A high-voltage repetitive pulsed power supply (PPS) with variable pulsewidth has been designed and developed for generating high-intense electron beams suitable for high RF applications. In this present work, a new passive method is proposed using a suitably designed Marx generator and peaking capacitor. System parameters along with the operating pressure of the peaking switch are designed to achieve the variable pulsewidth at an operating voltage higher than 300 kV and a repetition rate of 100 Hz. Based on this concept, a system is designed, developed, and tested at a voltage of 300 kV with a load current of 5 kA. The variable pulsewidth of 115–204 ns has been achieved from the same PPS and with the same load.

This paper describes a complete cycle of designing, developing, and characterising a Pulsed Power System (PPS) and generating microwaves using the relativistic source. For low impedance relativistic High Power Microwave (HPM) sources, Blumlein Pulse Forming Line (BPFL) based high voltage pulsed power systems are the most suited. An HPM source such as a virtual cathode oscillator (VIRCATOR) operating in nanosecond durations consists of a primary voltage source that charges a Marx pulse generator’s capacitor bank over a long time. The requirements of a diode load are met by compressing the output pulse width of a Marx generator by a BPFL. This article describes the novel design, construction and characterization of a circulating De-Ionized (DI) water insulated BPFL pulsed power system. A novel approach of insulating gas filled Marx generator of this class/rating is attempted. A pulse power system consisting of high pressure gas insulated Marx generator and circulating DI water-based BPFL was developed and experimented with the resistive load as well as HPM source. The PSPICE simulation of the Blumlein circuit for various load conditions is described. Criticalities in the design of end bushings are elaborated along with the development and testing of a compact BPFL-based pulsed power system.

Objectives Healthcare workers (HCWs) are at high risk of latent tuberculosis infection (LTBI) due to their continued occupational exposure. The incidence of LTBI among the HCWs has seldom been investigated. Primary health centres (PHCs) provide effective and affordable medical care largely for the local population. The HCWs of PHCs who are likely to have increased occupational exposure have an increased risk of reactive as well as LTBI, and contribute to overall TB transmission than the general population. Methods A cross-sectional study (March–April 2024) was carried out to assess the burden of LTBI among the HCWs of PHCs (n=64) across Chennai, India. Blood samples were analyzed for gamma interferon using a QuantiFERON–TB Gold Plus assay. A complete baseline health profile, including complete blood count, blood glucose, liver and renal functions, and ferritin levels was estimated to identify potential biomarkers that are independently associated with LTBI. Results The present study revealed an LTBI prevalence of 25.3% (n=99) among PHC workers. The red cell distribution width was significantly associated with LTBI positivity among different biochemical and haematological parameters analyzed. Factors such as individuals age, underlying comorbid conditions (30.3%; n=30), and longer employment duration (28%; n=28) were significantly associated with IGRA positivity. IGRA positivity was significantly associated with decreased RDW–SD in females, overweight, and participants with O blood group. Conclusions The study reported a high prevalence of LTBI among HCWs of PHCs, which necessitates their periodical screening for the elimination of TB. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the National Health Mission, Tamil Nadu (680/NGS/NHMTNMSC/ENGG/2021) for the Directorate of Public Health and Preventive Medicine, WGS facility. M.L. is supported by grants through AI52731, the Swedish Research Council, the Swedish, Physicians against AIDS Research Foundation, the Swedish International Development Cooperation Agency, SIDASARC, VINNMER for Vinnova, Linkoping University Hospital Research Fund, CALF, and the Swedish Society of Medicine. V.V. is supported by the Office of Research Infrastructure Programs (ORIP/NIH) base grant P51 OD011132 to ENPRC A.M. is supported by Grant No. 12020/04/2018‐HR, Department of Health Research, Government of India. The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The authors thank the Indian SARS CoV‐2 Genomics Consortium (INSACOG), Department of Biotechnology, Ministry of Science and Technology, Government of India for their approval and inclusion of the State Public Health Laboratory (SPHL) as INSAGOG Genomic Sequencing Laboratory (IGSL) vide File No: RAD‐22017/28/2020‐KGDDBT‐Part (6) Dated 29th December 2021. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Ethical Committee of the Directorate of Public Health and Preventive Medicine, gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.

