ABSTRACT
Meningitis, an inflammatory disease affecting the meningeal layers of the brain and the spinal cord, poses a significant public health concern globally. Most meningitis cases are caused by viral infections, bacterial infections being the second most common cause, while fungal or parasitic infections are deemed rare. Despite the decrease in bacterial meningitis because of vaccination and treatment, a recent meningitis outbreak in the United States and Mexico highlighted ongoing challenges. The current meningitis outbreak is caused by a pathogenic fungus and is associated with surgical procedures performed under spinal anaesthesia as reported by the Centers for Disease Control and Prevention (CDC) on the 11 May of 2023. Around 20 cases with clinical suspicion of meningitis, including two fatalities, have been attributed to this rampant outbreak. Timely diagnosis, utilising diagnostic modalities such as lumbar puncture and pathogen detection methods, is crucial for appropriate management. Iatrogenic meningitis must be avoided by enhancing surveillance, infection control procedures, and adherence to aseptic practices. To lessen the effects of meningitis and enhance patient outcomes, the WHO's roadmap and preventive interventions, such as targeted immunisations, are essential.
ABSTRACT
BACKGROUND AND OBJECTIVES: With expansion of the pool of kidney grafts, through the use of higher-risk donors, and increased attention to donor management strategies, the 1-year graft survival rate is subject to change. It is, therefore, useful to elucidate 1-year graft survival rates by dissecting the characteristics of the low-risk and high-risk kidney transplant cases. The objective of our study was to evaluate factors purported to influence the risk of 1-year graft loss in kidney transplant recipients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We searched bibliographic databases from 2000 to 2017 and included observational studies that measured the association between donor, recipient, the transplant operation, or early postoperative complications, and 1-year death-censored graft loss. RESULTS: We identified 35 eligible primary studies, with 20 risk factors amenable to meta-analysis. Six factors were associated with graft loss, with moderate to high degree of certainty: donor age (hazard ratio [HR], 1.11 per 10-year increase; 95% confidence interval [95% CI], 1.04 to 1.18), extended criteria donors (HR, 1.35; 95% CI, 1.28 to 1.42), deceased donors (HR, 1.54; 95% CI, 1.32 to 1.82), number of HLA mismatches (HR, 1.08 per one mismatch increase; 95% CI, 1.07 to 1.09), recipient age (HR, 1.17 per 10-year increase; 95% CI, 1.09 to 1.25), and delayed graft function (HR, 1.89; 95% CI, 1.46 to 2.47) as risk factors for 1-year graft loss. Pooled analyses also excluded, with a high degree of certainty, any associations of cold ischemia time, recipient race, pretransplant body mass index, diabetes, and hypertension with 1-year graft loss. CONCLUSIONS: Recipient age, donor age, standard versus extended criteria donor, living versus deceased donor, HLA mismatch, and delayed graft function all predicted 1-year graft survival. The effect of each risk factor is small.
