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Background and Aims: Cardiovascular diseases are the leading causes of morbidity and mortality in chronic kidney disease (CKD) patients. Our aim was to derive predictors of cardiac morbidity, mortality, cardiac complications and to develop/validate a scoring tool in patients with CKD undergoing non-cardiac surgery. Methods: A prospective observational multicentre study was done on 770 patients with CKD. The primary outcome ('Event') was one or more than one of sudden cardiac death, pulmonary oedema, acute coronary syndrome, arrhythmia and 30-day mortality. Secondary outcome was hypertension and hypotension. Predictors of cardiac risk were identified. A scoring tool was developed on the 2018 dataset and was validated on the 2019 dataset. Results: The overall incidence of cardiac events was 290 (37.66) whereas the incidence of major adverse cardiac and cerebrovascular events was 15.04. Mortality due to cardiac cause was 13 (1.68). On multivariate regression analysis, seven perioperative variables had significant association with increased risk of events: age > 65 years (P = 0.004), metabolic equivalents (METS) ≤4 (P≤0.032), emergency surgery (P =0.032), mean arterial pressure >119 (P = 0.001), echocardiographic scoring (P = 0.054), type of anaesthesia (P ≤ 0.0001) and type of surgery (P = 0.056). Using these variables, a risk stratification tool was developed. C statistics showed favourable predictive accuracy (0.714) and the model showed good calibration. Conclusion: This risk scoring tool based on preoperative variables will help to predict the risk of events in high-risk CKD patients undergoing non-cardiac surgery. This will help in better counselling and optimisation. Keywords: Cardiovascular diseases, death,sudden cardiac, perioperative care, renal insufficiency chronic, risk assessment, Author(s): Alka Sachin Deo (corresponding author) [1]; Rijuta Kashyapi [2]; Veena Joshi [3]; Parimala Balakundi [1]; Padmalatha Raman [1] INTRODUCTION Cardiovascular complications after non-cardiac surgeries are major contributors to postoperative [...]

The components of the effective dose through inhalation from radon and its progeny are important for human health since they contribute to more than 50% of the total radiation dose from natural sources. As a consequence, radon has been identified as the second leading cause of lung cancer after smoking. Radon and its short lived decay products (218Po, 214Pb, 214Bi, 214Po) present in dwellings are a radiation hazard, particularly if such sources are concentrated in the enclosed areas like poorly ventilated houses and underground mines. The indoor radon, thoron, and progeny concentrations were measured in a small hilly town of Budhakedar and the surrounding area of Tehri Garhwal, India, by using LR-115 Type II plastic track detector in a twin cup radon dosimeter. The concentrations of radon progeny were measured as the highest in winter and the lowest in summer while the thoron progeny concentration was found maximum in rainy season and minimum in autumn. The annual exposure to the potential alpha energy of radon and thoron were found to vary from 0.04 WLM to 0.69 WLM with an average value of 0.29 WLM, and 0.03 WLM to 0.37 WLM with an aver- age value of 0.16 WLM, respectively. The annual effective dose due to the exposure to indoor radon and progeny in Budhakedar homes was found to vary from 0.16 mSv to 2.72 mSv with an average value of 1.14 mSv and the effective dose due to the exposure to thoron and progeny was found to vary from 0.18 mSv to 2.49 mSv with an average value of 1.05 mSv. The results of systematic study have been obtained by considering the room as a space in which the radon and thoron levels are directly related to the dynamic and static parameters.

Effective intervention design sould be part of the economic development plans of the area for which it is formulated. Integrated planning should fuse the energy plan with economic development plans instead of integrating energy sources and technologies. Intervention design should augment and facilitate economically productive activities aside from fulfilling subsistence requirements. Interventions should be identified for systems whose boundaries correspond to the biomass system's boundaries.

