Peritoneal Dialysis-Related Peritonitis: Rate, Clinical Outcomes and Patient Survival

Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis (PD). The study aimed to analyze the peritonitis rate, the cause, the outcomes, and the association of peritonitis with the survival of patients on peritoneal dialysis. Patient data were collected retrospectively from medical charts. A total of 96 patients received peritoneal dialysis in the PD center from 1 January 1999 to 31 December 2018. Episodes of peritonitis (n=159) were registered in 54 (56.3%) patients. The study population was divided into two groups, a group of patients (n=54) who experienced peritonitis and a group of patients free of peritonitis (n=42). The peritonitis rate was 0.47 episodes per patient year. The majority of causative microorganisms were gram-positive bacteria (53.5%). Outcomes of the episodes of peritonitis were resolved infection in 84.9% of episodes, catheter removal in 11.3% of episodes, and death in 3.8% of the episodes of peritonitis. A Kaplan–Meier analysis and log-rank test revealed that the group with peritonitis tended to survive significantly longer than the peritonitis-free group. A 67% reduction rate in the risk of patient mortality was observed for the peritonitis group compared with the peritonitis-free group (hazard ratio: 0.33, 95% CI 0.19-0.57, P=0.000). The prevention and management of PD-related infections, resulted in their worldwide reduction, supporting the use of PD as a first-line dialysis modality.

COVID 19 Pneumonia and a Rare Form of Fungal Peritonitis in a Patient Survivor on Peritoneal Dialysis

Peritoneal dialysis (PD) related peritonitis is usually caused by bacteria, but viruses and fungi could also affect the peritoneal membrane and cause cloudy effluent with negative bacterial cultures. We present a case of a PD patient who survived fungal peritonitis caused by Geotrichum klebahnii (March 2015) and COVID-19 pneumonia (April 2021) with peritonitis probably caused by the SARS-CoV-2 virus. The fungal peritonitis followed one episode of exit-site infection and two episodes of bacterial peritonitis treated with a wide-spectrum antibiotic. The patient’s PD catheter was removed immediately upon the diagnosis of fungal peritonitis, and an antifungal treatment was continued for 3 weeks after catheter removal. The new peritoneal catheter was reinserted 8 weeks after complete resolution of peritonitis, and the patient continued treatment with PD. The patient developed severe Covid-19 pneumonia with a sudden appearance of cloudy peritoneal effluent. There was no bacterial or fungal growth on the effluent culture. A PCR test for SARS-CoV-2 in peritoneal effluent was not performed. The peritoneal effluent became transparent with the resolution of the severe symptoms of Covid-19 pneumonia.

Sacrectomy with Ilio-Lumbar Stabilization Due to Low-Grade Chondrosarcoma of Sacrum and Iliac Wing. Case Report of the First Surgery Performed in the Republic of North Macedonia

Low - grade chondrosarcomas are primary malignant bone tumors that are resistant to chemo- and radiotherapy and are treated surgically. Sacral localization makes surgical resection technically difficult due to position, anatomic structures involved, and large tumor size at detection. The risk of complications is high. We present the introduction of a novel surgical technique in our country, sacrectomy with ilio-lumbar stabilization. This was performed on a 67-year-old man with low-grade chondrosarcoma of the sacrum with sacroiliac joint involvement. The procedure was performed via an antero-posterior approach in two stages. Ilio-lumbar fixation with a mesh cage bridge was used to obtain spinopelvic continuity and stability. Sacrectomy is a technically demanding procedure that requires careful preoperative planning and a multidisciplinary approach, as well as high level of surgical experience.

