Rituximab treatment in resistant lupus nephritis: A single-center prospective study.

BACKGROUND: Lupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus (SLE) and failure to respond to traditional immunosuppression increases morbidity and mortality. Rituximab has been considered a novel therapeutic option for the management of SLE. MATERIALS AND METHODS: We conducted a single-center, prospective, observational study from July 2018 to June 2019 to evaluate the effectiveness of rituximab in patients with resistant LN. Resistant LN was defined as the failure to respond to conventional immunosuppressive therapy including both cyclophosphamide and mycophenolate mofetil. All adult patients (> 18 years) with biopsy-proven class III/IV LN were included in the study. Four doses of intravenous rituximab (375 mg/m2) on 0, 1, 2, 3 weeks were administered. Patients were followed for 6 months, and the rates of complete renal response (CRR), partial renal response (PRR), or no renal response (NRR) were measured. The change in baseline 24-hour urine protein, mean serum creatinine levels, and mean serum CD-19 levels at 24 weeks were also measured. RESULTS: Six months after rituximab therapy, total sustained renal response (CRR+PRR) was observed in 52% cases of resistant LN (CRR was achieved in 24% of patients and PRR in 28%, respectively). Rituximab was associated with a significant decline in the 24-hour urine protein, even in non-responders. However, the improvement in eGFR and serum creatinine was not statistically significant. The mean absolute CD-19 count was significantly low in responders compared to the non-responder group. CONCLUSION: Rituximab is a safe and effective therapeutic strategy for patients with resistant LN.

Characteristics, maternal and neonatal outcomes of acute kidney injury in preeclampsia: A prospective, single-center study.

BACKGROUND: Preeclampsia is an important cause of pregnancy-related acute kidney injury (AKI). The objective of our study was to determine the incidence, characteristics, and maternal and neonatal outcomes of AKI in pregnant women with preeclampsia. MATERIALS AND METHODS: A prospective, observational, single-center study from January 2019 to January 2020. Patients admitted with preeclampsia were included. Patients with obstetric complications were excluded. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. RESULTS: Total number of patients with preeclampsia was 104, out of which 25% developed AKI. Among those with AKI, nulliparity (61.5%) was the most common risk factor for preeclampsia followed by prior history of preeclampsia (15.4%), pregestational hypertension (11.5%), pregestational diabetes mellitus (3.8%), and chronic kidney disease (3.8%). There was no significant difference in maternal mortality between those with AKI (15.4%) and without AKI (7.7%). Intermittent hemodialysis was needed in 15.4%. At the end of 90 days follow-up, complete recovery of renal function occurred in 53.8%, partial recovery in 23.1% and end-stage kidney disease (ESKD) in 7.7%. Perinatal death occurred in 26.9%, preterm birth in 23.1% and stillbirth in 7.7% of those with AKI and was not significantly different from those without AKI. The mean of birth weight in newborns delivered by patients with AKI (2.53 ± 0.73 kg) was significantly lower compared to those without AKI (2.82 ± 0.58 kg). CONCLUSION: AKI was associated with a lower mean birth weight of newborns. Complete recovery of renal function was seen in 53.8% of patients with AKI and preeclampsia.

Severe respiratory failure following ventriculopleural shunt.

Cerebrospinal fluid (CSF) diversion procedure has been used for long to treat hydrocephalus in children. The principle of shunting is to establish a communication between the CSF and a drainage cavity (peritoneum, right atrium, and pleura). Ventriculoperitoneal shunt is used most commonly, followed secondly by ventriculopleural shunt (VPLS). Hydrothorax due to excessive CSF accumulation is a rare complication following both the type of shunts and is more frequently seen with VPLS. We report a case of a 6-year-old female child presenting with massive CSF hydrothorax with respiratory failure following VPLS. The aim of the article is to highlight early recognition of this rare and life-threatening condition, which could easily be missed if proper history is not available.

MOB-CBAM: A dual-channel attention-based deep learning generalizable model for breast cancer molecular subtypes prediction using mammograms.

