Is It Cancer Hepatic Inflammatory Pseudotumor: An Important Hepatic Mass Differential

Introduction: Hepatic inflammatory pseudotumor (HIP), albeit rare, is an important pathology to be included in differentials for hepatic masses. The benign nature and treatment of this disease process should be considered especially in comparison to malignant hepatic processes. Case Description/Methods: A 66-year-old male with pre-existing history of compensated Hepatitis C cirrhosis status post direct-acting antivirals with sustained virologic response presented in shock after a syncopal episode. Initial work up revealed leukocytosis, thrombocytopenia, acute renal injury, elevated liver enzymes, and COVID-19 positive test. Patient underwent initial liver ultrasound revealing intrahepatic and extrahepatic biliary ductal dilation. Subsequent MRCP demonstrated diffuse thickening of intra and extra hepatic bile ducts suggestive of cholangitis and several hepatic masses concerning for abscesses versus possible metastatic cholangiocarcinoma. Patient improved symptomatically with antibiotics and supportive care. A liver biopsy was performed with pathology showing lymphoplasmacytic inflammation and fibroblastic infiltration suggestive of hepatic inflammatory pseudotumor. A repeat MRCP one week later showed interval decrease in size of liver lesions and repeat liver function tests also showed improvement. Patient was discharged on a course of ciprofloxacin and metronidazole. Patient had repeat MRCP 3 months after discharge, with further significant improvement in size of liver lesions. After multi-disciplinary discussion the plan was for further surveillance with imaging and labs in 2 months. Discussion(s): Inflammatory pseudotumors are benign and non-neoplastic lesions that can occur in any organ. They can appear as a malignant lesion when they arise in the liver and an accurate identification can allow for conservative management and prevent unnecessary invasive procedures. Hepatic inflammatory pseudotumors are often seen with concomitant infection or inflammatory processes. Liver biopsies distinguish these tumors from other malignant processes as they demonstrate a characteristic dense inflammatory infiltrate interspersed in stroma of interlacing bundles of myofibroblasts. This case highlights the importance of maintaining HIP on the differential diagnosis. (Figure Presented).

Higher pro-inflammatory cytokines are associated with anti-SARS-CoV-2 spike protein-specific seroconversion after two doses of COVAXINTM, COVISHIELDTM vaccination in renal transplant recipients

Introduction: Generating adequate cellular and humoral responses are essential principle of vaccination. Immune system of renal transplant recipient remained compromised and speculated to less likely to develop antibody after vaccination. SARS-CoV-2 neutralizing antibody after anti-SARS-CoV-2 vaccination is required for the protection from subsequent viral infection. During COVID-19 disease, anti-SARS-CoV-2 specific antibody formation was correlated with the inflammatory cytokines level. Although, there is limited informations about serum cytokines and antibody formation after COVAXINTM, COVISHIELDTM vaccination in RTRs. Therefore, in the current study, we have evaluated the inflammatory cytokines response and anti-SARS-CoV-2 specific antibody formation in renal transplant recipient. Method(s): In this study, we have recruited 171 live-related renal transplant recipients vaccinated with two doses of either COVAXINTM (whole inactivated virus-based vaccine) or COVISHIELDTM (Simian adenovirus containing full-length spike protein-based vaccine). A 5 ml blood sample was collected after two weeks of 2nd dose of vaccination. The serum was separated and stored at -200C till the analysis. Anti-SARS-CoV-2 spike protein-specific IgG antibody titer was determined by chemiluminescent microparticle immunoassay methods and Cytokines IL-10, TGF-beta, IFN-gamma, IL-6 were measured by the ELISA techniques. Result(s): The overall anti-SARS-CoV-2 spike protein specific seroconversion after vaccination was observed in 149/171(87.13%) of RTRs with median IgG titer in seroconversion group 1191.90 (IQR, 398.70-2652.45) au/ml. The median and interquartile serum cytokines IL-10 level in seroconversion (n=149) vs non-seroconversion (n=22) group was 88.89 (IQR, 55.5-125.92) vs 92.59 (IQR, 48.14-148.14) pg/ml. The median TGF-beta level in seroconversion vs non-seroconversion group was 692.10 (IQR, 446.05-927.63) vs 1001.31 (IQR, 813.15-1125.65) pg/ml. The median IL-6 level in seroconversion vs non-seroconversion group was 46.66 (33.3-66.66) vs 28.33 (16.66-34.16) pg/ml. The median IFN-gamma level in seroconversion vs non-seroconversion group was 98.0 (IQR, 57.40-111.60) vs 50.0 (IQR, 30.55-52.55) pg/ml. The cytokines IL-6 and IFN-gamma level was positively correlated with anti-SARS-CoV-2 specific protein antibody titer (r=0.192;p=0.012), IFN-gamma (r=0.188;p=0.014). TGF-beta and IL-10 were negatively correlated with anti-SARS-CoV-2 specific protein antibody titer. For IL-10 (r=-0.065;p=0.39), for TGF-beta (r=-0.246;p=0.002). Further IFN-gamma was negatively correlated with TGF-beta (r=-0.268;p<0.001). Conclusion(s): Higher pro-inflammatory cytokines (IL-6, IFN-gamma) levels were associated with anti-SARS-CoV-2 spike protein-specific seroconversion, whereas higher anti-inflammatory cytokines IL-10 and TGF-beta were negatively associated with seroconversion after vaccination in renal transplant recipients. No conflict of interestCopyright © 2023

