A Single Centre Experience of Post Renal Transplant Infections in a Tertiary Care Centre in Eastern India

Introduction: In developing countries, Post renal-transplant infections is the leading cause of mortality, morbidity and decreased allograft survival. Our aims and objectives was to determine the incidence and prevalence patterns of clinically or microbiologically confirmed infection in the post renal transplant patients of our population and profiling of infections in relation to time period from the Transplant and the induction agent, also to develop strategies to counter risk of post transplant infection. Method(s): This was a retrospective observational study. Time period: January 2020- April 2022. Post renal transplant recipients presenting with infections (with informed consent) was enrolled in this study. Recurrent episodes of infection by different organisms in a same patient treated as a separate event. Data was tabulated using MS excel and all results projected in bar graphs, pie charts, histograms. Differences of quantitative parameters between groups were assessed using the t test(for data that were normally distributed) or nonparametric test (for data that were not normally distributed). Differences of qualitative results were compared using chi2 test. Kaplan-meier was used for survival analysis. P < 0.05 was considered significant. Result(s): 213 incidents of post renal transplant infections were documented in 148 patients between the study period. Of the 85 patients who underwent renal transplant(57 living donor and 28 cadaveric) in this time period 33(38.8%) patients presented with 42 incidents of infections. Majority (74.3%) : Males. Mean age: 36.3+/-5.6 years. Most common cause of native kidney disease was chronic glomerulonephritis(30%). 121 (81.7%) had living donor transplant and 27(8.3%) patients had cadaveric transplant. Induction agent was basiliximab in 97 patients (65.5%) had 133 infections (62.4%) and ATG was used in 51 patients (34.5%) had 80(37.6%) infections. In recent transplant (last 2 yrs) cases-In Basiliximab group: infection rate 4.1 in 100 patient months and in ATG group infection rate was 5.7 in 100 patient months. (p=0.28). 37.5%cases had infections with graft dysfunction most commonly AKI. Immediate post transplant infections (<1 month) were 34 (15.9%), most commonly UTI (44.11%) followed by pneumonia (15.9%). 48(%) infections occurred between 1-6 months, most commonly pneumonia(27.08%) followed by UTI(22.9%) and superficial fungal infection. Pulmonary tuberculosis was in 14 (6.6%) cases. 3 cases had disseminated TB. Infectious diarrhea was in 18(8.4%) cases, most common organism isolated was EAEC and EPEC. CMV colitis found in 3 cases. 27 (18.2%) patients had NODAT/PTDM. ParvoB19 was in 11(5.16%), CMV in 5 and BKVN in 3 cases. 41(19.2%) cases had severe sepsis requiring intensive care support. New baseline s.cr was achieved in 29.1% cases. Infection related death was 24(16.2%). COVID 19 infection was in 41 cases, 31.7% developed graft dysfunction and 18 (43.9%) required hospital admission due to moderate or severe disease. 2 patients had mucormycosis, one of them died after admission. [Formula presented] Conclusion(s): Profiling of infection in our centre is essential to formulate future strategies for infection control especially as the DDKT & ABOi KT is on the rise. Proper survillence, screening protocol, vaccination and patient education are essential to reduce the burden of post transplant infection and for better graft and patient survival. No conflict of interestCopyright © 2023

The Discovery of Coronavirus - An Interesting Journey

The coronavirus, which is causing the ongoing Covid-19 pandemic and has crippled the entire world, was discovered by June Dalziel Almeida - a school dropout from Scotland who had no formal medical education. She had to master the knowhow of immune electron microscopy to climb up the academic ladder and she finally discovered the coronavirus only to see her research paper getting rejected by reputed journals. A single mother is now associated with the coronavirus, as well as with a significant contribution to the classification of viruses, viral imaging and bringing Rubella virus, Hepatitis B virus and Human immunodeficiency virus into the limelight.

