Pruritus in chronic kidney disease.

PURPOSE OF REVIEW: Among the many difficult symptoms that patients with kidney disease experience, pruritus is one of the most frequent and troubling. Because a substantial amount of new information has accumulated, we seek here to review the subject. RECENT FINDINGS: Pruritus is not only a common problematic symptom among patients with kidney disease, but its considerably more frequent than nephrologists recognize. The result for patients is not just uncomfortable itch but degraded quality of life as well. The pathogenesis is increasingly understood, but many aspects remain to be fully resolved. Importantly, research is progressing on treatment, leading to the first approved medication in the United States, difelikefalin, in August, 2021. SUMMARY: As nephrology is progressing to a greater focus on patient symptoms, recognition of the importance of pruritus has led to increased interest and improved diagnosis and treatment options.

In vitro activity of lactoferricin solution against Malassezia pachydermatis from otitis externa in dogs and cats.

BACKGROUND: Malassezia pachydermatis is a commensal organism of the skin, yet it may induce dermatitis and/or otitis. Lactoferricin (Lfcin) is an antimicrobial peptide obtained by the pepsin-mediated digestion of lactoferrin, a multifunctional innate-defence milk protein. The antibacterial activity of Lfcin is thought to cause alteration of bacterial membrane permeability, thus inducing cell death. OBJECTIVES: The aim of this study was to evaluate in vitro antifungal activity of different dilutions of Lfcin solution against M. pachydermatis strains isolated from ears of dogs and cats with otitis externa. METHODS AND MATERIALS: Fifty clinical Malassezia isolates from 40 dogs and 10 cats were tested. A dilution method in microtitre plates was used starting with a 20% Lfcin water solution. The different dilutions were 2:1 (13.3%), 1:1 (10%), 1:2 (6.7%), 1:5 (3.3%) and 1:10 (1.8%). Results were expressed as the value at which the growth of 50% (minimal fungicidal concentration MFC50 ) and 90% (MFC90 ) of yeast cells was inhibited. RESULTS: All strains showed susceptibility to 20% Lfcin solution (100%). With 1:5 and 1:10 dilutions corresponding to 3.3% and 1.8% Lfcin solutions, all strains showed resistance. The MFC50 and MFC90 values were observed at 13.3% and 20% Lfcin solutions. CONCLUSIONS AND CLINICAL RELEVANCE: The results indicated that Lfcin solution exhibits the antimicrobial activity specific to antimicrobial peptides. In particular, the 20% solution can be effective in killing M. pachydermatis isolated strains. Some susceptibilities also are evident at lower concentrations of ≤6.7% for four strains.

Antimicrobial Activity of Lactoferrin-Related Peptides and Applications in Human and Veterinary Medicine.

Antimicrobial peptides (AMPs) represent a vast array of molecules produced by virtually all living organisms as natural barriers against infection. Among AMP sources, an interesting class regards the food-derived bioactive agents. The whey protein lactoferrin (Lf) is an iron-binding glycoprotein that plays a significant role in the innate immune system, and is considered as an important host defense molecule. In search for novel antimicrobial agents, Lf offers a new source with potential pharmaceutical applications. The Lf-derived peptides Lf(1-11), lactoferricin (Lfcin) and lactoferrampin exhibit interesting and more potent antimicrobial actions than intact protein. Particularly, Lfcin has demonstrated strong antibacterial, anti-fungal and antiparasitic activity with promising applications both in human and veterinary diseases (from ocular infections to osteo-articular, gastrointestinal and dermatological diseases).

Identification by real-time PCR with SYBR Green of Leishmania spp. and Serratia marcescens in canine 'sterile' cutaneous nodular lesions.

BACKGROUND: Noninfectious, non-neoplastic, nodular to diffuse, so-called 'sterile' granulomatous/pyogranulomatous skin lesions (SGPSLs) are infrequently identified in dogs and may represent a diagnostic challenge. Their correct identification is based on history, histopathology and absence of intralesional foreign bodies and micro-organisms. HYPOTHESIS/OBJECTIVES: The aim of this study was to investigate the presence of Leishmania spp., Mycobacterium spp., Serratia marcescens and Nocardia spp. by real-time PCR in canine nodular skin lesions histologically diagnosed as putatively sterile. METHODS: Formalin-fixed skin biopsies were collected from 40 dogs. All samples were associated with an SGPSL diagnosis characterized by multifocal, nodular to diffuse, periadnexal and perifollicular pyogranulomas/granulomas. Neither micro-organisms nor foreign bodies were detected with haematoxylin and eosin staining, under polarized light. Further analyses included periodic acid Schiff, Ziehl-Neelsen, Fite Faraco, Giemsa and Gram histochemical stains; anti-Bacillus Calmette-Guérin (BCG) and Leishmania spp. immunohistochemistry; and real-time PCR analysis for Leishmania spp., Mycobacterium spp., S. marcescens and Nocardia spp. RESULTS: Special stains and BCG/immunohistochemistry were negative in all samples. Real-time PCR was positive for Leishmania spp. in four of 40 biopsies and for S. marcescens in two of 40 samples. Real-time PCR for Mycobacterium spp. and Nocardia spp. was negative. No correlation between real-time PCR positivity and a specific histological pattern was identified. CONCLUSIONS AND CLINICAL IMPORTANCE: Leishmania spp. have been previously identified as possible agents of certain SGPSLs, while the involvement of S. marcescens has not been investigated previously. According to our findings, Serratia spp. should be included in the list of agents possibly associated with a subgroup of granulomatous/pyogranulomatous skin lesions in dogs.