Diagnostic Potential of Calprotectin for Spontaneous Bacterial Peritonitis in Patients Withliver Cirrhosis and Ascites

The development of spontaneous bacterial peritonitis (SBP) is a serious and life-threatening condition in patients with cirrhosis and ascites. The aim of this study was to determine the diagnostic potential of calprotectin in ascites, for SBP in patients with liver cirrhosis and ascites before and after antibiotic treatment and to compare the mean values of calprotectin in ascites in patients with and without SBP. This prospective-observational study was comprised of 70 patients with cirrhosis and ascites, divided into two groups, the SBP and the non-SBP group. Quantitative measurements of calprotectin in ascites was completed with the Quantum Blue Calprotectin Ascites test (LF-ASC25), using the Quantum Blue Reader. The average value of calprotectin in the SBP group was 1.5 ± 0.40 μg / mL, and in the non-SBP group it was lower (0.4 ± 0.30). The difference between the mean values was statistically significant with p <0.05. The mean value of calprotectin in ascites before therapy among the SBP group was 1.5 ± 0.4, and after antibiotic therapy, the value decreased significantly to 1.0 ± 0.6; the difference between the mean values was statistically significant with p <0.05. ROC analysis indicated that calprotectin contributed to the diagnosis of SBP with a 94.3% sensitivity rating (to correctly identify positives), and the specificity was 62.5%, which corresponded to the value of 0.275. Our research confirmed that ascitic calprotectin was a good predictor, and is significantly associated with the occurrence of SBP in patients with liver cirrhosis. By monitoring the value of calprotectin in ascites on the 7th day of antibiotic treatment, the effectiveness of antibiotic treatment in patients with SBP can be determined.

Solitary Fibrous Tumor of Adrenal Gland and Review of the Literature

Solitary fibrous tumor (SFT) is a rare and still controversial entity. This type of tumor first appeared in the literature as a pleural lesion, but, over the last decades, it has been reported in many extrathoracic sites. As a tumor of the adrenal gland, SFT is still rare and very uncommon, thus extensive research among the English language literature has been performed. We present here a case report of an adrenal SFT which is compared to 11 other known cases. Our case report is from a patient with SFT on the left adrenal gland, followed by mild symptoms of abdominal discomfort and hypertension. Physical examination, laboratory, and radiological tests were performed. The patient underwent surgery and the material was sent for histopathologic analysis for a definite diagnosis. Regular follow up appointments were performed over the course of two years. No recurrence of the tumor has been detected. We explain the symptoms, diagnosis, treatment, and additionally we describe the results and implications of the findings reported in the literature. Correct diagnosis is mandatory for optimal management of solitary fibrous tumor patients.

Neuropsychological Correlates of Internet Addiction

The Internet, mobile phones, and other similar tools are often necessary for the current functioning of both private life and business. During these two years of pandemic (2019-2021), Internet use, especially different games and mobile phones, were indispensable for the global population. Internet addiction is defined as a psychological dependence on the internet, regardless of the type of activity once logged on. Many studies have confirmed the correlation of stress, depression, and anxiety with internet addiction. It has also been proven that internet addiction, per se, increases the risk of depression, anxiety, and stress. Moreover, the COVID-19 pandemic has generated and promoted social isolation along with unmonitored and increased screen time, all of which are the main causes of internet addiction. The aim of this article is to give a short review of internet addiction research, terminology, and symptoms related to brain functioning. The source material was articles cited in the database, PubMed. Our interest was especially oriented towards the personality characteristics of users and addicted persons as well as neuroimage findings among affected people. We selected the newest articles, published in the period of 2012-2021, of which there are more than 2000. The selected obtained results will be presented and discussed.

Is Smartphone Addiction in the Younger Population a Public Health Problem?

Problematic smartphone use and or addiction is defined as a form of behaviour characterized by the compulsive use of a smartphone that results in various forms of physical, psychological, or social harm. Global popularity in the area of the use of smartphones has raised concerns about the negative effects associated with problematic smartphone use, especially in the younger population. Having no consensual definition of smartphone addiction (SA), this behavioural addiction is based on the classic addiction symptomology that was included in DSM-5 criteria for compulsive gambling and substance abuse (APA 2013) This article provides a review of current research related to SA. Articles were found in the PUBMED database using related key words. Statistics confirm the exponential rise of this problem globally, especially in children and adolescents. Therefore, one must make this a high priority among public health issues.

