Change Ideas for First Quality Improvement Project

Indian Journal of Pediatrics -     

Risk of Vancomycin-induced Nephrotoxicity in the Population With Chronic Kidney Disease

The antibiotic vancomycin has been available since the 1950s but has been used more commonly since the early 1980s because of the widespread appearance of methicillin-resistant Staphylococcus aureus. Infectious Diseases Society of America guidelines recommend achieving vancomycin trough levels of 10 to 20 μg/mL. Usage of vancomycin in high dosages especially ≥4 g/d has led to an increase in the incidence of vancomycin-induced nephrotoxicity, particularly in patients with chronic kidney disease (CKD). This review focuses on the impact of vancomycin-induced nephrotoxicity in patients with CKD. Patients with CKD are at increased risk of developing acute kidney injury and subsequently requiring renal replacement therapy. There is substantial need for vancomycin pharmacokinetic studies to be performed in the population with CKD to develop an optimum vancomycin nomogram in these patients. At present, tight monitoring of vancomycin trough levels in the population with CKD is recommended to help prevent acute kidney injury and its associated high morbidity, mortality and health care costs.     

Microstructure and deformation behavior of biocompatible TiO2 nanotubes on titanium substrate

Titanium oxide coatings have been shown to exhibit desirable properties as biocompatible coatings. We report on the quantitative microstructure characterization and deformation behavior of TiO₂ nanotubes on Ti substrate. Nanotubes were processed using anodic oxidation of Ti in a NaF electrolyte solution. Characterization of the as-processed coatings was conducted using scanning electron microscopy and focused ion beam milling. Increases in anodization time had no significant effect on tube diameter or tube wall thickness. Coating thickness, however, increased with time up to 2 h of anodization, at which point an equilibrium thickness was established. Nanoindentation was used to probe the mechanical response in terms of Young’s modulus and hardness. Progressively higher values of elastic modulus were obtained for thinner films consistent with increasing effects of the Ti substrate. A possible deformation mechanism of densification of the porous oxide and wear of the dense surface is suggested and discussed.     

Podophyllum hexandrum Offers Radioprotection by Modulating Free Radical Flux: Role of Aryl-Tetralin Lignans

We have evaluated the effect of variation in aryl-tetralin lignans on the radioprotective properties of Podophyllum hexandrum. Two fractionated fractions of P. hexandrum [methanolic (S1) and chloroform fractions (S2)], with varying aryl-tetralin lignan content were utilized for the present study. The peroxyl ion scavenging potentials of S1 and S2 were found to be comparable [i.e. 45.88% (S1) and 41% (S2)] after a 48 h interval in a time-dependent study, whereas in a 2 h study, S2 exhibited significant (P < 0.05) antioxidant activity in different metal ion + flux states. In the aqueous phase, S2 exhibited non-site-specific reactive oxygen species scavenging activity, i.e. 73.12% inhibition at 500 mug ml(-1). S1 exhibited 58.40 +/- 0.8% inhibition (at 0.025 mug ml(-1)) of the formation of reactive nitrite radicals, comparable to S2 (52.45 +/- 0.825%), and also showed 45.01% site-specific activity (1000 mug ml(-1)), along with significant (P < 0.05) electron donation potential (50-2000 mug ml(-1)) compared to S2. Such activities of S1 could be attributed to the significantly (P < 0.05) higher levels of podophyllotoxin beta-d-glucopyranoside (16.5 times) and demethyl podophyllotoxin glucoside (2.9 times) compared with S2. Together, these findings clearly prove that aryl-tetralin lignan content influences the radiation protective potential of the Podophyllum fractions to a great extent.     

Gestational diabetes mellitus: fetal liver length measurements between 21and 24 weeks' gestation

PURPOSE: To evaluate sonographic measurements of the fetal liver, fetal abdominal fat layer, interventricular septum, and Wharton's jelly area between 21 and 24 weeks' gestation in women with gestational diabetes mellitus (GDM). METHODS: A total of 123 consecutive healthy pregnant women underwent sonographic examination at 21-24 weeks' gestational age. The measurements included fetal biometry, detailed anomaly scan, and fetal body composition measurements (subcutaneous fat, liver size, cardiac muscle thickness, and Wharton's jelly area). GDM was confirmed by way of a 75-g oral glucose tolerance test using World Health Organization criteria within 1 week of the examination. RESULTS: Nineteen (15.4%) women were diagnosed with GDM, while 104 (84.6%) women were without GDM. The mean fetal liver length was 36 mm (95% CI 32-37) in women with GDM and 31 mm (95% CI 30-33) in women without GDM (p < 0.01). Liver enlargement was related to maternal fasting glucose levels and not 2-hour postprandial levels. There was no significant difference in the fetal biometric and other fetal body measurements between the 2 groups. CONCLUSIONS: The findings of this study suggest that midtrimester fetal liver length appears to be longer in GDM than in normal pregnancies. However, the fetal abdominal fat layer, interventricular septum, and Wharton's jelly were not affected. Nevertheless, further, larger randomized studies are required to confirm these findings.     

Presence of Recombinant Bat Coronavirus GCCDC1 in Cambodian Bats

Bats have been recognized as an exceptional viral reservoir, especially for coronaviruses. At least three bat zoonotic coronaviruses (SARS-CoV, MERS-CoV and SARS-CoV-2) have been shown to cause severe diseases in humans and it is expected more will emerge. One of the major features of CoVs is that they are all highly prone to recombination. An extreme example is the insertion of the P10 gene from reoviruses in the bat CoV GCCDC1, first discovered in Rousettus leschenaultii bats in China. Here, we report the detection of GCCDC1 in four different bat species (Eonycteris spelaea, Cynopterus sphinx, Rhinolophus shameli and Rousettus sp.) in Cambodia. This finding demonstrates a much broader geographic and bat species range for this virus and indicates common cross-species transmission. Interestingly, one of the bat samples showed a co-infection with an Alpha CoV most closely related to RsYN14, a virus recently discovered in the same genus (Rhinolophus) of bat in Yunnan, China, 2020. Taken together, our latest findings highlight the need to conduct active surveillance in bats to assess the risk of emerging CoVs, especially in Southeast Asia.     

Supracardiac Total Anomalous Pulmonary Venous Connection with A Descending Vertical Vein

The commonly used Darling classification for total anomalous pulmonary venous connection (TAPVC) consists of supracardiac, cardiac, infracardiac, and mixed types (Craig et al., Lab Invest 6:44–64, 1967). In supracardiac TAPVC, the common pulmonary vein drains superiorly into the left innominate vein, the superior vena cava, or the azygos vein by way of an ascending vertical vein. We describe a case of supracardiac TAPVC draining into the azygos vein atypically by way of a descending vertical vein.