Quality of life in dialysis versus kidney transplantation

Introduction: The compromised health-related quality of life (HRQOL) of patient with end-stage renal disease(ESRD) is now well documented. One of the main pointswhen treating patients with ESRD, whose cure is not arealistic goal, is maximizing functioning and well-being,which refer to the ability to perform various dailyactivities and functions and to more subjective internalstates such as symptoms and feelings.Aim: Is to study the difference in QOL between dialysispatients and living renal transplant recipients using SF-36 Health survey and factors affecting QOL.Setting and participant: Seventy patients were includedin our study 34 of them were males and 36 females. Theywere divided into 3groups: Group Ia: 30 hemodialysispatients of at least 6 months duration on dialysis, GroupIb: 10 continuous ambulatory peritoneal dialysis (CAPD)and Group II: 30 recipients of living renal transplants of? 6 months duration. SF-36 questionnaire was filled byall patients; it includes eight subscales which can also becombined into two component summary scores, Aphysical component summary PCS {general heath (GH),physical function (PF), role-physical (RP), bodily pain(BP)} and a mental component summary MCS {roleemotional(RE), vitality (VT), mental health (MH), andsocial function (MH)}. Data were analyzed from thisquestionnaire to determine the QOL for all patients andwere correlated also with clinical and laboratoryparameters.Results: Among hemodialysis patients, PCS, PF and VTparameters were better in young subjects and MH waspositively correlated with the hemoglobin level. Patientswithout co-morbid conditions had significantly betterQOL in PF and RP parameters. QOL was significantlybetter in employed than unemployed persons regardingPF, RP, VT, SF, GH and PCS. As regard CAPD patients without co-morbid conditions had significantly better QOL than those with co-morbid condition regarding RP, GH, SF and PCS. Among recipients of renal transplantation, there was a significant positive correlation between hemoglobin level and QOL parameters PCS, MCS, VT, SF and MH and a significant negative correlation between age of transplanted recipients and PF and VT was recorded. Finally in comparison of the three studied groups there was significant difference between the studied groups as regard PF parameter of SF-36 health survey which was higher in transplanted group than HD and CAPD.Conclusion: In hemodialysis patients the best quality of life was to males young aged with high hemoglobin level and no co-morbid conditions. In CAPD the best quality of life was to young aged and no co-morbid conditions. In renal transplant the best quality of life was to young age and high hemoglobin level. Finally there was no difference in QOL with three forms of renal replacement therapy

Assessment of cognitive dysfunction in kidney disease

Background: Cognitive dysfunction, include reducedmental alertness, intellectual impairment, decreasedattention and concentration, memory deficits anddiminished perceptual-motor coordination. Both CKDand chronic dialysis patients are thought to be associatedwith cognitive impairment. Cognitive impairment maydecrease an individual's quality of life, increase resourceutilization and result in suboptimal medical care.Neurophysiologic tests using imaging techniques areused to evaluate structural and functional abnormalities.Neuropsychological testing uses validated questions andscreening tests to evaluate cognition.Setting and participants: This study was carried out on120 patients with different stages of CKD fromnephrology outpatient clinic and hemodialysis unit inAin Shams University Hospitals. Group I: 50 CKDpatients, stage ? and stage IV. Group II: 50 ESRDpatients on regular hemodialysis with K t/v > 1.1. GroupIII: 20 acute kidney injury patients, followed up till theirrenal functions stabilized. Group ?V: 20 healthy subjectsmatched with patients. All patients underwent laboratoryinvestigations and psychometric tests which include trialmaking test part B, digit span test, digit symbol test,mini-mental state examination.Results: There were highly significant differences ofmean values of cognitive function tests between (groupsI,II and III as compared with group IV (control group),stage III CKD and stage IV CKD, CKD andhemodialysis patients, AKI patient at the insult and afterrecovery) and finally between hemoglobin and cognitivefunction tests score.Conclusions: There were significant differences of cognitive function tests results between CKD, III,IV,V, AKI patients as compared with healthy group, suggesting that kidney disease affects cognitive performance, there were significant differences of cognitive function tests results between stage III CKD and stage IV CKD, suggesting that the degree of cognitive impairment is associated with the severity of CKD, also significant differences of cognitive function tests results between CKD and ESRD on hemodialysis, suggesting that dialysis improves cognitive performance. Our results showed significant differences of cognitive function tests results between AKI patients at the insult and after recovery, suggesting that AKI also impair cognitive function. Finally cognitive performance is affected by hemoglobin level in CKD stage III, IV, V on hemodialysis and AKI patients, suggesting that treatment of anemia in AKI, CKD and ESRD patients improve cognitive performance

