Risk factors for peritonitis related to peritoneal dialysis.

BACKGROUND: The aim of this study was to evaluate risk factors for peritonitis associated with peritoneal dialysis in our centre. METHODS: Forty patients on chronic peritoneal dialysis between 2006-2010 were enrolled in this study. Nutritional, sociodemographical, psychological, dialysis related (peritoneal modality, characteristics and adequacy) possible risk factors associated with the development of peritonitis were recorded. Data of patients with and without peritonitis were compared using the Student's t-test and chi-square test. RESULTS: There were 31 episodes of peritonitis among 21 patients, while other 19 patients had not experienced peritonitis resulting in a rate of 1 episode / 44 patient months. Staphylococcus aureus was the most frequent microorganism isolated (31 %). Hypoalbuminemia, technical problems, poor personal and environmental hygiene, low educational status, current or former smoking history and less urine output were observed significantly more in patients who had peritonitis. CONCLUSIONS: Our results confirm that educational, psychological, nutritional, smoking and hygiene status and amount of urine output are closely associated with peritonitis among peritoneal dialysis patients. Measures to improve these factors may help prevent and control peritoneal dialysis related peritonitis (Tab. 4, Ref. 14).

The relationship between dermatological findings and serum interleukin 31 and serum uridine diphosphate glucose ceramide glucosyltransferase levels among patients with chronic kidney disease.

BACKGROUND: Cutaneous diseases are observed with increasing duration and severity of renal disease in patients with chronic kidney disease (CKD). This study aimed to elucidate dermatological manifestations at different stages of CKD and determine their relationship with interleukin 31 (IL-31), a T-cell cytokine that induces severe pruritus, and uridine diphosphate (UDP)-glucose ceramide glucosyltransferase (UGCG), an enzyme that metabolizes ceramide, which plays an important role in moisturizing epidermis. METHODS: In this retrospective cohort study 145 patients with a mean age of 46 ± 17 years were categorized into hemodialysis (group 1), peritoneal dialysis (group 2),  kidney transplant (group 3), CKD (group 4), and healthy control (group 5) groups. Serum IL-31 and  UGCG levels were measured using enzyme-linked immunosorbent assay, and clinical dermatologists evaluated dermatological manifestations. RESULTS: In the overall cohort, pruritus was significantly and inversely correlated with glomerular filtration rate and serum hemoglobin and albumin levels (p <0.005). Additionally, pruritus was significantly more frequent in group 2 than in group 5; and significantly less frequent in group 3 than in groups 1, 2, and 4 (p =0.01). In group 4, the patients with longitudinal nail ridges had significantly higher serum IL-31 levels than those without longitudinal nail ridges in their nails (p =0.02). Furthermore, in group 2, the patients with pruritus had significantly lower UGCG levels than those without pruritus (p =0.045). CONCLUSION: IL-31 might play a role in the development of longitudinal nail ridges, whereas UGCG might provide protection from pruritus and xerosis in patients with CKD.  HIPPOKRATIA 2019, 23(2): 75-80.

The comorbidity of reduplicative paramnesia, intermetamorphosis, reverse-intermetamorphosis, misidentification of reflection, and capgras syndrome in an adolescent patient.

Delusional misidentification syndromes may be superimposed on neurological or psychiatric disorders and include delusional beliefs that the people, objects, or places around the patient change or are made to change with one another. In this paper, an adolescent patient displaying Capgras syndrome, metamorphosis, reverse-intermetamorphosis, misidentification of reflection, and reduplicative paramnesia was presented. The findings that our patient struggled with visuospatial tests applied in the acute phase as well as the observation that she refused to meet her family face-to-face while accepting to speak on the phone may support the role of right hemisphere and visuospatial functions in the development of those syndromes. Further studies or case series evaluated more extensively are needed to reveal the relationship between right hemisphere functions and delusional misidentification syndromes.

Indirect estimation of VO2max in athletes by ACSM's equation: valid or not?

AIM: The purpose of this study was to assess the indirect calculation of VO2max using ACSM's equation for Bruce protocol in athletes of different sports and to compare with the directly measured; secondly to develop regression models predicting VO2 max in athletes. METHODS: Fifty five male athletes of national and international level (mean age 28.3 ± 5.6 yrs) performed graded exercise test with direct measurement of VO2 through ergospirometric device. Moreover, 3 equations were used for the indirect calculation of VO2max: a) VO2max= (0.2 · Speed) + (0.9 · Speed · Grade) + 3.5 (ACSM running equation), b) regression analysis model using enter method and c) stepwise method based on the measured data of VO2. Age, BMI, speed, grade and exercise time were used as independent variables. RESULTS: Regression analysis using enter method yielded the equation (R=.64, standard error of estimation [SEE] = 6.11): VO2max (ml·kg(-1)·min(-1)) = 58.443 - (0.215 · age) - (0.632 · BMI) - (68.639 · grade) + (1.579 · time) while stepwise method (R = .61, SEE = 6.18) led to: VO2max (ml·kg(-1)·min(-1)) = 33.971 - (0.291 · age) + (1.481 · time). The calculated values of VO2max from these regression models did not differ significantly from the measured VO2max (p>.05). On the contrary, VO2max calculated from the ACSM's running equation was significantly higher from the actually measured value by 14.6% (p <.05). CONCLUSIONS: In conclusion, it seems that ACSM's equation is not capable of accurately predicting VO2max in athletes aged 18-37 years using Bruce protocol. Only the regression models were correlated moderately with the actually measured values of VO2max.

Evaluation of nutritional parameters of hemodialysis patients.

BACKGROUND: This study was performed to investigate nutritional parameters of hemodialysis patients by using anthropometric and biochemical measurements. METHODS: Data from the last 6 months of 22 adult hemodialysis patients with a mean age of 61 ± 14 years were analyzed retrospectively. Dialysis vintage, normalized protein catabolic rate (nPCR), serum biochemical parameters, mid arm muscle circumference (MAMC) were determined as mean and standard deviation. Correlations between the variables were computed by coefficient p of Pearson. RESULTS: We found significant positive correlations: age of patients versus C-reactive protein, MAMC versus LDL-Cholesterol, MAMC versus body mass index, albumin versus hemoglobin. There were also significant negative correlations: age versus serum creatinine, age versus albumin, age versus intact parathyroid hormone (iPTH), dialysis vintage versus MAMC. CONCLUSION: In conclusion, age seem to be negatively associated with iPTH and albumin. As dialysis vintage increases, muscle mass seems to decrease.

Ramsay Hunt syndrome in renal transplantation recipient: a case report.

Ramsay Hunt syndrome develops upon reactivation of a latent virus within the geniculate ganglion. The patient presents with acute facial paralysis, severe ear pain, and a vesicular eruption of the external auditory canal and concha. Varicella zoster virus seropositivity occurs among approximately 90% of members of society. In these persons, virus reactivation may occur especially with advancing age and immunosuppression. We present a case of Ramsay Hunt syndrome that developed in a 35-year-old male patient, who had undergone a renal transplantation 8 months prior and had received maintenance immunosuppression.