bluuebunny/crossref_metadata_2025 huggingface dataset:
“An unusual cause of pain abdomen”: Acute mercury poisoning
Authors: Tale Sudheer , Kolli Mrudula , Pahel Soibam , Pudi Sivaji , Garbhapu Anil
Published: June 2022

The severity of mercury intoxication depends on the chemical form, dose, and route of exposure. Mercury intoxication has a wide variety of clinical manifestations that may involve the neurological, gastrointestinal, and dermatological systems. After diagnosis is made, prompt treatment is necessary to avoid systemic complications. Here, we report an unusual case of accidental ingestion of mercury and presenting as acute pain abdomen. She was managed conservatively and discharged in hemodynamically stable condition.
Development and feasibility testing of a smartphone video-based exercise program for patients with knee osteoarthritis
Authors: Mbada Chidozie E. , Oluwatobi Sonuga , Awosika Henry Akintunji , Esan Oluwadare , Oke Kayode Israel , Makinde Moses Oluwatosin , Oyewole Oyeleye Olufemi , Oyewole Adewale Isaiah , Christiana Odole Adesola , Fatoye Francis
Published: June 2022

Background:

Telerehabilitation has been recommended as a potential solution to bridge service delivery gap, especially in geographically remote areas with shortage of healthcare personnel and lack of access to physical therapy. This study was aimed to develop and test the feasibility of a smartphone video-based exercise program (VBEP) for patients with knee osteoarthritis (OA).

Methods:

This two-phase study involved the development and feasibility testing stages. A three-round modified Delphi approach was employed in the development phase involving a panel of four experts and a patient with knee OA. Based on consensus, five types of exercises comprising seated knee flexion and extension, quadriceps isometric setting, quadriceps strengthening exercise, hamstring clenches, and wall squats were developed into a video-program for knee OA. 15 consenting patients with knee OA participated in the feasibility testing of the program after 2 weeks of utilization. Feasibility of the VBEP was assessed using system usability scale and user experience questionnaire, respectively. The quadruple visual analog scale was used to assess the pain intensity.

Results:

The mean age and pain intensity of the participants were 67.3 ± 6.4 years and 61.1 ± 10.6, respectively. User perceived usability of the VBEP was 77.1 ± 13.1 (out of 100) with a high usability rating of 86.7%. Pragmatic quality score, hedonic quality rating, attractiveness, and perspicuity were 2.2 (out of 3.0), 1.6 (out of 3.0), 2.4 (out of 3.0), and 3.0 (out of 3.0), respectively. Efficiency, dependability, stimulation, and novelty scores were 2.3 (out of 3.0), 1.8 (out of 3.0), 2.3 (out of 3.0), and 1.0 (out of 3.0), respectively.

Conclusions:

The VBEP for knee OA has high usability and quality rating, as well as good user experience, and it may be a feasible alternative platform for rehabilitation of patients with knee OA.
Cognitive rehabilitation via head-mounted virtual reality technology in patients with Alzheimer’s disease: A systematic review
Authors: Zhao Yanfeng , Yu Junxiao , Liu Jiamin , Chen Zhen , Xiang Wentao , Zhu Songsheng , Qian Yunzhi , Wang Rongkun , Mao Jinyang , Feng Zhaodan , Liu Bin , Li Jianqing
Published: June 2022

Recent clinical research emphasizes utilizing virtual reality (VR) technology in cognitive impairment rehabilitation. The high immersion and polymorphism make a practical option in cases where the current head-mounted devices (HMD). VR has been used in Alzheimer’s disease (AD) patients. The function of HMD is better than traditional therapies in clinical diagnosis; however, its application in treatment for AD patients remains unclear. The Web of Science databases were searched from January 2016 to August 2021. In addition, research or review articles were filtered according to the preferred reporting items for systematic reviews and meta-analyses guidelines. We bring into a total of 11 studies published in recent 5 years which show high degree of clinical feasibility. One study showed combined cognitive-behavioral therapy and VR in designing a reminiscence therapy for dementia patients; five other studies were focused on spatial navigation and posture positioning for AD patients and one of them showed effective clinical feasibility; other two studies were aimed at helping AD patients who lacked of attention and failed to propose unique advantage due to the samples data were not large enough for clinical validation. Last three studies were using a comprehensive task model in overall cognitive level and obtain considerable training in specific AD patients. HMD VR has become a reliable tool for cognitive rehabilitation in AD patients’ prophylactic treatment: Patients with AD in nursing homes and families showed greater interest in VR-based attention and spatial way finding tasks, and their performance was better for a period of time after the end of the task. Combining the VR tasks with clinical cognitive theory and traditional task models will exert more benefits. More clinical case will further determine the potential of VR in AD patients to develop a practical new path for cognitive rehabilitation in the near future.
Super-resolution reconstruction of magnetic resonance images based on multi-scale feature extraction Super-Resolution Convolution Neural Network
Authors: Feng Rui , Li XiuHan , Wang Wei , Yu JunXiao , Cao Da , Li YiShuo , Wu XiaoLing
Published: June 2022

Background:

Low-resolution magnetic resonance imaging (MRI) has high imaging speed, but the image details cannot meet the needs of clinical diagnosis. More and more researchers are interested in neural network-based reconstruction methods. How to effectively process the super-resolution reconstruction of the low-resolution images has become highly valuable in clinical applications.

