Resilience and challenges of peritoneal dialysis survivors in the aftermath of the 2023 Kahramanmaraş earthquake

INTRODUCTION

Peritoneal dialysis (PD) remains understudied in disaster nephrology. This retrospective multicenter study explores the experiences of PD survivors following the February 6, 2023, Kahramanmaraş Earthquake.

METHODS

Adult PD patients from 11 affected cities were analyzed to assess challenges faced during and postearthquake, alongside clinical outcomes.

RESULTS

Among 101 participants (median age: 45 years, median PD duration: 24 months), 57 were female, with 79 on continuous ambulatory PD. Challenges included power outages and water shortages, with primary shelter in kin's houses (33%) and homes (28%). Twelve patients experienced PD program delays, and three lacked assistance postdisaster. Sixteen patients changed PD modalities, with seven experiencing postearthquake peritonitis. Clinical parameters remained stable, except for a slight decrease in hemoglobin levels.

CONCLUSION

Despite challenges, PD survivors exhibited resilience, highlighting the importance of addressing peritonitis and unusual pathogens in disaster preparedness initiatives.

Sodium bicarbonate is a potential alternative to classic heparin as a lock solution for non-tunneled dialysis catheters: a result from the prospective randomized BicarbLock trial

OBJECTIVE

Temporary vascular access is mandatory for acute hemodialysis. Heparin lock solution is the standard of care worldwide. Many lock solutions were studied in terms of thrombosis and catheter-related infection prevention, but none replaced heparin as a standard measure. Our main aim is to investigate the effectiveness of sodium bicarbonate (NaHCO3), a ubiquitous and cheap option as a catheter lock solution, in comparison with traditionally used heparin in non-tunneled hemodialysis catheters.

METHODS

We conducted our prospective study between March 2021 and March 2022. Our study included 441 patients > 18 years old who needed either femoral or jugular non-tunneled dialysis catheters. Patients were assigned to either heparin (5000 IU/ml) or 8.4% sodium bicarbonate on a consecutive basis. Basic characteristics and information regarding catheters, dialysis sessions, and complications were recorded. We divided patients according to the catheter insertion site as well as the lock solution.

RESULTS

We analyzed 426 patients divided into four groups: jugular heparin (n = 113), jugular bicarbonate (n = 113), femoral heparin (n = 113), and femoral bicarbonate (n = 100). Basal characteristics were similar for all groups. The mean time to last effective dialysis in our institution was 10.7 ± 12.1 days for heparin vs 11.5 ± 10.8 days for the bicarbonate group. 25 (5.9%) patients had some kind of blood flow problems (13 in the heparin and 12 in the bicarbonate group). There was no significant difference in terms of catheter malfunction among groups (p = 0.50). Out of these 25 cases, only 12 (7 in heparin and 5 in the bicarbonate arm) had catheter dysfunction (p = 0.386). Sixty-four patients (28%) with jugular catheters were discharged with patent catheters and continued their dialysis in other facilities.

CONCLUSION

Sodium bicarbonate is as effective as classic unfractionated heparin in preventing catheter lumen thrombosis with a comparable incidence of catheter-related complications. Furthermore, it is a cost-effective option that can be used confidently, especially when heparin is contraindicated.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04772209 (26.02.2021).

Thirst intensity survey in ADPKD patients

INTRODUCTION

With increased fluid intake and tolvaptan treatment, the growth rate of cysts can be theoretically decelerated in autosomal polycystic kidney disease. In this prospective study, it was planned to evaluate thirst sensation in these patients and the parameters affecting its intensity.

METHODS

Forty-one ADPKD patients on tolvaptan and 40 ADPKD patients not on tolvaptan as the control group were evaluated for thirst distress sensation and intensity. The feeling of thirst and the discomfort caused by excessive fluid intake was assessed with Thirst Distress Scale-HF 12 questions (60/12). Thirst intensity was evaluated with a 100 mm visual scale.

RESULTS

Of the whole group, 35.8% (29) were males, and 64.2% (52) were females. The mean age of the tolvaptan group was 39.17 ± 9.35 years and for the control group, it was 41.95 ± 12.29 years. There was a negative correlation between the thirst distress score of the patients and an increase in creatinine level after a year of tolvaptan treatment (r = - 0.335, p = 0.035). The patients not taking thiazide had higher thirst intensity scores (p = 0.004). There was no impact of tolvaptan dosage, total kidney volume, serum sodium, urinary osmolarity or eGFR on thirst distress and thirst intensity scores.

DISCUSSION/CONCLUSION

Only thiazide co-treatment had a positive impact on thirst distress and intensity when given tolvaptan. Thirst Distress Scale for ADPKD patients can be used to classify patients before and during tolvaptan treatment.

Phlebectomy versus Sclerotherapy in Varicose Vein Patients: A Comparative Study

Varicose veins are part of the spectrum of chronic venous disease and include spider telangiectasias, reticular veins, and true varicosities. It may present without advanced signs of chronic venous insufficiency. Sclerotherapy is a treatment choice for patients with varicose veins of lower extremity; it uses the intravenous injection of chemical drugs to achieve the goal of inflammatory occlusion. Phlebectomy, a minimally invasive procedure usually used for higher diameter of varicose veins at the surface of the skin. Objective of the study was to compare the outcome of Phlebectomy and Sclerotherapy in varicose vein patients. It was a quasi experimental study was conducted in the Department of Vascular Surgery in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of June 2019 to May 2020. Patients admitted with varicose vein and varicosity of the lower limbs with valves and perforator incompetence in the Department of Vascular Surgery, BSMMU, Dhaka, Bangladesh. During this period 60 patients were selected purposive randomly. Patients were divided to 30 patients were treated with Phlebectomy (Group I) 30 patients were treated with Sclerotherapy (Group II). Data were collected according to the pre-designed semi-structured data collection sheet. After editing data analysis were carried out by using the Statistical Package for Social Science (SPSS) version 22.0 Windows software. This study shows average age 40.73±15.50 years in Phlebectomy (Group I) and 38.43±11.08 years in Sclerotherapy (Group II). Males are more commonly involved than females between two groups which was 76.7% in Phlebectomy (Group I) and 70.0% in Sclerotherapy (Group II). The change CEAP improved to 93.3% in patients who underwent phlebectomy when compared to 83.3% in patients who underwent sclerotherapy. During the follow-up with duplex at treated veins showed 93.3% complete occlusion of treated veins in the phlebectomy group, while only 70.0% of the patients in the sclerotherapy group showed evidence of complete occlusion. In phlebectomy group recurrence of leg varicosities were found 6.7% of the patients, while 26.7% of the patients in the sclerotherapy group. The difference was statistically significant between two groups (p=0.038). This study shows phlebectomy to be much better option than sclerotherapy for the treatment of varicose veins and hence can be used routinely. Both phlebectomy and sclerotherapy not only revealed minimal time taken for return to normal activity but also proved to be safer with regard to complications.

