Initial Treatment of Dialysis Associated Peritonitis: A Controlled Trial of Vancomycin versus Cefazolin

1991 ◽  
Vol 11 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Michael J. Flanigan ◽  
Victoria s. Lim
Keyword(s):  
Peritoneal Dialysis ◽  
Hospital Admissions ◽  
Controlled Trial ◽  
Intraperitoneal Administration ◽  
Patient Treatment ◽  
Treatment Center ◽  
University Of Iowa ◽  
Chi Square ◽  
Home Dialysis ◽  
The University

Objective To determine if intraperitoneal administration of vancomycin (a slowly absorbed antibiotic) im proves the management of dialysis-associated peritonitis over that obtained by using cefazolin, an equally potent, rapidly absorbed antibiotic. Setting A university operated teaching hospital, with patient treatment initiated at home. Patients One hundred thirty-one patients trained to perform peritoneal dialysis (CAPD and CCPD) and followed at the University of Iowa Hospitals and Clinics Home Dialysis Treatment Center. Design Patients were prospectively allocated into groups adding either vancomycin 25 mgm/L, orcefazolin 50 mgm/L to their dialysate when signs or symptoms of peritonitis developed. Treatment results were analysed using chi-square testing. Findings Compared to cefazolin, initial peritonitis therapy with vancomycin improved the peritonitis resolution rate [67% vs 81 %; p=0.008], reduced the incidence of hospital admissions [68% vs 48%; p=0.001], and decreased the risk of superinfection [4% vs 0%; p=0.039]. Conclusion Vancomycin appeared to be superior to cefazolin in the treatment of peritoneal dialysis associated peritonitis.

Tidal Peritoneal Dialysis: Preliminary Experience

1992 ◽  
Vol 12 (3) ◽  
pp. 304-308 ◽  
Author(s):  
Michael J. Flanigan ◽  
Cynthia Doyle ◽  
Victoria S. Lim ◽  
Gary Ullrich
Keyword(s):  
Peritoneal Dialysis ◽  
Tertiary Care ◽  
Tidal Flow ◽  
Clinic Visit ◽  
Residual Volume ◽  
University Of Iowa ◽  
Home Dialysis ◽  
Dialysate Flow ◽  
Fill Volume ◽  
Tidal Peritoneal Dialysis

Objectives To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD). Design An open enrollment pilot study. Setting The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital. Patients Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time. Interventions Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD. Measurements Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement. Results Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 + 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/ kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription. Conclusion TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).

A Randomized, Multicenter, Open-Label Trial to Establish Therapeutic Equivalence between the Carex and Ultra Disconnect Systems in Patients on Continuous Ambulatory Peritoneal Dialysis

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 139-143 ◽  
Author(s):  
Loke-Meng Ong ◽  
Teck-Onn Lim ◽  
Lai-Seong Hooi ◽  
Zaki Morad ◽  
Poh-Choo Tan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Controlled Trial ◽  
Treatment Center ◽  
Ratio Test ◽  
Therapeutic Equivalence ◽  
Open Label ◽  
Significant Treatment ◽  
Technical Problems ◽  
Technique Failure

Objective In the present study, we undertook to establish therapeutic equivalence with respect to peritonitis and technique failure between the Carex disconnect system (B. Braun Carex, Mirandola, Italy) and the standard Ultra system (Baxter Healthcare, Tokyo, Japan) in patients on continuous ambulatory peritoneal dialysis (CAPD). Design This multicenter, parallel group, randomized controlled trial involved 363 prevalent CAPD patients from 8 centers. The primary endpoint was peritonitis rate; secondary endpoints were technique failure and technical problems encountered. The duration of the evaluation was 1 year. Results The risk of peritonitis on Carex varied between the centers. We found a significant treatment-center interaction effect (likelihood ratio test: p = 0.03). The incidence rate ratio (IRR) of peritonitis on Carex as compared with Ultra ranged from 0.4 to 7.2. In two centers, Carex was inferior to Ultra with regard to peritonitis; but, in five centers, the results were inconclusive. Equivalence was not demonstrated in any center. The overall rate of peritonitis in the Carex group was twice that in the Ultra group [IRR: 2.18; 95% confidence interval (CI): 1.51 to 3.14]. Technique failure and technical problems were more common with the Carex system. Technique failure rate at 1 year was 44% in the Carex group and 22% in the Ultra group. Conclusions Equivalence between the Carex disconnect system and the Ultra disconnect system could not be demonstrated. The risk of peritonitis on Carex varied significantly between centers.

