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The decentralized standalone treatment of faecal sludge is a generally cumbersome, energy-intensive, and expensive process. Particle size enlargement, dewatering, and disinfection are the crucial unit operations that contribute to the major portion of the operational expenditure. Therefore, the present study took up the task to investigate and yield a natural alternative to each of the above-delineated unit operations. Crushed seed powders of Moringa, Guilandina bonduc, Nirmali, tamarind, soap nut, nutmeg, jackfruit, and custard apple were experimented as natural coagulants, while a double-stitched cow dung-lined jute tube was utilized as the media for solid-liquid separation. Finally, the powder of Neem and custard apple seed and leaf were considered herbal disinfectants for the separated liquid and solid fractions, respectively. The findings of the physicochemical and biological analyses of the above unit operations were compared with a conventional polymer-based Geotube-driven treatment scheme. The natural alternatives registered some promising outcomes. However, the combined treatment efficiency of 79.32% (mean value of TS, TSS, TDS, COD, and BOD percentage removal) for pollutant removal and disinfection could not exceed the value of 97.98% offered by the conventional method. Further, the financial comparison for processing a 10 KL batch of FS indicates that the conventional scheme is considerably cheaper (USD 7.95) than the herbal alternate (USD 22.1). Therefore, though the present findings depict promising alternatives for sustainable and eco-friendly faecal sludge treatment, the authors advocate conducting further research to address the existing challenges to facilitate their seamless implementation on a field-scale level.

Asunto(s)

Semillas , Aguas del Alcantarillado , Aguas del Alcantarillado/análisis , Estudios de Factibilidad , Heces/química , Semillas/química , Terapia Combinada , Eliminación de Residuos Líquidos/métodos

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Epidermolysis Bullosa is an inherited mechanobullous disorder which presents in the neonatal period as blistering skin lesions. In this case report, we describe an uncommon presentation of Epidermolysis Bullosa Simplex in a term infant, weighing 2640 g, born to a mother who was also diagnosed with Epidermolysis Bullosa Pruriginosa during the course of the evaluation of her newborn. The clinical situation presented us with a unique dilemma with regard to routine newborn care practices including handling, skin and diaper care. Though the presentation was typically characteristic of EB, we illustrate with images the diagnostic modalities and challenges faced in the hospital while caring for this fragile skin in a low and middle-income country's neonatal intensive care unit. This is the first reported case of a neonate with Epidermolysis Bullosa Simplex born to a mother with Epidermolysis Bullosa Pruriginosa.

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Background: Candida albicans is one of the most common pathogenic yeasts, responsible for causing candidiasis. The use of conventional antifungal agents for the treatment of Candida is reported to be less effective and hence alternative therapies for the treatment are needed. Essential oils of medicinal plants may serve as a strong candidate for natural products in modern therapies. Aim: The aim of this study was to determine the synergistic potential of essential oils extracted from leaves of Aegle marmelos (L.) Correa and a potent antifungal agent, nystatin, against three clinical isolates of C. albicans using checkerboard assay. Materials and methods: The antifungal activity of the essential oils of A. marmelos was screened against test cultures by disc diffusion technique. Antibiograms of the test organisms were developed. To determine the minimum fungicidal concentration of the essential oil and nystatin, the broth microdilution method was employed, and a checkerboard assay was used to investigate the synergistic potential of the essential oil and nystatin against the clinical isolates under study. The data were expressed as mean ± standard deviation. Results: The Σ fractional inhibitory concentration values were calculated as 0.12, 0.37, and 0.28 for three different strains of C. albicans used, respectively, which was <0.5, therefore, the synergy was demonstrated between essential oils and nystatin against the test cultures. Conclusions: Combinatorial therapy of the essential oils extracted from the leaves of A. marmelos and nystatin may be considered a line of treatment for candidal infections.

