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Byline: A. Mathur, A. Yadav, S. Jasuja, A. Jindal, H. Malhotra Sir, Aggressive angiomyxoma (AA) is a rare mesenchymal tumor of pelvic-perineal region with female:male ratio of 6:1[sup][1] and only [...]

Byline: S. Jasuja, A. Mathur, S. Bhakal, P. Manghera, H. Malhotra Sir, Xeroderma pigmentosum (XP) is a rare group of disorder with reported incidence in US and Europe being 1:250,000 [...]

These Lipid Association of India (LAI) recommendations refer to specific patient populations. They follow the previously published LAI part 1 recommendations. These part 2 LAI recommendations focus on specific patient groups. These include patients with heart failure, chronic kidney disease, non-alcoholic fatty liver disease, cerebrovascular disease, thyroid disorders, inflammatory joint diseases, familial hypercholesterolaemia and human immunodeficiency virus infection. We also consider women, the elderly and post-transplantation patients. The current recommendations are based, as much as possible, on available data from Indian populations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Outbreaks of rotavirus gastroenteritis in elderly adults are reported infrequently but are often caused by G2P[4] strains. In 2011, outbreaks were reported in 2 Illinois retirement facilities. OBJECTIVE: To implement control measures, determine the extent and severity of illness, and assess risk factors for disease among residents and employees. DESIGN: Cohort studies using surveys and medical chart abstraction. SETTING: Two large retirement facilities in Cook County, Illinois. PATIENTS: Residents and employees at both facilities and community residents with rotavirus disease. MEASUREMENTS: Attack rates, hospitalization rates, and rotavirus genotype. RESULTS: At facility A, 84 of 324 residents (26%) were identified with clinical or laboratory-confirmed rotavirus gastroenteritis (median age, 84 years) and 11 (13%) were hospitalized. The outbreak lasted 7 weeks. At facility B, 90 case patients among 855 residents (11%) were identified (median age, 88 years) and 19 (21%) were hospitalized. The facility B outbreak lasted 9.3 weeks. Ill employees were identified at both locations. In each facility, attack rates seemed to differ by residential setting, with the lowest rates among those in more separated settings or with high baseline level of infection control measures. The causative genotype for both outbreaks was G2P[4]. Some individuals shed virus detected by enzyme immunoassay or genotyping reverse transcription polymerase chain reaction for at least 35 days. G2P[4] was also identified in 17 of 19 (89%) samples from the older adult community but only 15 of 40 (38%) pediatric samples. LIMITATION: Medical or cognitive impairment among residents limited the success of some interviews. CONCLUSION: Rotavirus outbreaks can occur among elderly adults in residential facilities and can result in considerable morbidity. Among older adults, G2P[4] may be of unique importance. Health professionals should consider rotavirus as a cause of acute gastroenteritis in adults. PRIMARY FUNDING SOURCE: None. [ABSTRACT FROM AUTHOR]

Diffuse alveolar hemorrhage is a serious complication of the small vessel vasculitis syndromes and carries a high mortality. Recombinant activated factor VII (rFVIIa) is a powerful hemostatic agent developed for treatment of bleeding in patients with hemophilia and antibodies to factors VIII or IX. It has been used increasingly in life-threatening hemorrhage in a variety of other settings in which conventional medical or surgical therapy is unsuccessful. We report the successful use of rFVIIa for massive pulmonary hemorrhage in a patient of microscopic polyangiitis, which was later complicated by thrombotic microangiopathy and posterior reversible encephalopathy syndrome. [ABSTRACT FROM AUTHOR]

Hepatitis A runs a benign course in children, but may have atypical presentations in adults. Very rarely acute renal failure complicates nonfulminant hepatitis A. We report a patient with nonfulminant acute viral hepatitis A with multiorgan involvement. Patient had biopsy proven acute interstitial nephritis, acute pancreatitis, acute myocarditis and required hemodialysis for 6 weeks. [ABSTRACT FROM AUTHOR]

The article describes the case of a 15-year-old girl with reflux nephropathy ESKD who underwent a related renal transplant in March 2000. The patient was given initial immunouppressants which included cycloprosine, azathioprine and prednisolone. Cycloprosine and azathioprine were stopped and relpaced with rapamycin and mycophenolate mofetil.

