Govind Ballabh Pant Hospital

Levamisole is a commonly used steroid-sparing medication in pediatric nephrotic syndrome. While use of this agent is associated with development of antineutrophil cytoplasmic antibodies (ANCA), there is limited data on their prevalence and antigen specificity. This cross-sectional study, conducted from October 2020 to June 2022, included 117 patients, aged 2-18years, with steroid-sensitive nephrotic syndromeandreceiving levamisole at a dose of 2-2.5mg/kg on alternate days for ≥ 6-months. All patients were screened for ANCA by indirect immunofluorescence and conventional ELISA. Patients positive on screening underwentprofile ELISAto determine its antigen specificity. Twenty (17.1%) patients tested positive for ANCA by either screening method. On profile ELISA, antibodies showed specificity to myeloperoxidase (n = 13), human neutrophil elastase (n = 6), proteinase-3 (n = 4), and/ortheir combination (n = 3). Risk factors independently associated with presence of ANCA included female sex [adjusted odds ratio (aOR) 3.1; 95% CI 1.0-9.3; P = 0.044] and cumulative prednisolone intake in the last 6-months[aOR 0.0041; 0.0001-0.21; P = 0.006]. Following levamisole discontinuation, ANCA was negative in all 16 patients who were retested at 40.6 (3-67.2) months. Antinuclear and anticardiolipin antibodies were present in 19 and 8 patients, respectively, and leukopenia in 4 patients. A significant proportion of patients with steroid-sensitive nephrotic syndrome receiving > 6-months' therapy with levamisole show positive ANCA, with antigen specificity against myeloperoxidase, neutrophil elastase and/or proteinase-3. The risk was higher in girls and lower in those receiving concurrent therapy with prednisolone in the past 6-months.Stopping levamisole therapy was associated with resolution of ANCA.

This study numerically investigates the flow characteristics around single and tandem cylinders positioned in close proximity to a moving wall at a Reynolds number of Re = 100. Using the finite volume method, simulations were performed for aspect ratios (AR) ranging from 1 to 5, while maintaining a fixed gap ratio (G/A = 0.5) and spacing ratio (S/A = 0.5). The results demonstrate that the moving wall significantly influences flow dynamics and stabilizes the wake. For an aspect ratio of 1, the merging of shear layers leads to the formation of elongated, steady vortices. As the aspect ratio increases from 2 to 5, the wake becomes increasingly smooth and the magnitude of positive vortices decreases, resulting in steady wake formation without significant oscillations. Force analysis reveals that the upstream cylinder exhibits chaotic drag (C d ) and lift (C L ) coefficients, whereas the downstream cylinder shows a consistent trend. Notably, the upstream cylinder maintains a higher drag coefficient than the downstream cylinder, with both being lower than that of a single isolated cylinder. The observed suppression of vortex shedding is primarily attributed to the interaction and coupling of shear layers between the moving wall and the cylinders, identifying shear alignment rather than viscous damping as the core mechanism of wake control.

Urine sediment examination is an important preliminary investigation for the nephrologist and helps him decide whether the patient has a proliferative or non-proliferative glomerular pathology. Recently, there is an increasing trend of using easier, non-specific dipstick method for urine examination leading to a decline in the importance of urine sediment examination. Here, we attempt to define guidelines for bio-chemical and microscopic parameters in order to develop a uniform and clinically relevant reporting system for urine sediment examination. Urine samples were reported as inactive or active sediment. A tiered system of reporting urine sediments was developed including inactive sediment, Inactive sediment with moderate/significant proteinuria, glomerular hematuria, and active sediment, active sediment with significant proteinuria / features of proliferative activity. The urine sediment was compared to kidney biopsies of these patients which were grouped into non proliferative and proliferative glomerulopathy. 795 paired samples of urine sediment and kidney biopsies were examined and compared. Patients of non-proliferative glomerulopathy (Minimal change disease, Focal segmental glomerulosclerosis, amyloid and membranous nephropathy) showed features of Inactive sediment. Patients with proliferative glomerulopathy (focal proliferative glomerulonephritis [GN], Diffuse proliferative GN, Membranoproliferative GN, Mesangio-proliferative GN and crescentic GN) predominantly showed active sediment, with increase in percentage of dysmorphic red blood cells and formed elements. The sensitivity of this urine reporting system was 82.0%, specificity 74.4% with p value <0.001. This system of reporting urine sediment is a sensitive and efficient method of predicting the severity of underlying kidney disease and need for performing renal biopsy.

