Varicella zoster virus and cytomegalovirus coinfection in a live related kidney transplant recipient: A case report.

Key Clinical Message: The immunomodulatory effect of CMV makes coinfection with other microbes, like VZV possible and potentially deadlier in the post kidney transplant period. Treatment should be started promptly. Both infections can be treated with Valganciclovir. Abstract: Infections are common complications in kidney transplant recipients owing to the lifelong immunosuppression. Cytomegalovirus (CMV) and Varicella Zoster Virus (VZV) infections are quite common in the posttransplant period. Coinfection with both however has been reported only once. The immunomodulatory effect of CMV makes their interaction with other organisms like VZV potentially sinister. This is a case of a young woman who developed coinfection with HZV and CMV in the first month following a live related kidney transplantation from her mother. Transplant surgery went well with good urine output, but serum creatinine did not fall below 1.7 mg/dL. Immunosuppression consisted of intravenous (IV), followed by oral prednisolone, Mycophenolate Sodium (MPS) and Tacrolimus. 25 days after an uneventful surgery, she developed fever, followed by pain and vesicular eruption on the forehead, typical of VZV infection, along with rising creatinine. CMV PCR yielded 300 copies/mL of DNA, which was undetectable in both donor and recipient pre-transplant. Total white blood cell count fell to 2 × 109/L. MPS was temporarily stopped. Treatment with Valgancyclovir led to resolution of fever, skin lesions and brought serum creatinine down to baseline over 2 weeks.

Staging and Management of Cervical Cancer at the Colposcopy Clinic of Bangabandhu Sheikh Sheikh Mujib Medical University (BSMMU), Bangladesh.

Anjuman SultanaCervical cancer (CC) ranks as the second most common cancer among women in Bangladesh. Unfortunately, due to late-stage diagnosis and inadequate treatment facilities, the mortality rate remains high. The stage at which CC is diagnosed plays a crucial role in predicting a woman's survival. This study aimed to determine the staging patterns of CC at presentation in the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) and the subsequent management provided to these women. This retrospective study was conducted at the BSMMU colposcopy clinic from January 2019 to June 2020. It included CC cases with known staging, spanning from January 2016 to June 2019. Data were collected from the colposcopy registry book, telephone interviews, and face-to-face discussions during follow-up appointments. The mean age of women diagnosed with CC was 48.59 years (±2 standard deviations). Among the 523 women studied, 107 (20.5%) were diagnosed at stage I, 124 (23.7%) at stage IIA, 240 (45.9%) at stage IIB, while the remaining 52 (9.90%) were diagnosed with Stage III and IV disease. Within the study population, 39 (7.5%) women underwent radical hysterectomy alone, 110 (21.00%) underwent radical hysterectomy followed by adjuvant therapy, and 184 (35.14%) received primary radiotherapy or concurrent chemoradiation. A significant portion of CC cases presented at an early stage, underscoring the importance of an effective screening program to prevent advanced-stage disease and enhance early detection rates. Establishing a patient navigation system immediately after diagnosis is crucial to prevent the loss of follow-up and ensure timely treatment. It is imperative to enhance the healthcare system's capacity to ensure timely treatment for cancer patients.

Chronic Kidney Disease Awareness Campaign and Mobile Health Education to Improve Knowledge, Quality of Life, and Motivation for a Healthy Lifestyle Among Patients With Chronic Kidney Disease in Bangladesh: Randomized Controlled Trial.

BACKGROUND: Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. OBJECTIVE: This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. METHODS: This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. RESULTS: The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group × time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group × time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group × time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01). CONCLUSIONS: The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/30191.

Protein Energy Wasting in a Cohort of Maintenance Hemodialysis Patients in Dhaka, Bangladesh.

Malnutrition is associated with high rates of mortality among patients with end stage kidney disease (ESKD). There is a paucity of data from Bangladesh, where around 35,000−40,000 people reach ESKD annually. We assessed protein-energy wasting (PEW) amongst 133 patients at a single hemodialysis setting in Dhaka. Patients were 49% male, age 50 ± 13 years, 62% were on twice-weekly hemodialysis. Anthropometric, biochemical, and laboratory evaluations revealed: BMI 24.1 ± 5.2 kg/m2, mid-arm muscle circumference (MAMC) 21.6 ± 3.6 cm, and serum albumin 3.7 ± 0.6 g/dL. Based on published criteria, 18% patients had PEW and for these patients, BMI (19.8 ± 2.4 vs. 25.2 ± 5.2 kg/m2), MAMC (19.4 ± 2.4 vs. 22.2 ± 3.8 cm), serum albumin (3.5 ± 0.7 vs. 3.8 ± 0.5 g/dL), and total cholesterol (135 ± 34 vs. 159 ± 40 mg/dL), were significantly lower as compared to non-PEW patients, while hand grip strength was similar (19.5 ± 7.6 vs. 19.7 ± 7.3 kg). Inflammatory C-reactive protein levels tended to be higher in the PEW group (20.0 ± 34.8 vs. 10.0 ± 13.9 p = 0.065). Lipoprotein analyses revealed PEW patients had significantly lower low density lipoprotein cholesterol (71 ± 29 vs. 88 ± 31 mg/dL, p < 0.05) and plasma triglyceride (132 ± 51 vs. 189 ± 103 mg/dL, p < 0.05), while high density lipoprotein cholesterol was similar. Nutritional assessments using a single 24 h recall were possible from 115 of the patients, but only 66 of these were acceptable reporters. Amongst these, while no major differences were noted between PEW and non-PEW patients, the majority of patients did not meet dietary recommendations for energy, protein, fiber, and several micronutrients (in some cases intakes were 60−90% below recommendations). Malnutrition Inflammation Scores were significantly higher in PEW patients (7.6 ± 3.1 vs. 5.3 ± 2.7 p < 0.004). No discernible differences were apparent in measured parameters between patients on twice- vs. thrice-weekly dialysis. Data from a larger cohort are needed prior to establishing patient-management guidelines for PEW in this population.