Aim: Nutrition is a significant issue for ESRD patients on maintenance hemodialysis (MHD). We studied impact of 3 months of general dietary counselling on various nutritional parameters. Methods: 38 patients were studied at baseline and after 3 months of dietary counselling by a trained renal dietician. Patients were counselled regarding intake of recommended protein and calories, and restriction of salt, fluids, potassium, free sugars and saturated fats. Nutritional parameters were assessed by anthropometry, 7 days nutritional diary intake and bioelectrical impedance. Paired student 't' test was used to evaluate impact of counselling. All data is expressed as pre v/s post counselling. Results: Post counselling, there was no significant change in weight (P=0.2), however there was significant decrease in BMI (21.97±3.38 v/s 21.41±3.09 kg/m², pre v/s post counselling respectively, P=0.037). There was significant decrease in calorie intake (1559.08±508.48 v/s 1347.13±355.12 kcal, P=0.003). There was significant decrease in carbohydrate intake (239.71 ± 86.28 v/s 189.04 ± 49.93 gm, P = 0.000). However there was no significant change in protein or fat intake (P=0.42 and 0.40 respectively). Similarly there was change in distribution of calorie intake with significant reduction in calories derived from carbohydrates (60.07±5.43 v/s 56.37±5.93%, P=0.003). There was significant decrease in potassium (1500.87±606.0 v/s 1066.92±372.07 mg/day, P=0.000), and phosphorus (1271.42±405.74 v/s 1122.58±292.81 mg/day, P=0.016). There was no significant change in calcium intake (890.90±389.61 v/s 825.92±268.51 mg/day, P=0.277). There was no significant change in total body water (TBW) (P=0.313). However there was significant decrease in extracellular water (ECW%) (48.04±7.72 v/s 44.61±7.79, P=0.009) and increase in intracellular water (ICW%) (52.09±7.60 v/s 55.26±7.78, P=0.014). There was increase although not statistically significant in protein mass, muscle mass, calcium mass, potassium mass and dry weight. There was significant increase in haemoglobin (9.52±1.9 v/s 10.03±2.06 gm/dl, P=0.046). There was increase in albumin that failed to reach statistical significance at 0.05 level (3.76±0.71 v/s 4.12±0.99 gm/dl, P=0.06). There was no significant change in calcium, phosphorus and cholesterol levels (all P> 0.05). Conclusion: Dietary counselling of 3 months had positive impact with significant decreased intake of potassium and phosphorus, decrease in ECW%, and increase in haemoglobin. There was increase in albumin and muscle mass although not statistically significant. However there was significant decrease in caloric intake and BMI. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 30-year-old male diagnosed with neoplasm aggressive angiomyxoma perineum. Topics discussed include the medical record of the patient, the diagnosis of his aggressive angiomyxoma perineum, his physical examinations through diagnostic imaging, his treatment, and an overview of the disease.

The article presents a case study of a 15-year-old female diagnosed with Xeroderma pigmentosum (XP). Topics discussed include the medical record of the patient, the diagnosis of her XP disease, her physical and clinical examinations, her extensive ulceroproliferative lesion, and an overview of the disease.

