bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed Presentation of Morphine-Induced Respiratory Depression: A Case Report
Authors: Mukhtar Islam , Mudawi Omar , Alashkar Abdulrahman H. , Abuajamieh Raed Ali
Published: December 2024

Opioid-induced respiratory depression (OIRD) is a serious threat that can lead to brain damage and death. Morphine is a commonly used opioid for postoperative pain management. However, the window during which patients are at risk of OIRD, as described in the literature, is largely based on the drug’s pharmacokinetics rather than actual clinical experiences. For morphine, OIRD is generally noted to occur within 5–72 min following administration. In this case, we present the case of a 73-year-old female who underwent open herniorrhaphy and developed respiratory depression 5 h after receiving an intravenous (IV) dose of morphine. The diagnosis of OIRD was confirmed by a positive response to naloxone. Defining a window during which patients are at risk of developing respiratory impairment after opioid administration has significant practical implications for the management of postoperative patients. Based on its half-life and our clinical experience, healthy patients receiving a therapeutic dose of IV morphine may develop OIRD for up to 6 h following administration. During this period, close monitoring is strongly recommended to ensure early detection and intervention if respiratory depression occurs.
An Interesting Case of Kidney Transplant Recipient with Multiple Concomitant Infections- 10 Years Post Transplantation
Authors: Rajesh Chilaka , Mishra Utkarsh , Jain Ankit , Jayaprakash T. , Bharadwaj Phaneesh , Rajmani Selvin Sundar , Jose Nisha , Eapen Jeethu Joseph , John Elenjickal Elias , Varughese Santosh
Published: December 2024

Opportunistic infections or pathogens that reactivate from latent infection in the renal transplant recipients often arise during the peak immunosuppression period and infections such as Pneumocystis jirovecii may arise in the late period of posttransplant. In developing countries, tuberculosis (TB) is a major concern among transplant patients. Here, we present a case of 42-year-old male who presented after 10 years of renal transplant with a history of fever. On evaluation, he was diagnosed to have concomitant multiple infections like disseminated TB, Cryptococcal meningitis, Cytomegalovirus viremia, and Pneumocystis infection. He was treated with appropriate antibiotics, antifungal, and antiviral with close monitoring of drug-related side effects and graft function. Detailed evaluation and to look for concomitant infections is required for transplant patients who had no response to one particular group of drugs after initial diagnosis. He had stable graft function and developed drug-related side effects which required dose reduction intermittently. This case taught us how to manage four major infections with balancing immunosuppression, antibiotics, and graft function that we see in day-to-day practice of transplant clinics.
Cutaneous Coccidian Parasitic Infection in a Renal Transplant Recipient
Authors: Hameed Ramzeen Nilam , Unni V. Narayanan , Bipi K. , Warrier Anup , Thomas Joe
Published: December 2024

One of the leading causes of mortality in solid organ transplant patients is infections, with the other two being cardiovascular disease and malignancy. Opportunistic infections are well known in solid organ transplant recipients. Coccidia is known to present with gastrointestinal manifestations; however, Coccidia presenting with cutaneous manifestations is not reported, to the best of our knowledge. We report the case of a renal transplant recipient who presented with subcutaneous nodules due to a coccidian parasite.
Role of Luminex Crossmatch in Renal Transplantation – A Comprehensive Case Study
Authors: Basavanna Rajeshwari , Jogale Suchita P. , Deshpande Anand S.
Published: December 2024

The significance of pre-transplant screening for donor-specific anti-HLA antibodies dates back to the 1960s. The advent of Complement Dependent Cytotoxicity (CDC) assay, flow cytometry, and solid-phase assays has transformed the detection of anti-HLA antibodies, particularly in renal transplant cases. While the utilization of solid-phase assays offers numerous advantages, it is imperative to acknowledge their inherent limitations when striving to deliver accurate results to patients. In this study, we present three cases characterized by false positivity observed either in cross-matching or HLA antibody screening. These instances underscore the critical role of clinical history consideration and the adoption of highly sensitive and specific multiple platforms to effectively address and rectify false positive and false negative results. This approach enhances patient care and ensures the provision of accurate and reliable pre-transplant assessments and post-transplant monitoring.
A Case of Repeat Kidney Transplant Intolerant to Multiple First-line Immunosuppressive Agents Mycophenolate Mofetil, Azathioprine, and Calcineurin Inhibitors
Authors: Arora Puneet , Duggal Rajan , Garg Deepak , Naseem Tarique
Published: December 2024

A repeat kidney transplant is the preferred treatment for graft failure due to its enhanced survival benefits and improved quality of life, despite facing greater medical, immunological, and surgical challenges compared to the first transplant. Immunosuppressive medications are indispensable for organ recipients to prevent rejection and prolong the viability of transplanted organs. At present, triple-drug therapy comprising calcineurin inhibitors, corticosteroids, and antiproliferative medications is the prevailing protocol for immunosuppressive treatment in renal transplant recipients. In conjunction with the intended therapeutic outcomes, the administration of immunosuppressive agents entails the potential for specific adverse reactions. This patient developed chronic diarrhea due to mycophenolate mofetil, severe bone marrow suppression with azathioprine due to thiopurine methyltransferase enzyme deficiency, and developed thrombotic microangiopathy with tacrolimus, despite maintaining recommended therapeutic drug levels, leading to the withdrawal of all three drugs. The case highlights the need for newer immunosuppressive drugs and protocols that are more effective and less toxic.
Rare Case of Congenital Thrombotic Thrombocytopenic Purpura Presenting as Posttransplant Thrombotic Microangiopathy
Authors: Viswanathan Akila , Panchangam Vidyashankar , Shetty Shashank , Reddy Govardhan , Tonshal Sanjeev S. , Doraiswamy Prakash , Shashank M. R. , Gowda Kiran Krishne , Anoop Parameswaran
Published: December 2024

