Characteristics and Graft Outcomes of Kidney Transplant Candidates with Enteric Risk Factors and Elevated Plasma Oxalate Levels.

INTRODUCTION: This study describes patient characteristics and examines graft function of kidney transplant recipients (without primary hyperoxaluria) with elevated plasma oxalate (POx) and enteric risk factors prior to transplant at our institution. METHODS: Kidney transplant recipients between 2012 and 2020 with elevated POx at the time of kidney transplant evaluation were included. A matched control cohort was gathered using patient/donor age, living/deceased donor type, panel reactive antibody, kidney donor profile index, and human leukocyte antigen mismatch as matching variables. Graft function at 1 year and at last follow-up was reported. RESULTS: A total of 106 patients with elevated POx were identified. A third of the patients had Roux-en-Y gastric bypass, a third had other enteric risks, and a third did not have an identifiable enteric risk. Median eGFR (estimated glomerular filtration rate) at 1 year and at last follow-up was similar between cases and controls except for subgroup of patients with pre-transplant POx >30 µmol/L where 1-year eGFR was lower compared to controls. Across eGFR categories, more cases were in eGFR category <30 mL/min/1.73 m2 compared to controls. CONCLUSION: Roux-en-Y gastric bypass is the most common identifiable risk for elevated POx in kidney transplant candidates. 1-year graft function was not inferior in cases compared to matched controls except for subgroup with POx >30 µmol/L pre-transplant.

A Case of Type II Achalasia Presenting With Markedly Elevated Troponins.

Achalasia is an esophageal motility disorder that presents with dysphagia to solids and liquids and regurgitation of undigested food. Cardiac troponin (cTn) is a sensitive biomarker for myocardial injury, and elevated levels suggest an increased risk of mortality from acute coronary syndrome (ACS). Non-cardiac gastrointestinal (GI) causes of troponin elevation are rare and have generally been described in cases of critical illness (e.g., significant gastrointestinal bleeding (GIB) or acute liver failure). We report a rare case of type II achalasia presenting with markedly elevated troponins. This case illustrates an important GI-related mimic of ACS that should be considered by frontline providers and gastroenterologists.

Functional recovery following surgery for chronic subdural hematoma.

BACKGROUND: Among the elderly, chronic subdural hematoma is a relatively common neurosurgical condition. Presenting symptoms range from headache and focal neurological deficits to seizure and coma depending on location and extent of brain compression. Functional recovery following surgery for chronic subdural hematoma is central to quality of life and ongoing health for elderly patients; however, there is a paucity of data regarding functional recovery in this population. METHODS: In this study, the physical activity of patients who underwent surgical evacuation of chronic subdural hematoma was surveyed, as well as participation in physical therapy following surgery. In total, 38 patients completed the survey. RESULTS: Of the 30 patients who exercised regularly before surgery, 28 (90.3%) returned to exercise within 1 year after surgery. Of 13 patients who reported playing hobby sports before surgery, 9 (69.2%) returned to those sports. 17/38 (44.7%) patients participated in physical therapy after surgery. 35/38 (92.1%) of patients reported that the surgery improved their quality of life. CONCLUSION: The majority of patients who underwent surgery for chronic subdural hematoma were able to return to exercise within 1 year. Participation in physical therapy was associated with return to exercise and sports. Further study is needed to determine which factors contribute to a return to baseline levels of physical activity following surgery for chronic subdural hematoma.

Modulation of Interleukins in Sepsis-Associated Clotting Disorders: Interplay With Hemostatic Derangement.

Interleukins play a central role in the immune system and are involved in a variety of immunological, inflammatory, and infectious disease states including sepsis syndrome. Levels of interleukins may correlate with overall survival and may directly or indirectly affect some of the regulators of coagulation and fibrinolysis, thereby disrupting hemostasis and thrombosis. Our hypothesis is that in sepsis-associated coagulopathies (SACs), interleukins may be upregulated, leading to hemostatic imbalance by generating thrombogenic mediators. We profiled the levels of interleukins IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, and IL-10 in addition to d-dimer (DD) in patients with SAC and in normal donors. We observed the highest increase in interleukins IL-6 (322-fold), IL-8 (48-fold), IL-10 (72-fold), and DD (18-fold). This suggests that interleukins such as IL-6 and IL-10 have a close association with coagulopathy and fibrinolytic dysregulation in sepsis and can be considered as candidates for potential therapeutic targets in SAC.