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Introduction: Kidney transplant recipients (KTR) are at increased risk of morbidity and mortality due to coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics and outcomes of COVID-19 in KTR. Methods: We reviewed the clinical profile, outcomes, and immunological responses of recipients admitted with COVID-19. We determined the risk factors for mortality and severe COVID-19. Results: Out of 452 recipients on follow-up, 60 were admitted with COVID-19. Prevalent comorbidities were hypertension (71%), diabetes (40%), lung disease (17%). About 27% had tuberculosis. The median Sequential Organ Failure Assessment score at presentation was 3 (interquartile range [IQR] 1--5). There was a high incidence of diarrhea (52%) and anemia (82%). Treatment strategies included antimetabolite withdrawal (85%), calcineurin inhibitor decrease or withdrawal (64%), increased steroids (53%), hydroxychloroquine (21%), remdesivir (28.3%), and tocilizumab (3.3%). Severe COVID-19 occurred in 34 (56.4%) patients. During a median follow-up of 42.5 days (IQR 21--81 days), 83% developed acute kidney injury (AKI) and eight (13%) died. Mortality was associated with the baseline graft dysfunction, hypoxia at admission, lower hemoglobin and platelets, higher transaminases, higher C reactive protein, diffuse radiological lung involvement, hypotension requiring inotropes, and Kidney Diseases Improving Global Outcomes (KDIGO) stage 3 AKI (univariate analysis). Around 57% of patients remained RT-PCR positive at the time of discharge. By the last follow-up, 66.6% of patients developed IgM (immunoglobulin M) antibodies and 82.3% of patients developed IgG antibodies. Conclusion: COVID-19 in kidney transplant recipients is associated with a high risk of AKI and significant mortality. [ABSTRACT FROM AUTHOR]

Summary: Evidence on the evolution of graft function in kidney transplant recipients recovering from coronavirus disease‐2019 (COVID‐19) is lacking. This multicenter observational study evaluated the short‐term clinical outcomes in recipients with acute kidney injury (AKI) secondary to COVID‐19. Out of 452 recipients following up at five centers, 50 had AKI secondary to COVID‐19. 42 recipients with at least 3‐month follow‐up were included. Median follow‐up was 5.23 months [IQR 4.09–6.99]. Severe COVID‐19 was seen in 21 (50%), and 12 (28.6%) had KDIGO stage 3 AKI. Complete recovery of graft function at 3 months was seen in 17 (40.5%) patients. Worsening of proteinuria was seen in 15 (37.5%) patients, and 4 (9.5%) patients had new onset proteinuria. Graft failure was seen in 6 (14.3%) patients. Kidney biopsy revealed acute tubular injury (9/11 patients), thrombotic microangiopathy (2/11), acute cellular rejection (2/11), and chronic active antibody‐mediated rejection (3/11). Patients with incomplete recovery were likely to have lower eGFR and proteinuria at baseline, historical allograft rejection, higher admission SOFA score, orthostatic hypotension, and KDIGO stage 3 AKI. Baseline proteinuria and the presence of orthostatic hypotension independently predicted incomplete graft recovery. This shows that graft recovery may remain incomplete after AKI secondary to COVID‐19. [ABSTRACT FROM AUTHOR]

In the article, the authors present a prospective multicentre study which determined the effect of COVID-19 infection on tacrolimus trough concentrations (C0) in kidney transplant recipients (KTR). Other topics include how supratherapeutic tacrolimus could lead to kidney injury and neurotoxicity, and some other possible adverse effects like diarrhoea and high serum creatinine levels.

We longitudinally studied the presence of anti-SARS-CoV-2 IgG antibodies in KTRs after symptomatic coronavirus disease-2019 (COVID-19). Keywords: kidney transplantation; COVID-19; anti-SARS-CoV-2 antibodies; immunological response EN kidney transplantation COVID-19 anti-SARS-CoV-2 antibodies immunological response 1 2 2 09/22/21 20210801 NES 210801 CONFLICT OF INTEREST All authors declare that they have no conflict of interests. Kidney transplantation, COVID-19, anti-SARS-CoV-2 antibodies, immunological response. [Extracted from the article]

Imidazoline surfactants belong to the category of cationic surfactants. Cationic surfactants are often quaternary nitrogen salts and are widely used both in nonaqueous systems and in applications such as textile softeners, dispersants, and emulsifiers. This study describes the surface-active properties of cationic imidazolinium surfactants synthesized from different fatty acids. Their laundry performance in combination with nonionic surfactants like detergency, foaming property, softening property, rewettability etc., is also emphasized. [ABSTRACT FROM AUTHOR]