Middle-aged female underwent transplantation with her mother as a donor after appropriate desensitization. The patient developed graft dysfunction with systemic features of thrombotic microangiopathy. Renal allograft biopsy was suggestive of antibody-mediated rejection. She was treated with plasmapheresis followed by intravenous immunoglobulin. However, due to lack of response, further workup was sent and the patient was found to have ADAMTS 13 levels <1% with no evidence of antibodies. Hence, she was diagnosed to have congenital thrombotic thrombocytopenic purpura. A graft nephrectomy was done, and the patient was managed with frozen plasma infusions until remission. Currently, the patient is back on maintenance hemodialysis and is doing well and planned for a genetic study.
Utility of an Objective Scoring System for Acute Tubular Injury in Renal Allograft Biopsies
Authors: Agrawal Neha , Gowrishankar Swarnalata
Published: December 2024

Introduction:

Banff criteria define various parameters involved in rejection episodes in renal allografts. However, definite objective criteria to diagnose tubular injury are not well addressed. In the present study, we aim to examine a morphological scoring system for diagnosing and grading acute tubular injury in graft biopsies. Furthermore, we assess the correlation of various morphological features of tubular injury with graft dysfunction at the time of biopsy.

Materials and Methods:

Fifty renal allograft biopsies with a histological diagnosis of acute tubular injury were selected. The inclusion criteria included absence of rejection, significant interstitial inflammation, infection, or interstitial fibrosis/tubular atrophy >10%. The tubular injury was assessed and scored under five parameters: loss of brush border, presence of lucency, flattening of tubular epithelium, loss of nuclei, and presence of cast or debris. All parameters were scored from 0 to 2 based on objective criteria and assessed in five microscopic fields at ×200. A cumulative score was calculated for each biopsy. A correlation with serum creatinine at the time of biopsy with individual scores and cumulative scores was done. Statistical analysis was done and the Pearson correlation coefficient was obtained.

Results:

All the individual scores of tubular injury showed a positive correlation with serum creatinine at biopsy, with Pearson correlation coefficient varying from 0.670 to 0.490. The cumulative score for tubular injury also showed a strong positive correlation with serum creatinine, with Pearson correlation = 0.761.

Conclusion:

An objective semi-quantitative morphological scoring system may help in assessing the extent of tubular injury in graft biopsies, as this correlates well with graft dysfunction.
A Mixed Method Study on Kidney Transplant Recipients’ Quality of Life
Authors: Chundawat Bheru Singh , Chaturvedi Dharmesh , Suthar Vaneshvar , Gupta Kapil , Yadav Kaushlendra Singh , Pattnaik Shweta
Published: December 2024

Background:

Chronic kidney disease is progressive irreversible deterioration in renal function where body is unable to maintain metabolic, fluid, and electrolyte balance. It occurs with a gradual reduction in the function of the kidneys over time. The purpose of the study was to gain deeper understanding of the quality of life (QoL) of kidney transplant recipients.

Materials and Methods:

A sequential exploratory research design was adopted in the study. The study was conducted in the nephrology outpatient department unit of Choithram Hospital and Research Centre, Indore. Nonprobability purposive sampling technique was used to collect data from the participants. The data were then analyzed using descriptive and inferential statistics.

Results:

During the data analysis in qualitative research design, five themes emerged, which were Physical life, Social life, Economic improvement, Change in attitude toward life, and Challenges. Sixty percent of kidney transplant recipients had a good QoL. The quantitative study results supported the themes that emerged from the qualitative study.

Conclusion:

The Study concluded that transplant certainly improves the QoL so there should be counseling for patients regarding kidney transplantation. It was very imperative from the viewpoint of the medical professionals to support renal transplant but in our research findings, kidney transplant recipients were also in favor of kidney transplant.
Our Unique Experience with Low-Dose Alemtuzumab as an Induction Agent for Renal Transplantation: A Case Series
Authors: Josi Cherin , Parthasarathy Arjun , Sundar Divya , Matthew Milly , Rajendran Premkumar , Abraham Georgi
Published: December 2024

