Prolonged Bleeding Following Removal of Arterio-Venous Fistula Needles after Hemodialysis Therapy

2020 ◽  
Vol 31 (1) ◽  
pp. 83-105
Author(s):  
Chacha M. Makuri ◽  
Omary Minzi ◽  
Alphonce Marealle ◽  
Paschal Ruggajo
Keyword(s):  
Elevated Serum ◽  
Fixed Dose ◽  
Individual Risk ◽  
Maintenance Hemodialysis ◽  
P Value ◽  
Case Report Form ◽  
Serum Urea ◽  
Prolonged Bleeding ◽  
Compression Time ◽  
Venous Fistula

Background: Bleeding at fistula sites in patients with end stage renal disease (ESRD) is a common and potentially serious complication that contributes to blood loss (anemia). This study aimed to determine the factors that influence prolonged bleeding at fistula puncture sites following removal of fistula needles.Methods: This was a descriptive cross-sectional study. We consecutively enrolled patients who underwent maintenance hemodialysis between May and October 2017 at Muhimbili National Hospital and Access Dialysis Centre in Dar es Salaam, Tanzania. A case report form (CRF) was used for data collection.Prolonged bleeding was assessed by measuring activated partial thromboplastin time (aPTT) and compression time (CT). Descriptive statistics and regression analysis were used to assess the association between factors and tease out the independent factors associated with prolonged bleeding at fistula puncture site. A two-tailed p-value <0.05 was used as a cut-off for statistical significance.Results: One hundred and fifteen patients were recruited for the study whereby 81(70.4%) of participants had elevated aPTT (> 31 seconds) and 4 (3.5%) had prolonged compression time (> 15 minutes). The mean aPTT and compression time of the participants were 42 ± 17.6 seconds and 5 ± 2.9 minutes respectively. Over half of participants 67(58.2%) had normal compression time (≤ 15 minutes). Elevated serum urea levels (> 7.4mmol/L) was the only factor significantly associated with elevated aPTT (OR=4.143 95% C.I (1.021-16.810), p=0.047).Conclusion: The findings have demonstrated that elevated serum urea levels are significantly associated with prolonged bleeding time following removal of Arterio-Venous fistula needles after completion of a hemodialysis therapy session. This study suggests that, in hemodialysis procedure where a fixed dose of heparin is generalized to all patients there is a chance of exceeding the individual’s requirements.Recommendations: Serum urea levels should be factored in when gauging the individual risk of arterio-venous fistula site bleeding for patients using heparin for anticoagulation during hemodialysis. Further studies with large sample sizes are recommended to elucidate how other predisposing factors may affect A-V fistula bleeding. Keywords: Hemodialysis, heparin, prolonged bleeding, urea reduction ratio, A-V Fistula, aPTT, Compression time, blood urea.

scholarly journals Clinical profile and serum homocysteine level in young patients with stroke: a prospective, observational study

2019 ◽  
Vol 6 (4) ◽  
pp. 1134
Author(s):  
Manoharan S. ◽  
Sathyasagar K. ◽  
Natesh Prabhu M.
Keyword(s):  
Homocysteine Level ◽  
Elevated Serum ◽  
Young Patients ◽  
Individual Risk ◽  
P Value ◽  
Serum Homocysteine ◽  
Cortical Vein Thrombosis ◽  
Number Of Patients ◽  
Significant Difference ◽  
Stroke In Young

Background: According to the WHO, stroke is the second most important cause of death in elderly people with age >60 years and fifth leading cause in the age group of 15 to 59 years. Hyperhomocysteinemia has been linked to increased incidence of ischemic strokes. Thus, the aim of the present study was to assess serum homocysteine levels as an individual risk factor of stroke in young patients.Methods: This was a prospective, cross-sectional, single center study performed in 50 patients admitted in the Department of Medicine, Thanjavur Medical College and Hospital, Thanjavur, over a period of 7 months (i.e., from December 2013 to June 2014). Young patients, aged 1545 years, and diagnosed with stroke were included in the study. Serum homocysteine was measured by fluorescein polarization immunoassay (FPIA). Significant difference between the patients with normal and elevated mean serum homocysteine levels was identified by using unpaired t-test. P value ≤0.05 was considered as statistically significant.Results: Majority of the stroke patients were male (78%). Similarly, male patients dominated the total number of patients with elevated serum homocysteine levels (75%). Thirty-two (64%) patients had an elevated serum homocysteine level. There was a significant difference between the patients with increased homocysteine levels as compared to patients with normal homocysteine levels (p value <0.05). Out of 32 patients with hyperhomocysteinemia, 27 (84.38%) patients had ischemic stroke, 4 (12.50%) had cortical vein thrombosis and 1 (3.12%) had hemorrhagic stroke.Conclusions: Findings of the present study confirm that hyperhomocysteinemia is associated with an increased incidence of stroke in young patients. As healthcare providers, we must stress on prevention of stroke, especially by identifying treatable risk factors.

