Why do people sell their kidneys? A thematic synthesis of qualitative evidence.

Globally, demands for the kidneys have surpassed supply both living and deceased donors. High demands relative to the availability have made the kidney one of the most saleable human organs. The main objective was to explore the drivers of kidney selling. Literature related to kidney selling and its drivers was explored in three databases including MEDLINE (PubMed), Scopus (Elsevier), and JSTOR covering the period from 1987 to 2022. A total of 15 articles were selected, which underwent thematic analysis. Investigators independently assessed the articles for relevance and study quality to synthesize the data. The thematic analysis involved a critical approach to understanding the reasons for kidney selling by examining power disparities and social inequities. Kidney selling and the underlying reasons for it showed similarities across various geographic regions. Several factors were identified which increased individuals' vulnerability for kidney selling. At the micro level, poverty and illiteracy emerged as significant factors. Lack of financial safety nets obliged family to resort to kidney selling which helped to alleviate poverty, resolve debt, and other urgent financial issues. Nonetheless, the revenues from kidney selling were also used to purchase luxury items (diverting away from investing in livelihood expenses) such as buying motorbikes, mobile phones and televisions. Family, and gender responsibilities also played roles in kidney selling such as obligations related to paying dowry made parents particularly vulnerable. Surprisingly, a few victims of kidney selling later adopted kidney brokering role to support their livelihood. Kidney selling was further fostered by lack of stringent policy to regulate and monitor background checks for kidney transplantation. There were myriad factors that affected individual's vulnerability to kidney selling which stemmed from micro (poverty, illiteracy), meso (weak legal system, lacking stringent institutional policy, regulatory framework) and macro (social inequalities, corruption, organ shortage, insufficient health infrastructure) levels.

Antihypertensive Medications Use among Chronic Hemodialysis Patients Visiting the Outpatient Department of Nephrology of a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Anti-hypertensive medications are prescribed for the management of high blood pressure which is the leading cause of mortality in chronic hemodialysis patients. The objective of our study was to find out the prevalence of anti-hypertensive medication use among chronic hemodialysis patients visiting the outpatient Department of Nephrology of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted among chronic hemodialysis patients visiting the Department of Nephrology of a tertiary care centre from 2 April 2022 to 30 September 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 062-078/079). A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: The prevalence of anti-hypertensive medications use was present in 102 (97.14%) (93.95-100, 95% Confidence Interval) patient undergoing hemodialysis. The three common drugs prescribed for hypertensive patients were amlodipine 79 (77.45%), torsemide 59 (57.84%), and prazosin 48 (47.05%). Conclusions: The prevalence of antihypertensive medication use among patients undergoing hemodialysis was higher than other similar studies done in similar settings. Keywords: anti-hypertensive drugs; hemodialysis; prevalence.

Kidney Sellers From a Village in Nepal: Protocol for an Ethnographic Study.

BACKGROUND: Kidney selling is a global phenomenon, with higher-income countries functioning as recipients and lower-income countries as donors, reflecting the gaps due to poverty and vulnerability. In recent years, an increasing number of residents in a village near the capital city of Nepal have been selling their kidneys; however, the factors embedded in the local social, cultural, political, and individual context driving kidney selling are poorly understood. OBJECTIVE: The aim of this study is to explore the drivers of kidney selling and its consequences in Hokse village in central Nepal, using ethnographic methods and multistakeholder consultations. METHODS: An ethnographic approach will be adopted along with in-depth interviews and key informant interviews among the residents and kidney sellers in the village. Relevant participants in the village will be selected purposively using a snowball approach. The number of participants will be predicated on the principles of data saturation. In addition, consultations with relevant stakeholders will be conducted at various levels, which will include authorities within and outside the village, and policymakers. All interviews will be conducted face to face, audio-recorded for transcription, and subjected to a thematic analysis. RESULTS: This study was approved by Mahidol University Central Institutional Review Board (MU-CIRB 2020/217.1808) in September 2020 and by Nepal Health Research Council (NHRC 716/2020 PhD) in January 2021. The fieldwork started in February 2021 and the data analysis was completed in September 2021. CONCLUSIONS: This study is expected to provide insight into the reasons underlying the practice of kidney selling based on the example of Hokse village, along with the perspectives of multiple stakeholders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/29364.

'The broker also told me that I will not have problems after selling because we have two and we can survive on one kidney': Findings from an ethnographic study of a village with one kidney in Central Nepal.

