Abstract
Background and Aims
Currently, the dose of rituximab used in nephrology practice is mostly extrapolated from the dose used in lymphoproliferative disorders. It is possible that a lesser dose ...may suffice when treating a non-neoplastic disorder. We conducted this study to study the clinical response and CD19 B cell suppression with a single dose of 100mg rituximab in nephrology practice
Method
This was a single center prospective study of role of 100mg rituximab as initial dose in steroid dependent (SDNS), frequently relapsing nephrotic syndrome (FRNS), idiopathic membranous nephropathy (MN) and high immunologic risk kidney transplantation with subsequent doses based on CD19 B cell reconstitution.
Results
Following 100mg rituximab in 42 patients, CD19 B cell percentage decreased from 16.3+7.6 to 0.3±0.3, 1.9±1.7 and 4.0±4.5 by 30, 90 and 180 days respectively. At 30th day, 40(95.2%) had CD19 B cell count <1%. Of the 30 patients with SDNS and FRNS followed up for one year, 29(96.7%) went into remission at day 30. Remission was sustained in 23(76.6%) at day 180 and 21(70%) at 1 year. There was significant decrease P <0.001 in the dose of steroids needed to maintain remission at 180 days following rituximab (0.27±0.02mg/Kg to 0.02±0.00mg/Kg). Of the five patients with MN, four patients achieved remission by 6 months. Remission was sustained in three patients by 1 year. Of the 7 kidney transplant recipients, 2 had antibody mediated rejections though CD19 B cells were suppressed even at one year.
Conclusion
Low dose of 100 mg rituximab is sufficient to deplete CD19 B cells for up to 90days and is effective in inducing remission in SDNS and FRNS and MN. Targeting subsequent doses depending on CD19 B cell reconstitution may prevent relapses, limit toxicity and be cost effective.
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Abstract
Background and Aims
Leptospirosis is a common zoonotic disease and acute kidney injury(AKI) is very commonly associated with it, often seen as a marker of disease severity. Renal replacement ...therapy(RRT) is often required in patients with clinical indications like uremia, oliguria, pulmonary edema and hyperkalemia. The two classical modalities employed for RRT are hemodialysis and peritoneal dialysis. We designed this study to evaluate the clinical outcome among patients with leptospirosis associated AKI requiring dialysis.
Method:
Basic clinical and demographic parameters of our patients were studied. The dialysis modality for each patient was decided based on their predominant clinical presentation. The duration of dialysis dependency and hospitalization along with final clinical outcome in terms of renal recovery or death were recorded. Appropriate statistical methods were used for analysis of results
Results
Thirty two patients underwent renal replacement therapy for leptospirosis associated AKI. Among them 22 received hemodialysis and 10 received peritoneal dialysis. Mortality in our group was 12.5%. Multiorgan involvement, need for mechanical ventilation and oliguric AKI were observed to be predictors of mortality along with hyperbilirubinemia, hypoalbuminemia, hyperkalemia and elevated creatinine phosphokinase levels. Peritoneal dialysis was observed to be associated with a shorter duration of dialysis dependency and hospitalization, however no significant impact on mortality was noticed.
Conclusion
Leptospirosis is a disease of great epidemiological significance in our part of the county. Prompt initiation of RRT in indicated patients leads to an acceptable clinical outcome with good renal recovery. Peritoneal dialysis is slowly losing popularity, which may be revived with proper training of medical personnel and good patient selection.
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This systematic review and meta-analysis aimed to assess the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and mortality in patients with COVID-19.
Systematic literature ...search from several electronic databases were performed. The outcome was mortality (non-survivor) in patients with COVID-19 pneumonia. NT-proBNP data were in continuous variable (pg/mL), dichotomous data (elevated/non-elevated) and effect estimate adjusted to cardiac injury/elevated biomarkers of cardiac injury.
A total of 967 patients from six studies were included in this analysis. NT-proBNP was higher in non-survivor group (standardised mean difference 0.75 (0.44, 1.07), p<0.001; I
: 61%). Elevated NT-proBNP was associated with increased mortality (RR 3.63 (92.21, 5.95), p<0.001; I
: 60%). Sensitivity analysis by removing a study reduces heterogeneity (risk ratio 3.47 (2.36, 5.11), p<0.001; I
: 49%). Pooled adjusted HR (adjusted to cardiac injury/elevated biomarkers of cardiac injury) showed that elevated NT-proBNP was independently associated with mortality (HR 1.37 (1.19, 1.57), p<0.001; I
: 0%, p=0.77). Pooled analysis of multiple cut-off point resulted in a sensitivity of 76% (46%-92%) and specificity of 88% (71%-96%). Summary receiver operating characteristic curve analysis demonstrates an area under curve of 0.90 (0.87-0.93). Elevated NT-proBNP has a likelihood ratio (LR) +6.4 and LR -0.3.