scholarly journals POS0826 SKIN LIMITED IGA VASCULITIS IN ADULTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 666.1-666
Author(s):  
A. Hočevar ◽  
J. Ostrovrsnik ◽  
K. Perdan-Pirkmajer ◽  
M. Tomsic ◽  
Z. Rotar
Keyword(s):  
Clinical Characteristics ◽  
Systemic Disease ◽  
Elevated Serum ◽  
Skin Lesions ◽  
Current Smoker ◽  
P Value ◽  
Symptom Duration ◽  
Iga Vasculitis ◽  
Reactive Protein

Background:IgA vasculitis (IgAV) could be limited to skin or evolve into a systemic disease, affecting characteristically joints, gastrointestinal tract and/or kidneys.Objectives:We aimed to look for differences between adult IgAV patients with disease limited to skin compared to systemic IgAV.Methods:Medical records of histologically proven adult IgAV cases, diagnosed between January 2010 and December 2020 at our secondary/tertiary rheumatology centre were analyzed.Results:During the 132-month observation period we identified 328 new IgAV cases (59.5% males, median (IQR) age 64.3 (45.1; 76.1) years). Ninety-four (40.2%) patients had skin limited disease, and the rest systemic IgAV.Clinical differences between skin limited and systemic adult IgAV are presented in table 1. Adults with IgAV limited to skin were significantly older, had less commonly skin lesions above the waistline and a lower level of C reactive protein compared to patients with a systemic disease. There were no differences in the frequency of skin necroses between the compared IgAV subgroups. The frequency of potential vasculitis triggers (prior infections, new medications, malignancy) was similar between the compared subgroups.Table 1.Clinical characteristics of IgA vasculitis patients with skin limited and systemic diseaseClinical characteristicsSkin limited IgAV (94)Systemic IgAV (234)P valueMale gender (%)54.361.50.263Age (years)*68.0 (55.0-80.5)61.5 (41.7-75.8)0.007Current smoker (%)13.821.80.123Antecedent infection (%)28.733.80.434New medication23.423.51.0History of cancer12.810.70.569Symptom duration (days)*7 (5-21)8 (5-14)0.756Purpura above waistline36.255.60.002Skin necroses (%)52.145.70.329ESR /mm/h) *32 (18-52)34 (17-53)0.873CRP (g/l) *13.5 (1-32)30 (11-68)<0.001Elevated serum IgA (%)50.649.10.892Legend: * median and IQR;Follow up data were available for 250 (76.2%) patients. During the follow up of median (IQR) 12.5 (6.8 – 22.4) months 35 patients relapsed (13/70 (18.6%) with skin limited IgAV and 22/180 (12.2%) with systemic IgAV, p= 0.224).Conclusion:Skin limited IgAV was associated with older age and less extensive skin puprura in adults. However, relapses of purpura were as common as in systemic IgAV.Disclosure of Interests:None declared

Assessment of nutritional status of hemodialysis patients by subjective global assessment score: a single centre study from Karachi, Pakistan

2022 ◽  
Vol 71 (12) ◽  
pp. 2761-2765
Author(s):  
Lubna Ghazi ◽  
Murtaza Dhrolia ◽  
Aamna Hamid ◽  
Ruqaya Qureshi ◽  
Kiran Nasir ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Global Assessment ◽  
Practical Method ◽  
Hemodialysis Patients ◽  
Normal Weight ◽  
Maintenance Hemodialysis ◽  
P Value ◽  
Binary Logistic Regression Analysis ◽  
Subjective Global Assessment ◽  
Cross Sectional