The use of an induction agent in renal transplant is based on the center or physician’s protocol. Alemtuzumab was used as an induction agent in 1998 for the first time and has been used since then as an induction agent off-label. There has been no consensus on the dosage of alemtuzumab. We describe our experience of using low-dose alemtuzumab in 13 patients who have undergone live-related kidney transplantation. Twelve patients received Alemtuzumab 15 mg as a single dose intravenous (IV) on day 0 along with methylprednisolone. One patient received 10 mg of alemtuzumab. Tacrolimus, mycophenolate mofetil, and steroids were the maintenance immunosuppressive agents. Postoperatively, white blood cell and differential count and renal function were monitored daily. We transplanted 13 patients, 2 females and 11 males, including one pediatric patient. The mean age of the patients was 33 (±12) years. All the patients underwent live donor kidney transplants. One patient had regrafting. All the patients had their CDC and flow crossmatch done and were negative. They had end-to-side anastomosis with the external iliac artery, and the cold ischemia time was around 22 min. The mean absolute lymphocyte count before the transplant was 1520 (±627)/mm3, and posttransplant, it was 30 (±16)/mm3; the mean creatinine was 1.0 (±0.2) on discharge. None of the patients had any episode of rejection. There were five episodes of urinary tract infection and one episode of wound infection among the patients. Alemtuzumab, given in a dose of 15 mg IV (50% reduction), is a useful induction adjuvant and can be a cost-effective strategy for induction in renal transplant recipients to prevent acute rejection.
A Prospective Study to Assess the Best Optimal Dose of Tacrolimus before Renal Transplantation and Its Impact on Graft Survival and Patient Outcome in Renal Transplant Recipients
Authors: Gogoi Niranjan , Jain Charu , Agarwal Megha , Agarwal Dhananjay , Gupta Ajay , Kumar Munesh
Published: December 2024

Background:

The treatment of renal transplantation has been revolutionized by the advent of calcineurin inhibitors like tacrolimus (TAC). There is a wide variation in the expression of cytochrome p450 enzyme for TAC metabolization in Indian population. This variation may lead to unpredictable outcome in renal transplants (RTs). Early identification of patients at risk may help to improve graft outcome.

Aims and Objectives:

To assess the best optimal dose of tacrolimus and its impact on graft survival and patient outcome in renal transplant recipients.

Materials and Methods:

A prospective longitudinal study was conducted in the Department of Nephrology for 1 year after due approval. Patients with end-stage renal disease undergoing RT on TAC with available TAC trough concentration 1 month before transplantation were included and analyzed for graft function and patient outcome in terms of adequate immunosuppression and renal function.

Results:

Among total 30 recipients, 17 (56.7%) were fast-TAC metabolizers (concentration-to-dose [C/D] ratio <1 μg/ml·1/mg) and the rest 13 (43.3%) were slow-TAC metabolizers (C/D ratio ≥1 μg/ml·1/mg). TAC dose modification was done in 14 (86%) fast metabolizers and 6 (46.15%) slow metabolizers (adapted group) 3 days before RT to keep the drug in therapeutic range. Among the adapted group, 15/20 patients (fast metabolizers – 10 and slow metabolizers – 5) had achieved early target trough levels (at day 4) in comparison to the control group 3/10 (fast metabolizers – 0 and slow metabolizers – 3) (P < 0.05). Three cases of biopsy-proven acute graft rejection were found among fast-TAC metabolizers, contrary to one case among slow-TAC metabolizers (P = 0.182). One patient showed TAC-related toxicity in biopsy.

Conclusion:

Optimizing the dose of TAC before renal transplantation may facilitate individualization of immunosuppression and can improve graft outcome.
Incidence, Risk Factors, and Treatment Outcome of Acute Renal Allograft Rejection
Authors: Akhil Remyasri , Mathew Eby , Prasannan Bipi , Urs Vishnu Dev , Unni V. Narayanan
Published: December 2024

Background:

Acute rejection occurs at any time following renal transplantation. The study aims to find the incidence, risk factors, and outcome of acute rejection in kidney transplantation.

Materials and Methods:

Retrospective cohort study conducted from January 2015 to April 2023, included patients with biopsy-proven acute graft rejection. Data were collected from electronic medical records. Rejection and no rejection groups were compared for the variables.

Results:

Out of 371 patients, acute rejection occurred in 36 (9.7%) patients at 1 year of transplantation. Thirty (8%) were early acute rejections (EARs) and 22 (6%) were late acute rejections (LARs). Higher human leukocyte antigen (HLA) mismatches, historical positive crossmatch, and history of blood transfusions were risk factors for acute rejection (P < 0.05). Incidence of LAR beyond 1 year was 11/23 (48%) in those who had received induction therapy at transplantation versus 5/29 (17.2%) in those who did not (P = 0.045). One out of five patients (3.4%) who received antithymocyte globulin (ATG) experienced EAR, in contrast to 8/18 (5.2%) patients who received basiliximab (P = 0.037). A complete response to treatment was observed in 22/30 (73.3%) patients with EAR and 2/22 (9.09%) with LAR (P < 0.001). At 23.77 ± 24.6 months of follow-up, graft survival was 12/12 (100%) in those with early T-cell-mediated rejection (TCMR) compared to 5/9 (55.6%) with late acute TCMR (P = 0.01).