Transplantation in Asia during the coronavirus disease-19 (COVID-19) pandemic: briefs from member countries of the Asian Society of Transplantation.

The coronavirus disease-19 (COVID-19) pandemic has affected 1,029,968 people in Asia as of May 16, 2020. Although Asia was the first continent to be affected, many countries in the region continue to battle COVID-19, which challenges the way transplant programs provide their services. Given the diversity of healthcare systems in Asia, the countermeasures in response to COVID-19 are as potentially diverse. This review reports the experiences of transplant services in member countries of the Asian Society of Transplantation (AST) as well as provides a platform for sharing of best practices during the COVID-19 pandemic. AST invited member countries to provide a short description of their transplant experiences during the COVID-19 pandemic. Whenever information is available, countries were asked to provide information on COVID-19 related statistics, status of transplant programs, mitigation measures taken to prevent COVID-19, and other areas of transplant programs impacted by COVID-19. Ten countries responded to the invitation of which seven still have active transplant programs at varying levels of activity. All countries have protocols for donor/recipient screening and countermeasures to prevent COVID-19 infections in recipients and healthcare providers. Interestingly, these countries report only 16 transplant recipients with COVID-19 infection but no cases of donor-transmitted COVID-19 infection. Despite the diversity of healthcare systems in Asia, transplant centers in Asia have taken appropriate precautions to avoid COVID-19 infections, though the long-term impact of COVID-19 remains unclear.

The role of the Kidney Foundation of Bangladesh in promoting kidney care in a resource-limited environment.

BACKGROUND: Prior to 2003 in Bangladesh, ~ 80% of kidney-failure patients could not afford treatment. The Kidney Foundation Bangladesh (KFB) was formed in 2003 with an aim to create awareness, to promote prevention of kidney disease to families and population, at risk as well as offer treatment to those afflicted with kidney failure. METHODS: KFB runs a 150-bed hospital for treatment of kidney disease, dialysis, and transplantation at an affordable price. New patients visiting the OPD pay only US$ 5.00 to consult a specialist, and dialysis and transplant patients pay US$1 for each consultation. All laboratory tests are discounted by 30% for all patients except patients with dialysis and transplantation who enjoy a 50% discount. Patients on HD pay only US$ 20.00 per session, and a renal transplant surgery costs US$ 3,000.00. RESULTS: From October 2004 to December 2014, there were 102,578 patients who received treatment in OPD in KFB at an affordable price. Similarly, more than 40,000 people per year benefited from various laboratory tests. A total of 11,099 patients were admitted in KFB hospital from January 2010 to December 2014. Of them, 2,409 (22%) were diagnosed as ESRD, and all of them were initially managed with dialysis either through a noncuffed catheter (82%) or by an AV fistula (8%); of the 388 continued on HD, 300 underwent transplantation, 289 agreed to shift to CAPD treatment, and rest of the patients were shifted to other HD centers. Simultaneously, a total of 3,600 patients were screened in rural, urban, and disadvantaged populations from 2004 to 2007 for detection of CKD. CONCLUSION: KFB is offering treatment for patients with kidney disease and kidney failure, not only at an affordable price, but also without compromising quality.

Rhino-orbital mucourmycosis in a non-immunocompromised patient.

Mucormycosis, also known as phycomycosis or zygomycosis, is caused by common Zygomycete fungi frequently found in soil and decaying vegetation. These mainly infect immunocompromised patients and cause an acute fulminating fungal disease; mucormycosis rarely affects otherwise healthy people. Mucormycosis is a fatal infection with a poor prognosis. Of the different types of mucormycosis, the rhinocerebral type is the most severe one, and its type 2 subtype, the rhino-orbital-cerebral form is the deadliest variety. Here, we report a case of mucormycosis presenting with extensive necrosis of the maxilla with extension into the retrobulbar and infrabulbar region in an otherwise healthy patient. He underwent extensive debriding surgery followed by amphotericin B first and then oral antifungal therapy, but unfortunately, even after extensive surgery and medical treatment, he did not survive.