Kidney selling is a global phenomenon engraved by poverty and governance in low-income countries with the higher-income countries functioning as recipients and the lower-income countries as donors. Over the years, an increasing number of residents in a village near the capital city of Nepal have sold their kidneys. This study aims to explore the drivers of kidney selling and its consequences using ethnographic methods and multi-stakeholder consultations. An ethnographic approach was used in which the researcher lived and observed the residents' life and carried out formal and informal interactions including in-depth interviews with key informants, community members and kidney sellers in Hokse village, Kavrepalanchok district. Participants in the village were interacted by researchers who resided in the village. In addition, remote interviews were conducted with multiple relevant stakeholders at various levels that included legal workers, government officers, non-government organization (NGO) workers, medical professionals, and policymaker. All formal interviews were audio-recorded for transcription in addition to field notes and underwent thematic analysis. The study identified processes, mechanisms, and drivers of kidney selling. Historically, diversion of a major highway from the village to another village was found to impact the livelihood, economy and access to the urban centres, ultimately increasing poverty and vulnerability for kidney selling. Existing and augmented deprivation of employment opportunities were shown to foster emigration of villagers to India, where they ultimately succumbed to brokers associated with kidney selling. Population in the village also maintained social cohesion through commune living, social conformity (that had a high impact on decision making), including behaviours that deepened their poverty. Behaviours such as alcoholism, trusting and following brokers based on the persuasion and decision of their peers, relatives, and neighbours who became the new member of the kidney brokerage also contributed to kidney selling. The other reasons that may have influenced high kidney selling were perceived to be a poor level of education, high demands of kidneys in the market and an easy source of cash through selling. In Hokse village, kidney selling stemmed from the interaction between the brokers and community members' vulnerability (poverty and ignorance), mainly as the brokers raised false hopes of palliating the vulnerability. The decision-making of the villagers was influenced heavily by fellow kidney sellers, some of whom later joined the network of kidney brokers. Although sustained support in livelihood, development, and education are essential, an expanding network and influence of kidney brokers require urgent restrictive actions by the legal authority.

Role of Conservative Management in Stump Appendicitis: A Case Series.

Stump appendicitis is a rare, delayed complication of appendectomy. It is seen following both open and laparoscopic appendectomy and may occur weeks to years following the initial appendectomy. We report two cases of stump appendicitis seen at our hospital. Both cases were diagnosed based on radiological findings and successfully managed conservatively with antibiotics. Although the usually recommended treatment for stump appendicitis is completion appendectomy, conservative management may be suitable for some patients. This report highlights the possibility of utilizing a conservative approach in the management of stump appendicitis compared to the recommended operative intervention. Awareness of the possibility of stump appendicitis is crucial for early diagnosis and treatment, to prevent potentially catastrophic complications.

EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE: To assess the effect of locally applied bisphosphonate drugs on alveolar bone defects caused by periodontitis and marginal bone level after placement of dental implants. MATERIALS AND METHODS: Three electronic databases (PubMed/MEDLINE, Web of Science, and Scopus) were searched from January 2010 until May 2020 for randomized controlled clinical trials reporting the effect of locally delivered bisphosphonates on alveolar bone. The risk of bias was assessed and quantitative synthesis was conducted with both fixed and random-effects meta-analyses by using RevMan version 5.3. Subgroup and sensitivity analyses were performed whenever required. RESULTS: Among the included studies, the effect of locally delivered bisphosphonates on alveolar bone regeneration in periodontitis was measured by 15 studies and on marginal bone level after installation of dental implants by three studies. Bisphosphonates showed significantly higher intrabony defect depth reduction than placebo/control in vertical bone defects treated with non-surgical approach (MD = 1.69mm; 95% CI, 1.32-2.05; P < 0.00001; I²=93%) or surgical approach (MD = 0.70mm; 95% CI, 0.23-1.16; P = 0.003; I²â€¯= 78%) and in class II furcation defects treated with non-surgical approach (MD = 1.61mm; 95% CI, 1.15-2.07; P < 0.00001; I²â€¯= 99%) or surgical approach (MD = 0.24mm; 95% CI, 0.05-0.42; P = 0.01; I²â€¯= 62%). Clinical attachment loss increased by 1.39mm (95% CI, 0.92-1.85; P < 0.01; I²=93%) and 1mm (95% CI, 0.75-1.26; P < 0.001; I²â€¯= 0%) in vertical bone defects after non-surgical and surgical treatments, respectively, and by 1.95mm (95% CI, 1.37-2.53; P < 0.00001; I²â€¯= 96%) and 0.84mm (95% CI, 0.58-1.10; P < 0.01, I²â€¯= 47%) after non-surgical and surgical treatment in class II furcation defects, respectively. Lesser marginal bone loss during pre-loading (MD = -0.18 mm; 95% CI, -0.24- -0.12; P<0.00001; I²=0%) and 1-year post-loading (MD = -0.33 mm; 95% CI, -0.59-0.07; P = 0.01; I²â€¯= 0%) periods was observed when bisphosphonate coated dental implants were used. CONCLUSION: Locally delivered bisphosphonates induce bone regeneration in periodontal defects and decrease the rate of marginal bone loss after dental implant therapy.

mHealth Technology Translation in a Limited Resources Community-Process, Challenges, and Lessons Learned From a Limited Resources Community of Chiang Mai Province, Thailand.