Conclusion:

The incidence of acute rejection was highest within the first posttransplant year. Higher HLA mismatches, historical positive crossmatch, and history of blood transfusion were risk factors for acute rejection. ATG was effective in preventing EAR. LAR occurring beyond the first posttransplant year was independent of induction therapy at time of transplantation. Treatment response was better with EAR compared to LAR. Graft survival was better with early acute TCMR compared to late acute TCMR.
First-year Students and Organ Donation: A Multidisciplinary Study Conducted in Eastern India Analyzed by Ordinal Regression
Authors: Datta Panchali , Bhattacherjee Sharmistha
Published: December 2024

Background:

Organ transplantation is becoming increasingly common and established as the preferred treatment for individuals with end-stage organ failure. The global organ transplantation demand–supply gap is greater in Southeast Asia and more so, in India. This study aims to uncover the underlying factors contributing to the disparity between the awareness and willingness for organ transplantation. First-year students possess the potential to function as catalysts for change in their families and society about organ donation, due to their influential role in shaping the future society.

Objective:

The objective of this study was to evaluate the level of knowledge, attitude, and willingness toward organ donation among first-year students from various fields and to find out their relationship with specific sociodemographic factors.

Materials and Methods:

The study employed a cross-sectional observational design and included 762 first-year students from several colleges in Eastern India, studying disciplines such as medicine, nursing, engineering, and business. Using Google Forms, a validated and predesigned questionnaire was developed and then sent to participants sharing the QR code. The analysis was conducted using SPSS version 20.0.

Results:

Among the 762 participants, while 68.6% had a satisfactory to excellent understanding of organ donation, just 5.9% had a positive attitude toward it. Furthermore, if called upon, 21.4% said they would be willing to donate organs. A statistically significant correlation was seen between knowledge, attitude, and the willingness to donate organs.

Conclusions:

Multiple factors exert influence on organ donation, encompassing elements such as information, cultural views, and individual motivation. Comprehending these components is crucial for developing efficient strategies to promote organ donation.
Indocyanine green with methylene blue dye as an alternative to standard dual dye technique for sentinel lymph node biopsy in node-negative early breast cancer: Experience from a tertiary cancer institute
Authors: Bandegudda Santhoshkumar , Bindlish Ridhima , Naidu Chandra C K , Mohandas Anu , Patel Rajkumar Pareshbhai , Kodandapani Suseela , Raju KVVN , Thammineedi Subramanyeshwar R.
Published: December 2024

Background:

Sentinel lymph node (SLN) biopsy by a dual technique using technetium and methylene blue (MB) is a standard method of assessing the axilla in node-negative breast cancer. However, technetium has few drawbacks and not easily available, especially during the situation like COVID-19 pandemic. This warrants for the development of alternate techniques of SLN biopsy replacing the technetium.

Methods:

A retrospective study of prospectively entered data was collected from 1st of January to 31st of December 2020 in a tertiary cancer center in India. A total of 86 node-negative breast cancer patients, who underwent SLN biopsy using dual technique either by technetium and MB or indocyanine green (ICG) and MB were studied. There were 52 patients in technetium and MB group and 34 patients in the indocyanine green and MB group.

Results:

There was no statistically significant difference in age, quadrant of a tumor, type of surgery, histopathology, grade, size of tumor, and hormone receptor status between the groups. Both techniques had similar identification rates, mean sentinel nodes removed, and SLN positivity rate.

Conclusion:

In circumstances where technetium is not available, ICG with MB can be considered as a safe alternative technique for SLN biopsy.
How stressful is caregiving? A question worth asking
Authors: Thakur Pragyat , Aashita  , Sharma Rajiv
Published: December 2024

Introduction:

Caring for chronically ill patients is often an emotionally demanding task. Apart from physical, social, and economic burdens, inadequate information, preparation, and support for caregivers lead to significant distress, which is often underestimated.

Objectives:

This study aimed to estimate the prevalence and evaluate the factors contributing to stress in caregivers of terminally ill cancer patients and analyze the effects of such stress on the caregivers.

Methods:

Caregivers of 88 terminally ill patients admitted to our hospice facility between October 2019 and February 2020 were evaluated for stress using the Caregiver Strain Index (CSI) tool. Contributing factors and consequences of caregiver stress were analyzed using multivariate analysis.

Results:

A CSI score of ≥7 was present in 77.8% of caregivers, reflecting significant stress levels. Age more than 50, female sex, education status, financial constraints, physical strain, and emotional adjustments contributed significantly to overall caregiver stress, in multivariate analysis (P <0.05).

Conclusion:

Caregiver stress is a significant problem, and the absence of support systems in developing countries further compounds their suffering. Methodical evaluation of stress and suitable coping strategies is the need of the hour.
Improved Clinical Outcomes with Appropriate Meropenem De-escalation in Patients with Febrile Neutropenia
Authors: Luu Tyler , Fan Austin , Shaw Reid , Dalal Hina , Adams Jenna , Santarossa Maressa , Reid Gail , Tsai Stephanie , Clark Nina M. , Albarillo Fritzie S.
Published: December 2024

Introduction:

Antibiotic stewardship is a critical aspect of managing cancer patients with febrile neutropenia (FN) to limit the development of drug-resistant organisms and minimize adverse drug effects. Thus, it has been recommended that patients with FN receiving empiric antibiotics should be re-evaluated for safe antibiotic de-escalation.

Methods:

Subjects treated with meropenem for febrile neutropenia who met Loyola University Medical Center’s (LUMC) criteria for de-escalation were stratified based on whether meropenem was de-escalated, and 30-day all-cause mortality for both groups was assessed.

