Meningioma in a Kidney Transplant Recipient a Risk Factor for Primary Central Nervous System Lymphoma

Introduction: Calcineurin inhibitor (CNI) neurotoxicity is common;has a wide array of presentation. Compromised blood brain barrier (BBB) is a risk factor. We studied a case of PCNSL in a kidney transplant recipient (KTR) with meningioma in order to bring to awareness of association between meningioma and PCNSL. Case Description: A 56-year-old female is a deceased donor KTR from 11-years ago by thymoglobulin induction. She develops new left hemiparesis and confusion. She was maintained on Tacrolimus (FK), Mycophenolate (MMF) and Prednisone. FK levels were therapeutic and and serum creatinine was 0.9 mg/dL. Epstein Barr Virus (EBV) and SARS-CoV-2 antigen tests were negative. Computed tomography (CT) of the brain showed a 4.2 x 4.5 x 3.9 cm mass centered in the left lentiform nucleus;midline shift of 1.1cm and a calcified meningioma. CT of the abdomen and pelvis was normal. Brain biopsy was consistent with PCNSL lymphoma. EBV encoded RNA staining was positive. Despite cytoreductive surgery and chemotherapy, PCNSL progressed. Her family elected hospice care. Discussion(s): Meningioma is common primary brain tumor with latency period of up to 30 years. A meningioma makes BBB permeable due to neo-angiogenesis at its margins. PCNSL constitute only 1% of Non-Hodgkin Lymphoma (NHL). Yet, PCNSL is 65 times more common in solid organ transplant recipients (SOTR) than in general population and six times more common than Non-Hodgkin's lymphoma (NHL). Therefore, we posit that PCNSL is a form of neurotoxicity due to persistently high concentration CNI via a permeable BBB. EBV is present in 90% of cases which makes host cell genome vulnerable to neurostructural changes. In our case PCNSL occurred despite therapeutic levels of CNI and despite absence of EBV in the serum. Conclusion(s): Meningioma related BBB permeability, increases severity of neurotoxicity and therefore, risk of PCNSL in a SOTR. Due to long latency of meningioma, risk of PCNSL can be and should be assessed prior to transplantation.

ChAdOx1 nCoV-19 vaccine and its self-reported adverse events: a cross-sectional study from Western Nepal

Background: There are various COVID-19 vaccines launched in different parts of the world. As the vaccination drive is increasing, the reports of adverse events following immunization (AEFI) are increasingly reported. Therefore, this research aims to document the adverse events and their determinants following COVID-19 vaccination.

Learnings from COVID-19 Forced Lockdown on Regional Air Quality and Mitigation Potential for South Asia

South Asia is a hotspot of air pollution with limited resilience and hence, understanding the mitigation potential of different sources is critically important. In this context the country lockdown initiated to combat the COVID-19 pandemic (during March and April 2020 that is the pre-monsoon season) provides an unique opportunity for studying the relative impacts of different emission sources in the region. Here, we analyze changes in levels of air quality species across the region during selected lockdown periods using satellite and in-situ datasets. This analysis compares air quality levels during the lockdown against pre-lockdown conditions as well as against regional long-term mean. Satellite derived AOD, NO2, and CO data indicates an increase of 9.5%, 2%, and 2.6%, respectively, during the 2020 lockdown period compared to pre-lockdown over the South Asia domain. However, individual country statistics, urban site data, and industrial grid analysis within the region indicate a more varied picture. Cities with high traffic loads reported a reduction of 12–39% in columnar NO2 during lockdown, in-situ PM2.5 measurements indicate a 23–56% percent reduction over the country capitals and columnar SO2 has an approximate reduction of 50% over industrial areas. In contrast, pollutant emissions from natural sources e.g., from biomass burning were observed to be adversely affecting the air quality in this period potentially masking expected lockdown related air quality improvements. This study demonstrates the need for a more nuanced and situation specific understanding of sources of air pollutants (anthropogenic and natural) and for these sources to be better understood from the local to the regional scale. Without this deeper understanding, mitigation strategies cannot be effectively targeted, wasting limited resources as well as risking unintended consequences both for the atmosphere and how mitigation action is perceived by the wider public. © The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are cited.

Nexus between Water Security Framework and Public Health: A Comprehensive Scientific Review

Water scarcity, together with the projected impacts of water stress worldwide, has led to a rapid increase in research on measuring water security. However, water security has been conceptualized under different perspectives, including various aspects and dimensions. Since public health is also an integral part of water security, it is necessary to understand how health has been incorporated as a dimension in the existing water security frameworks. While supply-demand and governance narratives dominated several popular water security frameworks, studies that are specifically designed for public health purposes are generally lacking. This research aims to address this gap, firstly by assessing the multiple thematic dimensions of water security frameworks in scientific disclosure;and secondly by looking into the public health dimensions and evaluating their importance and integration in the existing water security frameworks. For this, a systematic review of the Scopus database was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A detailed review analysis of 77 relevant papers was performed. The result shows that 11 distinct dimensions have been used to design the existing water security framework. Although public health aspects were mentioned in 51% of the papers, direct health impacts were considered only by 18%, and indirect health impacts or mediators were considered by 33% of the papers. Among direct health impacts, diarrhea is the most prevalent one considered for developing a water security framework. Among different indirect or mediating factors, poor accessibility and availability of water resources in terms of time and distance is a big determinant for causing mental illnesses, such as stress or anxiety, which are being considered when framing water security framework, particularly in developing nations. Water quantity is more of a common issue for both developed and developing countries, water quality and mismanagement of water supply-related infrastructure is the main concern for developing nations, which proved to be the biggest hurdle for achieving water security. It is also necessary to consider how people treat and consume the water available to them. The result of this study sheds light on existing gaps for different water security frameworks and provides policy-relevant guidelines for its betterment. Also, it stressed that a more wide and holistic approach must be considered when framing a water security framework to result in sustainable water management and human well-being.