Hemodialysis Experience of a Large Group of Syrian Refugees in Turkey: All Patients Deserve Effective Treatment

Background/Aims: Refugee dialysis is a worldwide growing dilemma with limited experience. This report presents the largest hemodialysis (HD) patient registry data of Syrian refugees in Turkey. Methods: Demographic, clinical, laboratory, and dialysis practice data of 345 Syrian HD patients during one year were collected and analyzed. Results: There were 345 prevalent Syrian HD patients at the end of 2016. Majority of the patients were placed in the Southeast Anatolian Region. The majority of the patients (74.8%) are in the age range of 20-64 years. Dialysis vintage in Turkey is less than 12 months in 20.8% and less than one month in 29.3% of patients. The vascular access was arteriovenous fistula in the majority of patients (72.5%). Kt/V is over 1.7 in 57%, serum albumin is above 35 g/L in 65.8% and hemoglobin level is more than 100 g/L in %65.2 of the patients. The ratio of patients with serum phosphorus level of 1.13-1.77 mmol/L was 56.2%. Twenty Syrian HD patients (14 male, 6 female) died within the year 2016 and annual mortality rate was 5.7%. Conclusion: This study with the largest number of Syrian refugees undergoing maintenance hemodialysis showed good dialysis practices, acceptable values for dialysis adequacy and biochemical parameters along with lower mortality compared to native HD population of Turkey. Longer follow up will enrich the knowledge related to care of refugee population in all over the world.

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Longitudinal Motor Functional Outcomes and Magnetic Resonance Imaging Patterns of Muscle Involvement in Upper Limbs in Duchenne Muscular Dystrophy

Medicina ◽

10.3390/medicina57111267 ◽

2021 ◽

Vol 57 (11) ◽

pp. 1267

Author(s):

Claudia Brogna ◽

Lara Cristiano ◽

Tommaso Verdolotti ◽

Giulia Norcia ◽

Luana Ficociello ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Duchenne Muscular Dystrophy ◽

Magnetic Resonance ◽

Muscular Dystrophy ◽

Resonance Imaging ◽

Muscle Mri ◽

Functional Changes ◽

One Year ◽

Age Range

Background and Objectives: The aim of this study was to evaluate longitudinal changes using both upper limb muscle Magnetic Resonance Imaging (MRI) at shoulder, arm and forearm levels and Performance of upper limb (PUL) in ambulant and non-ambulant Duchenne Muscular Dystrophy (DMD) patients. We also wished to define whether baseline muscle MRI could help to predict functional changes after one year. Materials and Methods: Twenty-seven patients had both baseline and 12month muscle MRI and PUL assessments one year later. Results: Ten were ambulant (age range 5–16 years), and 17 non ambulant (age range 10–30 years). Increased abnormalities equal or more than 1.5 point on muscle MRI at follow up were found on all domains: at shoulder level 12/27 patients (44%), at arm level 4/27 (15%) and at forearm level 6/27 (22%). Lower follow up PUL score were found in 8/27 patients (30%) at shoulder level, in 9/27 patients (33%) at mid-level whereas no functional changes were found at distal level. There was no constant association between baseline MRI scores and follow up PUL scores at arm and forearm levels but at shoulder level patients with moderate impairment on the baseline MRI scores between 16 and 34 had the highest risk of decreased function on PUL over a year. Conclusions: Our results confirmed that the integrated use of functional scales and imaging can help to monitor functional and MRI changes over time.

