An evaluation of suspected cases of Hantavirus infection admitted to a tertiary care university hospital in Düzce, Turkey, between 2012 and 2018

Background/aim: Hantavirus is a rodent borne zoonosis caused by the members of the virus family Bunyaviridae, genus Hantavirus. In this study, we aimed to determine the role of peripheral blood leukocyte ratio in differential diagnosis of Hantavirus disease. Materials and methods: The medical records of patients at the Düzce University Medical Faculty were examined retrospectively. A total of 20 patients diagnosed with hantavirus infection confirmed by serologic tests were included in the study (Group 1). The other group consisted of 30 patients suspected of hantavirus infection but found negative (Group 2). Demographic, clinical and laboratory characteristics, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte (LMR) ratios of both groups were compared. Results: As a result of the istatistics analysis, no difference was found between the groups' age, sex, and clinical complaints except lethargy-weakness (P = 0.004) and diarrhea (P < 0.001). Hemogram analysis showed a significant difference between the groups in terms of leukocyte, hemoglobin, hematocrit, platelet, mean platelet volume (P < 0.05) and PLR (P = 0.001) and LMR (P = 0.003) values from peripheral blood leukocyte ratios. Conclusion: In conclusion, NLR, PLR, and LMR ratios may be useful for clinicians in differential diagnosis of Hantavirus in patients presenting with similar symptoms of Hantavirus disease.

The effects of ultrafiltration and diuretic therapies on oxidative stress markers in patients with cardio-renal syndrome.

BACKGROUND: Cardiorenal syndrome (CRS) is defined as complex pathophysiological disorder of the heart and kidneys. Both heart and renal failure are characterized by increased systemic oxidative stress in CRS. The aim of the present study is to assess the impacts of ultrafiltration (UF) and furosemide treatment on oxidative stress markers and renal functions in patients with CRS. METHODS: In the study 77 patients with CRS (37 patients in the UF group and 40 patients in the furosemide group) were included. Plasma superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), glutathione peroxidase (GSH-Px) levels were studied in all patients on admission and at the end of the study. RESULTS: Plasma SOD, CAT, MDA and GSH-Px levels did not show significant difference between the groups. CONCLUSIONS: The effects of UF and furosemide therapies were similar on oxidative stress markers in patients with CRS. These methods safely decrease volume overload in a short-term period.

Association of anxiety, sleepiness, and sexual dysfunction with restless legs syndrome in hemodialysis patients.

Restless legs syndrome (RLS) is characterized by unpleasant sensations, pain in the legs along with irresistible urges to move the legs when at rest. It is often accompanied by sleep disturbance. The purpose of this study was to assess the association of anxiety and sleepiness with sexual function in hemodialysis patients with and without RLS. Sociodemographic parameters, laboratory data of hemodialysis patients from three dialysis centers were collected prospectively. Anxiety, sleepiness, sexual function, and presence of RLS symptoms were assessed with standardized questionnaires as the RLS Diagnosis and Scale, Hamilton Anxiety Rating Scale, Epworth Sleepiness Scale (ESS), Arizona Sex Experiences Scale (ASEX). Univariate, regression tree method were used for statistical analysis. RLS was observed in 45.9% (n = 113) of hemodialysis patients (n = 246). The mean age of patients and duration of hemodialysis were 59.7 ± 14.0 and 4.9 ± 4.2 years, respectively. The correlation between Arizona Sexual Experiences Scale (ASEX) and sociodemographic features was significant (P < 0.0001). Patients with RLS had higher scores for anxiety (9.4 ± 7.8 with RLS and 6.8 ± 6.0 without), higher ESS (ESS, 6.6 ± 5.2 with RLS and 4.6 ± 4.0 without), and higher ASEX (24.6 ± 5.7 with RLS and 22.5 ± 6.8 without) than did those without RLS. The presence of RLS symptoms in hemodialysis patients was associated with sleepiness, anxiety, and sexual dysfunction. A regression tree method, which is a different statistical method, can help physicians estimate patients ASEX, RLS, ESS, and anxiety scores.