Methods:

We introduced Super-Resolution Convolution Neural Network (SRCNN) into the reconstruction of magnetic resonance images. The SRCNN consists of three layers, the image feature extraction layer, the nonlinear mapping layer, and the reconstruction layer. For the feature extraction layer, a multi-scale feature extraction (MFE) method was used to extract the features in different scales by involving three different levels of views, which is superior to the original feature extraction in views with fixed size. Compared with the original feature extraction only in fixed size views, we used three different levels of views to extract the features of different scales. This MFE could also be combined with residual learning to improve the performance of MRI super-resolution reconstruction. The proposed network is an end-to-end architecture. Therefore, no manual intervention or multi-stage calculation is required in practical applications. The structure of the network is extremely simple by omitting the fully connected layers and the pooling layers from traditional Convolution Neural Network.

Results and Conclusions:

After comparative experiments, the effectiveness of the MFE SRCNN-based network in super-resolution reconstruction of MR images has been greatly improved. The performance is significantly improved in terms of evaluation indexes peak signal-to-noise ratio and structural similarity index measure, and the detail recovery of images is also improved.
Reperfusion and reperfusion injury after ischemic stroke
Authors: Gao Jie , Wehbe Alexandra , Li Fengwu , Chaudhry Naveed , Peng Changya , Geng Xiaokun , Ding Yuchuan
Published: June 2022

Objectives:

Stroke is a leading cause of distress, disability, and death worldwide. The goal of reperfusion therapy for acute ischemic stroke (AIS) is the restoration of cerebral blood flow (CBF). If initiated too late, however, reperfusion therapy may paradoxically exacerbate tissue injury. Beyond a critical period, restoration of CBF may amplify already deranged inflammatory, apoptotic, and metabolic processes, increasing neurologic damage. This study was conducted to evaluate how timing of reperfusion therapy affects inflammatory, apoptotic, and metabolic responses after AIS.

Materials and Methods:

A total of 49 male Sprague-–Dawley rats were divided into four groups, either subject to 2- or 4-h of middle cerebral artery occlusion (MCAO) before reperfusion, 24 h of MCAO with no reperfusion, or a control group. Seven rats from each group were used for histological assay and for Western Blotting, respectively.

Results:

Infarction volumes were slightly decreased in the 2- and 4-h ischemia groups compared to the permanent ischemia group (49.5%, 49.3%, and 53.1%, respectively). No significant variation in neurological deficit scores was observed when comparing 2- and 4-h ischemia groups to the permanent ischemia group. Glucose metabolism protein (GLUT1 and GLUT3) expression was increased in all ischemia groups compared to the control group (P < 0.05). Expression of pro-inflammatory proteins (tumor necrosis factor α, interleukin-1 β, intercellular adhesion molecule-1, and vascular cell adhesion protein-1 was significantly increased in all ischemia groups compared to the control group at 24 (P < 0.05). There was significantly increased expression of pro-apoptotic proteins (caspase-3, cleaved caspase-3, and Bax) and significantly reduced anti-apoptotic protein (Bcl-2) expression in all the ischemia groups compared to the control group at 24 h (P < 0.05). Nuclear factor kappa (NF-κB) expression was significantly increased in all ischemia groups compared to the control group at 24 h (P < 0.05).

Conclusion:

The results of this study displayed relationships between the timing of reperfusion therapy and the multiple pathways discussed. There is potential utility in exploring and targeting components of the post-AIS inflammatory, apoptotic, and metabolic responses for neuroprotection against AIS and reperfusion injury.
Cardiac catheterization laboratory activation by social media reduces reperfusion time of patients transferred for primary percutaneous coronary intervention in community hospital
Authors: Wang Guozhong
Published: June 2022

Objective:

The objective of the study is to evaluate the impact of cardiac catheterization laboratory (CCL) activation by WeChat in community hospitals transfer for primary percutaneous coronary intervention (PCI) bypassing emergency department (ED) on time delay in ST-segment elevation myocardial infarction (STEMI) patients.

Methods:

This was a retrospective, cohort study of STEMI patients who were transferred from community hospitals to Luhe Hospital for primary PCI. Patients were divided into two groups: in CCL group, electrocardiogram (ECG) was transmitted through WeChat in the community hospital and the patients were transferred directly to CCL by emergency medical services (EMS) (n = 43); in control group, patients without ECG transmission were transferred by EMS to ED before CCL arrival (n = 57). The primary endpoint was median first medical contact (FMC)-to-device (FMC2D) times. The secondary endpoint was door-to-device (D2D) times.

Results:

The baseline clinical data and angiographic features among the two groups were similar (all P > 0.05. There was no difference in the symptom onset-to-FMC time (median interquartile range [IQR] min, 100.00 [74.50–247.00] vs. 105.00 [70.00–180.00], P > 0.05) between the two groups. Compared to control group, CCL group had shortened FMC2D times (median IQR min, 95.00 [72.60–160.58] vs. 160.79 [124.72–205.50], P < 0.001) and shortened D2D time (median IQR min, 17.18 [13.77–21.15] vs. 49.27 [40.26–64.90], P < 0.001). Achievement of the FMC2D time goal of <120 min rose from 29.82% in the control group to 76.74% in the CCL group (P < 0.001).

