Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Membranous glomerulonephritis and transitional cell carcinoma, improved proteinuria after each tumor resection

Nephrotic syndrome has been described in association with solid tumours, such as carcinoma of the lung or colon, whilst the relationship between urinary tract cancers and proteinuria is reported less frequently. We describe a case of a 75-year-old man with nephrotic syndrome and relapsing transitional cell carcinoma affecting the bladder. Renal biopsy showed membranous nephropathy. The patient underwent four transurethral tumour resections and each time we observed improved proteinuria by 3-4 weeks after surgery. On the contrary, steroid treatment was clearly unrelated to this improvement. We conclude that, at least in this case, surgical treatment of the tumour led to improved proteinuria whilst steroid treatment was not beneficial

Ash split cath(registered trademark) in geriatric dialyzed patients

Vascular access is the essential step in performing hemodialysis in uremic patients. In the absence of a permanent and utilizable native arterio-venous fistula, the use of a tunnelled catheter makes dialysis therapy possible. The Ash Split Cath, a recently introduced chronic hemodialysis catheter, was inserted in five patients (7.1 % of our prevalent dialysis population) because of repeated venous thrombosis in three patients and a poor venous tree in two. The mean age of patients was 78 years (plus or minus) 7. The average blood flow rate was 250 (plus or minus) 50 ml/minute and the mean venous pressure 140mm Hg (plus or minus) 35. Recirculation determined by low flux technique was less than 2 %. KT/V calculated 3 months after the catheter placement was 1.2 (plus or minus) 0.02. During the follow-up we did not document any infection of the exit site or related to the catheter. This device is simple to place, gives adequate dialysis treatment and is useful in geriatric dialyzed patients in whom the arterio-venous fistula can no longer be used

Placement, performance and complications of the Ash Split Cath hemodialysis catheter

A tunneled catheter is the alternative vascular access for those patients in need of hemodialysis who cannot undergo dialysis through an arterio-venous fistula or a vascular graft. This study was undertaken to evaluate the performance of the Ash Split Cath, a 14 French chronic hemodialysis catheter with D-shaped lumens and a Dacron cuff. After tunneling through a transcutaneous portion the catheter enters the venous system, where it splits into two separate limbs. Data regarding catheter positioning, function and adequacy of dialysis were collected from two hemodialysis facilities. Twenty-eight Ash-split catheters were placed in 28 patients, with no complications, and immediate technical success was 100%. Patients were followed up for a total of 7,286 catheter days. No catheter-related infections were observed. Only one catheter failed after 15 days, with a primary catheter patency of 96% for the whole study length. Mean blood flow was 303 +/- 20 ml/min at 1 week after insertion, 306 +/- 17 ml/min at 3 months, 299 +/- 44 ml/min at 6 months, and 308 +/- 16 ml/min at 12 months. With a mean dialysis session duration of 234 +/- 25 minutes, adequate dialysis dose was observed for 96% of catheters, as reflected by a mean urea reduction ratio (URR) of 71% +/- 8 or a mean urea kinetic modeling, or Kt/V, value of 1.51 +/- 0.3 during follow up. In conclusion, compared with previous studies we report the best permanent catheter performance, confirming that the Ash-split catheter is a good alternative for vascular access in hemodialysis patients who are not candidates for surgical A-V fistula or graft placement

Acute renal failure due to a calculus obstructing a transplanted kidney

Nephrolithiasis is a rare finding in kidney transplantation and anuria could be the only clinical sign. We report the case of a 52-year-old Caucasian male renal transplant recipient admitted due to acute renal failure (ARF) and anuria. He reported no symptoms and a palpable bulge in the right iliac fossa corresponding to the graft was present. Ultrasonography showed hydronephrosis of the graft. A double-J ureteral stent was inserted with resolution of ARF. ARF with anuria and the presence of a palpable non-tender, elastic mass over the graft could be the clinical picture of obstructive ARF in a transplanted kidney

Acute toxic hepatitis after amiodarone intravenous loading.

A CASE REPORT OF A WOMAN WITH ACUTE TOXIC HEPATITIS AFTER AMIODARONE INTRAVENOUS LOADING IS REPORTED, ALONG WITH A REVIEW OF THE LITERATURE AND DISCUSSION

Renal cholesterol microembolism: Is steroid therapy effective?

