Strategies for Management of Peritoneal Dialysis Patients in Singapore during COVID-19 Pandemic

Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. The highly infectious nature of this virus has led to the implementation of the Disease Outbreak Response System Condition orange status in Singapore since early February 2020. This paper summarises the strategies for management of several aspects of PD in Singapore during this COVID-19 pandemic, including PD catheter insertion, PD training, home visit and assisted PD, outpatient PD clinic, inpatient management of PD patients with or without COVID-19 infection, PD as KRT for COVID-19 patients with acute kidney injury, management of common complications in PD (peritonitis and fluid overload), and management of PD inventory.

Reduction of the cetrorelix dose in a multiple-dose antagonist protocol and its impact on pregnancy rate and affordability: A randomized controlled multicenter study / 대한생식의학회지

OBJECTIVE: To determine whether reducing the cetrorelix dose in the antagonist protocol to 0.125 mg had any deleterious effects on follicular development, the number and quality of retrieved oocytes, or the number of embryos, and to characterize its effects on the affordability of assisted reproductive technology. METHODS: This randomized controlled study was conducted at the Fertility Unit of Tanta Educational Hospital of Tanta University, the Egyptian Consultants' Fertility Center, and the Qurrat Aien Fertility Center, from January 1 to June 30, 2017. Patients' demographic data, stimulation protocol, costs, pregnancy rate, and complications were recorded. Patients were randomly allocated into two groups: group I (n=61) received 0.125 mg of cetrorelix (the study group), and group II (n=62) received 0.25 mg of cetrorelix (the control group). RESULTS: The demographic data were comparable regarding age, parity, duration of infertility, and body mass index. The dose of recombinant follicle-stimulating hormone units required was 2,350.43±150.76 IU in group I and 2,366.25±140.34 IU in group II, which was not a significant difference (p=0.548). The duration of stimulation, number of retrieved oocytes, and number of developed embryos were not significantly different between the groups. The clinical and ongoing pregnancy rates likewise did not significantly differ. The cost of intracytoplasmic sperm injection per cycle was significantly lower in group I than in group II (US $494.66±4.079 vs. US $649.677±43.637). CONCLUSION: Reduction of the cetrorelix dose in the antagonist protocol was not associated with any significant difference either in the number of oocytes retrieved or in the pregnancy rate. Moreover, it was more economically feasible for patients in a low-resource country.

Histological study of hysteroscopy guided endometrial biopsy from secondary infertile patients after removal of a copper intrauterine contraceptive device

The intrauterine device [IUD] is a long-acting reversible method of contraception. Copper T380 IUD is a copper-wrapped T-shaped IUD containing no hormones. Although the IUD has been a contraceptive method for about 50 years, the possibility of causing subsequent secondary infertility remains controversial. This work was conducted to study the endometrial structure in patients suffering from secondary infertility after copper IUD removal. Thirty secondary infertile patients aged between 20 and 35 years were classified into two groups: the control group [10 patients], with no past history of IUD insertion, and the IUD group [20 patients], with a history of copper IUD insertion for 6 months to 3 years [subgroup B1] or for more than 3 years [subgroup B2]. Preovulatory hysteroscopy-guided endometrial biopsies were obtained and processed for light microscopy and transmission and scanning electron microscopy. Specimens from subgroup B1 showed focal loss of surface epithelium, cytoplasmic vacuolation, and small dark nuclei in surface epithelial cells. The stroma showed extravasated red blood cells, wide empty spaces, and cellular infiltration. In addition, the uterine glands of subgroup B2 appeared irregular and dilated with accumulated secretion and cellular debris as well as epithelial stratification. Ultrastructurally, focal loss, distortion and swelling of microvilli, indented nuclei, dilated rough endoplasmic reticulum, swollen mitochondria, and secondary lysosomes were observed in the surface epithelial cells. Scanning electron microscopy showed focal loss of microvilli, irregular surface, and mushroom-like protrusions in subgroup B1. These changes were more prominent in subgroup B2 with the appearance of fissures and corrugation of the surface. Copper IUD could induce different degrees of structural changes in the endometrium, which were directly proportional to the duration of IUD insertion. These changes could explain the secondary infertility that may occur in some cases after IUD removal

Gene regulation of pteridine reductase 1 in leishmania promasti-gotes and amastigotes using a full-length antisense construct

Pteridine metabolic pathway is unusual features of Leishmania, which is necessary for the growth of parasite. Leishmania has evolved a complex and versatile pteridine salvage network which has the ability of scavenging a wide area of the conjugated and unconjugated pteridines especially folate and biopterin. In this study, we focus on the inhibition of ptr1 gene expression. L. major ptr1 gene was cloned into pcDNA3 and digested using KpnI and BamHI. The gene was subcloned so that antisense will transcribe and called pcDNA-rPTR. Leishmania major was cultured and late logarithmic-phase promastigotes were harvested. The promastigotes were divided into two groups. One group was transfected with 50 micro g of pcDNA-rPTR, whereas the other group was transfected with pcDNA3. Transfected cells were cultured and plated onto semi-solid media. Mouse pritonean macrophages were transfected using pcDNA-rPTR-tansfected promastigotes. Western blotting was performed on mouse transfected pritonean macrophages and extracts from transfected promastigotes of L. major using a L. major ptr1 antibody raised in rabbits. The PTR1 protein was not expressed in pcDNA-rPTR- tansfected promastigotes and mouse macrophage transfected with pcDNA-rPTR- tansfected promastigotes. This approach might be used to study the pteridine salvage pathway in Leishmania or to assess the possibility of using gene expression inhibition in the treatment of leishmaniasis.