Invasive weed (Parthenium hysterophorus) response to chemical and allelopathic extracts at different stages

Parthenium hysterophorus L. is a noxious alien invasive weed species rapidly spreading in Bangladesh. P. hysterophorus examined the prospects of using allelopathic extracts during the period of July 2021 to June 2022. Experiments were conducted in the net house at Sher-e-Bangla Agricultural University, in non-cropped areas of Khustia and cropped areas of Chudanga. The net house experiments were laid out in complete randomized design (CRD) and replicated three times separately for each growth stage. Results showed that by using pretilachlor, pendimethalin, bensulfuron methyl + pretilachlor, bensulfuron methyl + acetachlor, oxadiazon, and pyrazosulfuron-ethyl + pretilachlor decreased the seed germination of parthenium at pot bioassay under both puddle and dry sown condition. At rosette stage of parthenium weed, glyphosate and carfentrazone ethyl (5%) + glyphosate with ½, ¾, and full doses gave 100% mortality at three weeks after treatment (WAT). In cropped areas carfentrazone Ethyl (5%) + glyphosate (36%) and quizalofop-p-ethyl resulted in a 100% and 90% mortality rate at 21 DAT. Overall, the efficacy of herbicides was more effective on rosette parthenium than bolted plants. A phytotoxic response to weed growth was induced by aqueous extracts of Oryza sativa L. var. Boteswar, Triticum aestivum L. var. BARI gom-21, Helianthus annus L., Datura metel, Mangifera indica L., Delonix regia, and Acacia nilotica. Delonix regia was the most effective for inhibition of germination (29%). Whereas Datura metel extracts and Oryza sativa var. Boteswar straw extracts significantly reduced root (1.5 mm) and shoot (3.8 mm) length. SAARC J. Agric., 21(1): 239-252 (2023)

Domestic Violence against the Female Garment Workers in Selected Area of Bangladesh

Domestic violence is a global problem and it affects millions of people and often results in physical, sexual and emotional injuries and even deaths. The study was to assess the prevalence, form and reasons of domestic violence among the female garment workers in Dhaka, Gazipur and Narayanganj of Bangladesh. This Cross sectional descriptive study was conducted at four Garments in Bangladesh named Tusuka Fashions Limited Dhaka, Ananta Casual Wear Limited, Gazipur, Spectra Sweaters Limited, Dhaka and Modele de capital Limited Narayanganj from January 2019 to December 2019. Three hundred and six (306) female garment workers were taken as sample. A semi-structured questionnaire and Abuse Assessment Screen was used. Then in-depth interviews were conducted. The study results revealed that the mean age of the respondents was 29.85 years and almost two-third (69.0%) of the respondents was Muslim. About 246(81.0%) were married and 164 (64.06%) had 1-2 children. Two third respondents (63.0%) were married for 5-15 years and 72.0% lived in nuclear families and the majority (39.5%) of the respondents had monthly income of BDT 15000-30000 where mean monthly income was BDT ±23,529. Proportion of Domestic Violence was 15.4% and all of them (100.0%) were the victim of both physical and mental violence. Husband was the perpetrators in 98.0% cases and most of the cases (43.0%) reason of domestic violence was relationship doubt with another person. Significant difference (p<0.05) found between domestic violence with religion and marital status, duration of marriage, number of children and family monthly income. The study findings demand an intensified effort should be made towards creating awareness about the domestic violence and solved this to improve their quality of life.

Does Monocyte Chemoattractant Protein-1 Levels determine the prognosis of COVID-19 disease in kidney transplant recipients?

Background

In the normal population, a high MCP-1 level is an important biomarker for the progression of COVID-19 disease. This study aimed to investigate whether MCP-1 level can determine the disease prognosis in kidney transplant (KT) patients with COVID-19.

Methods

A total of 89 patients, including 49 KT patients (Group 1) diagnosed with COVID-19 who required hospitalization, and 40 KT patients who did not have COVID-19 disease (Group 2), were included. Demographic characteristics and laboratory results of the patients were recorded. The serum reserved for MCP-1 was stored at -80 degrees and studied blindly by a single microbiologist at the end of the study.

Results

While the mean age of the patients was 51.0 (40.0-59.50) years in Group 1, it was 48.0 (40.75-54.75) years in Group 2(P>0.05). In terms of the female gender, it was 36 (73.5%) and 27 (67.5%) in Group 1 and Group 2, respectively (P>0.05). Similarly, there was no significant difference between the two groups regarding primary disease and basal graft function (p>0.05). There was a statistically significant difference in inflammation indicators in Group 1 compared to Group 2(P<0.05). A correlation was found between inflammation indicators and COVID-19(P<0.05). However, no significant correlation was detected between COVID-19 disease and MCP-1 levels in both groups (P>0.05). Also, according to basal MCP-1 levels, we did not find a significant difference between survival and non-survival patients (164,0pg/mL (146,0-202,0) vs 156,0 pg/mL (143,0-173,0), respectively  (p>0.05).

Conclusion

MCP-1, an indicator of inflammation, was not found to be a predictor of prognosis of COVID-19 disease in kidney recipients.

COVID-19 Vaccination and New Onset Glomerular Disease: Results from the IRocGN2 International Registry

Key Points

IgAN and MCD are the most common de novo glomerular diseases reported after COVID-19 vaccination, particularly after mRNA vaccination. Membranous nephropathy, pauci-immune GN, and collapsing GN have also been attributed to COVID-19 vaccination, some with dual histologies. Recovery of kidney function and proteinuria remission is more likely in IgAN and MCD by 4–6 months compared with the other glomerular diseases.

Background

Patients with de novo glomerular disease (GD) with various renal histologies have been reported after vaccination against SARS-CoV-2. Causality has not been established, and the long-term outcomes are not known. To better characterize the GDs and clinical courses/outcomes, we created the International Registry of COVID-19 vaccination and Glomerulonephritis to study in aggregate patients with de novo GN suspected after COVID-19 vaccine exposure.

Methods

A REDCap survey was used for anonymized data collection. Detailed information on vaccination type and timing and GD histology were recorded in the registry. We collected serial information on laboratory values (before and after vaccination and during follow-up), treatments, and kidney-related outcomes.

Results

Ninety-eight patients with GD were entered into the registry over 11 months from 44 centers throughout the world. Median follow-up was 89 days after diagnosis. IgA nephropathy (IgAN) and minimal change disease (MCD) were the most common kidney diseases reported. Recovery of kidney function and remission of proteinuria were more likely in IgAN and MCD at 4–6 months than with pauci-immune GN/vasculitis and membranous nephropathy.

Conclusions

The development of GD after vaccination against SARS-CoV-2 may be a very rare adverse event. Temporal association is present for IgAN and MCD, but causality is not firmly established. Kidney outcomes for IgAN and MCD are favorable. No changes in vaccination risk-benefit assessment are recommended based on these findings.

