Development of a calculated panel reactive antibody calculator for the United Arab Emirates: a proof of concept study.

Calculated panel reactive antibody (CPRA) is used to help increase sensitized patient's access to transplantation. United Arab Emirates (UAE) has a diverse resident population hence we developed a UAE-CPRA calculator based on HLA antigen frequencies of the different ethnic groups that represent the UAE population. HLA antigen frequencies at serological split antigen level for HLA-A, -B, -C, -DRB1 and -DQB1 of 1002 healthy unrelated donors were performed. We subsequently compared the performance of the UAE CPRA calculator with the Organ Procurement and Transplantation Network (OPTN) and the Canadian CPRA calculators in 110 Kidney Transplant waitlist patients from January 2016 to December 2018. Lin's concordance correlation coefficient showed a moderate agreement between the UAE and OPTN calculator (Rc = 0.949, 95% CI 0.929-0.963) and the UAE and Canadian calculators (Rc = 0.952, 95% CI 0.932-0.965). While there continued to be a moderate agreement (Rc = 0.937, UAE versus OPTN calculator) in the lower sensitized group, a poor agreement (Rc = 0.555, UAE versus OPTN calculator) was observed in the higher sensitized group. In this study, we provide a template for countries to develop their own population-specific CPRA calculator. Implementation of the CPRA algorithm based on HLA frequencies of the multi-ethnic UAE population will be more fitting to increase access to transplantation and improve transplant outcomes. Our study demonstrates that the CPRA calculators developed using the data from the western population had poor correlation in our higher sensitized patients disadvantaging them in potential organ allocations systems. We plan to further refine this calculator by using high resolution HLA typing to address the problem of a genetically diverse population.

Non-Traumatic Rib Fractures, Haemothorax And Chest Wall Hernia Associated With Excessive Coughing.

Haemothorax is presence of blood in pleural cavity and is usually caused by chest trauma. Spontaneous rib fractures leading to haemothorax due to excessive coughing has seldom been described in the literature. We report an unusual case with asthma exacerbation who developed intense coughing followed by chest pain, breathlessness, and widespread bruising, without trauma or coagulopathy. Initial chest X-ray (CXR) and CT pulmonary angiogram (CTPA) showed no significant abnormality. CT scan on subsequent presentation showed left sided haemothorax with rib fractures. The patient was managed successfully with chest tube drainage. On follow up imaging, haemothorax resolved but he was found to have malunited rib fractures with chest wall hernia due to wide separation between ribs. He was referred to cardiothoracic surgeons for rib fixation and chest wall repair.

Partnership 4.0: smallholder farmer partnership solutions.

The current pseudo-partnership pattern causes the farmers' income to be low from the results of their farming activities, so a partnership pattern is needed that is able to create a mutual partnership. The research which was conducted in Cikarawang Village, Bogor Regency, West Java Province - Indonesia aims; (1) recognize the existing condition of farmers and the use of agricultural land; (2) knowing the distribution of agricultural commodities; (3) identify existing partnership patterns; and (4) provide solutions for partnership patterns that benefit farmers. By using mixed-methods combined with the Drone Participatory Mapping (DPM) approach to produce Data Desa Presisi (DDP), this study succeeded in identifying three statuses of farmers, namely: cultivators, owners and cultivators of their own land, and owners who work on their own land at the same time working on other people's land, with an average access to land management of 3,437.32 m2. The small access of each farmer in land management is further exacerbated by the variety of agricultural commodities that are cultivated by farmers. There are at least 19 types of agricultural commodities that are cultivated, but do not meet the economic scale that is able to improve the welfare of farmers. This condition opens up opportunities for the partnership pattern between farmers and middlemen to continue to survive which is actually detrimental to farmers. Partnership 4.0 innovation is present to replace the old partnership pattern by focusing on the basis of technology and information that is fully accessible to farmers to jointly control agricultural activities (upstream-downstream). Partnership 4.0 places farmers and offtakers on an equal footing, so that smallholders can benefit and help achieve the welfare of smallholders.

Motives and Passion of Adults from Pakistan toward Physical Activity.