Association of urinary mitochondrial DNA with COVID-19 related acute kidney injury, mitochondrial stress, and inflammation in renal transplant recipients

Introduction: ACE-receptors are profusely expressed in the renal cell, making it highly susceptible for severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection. After entering the cells, the virus induces high levels of cytokines, chemokines, and inflammatory responses, resulting neutrophilic infiltration, activation, and profuse reactive oxygen species (ROS) formation, leading to cellular necrosis and acute tubular injury. Proximal convoluted tube cell are rich in mitochondria and susceptible for developing acute kidney injury (AKI) due to mitochondrial stress. Early detection of AKI may helpful in its management, limiting the severity, avoiding nephrotoxic medicines and modifying the drug dose depending on renal function. Therefore, in the current study, we have determined the utility of urinary mitochondrial DNA (umt-DNA) and neutrophil gelatinase-associated lipocalin (NGAL) in predicting COVID-19-associated acute kidney injury (AKI) and mitochondrial stress and demonstrated the inflammatory response of urinary mt-DNA. Method(s): Live-related RTRs(n=66), who acquired SARS-CoV-2 infection and were admitted to a COVID hospital were included and subclassified into AKI (N=19) with > 25% spike in serum creatinine level from the pre-COVID-19 serum creatinine level, and non-AKI (N=47) whose serum creatinine value remained stable similar to the baseline value, or a rise of < 25% of the baseline values of pre-COVID-19. A 50ml urine sample was collected and umt-DNA and N-GAL was determined by the RT-PCR and ELISA methods respectively. A 10ml blood sample from 10 healthy volunteers was also collected for PBMC isolation and inflammatory response demonstration. A 1x106 PBMC was stimulated for 24hrs. with 1microg/ml of urinary DNA or TLR9 agonist CpG oligodeoxynucleotide (5'-tcgtcgttttcggcgc:gcgccg-3') in duplicate. Unstimulated PBMCs served as control. The gene expression of IL-10, IL-6, MYD88 was analyzed by the RT-PCR and IL-6, IL-10 level in supernatants by the ELISA. Result(s): Both the urinary mitochondrial gene ND-1 and NGAL level was significantly higher in AKI group compared to non-AKI. The mean ND-1 gene Ct in AKI group was (19.44+/-2.58 a.u) compared to non-AKI (21.77+/-3.60;p=0.013). The normalized ND-1 gene Ct in AKI was (0.79+/-0.11 a.u) compared to non-AKI (0.89+0.14;P=0.007). The median urinary NGAL level in AKI group was (453.53;range, 320.22-725.02, 95% CI) ng/ml compared to non-AKI (212.78;range, 219.80-383.06, 95%CI;p=0.015). The median urine creatinine normalized uNGAL was 4.78 (0.58-70.39) ng/mg in AKI group compared to 11.26 ng/mg (0.41-329.71) in non-AKI group. The area under curve of ND-1 gene Ct was 0.725, normalized ND-1 Ct was 0.713 and uNGAL was 0.663 and normalized uNGAL was 0.667 for detecting the AKI and mitochondrial stress. The IL-10 gene expression was downregulated in umt-DNA treated PBMCs compared to control (-3.5+/-0.40vs1.02+/-0.02, p<0.001). IL-6 and Myd88 gene expression was upregulated. The culture supernatant IL-10 and IL-6 level in umt-DNA treatment PBMCs vs control was 10.65+/-2.02 vs 30.3+/-5.47, p=0.001;and 200.2+/-33.67 vs 47.6+/-12.83, p=0.001 pg/ml respectively. Conclusion(s): Urinary mt-DNA quantification can detect the Covid19 associated AKI and mitochondrial distress with higher sensitivity than uNGAL in RTRs. Urinary mt-DNA also induces a robust inflammatory response in PBMCs, which may exacerbate the Covid19 associated allograft injury. No conflict of interestCopyright © 2023

Obesity is Associated with Improved Outcome of Extracorporeal Membrane Oxygenation for Severe Covid-19 Pneumonia

