Increasing Uptake of COVID-19 Vaccination and Reducing Health Inequalities in Patients on Renal Replacement Therapy-Experience from a Single Tertiary Centre.

BACKGROUND: COVID-19 vaccination has changed the landscape of the COVID-19 pandemic; however, decreased uptake due to vaccine hesitancy has been observed, particularly in patients from minority ethnic backgrounds and socially deprived areas. These patient characteristics are common in patients on Renal Replacement Therapy (RRT), a population at extremely high risk of developing serious illness from COVID-19 and who would thus benefit the most from the vaccination programme. We designed a bespoke COVID-19 vaccination programme for our RRT population with the aim of decreasing health inequalities and increasing vaccination uptake. METHODS: Key interventions included addressing vaccine hesitancy by deploying the respective clinical teams as trusted messengers, prompt eligible patient identification and notification, the deployment of resources to optimise vaccine administration in a manner convenient to patients, and the timely collection and analysis of local safety and efficacy data. First, COVID-19 vaccination data in relation to ethnicity and social deprivation in our RRT population, measured by the multiple deprivation index, were analysed and compared to uptake data in the total regional adult clinically extremely vulnerable (CEV) population in Greater Manchester (GM). Univariate logistic regression analysis was used to explore the factors associated with not receiving a vaccine. RESULTS: Out of 1156 RRT patients included in this analysis, 96.7% received the first dose of the vaccination compared to 93% in the cohort of CEV patients in the GM. Age, gender, ethnicity, and a lower index of multiple deprivation were not identified as significant risk factors for poor first dose vaccine uptake in our cohort. Vaccine uptake in Asian and Black RRT patients was 94.9% and 92.3%, respectively, compared to 93% and 76.2% for the same ethnic groups in the reference CEV GM. Vaccine uptake was 96.1% for RRT patients in the lowest quartile of the multiple deprivation index, compared to 90.5% in the GM reference population. CONCLUSION: Bespoke COVID-19 vaccination programmes based on local clinical teams as trusted messengers can improve negative attitudes towards vaccination and reduce health inequalities.

Predictive Analysis of Gallbladder Wall Thickness as a Marker for Bleeding Risk and Need for Transfusion in Dengue Patients.

Increased gallbladder wall thickening (GBWT) is a manifestation of increased capillary permeability caused by severe dengue. This study was carried out to link the severity of GBWT with bleeding risk and the need for transfusion. This retrospective study included all patients diagnosed with dengue infection either via dengue nonstructural protein-1 antigen or IgM antibody. Pearson's correlation, linear regression, and receiver operating characteristic curves were used for predictive analysis of GBWT with events of bleeding and need for transfusion of platelets during the hospital stay. A total of 177 participants met the inclusion criteria; the mean age was 33.17 ± 13.63 years. Mean GBWT was found to be 0.37 ± 0.15 cm, with 46.3% of patients having a thickness greater than 0.30 cm. A total of 16 patients had bleeding events, of which 7.3% had minor bleeding and 1.7% had a major bleeding event. Linear regression analysis showed that increased GBWT was associated with decreased platelet count on admission (P = 0.002) and lowest platelet counts (P = 0.004). GBWT was found to be predictive of bleeding events and transfusion of platelets at higher sensitivity and specificity than was either platelet count on admission and lowest platelet counts.

Assessing the Mental Impact and Burnout among Physicians during the COVID-19 Pandemic: A Developing Country Single-Center Experience.

Health-care workers are on the front line to combat the peculiar coronavirus disease-19 (COVID-19) pandemic and are susceptible to acquiring this infection. This study is aimed at documenting the effect of "coronaphobia" on mental well-being and to report burnout among physicians. The study was conducted as a cross-sectional survey between November 17, 2020 and January 1, 2021 via a Google form distributed among the physicians of a tertiary care hospital, in Karachi, Pakistan. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) was used to assess the mental well-being of physicians. Burnout was documented by using the Maslach Burnout Inventory Human Services Survey for Medical Personnel. Eighty-seven physicians participated in the survey (mean age, 30.9 ± 7.3 years). The mean WEMWBS score of the study participants was 51.6 ± 10.8. Regarding the WEMWBS, emotional exhaustion was observed in 54% (N = 47) of participants, depersonalization in 77% (N = 67), and low personal accomplishment was reported in 31% (N = 27) of participants. The results of the survey further highlight that depersonalization, emotional exhaustion, and low personal accomplishment were associated significantly with a history of COVID-19 infection and COVID-19 postings. Hence, immediate measures are required to reduce the burnout among physicians while battling the second wave of the pandemic.