Conclusion:

CCL activated by WeChat can reduce reperfusion time of STEMI patients who are transferred for PCI from community hospitals.
Sustaining essential health services for maternal, newborn, child, adolescent, and elderly people amid the ongoing coronavirus disease-2019 pandemic
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: June 2022

The ongoing coronavirus disease-2019 (COVID-19) pandemic continues to disrupt the health-care services, including the essential ones, even after the detection of the novel viral infection 2 years back. The population group comprising mothers, antenatal women, newborns, children, adolescents, and elderly people is a vulnerable one. The COVID-19 pandemic has significantly accounted for the disruption of services targeting the above population groups, especially in low- and middle-income nations. COVID-19 pandemic has resulted in a wide range of problems targeting the above population groups, which has indirectly impacted the delivery of care and services. There arises the need to take specific measures to reduce the impact of the potential problems that have emerged. To conclude, the COVID-19 pandemic has resulted in significant interruptions in the health-care services aimed for the welfare of mothers, antenatal women, newborns, children, adolescents, and elderly people. However, as these are vital population groups, we have to adopt a multisectoral approach involving different stakeholders and move forward toward improving the reach of health-care services.
Evaluation of palliative care training program for medical interns in a tertiary care teaching hospital, South India
Authors: Elayaperumal Suguna , Venugopal Vinayagamoorthy , Adinarayanan S. , Dongre Amol R.
Published: June 2022

Introduction:

The Department of Community Medicine has been training medical interns for providing hospital-based palliative care (HBPC) and community-based palliative care (CBPC) services with an interprofessional team. This study was done to evaluate the training program on palliative care developed for medical interns.

Material and Methods:

It was a retro-pre type of program evaluation done among 172 interns between January 2016 and December 2017. One day program was conducted for the interns by faculty trained in palliative care, followed by placement in HBPC and CBPC program. At the end of training, self-perceived improvement in knowledge was collected on a five-point Likert scale. Certificates were issued on completion. Data were entered and analyzed using Epi Info (version 7.2.2.6) software. Wilcoxon signed-rank test was applied between pre- and post-scores. Manual content analysis was done for open-ended questions.

Results:

The mean age of the participants was 22.5 ± 0.8 years, with 76 (44.2%) males and 96 (55.8%) females. There was statistically significant improvement in perceived knowledge scores after attending the training. Areas of learning, values learned, and uses of learning in future career and suggestions for improving the training program were the categories obtained.

Conclusion:

The training program improved the self-perceived knowledge on palliative care among medical interns. The exposure to HBPC and CBPC program had a positive effect on their attitude and perceived skills for caring of chronically ill patients. Such programs can be initiated by other palliative care providing institutions for training medical interns.
Medical officer's perspectives and professional challenges in handling poisoning cases in rural India
Authors: Mahadik Kakasaheb , Raut Asawari , Chowdhury Monidipa , Asad Ali Haider , More Shubham
Published: June 2022

Introduction:

Poisoning is a significant public health problem in developing countries, more so in rural areas. Very little is known about the treatment available for poisoning cases in the context of rural health care provision in India. This study explores the perceptions of the primary health care medical officers regarding the management of poisoning cases.

Material and Methods:

A semistructured, self-designed survey form was used to interview the medical officers in Pune district. The interview focused on understanding rural hospital settings in terms of infrastructure, available facilities, and medical officers' perception of professional challenges in the management of poisoning cases.

Results:

Underreporting of poisoning cases in these primary health centers (PHCs) and transferring to higher hospitals without basic first aid provided was noted through interviews.

Conclusion:

Medical officers in rural PHCs lack the necessary training and knowledge required for the management of poisonings which is further worsened by lack of resources. There is a need to focus on poison management in continuous medical education. Training programs and education for medical officers are needs of the hour.
COVID-19 pandemic
Authors: Sharma Priya , Rattan Saurabh , Katoch Vikram , Gupta Gurdarshan , Narain Jai P.
Published: June 2022

Introduction:

Coronavirus disease or COVID-19 emerged in December 2019 in China and thereafter spread to all regions of the world including India. In the Himalayan state of Himachal Pradesh, India, the first case was identified in the month of March 2020. As the most populous district of the state of Himachal Pradesh, Kangra not only identified the first case in the state but also thereafter suffered disproportionately due to the virus causing severe health and economic disruption. The study was carried out to better understand the pattern and trends of COVID-19 pandemic in the district since its emergence, covering the first and the second wave to use the data to prepare the future course of action.

Materials and Methods:

A robust database comprising real-time data in a line list format was created. The observations covered all confirmed COVID-19 cases in the district from March 20, 2020, to June 30, 2021, in terms of disease progression and distribution in time, place, and person, and the possible risk factors for severe disease.

Results:

During the study period, 45,871 cases and 1030 deaths were reported in Kangra district, with a case fatality rate of 2.2%. Of the 12 districts of the state, Kangra reported the highest number of cases (22.6%) and deaths (29.7%). Ninety percent of all cases occurred during the second wave. While the first wave peaked in December 2020 with 2596 cases, the highest number of cases occurred in May 2021 when as many as 25,625 cases were reported. The test positivity rate of 15.2% during the second wave which was many times higher than that seen during the previous year. The case fatality rates during the first and second waves were 2.2% and 2.1%, respectively.