Morbidly obese patients are considered to be poor candidates for extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure due to COVID-19 pneumonia. A body mass index (BMI) greater than or equal to 40 is a relative contraindication to ECMO by the Extracorporeal Life Support Organization (ELSO) COVID-19 guidelines. This study seeks to determine the impact of obesity on survival of patients with COVID-19 on ECMO. This project is a retrospective cohort study of a multicenter US healthcare system queried from January 2020 to December 2021. All patients aged 16 years and older with COVID-19 treated with ECMO support were included in the study. Patients with missing data on ECMO duration were excluded from secondary analyses. The primary outcome was in-hospital mortality in a time-to-event analysis after ECMO initiation, with a comparison between patient groups based on body mass index (BMI) categories. Secondary outcomes included ventilator days, intensive care days, complications, and discharge destination. We identified 335 patients for the primary analysis;66 were removed from secondary analysis due to missing data for duration of ECMO. There were no baseline differences between obese and non-obese patients in terms of demographics, comorbidities, pre-ECMO treatments, or hospital length of stay. Obese patients were more likely to be younger (median age 41 vs 45;p = 0.016). Obesity (BMI ≥ 30) was associated with a decreased risk of mortality, odds ratio 0.620 (95% CI 0.399 - 0.964;p = 0.0338) after controlling for age. Severe obesity (BMI ≥ 40) was not associated with increased mortality compared to non-obese. Secondary analysis of 269 patients with complete data demonstrate overall in-hospital mortality of 34.3%. There was no difference in ECMO duration, ICU length of stay, rate of blood stream infection, stroke, or blood transfusion between BMI groups. Obesity is not associated with increased mortality on ECMO for COVID-19. Neither obesity nor severe obesity should be used to rule out candidacy for the use of ECMO in this population. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Loss aversion or hand-to-mouth behaviour in private consumption models

This study empirically tests whether the loss aversion or hand-to-mouth theories of consumption behaviour is present in Fiji. The loss aversion hypothesis implies that consumers would maintain their consumption when income falls. To estimate this model, we apply the nonlinear autoregressive distributed lag model with annual data from 1981 to 2019. Our findings are in contrast to the predictions of the loss aversion hypothesis and support the hand-to-mouth hypothesis in Fiji. The results are robust to alternative measures of liquidity, and a sample that includes the COVID-19 pandemic. We contribute to the literature by providing evidence of nonlinearity's in the consumption-income association. The findings are useful for policymakers in developing countries for policies on economic growth and stabilization. © 2023 New Zealand Association of Economists Incorporated.

A Study of Long-Term Outcome of Mycophenolate Dose Modulation in Renal Allograft Recipients With SARS-CoV2 Infection During COVID-19 Pandemic

Introduction: A significant reduction of acute rejection rates was observed after using Mycophenolate mofetil (MMF) in renal transplant recipients (RTR). However, side-effects like hematological and gastrointestinal intolerance often occur when MMF is used in routine doses.MMF dose reduction is required during its side-effects or co-existing infection in RTR.The outcome of MMF dose modulation in RTR is not well established. COVID-19 pandemic has given an opportunity to study the effect of MMF dose modulation on graft function as large number of RTR who had Covid19 received MMF dose reduction or discontinuation. This study's objective was to determine whether MMF dose reduction or discontinuation was associated with the effect on allograft function after renal transplantation. We included all RTR who had an infection with SARS-CoV2 and received MMF dose reduction or discontinuation Methods: We prospectively collected data of Renal transplant recipients developing covid 19 infection during the first and second covid waves. Management including decision on admission, immunosuppression modulation, antibiotics were done based on clinician's discretion subject to logistics and the prevailing guidelines by the ISOT. All patients were followed up for minimum 15 months for graft dysfunction, biopsy rate, biopsy proven acute rejection ( BPAR). The effect of immunosuppression modulation - MMF cessation (Group A) Vs MMF reduction/no manipulation (Group B) and its bearing on the incidence of rejection and was compared. Additional factors such as follow - up sub therapeutic CNI levels, development of DSA ( when done ), steroid increment were studied regression model. Kaplan - meier survival curves for 24 months drawn. Result(s): Among 251 renal transplant patients with SARS-CoV2 infection, 38 patients died during Index admission. 45 patients has not completed for 15 months.168 patients completed 15 month follow - up. Among them, anti-metabolite were reduced in 115 ( 68.5%), stopped in 42 (25%), not manipulated in 5 ( 3%) and 6 patients were not on anti-metabolites and hence excluded from present analysis. Of the 162 patients, MMF had been stopped for 2 weeks or until presumed clinical recovery in 42 patients ( Group A) and the rest in 120 patients ( Group B). Mean age was 41.18 ( +/- 12.8) and 75.6 % had mild COVID. Median duration of follow-up was 18 months ( 14q1-22q3 months). Total Readmission rate was 66 ( 40.7%) (Group A 21( 50%) Vs Group B 45 ( 37.5 %). Graft Biopsy was done in 16% of patients. 9.3 % patients had acute rejection ( 11.9% Vs 8.3%, p 0.05). Among those who had rejection, ABMR was seen in 2, ACR in 3, CABMR in 5 and combined rejection in 1. Conclusion(s): MMF dose modulation to tackle an infectious episode may be associated with graft dysfunction and rejection on follow-up and close follow up is needed in any patient in whom MMF dose in manipulated No conflict of interestCopyright © 2023

