Prevention of Diabetic Nephropathy Through RAAS Blockade in a Resource Poor Setting – A review of Evidence

Background@#In Fiji, 1 in every 3 Fijian is being diagnosed with diabetes. The contribution of chronic kidney disease (CKD) to mortality in Fiji has increased to become the fourth leading cause of death in the country. Fiji Ministry of Health and Medical Services data show that admissions to hospitals for CKD are increasing and treatment of end‐stage kidney disease (ESKD) is a growing burden. Since renal replacement therapy is not readily available or affordable in Fiji, it is advisable to prevent or slow the progression of renal disease to ESKD. Early deduction of renal impairment in diabetic patient is paramount and foremost is to identify proteinuria in the earliest stage. Angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) offer reno-protection. These agents reduce proteinuria, a risk marker for renal disease progression.@*Aim@#To evaluate and provide evidence for use ACE-I and ARB in prevention of diabetic nephropathy in our clinical setting.@*Method@#An online search using MESH terms that best answered our research question was conducted on the Medline database. Four seminal papers were identified after shifting through abstracts of 210 studies. These papers were evaluated and conclusions discussed.@*Results@#ACE-I and ARBs are equally reno-protective agents when used individually; it slows the progression of diabetic renal impairment to ESKD and reduces proteinuria to almost normal levels. ARBs are likely to be used as first line agent in patients who have already developed significant diabetic proteinuria since additional blood pressure lowering capabilities of this class of drug may have accentuated benefits. Additionally, ARB’s should be used in patients who cannot tolerate ACE-I induced side effects. For prevention and conversion of diabetic nephropathy to normo-proteinuria; moderate to maximum doses of ACE-I or ARB should be used in clinical practice. Combination of ACE-I plus ARB in management is not recommended. ACE-I still remains the most cost-effective drug for a low resourced clinical setting such as ours.

Should We Give Antiemetic Drugs To Children In The Emergency Department?

@#Acute Gastroenteritis with Vomiting in children is one of the most common causes for visiting Emergency departments. Even though this is a self-limiting disease, vomiting, when it escalates, makes physicians take proactive measures such as intravenous fluid administration and eventually hospital admissions and observations to prevent worse outcomes. Ondansetron is a potent antiemetic drug with low risks of adverse events when compared to other antiemetic medications and it is still not used widely in clinical practice. This article examines evidence for use and compares the efficacy of antiemetic drugs in children who present to the emergency department with vomiting from Acute Gastroenteritis by reviewing two papers.

Purple Urine Bag Syndrome in Two Palliative Care Patients

@#Purple urine bag syndrome (PUBS) is a rare manifestation of urinary tract infections resulting in bright purple discolouration of the urine catheter bag and tubing. The phenomenon is common in elderly woman with constipation and urinary tract infections associated with long term indwelling catheter (IDC) use. We present two cases of PUBS witnessed in the emergency department.