The optimization of peritoneal dialysis training in long-term

Peritoneal dialysis is a home based therapy for patients with advanced chronic kidney disease. This method provides adequate clearance of uremic toxins and removal of excess fluid when a proper dialysis prescription is combined with patient adherence. Peritonitis is the most frequent infectious complication among these patients and may render the continuity of the treatment. Training patients and their caregivers have prime importance to provide proper treatment and prevent complications including infectious ones. The training methods before the onset of treatment are relatively well established. However, patients may break the rules in the long term and tend to take shortcuts. So, retraining may be necessary during follow-up. There are no established guidelines to guide the retraining of PD patients yet. This review tends to summarize data in the literature about retraining programs and also proposes a structured program for this purpose

The Causes of Acute Fever Requiring Hospitalization in Geriatric Patients: Comparison of Infectious and Noninfectious Etiology

Introduction. Infectious diseases may present with atypical presentations in the geriatric patients. While fever is an important finding of infections, it may also be a sign of noninfectious etiology. Methods. Geriatric patients who were hospitalized for acute fever in our infectious diseases unit were included. Acute fever was defined as presentation within the first week of fever above 37.3°C. Results. 185 patients were included (82 males and 103 females). Mean age was 69.7 ± 7.5 years. The cause of fever was an infectious disease in 135 and noninfectious disease in 32 and unknown in 18 of the patients. The most common infectious etiologies were respiratory tract infections (n = 46), urinary tract infections (n = 26), and skin and soft tissue infections (n = 23). Noninfectious causes of fever were rheumatic diseases (n = 8), solid tumors (n = 7), hematological diseases (n = 10), and vasculitis (n = 7). A noninfectious cause of fever was present in one patient with no underlying diseases and in 31 of 130 patients with underlying diseases. Conclusion. Geriatric patients with no underlying diseases generally had infectious causes of fever while noninfectious causes were responsible from fever in an important proportion of patients with underlying diseases

Tuberculous meningitis together with systemic brucellosis

We present a case of a 57-year-old woman admitted with findings of meningitis. Cerebrospinal fluid (CSF) tests revealed a pleocytosis together with a low CSF glucose concentration. Empirically, antituberculosis treatment was started. Rose Bengal and Wright tests were performed to exclude brucellosis with central nervous system involvement. These tests were positive in serum but not in CSF. Antibrucellosis treatment with doxycycline and ceftriaxone was started without withdrawing the antituberculosis treatment because of the possibility of simultaneous infection with both tuberculosis and brucellosis agents. Finally, this approach was shown to be correct when tuberculosis was isolated from the culture of CSF. Clinicians in endemic regions for brucellosis should be careful while diagnosing subacute/chronic meningitis. Other possible similar etiologies such as Mycobacterium tuberculosis must be ruled out before attributing the meningitis to brucellosis

Severe thrombocytopenia and alveolar hemorrhage represent two types of bleeding tendency during tirofiban treatment: Case report and literature review

Tirofiban is a glycoprotein (GP) IIb/IIIa receptor antagonist used in the treatment of acute coronary syndrome (ACS). Thrombocytopenia is a well-known complication of GPIIb/IIIa inhibitors. Life-threatening complications such as alveolar and gastrointestinal system hemorrhages may occur in the course of thrombocytopenia. Platelet count should be monitored closely, including during the first few hours of the infusion. Adverse events may be prevented by prompt discontinuation of the therapy. Herein we present two cases of profound and sudden thrombocytopenia associated with tirofiban use in the treatment of ACS together with a review of the literature

Effects of systemic Thalidomide and intracerebroventricular Etanercept and Infliximab administration in a Streptozotocin induced dementia model in rats

