CLINICAL, RADIOLOGICAL, MICROBIOLOGICAL PROFILE AND OUTCOMES OF PULMONARY INFECTIONS IN RENAL TRANSPLANT RECIPIENTS: A PROSPECTIVE STUDY

Introduction: Pulmonary infections in renal transplant recipients (RTR) may range from diverse forms lung parenchyma and pleura involvement with different typical and atypical bacteria, viruses, fungi and mycobacteria. Radiological and microbiological diagnosis is essential to plan management. This study assesses the clinico-radiological, microbiological and outcomes of pulmonary infections in RTR. Methods: This study was a single-center prospective observational study, conducted over 4 years in a tertiary care hospital in Mumbai. The study included RTR > 18 years with pulmonary infections. Pulmonary infections were defined as typical clinical features like cough, expectoration, fever, dyspnea, hemoptysis, etc with radiological findings like new infiltrates/consolidation on chest X-ray / CT scan with or without microbiological abnormality on sputum/ broncho-alveolar lavage (BAL) fluid/ pleural fluid. COVID-positive cases were excluded from the study. The clinical details of transplant, risk factors, induction, and maintenance regimens were recorded. All investigations done and treatment undertaken were part of standard management protocols. Patients were followed up for the assessment of outcome and resolution. Appropriate IEC approval was taken. Results: 50 RTR patients were included, predominantly males (60%), mean age 39.62 ±12.14 years, with 37 (74%) having live-related renal transplants. 9 (18%) patients presented 6 months of transplant, 5 (10%) from 6-12 months, 12 (16%) from 1-2 years and 24 (48%) ≥ 2 years since transplant. Risk factors included history of acute rejection in 6 patients (12%), NODAT in 5 (10%), prior diabetes in 8 (16%), and ATG induction in 19 (38%). Fever was the chief presenting complaint in 47 cases (94%), cough with expectoration in 32 (64%), and breathlessness in 24 (48%). Associated graft dysfunction was seen in 21 (42%) patients. 10 (28%) patients needed mechanical ventilation support while 18 (36%) had features of severe sepsis with MODS. Sputum was contributory in 16 patients with features of Streptococcus spp in 04 (8%), H. influenza in 1 (2%), gram-negative bacteria (GNB) in 4 (8%), AFB positive in 04 (6%), fungal/PCP in 3 (6%). BAL showed positive findings in 35 cases with positive bacteria (culture/ staining) in 15 (30%) [gram positive in 9 (18%) and GNB in 6 (12%)], BAL AFB/gene expert positive in 8 (16%), fungal stain/culture in 5 (Aspergillus 03, Mucor 01, candida 01), PCP stain/culture in 05 (10%) and CMV PCR positive in 2 (4%). In 14 cases, no organism could be isolated and was treated empirically. 2 patients who had exudative pleural effusion with raised ADA were treated for tuberculosis. Multivariate regression analysis showed that the statistically significant factors associated with pulmonary infections were diabetes/ NODAT, ATG induction. Mean duration of hospital stay was 14.26 ±4.22 days. Most patients recovered completely while death occurred in 06 (12%). Conclusions: Pulmonary infections were a significant cause of morbidity and mortality in RTR patients, with an increased risk in patients who were exposed to ATG induction or diabetes. HRCT chest and BAL were the key diagnostic modalities. Bacterial organisms are the commonest followed by fungal/mycobacterial or viral. High index suspicion and early antimicrobial therapy are key to successful therapy. No conflict of interest

Mucormycosis in COVID-19 pandemic: study at tertiary hospital in India.

