Two-dose daclizumab induction in pediatric renal transplantation

Abstract:  DCZ, an IL-2 receptor antagonist, has been widely used for induction therapy in pediatric and adult solid organ transplantation. Originally, it was recommended as a five-dose regimen; however, fewer doses may be efficacious and less costly for prevention of rejection. There is limited experience with the use of fewer doses in pediatric renal transplantation. We retrospectively reviewed the outcomes of 26 primary pediatric renal transplants performed at a single center between June 2004 and May 2007 receiving induction therapy with two-dose DCZ (1.5 mg/kg preoperatively and day seven post-transplant). Maintenance immunosuppression included tacrolimus, MMF, and prednisone in all patients. Forty-six percent were African American and 92% were deceased-donor transplants. After a mean follow-up of 17.8 ± 7.5 months, acute rejection was noted in 11.5% and graft survival was 92.3%. CMV infection occurred in 11.5%, but no case of BK nephropathy or post-transplant lymphoproliferative disorder was observed. Our preliminary results suggest that induction therapy with two-dose DCZ was convenient, economical, and effective in preventing rejection episodes without an increase in adverse events or hospital stay. Larger randomized clinical trials with longer duration of follow-up are needed to more fully validate the use of this regimen in pediatric renal transplantation.     

Towards the development of flexible carbon nanotube–parafilm nanocomposites and their application as bioelectrodes

Soft, flexible and conductive interfaces, which can be used as electrode materials integrated with commercial electronic components and the human body for continuous monitoring of different analytes are in high demand in wearable electronics. In the present work, we explore the development of a functionalized multi-walled carbon nanotube^‡–parafilm^§ nanocomposite (f-MWCNT–PF) for the fabrication of a flexible electrochemical platform for glucose detection. The f-MWCNT–PF nanocomposite was characterized by transmission electron microscopy, energy dispersive X-ray analysis, Fourier-transform infrared spectroscopy, Raman spectroscopy, and electrochemical techniques. A bioelectrode fabricated by immobilization of glucose oxidase at the f-MWCNT–PF surface was further characterized by atomic force microscopy and tested for glucose. The bioelectrode provides two linear regions of glucose detection: a linear range from 0.08 mM to 3 mM, with a correlation coefficient of 0.982 and a sensitivity of 35.322 μA mM⁻¹; and a linear range from 5 mM to 25 mM, with a correlation coefficient of 0.964 and a sensitivity of 9.346 μA mM⁻¹. The proposed method was successfully applied to measure glucose in blood serum samples, differentiating healthy and diabetic persons. Additionally, the lower detection region could be effectively applicable for glucose sensing in sweat or interstitial fluid samples. The flexible, water-repellant sensing platform can be used as a universal platform for analyte detection, demanding waterproof, conductive platforms for biosensing applications, as it is suitable for protein/enzyme immobilization.

Soft, flexible and conductive interfaces, which can be used as electrode materials integrated with commercial electronic components and the human body for continuous monitoring of different analytes are in high demand in wearable electronics.     

A case of primary leptomeningeal gliomatosis confined to the spinal cord

We report a case of primary leptomeningeal gliomatosis limited to the spinal cord occurring in a 52 years-old patient, who presented with back pain and leg weakness. MRI-scan of the craniospinal axis revealed an enhancing cervicothoracic lesion confined to the leptomeninges. A diagnostic biopsy was taken followed by a six level cervicothoracic laminoplasty with the aim of debulking of the dorsal portion of the tumour and relieving cord compression. Two weeks following surgery, the patient developed bilateral arm weakness. Repeat imaging revealed extension of the lesion to the level of the lower medulla. This patient underwent spinal radiotherapy and concomitant chemotherapy with Temozolomide, but she died of pneumonia 8.5 months after the time of diagnosis. No post-mortem was performed. Primary leptomeningeal gliomatosis exclusively involving the spinal cord is an extremely rare condition bearing a dismal prognosis. It can be suspected on neuroimaging, but histopathological examination is required for the final diagnosis. No current treatment protocols are available. Decompressive surgery may have a role in relieving symptoms, but no substantial benefit has been proven in administering radio-chemotherapy.     

Impact of Living Donor Liver Transplantation on COVID-19 Clinical Outcomes from a Quaternary Care Centre in Delhi

Background and AimsThe anticipated fear of serious outcomes in coronavirus infected liver transplant recipients led to disruption of transplant services globally. The aim of our study was to analyze COVID-19 severity in transplant recipients and to compare the difference of COVID-19 clinical outcomes in early (<1 year) vs. late (>1 year) post-transplant period.Methods41 post-living donor liver transplant recipients with COVID-19 infection were studied retrospectively from 1st April 2020 to 28th February 2021.ResultsThe median age was 49.00 years with a male preponderance (80.49%). Fifteen patients had infection within 1 year of transplant and 26 were infected after 1 year of transplant. The overall median interval between transplantation and COVID-19 diagnosis was 816.00 days. Fever and malaise were the common presenting symptoms. The most common associated comorbidities were diabetes mellitus (65.85%) and hypertension (46.34%). The severity of illness was mild in 28 (68.29%), moderate in 4 (9.76%), severe in 6 (14.63%) and critical in 3 (7.32%). To identify associated risk factors, we divided our patients into less severe and more severe groups. Except for lymphopenia, there was no worsening of total bilirubin, transaminases, alkaline phosphatase, and gamma-glutamyl transferase in the more severe group. Eight (19.51%) patients required intensive care unit admission and three (7.32%) died, while none suffered graft rejection. In recipients with early vs. late post-transplant COVID-19 infection, there were similar outcomes in terms of severity of COVID-19 illness, intensive care unit care need, requirement of respiratory support, and death.ConclusionLiving donor liver transplantation can be performed during the COVID-19 pandemic without the fear of poor recipient outcome in cases of unfortunate contraction of severe acute respiratory syndrome coronavirus-2.     