Classification And Errors Analysis of COVID-19 Using Supervised Machine Learning Algorithm and Visualisation

During pandemic many people died as a result of the covid-19 sickness, which appeared in 2019 and spread over the world. The objective of research work is to wards the occurrence of COVID to improve classification accuracy and threshold curve predictions on real-life dataset for Receiver Operator Characteristics (ROC) value. This paper goals the real-life COVID patients from the five countries to test the experiment. The proposed methodology involves of two steps;used Weka for calculating the accuracy by applying Decision Table machine learning classifier and compare the results of all the five countries, secondly, the improvement in ROC value in terms of initial care predictions by area under ROC analysis. For our COVID dataset has 209 instances and 16 attributes, Weka has performed on the number of training instances are 184, number of Rules applied is 20, search direction has been applied in forward direction, total number of subsets evaluated is 96, merit of best subset found is 82.609 and time taken to build model is 0. 06 seconds. One advantage of our suggested mode list hat it keeps the original data intact, ensuring experiment quality. A further advantage is that the model can be used with additional data sets to produce the highest accuracy and ROC analysis out comes.Copyright © 2022, Anka Publishers. All rights reserved.

Human Leukocyte Antigen Association with Anti-SARS-CoV-2 Spike Protein Antibody Seroconversion in Renal Allograft Recipients - An Observational Study

Cellular and humoral responses are required for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) eradication. Antigen-presenting cells load SARS-CoV-2 peptides on human leukocyte antigen (HLA) with different avidities and present to T- and B-cells for imposing humoral and cellular responses. Due to immunosuppression, renal transplant recipient (RTR) patients are speculated to poorly form the antibody against the SARS-CoV-2. Therefore, determining the association of specific HLA alleles with anti-SARS-CoV-2 spike protein antibody formation will be helpful in managing the RTR having specific HLA alleles from SARS-CoV-2 infection and vaccination. Material(s) and Method(s): In this study, anti-SARS-CoV-2 spike protein antibody in 161 RTRs was determined by the chemiluminescent microparticle immunoassay methods, and HLA alleles were determined by the polymerase chain reaction-single-strand oligonucleotide methods and analyzed to study the HLA allele association with anti-SARS-CoV-2 spike protein-specific humoral response and severity of COVID-19 symptoms in recently SARS-CoV-2-infected RTRs. Result(s): The anti-SARS-CoV-2 spike protein specific antibody seroconversion rate in RTRs was 90.06% with a median titer of 751.80 AU/ml. The HLA class I alleles, A*11 in 22.1%, A*24 in 21.37%, A*33 in 20.68%, HLA B*15 in 11%, B*07 in 8.27%, HLA-C*30 in 20.93%, C*70 in 23.25% and HLA Class II alleles, DRB1*07 in 18.62%, DRB1*04 in 13.8%, HLA-DRB1*10 in 14.48%, HLA-DQA1*50 in 32.55% of RTRs were associated with the seroconversion. The mean SARS-CoV-2 clearance time was 18.25 +/- 8.14 days. Conclusion(s): RTRs with SARS-CoV-2 infection developed a robust seroconversion rate of 90.0% and different alleles of HLA-B, DRB1, and DQA1 were significantly associated with the seroconversion. Copyright © 2022 Indian Journal of Transplantation.

A Case Series on Glomerular Disease Manifesting for the First Time after Covid 19 Vaccination