Globally, a large proportion of people do not participate in adequate physical activity to gain health benefits. Physical inactivity is a primary risk factor for global mortality. Research suggests that motives and passion influence participation in physical activity. The main purposes of the present study were to examine the relationship between motives and passion for participation in physical activity among adults, and to examine whether motives and passion predicted physical activity. Prior to data collection, we translated and validated the Physical Activity and Leisure Motivation Scale (PALMS) and the Passion Scale (PS) into Urdu. With the research sample, both translated questionnaires showed acceptable internal consistency, test-retest reliability, and factorial validity. To address the main purposes, we then employed a quantitative, cross-sectional research design, with a sample of 572 adults between 18 and 65 years (31.51 ± 10.25), who regularly participated in moderate-to-vigorous physical activity. Participants completed the PALMS, the PS, and the International Physical Activity Questionnaire (IPAQ). Correlation coefficients showed strong relationships between motives and harmonious passion, and weaker, negative relationships between motives and obsessive passion. We used stepwise multiple regression to test whether motives and passion subscales were significant predictors of overall PA measured by the IPAQ. In step 1 of the regression model, mastery and physical condition motives were significant predictors of overall physical activity. Further, in step 2, the mastery motive and harmonious passion were significant predictors of overall physical activity, accounting for 26% of the variance, with F (5, 566) = 38.84, p < 0.01. The present study provides a basis for physical activity interventions examining whether increasing motives and passion leads to higher adherence to and lowered dropout from physical activity.

Physical activity in Pakistani perspective: issues, implications, and recommendations.

It has been established that the benefits of physical activity on physical, psychological and social aspects of humans are substantially correlated with cardiovascular disorders, obesity, cancer, social anxieties and depressions, and enhanced socio-economic profile. In children and adolescents, physical activity has been correlated with academic achievements, social harmony and mental health. Similarly, in adults/old people, physical activity has been of variable benefits, bringing the chances of prolonged healthier lives. Though substantial work has been reported globally, there still is a paucity of literature in Pakistan regarding various aspects of physical activity. The current narrative review was planned to summarise the research work conducted in, or has emanated from, Pakistan in teens/college/school and university students, and adults from Pakistan on associated aspects of physical activity, its present scenario, pitfalls, future horizons, and to ultimately deduce gaps in research areas which can be taken up for the directional approach to enhance physical activity within the Pakistani community.

Utility of thoracic computed tomography to predict need for early surgery and recurrence after first episode of primary spontaneous pneumothorax.

INTRODUCTION: CT imaging is not advocated by British Thoracic Society guidelines after first episode of primary spontaneous pneumothorax (PSP). There is emerging evidence that emphysema-like changes and CT-based dystrophy severity score (DSS) can predict need for early surgery and recurrence. OBJECTIVES: We aimed to assess the role of DSS during first episodes of PSP in predicting the need for early surgery and recurrence. METHODS: We conducted a retrospective analysis of consecutive PSP episodes (n=197) admitted to our institution from 1 January 2012 to 31 December 2017. DSS was calculated based on type, number and distribution of blebs and bullae. Patients were categorised as low-grade (0-3) or high-grade (4-6) DSS assessed by a thoracic radiologist. RESULTS: Forty-five PSP patients had CT at first presentation. Eight patients had low-grade DSS; all were managed non-surgically and none had recurrence over 12 months. Thirty-seven patients had high-grade DSS. Of these, 25 (67.5%) were managed surgically, with three having contralateral recurrence over 12 months; 12 (32.5%) were managed non-surgically, and of these two patients had ipsilateral recurrence over 12 months. CONCLUSION: DSS seems to predict the need for early surgery and recurrence and CT can be used to risk-stratify patients after a first episode of PSP.

TB Meningitis and TB Peritonitis: Abdominal Pseudocyst and VP-Shunt Link.

TB meningitis (TBM) carries high morbidity and mortality and is a relatively common extrapulmonary TB in the third world countries. TBM as thick exudative disease manifests on MRI and CT as nodular basal leptomeningitis, hydrocephalus, basal infarcts, and tuberculomas. Hydrocephalus is treated with ventriculoperitoneal shunting (VPS). Shunt malfunction and revision are common. We report a case of multidrug-resistant TBM with spinal involvement and dissemination of the disease via VPS causing TB peritonitis (TBP). TBP presented as a large abdominal pseudocyst around the catheter tip with shunt malfunction. There was no evidence for any other site of extra-CNS disease. TBP per se is relatively less common. This is the first case reporting VPS as a means of TB spread.

Atypical presentation of cystic fibrosis at 70 years of age.

Cystic fibrosis (CF) is an autosomal recessive condition, mostly diagnosed in infancy. It is uncommon for adults to be diagnosed with CF, especially after the age of 65. Individuals, who are diagnosed later in life, usually have milder disease and single organ involvement which can be challenging for clinicians to diagnose. Adult CF patients are more likely to be pancreatic sufficient. They have predominantly upper lobe bronchiectasis, lower incidence of Pseudomonas aeruginosa compared with Staphylococcus aureus and are more likely to have mutations other than ΔF508.

Empyema thoracis secondary to community-acquired Panton-Valentine leukocidin (PVL) methicillin-resistant Staphylococcus aureus (MRSA) infection.