This report aims to provide practical advice about the implementation of a public health monitoring system using both geographic information system technology and mobile health, a term used for healthcare delivery via mobile devices. application amongst household residents and community stakeholders in the limited resource community. A public health monitoring system was implemented in a semi-rural district in Thailand. The challenges encountered during implementation were documented qualitatively in a series of monthly focus group discussions, several community hearings, and many targeted interviews. In addition, lessons learned from the expansion of the program to 75 other districts throughout Thailand were also considered. All challenges proved solvable yielding several key pieces of advice for future project implementation teams. Specifically, communication between team members, anticipating technological challenges, and involvement of community members are critical. The problems encountered in our project were mainly related to the capabilities of the data collectors and technical issues of mobile devices, internet coverage, and the GIS application itself. During the implementation phase, progressive changes needed to be made to the system promptly, in parallel with community team building in order to get the highest public health impact.

Poly(vinyl alcohol)-coated chitosan microparticles act as an effective oral vaccine delivery system for hepatitis B vaccine in rat model.

The present study focused on the development of an effective oral vaccine delivery system of poly(vinyl alcohol)-coated chitosan microparticles-based recombinant hepatitis B vaccine. Chitosan microparticles were prepared by ionotropic gelation technique; they were loaded with recombinant hepatitis B vaccine and coated with poly(vinyl alcohol). The average sizes of the microparticles were measured in the range of 100-410 nm. The optimal loading capacity and loading efficiency were recorded around 3.4 and 74%, respectively. In vitro release study shows that the prepared microparticles release the antigen in a sustained manner. Moreover, the microparticles were resistant to simulated gastric environment and release the antigen in the targeted intestinal milieu. Furthermore, oral immunisation of rats with poly(vinyl alcohol)-coated chitosan hepatitis-B microparticles vaccine shows comparable seroprotective immune response to presently practiced intramuscular vaccination. The results demonstrated that poly(vinyl alcohol)-coated chitosan microparticles have the potential for being used as an oral vaccine delivery system for hepatitis B vaccine and may be a suitable alternative for needle-based vaccination.

Detection of granularity in dermoscopy images of malignant melanoma using color and texture features.

Granularity, also called peppering and multiple blue-grey dots, is defined as an accumulation of tiny, blue-grey granules in dermoscopy images. Granularity is most closely associated with a diagnosis of malignant melanoma. This study analyzes areas of granularity with color and texture measures to discriminate granularity in melanoma from similar areas in non-melanoma skin lesions. The granular areas in dermoscopy images of 74 melanomas and 14 melanomas in situ were identified and manually selected. For 200 non-melanoma dermoscopy images, those areas which most closely resembled granularity in color and texture were similarly selected. Ten texture and twenty-two color measures were studied. The texture measures consisted of the average and range of energy, inertia, correlation, inverse difference, and entropy. The color measures consisted of absolute and relative RGB averages, absolute and relative RGB chromaticity averages, absolute and relative G/B averages, CIE X, Y, Z, X/Y, X/Z and Y/Z averages, R variance, and luminance. These measures were calculated for each granular area of the melanomas and the comparable areas in the non-melanoma images. Receiver operating characteristic (ROC) curve analysis showed that the best separation of melanoma images from non-melanoma images by granular area features was obtained with a combination of color and texture measures. Comparison of ROC results showed greater separation of melanoma from benign lesions using relative color than using absolute color. Statistical analysis showed that the four most significant measures of granularity in melanoma are two color measures and two texture measures averaged over the spots: relative blue, relative green, texture correlation, and texture energy range. The best feature set, utilizing texture and relative color measures, achieved an accuracy of 96.4% based on area under the receiver operating characteristic curve.

Concentric decile segmentation of white and hypopigmented areas in dermoscopy images of skin lesions allows discrimination of malignant melanoma.

