Obstructive sleep apnea syndrome in end stage renal disease patients undergoing hemodialysis

Obstructive Sleep Apnea Syndrome (OSAS) is very prevalent among End Stage Renal Disease (ESRD) patients. The syndrome is considered to be an important cardiovascular risk factor for the general population and for Chronic Kidney Disease (CKD) patients, as well. The augmented cardiovascular morbidity and mortality in ESRD patients makes the early diagnosis and treatment of the syndrome in this population a necessity. The present review focuses on the clinical presentation and the signs and symptoms of the syndrome in ESRD patients that in many cases differ from the ones on the general population. Furthermore, it attempts to explain the special conditions and mechanisms related to CKD that lead to the pathogenesis of the syndrome and explain its augmented relation to cardiovascular risk. It aims to help nephrologists understand the syndrome, be aware of its high prevalence and impact on this population, achieve an early referral and accurate diagnosis of the syndrome and consider the therapeutic options suitable for this population

Setting up the first clinical skills laboratory in Greece: Results from one-year evaluation

Following contemporary trends in medical education, the Medical School the Aristotle University of Thessaloniki initiate the development of the first Clinical Skills Laboratory (CSL) in a Greek setting. The aim of this study was to investigate the feasibility of CSL’s implementation and its response to the students needs and expectations. All students (132) who completed CSL training, during the academic year 2005-2006 participated in the study. Students training took place on a weekly basis. After the completion of all parts, an anonymous questionnaire was distributed to the students in order to evaluate the CSL

Risk of peritoneal dialysis catheter‐associated peritonitis following kidney transplant

ObjectivePeritoneal dialysis (PD) patients have equivalent or slightly better kidney transplant outcomes when compared to hemodialysis (HD) patients. However, given the risk for postoperative infection, we sought to determine the risk factors for PD catheter‐associated infections for patients who do not have the PD catheter removed at the time of engraftment.MethodsDemographic and outcomes data were collected from 313 sequential PD patients who underwent kidney transplant from 2000 to 2015. Risk factors for postoperative peritonitis were analyzed using logistical regression.ResultsOf 329 patients with PD catheters at transplant, 16 PD catheters were removed at engraftment. Of the remaining 313 patients, 8.9% suffered post‐transplant peritonitis. On univariate analysis, patients with peritonitis were significantly more likely to have used the PD catheter or HD within 6 weeks after transplant. Multivariate analysis had similar findings, with increased risk for those using the PD catheter after transplant, with a trend for those who underwent HD only within 6 weeks of transplant.ConclusionThese results suggest that delayed graft function requiring any type of dialysis is associated with increased post‐transplant peritonitis risk.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142978/1/ctr13189_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142978/2/ctr13189.pd

Prolonged intraperitoneal infusion of 5-fluorouracil using a novel carrier solution.

A novel peritoneal carrier solution, Icodextrin 20 (7.5%), has allowed exploration of prolonged, intraperitoneal (i.p.) infusion of the cytotoxic drug 5-fluorouracil (5-FU). A phase I and pharmacokinetic study was performed to determine the toxicities and maximum tolerated dose of prolonged and continuous intraperitoneal 5-FU in patients with peritoneal carcinomatosis. Seventeen patients were entered into this study. Each patient had a Tenckhoff catheter placed into the peritoneal cavity under general anaesthetic. After initial flushing and gradual increase in exchange volumes with Icodextrin 20, 5-FU was administered daily from Monday to Friday, 50% as a bolus in the exchange bag and 50% in an elastomeric infusor device delivering continuous 5-FU to the peritoneal cavity at 2 ml h-1. Treatment was continued for 12 weeks or until intolerable toxicity developed. Abdominal pain and infective peritonitis proved to be the main dose-limiting toxicities. Initial problems with infective peritonitis were overcome by redesign of the delivery system, and it proved possible to deliver 300 mg m-2 5-FU daily (5 days per week) for 12 weeks. Pharmacokinetic studies showed i.p. steady-state 5-FU concentrations (mean 47 500 ng ml-1) that were > 1000-fold higher than systemic venous levels (mean 30 ng ml-1)

Payments and quality of care in private for-profit and public hospitals in Greece

<p>Abstract</p> <p>Background</p> <p>Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged.</p> <p>Methods</p> <p>Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003.</p> <p>Results</p> <p>PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities.</p> <p>Conclusions</p> <p>In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision.</p

PATIENT SELECTION FOR AUTOMATED PERITONEAL DIALYSIS: FOR WHOM, WHEN?