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Non-Surgical Crigler massage for treatment of congenital nasolacrimal duct obstruction in infants below one year age.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.06.6216 ◽

2021 ◽

Vol 28 (06) ◽

pp. 804-807

Author(s):

Mohammad Alam

Keyword(s):

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Medical Sciences ◽

Congenital Nasolacrimal Duct Obstruction ◽

Duct Obstruction ◽

Topical Antibiotics ◽

One Year ◽

Medical University ◽

Age Range

Objective: To analyse the efficacy of non-surgical Crigler massage for treatment of congenital nasolacrimal duct obstruction in infants below one year age. Study Design: Setting: Khyber Medical University Institute of Medical Sciences (KMU-IMS) KDA Teaching Hospital Kohat. Period: April 2014 to June 2019. Materials & Methods: on Non-Surgical Crigler massage for conservative treatment of congenital nasolacrimal duct obstruction in infants below one year age. Proper proforma was designed for documentation of patients and their follow up. Consents were taken from their parents. 93 patients with age range of 2-6 months with congenital nasolacrimal duct obstruction were included in the study out of which 51(54.83%) were male and 42(45.16%) were female. 79(84.94%) patients had unilateral while 14(15.05%) patients had bilateral congenital nasolacrimal duct obstruction. So total 107 eyes with congenital nasolacrimal duct obstruction were included. Parents were trained and educated for conservative non-surgical Crigler massage of the lacrimal sacs along with topical antibiotics. Parents were instructed to do 8-10 massage four times a day. Patients were followed up to one year of age. 11 patients were lost from complete follow up in which 9 had unilateral while 2 patients had bilateral congenital nasolacrimal duct obstruction. Cumulatively 13 eyes were missed from follow up. Final results of remaining 82 patients with 94 eyes were analysed. Results: Out of 94 eyes epiphora was abolished with negative regurgitation test in 68(72.34%) patients at the end of one year while in 26(27.65%) the procedure was failed. Conclusion: Non-surgical conservative Crigler massage is very successful in management of congenital nasolacrimal duct obstruction.

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An Ex-Press implant versus trabeculectomy in a fibrotic bleb with late failure after previous trabeculectomy

International Journal of Ophthalmology ◽

10.18240/ijo.2021.03.08 ◽

2021 ◽

Vol 14 (3) ◽

pp. 383-387

Author(s):

Faried Wagdy ◽

◽

Hisham Elsorogy ◽

Ahmed Alnagdy ◽

Dina Abd Elfattah ◽

...

Keyword(s):

Postoperative Complications ◽

Open Angle Glaucoma ◽

Implant Surgery ◽

Late Failure ◽

Group I ◽

The Mean ◽

The Difference ◽

One Year ◽

Age Range

AIM: To compare the outcome of an Ex-Press implant and subscleral trabeculectomy (SST) in the management of glaucoma after previous trabeculectomy on a fibrotic bleb. METHODS: This randomized prospective study included 28 eyes from 28 patients (age range: 42-55y) with primary open angle glaucoma (POAG) presented with elevated intraocular pressure (IOP) with fibrotic bleb despite previous SST for more than 4mo. The eyes enrolled in the study were divided into two groups: group I (subjected to Ex-Press implant surgery) and group II [subjected to SST with mitomycin C (MMC)]. The follow-up continued one year after surgery to evaluate IOP, visual acuity (VA), visual field (VF), and postoperative complications. RESULTS: A significant decrease in IOP was found in both groups with a higher reduction in Ex-Press implant surgery with the mean IOP of 14.50 mm Hg (P=0.001), while the SST group recorded the mean IOP of 16.50 mm Hg (P=0.001) after one year. However, the difference between the two groups in terms of the decrease in IOP was insignificant. Fewer postoperative complications were recorded in the Ex-Press implant surgery and more cases requiring further anti-glaucomatous medications were seen in the SST group. Both groups showed stability in terms of VA and VF. CONCLUSION: Ex-Press implant surgery and SST with MMC are two surgical alternatives for controlling IOP in late failure that occurs more than 4mo after previous SST with a fibrotic bleb. However, Ex-Press shunt is a safer surgery with fewer complications.