Chronic prolonged hyponatremia (CPH) is a risk factor for hip fracture in the general population. Whether CPH increases hip fracture risk in chronic kidney disease (CKD) patients is unknown. Case-control study in patients over 60 years of age with stage 3 or greater CKD. Patients who had a hip fracture were referred to as cases (n = 1236) and controls had no hip fracture (n = 4515). Patients were classified as having CPH if serum sodium was <135 mEq/L on at least two occasions separated by a minimum of 90 days prior to the diagnosis of hip fracture (cases) or at any time during the study period (controls). Conditional logistic regression models were used to test the association between CPH and hip fracture. Analyses were conducted for patients with and without osteoporosis and falls and for patients with age >70 years versus ≤70 years. CPH was present in 21% of cases and 10% of controls (p < 0.001; sodium level: 131–134 mEq/L). In univariate logistic regression analysis, CPH was associated with higher odds of hip fracture (odds ratio [OR] 2.44, (95% [CI] 2.07–2.89). In a multivariate model adjusted for comorbidities, medications and laboratory parameters CPH association with higher odds of Hip fracture was attenuated but remained significant (OR 1.36, 95% CI 1.04–1.78). The association between CPH and risk of hip fracture was consistent in patients with or without osteoporosis and falls and across the age strata. Chronic prolonged hyponatremia is a risk factor for hip fracture in CKD patients older than 60 years of age. • Chronic prolonged hyponatremia is associated with hip fracture in elderly with CKD. • Remained significant adjusted for comorbidities medications and laboratory parameters. • The association was consistent in patients with and without osteoporosis and falls. • This association was consistent across the age strata (>70 or <70 years). [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce. [ABSTRACT FROM AUTHOR]

Kidney transplant recipients (KTRs) are at a higher risk for developing severe COVID-19 which can be associated with cardiovascular complications. We studied five KTRs recipients infected with COVID-19 who developed severe cardiovascular complications. Two patients presented with ST segment myocardial infarction and two with clinically suspected myocarditis. One patient presented with atrial fibrillation. Two of these patients developed cardiogenic shock. Inflammatory markers were at peak during the event in four of these who had presented with severe COVID-19. Coronary angiography done in two patients with STEMI did not reveal any evidence of atherosclerotic coronary artery disease. Also, based on the cardiovascular (CV) risk estimation by Framingham score, four patients had low CV risk and one patient had intermediate CV risk. All five patients survived. Even with low CV risk, KTRs can develop myocardial injury and arrhythmias solely because of severe COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused significant global disruption, especially for chronic care like hemodialysis treatments. Approximately 10,000 end-stage kidney disease (ESKD) patients are receiving maintenance hemodialysis (MHD) at 174 dialysis centers in Greater Mumbai. Because of the fear of transmission of infection and inability to isolate patients in dialysis centers, chronic hemodialysis care was disrupted for COVID-19-infected patients. Hence, we embarked on a citywide initiative to ensure uninterrupted dialysis for these patients. Materials and Methods: The Municipal Corporation of Greater Mumbai (MCGM) designated 23 hemodialysis facilities as COVID-positive centers, two as COVID-suspect centers, and the rest continued as COVID-negative centers to avoid transmission of infection and continuation of chronic hemodialysis treatment. Nephrologists and engineers of the city developed a web-based-portal so that information about the availability of dialysis slots for COVID-infected patients was easily available in real time to all those providing care to chronic hemodialysis patients. Results: The portal became operational on May 20, 2020, and as of December 31, 2020, has enrolled 1,418 COVID-positive ESKD patients. This initiative has helped 97% of enrolled COVID-infected ESKD patients to secure a dialysis slot within 48 hours. The portal also tracked outcomes and as of December 31, 2020, 370 (27%) patients died, 960 patients recovered, and 88 patients still had an active infection. Conclusions: The portal aided the timely and smooth transfer of COVID-19-positive ESKD patients to designated facilities, thus averting mortality arising from delayed or denied dialysis. Additionally, the portal also documented the natural history of the COVID-19 pandemic in the city and provided information on the overall incidence and outcomes. This aided the city administration in the projected resource needs to handle the pandemic. [ABSTRACT FROM AUTHOR]

Summary: Water samples of the river Narmada from origin to end were analyzed for the presence of shigellae. Analysis of 40 water samples by biotyping, serotyping, and molecular typing were done. Out of all 40 isolates, 23 were identified as Shigella flexneri, 10 as Shigella sonnei, and seven as Shigella dysenteriae. Serotyping was found to be a better identification method than biotyping since biotyping was not found to be very sharp. In the present investigation, amplified ribosomal DNA restriction analysis (ARDRA) with a probe complementary to 16S rRNA was performed. Repeated ARDRA analysis establishes the similarities between the isolates and thus suggested ARDRA as authentic and precise detection protocol. The isolates were also analyzed for the presence of virulence genes including ipaBCD, ipaH, and stx1 and all the 40 isolates of Shigella showed positive result for ipaH gene while the plasmid encoded invasion-associated genes ipaBCD was present only in S. flexneri and stx1 gene was present only in S. dysenteriae. This study demonstrated the existence of Shigella in the river Narmada and dispersion of different virulence genes among these isolates, which appear to constitute an environmental reservoir of Shigella-specific virulence genes. [Copyright &y& Elsevier]

A rights-based approach in HIV service delivery for adults is increasingly taking root in sub-Saharan Africa in the context of greater availability of antiretroviral therapy. Yet there has been comparatively little progress in strengthening a rights-based approach to adolescent HIV services, which we learned during a qualitative study in 2010 among 111 adolescents living with HIV, 21 parents and 38 health providers in three districts in Zambia. Adolescents in the study expressed a range of information and support needs and wanted locally relevant interventions to meet those needs. They wanted greater access to HIV, sexual and reproductive health information, information on how to protect themselves, privacy and confidentiality in service sites, skills training so as to be able to earn money, and better control over disclosure of their HIV status to others. Both health workers and parents acknowledged that information and services needed to be improved to meet those needs far better. This paper provides examples of successful programmes in Zimbabwe, Uganda, Tanzania, Botswana and South Africa and calls for adolescent services to be linked to both paediatric and adult services, peer networks to be established to increase adolescents' ability to collectively voice their concerns and support each other, interventions supporting adolescents' control over self-disclosure, and lastly that adolescent health should become a training specialty in sub-Saharan Africa. L'approche basée sur les droits de la prestation de services en matière de VIH pour les adultes est en train de s'enraciner en Afrique subsaharienne, dans le contexte de la disponibilité accrue du traitement antirétroviral. Pourtant, il y a eu comparativement peu de progrès accomplis pour renforcer cette approche des services en matière de VIH pour adolescents. C'est qu'a révélé une étude qualitative menée en 2010 auprès de 113 adolescents vivant avec le VIH, 21 parents et 38 prestataires de santé dans trois districts en Zambie. Ces adolescents ont exprimé un éventail de besoins en information et soutien et souhaitaient des interventions pertinentes localement pour répondre à ces besoins. Ils voulaient avoir un accès élargi aux informations sur le VIH, la santé sexuelle et génésique, connaître les moyens de se protéger, bénéficier de confidentialité dans les sites de services, se former afin de pouvoir gagner de l'argent et mieux maîtriser la révélation de leur séropositivité aux autres. Les agents de santé et les parents ont reconnu que ces informations et services devaient être améliorés pour satisfaire bien mieux ces besoins. L'article donne des exemples de programmes réussis au Zimbabwe, en Ouganda, en République-Unie de Tanzanie, au Botswana et en Afrique du Sud et recommande de lier les services pour adolescents aux services pédiatriques et pour adultes, de créer des réseaux de pairs pour renforcer la capacité des adolescents à faire entendre collectivement leurs préoccupations et se soutenir mutuellement, de réaliser des interventions favorisant le contrôle des adolescents sur l'autorévélation et enfin de faire de la santé des adolescents une spécialité de la formation en Afrique subsaharienne. Cada vez más se está arraigando en Ãfrica subsahariana el enfoque en la prestación de servicios de VIH para adultos basado en los derechos, en el contexto de mayor disponibilidad de terapia antirretroviral. Sin embargo, se han visto relativamente pocos avances en fortalecer el enfoque basado en los derechos con relación a los servicios de VIH para adolescentes, lo cual averiguamos durante un estudio cualitativo realizado en 2010 entre 113 adolescentes que vivían con VIH, 21 padres y 38 profesionales de la salud de tres distritos de Zambia. Los adolescentes del estudio expresaron una variedad de necesidades de información y apoyo y querían intervenciones pertinentes para la localidad, que atendieran esas necesidades. Querían mayor acceso a información sobre VIH y salud sexual y reproductiva e información sobre cómo protegerse; privacidad y confidencialidad en las unidades de salud; capacitación en habilidades para poder ganar dinero; y mejor control de la revelación de su estado de VIH a otras personas. Tanto los trabajadores de la salud como los padres reconocieron que es necesario mejorar la información y los servicios para atender mucho mejor esas necesidades. En este artículo se exponen ejemplos de programas exitosos en Zimbabue, Uganda, Tanzania, Botsuana y Sudáfrica y se hace un llamado a vincular los servicios para adolescentes con los servicios para niños y adultos; a establecer redes de pares para aumentar la capacidad de los adolescentes para expresar sus inquietudes de manera colectiva y apoyarse unos a otros; a realizar intervenciones que apoyen el control de los adolescentes sobre la autorevelación; y, por último, a que la salud de la adolescencia sea una especialidad de formación en Ãfrica subsahariana. [ABSTRACT FROM AUTHOR]