Coronavirus disease 2019 (COVID-19) and pregnancy

Women perhaps are more exposed to coronavirus disease 2019 (COVID-19), caused by the novel coronavirus (CoV) called as the severe acute respiratory syndrome-CoV-2 (SARS-CoV-2), as compared to men, due to their greater contribution in healthcare and social services. Globally, around 70% of health and social service providers constitute of female. The pandemic is also poising serious threat to female sexual and reproductive health. Particularly, pregnant women are at risk and need special antenatal care besides routine health services. SARS-CoV-2 infection leads to the path of an exaggerated immune reaction in an infected individual. This leads to ‘cytokine storm’ causing massive tissue damage, systemic inflammation, increased body temperature, and in turn, these may lead to multiple organ failure. The gonads are also susceptible to damage and impairment in reproductive functions. Thus, it is vital to acquire information on the impact of this virus on gestational changes and pregnancy outcome. Given the limitation of data on COVID-19 mediated changes in pregnant women, this article also reviews the effects of two previous coronavirus infections - severe acute respiratory syndrome (SARS) caused by SARS-CoV and the Middle East respiratory syndrome (MERS) caused by MERS-CoV to predict the possible impact of the novel SARS-CoV-2 on pregnancy outcomes. Analysis of available literature reveals that unlike coronavirus infections of pregnant women caused by SARS and MERS, COVID-19 seems less likely to cause maternal death. Importantly, alike SARS and MERS, there were no confirmed cases of intrauterine transmission of SARS-CoV-2 from mothers with COVID-19 to their fetuses. Further broad-spectrum research is necessary to reach a consensus regarding the vertical transmission of SARS-CoV-2 and whether it adopts any other mechanisms to affect pregnancy outcomes.

Surgeon’s dilemma during covid-19

The coronavirus disease 2019 (COVID-19) pandemic has brought about unprecedented adaptations in healthcare management, be it at a local or global level. Surgeons are facing a lot of dilemmas in the ongoing pandemic regarding the practice. On one side there are compulsions to manage the surgical patients without any hesitation in the operation theatre, there is another side of surgeons where he must return back home safely without self getting infected with the virus. Till the curve flattens, its going to be a surgical challenge and a herculean task for the surgeons at large to fight the COVID-19.

Saving the savior in COVID19 pandemic: Face masks

Using masks for self-protection has a long history. There are records of the use of masks ranging as far back as the Roman era to Medieval Europe, where masks were used as protective devices. During many festivities, masks were used as a fashion statement. Gas masks were commonly used during the world wars. As pollution started growing, people started using pollution masks. 2020 might be the only era when the entire human population has been forced to wear masks to protect themselves and to protect others. As expected, the healthcare workers, who are leading the fight against the COVID19, are the ones who are most at the need of these devices. Unfortunately, there is a shortage of personal protection equipment all over the world. Hence, we must understand their properties and strengths, and hence that we can achieve maximum benefits from the limited resources.

Conducting Interdepartmental Tele-Joint Clinic during the Coronavirus Disease 2019 Pandemic in a Tertiary Cancer Care Center

Introduction: The coronavirus disease 2019 pandemic has posed numerous challenges to health care across the globe. Time is of the essence in cancer care to prevent disease progression. Materials and Methods: TrueConf (R), a local area network-based software, has been used for holding joint clinic meetings which are an essential part of cancer management at our hospital. Results: A total of 12 meetings were held over a period of 12 weeks where 42 patients were examined and their clinicoradiological evaluation was done. Further treatment decisions were made based on these joint clinics. Conclusion: TrueConf (R) is an economical platform and easily implementable system, easing decision-making for critical cases, avoiding crowding in outpatient departments.

Health care workers facing social ostracism during COVID-19

Ever since the World Health Organisation (WHO) declared on March 11th 2020, Coronavirus Disease 2019 (COVID-19) a ‘pandemic’due to alarming level of spread of the Corona virus infection, doctors and the health care workers are facing discrimination and are socially ostracised. Stigma associated with COVID-19 poses a serious threat to the physical and mental wellbeing of health care workers. This article while highlighting the problems also suggests measures the doctors and health care workers should take so that they can address this stigma efficiently.