Aim: Most studies of nutrition in CRY patients have reported high prevalence of protein energy malnutrition. Nutritional status is one of the most important markers of morbidity and mortality in maintenance hemodialysis (MHD) patients. We studied nutritional status of our 38 patients who were on maintenance haemodialysis. Materials and Methods: Nutritional status was assessed on the basis of nutritional dietary intake (7 days diary), anthropometry and bioelectrical impedance. Multiple regression analysis with calorie intake as dependent and 6 independent variables {duration of dialysis (in months), duration of CRY (in months), frequency of dialysis, parentral nutrition during dialysis and number of dialysis centers} were studied. Results: There were total of 38 patients: 29 male and 9 female; 27 vegetarians and 11 non-vegetarians; 15 diabetic and 23 non-diabetic. Mean body weight was 59.75±10.29 kg; BMI: 21.97±3.38 kg/m²; waist hip ratio: 0.87+0.06; total calorie consumption: 1600±508 kcal (v/s recommended 1543.82±113.9 kcal, P=0.52); carbohydrate intake 239.7±86.28 gm/day (v/s recommended 231.7±17.3 gm/day, P = 0.58); protein: 52.63±14.91 gm/day (v/s recommended 77.26±7.03 gm/day, P=0.0); fat: 47.52±15.96 gm/day (v/s recommended 40.58±6.17 gm/ day, P = 0.013); calcium intake: 890.9±389.6 mg/day (v/s recommended 400 mg/day, P=0.0); phosphorus: 1271.42±405.74 mg/day (v/s recommended 400 mg/day, P= 0.0); potassium: 1500.87±606.0 mg/day (v/s recommended 800 mg/day, p=0.0); Iron: 14.35±5.43 gm/day. Break up of total calorie intake showed that 60±5.43% were derived from carbohydrates, 26.7±4.93% from fat and 13.22±1.65% from proteins. Bioelectrical impedance analysis showed BMI: 22.57±4.2 kg/m²; resting metabolic rate: 1299.26±200.72; total body water%: 51.90±10.36 1; extra cellular water %: 48.04±7.72 1; Intracellular water: 52.09±7.6 1; protein mass: 9.99±8.88 kg; muscle mass: 21.25±4.68 kg; calcium mass: 933.39±171.73 gm; dry weight 56.72±11.70 kg; mean body fat%: 23.13±10.71; mean fat free mass%: 76.37±11.25. Lab data showed mean Hb: 9.52±1.90 gm/dl; calcium: 8.93±1.27 mg/dl; phosphorus: 6.54±1.97 mg/dl; potassium: 4.63±1.03 mg/dl; albumin: 3.76±0.71 gm/dl; cholesterol: 141.82±33.66 gm/dl; transferrin saturation: 24.44±19.17%; S. ferritin: 610.71±413.51 ng/ml. By anthropometry 12 patients (31.6%) were under weight; 17(14.7%) had normal weight; 6 (15.8%) overweight; and 3(7.9%) obese. By bioelectrical impedance, 13(34.2%) were under weight; 16(42.1%) were normal weight; and 9(23.7%) were over weight. Multiple regression analysis done taking calories, as dependent and 6 independent variables did not revealed any statistically significant variable. Conclusion: One third of our patients were underweight. Total calorie and carbohydrate intake was not statistically different from recommended values. However, total fat, calcium, potassium and phosphorus intake was statistically significantly higher than recommended while total protein intake was significantly lower than recommended. There was significant prevalence of low Hb, high phosphorus and high ECW%. Serum levels of calcium, albumin, transferrin saturation and ferritin were within recommended range. Calorie distribution of dietary intake was within normal range. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a common cause of death in patients with pulmonary arterial hypertension (PAH). Treatment requires careful fluid management and hemodynamic support. This study compares patients with or without PAH presenting with sepsis with a focus on initial fluid resuscitation., Methods: This retrospective analysis compared adults with and without PAH admitted for sepsis at two academic hospitals between 2013 and 2022. Prior PAH diagnosis was verified by review of right heart catheterization data and sepsis present on admission was verified by chart review. Demographics, vital signs, laboratory values, imaging results, treatment approaches, and all-cause mortality data were obtained. Controls were propensity score weighted by age, sex, and Charlson Comorbidity index. Logistic regression models controlling for age and Charlson comorbidity indices were used to examine factors associated with survival., Results: Thirty patients admitted for sepsis with pre-existing PAH were compared to 96 matched controls. Controls received significantly more fluids at 24 h compared to PAH patients (median 0 mL v. 1216 mL, p < 0.001), while PAH patients were more likely to receive vasoactive medications (23.3% vs. 8.3%, p = 0.037). At 30 days, 7 PAH patients (23.3%) and 13 control patients (13.5%) had died (p = 0.376). PAH patients that received more fluids had decreased mortality (OR 0.31, 95% CI 0.11-0.92, p = 0.03) and patients who received fluids had shorter mean time to antibiotics (2.3 h v. 6.5 h, p = 0.04), although decreased time to antibiotics was not associated with mortality. Patients who received no fluids more often had previously identified right ventricular systolic dysfunction (62.5% v. 28.6%, p = 0.136)., Conclusion: Patients with PAH and sepsis have high mortality and receive different treatments than controls, with more reliance on vasopressors and less on fluid resuscitation. PAH patients who received less fluids had higher mortality and those who received no fluids had a longer time to receiving antibiotics, indicating a potential delay in recognizing sepsis. Timely recognition of sepsis and dynamic decision-making around fluid resuscitation remains critical in this high-risk population., (© 2024. The Author(s).)

