Vol 24, No 4 (2024)

The Coronavirus-19 (COVID-19) hasn’t seen the dawn since its emergence, however waxing and waning has resulted in the emergence of deadly variants. The effects of pandemic have not been limited to its virulence, but have rather conferred multiple collateral effects, especially in developing countries; thereby, designating it as a SYNDEMIC. The same culminated in neglect of non-COVID-19 conditions like tuberculosis (TB) and human immunodeficiency virus-acquired immunodeficiency syndrome (HIV/AIDS). Besides being the prognostic factor for severe COVID-19, these infections in hidden pockets served as reservoir for emergence of the deadly Omicron. Another significant impact of this juxtaposition was on the delivery of healthcare services for TB and HIV.

2:The unanticipated COVID-19 pandemic turned the path of ongoing progress of elimination programs. Direct consequences of the COVID-19 pandemic were pronounced on diagnosis, treatment, and services for patients with TB and HIV. Essential TB services were reallocated to the COVID-19 rapid response task force. However, despite escalating the tribulations, this triple burden has simultaneously taught lessons to escalate the progress of halted programs. The pandemic has catalyzed an unusual level of collaboration among scientists, which can be exploited for TB and HIV. Fast-track diagnostics, digitalization, contact tracing, and vaccine development have enabled world to envision the same for TB/HIV.

India has the largest problem of tuberculosis (TB) infection globally (estimated at about 35-40 crores cases), and around 18-36 lakh develop active tuberculosis annually. Latent TB is defined as a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifested active TB. The progression of a latent infection to active tuberculosis increases several-fold in childrep < 0 years of age and in people with some or the other form of an immunocompromising condition. Therefore, to cater to this gigantic problem of tuberculosis, it is necessary to have awareness about latent tuberculosis infection (LTBI) amongst clinicians and to prioritise its diagnosis and treatment in high-risk groups. India plans to end TB well before the deadline set by the World Health organisation (WHO). However, this can only be achieved with effective strategies targeting LTBI. Multiple treatment regimens have been approved for LTBI treatment, and all have comparable efficacy. The selection of one regimen over the other depends on various factors, such as availability, risk of adverse events, age, and drug interactions. Recently, the WHO, as well as the Revised National TB Control Programme (RNTCP), have updated their guidelines on TB preventive treatment in 2020 and 2021, respectively. This review has been especially prepared to acknowledge the differences in approach to LTBI in developed and developing countries.

Introduction::Appropriate care and treatment of a wound is the need of the hour whether it is an infected or a non-infected wound. If wound healing is delayed for some reason, it leads to serious complications and further increases the hospital stay and cost of treatment. Herein, we describe a novel antimicrobial wound dressing formulation (VG111), with an objective to generate the preliminary data showing the distinct advantages in various types of wounds.

Method::This case series involved the treatment of acute cases of wounds or chronic wounds that did not respond well to conventional wound healing treatments with VG111 in patients with different etiologies. Thirteen cases of patients that included patients with diabetes, pressure ulcers, burns, trauma, and others treated with VG111 showed rapid wound healing in all the cases even obviating the need for a graft when complete skin regeneration occurred.

Result::This was illustrated by clearing of the wound infections, reduction/disappearance of the exudate, appearance of intense granulation, epithelialization, and anti-biofilm activity followed by complete wound closure. This VG111 precludes the need for systemic antimicrobial agents in localized infections and therefore, this single agent is an attempt to address the limitations and the drawbacks of the available products.

Conclusion::Despite patients belonging to the old age group and having comorbidities like diabetes, still VG111 showed effective rapid wound healing, and that too without any scar formation in hardto- heal, infected, and non-infected wounds.

Background:Infections caused by anaerobic bacteria occur frequently and can be serious and life-threatening. Anaerobes are a rare cause of community-acquired pneumonia with Streptococcus pneumonia and respiratory viruses being the most frequently detected pathogens. We, herein, report a case of Fusobacterium/Peptostreptococcus parapneumonic effusion with empyema in a patient without risk factors for aspiration pneumonia. This case presents an opportunity to discuss an unusual case of community-acquired empyema secondary to anaerobic infection in a patient without the common risk factors for aspiration.

Case Presentation:A 59-year-old male patient without significant past medical history apart from a twenty-five-year history of smoking presented due to left flank pain and shortness of breath. Findings of a complicated parapneumonic effusion were found on imaging, resulting in surgical decortication and prolonged antibiotic therapy.

Discussion:Parapneumonic effusions and empyema are relatively common complications of pneumonia. It is important to note that the incidence of anaerobic empyema has been on the rise due to more modern culturing techniques.

Conclusion:This case highlights an unusual presentation of community-acquired empyema secondary to anaerobes without any risk factors for aspiration pneumonia. Therefore, clinicians should consider the possibility of anaerobic coverage in the treatment of community-acquired empyema in the appropriate setting.

