Renal Transplantation and Pregnancy

Introduction: Although pregnancy after kidney transplantation is feasible, complications are relatively common and this needs to be considered in patient counseling and clinical decision making.Review: Fertility generally returns after renal transplantation. Approximately 74% of pregnancies in kidney transplant recipients end successfully in life births. Published reports suggest that pregnancy has no adverse affects on graft survival although patients with higher pre-pregnancy serum creatinine have a trend toward increased post-pregnancy serum creatinine. There is, however, a significantly increased risk of preeclampsia, gestational diabetes, cesarean section and preterm delivery compared to the general population. Almost half life births are preterm, and low birth weight is very common. Immunosuppressive medications are required to be continued during pregnancy in transplant recipients to prevent graft rejection, except for  sirolimus and mycophenolate mofetil (MMF) which are contraindicated during pregnancy. The incidence of birth defects in the live born is similar to the general population, except for pregnancies exposed to MMF which have a high incidence of birth defects. Every female in the reproductive age group should be counseled regarding pregnancy including the potential risks to the graft, to the mother and to the child. Timing pregnancy should be based upon whether graft function is optimal, but the general recommendation is to wait one year post transplantation before conception.Conclusion: Pregnancy in renal transplant patients should be planned with combined care from surgeons, nephrologists, obstetricians, pediatricians and dietitians which offers the best chance of a favorable outcome in the mother and the fetus

Developing a scalable training model in global mental health: pilot study of a video-assisted training Program for Generalist Clinicians in Rural Nepal.

BackgroundIn low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists.MethodsWe implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of 'Yes' or 'No' questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback.ResultsFor each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components.ConclusionVideo lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants

Anaphylaxis to Ceftriaxone – Evaluation of Two Cases

Allergic reactions to beta-lactamase antibiotics are the most common cause of adverse drug reactions mediated by specific immunological mechanism. Anaphylaxis is diagnosed clinically. In two of our cases, patients developed acute respiratory distress syndrome (ARDS) secondary to anaphylaxis, which was however managed successfully without residual deficits

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

Background: Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation. Partnerships network We describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community. Conclusions: We propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal.

BackgroundMental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation.Partnerships networkWe describe our partnerships network as a case example that addresses challenges in delivering mental healthcare and which can serve as a model for similar settings. Our perspectives are informed from integrating mental healthcare services within a rural public hospital in Nepal. Our approach includes training and supervising generalist health workers by off-site psychiatrists. This is made possible by complementing the strengths and weaknesses of the various groups involved: the public sector, a non-profit organization that provides general healthcare services and one that specializes in mental health, a community advisory board, academic centers in high- and low-income countries, and bicultural professionals from the diaspora community.ConclusionsWe propose a partnerships model to assist implementation of promising programs to expand access to mental healthcare in low- resource settings. We describe the success and limitations of our current partners in a mental health program in rural Nepal