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Objectives: Objective is to study the clinical profile of retinal vasculitis in a tertiary eye care Centre in South Kerala. Materials and Methods: All consecutive patients diagnosed with retinal vasculitis in a tertiary eye care Centre over a period of one year were evaluated for ocular and systemic risk factors for developing the disease. Patients more than 10 years of age were included in the study. Patients with diabetic and hypertensive retinopathy were excluded from the study. Data was collected using a pretested proforma. Demographic variables, risk factors, symptoms, clinical signs and visual acuity at presentation were studied. Examination tools used were Log MAR chart, slit lamp, direct & indirect ophthalmoscope. Results: 38 eyes of 28 patients were included in the study. Defective vision and floaters were the main symptoms whereas vitritis and vascular sheathing were the most common signs. Secondary retinal vasculitis (82.2%) was more common than primary retinal vasculitis (17.8%). Also infectious etiology was commoner than autoimmune diseases. Unilateral disease was common in secondary retinal vasculitis. Toxoplasma gondii was the most common agent associated with secondary retinal vasculitis in our hospital. Keywords: Frosted branch angiitis, Investigations, Occlusive vasculitis, Retinal vasculitis, Toxoplasma.

Purpose: To study the anatomical and functional outcomes, complications and reasons for failure of scleral buckling in primary rhegmatogenous retinal detachment Design: Prospective Observational Study Materials and Methods: 17 eyes of 16 consecutive patients who had undergone scleral buckling for rhegmatogenous retinal detachment at a tertiary care teaching Ophthalmic Institute in South India from January 2015 were taken up for the study. Important points like history of trauma, spectacle use and cataract surgery were noted from the history. Detailed evaluation including snellen visual acuity converted to Logmar vision, Slit Lamp Evaluation, Fundus examination, Applanation tonometry etc were done and documented before surgery and the same parameters were again noted during the follow up examinations on the first post operative day and then at 2 weeks, 4 weeks, 3months and 6 months. Surgical parameters like number and location of breaks, macular status, type of buckling etc were also recorded diligently. Results: 15 Out of the 17 eyes (88%) achieved anatomical success with the retina attached at 4 weeks of post operative follow up. The cause of failure in the remaining 2 cases was missed retinal breaks and were rescued by vitrectomy. The mean average pre operative vision was 2.23 which improved to a mean average vision of 1.49, 1.30, 1.15, 1.04, 1.01 at 1st post operative day, 2weeks, 4 weeks, 3months and 6 months respectively. The change was found to be significant. The macula on RRDs (4 eyes) had better visual improvement with mean pre op Logmar vision improving from 0.842 to a post op Logmar vision of 0.37 and 0.15 at 4 weeks and 6 months respectively. Conclusions: Scleral buckling provides a reasonably good anatomical outcome in properly selected cases of primary rhegmatogenous retinal detachment. It also provides a moderate visual outcome. The post operative visual outcome depends mainly on the pre operative status of macula. The main cause for failure of sclera

In this modern era of global competition, factors such as customer expectation and customer satisfaction vitally contributes towards the success of any industry and the Indian banking industry is not an exception. The role of customers is The existing Indian banking landscape customers play a vital role. It is the responsibility of banks to satisfy the customers in order to retain them for their very survival and success. Customer’s expectations and customer satisfaction and service quality are highly related. The banks should be able to minimize and eliminate the gap between perceived service quality of customers and the actual service provided. The present paper evaluates the level of service quality is in commercial bank in Kerala. The study also attempted to ascertain the dimensions of service quality in banks. . The present work finds out that tangibility and assurance as the foremost dimensions of service quality with their key influence on the customers. But, both the parameters of responsiveness and empathy show a lower level of satisfaction among the customers. It is suggested to the banking sector that apart from ensuring the trust of customers, it should improve their operations in providing highly advanced technological services to the customers with easy access and instant delivery features. . Thus, by providing enhanced quality in the banking services, the banks would be able to create a whole gamut of satisfied customers which would ultimately lead to further the efficiency and performance in the banking landscape.

