Outbreak of Peritonitis in a Continuous Ambulatory Peritoneal Dialysis Population Following the Use of Contaminated Peritoneal Dialysis Fluids

Introduction: Most cases of peritonitis during continuous ambulatory peritoneal dialysis (CAPD) are attributed to breaches of the aseptic technique. In this report, we describe an outbreak of CAPD related peritonitis that followed the use of potentially contaminated PD fluid. Outbreak report: CAPD was introduced in the adult nephrology unit at Soba University Hospital in December 2008 with fairly satisfactory functioning and results. In June 2009, we obtained a new supply of PD fluids and started using it. Soon afterwards, a mould was found inside a new unused dialysate bag. During the following days, six patients were diagnosed to have PD related peritonitis. All patients in the unit were immediately shifted to another brand of PD fluids. Enquiry revealed that this supply of PD fluid was stored in a warm and humid environment. We surveyed the 1469 bags in the hospital stock and found another three bags (0.2%) that contained visible mould by the naked eye. The four contaminated bags contained 2.5% dextrose and were from different batches. All of them had lost the negative vacuum between the inner bag and the outer plastic envelope, but had no obvious tears in the envelope and no obvious fluid leakage. Our peritonitis rate before the outbreak was one episode in 21.7 patient-months. This sharply rose to one episode in 2.5 patient-months during the month of the outbreak, and dropped down to one episode in 17.8 patient-months in the 6-months following the outbreak. Conclusion: Contamination of PD fluids can occur during handling and storage. Patients should meticulously examine each bag before usage. Any bag that has lost the vacuum between the inner bag and its outer envelope is potentially breached and should not be used. Keywords: Contamination; Fungal peritonitis; Outbreak; Penicillium spp.; Peritoneal dialysi

Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta-analysis

AIMS: To conduct a systematic review and meta-analysis of published observational evidence to assess the difference in the prevalence and progression of diabetic nephropathy, and the development of end-stage renal disease (ESRD) in people from three different ethnic groups with type 2 diabetes (T2DM). MATERIALS AND METHODS: Relevant studies were identified in a literature search of MEDLINE, EMBASE and reference lists of relevant studies published up to May 2018. We decided a priori that there were no differences in the prevalence and progression of diabetic nephropathy, and the development of ESRD in the three ethnicities with T2DM. Pooled relative risks of microalbuminuria by ethnicity were estimated by fitting three random effects meta-analyses models. A narrative synthesis of the nephropathy progression in the studies was carried out. The review was registered in PROSPERO (CRD42018107350). RESULTS: Thirty-two studies with data on 153 827 unique participants were eligible for inclusion in the review. The pooled prevalence ratio of microalbuminuria in South Asian compared with white European participants was 1.14 (95% confidence interval [CI] 0.99, 1.32; P = 0.065), while for African Caribbean vs South Asian participants the pooled prevalence ratio was 1.08 (95% CI 0.93, 1.24; P = 0.327). Results for renal decline were inconsistent, with preponderance towards a high rate of disease progression in South Asian compared with white participants. The estimated pooled incidence rate ratio (IRR) for ESRD was significantly higher in African Caribbean vs white European participants: 2.75 (95% CI 2.01, 3.48; P < 0.001). CONCLUSION: The results of this review did not show a significant link between ethnicity (South Asian, white European and African Caribbean) and the prevalence of microalbuminuria; however, the IRR for ESRD in African Caribbean compared with white European participants was significantly higher. Further research is needed to explore the potential non-albuminuric pathways of progression to ESRD

Potential therapeutic road for targeting the SARS-CoV-2 at throat

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has become a serious public health problem for 183 out of 197 countries in the world. Understanding the routes and pathogenesis of the coronavirus is important and it is considered that the studies on host cell receptor Angiotensin Converting Enzyme 2 (ACE2) may be valuable for the treatment and prevention of the disease. AIM: To evaluate the possibility of inhibition of SARS-CoV-2 at throat

Prevalence of dengue fever virus antibodies and associated risk factors among residents of El-Gadarif state, Sudan

Abstract Background Dengue fever, caused by dengue virus (DENV), has become one of the most important mosquito-borne viral diseases with a steady rise in global incidence, including the Sudan. Sporadic cases and frequent acute febrile illness outbreaks, compatible with Dengue fever, have been reported in El-Gadarif State, Sudan. However, diagnosis was based almost exclusively on clinical signs without confirmatory laboratory investigations. Despite the magnitude of the problem in El-Gadarif State, no information is currently available with regard to the epidemiology of the disease in this State. El-Gadarif State is one of the largest commercial centers in the Sudan. The objective of the present investigation is to estimate the prevalence of DENV antibodies, and determine the potential risk factors associated with seropositivity among residents of El-Gadarif State. Methods A cross sectional study was conducted in a total of 701residents randomly selected from all 10 localities in El-Gadarif State. The sera from the 701 residents were tested for the presence of DENV-specific immunoglobulin G (IgG) antibodies using a commercially available Anti-dengue IgG enzyme-linked immunosorbent assay (ELISA). Results Among the 701 residents, 334 residents (47.6%) were seropositive for DENV. Mosquito control (OR = 2.73, CI = 1.37–5.87, p-value = 0.001); low income (OR = 2.31, CI: 1.71–6.36, p value = 0.032); sleeping out-doors (OR = 3.73, CI = 2.63–6.23, p-value = 0.013), and localities were determined as potential risk factors for contracting DENV infection. Conclusions The prevalence rate of DENV antibodies among residents of El-Gadarif State is significantly high (47.6%). Further epidemiologic studies including, distribution of mosquito vectors and implementation of improved surveillance are urgently warranted for better prediction and prevention of a possible DENV outbreak in El-Gadarif State, Sudan