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

What's the middle ground? Institutionalized vs. emerging water-related stakeholder engagement processes

[Departement_IRSTEA]Eaux [TR1_IRSTEA]GEUSI [ADD1_IRSTEA]Gestion intégrée de la ressource et des infrastructuresInternational audienceIn this day and age, it is widely argued that stakeholder engagement in water-related decision-making processes yields many benefits, including legitimacy, acceptance and trust. Key legal frameworks, such as the European Water Framework Directive and the Aarhus Convention, have spurred the emergence of formal forms of stakeholder engagement. On the other hand, many engagement processes are spontaneous and self-organized. This article investigates the strategies used in formal (government-led) and informal (bottom-up) engagement processes in search of a middle ground. To this end, case studies in the Netherlands, the United States, Uganda and Ethiopia are analyzed using the OECD's stakeholder engagement checklist. We conclude with reflection on the ways forward to make formal and informal stakeholder engagement complementary

Policymakers' reflections on water governance issues

The two cultures theory argues that policy makers and scientists have different cultures and difficulty in communicating with each other. Others argue that there is increasing co-production of knowledge. This essay aims to assess the concerns of policy makers based on our policy work, policy-related research work, and our day-to-day experiences in terms of three questions: What are the perceived major issues for water governance? What are the major challenges in the structure of the existing global water governance approach? What is the vision for improving global water governance? This essay combines views from governmental, hybrid, inter- and non-governmental policy makers. It argues that water covers so many issues, aspects, and sectors that a key challenge is whether water should be governed as a sector or as a cross-cutting issue. It looks at how this challenge plays out within the United Nations system and leads to specific goal setting, while missing an overall visionary approach and a legally binding system of governance; within the hybrid arena, where it leads to inclusive discussion but not necessarily triggering consensus decisions; within nation states, where it has led to a loss of focus and a multitude of gaps and overlaps; and within transnational cooperative projects, where it has led to multiple interpretations of what is good practice. It then identifies a series of research questions

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

In Vitro and In Vivo Comparison of Changes in Antibiotics Susceptibility of E. coli and Chicken’s Intestinal Flora after Exposure to Amoxicillin or Thymol

This study aims at verifying, in vitro, the extent to which the use of amoxicillin or thymol induces the selection of resistant bacteria and at evaluating in vivo their effects on the development of antimicrobial resistance in the intestinal flora of poultry. E. coli strain was subcultured on agar plates containing increasing concentrations of either amoxicillin or thymol. Thereafter, minimal inhibitory concentrations (MICs) of thymol, amoxicillin, and two other antibiotics, tylosin and colistin, were determined using the microdilution method. Groups of chicks were subjected to a 2-week regime of either amoxicillin or thymol added to their drinking water. During the treatment with either thymol or amoxicillin, the total aerobic mesophilic flora (TAMF) was counted on thymol-gradient plates or amoxicillin-gradient plates and the MICs of antibiotics and thymol for E. coli isolates were determined. The in vitro test showed that for E. coli, which had been serially subcultured on increasing concentrations of amoxicillin, a 32-fold increase in MIC values for amoxicillin and a 4-fold increase for colistin and tylosin were noted. However, the MIC of thymol for this strain remained constant. For the E. coli, which had been serially subcultured on increasing concentrations of thymol, no change in the MIC values for antibiotics and thymol was observed. The in vivo test confirmed the in vitro one. It demonstrated that exposure to amoxicillin induced a selection of antimicrobial resistance in TAMF and intestinal E. coli, whereas exposure to thymol did not. The results showed that the group receiving thymol had a lower consumption index compared to the other groups. This study demonstrates the feasibility of this natural product as an alternative solution to the current use of antibiotics in poultry farming

The Antistaphylococcal Activity of Amoxicillin/Clavulanic Acid, Gentamicin, and 1,8-Cineole Alone or in Combination and Their Efficacy through a Rabbit Model of Methicillin-Resistant Staphylococcus aureus Osteomyelitis

The aim of this research paper is to test the antistaphylococcal effect of 1,8-cineole, amoxicillin/clavulanic acid (AMC), and gentamicin, either separately or in combination against three Staphylococcus aureus strains isolated from patients suffering from osteomyelitis. This activity was tested in vitro by using the microdilution method and the checkerboard assay. The efficacy of these three antibacterial agents was then tested in vivo by using an experimental model of methicillin-resistant S. aureus osteomyelitis in rabbits. This efficacy was assessed after four days of treatment by counting the number of bacteria in the bone marrow. The obtained results in vitro showed that the combination of the AMC with gentamicin did not induce a synergistic effect, whereas the combination of the two antibiotics with 1,8-cineole did. This effect is stronger when AMC is combined with 1,8-cineole as a total synergistic effect was obtained on the three strains used (FIC ≤ 0.5). In vivo, a significant reduction was noted in the number of colonies in the bone marrow when rabbits were treated with AMC associated with either 1,8-cineole or gentamicin compared to rabbits treated with AMC, gentamicin, or 1,8-cineole alone. These results demonstrated that 1,8-cineole showed a synergistic effect in combination with both AMC and gentamicin, which offer possibilities for reducing antibiotic usage. Also, the AMC associated with 1,8-cineole could be used to treat MRSA osteomyelitis

Effect of the quality of water used for dialysis on the efficacy of hemodialysis: A single-center experience from Morocco

The quality of the water used for dialysis has been suggested as a factor causing inflammation in patients on hemodialysis (HD). We therefore conducted this study to identify the effect of quality of the water on nutritional state, inflammation and need for human recombinant erythropoietin (EPO) in patients undergoing HD at Agadir, Morocco. This prospective study included patients on HD for at least one year. The water treatment was done according to the standard protocol, which was followed by additional enhancement of ultrafiltration using an additional polysulfone filter (diasafe, Fresenius, Bad Homburg, Germany) before the dialyser. Water was monitored regularly during the study period to ensure acceptable levels of bacterial count as well as endotoxin levels. Various parameters including dry weight, systolic and diastolic blood pressure (PA) before and after an HD session, need for human recombinant EPO, levels of hemoglobin (Hb), albumin, ferritin, C-reactive protein (CRP), and the dose of dialysis delivered (Kt/V) were measured first at the beginning of the study and thereafter, in the third, sixth and 12 th months of the study. The study involved 47 patients, and after 12 months of the study, an improvement in median dry weight (1.2 kg, P = 0017) and a simultaneous median reduction of 20.7 IU/kg/week of EPO, with an in-crease of the median level of Hb, was noted. The results of our study suggest that by improving the biocompatibility of HD with the use of good quality water, patients acquire a better nutritional, inflammatory and hematologic status