BACKGROUND AND OBJECTIVE: Deep Learning models have emerged as a significant tool in generating efficient solutions for complex problems including cancer detection, as they can analyze large amounts of data with high efficiency and performance. Recent medical studies highlight the significance of molecular subtype detection in breast cancer, aiding the development of personalized treatment plans as different subtypes of cancer respond better to different therapies. METHODS: In this work, we propose a novel lightweight dual-channel attention-based deep learning model MOB-CBAM that utilizes the backbone of MobileNet-V3 architecture with a Convolutional Block Attention Module to make highly accurate and precise predictions about breast cancer. We used the CMMD mammogram dataset to evaluate the proposed model in our study. Nine distinct data subsets were created from the original dataset to perform coarse and fine-grained predictions, enabling it to identify masses, calcifications, benign, malignant tumors and molecular subtypes of cancer, including Luminal A, Luminal B, HER-2 Positive, and Triple Negative. The pipeline incorporates several image pre-processing techniques, including filtering, enhancement, and normalization, for enhancing the model's generalization ability. RESULTS: While identifying benign versus malignant tumors, i.e., coarse-grained classification, the MOB-CBAM model produced exceptional results with 99 % accuracy, precision, recall, and F1-score values of 0.99 and MCC of 0.98. In terms of fine-grained classification, the MOB-CBAM model has proven to be highly efficient in accurately identifying mass with (benign/malignant) and calcification with (benign/malignant) classification tasks with an impressive accuracy rate of 98 %. We have also cross-validated the efficiency of the proposed MOB-CBAM deep learning architecture on two datasets: MIAS and CBIS-DDSM. On the MIAS dataset, an accuracy of 97 % was reported for the task of classifying benign, malignant, and normal images, while on the CBIS-DDSM dataset, an accuracy of 98 % was achieved for the classification of mass with either benign or malignant, and calcification with benign and malignant tumors. CONCLUSION: This study presents lightweight MOB-CBAM, a novel deep learning framework, to address breast cancer diagnosis and subtype prediction. The model's innovative incorporation of the CBAM enhances precise predictions. The extensive evaluation of the CMMD dataset and cross-validation on other datasets affirm the model's efficacy.

Mastering Femtosecond Stimulated Raman Spectroscopy: A Practical Guide.

Femtosecond stimulated Raman spectroscopy (FSRS) is a powerful nonlinear spectroscopic technique that probes changes in molecular and material structure with high temporal and spectral resolution. With proper spectral interpretation, this is equivalent to mapping out reactive pathways on highly anharmonic excited-state potential energy surfaces with femtosecond to picosecond time resolution. FSRS has been used to examine structural dynamics in a wide range of samples, including photoactive proteins, photovoltaic materials, plasmonic nanostructures, polymers, and a range of others, with experiments performed in multiple groups around the world. As the FSRS technique grows in popularity and is increasingly implemented in user facilities, there is a need for a widespread understanding of the methodology and best practices. In this review, we present a practical guide to FSRS, including discussions of instrumentation, as well as data acquisition and analysis. First, we describe common methods of generating the three pulses required for FSRS: the probe, Raman pump, and actinic pump, including a discussion of the parameters to consider when selecting a beam generation method. We then outline approaches for effective and efficient FSRS data acquisition. We discuss common data analysis techniques for FSRS, as well as more advanced analyses aimed at extracting small signals on a large background. We conclude with a discussion of some of the new directions for FSRS research, including spectromicroscopy. Overall, this review provides researchers with a practical handbook for FSRS as a technique with the aim of encouraging many scientists and engineers to use it in their research.

Idiopathic Nonlupus Full-House Nephropathy: Clinicopathological Presentation and Comparison with Lupus Full-House Nephropathy.

Full-house pattern on immunofluorescence (IF) on kidney biopsy in a patient without systemic lupus erythematosus is termed as nonlupus full-house nephropathy (FHN). In this study, we retrospectively compiled patients with nonlupus FHN and compared them with lupus FHN for clinicopathological presentation. We included patients with full-house IF patterns in renal biopsies collected from March 2007 to August 2018, clinical and histopathological data at the time of presentation were studied retrospectively. Treatment received and outcome at the end of follow-up was studied. Patients with nonlupus FHN who did not show any systemic disease (idiopathic group) were compared with a group of lupus nephritis patients. Of 178 patients, 34 had nonlupus FHN with 21 having idiopathic nonlupus FHN and 13 patients having secondary nonlupus FHN (membranous nephropathy, IgA nephropathy, postinfection glomerulonephritis). Males were more often in idiopathic nonlupus FHN patients than lupus FHN patients (P = 0.005). Kidney biopsies more often showed a mesangial (P = 0.0006) and less proliferative pattern of injury (P = 0.0002) and less intense C1q staining (P = 0.0001) in idiopathic nonlupus than lupus FHN. Clinically, idiopathic nonlupus FHN presented with more proteinuria (P = 0.0059) and less complement consumption (P = 0.001) than lupus FHN patients. Compared to lupus FHN, nonlupus has mainly nephrotic syndrome as clinical presentation. There was no difference in the clinical outcome between lupus FHN and idiopathic nonlupus FHN. Nonlupus FHN is not a very common condition and has less female involvement than in lupus FHN. Idiopathic nonlupus FHN has certain histopathological features with less C1q staining by IF, less frequent proliferative lesions and higher mesangial or membranous lesions by light microscopy compared to lupus FHN. Regarding outcomes, there is no significant difference between lupus FHN and idiopathic nonlupus FHN.

