LTSI Consensus Guidelines: Preoperative Pulmonary Evaluation in Adult Liver Transplant Recipients.

The relationship between chronic liver disease and respiratory symptoms and hypoxia is well recognized. Over the last century, three pulmonary complications specific to chronic liver disease (CLD) have been characterized: hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. Apart from that coexisting pulmonary disease like chronic obstructive lung disease and interstitial lung disease also complicate the outcomes after liver transplantation (LT). Assessment for evaluation of underlying pulmonary disorders is essential to improve outcomes in patients with CLD, posted for LT. This consensus guideline of the Liver Transplant Society of India (LTSI) provides a comprehensive review of pulmonary issues in CLD, related and unrelated to underlying liver disease and gives recommendations for pulmonary screening in specific clinical scenarios in adults with chronic liver disease planned for LT. This document also aims to standardize the strategies for preoperative evaluation of these pulmonary issues in this subset of patients. Proposed recommendations were based on selected single case reports, small series, registries, databases, and expert opinion. The paucity of randomized, controlled trials in either of these disorders was noted. Additionally, this review will highlight the lacunae in our current evaluation strategy, challenges faced, and will provide direction to potentially useful futuristic preoperative evaluation strategies.

Good outcomes of living donor liver transplant in primary sclerosing cholangitis: an experience from North India.

BACKGROUND: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease. In the absence of effective medical therapy, liver transplant is the definitive treatment for advanced stage. However, recurrence of PSC after liver transplant is of concern which can lead to graft failure and may require retransplant. There are limited data on outcomes of living donor liver transplant (LDLT) in PSC. Also, in LDLT as donors are genetically related there can be an increased risk of recurrence. We conducted this retrospective study to analyze the outcomes of LDLT in PSC at a tertiary liver transplant center in north India. METHODS: We conducted a retrospective analysis of 3213 transplant recipients who underwent LDLT from January 2006 to May 2021. Of these 26 (0.80%) patients had PSC as indication for liver transplantation (PSC = 24, PSC-AIH overlap = 2). Data analysis was done to look for baseline demographics, clinical details, transplant outcomes, PSC recurrence, and survival. RESULTS: Mean age of study group was 42 (± 13.8) years and 19 patients (73.1%) were males. All patients had decompensated cirrhosis at the time of transplant. Mean CTP score and MELD score were 9.5 (± 1.8) and 18.9 (± 7.1), respectively. Sixteen patients received modified right lobe graft, seven extended right lobe graft and five patients received left lateral graft. Median graft weight and mean graft to recipient weight ratio (GRWR) were 633.5 (IQR 473.5-633.5) grams and 1.23 (± 0.42), respectively. Most common biliary anastomosis was hepaticojejunostomy, done in 19 (73.1%) while duct to duct anastomosis was performed in 7 (26.9%) patients. Median follow-up was 96 (36-123) months. One patient had ulcerative colitis and none had cholangiocarcinoma. Two (7.7%) patients had bile leak during early post-transplant period. Three (11.1%) patients developed graft rejection and were managed successfully with steroid pulses. Three patients died during early post-transplant period while seven deaths occurred during long-term follow-up including one death due to COVID-19. Five (21.73%) patients had recurrence of PSC of which two patients had graft loss including one after retransplantation. The one year graft and patient survival rate was 88.5%. CONCLUSION: LDLT can be performed in PSC with good long-term outcomes with a risk of PSC recurrence in about one-fifth patients.

Mental health outcome in hospitalized COVID-19 patients: An observational analysis from North Indian tertiary care hospital.

Aim: The study investigate the severity of perceived stress and wide domains of psychiatric symptoms reported on initial screening in hospitalized patients of COVID-19 with a second aim to determine the role of sociodemographic factors and coping styles in the hospitalized patients of COVID-19. Method: Total 224 patients of COVID-19 infection, hospitalized in various isolation facilities were assessed via web-based self-reported questionnaires on perceived stress scale, brief cope inventory, and DSM-5 crosscutting level-1 questionnaire. Results: Majority of the patients reported moderate level of stress followed by mild and severe. Depression and Anxiety symptoms were most common psychopathologies though the patients have reported greater severity in various domains of psychiatric symptoms. Coping styles explains most of variance (64.8%) of the perceived stress. Similarly total PSS scores, coping styles, COVID-19 status and sociodemographic factors contributed significantly to the variance of all psychiatric symptoms. Conclusion: Factors like female gender, being married, belonging to nuclear families, service class and urban domicile are the significant factors determining higher risk of stress and developing more psychopathologies. Furthermore, coping styles used by the patients have a greater moderating effect on mental health symptoms and their perceived stress which can be a major area for interventions to reduce the mental health morbidities.

