EMPHYSEMATOUS PYELONEPHRITIS: A CASE REPORT

Emphysematous pyelonephritis is a rare life threatening fulminant necrotizing infection of the kidney with high mortality. It is characterized by characteristic gas formation within or around the kidney on radiological investigations, while E.Coli is the most common causative organism. We report a case of 60 year old female suffering from diabetes mellitus since 3 years, who presented with high grade fever, abdominal pain, vomiting and dysuria. She was diagnosed as a case of emphysematous pyelonephritis and successfully treated. KEYWORDS: Emphysematous pyelonephritis; Antibiotics

EMPHYSEMATOUS PYELONEPHRITIS: A CASE REPORT

Emphysematous pyelonephritis is a rare life threatening fulminant necrotizing infection of the kidney with high mortality. It is characterized by characteristic gas formation within or around the kidney on radiological investigations, while E.Coli is the most common causative organism. We report a case of 60 year old female suffering from diabetes mellitus since 3 years, who presented with high grade fever, abdominal pain, vomiting and dysuria. She was diagnosed as a case of emphysematous pyelonephritis and successfully treated. KEYWORDS: Emphysematous pyelonephritis; Antibiotics

Differences in HIV Burden and Immune Activation within the Gut of HIV-Positive Patients Receiving Suppressive Antiretroviral Therapy

Background. The gut is a major reservoir for human immunodeficiency virus (HIV) in patients receiving antiretroviral therapy (ART). We hypothesized that distinct immune environments within the gut may support varying levels of HIV. Methods. In 8 HIV-1-positive adults who were receiving ART and had CD4+ T cell counts of >200 cells/µL and plasma viral loads of <40 copies/mL, levels of HIV and T cell activation were measured in blood samples and endoscopic biopsy specimens from the duodenum, ileum, ascending colon, and rectum. Results. HIV DNA and RNA levels per CD4+ T cell were higher in all 4 gut sites compared with those in the blood. HIV DNA levels increased from the duodenum to the rectum, whereas the median HIV RNA level peaked in the ileum. HIV DNA levels correlated positively with T cell activation markers in peripheral blood mononuclear cells (PBMCs) but negatively with T cell activation markers in the gut. Multiply spliced RNA was infrequently detected in gut, and ratios of unspliced RNA to DNA were lower in the colon and rectum than in PBMCs, which reflects paradoxically low HIV transcription, given the higher level of T cell activation in the gut. Conclusions. HIV DNA and RNA are both concentrated in the gut, but the inverse relationship between HIV DNA levels and T cell activation in the gut and the paradoxically low levels of HIV expression in the large bowel suggest that different processes drive HIV persistence in the blood and gut. Trial registration. ClinicalTrials.gov identifier: NCT00884793 (PLUS1

Ginseng and Memory

For thousands of years, Chinese medicine has used the herb ginseng as a memory tonic with the belief that ginseng can improve learning and memory, especially in aging humans. Recent studies have sought to validate this claim. Experiments done on rats have shown that ginsenosides, the saponins of ginseng, can partially prevent scopolamine-induced memory deficits in rats. Ginsenosides are thought to increase choline uptake in the central cholinergic nervous system, which plays important roles in learning and memory. Further experiments have shown that ginseng extracts can improve the retention of learned behavior in young (aged 3 months) as well as old (aged 26 months) rats. The potential beneficial effects of the polysaccharide fractions of ginseng on learning and memory still warrant further experimentation. The favorable effects of ginseng on learning and memory make it a promising drug for the use in geriatric practice

Controversies in the treatment of Crohn’s disease: The case for an accelerated step-up treatment approach

The ideal treatment strategy for Crohn’s disease (CD) remains uncertain, as does the optimal endpoint of therapy. Top-down versus step-up describes two different approaches: early use of immunomodulators and biological agents in the former versus initial treatment with steroids in the latter, with escalation to immunomodulators or biological drugs in patients proven to be steroid refractory or steroid dependent. Top-down therapy has been associated with higher rates of mucosal healing. If mucosal healing proves to be associated with better long-term outcomes, such as a decreased need for hospitalization and surgery, top-down therapy may be the better approach for many patients. The main concern with the top-down approach is the toxicity of the immunomodulators and biological agents, which have been linked with infectious complications as well as an increased risk of lymphoma. It is unlikely that one strategy will be best for all patients given the underlying heterogeneity of CD presentation and severity. Ultimately, we must weigh the safety and efficacy of the therapies with the risks of the disease itself. Unfortunately our ability to risk stratify patients at diagnosis remains rudimentary. The purpose of this paper is to review the data that supports or refutes the differing treatment paradigms in CD, and to provide a rationale for an approach, termed the “accelerated step-up” approach, which attempts to balance the risks and benefits of our currently available therapies with the risk of disease related complications as we understand them in 2008

Endoscopic Surveillance in Long-standing Colitis.

Opinion statementThere is a relative increase in the risk of colon cancer in patients with inflammatory bowel disease (IBD) affecting the colon, and endoscopic surveillance is advocated to mitigate this risk. The current standard practice is to survey this high-risk patient population using colonoscopy. Chromoendoscopy with targeted biopsies has emerged as the colonoscopy modality recommended by the major societies to optimize dysplasia detection. Studies over the past year support the improved yield from targeted as compared to random biopsies and improved dysplasia detection from chromoendoscopy as compared to white light endoscopy. Ongoing efforts should focus on the implementation of chromoendoscopy as the primary modality for colorectal cancer surveillance in IBD. Our review will describe current status and provide an update on the recent literature on surveillance colonoscopy in patients with IBD

Does Manual Abdominal Pressure During Colonoscopy Put Endoscopy Staff and Patients at Risk? Experiences of Endoscopy Nurses and Technicians.

Endoscopy staff suffer work-related musculoskeletal disorders at a rate greater than or comparable to nurses and technicians in other subspecialities, which may be attributable to the widespread use of manual pressure and repositioning during colonoscopy. In addition to negatively impacting staff health and job performance, colonoscopy-related musculoskeletal disorder injuries may also signal potential risks to patient safety. To assess the prevalence of staff injury and perceived patient harm relating to the use of manual pressure and repositioning techniques during colonoscopy, 185 attendees of a recent national meeting of the Society of Gastroenterology Nurses and Associates were asked to recall experiencing injuries to themselves or observing injuries to other staff or patients during colonoscopy. A majority of respondents (84.9%, n = 157) reported either experiencing or observing staff injury, whereas 25.9% ( n = 48) reported observing patient complications. Among respondents who perform manual repositioning and apply manual pressure during colonoscopy (57.3%, n = 106), 85.8% ( n = 91) reported experiencing musculoskeletal disorders from performing these tasks; 81.1% ( n = 150) reported no awareness of colonoscopy-specific ergonomics policies at their facility. Results highlight the relationship between the physical job requirements of endoscopy nurses and technicians, staff musculoskeletal disorders, and patient complications, and suggest that implementation of staff safety protocols may benefit patients as well as endoscopy staff