Histological patterns of renal diseases in children: A 12-year experience from a single Tertiary Care Center in North-East India.

This study was conducted to retrospectively investigate the indications for renal biopsy in the native kidneys of children and to analyze the pathological findings in a single tertiary care hospital in North-East India for the past 12 years. All children (≤18 years) who underwent renal biopsy at our hospital from March 2007 to April 2018 were included. Renal tissue specimens were studied under light and immunofluorescence microscopy. The study group included 254 patients (female 57%). The median age was 15 years (range 6-18 years). The most frequent indications for renal biopsy were nephrotic syndrome (NS) (53.9%), urinary abnormality in systemic disease (22.1%), nephritic syndrome (15.4%), asymptomatic hematuria (4.7%), significant proteinuria (3.1%), and unexplained renal failure (0.8%). On histopathological examination, primary glomerular diseases were the most frequent (68.9%) followed by secondary glomerular diseases (30.3%) and tubulointerstitial diseases (0.8%). The most common primary glomerular diseases were minimal change disease (26.8%), focal segmental glomerular sclerosis (12.2%), diffuse proliferative glomerulonephritis (9.1%), membranous nephropathy (8.7%), IgA nephropathy (8.3%), membranoproliferative glomerulonephritis (2%), and mesangioproliferative glomerulonephritis (2%). Lupus nephritis (LN) (29.5%) was the most common secondary glomerular disease. NS was the most common indication of renal biopsy, and LN was the most common histopathological diagnosis in children ≤18 years.

A Comparable Study on the Outcomes of Urgent Initiated Peritoneal Dialysis Versus Conventional Start, A Single Centre Study from North-East India.

INTRODUCTION: To avoid temporary hemodialysis, urgent initiated PD (UIPD) has been designed. In these patients, PD is initiated within 3 days after PD catheter placement. In this study, we evaluated the outcomes of UIPD in end-stage renal disease patients compared with the conventional start of PD. METHODS: This is a single-center observational study, comparing outcomes of UIPD to conventional initiation of PD. All patients diagnosed with ESRD from March 2013 to February 2019 and were willing for CAPD were recruited. In UIPD group treatment was initiated at day 2 of catheter insertion with a dialysate volume of 1000 mL per dwell for 2 hours gradually increased to 2000 mL per dwell volume by 8 to 10 days. RESULTS: During the study period, 98 patients were started on peritoneal dialysis in our hospital: 35 UIPD, 63 conventional PD. The mean age was 60.81 ± 13.04 years. 67% of patients were males with diabetes mellitus (32%) being the most common cause of CKD. Among the patients in UIPD, the mean age was 58.49 ± 16.1 years, while as in conventional group mean age was 62.10 ± 10.9 years. The Median follow-up time was 381 days. Technique survival was seen in 95 patients (96.9%). There was no difference in technique failure between UIPD vs conventional group. Total complications in our study occurred in 16 patients out of 98 patients during this period. There was no significant difference in the complication rates between the UIPD group and the conventional group. CONCLUSION: Our study showed that catheter patency, technique survival, and catheter-related complications were comparable between UIPD and conventional start peritoneal dialysis.

Incidence, Risk Factors, and Outcome of Cardiac Arrhythmia Postcardiac Surgery in Children.