Elevated NT-proBNP level was associated with increased mortality in COVID-19 pneumonia.
The corrosion behaviour of AZ91D magnesium alloy reinforced with 5-wt% of various Ultra High-Temperature Ceramics (UHTC) such as TaC, HfC, TiN, TiB2, and TiC has been analysed in this current ...research work. AZ91D magnesium alloy and proposed composites were fabricated through ultrasonic assisted squeeze casting process and followed by T6 heat treatment at different ageing temperatures (170, 200, 230, and 260 °C). As per ASTM standards, the fabricated composites were subjected to various analyses on density, porosity, microstructure, hardness, and corrosion behaviour. The distribution of reinforcements was revealed by the optical microscope and scanning electron microscope images of composites. The presence of primary phase (α-Mg), intermetallic phase (β-Mg17Al12) and reinforcements in the composites were confirmed in the XRD analysis. Because of high densification, lower grain size, and lesser porosity level, TaC and HfC particulate reinforced composites showed higher hardness (170.3 and 160.4 HV respectively) at 230 °C compared to other composites. The salt spray corrosion test (3.5 wt% NaCl) on composites with varying exposure times (24, 48, and 72 h) revealed that, due to the formation of a dense and stable anti-corrosion protective layer with reduced β-Mg17Al12 phase, TaC and HfC composites exhibited higher corrosion resistance up to 48 h and ageing temperature of 230 °C. The scanning electron microscope image of the corroded samples showed pits and crack formation at an exposure period of 72 h.
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•A novel ultrasonic assisted squeeze casting process was used for fabricating UHTC uhtc reinforced magnesium composites.•The optimized combinations of Ultrasonic assisted- Squeeze casting parameters, first in time considered for fabricating the composites.•Five different UHTC particulates (TaC, HfC, TiN, TiB2, and TiC) are chosen as reinforcements for fabricating and analyzing the corrosion behavior.•The influence of different parameters such as various ageing temperatures (170, 200, 230, and 260 °C) and different exposure times (24, 48, and 72 h) on the corrosion behavior of AZ91D/UHTC composites through salt spray corrosion tester at 3.5% NaCl concentration was analyzed.•He has the most robust relationship with Magnesium alloy and notable improvements were identified in density, porosity, hardne.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Objective:
To investigate the association between hypertension and outcome in patients with Coronavirus Disease 2019 (COVID-19) pneumonia.
Methods:
We performed a systematic literature search from ...several databases on studies that assess hypertension and outcome in COVID-19. Composite of poor outcome, comprising of mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care unit (ICU) care and disease progression were the outcomes of interest.
Results:
A total of 6560 patients were pooled from 30 studies. Hypertension was associated with increased composite poor outcome (risk ratio (RR) 2.11 (95% confidence interval (CI) 1.85, 2.40), p < 0.001; I2, 44%) and its sub-group, including mortality (RR 2.21 (1.74, 2.81), p < 0.001; I2, 66%), severe COVID-19 (RR 2.04 (1.69, 2.47), p < 0.001; I2 31%), ARDS (RR 1.64 (1.11, 2.43), p = 0.01; I2,0%, p = 0.35), ICU care (RR 2.11 (1.34, 3.33), p = 0.001; I2 18%, p = 0.30), and disease progression (RR 3.01 (1.51, 5.99), p = 0.002; I2 0%, p = 0.55). Meta-regression analysis showed that gender (p = 0.013) was a covariate that affects the association. The association was stronger in studies with a percentage of males < 55% compared to ⩾ 55% (RR 2.32 v. RR 1.79).
Conclusion:
Hypertension was associated with increased composite poor outcome, including mortality, severe COVID-19, ARDS, need for ICU care and disease progression in patients with COVID-19.
The purpose of this study was to determine the youth's perception of Majlis Dhikr in minimizing online Game addiction and to know the role of Majlis Dhikr in minimizing Online Games experienced by ...the youth of Dusun Patemon Pamekasan. This research uses a qualitative approach with the type of case study. The data sources in this study were community leaders and some residents of Patemon hamlet, West Dempo Village. Data collection procedures used are interviews, observation, and documentation. Data analysis was carried out by data reduction, data presentation, and drawing conclusions. Checking the validity of the data is done through continuous observation, peer checking, and triangulation. The results showed that (1) Youth Perceptions of Majliz Zikir in minimizing addiction to online games greatly appreciated and supported these religious activities so that they could reduce online game addiction (2) The activities of Majlis Zikir in minimizing online game addiction were quite influential, due to the activities The youth's playing time online is reduced in addition to providing insight into the negative impact of online gaming.
Abstract
Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM
Objectives
The role of Candida in sputum culture is unclear and is generally not treated when present in sputum samples. The ...objective of this study is to describe the clinical findings of patients with Candida spp. in sputum and their antifungal susceptibility pattern to know the local epidemiology of antifungal resistance.