Tumor necrosis factor-alpha (TNF-alpha) upregulation enhances amyloid beta (AP beta) induced neurotoxicity in Alzheimer's disease (AD). Intracerebroventricular streptozotocin (STZ) administration causes pathological changes and cognitive deficits similar to those seen in AD by causing impairment of brain glucose and energy metabolism. Recent reports indicate a protective role of Thalidomide. Etanercept, and Infliximab, all of which have anti-TNF-alpha activity, against cognitive and neuropathological changes in experimental and clinical studies. We aimed to investigate the protective effects of Thalidomide, Etanercept, and Infliximab in a rat model of intracerebroventricular STZ-induced dementia. Sprague-Dawley rats (250-300 g) were separated to sham (n = 6) and STZ (n = 24) groups. The STZ group was divided into four groups (STZ, STZ-thalidomide, STZ-etanercept, and STZ-infliximab). Morris's water maze (MWM) and passive avoidance (PA) tests were performed. At the end of the third week, brain tissues were obtained. Histopathological analysis, immunohistochemistry, and electron microscopic examinations were done. The improvement performance of the STZ group was significantly reduced in the MWM test (p < 0.001). Compared with the STZ, STZ-thalidomide, STZ-etanercept, and STZ-infliximab groups had significantly better performance (p < 0.001. <0.05 and <0.05, respectively) in the MWM test. STZ administration caused a significant decrease in the mean escape latency in PA reflex (p < 0.001). Thalidomide, Etanercept, and Infliximab were associated with better PA reflexes compared to the STZ group (p < 0.001 for all). Morphological and immunohistochemical results showed increased neurodegenerative changes compared to sham group. Our findings are in line with the findings reported in the literature and encourage further studies with TNF-alpha antagonists, in particular Thalidomide. (C) 2015 Elsevier GmbH. All rights reserved

ACUTE PHOSPHATE NEPHROPATHY AFTER ORAL SODIUM PHOSPHATE FOR BOWEL PREPARATION IN AN ELDERLY PATIENT

Acute phosphate nephropathy (APN) can result from oral sodium phosphate (OSP) (dibasic sodium phosphate and monobasic sodium phosphate) purgatives used for bowel cleansing before colonoscopy. Hyperphosphatemia, symptomatic hypocalcemia, hypernatremia, hypokalemia, high anion gap metabolic acidosis and acute kidney injury (AKI) are sometimes seen after OSP. Here in a case of AKI which advanced after preparation for colonoscopy with OSP is presented. The patient was a 77 year old female. She had type 2 diabetes mellitus and hypertension. A colonoscopy was performed to investigate the etiology of constipation. OSP was administered for preparation of colonoscopy and, after the procedure AKI which clinically compatible with APN developed. APN was shown with renal biopsy

Assessment of Mean Platelet Volume in Patients with AA Amyloidosis and AA Amyloidosis Secondary to Familial Mediterranean Fever: A Retrospective Chart - Review Study

WOS: 000469780200001PubMed ID: 31123243Background: Amyloidosis is a protein-misfolding disease characterized by the deposition of aggregated proteins in the form of abnormal fibrils that disrupt tissue structure, ultimately causing disease. Amyloidosis is very frequent in untreated familial Mediterranean fever (FMF) patients and it is the most important feature that determines the prognosis of FMF disease. The mean platelet volume (MPV) in FMF has been previously studied. However, whether MPV level in FMF patients is lower or higher compared to healthy controls remains a topic of ongoing debate. In this study, we aimed to investigate MPV values and to assess the correlation between MPV and proteinuria in patients with AA amyloidosis and AA amyloidosis secondary to familial Mediterranean fever (AA-FMF) through a retrospective chart-review. Material/Methods: This study was carried out on 27 patients with AA amyloidosis, 36 patients with AA amyloidosis secondary to FMF (a total of 63 patients with AA), and 29 healthy controls. There was no statistically significant difference between the AA patients and the control group (p=0.06) or between the AA-FMF group and the control group in terms of MPV values (p=0.12). Results: We found a statistically significant negative correlation between MPV and thrombocyte count in all groups (p<0.05 for all groups), but there was no correlation between MPV and proteinuria levels in AA patients (p=0.091). Conclusions: While similar results also exist, these findings are contrary to the majority of previous studies. Therefore, further controlled clinical prospective trials are necessary to address this inconsistency