RENAL TRANSPLANTATION – AN EARLY EXPERIENCE

Renal transplant (RT) is now a therapy of choice for end stage renal disease (ESRD). The Nephrology Unit, Asvini started functioning in Dec 90 and to date 1298 sittings of hemodialysis have been given to 45 patients. Of these, 35 were in ESRD and 11 patients underwent renal transplantation at this hospital during the period Jan 91 – Dec 93. One patient expired after 18 months of transplantation due to infection. Early experience in screening patients for RT, use of immunosuppression, management of rejection episodes and protocol are presented with special emphasis on its relevance to the Armed Forces.KEY WORDS: Transplantation, Renal Failure, Immunosuppression, Rejection     

HIV AND TUBERCULOSIS CO-INFECTION IN A REFERRAL CHEST HOSPITAL

Serving personnel of Armed Forces admitted with tuberculosis between Apr 1996–1999 were evaluated for co-infection of tuberculosis and HIV. Sixty (1.06%) of tuberculosis patients were found to be HIV positive. Initial test was done by spot kits and subsequently confirmed by ELISA on two different samples. Majority of the cases were in sexually active age group 48 (80%). Alcohol and smoking was associated in 80% cases. Thirty six (60%) were sputum smear positive for AFB. Twenty eight (46.7%) gave history of exposure to sex workers. Family members were not available for study. Sero prevalence of HIV in association with tuberculosis is less in Armed Forces compared to civil population.KEY WORDS: HIV, Seroprevalence, Tuberculosis     

Muramyl dipeptide: Not just another brick in the wall

The robust expression of microbial pattern recognition receptors such as TLR4 and Nod2 in intestinal stem cells reflects an active communication dynamic between the host and the gut microbiota. A new study reveals that muramyl dipeptide, the bacterial cell wall peptidoglycan motif, activates Nod2 within crypt base columnar Lgr5-positive stem cells and promotes their survival. Apart from the immediate relevance to the growth of organoids for in vitro experiments, the study raises new questions about the molecular mechanisms whereby gut microbes influence intestinal physiology.     

Congenital Pulmonary Vein Stenosis: Encouraging Mid-term Outcome

Congenital pulmonary vein stenosis (PVS) is a rare entity with limited outcome literature. Multiple interventional approaches have evolved including surgical and catheterization techniques. Our objective is to report our center experience and to compare short-term and mid-term outcomes among these therapeutic modalities. Retrospective study on 23 patients (n = 23) with PVS that required intervention over the last 13 years (2000–2013). Patients were divided into three groups based on type of initial intervention. Of these, 10 (43.5 %) had balloon angioplasty, 3 (13.0 %) had surgical dilation, and 10 (43.5 %) had surgical marsupialization. Mortality and number of re-interventions were our primary outcomes. Mean age at diagnosis was 10.9 ± 18.4 months. Mean age at initial intervention was 14.5 ± 18.0 months. Mean pre- and post-initial intervention PVS gradients were 9.2 ± 3.4 and 3.4 ± 2.2 mmHg, respectively. Mean survival time and re-intervention-free survival time were 4.8 ± 4.0 and 2.8 ± 3.4 years. No statistical significance was found between the interventions with respect to survival time (p = 0.52) and re-intervention free time (p = 0.78). High initial pre- and post-intervention gradients were significantly associated with re-intervention-free survival (p = 0.01 and p = 0.03, respectively). Patients with bilateral disease have increased mortality (p = 0.01) and decreased 5-year survival (p = 0.009) compared to patients with unilateral disease irrespective of type of intervention. No statistically significant difference in mortality or re-intervention rate was present among these different therapeutic modalities. This study has the longest follow-up so far reported in the current literature (58 months) with overall survival of 78 %.     

Disseminated Fusarium oxysporum neurospinal infection

We report a case of disseminated meningospondylodiscitis in an elderly diabetic patient caused by Fusarium oxysporum. As the clinical presentation was nonspecific, the diagnosis of the condition could only be arrived at after laboratory and imaging studies. The diagnosis of the condition requires a high index of suspicion. Patient underwent thorough surgical debridement along with a short course of variconazole and remained asymptomatic after 36 months of diagnosis. Fusarium is a large genus of filamentous fungi widely distributed in soil and in association with plants. It is known to cause local infections (nail, cornea) in healthy humans and disseminated infection only in the immunocompromised.     

Predictors of acceptance and willingness to pay for the COVID-19 vaccine in the general public of India: A health belief model approach

Objective:To determine the predictors of acceptance and willingness to pay(WTP)for the COVID-19 vaccine among the Indian public and to provide insights for future demand forecasts and pricing considerations.Methods:A nationwide,web-based,self-administered,crosssectional survey was conducted from 5 to 20 October 2020.The health belief model(HBM)approach was used as a theoretical framework to assess the predictors of acceptance of and WTP for the COVID-19 vaccine.Results:Of 2480 respondents,2451 completed the online survey,yielding a response rate of 98.8%.Participants who participated in the survey had diverse demographics in terms of their location,educational level,occupation type,and family income.Among 2451 respondents,the majority(89.3%)intended to receive the COVID-19 vaccine.Respondents with high perceived benefits of COVID-19 vaccination,such as reduction in worry(OR 5.87;95%CI 4.39-7.96)and sickness(OR 4.31;95%CI 3.31-5.62),showed higher intention to receive the vaccine.However,respondents with a high perception of the side effects and barriers to vaccination(OR 0.36;95%CI 0.25-0.54)and vaccine shortage(OR 0.58;95%CI 0.41-0.81)showed lower intention to receive the vaccine.The majority(2162,88.21%)of respondents were willing to pay an amount of INR:500-1000 or USD:6.81-13.62 for a dose of COVID-19 vaccine,with a median(Q1,Q3)of INR:500(500,1000)or USD:6.81(6.81,13.62).The higher marginal WTP for the COVID-19 vaccine was influenced by advanced age,marital status,female sex,intermediate educational background,high family income,fair or poor perceived health status,and no affordable barriers.Conclusions:The majority of respondents intended to receive the COVID-19 vaccine.Healthcare interventions focusing on HBM constructs and demographic predictors associated with low intention to receive the vaccine can be effective in enhancing the coverage of the COVID-19 vaccine.The findings of this study provide guidance for the future price considerations of the COVID-19 vaccine.