Nasopharyngeal Carriage of Streptococcus pneumoniae Serotypes Among Healthy Children in Northern India

Streptococcus pneumoniae (SP) infections cause morbidity and mortality among children worldwide. Hence India introduced 13-valent pneumococcal conjugate vaccine (PCV-13) in 2017 in a phased manner. The primary objective of this study was to assess the proportion of healthy children having nasopharyngeal colonization (NP) with SP. Secondary objective was to determine prevalent serotype of SP among the PCV13 vaccinated and non-vaccinated children. This cross-sectional study was conducted in 4 hospitals of Lucknow District, Northern India. Three hundred healthy children (2-59 months) were recruited between July and August 2019 from vaccination-clinics of hospitals. NP specimen was cultured using 5% sheep blood agar plate containing gentamicin. Pneumococcal isolates were identified by optochin sensitivity and bile-solubility tests. Serotyping was done using Quellung Method. Of the 300 healthy children, 56.7% (170/300) were males and 59.3% (181/300) had received at least one dose of PCV13 vaccine. The NP carriage rate of SP among healthy children was 37.7% (113/300). Vaccine serotypes were found in 33.3% (22/66) in PCV vaccinated children and 48.9% (23/47) in non-vaccinated children (p 0.09). Common vaccine serotypes that isolated were: 18C, 19A, 19F, 23F, 3, 4, 6A, 6B, 9 V. Thus more than one-third of healthy children had NP colonization with SP. Adjusting for age, there was a trend for significant reduction in vaccine serotypes in the NP with one doses versus two or more doses (ptrend = 0.04).

Strategies to prevent SARS-CoV-2 transmission in hemodialysis centres across Europe - Lessons for the future

Background

Early reports on the pandemic nature of COVID-19 directed the nephrology community to develop infection prevention and control guidance. We aimed to make an inventory of strategies that dialysis centres followed to prevent infection with COVID-19 in the first pandemic wave.

Methods

We analyzed IPC measures taken by hemodialysis centres treating patients presenting with COVID-19 between March 1, 2020 and July 31, 2020 and that completed the European Renal Association COVID-19 Database centre questionnaire. Additionally, we made an inventory of guidelines published in European countries to prevent spread of SARS-CoV-2 in dialysis centres.

Results

Data from 73 dialysis units located in and bordering Europe were analyzed. All participating centres implemented IPC measures to mitigate the impact of SARS-CoV-2 during the first pandemic wave. Measures mentioned most often included triage with questions before entering the dialysis ward, measuring body temperature, hand disinfection, masking for all patients and staff, and personal protective equipment for staff members. These measures were also recommended in most of the 14 guidelines that were identified in the inventory of national guidelines and were also scored as being among the most important measures by the authors of this paper. Heterogeneity existed between centres and national guidelines regarding the minimal distance between dialysis chairs and recommendations regarding isolation and cohorting.

Conclusions

Although variation existed, measures to prevent transmission of SARS-CoV-2 were relatively similar across centres and national guidelines. Further research is needed to assess causal relationships between measures taken and spread of SARS-CoV-2.

The clinical frailty scale as a triage tool for ICU admission of dialysis patients with COVID-19 - An ERACODA analysis

Background

Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill coronavirus disease 2019 (COVID-19) patients. This study evaluates the impact of CFS on intensive care unit (ICU) admission rate and hospital and ICU mortality rates in hospitalized dialysis patients with COVID-19.

Methods

We analysed data of dialysis patients diagnosed with COVID-19 from the European Renal Association COVID-19 Database. The primary outcome was ICU admission rate and secondary outcomes were hospital and ICU mortality until 3 months after COVID-19 diagnosis. Cox regression analyses were performed to assess associations between CFS and outcomes.

Results

A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients >75 years of age with a CFS of 7–9 and highest (27%) in patients 65–75 years of age with a CFS of 5. A CFS of 7–9 was associated with a lower ICU admission rate than a CFS of 1–3 [relative risk 0.49 (95% confidence interval 0.27–0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7–9 (69%). Only 9% of patients with a CFS ≥6 survived after ICU admission. After adjustment for age and sex, each CFS category ≥4 was associated with higher hospital and ICU mortality compared with a CFS of 1–3.

Conclusions

Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.

1012 A Close Loop Audit of Acute Food Bolus Obstruction at a District General Hospital

Aim

The British Society of Gastroenterology (BSG) recommends biopsies from two different regions in the oesophagus. A close loop audit was undertaken to assess performance at a district general hospital, against these guidelines and following newly agreed trust guidelines after the first audit cycle of a follow up OGD within 6 weeks of the presentation.

Method

Data was collected of patients admitted with a food bolus over the first cycle (March2019 to February 2021) and the second cycle (1/10/21 to 14/10/21). Exclusion criteria were age of less than 18 and sharp food bolus.

Results

69 patients were identified. Average age was 60 years. There were 67% male patients and 33% female. 20% of patients underwent a follow up OGD in the first cycle and 45%underwent a follow up OGD within six weeks. 7% had two regions biopsy in the first cycle and21% in the second cycle. Average OGD follow up time was 92 days in the first cycle and 59days in the second cycle. Commonest findings on histology results were eosinophilic oesophagitis and Barrett's oesophagus (22% each), GORD (15%) and carcinoma (7%).

Discussion

Food bolus obstruction indicates the presence of pathology of the oesophagus and should be investigated as so, even despite spontaneous recovery from the acute event. Number of patients undergoing OGD within six weeks and a two regions biopsy improved through this audit by implementing the new trust guidelines.

OUP accepted manuscript

Background

In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19.

Methods

Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m²), divided into: <18.5 (lean), 18.5–24.9 (normal weight), 25–29.9 (overweight), 30–34.9 (obese I) and ≥35 (obese II/III), with 3-month mortality was investigated using Cox proportional-hazards regression analyses.

Results

In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients (N = 2343) and among those living with a kidney transplant (N = 817) (P_interaction = 0.99), but differed by sex (P_interaction = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively.

Conclusion

In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.

Suicidal Behaviors among Patients Attending for Psychiatric Care in a Tertiary Care Hospital of Bangladesh

Suicide is a major preventable public health problem globally however, under attended in Bangladesh. It happens because of multi-factorial involvement; nevertheless, past suicidal attempt is a significant predictor of future suicidal behavior. We aimed to assess the suicidal behaviors among the patients visiting for psychiatric care in a tertiary care hospital of Bangladesh. This cross-sectional study was conducted among the patients attending at department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, from March 2018 to February 2019. A total of 379 patients were interviewed with pre-tested semi structured questionnaire. Non probability purposive sampling was used to collect data. Data were entered into Statistical Package for the Social Sciences 16.0 software and analyzed Among the 379 respondents, 197(52%) were male, 52.5% were married. Mean±SD age of the respondents was 29.94±11.32 year ranging from 18 to 75 years. About 24% percent of the respondents had family history of mental illness, 4% had family history of completed suicides. Prevalence of life time suicidal ideation among the patients was found as 32.5%, one-year prevalence rate 26.4%, one month 17.2% and within last two days it was found as 11.3%. The rate of suicidal plan was 14.0%, preparation 10.0% and attempt was 7.4%. Mean±SD age of onset of suicidal ideation was 24.33±8.9 year ranging from 14 to 57 years. About one in three psychiatric patients had life time suicidal ideation. Third decade of life was found to be vulnerable for onset of suicidal thoughts.