Background: Micro-incision vitrectomy surgery otherwise called minimally invasive vitrectomy surgery (MIVS) is undoubtedly one of the most impressive evolutions in the surgical retina field of the past decade. This self-healing suture less procedure is safe and reliable with rapid visual recovery. The present study enlightens the visual outcome following MIVS for rhegmatogenous retinal detachment.Methods: This prospective study was done in 68 patients who underwent MIVS for rhegmatogenous retinal detachment. A detailed ocular examination of the patients undergoing MIVS was done. Outcome of the surgery was assessed in terms of functional and anatomical success after one week, 6 weeks and third month.Results: Of the 68 patients, maximum number of patients was in the age group of 51-60 years. Risk factors were previous cataract surgery in 28%, lattice degeneration in 26%, trauma in 22%, myopia in 18% and no specific risk factors in 6%. Mean preoperative BCVA was log MAR 2.16±0.37 and mean post-operative BCVA was log MAR 1.22±0.35 with p value of

The region around Wadakkancheri, Trichur District, Kerala is known for microseismic activity, since 1989. Studies, subsequent to 2nd December 1994 (M =4.3) earthquake, identified a south dipping active fault (Desamangalam Fault) that may have influenced the course of Bharathapuzha River. The ongoing seismicity is concentrated on southeast of Wadakkancheri and the present study concentrated further south of Desamangalam Fault. The present study identifies the northwestern continuity of NW–SE trending Periyar lineament, which appears to have been segmented in the area. To identify the subtle landform modifications induced by ongoing tectonic adjustments, we focused on morphometric analysis. The NW–SE trending lineaments appear to be controlling the sinuosity of smaller rivers in the area, and most of the elongated drainage basins follow the same trend. The anomalies shown in conventional morphometric parameters, used for defining basins, are also closely associated with the NW–SE trending Periyar lineament/s. A number of brittle faults that appear to have been moved are consistent with the present stress regime and these are identified along the NW–SE trending lineaments. The current seismic activities also coincide with the zone of these lineaments as well as at the southeastern end of Periyar lineament. These observations suggest that the NW–SE trending Periyar lineaments/faults may be responding to the present N–S trending compressional stress regime and reflected as the subtle readjustments of the drainage configuration in the area.

The great 1934 Himalayan earthquake of moment magnitude (Mw) 8.1 generated a large zone of ground failure and liquefaction in north Bihar, India, in addition to the earthquakes of 1833 (Mw similar to 7.7) and 1988 (Mw 6.7) that have also impacted this region. Here, we present the results of paleoliquefaction investigations from four sites in the plains of north Bihar and one in eastern Uttar Pradesh. The liquefaction features generated by successive earthquakes were dated at AD 829-971, 886-1090, 907-1181, 1130-1376, 1112-1572, 1492-1672, 1733-1839, and 1814-1854. One of the liquefaction events dated at AD 829-971, 886-1090, and 907-1181 may correlate with the great earthquake of AD similar to 1100, recognized in an earlier study from the sections across the frontal thrust in central eastern Nepal. Two late medieval liquefaction episodes of AD 1130-1376 and 1492-1672 were also exposed in our sites. The sedimentary sections also revealed sandblows that can be attributed to the 1833 earthquake, a lesser magnitude event compared to the 1934. Liquefactions triggered by the 1934 and 1988 earthquakes were evident within the topmost level in some sections. The available data lead us to conjecture that a series of temporally close spaced earthquakes of both strong and large types, not including the infrequent great earthquakes like the 1934, have affected the Bihar Plains during the last 1500 years with a combined recurrence interval of 124 +/- 63 years.

The Achankovil shear system is one of the major crustal scale structures in Peninsular India. This NW-SE trending shear zone stretches across the Western Ghats for a strike length of 120 km. A number of parallel lineaments demarcate this 15-20 km wide shear zone. Many studies were carried out to understand the origin and delineation of this structure. Low level seismicity reported in this region, however, does not suggest any relation with this shear zone and thus no significant study was carried out to understand its neotectonic behavior. However, there are a couple of faults identified in the southern end of this shear system viz., Thenmala and Thenmala south faults. Even though these faults were demarcated in hilly terrain of Western Ghats, its expression into the plain area east of the mountain terrain were not identified during the earlier studies. The present study however, delineated the signatures of these faults further in the southeast from satellite images. The traces of these faults are observed as multiple slip planes with varying deformation pattern. A group of N-S trending lineaments are also observed in hill ranges. Similarly, N-S trending long persistent vertical joints are observed in the plain area are free from displacement. The traces of NW-SE trending brittle faults observed in these areas crosscut all the joints including the N-S trending vertical ones. These observations suggest that the geomorphic signature associated with Thenmala lineaments may represent the youngest deformation (brittle) of the region.