Aim: Kidney biopsy (KB) is the gold standard procedure for diagnosing kidney diseases. Globally, nephrologists are trained to perform KB. However, the past few decades have witnessed a transition where interventional radiologists (IRs) are now preferentially performing the procedure. Our survey-based cross-sectional study aimed to investigate the current trends of KB operators in the Asia-Pacific region (APR) in practicing interventional nephrologists., Material and Methods: The Association of Vascular Access and intervenTionAl Renal Physicians (AVATAR) Foundation from India conducted a multinational online survey among interventional nephrologists from the APR to investigate who does KB, if the nephrology training curriculum includes KB, and whether nephrologists have access to ultrasound., Results: Out of 21 countries from the APR that participated in our survey, 10 countries (47.4%) reported that more than 70% of their nephrologists performed KB, whereas in 11 countries (57.6%), KB was most likely done by an IR. The frequency of nephrologists performing KB ranged from 0% in Afghanistan to 100% in countries such as Pakistan, Singapore, and Thailand. Formal training for KB and access to ultrasound was available to nephrologists in 80% of the responding countries., Conclusion: Our study shows that despite the availability of training and access to USG, a significant number of nephrologists are not performing KB in the APR. Similar to the trends observed in Western countries, the observed pattern in the APR could be due to lack of time, less incentive, hospital policy, or interest of nephrologists in other aspects of intervention nephrology.

Aim: This cross-sectional survey aimed to determine the prevalence of Interventional Nephrology (IN) practice amongst nephrologists in the Asia-Pacific Region (APR), specifically related to dialysis access (DA)., Methods: The Association of VA and intervenTionAl Renal physicians (AVATAR) Foundation from India conducted a multinational online survey amongst nephrologists from the Asia-Pacific to determine the practice of IN in the planning, creation, and management of dialysis access. The treatment modalities, manpower and equipment availability, monthly cost of treatment, specifics of dialysis access interventions, and challenges in the training and practice of IN by nephrologists were included in the survey., Results: Twenty-one countries from the APR participated in the survey. Nephrologists from 18 (85.7%) countries reported performing at least one of the basic dialysis access-related IN procedures, primarily the placement of non-tunnelled central catheters (n-TCC; 71.5%). Only 10 countries (47.6%) reported having an average of <4% of nephrologists performing any of the advanced IN access procedures, the most common being the placement of a peritoneal dialysis (PD) catheter (20%). Lack of formal training (57.14%), time (42.8%), incentive (38%), institutional support (38%), medico-legal protection (28.6%), and prohibitive cost (23.8%) were the main challenges to practice IN. The primary obstacles to implementing the IN training were a lack of funding and skilled personnel., Conclusion: The practice of dialysis access-related IN in APR is inadequate, mostly due to a lack of training, backup support, and economic constraints, whereas training in access-related IN is constrained by a lack of a skilled workforce and finances., (© 2023 Asian Pacific Society of Nephrology.)

