dominated by members of the Phylum Proteobacteria, Bacteriodetes and Cyanobacteria, with communities showing a clear upstream to downstream transition in community composition. To improve the water quality of the middle Ganga, and decrease ecological and human health risks, future mitigation must reduce urban wastewater inputs in the urbanised tributaries of the Ramganga, Kali and Yamuna Rivers. [ABSTRACT FROM AUTHOR]