Fortis Escorts Heart Institute

End-stage renal disease (ESRD) is a critical global health concern, with kidney transplantation being the preferred treatment for children with stage 5 chronic kidney disease. However, ABO-incompatibility (ABOi) poses a major barrier to successful transplantation. While advances in antibody removal techniques, including immunoadsorption (IA), have enabled ABOi kidney transplantation, cost remains a significant challenge, especially in low-resource settings. Most available data focus on adults, with limited pediatric reports, particularly using reusable IA columns. We report the case of a 7-year-old girl who underwent ABOi kidney transplantation from her mother, despite an exceptionally high pretransplant anti-B IgG antibody titer of 1:1 024. She received a single dose of Rituximab (200 mg) 14 days pretransplant, followed by two IA sessions using a reusable Vitrosorb IA column. The first session reduced titers to 1:16, but a rebound increase to 1:128 necessitated a second session, bringing titers down to 1:8. A final plasmapheresis session stabilized titers before transplantation. The surgery was uneventful, and post-transplant antibody levels remained controlled. The patient demonstrated good graft function and was discharged in stable condition. This is the highest reported pretransplant titer (1:1 024) in a pediatric ABOi kidney transplant case. The use of a reusable Vitrosorb IA column proved both effective and cost-efficient, making it a viable option in resource-limited settings. Our findings suggest that IA reuse is safe, reduces financial burden, and warrants further investigation for broader clinical application.

IntroductionCommunity Acquired Pneumonia (CAP) is a commonly encountered disease, one third of which is severe Community Acquired Pneumonia (SCAP) that can be life threatening. SCAP remains a frequent reason for admission to hospital and escalation of treatment including intensive care unit (ICU) admission. The mortality rate of patients of SCAP admitted to ICU may be over 30% depending on multiple factors (1). There is insufficient information regarding SCAP in Indian population. Thus the aim of the study is to observe outcomes of SCAP in a tertiary hospital setting, risk factors, mode of respiratory support in patients with SCAP.ObjectivesTo observe the mortality in patients with SCAP.ICU length of stayRisk factorsType of respiratory support.Materials and methodsThis is a prospective observational single center study conducted at Intensive Care Unit of Fortis Escort heart institute Okhla, New Delhi from September 2023 to November 2024 after obtaining approval from Institutional Ethical Committee. 50 patients were admitted to our hospital ICU with the diagnosis of SCAP in accordance to the criteria of American Thoracic Society Guidelines (2001). The patients underwent clinical and diagnostic evaluations to detect the severity of illness as well as the aetiology and other risk factors influencing the eventual outcome of SCAP.ResultsData was tabulated and analyzed by proper statistical tests. Mean age of the participants was 68 years. In ICU mortality in SCAP in our study is 16% which is lower than predicted mortality by APACHE II score (vs 25%, average APACHE II score 19). mean length of ICU stay is 4.65 days. While etiology was not found in 56% of participants, 12% grew streptococcus pneumoniae in their cultures, 22% had gram negative bacteria (klebsiella pneumoniae> Escherichia Coli>Pseudomonas Aeruginosa) and 10% had H1N1 viral influenza infections. 66% patients were initially managed with non-invasive ventilations (NIV), 8% participants were managed with high flow nasal cannula (HFNC)/conventional oxygen therapy, 26% participants were managed with invasive ventilation as means of initial respiratory support. Mortality was 8% in invasive ventilation group and 12% in NIV group.ConclusionA significant finding of our study is the association of GNBs with SCAP which are usually associated with hospital acquired pneumonia. This highlights the importance of a development of local pneumonia guidelines focusing on its aetiology and management. This study also indicates that while NIV is frequently utilized in SCAP patients, it has a notable crossover rate to invasive ventilation and significant mortality in both groups. These findings suggest that there is significant mortality in both groups and we should remain careful in selecting NIV as a mode of initial respiratory support in patients with SCAP.

Abstract: BACKGROUND: Anaemia may aggravate symptoms and even masquerade as coronary heart disease (CHD). Correction of anaemia leads to improvement in the quality of life. Cardiologists should be aware of the problem of anaemia, its pathogenesis and the systematic workup of anaemia in CHD and heart failure (HF) populations. AIMS AND OBJECTIVES: To study the prevalence, severity, and causes of anaemia in ambulatory coronary heart disease and heart failure populations. MATERIALS AND METHODS: In this single centre, retrospective observational study, we reviewed 26,600 consecutive electronic prescriptions generated in an adult cardiology outpatient service between September 2017 and August 2024. The prescriptions were assessed for the primary diagnosis, presence and severity of anaemia, and iron and vitamin B12 deficiency. RESULTS: Anaemia was recorded in 1,600/26,600 (6.01%) prescriptions in unselected population, 1,100/14,600 (7.53%) prescriptions in CHD population, 20/488 (4.09%) in dilated cardiomyopathy (DCMP) and 104/272 (38.2%) in heart failure population. Majority of CHD and HF patients had mild anaemia 49.9% and 47.1% respectively. Severe anaemia was found in 2.0% and 1.92% in of CHD and HF patients respectively. Iron Deficiency was found in 921/1600 (57.5%), 877/1100 (79.7%) and 32/104 (30.7%) in unselected, CHD and HF patients respectively. Vitamin B12 deficiency was found in 236/1600 (14.7%), 458/1100 (41.6%) and 23/104 (22.1%) in unselected CHD and HF patients respectively. Several patients had concomitant iron and B12 deficiency. CONCLUSION: Anaemia in CHD and HF population is multifactorial. Routine screening for anaemia and workup for iron and B12 deficiency should be done in suitable cases. Iron deficiency may have varied consequences, anaemia being one of them.