Urinary Proteomics in Kidney Transplantation

Although kidney transplantation is the best treatment option for end stage kidney disease, it is still associated with long-term graft failure. One of the greater challenges for transplant professionals is the ability to identify grafts with a high risk of failure before initial decline of eGFR with irreversible graft changes. Transplantation medicine is facing an emerging need for novel disease end point-specific biomarkers, with practical application in preventive screening, early diagnostic, and improved prognostic and therapeutic utility. The aim of our review was to evaluate the clinical application of urinary proteomics in kidney transplant recipients at risk for any type of future graft failure.

Diagnostic and Prognostic Markers of Periodontal Disease

Aim of the study: The aim of this study is to determine the values of salivary enzyme biomarkers (alkaline phosphatase – ALP, aspartate aminotransferase – AST and lactate dehydrogenase – LDH) in subjects with healthy and diseased periodontium and to investigate the possibility of using these salivary enzymes as diagnostic and prognostic markers. Methods: We collected saliva with the spitting method from all examinees in the morning, using the recommendations provided by Navazesh. The values of the enzymes in saliva were determined spectro-photometrically, with the following methods: ALP-IFCC, AST-IFCC, LDH-PYRUVATE. IGI Silness-Löe was used to determine the presence of gingival inflammation, and to determine the presence of clinically manifest periodontitis, we determined the clinical loss of periodontal attachment with a graduated periodontal probe. For statistical purposes, we used the method of ANOVA Chi Square and Student’s t-test. Results: The difference in the average salivary AST and LDH values between the first and the second group, as well between the first and third group is statistically significant (p < 0.000). The difference in the average salivary AST and LDH values between the examinees with gingivitis and the examinees with clinically manifest periodontal disease is statistically insignificant (p < 0.485101 for AST, p < 0.816665 for LDH). The difference in the average salivary levels of ALP between the three groups is statistically significant (p < 0.000). Conclusion: The salivary levels of AST, LDH, and ALP can be used as diagnostic markers, while ALP can also be used as a prognostic marker for periodontal disease.

Epinephrine and Dexamethasone as Adjuvants in Upper Extremity Peripheral Nerve Blocks in Pediatric Patients

Introduction: Regional anesthesia in children in recent years has been accepted worldwide. The increased interest in it is partly due to the use of ultrasonography which provides confidence and accuracy to the anesthesiologic team. Adjuvants are used to extend the duration of the sensory and motor blocking, limiting the cumulative dose of local anesthetics. The use of adjuvants in peripheral nerve blocks in the pediatric population is still under research. Aim: To observe the effect of epinephrine and dexamethasone as adjuvants to local anesthetics in peripheral upper extremity nerve blocks in pediatric patients. Materials and methods: The study included 63 patients, aged group 4-14 years, admitted to the University Clinic of Pediatric Surgery for surgical treatment of upper limb fractures in the period of January 2020 until March 2021. Patients were randomized into three groups, and all patients in the groups received analgo-sedation prior to peripheral nerve block. Patients in group 1 (21 patients) received supraclavicular, or interscalene block with 2 ml lidocaine 2% and bupivacaine 0.25% (max 2mg/kg) with a total volume of 0.5ml/kg. In group 2, the patients (21) received 25 μg of epinephrine in 2 ml of 2% solution of lidocaine and 0.25% bupivacaine (max 2 mg/kg) with a total volume of 0.5 ml/kg, and in group 3, the patients (21) received 2% lidocaine 2ml and 0.25% bupivacaine (max 2mg/kg) in combination with 2mg dexamethasone with a total volume of 0.5ml/kg. Results: Results showed that in patients in group 1, the average duration of the sensory block was 7 hours, while the duration of the motor block was 5 hours and 30 minutes. In group 2 (epinephrine), the durations of both sensory and motor block were prolonged for about 30 minutes on average compared to the first group. In group 3 (dexamethasone) the duration of the sensory and motor block was significantly longer compared with the first two groups (p<0.0001). Conclusion: Epinephrine and dexamethasone prolong the duration of action of local anesthetics in peripheral nerve blocks of the upper extremity in pediatric patients and thus reduce the need for analgesics in the postoperative period.