Comparison of Vancomycin versus Cefazolin as Initial Therapy for Peritonitis in Peritoneal Dialysis Patients

2002 ◽  
Vol 22 (3) ◽  
pp. 339-344 ◽  
Author(s):  
Quresh Khairullah ◽  
Robert Provenzano ◽  
Jukaku Tayeb ◽  
Aijaz Ahmad ◽  
Radhakrishnan Balakrishnan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cell Count ◽  
Controlled Trial ◽  
Residual Renal Function ◽  
Initial Therapy ◽  
Patient Treatment ◽  
Gram Positive ◽  
Gram Negative Organisms ◽  
The Cost

The incidence of peritonitis ranges from 1 episode every 24 patient treatment months to 1 episode every 60 patient treatment months [Keane WF, et al. ISPD Guidelines/Recommendations. Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 update. Perit Dial Int 2000; 20:396–411.]. Gram-positive organisms account for over 80% of continuous ambulatory peritoneal dialysis (PD)-associated peritonitis. Recent fear of vancomycin-resistant enterococci (VRE) has prompted suggestions of limiting vancomycin use. Fifty-one episodes of peritonitis in 30 patients studied over 2 years were evaluated. Cloudiness of the PD fluid and/or abdominal pain were considered suggestive of peritonitis and were confirmed by cell count and culture. Baseline cell count, Gram stain, and cultures were obtained, with periodic follow-up. Patients were randomized to receive either vancomycin 1 g/L intraperitoneally (IP) as loading dose, repeated on day 5 or day 8, depending on residual renal function, for 2 weeks, or cefazolin 1 g in the first PD bag and continued with 125 mg/L every exchange for 2 or 3 weeks, depending on culture results. All patients also received gentamicin 40 mg IP every day until the culture results were available. A similar randomized trial comparing vancomycin and cefazolin in the past used a lower concentration of cefazolin 50 mg/L [Flanigan MJ, Lim VS. Initial treatment of dialysis associated peritonitis: a controlled trial of vancomycin versus cefazolin. Perit Dial Int 1991; 11:31–7.]. Peritoneal dialysate fluid cultures revealed 31 (60.7%) gram-positive organisms, 7 (13.7%) gram-negative organisms, and 2 (3.9%) cultured yeast; 11 (21.5%) cultures yielded no growth. The incidence of peritonitis at our center was 1 episode every 42 patient treatment months. No case of VRE was noted. There was no statistical difference in clinical response or relapse rate for the two protocols. It was the authors’ and nurses’ observation that patient compliance and satisfaction was better with vancomycin, and the cost per treatment was 23% less than cefazolin. Based on these data we believe vancomycin should still be considered for first-line treatment of PD-associated peritonitis.

scholarly journals A Ten-Year Trend of Cutaneous Leishmaniasis at University of Gondar Hospital, Northwest Ethiopia: 2009-2018

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ayalew Jejaw Zeleke ◽  
Adane Derso ◽  
Arega Yeshanew ◽  
Rezika Mohammed ◽  
Helina Fikre
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Age Groups ◽  
Disease Status ◽  
Epidemiological Studies ◽  
Northwest Ethiopia ◽  
Treatment Center ◽  
Chi Square ◽  
Long Time ◽  
Chi Square Test ◽  
The University

Background. Cutaneous leishmaniasis (CL), which is one form of leishmaniasis, may show variations over years across regions, and epidemiological studies are crucial to estimate the cases of the disease status over a long time. This study is aimed at determining the trend of CL among patients at the University of Gondar Leishmaniasis Research and Treatment Center, northwest Ethiopia between 2009 and 2018 years. Methods. A ten-year data were extracted retrospectively. We included all patients who were visiting the center for CL diagnosis during the last ten years. Giemsa-stained skin slit microscopy was used to diagnose the disease. A chi-square test was used to compare the proportions of patients infected across years, seasons, months, sex, and age groups. Result. During the 10 years, a total of 1079 samples were requested for the diagnosis of CL. The cumulative average annual prevalence was found to be 55.4% (598/1079). The highest and lowest proportions of CL cases were recorded in 2014 (69.5%) and 2018 (35.4%), respectively. However, the percentage of CL cases did not show any significant differences over the study period. The number of suspected patients was significantly increased over the years (being lowest in 2009 and highest in 2017). The proportion of CL cases showed a remarkable difference across months but not seasons. CL was the highest within 15-49 years of age and males. Conclusion. The prevalence of CL did not show any significant differences over the last ten years. However, a remarkable increase of CL suspected cases was observed across the years. The disease showed significant association with age, sex, and months, but not seasons.