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INTRODUCTION: Quality of life (QoL) of hemodialysis patients can be examined in two aspects: kidney-specific quality of life and general quality of life. OBJECTIVE: To determine the QoL among patients undergoing hemodialysis, to assess patients' QoL on hemodialysis, and to determine the factors associated with QoL among hemodialysis patients in Oman. METHOD: A cross-sectional study was carried out with 205 patients to measure the QoL across various demographic and clinical variables in Oman. The Arabic version of the KDQOL-SFtool was used to collect data from patients undergoing hemodialysis to give QoL quantitative measures. RESULTS: The physical-QoL was 45.7 (95% CI, 44.3, 47.0), which is less than half that of a healthy human. The emotional-QoL is 53.33 (95% CI, 51.1, 55.5), slightly more than half in a healthy human-QoL. The difference between physical and emotional-QoL scores is -7.66 (95% CI, -10.3, -5.1), showing that physical QoL is significantly less than emotional-QoL. The overall general QoL score was 49.5 (95% CI, 47.8, 51.2), half the QoL score of a healthy human. Younger patients are also more likely to experience emotional problems compared with older patients. Patients with 5-8 mg/l levels of serum creatinine have lower emotional wellbeing. People on low incomes experienced social difficulties, while the maximum burden was found in physical activities and minimum social function. CONCLUSION: Both physical (45.7) and emotional (53.3) QoL scores in dialysis patients are nearly half those of an average human. Hence, there is a poor QoL among dialysis patients like other studies, and therefore, further improvement of renal rehabilitation in dialysis patients is warranted to improve patients' QoL.

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Cystinuria is a common aminoaciduria due to a COAL transporter defect in renal tubular epithelium. Increased level of cystine in urine with occasional cystine crystal can be diagnostic. With reference to clinical examinations, symptoms and laboratory reports we present a case of primary cystinuria. Prevention of complication in cystinuric relies on detection at early stage and targeting treatment towards maintaining low level of urinary cystine level.

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The anemia of chronic kidney disease (CKD) is a common comorbidity seen in kidney diseases. It is also associated with increased cardiovascular morbidity and mortality and diminished quality of life. Often, patients with CKD of different stages require erythropoiesis-stimulating agents (ESAs) to maintain their hemoglobin (Hb) within the target range. Darbepoetin alfa is a newer ESA with a longer half-life than recombinant human erythropoietin (EPO). The objective of this study is to assess the efficacy and safety profile of twice-monthly (Q2W) and once a month (1QM) darbepoetin alfa in CKD patients, not on dialysis. The secondary objective was to assess the appropriate dose conversion from EPO to darbepoetin. Patients with CKD not on dialysis, receiving darbepoetin alfa every other week, or once every month, and with stable Hb levels between 10 and 12 g/dL, were enrolled in this single-center, open-label, single-arm study. In this study, 36 patients (21 female, 15 male) were enrolled with a mean age of 46.4 ± 20.12 years. About 56% of the patients (n = 20) received darbepoetin alfa 40 µg Q2W for more than three months and 36% (n = 13) were on once-monthly doses, whereas the other 8% (n = 3) were on variable doses ranging from 20 to 60 µg every two weeks. More than 80% of the patients were converted from short-acting EPO to darbepoetin corresponding to a conversion ratio of 672.2 IU:1 µg (standard deviation = 488.5). Hb levels ≥10 g/dL were maintained in 77.78% of the patients. The safety profile of darbepoetin alfa in this study was recorded, and no significant adverse effects were noted. Our study suggests that darbepoetin alfa, administered in fixed small doses and frequency of Q2W or Q1M, maintained Hb levels ≥10 g/dL in patients with CKD, not on dialysis.

Asunto(s)

Anemia , Darbepoetina alfa , Esquema de Medicación , Eritropoyetina , Femenino , Hematínicos , Hemoglobinas , Humanos , Fallo Renal Crónico , Masculino , Persona de Mediana Edad , Calidad de Vida , Diálisis Renal , Insuficiencia Renal Crónica

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INTRODUCTION: An abdominoscrotal hydrocele (ASH) consists of a large inguinoscrotal hydrocele which communicates in an hour glass fashion with a large "intraabdominal component". Mostly affects single testis but very rarely can present bilaterally. PRESENTATION OF CASE: We are presenting here a young 25 year old patient with large right sided scrotal swelling encroaching over lower abdomen. Clinically it was abdominoscrotal hydrocele which was confirmed with CT abdomen and later on subjected for surgery. DISCUSSION: Abdominoscrotal hydrocele is rarest type of hydrocele; first described by Dupuytren. The etiology of ASH is unknown; however, different theories have been described in literature to explain the pathogenesis. Diagnosis of ASH is done by clinical examination and is confirmed by radiological examination. Though ultrasonography is the first choice, in few selected cases contrast enhanced computerized tomography or magnetic resonant imaging may be helpful for more anatomical delineation. It may present with various complications secondary to pressure exerted by the components of the ASH. Surgical excision of the sac is the only definitive treatment option. There is no role of conservative treatment. Sometimes, decompression of the cyst needed to ease the dissection of the sac. CONCLUSION: Abdominoscrotal hydrocele differential should be considered while dealing with large lower abdominal swelling along with scrotal swelling.