Tracking Side Effects of the COVID-19 Vaccine in Mymensingh District of Bangladesh

The Coronavirus disease 2019 (COVID-19) has turned into a worldwide human tragedy and economic devastation. There had an intensive search for an effective drug against the coronavirus but not led to any breakthrough agents. Only one choice was left namely an effective and safe vaccine. Many people are ambivalent regarding corona vaccines because they also fear possible side effects from vaccination. This study was designed to track the side effects after first and second dose of the Oxford-AstraZeneca vaccines used in Mymensingh district of Bangladesh. This cross-sectional descriptive type of observational study was conducted in Mymensingh Medical College, Mymensingh, Bangladesh during the period of five months from 1 February, 2021 to 30 June, 2021 among 293 purposively selected vaccine recipients who received two doses of the Oxford-AstraZeneca vaccines. Data were collected by face to face interview of the selected vaccine recipients using a semi-structured questionnaire. Data were inputted into SPSS version 26.0. Qualitative data were summarized by percentage and quantitative data were summarized by mean and standard deviation. Necessary bivariate and multivariate analysis was done. Mean age of the respondents was 40.3 years with a standard deviation of ±8.7 years. Among the vaccine recipients female were 159(54.3%) and male were 134(45.7%). The most of the vaccine recipients were graduate and master 256(87.3%) and more than half of the vaccine recipients (156, 53.2%) were government service holder. The most of the vaccine recipients (242, 86.0%) were from urban area and 263(89.8%) vaccine recipients were non-smoker. Sixty eight (23.2%) of the vaccine recipients had different types of co-morbidities. It was found that 217(74.1%) vaccine recipients had side effects after first dose while 162(55.3%) had side effects after second dose. The difference in occurrence of side effects of first and second dose was statistically highly significant (p<0.001). Pain on the injection site was present in 172(58.7%) vaccine recipients after first dose and in 142 (48.5%) after second dose. Fever was prevalent in 98 (33.4%) after first dose and in 61 (20.8) after second dose. Headache was in 61(20.8%) and in 22(7.5%) after first and second dose respectively. Thirty one (10.6%) vaccine recipients had loose motion after first dose and 26(8.9%) had this after second dose. First dose of vaccination caused nausea in 28(9.6%) and second dose caused it in 16(5.5%) vaccine recipients. Joint pain was prevalent in 24(8.2%) after first dose and in 15(5.1%) after second dose. Rash was present in 9(3.1%) and in 3(1.0%) after first and second dose respectively. Cough was present in 5(1.7%) after first dose and in 2(0.7%) after second dose. Each 2(0.7%) had history of fainting and bodyache and 1(0.3%) reported intense weakness after first dose only. Side effects of first dose of AstraZeneca vaccine were more prevalent in female (124, 78.0%) than male (93, 69.4%). The side effects of second dose of AstraZeneca vaccine were also more prevalent in female (103, 64.8%) than male (59, 44.0%). The study results revealed that 217(74.1%) vaccine recipients had side effects after first dose while 162(55.3%) had side effects on second dose of the Oxford-AstraZeneca vaccine. Commonly experienced side effects were pain in the injection site, fever, headache, diarrhoea and joint pain. Most of the people tolerated these side effects and did not use any medicine.

Expression analysis of transcription factors in sugarcane during cold stress

Transcription factors (TF) are a wide class of genes in plants, and these can regulate the expression of other genes in response to various environmental stresses (biotic and abiotic). In the current study, transcription factor activity in sugarcane was examined during cold stress. Initially, RNA transcript reads of two sugarcane cultivars (ROC22 and GT08-1108) under cold stress were downloaded from SRA NCBI database. The reads were aligned into a reference genome and the differential expression analyses were performed with the R/Bioconductor edgeR package. Based on our analyses in the ROC22 cultivar, 963 TF genes were significantly upregulated under cold stress among a total of 5649 upregulated genes, while 293 TF genes were downregulated among a total of 3,289 downregulated genes. In the GT08-1108 cultivar, 974 TF genes were identified among 5,649 upregulated genes and 283 TF genes were found among 3,289 downregulated genes. Most transcription factors were annotated with GO categories related to protein binding, transcription factor binding, DNA-sequence-specific binding, transcription factor complex, transcription factor activity in RNA polymerase II, the activity of nucleic acid binding transcription factor, transcription corepressor activity, sequence-specific regulatory region, the activity of transcription factor of RNA polymerase II, transcription factor cofactor activity, transcription factor activity from plastid promoter, transcription factor activity from RNA polymerase I promoter, polymerase II and RNA polymerase III. The findings of above results will help to identify differentially expressed transcription factors during cold stress. It also provides a comprehensive analysis of the regulation of the transcription activity of many genes. Therefore, this study provides the molecular basis for improving cold tolerance in sugarcane and other economically important grasses.

Depression, Anxiety and Stress among the Students and Their Academic Performance in Selected Medical Colleges of Bangladesh

Medical education is associated with a great psychological distress that affects many aspects of students' lives, including their academic performance and professional development. The objective of the study was to determine the level of depression, anxiety and stress and their academic performance among fifth year medical students. This was a cross-sectional descriptive study conducted in Dhaka Medical College, Mymensingh Medical College, Anwar Khan Modern Medical College and Community Based Medical College of Bangladesh. For this purpose, 359 students were taken as sample and self-administered semi-structured questionnaire was used to collect data. Depression, anxiety and stress were assessed by using short form DASS-21 BV score. The results showed that, the mean age of students was 22.74 years with female predominance 230(64.0%). Majority 319(88.9%) of the respondents' parents monthly income was ≤100000 taka and one third 126(35.1%) respondents' monthly study expenditure was in between 5001 to 10000 taka. Four fifth 317(88.0%) of the respondents came from nuclear type of family and two third 245(68.2%) lived in hostel. Half 178(50.0%) of the respondents were eldest in birth order. Majority 221(61.6%) of the students were admitted to medical college by their own motivation and interest. Symptoms of depression, anxiety and stress were present in 179(49.9%), 215(59.9%) and 161(44.8%) respectively. No significant association was found between academic performance with depression or anxiety or stress, except class attendance of Gynaecology and Obstetrics which was significantly associated with stress (p=0.016); the students who suffered from more stress, their class attendance were very poor. Students who reappeared in MBBS professional examination were significantly associated with depression (p=0.032) and stress (p=0.036). There was significant difference between students of public and private medical colleges in terms of anxiety (p=0.031) that is students of public medical colleges more suffered from depression, anxiety and stress in comparison to private medical colleges. Depression (p=0.001) and anxiety (p=0.010) were significantly associated with motivation to study MBBS. No significant difference of depression, anxiety or stress was found with sex difference. This study revealed that fifth year MBBS students suffered more from depression, anxiety and stress. The causes of depression, anxiety and stress should be identified and resolved to improve their mental health and academic performance.

