Efficacy of therapeutic plasma exchange in pediatric cases of acute liver failure as an extracorporeal liver support system.

BACKGROUND: Acute liver failure in the pediatric population is often accompanied by deranged metabolism, severe encephalopathy and coagulopathy. A liver transplant is the most viable option for the management of such patients. Therapeutic plasma exchange (TPE) is helpful in improving the liver biochemistry profile, thereby, increasing their likelihood of undergoing a liver transplant METHOD: The study was conducted over a period of 3 years (January 2018 to December 2021). Indications mainly consisted of ALF with hepatic encephalopathy, worsening liver parameters in spite of medical management, and candidacy for undergoing a liver transplant. Plasma exchange was performed daily or alternatively until the patient recovered, succumbed, or was stable enough to undergo a transplant. Biochemical parameters serum bilirubin, ALT, AST serum ammonia serum urea, serum creatinine were recorded before and after TPE sessions. RESULTS: The study group comprised 14 patients of which a total of 28 TPE was performed. There were a total of 5 cases of cryptogenic ALF, 4 of Wilson disease, 2 cases each of infection-related ALF and autoimmune hepatitis, and a single case of drug-induced hepatitis. A total of 5 out of 14 patients underwent a liver transplant and amongst the 9 who did not undergo a transplant, 4 patients expired due to septic shock syndrome; the remaining 5 were discharged in a stable condition following TPE sessions. The disease-free survival was 78.9% and the transplant-free survival was 35.71%. CONCLUSION: TPE plays a crucial role in improving the biochemistry profile of the liver in children with liver failure.

Effectiveness of a group intervention led by lay health workers in reducing the incidence of postpartum depression in South India.

BACKGROUND: Postnatal depression is a highly prevalent disorder with serious implications on maternal and child outcomes. There are few studies examining feasible interventions in low-middle-income community settings. AIMS: To assess the effectiveness of a low intensity group intervention led by lay workers during the antenatal period in reducing postnatal depression at 6-2 weeks postpartum. METHODS: A parallel group design with both positive and negative controls was employed. 1 community site was allocated to each of the 3 arms. The active intervention consisted of problem based sessions with cognitive behavioural components. The primary outcome was the presence of depression on CIS-R and secondary outcome measures where Global Assessment of Functioning (GAF) scores, EPNDS scores and participant perceptions. RESULTS: 69, 75 and 70 women received active, positive control and negative control interventions respectively. Post partum depression diagnosed with the CIS-R was present in 14.06% (C.I.- 5.55%-22.57%) and 22.62% (C.I.15.62%-29.63%) in the active arm and two control (combined) arms respectively. There was a 1/3 lower proportion of postpartum depression and impaired functioning in the intervention group, though statistical significance was not reached (p = 0.30). There were high levels of satisfaction reported for the active intervention. CONCLUSION: There were trends for the possible effectiveness for this low intensity intervention and conclusions regarding its effectiveness can't be made as the sample size was small. There is a need to explore and develop locally relevant, innovative and feasible strategies for prevention of postnatal depression in resource constrained enviroments.

Prolonged, longstanding, ultra-high-dose abuse of sildenafil.

We report a 40-year-old male who self-administered sildenafil for 10 years, in progressively increasing doses from 100 mg per occasion in the 1(st) year to 1300 mg per occasion in the 9(th)-10(th) years of (ab)use. The frequency of abuse was 2-3/week. The only adverse effect of concern that was reported was transient (up to about 12 h), self-limited blurring of vision in the last 2 years, especially in the last 2 months at the highest dose. The patient was otherwise normal. This report is unique because it describes what may be the highest dose of sildenafil reported in literature, abused across a protracted period of time. We discuss issues related to dose and safety of and tolerance to the drug.

Accumulation of few heavy metals in sewage sludges, soils and plants of Coimbatore, Tamil Nadu (India).

A study was carried out in Coimbatore district of Tamil Nadu (India) to assess the distribution pattern of heavy metals in the soils and plants irrigated with sewage effluent/sludge. About 69 soil samples (surface and subsurface), 65 plant samples as well as 34-sewage sludge samples were collected from various tehsils of Coimbatore. Six tehsils in Coimbatore have been identified and categorized into two groups--Class I City (densely populated tehsils) and Class II city (thinly populated tehsils). The available micronutrients like Fe, Mn, Zn and Cu; heavy metals: Cr, Cd, Ni, and Pb were within the safe limits. However, the total Cr and Cd concentrations were relatively higher in the sludge samples collected from Coimbatore and Tiruppur tehsils compared to other tehsils, while for Ni, the sequence was in the order Coimbatore > Tiruppur > Palladam > Pollachi > Avinashi > Mettupalayam and for Pb, Coimbatore > Mettupalayam > Palladam > Tiruppur > Avinashi > Pollachi. Soil analysis results indicated that heavy metal concentration recorded higher level in soils of Class I city (densely populated tehsils) compared to Class II city (thinly populated tehsils). The plant samples analyzed had also registered higher concentration of total Cd, Ni and Pb, which were classified under toxic, excessive and below excessive level, respectively. Correlation analysis revealed that iron (Fe), zinc (Zn), copper (Cu), cadmium (Cd) and lead (Pb) were significantly negatively correlated with pH of soil. EC had a significant positive correlation with available iron (Fe), zinc (Zn), cadmium (Cd) and lead (Pb). A significant positive correlation of Fe, Mn, Zn, Cu, Cd and Pb was also registered with OC. Among the plant samples collected, it was evident that heavy metal concentrations were recorded higher in grass spp followed by Amaranthus spp. It was inferred from the study that soils samples had higher levels of heavy metals even though the values recorded were below the critical value/toxic limit. However, long-term and indiscriminate application of untreated (raw) sewage sludge and/or letting of sewage effluent directly to agricultural field without prior treatment may result in accumulation of toxic metals in surface and subsurface soils and subsequent biotransfer (bioaccumlation) into the food chain, it may further lead to toxicity not only to plants and animals but also to consumers of the harvested crops.

Lorazepam-induced Short-term Remission of Symptoms in a Case of Paranoid Schizophrenia.

Conventionally, antipsychotics are used to treat schizophrenia due to predominant dopamine antagonist activity. The use of various types of Benzodiazepines (BZDs) in the treatment of Schizophrenic symptoms like agitation and psychotic excitement in general and control of florid psychotic symptoms such as hallucinations and delusions in particular is well known. However, the use of BZDs, specifically in remission of paranoid schizophrenia, is not reported so far. Here, we are reporting a case of an elderly female patient with chronic paranoid schizophrenia showing short-term remission in paranoid symptoms with injectable lorazepam.