Results:

181 patients met criteria for meropenem de-escalation. Sixty patients (31.3%) were ade-escalated (MDE), and 121 subjects were not (NDE). The 30-day all-cause mortality was 8.3% (n = 5/60 subjects) in the MDE group and 2.4% (n = 3/121) in the NDE group but was not statistically significant (P=0.1). Median hospital length of stay was 13 days in the MDE group versus 20 days in the NDE group (P = 0.049). CDI rate was also lower in the de-escalated group. In addition, consultations by infectious diseases physicians were more common in the de-escalation group. Logistic regression model demonstrated positive culture (OR 4.78, P = 0.03), including positive blood culture (OR 8.05, P = 0.003), and GVHD (OR 19.44, P = 0.029), and were associated with high rates of appropriate de-escalation. Immunosuppression (OR 0.22, P = 0.004) was associated with lower rates of appropriate de-escalation.

Conclusion:

Appropriate meropenem de-escalation in FN patients is safe and can result in improved clinical outcomes.
Hypersensitive Pneumonitis Masquerading as Acute Severe Asthma
Authors: Babu Sarath Balaji , Sohanraj Chetan Kumar , Chellakutti Thangaraj
Published: December 2024

Hypersensitive pneumonitis (HP) is an uncommon cause of interstitial lung diseases in children and is often misdiagnosed as a case of asthma and treated with inhaled corticosteroids. Prompt identification of exposure in children can reduce unnecessary investigations and step-up therapy. Early identification of HP can bring better outcomes in children. We present the case of an 8-year-old boy with a recent onset of poorly controlled asthma, who presented with cyanosis, and was found to have been exposed to pigeons; his serum specific protein level for pigeon exposure was positive with lymphocytic broncho-alveolar lavage and computed tomography of the chest, consistent with HP, and on administration of oral steroids recovered completely.
Behavioral Insomnia of Childhood and Sleep Coaching for Children: A Narrative Review
Authors: Ghosh Gautam
Published: December 2024

Childhood insomnia is a sleep disorder that makes it hard for children to fall asleep, stay asleep, or sleep long enough. Behavioral insomnia during childhood (BIC; more commonly known as bedtime problems and night waking) commonly occurs in young children (<5 years). If left untreated, bedtime problems and night waking can result in impairments in behavior, emotion regulation, and academic performance, yet it has been shown that pediatricians do not adequately address sleep in routine child wellness visits and under-diagnose sleep issues. Pediatricians receive little formal training in medical school or in residency regarding sleep medicine. An understanding of the physiology of sleep is critical to a pediatrician’s ability to effectively and confidently counsel patients about sleep. Treatments for bedtime problems and night waking have been found to be efficacious and durable. This article begins with a review of the diagnostic criteria and clinical presentation of BIC. This is followed by a brief review of application of operant theory to behavioral interventions for BIC and a detailed discussion of application of these treatments for bedtime problems and night waking in young children.
Combined Methylmalonic Acidemia with Hyperhomocysteinemia cblC Type 1: A Rare and Treatable Cause for Pediatric Cerebral Venous Sinus Thrombosis
Authors: Viswanathan Lakshminarayanapuram Gopal , Seshagiri Doniparthi V. , Nagappa Madhu , Bharath Rose Dawn , Sinha Sanjib
Published: December 2024

Abstract

A six-year-old girl with progressive cognitive decline, behavioral disturbances, and language impairment was initially treated with antipsychotics, showing gradual improvement. After a febrile episode, she developed mutism and excessive daytime sleepiness. Laboratory tests revealed anemia, leukopenia, elevated homocysteine, and normal vitamin B12 levels. Genetic testing confirmed Methylmalonic aciduria with hyperhomocystinemia (cblC type). MRI demonstrated subcortical atrophy, white matter signal changes, restricted diffusion in the basal ganglia, and transverse sinus thrombosis. cblC type 1 is a rare genetic disorder with late-onset presenting with hematological and neurological complications. MRI findings of basal ganglia signal changes wth venous thrombosis is an unusual combination. Treatment includes high-dose hydroxycobalamin, betaine, and anticoagulants, with close monitoring for managing symptoms and preventing complications.
Management of Vein of Galen Aneurysmal Malformation in a Neonate: A Tightrope Walk
Authors: Narayan Vinitha , Luthra Ankur , Narayanan Vidhya , Chauhan Rajeev , Abdulmajed Mohamed Yaser Arafath Mohaideenbawa
Published: December 2024

Abstract

The vein of Galen aneurysmal malformation (VGAM) is a rare congenital intracranial high-flow arterio-venous shunt that can cause high-output cardiac failure in the neonate. Embolization of the VGAM by interventional neuroradiology is the procedure of choice. Treatment decisions should be individualized and based on a scoring system like the Bicetre score. We report our experience of the anesthetic management of a neonate with high-output cardiac failure who underwent transarterial embolization. We highlight the risk of acute pulmonary edema during the procedure and stress the importance of strict fluid and hemodynamic management.
Role of Cystatin C for Early Detection of Acute Kidney Injury in Children
Authors: Luna Sharmin Akter , Bushra Farhana , Sultana Jakia , Sultana Nadira , Mamun Abdullah-Al , Huque Syed Saimul , Jesmin Tahmina , Begum Afroza , Roy Ranjit Ranjan
Published: December 2024

Background:

Acute kidney injury (AKI) has been associated with high morbidity and mortality in children, including neonates. Early diagnosis would be of great value for treatment and prevention.