The Himalaya has experienced three great earthquakes during the last century1934 Nepal-Bihar, 1950 Upper Assam, and arguably the 1905 Kangra. Focus here is on the central Himalayan segment between the 1905 and the 1934 ruptures, where previous studies have identified a great earthquake between thirteenth and sixteenth centuries. Historical data suggest damaging earthquakes in A.D. 1255, 1344, 1505, 1803, and 1833, although their sources and magnitudes remain debated. We present new evidence for a great earthquake from a trench across the base of a 13m high scarp near Ramnagar at the Himalayan Frontal Thrust. The section exposed four south verging fault strands and a backthrust offsetting a broad spectrum of lithounits, including colluvial deposits. Age data suggest that the last great earthquake in the central Himalaya most likely occurred between A.D. 1259 and 1433. While evidence for this rupture is unmistakable, the stratigraphic clues imply an earlier event, which can most tentatively be placed between A.D. 1050 and 1250. The postulated existence of this earlier event, however, requires further validation. If the two-earthquake scenario is realistic, then the successive ruptures may have occurred in close intervals and were sourced on adjacent segments that overlapped at the trench site. Rupture(s) identified in the trench closely correlate with two damaging earthquakes of 1255 and 1344 reported from Nepal. The present study suggests that the frontal thrust in central Himalaya may have remained seismically inactive during the last similar to 700years. Considering this long elapsed time, a great earthquake may be due in the region.

Gold occupies a pivotal role in the social and economic life of poor and rich alike. In India, besides the economic and strong social considerations, individuals are highly sentimental about the gold in their possession, as the gold ornaments are passed on from one generation to another. Acquisition of gold is considered auspicious and necessary for making family ornaments to get a sense of wellbeing in our country. Gold is increasingly considered as an investment that appreciates over years and provides a hedge against inflation and also medium that can be pledged easily during difficult times for securing financial accommodation.

Semantic web sites that are designed and developed using well defined software quality parameters particularly those related to customers' satisfaction should perform well over the global business. In this paper several parameters are considered and a parameter matrix is proposed. A number of leading websites have been evaluated using this matrix and the evaluation results are presented.

The effects of blend ratio, compatibilization and vulcanization on the permeability of O2 and N2 gas through HDPE/EVA blends were analyzed. As the volume fraction of EVA in the blend increases the permeability increases. The variation in permeability is correlated with the phase morphology. Oxygen exhibits a higher permeability than nitrogen because the “kinetic diameter” of N2 is greater than that of O2. The O2/N2 selectivity of HDPE is higher than that of EVA and as a result the selectivity decreases with increase in EVA content in the system. The O2 and N2 permeabilities decrease and O2/N2 selectivity increase upon compatibilization and dynamic vulcanization. The experimental gas permeabilities in HDPE/EVA blends are compared with several theoretical models of permeation.

Encapsulating peritoneal sclerosis (EPS) is a serious condition whose frequency is increasing the longer the duration of peritoneal dialysis. To identify prognostic indicators of EPS, we studied here longitudinal changes in peritoneal membrane function of patients who later developed this complication. We identified all patients with an unequivocal diagnosis of EPS who began their peritoneal dialysis in our unit over a 20-year period and matched each of them for dialysis duration and age with four control patients who completed their dialysis. The dialysate/plasma creatinine ratio increased with time in both groups but was significantly higher in the patients with EPS only at the time their dialysis was discontinued. The ultrafiltration capacity was significantly worse for at least 2 years before stopping dialysis, diverging further at the time dialysis ceased, suggesting reduced osmotic conductance in the EPS patients. Both the glucose exposure rate for the 5 years preceding stoppage of dialysis and exposure to the osmotic agent icodextrin were significantly higher. Residual renal function was less in the EPS group, but there was no significant difference in the rates of peritonitis compared to the control group. The 24 h peritoneal protein clearance was not significantly different in EPS patients, possibly due to a greater fibrous matrix. Thus, our study shows that regular peritoneal membrane function tests can identify most patients at high risk of developing EPS before its occurrence.