Conclusions:

The study highlights an explosive surge in COVID-19 cases during the second wave, indicating the highly infectious nature of the virus. While absolute number of deaths was several times greater during the second wave, the case fatality rates did not differ greatly between the two waves.
Multiplicity of noncommunicable diseases among the elderly in a suburban area of Delhi
Authors: Prabhakar Tushar , Goel Manish Kumar , Acharya Anita Shankar
Published: June 2022

Introduction:

Continuing advancements in quality of health care has led to increased life expectancy over time. This in turn has resulted in increased prevalence of noncommunicable diseases (NCDs), especially among the elderly. An appropriate portrayal of its epidemiology is essential to adequately understand the health-care needs of the population. The evidence generated from the study will give us an incentive to address the rising burden of polymorbidities. We did the study to assess the prevalence and pattern of NCDs in the elderly above 60 years of age and to determine age- and sex-wise distribution of single and multiple NCDs.

Materials and Methods:

A community-based cross-sectional study was conducted among 350 elderly participants over 60 years of age in Mehrauli area of Delhi. Data were collected using a semi-structured questionnaire. Detailed general and systemic examination was also done.

Results:

A total of 87.4% of the study population were suffering from at least one NCD. The number of NCDs per person is 2.41. Overall, 80 out of the total 350 study participants (22.9%) had a single NCD, whereas 226 (64.6%) had two or more NCDs. Hypertension was the most prevalent NCD, followed by cataract, osteoarthritis, diabetes mellitus, and obesity.

Conclusion:

The prevalence of NCDs was quite high among the elderly. Multimorbidity was more common among the oldest-old age group and elderly women. This calls for increased focus on timely and comprehensive screening for NCDs in adults and asserts the need to approach the screening and management of NCDs in a more holistic way and not as isolated health events.
Horizontal unidirectional airflow for reducing cross-infection of COVID-19
Authors: Sharma Hunny , Ruikar Manisha
Published: June 2022

Recent decades have witnessed the emergence of many airborne diseases such as severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19, which have highlighted the importance of effective ventilation in residential, work, or hospital premises. Ventilation which plays an essential role in reducing or diluting the airborne contaminants. However, it is not always easy to achieve by natural ventilation as it depends on many other factors such as temperature and climatic conditions. (wind velocity, wind direction, and housing pattern/design). Horizontal unidirectional airflow (HUAF) is one such method that can be achieved at low cost and can reduce cross-infection of COVID-19 to much extent. Hence, this narrative review aims to bring some insight into what is HUAF, how it can be achieved, and what are its possible implications in preventing COVID-19 transmission.
Cost analysis of outpatient department prescriptions in the community pharmacies during the coronavirus disease-2019 pandemic in Maharashtra
Authors: Reji Sharon , Mishra Preeti Santosh , Retiwale Salman , Deshpande Prasanna R.
Published: June 2022

Introduction:

Community pharmacy is a place under the direct supervision of the pharmacist where the prescription orders are compounded and dispensed. In India, there are limited studies published on the economic evaluation of community pharmacy. This study aimed to conduct a cost analysis of outpatient department prescriptions in the community pharmacies during the coronavirus disease-2019 pandemic on various parameters such as the total cost, average cost/prescriptions, age-wise cost, prescribers, drug class, pharmacy wise, route of administration, and diagnosis cost.

Material and Methods:

The analysis of total and average cost per prescription was conducted. The study was carried out for 6 months during. The number and type of drugs prescribed and the frequency and total cost of the prescriptions were noted. Statistical analysis was conducted for different demographics and various parameters.

Results:

A total of 1166 prescriptions were analyzed in the study. Out of 3704 drugs prescribed 99.9% were branded ones. The average number of drugs/prescriptions was 3.17. The predominance of male patients (60%) was seen. On the overall cost of prescriptions the statistical significance of the overall cost was established at (P < 0.00001). The sum of all the prescriptions accounted for .10, 86,504.65. The average cost/prescription was .931.82.

Conclusion:

The average total cost/prescription was found to be higher in our study. There is a need for further studies to be done in the field of community pharmacy.
Awareness, Attitude, and Perception toward Organ Donation in General Population of Haryana, India
Authors: Varshney Shyamli , Kansra Pooja , Perumallapalli Aditya , Garg Anurag
Published: June 2022

Introduction:

Organ donation is defined as an act of giving one or more organs, without compensation, for transplantation to another person the shortage of organ donation remains one of the biggest barriers globally to the organ transplantation process. The state of Haryana has in the recent past grown leaps ahead in terms of medical tourism, but according to recent data by the MOHAN Foundation, Haryana is among the poorest performers in organ donation, more specifically cadaveric organ donation. This study aimed to assess the attitudes and awareness of organ donation in the general population of Haryana and to find out the barrier to the low organ donation numbers in the state.

Materials and Methods:

This study was a community-based cross-sectional study carried out among the general population of Haryana. A questionnaire was administered to 500 randomly selected people above the age of 18 in the chosen population. The data were coded and analyzed using Microsoft Excel and SPSS software.

Results:

A large number, 40.6% (203/500), of the participants in the survey were unaware of the term “organ donation.” Only 24.5% (72/293) of participants were able to correctly identify that “organ donation” was possible from both cadavers and living human beings. 98.6% (289/293) of the participants of the survey were unaware of any legislation regarding organ donation. A dismal 27.3% (80/293) of participants were willing to donate their organs after death. Of those unwilling, 60.1% (128/213) reported that they did not want to donate because of their religion. Of those willing to donate, 28.7% (23/80) reported that they would only donate to a person of the same religion.