Objective: Despite being an important predictor of morbidity and mortality, routine screening for malnutrition in dialysis patients is not a common practice in Pakistan. Modified Subjective Global Assessment (SGA) is a convenient, inexpensive and practical method to assess nutritional status particularly in resource limited setup. Methods: This cross sectional study was conducted in The Kidney Center Post Graduate Training institute (TKC-PGTI). Patients on maintenance hemodialysis (MHD) were included through non-probability consecutive sampling. A one-time SGA score was calculated based on the history and physical examinations using modified SGA or Dialysis Malnutrition Score (DMS). Chi square test was applied to find association between variables, while to observe the amount of effect of factors on SGA score; binary logistic regression analysis was run. P value of ? 0.05 considered significant. Results: Mild-Moderately malnourished patients were the most frequent in our study 96(64%).None of patient had severe malnourishment. Females were 2.6 times more prone for malnourishment (p value=0.009). More than 5- years on hemodialysis also increased the risk of malnourishment by 12.5 times (p value <0.001). Overweight patients had 85 % less chance of being malnourished as compare to patients with normal weight (p value=0.004). Conclusion: Malnutrition is quite common in hemodialysis patients, which necessitates its regular assessment and monitoring. There is a need to assess the reasons of more malnourishment in female as compared to male. Similarly, the longer duration (> 5 years) on hemodialysis also need attention for prevention and cure of malnourishment.  Continuous...

Abstract 67: Cardiac Arrest and Surgical Case Volume, Household Income and Availability of Trauma and Cardiac Surgery Are Associated with Higher Risk-Standardized Survival After Cardiac Arrest Among University Hospital Consortium Institutions in 2012

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael C Kurz ◽  
John P Donnelly ◽  
Henry E Wang
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Surgery ◽  
Household Income ◽  
University Hospital ◽  
Individual Risk ◽  
P Value ◽  
Case Volume ◽  
Surgical Case ◽  
Catchment Areas ◽  
Cardiac Arrest Survival

Objective: Wide variation exists in cardiac arrest survival. Historically cardiac arrest research has focused upon clinical pre-arrest and intra-arrest factors to explain this variation in outcomes. In-hospital post-arrest care is increasingly recognized as an important aspect of survival. We sought to identify hospital characteristics associated with improved cardiac arrest survival. Methods: We examined all participating hospitals in the University Hospital Consortium (UHC) clinical database with more than 25 adult cardiac arrests in 2012. Cases were identified using International Classification of Diseases, 9th Edition, code 427.5 (cardiac arrest) or 99.60 (CPR), excluding prisoners, pregnant patients, transfers, and hospice patients. We estimated hospital-specific risk-standardized survival rates (RSSRs) using hierarchical logistic regression, adjusting for individual risk of mortality. Institutions in the highest RSSR quartile were compared with those in the lowest three quartiles using Pearson chi-square tests of association. Results: UHC institutions admitted 3,686,296 patients in 2012, of which 33,700 patients experienced cardiac arrest. Overall survival was 42.3% (95% CI 41.8-42.9) with median RSSR of 42.7% (IQR 35.5-50.8). Hospitals in the highest quartile of RSSR had higher cardiac arrest volume (median 193 vs. 150, p-value 0.019), higher annual surgical operation volume (21,177 vs. 14,122, 0.007), cared for patients from catchment areas with higher household income ($60,753 vs. $56,424, 0.027), and were more likely to be a trauma (79% vs 59%, 0.024) or cardiac surgery center (91% vs 70%, 0.007). In addition, hospital size (477 vs 415 beds, 0.060) and teaching status (77% vs. 62%, 0.067) demonstrated a trend toward association with higher RSSR. Conclusion: Among hospitals in the UHC, those with higher cardiac arrest and surgical case volume, patient household income, and availability of trauma and cardiac surgery were associated with improved RSSR.