The use of the various forms of automated peritoneal dialysis (APD) has increased considerably in the past few years. This increase has in part been driven by technology, through improved cycler design. Other contributing factors include better adjustment of APD to patient lifestyle, the flexibility that APD offers to patients, and the increased ability of APD to achieve adequacy and ultrafiltration targets. For high transporters and for patients unable to perform peritoneal dialysis (PD) on their own ( for example, pediatric and elderly patients), APD is considered the most suitable PD modality. Furthermore, APD has been associated with improved compliance, lower intraperitoneal pressure, and lower incidences of peritonitis. On the other hand, concerns have been raised regarding increased complexity and cost, a more rapid decline in residual renal function, inadequate sodium removal, and disturbed sleep. Automated PD is an alternative to continuous ambulatory PD when a higher dialysis dose is needed, and it could be a reliable alternative for unplanned or urgent dialysis start. Other than beneficial results in high transporters, the medical advantages of APD remain controversial. Individual patient choice therefore remains the main indication for the application of APD, which should be made available to all patients starting PD

CALCIUM METABOLISM AND BONE DISEASE IN CHRONIC ALCOHOLICS

IN ORDER TO DELINEATE THE PATHOGENESIS OF THE ALCOHOLIC BONE 15 CHRONIC ALCOHOLIC MEN, AGED 29-55 YEARS WERE STUDIED. VARIOUS BIOCHEMICAL, RADIOLOGICAL, HISTOLOGICAL AND RADIO-IMMUNOLOGIC PARAMETERS WERE USED. THE PATIENTS WERE FOUND TO HAVE A HIGH (66,6%) PREVALENCE OF OSTEOPENIA AND BONE DEMINERALIZATION, IN THE ABSENCE OF ALCOHOL-INDUCED HEPATITIS OR CIRRHOSIS. LOW DIETARY CALCIUM ANDHIGH URINARY CALCIUM EXCRETION, CORRELATED WITH OSTEOPENIA AND BONE DEMINERALIZATION, SUGGESTING BOTH FACTORS CONTRIBUTE TO THE BONE DISEASE OBSERVED IN ALCOHOLIC POPULATIONS. PLASMA 25-OH-D3 CONCENTRATIONS WERE LOW BUT DID NOT CORRELATE WITH INDICES OF OSTEOPENIA. AN ADDITIONAL, CONTRIBUTING TO THE ALCOHOLICBONE DISEASE FACTOR, APPEARS TO BE CIGARETTE SMOKING WHICH IS VERY COMMON AMONG CHRONIC ALCOHOLICS.ΜΕ ΣΚΟΠΟ ΤΗΝ ΔΙΕΡΕΥΝΗΣΗ ΤΗΣ ΠΑΘΟΓΕΝΕΙΑΣ ΤΗΣ ΑΛΚΟΟΛΙΚΗΣ ΟΣΤΕΟΠΑΘΕΙΑΣ, ΜΕΛΕΤΗΘΗΚΑΝ 15 ΧΡΟΝΙΟΙ ΑΛΚΟΟΛΙΚΟΙ ΑΝΔΡΕΣ ΗΛΙΚΙΑΣ 29-55 ΧΡΟΝΩΝ, ΧΡΗΣΙΜΟΠΟΙΩΝΤΑΣ ΔΙΑΦΟΡΕΣΒΙΟΧΗΜΙΚΕΣ, ΑΚΤΙΝΟΛΟΓΙΚΕΣ, ΙΣΤΟΛΟΓΙΚΕΣ ΚΑΙ ΡΑΔΙΟΙΣΟΤΟΠΙΚΕΣ ΠΑΡΑΜΕΤΡΟΥΣ. ΕΙΔΙΚΩΤΕΡΑ, ΜΕΛΕΤΗΣΑΜΕ ΤΗΝ ΗΜΕΡΗΣΙΑ ΚΑΤΑΝΑΛΩΣΗ ΑΙΘΥΛΙΚΗΣ ΑΛΚΟΟΛΗΣ, ΚΑΦΕΙΝΗΣ ΚΑΙ ΤΣΙΓΑΡΩΝ ΚΑΙ ΤΗΝ ΗΜΕΡΗΣΙΑ ΠΡΟΣΛΗΨΗ ΑΣΒΕΣΤΙΟΥ ΚΑΙ ΠΡΩΤΕΙΝΗΣ. ΠΑΡΑΛΛΗΛΑ ΕΡΕΥΝΗΘΗΚΕ Η ΛΕΙΤΟΥΡΓΙΑ ΚΑΙ Η ΜΟΡΦΟΛΟΓΙΑ ΤΟΥ ΗΠΑΤΟΣ ΚΑΙ Η ΑΠΟΡΡΟΦΗΣΗ ΑΣΒΕΣΤΙΟΥ ΑΠΟ ΤΟ ΓΑΣΤΡΕΝΤΕΡΙΚΟ ΣΥΣΤΗΜΑ ΤΩΝ ΑΣΘΕΝΩΝ ΑΥΤΩΝ. ΕΠΙΣΗΣ ΜΕΤΡΗΘΗΚΑΝ ΤΑ ΕΠΙΠΕΔΑ ΑΣΒΕΣΤΙΟΥ,ΦΩΣΦΟΡΟΥ, ΜΑΓΝΗΣΙΟΥ ΚΑΙ ΥΔΡΟΞΥΠΡΟΛΙΝΗΣ ΣΤΟΝ ΟΡΟ ΚΑΙ ΤΑ ΟΥΡΑ, ΚΑΘΩΣ ΚΑΙ ΤΑ ΕΠΙΠΕΔΑ ΤΗΣ ΒΙΤΑΜΙΝΗΣ D3 ΚΑΙ ΤΗΣ ΠΑΡΑΘΟΡΜΟΝΗΣ ΣΤΟ ΠΛΑΣΜΑ ΤΩΝ ΑΛΚΟΟΛΙΚΩΝ. Η ΜΕΛΕΤΗΤΩΝ ΟΣΤΩΝ ΣΤΗΡΙΧΤΗΚΕ ΣΤΟ ΣΠΙΝΘΗΡΟΓΡΑΦΗΜΑ ΟΣΤΩΝ, ΣΤΗ ΜΕΤΡΗΣΗ ΤΟΥ ΟΛΙΚΟΥ ΑΣΒΕΣΤΙΟΥ ΤΟΥ ΣΩΜΑΤΟΣ, ΣΤΟΝ ΚΑΘΟΡΙΣΜΟ ΤΗΣ ΠΕΡΙΕΚΤΙΚΟΤΗΤΑΣ ΤΟΥ ΟΣΤΟΥ ΣΕ ΜΕΤΑΛΛΑ, ΣΤΟ ΚΑΘΟΡΙΣΜΟ ΤΟΥ ΠΑΧΟΥΣ ΤΟΥ ΦΛΟΙΟΥ ΚΑΙ ΤΗΣ ΟΣΤΙΚΗΣ ΠΥΚΝΟΤΗΤΑΣ, ΣΤΟΝ ΕΛΕΓΧΟ ΤΗΣ ΥΠΟΠΕΡΙΟΡΙΣΤΙΚΗΣ ΑΠΟΡΡΟΦΗΣΗΣ ΚΑΙ ΤΕΛΟΣ ΣΤΟΝ ΜΙΚΡΟΣΚΟΠΙΚΟ ΕΛΕΓΧΟ ΤΩΝ ΟΣΤΩΝ (ΒΙΟΨΙΑ ΟΣΤΟΥ). ΜΕΤΑ ΤΟ ΤΕΛΟΣ ΤΗΣ ΜΕΛΕΤΗΣ, ΑΝΑΖΗΤΗΘΗΚΑΝ ΟΙ ΕΝΔΕΧΟΜΕΝΕΣ ΔΙΑΦΟΡΕΣ ΤΩΝΔΙΑΦΟΡΩΝ ΠΑΡΑΜΕΤΡΩΝ, ΑΝΑΜΕΣΑ, ΣΤΟΥΣ ΧΡΟΝΙΟΥΣ ΑΛΚΟΟΛΙΚΟΥΣ ΚΑΙ ΣΕ ΦΥΣΙΟΛΟΓΙΚΑ ΑΤΟΜΑ. ΟΛΕΣ ΟΙ ΠΑΡΑΜΕΤΡΟΙ ΣΥΣΧΕΤΙΣΤΗΚΑΝ Η ΜΙΑ ΜΕ ΤΗΝ ΑΛΛΗ ΚΑΙ ΒΡΕΘΗΚΑΝ ΟΙ ΣΤΑΤΙΣΤΙΚΑ ΣΗΜΑΝΤΙΚΕΣ ΣΥΣΧΕΤΙΣΕΙΣ ΜΕΤΑΞΥ ΤΟΥΣ. ΟΙ ΑΣΘΕΝΕΙΣ ΜΑΣ, ΠΟΥ ΔΕΝ ΕΙΧΑΝ ΚΑΜΙΑΕΝΔΕΙΞΗ ΚΙΡΡΩΣΗΣ # ΗΠΑΤΟΠΑΘΕΙΑΣ ΑΠΟ ΟΙΝΟΠΝΕΥΜΑ, ΒΡΕΘΗΚΑΝ ΝΑ ΕΧΟΥΝ ΑΥΞΗΜΕΝΟ (66,6%) ΕΠΙΠΟΛΑΣΜΟ ΟΣΤΕΟΠΕΝΙΑΣ. Η ΧΑΜΗΛΗ ΠΡΟΣΛΗΨΗ ΑΣΒΕΣΤΙΟΥ ΚΑΙ Η ΑΥΞΗΜΕΝΗ ΑΠΕΚΚΡΙΣΗ ΑΣΒΕΣΤΙΟΥ ΑΠΟ ΤΟΥΣ ΝΕΦΡΟΥΣ, ΒΡΕΘΗΚΑΝ ΝΑ ΕΧΟΥΝ ΣΗΜΑΝΤΙΚΗ ΣΤΑΤΙΣΤΙΚΑ ΣΥΣΧΕΤΙΣΗ ΜΕ ΤΗΝ ΟΣΤΕΟΠΕΝΙΑ. ΤΟ ΓΕΓΟΝΟΣ ΑΥΤΟ ΜΑΣ ΟΔΗΓΕΙ ΣΤΟ ΣΥΜΠΕΡΑΣΜΑ ΟΤΙ ΟΙ ΔΥΟ ΑΥΤΟΙ ΠΑΡΑΓΟΝΤΕΣ ΣΥΜΒΑΛΛΟΥΝ ΣΤΗΝ ΕΚΔΗΛΩΣΗ ΤΗΣ ΟΣΤΕΟΠΑΘΕΙΑΣ ΠΟΥ ΠΑΡΑΤΗΡΕΙΤΑΙ ΣΤΟΥΣ ΧΡΟΝΙΟΥΣ ΑΛΚΟΟΛΙΚΟΥΣ. Η ΠΥΚΝΟΤΗΤΑ ΤΗΣ ΒΙΤΑΜΙΝΗΣ 25-ΟΗ-D3 ΗΤΑΝ ΧΑΜΗΛΗ ΑΛΛΑ ΔΕΝ ΠΑΡΟΥΣΙΑΣΕ ΣΤΑΤΙΣΤΙΚΗ ΣΥΣΧΕΤΙΣΗ ΜΕ ΤΗΝ ΟΣΤΕΟΠΑΘΕΙΑ. ΕΝΑΣ ΕΠΙΠΡΟΣΘΕΤΟΣ ΠΑΡΑΓΟΝΤΑΣ ΓΙΑ ΤΗΝ ΑΛΚΟΟΛΙΚΗ ΟΣΤΕΟΠΑΘΕΙΑ, ΦΑΙΝΕΤΑΙ ΝΑ ΕΙΝΑΙ ΤΟ ΚΑΠΝΙΣΜΑ, ΤΟ ΟΠΟΙΟ,ΠΟΛΥ ΣΥΧΝΑ, ΣΥΝΟΔΕΥΕΙ ΤΟΝ ΧΡΟΝΙΟ ΑΛΚΟΟΛΙΣΜΟ