A nodulo-cystic eumycetoma caused by Pyrenochaeta romeroi in a renal transplant recipient: A case report

<p>Abstract</p> <p>Introduction</p> <p><it>Pyrenochaeta romeroi </it>(<it>P. romeroi</it>) is a saprophytic fungus found in soil and plants. The fungal spores can be introduced into deeper tissues by trauma. It causes eumycetoma, which affects skin and subcutaneous tissues.</p> <p>Case presentation</p> <p>A 57-year-old South Asian man presented with a painless, nodular lesion (1 cm × 0.5 cm) on the left knee. He had had a renal transplant eight months earlier for end-stage renal failure. The patient was on tacrolimus, mycophenolate mofetil and prednisolone for immunosuppression. The lesion had progressed dramatically (to 5 cm × 5 cm) despite antibiotic treatment. The size and location of the lesion was severely affecting his quality of life, so an excision biopsy was performed. Nuclear ribosomal repeat-region sequencing confirmed the causative organism as <it>P. romeroi</it>. An <it>in vitro </it>antifungal susceptibility test demonstrated that <it>P. romeroi </it>was sensitive to voriconazole. Following a successful surgical removal, voriconazole was continued orally for two months.</p> <p>Conclusion</p> <p>To the best of our knowledge, we are reporting the first case of Eumycetoma caused by <it>P. romeroi </it>in a renal transplant recipient. Physicians should be aware of this rare fungal disease in transplant recipients. We recommend a combination of medical and surgical management in these immunosuppressed patients.</p

Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study.

INTRODUCTION: Arteriovenous fistulas (AVFs) are considered the best and safest modality for providing haemodialysis in patients with end-stage renal disease. Only 20% of UK centres achieve the recommended 80% target for achieving dialysis of the prevalent dialysis population via permanent access (as opposed to a central venous catheter). This is partly due to the relatively poor maturation rate of newly created fistulas, with as many as 50% of fistulas failing to mature.The Surveillance Of arterioveNous fistulAe using ultRasound study will examine whether a protocolised programme of Doppler ultrasound (US) surveillance can identify, early after creation, potentially correctable problems in those AVFs that subsequently fail to mature. METHODS AND ANALYSIS: This is a multicentre observational study that will assess newly created AVFs by Doppler US performed at 2, 4, 6 and 10 weeks after creation. The primary outcome measure will be primary fistula patency at week 10. Secondary outcome measures include: successful use of the fistula; clinical suitability for dialysis; creation of new fistula or radiological salvage; fistula thrombosis; secondary fistula patency rate and patient acceptability. ETHICS AND DISSEMINATION: The study has been approved by the Cambridgeshire and Hertfordshire Research Ethics Committee and by the Health Research Authority (REC 18/EE/0234). The results generated from this work will be published as open access, within 3 years of trial commencement. We will also present our findings at key national/international renal meetings, as well as support volunteers at renal patient groups to disseminate the trial outcome. TRIAL REGISTRATION NUMBER: ISRCTN36033877

Early ultrasound surveillance of newly-created haemodialysis arteriovenous fistula

