Renal resistive index measurements by ultrasound in patients with liver cirrhosis:Magnitude and associations with renal dysfunction

BACKGROUND The hemodynamic alterations seen in liver cirrhosis lead to renal vasoconstriction,ultimately causing acute kidney injury(AKI).The renal resistive index(RRI)is the most common Doppler ultrasound variable for measuring intrarenal vascular resistance.AIM To evaluate the association of the RRI with AKI in patients with liver cirrhosis and to identify risk factors for high RRI.METHODS This was a prospective observational study,where RRI was measured using Doppler ultrasound in 200 consecutive hospitalized patients with cirrhosis.The association of RRI with AKI was studied.The receiver operating characteristic(ROC)curve analysis was utilized to determine discriminatory cut-offs of RRI for various AKI phenotypes.Multivariate analysis was conducted to determine the predictors of high RRI.RESULTS The mean patient age was 49.08±11.68 years,with the majority(79.5%)being male;the predominant etiology of cirrhosis was alcohol(39%).The mean RRI for the study cohort was 0.68±0.09,showing a progressive increase with higher Child-Pugh class of cirrhosis.Overall,AKI was present in 129(64.5%)patients.The mean RRI was significantly higher in patients with AKI compared to those without it(0.72±0.06 vs 0.60±0.08;P<0.001).A total of 82 patients(41%)had hepatorenal syndrome(HRS)-AKI,29(22.4%)had prerenal AKI(PRA),and 18(13.9%)had acute tubular necrosis(ATN)-AKI.The mean RRI was significantly higher in the ATN-AKI(0.80±0.02)and HRS-AKI(0.73±0.03)groups than in the PRA(0.63±0.07)and non-AKI(0.60±0.07)groups.RRI demonstrated excellent discriminatory ability in distinguishing ATN-AKI from non-ATN-AKI(area under ROC curve:93.9%).AKI emerged as an independent predictor of high RRI(adjusted odds ratio[OR]:11.52),and high RRI independently predicted mortality among AKI patients(adjusted OR:3.18).CONCLUSION In cirrhosis patients,RRI exhibited a significant association with AKI,effectively differentiated between AKI phenotypes,and predicted AKI mortality.

Prevalence and risk factors of lymphatic dysfunction in cirrhosis patients with refractory ascites:An often unconsidered mechanism

BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis patients.Therefore,assessment of lymphatic dysfunction in cirrhosis patients with refractory ascites(RA)can be crucial as it would call for using different strategies for fluid mobilization.AIM To assessing the magnitude,spectrum,and clinical associations of lymphatic dysfunction in liver cirrhosis patients with RA.METHODS This observational study included 155 consecutive cirrhosis patients with RA.The presence of clinical signs of lymphedema,such as peau d’orange appearance and positive Stemmer sign,intestinal lymphangiectasia(IL)on duodenal biopsy seen as dilated vessels in the lamina propria with strong D2-40 immunohistochemistry,and chylous ascites were used to diagnose the overt lymphatic dysfunctions.RESULTS A total of 69(44.5%)patients out of 155 had evidence of lymphatic dysfunction.Peripheral lymphedema,found in 52(33.5%)patients,was the most common manifestation,followed by IL in 42(27.0%)patients,and chylous ascites in 2(1.9%)patients.Compared to patients without lymphedema,those with lymphedema had higher mean age,median model for end-stage liver disease scores,mean body mass index,mean ascitic fluid triglyceride levels,and proportion of patients with hypoproteinemia(serum total protein<5 g/dL)and lymphocytopenia(<15%of total leukocyte count).Patients with IL also had a higher prevalence of lymphocytopenia and hypoproteinemia(28.6%vs.9.1%,P=0.004).Seven(13%)patients with lymphedema had lower limb cellulitis compared to none in those without it.On multivariate regression analysis,factors independently associated with lymphatic dysfunction included obesity[odds ratio(OR):4.2,95%confidence intervals(95%CI):1.1–15.2,P=0.027],lymphocytopenia[OR:6.2,95%CI:2.9–13.2,P<0.001],and hypoproteinemia[OR:3.7,95%CI:1.5–8.82,P=0.003].CONCLUSION Lymphatic dysfunction is common in cirrhosis patients with RA.Significant indicators of its presence include hypoproteinemia and lymphocytopenia,which are likely due to the loss of lymphatic fluid from the circulation.Future efforts to mobilize fluid in these patients should focus on methods to improve lymphatic drainage.