We report a case of a previously fit middle-aged man presenting to the outpatient setting with unilateral pleural effusion, with minimal symptoms. On subsequent investigations, he was diagnosed with empyema thoracis secondary to Panton-Valentine leukocidin (PVL)-toxin positive community-acquired methicillin-resistant Staphylococcus aureus (MRSA). The patient was treated with prolonged antibiotics and pleural drainage, and he remained haemodynamically stable throughout hospital admission. PVL is a cytolytic exotoxin produced by some strains of S. aureus Such strains often cause recurrent skin and soft tissue infections, usually in previously fit and healthy individuals. Less commonly, invasive infections occur; these carry a high mortality rate if associated with necrotising pneumonia or septic shock. PVL genes are present in approximately 2% of clinical isolates of S. aureus in the UK. PVL-producing MRSA infections are on the rise and present significant clinical and public health challenges.

How should complete lung collapse secondary to primary spontaneous pneumothorax be managed? .

Management of primary spontaneous pneumothorax (PSP) depends on the symptoms and size of lung collapse. The British Thoracic Society recommends needle aspiration (NA) for all PSP requiring intervention, followed by intercostal drain (ICD) if NA fails. We compared the role of NA versus ICD as the first step in PSP with 'complete lung collapse'.This was a retrospective observational study of 877 consecutive pneumothorax episodes at University Hospitals of North Midlands, Stoke on Trent, UK. Chest X-ray (CXR) at presentation was reviewed to identify PSP with complete lung collapse. The primary outcome measure was successful lung re-inflation after initial intervention.Two-hundred and sixty-six PSP patients were identified; 69 had complete lung collapse on CXR of which 35 had NA and 34 had ICD. The ICD group had a significantly better immediate success compared with the NA group (62% versus 11%, odds ratio (OR) = 12.5, p<0.0001; after adjustment for potential confounders, OR increased to 26.4, p=0.0001) although long-term outcomes were comparable.There should be clear consensus on definition and management of complete lung collapse. PSP with complete lung collapse could be managed as a separate subgroup where ICD placement is considered to be the first intervention.

Unusual case of bilateral haemotympanum after endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA).

We present a case of bilateral haemotympanum (HT) during endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA). A 64 year-old-man underwent EBUS-TBNA for mediastinal lymph nodes (LN) staging. Medical history included emphysema and angina. Medication included aspirin until the day before procedure. Full blood count and clotting screen were normal. He received sedation (5 mg midazolam, 1000 mcg alfentanil) and topical anaesthesia (16 mL 1% lignocaine) but coughed excessively throughout the procedure. Left hilar LN was the only area sampled. Spontaneous bleeding ensued from both ears towards the end of the procedure. Patient remained haemodynamically stable. The procedure was aborted and otolaryngology consult sought. Otoscopy showed bilateral haematoma from anterior ear canal with normal tympanic membranes and no hearing loss. Nasendoscopy revealed erythematous ostium of both Eustachian tubes. Bleeding stopped spontaneously and patient required no further imaging or treatment. We report this case to increase awareness of this very rare complication resulting from excessive coughing during EBUS-TBNA.

Massive haemoptysis secondary to mycotic pulmonary artery aneurysm in subacute invasive aspergillosis.

A 68-year-old man, presented with 3 week history of infective symptoms and mild haemoptysis. Past medical history included severe emphysema and a chronic right upper lobe (RUL) cavity. He was discharged from follow-up a year ago in view of clinical and radiological stability; previous bronchoscopic examinations yielded no specific diagnosis. CT scan on admission confirmed complex cavitary consolidation of RUL. He developed massive haemoptysis requiring intubation and ventilation. CT pulmonary angiogram (CTPA) revealed 16 mm RUL pulmonary artery (PA) aneurysm which was successfully embolized. Sputum cultures, aspergillus antigen and rapidity of clinical progression suggested a diagnosis of subacute invasive aspergillosis (SAIA), prompting treatment with Voriconazole. Bronchoscopy showed blood ooze from RUL even after embolization. Unfortunately, patient continued to deteriorate and succumbed to profound septicaemia.

Unusual case of hemidiaphragmatic paralysis secondary to cervical herpes zoster.

Hemidiaphragmatic paralysis is usually caused by surgery, malignancy or trauma and rarely by viral infections. Herpes zoster (shingles) results in varied neurological complications, but peripheral motor involvement or diaphragmatic paralysis is rare. We report the case of an 87-year-old male who presented with worsening breathlessness soon after an episode of shingles, affecting his right neck and upper chest. He had no alarm symptoms, history of trauma or malignancy. Skin lesions resolved after a few weeks, but his breathing did not improve. Chest X-ray revealed a new finding of elevated right hemidiaphragm; diaphragmatic ultrasound confirmed paradoxical cranial movement of right hemidiaphragm on sniff testing. CT scan showed no lung mass and complete collapse of right lower lobe due to elevated right hemidiaphragm. Patient has required no treatment and is under regular follow-up with the ventilation clinic.