IntroductionWe assess if ultrasound surveillance of newly-created arteriovenous fistulas (AVFs) can predict nonmaturation sufficiently reliably to justify randomized controlled trial (RCT) evaluation of ultrasound-directed salvage intervention.MethodsConsenting adults underwent blinded fortnightly ultrasound scanning of their AVF after creation, with scan characteristics that predicted AVF nonmaturation identified by logistic regression modeling.ResultsOf 333 AVFs created, 65.8% matured by 10 weeks. Serial scanning revealed that maturation occurred rapidly, whereas consistently lower fistula flow rates and venous diameters were observed in those that did not mature. Wrist and elbow AVF nonmaturation could be optimally modeled from week 4 ultrasound parameters alone, but with only moderate positive predictive values (PPVs) (wrist, 60.6% [95% confidence interval, CI: 43.9–77.3]; elbow, 66.7% [48.9–84.4]). Moreover, 40 (70.2%) of the 57 AVFs that thrombosed by week 10 had already failed by the week 4 scan, thus limiting the potential of salvage procedures initiated by that scan’s findings to alter overall maturation rates. Modeling of the early ultrasound characteristics could also predict primary patency failure at 6 months; however, that model performed poorly at predicting assisted primary failure (those AVFs that failed despite a salvage attempt), partly because patency of at-risk AVFs was maintained by successful salvage performed without recourse to the early scan data.ConclusionEarly ultrasound surveillance may predict fistula maturation, but is likely, at best, to result in only very modest improvements in fistula patency. Power calculations suggest that an impractically large number of participants (>1700) would be required for formal RCT evaluation

The effects of erythropoietin (EPO) and carbon monoxide (CO) on renal ischaemia/reperfusion (I/R) injury in an isolated porcine kidney model

Kidney transplantation remains the best modality for renal replacement therapy, the key problem being lack of suitable organs for transplantation. Thus renewed interest in non-heart-beating-donor (NHBD) organs is on the increase to bridge this gap. NHBD organs are subjected to ischaemia-reperfusion (I/R) injury; the underlying pathophysiology, a complex inter-related sequence leading to short and long term renal allograft dysfunction. The aim of the study was to validate normothermic resuscitation perfusion (NP) as a preservation model followed by investigating the use of erythropoietin (EPO) and carbon-monoxide (CO). Porcine kidneys were perfused with normothermic-autologus blood on an isolated-organ perfusion system (IOPS), design based on cardio-pulmonary bypass technology. Renal haemodynamics and functions were then measured during 3hr reperfusion. NP restored renal blood flow and improved renal function, as assessed by % serum creatinine fall, area under curve (AUC) of serum creatinine. EPO when added to NP did not seem to add any major benefit other than marginally improve oxygen consumption. Carbon monoxide delivered as carbon monoxide-releasing molecule-3 (CORM-3) was able to improve urine output, renal blood flow, reduce intrarenal resistance as well as improve renal function reflected by significant improvement in AUC of creatinine clearance. Normothermic resuscitation preservation not only reversed some of the deleterious effects of I/R injury, it also plays an important role as a versatile delivery system to assess various manipulatory agents that have potential in ameliorating I/R injury. This study provides further evidence that CO may be protective in renal perfusion injury and supports the use of low-dose CO releasing molecules as a method of CO delivery. Thus CORM-3 has the potential application in the field of NHBD kidney transplantation, which continues to be an expanding source of transplant kidneys. While EPO did not add any major benefits when used as a manipulating agent, may have its shortfall when applied to a NHBD kidney programme

The effects of erythropoietin (EPO) and carbon monoxide (CO) on renal ischaemia/reperfusion (I/R) injury in an isolated porcine kidney model

Kidney transplantation remains the best modality for renal replacement therapy, the key problem being lack of suitable organs for transplantation. Thus renewed interest in non-heart-beating-donor (NHBD) organs is on the increase to bridge this gap. NHBD organs are subjected to ischaemia-reperfusion (I/R) injury; the underlying pathophysiology, a complex inter-related sequence leading to short and long term renal allograft dysfunction. The aim of the study was to validate normothermic resuscitation perfusion (NP) as a preservation model followed by investigating the use of erythropoietin (EPO) and carbon-monoxide (CO). Porcine kidneys were perfused with normothermic-autologus blood on an isolated-organ perfusion system (IOPS), design based on cardio-pulmonary bypass technology. Renal haemodynamics and functions were then measured during 3hr reperfusion. NP restored renal blood flow and improved renal function, as assessed by % serum creatinine fall, area under curve (AUC) of serum creatinine. EPO when added to NP did not seem to add any major benefit other than marginally improve oxygen consumption. Carbon monoxide delivered as carbon monoxide-releasing molecule-3 (CORM-3) was able to improve urine output, renal blood flow, reduce intrarenal resistance as well as improve renal function reflected by significant improvement in AUC of creatinine clearance. Normothermic resuscitation preservation not only reversed some of the deleterious effects of I/R injury, it also plays an important role as a versatile delivery system to assess various manipulatory agents that have potential in ameliorating I/R injury. This study provides further evidence that CO may be protective in renal perfusion injury and supports the use of low-dose CO releasing molecules as a method of CO delivery. Thus CORM-3 has the potential application in the field of NHBD kidney transplantation, which continues to be an expanding source of transplant kidneys. While EPO did not add any major benefits when used as a manipulating agent, may have its shortfall when applied to a NHBD kidney programme.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Stem Cells and Their Role in Renal Ischaemia Reperfusion Injury

