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

Prospective Effects of Induced Mutation by Gamma Radiation in Essential Oil Production of Lemongrass (Cymbopogon citratus)

This review discusses the prospective effects of induced mutation in lemongrass, Cymbopogon citratus by gamma radiation towards its essential oil production by comparing available literatures on radiation studies in Cymbopogon genus. Previous studies on Cymbopogon mutation breeding program have shown that most of the analyses were limited to physical characteristic observation and concise chemical analysis in their essential oil yield. The issue that comes into view is the on-going things that happen in their essential oil biosynthesis correlated with its biological properties and chemical composition changes. Finding the exact cause of where and how the radiation had triggered the differences in essential oil production between mutant and its control variety need to be studied. This concern possibly could be answered by analysing the changes between both varieties on their interactions within chemical, biological and genetic perspectives. Thus, strong understanding could be build for better analysis in lemongrass mutation breeding

Successful Conservative Management of Scrotal Edema Resulting from Uncomplicated Peritoneal Fluid Leak

Introduction: Peritoneal fluid leaks are frequent in continuous ambulatory peritoneal dialysis (CAPD) patients and may manifest as subcutaneous or genital edema or as apparent ultrafiltration (UF) failure. Genital swelling in CAPD patients is often due to dialysate leak through a small clinically-undetectable inguinal hernia, and may require herniorrhaphy. If imaging studies exclude an associated hernia or patent processus vaginalis, a conservative approach may be adopted. Case report: An 80 year-old bed-ridden male developed gross bilateral scrotal swelling (without cough impulse) and apparent UF failure shortly after initiation of CAPD. Computed tomography peritoneography (CTP) showed bilateral scrotal fluid collections without a hernia or patent processus vaginalis. An attempt to maintain the patient on CAPD by reducing the dialysate volume, scrotal elevation and adopting a supine position was not successful; CAPD was substituted with temporary hemodialysis (HD) for four weeks. Scrotal swelling reversed after one week of CAPD cessation and did not recur when supine PD with intermittent dry periods was reinstituted a few weeks later. Satisfactory UF could also be easily attained. This was compatible with caudal fluid migration through peritoneal defects being the underlying cause. The patient had been successfully maintained on CAPD for the last 18 months. Conclusion: Fluid dissection through soft tissues can result in gross genital edema and apparent ultrafiltration failure in CAPD patients. Supine PD, scrotal elevation with intermittent dry periods may be a practical alternative management in the absence of automated dialysis facilities. The severity of dialysate leak does not preclude a satisfactory response to this conservative management. Keywords: peritoneal dialysis, dialysate leak, genital edema, ultrafiltration failur

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

The Moore-Penrose Pseudoinverse. A Tutorial Review of the Theory

In the last decades the Moore-Penrose pseudoinverse has found a wide range of applications in many areas of Science and became a useful tool for physicists dealing, for instance, with optimization problems, with data analysis, with the solution of linear integral equations, etc. The existence of such applications alone should attract the interest of students and researchers in the Moore-Penrose pseudoinverse and in related sub jects, like the singular values decomposition theorem for matrices. In this note we present a tutorial review of the theory of the Moore-Penrose pseudoinverse. We present the first definitions and some motivations and, after obtaining some basic results, we center our discussion on the Spectral Theorem and present an algorithmically simple expression for the computation of the Moore-Penrose pseudoinverse of a given matrix. We do not claim originality of the results. We rather intend to present a complete and self-contained tutorial review, useful for those more devoted to applications, for those more theoretically oriented and for those who already have some working knowledge of the sub ject.Comment: 23 page

Genetic variation in Fcγ receptor IIa and risk of coronary heart disease: negative results from two large independent populations

Background The role of the Fcgamma receptor IIa (FcgammaRIIa), a receptor for C-reactive protein (CRP), the classical acute phase protein, in atherosclerosis is not yet clear. We sought to investigate the association of FcgammaRIIa genotype with risk of coronary heart disease (CHD) in two large population-based samples. Methods FcgammaRIIa-R/H131 polymorphisms were determined in a population of 527 patients with a history of myocardial infarction and 527 age and gender matched controls drawn from a population-based MONICA- Augsburg survey. In the LURIC population, 2227 patients with angiographically proven CHD, defined as having at least one stenosis [greater than or equal to]50%, were compared with 1032 individuals with stenosis H genotype was not independently associated with lower risk of CHD after multivariable adjustments, neither in the MONICA population (odds ratio (OR) 1.08; 95% confidence interval (CI) 0.81 to 1.44), nor in LURIC (OR 0.96; 95% CI 0.81 to 1.14). Conclusion Our results do not confirm an independent relationship between FcgammaRIIa genotypes and risk of CHD in these populations

