Incidence of acute pancreatitis among patients with leptospirosis requiring extracorporeal membrane oxygenation (ECMO): a descriptive study

Background Acute pancreatitis (AP) is an infrequently reported manifestation of leptospirosis. It is more commonly seen in patients with acute respiratory distress syndrome. Despite novel modalities such as extracorporeal membrane oxygenation (ECMO), the mortality rate remains high and whether this is associated with the lung injury caused by the inflammation in AP remains unclear.Objectives and methods A descriptive study was conducted at a tertiary hospital in the Philippines. Primary outcome was defined as the presence or absence of AP. Secondary outcomes were defined as 28-day mortality rate, length of hospital stay, ECMO days, renal replacement therapy (RRT) days, days on mechanical ventilation, presence of local complications of AP and development of nosocomial infections.Results A total of 27 patients were included in the study, and 88.89% (n=24) were men. The mean age for all patients was 33.59±10.22 years. Out of the 27 patients, 19 (70.37%) were diagnosed with AP. Among these 19 patients, one (5.26%) had necrotising pancreatitis and two (10.52%) developed local complications of pancreatitis. Six patients (31.58%) died among those who developed AP, while one (12.50%) died among those who did not. The duration of hospital stay, ECMO, RRT, mechanical ventilation and development of nosocomial infections was also higher in the group who presented with AP.Conclusion AP is an under-reported complication of leptospirosis. Our study demonstrated a higher mortality and morbidity in patients with leptospirosis who developed AP

TRANSFORM STUDY: IMPACT OF DONOR TYPE ON 12-MONTH OUTCOMES OF EVEROLIMUS AND REDUCED CALCINEURIN INHIBITOR VERSUS MYCOPHENOLATE AND STANDARD CALCINEURIN INHIBITOR IN DE NOVO KIDNEY TRANSPLANT PATIENTS

Nephrolog

Randomized trial of alemtuzumab for prevention of graft rejection and preservation of renal function after kidney transplantation

10.1097/01.tp.0000166921.14670.33Transplantation806765-77

A Scoring Tool to Predict Pulmonary Complications in Severe Leptospirosis with Kidney Failure

Rapid identification of patients likely to develop pulmonary complications in severe leptospirosis is crucial to prompt aggressive management and improve survival. The following article is a cohort study of leptospirosis patients admitted at the National Kidney and Transplant Institute (NKTI). Logistic regression was used to predict pulmonary complications and obtain a scoring tool. The Kaplan–Meir method was used to describe survival rates. Among 380 patients with severe leptospirosis and kidney failure, the overall mortality was 14%, with pulmonary hemorrhage as the most common cause. In total, there were 85 (22.4%) individuals who developed pulmonary complications, the majority (95.3%) were observed within three days of admission. Among the patients with pulmonary complications, 56.5% died. Patients placed on mechanical ventilation had an 82.1% mortality rate. Multivariate analyses showed that dyspnea (OR = 28.76, p p p p p p 2 (63% sensitivity, 88% specificity). Pulmonary complications in severe leptospirosis with kidney failure have high mortality and warrant timely and aggressive management

Autologous dendritic cell transplantation as an adjuvant treatment in pleomorphic lung carcinoma

We embarked on autologous dendritic cells (DC) transplantation as an adjuvant therapy with chemotherapy in a pleomorphic lung carcinoma patient. DC were isolated from PBMC and primed with the autologous tumor lysate. No adverse event was noted in DC transplantation. DC administration also correlated with immunomodulation, as evidenced by an approximately 5-fold increase in serum interferon gamma after 2 months. The utility of autologous DC transplantation may offer a clinical benefit with virtually no adverse event