Prognostic utility of CURB-65 and E-CURB-65 scoring systems in healthcare associated pneumonia patients: Short- and long-term mortality.

BACKGROUND: The aim of our study is to evaluate whether the CURB-65 or expanded-CURB-65 score can be used in healthcare-associated pneumonia (HCAP) and subgroups of HCAP patients at the same efficiency. Thirty and 90-day mortality rates of the patients and predictive values of CURB-65 and E-CURB-65 scores were compared. PATIENTS AND METHODS: This is a retrospective study of patients who presented to the Emergency Department between January 2015 and January 2016. All patient charts above 18 years of age were evaluated according to American Thoracic Society and the Infectious Diseases Society of America (ATS/IDSA) pneumonia diagnostic criteria and pneumonia diagnoses were confirmed. RESULTS: 167 pneumonia patients (27.8%) of all pneumonia cases were grouped as HCAP and 433 (54.4%) were grouped as community-acquired pneumonia (CAP). 43% (n = 72) of HCAP patients were classified as nursing home-associated pneumonia (NHAP) and 57% (n = 95) were classified as HCAP (except NHAP) group. NHAP patients were older than the other groups. HCAP (except NHAP) group had somehow more comorbid diseases when compared with the other groups. However, the NHAP group had more unstable vital signs and confusion rates. Hospital and ICU admissions, 30-90-day mortality rates were all significantly higher in NHAP group E-CURB-65 was found to have better predictive values than CURB-65 for 30-day and 90-day mortalities overall. CONCLUSION: According to our results, commonly used scoring systems, CURB 65 and E-CURB 65, are not suitable for HCAP, NHAP, and HCAP (except NHAP) patients. NHAP patients have significant worse prognosis compared with CAP and HCAP (except NHAP) in terms of admission to intensive care and 30 and 90-day mortality rates.

Electron microscopic examination of effects of bogma raki and walnut on cochlea: an experimental study.

Illegal alcohol beverages known as bogma raki in our country are consumed widely in our region. The studies investigating the relationship between alcohol consumption and hearing ability report different results. In this study, we aimed to investigate the toxic effects of bogma raki that contains neurotoxic substances on cochlea by electron microscopy. To the best of our knowledge, this study is the first in the literature. A total of 48 Wistar male albino rats (aged 12-16 weeks and weighing 200-240 g) were used in the study. The rats were divided into 4 groups with 12 animals in each group. The groups include control, bogma raki, walnut, and walnut + bogma raki groups. Bogma raki (30% v/v, 9.2 ml kg(-1) day(-1)) is added to drinking water of rats in bogma raki group (n = 12) for 4 weeks. Walnut group rats (n = 12) are fed with standard rat food and walnut without limitation (10 g kg(-1) day(-1)). Bogma raki + walnut group rats (n = 12) are fed with standard rat food and walnut and bogma raki is added to drinking water. The cochleas were dissected and removed en bloc and examined by electron microscopy. Perineuronal oedema around neurons of spiral ganglion and hairy cells of organ of Corti were present in the bogma raki group, walnut group and bogma raki + walnut group under electron microscopic examination. Comparing these three groups, there were no differences in the ultrastructural pathological changes. In the ultrastructural examination of the myelinated axons forming cochlear nerve, no ultrastructural pathology was detected in all the groups.

Investigation of demodex species frequency in patients with a persistent itchy ear canal treated with a local steroid.

OBJECTIVE: To investigate the frequency of demodex species in the external acoustic meatus in patients with an itchy ear canal. METHODS: Patients were assigned to one of three groups. Group one consisted of 54 patients with an itchy ear canal who were using a local agent, while group two was composed of 51 patients with an itchy ear canal who were not using a local agent. Group three consisted of 50 healthy individuals without an itchy ear canal. RESULTS: Demodex species test results were positive in nine (5.8 per cent) of the cases. Six of these positive cases were in group one, two in group two and one in group three. The frequency of demodex species in the external acoustic meatus was similar between those patients with an itchy ear canal who did not use a local agent and the healthy individuals (p = 0.571), but it was significantly higher in those using a local steroid compared with those not using a local agent (p = 0.046). CONCLUSION: Although demodex species was not significantly higher in patients with an itchy ear canal compared with the control group, use of a local steroid increased the parasite frequency in the external ear canal of affected patients.

Effect of phosphodiesterase-5 inhibitor on hearing.

OBJECTIVE: Following a report of sudden hearing loss in a patient taking phosphodiesterase type 5 inhibitor, and a Food and Drug Administration announcement concerning this class of drugs, a study was planned to investigate if ototoxicity occurs in patients using phosphodiesterase 5 inhibitor for erectile dysfunction. METHODS: Eighteen patients with erectile dysfunction who had been using phosphodiesterase 5 inhibitor were included in the study. Audiometric tests were performed on all patients, between the frequencies 250 and 16,000 Hz, before and 1, 5 and 72 hours after drug ingestion. RESULTS: Four patients showed a unilateral threshold decrease compatible with ototoxicity criteria; this change was reversible. A statistically significant difference in pre- versus post-drug hearing thresholds was observed in the right ear at 10,000 Hz (p = 0.008). There were no statistically significant hearing threshold differences at any other frequencies (p > 0.05). CONCLUSION: Although temporary ototoxicity was noted in four patients, we could not find any permanent, deleterious effect of phosphodiesterase type 5 inhibitor on hearing thresholds.