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Ischaemia-reperfusion injury (IRI) remains one of the leading causes of acute kidney injury (AKI). IRI is an underlying multifactorial pathophysiological process which affects the outcome in both native and transplanted patients. The high morbidity and mortality associated with IRI/AKI and disappointing results from current available clinical therapeutic approaches prompt further research. Stem cells (SC) are undifferentiated cells that can undergo both renewal and differentiation into one or more cell types which can possibly ameliorate IRI. &lt;b&gt;&lt;i&gt;Aim:&lt;/i&gt;&lt;/b&gt; To carry out a detailed literature analysis and construct a comprehensive literature review addressing the role of SC in AKI secondary to IRI. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Evidence favouring the role of SC in renal IRI and evidence showing no benefits of SC in renal IRI are the two main aspects to be studied. The search strategy was based on an extensive search addressing MESH terms and free text terms. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The majority of studies in the field of renal IRI and stem cell therapy show substantial benefits. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; Studies were mostly conducted in small animal models, thus underscoring the need for further pre-clinical studies in larger animal models, and results should be taken with caution. SC therapy may be promising though controversy exists in the exact mechanism. Thorough scientific exploration is required to assess mechanism, safety profile, reproducibility and methods to monitor administered SC.</jats:p

Structural and luminescent properties of Eu3+ doped multi-principal component Ce0.2Gd0.2Hf0.2La0.2Zr0.2O2 nanoparticles

We report the luminescent properties and local structural studies of multi-principal component Ce0.2Gd0.2Hf0.2La0.2Zr0.2O2 oxide nanoparticles using Eu3+ as a luminescent dopant. A simple chemical co-precipitation of metal salts accompanied by peptization in an acidic medium was carried out to obtain various compositions of Eu3+-doped Ce0.2Gd0.2Hf0.2La0.2Zr0.2O2 nanoparticle sols. The sols were dried in an oven at 110 °C for 24 h, and the resultant powder was calcined in static air for 2 h at 500 °C, 750 °C, and 1000 °C. The calcined nanoparticles were characterized by using x-ray diffraction (XRD), UV–Visible spectroscopy (UV–Vis), and Photoluminescence spectroscopy (PL). All the calcined Eu3+-doped samples revealed a single-phase cubic fluorite solid solution without any phase separation. PL studies on various concentrations of Eu3+ doping and calcination temperatures have been evaluated. The Eu3+ emission features are excitation wavelength-dependent. In addition, PL emission intensity increased with increasing Eu3+ concentration and calcination temperatures. The luminescent properties of these multi-principal component oxides were associated with its local environment based on the location of Eu3+ inside the host lattice. The asymmetric ratios calculated from the emission spectrum provided an insight into the local environment around the Eu3+ ion and confirmed that the system contains disordered defects even when heat treated at higher temperatures showing a stable defect fluorite structure. The reported Eu3+ doped Ce0.2Gd0.2Hf0.2La0.2Zr0.2O2 nanoparticles will be a suitable candidate for imaging as well as in lighting applications