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Changes in measures of cognitive function in patients with end-stage kidney disease on dialysis and the effect of dialysis vintage: A longitudinal cohort study

PLoS ONE ◽

10.1371/journal.pone.0252237 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252237

Author(s):

Karumathil M. Murali ◽

Judy Mullan ◽

Steven Roodenrys ◽

Hicham I. Cheikh Hassan ◽

Maureen Lonergan

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Kidney Disease ◽

Analysis Of Covariance ◽

End Stage Kidney Disease ◽

Change Scores ◽

Dialysis Vintage ◽

One Year ◽

End Stage

Introduction Prevalence of cognitive impairment increases with worsening severity of chronic kidney disease (CKD) and majority of end-stage kidney disease (ESKD) patients on dialysis have cognitive impairment. Trends of cognitive function (CF) in this population are less well known with published studies reporting conflicting results. Methods We assessed CF in a cohort of non-dialysis CKD and ESKD patients undergoing dialysis using modified mini-mental state examination (3MS), trail-making test (TMT-A & B) scores and Stroop task, and evaluated demographics, comorbidities and depression using Beck depression inventory at baseline. We repeated tests of CF and depression ≥ 1-year after baseline in both groups and compared change scores in CF and depression between ESKD/ CKD sub-groups. Among ESKD patients we compared change scores between patients with dialysis vintage of <1-year and >1-year. Analysis of covariance was used to adjust for the effect of age on these change scores. Results At baseline (N = 211), compared to CKD (N = 108), ESKD (N = 103) patients had significantly worse CF based on 3MS and TMT-A & B scores, and depression scores. On follow-up (N = 160) 3MS scores, especially the memory subscale significantly improved in ESKD, but worsened in CKD, with no significant changes in TMT A /TMT-B, or depression scores after adjusting for age. Among ESKD patients, 3MS, especially memory subscale improved in patients with dialysis vintage <1-year compared to >1-year. The 51 patients who discontinued after baseline assessment had worse baseline CF scores suggesting differential attrition. Conclusion Though baseline cognitive scores were worse in ESKD patients on dialysis, compared to CKD, their 3MS, especially memory subscale improved on follow-up. Among ESKD patients, the improvement was significant only in patients who have been on dialysis for less than one-year which may indicate a beneficial effect of clearance of uraemic toxins. Differential attrition of study subjects may have impacted the observed results.

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Active Smoking is Associated with Lower Dialysis Adequacy in Prevalent Dialysis Patients

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.851 ◽

2019 ◽

Vol 7 (21) ◽

pp. 3615-3618

Author(s):

Lada Trajceska ◽

Gjulsen Selim ◽

Marija Zdraveska ◽

Deska Dimitrievska ◽

Daniela Mladenovska ◽

...

Keyword(s):