Conclusion:

The overall levels of awareness about the organ donation and acute shortage of organ donors in Haryana as well as awareness about the prevalent low rates themselves remain low. There are various religious biases leading to negative attitude toward organ donation.
Is Inferior Vena Cava Diameter, a Reliable Indicator for Fluid Status in End-Stage Renal Disease Patients? - A Prospective Observational Study
Authors: Trivedi Viral , Prajapati Megha , Prajapati Devendra Jayantibhai , Bhosale Guruprasad , Nayak Janki , Panchal Harsh
Published: June 2022

Introduction:

Adequate allograft perfusion is the key component of renal-transplant surgeries. This requires meticulous management of volume status in end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). Various methods have been tried to unveil the most dependable parameter. So far, central venous pressure (CVP) has been a reliable parameter for guiding fluid therapy. Recently, in the past decade, inferior vena cava (IVC) diameter (IVCD) has emerged as a promising indicator for volume assessment in critically ill patients. However, very limited data are available regarding use of IVC diameter in ESRD patients. This study is an attempt to determine the efficacy of IVC diameter in predicting the volume status of renal-transplant recipients by comparing it with conventional method, CVP.

Methods:

Enrolling 60 live donor renal-transplant recipients from a single center, the mean IVCD and IVC collapsibility index (IVC-CI) were measured and compared with CVP. IVC measurements were recorded using bedside ultrasonography. CVP was measured using central venous catheter placed in superior vena cava, through a water column on a standardized scale. The data were analyzed using SPSS Version 20.

Results:

The mean age of the participants was 38.92 ± 10.46 years. The mean CVP was 6.78 ± 2.86 cmH2O, the mean IVCD was 1.30 ± 0.43 cm, the mean IVC-CI was 24.27% ± 15.45%. Based on Pearson's correlation test, there was no linear correlation between CVP and IVCD as well as CVP and IVC-CI.

Conclusion:

For the assessment of fluid status and fluid responsiveness in ESRD patients with MHD, ultrasound assessment of IVCD and IVC-CI is not routinely helpful.
A Study Comparing Office Blood Pressure with Ambulatory Blood Pressure in Successful Adult Kidney-Transplant Recipients at a Tertiary Care Center in North India
Authors: Bhat Tariq , Idrees Mohammad , Wani Muzafar Maqsood , Naik Muzafar , Wani Imtiyaz Ahmad , Wani Abdul Ahad , Wani Mohammad Saleem , Bhat Mohammad Ashraf , Hamid Arif
Published: June 2022

Introduction:

Hypertension is common following successful renal transplantation and has adverse effects on cardio-vascular and graft health. Blood pressure (BP) readings obtained during clinical visits can be misleading and ambulatory blood pressure monitoring (ABPM) is a more reliable and accurate non-invasive method of BP monitoring.

Aims and Objectives:

To compare office BP with ambulatory BP recordings in successful adult kidney transplant recipients (KTRs).

Material and Methods:

Office BP (OBP) was measured with mercury sphygmomanometer according to standardized procedure as the mean of two readings taken 1 minute apart; thereafter, 24 hour ABPM was done using automated oscillometric device (Meditech device) in 56 KTRs.

Results:

OBP missed hypertension in 68% of KTRs who had normal OBP (masked phenomenon) and OBP overestimated hypertension in 11% of KTRs with uncontrolled OBP (white coat phenomenon). Thirty-four percent of patients were normal dippers, 32% non-dippers, 25% reverse dippers and 9% were extreme dippers.

Conclusions:

ABPM is a valuable tool in detecting dipping status, white coat and masked phenomena which are frequent problems among KTRs and should be considered as part of routine management of hypertension in KTRs.
Remdesivir in Renal Transplant Patients with Coronavirus Disease 2019
Authors: Latief Muzamil , Abbas Farhat , Iqbal Mohd , Hassan Zhahid , Goud L. Naresh , Shafi Obeid
Published: June 2022

Introduction:

Remdesivir has shown broad-spectrum antiviral activity. This drug is approved by the Food and Drug Administration for coronavirus disease 2019 (COVID-19) management. Other than a few case series and case reports, not much information is available on its use in kidney transplant recipients (KTRs).

Materials and Methods:

We describe our experience of seven KTRs with COVID-19. All the patients were hypoxemic. High-resolution computed tomography (CT) chest was done in all the patients. Injection remdesivir 200 mg on day 1 followed by 100 mg daily was given for a maximum of 5 days irrespective of estimated glomerular filtration rate (eGFR).

Observations and Results:

Mean age of patients was 46.28 ± 10.41 years and one patient was female. Mean CT severity score was 15. In our study, 2 patients who required mechanical ventilation expired. None of our patient had worsening of acute kidney injury (AKI) or new-onset AKI after institution of remdesivir.

Discussion:

Optimal management for this patient population remains unknown, therefore, treatment of COVID-19 in KTRs varies from center to center. The studies on remdesivir use in KTRs with COVID-19 are not extensive. Our series does indicate safety of remdesivir in KTRs.

