Contact tracing for COVID-19 in a healthcare institution: Our experience and lessons learned

During the initial phases of the COVID-19 pandemic contact tracing was used to control spread of the disease. It played a key role in health care institute which continued to work even during lockdown. In this piece of work, we share the lessons learnt from the contact tracing activity done in the health care institution during April to July 2020. The training needs of persons involved in contact tracing, the follow of activities, use of technology, methods to fill the missing gaps were the key lessons learnt. Its documentation supports in setting up contact tracing activity for any emerging infectious disease outbreaks in future

Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study

18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016

Comparison of P300 Cognitive-evoked Potentials and Visual and Auditory Reaction Time in Stage 5 Chronic Kidney Disease Patients on Different Treatment Modalities

Patients with chronic kidney disease (CKD) are at a higher risk of cognitive impairment. Poor quality of life and decreased compliance are frequently observed with cognitive decline among CKD patients. Cognitive impairment among Stage 5 CKD patients varies with different modalities of treatment, and contradicting results have been reported. Fifty-four medically stable Stage 5 CKD patients undergoing different modalities of treatment were recruited: Patients with Stage 5 CKD on maintenance hemodialysis (HD) (n = 18), continuous ambulatory peritoneal dialysis (CAPD) (n = 18), and conservative management (CM) (n = 18). Eighteen apparently healthy participants were recruited as a control group. The cognitive functions assessed were P300 event- related potential, auditory and visual reaction times (VRTs). Kidney function was assessed by serum creatinine and estimated glomerular filtration rate. Creatinine levels were significantly higher in all three treatment groups compared with the control group. Multivariate analysis revealed a significant association between the CKD groups (n = 54) and the parameters of cognitive function. P300 latency was prolonged in all treatment groups compared with the control group and was significantly prolonged in patients on CM compared with HD and CAPD patients. The VRT of CM patients was found to be significantly higher compared with the control group. The auditory reaction time was significantly prolonged in all treatment groups compared with the control group and in the CM group compared with the CAPD group. Cognitive function was more affected in Stage 5 CKD patients on CM compared with patients undergoing HD or CAPD

Short-term Changes in Urine Beta 2 Microglobulin Following Recovery of Acute Kidney Injury Resulting From Snake Envenomation

Introduction: Urine β2 microglobulin (β2m) is a validated marker to diagnose sepsis and toxin-related acute kidney injury (AKI). In the current study, we used urine β2m as a potential marker to identify persistent tubular dysfunction following a clinical recovery from snake venom–related AKI. Methods: A total of 42 patients who developed AKI following hemotoxic envenomation were followed up for a period of 6 months. Urine albumin excretion, estimated glomerular filtration rate (eGFR), and urine β2m levels were measured at 2 weeks, 3 months, and 6 months following discharge. Results: At the end of 6 months of follow-up, 6 patients (14.3 %) progressed to chronic kidney disease (CKD) (eGFR  30 mg/d). The urine β2m levels were 1590 μg/l (interquartile range [IQR] 425–5260), 610 μg/l (IQR 210–1850), 850 μg/l (IQR 270–2780) at 2 weeks, 3 months, and 6 months, respectively (P = 0.020). The levels of urine β2m in the study population at the end of 6 months remained significantly higher compared with the levels in healthy control population (850 μg/l [IQR 270–2780] vs. 210 μg/l [IQR 150–480]; P = 0.001). The proportion of patients with urine β2m levels exceeding the 95th percentile of control population (>644 µg/l) during the 3 follow-up visits were 70.7% (n = 29), 48.8 % (n = 20), and 51.2% (n = 21). Similar trends were noticed in a sensitivity analysis, after excluding patients with CKD. Conclusions: Urine β2m levels remain persistently elevated in approximately half of the individuals who recover from AKI due to snake envenomation. Keywords: acute kidney injury, beta 2 microglobuli

Analytical Study of Ocular Surface Changes in Patients of Chronic Kidney Disease undergoing Hemodialysis and Peritoneal Dialysis

Objectives The idiopathic group is a significant cause of chronic kidney disease (CKD) in developing countries. Literature available on ocular surface changes has predominantly been reported in patients undergoing hemodialysis. Little is known about the changes in patients undergoing peritoneal dialysis. The present study aimed to identify ocular surface changes in an idiopathic group of CKD undergoing dialysis. Aim To compare tear film disorders and the severity of ocular surface changes (goblet cell density, squamous metaplasia, and corneoconjunctival calcification) in patients of idiopathic etiology with CKD undergoing hemodialysis and peritoneal dialysis. This is an analytical study. Materials and Methods Asymptomatic adult patients of idiopathic CKD, on treatment with dialysis underwent comprehensive ophthalmic examination, including best-corrected visual acuity, slit-lamp examination, and a dilated fundus examination. Dry eye assessment was done by ocular surface staining score, Schirmer test, and tear breakup time (TBUT). Conjunctival impression cytology was studied to assess changes on ocular surface. Chest X-rays for aortic calcification were reviewed and data analyzed. Results Both eyes of 76 patients of hemodialysis and 32 patients of peritoneal dialysis were studied. Ocular surface staining (OSS) scores were low. Impression cytology showed a drop in goblet cell density, presence of squamous metaplasia, and conjunctival keratinization significantly more in the hemodialysis group. No correlation was seen between the presence of conjunctival calcification and aortic calcification. Conclusion The hemodialysis group had mild subclinical dry eye but keratinization of conjunctiva was seen. Similarly, advanced squamous metaplasia was seen in the peritoneal dialysis group. These changes were positively correlated to decrease in goblet cell density

Early eosinophilic antibody-mediated rejection in a renal allograft recipient

Although the predominant component of acute allograft rejection is the T-cells, the milieu is not devoid of other inflammatory cells including plasma cells, eosinophils, and histiocytes. Apart from the CD8 T cell and CD4 T cell-FasL cytotoxicity, experimental models had proven a pivotal role of Th-2 cells in acute rejection, and these have been associated with marked tissue eosinophilia. Herein, we present a unique case of severe eosinophilic acute antibody-mediated rejection in a 22 years old deceased donor renal allograft recipient, within 4 days of transplantation without peripheral eosinophilia. The pathology was successfully dealt with the prevailing modalities of therapy, including steroids, plasmapheresis, intravenous immunoglobulin, and bortezomib. Concurrently, we have briefly reviewed the literature about the role of eosinophils in graft rejection and its prognostication