Effects of spironolactone in an experimental model of chronic cyclosporine nephrotoxicity.

BACKGROUND: Cyclosporine (CsA)-associated nephrotoxicity is a long-term complication in transplant patients. Chronic CsA nephrotoxicity is associated with renal fibrosis and hyaline arteriolopathy. The aim of this study was to investigate the effect of spironolactone on functional and structural alterations as well as on platelet-derived growth factor B (PDGF-B) and transforming growth factor (TGF) beta expression induced by CsA in a rat model of chronic CsA nephrotoxicity. MATERIALS AND METHODS: Twenty-four rats were divided into 3 groups. Group 1 (G1) received vehicle only (V); G2, CsA (15 mg/kg/d; CsA) by intraperitoneal (IP) injection; and G3, a similar CsA dosage + spironolactone (20 mg/kg/d; CsA + Ald.) by the oral route. At the end of 28 days, glomerular filtration rate (GFR) and blood CsA levels were measured as well as histopathological and immunohistochemical analyses performed on renal tissue. RESULTS: Mean CsA trough levels in G2 and G3 were both above 2000 ng/mL. In G2, GFR was lower than G1 and G3 (0.35 +/- 0.05, 1.64 +/- 0.24, and 1.20 +/- 0.25 mL/min, respectively; P < .001). There was a significantly increased number of arteriolopathic changes in G2 and G3 vs G1 (16% +/- 3.7%, 15% +/- 6.8%, 3% +/- 1.2%, respectively; P < .001). Interstitial fibrosis was significantly increased in G2 vs G1 and G3 (52%, 0%, 27%, respectively; P < .05). Marked by up-regulated PDGF-B and TGF beta expressions were observed in G2 vs G1 or G3: 100%, 0%, 37.5%, respectively, for PDGF-B (P < .001) and 87.5%, 0%, 12.5%, respectively, for TGF beta (P < .001). CONCLUSION: Our results suggested that chronic CsA nephrotoxicity may be mitigated by aldosterone receptor blockade which seemed to be associated with down-regulation of PDGF-B and TGF beta expression.

Renal protective effects of leukotriene receptor blockers in an experimental model of cyclosporine nephrotoxicity.

BACKGROUND: Chronic cyclosporine (CsA) nephrotoxicity is associated with renal fibrosis and hyaline arteriolopathy. Fibrogenic cytokines, such as transforming growth factor-beta (TGF-beta) and vascular endothelial growth factor (VEGF), play a pivotal role in CsA nephrotoxicity. Previous studies have demonstrated the possible role of leukotrienes (LT) in chronic CsA nephrotoxicity. The aim of this study was to examine the possible beneficial effects of LT blockers in attenuating the morphological and histochemical effects induced by CsA in a rat model of CsA nephrotoxicity. MATERIALS AND METHODS: Twenty-four male Wistar rats were divided into 3 groups (n = 8). The first group (G1) was treated with vehicle intraperitoneally (IP) for 60 days. The second group (G2) was treated with 15 mg/kg CsA IP for 60 days. The third group (G3) was treated with the same dose of CsA plus 4 mg/kg montelukast administered by oral gavage for 60 days. RESULTS: There was a statistically significant decrease in glomerular filtration rate (GFR) among G2 compared with G1 animals: 0.41 +/- 0.03 vs 1.63 +/- 0.12 mL/min (P < .001), or G3 hosts: 0.41 +/- 0.03 vs 0.95 +/- 0.05 mL/min (P < .005), respectively. The percentage of hyaline arteriolopathic changes was higher in G2 than G1 or G3: 81.66% +/- 8.2% vs 11.83% +/- 0.87% (P < .01) or 37.0% +/- 8.8% (P < .01), respectively. Fibrosis score was higher in G2 compared with G1 or G3: 1.5 +/- 0.04 vs 0.16 +/- 0.02 (P < .001) and 1.0 +/- 0.05 (P < .05), respectively. TGF-beta and VEGF immunoexpression were significantly increased in G2 compared with G1 (P < .05) or G3 (P < .05). CONCLUSIONS: Our study suggested that LT may play a critical role in the pathogenesis of chronic CsA nephrotoxicity; the administration of montelukast, a LT receptor blocker, may prevent CsA-induced nephrotoxicity.

Effects of cholesteryl ester transfer protein TAQ1B polymorphism in renal transplant patients.

