MANAGEMENT AND ASSESSMENT OF DEHYDRATION IN PEDIATRICS

The level of fluid deficit may be difficult to scientifically quantify and there is no laboratory worth that is either delicate or details to approximate the degree of dehydration in children. Rehydration may take place by means of oral, subcutaneous, or IV paths. We performed a search using electronic databases; MEDLINE, science-direct, and EMBASE, through October, 2018. Dehydration related to gastroenteritis makes up a considerable worry of disease worldwide. Most of dehydration is amenable to ORT; only the treatment of severe dehydration needs IVF. Prior pilot data on the superiority of rapid IVF administration for rehydration has actually been refuted. Nevertheless, a new research suggests that initial rehydration with glucose including IVF trends toward lowering the return visits and decreasing the admission rates. More data on the efficiency and safety and security of antiemetics has actually been produced. Antiemetics have been proven well tolerated without masking severe alternate diagnoses, efficacious in improving the success of ORT, and affordable. These brand-new data supporters highly for the consolidation of antiemetics right into the scientific guidelines. Variability in guideline conformity has been shown, with doctors mentioning troubles in evaluating dehydration and scientific judgment as factors for variation

Prevalence of vitamin D deficiency in peritoneal dialysis patients

Peritoneal dialysis (PD) patients have a high risk of developing vitamin D deficiency as 25(OH) vitamin D, the precursor of active vitamin D, is lost during dialysis. This crosssectional study was conducted to investigate the prevalence of vitamin D deficiency among adult Saudi patients on regular PD The data was collected in the summer of 2010 from patients who were on PD for more than six months at the King Khalid University Hospital, Riyadh. We recorded the demographic and clinical parameters for all patients. Blood samples were taken for serum vitamin D level (25 OH), serum parathyroid hormone (PTH) levels and other necessary biochemical parameters. There were 27 patients (11 males and 16 females) with a mean age of 46 (15-78 ± 21) years. Five patients were on continuous ambulatory PD and 22 patients were using automated PD. The average time on PD was 27.5 (6-84 ± 18.5) months. The mean serum vitamin D 25 (OH) level was 16.1 (4.9-41.5 ± 8.23) nmol/L. Sixteen (59.2%) of the patients had levels below 15 nmol/L, while another eight patients (29.6%) had vitamin D levels between 15 and 25 nmol/L, indicating a marked deficiency. The mean serum calcium was 2.2 (1.7-2.6 ± 0.2) mmol/L and the mean serum phosphorous was 1.48 (0.64-2.22 ± 0.37) mmol/L. Fifteen patients (55.5%) had significant hyperparathyroidism (serum PTH levels above 30 pmol/L). Majority of the PD patients in our center had vitamin D deficiency. The possible reasons include chronic renal failure, dietary restrictions, loss of vitamin D and decreased exposure to sunlight

Cytomegalovirus disease in a renal transplant recipient: the importance of pre-transplant screening of the donor and recipient

A 16-year-old female patient who was born with a single kidney developed chronic kidney disease during her early childhood due to reflux nephropathy and recurrent urinary tract infection. She progressed to end-stage renal disease (ESRD) and was commenced on renal replacement therapy in the form of peritoneal dialysis in May 2011. Subsequently, she underwent living unrelated donor kidney transplantation in China. She was hospitalized soon after returning to Saudi Arabia for management of high-grade fever, shortness of breath, and deterioration of renal function, which was found to be due to cytomegalovirus (CMV) disease, proved by kidney biopsy and presence of high level of anti-CMV immunoglobulins. Allograft biopsy showed mature viral particles sized between 120 and 149 nm in the nuclei of the glomerular endothelial cells. The patient was treated with valgancyclovir and specific CMV immunoglobulin, as well as by reducing and even stopping the dose of tacrolimus and mycophenolate. Despite all these measures, her condition continued to deteriorate and she finally died. Our study emphasizes that unrelated renal transplantation, especially if unplanned and improperly prepared, is a very risky procedure that might transfer dangerous diseases and increase the morbidity and mortality of the patients. We strongly stress the need for mandatory and proper screening for CMV carrier status among donors as well as recipients prior to transplantation. Also, a recommendation is made to reject CMV-positive donors

3D printing and silicone models of primary skin lesions for dermatological education as remote learning tool