Clinical Laboratory ◽

Smoking Status ◽

Reduction Rate ◽

Cross Sectional Study ◽

Dialysis Session ◽

Active Smoking ◽

Dialysis Patients ◽

Dialysis Adequacy ◽

Cross Sectional ◽

Dialysis Vintage

BACKGROUND: Dialysis adequacy measured by single pool Kt/V (spKt/V) lower than 1.2 or urea reduction rate (URR) lower than 65% is associated with a significant increase in patient mortality rate. Patients’ adherence to the medical treatment is crucial to achieve recommended targets for spKt/V. Smoking is a recognized factor of non-adherence. AIM: In this study we sought to assess the association of active smoking and dialysis adequacy. METHODS: A total of 134 prevalent dialysis patients from one dialysis center were included in an observational cross-sectional study. Clinical, laboratory and dialysis data were obtained from medical charts in previous 6 months. The number of missed, on purpose interrupted or prematurely terminated dialysis sessions was obtained. Dialysis adequacy was calculated as spKt/V and URR. Patients were questioned about current active smoking status. T-test and Chi-Square test were used for comparative analysis of dialysis adequacy with regard to smoking status. RESULTS: The majority of patients declared a non-smoking status (100 (75%)) and 34 (25%) were active smokers. Male gender, younger age and shorter dialysis vintage were significantly more often present in the active smokers ((9 (26%) vs 25 (73%), p = 0.028; 57.26 ± 12.59 vs 50.15 ± 14.10, p = 0.012; 118.59 ± 76.25 vs 88.82 ± 57.63, p = 0.030)), respectively. spKt/V and URR were significantly lower and Kt/V target was less frequently achieved in smokers ((1.46 ± 0.19 vs. 1.30 ± 0.021, p = 0.019; 67.14 ± 5.86 vs. 63.64 ± 8.30, p = 0.002; 14 (14%) vs. 11 (32%), p = 0.023), respectively. Shorter dialysis sessions, larger ultra filtrations and higher percentage of missed/interrupted dialysis session on patients’ demand were observed in smokers (4.15 ± 0.30 vs. 4.05 ± 0.17, p = 0.019; 3.10 ± 0.78 vs. 3.54 ± 0.92, p = 0.017; 25 (0.3%) vs. 48 (1.8%), p = 0.031), respectively. CONCLUSION: Active smokers, especially younger men, achieve lower than the recommended levels for dialysis adequacy. Non-adherence to treatment prescription in smokers is a problem to be solved. Novel studies are recommended in patients on dialysis, to further elucidate the association of dialysis adequacy with the active smoking status.

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Possibilities of applying the method of radiofrequency (RF)thermal destruction to correct spasticity in childrenwith cerebral palsy

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors3146-49 ◽

2015 ◽

Vol 3 (1) ◽

pp. 46-49

Author(s):

Alexey Vasilievich Zvozil ◽

Valery Vladimirovich Umnov ◽

Vladimir Aleksandrovich Novikov ◽

Dmitry Valerievi Umnov

Keyword(s):

Cerebral Palsy ◽

Gastrocnemius Muscle ◽

Thermal Destruction ◽

Statistical Processing ◽

Children With Cerebral Palsy ◽

Flexor Muscles ◽

Muscles Of The Hand ◽

One Year ◽

Age Range

For the treatment of focal spasticity in the TurnerInstitute we developed and applied the approach toreduce spasticity in children with cerebral palsy byapplying the method of radiofrequency thermal de-struction of peripheral nerves and muscle motorpoints. This method is based on the effect of heatrelease during the passage through biological tissueof radiofrequency currents. The procedure was totally performed in 112 patients aged 1,2 to 14 yearsold with a level of spasticity over 3 points on a scaleAshworth. In order to reduce hypertonia of femuradductors, the target for RF ablation was obturatornerve; we targeted on the motor point of the gastrocnemius muscle in equinus, to reduce forearm flexorhypertonia we targeted on the musculo-cutaneousnerve, flexor muscles of the hand we intervened on their motor points. A positive result was maintained at follow-up of 6 months to one year in all patients, maximum - 2 years. The obtained results are preliminary and subject to further statistical processing, but they are quite comparable with the results of the use of type A botulinum toxin preparations. The proposed method of treatment is minimally invasive, virtually devoid of the risk of postoperative complications, can cut one stage spasticity in the muscles of various motor segments in children with cerebral palsy of great age range, including children up to 2 years old.

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P1116IS DIALYSIS ADEQUACY AMELIORATED AFTER INCREASING DIALYSATE FLOW RATE IN CHRONIC HEMODIALYSIS? - ONE YEAR FOLLOW-UP

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1116 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Aggeliki Barbatsi ◽

Eugenia Karakou ◽

Theodoros Chiras ◽

Jacob Skarakis ◽

Nikolaos Trakas ◽

...

