Determinants of outcomes in chronic pediatric peritoneal dialysis: a single center experience.

BACKGROUND: In situations where it may take a long time to perform renal transplantation peritoneal dialysis may become a long-term maintenance treatment, especially in countries with low donor rates. Therefore, we aimed to evaluate peritonitis, catheter revision and survival rates in children on chronic peritoneal dialysis (CPD); and to define related factors in a single tertiary center from a WHO upper middle income country. METHODS: Between January 1998 and September 2018, data of pediatric patients receiving CPD with a followup longer than 3 months were retrospectively analyzed. Demographic, clinical and catheter-related data were collected. Patients were grouped as being operated before/after 2009 in order to evaluate the effects of 2 different periods on outcomes. RESULTS: A total of 229 catheters in 132 patients were included in the study. The female to male ratio was 60/72. The mean age at the time of dialysis was 8.9 ± 5.5 years. The median follow-up period was 22.5 months (IQR 8.25-50; range 3-139). Peritonitis incidence in 1998-2008 and 2009-2018 periods was 0.13 episodes/patient-year and 0.09 episodes/ patient-year, respectively. The overall revision rate was 1 per 46.7 patient-months. Peritonitis history was the only independent risk factor for access revision (p=0.003). Peritoneal dialysis failure was observed in 25% (33/132) of patients. The need for catheter revision due to any cause, the presence of peritonitis, history of HD and infancy were independent risk factors for PD failure. The overall mortality rate was 15.2%(20/132). Having a history of temporary PD catheter placement and being infant were independent risk factors for mortality. CONCLUSIONS: Access revision is still an important complication leading to PD failure despite the development of surgical techniques. Peritonitis is the most important cause of access revision and PD failure.

Characteristics of Blastocystis hominis infection in a Turkish university hospital.

In order to determine characteristics of Blastocystis (B.) hominis infection; 770 individuals' stool specimens were examined both by simple and concentration techniques and stained with iodine solution and trichrome in the Parasitology Laboratory of Hacettepe University Faculty of Medicine, Turkey. Among the examined 770 specimens, B. hominis was detected in 94 (12.2%). B. hominis was the most common intestinal parasite among the study group. It was mostly detected with Dientamoeba fragilis. Among the groups the incidence of B. hominis in allergic patients was higher than controls. Among the immunosuppressed patients, B. hominis was detected significantly higher in patients who had solid tumours. Of the 48 individuals who had only B. hominis in their stool the most common symptom was abdominal pain. Concentration technique with trichrome stain was more sensitive than simple smear with lugol solution for the detection of B. hominis. Studies with more patients must be planed to understand the B. hominis infection in solid tumour patients and coexistence of B. hominis and D. fragilis.

A multicenter study of patients with adult-onset Still's disease compared with systemic juvenile idiopathic arthritis.

Adult-onset Still's disease (AOSD) has often been regarded as the adult spectrum of systemic juvenile idiopathic arthritis (sJIA). The present study aims to compare the clinical and laboratory features, the disease course and the response to treatment in patients having AOSD with those having sJIA. Retrospective review of all available data that were filled out by adult and paediatric rheumatologists from six centers using a standard data extraction form was performed. A total of 95 patients with AOSD and 25 patients with sJIA were recruited for the study. The frequency of fever, rash, myalgia, weight loss and sore throat was higher in patients with AOSD. The pattern of joint involvement differed slightly. Laboratory findings were similar in both groups, except that liver dysfunction and neutrophilia were more common among adults. A multiphasic pattern dominated the childhood cases, whereas the most frequent course was a chronic one in adults. Corticosteroids and methotrexate were the most commonly employed therapy; however, chloroquine was another popular therapy in the adult group. We showed a difference in the rate of clinical and laboratory features between patients with AOSD and those with sJIA. AOSD and sJIA may still be the same disease, and children may simply be reacting differently as the result of the first encounter of the putative antigens with the immune system.

Low serum apolipoprotein AI levels in amyloidosis related to familial Mediterranean fever.

Amyloidosis (A) related to familial Mediterranean fever (FMF) causes serious morbidity and mortality in children. Our study evaluates serum levels of apolipoprotein (Apo) AI, AII, B, and E and Apo AII/AI ratios as a non-invasive diagnostic tool for amyloidosis in children with FMF and FMF-A. Results were compared with those of patients with childhood nephrotic syndrome (NS) and healthy children (controls). Significantly lower serum levels of Apo AI (90.20+/-28.30 mg/dl) were documented in patients with FMF-A than in all other groups (FMF 126.89+/-51.07 mg/dl, NS 140.38+/-33.73 mg/dl, and controls 134.67+/-12.73 mg/dl) ( P<0.01). Diagnostic sensitivity, specificity, and predictive value for this test were 85%, 80%, and 85%, respectively. Apo AII/AI ratio results were essentially equal in all groups ( P>0.05). It is concluded that a decreased Apo AI serum level, but not Apo AII/AI ratio, is a useful, non-invasive test for the early diagnosis of FMF-A in children.