Objective:

The goal of this study was to assess the role of cystatin C to detect AKI early in children who were at risk.

Materials and Methods:

This prospective analytical study was conducted at Department of Paediatric Nephrology and performed on critically and non-critically ill patients admitted in the Department of General Paediatrics and Allied, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study period ranged from May 2018 to July 2019. Patients aged 4 days–17 years were included, who were at risk for AKI. The risk was considered when patients presented with symptoms of hypovolemia, shock, sepsis, and used nephrotoxic agents. Anthropometry was measured in all patients with the standard method. Then, blood samples were collected to assess creatinine at 0, 48, and 72 h for the contrast group and on the fifth day instead of 72 hr for the non-contrast group, to assess cystatin C at 0 and 48 h. For diagnosis of AKI, Kidney Disease Improving Global Outcomes criteria were used for all patients.

Results:

A total of 52 patients at risk of AKI were enrolled in this study, among which 42 were in the older age group and 10 were neonates. Twenty patients (38%) developed AKI. The mean age of the older age group was 11.3 ± 3.7 years with male preponderance, and mean age in neonates was 10.8 ± 5.4 days with female preponderance. The major risk factor for AKI was nephrotoxic drugs, followed by hypovolemia in the older age group. In neonates, the primary risk factor for AKI was hypovolemia, followed by sepsis and asphyxia. Cystatin C level increased in serum 1–2 days before creatinine in patients with AKI. Only 6 (30%) patients with AKI were detected by creatinine levels within 48 h and all AKI patients by cystatin C within 48 h. The ability of serum cystatin C to predict AKI at 48 h was analyzed, which revealed the area under the curve (AUC) was 0.93 with 95% confidence interval (CI) = 0.864–0.995. Using a cut-off value of 1.35 mg/L for cystatin C, the sensitivity and specificity were 95% and 84% (95% CI = 0.779–0.997 and 0.737–0.873), respectively. The positive predictive value and negative predictive value, accuracy, positive likelihood ratio, and negative likelihood ratio were 79%, 96%, 88.7%, 6.08, and 0.06, respectively. The association between age, gender, height, weight, body mass index, and risk factors and cystatin C was explored, revealing no effects on cystatin C.

Conclusion:

Serum cystatin C is an effective and early marker for detection of AKI in children at risk.
Acute Kidney Injury in a Child Due to Wasp Stings: A Case Report
Authors: Chowdhury Md. Murad , Akhter Shammi , Biswas Susmita , Quader Mohammed Maruful , Kayes Mohammad Imrul
Published: December 2024

Following a wasp sting, a child may present with multisystem involvements, such as anaphylactic shock, acute renal failure, and acute liver failure. Multiple toxins in wasp venom, including melitin, apamin, phospholipase A2, hyaluronidase, and chemotactic peptides, are responsible for various systemic involvements. Here, we report a 10-year-old boy who developed swelling of the whole body, anuria for 18 h, and respiratory distress after 40 h following multiple wasp stings. Initially, the patient was managed with one session of peritoneal dialysis, and subsequently, the patient switched to intermittent hemodialysis. After four sessions of intermittent hemodialysis, urine output was established. After a total of eight sessions of intermittent hemodialysis, the patient was discharged from the hospital with regular follow-up advice. The management of wasp sting should be started as early as possible, and when progressive renal failure ensues, intensive dialysis support results in good renal recovery with the return of renal function to normal in the majority of the survivors.
Radioactivity concentration of natural and anthropogenic radionuclides in the soil of Banswara region, Rajasthan and associated radiation index parameters
Authors: Gill Rajpal , Meena Balram , Tiwari Shailesh Nath , Saradhi I. V. , Kumar A. Vinod
Published: December 2024

Activity concentrations of gamma-emitting naturally occurring radionuclides (NORM’s) of 226Ra, 232Th, and 40K along with anthropogenic radionuclides of 137Cs in soil samples collected around the new upcoming nuclear power plant site at Banswara district, of Rajasthan, India were estimated. The mean radioactivity concentrations of 226Ra, 232Th, 40K, and 137Cs in surface soil samples of Banswara region were 17.6, 36.4, 309.7, and 1.4 Bq.kg−1, respectively. The mean activity of 226Ra, 232Th, and 40K is lower when compared to the world average values. Average radium equivalent activity (Raeq), absorbed gamma dose rates in air (DR), and annual effective dose (AED) for the soil of the study area are calculated as 94.0 Bq.kg−1, 43.0 nGy.h−1, and 0.26 mSv.y−1, respectively. Estimated AED to the general public is 0.24 mSv.y−1, which is comparable to the global values due to terrestrial radiation. These radiological index parameters were compared with internationally approved values and the recommended safety limits. The study and analysis of collected soil samples from the Banswara region of Rajasthan indicate that the soil of this area does not pose any significant radiological health hazard to the people residing in adjacent areas. Multivariate Statistical analysis of Pearson correlation and analysis of variance (ANOVA) has been carried out. The result of ANOVA test indicated that there is no remarkable difference in the total variance of radioactivity of NORMs with respect to distance and it also indicated that the soil of the area belongs to a similar lithologic origin. The Pearson correlation of 226Ra with 232Th (r = 0.53) and 40K (r = 0.68) showed a fairly positive correlation, suggesting that their content in soil samples were mostly influenced and controlled by sources of similar origin. Spatial distribution maps using the kriging interpolation algorithm have been generated for the 30 km × 30 km area.
An observational study on digital addiction among school-going children of adolescent age group
Authors: Kolli Katyayani , Pasupula Sai Kiran , Kiran Vaddadi Venkat , Nair Vishnu Gopinadhan , Sandra BR , Jyothi Neeli Uma
Published: December 2024