BACKGROUND: Different vaccines have been developed against SARS nCoV 19 and deployed in mass immunization campaigns across the world. In India, Covishield (ChAdOx1 nCoV-19) manufactured by Serum Institute of India) and Covaxin (BBV152) manufactured by Bharat Biotech are two such vaccines that have been made available. The former is a replication-deficient adenovirus vaccine while the latter is an inactivated whole virion vaccine. There has been many case reports of new onset or relapse of glomerular disease occurring after Covid-19 vaccination. This is attributed to heighten off target effect of immune response of the vaccine. AIM OF THE STUDY: We present a case series of four patients where glomerular disease manifested for the first time after Covid-19 vaccination in our center. METHOD(S): We have included in our case series those patients whose clinical features manifested for the first time within 1 month of Covid-19 vaccination and whose renal biopsy showed glomerular pathology. RESULT(S): Case 1: A 12-year-old male presented to us with abrupt onset of edema leading to anasarca on 30/4/2022. He had received first dose of Covid-19 vaccine (Covaxin) on 26/4/2022. His labs showed urine protein of 3+ and nil RBC, serum creatinine 0.7 mg/dl, serum albumin 1.9 mg/dl, and dyslipidemia (total cholesterol 378 mg/dl, triglycerides 191 mg/ dl). He underwent renal biopsy in view of nephrotic syndrome. It was suggestive of minimal change disease. He was started on prednisolone at 2 mg/kg/day. Case 2: A 39-year-old female presented to us with abrupt onset of maculopapular rash, fever, and bilateral lower limb swelling on 25/1/2022. She had received second dose of Covid-19 vaccine (Covishield) on the same day in the morning. She was found to have hypertension with BP of 160/100 mm Hg. Her labs showed urine protein of 2+ and 18-20 RBC/high power field, serum creatinine 1.9 mg/dl, serum albumin 3.7 mg/dl, negative ANA and ANCA, and normal complement levels. She underwent renal biopsy in view of renal failure with active urinary sediments. It was suggestive of focal and segmental glomerulosclerosis (FSGS). Case 3: A 37-year-old male patient with history of hypertension (on irregular treatment) presented to us with history of gross hematuria without passage of clots in May 2022 about three days after receiving booster dose of Covishield vaccine. He did not have edema, rash, joint pain, or decreased urine output. His labs showed urine protein of 2+ and 5-6 RBC/high power field, serum creatinine 2.0 mg/dl, serum albumin 4.0 mg/dl, negative ANA and ANCA, and normal complement levels. He underwent renal biopsy in view of renal failure with active urinary sediments. It was suggestive of IgA nephropathy (M1E0S1T1C0). Case 4: An 18-year-old female with family history of nail patella syndrome presented to us with history of abrupt onset of edema of both lower limbs on 21/11/2021. She also had rash at the time of presentation. She had received first dose of Covid-19 vaccine (Covaxin) on 20/11/2021. Her labs showed urine protein of 2+ and numerous RBC/high power field, serum creatinine 1.4 mg/dl, serum albumin 2.98 mg/dl, negative ANA, and dsDNA and low complement levels (C3 14.1 mg/dl, C4 10.1 mg/dl: both being low). She underwent renal biopsy in view of renal failure with active urinary sediments. It was suggestive of membranoproliferative glomerulonephritis (MPGN). She was started on prednisolone at 1 mg/kg/day. CONCLUSION(S): Different vaccines have different mechanisms of action, but their target remains the spike protein of the SARS Cov2 virus. Glomerular disease has mostly been reported with mRNA-based vaccines. Here we have reported glomerular disease occurring in close temporal relation to Covishield and Covaxin which have different mechanism of action. There have been reports of IgA nephropathy, minimal change disease and FSGS which manifested soon after vaccination. MPGN after Covid-19 vaccination is rarely seen. Thus, this case series shows that post- Covid vaccination glomerular disease can have varied pathologies.

Elevated Urinary Mitochondrial DNA Induces Inflammation and Associated with Acute Kidney Injury in Sars-Cov-2 Infected Renal Allograft Recipient

BACKGROUND: Severe acute respiratory coronavirus-2 (SARS-CoV-2) affected multiple organs including kidney. SARSCoV- 2 open reading frame protein 3a induces necroptosis in infected cell leading release of mtDNA which binds to TLR9 and trigger innate immunity which may lead to acute allograft injury. AIM OF THE STUDY: To determine the specificity and sensitivity of urinary mitochondrial DNA (umt-DNA) and neutrophil gelatinase-associated lipocalin (NGAL) in predicting COVID-19-associated acute kidney injury (AKI) mitochondrial stress and inflammation. METHOD(S): Live-related RTRs (n = 66) who acquired SARSCoV- 2 infection and were admitted to a COVID hospital were included and subclassified into AKI (N = 19) with >25% spike in serum creatinine level from the pre-COVID-19 serum creatinine level and non-AKI (N = 47) whose serum creatinine value remained stable similar to the baseline value or a rise of < 25% of the baseline values of pre-COVID-19. A 50 ml urine sample was collected and umt-DNA and N-GAL was determined by the RT-PCR and ELISA methods respectively. A 1 x 106 PBMCs were stimulated for 24 hrs. with 1mug/ml of urinary DNA or CpG oligodeoxynucleotide (5) in duplicate. Unstimulated PBMCs served as control. The gene expression of IL-10 IL-6 and MYD88 was analyzed by the RT-PCR and IL-6 IL-10 level in supernatants by the ELISA. RESULT(S): Both the urinary mitochondrial gene ND-1 and NGAL level were significantly higher in AKI group compared to non-AKI. The mean ND-1 gene Ct in AKI group was (19.44 +/- 2.58 a.u) compared to non-AKI (21.77 +/- 3.60;p = 0.013). The normalized ND-1 gene Ct in AKI was (0.79 +/- 0.11 a.u) compared to non- AKI (0.89+0.14;P = 0.007). The median urinary NGAL level in AKI group was (453.53;range, 320.22-725.02, 95% CI) ng/ml compared to non-AKI (212.78;range, 219.80-383.06, 95%CI;p = 0.015). The median urine creatinine normalized uNGAL was 4.78 (0.58-70.39) ng/mg in AKI group compared to 11.26 ng/mg (0.41-329.71) in non-AKI group. The area under curve of ND-1 gene Ct was 0.725, normalized ND-1 Ct was 0.713, and uNGAL was 0.663 and normalized uNGAL was 0.667 for detecting the AKI and mitochondrial stress. The IL-10 gene expression was downregulated in umt-DNA-treated PBMCs compared to control (-3.5 +/- 0.40 vs 1.02 +/- 0.02, p < 0.001). IL-6 and Myd88 gene expression was upregulated. The culture supernatant IL-10 and IL-6 level in umt-DNA treatment PBMCs vs control was 10.65 +/- 2.02 vs 30.3 +/- 5.47, p = 0.001 pg/ml;and 200.2 +/- 33.67 vs 47.6 +/- 12.83pg/ml, p = 0.001 respectively. CONCLUSION(S): Urinary mt-DNA quantification can detect the Covid-associated AKI and mitochondrial distress with higher sensitivity than uNGAL in RTRs and induces inflammation in PBMCs.