Homoeopathy as an Adjuvant to Standard Care in Moderate and Severe Cases of COVID-19: A Single-Blind, Randomized, Placebo-Controlled Study.

OBJECTIVES: This study aimed to evaluate whether individualized homeopathic medicines have a greater adjunctive effect than adjunctive placebos in the treatment of moderate and severe cases of coronavirus disease 2019 (COVID-19). METHODS: The study was a randomized, single-blind, prospective, placebo-controlled clinical trial set in the clinical context of standard care. INTERVENTION: Patients of either sex, admitted in a tertiary care hospital, suffering from moderate or severe COVID-19 and above 18 years of age were included. In total, 150 patients were recruited and then randomly divided into two groups to receive either individualized homeopathic medicines or placebos, in addition to the standard treatment of COVID-19. OUTCOME MEASURES: The primary outcome was time taken to achieve RT-PCR-confirmed virus clearance for COVID-19. Secondary outcomes were changes in the Clinical Ordinal Outcomes Scale (COOS) of the World Health Organization, the patient-reported MYMOP2 scale, and several biochemical parameters. Parametric data were analyzed using unpaired t-test. Non-parametric data were analyzed using the Wilcoxon signed rank test. Categorical data were analyzed using Chi-square test. RESULTS: In total, 72 participants of the add-on homeopathy (AoH) group showed conversion of RT-PCR status to negative, in an average time of 7.53 ± 4.76 days (mean ± SD), as compared with 11.65 ± 9.54 days in the add-on placebo (AoP) group (p = 0.001). The mean COOS score decreased from 4.26 ± 0.44 to 3.64 ± 1.50 and from 4.3 ± 0.46 to 4.07 ± 1.8 in the AoH and AoP groups respectively (p = 0.130). The mortality rate for the AoH group was 9.7% compared with 17.3% in the AoP group. The MYMOP2 scores between the two groups differed significantly (p = 0.001), in favor of AoH. Inter-group differences in the pre- and post- mean values of C-reactive protein, fibrinogen, total leukocyte count, platelet count and alkaline phosphatase were each found to be statistically significant (p <0.05), favoring AoH; six other biochemical parameters showed no statistically significant differences. CONCLUSION: The study suggests homeopathy may be an effective adjunct to standard care for treating moderate and severe COVID-19 patients. More rigorous, including double-blinded, studies should be performed to confirm or refute these initial findings.

Structural aspects of SARS-CoV-2 mutations: Implications to plausible infectivity with ACE-2 using computational modeling approach.

Some of the SARS-CoV-2 variants are said to be more infectious than the previous others and are causing panic around the globe. Cases related to Delta plus (δ+) and omicron (ο) variants are on the rise worldwide. This sudden surge warrants an investigation into the reasons for its binding with ACE-2. The present study attempts to find out the structural basis of binding interactions of SARS-CoV-2 mutants based on computational modeling and comparative analysis. In silico strategies including protein-protein docking, mutation analysis, molecular dynamics, and binding energy calculations were used to study the binding of the 'receptor binding domain' (RBD) of the seven 'variants of concern' which include Alpha (α), Beta (ß), Gamma (γ), Kappa (κ), Delta (δ), Delta plus (δ+) and omicron (ο) with ACE-2 (human angiotensin-converting enzyme-2) and with antibodies. Among all the variants dealt with in this study, Delta plus and omicron were found to be binding more strongly to ACE-2 than others due to inherent mutations and the consequent change in the hydrophilic and hydrophobic environment of the binding site. Furthermore, molecular dynamic (MD) simulations and subsequent MM/PBSA calculations provided useful structural insights into key residues participating in the interaction. Infectivity of a virus could be dependent on the interplay of evading antibodies and simultaneously attaching strongly with the host receptor. A cross-correlation between mutant spike proteins' binding with ACE-2 and antibodies provides a holistic assessment of the binding nature of these mutants vis-à-vis native virus and offers opportunities for designing potential therapeutics against these new mutants.

Living donor liver transplant outcomes during the COVID-19 pandemic: does a decrease in case volume impact the overall outcomes?