Compensated liver cirrhosis:Natural course and disease-modifying strategies

Compensated liver cirrhosis(CLC)is defined as cirrhosis with one or more decompensating events,such as ascites,variceal haemorrhage,or hepatic encephalopathy.Patients with CLC are largely asymptomatic with preserved hepatic function.The transition from CLC to decompensated cirrhosis occurs as a result of a complex interaction between multiple predisposing and precipitating factors.The first decompensation event in CLC patients is considered a significant turning point in the progression of cirrhosis,as it signals a drastic decline in median survival rates from 10-12 years to only 1-2 years.Furthermore,early cirrhosis has the potential to regress as liver fibrosis is a dynamic condition.With the advent of effective non-invasive tools for detecting hepatic fibrosis,more and more patients with CLC are currently being recognised.This offers clinicians a unique opportunity to properly manage such patients in order to achieve cirrhosis regression or,at the very least,prevent its progression.There are numerous emerging approaches for preventing or delaying decompensation in CLC patients.A growing body of evidence indicates that treating the underlying cause can lead to cirrhosis regression,and the use of non-selective beta-blockers can prevent decompensation by lowering portal hypertension.Additionally,address-ing various cofactors(such as obesity,diabetes,dyslipidaemia,and alcoholism)and precipitating factors(such as infection,viral hepatitis,and hepatotoxic drugs)that have a detrimental impact on the natural course of cirrhosis may benefit patients with CLC.However,high-quality data must be generated through well-designed and adequately powered randomised clinical trials to validate these diseasemodifying techniques for CLC patients.This article discussed the natural history of CLC,risk factors for its progression,and therapeutic approaches that could alter the trajectory of CLC evolution and improve outcomes.

Comprehensive isotopic characterization of the hydrological processes of the Indus river basin(IRB):A comparison between Upper Indus Basin(UIB)and Lower Indus Basin(LIB)

The Indus river basin(IRB)is one of the most depleted water basins globally,having significant challenges for its water sector.Monitoring of stable isotope composition(δ^(18)O and δ^(2)H)across IRB is a critical aspect that can provide deeper insights for investigating complex hydrological processes.This work analyses the spatial pattern of the isotopic signature using a comprehensive compilation of available datasets of the Global Network of Isotopes in River(GNIR)and Global Network of Isotopes in Precipitation(GNIP),along with the previously published isotopic studies in the Indus basin.Additionally,this work provides a detailed comparison of the isotopic signature of the Upper Indus Basin(UIB),and Lower Indus Basin(LIB).The IRBs waterline was found to beδ^(2)H=7.89×δ^(18)O+13.51,which shows a close similarity with the Global Meteoric Water Line(GMWL),indicating the meteoric origin of the water with insignificant secondary evaporation prevailing across the basin.The Main Indus Channel(MIC)river water line(δ^(2)H=8.88×δ^(18)O+26.05)indicates a major contribution from the meteoric origin(precipitation/rain)of water with minimal effect of evaporation processes.The water line for UIB samples,(δ^(2)H=7.88×δ^(18)O+11.94)was found to be moderately higher in slope than LIB samples(δ^(2)H=7.17×δ^(18)O+7.16).However,the slopes of both UIB and LIB river water lines closely approached the slope of GMWL and were consistent with the slope of IRB water line,which indicates similarity in contribution of water sources.The higher slope and intercept in UIB suggest that meteoric water sources contributed to streamflow viz.from snow/glacier with insignificant evapotranspiration,which is also validated by the scarce vegetation cover in the UIB.However,the lower slope and intercept in LIB suggest stream water contribution from significantly evaporated groundwater and precipitation with a complete homogenization of discharge coming from the UIB.Results substantiate that distinct isotopic signatures found in different stretches of the IRB and along the MIC are caused by variations in basin characteristics,hydro-meteorological processes,water mixing,and minor influence of anthropogenic variables.