Consanguinity and its relevance to clinical genetics

Consanguineous marriages have been practiced since the early existence of modern humans. Until now, consanguinity is widely practiced in several global communities with variable rates. The present study was undertaken to analyze the effect of consanguinity on different types of genetic diseases and child morbidity and mortality. Patients were grouped according to the types of genetic errors into four groups: Group I: Chromosomal and microdeletion syndromes. Group II: Single gene disorders. Group III: Multifactorial disorders. Group IV: Diseases of different etiologies. Consanguineous marriage was highly significant in 54.4% of the studied group compared to 35.3% in the control group (P < 0.05). Consanguineous marriages were represented in 31.4%, 7.1%, 0.8%, 6%, 9.1% among first cousins, one and a half cousins, double first cousins, second cousins and remote relatives respectively in the studied group. Comparison between genetic diseases with different modes of inheritance showed that recessive and multifactorial disorders had the highest values of consanguinity (78.8%, 69.8%, respectively), while chromosomal disorders had the lowest one (29.1%). Consanguineous marriage was recorded in 51.5% of our cases with autosomal dominant diseases and in 31% of cases with X linked diseases, all cases of mental retardation (100%) and in 92.6% of patients with limb anomalies (P < 0.001). Stillbirths, child deaths and recurrent abortions were significantly increased among consanguineous parents (80.6%, 80%, 67%) respectively than among non consanguineous parents. In conclusion, consanguineous marriage is significantly higher in many genetic diseases which suggests that couples may have deleterious lethal genes, inherited from common ancestor and when transmitted to their offsprings, they can lead to prenatal, neonatal, child morbidity or mortality. So public health education and genetic counseling are highly recommended in our community.Keywords: Consanguinity; Chromosomal abnormality; Genetic counseling; Child death; HomozygosityThe Egyptian Journal of Medical Human Genetics (2013) 14, 157–16

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Outcome of individualized dialysate sodium concentration for hemodialysis patients

To evaluate the individualization of dialysate sodium (Na + ) concentration in hemodialysis (HD), we studied 40 stable chronic HD patients in a single-blind crossover design. They underwent 36 consecutive HD sessions with the dialysate Na + concentration set at 138 mmol/L, followed by 36 sessions of dialysate Na + set to match the patients average pre-HD plasma Na + levels. We multiplied the midweek pre-HD measured Na + by the Donnan coefficient of 0.95 (individualized Na + ). Pre-HD Na + dialysis sodium levels were nearly constant, with no variation between the two phases and a mean of 137.45 ± 2.04 mmol/L. Post-HD serum Na + was signi-ficantly higher during the standard phase (139.7 ± 2 mmol/L) than during the individualized phase (137.1 ± 1.6 mmol/L). Also, interdialytic weight gain (IDWG) was significantly more reduced during the individualized phase (3.25 ± 0.56%) than during the standard phase (3.94 ± 0.92%), P <0.001. Episodes of distressing symptoms including headache, muscle cramps and hypotension were significantly less frequent in the individualized phase. The mean of the pre-HD and post-HD systolic and diastolic blood pressures significantly decreased during the individualized phase, and we could reduce the doses of antihypertensive drugs in 10 (33.33%) patients. Individualized dialysate Na + concentration was associated with a decrease in IDWG and dialysis hypotension and related symptoms and better BP control in stable chronic HD patients

Profile of disorders of sexual differentiation in the Northeast region of Cairo, Egypt