Characterization of wheat-Thinopyrum bessarabicum genetic stock for stripe rust and Karnal bunt resistance

Utilization of modern breeding techniques for developing high yielding and uniform plant types ultimately narrowing the genetic makeup of most crops. Narrowed genetic makeup of these crops has made them vulnerable towards disease and insect epidemics. For sustainable crop production, genetic variability of these crops must be broadened against various biotic and abiotic stresses. One of the ways to widen genetic configuration of these crops is to identify novel additional sources of durable resistance. In this regard crops wild relatives are providing valuable sources of allelic diversity towards various biotic, abiotic stress tolerance and quality components. For incorporating novel variability from wild relative's wide hybridization technique has become a promising breeding method. For this purpose, wheat-Th. bessarabicum amphiploid, addition and translocation lines have been screened in field and screen house conditions to get novel sources of yellow rust and Karnal bunt resistant. Stripe rust screening under field conditions has revealed addition lines 4JJ and 6JJ as resistant to moderately resistant while addition lines 3JJ, 5JJ, 7JJ and translocation lines Tr-3, Tr-6 as moderately resistant wheat-Thinopyrum-bessarabicum genetic stock. Karnal bunt screening depicted addition lines 5JJ and 4JJ as highly resistant genetic stock. These genetic stocks may be used to introgression novel stripe rust and Karnal bunt resistance from the tertiary gene pool into susceptible wheat backgrounds.

Characteristics and outcomes of hospitalised older patients with chronic kidney disease and COVID-19: A multicenter nationwide controlled study

OBJECTIVE

Older adults with co-morbidities have been reported to be at higher risk for adverse outcomes of coronavirus disease 2019 (COVID-19). The characteristics of COVID-19 in older patients and its clinical outcomes in different kidney disease groups are not well known.

METHODS

Data were retrieved from a national multicentric database supported by Turkish Society of Nephrology, which consists of retrospectively collected data between 17 April 2020 and 31 December 2020. Hospitalised patients aged 18 years or older with confirmed COVID-19 diagnosis suffering from stage 3-5 chronic kidney disease (CKD) or on maintenance haemodialysis (HD) treatment were included in the database. Non-uraemic hospitalised patients with COVID-19 were also included as the control group.

RESULTS

We included 879 patients [388 (44.1%) female, median age: 63 (IQR: 50-73) years]. The percentage of older patients in the CKD group was 68.8% (n = 188/273), in the HD group was 49.0% (n = 150/306) and in the control group was 30.4% (n = 70/300). Co-morbidities were higher in the CKD and HD groups. The rate of presentation with severe-critical disease was higher in the older CKD and HD groups (43.6%, 55.3% and 16.1%, respectively). Among older patients, the intensive care unit (ICU) admission rate was significantly higher in the CKD and HD groups than in the control group (38.8%, 37.3% and 15.7%, respectively). In-hospital mortality or death and/or ICU admission rates in the older group were significantly higher in the CKD (29.3% and 39.4%) and HD groups (26.7% and 30.1%) compared with the control group (8.6% and 17.1%). In the multivariate analysis, in-hospital mortality rates in CKD and HD groups were higher than control group [hazard ratio (HR): 4.33 (95% confidence interval [CI]: 1.53-12.26) and HR: 3.09 (95% CI: 1.04-9.17), respectively].

CONCLUSION

Among older COVID-19 patients, in-hospital mortality is significantly higher in those with stage 3-5 CKD and on maintenance HD than older patients without CKD regardless of demographic characteristics, co-morbidities, clinical and laboratory data on admission.

Characteristics and outcomes of acute kidney injury in hospitalized COVID-19 patients: A multicenter study by the Turkish society of nephrology

BACKGROUND

Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.

METHODS

In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients.

RESULTS

The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (CKD) (37.6%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 81.7% and partial in 17.2% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. In-hospital mortality rate was not different in patients with preexisting non-dialysis CKD compared to patients without CKD (34.4 versus 34.0%, p = 0.924). By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality.

CONCLUSIONS

Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. However, preexisting non-dialysis CKD did not increase in-hospital mortality rate among AKI patients. Renal problems continue in a significant portion of the patients who were discharged.

Episode of Hepatitis C viral infection in the people of Swat, Pakistan

Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

MO357ACUTE KIDNEY INJURY IN HOSPITALIZED COVID-19 PATIENTS: A MULTICENTRE STUDY BY TURKISH SOCIETY OF NEPHROLOGY

Background and Aims

Acute kidney injury (AKI) is common in coronavirus disease-2019 (COVID-19) and the severity of AKI is linked to adverse outcomes. In this study, we investigated the factors associated with in-hospital outcomes among hospitalized patients with COVID-19 and AKI.

Method

In this multicenter retrospective observational study, we evaluated the characteristics and in-hospital renal and patient outcomes of 578 patients with confirmed COVID-19 and AKI. Data were collected from 34 hospitals in Turkey from March 11 to June 30, 2020. AKI definition and staging were based on the Kidney Disease Improving Global Outcomes criteria. Patients with end-stage kidney disease or with a kidney transplant were excluded. Renal outcomes were identified only in discharged patients.

Results

The median age of the patients was 69 years, and 60.9% were males. The most frequent comorbid conditions were hypertension (70.5%), diabetes mellitus (43.8%), and chronic kidney disease (41.5%). The proportions of AKI stages 1, 2, and 3 were 54.0%, 24.7%, and 21.3%, respectively. 291 patients (50.3%) were admitted to the intensive care unit. Renal improvement was complete in 80.7% and partial in 17% of the patients who were discharged. Renal outcomes were worse in patients with AKI stage 3 or baseline CKD. The overall in-hospital mortality in patients with AKI was 38.9%. By multivariate Cox regression analysis, age (hazard ratio [HR] [95% confidence interval (95%CI)]: 1.01 [1.0-1.03], p = 0.035], male gender (HR [95%CI]: 1.47 [1.04-2.09], p = 0.029), diabetes mellitus (HR [95%CI]: 1.51 [1.06-2.17], p = 0.022) and cerebrovascular disease (HR [95%CI]: 1.82 [1.08-3.07], p = 0.023), serum lactate dehydrogenase (greater than two-fold increase) (HR [95%CI]: 1.55 [1.05-2.30], p = 0.027) and AKI stage 2 (HR [95%CI]: 1.98 [1.25-3.14], p = 0.003) and stage 3 (HR [95%CI]: 2.25 [1.44-3.51], p = 0.0001) were independent predictors of in-hospital mortality. The in-hospital mortality rates across AKI stages by age, gender, and diabetes mellitus were shown in the Figure.

Conclusion

Advanced-stage AKI is associated with extremely high mortality among hospitalized COVID-19 patients. Age, male gender, comorbidities, which are risk factors for mortality in patients with COVID-19 in the general population, are also related to in-hospital mortality in patients with AKI. Renal problems continue in a significant portion of the patients who were discharged.

