Experience with direct acting anti-viral agents for treating hepatitis C virus infection in renal transplant recipients

In recent past, direct-acting anti-viral drugs (DAAs) have become the standard of care for the treatment of hepatitis C virus (HCV) infection. However, the experience with the use of these drugs in Indian renal transplant recipients is limited. We retrospectively reviewed our experience with DAA-based treatment for HCV infection in such patients. Between April 2015 and December 2016, six adults (median age 41 [range 34–52] years, male 5; GT1 2, GT3 3, and GT4 1; including three with prior failed interferon-based treatment) had received genotype-guided, DAA-based anti-HCV treatment 1 to 158 (median 15) months after renal transplantation. Of them, four completed the planned 24-week treatment without any significant adverse event. One of them had increase in serum creatinine after 16 weeks of treatment with sofosbuvir and daclatasvir, with acute interstitial nephritis on kidney biopsy; his renal function improved on stopping the drugs. The other patient had preexisting mild renal dysfunction, which worsened after 8 weeks of sofosbuvir-ledipasvir treatment; this did not reverse on stopping treatment. All the six patients achieved undetectable HCV RNA after 4 weeks of treatment and also achieved sustained virologic response, i.e. lack of detectable HCV RNA in serum 12 weeks after stopping treatment. Overall, DAA-based treatment was effective in treating HCV infection in our renal transplant recipients; however, caution and monitoring of renal function during such treatment is advisable in patients who have additional factors that predispose to renal injury.     

Lymph node retrieval in pancreaticoduodenectomy specimens: does educating the pathologist matter?

Background:Many previous studies have suggested that the number of lymph nodes retrieved should serve as a benchmark for assessing the adequacy of the resection. The aim was to retrospectively observe the impact of nodal retrieval after educating the pathologist.Methods:Patients undergoing a pancreaticoduodenectomy (PD) between September 2005 and March 2009 were included in the study. The PDs performed between September 2005 and March 2008 were designated as Group A. The pathologistswere educated regarding the importance of nodal counts in PD by the surgeon on the 1st April 2008. PDs performed betweenApril 2008 and March 2009 were designated as Group B.Results:Ninety-eight PDs performed by a single surgeon (D.R.J.) for peri-ampullary malignancy were evaluated. The median number of lymph nodes retrieved in Group A was 11(3–32) nodes. The median number of lymph nodes retrieved in Group B was 22 (10–29) nodes (P < 0.001).The lymph node ratio (positive/total nodes), median number of positive nodes retrieved, and the node positivity (node positive compared to node negative) rate did not change.Discussion:A single intervention with the pathologists did impact the number of lymph nodes retrieved from PD specimens. However, the lymph node ratio and lymph node positivity rate remained unchanged. The pathologist is critical to nodal retrieval in PD, but the use of this lymph node number for benchmark of surgical adequacy may be simplistic.     

Spectral monitoring of two-spotted spider mite damage to pepper leaves

Two-spotted spider mites (TSSM; Tetranychus urticae Koch) cause significant damage to crops and yields, in the field as well as in greenhouses. By feeding, TSSM destroy chloroplast-containing cells; this damage can be spectrally detected in the reflectance of the visible and near-infrared regions. This study focuses on hyperspectral reflectance data of greenhouse pepper (Capsicum annuum) leaves, obtained by integrated sphere. The reflectance data were transformed into vegetation indices allowing early TSSM damage detection by separation between leaf damage levels. One-way analysis of variance of coupled damage levels was applied to each of the vegetation indices. We concluded that early identification of TSSM greenhouse pepper leaf damage can be obtained by multispectral means. Furthermore, the proposed methods may identify the damage on the upper side of the leaves although the TSSM feed on the underside of leaves.