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BACKGROUND: The occurrence of acute kidney injury (AKI) in acute-on-chronic liver failure (ACLF) negatively impacts the survival of patients. There are scant data on the impact of serum urea on outcomes in these patients. We performed this study to evaluate the relationship between admission serum urea and the survival in patients with ACLF and AKI. METHODS: A prospective study was conducted on patients with ACLF (as per Asian Pacific Association for the Study of the Liver criteria) and AKI (as per Acute Kidney Injury Network criteria) hospitalized in the gastroenterology ward between October 2016 and May 2018. Demographic, clinical and laboratory parameters were recorded, and outcomes were compared in patients with respect to the admission serum urea level. RESULTS: A total of 103 of 143 hospitalized patients with ACLF had AKI and were included as study subjects. The discrimination ability between survivors and the deceased was similar for serum urea levels (area under the receiver operating characteristic curve [AUROC] [95% confidence interval {CI}]: 28 days survival, 0.76 [0.67-0.85]; 90 days survival, 0.81 [0.72-0.91]) and serum creatinine levels (AUROC [95% CI]: 28 days survival, 0.75 [0.66-0.84]; 90 days survival: 0.77 [0.67-0.88]) in patients with ACLF and AKI. However, on multivariate analysis, admission serum urea (not serum creatinine) was an independent predictor of mortality in these patients both at 28 days (p = 0.001, adjusted hazard ratio [AHR]: 1.013 [1.005-1.021]) and 90 days (p = 0.001, AHR: 1.014 [1.006-1.022]). CONCLUSION: Over two-thirds of patients with ACLF had AKI. The discrimination ability between survivors and the deceased was similar for both serum urea and serum creatinine levels. However admission serum urea was found to be a better predictor of mortality than serum creatinine in patients with ACLF and AKI.

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While local anthropogenic emission sources contribute largely to deteriorate metro air quality, long range transport can also play a significant role in influencing levels of pollutants, particularly carbon monoxide (CO) that has a relatively long life span. A nationwide lockdown of two months imposed across India amid COVID-19 led to a dramatic decline in major sources of emissions except for household, mainly from cooking. This initially led to declined levels of CO in two of the largest megacities of India, Delhi and Mumbai under stable weather conditions, followed by a distinctly different variability under the influence of prevailing mesoscale circulation. We hereby trace the sources of CO from local emissions to transport pathways and interpret the observed variability in CO using the interactive WRF-Chem model and back trajectory analysis. For this purpose, COVID-19 emission inventory of CO has been estimated. Model results indicate a significant contribution from externally generated CO in Delhi from surrounding regions and an unusual peak on 17th May amid lockdown due to long range transport from the source region of biofuel emissions in central India. However, the oceanic winds played a larger role in keeping CO levels in check in a coastal megacity Mumbai which otherwise has high CO emissions from household sources due to a larger share of urban slums. Keeping track of evolving carbon-intensive pathways can help inform government responses to the COVID-19 pandemic to prioritize controls of emissions sources.

Asunto(s)

Contaminantes Atmosféricos , Contaminación del Aire , COVID-19 , Contaminantes Atmosféricos/análisis , Contaminación del Aire/análisis , Control de Enfermedades Transmisibles , Monitoreo del Ambiente , Humanos , India , Pandemias , Material Particulado/análisis , SARS-CoV-2

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BACKGROUND: The etiology of cirrhosis of liver is known to change with time due to various factors including awareness, preventive interventions, and lifestyle changes in society. However, there is scarce Indian data available about temporal trends in etiology of cirrhosis of liver. Hence, the aim of this study was to study the temporal trends in the etiology of cirrhosis of liver. MATERIALS AND METHODS: This is a retrospective study conducted in the Department of Gastroenterology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, from January 2005 to December 2017. Data were collected from hospital records of all patients admitted to the Gastroenterology unit. A Poisson regression model was used to compare the hospitalization rate for different etiologies of cirrhosis of liver. All data were analyzed using Stata version 5.1 software. RESULTS: A total of 4,331 hospitalized patients of cirrhosis of liver were included in the analysis, of whom 2,742 (63.3%) had alcohol-related cirrhosis, 858 (19.8%) had viral hepatitis-related cirrhosis, and 731 (16.9%) had cirrhosis of liver due to nonalcohol and nonviral causes. The proportion of alcohol-related cirrhosis was increased by 26% from 2005 to 2017 (RR 1.26, p for trend <0.001). Though there were minimal ups and downs observed in the admission rate of viral hepatitis-related liver cirrhosis during later years, this was remarkably reduced by 73% (RR 0.27, p for trend <0.001) in the year 2017 at the end of the study. Similarly, the proportion of cirrhosis due to nonalcohol and nonviral causes decreased by 26% (RR 0.74, p for trend <0.001) by 2017. CONCLUSION: Alcohol is the most common cause of cirrhosis of liver and the burden of alcohol-related cirrhosis is significantly increasing in comparison to other causes including viral infection, nonalcoholic steatohepatitis (NASH), and autoimmune hepatitis. HOW TO CITE THIS ARTICLE: Mishra D, Dash KR, Khatua C, et al. A Study on the Temporal Trends in the Etiology of Cirrhosis of Liver in Coastal Eastern Odisha. Euroasian J Hepato-Gastroenterol 2020;10(1):1-6.

