COVID-19 and stress of Indian youth: An association with background, on-line mode of teaching, resilience and hope.

Background: COVID-19 pandemic causes serious threats to physical health and triggers wide varieties of psychological problems, including anxiety and depression. Youth exhibit a greater risk of developing psychological distress, especially during epidemics influencing their wellbeing. Objectives: To identify the relevant dimensions of psychological stress, mental health, hope and resilience and to examine the prevalence of stress in Indian youth and its relationship with socio-demographic information, online-mode of teaching, hope and resilience. Method: A cross-sectional online survey obtained information on socio-demographic background, online-mode of teaching, psychological stress, hope and resilience from the Indian youth. A Factor Analysis is also conducted on the recompenses of the Indian youth on psychological stress, mental health, hope and resilience separately to identify the major factors associated with parameters. The sample size in this study was 317, which is more than the required sample size (Tabachnik et al., 2001). Results: About 87% of the Indian youth perceived moderate to a high levels of psychological stress during the current COVID-19 pandemic. Different demographic, sociographic and psychographic segments were found to have high stress levels due to the pandemic, while psychological stress was found to be negatively correlated with resilience as well as hope. The findings identified significant dimensions of the stress caused by the pandemic and also identified the dimensions of mental health, resilience and hope among the study subjects. Conclusion: As stress has a long-term impact on human psychology and can disrupt the lives of people and as the findings suggest that the young population of the country have faced the greatest amount of stress during the pandemic, a greater need for mental health support is required to the young population, especially in post pandemic situations. The integration of online counselling and stress management programs could assist in mitigating the stress of youth involved in distance learning.

Randomized trial of steroid free immunosuppression with basiliximab induction in adult live donor liver transplantation (LDLT).

BACKGROUND: Corticosteroids are an integral part of immunosuppression following solid organ transplantation, despite their metabolic complications. We conducted a randomized trial to evaluate the efficacy of steroid-free immunosuppression following live donor liver transplantation (LDLT). METHODS: We randomized 104 patients stratified based on pre-transplant diabetic status to either a steroid-free arm (SF-arm) (Basiliximab + Tacrolimus and Azathioprine,n = 52) or Steroid arm (S-Arm) (Steroid + Tacrolimus + Azathioprine,n = 52). The primary endpoint was the occurrence of metabolic complications (new-onset diabetes after transplant (NODAT), new-onset systemic hypertension after transplant (NOSHT), post-transplant dyslipidemia) within 6 months after transplant. Secondary endpoints included biopsy-proven acute rejection (BPAR) within six months, patient and graft survival at 6 months. RESULTS: The incidence NODAT was significantly higher in S-arm at 3 months (64.5%vs. 28.1%,p-0.004) and 6 months (51.6% vs. 15.6%,p-0.006). Likewise, the incidence of NOSHT (27.8% vs. 4.8%,p-0.01) and hypertriglyceridemia (26.7% vs. 8%,p-0.03) at six months was significantly higher in S-arm. However, there were no differences in BPAR (19.2% vs. 21.2%, p-0.81), time to first rejection (58 vs. 53 days, p-0.78), patient and graft survival (610 vs. 554 days,p- 0.22). CONCLUSION: Following LDLT, basiliximab induction with tacrolimus and azathioprine maintenance resulted in significantly lower metabolic complications compared to the triple-drug regimen of steroid, tacrolimus, and azathioprine.

Antegrade Hepatic Artery and Portal Vein Perfusion Versus Portal Vein Perfusion Alone in Living Donor Liver Transplantation: A Randomized Trial.

Traditionally, deceased donor liver grafts receive dual perfusion (DP) through the portal vein and the hepatic artery (HA) either in situ or on the back table. HA perfusion is avoided in living donor liver grafts for fear of damage to the intima and consequent risk of hepatic artery thrombosis (HAT). However, biliary vasculature is predominantly derived from the HA. We hypothesized that antegrade perfusion of the HA in addition to the portal vein on the back table could reduce the incidence of postoperative biliary complications. Consecutive adult patients undergoing living donor liver transplantations were randomized after donor hepatectomy to receive graft perfusion of histidine-tryptophan-ketoglutarate solution either via both the HA and portal vein (DP group, n = 62) or only through the portal vein (standard perfusion [SP] group, n = 62). The primary endpoint was the occurrence of biliary complications (biliary leak/stricture). Secondary endpoints included HAT and patient survival. The incidence of biliary stricture was significantly lower in the DP group (6.5% versus 19.4%; odds ratio, 0.29; 95% confidence interval, 0.09-0.95; P = 0.04). There was no significant reduction in the incidence of HAT, bile leak, or hospital stay between the 2 groups. The 3-year mortality and graft survival rates were significantly higher among patients who received DP compared with SP (P = 0.004 and P = 0.003, respectively). On multivariate analysis, nonperfusion of the HA and preceding bile leak were found to be risk factors for the development of biliary stricture (P = 0.04 and P < 0.001, respectively). In conclusion, DP of living donor liver grafts through both the HA and portal vein on the back table may protect against the development of biliary stricture. This could translate to improved patient survival in the short term.