Background 1.6 million patients worldwide are victims of hip fracture. The incidence is expected to rise with ageing of world’s population. Elderly patients with hip fracture pose a medical challenge for the anesthesiologist and are often associated with high incidence of morbidity and mortality. Early surgical fixation of fractured joint is necessary to reduce associated morbidity. Advanced age and delayed surgical correction and medical history are independent factors determining 1 year mortality after hip fixation which is 23.9% in these patients. Objective: In this case series where we share our experience of fracture femur fixation performed under USG guided combined lumbosacral block for 19 patients of ASA 3/4 physical status. Method: Hip fracture fixation was performed under USG guided and neurostimulation technique Lumbar plexus and Para-sacral sciatic nerve block with 20 ml and 15 ml of 0.3% Ropivacaine respectively. All patients were shifted to ICU for further care. Conclusion: USG guided Lumbosacral plexus block for surgeries around the hip joint can be used as a sole anesthetic in high-risk patients. Detailed preoperative evaluation and optimization, vigilant patient selection, counselling, monitoring, providing optimum drug dosage are key for success. Keywords: Lumbosacral plexus block, Hip fracture, USG-guided

ABSTRACTIn December 2023, we observed a notable shift in the COVID-19 landscape, when the JN.1 emerged as a predominant SARS-CoV-2 variant with a 95% incidence. We characterized the clinical profile, and genetic changes in JN.1, an emerging SARS-CoV-2 variant of interest. Whole genome sequencing was performed on SARS-CoV-2 positive samples, followed by sequence analysis. Mutations within the spike protein sequences were analyzed and compared with the previous lineages and sublineages of SARS-CoV-2, to identify the potential impact of these unique mutations on protein structure and possible functionality. Several unique and dynamic mutations were identified herein. Our data provides key insights into the emergence of newer variants of SARS-CoV-2 in our region and highlights the need for robust and sustained genomic surveillance of SARS-CoV-2.

Introduction: Recurring painful mass with no signs of inflammation over the hip in a case of revision total hip replacement in known RA is a diagnostic dilemma and has not been reported when no Implant wear debris, infection, expanding hepatoma, Pseudoaneurysm, synovial cyst, sarcoma were excluded in a multiple operated Revision THR.Case Presentation: We report a case of a large rice body containing lobulated recurring clinically non-inflammatory painful cystic swelling over the lateral aspect of a multiple operated revision total hip replacement on the right hip in a known RA patient, a 64 years female. She had both hip and knee primary replacement done in 2008 and revision right Hip following periprosthetic fracture in 2016. Conclusion: This case report helps in a systematic approach to diagnose and manage a case of large recurring painful rice body containing cystic swelling of the hip following multiple operated Revision THR.

OBJECTIVES:Geographical Information Surveillance (GIS) is an advanced digital technology tool that maps location-based data and helps in epidemiological modeling. We applied GIS to analyze patterns of spread and hotspots of COVID-19 cases in the Vellore district in South India. METHODS:Laboratory-confirmed COVID-19 cases from the Vellore district and neighboring taluks from March 2020 to June 2021 were geocoded and spatial maps were generated. Time trends exploring urban-rural burden with an age-sex distribution of cases and other variables were correlated with outcomes. RESULTS:A total of 45,401 cases of COVID-19 were detected, with 20,730 cases during the first wave and 24,671 cases during the second wave. The overall incidence rates of COVID-19 were 462.8 and 588.6 per 100,000 population during the first and second waves, respectively. The spread pattern revealed epicenters in densely populated urban areas with radial spread sparing rural areas in the first wave. The case fatality rate was 1.89% and 1.6% during the first and second waves, which increased with advancing age. CONCLUSIONS:Modern surveillance systems like GIS can accurately predict the trends and spread patterns during future pandemics. In addition, real-time mapping can help design risk mitigation strategies, thereby preventing the spread to rural areas.

A rare complication of acute cholecystitis is a pseudoaneurysm of the cystic artery. We discuss a case of a 65-year-old man with synchronous cholecystoenteric fistula and cystic artery pseudoaneurysm managed by selective angioembolization of the cystic artery, followed by interval cholecystectomy.