Perineal herniorrhaphy: perioperative data from 100 dogs

1995 ◽  
Vol 31 (4) ◽  
pp. 331-342 ◽  
Author(s):  
G Hosgood ◽  
CS Hedlund ◽  
RD Pechman ◽  
PW Dean
Keyword(s):  
Urinary Bladder ◽  
Elevated Serum ◽  
Clinical Signs ◽  
Serum Urea ◽  
Mixed Breed ◽  
Hospitalization Period ◽  
Perineal Swelling ◽  
Perineal Defect ◽  
Rectal Palpation

One hundred dogs (83 intact males, 15 castrated males, and two intact females) underwent 110 perineal herniorrhaphy procedures. Mixed-breed dogs (n = 32), miniature poodles (n = 14), Boston terriers (n = 11), and Pekingese (n = 9) were represented most frequently. Perineal swelling (n = 48) and a perineal defect on rectal palpation (n = 31) were common clinical signs. Twenty dogs had urinary bladder retroflexion and were significantly more likely to have elevated serum urea nitrogen and creatinine concentrations, hyperkalemia, hyperphosphatemia, and neutrophilic leukocytosis. Only five of 43 dogs evaluated radiographically had prostatomegaly. Of 30 dogs receiving oral barium, all had rectal deviation. The most frequent complications during the hospitalization period were incisional (n = 35), followed by rectal prolapse (n = 9), tenesmus (n = 8), and depression (n = 8). Fifty-six of 70 dogs with follow-up had no complications.

Pharmacokinetic and Pharmacodynamic Evaluation of a Biosimilar Rituximab in Newly Diagnosed Diffuse Large B-Cell Lymphoma (DLBCL) Treated with R-CHOP (Rituximab, Cyclophosphamide, Adriamycin, Vincristine, Prednisolone).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4491-4491 ◽  
Author(s):  
Auro Viswabandya ◽  
P.V. Prashanthi ◽  
C. Nirmala Raju ◽  
Reena Rajsekhar ◽  
Vikram Mathews ◽  
...  
Keyword(s):  
B Lymphocyte ◽  
Stage Iv ◽  
B Cell Lymphoma ◽  
Fixed Dose ◽  
P Value ◽  
Newly Diagnosed ◽  
Blood Samples ◽  
Significant Difference ◽  
Post Infusion ◽  
Multi Center Study

Abstract Addition of rituximab (375 mg/m2) to CHOP has been shown to improve survival in patients with DLBCL. However there is limited data on the pharmacokinetics (PK) and pharmacodynamics (PD) of this drug in this condition. We have evaluated the PK and PD of a biosimilar rituximab (Reditux®, Dr. Reddy’s Laboratories Ltd, Hyderabad, India) in 17 patients with newly diagnosed DLBCL treated at a single center with R-CHOP as part of a multi-center study undertaken to assess the safety and efficacy of this drug. R-CHOP (rituximab-375mg/m2; cyclophopsphamide-750mg/m2; adriamycin-50mg/m2; vincristine-1.4mg/m2 on day 1 and prednisolone-60mg/m2 on days 1 to 5) was given every 3 weeks for a total of 6 cycles. Blood samples for measurement of rituximab were collected just prior to start of infusion and 10min, 24, 72, 192 and 360 hours post-infusion for all patients during cycle 1 and in 6 patients during cycle 6 also. Additional samples were collected pre- and 10 minutes post-infusion after cycles 2, 3, 4, 5 and 6. Plasma rituximab levels were quantified using an immunoassay (sensitivity: 1ug/ml). B-lymphocyte counts were measured in peripheral blood samples taken from all patients at the beginning of each cycle. All patients were evaluated for clinical and radiological response after the 2nd, 4th and 6th cycles. Patients, mean age: 52 years (range:31–71) had disease in the following stages: stage II: 5, stage III: 7, stage IV: 5. Twelve out of 17 patients achieved complete remission while 5 had partial response (NCI criteria). At a mean follow-up of 5 months (range: 3–8), 3 patients had relapse of the disease. The arithmetic mean ±SD of PK parameters of Rituximab during cycle 1 were as follows: T½(hrs): 167±63; Cmax(ug/ml): 186±49; Cmin(ug/ml): 22.4±12.84; AUC0-∞ (ug.hrs/ml): 28162±11227) and Cl/F (ml/kg/hr): 23.8±10.8. These data are comparable with values previously reported for rituximab in other conditions. Though a 2–7 fold inter-individual variation was noted among these patients, there was no significant difference in these parameters between those in whom the disease relapsed as opposed to those who maintained remission. Among the 6 patients in whom data was available for the 1st and 6th cycles (table), there was significant reduction in Cl/F with associated increase in Cmax and AUC in the 6th cycle as compared to the 1st cycle. In 16 patients for whom the data was available, pre-treatment mean B lymphocyte count which was 121/ul (range:1.5–410.5) dropped to a mean of 9.9/ul (range:0.3–62.3) after the first cycle and remained in that range for the rest of treatment period. These data show that even with a 3-weekly regimen, therapeutic trough levels (25 μg/ml) of rituximab was observed across all cycles. In fact, the changing PK parameters of the drug with progressive cycles of R-CHOP suggest that fixed-dose regimens may not be the optimal way to administer this drug. Parameter Cycle1 (n=6) Cycle 6 (n=6) p value T ½ (hours) 200 386 0.0481 Cmax (μg/ml) 203 279 0.0556 Cmin (360Hr) 24.71 82.16 0.0028 AUC0- ∞ (μg.hrs/ml) 31167 92240 0.0049 Cl/F(ml/kg/hr) 20.5 7.6 0.0030