Effect of different protein based feed on the growth of mahseer

For the proper growth of fish, it is necessary to feed the fish with a proper and balanced diet. A study was conducted to find out the effect of different protein-based diets on fingerlings of Tor putitora (mahseer). A feed with dietary protein levels of 35%, 40%, 45%, and 50% were prepared. The effect of different protein-based feed on weight gain, standard growth rate (SGR), food conversion ratio (FCR), percent weight gain, food conversion efficiency (FCE), and protein efficiency ratio (PER) was studied. An increase was observed in the growth rate with an increase in protein concentration up to 45%. The fingerlings fed a 45% protein diet shown the highest growth, followed by 50%, 40%, and 35%. The SGR value was greatest for 45% protein diet (8.56) followed by 50% and 40%, while the least values were observed for 35% protein feed (1.57). The same trend was observed for FCE. The highest PER values was observed in fishes fed 45% protein-based feed (0.65) followed by 50% (0.56), 40% (0.38) and35% (0.17). The food conversion ratio was lowest for 45% protein diet (3.41), while the greatest for 35% protein feed (16.85). It was concluded that a 45% protein-based diet was the best feed formulation for higher production of Tor putitora. However, research on the same percentage of protein diet is recommended for yearlings.

Evaluation of microbial contamination level and the drug susceptible pattern of the isolates cultivated from famous dessert food

Present study endeavored to evaluate the microbial contamination level along with their drug resistant pattern in some popular desert food items collected from different food shops in Dhaka city, Bangladesh. The microbial evaluation was conducted through conventional cultural methods and drug susceptibility test was executed through disc diffusion method. All the samples were found to be contaminated with heterotrophic bacteria as well as fungi within the range of 103 to 105 CFU/g. In case of specific microflora, the growth of Staphylococcus spp. was very high in sweet, faluda, milk cake and ice cream as estimated up to 105 CFU/g, halua and sweet yogurt showed 104 CFU/g while rest of the samples revealed 103 CFU/g. E. coli was found only in faluda and ice cream up to 103 CFU/g whereas Klebsiella spp. was estimated in all the samples within the range of 102 CFU/g to 105 CFU/g. Salmonella spp., Pseudomonas spp. and Bacillus spp. were totally absent in all the samples. Most of the isolates were found to be resistant against most of the antibiotics. Meanwhile, streptomycin (10 µg), gentamicin (10 µg), azithromycin (15 µg), and nalidixic acid (5 µg) were effective drug against both E. coli and Staphylococcus spp.

Clinical outcomes of COVID-19 in hemodialysis patients in the city of Zonguldak, Turkey

Purpose

Patients on maintenance hemodialysis are vulnerable to viral infections like COVID-19 because of the low chance of obedience and complying with rules besides the need for transfer to distant dialysis facilities. We investigated the impact and clinical effect of treatment of COVID-19 in dialysis patients.

Methods

We included patients on maintenance hemodialysis at different healthcare facilities in Zonguldak city. With the diagnosis of the first infected HD case, all other patients who shared the same session were screened. Hospitalized and clinically confirmed cases were included. COVID-19 diagnosis was made based on clinical, biochemical along radiologic findings.

Results

34 (F/M:19/15, mean age 62 ± 13.2 years, dialysis duration 66.9 ± 57.7 months, length of hospital stay 16.2 ± 7.9 days) were diagnosed with COVID-19 infection. The prevalence of COVID-19 was found to be 18.4% of our exposed population. 38.2% of our patients were initially diagnosed by CT screening while asymptomatic. 35.3% had a fever as the first presenting symptom. Lymphopenia was the most common laboratory finding. Except for one, all had at least one comorbidity. Out of 12 (35.3%) patients admitted to ICU 6(17.6%) died. The deceased patients were older, presented with lower serum albumin and lymphocyte count, and had higher CRP and fibrinogen levels. High CRP level on admission was the only significant predictor of mortality.

Conclusion

Early detection will lower mortality. In this study, with a low prevalence of COVID-19, the importance of early screening of both symptomatic and asymptomatic patients was shown to be highly important. Further studies are still needed to find out the most appropriate medical management.

Outcome of Management of Liver Abscess by Surgical Approach in a Tertiary Care Hospital

Liver abscess is a serious, life threatening condition. A recent development in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The purpose of this study is to search for the clinical presentations and surgical outcomes of liver abscess in our country. The markers of the outcome are mortality, duration of hospital stay and complications such as wound infection, residual disease following surgery, biliary leakage, intra abdominal abscess formation. This observational cross sectional study was conducted in Mymensingh Medical College & Hospital (MMCH), Bangladesh for 12 months from 1st January 2017 to 31st December 2017. Total 25 patients presenting with the features of liver abscess were included in this study by convenient and purposive sampling according to the inclusion and exclusion criteria. Surgical principles of liver abscess management were applied and outcomes were observed. The patients were diagnosed on the basis of clinical feature, findings of abdominal ultrasound and occasionally by doing CT scan. Most of the patients (28%) were in the age group of 51-60 years. Regarding sex distribution majority of the patients (64%) was male. Most of patients presented with fever (92%), anorexia and vomiting (32%), upper abdominal pain (84%). Hepatomegaly and reactive pleural effusion are the important findings present in 9(36%) and 8(32%) patients respectively. Size of the liver abscess was more than 5cm in 72% patients. Among the patients right lobe was predominantly involved. It was found during laparotomy that 4 patients (16%) had spontaneous rupture of abscess into peritoneal cavity. One (4%) patient developed biliary leakage after surgical drainage. No intra abdominal abscess or residual diseases was observed after surgery. Among the patients 24% developed wound infection. The overall mortality rate was 12%. The median length of hospital stay was 8 days (range: 1-15 days). Outcome of surgical drainage of liver abscess in tertiary care hospital of our country shows satisfactory result. So, patients with large multiple liver abscess, septic shock, failures of percutaneous drainage should be treated by early open surgical intervention.

Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey

Background

Chronic kidney disease (CKD) and immunosuppression, such as in renal transplantation (RT), stand as one of the established potential risk factors for severe coronavirus disease 2019 (COVID-19). Case morbidity and mortality rates for any type of infection have always been much higher in CKD, haemodialysis (HD) and RT patients than in the general population. A large study comparing COVID-19 outcome in moderate to advanced CKD (Stages 3–5), HD and RT patients with a control group of patients is still lacking.

Methods

We conducted a multicentre, retrospective, observational study, involving hospitalized adult patients with COVID-19 from 47 centres in Turkey. Patients with CKD Stages 3–5, chronic HD and RT were compared with patients who had COVID-19 but no kidney disease. Demographics, comorbidities, medications, laboratory tests, COVID-19 treatments and outcome [in-hospital mortality and combined in-hospital outcome mortality or admission to the intensive care unit (ICU)] were compared.