Impact of Fasting Lipid Profile on Chronic Kidney Disease Patients Having Fatty Liver Disease.

Background and objectives Chronic kidney disease (CKD) share a common pathophysiology with non-alcoholic fatty liver disease (NAFLD). This study aims to identify the lipid derangements in patients of CKD and to associate them with radiological evidence of NAFLD. Material and methods A cross-sectional observational study was performed in a tertiary care hospital, to include all chronic kidney disease patients (n=238) through non-probability consecutive sampling. The criteria for inclusion were baseline estimated Glomerular filtration rate (eGFR) below 60 ml/min/1.73m2 for at least three months and chronic renal parenchymal changes on ultrasound. Two study groups were identified based on ongoing hemodialysis, while two further study groups were identified based on radiological evidence of fatty liver disease. Results The mean age of the study population was 48.52 ± 9.44 years with no difference amongst hemodialysis status, females elder than males (p= 0.027), those with fatty liver were much younger (p=0.014), and the most common age group below 50 years (p=0.005) among the fatty liver group. Radiological evidence of NAFLD was found amongst two-third of the study group with the status of hemodialysis indifferent among the study population (p=0.436). The mean values amongst fatty liver versus non-fatty liver groups revealed high creatinine, alanine transaminase (ALT), high-density lipoprotein (HDL), triglycerides (TG), and very-low-density lipoprotein (VLDL) in the fatty liver group, low-density lipoprotein (LDL) and total cholesterol (TC) were indifferent amongst the groups, while LDL/HDL ratio was higher in the non-fatty liver group. Conclusion A significantly higher HDL was found in fatty liver associated with CKD as compared to the non-fatty liver group.

Pericardial Tumor, a Rare Manifestation of Sjogren's Syndrome Secondary to Systemic Lupus Erythematosus.

We are presenting a case of pericardial tumor in an elderly female patient who presented with low-grade fever, purpuric rashes all over the body, grittiness in the eyes, and dry mouth with decreased oral intake, night sweats, weight loss, chest pain, and dyspnea. She was diagnosed with Sjögren's syndrome secondary to systemic lupus erythematosus (SLE) with positive anti-nuclear antibody (ANA), anti-double-stranded DNA (anti-ds-DNA), and anti-Sjögren's-syndrome-related antigen A autoantibodies (SS-A/Ro) antibodies. Computerized tomography scan of the chest with contrast showed multiple calcified mediastinal lymph nodes and a well-defined solid cystic lesion adjacent to the left atrial appendage in favor of a pericardial tumor with minimal pericardial effusion. Biopsy could not be done due to the risk of cardiac tamponade and pneumothorax secondary sensitive location of the tumor. The patient was referred to the oncology and cardiothoracic surgery department for an opinion regarding resection of the tumor and further palliative management. This case is unique in a way that the current literature does not associate SLE with pericardial tumor, while our patient had no other primary malignancy or secondary metastasis ruled out on a positron emission tomography (PET) scan.

Functioning uterus with absent cervix, short vagina and transverse septum.

A 25-year-old married lady with primary amenorrhea, infertility, lower abdominal pain and dyspareunia underwent vaginoplasty, total abdominal hysterectomy with right adnexal clearance for congenital absent cervix, vaginal septum with functioning uterus and right sided endometrioma. Mould was kept in vagina for 2 weeks followed by intermittent vaginal dilatation for one week. Couple was advised normal coital function and intermittent vaginal dilatation at home. Patient was followed regularly in OPD for 4 months and there was no complaint regarding sexual life.

Pregnancy with macroprolactinoma.

A macroprolactinoma recurred in a 25-year-old lady, who had initially presented with inability to conceive, secondary amenorrhea, galactorrhea and persistent headache. She was diagnosed as a patient of pituitary macroadenoma of 1.7 cm with elevated serum prolactin level. She was given Bromocriptine, which normalized her menstruation as well as the prolactin level followed by conception during treatment. Pregnancy remained uneventful till 27 weeks when she developed severe headache and total loss of vision from left eye and partial from right eye at 27 weeks. MRI showed enlargement of macroadenoma upto 2.5 cm with compression on optic chiasma. Transsphenoidal adenectomy was performed. After surgery visual field defect improved but plasma prolactin level remained elevated. She delivered vaginally at 39 weeks. Later, treatment with Bromocriptine (15 mg/day) failed to keep prolactin level normal and Lisuride hydrogen (0.8 mg/day) reduced the prolactin levels.