Indian Journal of Transplantation最新文献

Aim: This study aims to assess the impact of weight gain on patient and graft survival in renal transplant recipients over a 10-year period.

Materials and methods: A retrospective cohort study was conducted on 716 renal transplant recipients aged 18-67 at a tertiary care center in South India. Weight change was assessed at 1 year and at the last follow-up, with significant weight gain defined as an increase of more than 5%. Data on baseline characteristics, comorbidities, and transplant-related factors were collected. Statistical analyses, including Log Rank and Mantel-Cox tests, were used to evaluate the impact of weight gain on survival outcomes, while logistic regression identified factors influencing weight gain and loss.

Results: At 1-year posttransplant, 70% of patients experienced weight gain, with 54.1% showing significant increases. Significant weight gain at 1 year was not associated with improved patient survival. However, at the last follow-up, 79.3% of patients had gained weight, with 68.7% showing significant increases. Significant weight gain at the last follow-up was associated with improved graft and patient survival. Factors influencing weight gain included age at transplant (odds ratio [OR] =1.05), female gender (OR = 1.40), and cytomegalovirus (CMV) viremia (OR = 1.25). Factors influencing weight loss included age (OR = 1.07), pretransplant hypertension (OR = 1.50), posttransplant hypertension (OR = 1.45), and CMV viremia (OR = 1.30). However, excessive weight gain culminating in Class II obesity was associated with reduced patient survival.

Conclusion: Significant weight gain after renal transplantation is common and linked to improved graft and patient survival at the last follow-up. These findings emphasize the need for monitoring weight posttransplant and implementing targeted interventions to manage weight gain, potentially enhancing long-term outcomes for transplant recipients.

This retrospective, single-center study analyzed the clinical profile and outcomes of dematiaceous fungal infections in kidney transplant recipients over a 12-year period (2010-2022). Out of 1,041 transplant recipients, 69 developed major fungal infections, with dematiaceous fungi accounting for 8.6% of cases (n=6). These infections affected predominantly middle-aged adults (mean age 47 ± 13.1 years), with a slight male predominance. Most patients received kidneys from live-related donors and were maintained on standard immunosuppressive regimens. Dematiaceous fungal infections manifested on average 3.43 ± 1.8 years post-transplant, presenting as skin lesions, arthritis, or sinusitis. Diagnosis was confirmed through culture and histopathology, revealing phaeohyphomycosis in most cases. Management included long-term oral itraconazole therapy with regular monitoring; only one patient experienced a recurrence after five years. The findings underscore the need for heightened clinical suspicion in transplant recipients presenting with atypical skin or joint lesions, and highlight the importance of early microbiological and histopathological assessment. Prompt antifungal therapy, often alongside surgical intervention, is essential to prevent disease progression.

To study the clinical profile and outcomes of rare mycobacterial infections such as nontuberculous mycobacteria (NTM) and Mycobacterium leprae kidney transplant recipients. This is a retrospective analysis of clinical outcomes of the uncommon infections in renal allograft recipients over 22 years during 2000-2022 from a tertiary care center in southern India; the clinical data were obtained from electronic medical records of nephrology and clinical microbiology departments. Institutional review board approved this study vide minute number 13641 dated 02.12.2020. A total of 1970 patients underwent renal transplantation at our institute, from January 1, 2000, to December 31, 2022. During this period, five patients were diagnosed with mycobacterial infections, three of whom had NTM infections and two with Mycobacterium leprae infections. The patients were all diagnosed by isolating organism in blood and/or pus cultures. All patients were similarly managed initially with a reduction of immunosuppressive drugs and appropriate antibiotics as per protocol. At present, there is no standard serodiagnostic test available to reliably detect patients with rare infections. Initial cultures may yield negative results due to slow growth and inconsistent colony appearance. Our research revealed that the majority of patients had negative sputum cultures and negative Gram stains. Therefore, it is essential to maintain a high level of suspicion and conduct thorough investigations in postrenal transplant recipients to achieve early diagnosis, administer appropriate treatment, and prevent disease spread.

Background: A conversational agent powered by artificial intelligence, commonly known as a chatbot, is one of the most recent innovations used to provide information and services during the COVID-19 pandemic. However, the multitude of conversational agents explicitly designed during the COVID-19 pandemic calls for characterization and analysis using rigorous technological frameworks and extensive systematic reviews.

Objective: This study aims to describe the general characteristics of COVID-19 chatbots and examine their system designs using a modified adapted design taxonomy framework.

Methods: We conducted a systematic review of the general characteristics and design taxonomy of COVID-19 chatbots, with 56 studies included in the final analysis. This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to select papers published between March 2020 and April 2022 from various databases and search engines.

Results: Results showed that most studies on COVID-19 chatbot design and development worldwide are implemented in Asia and Europe. Most chatbots are also accessible on websites, internet messaging apps, and Android devices. The COVID-19 chatbots are further classified according to their temporal profiles, appearance, intelligence, interaction, and context for system design trends. From the temporal profile perspective, almost half of the COVID-19 chatbots interact with users for several weeks for >1 time and can remember information from previous user interactions. From the appearance perspective, most COVID-19 chatbots assume the expert role, are task oriented, and have no visual or avatar representation. From the intelligence perspective, almost half of the COVID-19 chatbots are artificially intelligent and can respond to textual inputs and a set of rules. In addition, more than half of these chatbots operate on a structured flow and do not portray any socioemotional behavior. Most chatbots can also process external data and broadcast resources. Regarding their interaction with users, most COVID-19 chatbots are adaptive, can communicate through text, can react to user input, are not gamified, and do not require additional human support. From the context perspective, all COVID-19 chatbots are goal oriented, although most fall under the health care application domain and are designed to provide information to the user.

Conclusions: The conceptualization, development, implementation, and use of COVID-19 chatbots emerged to mitigate the effects of a global pandemic in societies worldwide. This study summarized the current system design trends of COVID-19 chatbots based on 5 design perspectives, which may help developers conveniently choose a future-proof chatbot archetype that will meet the needs of the public in the face of growing demand for a better pandemic response.