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Crop residue burning during post monsoon season in the neighboring provinces leads to frequent episodes of extreme pollution events, associated with premature morbidity and mortality. A synergistic use of multiple satellite measurements in conjunction with actual field incidences data at the ground led us to develop the realistic high-resolution emission inventory of the hazardous pollutant PM2.5 due to stubble burning. We quantify the share of biomass burning in deteriorating Delhi's air quality during 2018 using the SAFAR chemical transport model that has been validated with dense observational network of Delhi. The impact of biomass burning on Delhi's PM2.5 is found to vary on day-to day basis (peaking at 58%) as it is highly dependent on transportation pathway of air mass, controlled by meteorological parameters from source to target region. Comprehending the multi-scale nature of such events is crucial to plan air quality improvement strategies.

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BACKGROUND AND AIM: Acute kidney injury (AKI) commonly occurs in patients with chronic liver disease (CLD). As per the International Club of Ascites, AKI is classified into three stages; stage 1 has recently been divided into subgroups 1A and 1B. We performed a prospective study to validate the association between subgrouping and outcome. METHODS: This study was conducted using decompensated cirrhosis (DC) patients hospitalized in the Gastroenterology ward between August 2016 and May 2018. Demographic, clinical, and laboratory parameters were compared between AKI 1A and AKI 1B patients. The duration of hospitalization and outcome were compared. RESULTS: A total of 528 subjects were enrolled; 296 (56.1%) had AKI, and of them, 61.48% (n = 182) had stage 1, 20.95% (n = 62) had stage 2, and 17.57% (n = 52) had stage 3 AKI. Of the enrolled patients, 100 (54.94%) had early (AKI 1A) and 82 (45.06%) had late stage 1 AKI (AKI 1B). Patients with AKI 1B had higher total leucocyte count, total bilirubin, serum urea, serum creatinine (SCr), model for end-stage liver disease (MELD), MELD-Na+, and child-turcotte-pugh (CTP) score and decreased serum albumin than AKI 1A. The prevalence of hepatorenal syndrome (HRS), acute on chronic liver failure (ACLF) were higher in AKI 1B patients, and they had a prolonged hospital stay compared to AKI 1A patients. Furthermore, AKI 1B patients had significantly lower survival both at 28 days and 90 days. CONCLUSION: Our study validates the subclassification of stage 1 AKI. Patients with AKI 1B more often progress to higher AKI stages with significantly lower 28-day and 90-day survival rates. Results justify subclassification and suggest the need for early intervention. The small increase in SCr should be viewed with caution in AKI stage 1A.

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The Indian capital Delhi experienced an environmental emergency in early November 2017 when levels of toxic PM2.5 particles surpassed WHO guidelines by 25 times (11 times by Indian Standards) for a prolonged period of a week (peak 24 h average ~650 µg/m3). We hereby demonstrate the role that monsoon dynamics played in linking and mixing dust emitted from a large natural dust storm, 3000 km away in the Middle East, with smoke from agriculture fires in northwest India. This dust and smoke rich air was then transported to Delhi where, under stagnant conditions, it mixed with local emissions resulting in very high pollution levels. The heavy aerosol-laden air altered the land-skin surface air temperature difference resulting in increased surface wind speeds, favouring faster dispersion and an unusual sharp decline in PM2.5 (PM2.5-110 µg/m3). Understanding the multi-scale nature of such events is important in improving our abilities to forecast these events and in developing effective air quality management strategies for the mega cities.