Study of Incidence, Clinical profile and Outcomes among patients hospitalized for COVID-19 with Acute Kidney Injury.

The ongoing COVID-19 pandemic has thrown newer challenges for the health care professionals to manage the affected patients. Though the so called second wave is in a declining trend at present but possible third wave is looming in the near future. Initially patients appeared to have a respiratory limited disease but there are now increasing reports of multiple organ involvement including renal disease in association with COVID-19. The current study aims to highlight the incidence of acute kidney injury (AKI) in COVID-19 patients, as well as the clinical profile and outcomes in that subset of patients in a tertiary hospital setting, in order to better understand the role renal disease plays in the disease process. MATERIAL: Methods: This retrospective, observational study involved a review of data from electronic health records of patients aged more than 18 years with laboratory confirmed COVID-19 admitted to our hospital from February 27 to May 30, 2021. Data was analysed using SPSS version-21.0 by descriptive statistics. We describe the incidence of AKI, dialysis requirement, requirement of mechanical ventilation and mortality. OBSERVATION: Results of 400 hospitalized patients with COVID-19, 252(63%) were male, 148(37%) were female. AKI occurred in 72 (18%) patients. The proportions with stages 1, 2, or 3 AKI were 35(48.3%), 11 (15.1%), and 26 (36.6%), respectively. 22 (32%) patients with AKI required dialysis. About 42(58.33%) patients with AKI were admitted in Intensive care Unit and 35(48%) patients with AKI required mechanical ventilation. In-hospital mortality was (25%) among patients with AKI versus (7.01%) among those without AKI (OR, 4.42; 95% confidence interval, 2.23 to 8.73). CONCLUSION: Conclusions AKI is common among patients hospitalized with COVID-19 and is associated with high morbidity and mortality.

Cardiac nociceptive reflexes after transmyocardial laser revascularization: implications for the neural hypothesis of angina relief.

OBJECTIVE: The mechanism by which transmyocardial laser revascularization relieves angina is not understood. One theory is that laser-induced thermal damage to cardiac nerves results in cardiac denervation. This study examined the acute effects of transmyocardial laser revascularization on reflex responses mediated by cardiac nociceptors, the left ventricular receptors with sympathetic afferent fibers that are thought to mediate anginal chest pain. METHODS: Experiments were performed in 13 chloralose-anesthetized dogs with sinoaortic denervation and vagotomy. Left ventricular receptors with sympathetic afferent fibers were activated by epicardial and intracoronary bradykinin before and 45 minutes after transmyocardial laser revascularization. Reflex responses elicited by bradykinin were quantitated by direct recording of efferent renal sympathetic nerve activity. Transmyocardial laser revascularization was performed in the open-chest model with a hand-held holmium:YAG laser (2.1-microm wavelength). RESULTS: An average of 44.5 +/- 1.0 channels were created. Before transmyocardial laser revascularization, reflex increases in renal sympathetic nerve activity were elicited by both epicardial and intracoronary bradykinin. After transmyocardial laser revascularization, there was no significant attenuation in the reflex responses to either epicardial (before, 66% +/- 8%; after, 100% +/- 24%; P =.19) or intracoronary (before, 124% +/- 37%; after, 108% +/- 25%; P =.44) bradykinin. CONCLUSIONS: Transmyocardial laser revascularization has no significant short-term effect on reflexes mediated by left ventricular receptors with sympathetic afferent fibers in anesthetized dogs. These results indicate that transmyocardial laser revascularization does not acutely interrupt the afferent nerves, which are believed to transmit the perception of anginal pain.

In vivo effect of coronary laser angioplasty on atherosclerotic plaques: histopathologic analysis.