OBJECTIVE: To study the incidence of postoperative cardiac arrhythmias in children undergoing cardiac surgery and to evaluate the risk factors and outcome of these patients. MATERIALS AND METHODS: This retrospective observational study was conducted in the cardiac pediatric intensive care unit and included children <18 years of age. Children were monitored in the early postoperative period (72 h) for any sustained rhythm abnormality and were classified using standard definition. Details of treatment and their response were assessed. Risk factors for arrhythmias were evaluated using multivariate logistic regression analysis. RESULTS: Five hundred and thirty-six children were included and the prevalence of arrhythmia was 14.4% (n = 77). The most common arrhythmia was complete heart block (CHB) (n = 28; 5.2%), followed by junctional ectopic tachycardia (JET) (n = 25; 4.7%), junctional escape rhythm (n = 13; 2.4%), supraventricular tachycardia (SVT) (n = 8; 1.5%), and ventricular tachycardia (VT) (n = 3; 0.6%). Cardiac pacing was required in all CHB; 8 (28.6%) required a permanent pacemaker. Six (24%) patients with JET responded to conventional measures; 19 (76.0%) patients required amiodarone and 5 (20%) required cooling to 34°C or cardiac pacing. Temporary cardiac pacing was required in 9 (69.2%) cases of junctional escape rhythm. Seven (87.5%) events of SVT responded to adenosine and 1 (12.5%) required cardioversion. Two (66.7%) of VT responded to cardioversion while 1 (33.3%) was refractory. Five (6.5%) patients with arrhythmia died. In the multivariate logistic regression analysis, age <1 year, risk adjustment for congenital heart surgery category ≥3, and cross-clamp time >67 min were independent risk factors. CONCLUSION: Early postoperative period following cardiac surgery is extremely vulnerable to cardiac arrhythmias. Although majority are self-limiting, some can be life-threatening.

Vasoactive-ventilation-renal score in predicting outcome postcardiac surgery in children.

OBJECTIVE: The objective of this study was to evaluate vasoactive-ventilation-renal (VVR) score to predict outcome postcardiac surgery in children and establish the time at which the score is best to predict outcome. MATERIALS AND METHODS: This prospective cohort included children ≤18 years recovering from cardiac surgery for congenital heart disease. Data were collected from the Intensive Care Unit (ICU) and vasoactive-inotropic score (VIS) and VVR scores calculated at admission, 24 h, and 48 h postoperatively. Outcome of interest was prolonged length of ICU stay (defined as length of stay [LOS] in the upper 25th percentile) and ICU mortality. Correlation between the outcome and scores was obtained and receiver operating characteristic (ROC) curves generated. Independent association of the scores with the outcome was also established. RESULTS: One thousand ninety-seven patients were enrolled with a median age of 24 months (range: 2 days-18 years) including 14.6% with single ventricle physiology. Pediatric ICU LOS >89 h was considered prolonged, and mortality was 2.2%. VVR score correlated better with outcome and had greater area under the curve (AUC) for ROC curve than the corresponding VIS at each study time point. The AUC of ROC curve for VVR score was greatest at 48 h for predicting both prolonged LOS (0.87) and mortality (0.92). VVR score at 48 h remains strongly associated with both prolonged LOS (odds ratio [OR] - 1.24; P = 0.000) and mortality (OR - 1.16; P = 0.000). CONCLUSION: VVR score is effective and robust bedside method to predict prolonged LOS and mortality postpediatric cardiac surgery. VVR score at 48 h was the best to predict outcome.

Predictors and outcome of early extubation in infants postcardiac surgery: A single-center observational study.

OBJECTIVE: The objective of the current study was to evaluate the timing of first extubation and compare the outcome of patient extubated early with others; we also evaluated the predictors of early extubation in our cohort. MATERIALS AND METHODS: This prospective cohort study included children <1 year of age undergoing surgery for congenital heart disease. Timing of first extubation was noted, and patients were dichotomized in the group taking 6 h after completion of surgery as cutoff for early extubation. The outcome of the patients extubated early was compared with those who required prolonged ventilation. Variables were compared between the groups, and predictors of early extubation were evaluated using multivariate logistic regression analysis. RESULTS: One hundred and ninety-four (33.8%) patients were extubated early including 2 extubation in operating room and 406 (70.7%) were extubated within 24 h. Four (0.7%) patients died without extubation. No significant difference in mortality and reintubation was observed between groups. Patient extubated early had a significant lower incidence of sepsis (P = 0.003) and duration of Intensive Care Unit (ICU) stay (P = 0.000). Age <6 months, risk adjustment for congenital heart surgery category ≥3, cardiopulmonary bypass time ≥80 min, aortic cross-clamp time ≥ 60 min, and vasoactive-inotropic score >10 were independently associated with prolonged ventilation. CONCLUSION: Early extubation in infants postcardiac surgery lowers pediatric ICU stay and sepsis without increasing the risk of mortality or reintubation. Age more than 6 months, less complex of procedure, shorter surgery time, and lower inotropic requirement are independent predictors of early extubation.

Respiratory Morbidity Following Pediatric Orthotopic Liver Transplantation.

We evaluated the pulmonary complications following orthotopic liver transplantation in 45 children (age <18 y). 22 patients (49%) developed respiratory complications. Pediatric end-stage liver disease (PELD) score >25 and positive fluid balance were independent risk factors. Patients with respiratory complication had significantly higher mortality and intensive care unit stay.