Methods
Patients with respiratory symptoms attending the tertiary care hospital during the study period of 6 months from June 2021 to December 2021. A total of 23 sputum samples were processed in the microbiology laboratory. Samples were processed following conventional mycological procedures including direct microscopy (visualization of budding yeast cell on grams stain), growth on sabouraud dextrose agar, Germ tube test, and CHROMagar. The isolates were identified by rapid identification (ID) of yeast and yeast-like organisms in the BD PhoenixTM Automated Microbiology System.
Antifungal Susceptibility Testing (AFST) was carried out by disk diffusion susceptibility testing, Zone interpretation criteria as per M44/A2 protocol of CLSI were used. Antifungal used were amphotericin B (20 mcg), itraconazole (10 mcg), fluconazole (25 mcg), and voriconazole (1 mcg). Results of tests done on 23 isolates were collated and analyzed retrospectively.
Clinical profile of the patients was taken retrospectively from record section and analyzed.
Results
Of the 23 patients, most common presentation was fever followed by cough and dyspnea. A total of 34% patients were receiving some form of steroid (injectable or inhalational). Only 2 patients were COVID positive by RT-PCR and 7(30%) patients had some radiological findings like consolidation, emphysematous changes, etc. Immunodeficiency condition was seen in 4 (17%) patients like tuberculosis and diabetes mellitus.
Of the 23 samples, C. albicans showed prevalence of 91% as compared with C. tropicalis (5%) and C. glabrata (4.8%). AFST showed Candida spp. was found to be mostly sensitive to voriconazole and fluconazole. Resistance to amphotericin B was seen in most Candida spp. Itraconazole was not susceptible to even one isolate only 4 samples were intermediate (Fig. 1).
Conclusions
Infections with Candida spp. are usually of low virulence and are associated with a few well-defined risk factors as immunocompromised state, malignancy, and steroid therapy. Understanding these risk factors, identifying the species with changing trends in antifungal resistance, instituting infection control practices to reduce morbidity and mortality in critical care areas can improve outcomes.
Surveillance of the rates of Candida infection in critical areas, reporting of outbreaks and continuous monitoring of antifungal susceptibility patterns will help in choosing the best therapeutic management of complicated cases. Comparison of trends in infection rates amongst hospitals between various Indian cities and their resistance patterns can reveal vital information regarding the breakdown of infection control measures. Most Candida infections are of low virulence and only become significant in the vulnerable critical care areas. With the rise in prevalence of inherently azole-resistant species and rising use of echinocandins in ICUs, identifying risk factors and controlling the infection early can improve patient outcomes.
This study aimed to examine the psychometric properties of the Brief Sensation-seeking Scale (BSSS, Hoyle et al., 2002) in an Indonesian sample. A set of questionnaires consisting of an adaptation of ...the BSSS, Ten Item Personality Inventory (TIPI)-Indonesia, and a risky driving behavior scale were administered to 360 participants with an average age of 25.23 years. The reliability test using the internal consistency method showed high reliability (α=0.79). CFA analysis shows that the factor structure of the 4-factor BSSS-Indonesia model is more fit to the data than the 1-factor model. Construct validity was also found from the results of the correlation analysis of the BSSS-I score with the personality traits of openness to experience (convergent), agreeableness, and conscientiousness (discriminant). Regarding demographics, it was found that there were differences in the average scores between both sexes and age groups. The BSSS-I score was also found to be a significant predictor of risky driving behavior (concurrent validity). Taken together, the findings of this study show satisfactory evidence of psychometric properties, in line with previous adaptation of BSSS in several other cultures. This indicates that the BSSS-I is a sound instrument to measure trait sensation-seeking in the Indonesian population.
In this study, magnesium alloy (AZ91D) matrix composites reinforced with 1 wt% of nano alumina (n-Al2O3) were fabricated using novel Ultrasonic Treatment (UST) assisted squeeze casting method. UST ...was carried out at four different levels of ultrasonic power namely, 0 W (without UST), 1500 W, 2000 W and 2500 W at constant frequency and time. The composites were heat-treated at T6 condition under argon gas protected environment. Microstructural analysis was done using optical microscopy and high-resolution scanning electron microscopy. Physical, mechanical and tribological properties of the composites were evaluated. A significant refinement in grain structure and improvement in porosity was seen on an increase in UST power. Improvement was seen in micro-hardness, yield strength, ultimate tensile strength and % of elongation of the composite fabricated at 2500 W by 18%, 48%, 28%, and 10% respectively compared to an untreated composite. The composite fabricated at 2500 W showed less wear rate and coefficient of friction when compared to other composites at all sliding conditions. Scanning electron microscope images of the worn surface of the composite pins revealed that the wear mechanisms dominated were abrasion, adhesion, oxidation and delamination.
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