Introduction: Laparoscopic cholecystectomy (LC) in patients with extrahepatic portal vein obstruction causing portal cavernoma (PC) is considered high risk because of portosystemic collateral veins in the hepatocystic triangle. The literature is limited to isolated case reports. We describe our experience of LC in patients with PC. Patients and Methods: Data of patients with PC who underwent LC for symptomatic gallstones or related complications was reviewed. Patients with simultaneous cholecystectomy with splenorenal shunt and open cholecystectomy were excluded. Pre-operative evaluation consisted of complete blood count, international normalisation ratio and liver function tests, ultrasound of the abdomen with Doppler, contrast-enhanced computerised tomography, magnetic resonance cholangiopancreatography and esophagogastroscopy as indicated. A standard four-port LC was performed. The technical principles followed were to avoid injury to the collateral veins, liberal use of energy sources and division of dominant collateral veins between clips. Results: Seven adult patients including three females underwent LC. Three patients had thrombosis of previous surgical shunt with persistent PC. The remaining four patients did not have any indication for shunt surgery. Successful LC was performed in six patients. The median duration of surgery was 170 (130-250 min). Blood transfusion was not required. All the patients had uneventful post-operative recovery. The histopathology of gall bladder consists of acute cholecystitis in three patients and chronic cholecystitis in four. Conclusion: LC is feasible in patients with PC at a centre with experience in both laparoscopic and portal hypertension surgeries. Excellent outcome with low rate of conversion to open surgery can be achieved.

Background and Aim:There is limited data on imaging features of extra hepatic portal venous obstruction (EHPVO) induced portal biliopathy.We describe a decade long experience of imaging spectrum of EHPVO induced portal biliopathy using MR/CT in a referral centre for liver diseases.Methods: Retrospective data of patients with primary EHPVO on contrast magnetic resonance imaging MRI/ computed tomography (CT) (n=120) and portal biliopathy (PB) on subsequent magnetic resonance cholangiopancreatography (MRCP) (n=80/120) between June 2009 -2019 was collected.Categorisation of portal biliopathy was as per the Sarin classification and the corresponding, relevant imaging parameters were studied and analysed.Results: Sarin Type 1 biliopathy was present in 16.3 %, Type 2 in 13.8%, Type 3a in 8.8% and Type 3b in 61.3%patients.The median total serum bilirubin was 1.6 (0.9-3.4) mg/dl with a mean CBD diameter of 6.7 ± 2.9 mm.Bilobar and unilobar IHBRD were observed in 87.5% and 6.3% patients respectively.The mean CBD angle was 138.9 ± 18.8º.CBD showed smooth wall contours (10%), extrinsic indentations (83.8%) and smooth strictures (6.3%).The median CBD stricture length was 26 mm (1.25-45 mm).Pre-stenotic dilatation was observed in 66.3% with stricture length >16 mm (sensitivity 81.1 % specificity 78%) predisposing to it.Statistically significant associations were tabulated according to the classification of PB. Conclusion:This study provides the decade long experience of imaging findings in EHPVO induced portal biliopathy according to its classification and its clinical implications.

To assess the performance of shear wave ultrasound elastography (SWE) for non‐invasive grading of fibrosis in normal BMI patients with varied aetiology chronic liver disease.

Aim: To evaluate the functional outcomes of the Bristow-Latarjet procedure in patients with recurrent shoulder dislocations. Objective: "Recurrent dislocation of the shoulder", is a common problem in youngsters. Basically, the ball of the shoulder joint slips out of it's socket. First time it is caused by significant injury, fall while playing in the playground or an accident. It becomes "recurrent", if repeated dislocation (slipping of ball out of the socket) happens with trivial injury or in sleep too. Such patients need an MRI and Surgical treatment like Arthroscopic Bankart Repair (Key Hole surgery). But, sometimes the socket gets partly eroded by repeated dislocation, (Bony Bankart lesion) in which case, keyhole surgery cannot be performed, rather a open surgery called as Bristow latarjet procedure, is required, which prevents further recurrent dislocations.

Aim: A comparative evaluation of the surgical treatment and outcome of patients with stable intertrochanteric fractures treated with long versus short INTERTAN nail. Objectives: Inter-trochanteric fractures of femur are among the most common orthopedic injury in elderly age group. Proximal femoral nailing with INTERTAN has become a popular method of stabilization of inter-trochanteric fractures in adults. stable trochanteric fractures can be treated using the conventional proximal femoral nailing method or the newly deviced proximal femoral nailing with INTERTAN nail. The present study was conducted to assess and evaluate the outcomes following treatment of stable inter-trochanteric fracture femur with long INTERTAN nail vs short INTERTAN nail.

