Silent infection in clotted hemodialysis access grafts.

Thrombotic and infectious complications are frequent causes of hemodialysis vascular access failure and contribute considerably to the cost of care for chronic hemodialysis patients. Although there is clear indication for removal of patent grafts in unresolved bacteremia, there are no guidelines for the management of clotted nonfunctioning grafts. To evaluate for the existence and clinical relevance of silent infection in clotted nonfunctioning hemodialysis grafts, a study was conducted with a series of 20 hemodialysis patients who presented with fever (15 patients), or fever and clinical signs of sepsis (five patients), in whom the source of infection was not immediately localized to any organ system. Comparison was made with 21 asymptomatic patients with clotted grafts who served as control subjects. All patients and control subjects came from a pool of 115 chronic hemodialysis patients in an outpatient hemodialysis unit in the Houston metropolitan area, who were on hemodialysis for a period of time ranging from 3 to 15 yr. Indium scans were performed, followed by removal of the clotted grafts in all patients and control subjects. Bacterial cultures of the recovered surgical material and blood were done concomitantly in all study participants. Indium scans showed positive uptake in or around the clotted grafts in all of the patients and in 15 of the control subjects. Purulent material was found in the grafts in all patients and in 13 of 15 indium scan-positive control subjects. When positive, blood culture pathogens were identical to those cultured from the graft material in all instances. The predominant pathogens were Staphylococcus aureus, followed by Staphylococcus epidermidis. There was no evidence of graft infection in the control subjects if indium scan was negative. Chart review dating back to the start of dialysis revealed five past infectious episodes in the patient group, compared with four in the control group. These findings suggest that clotted nonfunctioning grafts are frequent harbingers of infection. They should be suspected as the source of infection in every hemodialysis patient that presents with fever, even in the absence of clinical signs of graft site infection.

Download Full-text

Cold spray for reducing venopuncture pain in hemodialysis patients; a randomized double-blinded controlled trial

Journal of Nephropharmacology ◽

10.15171/npj.2020.01 ◽

2019 ◽

Vol 9 (1) ◽

pp. e01-e01

Author(s):

Zahra Shafii ◽

Neshiman Abdi Bastami ◽

Amir Ahmad Nasiri

Keyword(s):

Cold Spray ◽

Controlled Trial ◽

Intervention Group ◽

Needle Insertion ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Pain Severity ◽

Control Group ◽

Double Blinded ◽

And Control

Introduction: The pain due to cannulation and needle insertion into blood vessels becomes problematic among patients suffering hemodialysis. Objectives: The present study aimed to assess the pain relieving effects of cooling sprays among patients undergoing hemodialysis. Patients and Methods: Eighty patients aged higher than 18 years who were on chronic hemodialysis were randomly assigned into two groups including the group received cooling spray for relieving pain (n = 40) and the group received stilled water as placebo (n = 40). In the intervention group and in a hemodialysis session, 2 puffs of the Cramer Cold Spray were sprayed 30 seconds before the cannulation. The pain severity was assessed by the visual analogue scale (VAS) method. Results: The mean of pain severity score was not different between the intervention and control group before intervention, however after intervention, the patients in the intervention group experienced milder pain due to cannulation as compared to control group (3.28 ± 1.13 versus 5.30 ± 1.76; P < 0.001). Interviewing with the patients receiving cooling spray showed willingness to the use of spray in 87.5% of cases. The local complication due to the use of cold spray was revealed only in 5% of patients. Conclusion: The use of cooling spray in hemodialysis patients can reduce the pain caused by needle insertion. This method can be routinely used as a non-pharmacological pain relief method to reduce pain in hemodialysis patients

Download Full-text

α1-Acid glycoprotein and seminal parameter in chronic hemodialysis patients

Urologia Journal ◽

10.1177/0391560319899842 ◽

2020 ◽

pp. 039156031989984

Author(s):

Gilmar Pereira Silva ◽

Vitor Pereira Xavier Grangeiro ◽

Carmelita Félix Dantas de Oliveira ◽

Francisco Lima Neto ◽

Daniel Holanda Barroso

Keyword(s):

Seminal Plasma ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Control Group ◽