Prediction of VOD Using Biomarkers of Endothelial Injury.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3267-3267
Author(s):  
Corey Cutler ◽  
J. Aldridge ◽  
H. T. Kim ◽  
S. Ayanian ◽  
G. Bradwin ◽  
...  
Keyword(s):  
Conditioning Regimen ◽  
Elevated Serum ◽  
Endothelial Damage ◽  
Endothelial Injury ◽  
Intercellular Adhesion Molecule ◽  
P Value ◽  
Intercellular Adhesion Molecule 1 ◽  
Wilcoxon Rank Sum Test ◽  
Gvhd Prophylaxis ◽  
Von Willebrand

Abstract Veno-occlusive disease (VOD) of the liver occurs with a frequency of 5–15% after myeloablative conditioning and allogeneic stem cell transplantation (SCT). While risk factors for VOD are well known, predicting the occurrence of VOD in individuals remains challenging. Since the primary mechanism of injury in VOD is conditioning-related damage to hepatic sinusoidal endothelial cells and hepatocytes, we measured soluble biomarkers of endothelial injury in the peri-transplant period to determine if they correlated with the occurrence of VOD. Methods: 59 patients received cyclophosphamide (1800 mg/m2 x 2) and TBI (14 Gy) as conditioning therapy, and tacrolimus with sirolimus (Sir+) or methotrexate (Sir-) as GVHD prophylaxis. Only patients with HLA-matched donors were included and selected for analysis based on the occurrence of VOD (VOD+ n=18, VOD- n=41), diagnosed by clinical, radiologic and pathologic criteria. Banked samples collected after conditioning but prior to SCT (day -1) and weekly after SCT (day 7, 14, 21) were thawed and analyzed by ELISA using commercially available kits and quantified using a VersaMax plate reader. Von Willebrand Factor (vWF) and thrombomodulin were assayed in plasma, and E-selectin and soluble intercellular adhesion molecule-1 (ICAM) were assayed in serum. Assays were performed in duplicate and results are the mean of two assays. Not all patients had every time point analyzed due to missing specimens. The within-sample results were compared using the 2-sided Wilcoxon rank-sum test, and the Bonferroni method was used to adjust for multiple comparisons (p value for significance=0.0125). Results: Comparing patients who did and did not develop VOD, patients with VOD had significantly elevated levels of vWF suggestive of endothelial damage at all timepoints prior to the development of VOD in comparison with controls (p≤0.0118, Figure). Thrombomodulin levels were predictive of VOD at all post-SCT timepoints (p≤0.0013, Figure). ICAM levels were significantly elevated up to Day 21 (p≤0.0028). E-selectin was less useful and statistically significant increases in levels were not observed. Since sirolimus has effects on endothelial function that may contribute to VOD through mechanisms different than the conditioning regimen, we stratified the analyses by sirolimus exposure, comparing Sir+VOD+ patients with Sir+VOD- controls. vWF levels in Sir+VOD+ patients were predictive for VOD at all timepoints when compared with controls (p≤0.003). Thrombomodulin levels were informative against controls for all post-SCT timepoints (p≤0.003). ICAM was informative as well (p≤0.003 pre-SCT, day 7, 14), while E-selectin levels were uninformative. The discriminative value of elevated serum and plasma biomarkers was limited to Sir+ patients in this small dataset, since other than some vWF timepoints, biomarkers could not distinguish Sir- patients who developed VOD patients from control groups without VOD. There were no differences in biomarkers among VOD- patients, suggesting that in the absence of VOD, markers of endothelial injury are not elevated even when sirolimus is used. Conclusions: Plasma vWF and thrombomodulin and serum ICAM elevations before and early after SCT can be used to predict the occurrence of VOD. These assays are most useful in patients receiving sirolimus. This analysis demonstrates the contribution of sirolimus to endothelial injury and VOD after SCT, and may help select patients in whom prophylactic or pre-emptive strategies against endothelial damage and VOD may be useful. Figure Figure