AbstractThis retrospective study has been conducted to determine the frequency, types, clinical presentation and associated genomic errors in patients with sex differentiation errors and their relatives. The present study comprised of 908 index patients with sex differentiation errors who were registered at the Medical Genetics Center (ASUMGC), Ain Shams University. Out of 28,736 patients attending the center and 660,280 patients attending the Pediatrics clinic during the interval of 1966–2009. Our results showed that, the frequency among all patients attending the Pediatrics Hospital was 0.14%. Disorders of sex chromosome (Klinefelter syndrome and Turner syndrome) were the commonest, followed by mullerian dysgenesis. The commonest age of presentation was adolescence (>15–18years) (36.56%), followed by patients aged 18years or more (24.88%). In our study, 32.26% presented with primary female infertility, 27.86% adolescent girls presented with primary amenorrhea, 16.29% presented with male infertility, 10.35% presented with ambiguous genitalia at birth or soon afterward, 6.60% were females who presented with delayed 2ry sexual characters and short stature, 3.96% of our cases were boys who presented with microtestes and delayed 2ry sexual development and 2.75% presented with hirsutism. Central nervous system abnormalities were reported in 5.94% of our patients, ocular abnormalities in 4.29%, and cardiovascular system abnormalities in 2.86%. Three hundred and ninety-two multiple mutant genomic errors were defined among relatives of index cases of DSD families, where definable errors represented 35.24% and non-definable errors represented 7.92%. Cytogenetic findings of various DSD showed that, 33.46% of cases with Turner syndrome phenotype had (45,X), and 64.89% were mosaic (45,X/46,XX). While, among the 130 studied cases with Klinefelter syndrome phenotype, 83.84% had 47,XXY. Out of 75 patients with ovotesticular DSD, 85.33% possessed a 46,XX chromosome complement. To conclude, sex determination and differentiation are sequential processes that involve genetic, gonadal, phenotypic and psychological sex. Disorders of sexual differentiation, or syndromes of intersexuality, result when errors occur at any of these steps. Establishing a precise diagnosis in DSD is just as important as in other chronic medical conditions with lifelong consequences

Molecular Characterization of Eimeria Species Naturally Infecting Egyptian Baldi Chickens

  Background: Coccidiosis is a serious protozoal disease of poultry. The iden-tification of Eimeria species has important implications for diagnosis and con-trol as well as for epidemiology. The molecular characterization of Eimeria spe-cies infecting Egyptian baladi chickens was investigated. Methods:Eimeria species oocysts were harvested from intestines of naturally infected Egyptian baldi chickens. The morphometry characterization of oocysts along with COCCIMORPH software was done. The DNA was extracted ini-tially by freezing and thawing then the prepared samples was subjected to commercial DNA kits. The DNA products were analyzed through conven-tional polymerase chain reaction by using amplified region (SCAR) marker. Results:The PCR results confirmed the presence of 7 Eimeria species in the examined fecal samples of Egyptian baldi breed with their specific ampilicon sizes being E. acervulina (811bp), E. brunette (626bp), E. tenella (539bp), E. max-ima (272bp), E. necatrix (200bp), E. mitis (327bp) and E. praecopx (354bp). A sequencing of the two most predominant species of Eimeria was done, on E. tenella and E. máxima. Analysis of the obtained sequences revealed high identi-ties 99% between Egyptian isolates and the reference one. Similarly, E. maxima isolated from Egyptian baldi chickens showed 98% nucleotide identities with the reference strain. Only single nucleotide substitution was observed among the Egyptian E. tenella isolates (A181G) when compared to the reference one. The Egyptian isolates acquired 4 unique mutations (A68T, C164T, G190A and C227G) in compared with the reference sequence. Conclusion:This is the first time to identify the 7 species of Eimeria from Egyptian baladi chickens

Correlation between interdialytic weight gain, left ventricular hypertrophy and FGF- 23 in prevalent hemodialysis patients

Background:Patients with end-stage renal disease are suspected to have significant volume shifts and thereby cardiovascular strain as a result to interdialytic weight gain, chronic fluid overload and fluid removal during dialysis. In long-term hemodialysis patients, higher IDWG (interdialytic weight gain) could be associated with poor survival. Patients with the lowest interdialytic weight gain have the greatest survival. Certain laboratory and imaging modalities could help to assess and monitor the appropriate fluid balance for hemodialysis patients. FGF -23 might be associated with cardiovascular morbidity in ESRD patients. Objective: To evaluate correlation between hypervolemia and left ventricular hypertrophy and FGF-23 in hemodialysis patients. Patients and Methods: This cross sectional study was conducted on 60 prevalent hemodialysis patients. Patients were divided into two groups according to interdialytic weight gain (IDWG): Group I (low IDWG): Patients with absolute weight gain &lt; 3 kg. Group II (high IDWG): patients with weight gain &ge; 3 kg. FGF 23, routine laboratory tests and echocardiography were done for both groups. Results: high IDWG group has higher systolic blood pressure and LVMI than low IDWG group. In all patients group, FGF-23 had a positive correlation with (weight gain, Na, PO4, PTH, systolic, diastolic blood pressure, LV wall septal and posterior wall thickness and left ventricular mass index) and had a negative correlation with Hb level. Conclusion: FGF-23 could be a marker of volume overload and LVH in ESRD patients, which affect morbidity and mortality in these patients. FGF- 23 might be a marker of anemia in ESRD as it has a negative correlation with HB