Background: Autoimmune diseases` incidence had increased significantly by 1995-as compared to 1983, by when tubectomy, contraception was being steadily implemented; hence an altruistic correlation was sought after. Methods: Data of 64 people with varied autoimmune diseases spread over 1989-2012 from 7 geographical locations, each separated by ~500 km distance, was tabulated into 3 age groups, namely 20-35 years, 35-50 years, >50 years and association with contraception status, consumption of fish without scales, gills, shell fish, was analyzed by bio informatics, retrospectively in 2012. In 2002, 2003 data of 105 patients from the community and hospital was analyzed for association of contraception status, prevalent diseases and estrogen levels. Results: Contraceptive users demonstrated 15 fold increase in auto-immune diseases among 20-35 years [p <0.0005]; 40 fold increase in auto-immune diseases among 35-50 years [p <0.0005]; 5 fold increase in autoimmune diseases were seen with consumption of fish without scales and gills in non contraceptive users also. Endogenous estrogen was reduced below normal in 61% of patients using contraception [p <0.0005]. Conclusion: The concept is contraception results in smashed fragmentation of Germ Cells, to a centric fragments, ring chromosomes, chromatid breaks, being identified by immune surveillance as foreign, leading to auto immunity; associated reduced endogenous estrogen or androgen, results in defaulted cell cycle, cell metabolism of differentiation, growth, controlled multiplication, degeneration, apoptosis, regeneration, genomic repertoire, leading to impaired immunity; auto-immunity is also produced by consumption of fish without scales and gills due to its toxins mediated cytotoxicity, by molecular mimicry, in non contraceptive users also. Abstinence for 7 days after last menstrual period, prevents exposure of raw endometrial surface to germ cells; abstinence for 45 days after male baby delivery, 90 days after girl baby delivery prevents germ cells exposure to raw placental detached surface and reduces auto immunity.

Background and Aims Acute kidney injury is a global health problem. This study aims to determine the risk factors for poor outcome and to describe the clinical profile, etiology & outcomes of patients with Acute Kidney Injury (AKI) admitted to the Critical Care Unit from a tertiary care centre in South India. Method It was a prospective cohort study conducted in a tertiary care hospital in South India from December 2016 to Novemeber 2019. All patients in the ICU were screened for enrolment in AKI using RIFLE criteria with creatinine, GFR and urine output daily for a period of seven days. Results A total of 152 patients were taken for final analysis after exclusions. The mean age of the subjects was 44.15 years. Majority of the study subjects (55.9%) belonged to 26 – 50 years of age. Majority of the study subjects were females (51.3%) and the rest were males. Sepsis was found to be present in 52% (79) of the study subjects followed by Gastrointestinal loss 36.2% (55), crush injury 9.03% (15), snake bite 3.3% (5), poisoning 4.6% (7) and acute liver failure 1.3% (2). It was found that 62.5% (95) of the study subject’s AKI had resolved after appropriate management. Among the rest of the study subjects,27.6% required haemodialysis for recovery, 3.3% had persistence of AKI, 3.9% progressed to CKD and 2.6% died. The latter three categories were considered as poor outcomes of AKI. In our study, 29.8%people who had systemic hypertension and 28.2%people who had diabetes mellitus had poor outcome. It was found that in our study, sepsis and GI loss both contributes to poor outcome of AKI in univariate regression analysis whereas Gastrointestinal loss alone contributes to poor outcome of AKI with multivariate regression analysis. Conclusion In conclusion, even though sepsis is the commonest cause of AKI, Gastrointestinal loss independently contributes to poor outcome of AKI. Majority of the people recovered from AKI spontaneously with conservative management. Few people required dialysis for recovery of AKI & very few people progressed to CKD.

included mild lymphocytopenia (920/mL and 868/mL respectively), normal C-reactive protein and liver enzyme levels, and stable serum creatinine and urea levels. MMF was discontinued, while steroid dose was increased by twice in both patients. Due to fever, a 3-day course of azithromycin was administered to the female patient. Normalization of total lymphocyte count permitting the progressive re-initialization of MMF and reduction of steroid dose was observed at 14 th and 5 th day of the disease respectively. Graft function remained stable in both patients. Conclusions: The outcome of SARS-CoV-2 infection during both early and late post-transplant period seems favorable in pediatric KT recipients. Immunosuppression interruption may be beneficial for preventing acute disease complications. Optimal treatment strategies need to be established.

included mild lymphocytopenia (920/mL and 868/mL respectively), normal C-reactive protein and liver enzyme levels, and stable serum creatinine and urea levels. MMF was discontinued, while steroid dose was increased by twice in both patients. Due to fever, a 3-day course of azithromycin was administered to the female patient. Normalization of total lymphocyte count permitting the progressive re-initialization of MMF and reduction of steroid dose was observed at 14 th and 5 th day of the disease respectively. Graft function remained stable in both patients. Conclusions: The outcome of SARS-CoV-2 infection during both early and late post-transplant period seems favorable in pediatric KT recipients. Immunosuppression interruption may be beneficial for preventing acute disease complications. Optimal treatment strategies need to be established.

We discuss the use of urine electrolytes and urine osmolality in the clinical diagnosis of patients with fluid, electrolytes, and acid-base disorders, emphasizing their physiological basis, their utility, and the caveats and limitations in their use. While our focus is on information obtained from measurements in the urine, clinical diagnosis in these patients must integrate information obtained from the history, the physical examination, and other laboratory data.