Immunological and Cardiometabolic Risk Factors in the Prediction of Type 2 Diabetes and Coronary Events: MONICA/KORA Augsburg Case-Cohort Study

BACKGROUND: This study compares inflammation-related biomarkers with established cardiometabolic risk factors in the prediction of incident type 2 diabetes and incident coronary events in a prospective case-cohort study within the population-based MONICA/KORA Augsburg cohort. METHODS AND FINDINGS: Analyses for type 2 diabetes are based on 436 individuals with and 1410 individuals without incident diabetes. Analyses for coronary events are based on 314 individuals with and 1659 individuals without incident coronary events. Mean follow-up times were almost 11 years. Areas under the receiver-operating characteristic curve (AUC), changes in Akaike's information criterion (ΔAIC), integrated discrimination improvement (IDI) and net reclassification index (NRI) were calculated for different models. A basic model consisting of age, sex and survey predicted type 2 diabetes with an AUC of 0.690. Addition of 13 inflammation-related biomarkers (CRP, IL-6, IL-18, MIF, MCP-1/CCL2, IL-8/CXCL8, IP-10/CXCL10, adiponectin, leptin, RANTES/CCL5, TGF-β1, sE-selectin, sICAM-1; all measured in nonfasting serum) increased the AUC to 0.801, whereas addition of cardiometabolic risk factors (BMI, systolic blood pressure, ratio total/HDL-cholesterol, smoking, alcohol, physical activity, parental diabetes) increased the AUC to 0.803 (ΔAUC [95% CI] 0.111 [0.092-0.149] and 0.113 [0.093-0.149], respectively, compared to the basic model). The combination of all inflammation-related biomarkers and cardiometabolic risk factors yielded a further increase in AUC to 0.847 (ΔAUC [95% CI] 0.044 [0.028-0.066] compared to the cardiometabolic risk model). Corresponding AUCs for incident coronary events were 0.807, 0.825 (ΔAUC [95% CI] 0.018 [0.013-0.038] compared to the basic model), 0.845 (ΔAUC [95% CI] 0.038 [0.028-0.059] compared to the basic model) and 0.851 (ΔAUC [95% CI] 0.006 [0.003-0.021] compared to the cardiometabolic risk model), respectively. CONCLUSIONS: Inclusion of multiple inflammation-related biomarkers into a basic model and into a model including cardiometabolic risk factors significantly improved the prediction of type 2 diabetes and coronary events, although the improvement was less pronounced for the latter endpoint

Perceived risk of infection and death from COVID-19 among community members of low- and middle-income countries: A cross-sectional study [version 1; peer review: awaiting peer review]

Background: Risk perceptions of coronavirus disease 2019 (COVID-19) are considered important as they impact community health behaviors. The aim of this study was to determine the perceived risk of infection and death due to COVID-19 and to assess the factors associated with such risk perceptions among community members in low- and middle-income countries (LMICs) in Africa, Asia, and South America. Methods: An online cross-sectional study was conducted in 10 LMICs in Africa, Asia, and South America from February to May 2021. A questionnaire was utilized to assess the perceived risk of infection and death from COVID-19 and its plausible determinants. A logistic regression model was used to identify the factors associated with such risk perceptions. Results: A total of 1,646 responses were included in the analysis of the perceived risk of becoming infected and dying from COVID-19. Our data suggested that 36.4% of participants had a high perceived risk of COVID-19 infection, while only 22.4% had a perceived risk of dying from COVID-19. Being a woman, working in healthcare-related sectors, contracting pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, as well as seeing or reading about individuals infected with COVID-19 on social media or TV were all associated with a higher perceived risk of becoming infected with COVID-19. In addition, being a woman, elderly, having heart disease and pulmonary disease, knowing people in the immediate social environment who are or have been infected with COVID-19, and seeing or reading about individuals infected with COVID-19 on social media or TV had a higher perceived risk of dying from COVID-19. Conclusions: The perceived risk of infection and death due to COVID-19 are relatively low among respondents; this suggests the need to conduct health campaigns to disseminate knowledge and information on the ongoing pandemic