Conclusion:

We observed that remdesivir can be used in KTRs with COVID-19 with hypoxemia irrespective of eGFR. We suggest that large-scale studies should be done to substantiate these findings.
Organ Donation and the Medicolegal Aspects
Authors: Thyagarajan Ishwarya , Kanvinde Hemal , Shroff Sunil , Sahi Muneet Kaur
Published: June 2022

Context:

In India, the majority of brain-dead organ donors are victims of road traffic accidents, thereby making them entities in medicolegal cases (MLC). This places an additional burden and complicates the organ donation process, as an inquest must be conducted by the police station closest to the accident spot before the possibility of organ donation is considered. Following organ retrieval and donation, a postmortem is required before the body is handed back to the police. These procedures cause delays in the organ donation process and subsequently in families receiving the body of their loved ones. The problem is compounded by the fact that there are variations in the inquest and postmortem procedures in different states.

Aim:

The study aims to comprehensively enumerate the medicolegal protocols followed by the states having an active deceased organ donation program.

Design and Methods:

A survey, using a structured questionnaire, was conducted among the senior Transplant Coordinators (key stakeholders in the organ donation process) of eight states. Their experiences handling MLC and the state protocols adhered to were captured.

Results:

It was found that there were differences in protocols followed by the states with respect to medicolegal organ donation cases. Significant variations were observed in the police inquest and postmortem procedures. A need for training of the police personnel in the medicolegal aspects of the organ donation process is evident from the survey responses.

Conclusions:

The undue delays lead to difficulties in completing the donation and also cause distress among the family members who have said yes to organ donation despite their grief. The study recommends the need for uniformity in protocols to ease pain points in this program. This is of paramount importance in instances of interstate-organ donation cases.
Outcomes of ABO-Incompatible Kidney Transplantation with Respect to Baseline Isoagglutinin Immunoglobulin G Titers
Authors: Gaur Lovy , Bhalla Anil Kumar , Shingada Aakash , Gupta Ashwani , Malik Manish , Gupta Anurag , Bhargava Vinant , Gupta Pallav , Joshi Anant , Jauhari Harsh , Ranjan Vivek , Khillan Kamini , Rana D. S.
Published: June 2022

Background:

ABO-incompatible kidney transplantation is one of the ways to increase the donor pool by as much as 30%–35%. Studies comparing baseline titers have shown conflicting results with respect to graft outcomes. This study attempts to evaluate the outcomes of ABO-incompatible transplant with high and low baseline immunoglobulin G (IgG) isoagglutinin titers to the outcomes of ABO compatible transplant.

Materials and Methods:

This was a retrospective observational study, in which 954 renal transplant recipients were included in the study. Of these, 873 patients had undergone ABO compatible kidney transplantation. Of the 81 patients who underwent an ABO-incompatible transplantation, 67 belonged to the low titer group (defined as the baseline IgG ≤ 1:64) and 14 belonged to the high titer group (defined as baseline IgG ≥ 1:128). Patients were followed up for a period of 1 year. Laboratory assessments were performed at baseline and at each visit. Graft survival, rejection episodes, patient survival, and infections were assessed on a continuous basis. Graft loss was defined by the need to return to dialysis.

Results:

Death censored graft survival was 92.3% in the high titer group as compared to 98.2% in ABO compatible group, but this difference was not significant (P = 0.231). Graft survival in the low titer group (96.8%) was comparable to the compatible group (P = 0.328). The proportion of patients who developed biopsy-proven rejections was lower in ABO compatible groups (6.5%) when compared to ABOi high (21.4%) and low titer groups (13.4%), respectively (P = 0.063 and 0.033, respectively). Antibody-mediated rejections were significantly fewer in ABO compatible group (1.8%) versus high titer group (21.4%) and low titer group (11.9%) (P = 0.003 and P < 0.001, respectively). Patient survival was higher in ABOc group (97.9%) as compared to high (92.9%) and low titer (94.0%) groups though the difference did not achieve statistical significance. Most of the deaths were attributed to infections.

Conclusion:

ABO-incompatible transplantation is an acceptable treatment for those with end-stage renal disease; however, this comes with a caveat of increased risk of acute rejections and infections in patients with baseline titers of 1:128 or higher.
Clinical Characteristics and Immunosuppression Management in Kidney Transplant Recipients Infected with Severe Acute Respiratory Syndrome Coronavirus 2 Infection - An Observational Study
Authors: Somasundaram Kiruthika , Thoppalan Balasubramaniyan , Chellaiah Vasudevan , Kumar R. P. Senthil , Murugesan V. , Thirumavalavan S.
Published: June 2022

Background:

COVID-19 infected kidney transplant patients need specialist care in tailoring their immunosuppression drugs alongside routine care.

Methods and Materials:

This is an observational data from a single center of 12 kidney transplant recipients (KTR) who were hospitalized with COVID-19 from April 2020 to November 2020. The demographics, COVID treatment including immunosuppressive drug regimen were reviewed. Their graft function during the stay, at the time of discharge, and 30 days after discharge was also reviewed.

Results:

Of 12 patients included, 83% were male patients. The median age was 37 years and the median time since transplant was 42 months. Common comorbidities were diabetes (50%), hypertension (50%), and cardiovascular disease (8%). Ninety-two percent had triple immunosuppressive regimen whereas 8% were in steroid-free protocol. Fifty percent had mild COVID, 8% had moderate disease, and 41% has severe COVID which was managed with institution-specified protocol. Steroids dose was increased in all patients. Antimetabolite was uniformly withdrawn in all patients irrespective of disease severity. Acute kidney injury was noted in 50% of patients which recovered to baseline at discharge. Graft function at 2 weeks and 30 days after discharge was stabilized close to their baseline value. Mortality was 8%.