Background:With the emergence of vaccines for COVID-19, mortality and severity of disease have decreased. However, patients with certain comorbidities, such as immunosuppression, CKD, and renal transplant, still have higher mortality rates as compared to the general population. Current data suggests that the risk of developing COVID-19 among transplant patients was reported to be about 5%, which is significantly higher than the risk rate of 0.3% in the general population. Studies utilizing larger sample sizes (i.e., multiple cohorts, sites, hospitals) comparing COVID-19 outcomes among renal transplant patients with a control group are lacking.

background:Coronaviruses belong to a family of Viruses that can cause range of illnesses ranging from the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) (1,2). In 2019 a new Coronavirus was identified and was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) which belongs to the genus beta-CoV which also includes Severe Acute Respiratory Syndrome CoV (SARS-CoV), and Middle Eastern Respiratory Syndrome CoV (MERS-CoV) (2). World Health Organization (WHO) later announced an alternative name for the disease caused by SARS-CoV-2: CoV disease (COVID-19) (2). As of May 25, 2022 an estimated 524,339,768 cases of COVID-19 were reported to World health organization including 6,281,260 deaths related to COVID globally. However, the disease affects patients with certain risk factors disproportionally. Recent data has shown chronic comorbidities, such as acute kidney injury, COPD, diabetes, hypertension, CVD, cancer, increased D-dimer, along with demographic variables such as male gender, older age, current smoker, and obesity are clinical risk factors for a fatal outcome associated with coronavirus [3]. With the emergence of COVID-19 vaccines, severity and mortality of the disease decreased and has contributed in controlling the pandemic that has claimed so many lives across the globe (4). Even with the emergence of vaccine, the disease continued to claim a disproportionate number of lives, particularly among immunocompromised individuals

Objective:The purpose of this descriptive study was to compare the mortality rate between vaccinated and unvaccinated kidney transplant recipients.

objective:The purpose of this study is to provide a descriptive overview of clinical outcomes between vaccinated and unvaccinated kidney transplant recipients in a single transplant center in West Texas

Methods:Participants were recruited at a community-based transplant clinic in West Texas. Results Among the group of participants who tested positive for COVID-19 between 2020 and 2022, higher mortality rates and longer hospital stays were noted among those unvaccinated (72% unvaccinated had greater than 5-day length of stay vs. 33% vaccinated).

method:Retrospective Data was collected from Kidney Transplant Clinic at a Medical Center located in El Paso, Texas. Data was gathered between January 2020 and January 2022 from the transplant database. Data was extrapolated for demographics including age, race, gender. Other data included vaccinated vs. unvaccinated status, comorbidities, immunosuppression status, outcomes such as length of stay in the hospital and mortality rate. A total of 38 patients were included in the study between the year 2020 and 2022. In cases where the patient died, missing data was collected from the next of kin. Inclusion criteria included aged 18 and older, being a kidney transplant recipient (deceased and living) and had a current functioning transplanted kidney. We included all patients who tested positive for COVID-19 during January 2020 to December 2022. Patient whose data could not be obtained since they were deceased and/or did not have next of kin were excluded from the study. Patients were also excluded from the study if their missing data could not be obtained or validated by patient or next of kin.

Conclusion:Our study suggests that vaccination against COVID-19 decreases mortality rates in kidney transplant recipients.

result:Among the 38 patients included in the data set 94.7% identified as Hispanic vs 5.2% were non-Hispanics and 71% were male vs 28.9% were females. The majority of the patients were vaccinated (71% vs 28.9% non-vaccinated). The data also showed higher rates of death in Unvaccinated population as opposed to vaccinated patients (90.9% vs 14.8%). 72% of unvaccinated transplant recipients had a length of stay greater than 5 days compared to 33% of vaccinated patients. All of the patients evaluated in the cohort had two or more comorbidities such as HTN, atrial fibrillation and DM2 (100%). Among patients included in the cohort 84.2% were deceased renal transplant recipients while 15.7% living renal transplant recipients. Furthermore, increased mortality rates were seen among patients treated with higher induction doses (greater than 350mg). A total of 20 patients in the cohort received greater than 350 mg of induction doses out of which 9 were unvaccinated (45%) and 12 were vaccinated (60%). Out of the 9 unvaccinated patients 8 patients died (88%) while 1 patient survived (11.1). Respiratory failure was the main cause of death among patients that passed away, regardless of vaccine status (90.9% Vaccinated vs 14.8% unvaccinated).

conclusion:Large phase 3 clinical trials are still currently underway worldwide to study the effects of vaccine on transplant patient. Our study suggests that vaccination against COVID 19 decreases mortality rates in Kidney Transplant recipient. Our retrospective study compared mortality rates between vaccinated and unvaccinated Kidney transplant recipients in a small clinic setting. It is important to have a large prospective double-blind study on the use of vaccinations in renal transplant recipients would be useful to study the effectiveness on this population.