Hemodialysis-related headache.

Headache is one of the most frequently encountered neurological symptoms during hemodialysis. According to International Classification of Headache criteria dialysis-related headache was defined as the headache occurring during hemodialysis with no specific characteristic. It resolves spontaneously within 72 hours after the hemodialysis session ends. There are few studies in the literature investigating the clinical features of dialysis headache. The pathophysiology of hemodialysis-related headache is not known, but various triggering factors have been identified, including changes in blood pressure, serum sodium and magnesium levels during hemodialysis sessions, caffeine deprivation and stress. The aim of this article is to evaluate and analyze features of headache in patients undergoing hemodialysis.

Can influenza H1N1 vaccination lead to the membranous glomerulonephritis?

In 2009 winter, Influenza A (H1N1) monovalent split virus vaccine was used prevalently in the whole world as a result of the pandemic caused by Influenza (H1N1) virus. The vaccine's adverse effects were observed closely and vaccination has been found as safe in most studies. But some reports about immune response related diseases after influenza vaccinations are remarkable. The close relationship between membranous glomerulonephritis and antigens is known, particularly in seconder forms which occur after viral infections and vaccinations. So this case report is about a 56-year-old man, who developed membranous glomerulonephritis 23 days after the vaccination against Influenza A (H1N1) virus.

Single-dose-dexketoprofen-induced acute kidney injury due to massive rhabdomyolysis.

A 70-year-old male patient was admitted complaining of weakness and pain in his arms and lower limbs. His serum creatine kinase and serum creatinine were markedly elevated (36,248 IU/L and 2.8 mg/dL, respectively). He had taken dexketoprofen trometamol because of a common cold, which had developed the previous night. Acute kidney injury caused by dexketoprofen-induced rhabdomyolysis was diagnosed by ruling out other possible causes, such as dermato/polymyositis, myxedema, brucellosis, and hepatitis. Dexketoprofen administration was stopped. As diuresis did not restore spontaneously, the patient was treated with I.V. alkaline solutions and mannitol. Hemodialysis was performed because of anuria and severe metabolic acidosis. The patient's renal function later recovered. In conclusion, dexketoprofen may be a potential risk factor for acute kidney injury and rhabdomyolysis.

Hiccups, a rare complication arising from use of a central venous catheter.

Central venous cannulation is a common procedure for acute hemodialysis. Hiccups are a rare complication of internal jugular venous catheterization. In this case, hiccups appeared after the vena jugularis interna catheterization for acute hemodialysis in a patient with acute renal failure and was treated with the reposition of the catheter.

Two daytime icodextrin exchanges decrease brain natriuretic peptide levels and improve cardiac functions in continuous ambulatory peritoneal dialysis patients.

AIM: Peritoneal dialysis patients with ultrafiltration failure frequently have fluid overload. It is known that the increase in the ultrafiltration is associated with decrease in the left ventricle (LV) dysfunction. This study was designed to examine the potential effects of serum brain natriuretic peptide (BNP) on cardiac functions and to determine the relationship between BNP and cardiac parameters in continuous ambulatory peritoneal dialysis (CAPD) patients with ultrafiltration failure. METHODS: Twenty-eight patients with high or high-average membrane permeability as indicated by the peritoneal equilibration test were enrolled and randomized to receive either once or twice daily icodextrin. Serum BNP levels and echocardiographic measurements were evaluated at baseline and at the end of the eighth week. The correlations between the percentage changes of parameters from baseline were also studied. RESULTS: In both groups there was a significant decrease in serum BNP, LV mass, heart rate (HR) and cardiothoracic index (CTI) and an improvement in ejection fraction (all P < 0.05). However, the percentage of change in all these parameters was significantly better in the twice daily compared with once daily group (all P < 0.05). Furthermore, the percentage decrease in BNP was positively correlated with the percentage decrease in HR, LV mass and BP. CONCLUSION: Twice daily icodextrin treatment might be useful in hypervolaemic CAPD patients for the improvement of cardiac functions. BNP monitoring may be useful to follow up these patients.

