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Renal Transplantation Is Associated with Improved Clinical Outcomes in Nephrogenic Systemic Fibrosis
Rabi Yacoub,Kiran Kandukurti,Mandip Panesar
ISRN Transplantation , 2013, DOI: 10.5402/2013/303175
Abstract: Nephrogenic systemic fibrosis is a debilitating disorder seen in chronic kidney disease patients and is characterized by stiffening of the joints and thickening of the skin. Treatment options are limited, but some patients have had an improvement of their clinical symptoms after renal transplantation and the use of immunosuppression. Although there is a variable response to renal transplantation, it is currently unknown what factors promote a favorable outcome. Our objective was to evaluate if the response to renal transplantation was superior to other treatment modalities and to determine which characteristics allowed for a positive response to occur. We retrieved the data from the literature of 298 reported patients, compared the response to renal transplantation and to other treatments, and analyzed their characteristics. We found that more patients had a higher response to renal transplantation, as determined by softening of the skin and improved joint mobility, and among those that did respond, they had a shorter dialysis vintage. We suggest that if renal transplantation is to be considered as a treatment modality, it should be initiated at the earliest possible in the course of the disease to achieve maximum clinical benefit. 1. Introduction Nephrogenic systemic fibrosis (NSF) is primarily seen in chronic kidney disease (CKD) patients and is characterized by large areas of hardened skin with slightly raised plaques, papules, and hyperpigmentation. Biopsies of the affected areas show increased numbers of fibroblasts, alteration of the normal pattern of collagen bundles, and often increased dermal deposits of mucin [1]. The skin may have a “cobblestone” [2], “woody” [3, 4], or peau d’ orange appearance [5]. These lesions may be pruritic and accompanied by sharp pain or burning sensations [3, 6]. Movement of the joints may be so severely limited by the fibrosis that the flexibility is lost. The first cases were noted between 1997 and 2000 in hemodialysis (HD) patients or patients with a failed renal allograft who developed severe skin indurations that were initially thought to be scleromyxedema [7, 8]. Since Grobner reported a correlation between the use of gadolinium (Gd) in end-stage renal disease (ESRD) patients and NSF [9], additional reports supporting this correlation have been published [10, 11]. It is now recognized that low-stability gadolinium-based contrast agents, in the presence of permissive factors, most likely trigger the disease. The prevalence of NSF after exposure to gadodiamide (Omniscan) has been reported to be between 3% and 7%
Understanding Nephrogenic Systemic Fibrosis
Tushar Chopra,Kiran Kandukurti,Silvi Shah,Raheel Ahmed,Mandip Panesar
International Journal of Nephrology , 2012, DOI: 10.1155/2012/912189
Abstract: Nephrogenic systemic fibrosis (NSF) is a rare and a debilitating disease noted uncommonly in patients with impaired renal function when exposed to low-stability gadolinium-based contrast agents (Gd-CAs). According to experimental studies, cytokines released by the stimulation of effector cells such as skin macrophages and peripheral blood monocytes activate circulating fibroblasts which play a major role in the development of NSF lesions. The presence of permissive factors, presumably, provides an environment conducive to facilitate the process of fibrosis. Multiple treatment modalities have been tried with variable success rates. More research is necessary to elucidate the underlying pathophysiological mechanisms which could potentially target the initial steps of fibrosis in these patients. This paper attempts to collate the inferences from the in vivo and in vitro experiments to the clinical observations to understand the pathogenesis of NSF. Schematic representations of receptor-mediated molecular pathways of activation of macrophages and fibroblasts by gadolinium and the final pathway to fibrosis are incorporated in the discussion. 1. Introduction Nephrogenic systemic fibrosis (NSF) is a fibrosing disorder which predominantly occurs in patients whose estimated glomerular filtration rate is below 30?mL/min/1.73?m2 or who are on dialysis [1, 2]. Clinically, these patients present with a thickening and hardening of skin which is often associated with pain, muscle weakness, bone pain, and joint contractures leading to severe disability [3]. These lesions can be found all over the body but typically occur on the lower extremities and the face is usually spared [4]. NSF, first described in 1997, can affect both children and the elderly and has an average age of onset of 46.8 years [5, 6]. No genetic or racial predisposition has been established. The most common presenting morphology is sharply demarcated plaques (58%) with irregular edges but papules (32%), nodules (17%), and rarely macules, vesicles, blisters, bullae, and ulcers have also been reported [1, 4, 5, 7]. The lesions are progressive and later can evolve into wrinkles and woody skin with a cobblestone or “peau d’orange” texture [8]. NSF skin lesions are usually hyperpigmented and erythematous (39%) but can vary from violaceous, brown, tan, yellow, pink, orange-red, and grey-brown [4, 9]. Although initially named, “Nephrogenic Fibrosing Dermopathy,” since it was thought that the lesions were limited to the skin, it is now well documented that these lesions extend beyond the dermis and can
Extensive Cannon Ball Metastases—A Case Study of a 49-Year-Old Bulgarian Male  [PDF]
Kiran Kumar
Open Journal of Medical Imaging (OJMI) , 2014, DOI: 10.4236/ojmi.2014.43022
Abstract: Multiple pulmonary nodules on chest x-ray, known commonly as cannon ball secondaries, are the classical presentation of haematogenous dissemination of a malignant tumor to the lungs. This almost always indicates advanced stage of the disease with a very grim outlook in terms of cure or survival. In this report we present a patient with very extensive Cannon Ball Metastases due to advanced colonic malignancy.
Synthesis, Kinetics and Mechanism of Terpolymerization of Styrene, Vinyl Acetate with Acrylonitrile Initiated by P-Nitrobenzyl Triphenyl Phosphonium Ylide  [PDF]
Kiran Prajapati, Anuradha Varshney
International Journal of Organic Chemistry (IJOC) , 2011, DOI: 10.4236/ijoc.2011.12010
Abstract: Synthesis of terpolymers consisting of two electron-donating monomers, viz. styrene and vinyl acetate with one electron-accepting monomer, i.e. acrylonitrile, initiated by p-nitrobenzyl triphenyl phosphonim ylide in dioxane as diluent at 65°C for 150 min has been studied. The kinetic expression is Rpα[I]0.8[Sty] 1.2[VA] 1.4 [AN]1.2. The terpolymer composition was determined by the Kelen-Tüdos method. The values of reactivity ratios using r1 (Sty + VA) = 0.1 and r2 (AN) = 0.005. The overall activation energy is 46 kJ●mol●L–1. The formation of terpolymer is confirmed by the FTIR spectra showing bands at 3030 cm–1, 1598 cm–1, and 2362 cm–1, confirming the presence of phenyl, acetoxy and nitrile group respectively. The terpolymer has been characterized by 1H-Nuclear Magnetic Resonance, 13C-Nuclear Magnetic Resonance. The Differential Scanning Calorimetric curve shows the Tg of the polymer as 149.5°C. A scanning electron microscope confirms the polymer to be phosphorus free. Electron.Spin.Resonance spectra confirms phenyl radical responsible for initiation.
On Rayleigh Wave in Two-Temperature Generalized Thermoelastic Medium without Energy Dissipation  [PDF]
Baljeet Singh, Kiran Bala
Applied Mathematics (AM) , 2013, DOI: 10.4236/am.2013.41019