Safety and Efficacy Of Rituximab In adult’s Immune Thrombocytopenia (ITP) : Results After One-Year Of Follow-Up In 252 Patients From The Prospective French ITP-Ritux Registry

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 450-450 ◽  
Author(s):  
Mehdi Khellaf ◽  
Olivier Fain ◽  
Louis Terriou ◽  
Jean-François Viallard ◽  
Stéphane Cheze ◽  
...  
Keyword(s):  
Platelet Count ◽  
Conflicts Of Interest ◽  
Biological Data ◽  
Fixed Dose ◽  
Case Report Form ◽  
International Guidelines ◽  
Severe Hypotension ◽  
One Year

Introduction Adults with ITP usually respond to corticosteroids but typically relapse after discontinuation. Rituximab is thought to be an effective off-label second-line treatment but only few prospective data exist about its long-term efficacy and its long-term safety is a matter of concern. The tolerance and particularly the risk of severe infection is a crucial factor for assessing the risk/benefit ratio of this treatment in ITP. Three years ago, we opened a non-interventional prospective registry in France to investigate the safety (primary outcome) and the efficacy of rituximab in off-trials adults with ITP (ClinicalTrials.Gov: NC1101295). Two hundred and fifty two patients were included on a two-year period. A follow-up duration of five-year is planned. We report here the first results after one year of follow-up. Methods The ITP-Ritux registry was set up by the French reference center of adult’s immune cytopenias. Thirty one centers participated to the study. Consecutive patients diagnosed with primary ITP according to the international guidelines (Rodeghiero et al, Blood 2009) who were treated with rituximab were included. Patients with a secondary ITP and those who were previously treated with rituximab were excluded. Response to treatment was assessed according to international guidelines: complete response (CR) was defined by platelet count ³100x109/L and response (R) by a platelet count between 30 and 100x109/L with at least a doubling of the pre-treatment count. The prospective and sequential monitoring of rituximab efficacy and safety was made by using of a standardized electronic case report form. Study nurses visited each center regularly to update the clinical and biological data on the enrolled patients. Results Between July 2010 and July 2012, 252 patients (64% of females) with a mean age of 51±21 (16-97) years were enrolled. The median duration of ITP was 1.3 (0-56) years with 44 patients (17%) with a newly diagnosed ITP, 61 (24%) with persistent ITP and 147 (58%) with chronic ITP at time of rituximab treatment. The median platelet counts at time of ITP diagnosis and rituximab first infusion were respectively 18x109/L (1-100) and 17x109/L (1-186). Patients received a median of 2 treatment lines (range 0-7) before rituximab and 25 (10%) were splenectomized. The standard regimen of 375 mg/m2 weekly rituximab infusions for 4 weeks was administered to 179 patients whereas 73 patients (29%) received a fixed dose of 1000 mg on day 1 and day 15. At time of the present analysis, the median follow-up was 18 months and the one-year response was available in 209 patients. A one-year overall response was observed in 90/209 (43%) patients including a CR in 28% and a R in 15%. Nineteen patients who failed to respond to rituximab were splenectomized during the year following rituximab infusions. Sixty eight adverse events occurred in 47 patients (19%). Rituximab infusions have to be stopped in only 3 patients for severe hypotension, dyspnoea with laryngeal discomfort and reversible serum sickness respectively. Three other patients developed severe adverse event related to rituximab requiring admission in hospital including 1 episode of profound neutropenia while 6 episodes of infections occurred in 2 patients. Seven patients (2.7%) have died during follow-up, 52 to 385 days after rituximab infusions. All patients who died but one aged of 18 were 68 to 98-year old. Only one death could be potentially related to rituximab (enterococcus faecium pulmonary infection), 2 deaths were of unknown origin, other causes were: suicide (n=1), multiple myeloma (n=1) and fatal haemorrhage related to ITP (n=2). We did not observe any episode of progressive multifocal encephalopathy or any other case of opportunistic infection. Discussion and conclusion Our preliminary results based on the first large non-interventional prospective registry of ITP-adults treated with rituximab in the “real life” confirm that this treatment leads overall to 40% of response after one year of follow-up. Safety of rituximab at 1 year appears to be good since severe infections were uncommon and no opportunistic infections were observed. The ongoing monitoring and upcoming analysis with a planned follow-up up to 5-years will provide more data on long-term safety. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Vascular access parameters among prevalent dialysis patients: a single center survey