There is limited scientific evidence on the potential of spectral computed tomography (SCT) for differentiation of nodules in the cirrhotic liver. We aimed to assess SCT-generated material density (MD) parameters for nodule characterisation in cirrhosis. Dynamic dual-energy SCT scans of cirrhotic patients performed over 3 years were retrospectively reviewed. They were classified as hepatocellular carcinoma (HCC), regenerative or indeterminate, according to the European Association for the Study of the Liver criteria. MD maps were generated to calculate the area under the curve (AUC) and cutoff values to discriminate these nodules in the hepatic arterial phase (HAP) and portal venous phase (PVP). MD maps included iodine concentration density (ICD) of the liver and nodule, lesion-to-normal liver ICD ratio (LNR) and difference in nodule ICD between HAP and PVP. Three hundred thirty nodules belonging to 300 patients (age 53.0 ± 12.7 years, mean ± standard deviation) were analysed at SCT (size 2.3 ± 0.8 cm, mean ± SD). One hundred thirty-three (40.3%) nodules were classified as HCC, 147 (44.5%) as regenerative and 50 (15.2%) as indeterminate. On histopathology, 136 (41.2%) nodules were classified as HCC, 183 (55.5%) as regenerative and 11 (3.3%) as dysplastic. All MD parameters on HAP and the nodule difference in ICD could discriminate pathologically proven HCC or potentially malignant nodules from regenerative nodules (p < 0.001). The AUC was 82.4% with a cutoff > 15.5 mg/mL for nodule ICD, 81.3% > 1.8 for LNR-HAP and 81.3% for difference in ICD > 3.5 mg/mL. SCT-generated MD parameters are viable diagnostic tools for differentiating malignant or potentially malignant from benign nodules in the cirrhotic liver.

BACKGROUND:Acute Kidney Injury (AKI) is a dreaded complication of Covid-19 infection with high morbidity and mortality. Limited data exists on Indian experience. In a tertiary care hospital situated in South India, we analysed the incidence, clinical profile and outcomes of patients diagnosed with AKI due to COVID-19.METHODS:Retrospective data of Adult cases admitted with COVID-19 over a 8 month period from April - November 2020 was collected. Incidence, Demographics, Clinical profile, Management and Outcomes of COVID-19 associated AKI were analysed. Primary outcome was In- hospital mortality. Secondary outcomes were Dialysis Requirement and Renal Recovery.RESULTS:52 (7%) out of a total 718 patients with COVID-19 developed AKI. Mean Age was 58 years (IQR 51-69) with a striking male predominance of 92%.(Male:Female -9.4:1) (P&lt; 0.001). Co morbidities seen were Diabetes in 38 (73%) and Hypertension in 31(59%) and Coronary Artery Disease in 17(32%). Fever with myalgia was seen in 29 (46%), Respiratory symptoms in 31(59%), Oliguria in 26(50%) and Diarrhea in 2 (3%) patients. At admission, Hypoxemia and Hypotension were seen in 27 (51%) and 16 (30%) patients respectively. Urinalysis revealed &gt; 2+ dipstick Proteinuria in 24 (46%) and Microscopic hematuria in 16(34%) patients. 25 (48%) were admitted in Stage 3 AKI with a mean S.Creatinine level of 4.4 + 3.4 mg/dl. CT chest showed &gt; 50% lung involvement in 23 patients (44%). Mechanical ventilation was required in 20(38%). Hemodialysis was required in 12 (23%). The median duration of hospitalisation was 10 + 5 days. Primary Outcome of Mortality occurred in 44% of AKI cohort in comparison to 7% in Non AKI cohort (Relative Risk[RR]6.2; 95% Confidence Interval[CI], 4.1 to 9.4) (P= 0.001). Hypoxemia [RR,3.76;95% CI,1.4-9.5], Hypotension [RR 2.54; CI,1.5-4 ], Low Serum albumin [RR1.6;CI,1.1 - 2.3] and Requirement for mechanical ventilation [RR,11.3; CI, 2.9 - 23 ] were significant risk factors for mortality. All 5 patients who required both mechanical ventilation and Dialysis died. 31 patients (59%) were treated with Remdesivir therapy without survival benefit. Significantly higher C-Reactive Protein, Interleukin -6, D-Dimer levels and lower serum albumin levels were seen in those who died. Among the 29 patients who survived, the estimated GFR (e GFR) had recovered in 12 (41%) at discharge. After further followup of 4-6 weeks, the total number of patients who recovered renal function rose to 21 (72%).CONCLUSION:Mortality in COVID associated AKI stood at 44%. Multiple factors contributed to high mortality such as Severe disease with hypotension and extensive pulmonary involvement, High Neutrophil to Lymphocyte Ratio, Absolute Monocyte Count, inflammatory markers, d-Dimer and low serum albumin. It was encouraging to note that 72% of survivors recovered renal function by 4-6 weeks after discharge from hospital which means that it is worth the struggle to treat AKI in COVID-19.