Does the Use of High-Dose Corticosteroids in Renal Transplant Recipients during Long-Term Impact Covid-19 Have?

BACKGROUND: The long-term outcomes of renal transplant recipients (RTR) affected by SARS-COV2 infection are an unexplored area particularly given the heightened immunosuppression and post-COVID-19 sequelae and increased fungal infections. We aimed to analyze the patient and graft outcomes, infectious and non-infectious sequelae in RTR with COVID-19 over a long-term follow-up of 24 months. AIM OF THE STUDY: To analyze the patient and graft outcomes, infectious and non-infectious sequelae in RTR with COVID-19 over a long-term follow-up of 24 months. METHOD(S): This retrospective study included the RTR admitted during the two pandemic waves between March 25, 2020, and July 31, 2021. The survivors were followed for a maximum period of 24 months (till September 2022) and were studied for readmission rates, serious infection requiring hospitalization (SIRH), graft dysfunctions and biopsy-proven acute rejections (BPAR), patient and graft survival. RESULT(S): Of 251 RTRs with SARS-COV2 infection, 104 were treated during the first wave and 147 during the second wave. After an index mortality noted in 38 patients (15.1% - 11.5% in first wave vs 17.5% in second wave, P = 0.23), follow-up data of 213 patients were analyzed. 45 patients were lost to follow-up, and a complete follow-up data was available for 168 patients. A total of 70 patients (41.7%) required readmission with SIRH being the most common indication for readmission (19.6%) followed by rejection (8.9%). Patients who received high dose steroids during the COVID-19 illness had higher SIRH (32.4% vs 16%, p = 0.027). However, graft dysfunctions (13.5% vs 16%, p = 0.70) and the BPAR (8.1%vs9.2%, p = 0.84) were similar in both the groups. Overall mortality (5.4% vs 6.9%, p = 0.75) and graft loss (10.8% vs 5.3%, p = 0.23) were also similar at 24-month follow-up. CONCLUSION(S): The high-dose corticosteroid dosing in the RTRs during COVID-19 appears to be associated with increased infectious complications over long-term although the overall patient and graft survival was similar.

A Study of Long-Term Outcome of Mycophenolate Dose Modulation in Renal Allograft Recipients with Sars-Cov2 Infection during Covid-19 Pandemic