Keyword(s):

Flow Rate ◽

Reduction Rate ◽

Flow Distribution ◽

Chronic Hemodialysis ◽

Serum Urea ◽

Dialysis Adequacy ◽

Dialysate Flow ◽

Dialysate Flow Rate ◽

One Year

Abstract Background and Aims Hemodialysis (HD) adequacy, as measured by single pool (sp) Kt/V and urea reduction rate (URR), has been reported to be ameliorated after increasing dialysate flow rate (DFR). However, this is a matter of controversy as no benefit has been observed with dialyzers incorporating features to enhance dialysate flow distribution. We investigated the effect of increasing DFR on dialysis adequacy and on various laboratory parameters. Method Twenty-three patients, M/F=20/3, aged 65(44-89) years, dialyzed thrice weekly for 50(6-274) months, using polysulfone low flux dialyzers, participated in an annual randomized cross-over study. Patients were dialyzed with DFR of 500 ml/min and 700 ml/min for 6 consecutive months respectively, according to their usual dialysis prescription and with ultrafiltration volumes according to clinical need. Blood was sampled before and at the end of midweek sessions at the beginning of the first, 7th and 13rd month for urea, creatinine, potassium, sodium, albumin, total Ca and phosphate (sP). URR, spKt/V, corrected for albumin Ca(sCa) and sCa x sP product (CaxP) values were calculated. Results Under both 500 and 700 ml/min DFRs used, the expected post-dialysis alterations were found: decreased values in serum urea (respectively 161,5±38,0 to 49,9±20.1-p<0,001 and 140,3±30 to 56,0±20.4 mg/dl-p<0,001), creatinine (respectively 10,2±2 to 3.9±1,2-p<0,001 and 10,2±3,3 to 4,1±1,6 mg/dl-p<0,001), potassium (respectively 5,2±0,7 to 3,7±0,3 mM-p<0,001 and 5,3±0,6 to 3,9±0,3mM-p<0,001) and phosphate (respectively 5,4±1,7 to 2,9±0,6-p<0,001 and 5,7±1,6 to 2,6±0,6 mg/dl-p<0,001); increased values in serum albumin (respectively 4,3±0,4 to 4,7±0,4 g/dl-p=0,001 and 4,2±0,3 to 4,7±0,4 g/dl-p<0,001) and sCa (9,1±0,7 to 11,3±0,9 mg/dl-p<0,001 and 8,7±0,6 to 9,9±0,7 mg/dl-p<0,001). After increasing DFR from 500 to 700 ml/min we observed no reductions in pre-dialysis serum urea and creatinine levels or URR (68,6±8,1% to 69,9±7,9%-p=NS) and Kt/V (1,41±0,4 to 1,42±0,3-p=NS) values. However, under DFR of 700ml/min post-dialysis sCa, sP and sCa x sP product values were always lower compared with those under DFR of 500 ml/min (respectively 9,9±0.7 vs 10,8±0.8 mg/dl-p<0,001, 2,6±0,6 vs 2,9±0,6 mg/dl-p=0,02 and 25,6±6,2 vs 30,9±6,7 mg2/dl2-p<0,001). Conclusion DFR increase from 500 to 700 ml/min did not lead to favorable effects on dialysis adequacy but resulted in post-dialysis amelioration of serum calcium and phosphate levels and may be useful in cases of hypercalcemia, hyperphosphatemia and calcifications. DFR increase utility needs further investigation in patients with disorders of calcium-phosphate metabolism.

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Survivorship among the Aged Blind

Journal of Visual Impairment & Blindness ◽

10.1177/0145482x6505901001 ◽

1965 ◽

Vol 59 (10) ◽

pp. 333-338

Author(s):

Eugene Rogot

Keyword(s):

General Population ◽

Life Expectancy ◽

Causes Of Death ◽

Excess Mortality ◽

Follow Up Study ◽

One Year ◽

Blind Persons ◽

Age Range

A follow-up study of 11,732 persons first registered as legally blind in Massachusetts during the twenty-year period, 1940-1959, was conducted in order to determine survivorship patterns and causes of death among the blind. This paper reports findings for 5,976 blind persons who were sixty-five years of age or older at the time of registration. Life-expectancy values calculated for single years of age from sixty-five to ninety showed that blind males had lower values than the general population over most of this age range; differences in life-expectancy were roughly two years for ages sixty-five to seventy-two, about one year for ages seventy-three to seventy-nine, and essentially no difference for ages eighty to ninety. The pattern for females was very similar to that for males. The largest differences according to major causes of blindness were for diabetes with blind males age sixty-five and over having an observed life-expectancy almost four years less than expected, and blind females age sixty-five and over having a life-expectancy 4.8 years less than expected. For blind males as well as for blind females age sixty-five and over, excess mortality due to diabetes was particularly noted.