Objective: To analyze and evaluate the diagnostic performance of conventional diagnostic (qualitative) imaging features versus LI-RADSv2018 lexicon for indeterminate and atypical Hepatocellular carcinoma (HCC) on dynamic liver imaging with reference to histopathology. Patients and methods: This retrospective study (June 2009–June 2019) evaluated the performance characteristics of conventional imaging findings, versus the Liver Imaging Reporting and Data System (LIRADS) v2018, for interpretation of indeterminate and atypical HCC, in patients who underwent subsequent histopathological analysis (gold standard). A total of 100,457 dynamic hepatobiliary CT and MR examinations were performed over ten years at our institute. Using current international imaging guidelines, 3218 patients were found to have suspected liver cancer lesions on imaging. Classical enhancement pattern of typical HCC was seen in 2916 of these patients. These patients did not require further biopsy. We enrolled, the remaining (n = 302) patients, who underwent biopsy, into our study group. Two radiologists, blinded to pathology findings, reviewed and classified these lesions, in consensus, according to LI-RADS® lexicon and as per ‘conventional’ (Indeterminate, Atypical HCC, Classical HCC, other malignancies) imaging. The histopathology diagnosis was considered as the final diagnosis. Alpha feto protein (AFP) levels amongst various subgroups were compared. Statistical analysis was performed to calculate the efficacy of LIRADS versus qualitative imaging parameters in comparison with histopathology. Results: A total of n = 302 patients, [89 % men (n = 269), mean age 57.08 ± 12.43 years] underwent biopsy for suspected liver lesions. Qualitative imaging had 92.3 % (CI 88.53–94.91) sensitivity, 41.4 % (CI 25.51–59.26) specificity, positive predictive value (PPV) of 93.7 % (CI 90.11–96.02), negative predictive value (NPV) of 36.4 % (CI 22.19–53.38), positive likelihood ratio (PLHR) of 1.575 (CI 1.40–1.77) and negative likelihood ratio of (NLHR) 0.19 (CI 0.13-0.26). It correctly classified 87.4 % of lesions diagnosed on pathology. In comparison, LI-RADS was found to have 92 % sensitivity, 55.5 % specificity, 97 % PPV, 30.3 %, NPV, PLHR 2.068 (CI 1.62–2.64), NLHR 0.15 (CI 0.11-0.18) and 89.7 % diagnostic accuracy. A total of 38 patients (17 false negative, 21 false positive lesions) had discordant diagnoses on imaging versus histopathology. The kappa agreement between LIRADs and qualitative Imaging was found to be 0.77 ± .07 (p < 0.001). LIRADS and qualitative imaging collectively had 97 % sensitivity, 30 % specificity, 91.9 % PPV, 55.6 % NPV, PLHR of 1.39 (CI 1.27–1.51) and NLHR of 0.09 (0.048-0.19) which was better than, either reporting system, independently. Conclusion: It was observed that the LI-RADS v2018 lexicon with qualitative imaging as a combination technique added extra value in interpretation of atypical HCC or indeterminate lesions on dynamic CT and MRI compared to either as ‘stand- alone’ reporting systems.

It has been more than 50 years since Prof Thomas Starzl and colleagues [1] performed the first successful human liver transplantation (LT) in the United States.In the following years, LT gradually established its role as definitive therapy for patients with acute liver failure and end-stage liver disease, and later on for selected patients with hepatocellular carcinoma (HCC).Over this period, rapid advances have taken place in pre-operative management of these critically ill liver diseases patients, sophisticated operative techniques, implementation of optimal post-transplant immunosuppressive regimens to balance between adequate immunosuppression to prevent rejection and not too much to cause infection.For a successful outcome in LT, it needs a multidisciplinary approach with a hepatologist, liver transplant surgeon and liver intensivist who serve as pillars of the program and ably supported by allied specialities like cardiology, pulmonology, nephrology, infectious diseases, transfusion medicine, radiology and so on.Timely transplant is the key to success, failing which patients do end up becoming too sick and are not in a fit state for LT.Hence it is important to understand that referral for liver transplant should be considered at the onset of decompensation and not just based on MELD criteria alone due to long waiting list especially in a cadaveric transplant setting.It is prudent to identify these patients of end stage liver disease (ESLD) early, triage patients needing LT, optimize them medically prior to transplant, establish standard working protocols for posttransplant and long-term immunosuppression with careful tailoring of immunosuppression, keeping strict vigilance on possible post-transplant metabolic complications at any point of time.The goal of such a systematic and protocolised approach is to maximise good patient and graft outcomes in a replicable manner across the board amongst various centres in the world.