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OBJECTIVES: Nephropathy from BK virus (BKV) infection is a growing challenge in kidney transplant recipients globally. It is the result of contemporary potent immunosuppressives aimed at reducing acute rejection and improving allograft survival. Untreated BK virus infections lead to kidney allograft dysfunction or loss. Decreased immunosuppression is the principle treatment but predisposes to acute and chronic rejection. Screening for early detection and prevention of symptomatic BK virus nephropathy may improve outcomes. Although no approved antiviral drug is available, leflunomide, cidofovir, quinolones, and intravenous immunoglobulin have been used. Since the introduction of the new immunosuppressive agents in the transplant regimen at the Royal Hospital, Few cases of BK virus have been detected, and the challenge was to decide upon the best treatment option. MATERIALS AND METHODS: The audit was carried out at the Royal Hospital-Oman between January 2010 and December 2012. The nephrology consultant and the clinical pharmacist reviewed all the BK cases and the Royal Hospital. Extensive literature review carried out by the pharmacist to look into the prevalence, prognosis and treatment of BK nephropathy. A treatment protocol was prepared by the clinical pharmacist through guidance of the consultant and was peer reviewed by team of clinical pharmacists and nephrology doctors and approved by the consultant. RESULTS: The audit included 19 patients with positive BK virus ployoma nephropathy. The treatment options were applied stepwise in all the patients with BK virus nephropathy with success rate more than 70%. CONCLUSIONS: BK virus nephropathy is emerging at an alarming rate and requires increasing awareness. The uses of current treatment options are still questionable. Our audit confirms that reducing immunosuppression appears to be the criterian standard for the treatment of BK nephropathy.

Asunto(s)

Antivirales/uso terapéutico , Virus BK/patogenicidad , Hospitales , Inmunosupresores/efectos adversos , Trasplante de Riñón/efectos adversos , Infecciones Oportunistas/tratamiento farmacológico , Infecciones por Polyomavirus/tratamiento farmacológico , Infecciones Tumorales por Virus/tratamiento farmacológico , Adolescente , Adulto , Virus BK/inmunología , Niño , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , Auditoría Médica , Persona de Mediana Edad , Omán/epidemiología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/virología , Grupo de Atención al Paciente , Infecciones por Polyomavirus/diagnóstico , Infecciones por Polyomavirus/epidemiología , Infecciones por Polyomavirus/inmunología , Infecciones por Polyomavirus/virología , Prevalencia , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Infecciones Tumorales por Virus/diagnóstico , Infecciones Tumorales por Virus/epidemiología , Infecciones Tumorales por Virus/inmunología , Infecciones Tumorales por Virus/virología , Adulto Joven

RESUMEN

OBJECTIVES: We determine the significant relation of HDL cholesterol and total cholesterol/HDL cholesterol between CETP I405V genotypes and activity of CETP. CETP is an essential for transfer of cholesterol ester to the liver from peripheral tissues which facilitating its transfer to TG rich VLDL. Reduction activity of CETP I405V may associate with genotypes of CETP I405V. This study is undertaken to assess the presence and impact of CETP I405V genotype in our population. MATERIALS AND METHODS: In this study 100 acute myocardial infarction patients and 100 normal age & sex matched healthy individuals were included. Serum Lipid profile was estimated by using universal standard methods whereas CETP I405V genotype was studied by ARMS PCR. RESULT: There is presence of CETP 405Val genotype both in patient as well as in control group. RESULTs show that HDL cholesterol (p<0.0001) and ratio of total cholesterol/HDL cholesterol are significantly (p<0.0043) associated with Val/Val genotype. In addition to that the CETP I405V genotype is associated with inhibition of CETP activity with higher HDL-C level and decreased total cholesterol/HDL cholesterol ratio. CONCLUSION: Our results show that the CETP I405V genotypes are very much significantly determinant of HDL cholesterol in patients with CHD.