The melt rheological behavior of high-density polyethylene (HDPE)/ethylene vinyl acetate (EVA) blends has been examined with reference to the effect of blend ratio, shear stress, and temperature. The HDPE/EVA blends exhibit pseudoplastic behavior, and the observed rheological behavior of the blends was correlated with the extrudate morphology. The experimental values of the viscosity were compared with the theoretical models. The effect of maleic- and phenolic-modified PE compatibilizers on the viscosity of H70 blend was analyzed and found that compatibilization did not significantly increase the viscosity. The effect of dynamic vulcanization and temperature on the viscosity was also analyzed. The activation energy of the system decreased with increase in EVA content in the system. The phase continuity and phase inversion points of the blends were theoretically predicted and compared with the experimental values. The melt flow index (MFI) values of the blends were also determined and found that the MFI values decreased with increase in EVA content in the system. POLYM. ENG. SCI., 2010. © 2009 Society of Plastics Engineers

The region around Waclakkancheri, in the province of Kerala, India, which lies in the vicinity of Palghat-Cauvery ;hear zone (within the Precambrian crystalline terrain), has been a site of microseismic activity since 1989. Earlier studies had identified a prominent WNW-ESE structure overprinting on the E-W trending lineaments associated with Palghat-Cauvery shear zone. We have mapped this structure, located in a chamockite quarry near Desamangalam, Waclakkancheri, which we identify as a ca. 30 km-long south dipping reverse fault. This article presents the characteristics of this fault zone exposed on the exhumed crystalline basement and discusses its significance in understanding the earthquake potential of the region. This brittle deformation zone consists of fracture sets with small-scale displacement and slip planes with embedded fault gouges. The macroscopic as well as the microscopic studies of this fault zone indicate that it evolved through different episodes of faulting in the presence of fluids. The distinct zones within consolidated gouge and the cross cutting relationship of fractures indicate episodic fault activity. At least four faulting episodes can be recognized based on the sequential development of different structural elements in the fault rocks. The repeated ruptures are evident along this shear zone and the cyclic behavior of this fault consists of co-seismic ruptures alternating with inter-seismic periods, which is characterized by the sealed fractures and consolidated gouge. The fault zone shows a minimum accumulated dip/oblique slip of 2.1 m in the reverse direction with a possible characteristic slip of 52 cm (for each event). The ESR dating of fault gouge indicates that the deformation zone records a major event in the Middle Quaternary. The empirical relationships between fault length and slip show that this fault may generate events M >= 6. The above factors suggest that this fault may be characterized as potentially active. Our study offers some new pointers that can be used in other slow deforming cratonic hinterlands in exploring the discrete active faults.

Given the lack of proper constraints in understanding earthquake mechanisms in the cratonic interiors and the general absence of good quality database, here we reassess the seismic hazard in the province of Kerala, a part of the •stable continental interior•, based on an improved historical and instrumental database. The temporal pattern of the current seismicity suggests that >60% of the microtremors in Kerala occurs with a time lag after the peak rainfall, indicating that hydroseismicity may be a plausible model to explain the low-level seismicity in this region. Further, an increment in overall seismicity rate in the region in the recent years is explained as due to increased anthropogenic activities, which includes changes in hydrological pathways as a consequence of rapid landscape changes. Our analyses of the historical database eliminate a few events that are ascribed to this region; this exercise has also led to identification of a few events, not previously noted. The improved historical database essentially suggests that the central midland region is more prone to seismic activity compared to other parts of Kerala. This region appears to have generated larger number of significant earthquakes; the most prominent being the multiple events (doublets) of 1856 and 1953, whose magnitudes are comparable to that of the 2000/2001 (central Kerala) events. Occurrences of these historical events and the recent earthquakes, and the local geology indicative of pervasive faulting as shown by widely distributed pseudotachylite veins suggest that the NNW-SSE trending faults in central midland Kerala may host discrete potentially active sources that may be capable of generating light to moderate size earthquakes. The frequency of earthquakes in central Kerala evident from the historical database requires that the seismic codes stipulated for this region are made mandatory.

