Abstract Background Though the use of Hepatitis B viremic (HBV) donor kidneys may be a safe alternative to improve access to transplantation, there has not been wide acceptance of this practice. In this study, we determined the safety and effectiveness of HBV NAT (+) donor kidneys in a protocolized manner in an older adult population. Methods Over a 3‐year period, 16 decreased donor kidney transplants were performed with HBV NAT+ kidneys. Recipients of HBV NAT+ kidneys were treated with entecavir started pre‐operatively and continued for 52 weeks. Results HBV NAT+ kidneys were preferentially used in older (68 ± 5 vs. 64 ± 9 years; p = .01) recipients with less dialysis time (93.8% < 5 years vs. 67% <5 years; p = .03). In this cohort, 3/16 had detectable HBV PCR 1‐week post‐transplant, but all were negative at 9‐ and 12‐months. Calculated estimated glomerular filtration rate (eGFR) was slightly decreased 12‐months post‐transplant. Post‐transplant outcomes in an age‐matched cohort showed no difference in rates of delayed graft function, readmission within 30 days, and graft loss or death within 6 months of transplant ( p > .05). Conclusion Transplants with HBV NAT+ donor kidneys in a pre‐emptive treatment protocol allow for increased safe access to transplantation in older adult recipients with little or no dialysis time. image
Ebola virus is the single member of the species Zaire Ebola virus, which is the type species for the genus Ebola virus, family Filoviridae, order Mononegavirales.The natural reservoir of Ebola virus is believed to be bats, particularly fruit bats, and it is primarily transmitted between humans and from animals to humans through body fluids.The Ebola virus has a high mortality rate, with a current case fatality rate estimated to be around 50%.Mortality rates for previous outbreaks have varied from 25% to 90%, and those outbreaks have been relatively short-lived (WHO, 2014) seen near the tropical rainforests of remote villages in Central and West Africa.It is spread by close contact with patients or exposure to infected biologic fluids.The virus has been found in the blood, saliva, feces, breast milk, tears, and genital secretions of infected patients.Ebola virus causes significant immune suppression and a systemic inflammatory response, leading to multi organ failure and shock.No particular anti-viral therapy has demonstrated effectiveness in Ebola virus infection.Also, no vaccine for use in humans is yet approved by the regulatory bodies.No particular anti-viral therapy has demonstrated effectiveness in Ebola virus infection.Also, no vaccine for use in humans is yet approved by the regulatory bodies.The chief drug that is used in the symptomatic treatment of Ebola virus are: Belladona, Aconite, Bryonia.
Cytomegalovirus (CMV) and BK Polyomavirus (BKPyV) are the most common opportunistic pathogens following kidney transplantation. We evaluated 102 patients with a median age of 63 at Edward Hines VA Hospital from November 2020 to December 2022. Our primary interest was the incidence of CMV and BKPyV infections, as well as CMV and BKPyV coinfection. Secondary interests included time to infection, rejection, and graft and patient survival. There were no statistically significant differences in patient age, donor age, race, transplant type, incidence of delayed graft function, or induction in both cohorts (any infection (N = 46) vs. those without (N = 56)). There was a 36% (37/102) incidence of CMV, a 17.6% (18/102) of BKPyV and an 8.8% (9/102) incidence of coinfection. There was a decreased incidence of CMV infection in Basiliximab induction versus antithymocyte globulin (21% and 43%). CMV risk status had no effect on the incidence of CMV infection following transplant. African American recipients had a lower incidence of BKPyV infection (12% vs. 39%), yet a higher incidence was observed in those with high cPRA (50% vs. 14%). Most CMV and/or BKPyV infections occurred within the first six months post-transplant (54%). Immunosuppression management of the elderly should continually be evaluated to reduce opportunistic infections post-transplant.
Ischemic stroke has been illustrated to be an intermittent, life-endangering, complexity of COVID-19, affecting approximately 1–3% of admitted patients, and up to 6% of those in the intensive care units. Neuro-radiological abnormalities demonstrate the involvement of large vessels, multiple vascular territory infarction, small vessels, and vertebrobasilar territory occlusion. Studies speculate that cytokine storm-activated hypercoagulable condition, endotheliopathy, cardiac embolism, arterial dissection, and vasculitis-like mechanism may lead to its occurrence. Although the pathogenesis of stroke following a COVID-19 infection is multifarious and incompletely understood, however current evidence indicates crucial involvement of collective effects of virus-associated factors, medical condition of the host, and virus-host interactions. Amongst the hospital-admitted patients with COVID-19 infection, both prophylactic, as well as therapeutic anticoagulants, are capable of improvising hospital mortality rates and prognosis. In this chapter, we summarize the current knowledge on epidemiology, clinical manifestations, and pathophysiology of ischemic stroke in patients with COVID-19. We also aim to discuss the recent advancements and challenges for its diagnosis and rational management.
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