Acute kidney injury secondary to rhabdomyolysis: a rare presentation of chikungunya fever

Chikungunya fever is an arthropod-borne viral illness characterised by high grade fever and incapacitating arthralgias. It is considered benign; however, in the recent outbreaks, several complications have been reported worldwide. We report a case of male patient with Chikungunya fever, possibly contracted from infected mosquitoes endemic in Karachi, Pakistan. The clinical presentation included fever, myalgias and anuria. Investigations revealed renal failure and significantly raised creatinine phosphokinase [CPK], suggesting rhabdomyolysis to be the cause of acute kidney injury [AKI]. Rhabdomyolysis is likely occurred due to virus-induced myositis; a rare presentation of Chikungunya fever. The patient gradually recovered from renal failure following supportive care and renal replacement therapy

Reasons for removal of non-tunneled double lumen catheters in incident dialysis patients

Objective: To evaluate the reasons of removal of non-tunneled double lumen catheters [NTDLC] in incident hemodialysis [HD] patients in a tertiary renal care hospital. Study Design: Observational retrospective study. Place and Duration of Study: Department of Nephrology, The Kidney Centre Postgraduate Training Institute [TKC PGTI], Karachi, from June 2015 to May 2016

Methodology: All patients were selected who had naive NTDLC placement at TKC PGTI either in Emergency Room [ER] or Intensive Care Unit [ICU] during the study period. The reason for removal were observed. Data was analysed by SPSS 21 and mean, percentages and frequencies were calculated. Cross tabulation between variables was done to find significance

Results: A total of 429 NTDLCs were inserted in the study period, out of which 296 catheters were inserted for incident HD. One hundred and twenty-seven [42.9%] catheters were removed prematurely due to malfunction, and 50 [17%] due to catheter-related blood stream infection [CRBSI]. Methicillin resistant Staphylococcus aureus was the commonest organism responsible for CRBSI. One hundred and five [35.47%] catheters were removed because the permanent vascular access [PVA] became usable

Conclusion: Catheter malfunctions and infections frequently occurred in NTDLC used for HD, which culminated early removal of catheter. Early creation of PVA should be encouraged to reduce the complications in already immunocompromised patients

Mortality trend among hemodialysis patients during the islamic month of ramadan: a 24 years retrospective study

The effect of month of Ramadan on the mortality in hemodialysis patients, and to compare it with that in all other Islamic months. A descriptive study. Hemodialysis Unit, The Kidney Center, Karachi, from January 1989 to December 2012. All those patients who were diagnosed to have end stage kidney disease and on maintenance hemodialysis for more than 3 months, regardless of underlying cause of kidney failure were included. Patients with acute kidney injury were excluded. Status of the patients was recorded at the end of the study period. The fasting status of the patients was not mentioned. The deaths of the patients were further evaluated and frequencies of death in all twelve Islamic months were calculated. A total of 1,841 patients were registered, out of whom 897 [48.7%] died, and 269 [14.6%] survived till the end of the study. One thousand and fifty six [57.3%] were males, 651 [35.4%] were diabetic. Total number of 143 [7.76%] events occurred in Ramadan, out of which 94 patients died which make nearly 11% of the total deaths distributed in 12 Islamic months. Frequency of death was higher in Ramadan when compared with other months. Ramadan reflected a higher frequency of death. Therefore, there is a need to evaluate the risk factors in a prospective study so that the dialysis patients can be better managed during this period

Dialyzer reuse: justified cost saving for south Asian region

In spite of controversies, dialyzer reuse has remained an integral part of hemodialysis because of lower cost, good overall safety record, and improved membrane biocompatibility. Reuse declined in developed countries from the beginning of this century because of mass production of hemodialyzers at favourable price with better biocompatible membrane. Abandoning dialyzer reuse became challenging in South Asian region, where more than 40% of the population live below the International Poverty Line of [dollar sign]1.25 per day, less than 10% of end stage renal disease patients receive renal replacement therapy, and upto 70% of those starting dialysis stop treatment due to cost within the first 3 months. Dialyzer reuse is an efficient cost-saving method that allows the use of more efficient and expensive biocompatible synthetic membranes, thereby providing high-quality dialysis to individuals living in countries with limited medical resources without compromising the safety or effectiveness of the treatment

Effect of exogenous platelet-activating factor on sperm capacitation

Background: Freshly ejaculated spermatozoa in female reproductive system are not able to fertilize the egg. Spermatozoa first get capacitated by having some physiological changes and then become acrosome reacted to get this ability. Capacitating factors are present in female reproductive system and semen. Among capacitating factors a unique and potent signaling phospholipid is found in spermatozoa called Platelet Activating Factor [PAF]. ,Apart from the activation of platelets, PAF has numerous other effects related to reproduction like sperm motility, sperm capacitation, acrosome reaction, implantation, embryo development and parturition

Objective: It was aimed to study the effect of exogenous platelet activating factor on capacitation and acrosome reaction in normal sperms

Subjects and Methods: Twenty semen samples were collected as per WHO criterion for semen analysis from normospermic males. The sperms were separated from the seminal fluid by using Sydney IVF Sperm gradient kit. Chlortetracycline [CTC] assay was employed to assess the specific immunofluorescent pattern in spermatozoa for incapacitation, capacitation and acrosome reaction. A group of sperms incubated in sperm washing medium was compared with the group of sperms incubated in exogenous PAF

Results: The results were obtained as percentage of sperms stained with Chlortetracycline for the specific immunofluorescent pattern. A significant difference [p<0.05], was observed between the two groups revealing that the exogenous PAF significantly promotes sperm capacitation as well as acrosome reaction in the normospermic subjects

Ovarian response to ovulation induction

Objective: to analyze the response of ovaries to ovulation inducing agents

Patients and Methods: study period was _ June 2006 to December 2008. Study design was observational study. 833 patients were enrolled in this study. Different ovulation inducing agents were used to stimulate the ovaries. The median age was 26 years with a range of 21-39 years. Follicular development was assessed in both ovaries by TVS and endometrial thickness was noted on day 11 of the cycle. Data was analyzed by SPSS Version 11.0

Results: 37.82% patients showed f9tliculatdeyelqpment in both ovaries; 34.9% patients showed dominant follicle in right ovary while18.97% showed follicular development in· left ovary alone. Endometrial thickness was better in association with right sided follicular development

Conclusion: it was seen-that-right-ovary showed a better response to ovulation inducing agents as compared to the left ovary. Endometrial thickness was evaluable on day 11 showing growth. The significance of this finding is unclear and more studies need t9be done to confirm this finding