Background: High-volume centers (HVCs) are classically associated with better outcomes. During the coronavirus disease 2019 (COVID-19) pandemic, there has been a decrease in the regular liver transplantation (LT) activity at our center. This study analyzed the effect of the decline in LT on posttransplant patient outcomes at our HVC. Methods: We compared the surgical outcomes of patients who underwent LT during the COVID-19 pandemic lockdown (April 1, 2020 to September 30, 2020) with outcomes in the pre-pandemic calendar year (April 1, 2019 to March 31, 2020). Results: During the 6 months of pandemic lockdown, 60 patients underwent LT (43 adults and 17 children) while 228 patients underwent LT (178 adults and 50 children) during the pre-pandemic calendar year. Patients in the pandemic group had significantly higher model for end-stage liver disease (MELD) scores (24.39±9.55 vs. 21.14±9.17, P=0.034), Child-Turcotte-Pugh scores (11.46±2.32 vs. 10.25±2.24, P=0.03), and incidence of acute-on-chronic liver failure (30.2% vs. 10.2%, P=0.002). Despite performing LT in sicker patients with COVID-19-related challenges, the 30-day (14% vs. 18.5%, P=0.479), 3-month (16.3% vs. 20.2%, P=0.557), and 6-month mortality rates (23.3% vs. 28.7%, P=0.477) were lower, but not statistically significant when compared to the pre-pandemic cohort. Conclusions: During the COVID-19 pandemic lockdown the number of LT procedures performed at our HVC declined by half because prevailing conditions allowed LT in very sick patients only. Despite these changes, outcomes were not inferior during the pandemic period compared to the pre-pandemic calendar year. Greater individualization of patient care contributed to non-inferior outcomes in these sick recipients.

Convolutional neural network based CT scan classification method for COVID-19 test validation.

Given the novel corona virus discovered in Wuhan, China, in December 2019, due to the high false-negative rate of RT-PCR and the time-consuming to obtain the results, research has proved that computed tomography (CT) has become an auxiliary One of the essential means of diagnosis and treatment of new corona virus pneumonia. Since few COVID-19 CT datasets are currently available, it is proposed to use conditional generative adversarial networks to enhance data to obtain CT datasets with more samples to reduce the risk of over fitting. In addition, a BIN residual block-based method is proposed. The improved U-Net network is used for image segmentation and then combined with multi-layer perception for classification prediction. By comparing with network models such as AlexNet and GoogleNet, it is concluded that the proposed BUF-Net network model has the best performance, reaching an accuracy rate of 93%. Using Grad-CAM technology to visualize the system's output can more intuitively illustrate the critical role of CT images in diagnosing COVID-19. Applying deep learning using the proposed techniques suggested by the above study in medical imaging can help radiologists achieve more effective diagnoses that is the main objective of the research. On the basis of the foregoing, this study proposes to employ CGAN technology to augment the restricted data set, integrate the residual block into the U-Net network, and combine multi-layer perception in order to construct new network architecture for COVID-19 detection using CT images. -19. Given the scarcity of COVID-19 CT datasets, it is proposed that conditional generative adversarial networks be used to augment data in order to obtain CT datasets with more samples and therefore lower the danger of overfitting.

Predictors of ‘problematic internet use’ among adolescents and adults amid the pandemic in India

Background Globally, problematic internet use (PIU) is acknowledged as a significant behavioural problem in adolescents and youth. It is being researched for further clarity as an independent behavioural disorder. It is crucial to explore predictors of PIU to understand the high-risk psychosocial indicators of problematic internet use, particularly amid the COVID-19 pandemic in India. Aim The present study aimed at studying age, gender, mental health, coping strategies and lifestyle indicators as predictors for PIU in adolescents, young adults and middle-aged adults. Methods The study used a cross-sectional design, and the data was collected using Perceived Stress Scale, Internet Gaming Disorders-9, DSM-5 Self-Rated Level-1, and Brief-COPE scale. Multiple regression analysis was employed to find the predictors of PIU in a sample of 1027 i.e., adolescents (13–19 years), young adults (20–39 years), and middle-aged adults (40–60 years). Separate regression analyses were carried out for the three subgroups as well. Results Results showed that the age, perceived stress, maladaptive coping strategies (substance use, self-blaming, self-distraction, behavioural disengagement), repetitive thoughts and actions, and impact of COVID-19 were significant independent predictors of PIU. Furthermore, differences in independent predictors were found in different sub-groups of age. Discussion This study indicated that adolescents and youth are more susceptible to PIU. In addition, maladaptive coping strategies predicted PIU significantly, which indicates that PIU is not an effective coping strategy but can be understood as maladaptive behaviour involving escapism. Furthermore, only repetitive thoughts and actions predicted PIU, which clarifies PIU as an independent pathology. Conclusion This study found specific predictors for the three sub-groups – adolescents, young adults, and middle-aged adults - that would further aid management plans for problematic internet use. Moreover, the role of the COVID-19 pandemic on PIU is also critical.