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Vascular calcification of the venous side of an arterious-venous fistula

While reports of venous calcifications are scarce, vascular calcifications frequently occur in the arteries of uraemic patients. Venous calcification of an aged arterious-venous (a-v) fistula in a young patient with a long-standing history of hyperparathyroidism was detected on a forearm X-ray. Risk factors for vascular calcifications are still under debate, but calcium-phosphate product appears to be involved in its pathogenesis. We suggest that a-v fistula of patients with hyperparathyroidism history should be monitored as calcifications could be a risk factor for access thrombosis

Detection of urinary abnormalities in a community from northern Italy based on the World Kidney Day screening program

BACKGROUND: Chronic kidney disease (CKD) is a worldwide health problem, and promotion of the World Kidney Day has improved general population education and awareness of renal illnesses aimed at ameliorating disease prevention. The Kidney Day was also an opportunity for us to investigate risk factors for CKD in an Italian population. PATIENTS AND METHODS: A total of 1,341 subjects from the general population living in the area of Ferrara, a town in the northeast of Italy, aged 50-70 years, were investigated. From each participant age, sex, smoking status, current antihypertensive medications, hypercholesterolemic and diabetic status, body mass index (BMI), waist circumference and blood pressure (BP) were obtained. All subjects underwent dipstick urinalysis for the evaluation of proteinuria, hematuria and leukocyturia. RESULTS: Fifteen percent of patients were diabetics, and 20% were smokers. Mean BMI was 26.9 ± 4.3 kg/m(2), mean systolic BP was 133.7 ± 18.7 mmHg and mean diastolic BP 78.1 ± 9.9 mmHg. A total of 828 participants were not taking any antihypertensive drugs. In 24% of subjects, we found proteinuria, in 18% hematuria and in 16% leukocyturia. Proteinuria was significantly associated with age and diabetes, hematuria was associated with age, female sex and smoking status, and leukocyturia was associated with age and female sex. CONCLUSIONS: Urinary abnormalities are common in general population, and in many cases, various abnormalities overlap. These abnormalities could be associated with cardiovascular risk factors. We believe that our initiative, based on the experience of the World Kidney Day, could increase the awareness of general practitioners and general population of the risks of renal conditions

Risk factors for renal disease and urinary abnormalities in men and women: data from the World Kidney Day in the province of Ferrara, Italy.

Background: Chronic kidney disease (CKD) is a worldwide health problem due to its morbidity and mortality, and cost. World Kidney Day (WKD) has been planned to improve disease prevention. The aim of this study was to evaluate CKD risk factors and urinary abnormalities, collected on WKD along several years, in men and women. Patients and methods: Between 2006 and 2012, 1980 subjects, of whom 1012 women, from general population living in Ferrara area, a town in the north-east of Italy, were investigated. For each participant age, sex, smoking, hypertensive and diabetic status, body mass index (BMI), waist circumference (WC), and blood pressure (BP) were obtained. Moreover, body shape index (BSI) was calculated. All subjects underwent dipstick urinalysis. Results: Men had higher BMI, WC, and BP than women. Women had higher prevalence of abdominal obesity and higher BSI (0.0951 ± 0.0105 vs. 0.0920 ± 0.0071 m(11/6)kg(-2/3)), while men had higher prevalence of overweight. In women, hematuria and leukocyturia were more prevalent (16.9% vs. 12.8%; OR 95%CI 1.161 (1.042-1.294); p = 0.012; 18.5% vs. 7% OR 95%CI 1.538 (1.403-1.676); p < 0.001, respectively), while glycosuria was less frequent (4.2% vs. 8.8% OR 95%CI 0.642 (0.501-0.822); p < 0.001) than in men. Frequency of proteinuria was similar in the two sexes. Venn diagrams indicate a different overlap of urinary abnormalities in the two sexes. Conclusions: Risk factors for CKD collected during the WKD appear to be different in the two sexes, and urinary abnormalities overlap differently. Data collected during the WKD are related to sex, and women deserve greater attention