The effects of the blend ratio, reactive compatibilization, and dynamic vulcanization on the dynamic mechanical properties of high-density polyethylene (HDPE)/ethylene vinyl acetate (EVA) blends have been analyzed at different temperatures. The storage modulus of the blend decreases with an increase in the EVA content. The loss factor curve shows two peaks, corresponding to the transitions of HDPE and EVA, indicating the incompatibility of the blend system. Attempts have been made to correlate the observed viscoelastic properties of the blends with the blend morphology. Various composite models have been used to predict the dynamic mechanical data. The experimental values are close to those of the Halpin–Tsai model above 50 wt % EVA and close to those of the Coran model up to 50 wt % EVA in the blend. For the Takayanagi model, the theoretical value is in good agreement with the experimental value for a 70/30 HDPE/EVA blend. The area under the loss modulus/temperature curve (LA) has been analyzed with the integration method from the experimental curve and has been compared with that obtained from group contribution analysis. The LA values calculated with group contribution analysis are lower than those calculated with the integration method. The addition of a maleic-modified polyethylene compatibilizer increases the storage modulus, loss modulus, and loss factor values of the system, and this is due to the finer dispersion of the EVA domains in the HDPE matrix upon compatibilization. For 70/30 and 50/50 blends, the addition of a maleic-modified polyethylene compatibilizer shifts the relaxation temperature of both HDPE and EVA to a lower temperature, and this indicates increased interdiffusion of the two phases at the interface upon compatibilization. However, for a 30/70 HDPE/EVA blend, the addition of a compatibilizer does not change the relaxation temperature, and this may be due to the cocontinuous morphology of the blends. The dynamic vulcanization of the EVA phase with dicumyl peroxide results in an increase in both the storage and loss moduli of the blends. A significant increase in the relaxation temperature of EVA and a broadening of the relaxation peaks occur during dynamic vulcanization, and this indicates the increased interaction between the two phases. © 2003 Wiley Periodicals, Inc. J Appl Polym Sci 87: 2083–2099, 2003

The field investigations in the epicentral area of the 1994 Wadakkancheri (Desamangalam), Kerala, earthquake (M 4.3) indicate subtle, but clearly recognizable expressions of geologically recent fault zone, consisting of fracture sets showing brittle displacement and a gouge zone. The fracture zone confines to the crystalline basement, and is spatially coincident with the elongation of the isoseismals of the 1994 mainshock and a 10-km-long WNW-ESE trending topographic lineament. The preliminary results from the electron spin resonance (ESR) dating on the quartz grains from the fault gouge indicate that the last major faulting in this site occurred 430 ± 43 ka ago. The experiments on different grain sizes of quartz from the gouge showed consistent decrease in age to a plateau of low values, indicating that ESR signals in finer grains were completely zeroed at the time of faulting due to frictional heat. The results show a relatively young age for displacement on the fault that occurs within a Precambrian shear zone. Discrete reactivated faults in such areas may be characterized by low degree of activity, but considering the ESR age of the last significant faulting event, the structure at Desamangalam may be categorized as a potentially active fault capable of generating moderate earthquakes, separated by very long periods of quiescence.

