Pulmonary Complications of Everolimus in Liver Transplant Patients: A 10-Year Experience.

This retrospective study aims to evaluate the safety of everolimus when used as part of the immunosuppression regimen in patients who underwent liver transplant from 2009 to 2019 at a tertiary liver transplant center. Patients were divided into two groups: those who received everolimus as part of the post-transplant regimen and those who did not. The primary safety outcome measured was the development of new pulmonary complications that had been associated with everolimus use in prior studies. Lung function was determined by pulmonary function tests if available or CT scans of the chest. Secondary outcomes measured included everolimus discontinuation rates and survival rates. During the study period, 450 patients underwent liver transplant; 35% of patients received everolimus (n=156) and 65% of patients did not receive everolimus (n=292). Primary safety outcome of pulmonary complications was seen in 3.9% of patients who received everolimus (n=6) and 6.3% of the control group patients who did not receive everolimus (n=19). The association between everolimus use and new pulmonary complications was not significant with a chi-square statistic of 1.33 (p=0.249). Overall, 51.3% of patients who received everolimus during their post-transplant course discontinued the medication (n=80). Everolimus is safe from a pulmonary toxicity standpoint in liver transplant immunosuppression regimens as there was no significant difference found in pulmonary complications between patients who received the medication and those who did not.

Accuracy of Remote Diagnosis of Acute Posterior Segment Pathology by Residents and Attendings Captured with a Smartphone and Standard 20/28D Lens.

Background and Objective: To assess the use of a smartphone-based fundus camera in diagnosing acute posterior segment disease in the emergency room (ER) of an academic center, where standard fundus cameras are currently unavailable. Study Design/Patients and Methods: Images were obtained on 10 eyes with various types of posterior segment pathology. These were analyzed retrospectively by 35 reviewers (21 residents and 14 attending physicians). Accuracy of diagnosis was compared to in-office fundus photography. Results: The average probability of correct diagnosis was over 78%. There was no difference between resident and attending reviewers, except for one of the vitreous hemorrhage cases where residents performed better (p=0.039). Conclusion: Smartphone-based cameras are effective in screening for ocular diseases in the ER of academic centers, where residents and fellows are often the first providers to see various types of vision and life-threatening pathology.

Have the COVID-19 Pandemic and Lockdown Affected Children's Mental Health in Long Term? A Repeated Cross-Sectional Study.

ObjectiveThe study aimed to evaluate the impact of the COVID-19 pandemic on levels of anxiety and depressive symptoms in children and adolescents. DesignCross-sectional surveys were carried out on the mental health of children; one survey was conducted before the COVID-19 pandemic and one into the pandemic, 15 months after the implementation of lockdown, social distancing, and school closures. Demographic data and COVID-19 pandemic-related data were collected from specific parent-report and self-report questionnaires. ParticipantsParticipants included children and adolescents between ages 6-16 years, attending a tertiary care hospital without any diagnosed major psychiatric disorder or chronic disorder. AnalysisData was collected at two points (before the COVID-19 pandemic and during it) and compared. Levels of anxiety and depressive symptoms were compared and tested for statistically significant differences between these two points using appropriate statistical tests. Regression models were constructed to predict the factors affecting increased anxiety levels and depressive symptoms in the COVID-19 period. Results832 and 1255 children/adolescents were included in the study during the pre-COVID-19 and COVID-19 times, respectively. The median age of the participants was 10 years [Interquartile Range (IQR) = 4 years). The median (IQR) Spence Childrens Anxiety Scale score was 24 (12) at the pre-COVID-19 point and 31 (13) during the COVID-19 pandemic (p<0.001, r=-0.27). 11% and 16% of children reported being depressed at these two-time points, respectively (p=0.004, {varphi}c=-0.063). Regression analysis showed that many factors, including the duration of smartphone use, female gender, and only child status, were associated with increased anxiety or depression levels. ConclusionA large proportion of children had elevated anxiety and depressive symptoms during the pandemic relative to before the pandemic, suggesting a need for measures to engage children in healthy habits to protect childrens mental health and continuous monitoring of children during such scenarios. STRENGTHS AND LIMITATIONSO_LIWith the availability of pre-pandemic data, the repeated cross-sectional study design allowed us to compare the anxiety symptoms and prevalence of depression in children and adolescents during and before the COVID-19 lockdown and school closures. C_LIO_LIThe study is one of the few studies from low-to-middle income countries on this topic with large sample size. C_LIO_LIThe data was collected hospital setting, and all of the participants were attending a hospital, which could have resulted in a sampling bias. Although it is a tertiary care hospital, all of the patients included in the study came to us for primary care and were not referred. C_LIO_LIWe used standardised scales that are usually used for screening and evaluation purposes and not for diagnostic purposes. C_LIO_LIWe were unable to perform a longitudinal study with a follow-up that would offer clear evidence of any fluctuation in mental health during the course of the pandemic. C_LI