Abstract Background Kidney disease is the 9th leading cause of death in Singapore. While preventive effects have focused on early detection and education, little is known about the knowledge level of chronic kidney disease (CKD) locally. We seek to evaluate the knowledge of CKD among primary care patients. Methods We conducted a cross-sectional survey of a convenience sample of 1520 patients from 3 primary care centers. Those with existing CKD or on dialysis were excluded. Knowledge was assessed based on 7 questions on CKD in the self-administered questionnaire. One point was given for each correct answer with a maximum of 7 points. Results 1435 completed all 7 questions on CKD. Mean age was 48.9 ±15.0 (SD) years. 50.9% were male. 62.3% had a secondary and below education and 52.4% had a monthly household income of ≤ $2000. 43.7% had chronic diseases. Mean score was 3.44 ± 1.53 (out of a maximum of 7). Median score was 4. In multivariate logistic regression, being older {>60 years [Odds Ratio (OR) 0.50, 95% Confidence Interval (CI) 0.32-0.79]; 40–60 years (OR 0.62, 95% CI 0.43,0.89)}, less educated [up to primary education (OR 0.33, 95% CI 0.22-0.49)], having a lower monthly household income [ Conclusion This suggests that CKD education should be targeted at older patients with lower education and lower socioeconomic status.

Abstract Background In Singapore, the prevalence of end-stage renal disease (ESRD) and the number of people on dialysis is increasing. The impact of ESRD on patient quality of life has been recognized as an important outcome measure. The Kidney Disease Quality Of Life-Short Form (KDQOL-SF™) has been validated and is widely used as a measure of quality of life in dialysis patients in many countries, but not in Singapore. We aimed to determine the reliability and validity of the KDQOL-SF™ for haemodialysis patients in Singapore. Methods From December 2006 through January 2007, this cross-sectional study gathered data on patients ≥21 years old, who were undergoing haemodialysis at National Kidney Foundation in Singapore. We used exploratory factor analysis to determine construct validity of the eight KDQOL-SF™ sub-scales, Cronbach's alpha coefficient to determine internal consistency reliability, correlation of the overall health rating with kidney disease-targeted scales to confirm validity, and correlation of the eight sub-scales with age, income and education to determine convergent and divergent validity. Results Of 1980 haemodialysis patients, 1180 (59%) completed the KDQOL-SF™. Full information was available for 980 participants, with a mean age of 56 years. The sample was representative of the total dialysis population in Singapore, except Indian ethnicity that was over-represented. The instrument designers' proposed eight sub-scales were confirmed, which together accounted for 68.4% of the variance. All sub-scales had a Cronbach's α above the recommended minimum value of 0.7 to indicate good reliability (range: 0.72 to 0.95), except for Social function (0.66). Correlation of items within subscales was higher than correlation of items outside subscales in 90% of the cases. The overall health rating positively correlated with kidney disease-targeted scales, confirming validity. General health subscales were found to have significant associations with age, income and education, confirming convergent and divergent validity. Conclusions The psychometric properties of the KDQOL-SF™ resulting from this first-time administration of the instrument support the validity and reliability of the KDQOL-SF™ as a measure of quality of life of haemodialysis patients in Singapore. It is, however, necessary to determine the test-retest reliability of the KDQOL-SF™ among the haemodialysis population of Singapore.

Context: Studies have reported that clinical research has experienced tremendous growth during past few decades with many multinational pharmaceutical companies recruiting millions of Indians in clinical trials (CTs). However, there is hardly any literature that talks about the participants, their knowledge, and awareness of CTs. It is important that the general public is aware about CTs so that they can take their own informed decision to participate in CTs. Aim: To assess public awareness, perceptions, and attitudes toward CTs and their views on various methods to create awareness about CTs. Materials and Methods: Cross sectional survey was conducted with 200 non trial participants (NTPs) and 40 trial participants (TPs). Results: TPs were significantly (P < 0.0001) older than NTPs. More than 80% of both TPs and NTPs mentioned participation in CT helps advance medical science and strongly felt that there is a need to create awareness about CTs. Nearly 70% of TPs could not remember the phase of the trial while 20% did not know which type of trial they had participated. The main reason for participation in the trial was physician's advice. About 80% of both TPs and NTPs felt that participation in CT will increase with free medications and advice from friends/relatives who had good experience with trial. Conclusion: Results of this pilot study revealed need to create CT awareness among the general public. However, considering ethno-cultural, regional, and literacy-level differences throughout the country, a nationwide study would be appropriate to provide reliable results about awareness of CTs among Indians. [ABSTRACT FROM AUTHOR]