BACKGROUND: A significant reduction of acute rejection rates was observed after using Mycophenolate mofetil (MMF) in renal transplant recipients (RTR). However side-effects like hematological and gastrointestinal intolerance often occur when MMF is used in routine doses. MMF dose reduction is required during its side-effects or coexisting infection in RTR. The outcome of MMF dose modulation in RTR is not well established AIM OF THE STUDY: COVID-19 pandemic has given an opportunity to study the effect of MMF dose modulation on graft function as large number of RTR who had COVID-19 received MMF dose reduction or discontinuation. This study's objective was to determine whether MMF dose reduction or discontinuation was associated with the effect on allograft function after renal transplantation. We included all RTR who had an infection with SARS-CoV2 and received MMF dose reduction or discontinuation METHODS: We prospectively collected data of renal transplant recipients developing COVID-19 infection during the first and second covid waves. Management including decision on admission immunosuppression modulation antibiotics were done based on clinician'S discretion subject to logistics and the prevailing guidelines by the ISOT. All patients were followed up for minimum 15 months for graft dysfunction biopsy rate biopsy-proven acute rejection ( BPAR). The effect of immunosuppression modulation - MMF cessation (Group A) Vs MMF reduction/no manipulation (Group B) and its bearing on the incidence of rejection and was compared. Additional factors such as follow - up sub therapeutic CNI levels development of DSA ( when done ) steroid increment were studied regression model. Kaplan - Meier survival curves for 24 months drawn. RESULT(S): Among 251 renal transplant patients with SARSCoV2 infection, 38 patients died during Index admission. 45 patients have not completed for 15 months. 168 patients completed 15 month follow - up. Among them, antimetabolite were reduced in 115 (68.5%), stopped in 42 (25%), not manipulated in 5 ( 3%) and 6 patients were not on anti-metabolites and hence excluded from present analysis. Of the 162 patients, MMF had been stopped for 2 weeks or until presumed clinical recovery in 42 patients ( Group A) and the rest in 120 patients ( Group B). Mean age was 41.18 ( i' +/- 12.8), and 75.6% had mild COVID. Median duration of followup was 18 months ( 14q1-22q3 months). Total readmission rate was 66 (40.7%) (Group A 21 (50%) Vs Group B 45 (37.5%). Graft biopsy was done in 16% of patients. 9.3% patients had acute rejection (11.9% Vs 8.3%, p 0.05). Among those who had rejection, ABMR was seen in 2, ACR in 3, CABMR in 5 and combined rejection in 1 CONCLUSION(S): MMF dose modulation to tackle an infectious episode may be associated with graft dysfunction and rejection on follow-up and close follow-up is needed in any patient in whom MMF dose in manipulated.

Association of Human Leucocyte Antigens with Anti-Sars-Cov-2 Spike Protein Antibody Formation in Response to Vaccination in Renal Allograft Recipient

BACKGROUND: Cellular and humoral response are required for SARS-CoV-2 eradication. Antigen-presenting cell loads SARS-CoV-2 peptides on human leukocyte antigen with different avidity and present to T and B cell for humoral and cellular activity. Due to immunosuppression, renal transplant recipient patients are speculated to poorly form the antibody against SARS-CoV-2 virus. Therefore, determining the association of specific HLA alleles with anti-SARS-CoV-2 spike protein antibody formation will be helpful in managing the renal transplant recipient patients having specific HLA alleles from SARS-CoV-2 infection and vaccination. AIM OF THE STUDY: To study the association of human leukocyte antigens with anti-SARS-CoV-2 spike protein antibody formation in response to vaccination in renal allograft recipient METHODS: In this study, anti-SARS-CoV-2 spike protein antibody in 78 renal allograft recipient patients were determined by the chemiluminescent microparticle immunoassay methods and human leukocyte antigen alleles were determined by the polymerase chain reaction-single strand oligonucleotide methods and analyzed to study the association of human leukocyte antigens with anti-SARS-CoV-2 spike protein antibody formation in response to vaccination in renal allograft recipient RESULTS: The mean age of the patients in seroconversion vs non-seroconversion (45.88 +/- 8.86 vs 45.55 +/- 8.74, p value - 0.90). The post-transplant interval in seroconversion vs non-seroconversion (103.63 +/- 57.57 vs 77.45 +/- 35.25, p value - 0.14). The duration between the vaccination with both the doses and sample collection of renal transplant recipients in seroconversion vs non- seroconversion (47.58 +/- 30.18 vs 45.55 +/- 35, p value - 0.85). The anti-SARS-CoV-2 spike protein antibody seroconversion rate in renal allograft recipients were 85.9% with median titer in seroconversion vs non- seroconversion 3175.00 (IQR, 798.50 - 8391.70) vs 5.50 (IQR, 4.10 - 8.20, p value - 0.001). In covishield vs covaxin group 2500.70 (IQR, 146.40 - 7705.60) vs 1828.70 (IQR, 665.00 - 3765.10, p value - 0.63). The frequency of HLA class I alleles A*26 was 18.18%, B*08 was 18.18%, C*05 was 25% and Class II HLA alleles - DRB1*03 was 18.18%, and HLADQA1* 20 was 25% of patient were significantly associated with non-seroconversion and C*06 was 18.75% were significantly associated with seroconversion. CONCLUSION(S): Renal transplant recipients with anti-SARSCoV- 2 vaccination developed a robust seroconversion rate of 85.9% and alleles of A*26, B*08, C*05, DRB1*03, and DQA1*20 were significantly associated with non-seroconversion.