Background:

Behavioral addiction is a form of addiction that involves a compulsion to engage in a rewarding nonsubstance-related behavior called a natural reward, despite any adverse consequences to the person’s physical, mental, social, or financial well-being. Increased new gadget development, as well as remote teaching for children via apps, software, and recreational environments, have resulted in increased time spent with digital media at the expense of regular functioning. Its impact is more among school-going children and adolescents. The main objective of the study is to study the prevalence of digital addiction among school-going children.

Methodology:

This observational study comprised 289 school students from one school. The age range of subjects ranged between 12 and 16 years. A pretested and prevalidated questionnaire for addiction was done. Digital Addiction Scale for Children (DASC) is a simple self-report that comprises 25 questions based on the emerging clinical criteria used to diagnose addictive behavioral disorders.

Results:

The current study comprised 289 school students from one school. The age range of subjects ranged between 12 and 16 years with gender distribution of 134 males and 156 females, respectively. The total mean DASC score among females and males is 49.14 and 47.85, respectively.

Conclusion:

The prevalence of digital addiction is on alarming rise among school-going children. Awareness and effective treatment strategies need to be created for the well-being of future generation.
The Comparative Analysis of Ethanol Reforming Technologies Integrated with Solid Oxide Fuel Cell – Part II
Authors: Freitas B. R. , Lopes G. S. , Lopes M. V. O. , Souza A. E. M. , Junior F. O.
Published: December 2024

The primary objective of this study is to compare the performance of different ethanol reforming systems: steam reforming, partial oxidation, and autothermal reforming. The investigation involves assessing and contrasting the efficiency of these distinct reforming processes when integrated with a solid oxide fuel cell (SOFC), with focus on optimizing the dynamic functionality of the system, specifically in terms of energy balance. This research builds upon previous paper research, introducing an aspect by including a comparison of a third reforming process, autothermal reforming. Utilizing Matlab, a comprehensive thermodynamic analysis of the system was executed. The simulation results underscore the viability of the examined systems, highlighting the critical role of operational parameters in the process. While the electrical efficiency of SOFC-SR, SOFC-POX, and SOFC-ATR is comparable, the thermal efficiency analysis accentuates that the SOFC-POX system demonstrates superior efficiency, particularly with an elevated O/E (Oxygen/Ethanol) ratio, leading to reduced SOFC temperature.
Influence of the COVID-19 Pandemic on the Transition Process to Electronic Ticketing in Public Transport: A Case Study in a Brazilian City
Authors: Rodrigues Cádmo , Santos Júnior Wagner
Published: December 2024

The COVID-19 pandemic has reshaped public transportation dynamics globally, prompting shifts in passenger behavior and payment methods. Concurrently, the rise of fintech and Industry 4.0 has accelerated the adoption of digital payment solutions, aligning with the trend towards cashless societies. This study investigates the impact of the pandemic on the transition from cash to card payments for public transport fares in Belo Horizonte, Brazil. Leveraging data from the city's transparency portal, analyses were conducted on passenger numbers, payment methods, and card usage from November 2019 to November 2021. Findings reveal a steady usage of card payments compared to cash, with a notable increase in individual ticket card transactions post-vaccination. Conversely, employer-provided transportation voucher card usage experienced a decline. These trends suggest a preference among users for card-based payments, potentially driven by concerns over direct cash handling and adherence to social distancing guidelines. In conclusion, the study underscores the shifting landscape of public transportation payments in response to the pandemic, highlighting the role of digital solutions in enhancing safety and convenience for passengers.
Evaluation of Superficial Damage of Mechanical Components through Digital Image Analysis Using Deep Learning Framework
Authors: Cury Rudoniel , Gioria Gustavo , Chandrasekaran Balaji
Published: December 2024

Mechanical component failure often heralds superficial damage indicators such as color alteration due to overheating, texture degradation like rusting or false brinelling, spalling, and crack propagation. Conventional damage assessment relies heavily on visual inspections performed by technicians, a practice bogged down by time constraints and the subjective nature of human error. This research paper delves into the integration of deep learning methodologies to revolutionize surface damage evaluation, addressing significant bottlenecks in diagnostic precision and processing efficiency. We detail the end-to-end process of developing an intelligent inspection system: selecting appropriate deep learning architectures, annotating datasets, implementing data augmentation, optimizing hyperparameters, and deploying the model for widespread user accessibility. Specifically, the paper highlights the customization and assessment of state-of-the-art models, including EfficientNet B7 for multilabel classification and prominent object detection framework such as YOLO. Our results demonstrate the feasibility of automating damage detection, potentially transforming maintenance routines and reliability in mechanical settings. Follow-up research is planned to refine these methodologies, paving the way for a production-ready model that will further enhance the reliability and efficiency of mechanical component maintenance.
Optimizing Side Impact with Metaheuristics coupled with Penalty Methods
Authors: Souza Silva Paulo , Dezan Daniel Jonas , Ferreira Wallace Gusmão
Published: December 2024