Background: Kidney disease is the 9th leading cause of death in Singapore. While preventive effects have focused on early detection and education, little is known about the knowledge level of chronic kidney disease (CKD) locally. We seek to evaluate the knowledge of CKD among primary care patients. Methods: We conducted a cross-sectional survey of a convenience sample of 1520 patients from 3 primary care centers. Those with existing CKD or on dialysis were excluded. Knowledge was assessed based on 7 questions on CKD in the self-administered questionnaire. One point was given for each correct answer with a maximum of 7 points. Results: 1435 completed all 7 questions on CKD. Mean age was 48.9 ±15.0 (SD) years. 50.9% were male. 62.3% had a secondary and below education and 52.4% had a monthly household income of≤$2000. 43.7% had chronic diseases. Mean score was 3.44 ± 1.53 (out of a maximum of 7). Median score was 4. In multivariate logistic regression, being older {>60 years [Odds Ratio (OR) 0.50, 95% Confidence Interval (CI) 0.32-0.79]; 40–60 years (OR 0.62, 95% CI 0.43,0.89)}, less educated [up to primary education (OR 0.33, 95% CI 0.22-0.49)], having a lower monthly household income [

Quartz sand grains obtained from a deeply gullied topography along the banks of two tributaries of River Pravara in Maharashtra (India) have been examined with a scanning electron microscope (SEM). Quartz grains have been selected after a heavy mineral separation and micro-photographs of each grain were taken at various angles and magnifications. The sediments reveal features resulting from mechanical grinding as well as from chemical alteration. Conchoidal fractures, cleavage planes, grooves, v-shaped indentations etc. are the mechanical features documented on the grains whereas solution pits of varying sizes and intensity, precipitation surfaces, oriented v-pits, solution crevasses and etching are the features of chemical origin. Several evidences indicate that the samples have undergone digenetic changes. Few grains show the features of intense chemical breakdown. The overall assemblages of the grain surface features suggest that the samples have been subjected to subaqueous transport for a considerable period of time. The minor chemical features such as solution pits or semi circular arcuate steps found in abundance on these grains are due to the dissolution of the sediments in a low energy fluviatile environment. For clay mineralogy, fractions between <2 and <0.2 mm were separated out from the sediments. The clay fractions were then subjected to examination by X-ray diffraction (XRD) of oriented K/Ca saturated samples using a Philips Diffractometer and Nifiltered Cu Ka radiation with the scanning speed of 10 2ϴ min -1. The main clay minerals for all the samples are identical and show the presence of hydroxy-interlayered smectites with minor quantities of mica, kaolinite, smectites, quartz and feldspar. The first weathering product of the Deccan Basalt (DB) is the dioctahedral smectite. Since the present semi aridic climatic condition of the study area can not transform a smectite to HIS and either smectite to kaolin, it is quite likely that both the HIS and Sm/K are generated in the tropical humid climate of the Western Ghats and then carried through the exiting river system like Godavari, Adula and Mahalungi. Therefore it is evident that the clay minerals present in these sediments represent another climatic history more humid than the one prevailing at present. [ABSTRACT FROM AUTHOR]

The prevalence of gastrointestinal (GI) cancer is increasing across diverse regions of India, demanding further investigation at the state level. In response, a new department of surgical gastroenterology was started at a tertiary-care hospital in Pune, Western Maharashtra, in 2019. The objective of this study was to explore the pattern of admissions in terms of demographics and types of GI cancers over the last four years (i.e., 2020-2023). Retrospective admissions data were collected from hospital records for 2020-2023. A total of 2294 patients were treated at the outpatient department (OPD), and 135 patients were admitted to the inpatient department (IPD). The data comprised OPD/IPD admissions, age, gender, diagnosis, and length of stay (LoS). In addition to basic statistical reporting, t-tests were used to explore differences among the study variables. Out of 135 GI cancer patients, 57% were male. The mean age of inpatients per year ranged from 53 to 60 years, with an average age of 56.35 ± 10.14 years. The average LoS was 12.31 ± 9.39 days. From 2020 to 2023, the number of admissions increased from 5 to 57. The increase was more pronounced in men than women (57% vs. 43%, respectively). Furthermore, increased admission of younger patients was observed, and the average LoS decreased from 17 to 11 days from 2020 to 2023, respectively. A statistically significant difference in LoS (p = 0.023) was observed based on gender, where LoS was longer for women than for men on average (13.5 ± 10.8 vs. 9.46 ± 8.28, respectively). As GI cancer incidence is predicted to continue to increase in India, these new estimates will help to plan cancer prevention and control through intervention via   early detection and management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Subcommittee, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune issued approval I.E.SC./W/32/2024, dated 15/04/2024. The committee did not find any ethically objectionable toward publication of the manuscript. Hence, waiver is granted for this manuscript. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Thombare et al.)