ABSTRACT
The recent emergence and re-emergence of viral infections transmitted by vectors, Zika, chikungunya, dengue, and others, is a cause for international concern. Here, we provide a summary of the current understanding of the transmission, clinical features, diagnosis, global burden, and the likelihood of future epidemics by these viruses. Arboviruses transmitted by mosquitoes are challenging to diagnose and can have surprising clinical complications. Dengue, chikungunya, and Zika are the most important diseases caused by arboviruses worldwide, especially in tropical and subtropical regions. These are transmitted to humans by day-biting Aedes aegypti and Aedes albopictus mosquitoes. In India, the increase in the incidence of dengue and chikungunya cases is primarily linked to the dissemination of Aedes aegypti. A rapid and accurate diagnosis is paramount for effectively controlling dengue outbreaks. As there is no vaccination or specific treatment available for these viruses, vector control is the only comprehensive solution available.
ABSTRACT
Arterial spin labeling (ASL) is a functional magnetic resonance imaging (fMRI) technique that uses water in arterial blood as a tracer to map an area of interest where the intravascular and extravascular compartments exchange. Our review article focuses primarily on the role of ASL fMRI in assessing perfusion impairment in renal allografts in order to take appropriate steps to eliminate the cause of perfusion impairment at an early stage, thereby extending graft life. The study also highlights various other fMRI techniques that are used to analyze other parameters that affect kidney transplants both acutely and chronically. We gathered our data in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and our search strategy included exclusion/inclusion criteria. Several databases were used in the search strategy, including PubMed, Cochrane, and Science Direct, and the Medical Subject Headings (MeSH) strategy was specifically used for PubMed, and two people scrutinized those papers to conclude that a total of 10 research papers are included in our study. This review article includes papers involving 20 to 98 subjects who had renal allografts within the previous six months and had renal cortical perfusion values measured by ASL fMRI ranging from 35 to 304 ml/100 g/min. Furthermore, when compared to healthy kidney transplant patients, renal ASL perfusion values were significantly lower in subjects with the functional imbalance of kidney transplants. It had a positive correlation with the estimated glomerular filtration rate (eGFR). To summarize, ASL fMRI is critical in detecting renal allograft perfusion impairment.
ABSTRACT
Gastroparesis or gastric stasis is the delayed transit of the ingested contents through the stomach in the absence of mechanical obstruction. It can have multiple etiologies, most commonly idiopathic (ID) and diabetic (DM). Gastroparesis can cause significant distress to patients as it leads to symptoms like intractable nausea and vomiting, weight loss, abdominal bloating, early satiety, etc. The pathogenesis is mainly thought to be due to the dysfunction of the gastric pacemaker cells, i.e., interstitial cells of Cajal (ICC), and their interaction with the other gastric motor function regulatory components. There are several proposed treatment options for gastroparesis. Despite that, most patients remain refractory to medical treatment and require additional interventions for symptomatic relief. One such intervention is gastric electrical stimulation or gastric pacemaker, which aids in improving gastric motility. We have searched PubMed, PubMed Central (PMC), Medline, Science Direct, and Google Scholar for articles pertaining to the use of gastric electrical stimulation in gastroparesis published in the last 10 years. The keywords used include "gastroparesis", "gastric stasis", "gastric pacemaker'', "gastric electrical stimulation", "nausea", "vomiting", "abdominal bloating", "gastric neuromodulation". We have finally included twelve studies that were the most relevant to our research question and met the quality assessment criteria. Exclusion criteria consisted of pediatric population studies, studies conducted on animals, books, and grey literature. Overall, these twelve studies helped evaluate the impact of gastric pacemakers on symptoms of gastroparesis like nausea, vomiting, weight loss, abdominal bloating, and quality of life. We found that most studies favored gastric pacemakers, improving the incidence of nausea and vomiting in patients with gastroparesis. There was a marked improvement in the BMI as well. On the other hand, most open-labeled studies showed improved quality of life and Gastroparesis Cardinal Symptom Index (GCSI) scores, while randomized controlled trials and meta-analyses did not reflect the same result. In addition, some other parameters improved with gastric pacemakers, Inflammatory markers, insulin levels (especially in diabetics), and the number of hospitalizations. In conclusion, gastric pacemaker is a potential treatment option for patients with medically refractory gastroparesis. As noted from the results of our study, nausea/vomiting, weight loss, and overall GCSI scores have shown marked improvement with gastric electrical stimulation (GES). Nevertheless, more extensive research is needed to understand better the full extent of this device's use as a viable treatment option for patients suffering from gastroparesis.
ABSTRACT
We commend the article titled "Ethics of organ transplantation" by Sanjay Nagral for raising awareness about organ donation, especially kidney transplants, and shedding light on the Indian scenario. In this article, the author mentions that "If we wish to improve upon the current situation, the first step is total transparency on the part of the medical profession and open, public, debate on this and related issues."
