Dialysis Catheter-related Bloodstream Infections in Patients Receiving Hemodialysis on an Emergency-only Basis: A Retrospective Cohort Analysis.

BACKGROUND: An estimated 6500 undocumented immigrants with end-stage renal disease (ESRD) live in the United States. Those living in states that do not provide undocumented immigrants scheduled hemodialysis receive intermittent hemodialysis only when life-threatening conditions arise. Little is known about catheter-related bloodstream infections (CRBSIs) in this population. METHODS: We conducted a retrospective cohort study of emergency-only hemodialysis patients in the Harris Health System in Houston, Texas, between January 2012 and December 2015. We assessed CRBSI risk factors including demographics, comorbidities, and duration and frequency of hemodialysis. We investigated the microbiologic etiology of these infections, rates of recurrent CRBSI, and associated morbidity and mortality. RESULTS: The cohort included 329 patients; 90% were Hispanic, 60% had diabetes, and the average age was 51 years. A total of 101 CRBSIs occurred, with a rate of 0.84 infections per 1000 catheter-days. Cirrhosis and duration of hemodialysis during the study period were associated with increased risk of CRBSI. Seventeen CRBSIs were recurrent; infection with gram-positive bacteria predicted recurrence. Adherence to catheter-related infection guidelines was improved by infectious diseases consultation and associated with fewer recurrent infections. CRBSI was associated with prolonged hospitalization (mean, 15 days), composite complication rate of 8%, and a 4% mortality rate. CONCLUSIONS: Patients receiving emergency-only hemodialysis via tunneled catheters have a high CRBSI rate compared with infection rates previously reported in patients receiving scheduled maintenance hemodialysis. Increased CRSBI risk likely contributes to the increased morbidity and mortality seen in ESRD patients receiving emergency-only hemodialysis.

Clinical, demographic, and laboratory characteristics of COVID -19 infection and risk of in-hospital mortality. A single center 4.

Background: Despite advances in preventive measures, COVID -19 spread and mortality is continuing due to delay in timely diagnosis. This problem is partly dependent on variations in disease characteristics, distribution of risk factors particularly comorbidities and demographic characteristics of patients. This study aimed to determine the clinical presentation and associated factors of mortality in patients hospitalized with COVID -19 infection. Methods: Patients were divided into survivor and deceased groups, and clinical and laboratory findings and factors associated with mortality between the two groups were compared by calculating odds ratio (OR) with 95% confidence interval (95% CI). Results: A total of 257 patients (female 45.1%) with a mean age of 59.8+15.7 years and a mean hospital stay of 4.89+3.57 days were studied. Diabetes, hypertension, cardiovascular disease and chronic renal disease (CRD) were found in 29.6%, 37.5%, 16.3% and 3.5% of all patients, respectively. Forty-one (16%) patients died. Factors such as age >50 years, coexisting CRD, serum creatinine > 2 mg/dl; SPO2 <70% lymphocytes < 20% during hospitalization were independently associated with mortality. The adjusted ORs (95% CI) were 10.08 (1.39-73); 4.51(1.15-17.61); 6 (1.14-31.5); 16.8(2.93-96.7); and 4.9(1.31-18.1), respectively. Most of the expected effective drugs were not associated with lower mortality. Conclusion: These results indicate a high in-hospital mortality rate in COVID -19 patients. Some mortality factors occurring during hospitalization were reversible and could be prevented by timely diagnosis and appropriate treatment.

Evaluation of the effectiveness of crocin isolated from saffron in treatment of burning mouth syndrome: A randomized controlled trial.

OBJECTIVE: Burning mouth syndrome (BMS) is a debilitating disorder with few limited treatment modalities. Because of the proven association between BMS symptoms, and depression and anxiety, treatment modalities that alleviate the two latter etiologic factors can be clinically effective. Thus, owing to the antidepressant and potential analgesic effects of crocin (as an active constituent of saffron), the present study was performed to compare the effect of crocin and citalopram (as control) on BMS symptoms and depression/anxiety in patients with BMS. MATERIALS AND METHODS: The present double-blind randomized clinical trial was carried out on BMS patients. Patients were randomly divided into citalopram (n=21) and crocin (n=26) groups and treated for 11 weeks. BMS symptoms (based on Visual Analysis Scale (VAS)), as well as anxiety and depression (based on Hamilton questionnaire) were evaluated at baseline and during the treatment period. Mann-Whitney, Chi-Square test, Independent t-test, Friedman, and Spearman correlation were employed for statistical analysis. RESULTS: Our findings showed a significant effect for crocin on the severity of BMS symptoms, anxiety and depression in BMS patients. CONCLUSION: Crocin can be considered for treatment of BMS subjects with concurrent anxiety and/or depression.

The staining effect of different mouthwashes containing nanoparticles on dental enamel.

BACKGROUND: This study aimed to evaluate the effects of several mouthwashes containing nanoparticles on discoloration of dental enamel, and compare the results with that of 0.2% chlorhexidine (CHX). MATERIAL AND METHODS: Sixty intact premolars were randomly assigned to six groups. A spectrophotometer was used to measure the color of the teeth (T1) according to the CIELAB system. The specimens in groups 1 to 4 were then immersed in colloidal solutions containing nanoTiO2 (Group 1), nanoZnO (Group 2), nanoAg (Group 3) and nanoCuO (Group 4). In groups 5 and 6, a 0.2% CHX mouthwash and distilled water were used as positive and negative controls, respectively. After 24 hours of immersion, color determination was repeated (T2). The third color assessment was accomplished after brushing (T3). The L, a, and b values were recorded and the color change (?E) between different stages was calculated. RESULTS: ANOVA revealed significant between-group differences in the color change between T1 and T2 stages, as well as between T1 and T3 time points (p<0.05), whereas the color change between T2 and T3 was not significantly different among the study groups (p=0.09). ?ET1-T3 was significantly lower in the specimens immersed in distilled water or CHX as compared to the nanoparticle-containing mouthwashes (p<0.05). The highest ?E value pertained to the specimens immersed in nanoZnO-containing solution. The TiO2 nanoparticles caused the lowest staining among the tested nanoparticles. CONCLUSIONS: The mouthwashes containing nanoparticles produced comparable or even greater enamel discoloration compared to CHX. Brushing had little effect on removal of induced stains. KEY WORDS: Nanoparticle, mouthrinse, mouthwash, staining, enamel, discoloration, chlorhexidine.