Impact of single centre kidney-exchange transplantation to increase living donor pool in India: A cohort study involving non-anonymous allocation.

AIM: In India, 85% of organ donations are from living donors and 15% are from deceased donors. One-third of living donors were rejected because of ABO or HLA incompatibility. Kidney exchange transplantation (KET) is a cost-effective and legal strategy to increase living donor kidney transplantation (LDKT) by 25%-35%. METHODS: We report our experience with 539 KET cases and the evolution of a single-centre program to increase the use of LDKT. RESULTS: Between January 2000 and 13 March, 2024, 1382 deceased donor kidney transplantations and 5346 LDKT were performed at our centre, including 10% (n = 539) from KET. Of the 539 KET, 80.9% (n = 436) were ABO incompatible pairs, 11.1% (n = 60) were compatible pairs, and 8% (n = 43) were sensitized pairs. There were 75% 2-way (n = 2 × 202 = 404), 16.2% 3-way (n = 3 × 29 = 87), 3% 4-way (n = 4 × 4 = 16), 1.8% 5-way (n = 5 × 2 = 10), 2.2% 6-way (n = 6 × 2 = 12), and 1.8% 10-way KET (n = 10 × 1 = 10). Of the recipients 81.2% (n = 438) were male and 18.8% (n = 101) were female, while of the donors, 78.5% (n = 423) were female and 21.5% (n = 116) were male. All donors were near relatives; wives (54%, n = 291) and mothers (20%, n = 108) were the most common donors. At a median follow-up of 8.2 years, patient survival, death censored graft survival, acute rejection, and median serum creatinine levels of functioning grafts were 81.63% (n = 440), 91% (n = 494), 9.8% (n = 53) and 1.3 mg/dL respectively. We credited the success to maintaining a registry of incompatible pairs, high-volume LDKT programs, non-anonymous allocation and teamwork. CONCLUSION: This is the largest single-centre KET program in Asia. We report the challenges and solutions to replicate our success in other KET programs.

Benefits and risks of complete denture therapy in fully edentulous Indian patients.

The perceptions of the patients regarding the benefits and risk of complete denture treatment in completely edentulous patients are of interest. The study composed of 79 participants who presented themselves for complete denture therapy. The perception of the participants towards the complete denture therapy was recorded using a validated questionnaire. The answers of the questionnaire were evaluated in three domains: (1) Benefits (positive perception) of the complete denture therapy' (2) Risks (Negative perception) of the complete denture therapy and (3) Consequences of no treatment. The data were tabulated for descriptive analysis. The average age of the total population was 62.22 ranging from 58 to 80 years. Total population included in the study shows positive perception regarding the complete denture therapy. The benefits of the complete denture therapy show highest score (1817) by all the participants while the risks of the complete denture therapy show lowest score (237). The gender, denture experience and the socioeconomic status had no influence on the perception towards the complete denture therapy. Participants showed positive perception towards the complete denture therapy with highest score in benefits and lowest score for the risks of the complete denture therapy. The perception of the complete denture therapy was not influenced by the gender, denture experience and the socioeconomic status.

Comparative Evaluation of the Effect of Microwave, 1% Sodium Hypochlorite, and Sodium Perborate Disinfection on the Color Stability of Two Nanoparticle-Reinforced Heat-Polymerized PMMA Denture Base Resins: An In Vitro Study.

Introduction Older adults experience significant improvement in their quality of life by using removable prosthetics to replace missing teeth. Poly(methyl methacrylate) (PMMA) has become the most popular material for denture bases due to its ease of use and affordability. Recently, scientists have started adding nanoparticles like titanium dioxide (TiO2) and zirconium oxide (ZrO2) to PMMA to enhance its physical properties. These resins with nanoparticles need to stay the same color after being disinfected in different ways if they are going to be used for a long time. So, the purpose of this investigation was to assess whether or not there exists any difference between two kinds of thermally cured acrylic resin for artificial tooth bases strengthened with nanoparticles when subjected to various chemical sterilizers alongside microwave irradiation, as well as determine their comparative colorfastness levels.  Materials and methods In this lab experiment, we tested how well 5% TiO2 and 7% ZrO2 nanoparticle-reinforced PMMA resins held their color when exposed to microwave irradiation, 1% sodium hypochlorite, or sodium perborate disinfection. We made 120 specimens shaped like discs; half were treated using one method, while the other half were treated using a different method. Color was measured at baseline (T0), after one cycle (T1), after five cycles (T2), and after six months (T3) using a reflectance spectrophotometer, which calculates the color difference (∆E). Results All three methods of disinfection caused significant color changes (p<0.001); however, sodium perborate caused the least amount of change, followed by 1% sodium hypochlorite and microwave irradiation. The mean ∆E values showed that after one day, there was a change in color by 1.1 due to microwave disinfection, which increased to 5.7 after five days; on the other hand, for 1% sodium hypochlorite, the change was recorded as 0.7 after one month and 1.6 after three months and finally reached up to 2.6 after six months, while sodium perborate showed the least amount of change, with ∆E values recorded as 0.2 after one month, 0.5 after three months, and 0.8 after six months. Conclusion Sodium perborate proved to be the most effective disinfectant for maintaining color stability in 5% TiO2 and 7% ZrO2 nanoparticle-reinforced PMMA resins, thus making it ideal for routine disinfection. Therefore, according to this study, sodium perborate should be used as a disinfection method because it results in minimal color change in nanoparticle-reinforced PMMA dentures.