Dermoscopy, also known as dermatoscopy or epiluminescence microscopy (ELM), permits visualization of features of pigmented melanocytic neoplasms that are not discernable by examination with the naked eye. White areas, prominent in early malignant melanoma and melanoma in situ, contribute to early detection of these lesions. An adaptive detection method has been investigated to identify white and hypopigmented areas based on lesion histogram statistics. Using the Euclidean distance transform, the lesion is segmented in concentric deciles. Overlays of the white areas on the lesion deciles are determined. Calculated features of automatically detected white areas include lesion decile ratios, normalized number of white areas, absolute and relative size of largest white area, relative size of all white areas, and white area eccentricity, dispersion, and irregularity. Using a back-propagation neural network, the white area statistics yield over 95% diagnostic accuracy of melanomas from benign nevi. White and hypopigmented areas in melanomas tend to be central or paracentral. The four most powerful features on multivariate analysis are lesion decile ratios. Automatic detection of white and hypopigmented areas in melanoma can be accomplished using lesion statistics. A neural network can achieve good discrimination of melanomas from benign nevi using these areas. Lesion decile ratios are useful white area features.

Detection of atypical texture features in early malignant melanoma.

BACKGROUND: The presence of an atypical (irregular) pigment network (APN) can indicate a diagnosis of melanoma. This study sought to analyze the APN with texture measures. METHODS: For 106 dermoscopy images including 28 melanomas and 78 benign dysplastic nevi, the areas of APN were selected manually. Ten texture measures in the CVIPtools image analysis system were applied. RESULTS: Of the 10 texture measures used, correlation average provided the highest discrimination accuracy, an average of 95.4%. Discrimination of melanomas was optimal at a pixel distance of 20 for the 768 x 512 images, consistent with a melanocytic lesion texel size estimate of 4-5 texels per mm. CONCLUSION: Texture analysis, in particular correlation average at an optimized pixel spacing, may afford automatic detection of an irregular pigment network in early malignant melanoma.

Detection of basal cell carcinoma using color and histogram measures of semitranslucent areas.

BACKGROUND: Semitranslucency, defined as a smooth, jelly-like area with varied, near-skin-tone color, can indicate a diagnosis of basal cell carcinoma (BCC) with high specificity. This study sought to analyze potential areas of semitranslucency with histogram-derived texture and color measures to discriminate BCC from non-semitranslucent areas in non-BCC skin lesions. METHODS: For 210 dermoscopy images, the areas of semitranslucency in 42 BCCs and comparable areas of smoothness and color in 168 non-BCCs were selected manually. Six color measures and six texture measures were applied to the semitranslucent areas of the BCC and the comparable areas in the non-BCC images. RESULTS: Receiver operating characteristic (ROC) curve analysis showed that the texture measures alone provided greater separation of BCC from non-BCC than the color measures alone. Statistical analysis showed that the four most important measures of semitranslucency are three histogram measures: contrast, smoothness, and entropy, and one color measure: blue chromaticity. Smoothness is the single most important measure. The combined 12 measures achieved a diagnostic accuracy of 95.05% based on area under the ROC curve. CONCLUSION: Texture and color analysis measures, especially smoothness, may afford automatic detection of BCC images with semitranslucency.

Detection of asymmetric blotches (asymmetric structureless areas) in dermoscopy images of malignant melanoma using relative color.

BACKGROUND: Dermoscopy, also known as dermatoscopy or epiluminescence microscopy (ELM), is a non-invasive, in vivo technique, which permits visualization of features of pigmented melanocytic neoplasms that are not discernable by examination with the naked eye. One prominent feature useful for melanoma detection in dermoscopy images is the asymmetric blotch (asymmetric structureless area). METHOD: Using both relative and absolute colors, blotches are detected in this research automatically by using thresholds in the red and green color planes. Several blotch indices are computed, including the scaled distance between the largest blotch centroid and the lesion centroid, ratio of total blotch areas to lesion area, ratio of largest blotch area to lesion area, total number of blotches, size of largest blotch, and irregularity of largest blotch. RESULTS: The effectiveness of the absolute and relative color blotch features was examined for melanoma/benign lesion discrimination over a dermoscopy image set containing 165 melanomas (151 invasive melanomas and 14 melanomas in situ) and 347 benign lesions (124 nevocellular nevi without dysplasia and 223 dysplastic nevi) using a leave-one-out neural network approach. Receiver operating characteristic curve results are shown, highlighting the sensitivity and specificity of melanoma detection. Statistical analysis of the blotch features are also presented. CONCLUSION: Neural network and statistical analysis showed that the blotch detection method was somewhat more effective using relative color than using absolute color. The relative-color blotch detection method gave a diagnostic accuracy of about 77%.