Palliative Care in Kidney and Liver Diseases.

The role of palliative care is to recognize patients with advanced illnesses who are at risk for poor outcomes and to alleviate their pain and suffering. Patients with both kidney and liver disease are a very vulnerable population due to the unique pathophysiologic relationship these two organs share, which often leads to an abbreviated life expectancy and a significant symptom burden. These patients face many challenges in their care. This article discusses the importance of prognostication for early palliative care referrals as well as the management of the two most common complaints patients with kidney and liver disease face: pain and ascites.

Olfactory Distraction for Management of Nausea in Palliative Care Patients.

Nausea is one of the most common and debilitating symptoms Palliative Care patients experience. This can be caused by the life-limiting illness itself, its complications, or its treatments. While there are many options for management, including anti-emetics and motility agents, patients may develop refractory nausea or even intolerance to these treatments. Drug interactions, sedation, extrapyramidal effects, serotonin syndrome, and prolonged QT intervals with risk factors for Torsades de Pointes may all preclude use of these medications. Olfactory distraction using alcohol swabs has supporting literature in the emergency care setting as a means of alleviating nausea in a safe and effective way. We present a case series of 3 patients admitted to a Northwell facility who were referred to the Palliative Care consult service for severe nausea. The patients had nausea of varying etiology and were successfully managed with inhalation of alcohol swabs. This is the first case series that looks into applying this intervention to the Palliative Care population as an easy-to-use, readily-available, and safe method to manage nausea.

Palliative Care for Patients With Cancer and Kidney Disease.

Patients with cancer and kidney disease experience a range of symptoms that impact their quality of life. Pain, fatigue, decreased appetite, and depression are all common in this population. Kidney palliative care is patient-centered medical care focused on reducing symptoms and defining individualized goals of care for patients and their families. Pharmacologic management of pain in patients with cancer and kidney disease requires recognition of the type of pain, its cause, and the risks and benefits of different medication classes. This review describes basic symptom management options as well as considerations for discussing goals of care, prognosis, and end of life.

The Virulence of Grief in the Pandemic: Bereavement Overload During COVID.

The COVID-19 pandemic brought about bereavement overload as a risk factor for complicated grief. Bereavement overload (BO) describes individuals' reactions to losses transpiring in a quick succession, without the time and opportunity for coping [9]. It can occur during catastrophic events and impact everyone experiencing the loss.With the high death toll from COVID-19, many people have lost multiple loved ones followed by an abbreviated grieving process due to the nature of the pandemic. This can have psychosocial impact on survivors for years. One of the evolving roles of Palliative Care within and after the pandemic should be to recognize those suffering from BO. Obtaining loss histories may identify those at risk of pathologic grief to provide preventive bereavement care.We present three cases encountered in our health system during the COVID-19 pandemic amongst a family member, a patient, and a healthcare provider. In each case the Palliative Care Team worked closely with these individuals to identify COVID-associated BO and helped them reconcile their unresolved grief to be able to move forward. These cases reflect only a fraction of those who experienced loss during the pandemic, but they illustrate how grief can be complicated by the pandemic for everyone involved.Palliative Care will have a crucial role moving forward, in treating the pandemic of complicated grief within the pandemic to adapt to the needs of all survivors, as we realize the effects of COVID will last long after its virulence has waned.

Detection of feline herpes virus 1 via polymerase chain reaction and immunohistochemistry in cats with ulcerative facial dermatitis, eosinophilic granuloma complex reaction patterns and mosquito bite hypersensitivity.

