Scleroderma Renal Crisis Precipitated by Steroid Treatment in Systemic Lupus Erythematosus and Scleroderma Overlap Syndrome

Introduction: Connective tissue disorders can overlap in various ways. Patients may present with features of more than one specific disease without satisfying the diagnostic criteria and thereafter evolve into a specific disease entity. Occasionally, patients may fulfil simultaneouslythe diagnostic crateria of two or more diseases. Several cases of systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) overlap syndrome have been reported. SLE patients often develop lupus nephritis, the treatment of which is based on immunosuppression with corticosteroids (CS) and cytotoxic drugs. However, the use of high dose of CS has been associated with scleroderma renal crisis (SRC) in patient with SSc.Case report: a 43-year-old woman presented to the nephrology department of the Military hospital in Rabat, Morocco, in August 2011 with progressive dyspnea and oliguria. She was diagnosed as SLE and scleroderma overlap syndrome based on clinical and serologicalmarkers. Renal biopsy showed lupus nephritis. Immunosuppression consisting of high-dose steroid and cyclophosphamide pulses was given. There was response to treatment but 15 days later the course of the disease was complicated by scleroderma renal crisis evidencedby elevated blood pressure, deteriorating kidney function, hemolysis and thrombocytopenia. The patient was treated with perindopril and rapid reduction of steroid doses. This was followed by correction of hemolysis and thrombocytopenia. Two months later, the patient was off dialysis, but had chronic renal insufficiency with an estimated GFR of 25 ml/minute.Conclusion: This report describes the occurrence of SRC in a patient with lupus nephritis and SSc/SLE overlap syndrome who was treated by CS andcyclophosphamide

Parameters to Assess Nutritional Status in a Moroccan Hemodialysis Cohort

Introduction: Malnutrition is common in maintenance hemodialysis (HD) and is associated with increased mortality and morbidity in affected patients. The aim of this study was to determine the prevalence of malnutrition and correlate the methods of nutritional assessment.Methods: We evaluated the nutritional status of 40 prevalent HD patients by subjective global assessment (SGA) score, anthropometrics [body mass index (BMI), arm circumference (AC), triceps skin-fold thicknesses (TSF), arm muscle circumference (AMC)], biochemical tests [normalized protein equivalent to total nitrogen appearance (nPNA), and pre-dialysis serum albumin and serum prealbumin levels] and bio-electrical impedance (BEI) analysis to estimate body composition [lean tissue index (LTI) and fat tissue index (FTI)].Results: The study assessed 40 patients (20 males and 20 females) with a mean age of 50.7±16.5 years. The prevalence of malnutrition according to the different methods ranged from 5 % to 65%. There were highly significant gender-specific differences in AMC (p < 0.001) and TSF (p < 0.001). The BEI revealed a highly significant difference in LTI (p < 0.001) but no difference in FTI (p = 0.14) according to gender. There was a positive correlation between LTI and both serum albumin (r = 0.37; p = 0.018) and serum prealbumin (r = 0.53; p < 0.001). Also, there was a significant positive correlation between FTI and BMI (r = 0.59; p < 0.001), AC (r = 0.44; p = 0.004) and TSF (r = 0.61; p < 0.001).Conclusion: Our data suggest that BEI analysis provides a useful means of assessing nutritional status and was correlated with anthropometrics and biochemical findings.Keywords: Anthropometric Measurements; Bioelectrical Impedance; Hemodialysis; Malnutrition; Subjective Global Assessmen

Applying Sodium Profile with or without Ultrafiltration Profile Failed to Show Beneficial Effects on the Incidence of Intra- dialytic Hypotension in Susceptible Hemodilaysis Patients

Introduction: Intra-dialytic hypotension (IDH) is a common complication during hemodialysis (HD) treatment. Previous studies have reportedthat modulating dialysate sodium concentration combined or not with modulation of ultrafiltration (UF) rate may reduce the incidence of IDH. The aim of the present study was to evaluate the effect of sodium and UF profiles on the occurrence of intra-dialytic complications and dialysis quality.Methods: From a total of 64 patients, we selected 18 patients who suffered from recurrent IDH. Every patient received ten HD sessions utilizing each of the following treatments: (1) Control: constant sodium concentrationand UF rates. (2) Sodium and UF profiles: a linearly decreasing sodium concentration combined with a linearly decreasing UF rate. (3) Sodium profile:decreasing sodium concentration with constant UF rate.Results: Fourteen patients completed the study protocol. The incidence of IDH, mean inter-dialytic weight gain and the delivered dialysis dose were not different between the three treatments. However, symptomatic episodes of IDH were more commonand pre-dialysis systolic bloodpressure was higher during the second and third treatment modalities compared to controls. Isolated sodium profile was associated with more malaise and less achievement of target session duration compared to the other two treatments. Isolated sodium profile was associated withless achievement of target UF while combined sodium and UF profiles were associated with more achievement of target UF compared to controls.Conclusion: Our results indicate that sodium profile with or without UF profile does not have a beneficial effect on the incidence of IDH, achievement of target session duration or the delivered dialysis dose