The consolidation of microscopy technology into a university research support facility: Reflections on the 1980's and projections for the 1990's at the university of iowa

1993 ◽  
Vol 51 ◽  
pp. 476-477
Author(s):  
Kenneth C. Moore
Keyword(s):  
Laser Scanning ◽  
Freeze Fracture ◽  
Freeze Substitution ◽  
Research Support ◽  
University Of Iowa ◽  
Staff Members ◽  
The Past ◽  
Research Grade ◽  
The University ◽  
Support Facility

The University of Iowa Central Electron Microscopy Research Facility(CEMRF) was established in 1981 to support all faculty, staff and students needing this technology. Initially the CEMRF was operated with one TEM, one SEM, three staff members and supported about 30 projects a year. During the past twelve years, the facility has replaced all instrumentation pre-dating 1981, and now includes 2 TEM's, 2 SEM's, 2 EDS systems, cryo-transfer specimen holders for both TEM and SEM, 2 parafin microtomes, 4 ultamicrotomes including cryoultramicrotomy, a Laser Scanning Confocal microscope, a research grade light microscope, an Ion Mill, film and print processing equipment, a rapid cryo-freezer, freeze substitution apparatus, a freeze-fracture/etching system, vacuum evaporators, sputter coaters, a plasma asher, and is currently evaluating scanning probe microscopes for acquisition. The facility presently consists of 10 staff members and supports over 150 projects annually from 44 departments in 5 Colleges and 10 industrial laboratories. One of the unique strengths of the CEMRF is that both Biomedical and Physical scientists use the facility.

Five Decades of Research Experience in Speech Anatomy and Physiology

2016 ◽  
Vol 1 (5) ◽  
pp. 4-12
Author(s):  
David P. Kuehn
Keyword(s):  
Ohio State University ◽  
State University ◽  
Research Experience ◽  
University Of Iowa ◽  
University Of Illinois ◽  
Anatomy And Physiology ◽  
The Ohio State University ◽  
Speech Science ◽  
The University ◽  
East Carolina University

This report highlights some of the major developments in the area of speech anatomy and physiology drawing from the author's own research experience during his years at the University of Iowa and the University of Illinois. He has benefited greatly from mentors including Professors James Curtis, Kenneth Moll, and Hughlett Morris at the University of Iowa and Professor Paul Lauterbur at the University of Illinois. Many colleagues have contributed to the author's work, especially Professors Jerald Moon at the University of Iowa, Bradley Sutton at the University of Illinois, Jamie Perry at East Carolina University, and Youkyung Bae at the Ohio State University. The strength of these researchers and their students bodes well for future advances in knowledge in this important area of speech science.

Rheometers, Bioreactors, and Vocalization Forces: Using Basic Science Investigations to Help the Voices of Teachers

2008 ◽  
Vol 18 (3) ◽  
pp. 119-125
Author(s):  
Sarah Klemuk
Keyword(s):  
Basic Science ◽  
Tissue Growth ◽  
University Of Iowa ◽  
Support Cell ◽  
Rest Periods ◽  
Collaborative Studies ◽  
Professional Voice Users ◽  
The University ◽  
Science Investigations ◽  
Professional Voice

Abstract Collaborative studies at the University of Iowa and the National Center for Voice and Speech aim to help the voices of teachers. Investigators study how cells and tissues respond to vibration doses simulating typical vocalization patterns of teachers. A commercially manufactured instrument is uniquely modified to support cell and tissue growth, to subject tissues to vocalization-like forces, and to measure viscoelastic properties of tissues. Through this basic science approach, steps toward safety limits for vocalization and habilitating rest periods for professional voice users will be achieved.

The Kontakte Multimedia Project at The University of Iowa

2013 ◽  
Vol 17 (1) ◽  
pp. 25-42 ◽  
Author(s):  
James P. Pusack
Keyword(s):  
University Of Iowa ◽  
The University

Combining the Love of Art, Science, Business and Medicine to Innovate and Enhance Patient Health. Highlights from the 7th Annual Leaders in Medicine Symposium of the Cummings School of Medicine, Calgary, AB

2018 ◽  
pp. E51-E54
Author(s):  
Jennifer Beatty ◽  
Michael Peplowski ◽  
Noreen Singh ◽  
Craig Beers ◽  
Evan M Beck ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Clinical Care ◽  
Clinical Problem ◽  
Faculty Members ◽  
Guest Speaker ◽  
School Of Medicine ◽  
University Of Calgary ◽  
Patient Health ◽  
The University ◽  
Care Costs

The Leader in Medicine (LIM) Program of the Cumming School of Medicine, University of Calgary, hosted its 7th Annual LIM Research Symposium on October 30, 2015 and participation grew once again, with a total of six oral and 99 posters presentations! Over 45 of our Faculty members also participated in the symposium. This year’s LIM Symposium theme was “Innovations in Medicine” and the invited guest speaker was our own Dr. Breanne Everett (MD/MBA). She completed her residency in plastic surgery at University of Calgary and holds both a medical degree and an MBA from the University of Calgary. In her inspiring talk, entitled “Marrying Business and Medicine: Toe-ing a Fine Line”, she described how she dealt with a clinical problem (diabetic foot ulcers), came up with an innovation that optimized patient care, started her own company and delivered her product to market to enhance the health of the community. She clearly illustrated how to complete the full circle, from identifying a clinical problem to developing and providing a solution that both enhances clinical care and patient health as well as reduces health care costs and hospital admissions. The research symposium was an outstanding success and the abstracts are included in companion article in CIM.

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