Human Seminal Plasma ◽

Hormonal Profile ◽

Acid Glycoprotein ◽

Seminal Parameter ◽

The University ◽

And Control

Introduction: To find out the changes in seminal quality of hemodialysis chronic renal patients, we investigated the possible relationship between seminal parameter and seminal α1-acid glycoprotein levels in chronic hemodialysis patients. Methods: Prospective study of prevalence realized in the Hemodialysis Sector of the University Hospital of the University of Brasília, between July 2016 and December 2016. Men aged 18–60 years grouped into case groups (n = 81) represented by chronic hemodialysis patients and control group (n = 20) of healthy men without clinical or laboratory signs of infection and eugonadic. We performed a spermogram, hormonal profile, and assessment of leukocytes and seminal α1-acid glycoprotein level in the semen. The most appropriate statistical test was applied to verify differences and correlations between the studied variables. Results: The age in case and control is similar (49.47 ± 5.55 years vs 50.53 ± 4.24 years; p = 0.060). Mean level of α1-acid glycoprotein in human seminal plasma were not significantly different between case and control (48.52 ± 4.90 mg/L vs 46.33 ± 4.29 mg/L; p = 0.10) and between normosperm and oligosperm (47.76 ± 5.15 mg/L vs 49.48 ± 4.49 mg/L; p = 0.19). Mean level of α1-acid glycoprotein in human seminal plasma in the case group, which were classified into severe, moderate, mild, and normosperm, were similar to each other (p = 0.27) and did not correlate (p > 0.05) with the analyzed seminal parameters. All participants presented normal hormonal profile. Conclusion: Results of this study suggest that the seminal α1-acid glycoprotein levels do not help in the initial evaluation of patients with seminal parameter changes.

Download Full-text

Ultrafiltration (UF) Effectiveness on intradialytic hypertension (IDH) in chronic hemodialysed patients in a nephrology unit in Dakar: UF-IDH clinical trial

Global Journal of Urology and Nephrology ◽

10.28933/gjun-2020-05-1405 ◽

2021 ◽

pp. 25

Author(s):

Keyword(s):

Clinical Trial ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Control Group ◽

Cross Sectional ◽

Before And After ◽

Group A ◽

Group B ◽

And Control ◽

Interventional Group

Introduction Progressive ultrafiltration (UF) could improve IDH. The aim of this work was to evaluate the effectiveness of progressive UF in the management of IDH. Methods This randomized clinical trial in two groups: interventional group A (UF, n = 12) and control group B (n = 12), was conducted in chronic hemodialysis patients with IDH. A first phase of cross-sectional collection of BP before and after dialysis, during 2 weeks, made it possible to obtain this cohort of 24 patients. A progressive decrease in basal weight of 0.25 kg per session as a function of hemodynamic tolerance was achieved in group A. The primary endpoint, the proportion of patients with disappearance of IDH, was assessed at baseline end of the 4th and 8th week. Results At the 4th week, the IDH disappeared in 83.3% and 41.7% of the patients of the group A and B respectively with a hazard ratio (HR) at 0.29; IC 95 = [0.14-0.59]; p = 0.035. At the 8th week, the IDH was missing in 72.7% and 66.7% of the patients of the group A and B respectively with a HR at 0.76; IC 95 = [0.58-1.00]; p = 0.75. In addition, the decrease in basal weight was associated with the occurrence of side effects (p = 0.0001) with a HR of 5 [1.45-7.27]. UF discontinuation was required in 4 patients in group A (36.4%). Conclusion Progressive UF was associated with a significant reduction in the prevalence of IDH in our patients at week 4.

Download Full-text

Safety and efficacy of low-dose subcutaneous erythropoietin in hemodialysis patients.

Journal of the American Society of Nephrology ◽

10.1681/asn.v82288 ◽

1997 ◽

Vol 8 (2) ◽

pp. 288-293

Author(s):

K P Parker ◽

W E Mitch ◽

J C Stivelman ◽

E J Macon ◽

J L Bailey ◽

...