In this paper, Rayleigh surface wave is studied at a stress free thermally insulated surface of a two-temperature thermoelastic solid half-space in absence of energy dissipation. The governing equations of two-temperature generalized thermoelastic medium without energy dissipation are solved for surface wave solutions. The appropriate particular solutions are applied to the required boundary conditions to obtain the frequency equation of the Rayleigh wave. Some special cases are also derived. The non-dimensional speed is computed numerically and shown graphically to show the dependence on the frequency and two-temperature parameter.

Bone Transport in Tibial Gap Non-Union—A Series of 25 Cases  [PDF]
Manish Kiran, Rabi Jee
Open Journal of Orthopedics (OJO) , 2012, DOI: 10.4236/ojo.2012.24027

Gap non-union of the tibia is frequently associated with deformity, infection and shortening. Ilizarov’s method of bone transport was used in the management of twenty-five cases of gap non-union of the tibia. The mean bone gap was 6.53 cm (range 4 to 12 cm). Union was achieved in all cases within a mean period of 11.12 months. The mean time taken for union, per centimeter of bone gap was found to be 1.7 months/cm. Pin tract infection was the commonest complication, seen in 9 cases (36%). The other complications encountered were neuropraxia (n = 3) deviation of the transported bone segment (n = 7), buckling of skin at the advancing side of bone (n = 4), traumatic corticotomy (n = 3), incomplete corticotomy (n = 1), equinus deformity (n = 4), knee stiffness (n