Ulcerative dermatitis caused by feline herpes virus 1 (FHV-1) is an uncommon disease characterized by cutaneous ulcers secondary to epidermal, adnexal and dermal necrosis. Differential diagnoses for FHV-1 lesions include, but are not limited to, mosquito bite hypersensitivity and eosinophilic granuloma complex. Histopathological diagnosis of FHV-1 dermatitis is based on the detection of the intranuclear inclusion bodies. In cases where intranuclear inclusions are missing but clinical and histological findings are compatible with FHV-1 dermatitis, immunohistochemistry (IHC) and PCRs have been used. In this retrospective study, we evaluated the presence of FHV-1 by IHC and PCR in skin biopsies and compared the results of the two tests. Sixty-four skin biopsy specimens from cats with compatible lesions were reviewed and tested via PCR and IHC for evidence of FHV-1. Polymerase chain reaction was positive in 12 of 64 biopsies; PCR and IHC were positive only in two of 64 biopsies, and these cases were considered true positive cases. The higher number of PCR-positive cases was possibly attributed to amplification of viral DNA from a live attenuated vaccination, but a previous FHV-1 infection with subsequent amplification of latently inserted FHV-1 could not be excluded. If clinical signs and histopathology suggest FHV-1 infection in the absence of typical inclusion bodies, IHC is the preferred diagnostic test; PCR may be useful for initial screening, but due to false positives is not sufficient for a definitive diagnosis.

A case of drug-resistant staphylococcal para-aural abscess treated with photodynamic therapy in a West Highland White Terrier presenting with chronic otitis and craniomandibular osteopathy.

A 10-year-old canine with chronic unilateral otitis and a history of unsuccessful systemic and topical antibiotic treatments was referred. A computer tomography scan (CT scan) revealed unilateral chronic otitis with calcification of the ear canal, abscessation and fistula. On bacterial culture a Staphylococcus pseudintermedius sensitive to pradofloxacin was isolated. Systemic treatment with pradofloxacin, 3 mg/kg per os once daily, improved the infection and the dog had total ear canal ablation and bulla osteotomy performed. After one month, despite antibiotic treatment new fistulas developed in the same area. Bacterial culture revealed an drug-resistant S. pseudintermedius sensitive only to rifampicin. Under general anesthesia, the area was cleaned with 0.5% saline solution and 1 mL of indocyanine green (Emundo®, A.R.C.) was injected into the fistulas. A treatment with diode laser (A.R.C. Laser 810 nm, GmbH, Nurnberg, Germany) of four cycles 500 mw for 30 s, with a dosage of 50 J/cm2 in the effected area was performed. No antibiotic was administered and one week later, 50% of the fistulas were closed with a significant improvement of the patient's clinical condition. Cytology and bacterial culture were negative 72 h after the treatment. Total recovery occurred after two weeks. Photodynamic Therapy(PDT) is a promising antibacterial technique in case of localized refractory bacterial infections.

Diagnostic and therapeutic management of Cryptococcosis in a kitten with practical considerations to veterinary pediatric therapeutic approach.

A 3-months-old male domestic kitten was referred for repeated seizures. Analysis revealed Cryptococcus neoformans. Levetiracetam and fluconazole were administered without significant clinical improvements and without negativization. Hypothesizing resistance, therapy was switched to amphotericin B. Seizure disappeared. Haematological controls highlighted transitory increasing of CK, BUN, ALP and cholesterol. PCR repeated two weeks after the treatment was negative for Cryptococcus neoformans. Nowadays the cat is 5 years old, and no seizures occurred since the age of 5 months.

[Hospital readmission of diabetic patients: a follow-up of twelve months]. / Readmisión hospitalaria de pacientes diabéticos: seguimiento de 12 meses.

OBJECTIVE: To determine the risk factors associated with hospital readmissions in diabetes mellitus (DM). METHODS: Adult patients with DM hospitalized were evaluated with a follow up during one year. Odd ratios (OR) and 95% confidence intervals (95% CI) were calculated to identify predictors of hospital readmissions. RESULTS: There were 153 patients, with a mean age 58 ± 13) years, 97% had type 2 DM with a mean disease evolution of 166 ± 132) months; 131 patients were evaluated every 4 months with follow-up of 11 ± 1.2) months and 35% had hospital readmission. The causes were: infections (36%), chronic renal failure (27%), acute complications of DM (8%) and cardiovascular disease (11%). They were associated with ≤ 6 years of education (RR 2.9, 1.22-7.03 CI 95%), duration of DM > 132 months (RR 1.2, 1.00-1.6 CI 95), nephropathy (RR 2.3, 1.5-7.0 CI 95%), and abnormal glycemia upon being discharged from initial hospitalization (RR 2.5, 1.13-5.6 CI 95%). Two or more readmissions where associated significantly with nephropathy (p = 0.05) and the use of alternative treatment (p = 0.01). CONCLUSIONS: Multiple hospitalizations could be preventable with the identification of risk factors.