PROTOCOL: Social and behaviour change communication interventions for strengthening HIV prevention and research among adolescent girls and young women in low- and middle-income countries: An evidence and gap map.

Despite progress in several dimensions of the global HIV response, there seems to be a significant gender and age disparity. Numerous organizations consider it a top priority to accelerate HIV prevention programming among Adolescent Girls and Young Women (AGYW) as unequal gender norms, limited agency and voice, and reduced access to resources put them at higher HIV risk. Gender and age have also been identified as critical gaps within prevention research to ensure the development of biomedical interventions that are responsive to the biological and social needs of AGYW. Towards this, the objectives of the proposed evidence and gap map are to; identify and map existing evidence and gaps on the use of diverse Social and Behaviour Change Communication (SBCC) strategies to strengthen adoption of HIV prevention measures and participation in research among AGYW in LMICs; and, identify areas where more interventions and evidence are needed to inform the design of future SBCC strategies and programs for AGYW engagement in HIV prevention and research.

Marketing messages for post-pandemic destination recovery- A Delphi study

What is the best way to communicate with American outbound visitors as the travel recommences after the COVID-19 pandemic? This timely study aimed to find answers to this question faced by many destinations. To this end, ideas were sought from industry and academic experts on what message features may positively influence American visitors international travel intentions following the COVID-19 pandemic. Three rounds of conventional Delphi research delivered fifteen message features, eight of which attained panel consensus. These included COVID-related features such as safety , accurate pandemic information , a show of open outdoor spaces , and building visitor confidence along with destination-related features including positive destination attributes, authentic local experience, locals support , and reminder of joys of travel . Each message feature is discussed in detail with implications to the prescribed context.

Forum: Did "America First" Construct America Irrelevant?

Did "America First" construct America irrelevant? Answering this question has been the subject of much debate in the popular press, the policy community, and scholarly circles. That asked, it is worth remembering that scholars and policymakers have long argued that one of the most enduring and important aspects of the US role in the world is American structural power. Perhaps nowhere has the Trump administration's approach to world affairs been more notable in perhaps diminishing US structural power than in withdrawing from multilateral forums. On an individual level of analysis, however, Trump's ever-changing, whiplash style of leadership made allies and adversaries less certain about American actions, intentions, and the direction of future policy trajectories. These issues point to the possibility that such impacts were more about Trump being Trump and less about a decline in American structural power. Only time will tell whether President Biden is able to rebuild from that structural wreckage. With these ideas in mind, the forum editors asked scholars representing diverse voices and perspectives to provide varying analyses of America First, specifically in light of the emergence of multiple global challenges from the COVID-19 pandemic to racial reckoning through the climate crisis and more. As you will see, each author brings a decidedly different lens to the questions we pose below and also generates divergent analyses of the present and the future. [ABSTRACT FROM AUTHOR] Copyright of International Studies Perspectives is the property of Oxford University Press / USA 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.)

Stress, internet use, substance use and coping among adolescents, young-adults and middle-age adults amid the 'new normal' pandemic era.

Background: Globally, there is a constant state of flux amid the 'new normal' period of the COVID-19 pandemic. People try to accommodate to uncertainty, stress, and the threat of facing subsequent waves. It is crucial to explore and compare the psychological and behavioral processes of adolescents, young adults, and middle-aged adults amid such an era in a developing country like India. Aim: The present study compared the stress, internet use, substance use, and coping among adolescents, young adults, and middle-aged adults amid India's 'new normal' era. Methods: A cross-sectional design was used on an online platform. The sample included 1027 participants [ 456 adolescents; 347 young adults, and 224 middle age-adults] using PerceivedStress Scale, Internet Gaming Disorders-9, DSM-5 Self-Rated Level-1, and Brief-COPE scale. Results: Results showed moderate stress among all participants across all ages. Adolescent females perceived the highest stress (20.91, SD = 8.65); Adolescents reported higher internet use (Females: M = 3.59, S.D. = 2.44; Males: M = 3.40, S.D. = 2.30); Young and middle-aged adults Males reported significantly higher substance use (M = 1.60, S.D. = 2.96; M = 1.17, S.D. = 2.21). Maladaptive coping was used more by Young Adult Males (M = 10.83, S.D. = 4.66). Internet use was positively correlated with perceived stress (0.40) and maladaptive coping (0.40). Substance Use was also moderately positively correlated with maladaptive coping (0.38). Discussion: The study reveals significant variations in perceived stress, internet use, substance use, and coping based on gender and age variations. Adolescent females were the most affected and reported high perceived stress, whereas middle-aged adults were the least affected. Conclusion: The study provides further avenues to understand the stress and coping in different sections of society amid the 'new normal' era. It also gives an idea about resilience and identifies the sections of society which require focused interventions.