Conclusion:

Reduction of immunosuppression, especially the withdrawal of antimetabolites, was found to be safe without graft rejection in KTRs.
Stretching the Limits
Authors: Panwar Pankaj , Bansal Devanshu , Maheshwari Ruchir , Chaturvedi Samit , Desai Pragnesh , Kumar Anant
Published: June 2022

Context:

Optimum main renal artery (RA) length before first branching needed to achieve single lumen during laparoscopic donor nephrectomy (LDN) is not known.

Aims:

The aim of the study is to identify optimal minimum length of RA before first branching which can be safely harvested as a single lumen in LDN.

Settings and Design:

This is a single institutional, retrospective study.

Materials and Methods:

Records of consecutive left LDNs performed at our institute from January 2016 to June 2019 were reviewed. RA length was measured from preoperative computed tomography angiogram. We clipped RA using two Hem-o-lok® and one titanium clip while maintaining constant mild upward traction. Primary outcome was to identify lowest RA length at which chances of achieving a single lumen were maximum. Secondary outcomes included minimum RA length below which single lumen could not be achieved and incidence of intraoperative vascular complications.

Statistical Analyses:

Receiver operator characteristic curve was plotted according to donor RA length. Likelihood ratio positive (LR+) was used to identify optimum length of RA above which chances of achieving single lumen were maximum.

Results:

Four hundred and eighty-eight donors with single RA underwent left LDN during study period. LR +of achieving single lumen after clipping was maximum at 10mm cutoff. Single lumen could not be achieved below 6–7 mm cutoff. There were no vascular complications or re-explorations.

Conclusions:

Main left RA length ≥10 mm before first branching is most likely to yield single lumen for implantation with our technique.
A Novel Splice Site Mutation in Anthrax Toxin Receptor 2 (Capillary Morphogenesis Protein 2) Gene Results in Systemic Hyalinosis
Authors: Priyadharshini Indhra , Varala Sirisha , Bharadwaj Tallapaka Karthik , Krishna Ananthula Venkata
Published: June 2022

Infantile Systemic Hyalinosis, now included under the unifying term, “hyaline fibromatosis syndrome” (HFS) is a rare, progressive and fatal autosomal recessive disorder characterized by various dermatological manifestations such as thickened skin, papules and nodules, hyperpigmentation over bony prominences, gingival hypertrophy and systemic manifestations such as joint contractures, osteopenia, recurrent infections, diarrhea, and short stature. Histopathological examination of the affected tissue shows deposition of amorphous hyaline material. Mutations in the gene encoding capillary morphogenesis protein-2/anthrax toxin receptor 2 (ANTXR2) are implicated in the pathogenesis. Here, we report a 16-month-old toddler with HFS whose genetic analysis revealed a novel homozygous frameshift mutation in exon 13 of ANTXR2 gene.
A Clinical Study of the Pattern of Dermatoses among Schoolgoing Children Attending a Tertiary Care Center in North Karnataka
Authors: Chitapur Umamaheshwari G. , Athanikar Sharatchandra B. , Kikkeri Naveen Narayanshetty , Prabhu Sweta R.
Published: June 2022

Introduction:

Pediatric dermatoses are a distinct group of disorders, comprising skin problems encountered during childhood and adolescence.

Objectives of the Study:

This study aimed to assess the clinical pattern and prevalence of various dermatoses among schoolgoing children in a tertiary care center in North Karnataka.

Materials and Methods:

Patients in the age group of 5–14 years with skin diseases attending dermatology outpatient department were enrolled in this study. A predesigned pro forma was used for all cases. A detailed history was taken. Clinical examination and relevant laboratory investigations were done to confirm the diagnosis in doubtful cases.

Results:

This study included a total of 550 patients. The most common pattern of dermatoses was infections and infestations constituting 40.5% (223 cases). The other common dermatoses in order of prevalence were eczema/dermatitis constituting 14.4% (79 cases), papulosquamous disorders: 6.9% (38 cases), hypersensitivity disorders: 6.2% (34 cases), and pigmentary disorders: 5.1% (28 cases). Among the infections and infestations, fungal infections were most common (14%), followed by parasitic infestations (13.8%), viral infections (8.7%), and bacterial infections (4%). Pityriasis alba was the most common eczematous disease.

