ObjectiveTo evaluate the effectiveness of noradrenaline for the treatment of hepatorenal syndrome (HRS).BackgroundHRS represents the development of renal failure in cirrhotic patients. The standard treatment for HRS is terlipressin, which, as opposed to noradrenaline, is more expensive and less accessible in most tertiary care centers.Patients and methodsThirty consecutive patients with HRS type 1 received noradrenaline (1–4.0 mg/hour) and albumin for 14 days. The parameters recorded were: serum creatinine levels, creatinine clearance, mean arterial pressure (MAP), urine output, and serum sodium levels evaluated at baseline and on treatment days 1, 3, 7, and 14.ResultsMost patients achieved serum creatinine levels <1.5 mg/dL and were considered responders (22/30, 73%), whereas eight patients (27%) were nonresponders. At baseline, responders and nonresponders differed only regarding initial bilirubin levels and international normalized ratio values. Treatment duration was 7.5±3.2 days. Responders experienced a significant (p<0.05) decrease in serum creatinine levels (from 3.26±0.48 to 1.28±0.14 mg/dL), as well as a significant increase (p<0.05) in creatinine clearance (from 21±4.1 to 67.7±12.1 mL/min), urine output (from 583±41.1 to 1163±105 mL/day), MAP (from 79.2±2.94 to 93.9±2.34 mmHg), and serum sodium levels (from 125±2.01 to 132.3±1.39 mEq/L). In nonresponders, the MAP increased, but serum creatinine levels also increased, reflecting a decrease in creatinine clearance and urine output, with no significant change in serum sodium levels over the duration of the treatment.ConclusionIn most patients, noradrenaline treatment induced systemic vasoconstriction resulting in HRS reversal, with acceptable safety, in agreement with previously reported outcomes of terlipressin treatment.

Water is the most vital source and one of the precious natural resources of this planet. Due to industrialization and urbanization ground water quality is adversely affected. According to WHO, nearly 80% of all the diseases in human beings are caused by water. Many of the people of Mangalam, near Tirupathi, Andhra Pradesh, India are affected by pollution of drinking water. In the present study an attempt was made to assess the quality of ground water and its suitability for drinking purpose. EXPERIMENTAL Water samples and chemicalsFor the analysis of physicochemical parameters, 8 areas were selected located in and around Mangalam, near Tirupathi, India. The ground water samples were collected in clean and dry

INTRODUCTIONThe common hepatic artery originates from coeliac trunk, a branch of abdominal aorta, along with splenic and left gastric arteries. After its origin, it gives a gastroduodenal branch which heads downwards posterior to the pyloric part of stomach and the first part of duodenum. The hepatic artery proper arises from the common hepatic artery as one of the terminal branches and reaches the porta hepatis through the right free margin of the lesser omentum where it lies anterior to the portal vein and to the left of bile duct. The right gastric artery usually arises from hepatic artery proper. Hepatic artery proper then divides into right and left branches which supply the right and left lobes of the liver respectively. The gall bladder is supplied by a cystic branch from the right hepatic artery. Although variations of the branching pattern and distribution of the common hepatic artery are common, variations in its origin and course are relatively rare and are important in surgical and radiological point of view. One of the rare origins of the hepatic artery is from the superior mesenteric artery. With the advent of new diagnostic, therapeutic and operative techniques within the abdominal cavity, a sound knowledge of the variant courses of the abdominal vessels become important for dealing clinicians, surgeons and interventional radiologists. Surgeons undertaking hepatobiliary and gastric surgery must be acquainted with the anatomy of common hepatic artery and should be able to recognize its multiple anatomical variants to avoid subsequent thrombosis leading to ischaemia of the liver or bile duct and stomach with distressing consequences. The present study was carried out to document the normal anatomy and different variations of the common hepatic artery and to evaluate the possible clinical implications. Methods: A total of 36 properly embalmed and formalin fixed cadavers were dissected in the abdominal region and viscera were mobilized to expose the origin of important branches of the common hepatic artery. Results: Classical branching pattern of common hepatic artery was seen in 91.66% cases. Origin of right hepatic artery from superior mesenteric artery and accessory cystic artery from gastroduodenal artery was seen in 2.77% cases. In 5.55% cases, right gastric artery originated from left hepatic artery. Conclusions: Knowledge of such variations will play a significant role in avoiding technical difficulties during infusion therapy and chemoembolization of neoplasm in the liver. It is also valuable in carrying out surgical intervention safely in the abdomen and also in the interpretation of angiographic reports.

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Aim :Methodology : Results :Interpretation :The current study aimed to identify the hydro-geological processes that control the groundwater chemistry. Further, groundwater quality was also evaluated for drinking and irrigation purposes.Groundwater samples were collected from a semi-arid region of North India i.e., Ellenabad, Sirsa, Haryana. The samples were analyzed following the American Public Health Association standard methods for the examination of water and wastewater.Most of the groundwater samples of study area fall under hard category. The saline nature of -1 groundwater can be attributed to high concentration of total dissolved salts (340±104 mg l ). Majority of the -1 groundwater samples showed fluoride concentration below the permissible limit of WHO and BIS (1.0 mg l ). Multivariate analysis including sodium absorption ratio was calculated to assess the water quality for irrigation purpose and it was found appropriate for majority of crops, except for sensitive plant species.Potability assessment of groundwater showed that more than 40% samples were unacceptable for drinking purpose without any prior treatment, hence, it is essential to conduct a routine monitoring of groundwater to determine its aptness for drinking, domestic and agriculture purposes.

Introduction: Gerdy's tubercle is described as a triangular facet in standard textbooks of human anatomy. The present study addresses the prevalence and shape of the anterolateral tubercle, which has been named as Gerdy's tubercle in adult human tibia. Examination of tibia revealed in excess of usual variations in the shape and texture of tubercle present at the anterior surface of lateral condyle of tibia. Material and Methods: The study was conducted on 103 (52 right and 51 left) of either sex dry Indian tibia bone to study the shape and texture of Gerdy's tubercle. The shape and texture of tubercle were very inconsistent and varied from a small circular smooth facet to very irregular rough facet.

Background: Sciatic nerve, the thickest and the largest nerve of the body, is formed in the pelvis. After passing through the greater sciatic foramen, it enters the gluteal region, and subsequently the nerve passes on the back of thigh to reach the superior angle of popliteal fossa where it bifurcates into tibial and common fibular nerves. It usually divides into its terminal branches outside the pelvis; however it may rarely divide within the pelvis. In such cases, the tibial nerve and the common fibular nerve may leave the pelvis through different routes. The knowledge of different routes of exits of the sciatic nerve is of utmost importance for the surgeons and the interventionists dealing with this region as this is the site of innumerable surgical manipulations as well as nerve injuries during deep intramuscular injections in gluteal region, failed sciatic nerve block in anaesthesia and injury during posterior hip surgeries. These variations may result in non-discogenic sciatica because of the nerve compressions under other adjacent anatomic structures. Purpose of the study: This study is an attempt to analyse the course, distribution and levels of the division of sciatic nerve into tibial nerve and common fibular nerve and their clinical implications. Results: Out of the total 120 lower limbs studied, deviation from the usual described pattern was observed in four limbs. One cadaver showed bilateral variation while other two described unilateral disparity from the standard prototype. Conclusion: This knowledge of variant anatomy of division and course of sciatic nerve and its terminal branches will not only assist surgeons to take care during interventions, but also facilitate to plan accordingly during various surgical procedures and management.