Occult HBV infection in continuous ambulatory peritoneal dialysis and hemodialysis patients.

AIM: Occult hepatitis B virus (HBV) infection can be defined as the presence of HBV DNA in the liver and/or blood in the absence of detectable serum hepatitis B surface antigen (HBs Ag). There is a high prevalence of occult HBV infection in dialysis patients. This study investigated the prevalence of occult HBV infection in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) patients and compared the prevalence of occult HBV infection in dialysis patients either with or without hepatitis C virus (HCV) infection. METHODS: In this cross-sectional study, 71 CAPD patients and 71 HD patients were evaluated. HBV DNA testing was performed by polymerase chain reaction (PCR). We recorded general characteristics of the patients, duration of dialysis, HBs Ag, antibody to hepatitis B surface antigen (anti-HBs), antibody to hepatitis B core antigen (anti-HBc), anti-HCV antibody (anti-HCV), HCV RNA, serum alanine aminotransferase (ALT), and aspartate aminotransferase levels (AST). RESULTS: Twelve (16.9%) of the 71 HD patients and seven (9.8%) of the 71 CAPD patients were HBV DNA-positive. A statistically significant difference was not observed in the groups. Anti-HCV was negative and AST and ALT levels were normal in all of the HBV-DNA positive patients. Viral loads were low in both groups. CONCLUSION: This is the first study that analyzes occult HBV prevalence in CAPD patients. We conclude that the prevalence of the occult HBV may be common in CAPD patients as in HD patients, and HCV positivity is not a contributing factor to occult HBV infection in dialysis patients.

Extrapulmonary tuberculosis in a hemodialysis patient with unusual clinical presentation.

The incidence of active tuberculosis in patients undergoing maintenance dialysis for a long time is considerably higher than that in general population. A 39-year-old male treated by hemodialysis three times a week for six months was admitted to the hospital with a painless mass palpable under his right areola. X-ray examination of chest showed a hyperintense lesion. Computed tomography revealed a cystic mass in the superior segment of inferior lobe near the thoracic vertebrae. Needle aspiration of the lesion revealed granulomas and acid-resistant bacteria. Anti-tuberculous therapy was therefore initiated. After eight months the patient was admitted back with paraplegia. Magnetic resonance imaging (MRI) revealed that the lesion defined by computed tomography (CT) was extending to the spinal duct and compressing the spinal cord. A tissue biopsy was performed and granulomas were identified. Mycobacterium tuberculosis grew in the culture. This case suggests that in areas with a high incidence of tuberculosis renal patients in a high-risk group should be examined periodically to exclude insidious infection and reduce morbidity and mortality.

Effects of twice-daily icodextrin administration on blood pressure and left ventricular mass in patients on continuous ambulatory peritoneal dialysis.

BACKGROUND: Hypervolemia is a risk factor for left ventricular hypertrophy and hypertension in peritoneal dialysis patients. Icodextrin improves volume control by increasing ultrafiltration in peritoneal dialysis patients. AIM: To examine the effects of twice-daily icodextrin administration on blood pressure and left ventricular hypertrophy in peritoneal dialysis patients with hypervolemia and ultrafiltration failure. METHOD AND RESULTS: Administration of icodextrin twice daily resulted in a significant reduction in the left ventricular mass index (LVMI) of patients by the end of the third month (p < 0.05). The reduction in LVMI was also significant for the once-daily icodextrin group (p < 0.05). Mean blood pressure of patients receiving icodextrin twice daily was significantly reduced (p < 0.05). By the end of the third month no significant changes were observed in mean blood pressure of the patients using once-daily icodextrin (p > 0.05). No statistically significant changes were observed in weekly total creatinine clearances or Kt/V of patients in either group at the end of 3 months (NS). CONCLUSION: Twice-daily icodextrin administration was clinically beneficial as shown by reduced blood pressure and prevention of the progress of left ventricular hypertrophy without causing any decrease in dialysis adequacy or any side effects. The icodextrin metabolite results did not suggest any further increase in their values when comparing once- to twice-daily administration of icodextrin. Although prescription of icodextrin once daily may yield good clinical results in the long term, this study showed that it may be more efficient to use twice-daily icodextrin for at least a specific period for the purpose of obtaining quicker results in patients with ultrafiltration failure, serious hypervolemia, or hard-to-control blood pressure conditions.