Keyword(s):

Low Dose ◽

Ferritin Level ◽

Transferrin Saturation ◽

Hemodialysis Patients ◽

Control Group ◽

Dialysis Session ◽

Phase 2 ◽

Safety And Efficacy ◽

Control Subjects ◽

And Control

Anemia in hemodialysis patients is effectively treated by intravenous (IV) injections of recombinant human erythropoietin (rHuEPO) at each dialysis session. Because the hormone is effective by subcutaneous (SC) administration, it was decided that this study would evaluate low-dose weekly SC rHuEPO therapy. To determine the safety and efficacy of weekly SC rHuEPO administration to hemodialysis patients, only one third the weekly IV dose was given and the effects were compared with those from an age-, gender-, and nephrologic disease-matched control group treated in the standard fashion. Forty-four patients entered the trial and 27 completed the protocol along with 27 control subjects. During Phase 1, experimental and control subjects received standard IV rHuEPO at dialysis for 6 months. During Phase 2, experimental patients received weekly SC rHuEPO at one third the weekly IV dose for 10 months; control subjects continued to receive IV therapy. In Phase 3, both groups were treated for 6 more months with IV rHuEPO. In Phase 2, there was no significant reduction in hematocrit value, reticulocyte count, transferrin saturation, or ferritin level in the experimental group, even with only one third the weekly rHuEPO IV dose over the 10-month period. There were no significant differences between IV and SC rHuEPO administration or between experimental and control subjects in blood pressure, serum chemistries, or parameters of "dialysis adequacy." It was concluded that low-dose weekly SC rHuEPO administration is a safe and effective method for maintaining the hematocrit level of stable hemodialysis patients. This therapy could enhance the efficacy of rHuEPO and substantially reduce costs while preserving patient care outcomes.

Download Full-text

PENGGUNAAN SELAPUT AMNION SEGAR PADA INSISI LUKA OPERASI SEKSIO SESAREA

JOURNAL OBGIN EMAS ◽

10.25077/aoj.1.2.47-55.2017 ◽

2019 ◽

Vol 1 (2) ◽

pp. 47-55

Author(s):

Syahredi Syaiful Adnani ◽

Hafni Bachtiar

Keyword(s):

Wound Healing ◽

Caesarean Section ◽

Amniotic Membrane ◽

Healing Time ◽

Cost Of Care ◽

Control Group ◽

P Value ◽

Control Groups ◽

And Control ◽

Wound Healing Time

In the last few decades, the incidence of caesarean section is increasing in the world, especially in Indonesia. One of the way to treat tissue scar is through biologic and synthetic dressing where nowadays, amnion has been used as biologic dressing frequently. This study was conducted to determine the effect of the use of fresh amniotic membrane on wound incision Caesarean section compared with Caesarean section incision wound covered using regular gauze bandages and fixated with plaster in RS. Dr. Reksodiwiryo Padang. The design of this study is an experimen-tal study with Post test design with control group design. Sampling was done using a formula consecutive sampling two different test samples obtained an average of 72 people for each group. The analysis used include univariate and bivariate analyzes. The average wound healing time the difference was statistically significant (p value <0.05) in the treatment and control groups. There was highly significant difference in the proportion of local infection on day 3 between the treatment and control groups (p value <0.05). There were very significant differences in the proportion of local allergic reactions at day 3, and 5 between the treatment and control group (p <0.05). There are significant differences in terms of the cost of care per day between treatment and control groups (p <0.05). From this study, the average wound healing time has a very significant difference.Keywords: Fresh Amniotic Membrane, Wound Cesarean Section, Wound Healing

Download Full-text

Intermuscular Fat Content in Young Chinese Men With Newly Diagnosed Type 2 Diabetes: Based on MR mDIXON-Quant Quantitative Technique

Frontiers in Endocrinology ◽

10.3389/fendo.2021.536018 ◽

2021 ◽

Vol 12 ◽

Author(s):

Fuyao Yu ◽

Bing He ◽

Li Chen ◽

Fengzhe Wang ◽

Haidong Zhu ◽

...

