Introduction: Kidney transplantation (KT) is the gold standard treatment for end-stage renal disease (ESRD) patients. Hospital readmissions post-transplant is a common complication and can be considered an indication of avoidable morbidity and hospital quality, and there is a significant correlation between early hospital readmission (EHR) and adverse patient outcomes. This study aimed to assess the readmission rate following kidney transplants, the underlying causes, and possible ways to prevent it.Material and methods: We retrospectively reviewed the medical records of recipients from January 2016 to December 2021 in a single center. The primary objective of this study is to find the readmission rate for kidney transplants and the variables that contribute to readmission. Post-transplant complications that were resulted in the readmission categorized into surgical complications, graft-related complications, infections, DVT, and other medical complications. Results: Four hundred seventy-four renal allograft recipients met our inclusion criteria and were included in the study. 248 (52.3%) of the allograft recipients had at least one readmission during the first 90 days after the transplantation. 89 (18.8%) allograft recipients had more than one readmission episode in the first 90 days post-transplant. The perinephric fluid collection was the most common surgical complication (52.4%), and UTI was the most common infection (50%), causing readmission in the first 90 days post-transplant. The readmission odd ratio was significantly higher in patients above 60 years old and in kidneys with KDPI & GE; 85, and in recipients with DGF.Conclusion: EHR following a kidney transplant is a common complication. Identifying the causes not only helps the transplant centers to take further steps to prevent some incidents and help to improve the patients' morbidities and mortalities, but also it can reduce the unnecessary costs of readmissions. & COPY; 2023 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.

Objectives: A common complication after transplant is an opportunistic infection, in part due to the necessary immunosuppression regimens that patients are placed on. This study aimed to assess the outcomes and rates of infection in kidney transplant recipients on belatacept compared with kidney transplant recipients on standard immunosuppression therapy.Materials and Methods: We conducted a matched-pair case-control retrospective analysis of a prospectively recollected database of all adult kidney transplant patients at the SUNY Upstate Medical Hospital from January 1, 2016, to July 31, 2022.Results: Among study patients, 60.5% of patients in the belatacept group and 47.9% of patients in the standard immunosuppression regimen group were diagnosed with an infectious disease during follow-up, although no significant difference was shown between the 2 groups (P = .21). The most common infection in both groups was urinary tract infection, which was comparable between the groups (41.8% vs 50%; P = .42). No significant difference was shown between patients with early and late conversion to belatacept in terms of infection incident and type.Conclusions: Kidney transplant recipients who were converted to belatacept because of poor renal function had a similar infection rate compared with patients on standard immunosuppression treatment. Neither conversion to belatacept nor timing of conversion changed the risk of infection after kidney transplant. Our findings suggest that physicians may convert a kidney transplant recipient with poor renal function to belatacept without changing the patient's risk of opportunistic infection.

INTRODUCTION:Kidney transplantation (KT) is the gold standard treatment for end-stage renal disease (ESRD) patients. Hospital readmissions post-transplant is a common complication and can be considered an indication of avoidable morbidity and hospital quality, and there is a significant correlation between EHR and adverse patient outcomes. This study aimed to assess the readmission rate following kidney transplants, the underlying causes, and possible ways to prevent it.MATERIAL AND METHODS:We retrospectively reviewed the medical records of recipients from January 2016 to December 2021 in a single center. The primary objective of this study is to find the readmission rate for kidney transplants and the variables that contribute to readmission. Post-transplant complications that were resulted in the readmission categorized into surgical complications, graft-related complications, infections, DVT, and other medical complications.RESULTS:Four hundred seventy-four renal allograft recipients met our inclusion criteria and were included in the study. 248 (52.3%) of the allograft recipients had at least one readmission during the first 90 days after the transplantation. 89 (18.8%) allograft recipients had more than one readmission episode in the first 90 days post-transplant. The perinephric fluid collection was the most common surgical complication (52.4%), and UTI was the most common infection (50%), causing readmission in the first 90 days post-transplant. The readmission odd ratio was significantly higher in patients above 60 years old and in kidneys with KDPI ≥ 85, and in recipients with DGF.CONCLUSION:Early hospital readmission (EHR) following a kidney transplant is a common complication. Identifying the causes not only helps the transplant centers to take further steps to prevent some incidents and help to improve the patients' morbidities and mortalities, but also it can reduce the unnecessary costs of readmissions.

