Proton pump inhibitor use and the risk of peritoneal dialysis associated peritonitis.

BACKGROUND: The use of proton-pump inhibitors (PPI) has been associated with an increased risk of developing spontaneous bacterial peritonitis in patients with cirrhosis. Whether PPI use confers a similar risk in developing peritonitis in peritoneal dialysis (PD) patients remains unclear. AIM: To assess whether PPI use is associated with an increased risk of PD peritonitis. METHODS: Patients on PD were retrospectively identified. Data such as PPI use during PD, underlying diagnoses, comorbidities, and baseline serum tests were collected. Univariable and multivariable analysis was conducted using logistic regression to assess whether PPI use and other factors were associated with PD peritonitis. RESULTS: Fifty-seven patients were identified with a median (interquartile range (IQR)) age of 65.0 (51.5-74.0) years. The median (IQR) time on PD was 29.0 (17.5-45.0) months. Twenty-eight patients were on a PPI during PD. Fifty-seven percent of the PPI group went on to develop peritonitis, compared with 31% of patients without PPI exposure (odds ratio (OR) = 2.96; 95% confidence interval (CI): 1.00, 8.78; P = 0.050). Months on PD (OR = 1.03; 95% CI: 1.00, 1.06; P = 0.026), serum urea (OR = 0.88; 95% CI: 0.80, 0.97; P = 0.017), congestive cardiac failure (OR = 5.44; 95% CI: 1.29, 23.00; P = 0.021) and renovascular disease (OR = 14.59; 95% CI: 1.68, 126.67; P = 0.015) were identified as possible risk factors for peritonitis on univariable analysis. Following adjustment for covariates, serum urea, but not PPI use, was associated with PD peritonitis (OR = 0.87; 95% CI: 0.78, 0.98; P = 0.020). CONCLUSION: PPI use during PD was not associated with peritonitis. Due to the small number of patients and the limited number of studies investigating the effect of PPI use on PD peritonitis, further research is needed.

Rural work outcomes of medical students participating in a contracted Extended Rural Cohort (ERC) program by course-entry preference.

This paper evaluates rural work location outcomes of an Extended Rural Cohort (ERC) program in medical school. Students nominate a preference and are contracted to the program at entry to the medical course, involving 2-3 years continuous rural training. Data included 2412 graduates from a large university medical school cohort study. Regression modeling compared 2017 work location of ERC participants, by their level of preference for the ERC and students who had other (similar or shorter duration) rural training with a metropolitan-only trained group. Students who entered medicine with ERC as their first preference commonly had rural background (95.5%) compared with second or lower preferences (61.5% and 40.4%, respectively). Multivariate regression modeling identified ERC participants were more likely to work rurally (OR: 2.69-3.27, compared with metropolitan-trained), though higher odds were associated with lower preference for ERC. However, non-ERC students undertaking a similar duration rural training by opting for this "year by year" after course entry, had the strongest odds of rural work (OR: 4.62, 95%CI: 3.00-7.13) and work in smaller rural towns (RRR: 4.08, 95%CI: 2.36-7.06). The ERC attracts rural background students and increases rural work outcomes. However, students choosing a rural training path of equivalent duration after course entry may be more effective and improve rural workforce distribution.

Recurrent, Atypical Anti-Glomerular Basement Membrane Disease.

Anti-glomerular basement membrane disease (GBM) (Goodpasture's disease) typically presents with acute manifestations of rapidly progressive glomerulonephritis often accompanied by lung haemorrhage. Anti-GBM disease is usually monophasic. However, atypical presentations with indolent renal involvement are being increasingly recognized. Herein we report a patient who presented with lung haemorrhage, minimal renal involvement, and negative result for serum anti-GBM antibody, while immunofluorescence examination of the renal biopsy provided the diagnosis leading to the institution right treatment with excellent response. Interestingly, he had presented 10 years earlier with lung hemorrhage, more significant renal involvement clinically and histologically, with positive serum anti-GBM antibody. The present case is intended to increase our awareness regarding the variable presentations of anti-GBM disease, such as with negative serology and recurrence of anti-GBM disease. The presentation of anti-GBM nephritis with non-proliferative, non-crescentic glomerulonephritis is also highlighted. The possible explanations for negative serum anti-GBM antibody are explored with a brief review of literature.

Youth in Foster Care and the Reasonable and Prudent Parenting Standard.

Children in foster care face disproportionate rates of biopsychosocial challenges but social and extracurricular activities (SEAs) may support their healthy development. The Reasonable and Prudent Parenting Standard (RPPS), a 2014 federal policy, aims to increase access to these opportunities for children in foster care. Analyses of statutes from 50 US states and the District of Columbia (n = 51) revealed similarities and differences in state-level RPPS policy implementation. Building on these findings, researchers conducted semi-structured retrospective telephone interviews with foster parents across one southeastern state (n = 20) to identify local retrospective perspectives on RPPS implementation. Using thematic inductive coding two unique themes emerged about SEAs prior to RPPS: 1) negative social impacts and 2) complicated activity approval processes. Three unique themes emerged after RPPS: 1) empowerment, 2) implementation disparities and 3) resource recommendations. Policy implications include the need to support foster parents by increasing resources (funding, transportation, access), clarifying liability and clarifying motivation expectations.