Information from histopathologic examination of coronary arterial atherosclerotic plaques treated with in vivo laser energy is sparse. Directional atherectomy provides biopsies for study of tissue changes (injury) due to coronary arterial debulking devices, including laser. Sixteen patients who presented with acute ischemic coronary syndromes underwent debulking of a total of 17 obstructive intracoronary lesions with pulsed-wave holmium:YAG laser (2.1 microm wavelength). Laser was performed with the "pulse and retreat" technique which incorporates slow catheter advancement (0.5-1 mm/s) with controlled emission of energy. Immediately postlasing, directional atherectomy was utilized to obtain irradiated plaque tissue for pathologic examination. Extent of laser-induced tissue injury to plaques was graded as 0 (no tissue damage), 1 (small foci or charring and vacuoles), 2 (large amount of charring, edge disruption and vacuoles) and 3 (extensive tissue damage). Angiographically and clinically, all 17 lesions were successfully debulked with the laser energy (mean 47+/-25 pulses), with a reduction of target lesion percent diameter stenosis from 92+/-6% to 47+/-25%. Adjunct balloon dilations further reduced the target lesions to a final of 10+/-10% stenosis. The histopathologic examination of the lased specimens demonstrated that 13 lesions (76%) had no evidence of laser-induced injury (Grade 0). Four lesions had low-level injury (Grade 1), and none had evidence of Grade 2 or 3 laser-induced trauma. Therefore, a laser debulking technique, which incorporates slow catheter advancement with controlled emission of pulses, does not cause significant injurious effects to the irradiated plaque.

Multiple cutaneous malignancies in xeroderma pigmentosum.

A case of xeroderma pigmentosum with multiple cutaneous malignancies is being reported. The case presented with freckles, letigens, and keratosis, a non-tender ulcerated nodular lesion on the nose, a nodular ulcerated lesion on the right outer canthus of the conjunctiva, and a nodular growth which developed on the right cheek which on histopathology was found to be squamous cell carcinoma, basal cell carcinoma and malignant melanoma respectively.

Telepathology between Richmond and Beckley Veterans Affairs Hospitals: report on the first 1000 cases.

OBJECTIVE: A telepathology connection between Richmond VAMC and Beckley VAMC using dynamic robotic telepathology to provide pathology services remotely was established. MATERIALS AND METHODS: This study reports a 14-month experience using telepathology to diagnose surgical specimens obtained from patients at the Beckley VA Medical Center and viewed in Richmond 250 miles away. Over 14 months, 2325 slides representing 1000 cases were viewed. RESULTS: Discrepancies were observed in 20 of 2325 slides, or 0.86% of the total. None of the patients, where a discrepancy was found, were adversely affected by the preliminary report given. CONCLUSIONS: This study demonstrates that telepathology is a reliable and cost-effective alternative to on-site pathology services and reviews advantages and disadvantages of the system.

Reversible renal failure in a patient with the hypereosinophilia syndrome during therapy with alpha interferon.

Human recombinant interferon (IFN)-alpha (alpha)-2b was given to a 57-year-old man with hypereosinophilia syndrome refractory to prednisone and hydroxyurea. One year later, he developed progressive renal failure and nephrotic-range proteinuria. Percutaneous kidney biopsy showed focal and segmental glomerular and mesangial sclerosis, chronic interstitial nephritis, and focal tubular necrosis. Discontinuation of cytokine therapy led to marked improvement in renal function and significant reduction in proteinuria. The potential role of IFN-alpha as the cause of renal failure and nephrotic-range proteinuria is discussed. The spectrum of renal disease attributed to IFN-alpha and the proposed pathogenic mechanisms are reviewed.

Storage pool disease in chronic lymphocytic leukemia: abnormal aggregation and secretion without bleeding.

Although bleeding complications are relatively common in patients with chronic lymphocytic leukemia, they tend to be related to thrombocytopenia or an acquired clotting factor inhibitor. Chronic lymphocytic leukemia-associated thrombocytopenia, which may also contribute to the hemorrhagic risk, is generally caused by decreased production and immune-mediated destruction. This is the case of a 56-year-old man with longstanding chronic lymphocytic leukemia who developed thrombocytopenia (platelet counts of approximately 50,000/microL) with an associated abnormal platelet morphology. Although the patient did not suffer clinically significant bleeding, several tests of platelet function were grossly abnormal. Electron microscopic examination of the platelets revealed virtually complete absence of dense granules. Platelet aggregation did not occur with adenosine diphosphate (10 microM), collagen (2 micrograms/mL), or ristocetin (1 mg/mL). Doubling the agonist concentrations produced only minimal agglutination with ristocetin. The bleeding time was mildly prolonged at 9.0 and 10.5 minutes. Von Willebrand antigen and ristocetin cofactor levels were normal. Collagen-induced adenosine triphosphate secretion was less than 10% that of a matched normal control. In contrast, platelet force development was virtually normal, reaching 4,800 dynes at 1,200 seconds compared with 5,800 dynes for the healthy control. The patient's clots demonstrated enhanced clot modulus 44,000 dynes/cm2 versus 22,400 dynes/cm2 for the healthy control. The latter finding was primarily because of high fibrinogen concentration. This third report of storage pool disease in a patient with chronic lymphocytic leukemia demonstrates that dense granule release is not required for normal platelet-mediated force development.