Complications of Chronic Suppurative Otitis Media and Their Management: A Single Institution 12 Years Experience

To determine the incidence of otogenic complications of Chronic suppurative otitis media (CSOM) and its management. The study was conducted at the tertiary referral centre and teaching hospital. An analysis was made about the clinical and operative findings, surgical techniques and approaches, the overall management and recovery of the patient. The data were then compared with the relevant and available literature. Over the study period of 12 years, a total 45 cases of CSOM with complications were reviewed. Out of these 45 cases, 20 cases had extracranial (EC) while 25 cases had intracranial (IC) complications. The prevalence of each complication was 0.17 and 0.13 %, IC and EC respectively. The commonly encountered IC complications were brain abscess, meningitis and lateral sinus thrombophlebitis. Among the EC complications, mastoid abscess followed by labyrinthitis and facial nerve palsy were encountered. The reliable warning signs and symptoms of IC complications were fever, headache, earache vestibular symptoms, meningeal signs and impairment of consciousness. Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus epidermidis were the common organism isolated. Cholesteatoma and granulation in the middle ear were the major findings in both groups of cases. Surgery was main modality of management of these conditions. We observed that two patients fail to regain full facial nerve function despite of surgery. Mortality rate was zero but morbidity was seen in 15 % (3) and 28 % (7) of cases in EC and IC group respectively. The epidemiological presentation, clinical features and results of treatment are discussed. CSOM complications, despite its reduced incidence still pose a great challenge in developing countries, as the disease present in the advanced stage leading to difficulty in management and consequently higher morbidity. In this study we emphasize the importance of the accurate and early diagnosis followed by adequate surgical therapy with multidisciplinary approach.     

Sorbate Transport in Carbon Molecular Sieve Membranes and FAU/EMT Intergrowth by Diffusion NMR

In this paper we present and discuss selected results of our recent studies of sorbate self-diffusion in microporous materials. The main focus is given to transport properties of carbon molecular sieve (CMS) membranes as well as of the intergrowth of FAU-type and EMT-type zeolites. CMS membranes show promise for applications in separations of mixtures of small gas molecules, while FAU/EMT intergrowth can be used as an active and selective cracking catalyst. For both types of applications diffusion of guest molecules in the micropore networks of these materials is expected to play an important role. Diffusion studies were performed by a pulsed field gradient (PFG) NMR technique that combines advantages of high field (17.6 T) NMR and high magnetic field gradients (up to 30 T/m). This technique has been recently introduced at the University of Florida in collaboration with the National Magnet Lab. In addition to a more conventional proton PFG NMR, also carbon-13 PFG NMR was used.     

Lymph Node Central Necrosis on the Computed Tomography as the Predictor of the Extra Capsular Spread in Metastatic Head and Neck Squamous Cell Carcinoma

The aim of this study is to investigate the relationship between the presence of the cervical lymph node with central necrosis as on the preoperative imaging and postoperative histopathological identification of the lymph node extra capsular spread. This study is a prospective study conducted at J.L.N. Hospital and Research Centre, Bhilai (C.G), from August 2011 to January 2014. Thirty patients with metastatic head and neck squamous cell carcinoma were enrolled. All candidates were subjected to a detailed history taking and clinical examination. Their preoperative computed tomography (CT) scans were assessed with attention to the presence and absence of lymph node, lymph node size, shape, level, presence or absence of the lymph node central necrosis and other signs of the ECS such as thick walled enhancing nodal margin, loss of margin definition, alteration of adjacent fat planes. These patients then underwent surgery which included resection of the primary with the neck dissection. The preoperative records of the lymph node size and location were observed radio-graphically and analyzed with the resected lymph node histopathologically. These data was used for finding out correlation. Of the total 30 patients studied, 24 patients were male and 6 patients female with ratio of 4:1. The most common group of the patients were of malignancy of gingivobuccal sulcus. Out of the 30 patients 19 patients had the radiographic evidence of the central necrosis, out of which 11 had the extra capsular spread on the histological analysis. In no patients did we found histopathology extra capsular spread without central necrosis. Thus the central necrosis on the CT has the high sensitivity for detection of the extra capsular spread. Out of the 19 lymph node without extra capsular spread, 11 lymph nodes had no central necrosis on the preoperative CT, remaining 8 lymph node were having central necrosis on CT whereas post op histopathology of these 8 lymph nodes showed metastatic deposit, indicating the low specificity of the central necrosis in detection of the ECS. Lymph node central necrosis on pre-operative CT is sensitive indicator with a high negative predictive value for lymph node extra capsular spread. Future studies focusing on identifying molecular mediator involved in ECS to determine targets for adjuvant therapies in this subset of patients are recommended.