Results

A total of 1210 patients were included [median age, 61 (quartile 1–quartile 3 48–71) years, female 551 (45.5%)] composed of four groups: control (n = 450), HD (n = 390), RT (n = 81) and CKD (n = 289). The ICU admission rate was 266/1210 (22.0%). A total of 172/1210 (14.2%) patients died. The ICU admission and in-hospital mortality rates in the CKD group [114/289 (39.4%); 95% confidence interval (CI) 33.9–45.2; and 82/289 (28.4%); 95% CI 23.9–34.5)] were significantly higher than the other groups: HD = 99/390 (25.4%; 95% CI 21.3–29.9; P < 0.001) and 63/390 (16.2%; 95% CI 13.0–20.4; P < 0.001); RT = 17/81 (21.0%; 95% CI 13.2–30.8; P = 0.002) and 9/81 (11.1%; 95% CI 5.7–19.5; P = 0.001); and control = 36/450 (8.0%; 95% CI 5.8–10.8; P < 0.001) and 18/450 (4%; 95% CI 2.5–6.2; P < 0.001). Adjusted mortality and adjusted combined outcomes in CKD group and HD groups were significantly higher than the control group [hazard ratio (HR) (95% CI) CKD: 2.88 (1.52–5.44); P = 0.001; 2.44 (1.35–4.40); P = 0.003; HD: 2.32 (1.21–4.46); P = 0.011; 2.25 (1.23–4.12); P = 0.008), respectively], but these were not significantly different in the RT from in the control group [HR (95% CI) 1.89 (0.76–4.72); P = 0.169; 1.87 (0.81–4.28); P = 0.138, respectively].

Conclusions

Hospitalized COVID-19 patients with CKDs, including Stages 3–5 CKD, HD and RT, have significantly higher mortality than patients without kidney disease. Stages 3–5 CKD patients have an in-hospital mortality rate as much as HD patients, which may be in part because of similar age and comorbidity burden. We were unable to assess if RT patients were or were not at increased risk for in-hospital mortality because of the relatively small sample size of the RT patients in this study.

COVID-19-related mortality in kidney transplant and dialysis patients: results of the ERACODA collaboration

BACKGROUND

Patients on kidney replacement therapy comprise a vulnerable population and may be at increased risk of death from coronavirus disease 2019 (COVID-19). Currently, only limited data are available on outcomes in this patient population.

METHODS

We set up the ERACODA (European Renal Association COVID-19 Database) database, which is specifically designed to prospectively collect detailed data on kidney transplant and dialysis patients with COVID-19. For this analysis, patients were included who presented between 1 February and 1 May 2020 and had complete information available on the primary outcome parameter, 28-day mortality.

RESULTS

Of the 1073 patients enrolled, 305 (28%) were kidney transplant and 768 (72%) dialysis patients with a mean age of 60 ± 13 and 67 ± 14 years, respectively. The 28-day probability of death was 21.3% [95% confidence interval (95% CI) 14.3-30.2%] in kidney transplant and 25.0% (95% CI 20.2-30.0%) in dialysis patients. Mortality was primarily associated with advanced age in kidney transplant patients, and with age and frailty in dialysis patients. After adjusting for sex, age and frailty, in-hospital mortality did not significantly differ between transplant and dialysis patients [hazard ratio (HR) 0.81, 95% CI 0.59-1.10, P = 0.18]. In the subset of dialysis patients who were a candidate for transplantation (n = 148), 8 patients died within 28 days, as compared with 7 deaths in 23 patients who underwent a kidney transplantation <1 year before presentation (HR adjusted for sex, age and frailty 0.20, 95% CI 0.07-0.56, P < 0.01).

CONCLUSIONS

The 28-day case-fatality rate is high in patients on kidney replacement therapy with COVID-19 and is primarily driven by the risk factors age and frailty. Furthermore, in the first year after kidney transplantation, patients may be at increased risk of COVID-19-related mortality as compared with dialysis patients on the waiting list for transplantation. This information is important in guiding clinical decision-making, and for informing the public and healthcare authorities on the COVID-19-related mortality risk in kidney transplant and dialysis patients.

Mortality and morbidity of stairlift injuries: Analysis of the UK TARN database

AIMS

To investigate the incidence and pattern of injury in patients with a diagnosis of a fall from a stairlift.

METHODS

Data was analysed from the Trauma Audit and Research Network (TARN) database from 2000 to 2018 for those recorded suffering stairlift related injuries between the ages of 40-100 years. Patient demographics, injury mechanism and pattern, mortality rate and height of fall were analysed.

RESULTS

1069 patients were identified in the initial search with 651 having an eligible mechanism of injury. The mean age was 82 (range 41.4-100.1) years. The most common site of injury was the limbs (49.2%) with the most severe injuries to the head (mean AIS 3.1). The mean ISS was 12.5 (Range 1-75). There was no relationship between height of fall and ISS (r_s 0.054 p = 0.4). Individuals were 78% more likely to have an ISS score of 15 or more if they had a head injury, (OR: 0.12; 95% CI: 0.06-0.24) and 79% more likely to have sustained an injury to the thorax (OR: 0.21; 95% CI: 0.11-0.41). Injury to the head was 95% more likely in individuals with an ISS score greater than 25 points or more (OR: 0.05; 95% CI: 0.01-0.16) and 69% more likely for those who sustain injury to the thorax. Individuals with an ISS score of 25 points or more were 18 times more likely to have sustained injury getting off their stair lift compared to any other method of falling from their stair lift. Mortality was associated with injuries to the thorax in those aged 70 years or below, injuries to the face, spine and limb for those aged 71-85 years and with head injury in those over 85 years. The overall mortality rate was 15.7%.

CONCLUSION

Falls from stairlifts commonly result in limb injuries and most severe injuries are sustained to the head. When patients fall getting off from astairlift, have injuries to their head or thorax they have a higher ISS. The overall mortality is 15.7%. Given the increasing use of stairlifts in our ageing population, strategies should be considered to make these safer.

A Comparative Study of Craniosonogram and CT scan of Brain in CNS Complication of Perinatal Asphyxia

Pereinatal asphyxia is one of the most important complications related with the process of birth and this complications affect not only the brain but also many other organs. The purpose of this cross sectional study is to compare the role of craniosonogram and CT scan of the brain to delineate the cerebral pathology in respondent of preterm and term infant and to assess the Kappa test for agreement. This study was carried out in the department of Radiology & Imaging of Mymensingh Medical College Hospital, during the period of July 2015 to June 2017. A total number of 40 neonates clinically diagnosed as perinatal asphyxia referred for Craniosonogram and Computed tomography (CT) were included in this study. The test of agreement of USG in detection of neonatal cerebral pathology was calculated. Male to female ratio was 1:1.4. More than half (55.0%) patients were preterm age. The mean birth weight was found 2.3±0.6 kg and mean age was 22.7±12.7 days. Fifty five percent respondent mothers had antenatal check up and 27% had anemia, 11% had premature rupture of membrane, 9% had multiple pregnancy and 7% patient had hypertension. Cerebral pathology was found 28 and 31 cases by Craniosonogram and CT scan respectively. Germinal matrix hemorrhage/IVH (Intra ventricular hemorrhage) found 7(17.5%) in USG and 4(10.0%) in CT scan. Hypoxic ischaemic changes with mild ventriculomegaly observed 5(12.5%) in USG and 7(17.5%) in CT scan. Hypoxic ischaemic change found 4(10.0%) in USG and 5(12.5%) in CT scan. In USG evaluation of 28 patients having cerebral pathology & 16(72.7%) had in preterm group and 12(66.7%) in term group. In CT scan of brain 31 patients with cerebral pathology & 15(37.5%) in preterm group and 16(40.0%) in term group. CT scan found cerebral pathology 77.5% (31/40) cases and USG found 70.0% (28/40), with Kappa value was 0.551, which indicates that fair agreement between USG and CT scan for detection of cerebral pathology in respondent. Craniosonogram is a useful method in all neonates specially preterm to see the CNS complication of perinatal asphyxia.