Deceased donor kidney transplantation (DDKT) is common in high income Western countries with high transplantation rates. However, the utilization of deceased organs is suboptimal in Asia, due to a multitude of factors. Coherent policies are integral to the development of DDKT programs and deterrence of commercialization, but most are still at an infancy and formative stage in Asia. This review article identifies the glass ceiling effects of social, cultural, religious, political, and technical factors hampering the progress of DDKT in Asia. Additionally, it reviews the history of policy development in different countries and describes their idiosyncratic barriers and challenges. Lastly, it discusses innovative policy measures that can be undertaken to proliferate DDKT practice and curtail commercialization. The long-term ideal is to achieve regional equity and self-sufficiency, through a shared ethos of social and ethical responsibility that transcends and resonates with the different segments of the Asian community., Competing Interests: None of the authors declare any conflict of interest. This project did not receive any fundings., (© 2023 The Author(s).)

Background: Rifampin-resistant tuberculosis is a leading cause of morbidity worldwide; only one-third of persons start treatment, and outcomes are often inadequate. Several trials demonstrate 90% efficacy using an all-oral, 6-month regimen of bedaquiline, pretomanid, and linezolid (BPaL), but significant toxicity occurred using 1200-mg linezolid. After US Food and Drug Administration approval in 2019, some US clinicians rapidly implemented BPaL using an initial 600-mg linezolid dose adjusted by serum drug concentrations and clinical monitoring., Methods: Data from US patients treated with BPaL between 14 October 2019 and 30 April 2022 were compiled and analyzed by the BPaL Implementation Group (BIG), including baseline examination and laboratory, electrocardiographic, and clinical monitoring throughout treatment and follow-up. Linezolid dosing and clinical management was provider driven, and most patients had linezolid adjusted by therapeutic drug monitoring., Results: Of 70 patients starting BPaL, 2 changed to rifampin-based therapy, 68 (97.1%) completed BPaL, and 2 of the 68 (2.9%) experienced relapse after completion. Using an initial 600-mg linezolid dose daily adjusted by therapeutic drug monitoring and careful clinical and laboratory monitoring for adverse effects, supportive care, and expert consultation throughout BPaL treatment, 3 patients (4.4%) with hematologic toxicity and 4 (5.9%) with neurotoxicity required a change in linezolid dose or frequency. The median BPaL duration was 6 months., Conclusions: BPaL has transformed treatment for rifampin-resistant or intolerant tuberculosis. In this cohort, effective treatment required less than half the duration recommended in 2019 US guidelines for drug-resistant tuberculosis. Use of individualized linezolid dosing and monitoring likely enhanced safety and treatment completion. The BIG cohort demonstrates that early implementation of new tuberculosis treatments in the United States is feasible., Competing Interests: Potential conflicts of interest. C. A. H. reports honoraria from the Infectious Diseases Society of America for an IDWeek 2022 presentation, travel support from the University of Employer, and Pfizer stock ownership. M. C. S. reports grants from the National Institute of Minority Health and Health Disparities (R21MD017943-01; Neighborhood transportation vulnerability and geographic patterns of diabetes-related limb loss) and the American Diabetes Association (Diabetic Ulcer Computational Sensing System), paid to the institution, and payment from the Society for Advancement in Wound Care for speaking at the 2023 spring meeting. D. A. reports a grant from the Centers for Disease Control and Prevention (CDC) as the primary investigator of TB Centers of Excellence, travel support from the CDC, and participation in the CDC's Tuberculosis Trials Consortium data and safety monitoring board. L. C. reports grants from USAID (federal award to institution for global research capacity building) and the California Department of Public Health (training award to institution for pandemic response); an unpaid position as president of the Executive Leadership Board for the North American Region Union Against Tuberculosis and Lung Diseases; and an unpaid position on the coordinating board of STOP TB USA. M. B. D reports institutional contracts with the CDC and Westat. A. V. E. reports travel support for meetings from the CDC. K. A. R. reports grants and travel support from the CDC’s Division of TB Elimination and a position as the liaison for the National Association of County and City Health Officials to the Advisory Committee for the Elimination of Tuberculosis. M. C. R. reports travel support for meeting from Association of Public Health Laboratories (APHL) and positions as chair of the APHL Infectious Diseases Committee and member of the APHL Tuberculosis Subcommittee and the College of American Pathologists Microbiology Committee. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)