Peritonitis associated with Strongyloides stercoralis in a patient undergoing continuous ambulatory peritoneal dialysis.

A 67-year-old male continuous ambulatory peritoneal dialysis (CAPD) patient presented with abdominal pain and pruritus. Strongyloides stercoralis larvae were seen on dialysate sediment and stool microscopic examination. Albendazole was given and improved the symptoms in 4 days. There was no episode of relapsing peritonitis after the therapy. This is the first report of S. stercoralis peritonitis in patients on CAPD. Strongyloides should be considered as a probable peritoneal pathogen in CAPD patients.

Is there a difference between the allergic potencies of the iron sucrose and low molecular weight iron dextran?

BACKGROUND: The objectives of the present trial were to compare the side effects and safety of two intravenous iron preparations (iron-dextran, iron-sucrose) in patients with end stage renal disease. METHODS: A total of 60 patients were randomized and assigned to one of two treatment groups (iron-dextran, n = 30; iron-sucrose, n = 30). A standard test dose of 25 mg of low molecular weight iron-dextran and iron-sucrose were administered over 15 minutes during the initial visit, monitoring very closely for adverse reactions. If this dose was well tolerated, 75 mg of iron diluted in 100 mL of normal saline was administered over 30 minutes. Adverse reactions were recorded. RESULTS: The mean age of the patients was 51.5+/-17.4 years (range, 21 to 80 years). Of the 30 patients who received low molecular weight iron-dextran, 11 developed side effects (pruritus, 1 patient; wheezing, 1 patient; chest pain, 1 patient; nausea, 4 patients; hypotension, 1 patient; swelling, 1 patient; headache, 2 patients). Of the 30 patients who received iron-sucrose, 13 developed side effects (pruritus, 1 patient; wheezing, 1 patient; diarrhea, 1 patient; nausea, 4 patients; hypotension, 2 patients; swelling, 1 patient; headache, 3 patients). Adverse events occurred with similar frequency in the two treatment groups in our study (p > 0.05). We did not observe any serious reactions in the two groups. CONCLUSION: We conclude that the incidence of side effects associated with iron-dextran was not different than that of iron-sucrose in our study. Large scale randomized studies are needed to compare the full side effect profile of intravenous iron preparations more precisely.

Adrenal axis functions in patients with familial Mediterranean fever.

OBJECTIVE: Familial Mediterranean fever (FMF) is a hereditary disease characterized by recurrent attacks of fever with peritonitis, arthritis, pleuritis or erysipelas-like rash. It is unclear what effects of FMF itself on endocrine system and hormones are. None of the FMF patients without amyloidosis have been reported to have any endocrine disorders, except those who developed colchicine-induced diabetes insipidus. There is a large body of evidence to show that cytokines (IL-1, IL-6 and TNF-alpha) activate the hypothalamic-pituitary-adrenal (HPA) axis. We have designated this study to investigate the HPA axis in FMF patients without amyloidosis. METHODS: Twenty-one patients with FMF were included. ACTH stimulation test was performed on the healthy subjects and during attack period in the patients. In the patient group, same test was repeated during remission period. RESULTS: Peak cortisol levels were significantly higher in the attack period than those in the remission period of patients (p<0.05). CONCLUSION: The cytokines play a role on the activation of the HPA axis; we thought the axis would be affected in this disease. The response of cortisol to 250 mug ACTH was significant in attack period when compared with remission period. This result reveals that HPA axis is more activated in an FMF attack. Previous studies suggest that the adrenal hormones increase in acute inflammatory events, and eventually, the changes on these hormones are related to TNF and IL-6 levels. During the FMF attack, HPA axis may be stimulated by cytokines. It seems that HPA axis is regulated normally in FMF patients.