The Dynamics and Plasticity of Epigenetics in Diabetic Kidney Disease: Therapeutic Applications Vis-à-Vis

Chronic kidney disease (CKD) refers to the phenomenon of progressive decline in the glomerular filtration rate accompanied by adverse consequences, including fluid retention, electrolyte imbalance, and an increased cardiovascular risk compared to those with normal renal function. The triggers for the irreversible renal function deterioration are multifactorial, and diabetes mellitus serves as a major contributor to the development of CKD, namely diabetic kidney disease (DKD). Recently, epigenetic dysregulation emerged as a pivotal player steering the progression of DKD, partly resulting from hyperglycemia-associated metabolic disturbances, rising oxidative stress, and/or uncontrolled inflammation. In this review, we describe the major epigenetic molecular mechanisms, followed by summarizing current understandings of the epigenetic alterations pertaining to DKD. We highlight the epigenetic regulatory processes involved in several crucial renal cell types: Mesangial cells, podocytes, tubular epithelia, and glomerular endothelial cells. Finally, we highlight epigenetic biomarkers and related therapeutic candidates that hold promising potential for the early detection of DKD and the amelioration of its progression.

Successful Use of Extracorporeal Life Support and Continuous Renal Replacement Therapy in the Treatment of Cardiogenic Shock Induced by Tumor Lysis Syndrome in a Pediatric Patient With Lymphoma: A Case Report

The use of extracorporeal membrane oxygenation (ECMO) in the treatment of cardiopulmonary failure in children with malignant tumors is controversial. There are few reports on the use of ECMO in the treatment of children with tumor lysis syndrome. This article reports a case of a 9-year-old girl who presented with hyperkalemia and cardiogenic shock. The discovery of an abdominal mass with critical ultrasound provided key evidence for the initial diagnosis of tumor lysis syndrome. Cardiopulmonary resuscitation was performed for 1 h. Veno-arterial ECMO was installed at the bedside to provide cardiopulmonary support for the patient and was combined with continuous renal replacement therapy (CRRT) to improve her internal environment. The patient was ultimately diagnosed with mature B-cell lymphoma with tumor lysis syndrome. A severe electrolyte disorder led to cardiogenic shock. After the electrolyte imbalance was corrected, the patient's heart function gradually improved, ECMO was successfully weaned, and chemotherapy was continued with the support of CRRT. One month after ECMO weaning, the organ function of the patient had recovered and there were no serious complications. In this case report, we paid attention to the rapid diagnosis of the etiology behind a patient's shock with critical ultrasound as well as the initiation and management of extracorporeal cardiopulmonary resuscitation (ECPR), which provided us with valuable experience using VA-ECMO on critically ill children with tumors. It is also important evidence for the use of ECMO in the treatment of children with cardiopulmonary arrest secondary to malignancy.

Tuna Massage Training as An Effort to Improve the Nutritional Status of Toddlers

Difficulty eating in children cause malnutrition, dehydration, underweight, electrolyte imbalance, impaired cognitive development, anxiety disorders, and in more severe cases can be a life-threatening condition. Tuina massage is a massage technique that can overcome eating difficulties in toddlers. The purpose of this activity is to increase the knowledge and skills of health cadres about nutritional health and Tuina massage. The service was carried out in Pasir Lor village, Karanglewas district, which was attended by 23 cadres. Data collection techniques were carried out using questionnaires about toddler nutrition and observation sheets to assess Tuina's massage skills. The results of the activity showed that the knowledge of cadres before training was mostly in the sufficient category, while the knowledge of cadres after attending the training showed that the level of knowledge of cadres was mostly in the good category. Most of the health cadres have good skills in doing Tuina massage. The training activities were effective and able to increase the knowledge and skills of cadres about toddler nutrition and developmental problems and Tuina massage.