2020 ◽  
Vol 10 (2) ◽  
pp. 120-124
Author(s):  
Tanveer Bin Latif ◽  
Tanvir Rahman
Keyword(s):  
Vascular Access ◽  
Venous Catheter ◽  
Maintenance Hemodialysis ◽  
Similar Data ◽  
Age Group ◽  
Dialysis Unit ◽  
Medical Graduates ◽  
Number Of Patients ◽  
Venous Fistula ◽  
Access Surgery

Background: Vascular access is one of the most important outcome determinant of patients on hemodialysis. In Bangladesh increasingly more patients are started on hemodialysis as a lifesaving procedure. But we lack organized data on different aspects of dialysis practice. Data related to vascular access is even more scanty. Method: A survey was undertaken in one of the busy dialysis centers in Dhaka with a large number of patients on maintenance hemodialysis .Data were collected by doctors in dialysis units from patients along with records kept in the dialysis unit during November and December 2017. Results: Total 143 patients were included. 53% of these patients belonged to age group 61 to 80 years, 39% to age group 41 to 60 years; 56.6 % female and 43.4% male. 73.4% of the study patients received dialysis via central venous catheter at the initiation. But among the prevalent patients during study period, 84% patient were receiving dialysis via arterio-venous fistula and 5% via arterio-venous graft as permanent vascular access. Among these permanent vascular access left forearm was used in 47% and left upper arm in 33% of cases. Vascular ultrasound mapping before permanent access creation was done in only about 40% of cases. Almost 56 % of the vascular access surgery was done by experienced medical graduates in vascular access creation without any post graduate surgical qualifications. Conclusion: Vascular access data should be collected in a structured manner so that dialysis practice pattern of different centers and regions of the country can be compared. Similar data from several centers around the country will increase scope of improvement . Birdem Med J 2020; 10(2): 120-124

scholarly journals Ameliorative Effect of Methanol Extract of Hymenocardia acida Leaves on Gentamicin-Induced Renal Toxicity in Rats

2018 ◽  
pp. 1-9
Author(s):  
Nweje-Anyalowu Paul Chukwuemeka ◽  
Idakwoji Precious Adejoh ◽  
Iserhienrhien Lucky Osafanme ◽  
Anosike Joy Chizoba
Keyword(s):  
Methanol Extract ◽  
Histopathological Examination ◽  
Elevated Serum ◽  
Chloride Ion ◽  
Chloride Ions ◽  
Potassium Ion ◽  
Albino Rats ◽  
Histopathological Analysis ◽  
Serum Urea ◽  
Group I

Aim: This study evaluated the nephroprotective effect of methanol extract of Hymenocardia acida leaves in rat model of gentamicin induced renal damage. Materials and Methods: Twenty- four (24) Wistar albino rats of either sex weighing 150- 200g were divided into 4 groups of 6 animals each; Group I served as the control and received normal saline, Group II- IV received gentamicin (40 mg/kg, i.p), Groups III and IV also received 200 and 400 mg/kg body wt., p.o methanol extract of Hymenocardia acida leaves respectively for 15 days. Body weight measurement, serum urea, creatinine, electrolytes analyses and histopathological examination of kidney were carried out. Results: Gentamicin treatment caused nephrotoxicity as evidenced by marked elevation in Serum urea, creatinine, decreased sodium and chloride ions, elevated serum level of potassium ion and pathological signs such as congestion, focal areas of inflammation, tubular necrosis, and glomerular atrophy. Administration of the extract at doses of 200 and 400 mg/kg/ body wt significantly (p< 0.05) decreased Creatinine and urea levels, significantly (p< 0.05) increased sodium and chloride ion and significantly (p< 0.05)  decreased potassium ion level when compared to the gentamicin- alone- treated group. Histopathological analysis also revealed a gradual reversal of the pathological features caused by gentamicin toxicity. Conclusion: It was concluded that the extract possesses nephroprotective potential.

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