Maghsoudi, Behzad/0000-0002-1279-8799; Kritsotakis, Evangelos/0000-0002-9526-3852; Yalcin, Ata Nevzat/0000-0002-7243-7354; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; ALDEMIR KOCABAS, Bilge/0000-0002-6396-5243; Masjedi, Mohammad Reza/0000-0002-6871-382X; Masjedi, Mansoor/0000-0001-6175-9289; Gan, Chin Seng/0000-0002-6758-4798; Oncul, Oral/0000-0002-1681-1866; Sabetian, Golnar/0000-0001-8764-2150; YAMAN, Ayhan/0000-0002-5651-1286; Ozdemir, Halil/0000-0002-7318-1688; Leon, Hector Armando Rincon/0000-0003-0715-200X; Delia, Muntean/0000-0001-9100-4530; Atasay, Fatma Begum/0000-0002-9114-5293; Zand, Farid/0000-0003-3489-3372; Kuchenbecker, Ricardo/0000-0002-4707-3683; Medeiros, Eduardo A/0000-0002-6205-259X; ROMERO LOPEZ-ALBERCA, CRISTINA/0000-0001-5856-8668; Salomao, Reinaldo/0000-0003-1149-4598; ozdemir, sonay incesoy/0000-0003-2863-901X; Meco, Basak Ceyda/0000-0003-2951-9634; Horoz, Ozden Ozgur/0000-0001-7590-650X; Horhat, Florin George/0000-0001-6133-0204; Kazi, Mohammad Mukhit/0000-0003-3824-5540; Ciftci, Ergin/0000-0002-4955-160X; Abouqal, Redouane/0000-0002-6117-4341; Leblebicioglu, Hakan/0000-0002-6033-8543; Garcell, Humberto Guanche/0000-0001-7279-0062; Kendirli, Tanil/0000-0001-9458-2803; de Souza, Maria Cecilia B V/0000-0003-0318-3087; Sanaei Dashti, Anahita/0000-0002-2827-3575; UNAL, SERHAT/0000-0003-1184-4711; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Barahona G., Nayide/0000-0003-3559-6900; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Karabay, Oguz/0000-0003-0502-432X; Kaya, Sehnaz/0000-0003-0002-1517; ERDEVE, OMER/0000-0002-3193-0812; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Gikas, Achilleas/0000-0002-8455-9631; Baylan, Orhan/0000-0002-6529-7824; Mitrev, Zan/0000-0001-7859-8821; yildizdas, dincer/0000-0003-0739-5108; Ngo, Quy Chau/0000-0002-6787-2757; Duszynska, Wieslawa/0000-0002-5880-4904; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; Gupta, Umesh/0000-0001-7717-1404; Navarro Fuentes, Karla Reyna/0000-0002-6894-8872; zali, Mohammadreza/0000-0002-9027-4560; Morocho Tutillo, Diego Rolando/0000-0002-4974-7856; El Kholy, Amani/0000-0002-0645-7664; Kanj, Souha/0000-0001-6413-3396; Assiri, Abdullah/0000-0002-5605-2876; Unal, Necmettin/0000-0002-9440-7893; Jayatilleke, Kushlani/0000-0002-3931-6630; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000341307100001 PubMed: 25179325 We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U. S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The semantic web and other web services give plenty of room for product search, evaluation and comparison in E-commerce. However in many cases there have been very little efforts directed toward defining, evaluating and comparing semantic items/products on an E-commerce website, Oreste Signore (2004) particularly in term of visual expression, items availability and behaviour. Thus, this paper aims to address these issues by presenting an analysis of some typical E-commerce websites and a semantic evaluation of the available items/products and services.

Peritoneal dialysis (PD) patients may be overhydrated especially when inflammation is present. We hypothesized that patients with a plasma albumin below the median value would have measurable overhydration without a proportional increase in plasma volume (PV).We investigated a cross-sectional sample of 46 prevalent PD patients powered to detect a proportional increase in PV associated with whole body overhydration and hypoalbuminemia. PV was determined from (125)I-labeled albumin dilution, absolute total body water from D dilution (TBW(D)), and relative hydration from multifrequency bioimpedance analysis (BIA; Xitron 4200) expressed as the extracellular water (ECW):TBW(BIA) ratio.Whereas patients with plasma albumin below the median (31.4 g/dl) were overhydrated as determined both by BIA alone (ECW:TBW(BIA) 0.49 versus 0.47, P0.036) and the difference between estimated TBW(BIA) and measured TBW(D) (3.55 versus 0.94 L, P = 0.012), corrected PV was not different (1463 versus 1482 ml/m(2), NS). Mean PV was not different from predicted, and its variance did not correlate with any other clinical measures. Multivariate analysis showed that the only independent predictor of whole body overhydration was reduced plasma albumin.Hypoalbuminemia is an important determinant of tissue overhydration in PD patients. This overhydration is not associated with an increased plasma volume. Attempts to normalize the ECW:TBW ratio in hypoalbuminemic, inflamed PD patients may lead to hypovolemia and loss of residual renal function.

We report a case of Diamond Blackfan syndrome in 6yr old girl who was detected to have severe anaemia on D4 of life. The baby was detected to have polydactyly right hand (preaxial) and weak radial pulse on right side. On examination there was severe pallor without hepatosplenomegaly. The investigations revealed haemoglobin of 1.9 gm% with reticulocyte count of 0.3%. Other investigations were done to establish the cause of anaemia. The sickling test was negative, Peripheral blood smear revealed macrocytic anaemia, Hb electrophoresis revealed fetal haemoglobin of 2.7 %. Bone marrow examination revealed markedly reduced erythroid series, stress cytogenetics study done later was negative for any chromosomal breakage. Based on the clinical profile and investigation reports the diagnosis of Diamond Blackfan Syndrome was made. The child was put on corticosteroids which were gradually tapered. Subsequently any attempt at withdrawl of steroids resulted in fall in haemoglobin levels. Hence the child has been maintained on low dose steroids and has remained symptom free.

