Antibiotic Lock Therapy (ALT) for the prevention of Catheter Related Blood Stream Infection (CRBSI) in neurological patients treated with Therapeutic Plasma Exchange (TPE).

•Catheter related blood stream infection (CRBSI) is associated with several debilitating consequences for patients and medical institutions.•Antibiotic lock therapy (ALT) significantly reduced the incidence of CRBSI in patients receiving therapeutic plasma exchange (TPE).•Antibiotic lock therapy (ALT) reduced the medical care costs•ALT should be considered an acceptable and reasonable approach for patients receiving TPE.

Spontaneous hemorrhage of spinal epidural capillary hemangioma resulting in hyperacute neurologic deficit: A case report.

INTRODUCTION: Spinal epidural capillary hemangioma is a very rare variety of tumors, usually with a predilection for the thoracic spine. CASE PRESENTATION: A 16-year-old female complained of hyperacute neurologic deficit progressed within hour, which presented by acute paraplegia, and loss of all sensations from her lower limbs up to her breasts. Neurologic exam revealed paralysis of lower limbs (0/5 on both legs) with a flaccid tone, absence of reflexes, weakness of the trunk with sensory level T4, bilateral flexion of plantar reflexes, and loss of sphincters' controls. Emergent magnetic resonance imaging showed a dumbbell-shaped epidural mass in the posterior aspect of the spinal canal at the T1-T2 level, measuring approximately 1.1 × 4.5 × 1.5 cm in size. The lesion was isointense on T1-weighted, hyperintense on T2-weighted, and a little enhancement after gadolinium administration. The surgery was obtained nearly 16 hours after paralysis, which eradicated the lesion with good hemostasis. Histological examination showed a well-organized vascular tissue that haphazardly arranged and confirmed the diagnosis of capillary hemangioma. Neurological improvement was quickly observed within days after surgery and further complete recovery was achieved 2 months after discharge. CONCLUSION: We report an extremely rare case of spinal epidural capillary hemangioma, where acute spontaneous hemorrhage in the lesion resulted in the hyperacute neurologic deficit within an hour. Since these are benign lesions, the immediate surgical intervention results in a very favorable prognosis and is considered the treatment of choice. Also, this case highlighted and rose the question of a better neurologic improvement in younger age patients with spinal cord injury.

Determinants of hyperphosphatemia and its relation with hemoglobin levels among hemodialysis patients in two hospitals from Syria: a prospective cross-sectional study.

Hyperphosphatemia and anemia were both associated with several complications in chronic kidney disease (CKD) patients. This study aimed to determine the risk factors of hyperphosphatemia and its relation with anemia among hemodialysis (HD) patients. Secondly, it aimed to determine the prevalence of hyperphosphatemia and anemia. Material and methods: A prospective cross-sectional study was conducted among 146 HD patients from two HD centers in Syria, between June 2021 and March 2022. All patients at least 18 years old on maintenance HD were enrolled. The threshold of phosphorus (phos) level was divided by the upper normal range among HD patients (5.5 mg/dl). We used parametric and nonparametric statistics, the Pearson and Spearman correlations with simple and multiple linear regressions between study variables. Results: 36.9% of patients had a serum phos level of 5.5 or less (norm phos group), and 63.1% of patients had a serum phos level higher than 5.5 (high phos group). Also, 60.9% of patients had hemoglobin (Hb) less than 10 g/dl, and 40.4% of patients had Hb at least 10 g/dl. Age, type of HD access, phos binders (P-binders), parathyroid hormone (PTH), and calcium (Ca) showed significant effects on phos levels. Most patients were using arteriovenous fistula (AVF) (89.7%) as a HD access, and the meantime on HD was higher in the norm phos group compared to the high phos group. In a multivariate and univariate logistic regression analysis, hyperphosphatemia increased with increasing urea (Ur) and creatinine (Cr) levels, while the odds declined with increasing time on HD. Hb did not show a significant relation with phos by using several statistical methods. Discussion/Conclusion: A high prevalence of hyperphosphatemia and anemia was encountered among this sample of HD patients from Syria. There was no correlation between phos and Hb levels in contrast to previous conflicting studies, which mandates future studies to evaluate this correlation and further efforts to determine the range of phos that could have a benefit on anemia with respect to other comorbidities.

Antinuclear antibodies positive acute nonfulminant hepatitis A associated with acute renal failure and hives: a case report.

Acute hepatitis A (AHA) is a self-limited illness. While the prognosis for hepatitis A is generally good, complications with acute renal failure can have a negative impact. Presentation of case: A 60-year-old male was admitted due to fever and malaise for a week, accompanied by jaundice and reduced urine output over the past 3 days. The patient was exhausted with icteric skin and sclera, dark urine, bilateral pretibial grade II pitting edema, and a urinary output of nearly 1 l/day. Laboratory findings on admission showed acute liver injury and acute kidney injury with positive hepatitis A virus immunoglobulin M. Liver and kidney function tests were augmented gradually aligned with oliguria. Thereafter, the patient had an itchy rash on his back and abdomen. Screening for immune diseases came back negative except for positive antinuclear antibodies. The authors continued conservative management with dialysis, diuretics, and restricted hydration. After five hemodialysis sessions, urinary output improved and liver function tests were improved, however, kidney function tests were slowly improved. One month later, serum creatinine was reduced to 1.4 mg/dl, and 2 months later, it was 1.1 mg/dl. Conclusion: The authors experienced a rare case of nonfulminant AHA that resulted in severe acute renal failure and needed dialysis. Several hypotheses had been postulated for AHA-related nephropathy; however, hyperbilirubinemia-induced acute tubular necrosis was the most acceptable theory in the patient. Since AHA associated with antinuclear antibodies positive and hives rash could confuse the diagnosis, clinicians should consider extrahepatic manifestations associated with hepatitis A virus infection in such conditions after excluding immune disorders.

Delayed acyclovir therapy for disseminated varicella zoster in an adult kidney transplant recipient: a case report and literature review.

Kidney transplant recipients are at increasing risk for reactivation of varicella-zoster virus (VZV) infection. Presentation of case: A 31-year-old male was admitted with fever, chest pain, and dyspnea. Also, the complaints accompanied by generalized maculopapular, vesicular, hemorrhagic, itching, and painful rash with pustules and crusts on an erythematous base fill the entire body for the last 10 days. Chest computed tomography scan showed diffuse miliary and ground-glass opacities. The patient had a previous history of chickenpox infection in childhood, no recent contact with individuals suffering from VZV infection, and no known pretransplant serology for VZV. Due to the high clinical suspicion of reactivated VZV with pneumonitis and severe disseminated form, we started the treatment with intravenous acyclovir (ACV) for 10 days followed by oral ACV for a total of 21 days, along with stopping mycophenolate mofetil and increasing the prednisolone dose to 10 mg/d. The clinical status was improved and the rash receded with a flaked surface for old lesions. Conclusion: We experienced a successful ACV treatment for delayed and severe VZV infection with a literature review of VZV pneumonitis among kidney transplant recipients. To the best of our knowledge, this is the first case that presented a disseminated skin form with pneumonitis of VZV from Syria. This case supports the initiation of antiviral therapy for transplant patients even after 72 hours the onset of the rash despite the lack of evidence in these circumstances.