Priyamvada Singh

Plastics are integral part of society and have varied application. Plastics are composed of a network of molecular monomers bound together to form macromolecules. There are increasing concerns due to non degradability and generation of toxic gases on combustion during incineration. Due to fabrication of desired shape colour and specification convenient to customers there is increasing application in packaging, agriculture, automobiles and biomedical. They are indispensable to the modern generation due to development in information technology, intelligent and smart packaging system. Efforts are in progress for development of efficient and precise conversation of renewable raw materials into innovative polymeric product through recent technologies which are superior in terms of performance, environmental and cost perspectives. In rivers and at coastal regions the marine pollution is increasing at a faster rate due to indiscriminate disposal by the consumers. R&D studies are now centred for investigating whether consumption of plastic debris by marine organism translates into toxic exposures for people who consume seafood with particular relevance to plasticisers, stabilizers, heavy metals viz phthalates, BPA, lead cadmium, methyl mercury. Biological effects from pollution are linked with resulting economic effects and losses. A cornerstone of sustainable development is the establishment of affordable, effective and truly sustainable waste management practices in developing countries. Plastic waste management is a critical issue. Over 300 million metric tons of plastics are produced in the world annually and about fifty percent of this volume is for disposal applications, product that are discarded within a year of their purchase. It is the boon and bane of our times. Although there are multiple uses, its waste and the resultant pollution clogs up our rivers, oceans, lands and adversely affects the biodiversity. We need to plan for disposal of new synthetic product, implants etc which have completed their shelf life. In future polymeric adhesives and implants are to be developed which address total joint replacement features for patients with varied complications and age. It should be robust, biocompatible with surface treatment options to allow for reduced friction and wear throughout the implant life. In a CPCB supported study we have found that the soil and ground water quality may be affected in dumpsite areas. The International Organisation for standardization [ISO] Organisation for Economic Cooperation [OECD] and development, British specification [BS] Indian Standards [IS] need to be implemented for appropriate application and safe disposal. Globally steps are being taken for development of environmental friendly, innovative plastic items using the concept of green chemistry and also with safe disposal methods. Integrated waste management practices are to be encouraged, strengthened and supported with state of art scientific applications.

INTRODUCTION: Chronic kidney damage is routinely assessed semiquantitatively by scoring the amount of fibrosis and tubular atrophy in a renal biopsy sample. Although image digitization and morphometric techniques can better quantify the extent of histologic damage, we need more widely applicable ways to stratify kidney disease severity. METHODS: We leveraged a deep learning architecture to better associate patient-specific histologic images with clinical phenotypes (training classes) including chronic kidney disease (CKD) stage, serum creatinine, and nephrotic-range proteinuria at the time of biopsy, and 1-, 3-, and 5-year renal survival. Trichrome-stained images processed from renal biopsy samples were collected on 171 patients treated at the Boston Medical Center from 2009 to 2012. Six convolutional neural network (CNN) models were trained using these images as inputs and the training classes as outputs, respectively. For comparison, we also trained separate classifiers using the pathologist-estimated fibrosis score (PEFS) as input and the training classes as outputs, respectively. RESULTS: CNN models outperformed PEFS across the classification tasks. Specifically, the CNN model predicted the CKD stage more accurately than the PEFS model (κ = 0.519 vs. 0.051). For creatinine models, the area under curve (AUC) was 0.912 (CNN) versus 0.840 (PEFS). For proteinuria models, AUC was 0.867 (CNN) versus 0.702 (PEFS). AUC values for the CNN models for 1-, 3-, and 5-year renal survival were 0.878, 0.875, and 0.904, respectively, whereas the AUC values for PEFS model were 0.811, 0.800, and 0.786, respectively. CONCLUSION: The study demonstrates a proof of principle that deep learning can be applied to routine renal biopsy images.

Published data regarding the approach to management of diabetes mellitus in solid organ transplant (SOT) recipients are limited. We performed a retrospective chart review of SOT recipients with diabetes, above 18 years of age, who were usisng dulaglutide. There was a sustained, statistically significant reduction in the primary endpoints of weight, body mass index (BMI) and insulin requirement in 63 SOT recipients at 6, 12 and 24 months, respectively. A total of 59, 50 and 13 recipients were followed during 6, 12 and 24 months, with a mean paired difference for weight reduction of 2.07 ( P value <0.003), 4.007 ( P value <0.001) and 5.23 ( P value <0.034) kgs and a BMI reduction of 0.80 ( P value <0.001), 1.35 ( P value <0.005) and 2.015 ( P value <0.045) kg/m 2 , respectively. The mean paired difference for insulin reduction before and after dulaglutide treatment was 5.94 units ( P value <0.0002). There was no increased risk of malignancy, cardiovascular morbidity, graft‐failure or all‐cause mortality. Gastrointestinal manifestations were rare, even in patients with advanced chronic kidney disease (CKD), and required no change in immunosuppressive agents. Thus, dulaglutide may be considered an important option for diabetes management in SOT.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are gaining popularity in the management of diabetes in solid organ transplant (SOT) recipients. There are no studies available comparing the two GLP-1RAs dulaglutide and liraglutide in SOT. We performed a retrospective chart review to assess the safety and effectiveness of these agents in adult SOT with diabetes at 6, 12 and 24 months. There were 63 and 25 recipients on dulaglutide and liraglutide, respectively. There was a sustained reduction in primary endpoints of weight, BMI and insulin requirement with dulaglutide when compared to liraglutide. Decrease in weight was 2%, 4% and 5.2% with dulaglutide and 0.09%, 0.87% and 0.89% with liraglutide at 6, 12 and 24 months respectively. BMI reduction followed the same trend in the two groups. The percentage reduction for insulin was 26% with dulaglutide and 3.6% with liraglutide. There was a 10% reduction in creatinine and a 15% increase in estimated glomerular filtration rate (eGFR) at the end of 24 months with dulaglutide. However, there was an increase in creatinine by 7% and an 8% decrease in eGFR at the end of 24 months with liraglutide.