Tubulointerstitial fibrosis is a hallmark feature of chronic renal injury. Specific therapies to control the progression of renal fibrosis toward end-stage renal failure are limited. Previous studies have demonstrated that expression of endogenous bone morphogenic protein-7 (BMP-7) is reduced in the kidneys of several inducible mouse models of acute and chronic renal disease and that administration of exogenous recombinant human BMP-7 (rhBMP-7) has a beneficial effect on kidney function. Here we report that treatment with rhBMP-7 leads to improved renal function, histology, and survival in mice deficient in the alpha3-chain of type IV collagen and MRL/MpJlpr/lpr lupus mice, two genetic models for chronic renal injury and fibrosis. Such therapeutic benefit is also associated with a significant decrease in the expression of profibrotic molecules, such as type I collagen and fibronectin, in renal fibroblasts. Additionally, rhBMP-7 induces expression of active matrix metalloproteinase-2, which is potentially important for removal of fibrotic matrix. Collectively, these studies provide further evidence for rhBMP-7 as an important bone-associated protein with protective function against renal pathology.

Immunocompromised status keeps on being a challenge for a neurologist, especially in the context of the coronavirus disease-19 (COVID-19) pandemic. We report a clinical case of a human-immunode ciency virus (HIV)-positive patient who developed an acute transverse myelitis. Magnetic Resonance Imaging (MRI) examination showed longitudinally extensive spinal cord abnormality, and laboratory tests con rmed SARS-CoV-2 infection. The patient responded to methylprednisolone pulse therapy and therapeutic plasma exchange. No cases of HIV-positive patients with myelitis and COVID-19 has been reported yet.

Cytomegalovirus (CMV) infection is the most common viral infection in liver transplant recipients, affecting post-transplant patients and graft survival. Recent advances in diagnosis and management of CMV have led to marked reduction in incidence, severity, and its associated morbidity and mortality. CMV DNA assay is the most commonly used laboratory parameter to diagnose and monitor CMV infection. Current evidence suggests that both pre-emptive and universal prophylaxis approaches are equally justified in liver transplant recipients. Intravenous ganciclovir and oral valganciclovir are the most commonly used drugs for treatment of CMV disease. Most of the centre use valganciclovir prophylaxis for prevention of CMV disease in liver trasplant recipient. The aim of this article is to review the current standard of care for diagnosis and management of CMV disease in liver transplant recipients.

There are rising concerns among the medical community and the public regarding the side effects of different vaccines developed throughout the world and their short and long-term effects, particularly COVID19 vaccines. Most notably, post-vaccination demyelinating diseases such as acute disseminated encephalomyelitis, transverse myelitis, and multiple sclerosis relapses have been reported. We present a case of a 32-year-old male who presented with a 2 weeks history of acute confusional state and imbalance 1 week after receiving the second dose of COVID19 vaccination. MRI findings showed typical distribution of neuromyelitis optica spectrum disorder and the patient was positive for AQP4 IgG. The pathogenesis behind developing neuromyelitis optica and vaccines is still unknown. Few case reports have been reported of post-vaccination neuromyelitis optica spectrum disorder but to our knowledge, this would be the first case published of neuromyelitis optica following exposure to COVID19 vaccine.

Salmonella enterica subsp. arizonae is a common gut inhabitant of reptiles, with snakes as the most common reservoir. Though human cases due to this organism are exceedingly rare, it may infect young infants and immunocompromised individuals with a history of intimate associations with reptiles. Gastroenteritis is the most common presentation; others include peritonitis, pleuritis, osteomyelitis, meningitis, and bacteremia. We report a fatal case of S. enterica subsp. arizonae gastroenteritis in a 3-month-old child with microcephaly, with a review of earlier cases and problems encountered in identification of this rare human pathogen. CASE REPORTA 3-month-old female child presented to the Emergency Unit at Ram Manohar Lohia Hospital, New Delhi, India, with a history of fever and cough for 20 days and diarrhea with mucus and blood for 15 days. There was no history of similar illness in other family members or in the community. On admission, the child, who had microcephaly, appeared highly irritable and had tachypnea and bilateral crepitations. The spleen and liver were just palpable, and there was a rash all over the body. The patient was diagnosed as having pneumonia with persistent diarrhea. A fecal sample was sent for routine culture and microscopic examination, and the patient was empirically started on broad-spectrum antibiotics (ampicillin, cefotaxime, and amikacin). Investigations revealed a hemoglobin level of 11.0 g%, a total leucocyte count of 11,500/ml, and an erythrocyte sedimentation rate of 100. A urine culture was sterile, and cerebrospinal fluid biochemistry and cytology showed no abnormality. The chest X ray showed infiltration in both lungs, while the skull X ray was normal.The routine microscopic examination of feces did not reveal the presence of any protozoan or helminth. While fecal cultures grew a non-lactose-fermenting motile organism, the routine biochemical tests (indole, triple-sugar iron agar, citrate, urea, mannitol, and motility) for this isolate were obfuscating.

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Salmonella typhi is a true pathogen, which is capable of causing both intestinal and extraintestinal infections. Unusual presentations of Salmonella should always be kept in mind as this organism can cause disease in almost any organ of the body. S. typhi has been reported to cause the life-threatening infections such as meningitis, endocarditis, myocarditis, empyema, and hepatic abscess. Renal involvement by S. typhi is a relatively rare presentation. We report a case of renal abscess caused by S. typhi in an afebrile, 10-year-old child who did not have any clinical history of enteric fever. To our knowledge, this is the first reported case of isolation of S. typhi from the renal abscess, and interestingly this isolate was found to be resistant to quinolones.

PURPOSE:The aim of this study is to evaluate the predisposing risk factors, clinical presentations, laboratory parameters, and treatments taken and outcomes in patients of nocardiosis in the span of 5 years in a tertiary care hospital.MATERIALS AND METHODS:The patients whose specimens showed Nocardia like organism in Gram-staining, Kinyoun staining and characteristic colonies in culture were included in the retrospective analysis study. Retrospective analysis of associated risk factors, clinical presentations, and radiological findings was performed.RESULTS:Of the thirteen patients, 11 (76.9%) had immunosuppressive pathologies including solid organ transplantation, autoimmune disease, use of steroids, and immunosuppressive drugs as important risk factors. Four types of clinical manifestations were observed, pulmonary (46.1%), cutaneous (23.07%), cerebral (15.3%), and bacteremia (15.3%). The most common presentation was pulmonary with steroid therapy as a significant risk factor. Consolidation and pleural effusion were the common radiological findings in these cases. In eight of the nine patients anti-nocrdial drugs were given. Cotrimoxazole as monotherapy was given in four cases (44.44%), cotrimoxazole in combination with meropenem in two cases (22.22%); minocycline and linezolid were given in one case each. The overall mortality was 36.36% and was seen in patients with pulmonary nocardiosis.CONCLUSIONS:The study indicates that Nocardial infections are re-emerging on account of an increase in numbers of immunocompromised patients due to increased organ transplants, autoimmune diseases, malignancies, and use of immunosuppressive drugs and steroids. The diagnosis is often missed/not suspected and delayed because of the clinical resemblance to many other infections. Nocardial infection should be suspected and assessed particularly in immunocompromised patients not responding to treatment/improving clinically.