Letter from Glasgow Kohli, H S
The National medical journal of India,
07/2017, Letnik:
30, Številka:
4
Journal Article
Recenzirano
Edinburgh came to the fore with its epidemic of AIDS-related deaths linked to drug injecting. ...simultaneously, Edinburgh achieved notoriety for HIV among drug injectors but also as a centre for ...investigating the causes of the epidemic and helping to understand the new disease. Over the decades, health researchers have found that Scotland's health has been improving but at a much slower rate compared to other European countries.2-3 Some years ago, I even commented on the 'Scottish effect' in a Letter from Glasgow.4 As a consequence of Scotland's health improving more slowly than other countries, these countries in Europe have accelerated past Scotland over the past 50 years in terms of their health profile. Analysing the effects of political decisions on public health is a start, but meeting the challenges for public health for the future is a difficult task but a prize worth fighting for.
Relative risk of mortality due to bacteremia is multiple folds higher with the use of tunneled catheters compared to AVF and lower compared to non-tunneled catheter. ...a higher incidence of ...Gram-negative infection should be taken into account, and empirical Gramnegative antibiotic should also be started along with Gram-positive coverage for suspected CRBSI to salvage catheters and preserve vascular access. Because the data on HD tunneled catheter infection rates in developing country are limited, the use of tunneled vascular catheters is limited by economic constraints. Conclusion Though tunneled catheters have lower infection rate than nontunneled catheters, in resource poor settings the infection rates are high and Gram-negative infection are commoner than Gram-positive infection and empirical antibiotics should be given to cover both Grampositive and Gram-negative organisms.
Uremia is a state of heightened inflammatory activation. This might have an impact on several parameters including anemia management. Inflammation interferes with iron utilization in chronic kidney ...disease through hepcidin. We studied the body iron stores, degree of inflammatory activation, and pro-hepcidin levels in newly diagnosed patients with end-stage renal disease (ESRD), and compared them with normal population. In addition to clinical examination and anthropometry, the levels of iron, ferritin, C-reactive protein, tumor necrosis factor alfa, interleukin-6, and prohepcidin were estimated. A total of 74 ESRD patients and 52 healthy controls were studied. The ESRD patients had a significantly lower estimated body fat percentage, muscle mass, and albumin; and higher transferrin saturation (TSAT) and raised serum ferritin. Inflammatory activation was evident in the ESRD group as shown by the significantly higher CRP, IL-6, and TNF-α levels. The pro-hepcidin levels were also increased in this group. Half of the ESRD patients had received parenteral iron before referral. Patients who had received intravenous iron showed higher iron, ferritin, and TSAT levels. These patients also showed more marked inflammatory activation, as shown by the significantly higher CRP, TNF-α, and IL-6 levels. We conclude that our ESRD patients showed marked inflammatory activation, which was more pronounced in patients who had received IV iron. High hepcidin levels could explain the functional iron deficiency. The cause of the relatively greater degree of inflammatory activation as well as the relationship with IV iron administration needs further studies.
A 26-year-old female of end-stage renal disease (basic disease unclassified) on irregular hemodialysis for 2 years presented with complaints of severe painful bluish-black discoloration of hands and ...feet and low-grade fever, which was noticed 1 month before the admission Figure 1. Physical examination revealed pulse rate of 96/min, blood pressure of 150/90 mmHg, respiratory rate of 16/min, and temperature of 38.4°C. Bilateral radial and dorsalis pedis pulses were absent, rest pulses were present and symmetrical with a left side radiocephalic arteriovenous fistula. Laboratory parameters revealed hemoglobin of 6.5 gm/dl, total leucocyte count 9,300/mm 3, platelet count 3.6 × 109/L, serum urea 140 mg/dl, serum creatinine 8 mg/dl, serum calcium 8.5 mg/dl, serum phosphorus 10.8 mg/dl, intact PTH 2339 IU/ml, serum albumin 3 gm/dl, alkaline phosphatase 439 IU/ml, and normal prothrombin/activated thromboplastin time.
Hand Hygiene Wash hands with soap and water for at least 20 seconds, especially after blowing the nose, coughing, sneezing, or being in any public placeIf the hands are not soiled and/or soap is not ...available, use a hand sanitizer containing at least 60% alcohol“My 5 moments for hand hygiene” (https://www.who.int/gpsc/5may/background/5moments/en) are a simple, effective guide on how to perform hand hygieneIf soap or alcohol-based hand rub is not available, chlorinated water (0.05%) can be used, though repeated use can lead to dermatitis and should be watched out forRefrain from touching your eyes, nose and mouth with unwashed handsDry your hands with tissue paper (preferably) or with a clean, dry cloth, single-use towel or hand drier as available. General Cleaning 4 Like other coronaviruses, COVID-19 can survive on various surfaces for 2 hours to 9 days, depending on a number of environmental factorsClean frequently used objects/surfaces daily like phones, tablets, handles, keyboards, and switches, etc.Common disinfectants such as 70% ethanol or sodium hypochlorite (0.5%) and diluted household bleach (1 part bleach to 9 parts water) used for one minute should be effectiveList of household detergents effective against COVID-19 is available in https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2Cleaning with soap and water can be done if surfaces are dirtyClothes of COVID-19 suspected patients should be machine washed separately with warm water at 60-90°C and following any contact with such clothes, proper hand hygiene should be performed. Water Supply Though COVID-19 has not yet been detected in drinking water, like other coronaviruses, chlorination and disinfection with ultraviolet light as done in conventional, centralized water treatment methods should be effectiveIf a centralized supply is not available, household water treatment methods, including boiling, using nanomembrane filters, chlorine, or UV irradiation, may be used.
Focal segmental glomerulosclerosis (FSGS) is the most common cause of adult-onset nephrotic syndrome, but its pathophysiology is poorly understood. The question as to why only a subset of patients ...responds to treatment in unanswered. In the past few years, change of podocytic phenotype from stationary type in health to migratory type in disease has been described, of which loss of subpodocytic space is a surrogate marker. Diagnostic biopsies of adult-onset steroid-resistant calcineurin inhibitor-naïve primary FSGS cases, which were subsequently treated with tacrolimus were included in this retrospective study conducted from 2011 to 2013. The ultrastructure of all cases was studied in detail, especially in context to the presence or absence of subpodocytic space. In the present study, we have compared presence or absence of subpodocytic space in tacrolimus-responsive versus tacrolimus-resistant cases to identify potential electron microscopic features predictive of response to treatment, of which loss of subpodocytic space indicating migratory phenotype is the most important and consistent feature. The present series included 7 tacrolimus responsive cases (includes two cases with partial response) and seven tacrolimus-resistant cases. The tacrolimus-resistant patients were of older age, had a longer duration of illness, and a lower eGFR as compared to tacrolimus responsive cases. The subpodocytic space was preserved in patients on tacrolimus with complete remission and lost in patients with partial response and tacrolimus-resistant cases.
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