Biotoxicity of mercury to Chlorella vulgaris as influenced by amino acids.

The toxicity of mercury ion, on Chlorella vulgaris, is largely influenced by amino acids. Five amino acids, namely alanine, asparagine, glutamic acid, cysteine and histidine, were added separately to the medium containing static dose of mercury. Survival (%) of the alga was reduced with the increasing concentrations of mercury. Of these five amino acids, cysteine was found to be the most effective while alanine and glutamic acid were the least effective on reducing the toxic effect of mercury on the alga measured in terms of growth, chlorophyll and protein content. The order of detoxification was Alanine < Glutamate < Asparargine < Histidine < Cysteine. Amino acids from ligands with Hg2+ making it less toxic to the alga and produce an additional source of energy for growth and development.

Fine needle aspiration cytology (FNAC) in malignant bone tumours.

Patients with malignant bone tumours often come at a very late stage of disease to Medical Colleges. Because of their high mortality rate, accurate & quick diagnosis of these lesions become essential, inspite of clinical, radiological and histopathological assessments. A simple, inexpensive, safe & least traumatic technique-fine needle aspiration cytology (FNAC) in diagnosis of 55 malignant bone tumours was carried out. Specific tumour types metastatic tumour (12), Giant cell tumour (12), Ewing's sarcoma (10), Osteosarcoma (7), Multiple myeloma (7), Chordoma (3), Chondrosarcoma (3) and Fibrosarcoma (1) could be ascertained in 87.2% whereas malignant tumour was suggested in 94.5% (52 cases).

Change in toxicity effect of mercury at static concentration to Chlorella vulgaris with addition of organic carbon sources.

The effect of mercury on Chlorella vulgaris is influenced to a large extent by organic carbon sources like glucose, glutamate, and 2-oxoglutarate which is exhibited through changes in growth and metabolic processes of the alga in the presence of static dose (0.200 +/- 0.004, p = 0.05) of Hg2+. Addition of the three carbon sources to the Hg(2+)-amended Chu No 10+ medium resulted in an acceleration of pigment biomass, growth, and protein content of the green alga. Glucose at all concentrations was found to be more effective than the other two in reducing the mercury toxicity to C. vulgaris. However, the detoxifying effect is dependent on the type of carbon sources, their concentration and days of incubation. Glucose at 5 mg/l significantly reduced Hg2+ toxicity while glutamate and 2-oxoglutarate, at this concentration, did not show such capacity. Similarly the degree of significance of ameliorative effect increased with increase in incubation period which, however, varied with the carbon source. Availability of additional energy and formation of non-toxic or less toxic mercury are the probable causes of reduction in toxicity effects.

Isolation of Stomatococcus mucilaginosus from drug user with endocarditis.

Stomatococcus mucilaginosus was isolated from the blood of a patient with endocarditis and a past history of drug abuse and aortic valve replacement. At autopsy, Gram stain of the aortic valve revealed gram-positive cocci. Our isolate was atypical for S. mucilaginosus in that colonies were nonmucoid and nonadherent to agar surfaces. Cellular capsules were demonstrated by light and electron microscopy. Phenotypic characteristics identified by conventional methods as well as profile numbers obtained by using two commercial identification systems for staphylococci, the API Staph-Ident and the dms Staph Trac, are presented. Practical tests that differentiate S. mucilaginosus from the genera Micrococcus and Staphylococcus include growth on nutrient agar containing salt and lysostaphin susceptibility. Additional tests that helped differentiate our isolate from group D streptococci included hydrolysis of L-pyrrolidonyl-beta-naphthylamide and streptococcal serogrouping.