Mapping the Expression Profiles of Grain Yield QTL Associated miRNAs in Rice Varieties with Different Grain Size

microRNAs (miRNAs) are key regulatory molecules that fine tune gene expression at the transcriptional and post-transcriptional levels through the RNA silencing pathways. They play an important role in regulating plant growth, development and response to a/biotic stress conditions. Grain yield is a complex trait that is governed by the coordinated action of several genetic and environmental factors. A number of genes and miRNAs have been identified to affect the grain productivity and yield. In this study, we identified the miRNAs that map to grain yield QTLs in rice. The expression variations of these miRNAs and their target transcript were studied across different tissues of three indica rice varieties with different grain morphology. The varieties used include the extra-long and slender grained Pusa Basmati 1 (PB1), medium grain sized IR64 and the short grained Pokkali (PK). The windows for miRNA target correlation were captured and their putative role in regulating rice grain yield is discussed.

Word perception in noise at different channels in simulated cochlear implant listeners

AIM:To find out effect of different signal-to-noise ratios(SNRs) on word perception at different number of channels.METHODS: Thirty participants with normal hearing in the age range of 18-25 years(mean age 23.6 years) were involved in the study. For word perception test, there were 28 key-words embedded in sentences comprises of four lists processed for different channels(4, 8 and 32 channel) using AngelS im program at-5, 0 and +5 SNRs. The recorded stimuli were routed through audiometer connected with computer with CD player and presented in free field condition with speakers kept at 0° azimuth in a sound treated room.RESULTS: Repeated measure ANOVA showed significant main effect across different SNRs at 4 channel, 8 channel and at 32 channel. Further, Bonferroni multiple pairwise comparisons shows significant differences between all the possible combinations(4, 8 and 32 channel) at +5 dB SNR, 0 dB SNR and-5 dB SNR.CONCLUSION: Present study highlights the importance of more number of channels and higher signal to noise ratio for better perception of words in noise in simulated cochlear implantees.

Hydrogeological and Hydrochemical Characterization of Coastal Aquifers with Special Reference to Submarine Groundwater Discharge in Uttara Kannada, Karnataka, India

In coastal areas of our country,in spite of having excess rainfall(more than 3000 mm),groundwater become a rare commodity during summer.Number of researchers have discussed the issues related to water scarcity of coastal areas where there is a huge pressure on environment due to increased population,tourism,agriculture and industrial growth.Fast depletion of groundwater is also reported in coastal districts due to continuous discharge of direct runoff and also through subterranean flow which is termed as Submarine Groundwater Discharges(SGD).Large quantity of contaminants enter the ocean system through runoff.This necessitated a detailed investigation to understand the hydrological processes involved and the source of contaminants.The present investigation is an attempt to make quantitative and qualitative assessment of SGD based on hydrological,hydrogeological and hydrochemical components.Accordingly,water balance components were evaluated based on hydrological and hydrogeological investigations.Hydrochemical parameters were also evaluated to understand the impact of seawater intrusion in pre and post-monsoon of 2019.Study revealed that,there are signatures of considerable quantity of submarine groundwater discharge in parts of Honnavara,Kumta,Ankola and Karwar talukas.The influence of seawater in coastal aquifers is quite rare all along the coast of Uttara kannada district which is attributed to high groundwater recharge(15-20%)occurring in catchment areas.

Potential of Essential Oils as Alternative Permeation Enhancers for Transdermal Delivery

Transdermal drug delivery plays a significant part in the drug delivery system when compared to other routes of drug administration.The function of the stratum corneum(SC)is a barrier.Recently,numerous methods have been thrived to improve the perforation of drugs across the skin.The most effective method is to use enhancers since these agents enhance skin permeability.Natural penetration enhancers like essential oils demonstrate higher enhancement activity and are more widely accepted than synthetic penetration enhancers.High potential in the expansion and interaction with the SC intercellular lipids has led to an increasing interest in these oils as penetration enhancers.This article gives an overview of a few essential oils,including their mode of action and important parameters for permeation improvement.The present work can provide essential oils as alternative enhancers,and this could be useful in transdermal administration.