The methodology of surveillance for antimicrobial resistance and healthcare-associated infections in Europe (SUSPIRE): a systematic review of publicly available information.

OBJECTIVES: Surveillance is a key component of any control strategy for healthcare-associated infections (HAIs) and antimicrobial resistance (AMR), and public availability of methodologic aspects is crucial for the interpretation of the data. We sought to systematically review publicly available information for HAIs and/or AMR surveillance systems organized by public institutions or scientific societies in European countries. METHODS: A systematic review of scientific and grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was performed. Information on HAIs and/or AMR surveillance systems published until 31 October 2016 were included. RESULTS: A total of 112 surveillance systems were detected; 56 from 20 countries were finally included. Most exclusions were due to lack of publicly available information. Regarding AMR, the most frequent indicator was the proportion of resistant isolates (27 of 34 providing information, 79.42%); only 18 (52.9%) included incidence rates; the data were only laboratory based in 33 (78.5%) of the 42 providing this information. Regarding HAIs in intensive care units, all 22 of the systems providing data included central line-associated bloodstream infections, and 19 (86.3%) included ventilator-associated pneumonia and catheter-associated urinary tract infections; incidence density was the most frequent indicator. Regarding surgical site infections, the most frequent procedures included were hip prosthesis, colon surgery and caesarean section (21/22, 95.5%). CONCLUSIONS: Publicly available information about the methods and indicators of the surveillance system is frequently lacking. Despite the efforts of European Centre for Disease Control and Prevention (ECDC) and other organizations, wide heterogeneity in procedures and indicators still exists

Numerical modelling of lawsonite thin film as radiative cooling minerals for dew harvesting

Harvesting dew can be used as a renewable complementary source of water both for drinking and agriculture in specific arid or semi-arid water-stressed areas. Condensation of water vapor by nighttime radiative cooling is the phenomenon that can be explained the dew formation on plants or surfaces. In this paper, we propose the lawsonite mineral, as a potential radiative cooling material, for exploiting this natural phenomenon. Furthermore, a computer model that includes meteorological parameters, obtained from the coastal region of Southern Morrocco (Mirleft-South of Agadir), is used to determine the thermal balance and fit to dew mass evolution. In order to form global estimates of dew formation potential via our dew formation model, we combined different meteorological data with radiative properties of natural lawsonite condenser (CaAl2Si2O7(OH)2·H2O) to enhance the modelled dew yield. The daily modelled yields show that significant amounts of dew water can be calculated as a function of the condenser temperature, the thickness condenser as well as the wind speed. Keywords: Condensation, Radiative cooling, Lawsonite, Harvesting dew, Dew yiel

Stainless steel/tin/glass coating as spectrally selective material for passive radiative cooling applications

Glass substrates coated with a stainless steel-tin double layer were prepared in order to achieve the inverse greenhouse effect. The measurements of the optical properties of the samples indicate that the needed specific spectral selectivity is available. Practical tests of radiative cooling were performed during clear night using a blackbody radiator covered by the coated plate with glass facing the sky. The blackbody temperature was observed to be 6.0 degrees C below that of the ambient, and the cooling power was estimated to be 27.9 W/m(2). Diurnal measurements indicated that cooling of the blackbody radiator is achieved except for approximately 6 hours around noon. (C) 2008 Elsevier B.V. All rights reserved

Bisalbuminemia during remission of nephrotic syndrome

The bisalbuminemia acquired outside of the long-term antibiotic treatment is an exceptional event. It is a rare condition characterised by the presence of two distinct fractions of serum albumin on electrophoresis. This anomaly reflects the presence, at the same time, of a normal albumin and a modified albumin. These changes of albumin may be related to various causes. Their association with nephrotic syndrome is exceptional. We report a case of bisalbuminemia during a period of remission of nephrotic syndrome