Incidence of Infectious Diseases in Patients Suffering from Renal Diseases

Background: Infection is an invasion of an organism’s body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce. Patients with renal compromised states are more susceptible to infection than normal individuals. In the pre-dialysis era, about 45% of patients with the renal compromised state suffering from infection required hospitalization, while a total of about 78% of the enrolled subjects needed hospitalization. It was assumed that the debility caused by the uremic state increased the risk of infection, and the reversal of uremia would reduce the risk of infection.Aim: The main aim of the study is to report the incidence of infectious diseases in patients with renal compromised state and appropriate measures to be considered to control infectious conditions.Materials and Methods: The study was carried out as prospective and cross-sectional studies. During the study period, a total of 195 subjects were examined with the renal compromised state, of which 108 subjects were suffering from infectious co-morbidity, and were enrolled based on inclusion and exclusion criteria, which includes in-patients, out-patients, and patients on regular dialysis.Results: This shows the percentage prevalence of infections in patients with the renal compromised state is 55.38. Patients were found to show various infectious states.Conclusion: The conclusion shows the probability of encountering a subject with renal compromised state along with co-morbid infection is 0.55. Evidence-based international guidelines are of great value and are instrumental in helping reduce health-care-associated infections.Keywords: Incidence of infectious diseases, Renal compromised state, Renal disease

Mirizzi Syndrome with Endoscopic Ultrasound Image

We describe a 66-year-old Caucasian man with type 1 Mirizzi syndrome diagnosed on endoscopic ultrasound. He presented with acute onset of jaundice, malaise, dark urine over 3-4 days, and was found to have obstructive jaundice on lab testing. CT scan of the abdomen showed intrahepatic biliary ductal dilation, a 1.5 cm common bile duct (CBD) above the pancreas, and possible stones in the CBD, but no masses. Endoscopic retrograde cholangiopancreatography (ERCP) by a community gastroenterologist failed to cannulate the CBD. At the University Center, type 1 Mirizzi syndrome was noted on endoscopic ultrasound with narrowing of the CBD with extrinsic compression from cystic duct stone. During repeat ERCP, the CBD could be cannulated over the pancreatic duct wire. A mid CBD narrowing, distal CBD stones, proximal CBD and extrahepatic duct dilation were noted, and biliary sphincterotomy was performed. A small stone in the distal CBD was removed with an extraction balloon. The cystic duct stone was moved with the biliary balloon into the CBD, mechanical basket lithotripsy was performed and stone fragments were delivered out with an extraction balloon. The patient was seen 7 weeks later in the clinic. Skin and scleral icterus had cleared up and he is scheduled for an elective cholecystectomy. Mirizzi syndrome refers to biliary obstruction resulting from impacted stone in the cystic duct or neck of the gallbladder and commonly presents with obstructive jaundice. Type 1 does not have cholecystocholedochal fistulas, but they present in types 2, 3 and 4. Surgery is the mainstay of therapy. Endoscopic treatment is effective and can also be used as a temporizing measure or definitive treatment in poor surgical risk candidates

Efficacy of nasal mometasone for the treatment of chronic sinonasal disease in patients with inadequately controlled asthma

BACKGROUND: Chronic sinonasal disease is common in asthmatic patients and associated with poor asthma control; however, there are no long-term trials addressing whether chronic treatment of sinonasal disease improves asthma control. OBJECTIVE: We sought to determine whether treatment of chronic sinonasal disease with nasal corticosteroids improves asthma control, as measured by the Childhood Asthma Control Test and Asthma Control Test in children and adults, respectively. METHODS: A 24-week multicenter, randomized, placebo-controlled, double-blind trial of placebo versus nasal mometasone in adults and children with inadequately controlled asthma was performed. Treatments were randomly assigned, with concealment of allocation. RESULTS: Two hundred thirty-seven adults and 151 children were randomized to nasal mometasone versus placebo, and 319 participants completed the study. There was no difference in the Childhood Asthma Control Test score (difference in change with mometasone - change with placebo [DeltaM - DeltaP], -0.38; 95% CI, -2.19 to 1.44; P = .68; age 6-11 years) or the Asthma Control Test score (DeltaM - DeltaP, 0.51; 95% CI, -0.46 to 1.48; P = .30; age \u3e/=12 years) in those assigned to mometasone versus placebo. In children and adolescents (age 6-17 years) there was no difference in asthma or sinus symptoms but a decrease in episodes of poorly controlled asthma defined by a decrease in peak flow. In adults there was a small difference in asthma symptoms measured by using the Asthma Symptom Utility Index (DeltaM - DeltaP, 0.06; 95% CI, 0.01 to 0.11; P \u3c .01) and in nasal symptoms (sinus symptom score DeltaM - DeltaP, -3.82; 95% CI, -7.19 to -0.45; P = .03) but no difference in asthma quality of life, lung function, or episodes of poorly controlled asthma in adults assigned to mometasone versus placebo. CONCLUSIONS: Treatment of chronic sinonasal disease with nasal corticosteroids for 24 weeks does not improve asthma control. Treatment of sinonasal disease in asthmatic patients should be determined by the need to treat sinonasal disease rather than to improve asthma control