Ultrasound Guided Brachiocephalic Vein Cannulation using Supraclavicular Approach

The need of central vein cannulation has been increased since the increased case of critical patients and patients underwent high-risk patients. Supraclavicular approach of central vein cannulation is an alternative approach to central vein cannulation due to fewer anatomical variance, good longitudinal vein view, better visualization of needle during procedure, clear demarcation of landmarks, larger target area, better patient comfort, and fewer complications. This case study presents an ultrasound guided central vein cannulation using supraclavicular approach in 30 year old male patient diagnosed with septic shock, anemia, trombcytopenia, and electrolyte imbalance post laparotomy. The indication of central vein cannulation in the patient was to deliver volume resuscitation, to provide emergency vein access, to provide nutritional support, to deliver chemically caustic agents, and central vein pressure monitoring.

Neuroleptic Malignant Syndrome in an Elderly Patient with Bipolar Disorder

Neuroleptic malignant syndrome (NMS) is a well-known and potentially fatal complication of antipsychotic use. The elderly population, with multiple risk factors, are more vulnerable to this condition. We described a case of an 80-yearold man with bipolar disorder, previously on oral extended-release sodium valproate, aripiprazole and long-acting injectable paliperidone, who developed NMS. He presented with generalised muscle rigidity, fever, fluctuating blood pressure and elevated creatinine kinase during his hospitalisation for a manic episode. Contributing factors included old age, underlying vascular Parkinsonism, electrolyte imbalance, intercurrent lung infection with acute exacerbation of chronic obstructive pulmonary disease, hyperactive delirium, and repeated administration of parenteral typical antipsychotic. Antipsychotics were withheld promptly, and the patient was treated with dantrolene, bromocriptine and amantadine. His symptoms resolved after a week. He subsequently remained well with oral extended-release sodium valproate alone. Relevant clinical points are discussed. Clinical vigilance, close interdisciplinary cooperation, and prompt interventions are keys to successful to management of NMS in elderly patients.

Amphotericin B Induced Anaphylactic Reaction and Electrolyte Imbalance: A Case Report

Amphotericin B, a polyene antifungal antibiotic derived from a strain of Streptomyces nodosus. It acts by binding to sterols in the cell membrane of susceptible fungi, with a resultant change in the permeability of the membrane. Amphotericin B can cause allergic reactions, electrolyte imbalance and severe side effects, such as chest discomfort accompanied by dyspnea, flushing, agitation, tachypnea, tachycardia, hypoxemia, hypotension, or hypertension, are likely to develop following the injection of Amphotericin B. Anaphylaxis, cardiac toxicity and respiratory failure have also been associated to different formulations of Amphotericin B as life-threatening acute events. This case report is on a 57-year-old male patient who was admitted with a condition of left diabetic foot with non-healing medial supra heel ulcer and fungal infection on the site of wound. The patient was given Amphotericin B in emulsion form due to the high priority of fungal infection and the need for antifungal medicine, which led to anaphylactic reaction and electrolyte imbalance, which were treated immediately and the same preparation was continued with a low infusion rate. When infusion is discontinued, antihistamines can assist to alleviate the symptoms. In this case, it is recommended that the patient's condition and clinical parameters should be closely followed after the medicine has been administered.

COMPARATIVE CHARACTERISTICS OF EFFECTIVENESS AND SAFETY OF ADJUVANT SEDATION OF PATIENTS WITH ALCOHOLIC DELIRIUM

Chronic alcoholism is one of the factors of early mortality in the world. The most formidable complication of this addiction is the state of alcohol withdrawal with delirium. It is based on a long-term imbalance of the GABA and glutamatergic systems in the brain. Today, the search for an optimal sedation regimen that would be effective on the one hand, and, on the other hand, would have a sufficient safety profile, remains relevant. Three sedation regimens with the addition of ketamine, sodium oxybutyrate and dexmedetomidine were investigated. All were compared with the traditional sedation (control) regimen and with each other. The control points of the study were the following parameters: the duration of the episode of delirium, hemodynamics, plasma cortisol and serotonin, laboratory parameters of the state of the kidneys and liver. As a result of the study, we found that all of the proposed schemes had a shorter duration of delirium compared to the control. The shortest episodes of delirium were observed in the dexmedetomidine group. None of the proposed groups could adequately normalize hemodynamic parameters. We believe that the reason for this is both the peculiarities of the mechanism of action of the drugs we have chosen, and electrolyte imbalance, in particular, hypomagnesemia. The safety of our proposed sedation regimens requires further comprehensive research