Keyword(s):

Type 2 Diabetes ◽

Skeletal Muscle ◽

Fat Content ◽

Control Group ◽

Diabetic Patients ◽

Diabetes Group ◽

Control Subjects ◽

Intermuscular Fat ◽

And Control

ObjectiveSkeletal muscle fat content is one of the important contributors to insulin resistance (IR), but its diagnostic value remains unknown, especially in the Chinese population. Therefore, we aimed to analyze differences in skeletal muscle fat content and various functional MRI parameters between diabetic patients and control subjects to evaluate the early indicators of diabetes. In addition, we aimed to investigate the associations among skeletal muscle fat content, magnetic resonance parameters of skeletal muscle function and IR in type 2 diabetic patients and control subjects.MethodsWe enrolled 12 patients (age:29-38 years, BMI: 25-28 kg/m2) who were newly diagnosed with type 2 diabetes (intravenous plasma glucose concentration≥11.1mmol/l or fasting blood glucose concentration≥7.0mmol/l) together with 12 control subjects as the control group (age: 26-33 years, BMI: 21-28 kg/m2). Fasting blood samples were collected for the measurement of glucose, insulin, 2-hour postprandial blood glucose (PBG2h), and glycated hemoglobin (HbAlc). The magnetic resonance scan of the lower extremity and abdomen was performed, which can evaluate visceral fat content as well as skeletal muscle metabolism and function through transverse relaxation times (T2), fraction anisotropy (FA) and apparent diffusion coefficient (ADC) values.ResultsWe found a significant difference in intermuscular fat (IMAT) between the diabetes group and the control group (p<0.05), the ratio of IMAT in thigh muscles of diabetes group was higher than that of control group. In the entire cohort, IMAT was positively correlated with HOMA-IR, HbAlc, T2, and FA, and the T2 value was correlated with HOMA-IR, PBG2h and HbAlc (p<0.05). There were also significant differences in T2 and FA values between the diabetes group and the control group (p<0.05). According to the ROC, assuming 8.85% of IMAT as the cutoff value, the sensitivity and specificity of IMAT were 100% and 83.3%, respectively. Assuming 39.25ms as the cutoff value, the sensitivity and specificity of T2 value were 66.7% and 91.7%, respectively. All the statistical analyses were adjusted for age, BMI and visceral fat content.ConclusionDeposition of IMAT in skeletal muscles seems to be an important determinant for IR in type 2 diabetes. The skeletal muscle IMAT value greater than 8.85% and the T2 value greater than 39.25ms are suggestive of IR.

Download Full-text

APOPTOSIS INDEX BETWEEN FEMALES AND MALES IN REGULAR HEMODIALYSIS

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v19i3.410 ◽

2016 ◽

Vol 19 (3) ◽

pp. 150

Author(s):

Djoko Santoso

Keyword(s):

Age Groups ◽

Microtiter Plate ◽

Hemodialysis Patients ◽

Control Group ◽

Diabetic Patients ◽

Immunochemical Determination ◽

Apoptosis Index ◽

Significant Difference ◽

And Control ◽

Esrd Patients

Many reports have documented apoptosis index in hemodialysis patients, but to date, no single study has directly compared the apoptosis index of males to females. Data on mortality rate among hemodialytic patients in the hemodialysis center at the Department of Internal Medicine Dr Soetomo General Hospital, Surabaya, Indonesia show a high number predominated by female patients. Therefore, to answer the question of whether there is a gender difference in apoptosis index, the researcher studied leukocyte responses in male and female hemodialysis patients. The apoptosis index of the sample was measured by indirect immunoassay method. Cell lyses, followed by immunochemical determination of histone-complexed DNA fragments in a microtiter plate wells. The apoptosis quantization was obtained by determining the amount of colored product spectrophotometrically. One hundred and four non-diabetic subjects who received hemodialysis (HD), and 24 normal controls (NC), were evaluated. The apoptosis index in ESRD patients group and control group showed no significant difference (0.6172 vs 0.4008, p=0.114), neither did it vary in both sexes and age groups. When the sex factor was analyzed (after exclusion from the diabetic ESRD patients), females apoptosis index was significantly higher than that of the males (0.7325 vs 0.55175, p<0.05). In conclusion, apoptosis index in females among non-diabetic patients undergoing hemodialysis is higher than that occur in males and controls.