Liver Transplant Society of India Guidelines for Liver Transplant During COVID-19 times.

Coronavirus disease-2019 (COVID-19) pandemic has affected liver transplantation in many ways. There is risk of infection to the transplant recipients; and COVID-19 is associated with significant risk of mortality in patients on wait list. The Liver Transplant Society of India (LTSI) has prepared guidelines regarding selection of adult and pediatric patients for liver transplantation, transplant for acute liver failure, use of deceased donor organs, transplant techniques and minimally invasive donor hepatectomy, pre- and postsurgery testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related coronavirus disease 2019 in donors and recipients, role of COVID-19 antibody testing, shifting of recipients from COVID-19 to non-COVID-19 areas after recovery, isolation policy of team members exposed to COVID-19 patients, drug therapy of proven or suspected COVID-19 infection early posttransplant, care of SARS-CoV-2 positive donors and recipients and a separate COVID-19 consent for surgery.

"SARS-CoV-2 Infection in Liver Transplant Recipients - Immunosuppression is the Silver Lining?"

BACKGROUND: COVID-19 is associated with higher mortality among patients who have comorbidities. However, evidences related to COVID-19 among post liver transplant recipients are scarce and evolving. METHODS: Adult Indian patients who had undergone liver transplantation at our centre since 2006 and were under regular follow-up, were contacted either telephonically or on email. Data were recorded related to symptoms and diagnosis of COVID-19, need for hospitalization, and need for ICU stay and mortality. RESULTS: Eighty one (3.71%) of the 2182 adult Liver transplant (LT) recipients on regular follow-up reported SARS-CoV-2 infection between 1st April 2020 and 31st May 2021. Mean age was 51.3(±9.8) years, and 74(91.4%) were males. Thirty five (43.2%) patients had one or more comorbidities. Twenty one (25.9%) patients were transplanted less than 1 year ago. Forty four (54.3% ) patients had mild disease only while 23(28.4%) patients had severe COVID-19 disease. Of the 81 patients 14 patients died and overall mortality was 17.3. CONCLUSION: Uncomplicated liver transplant recipients without comorbidities who acquire SARS-CoV-2 do not have poor outcome.

Research note: important sub-streams for future visitor (trader) harassment research

PurposeThe purpose of this study is to ascertain the types of mitigation strategies used around the world to tackle the harassment of visitors by microtraders, the target population for these strategies, the number and ratio of countries/territories where used and to posit ideas on how the academy may assist in improving their effectiveness.Design/methodology/approachA total of 247 archives from 73 countries/territories were analysed using typological analysis, cross tabulation and frequency analysis.FindingsEight broad strategies were found. The top three most common were: policing, media/communication and legislative strategies. In total, 79 specific strategies were also named. The strategies targeted various groups at the destination. This paper then concluded with eight sub-streams for future trader harassment of visitor research being identified. They are research focussing on criminological, learning, research design and data analysis, environmental planning and design, work analysis and design, communication, technological and social infrastructure solutions.Originality/valueThis paper was the first to look at trader harassment mitigation strategies globally and the first to propose sub-streams in the area of visitor harassment research.

COVID-19 lockdown-induced changes in NO2 levels across India observed by multi-satellite and surface observations

We have estimated the spatial changes in NO2 levels over different regions of India during the COVID-19 lockdown (25 March–3 May 2020) using the satellite-based tropospheric column NO2 observed by the Ozone Monitoring Instrument (OMI) and the Tropospheric Monitoring Instrument (TROPOMI), as well as surface NO2 concentrations obtained from the Central Pollution Control Board (CPCB) monitoring network. A substantial reduction in NO2 levels was observed across India during the lockdown compared to the same period during previous business-as-usual years, except for some regions that were influenced by anomalous fires in 2020. The reduction (negative change) over the urban agglomerations was substantial (∼ 20 %–40 %) and directly proportional to the urban size and population density. Rural regions across India also experienced lower NO2 values by ∼ 15 %–25 %. Localised enhancements in NO2 associated with isolated emission increase scattered across India were also detected. Observed percentage changes in satellite and surface observations were consistent across most regions and cities, but the surface observations were subject to larger variability depending on their proximity to the local emission sources. Observations also indicate NO2 enhancements of up to ∼ 25 % during the lockdown associated with fire emissions over the north-east of India and some parts of the central regions. In addition, the cities located near the large fire emission sources show much smaller NO2 reduction than other urban areas as the decrease at the surface was masked by enhancement in NO2 due to the transport of the fire emissions.