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Pediatric Ulcerative Colitis in Kazakhstan: First Case Series from Central Asia and Current Clinical Management

Gastroenterology Insights ◽

10.3390/gastroent11020006 ◽

2020 ◽

Vol 11 (2) ◽

pp. 27-35

Author(s):

Dimitri Poddighe ◽

Aigerim Telman ◽

Ernas Tuleutayev ◽

Aigul Ibrayeva

Keyword(s):

Ulcerative Colitis ◽

Central Asia ◽

Clinical Studies ◽

Clinical Management ◽

Pediatric Patients ◽

Clinical Laboratory ◽

Case Series ◽

Developed Countries ◽

One Year

The diagnoses of ulcerative colitis have increased in pediatric patients in the last two decades. Whereas there are several reports from most areas of the world, no clinical studies describing the clinical management of pediatric ulcerative colitis are currently available from Central Asia. In this article, we first describe a case series of pediatric patients affected with ulcerative colitis in Kazakhstan. This is a retrospective study including 25 consecutive pediatric patients diagnosed with ulcerative colitis in a tertiary pediatric hospital. The available demographic, clinical, hematological and inflammatory parameters at diagnosis and at the first one-year follow-up have been provided and analyzed. Most pediatric patients diagnosed with ulcerative colitis were older than 12 years, with prevalence of male gender. The analysis of clinical, laboratory, endoscopic parameters at the diagnosis suggested a significant diagnostic delay compared to developed countries; however, most of them showed clinical, laboratory and endoscopic improvements at the one-year follow-up. Even though the therapeutic approach and outcomes resulted to be consistent with other clinical studies from developed countries, several aspects of the medical follow-up should be improved, especially in pediatric patients with extensive disease.

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Tuberculous meningitis in adult patients of a Mexican neurological referral center: A-six-year retrospective cohort study

10.1101/2020.12.02.20242420 ◽

2020 ◽

Author(s):

Maldonado-Diaz Ellis Daniela ◽

Soto-Hernández José Luis ◽

Salinas-Lara Citlaltepetl ◽

Kammar-Garcia Ashuin ◽

Cárdenas Graciela

Keyword(s):

Cohort Study ◽

Tuberculous Meningitis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Laboratory ◽

Hiv Positive ◽

Important Concern ◽

Lowenstein Jensen ◽

One Year

AbstractIntroductionTuberculosis (TB) remains as an important concern of public health worldwide because the high prevalence and severe sequelae. Tuberculous meningitis (TBM) is the most lethal and disabling form.AimTo describe the clinical, laboratory, and neuroimaging characteristics of TBM on admission at neurological center in Mexico City.MethodsRetrospective cohort study at the third level neurological center from 2010 to 2016. Clinical follow-up was evaluated at hospital discharge, three months, and one-year either due to lack of follow-up or mortality, during the follow-up the adverse events were registered.ResultsOne-hundred and six patients were included, 74 (69.8%) males and 32 (30.2%) females. From these 31 (29.2%) were HIV-positive. The median age was 35.5 (IQR:28-51). Pulmonary TB was found in 25% of the population. Alcoholism was observed in a half of the patients while diabetes in 15%, the latter being significant (p=0.04). Abnormalities in neuroimaging were significant among our population (p=0.003). Only one-third of the population had a positive Lowenstein-Jensen culture. There were no differences in clinical outcomes between HIV positive and non-HIV patients.ConclusionOur study shows data to those described in the literature. The initiation of empirical treatment in all patients with a high clinical suspicion of tuberculosis mandatory to try to avoid severe neurological sequels.

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