A Comparative Analysis of Chikungunya in Kidney Transplant Recipients Compared With the General Population: A Multicenter, Retrospective, Cohort Study From India.

OBJECTIVES: Chikungunya is an arboviral illness, with patients presenting with fever, arthralgias, and myalgias. Outbreaks have occurred in tropical regions, and the virus is now endemic to many tropics, including South Asia, with India contributing a large part of the global burden. The presentation and long-term effects on transplant recipients are largely unknown. MATERIALS AND METHODS: In this retrospective analytical study, we compared chikungunya infection in 44 kidney transplant recipients from multiple centers in India and 34 patients from the general population. Data were collected from medical records and patient recall. RESULTS: Differences in presentation were remarkable between the 2 groups, with significantly lower incidence of musculoskeletal symptoms on presentation in transplant recipients compared with the general population. The incidence of acute graft dysfunction was 17.08% in transplant recipients, with return to baseline at the end of 1 month. Acute symptomatology resolved in transplant recipients within 1 month, and insignificant chronic symptoms were reported after 3 months. CONCLUSIONS: Chikungunya in kidney transplant recipients is markedly different from that of the general population, with significantly lower incidence of musculoskeletal symptoms such as arthralgias. The infection caused acute graft dysfunction, but no long-term sequelae were shown at the end of 1 year.

A Real-World Perspective of Co-amoxiclav Prescription Pattern With Probiotics for Pediatric Patients With Respiratory Tract Infections: Results of Quantitative and Qualitative Approach in Indian Outpatient Settings.

BACKGROUND: Probiotics are co-prescribed with co-amoxiclav to prevent antibiotic-associated diarrhea (AAD). The study assesses the co-prescription pattern of probiotics with co-amoxiclav in pediatric patients with respiratory tract infections (RTIs). METHODS: This was a mixed methods research study with a retrospective study and a prospective survey. The retrospective part included a multicenter, observational, real-world study utilizing patients' electronic medical records for three years (2018-2020) from seven outpatient pediatric clinics and hospitals. The qualitative evaluation was performed with a predefined questionnaire. RESULTS: The patients having RTIs (N=984) were prescribed Clamp® (46.7%), CAA (23.8%), and CAM (29.5%). The mean age of the patients was 4.05 years, with 59.25% males and most patients having upper RTIs. Co-amoxiclav was prescribed twice daily for one to 15 days. A significantly lesser number of probiotic co-prescriptions were observed with Clamp® (19.57%) than with CAA (38.46%) and CAM (29.31%) at baseline (p<0.001). Similar findings were observed for follow-up visits one and two. Saccharomyces boulardii, Bacillus clausii,and lactic acid bacillus were the most commonly co-prescribed probiotics. The qualitative evaluation indicated that most clinicians were aware of the co-amoxiclav-related gastrointestinal side effects and the benefits of probiotics in preventing them. CONCLUSION: The frequency of co-prescriptions of probiotics with Clamp® among pediatric patients with RTIs was significantly less, potentially indicating better gastrointestinal tolerability.

Simultaneous determination of atorvastatin calcium, ezetimibe, and fenofibrate in a tablet formulation by HPLC.

An accurate, simple, reproducible, and sensitive HPLC method was developed and validated for the simultaneous determination of atorvastatin calcium, ezetimibe, and fenofibrate in a tablet formulation. The analyses were performed on an RP C18 column, 150 x 4.60 mm id, 5 pm particle size. The mobile phase methanol-acetonitrile-water (76 + 13 + 11, v/v/v), was pumped at a constant flow rate of 1 mL/min. UV detection was performed at 253 nm. Retention times of atorvastatin calcium, ezetimibe, and fenofibrate were found to be 2.25, 3.68, and 6.41 min, respectively. The method was validated in terms of linearity, precision, accuracy, LOD, LOQ, and robustness. The response was linear in the range 2-10 microg/mL (r2 = 0.998) for atorvastatin calcium, 2-10 microg/mL (r2 = 0.998) for ezetimibe, and 40-120 microg/mL (r2 = 0.998) for fenofibrate. The developed method can be used for routine quality analysis of the drugs in the tablet formulation.

Foreign body in tracheobronchial tree.

Foreign body inhalation into the tracheobronchial tree can prove to be a life threatening unless timely intervened and appropriate steps are being taken towards its management [1]. A review of 32 cases was done at MP Shah Medical College Jamnagar over a period of 2 years. Children were most susceptible to aspiration of foreign bodies. All the cases were selected on the basis of detailed clinical history, clinical features, and radiological findings. The cases which had a strong index of suspicion without any positive clinical history were also subjected to rigid bronchoscopy under general anesthesia. Maximum number of cases was in the age group of 1 to 3 years (62.5%). The minimum age group ranging from 6 months to maximum 8 years. The time of presentation of the patients varied from within 24 hours to upto 6 months. Only four patients presented within 24 hours. The maximum presenting period was within 1 week. Organic foreign bodies were most common presentation (groundnut). Other foreign bodies were grains, seeds, ball pen cap, stones and slate pencil. Definite history of inhalation was available only in 19 cases with symptoms of choking, breathlessness, cough and recurrent upper respiratory tract infection. Right main bronchus was found to be most common site of impaction (52%) followed by left main bronchus (32%) and tracheal foreign body (16%).