India and Nepal share long-standing cultural, historical and economic ties, formalised under the 1950 Treaty of Peace and Friendship. Despite close relations, a persistent irritant in their economic engagement is Nepal’s widening trade deficit with India. While often attributed to treaty provisions, this article, drawing on extensive data analysis and key informant interviews, argues that the deficit is primarily a reflection of Nepal’s structural supply-side constraints rather than India-specific factors. Nepal’s exports have steadily weakened as industrial growth has stagnated since the mid-1990s, while imports have expanded rapidly, fuelled by rising remittance-driven incomes that now account for nearly a quarter of its GDP. The contraction of manufacturing has reduced export competitiveness, even as import demand has accelerated, leading to a sustained external imbalance. Addressing this challenge requires a forward-looking strategy that prioritises investment in Nepal’s productive sectors, upgrading trade infrastructure, fostering cross-border value chains and enhancing bilateral investment cooperation.

Isolated neurofibromas of the gallbladder (GB) and common bile duct (CBD) are exceptionally rare benign tumors, often mimicking malignancies and posing diagnostic challenges. This paper reports the unique case of a 32-year-old male presenting with right upper quadrant pain, jaundice, and clay-colored stools. Imaging revealed a septate GB with mural thickening, a gallstone, and distal CBD annular thickening, indicating a dual malignancy (GB carcinoma and cholangiocarcinoma). A hepato-pancreatic-duodenectomy was performed because of a suspected malignancy. The histopathology examination unexpectedly revealed spindle cell lesions positive for S100 and neurofilament protein, confirming a primary neurofibroma of the GB and CBD. This first reported case of simultaneous dual-site involvement highlights the diagnostic difficulty because of malignancy mimicry, advocating for intraoperative frozen sections to guide surgical management and avoid overtreatment.

Background: Mauriac syndrome is an uncommon complication of poorly controlled type 1 diabetes mellitus (T1DM), characterized by hepatomegaly, growth retardation, delayed puberty, and Cushingoid features. We report 3 children with Mauriac syndrome and a review of 9 additional Indian cases from the literature. Clinical Description: Case 1: A 12 year-old-boy, diagnosed with type 1 Diabetes Mellitus (T1DM) two years ago, presented with short stature, and was found to be in Tanner Stage 1 with huge hepatomegaly and mild splenomegaly. elevated transaminases, uncontrolled blood sugar and glycosuria without ketonuria. Case 2: A 14-year old boy, diagnosed with T1DM at 8 years of age, having diabetic ketoacidosis a week prior, was referred for poor growth. He had short stature but no pallor, was in Tanner stage 1 with hepatosplenomegaly. Blood sugar was elevated, though liver enzymes and routine work-up were normal. Case 3: A 12 year-old-boy diagnosed with T1DM at 9 years with no significant past illness, but poor adherence to insulin and diet therapy, presented with abdominal distension and growth failure. Examination showed short stature, hepatomegaly, elevated transaminases. Management and Outcome: While Mauriac syndrome was confirmed by liver biopsy in Case 1, the diagnosis was in Case 2 and 3 were made based on the constellation of hepatomegaly, poor glycemic control, short stature, and delayed puberty. All three cases were strictly reinforced on intensified basal-bolus insulin therapy with titration and medical nutrition therapy. Some improvement in HbA1C and growth velocity were seen at 6months, 2 and 3 years, for Case1, 2, 3, respectively. Case 2 and 3 had achieved complete pubertal development at last follow-up. Conclusion: Mauriac syndrome, though rare, continues to be encountered in Indian children with poorly controlled T1DM. Diabetes education and optimized insulin therapy can reverse many features, including hepatomegaly, growth delay, and pubertal arrest. Awareness of this condition avoids misdiagnosis and ensures timely intervention.