Download Full-text

Thyroid Nodules in Patients with Acromegaly: Frequency According to the ACR TI-RADS Classification and its Relationship with Disease Activity

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1500-4591 ◽

2021 ◽

Author(s):

Mustafa Can ◽

Muhammet Kocabaş ◽

Melia Karakose ◽

Hatice Caliskan Burgucu ◽

Zeliha Yarar ◽

...

Keyword(s):

Disease Activity ◽

Thyroid Nodules ◽

Thyroid Volume ◽

Thyroid Stimulating Hormone ◽

Control Group ◽

Control Subjects ◽

Number Of Patients ◽

Significant Difference ◽

The Mean ◽

And Control

Abstract Purpose: In our study, we aimed to determine the frequency of thyroid nodules in patients with acromegaly according to the American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS) classification and its relationship with acromegaly disease activity. Methods: A total of 56 patients with acromegaly and age, sex, and body mass index matched with 56 healthy control subjects were included in our study. Thyroid-stimulating hormone, free thyroxine, and anti-thyroperoxidase antibody levels of patients and control subjects were measured. In addition, patients and healthy controls were evaluated by ultrasonography to determine thyroid structure, thyroid volume, and thyroid nodules and to make ACR TI-RADS classification. Results: Thyroid nodules were present in 31 (55.4%) of 56 patients in the acromegaly group and 20 (35.7%) of 56 subjects in the control group, and the frequency of thyroid nodules was significantly higher in the acromegaly group (p=0.038). The mean number of nodules in the acromegaly group and control group was 1.27±1.43 and 0.48±0.73, respectively, and the mean number of nodules was significantly higher in the acromegaly group (p=0.003). The number of patients with TI-RADS 1, TI-RADS 2, and TI-RADS 4 nodules in the acromegaly group was higher than the control group (p=0.026, p=0.049, p=0.007, respectively). No difference was found in terms of cytological findings between those who have undergone FNAB in the acromegaly group and control group. Conclusion: In our study, we found that the frequency of thyroid nodules, the number of thyroid nodules, and the number of TI-RADS 1, TI-RADS 2, and TI-RADS 4 nodules increased in patients with acromegaly. There was no significant difference between acromegaly disease activity and thyroid nodule frequency, number of thyroid nodules, and TI-RADS classifications.

Download Full-text

The Effects of Group Discussion Based Education on the Promotion of Self-Management Behaviors in Hemodialysis Patients

Journal of Caring Sciences ◽

10.15171/jcs.2018.034 ◽

2018 ◽

Vol 7 (4) ◽

pp. 225-232 ◽

Cited By ~ 1

Author(s):

Azam Mahjubian ◽

Nasrin Bahraminejad ◽

Koorosh Kamali

Keyword(s):

Group Discussion ◽

Hemodialysis Patients ◽

Wilcoxon Test ◽

Self Management ◽

Control Group ◽

Control Groups ◽

Educational Method ◽

Management Interventions ◽

And Control ◽

Management Behaviors

Introduction: Improving self-management of the patients undergoing hemodialysis is an effective way to reduce complications and to improve the quality of life of them. The current study aims to assess the effects of group discussion on the promotion of self-management behaviors in hemodialysis patients. Methods: In this quasi -experimental clinical trial study (with experimental and control groups) 60 patients were arranged in two experimental and control groups through using convenience sampling with random allocation. Self-management interventions were conducted on the experimental group during 3 to 4 sessions of group discussion. The control group received routine interventions. The data were collected through Li and colleagues' self-management standard questionnaire before and 3 months after the intervention. The data were analyzed via SPSS software version 13 and chi-square, t-test, Mann-Whitney, and Wilcoxon test. Results: The results showed that the mean scores of four dimension of self-management including participation with the medical team, problem solving, self-care and emotional management after the implementation of group were significantly different between the experimental and control groups. Conclusion: Based on the findings, group discussion was an effective educational method to promote self-management of chronic hemodialysis patients. Therefore, holding group discussion to reinforce the self- management behaviors in patients undergoing hemodialysis is recommended.

Download Full-text