Background: Significantly increased malignancy risk exists in patients who undergo renal transplantation.Post-transplant lymphoproliferative disorder (PTLD) is a relatively rare but potentially fatal condition arising after renal transplant.While majority are related to Epstein-Barr virus (EBV), EBV negative cases do occur.Three types are described.Early lesion consists of infectious mononucleosis type.Polymorphic PTLD shows malignant lymphoid infiltrates with mono or polyclonality not meeting all criteria.Monomorphic PTLD show malignant transformation of monoclonal B, T or natural killer cell lines meeting the criteria.Methods: The patient was a 53-year-old male who underwent a deceased donor renal transplant 4 years ago.He was on maintenance doses of triple immunosuppression consisting of tacrolimus, mycophenolate mofetil, and prednisolone.Three years later he developed fungal infection involving right knee joint (mucormycosis) which was treated liposomal amphotericin B. Six months later he presented with rapidly enlarging multiple nodular lesions over the right knee joint which was initially mistaken as recurrence of fungal infection.The biopsy from the lesion was diagnostic of large B cell lymphoma (co-expression of CD20 and CD45).Serum antibodies for EBV was negative.He was positive for immunoglobulin G antibodies against cytomegalovirus.The donor EBV status was unknown.Results: Immunosuppressives were withheld and chemotherapy regimen of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone was initiated.Tragically, he succumbed to the illness 3 months later with multiple metastases involving brain and lungs.Conclusions: PTLD is rare but serious complication which supervenes early in the post-transplantation course within 3-5 years.The site of origin of the tumor in the skin over knee joint is unusual in this case.Aggressive policy of early biopsy in suspicious nodules should be undertaken for early diagnosis of PTLD to improve the prognosis.The mortality is high in late stages.

Background: Progressive chronic kidney disease (CKD) results in secondary hyperparathyroidism (SHPT). After a successful renal transplant, theoretically SHPT should rapidly regress. But residual parathyroid overactivity may persist. Indian reports of post-transplant hyperparathyroidism (PTHP) are sparse. Methods: A cross sectional study was undertaken to identify the prevalence, clinical features, and risk factors for PTHP. One hundred twelve consecutive patients who underwent renal transplantation in our unit from 2014 to 2018 and completed 3 months of post-transplant period were included. We excluded patients with allograft dysfunction, active infections, and malignancy. Results: The total number of patients was 112; mean age 38±12 years; 88 males and 24 females; crescentic glomerulonephritis, diabetic nephropathy, and CKD of unknown etiology were 61%, 18%, and 16%, respectively. Transplant vintage was 48±44 months. Mean estimated glomerular filtration rate (GFR) was 71±28 mL/min/1.73 m2. Sixty-two percent of them had raised intact parathyroid hormone (PTH) levels. Only two out of the 76 cases of PTHP patients had raised serum calcium above 10.5 mg/dL with a poor sensitivity of 2.63% and with 98% specificity. Serum phosphorus of less than 2.5 mg/dL was encountered in only 14 out of 76 cases of hyperparathyroidism with a low sensitivity of 18% and specificity of 88%. In the hyperparathyroid group there was a significant reduction of 25-OHD3 (serum 25-hydroxyvitamin D3) levels when compared to control group (30±5 ng/mL vs. 23±8 ng/mL; P≤0.0001). ANOVA showed a significant association between PTH levels and female sex, estimated GFR levels, hemoglobin, calcium, and 25-OHD3 levels. PHD concentrations were significantly negatively correlated with serum calcium (r=–0.39, P=0.0003) and vitamin D levels (r=–0.50, P=0.002). Conclusions: Hyperparathyroidism is common in post renal transplant setting. Serum calcium and phosphorus levels fared poorly as screening tests. Vitamin D deficiency should be addressed in post-renal transplant setting to prevent this condition.