Tackling Fluid Overload in a High-transporter Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis

Introduction: Diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) are more prone to fluid overload than non-diabetic patients, but the use of hypertonic glucose solutions to improve their ultrafiltration (UF) may hamper their glycemic control. Maintaining euvolemia in such patients may be tricky and needs special care. Case report: A 72 year old diabetic and hypertensive patient presented with severe fluid overload shortly after initiation of CAPD despite producing more than one liter of urine per day. He only achieved modest ultrafiltration (UF) during the day, and had a negative UF during the long hypertonic night dwell. Peritoneal equilibration tests (PET) confirmed that he was a high transporter, and his weekly Kt/V was found to be 1.36. Since automated peritoneal dialysis (APD) is not yet available in Sudan, the PD prescription was modified to comprise five short cycles during the day, including two short hypertonic daytime dwells, and a dry abdomen at night. This approach succeeded in improving his fluid status, but required the addition of intra-peritoneal soluble insulin to his regular subcutaneous insulin in order to achieve acceptable blood sugar control. After 8 months his residual renal function (RRF) had declined remarkably and he began to suffer from intermittent fluid overload of variable degrees. Nevertheless, we managed to maintain him satisfactorily on CAPD for 14 months. Conclusion: Simple measures such as omitting the night dwell and using five short cycles during the day, including two short hypertonic dwells, can be effective in controlling fluid overload in diabetic patients who have a high transporter status. Key words: CAPD, diabetes mellitus, fluid overload, residual renal Functio

Large solitary luteinized follicle cyst of pregnancy and puerperium

Solitary luteinized follicle cyst is a rare cause of ovarian enlargement during pregnancy and puerperium. Only rare cases of this clinical condition have been reported in the literature. We report a case of a large solitary luteinized follicle cyst arising in a 32-year-old multipara four days post partum which required postpartum surgical intervention. The perinatal outcome is usually good, with liveborn infants being delivered at or near term. The complications of the disease include ovarian torsion, intra-cystic haemorrhage, and rupture. The condition should be included in the differential diagnostic workup whenever a growing simple cyst is encountered during pregnancy and puerperium.Key words: luteinized follicle cyst; pregnancy; puerperium

Six Cases of Fungal Peritonitis Complicating Peritoneal Dialysis in a Single Center in Sudan

Introduction: A national program of continuous ambulatory peritoneal dialysis (CAPD) has only recently been established in Sudan. In the head center of this national program, six of the 67 peritonitis episodes that were diagnosed during its 30 months of function were fungal in origin (9% of all episodes, 0.12 episode per year at risk). Here we describe the clinical features, predisposing factors, and outcomes of these six cases. Case series: Clinical presentation of fungal peritonitis did not differ from other cases of peritonitis. Among the six cases that were diagnosed in our center, five cases were due to Candida species and only one was due to Aspergillus. All patients had received antibiotic therapy within one month of diagnosing fungal peritonitis; five of them had received intraperitoneal (IP) antibiotics for a previous episode of bacterial peritonitis and one patient had received a course of oral antibiotics for exit site infection. Two of the patients were diabetic. All patients were treated with oral fluconazole, 200 mg daily, for three weeks, and all had their dialysis catheter removed. One patient died, and the others were transferred permanently to hemodialysis (HD). Two patients developed encysted intra-abdominal fluid collections 15 and 48 days after catheter removal. Conclusion: Fugal peritonitis complicating CAPD is not uncommon in our center, which serves a major portion of the CAPD population in the Sudan. Most patients responded to oral fluconazole treatment and catheter removal, but two of them suffered from late complications. Keywords: fungal peritonitis, peritoneal dialysis, Suda

Encysted Fluid Collections after Catheter Removal for Peritonitis in Peritoneal Dialysis Patients

Introduction: Peritonitis is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD). This case series describes episodes of peritoneal dialysis (PD) related fungal or Pseudomonas peritonitis that were complicated by the formation of encysted intra abdominal fluid collections despite prompt catheter removal and appropriate therapy. Case series: The first patient presented with fever and abdominal pain two weeks after removing his PD catheter because of fungal peritonitis. Examination revealed fluid collection in the former catheter tunnel. This turned out to be pus on surgical drainage. Abdominal computed tomography (CT) scan revealed another extensive encysted extra-peritoneal fluid collection that was aspirated and found to be clear transudate fluid. The second patient presented with abdominal pain and distention seven weeks after removing her PD catheter because of fungal peritonitis. She had a large intra abdominal encysted fluid collection that was drained under ultra sound guidance. The third patient presented with painless abdominal distention one month after removing the PD catheter because of Pseudomonas peritonitis. He had two encysted extra peritoneal fluid collections that were aspirated under ultra sound guidance. This occurred despite three weeks of treatment with oral fluconazole in the case of the first two patients and appropriate antibiotic therapy in the case of the third patient. Key Words: CAPD, Fungal peritonitis, Pseudomonas peritonitis, Encysted abdominal fluid collection, Suda

Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: Three public policy implications

Cervical cancer is an important public health problem worldwide, which comprises approximately 12% of all cancers in women. In Tanzania, the estimated incidence rate is 30 to 40 per 100,000 women, indicating a high disease burden. Cervical cancer screening is acknowledged as currently the most effective approach for cervical cancer control, and it is associated with reduced incidence and mortality from the disease. The aim of the study was to identify the most important factors related to the uptake of cervical cancer screening among women in a rural district of Tanzania. A cross sectional study was conducted with a sample of 354 women aged 18 to 69 years residing in Moshi Rural District. A multistage sampling technique was used to randomly select eligible women. A one-hour interview was conducted with each woman in her home. The 17 questions were modified from similar questions used in previous research. Less than one quarter (22.6%) of the participants had obtained cervical cancer screening. The following characteristics, when examined separately in relation to the uptake of cervical cancer screening service, were significant: husband approval of cervical cancer screening, women's level of education, women's knowledge of cervical cancer and its prevention, women's concerns about embarrassment and pain of screening, women's preference for the sex of health provider, and women's awareness of and distance to cervical cancer screening services. When examined simultaneously in a logistic regression, we found that only knowledge of cervical cancer and its prevention (OR = 8.90, 95%CI = 2.14-16.03) and distance to the facility which provides cervical cancer screening (OR = 3.98, 95%CI = 0.18-5.10) were significantly associated with screening uptake. Based on the study findings, three recommendations are made. First, information about cervical cancer must be presented to women. Second, public education of the disease must include specific information on how to prevent it as well as screening services available. Third, it is important to provide cervical cancer screening services within 5 km of where women reside