Semantic web links together and defines various parameters leading to user/customer satisfaction. Therefore it is important to identify the aspects of various customer satisfaction areas in online businesses, which can support semantic web. When recollecting about parameters in e-commerce, we will come automatically to the question: 'What are then these parameters ? Where do they lead to? There is a simple way of answering this question: Customer satisfaction. This means a high quality website, performing well in an expected way and comes out with a meaningful result can lead to customer satisfaction has to be semantic.

The rate of transport of small solutes across the peritoneal membrane is one of the most important measurements in PD patients. Significant between-patient variability is associated with an impact on small solute clearance, ultrafiltration and even survival. Cross-sectional and longitudinal studies show that solute transport generally increases with time on treatment although this is again highly variable between individuals and is likely to represent an increased vascularity of the membrane. Initially, there is a coupled decrease in the ultrafiltration capacity of the membrane that can be explained by the earlier loss of the osmotic gradient leading predominantly to reduced free water transport via aquaporins combined with more fluid reabsorption once the osmotic gradient has dissipated. Subsequently, in some patients a further disproportionate fall in ultrafiltration occurs due to uncoupling of fluid transport from solute transport as a result of a reduction in the osmotic conductance of the membrane. Drivers of this damage appear to be peritonitis, glucose exposure and early loss of residual renal function. Cytokines and growth factors appear to be involved in this process and may prove useful biomarkers of membrane injury in the future.

Background and objectives: Fast peritoneal membrane transport status may be due to inflammation or increased peritoneal membrane surface area. We evaluated the ability of peritoneal protein clearance (Pcl) to distinguish fast peritoneal membrane transport status as a consequence of peritoneal membrane inflammation and assess its impact on patient survival. Design, setting, participants, & measurements: Patients who initiated peritoneal dialysis at our center since January 1998 and had a baseline peritoneal equilibration test, measurement of dialysis adequacy, and 24-h dialysate Pcl were included. Demography, comorbidities, and biochemical data were prospectively collected. Follow-up was until death or the end of the period studied. Multivariate regression analysis identified factors that were associated with Pcl. A Cox proportional hazards model was used to identify factors that were associated with survival. Results: A total of 192 patients (56% men, mean age 54.3 ± 15.3; 32% with diabetes) were included. On univariate analysis, Pcl was negatively correlated with serum albumin and positively correlated with age, dialysate/plasma creatinine ratio (D/Pcr), the presence of peripheral vascular disease, and urine volume. On multivariate analysis, serum albumin, D/Pcr, urine volume, and peripheral vascular disease remained significant. Predictors of mortality were age, comorbidity grade, and Pcl but not D/Pcr. Conclusions: In this cohort, peritoneal transport status no longer predicted survival, whereas Pcl remained a predictor. Increased large-pore protein loss may reflect the severity of underlying cardiovascular disease, portending a poor prognosis for these patients.

The rate of transport of small solutes across the peritoneal membrane is one of the most important measurements in PD patients. Signifi cant between-patient variability is associated with an impact on

Failed transplantation is an increasingly common cause for starting dialysis treatment. As with all patients approaching dialysis there is a need for adequate physical and psychological preparation and yet whilst by definition these individuals are known to health professionals this is not always achieved. It is likely that given adequate information, a significant proportion of these patients would prefer PD on lifestyle grounds. There is increasingly strong evidence that patients commencing PD after transplant failure enjoy overall survival and technique survival that is no different to those new to dialysis, even when other risk factors such as age, comorbidity, race, gender and membrane function are taken into account. The risk of peritonitis is also not different. These patients tend to lose residual renal function more rapidly but this does not translate into worse outcomes. The role and benefit in modulating immune suppressive drugs before and after commencing PD is not clear.

Failed transplantation is an increasingly common cause for starting dialysis treatment. As with all patients approaching dialysis there is a need for adequate physical and psychological preparation and yet whilst by definition these individuals are known to health professionals this is not always achieved. It is likely that given adequate information, a significant proportion of these patients would prefer PD on lifestyle grounds. There is increasingly strong evidence that patients commencing PD after transplant failure enjoy overall survival and technique survival that is no different to those new to dialysis, even when other risk factors such as age, comorbidity, race, gender and membrane function are taken into account. The risk of peritonitis is also not different. These patients tend to lose residual renal function more rapidly but this does not translate into worse outcomes. The role and benefit in modulating immune suppressive drugs before and after commencing PD is not clear.