Urinary <Emphasis Type="Italic">N</Emphasis>-acetyl-beta-<Emphasis Type="SmallCaps">D</Emphasis> glucosaminidase (NAG) level in idiopathic nephrotic syndrome

Urinary N-acetyl-beta-D glucosaminidase (NAG) is a sensitive biomarker of renal parenchymal disease. The aim of this study was to investigate variations in the levels of NAG excretion among different sub-groups of nephrotic syndrome (first episode, relapsers, and resistant) and its prediction based on proteinuria. Thirty-five patients with idiopathic nephrotic syndrome, aged 1–12 years, as well as 15 age- and gender-matched normal children (controls) were enrolled in the study. Among the 35 patients, ten were classified with first episode nephrotic syndrome (FENS), 17 with relapsing nephrotic syndrome (RNS), and eight with steroid-resistant nephrotic syndrome (SRNS). Urinary NAG/creatinine levels were significantly increased in SRNS patients as compared to FENS and RNS patients (p < 0.001); the FENS and RNS groups had comparable levels. A urinary NAG/creatinine value of ≤108.9 U/g was found to identify steroid-sensitive patients with a sensitivity, specificity, positive predictive value, and negative predictive value of 78.8, 100, 100 and 77.7%, respectively. Significant correlations were found between experimental and predicted values of urinary NAG/creatinine in steroid sensitive nephrotic syndrome (SSNS) (R ² = 0.9643) and SRNS patients (R ² = 0.9823). Urinary NAG/creatinine values were found to be higher in SRNS than SSNS patients and have moderate predictive value for steroid responsiveness. This level can be obtained based on urinary protein/creatinine ratio or 24 h urinary protein levels.     

Teaching the slowing-down moments of operative judgment

Surgical judgment has been an elusive construct to define, let alone teach or assess. A recent study has characterized a phenomenon called slowing down when you should, and suggests it is a hallmark for operative judgment. This research highlights areas where surgical judgment can be identified and therefore taught more explicitly in the operating room. Through the identification of these slowing-down moments and an understanding of how control is negotiated between surgeon and trainee during these moments, this article uses several theoretic frameworks to understand how teaching judgment in the operating room can be optimized.     

Submergence Induced Tiller Mortality and Yield Reduction in Rice Can be Minimized Through Post-submergence Nitrogen Application

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - The main strategies enabling rice plants to cope up with flash flooding stress require growth regulation...     

Prophylaxis of venous thromboembolism during early inpatient rehabilitation after acquired brain injury: How guidelines change management

Purpose.?To establish guidelines for prophylaxis of venous thromboembolism (VTE) in younger adults undergoing early inpatient rehabilitation following acquired brain injury (ABI).

Method.?A two-phase (phase 1: retrospective; phase 2: prospective) observational study was carried out involving patients admitted to an inpatient neurological rehabilitation unit during a 40-month period. In phase 1, VTE prophylaxis was prescribed on an ad hoc basis. In phase 2, prophylaxis was considered in accordance with guidelines agreed locally. The prescribing behaviour in each phase of the study was compared using a VTE risk stratification tool based on expert opinion and a review of the literature.

Results.?Data were obtained on 94 patients in phase 1 and 23 patients in phase 2. During phase 1, the prophylactic prescribing behaviour of the referring hospitals and our unit after admission were similar ( p = 0.13). In phase 2, our prescribing behaviour had changed compared with that of the referring hospitals, with a significant increase in the proportion of patients on appropriate treatment ( p = 0.01) and a decrease in the numbers under-treated ( p = 0.002). We were also significantly less likely to under-treat ( p = 0.005) and more likely to over-treat ( p = 0.004) after admission during phase 2 compared with phase 1, whilst practice was variable in patients at moderate risk.

Conclusions.?Guidelines modify behaviour. They must stratify risk, particularly to avoid inconsistencies in the management of patients at moderate risk. There is a need to establish national guidelines for VTE prophylaxis during early inpatient rehabilitation after ABI; these guidelines should include a risk stratification tool.     

Geobacillus stearothermophilus (GBPI_16): A Resilient Hyperthermophile Isolated From an Autoclaved Sediment Sample

A hyperthermophilic bacterium has been isolated from autoclaved sediments which were originally collected from a hot spring site (Soldhar) located in Tapovan area in District Chamoli of Indian Himalayan Region. The bacterium exhibited growth between 55 and 95 °C under laboratory conditions. The growth curves, drawn at different temperatures (55, 65, 75, 85 and 95 °C), showed clear preference for high temperature for production of cell biomass. Broth culture of the bacterium after exposure to boiling temperature, exhibited increase in the colony forming units up to 20 min. Microscopic observations showed Gram +ve cells arranged in clusters or short to long chains bearing endospore with swollen solitary sporangia at terminal positions, and developed coiling at a later stage after subcultures. The bacterium survived second round of autoclaving but with deteriorated cell arrangement. Following polyphasic approach, the bacterium was identified as Geobacillus stearothermophilus. In lipase producing medium, the bacterium exhibited maximum cell biomass at 65 °C, coinciding with maximum lipase activity (25.8 U/L) after 14 h of incubation. Relatively high amylase activity was recorded; maximum (47.2 U/L) at 95 °C after 8 h of incubation, not showing correlation with cell biomass which attained maximum value after 16 h. Distinct peaks of amylase activity were recorded twice at all the 4 temperatures, first on or before 8 h and the second after 14 h of incubation. Elasticity in morphological structures and the production of thermostable enzymes at elevated temperatures are likely to play important role in conferring resilience to bacterium for survival and multiplication under high temperatures. The bacterium and its 16S rDNA sequence have been assigned accession numbers MTCC11501 and MCC2050, and FJ548759, respectively.     

Stromal rejection in penetrating keratoplasty following COVID-19 vector vaccine (Covishield) – A case report and review of literature

Endothelial rejection has been described following both m-RNA and vector-based vaccines for COVID-19. There is one case report of a stromal rejection described following influenza vaccination. We report a case of stromal rejection following vector-based COVID-19 vaccination, which might be the first case reported so far.