Staging of Bilateral Lung Transplantation for High-Risk Patients With Interstitial Lung Disease: One Lung at a Time

The choice of a single or bilateral lung transplant for interstitial lung disease (ILD) is controversial, as surgical risk, long-term survival and organ allocation are competing factors. In an effort to balance risk and benefit, our center adopted a staged bilateral lung transplant approach for higher surgical risk ILD patients where the patient has a single lung transplant followed by a second single transplant at a later date. We sought to understand the surgical risk, organ allocation and early outcomes of these staged bilateral recipients as a group and in comparison to matched single and bilateral recipients. Our analysis demonstrates that staged bilateral lung transplant recipients (n = 12) have a higher lung allocation score (LAS), lower pulmonary function tests and a lower glomerular filtration rate prior to the first transplant compared to the second (p < 0.01). There was a shorter length of hospital stay for the second transplant (p = 0.02). The staged bilateral compared to the single and bilateral case-matched controls had comparable short-term survival (p = 0.20) and pulmonary function tests at 1 year. There was a higher incidence of renal injury in the conventional bilateral group compared to the single and staged bilateral groups. The staged bilateral procedure is a viable option in select ILD patients.

Acute kidney injury after ex vivo lung perfusion (EVLP)

BACKGROUND

Ex vivo lung perfusion (EVLP) identifies viability for marginal organs but complicates and lengthens lung transplantation surgery. Preliminary evidence supports equivalency for EVLP-assisted versus traditional (non-EVLP) procedures regarding graft function, postoperative course, mortality, and survival. However, acute kidney injury (AKI), a common serious complication of lung transplantation, has not been assessed. We tested the hypothesis that EVLP-assisted and non-EVLP lung transplantations are associated with different AKI rates.

METHODS

Demographic, procedural, and renal data were gathered for 13 EVLP-viable lung transplantations and a non-EVLP group matched 4:1 for single versus double, pulmonary disease, and age. AKI was defined by AKI Network (AKIN) criteria and peak creatinine rise relative to baseline (Δ%Cr) during the 1st 10 postoperative days. Chi-square was performed for AKIN and 2-tailed t test for %ΔCr.

RESULTS

Patient and procedural characteristics were similar between the groups. One non-EVLP patient required postoperative dialysis. AKI rates were also similar, as assessed by both AKIN (EVLP 7/13 (54%) vs non-EVLP 32/52 (62%); P = .61) and %ΔCr (EVLP 91 ± 81% vs non-EVLP 72 ± 62%; P = .63).

CONCLUSIONS

We did not observe different AKI rates between EVLP-assisted and traditional lung transplant procedures. Although 1 non-EVLP patient required dialysis, AKI rates were otherwise similar. These findings further support EVLP as a strategy to expand the organ pool and reduce concerns for high-renal risk recipients. The small sample size and retrospective design are limitations. However, our sample size is similar to other reports, and it is the first to analyze AKI after EVLP-assisted lung transplantation. Larger multicenter prospective studies are needed.

Antimicrobial activity of essential oils of Physalis angulata. L

The need for a reduction in drug resistance led to the investigation of Argemone Mexicana L. as an agent against Bacillus subtilis, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, Candida stellatoidea and Candida torulopsis, using well diffusion and minimum inhibitory concentrations methods. The sensitivity of Bacillus Subtilis, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus to the essential oils of both the aerial and root parts were determined. Pseudomonas aeruginosa was resistant to the essential oil from both the aerial and root part of the plant. C. torulopsis, C. stellatoidea and C. albicans were susceptible to the essential oils from the aerial and root part of the plant. The minimum inhibitory concentrations ranging between 3.75 mg/ml and 4.0 mg/ml were recorded for Bacillus subtilis, Klebsiella pneumoniae by the aerial and the root extracts, but P. aeruginosa and S. aureus were not susceptible to the aerial and root extracts. The observed inhibition of selected bacteria and fungi by oils of Physalis angulata makes it a promising antimicrobial agent. This study justifies its uses for treatment of sores, cuts, intestinal and digestive problems and some skin-diseases often reported in folkloric medicine.

Studies on the fungal infestation of five traditionally smoke-dried freshwater fish in Ago-Iwoye, Nigeria

Samples of traditionally smoke-dried Clarias gariepinus (Burchell), Chrysichthys nigrodigitatus (Lacepede), Sarotherodon galilaeus (Trewavas), Heterotis niloticus (Cuvier) and Heterobranchus bidorsalis (Geoffroy) were obtained from Oja Oba Market, Ago-Iwoye, Nigeria and examined for fungal infestation. The fish samples incubated on potato dextrose agar (PDA) for 7 days showed fungal infestation. Fungi isolated and identified included Mucor sp., Aspergillus sp., Rhizopus sp. and Fusarium sp. Six fungal species were isolated from C. nigrodigitatus, five each on C. gariepinus and H. niloticus.

Changes in attitude, sexual behaviour and the risk of HIV/AIDS transmission in southwest Nigeria

This pilot study was carried out in southwest Nigeria to determine the current trends in sexual behaviours known to be associated with HIV transmission in Nigeria. Knowledge of AIDS in general and as an incurable disease was high (91.4% and 79.4% respectively). Knowledge of the means of AIDS transmission was also very high among both men and women. Overall, condom use was consistent at 25%, inconsistent at 55% and non-existent at 20% for all sexually active respondents. Over 60 per cent of sexually active respondents had two or more sexual partners, with significantly more males than females having this number of sexual partners (p < 0.01). Eighteen per cent of sexually active respondents had a history of sex with commercial sex workers while 25% had a history of at least one sexually transmitted disease. Using multiple logistic regression, the significant determinants of condom use among the sexually active group were: being in a stable sexual relationship, history of sex with commercial sex workers, self-perception of testing positive for HIV and self-perception of HIV/AIDS risk in Nigeria. Prevalence of condom use in this study was much higher than those reported in previous studies, suggesting a probable decline in high risk sexual behaviours among inhabitants of urban Southwest Nigeria since the advent of AIDS. Most sexually active respondents aged 19 years or below (adolescents) who perceived themselves at a high risk of testing positive for HIV had never used condoms. The non usage of condoms among this group of adolescents is disturbing, since they are at greatest risk of spreading the disease. Health education and promotion of safe sex practices need to be extensively targeted at adolescents.