Iraqi experience of performing Rehbein s procedure as a surgical treatment of Hirschsprung S disease at central child hospital

Since Hirschsprung s disease is- a complicated and frightful congenital anomaly to the parents, every effort should be taken to reach the optimal result that is beneficial to the patient, parents and surgeon also. Its incidence is 1; 5000, more common in male. The principle for treatment by Rehbien s procedure is to remove the agangilonic narrow segment including the dilated sigmoid colon by dissection of the upper rectum deep down into the pelvic cavity about 2 cm from peritoneal reflection and to elimination of achalasia of internal anal sphincter by vigorous dilatation. Assessment of the advantage of the Rehbein procedure in treatment of Hirschsprung disease. 50 cases [44 male and 6 female] with Hirschsprung s disease presented with positive history of delayed passing meconium, clinical symptoms and Ba-enema [different level of narrow segment] treated by Rehbien s procedure are presented at central teaching hospital for pediatrics between Aug 1998-april 2005 In children failed to thrive, colostomy was performed until their development had progressed well and corresponding to their age Rehbien s procedure was done primarily in 44 cases at the age of 2 months to 3.5 years [88%]. Children who were well corresponding to their age were treated with abdominal resection plus protective loop transverse colostomy at the same time 6 cases [12%]. 39 cases classified as very good [78%]; 8 cases classified as good [16%]; 3 cases classified as satisfactory or unsatisfactory [6%]; No disorders of urinary evacuation such as retention or incontinence were seen. We never observed anal incontinence. In 12 cases[24%], an anastomotic line stenosis was treated by Hegars dilator under general anesthesia and continued at home by the family, No anastomotic leak was found. 8 cases[16%] needed frequent anal dilatation under general anesthesia at intervals. 1 case needed sphincter'otomy. Hirschsprung disease is not an uncommon disease. Its treatment needs experience and surgery can have uncorrectable complications. I found that this procedure is efficient, easy to perform, and less time- consuming and carries few complications and finally keeps good relation with the families of the children

Posterior sagittal anorectoplasty [PSARP]. A new approach for treating anorectal malformations

Anorectal malformation is a congenital anomaly of different varieties and its correction needs good experience, knowledge about this varieties and specific surgical tools, otherwise the child may lose his the only chance to live normally without disastrous complication like incontinence. assessment of the advantage of this procedure in management of anorectal malformations and the percentage for anal continence. This study was carried out in the child's central teaching hospital in Baghdad total number [70] cases were included in the study, 37 males and 33 females: aged 7 days to 6 years. They attended the hospital between October 1998-october 2004.* Male defect included: 1] Low type....5 cases No colostomy needed. 2] Intermediate type....23 cases, needed colostomy. 3] High type.... 9 cases needed colostomy. Female defects: 1] Imperforate anus with vestibular fistula-31 cases. 2] Imperforate anus without fistula 2 cases. From the study we gain the following results- all the male patients with low and intermediate types 28 cases [40%] show 100% continence. All female patients with imperforated anus with vestibular fistula and without fistula 33 cases [47%] show 100% continence. The combination of male and female patients show 61 patients of 70 show 100%continence in a percentage of 87%. The nine cases [12.85%] with recto bladder neck fistula show poor continence due to their bad sacral contour associated with the poor development of pelvic muscles sphincter. This result was revealed from follow-up together with the presence of external sphincter muscle contraction which occurs during digital PR examination or by the use of surgical dilators. From the study we found that this procedure gives high percentage of continence and should be used instead of other procedures

Physician's definition and management of hypertension in Kuwait

Based on questionnaire responses elicited from 378 physicians working in April - May 1986, the study collected information on the physicians definition of hypertension and their usual modes of managing the problem. A large majority of the primary health care [PHC] physicians, as well those in hospitals, used multiple BP readings to diagnose the disease. However, 23% of physicians measured BP only if the patient presented some symptoms. When our findings are compared with an American study conducted in 1977, a substantial percentage of the Kuwait study physicians regarded a diastolic blood pressure [DBP] of 95-99 mm Hg. as normal for patients aged 40+, while almost all the American physicians considered a DBP less than 95 to be normal for all ages studied. Unlike the American study, 85% of the PHC and 55% of the hospital physicians in Kuwait used sedatives or tranquilizers as the initial therapy. The survey findings lead us to assert that there is a need to develop national guidelines for the definitional management of hypertension. There is also a need to institute blood pressure measurement as a routine procedure in the PHC setting. Finally, a multi-pronged approach including a strong emphasis on patient education is necessary