Propagation of Waves in a Two-Temperature Rotating Thermoelastic Solid Half-Space without Energy Dissipation  [PDF]
Baljeet Singh, Kiran Bala
Applied Mathematics (AM) , 2012, DOI: 10.4236/am.2012.312261
Abstract: The present paper is concerned with the propagation of plane waves in an isotropic two-temperature generalized thermoelastic solid half-space in context of Green and Naghdi theory of type II (without energy dissipation). The governing equations in xz plane are solved to show the existence of three coupled plane waves. The reflection of plane waves from a thermally insulated free surface is considered to obtain the relations between the reflection coefficients. A particular example of the half-space is chosen for numerical computations of the speeds and reflection coefficients of plane waves. Effects of two-temperature and rotation parameters on the speeds and the reflection coefficients of plane waves are shown graphically.
Kimura’s Disease—A Rare Cause of Head and Neck Swelling  [PDF]
Kiran Rao, Sudesh Kumar
International Journal of Otolaryngology and Head & Neck Surgery (IJOHNS) , 2014, DOI: 10.4236/ijohns.2014.34037

Kimura’s disease (KD) is a chronic inflammatory disorder with unknown etiology, most commonly manifesting as painless unilateral cervical lymphadenopathy or subcutaneous masses in the head or neck region. The disease is characterized by a triad of painless subcutaneous masses in the head or neck region, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E levels. Kimura’s disease is an unusual vascular tumor that typically occurs at 20 to 30 years of age. There has been no documented case of malignant transformation; however, recurrence rates after excision may be as high as 25%. Surgery and medical therapy are useful for treatment. We present a 14 years old male developed a unilateral cervical mass associated with KD. It was a recurrence of disease. As a complete excisional resection of the mass already done 1 year back at some other centre, we decided to give medical treatment for Kimura’s disease.

Structure and Dielectric Relaxation Behaviour of [Pb0.94Sr0.06][(Mn1/3Sb2/3)0.05 (Zr0.49Ti0.51)0.95]O3 Ceramics  [PDF]
Kumar Brajesh, Kiran Kumari
World Journal of Condensed Matter Physics (WJCMP) , 2015, DOI: 10.4236/wjcmp.2015.53022
Abstract: The field dependences of the dielectric response and conductivity are measured in a frequency range from 100 Hz to 1 MHz and in a temperature range from 300 K to about 775 K. The dielectric measurements (real and imaginary parts) of this composition with temperature (300 K - 775 K) at different frequencies (100 Hz - 1 MHz) unambiguously point towards relaxor behaviour of the material. The real part of the dielectric constant is found to decrease with increasing frequency at different temperatures while the position of dielectric loss peak shifts to higher frequencies with increasing temperature indicating a strong dispersion beyond the transition temperature, a feature known for relaxational systems such as dipole glasses. The frequency dependence of the loss peak obeys an Arrhenius law with activation energy of 0.15 eV. The distribution of relaxation times is confirmed by Cole-Cole plots as well as the scaling behavior of the imaginary part of the electric modulus. The frequency-dependent electrical data are also analyzed in the framework of the conductivity and modulus formalisms. Both these formalisms yield qualitative similarities in the relaxation times. The Rietveld analysis conforms that the materials exhibits tetragonal structure. The SEM photographs of the sintered specimens present the homogenous structures and well-grown grains with a sharp grain boundary.
Study of Rayleigh-Bénard Magneto Convection in a Micropolar Fluid with Maxwell-Cattaneo Law  [PDF]
Subbarama Pranesh, Rojipura V. Kiran
Applied Mathematics (AM) , 2010, DOI: 10.4236/am.2010.16062
Abstract: The effects of result from the substitution of the classical Fourier law by the non-classical Maxwell-Cattaneo law on the Rayleigh-Bénard Magneto-convection in an electrically conducting micropolar fluid is studied using the Galerkin technique. The eigenvalue is obtained for free-free, rigid-free and rigid-rigid velocity boundary combinations with isothermal or adiabatic temperature on the spin-vanishing boundaries. The influences of various micropolar fluid parameters are analyzed on the onset of convection. The classical approach predicts an infinite speed for the propagation of heat. The present non-classical theory involves a wave type heat transport (SECOND SOUND) and does not suffer from the physically unacceptable drawback of infinite heat propagation speed. It is found that the results are noteworthy at short times and the critical eigenvalues are less than the classical ones.
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