OBJECTIVE:Asthma as the most common chronic disease in childhood reduces the quality of life of children and their families. We aimed to estimate the cost of managing childhood asthma in Iran and to examine its variability depending on asthma severity.METHODS:The cost of asthma was estimated by building a cost assessment model regarding the factors that influence the cost of asthma in children including age and sex distribution, prevalence of disease severity, level of resource utilization depending on disease severity (3 groups of controlled, partly controlled and uncontrolled were defined). The model was comprised of both medical (cost of medication, physician visit and respiratory tests) and non-medical (transportation and hoteling) costs. Furthermore, the average family income in each category was figured and the share of asthma managing costs from the average income was calculated in different groups.FINDINGS:According to model, the total cost of childhood asthma in Iran was around 516.5 million dollars. Moreover, direct medical cost represented 49% of the total costs, among which 66% accounting for medication cost. Direct non-medical costs were estimated 51% with the majority (93%) expended on transportation. In addition, the mean annual cost per child was approximately 466 dollars. In addition, the results indicate the vast majority of patients (46%) are categorized in the uncontrolled group.CONCLUSION:The cost of childhood asthma in Iran is extremely high comparing to the average income of Iranian families in all categories of asthma severity. Considering the high amount of transportation cost, the accessibility of asthma treatment does not appear to be acceptable. The major source of costs is found to be related to medicine expenditure. Since it has been proven that using medicine does not necessarily result in a well-controlled disease status, alternative approaches should be considered in asthma management.

The Bacille Calmette-Guérin (BCG) vaccine is used more than any other vaccines in the world, whereas a lot of studies have spoken about allergy and its relationship with the BCG vaccine. The aim of this study was to determine the relationship between the levels of Thelper1(INF-gamma)/Thelper2 (IL-4, IL-13) in children suffering from Asthma and the scar size of BCG in them. 100 children who have got scar, 60 of them suffered from asthma and 40 did not suffer from it, were studied. The Chi-square test revealed that the frequency of cases with scar size larger than 5mm, is 43%in Asthmatic patients and 70% in control group that the observed difference was statistically significant (P = 0.01). T test also revealed that the average of INF-gamma is considerably lower in patients suffering from Asthma than the control group. (6.95±3.83 (pg/ml) in asthmatic group compared with 10.75±6.98 (pg/ml)in control group)(P = 0.001) wherease the average of IL-4 (30.90±16.51(pg/ml) in asthmatic group compared with9.95±7.44 (pg/ml) in control group) (p<0.001) and IL-13 (48.85±13.66 (pg/ml) in asthmatic group compared with10.49±12.44 (pg/ml) in control group)(p<0.001) is higher. It was demonstrated that the average of INF-gamma/IL-13(0.3054in asthmatic group compared with1. 9334 in control group) in patients suffering from asthma, is lower. The size of BCG scar in Asthmatic patients was, significantly, smaller than the control group. Moreover, the average of Thelper1(INF-gamma) was lower and the average of Thelper2 (IL-4.13) was higher in asthmatic patients. Therefore, there is a correlation between the size of BCG scar and the levels of Thelper1(INF-gamma) and Thelper2 (IL-4.13) with asthma; thus, there could also be a correlation between the scar size of BCG, Thelper1 and 2.

Background. Recurrent and chronic infections of ear, nose, and throat (ENT) such as sinusitis (rhinosinusitis) and otitis media are one of the most common health care problems worldwide and significantly impact quality of life in both children and adults. Antibody deficiencies are the most common type of primary immunodeficiency and also the most likely to present with recurrent ENT infections.Methods: A study was carried out to search for underlying immunodeficiencies in 103 patients with recurrent or chronic ear, nose and throat infections. Serum total IgG, IgA, and IgM levels were measured by kinetic nephelometry, and IgG subclasses by enzymelinked immunosorbent assay (ELISA). All patients were immunized intramuscularly with polyvalent pneumococcal vaccine (PENEUMO 23). Blood samples were drawn immediately before and 21 days after vaccination and antibodies to pneumococcal antigens were measured using a modified ELISA technique.Finding: Of 103 patients twenty one (20%) were found to have an immunodeficiency. One had a common variable immunodeficiency (CVID), 5 had selective IgA deficiency (one of them was associated with IgG2 deficiency and one with specific antibody deficiency). Eight patients had IgG-subclass deficiency including seven with an IgG2 deficiency and one patient with IgG3 deficiency. In 75 patients antibody titers of whole pneumococcal antigens were determined before and 21 days after immunization. Ten patients were found to have abnormally low antibody titers.Conclusion: The results of this study suggest that in a subpopulation of patients with a long standing history of ENT infections, a low serum immunoglobulin concentration or hypo responsiveness to pneurnococcal antigen would be associated with susceptibility to recurrent infections.