AIM: During the second wave of COVID-19, cases of mucormycosis were increased suddenly over a period of 3 months in Maharashtra, India. An attempt was made to study the clinical profile and risk factors associated with mucormycosis. MATERIALS AND METHODS: A retrospective descriptive study was carried out at a tertiary hospital during May 2021-July 2021. After obtaining informed written consent from the participants, various details of all participants, such as diabetes mellitus, use of steroids in COVID-19 treatment, use of immunosuppressant drugs, oxygen therapy, use of ventilators, complications that occurred during treatment, etc., were noted. All mucormycosis patients were treated with amphotericin B and aggressive surgical treatment. RESULTS: In the present study, 74.7% of mucormycosis patients were male. 77.4% of mucormycosis patients were above 40 years of age. 6.7% of mucormycosis patients were partially vaccinated. Among risk factors, 86.6% had diabetes mellitus, 84% had COVID-19 infection, 44% had received steroids, and 54.7% had received oxygen. 80% of patients were present during and within 1 month of COVID-19 infection. 52% of patients were presented in stage III and 41.3% were presented in stage II. Despite aggressive surgical debridement along with amphotericin B, mortality was 25.33%. 5.3% of patients had brain abscesses, 8% of patients had cavernous sinus thrombosis, 4% of patients had facial nerve palsy and 1.3% of patients had meningitis. CONCLUSION: Mucormycosis was predominantly seen in male above the age of 40 years COVID-19 infection and diabetes mellitus was common risk factor for mucormycosis.

Allelic variation in class I HLA determines CD8(+) T cell repertoire shape and cross-reactive memory responses to SARS-CoV-2

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Avoid zoom fatigue, be present and learn

This paper explores plausible reasons why some students report having more difficulty learning online, predominantly in Zoom synchronous classes, and suggests strategies that students can do to optimize their learning. During anonymous classroom observations, approximately 80% of 350 college students polled indicated it was harder to focus their attention and stay present while taking classes online. They also reported experiencing more isolation, anxiety, and depression compared to face-to-face classes, although much of this may be due to COVID-19 social isolation. Students often appear nonresponsive when attending online synchronous Zoom classes that negatively impacts the nonverbal dynamics of student-instructor interactions. Communication issues includes internet challenges, lack of facial expressions, body appearance, and movement. Students also report that it is more challenging to maintain attention, especially when they are multitasking. Suggested strategies are to optimize learning that includes arranging the camera so that you are visible, using active facial and body responses as if you are communicating to just one person face-to-face, configuring your body and environment (sitting upright and creating unique cues for each specific task), reducing multitasking and notifications, and optimizing arousal and vision regeneration. © 2021 International Society for Neurofeedback and Research. All rights reserved.

COVID-19 at War: The Joint Forces Operation in Ukraine.

The ongoing pandemic disaster of coronavirus erupted with the first confirmed cases in Wuhan, China, in December 2019, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) novel coronavirus, the disease referred to as coronavirus disease 2019, or COVID-19. The World Health Organization (WHO) confirmed the outbreak and determined it a global pandemic. The current pandemic has infected nearly 300 million people and killed over 3 million. The current COVID-19 pandemic is smashing every public health barrier, guardrail, and safety measure in underdeveloped and the most developed countries alike, with peaks and troughs across time. Greatly impacted are those regions experiencing conflict and war. Morbidity and mortality increase logarithmically for those communities at risk and that lack the ability to promote basic preventative measures. States around the globe struggle to unify responses, make gains on preparedness levels, identify and symptomatically treat positive cases, and labs across the globe frantically rollout various vaccines and effective surveillance and therapeutic mechanisms. The incidence and prevalence of COVID-19 may continue to increase globally as no unified disaster response is manifested and disinformation spreads. During this failure in response, virus variants are erupting at a dizzying pace. Ungoverned spaces where nonstate actors predominate and active war zones may become the next epicenter for COVID-19 fatality rates. As the incidence rates continue to rise, hospitals in North America and Europe exceed surge capacity, and immunity post infection struggles to be adequately described. The global threat in previously high-quality, robust infrastructure health-care systems in the most developed economies are failing the challenge posed by COVID-19; how will less-developed economies and those health-care infrastructures that are destroyed by war and conflict fare until adequate vaccine penetrance in these communities or adequate treatment are established? Ukraine and other states in the Black Sea Region are under threat and are exposed to armed Russian aggression against territorial sovereignty daily. Ukraine, where Russia has been waging war since 2014, faces this specific dual threat: disaster response to violence and a deadly infectious disease. To best serve biosurveillance, aid in pandemic disaster response, and bolster health security in Europe, across the North Atlantic Treaty Alliance (NATO) and Black Sea regions, increased NATO integration, across Ukraine's disaster response structures within the Ministries of Health, Defense, and Interior must be reinforced and expanded to mitigate the COVID-19 disaster.