Background and objectives: The corona pandemic affects many aspects of life – with challenges in medical treatment undoubtedly of paramount importance. However, continuing medical education needs to be consistently provided. During a semester with lockdown-phases and limited student-to-patient-contact availability, we supplied silicone models of primary skin lesions to every student and asked them to evaluate this teaching tool. Methods: In two anonymous online surveys, we asked students enrolled in dermatology (n = 222) at the Medical Facility of the Ludwig Maximilian University of Munich in the winter semester 2020/2021 – subsequent to online teaching – about their understanding and self-assessment of primary skin lesions before and after receiving silicone models for practice. The models were produced by layering different types of silicone into negative 3D printed molds made from polylactide to attain different degrees of hardness and colors. Results: Data from 211 (95.0 %) and 213 (95.9 %) of the 222 students were analyzed before and after receiving the silicone models, respectively. In all questions the students stated a highly significant improvement in their skills (P < 0.001). The majority of students evaluated the silicone models positively and reported a better understanding and learning of primary skin lesions. Conclusions: This study demonstrates the benefit of haptic experience in dermatology teaching not only in the time of COVID-19, but also thereafter

Living Unrelated Renal Transplant: Outcome and Issues

Living unrelated transplantation (LURT) is emerging as a practical option in renal transplantation due to shortage of living related and cadaver donors. We report a six-years (December 1991 to December 1996) follow-up of 60 LURT patients. The majority of these patients (95&#x0025;) were transplanted outside the Kingdom of Saudi Arabia; 37 in India, 14 in Egypt, five in the USA and one in Pakistan. Only three patients (emotionally related) were transplanted in Saudi Arabia. Before transplantation, 50 (83.4&#x0025;) patients were on chronic hemodialysis, three (5&#x0025;) on peritoneal dialysis and three (5&#x0025;) were transplanted pre-emptively. Post-operatively, the majority of the study patients were on three drug immunosuppressive therapy. One and five year graft survival was 93.0&#x0025; and 59.6&#x0025;, while patient survival at one and three years was 93.7&#x0025; and 81&#x0025;, respectively. Surgical complications included lymphocele in 10&#x0025; of the study patients, urinary leak in 8.3&#x0025;, and bleeding from the vascular anastomosis in 6.6&#x0025;. There were eight episodes of acute rejection in eight (13.3&#x0025;) patients and all episodes were successfully treated; two patients required monoclonal anti-lymphocyte antibodies (OKT3). Eleven (18.3&#x0025;) patients developed chronic rejection, which resulted in the loss of ten (90&#x0025;) allografts. Infection was the commonest cause for hospital admission; urinary tract infection (UTI) being responsible for 40&#x0025; of admissions. Three patients had Cytomegalovirus pneumonia, one had Pneumocystis Carinii pneumonia and one had candida pneumonia. Two (3&#x0025;) patients developed Kaposi&#x2032;s sarcoma. We conclude that LURT can help in overcoming the shortage of organs for transplant, however, commercial transplantion in developing countries is associated with high morbidity and mortality

Neutron Activation Analysis for Geochemical Characterization of Rocks from Gold Mines in Egypt

The present work was carried out to determine the elemental composition of granitoid rock samples from three gold mines (Sukari, Hamash, and Um Hagalig) in the South-eastern part of Egypt and quantification of the extent of the elemental enrichment. A total of 37 samples from the mines were subjected to neutron activation analysis, and the mass fractions of the elements were measured in mg/kg. The results show a dominance of K (76.9%), Fe (11.0%), Ca (8.7%), and Na (3.1%) for Sukari mine; Na (31.2%), Ca (28.5%), K (23.1%), and Fe (9.9%) for the Hamash mine; and for the Um Hagalig mine Na (31.1%), K (22%), Ca (21.7%), and Fe (20.8%). In addition, significant mass fractions of uranium, thorium and rare earth elements were found in Hamash and Um Hagalig. The average mass fractions of U in the investigated areas are measured to be 59.7, 48.2, and 30.8 mg/kg for Hamash, Sukary, and Um Hagalig, respectively. Furthermore, the average mass fractions of Th were significant and measured to be 3905, 1673, and 7 mg/kg for Hamash, Um Hagalig, and Sukary, respectively. Multiple ratio indicators and discrimination diagrams were used to better understand the origin of the elements in the samples studied. The indicators suggest that the provenance of the elements is mainly from metavolcanic and volcanic rocks. The findings should make an important contribution to the study of ores and minerals and thus represent an important area for environmental studies