In the automotive industry, a good vehicle is one that not only provides comfort and adequate on-road performance but also ensures safety for its users. Therefore, various standards have been created to qualify and ensure that cars meet minimum requirements. Assays include frontal and side impact tests. However, physical tests end up being costly if performed frequently, and thus, increasing the correlation between these and computational simulations has been explored in recent years. Within the computational scope, given the nonlinear nature of the functions involved in such studies, the use of metaheuristics (MH) with constraint handling techniques (CHT) has been employed to obtain better results for such scenarios. In this work, three MH algorithms are used: Archimedean Optimization (AOA), Sine-Cosine Algorithm (SCA), and Dung Beetle Optimization (DBO). They are coupled with CHTs of the penalty methods (PM) type in their most basic character, such as Static Penalty Method (SPM), Dynamic Penalty Method (DPM), and Adaptive Penalty Method (APM), and variations of the latter. The coupling of these techniques (MHs+PMs) forms a total of 15 ways to solve the classic car side impact problem, with each combination tested dozens of times to ensure repeatability and consistency, as well as statistical metrics. In conclusion, the use of DPM with any of the MHs is not the most suitable for this type of problem. Furthermore, all other combinations made are capable of achieving better, equal, or close results to those in the literature, with AOA+SPM obtaining the lowest value for the objective function and also the lowest mean.
Integrating Agenda 2030 with Lean practices and Industry 4.0 Technologies: Case Study in an Automotive Industry
Authors: Braggio Luis , Marinho Osmar , Soares Luis , Lino Alan , Rabelo Fábio , Muniz Jorge
Published: December 2024

Competitive companies constantly seek continuous increases in productivity, quality and services level. Lean Thinking (LT) is an efficient management model recognized in organizations and academia, with an effective management approach, well consolidated theoretically and empirically proven Within Industry 4.0 (I4.0) development concept, manufacturers are confident in the advantages of new technologies and system integration. The combination of Lean and I4.0 practices emerges from the existence of a positive interaction for the evolutionary step to achieve a higher operational performance level (exploitation of finances, workload, materials, machines/devices). In this scenario where Lean Thinking is an excellent starting point to implement such changes with a method and focus on results; that I4.0 offers powerful technologies to increase productivity and flexibility in production processes; but people need to be more considered in processes, in a context aligned with the Industry 5.0 (I5.0) concept created by the European Commission (2021), which represents a differentiated and broader focus, which includes: human-centric, sustainability and resilience, going beyond the production of goods and services solely for profit. Thus, an opportunity arises to discuss how the automotive industry can meet the Agenda 2030 and the Sustainable Development Goals (SDGs) by employing I5.0. This article aims to discuss the Agenda 2030 evolution in an automotive industry through the alignment and application of Lean and I4.0 technologies, to boost operational results, and thus correlate the 169 A3 project results through the A3 methodology application with the SDGs. Thus creating the opportunity to discuss the SDGs in the automotive industry, approach reflected that the mains SDG’s classified in the A3 projects are 8 - Decent Work and Economic Growth (44%), 9 - Industry, Innovation, and Infrastructure (36%) and 12 - Responsible Consumption and Production (11%), those three present a result of 91% of mentions, because it is possible to classify the A3 project with more than one SDG’s. This article contributes to reinforcing the links between Lean Thinking, industrial digital transformation, and the SDGs, pointing out human implications.
Techno-Economic Analysis of the Implementation of a Dual-Fuel ENGINE for Agricultural Applications
Authors: Rincon Alvaro Ferney Algarra , Alvarez Carlos Eduardo Castilla , Filho Aldir Carpes Marques , Oliveira Faria Rafael , Volpato Carlos Eduardo Silva , Oliveira Notório Ribeiro Jéssica
Published: December 2024

The growing demand for decarbonization and reduction of emissions from internal combustion engines used in the agricultural sector is mainly responsible for the utilization of alternative or low-carbon fuels. In this context, in situ biogas production and Dual-fuel technology bring an important opportunity for farmers to use gas with diesel or biodiesel in the agricultural machinery, reducing production costs and carbon emissions. To this end, this work evaluates efficiency, emissions, and economic performance in an internal combustion engine equipped with a Dual-fuel injection for diesel and methane. The tests were carried out on a four-cylinder turbocharged Agrale tractor, model BX6110, with modifications for run on diesel-NGV blends under operating conditions with engine speed from 1500 to 2150 rpm, fuel injection times of 80 to 200, at full load. The results showed that the diesel flow was constant during the tests, therefore, power increases depending on the NGV injected. Maximum power, lower specific fuel consumption and highest economic performance through Dual-fuel technology were reached with an injection time of 200. Reducing in CO2 emissions with short injection times is observed.