Antithyroid Antibody Status in Non-Pregnant Adult Bangladeshi Patients with Subclinical Hypothyroidism

Sub clinical hypothyroidism (SCH) is common in clinical practice. Autoimmunity is thought to be the most important cause of SCH. In this cross-sectional study, we investigated 120 SCH patients and 100 healthy controls attending the Endocrinology Outpatient Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from June 2014 to April 2015 for anti-thyroid antibodies (anti-TPO and anti-Tg). Measurement of serum TSH, FT4, anti-TPO, and anti-Tg antibodies were done by using the chemiluminescent sequential immunometric assay. SCH patients had a higher mean age; the frequencies of female subjects, those having family history of thyroid disease or other autoimmune diseases, and goiter were higher in SCH group than in the control group. Forty-five percent (45%) of SCH patients were positive for anti-thyroid antibodies (23.3% for both anti-TPO and anti-Tg, 16.7% for only anti-TPO, and 5% positive for only anti-Tg) in comparison to only 10% anti-thyroid antibody positive controls (none for both antibodies, 8% for only anti-TPO, and 2% positive for only anti-Tg). The SCH subjects in the lower age group, females and with a TSH >10μIU/mL had the higher frequency of thyroid autoimmunity. Female gender, high socioeconomic condition, the presence of other autoimmune diseases, the presence of goiter and TSH >10μIU/mL were associated with higher odds of anti-thyroid antibody positivity in the SCH group, though none were statistically significant. The frequency of anti-thyroid antibody was higher in SCH and was more prevalent among the females, younger patients and those having a goiter, other autoimmune diseases, and TSH >10μIU/mL.

Lifestyle and Depression in Urban Elderly of Selected District of Bangladesh

Global population is ageing and Bangladesh has one of the fastest growing ageing populations in this region. Growth in the elderly population relative to other age groups challenges existing health services, family relationships and social security. Combined with this, depression has become a major mental health problem for elderly people especially for urban elderly for nuclear family norm in urban areas. The study was descriptive type of cross-sectional in nature and was conducted in Rangpur Medical College Hospital, Rangpur & Prime Medical College Hospital, Rangpur, Bangladesh. The objective of this study was to assess the lifestyle and level of depression in urban elderly. Depression was measured by questionnaire of geriatric depression scale among 254 respondents. 87.8% of the respondents were age between 60-70 years. Majorities (63%) of the respondents were male, 54% of the respondents lived in nuclear type family and the rest (46%) in joint type of family. Among respondents near half (47.2%) of the respondents found Mild depressive, around one third (32.7%) were severe depressive, and the rest (20.1%) were normal. There was significant association between occupational status of the respondents and depression (x² = 45.600, df=14, p=0.000). Farmers unemployed found severely depressive (52.1%) followed by day-labourer (50%) and businessmen (37.5%). There was significant association between financial self dependency and depression of the respondents (x²= 34.072, df=4, p=0.000). Severe depression (43.8%) was found among those who were not financially self dependent. There was also significant association between monthly income and depression of the respondents (x²= 67.327, df=8, p=0.000). The study also found that lower income group (<Tk 10000) suffer more from severe depression (42.1% vs. 16.67%) than that of higher income group (Tk 50000-99999). Another significant association found between respondents living with family and depression (x²=16.025, df=2, P=0.000). Respondents those not living with family were suffering more from severe depression (55.55%). Association between social activity and depression (x²=31.724, df=4, p=0.000) revealed that those not involved in social activities were in severe depression (40.55%). The study concluded that lifestyle factors and socio-demographic conditions directly influence the state of depression. Those who lead a healthy social life with friends and family, with a stable income source are less prone to severe depression and vice versa. The study recommended the formulation of strategies for the well being of urban elderly that should include social awareness about positive lifestyle changes, social mobilization, health assurance, and response from the government so that depression and its associated serious diseases can be prevented.

Programming effects of maternal and gestational obesity on offspring metabolism and metabolic inflammation

With the increasing prevalence of obesity in women of reproductive age there is a need to understand the ramifications of this on offspring. The purpose of this study is to investigate the programming effects of maternal obesity during preconception and the preconception/gestational period on adiposity and adipose tissue inflammation in offspring using an animal model. Adult female C57Bl/6J mice were assigned either normal diet, high fat diet (HFD) prior to pregnancy, or HFD prior to and through pregnancy. Some offspring were maintained on normal diet while others started HFD later in life. Offspring were assessed for body composition and metabolic responses. Lipid storing tissues were evaluated for expansion and inflammation. Male offspring from the preconception group had the greatest weight gain, most subcutaneous adipose tissue, and largest liver mass when introduced to postnatal HFD. Male offspring of the preconception/gestation group had worsened glucose tolerance and an increase in resident (CD11c⁻) adipose tissue macrophages (ATMs) when exposed to postnatal HFD. Female offspring had no significant difference in any parameter between the diet treatment groups. In conclusion, this study demonstrates that prenatal and pregnancy windows have independent programming effects on offspring. Preconception exposure affects body composition and adiposity while gestation exposure affects metabolism and tissue immune cell phenotypes.

Commotio Cordis Caused During Hurling Game

A teenage boy had a cardiac arrest following a blow to the chest from a hurling ball (sliotar). Prompt resuscitation and automated external defibrillation enabled a full recovery. This is the first reported case of commotio cordis caused by a sliotar although it is described in other sports. Primary prevention of commotio cordis (CC) and secondary prevention of cardiac death are discussed.

African swine fever virus evasion of host defences

African swine fever virus causes a haemorrhagic fever in domestic pigs and wild boar. The continuing spread in Africa, Europe and Asia threatens the global pig industry. The lack of a vaccine limits disease control. To underpin rational strategies for vaccine development improved knowledge is needed of how the virus interacts with and modulates the host's responses to infection. The virus long double-stranded DNA genome codes for more than 160 proteins of which many are non-essential for replication in cells but can have important roles in evading the host's defences. Here we review knowledge of the pathways targeted by ASFV and the mechanisms by which these are inhibited. The impact of deleting single or multiple ASFV genes on virus replication in cells and infection in pigs is summarised providing information on strategies for rational development of modified live vaccines.