Conclusion:

The most common pattern of dermatoses seen in our study was infections and infestations, followed by eczematous disorders. A detailed knowledge about the pattern of dermatoses among schoolgoing children will help us in implementing essential changes in health education and disease control strategies in the area concerned.
A Comprehensive Review of Immunosuppressive Drugs in Pediatric Dermatoses
Authors: Bose Shiti , Madke Bhushan
Published: June 2022

Immunosuppressants are required for an array of pediatric dermatoses. Certain dermatological conditions require long-term use of immunomodulators such as methotrexate and mycophenolate mofetil. All immunosuppressants have varying toxicity profiles and long-term use of these in the pediatric age group may lead to significant adverse effects. This concise review focuses on the immunosuppressants commonly used for dermatoses in children and gives a comprehensive list of the various indications for use in each and associated adverse effects on long-term use. An English language search was done on studies published till date on immunosuppressant use in pediatric dermatoses. A documented review was prepared, analyzed, and presented in a narrative fashion to highlight the important pediatric indications for the use of the respective immunosuppressant, with special emphasis on the adverse effects on prolonged usage.
Successful Use of Acitretin in an Indian Child with Lipoid Proteinosis
Authors: Kote Shraddha P. , Chopkar Apoorva Dhananjay , Supekar Bhagyashree Babanrao , Mukhi Jayesh Ishwardas
Published: June 2022

Introduction:

Lipoid proteinosis is a rare autosomal recessive disease, characterized by deposition of Periodic Acid[FIGURE DASH]Schiff-positive hyaline material in the skin, mucous membrane of the upper aerodigestive tract, and different organs of the body, resulting in varied clinical manifestations.

Case Report:

We report a case of lipoid proteinosis in a 7-year-old boy who responded well to oral acitretin therapy.

Discussion:

Lipoid proteinosis is a rare disease entity, and very few reports have been mentioned in the literature based on its treatment modalities, with each treatment showing varied success rates. Oral acitretin can prove useful in cases of failure or inadequate response to other treatment, as seen in our case.
Efficacy and Safety of 10,600 Nm Fractional Carbon Dioxide Laser Versus 88% Phenol in Treatment of Idiopathic Guttate Hypomelanosis
Authors: Deepadarshan K. , Harish M. R. , Shashikumar B. M. , Chandran Priyanka R.
Published: June 2022

Background:

Idiopathic guttate hypomelanosis (IGH) is a common benign acquired leukodermic dermatosis characterized by multiple, discrete, hypopigmented-to-depigmented macules. Various treatment modalities were tried for this condition with varied results.

Purpose:

This study was conducted to compare the efficacy and safety of fractional carbon dioxide laser and 88% phenol in the treatment of IGH.

Methods:

A total of 40 patients with five IGH macules on each side were treated with one session of fractional carbon dioxide laser on the right side and a single application of 88% phenol on the left side and were assessed monthly for 3 months. The improvement in pigmentation was graded as ≤25% - poor, 26%–50% - minimal, 51%–75% - good, and >75% - excellent response.

Results:

A total of 32 patients completed the study. Out of the 160 macules treated with laser, 16 (10%) macules showed an excellent response and 40 (25%) showed a good response, and 40 (25%) and 48 (30%) macules in the phenol group showed excellent and good improvement, respectively. Side effects such as persistent scabbing and ulceration were seen only on the phenol side.

Conclusion:

Single application of 88% phenol was more efficacious than one session of fractional carbon dioxide laser in inducing pigmentation in IGH macules in this study. However, fractional carbon dioxide laser can be considered a safer alternative modality.
Assessment of the Saudi Arabian Telemedicine Experience During the COVID-19 Pandemic
Authors: Alsharif Sahar H. , Alsharif Nizar , Alassiri Rimaz , Khouj Ghaidaa , Alshareef Noura , Aloufi Anwaar , Hussain Arwa
Published: June 2022

Background:

COVID-19 is a pandemic disease that spreads rapidly. The World Health Organization recommended social distancing to prevent disease transmission. Telemedicine was one of the most important tools used during the pandemic to provide health-care services. Different clinics, including dermatology clinics, tended to use telehealth and online tools. In addition, various dermatological conditions were diagnosed and treated by family physicians using the telemedicine applications of the Saudi Ministry of Health (MOH).

Purpose:

The present study aimed to evaluate the efficacy of family physicians using telemedicine to diagnose and manage different dermatological conditions. Specifically, we aimed to identify the common dermatological conditions that family physicians faced during the COVID-19 pandemic, as well as the use of the various telemedicine applications launched by the Saudi MOH. We also intended to assess the need for dermatologists in the telemedicine applications of the Saudi MOH and suggest possible improvements to the telemedicine process and related Saudi MOH applications for sustainable online health care.

Methods:

The cross-sectional study was conducted across Saudi Arabia among family physicians and general practitioners to assess their perception of using telemedicine for dermatology-related consultations. The self-administered survey questionnaire contained 16 questions in five sections.

Results:

A total of 302 family medicine and general physicians completed the questionnaire. Altogether, 165 (54.6%) physicians reported that they had never used telemedicine before the COVID-19 pandemic, while 12.9% reported frequent to continuous use. During the pandemic, 86.8% of family and general physicians used telemedicine for dermatological consultations. The most used methods were phone calls (57.6%) and the SEHA application (42.7%). A total of 96.4% of participants reported that they dealt with dermatological conditions before the COVID-19 pandemic. Interestingly, about 99% of family physicians reported that they faced difficulty diagnosing dermatology-related consultations. Telemedicine was frequently used by all physicians in the central region compared with 76.7% of those in the western region (P = 0.035).

Conclusion:

Family physicians in Saudi Arabia increased their telemedicine practicing during the pandemic. Different telemedicine tools were used, such as phone calls, virtual clinics, and Saudi MOH applications (SEHA, TETAMMAN, TABAUD, TAWAKKALNA). The majority of family physicians faced difficulty diagnosing dermatological conditions. In addition, most reported that dermatologists should be part of health-care facilities and telemedicine centers to deal with dermatology-related consultations.