Pre and Posttransplant Vaccination for Solid Organ Transplant Recipient and in South Asia - Expert Group Opinion

Infections are common after solid organ transplantation (SOT) and are an important cause of significant morbidity and mortality. Many of these infections can be prevented or their severity reduced by vaccination in pre and posttransplantation period. It is better to complete the vaccination before transplantation as protection and seroconversion is better, and live vaccines are mostly contraindicated after SOT. Live vaccines should be given at least 4 weeks before transplantation but killed vaccines can be given up to 2 weeks before the planned transplantation. Vaccination for some diseases which are endemic in South Asia should be given, along with usual vaccinations. Serological monitoring is required for some vaccines to check their efficacy. Similarly, some vaccines are recommended for SOT recipients traveling to various endemic regions. Copyright © 2022 Indian Journal of Transplantation Published by Wolters Kluwer - Medknow.

Awareness, Knowledge and Attitude of Teledentistry Among Dentists in Kanchipuram District - A Cross-Sectional Survey

Introduction: A highly infectious and life-threatening novel coronavirus Corona Virus Disease (COVID-19) has been spreading worldwide, causing severe medical complications and practising dentistry is becoming difficult. To reduce the risk of spread of coronavirus infection between dentist and patient, teledentistry, an innovative digital tool, has the potential to reach patients straightforward without direct contact. Materials and Methods: A self-structured standard questionnaire was framed and distributed among dentists from July 2021 to August 2021. The survey consisted of 15 closed-ended and multiple-choice questions related to awareness, knowledge and attitude of teledentistry during this COVID 19 pandemic. After proper validation of the questionnaire from the experts and evaluating reliability, the survey was conducted by forwarding the link of the Google Form through social media. Totally 520 participants responded to the survey. The statistical analysis was performed using SPSS statistical software version 21. All statistical analyses were carried out at a significance level of P < 0.05. The descriptive data were analysed and compared using the Chi-square test. Results: Among specialists, general practitioners, postgraduate students and undergraduate students, specialists have better awareness, knowledge and attitude of teledentistry. Almost all participants have 50% knowledge about teledentistry and have a high (80%) attitude towards teledentistry. Conclusion: From this study, it is clearly understood that it is high time to increase the use of teledentistry practice by spreading knowledge among dentists and dental students. It is potentially an innovative digital tool in this new era of dentistry. It is an effective tool not only in the current pandemic situation but also in emergencies. Thus, teledentistry is a satisfied boon in the field of dentistry through the use of digital technology.

Comprehensive Therapeutic Interventions against Sars-Cov-2: A Review and Prospective

In December 2019, Wuhan City, Hubei Province, China, first reported pneumonia like symptoms with unknown aetiology caused by a novel coronavirus. The novel coronavirus was renamed as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by Coronaviridae Study Group of the International Committee on Taxonomy of Viruses and the disease was termed as Coronavirus Disease 2019 (COVID-19). As of 19 August, 2022, the infection has reached above 220 countries, areas or territories with a total of 591 683 619 confirmed cases and 6 443 306 deaths, as published by the World Health Organization (WHO). SARS-CoV-2 is strongly contagious as it has R0, 2.2-2.6, in comparison to SARS-CoV (<1) and Middle East respiratory syndrome coronavirus (MERS-CoV) (1.4-2.5), respectively. SARS-CoV-2 might become less virulent than the SARS-CoV and MERS-CoV, with the currently analyzed mortality of COVID-19 is 3.4%. The original SARS-CoV-2 has undergone "virus evolution"with the occurrence of numerous variants such as Alpha, Beta, Gamma and Delta etc. Recently, the circulating variant of concern is Omicron subvariants. Currently, real-time reverse transcription-polymerase chain reaction-based detection of the viral genome (RNA) is the gold standard for diagnosis of SARS-CoV-2 infection. At present, Remdesivir (RDV) and Baricitinib drugs as well as vaccines Pfizer-BioNTech and Moderna have been approved for the treatment of COVID-19 by Food and Drug Administration (FDA). In this review, we summarized the existing state of knowledge on approved antiviral therapy, combination therapy, blood-derived therapeutics and immunomodulators to treat COVID-19 pandemic. Copyright © 2022 The Authors.

Evaluation of Cost benefit Analysis using One-R Supervised Machine Learning Algorithm for Healthcare

Pandemic was present for the entire world from 2019 to 20. Due to this reason the workload for doctors and other healthcare professionals were increased. This workload will be eased by machine learning and the development of computer-aided analytical systems. The goal of the proposed methodology is towards the prevalence of COVID-19 to cost/benefit predictions on real-life dataset. Our proposed methodology is given for weka classification for the accuracy measurement ratios by applying 1R machine learning classifiers Considering the development of clustering with positive and negative occurrences ratios in terms of cost-benefit analysis's initial care projections. In this study 1R Supervised Machine Learning Algorithm have been applied to Covid 19 dataset provided by healthcare organization. The best classification accuracy is obtained from the algorithm of 1R with 75.54%. In this paper visualization Cost/Benefit Analysis and also analysed. Copyright © 2022, Anka Publishers. All rights reserved.