BACKGROUND: Dyslipidemia is an important complication in renal transplant patients. Cholesteryl ester transfer protein (CETP) mediates the exchange of cholesteryl ester between high density lipoproteins and low density lipoproteins. The aim of this study was to investigate CETP Taq1B gene polymorphism and lipid abnormalities in renal transplant patients. METHODS: We studied 29 renal transplant patients and 29 healthy controls. CETP Taq1B polymorphism was determined by polymerase chain reaction and restriction fragment length polymorphism techniques. Serum lipid levels were measured enzymatically. Statistical analyses was performed by SPSS for Windows version 7.5. RESULTS: The frequencies of CETP Taq1B B1B1, B1B2, and B2B2 genotypes in patients were 44.8%, 34.5%, and 20.7%; and in control subjects, 37.9%, 37.9%, and 24.2%, respectively. The patients with B1B1 genotype displayed higher levels of total cholesterol (TC), triglycerides, low density lipoprotein-cholesterol (LDL-C), very low density lipoprotein-cholesterol (VLDL-C), and diastolic blood pressure (DBP). (P<.05). Also, patients showing a B1 allele had higher levels of TC, LDL-C, VLDL-C, and DBP compared to healthy controls (P<.05). CONCLUSION: We observed that CETP Taq1B B1 allele and B1B1 genotype have effects on the serum lipid profile among renal transplant patients.

Inhibition of the renin angiotensin system decreases fibrogenic cytokine expression in tacrolimus nephrotoxicity in rats.

The aim of our study was to investigate the influence of angiotensin-converting enzyme (ACE) inhibition and angiotensin II receptor blockage on the renal function by light microscopic and immunohistochemical findings in a rat model of tacrolimus nephrotoxicity. Thirty-two male Wistar rats were divided into four groups of eight: G1 = control group; G2-G3, G4 = Tacrolimus (Tac) 1 mg/kg/d intraperitoneally (ip); G3 (Tac + Q) = ip Tac and peroral quinapril 10 mg/kg; and G4 (Tac + V) = Tac and valsartan 40 mg/d. Serum blood urea nitrogen (BUN), creatinine, and creatinine clearance were measured before and at the end of the study period. Renal tissues were assessed for light microscopic findings of tacrolimus toxicity. Transforming growth factor-beta, VEGF, PDGF, BMP-7, and interleukin-6 (IL-6) expression were semiquantitatively scored after immunohistochemical staining. At the end of the study period serum BUN and creatinine levels were increased in all groups, but creatinine clearance was not significantly changed between the groups. Afferent arteriolopathy was significantly less pronounced in G3 versus G2 and G4. Interstial fibrosis was significantly less pronounced in G3 and G4 versus G2. TGF-beta, PDGF, and IL-6 expression were significantly increased in G2, G3, and G4 compared to G1, and in G2 compared to G3 and G4. BMP-7 expression was significantly decreased in G2, G3, and G4 compared to G1, whereas the differences between G2, G3, and G4 failed to reach statistical significance. In conclusion, the results of our study suggested that renin angiotensin inhibition down-regulates fibrogenic cytokine expression in rats displaying tacrolimus nephrotoxicity.

Transforming growth factor-beta1, vascular endothelial growth factor, and bone morphogenic protein-7 expression in tacrolimus-induced nephrotoxicity in rats.

The aim of our study was to investigate transforming growth factor (TGF)-beta1, vascular endothelial growth factor (VEGF), and bone morphogenic protein-7 (BMP-7) expression in the rat model of chronic tacrolimus (TAC) toxicity compared to healthy controls. Seventeen male Wistar rats were divided into two groups: group 1 animals were healthy controls and Group 2 animals were treated with TAC (1 mg/kg per day intraperitoneally for 8 weeks). At the end of the study period the animals were sacrificed following renal function studies including blood urea nitrogen (BUN), serum creatinine, and creatinine clearance, and renal tissues were examined by light microscopy for the findings of tacrolimus toxicity, specifically for afferent arteriolopathy and interstitial fibrosis. TGF-beta1, VEGF, and BMP-7 expression were assessed by semiquantitative scoring of the immunohistochemically stained specimens. Mean TAC levels were 5.53 +/- 2.38 ng/mL in group 2. BUN, creatinine levels, and creatinine clearance were 57.99 +/- 11.13 vs 39.49 +/- 5.64 mg/dL; 0.60 +/- 0.16 vs 0.65 +/- 0.09 mg/dL; 0.97 +/- 0.39 vs 1.17 +/- 0.32 mL/min in group 2 versus group 1. Only the BUN level was significantly higher in group 2 compared to group 1. Afferent arteriolopathy and interstitial fibrosis were significantly increased in group 2 compared to group 1. TGF-beta1 and VEGF expression was significantly increased while BMP-7 expression was significantly decreased in group 2 versus group 1. In conclusion, our findings suggest that TAC-induced nephrotoxicity is associated with increased TGF-beta1 and VEGF and decreased BMP-7 expression.

Paraoxonase 192 polymorphism and its relationship to serum lipids in Turkish renal transplant recipients.

BACKGROUND: Cardiovascular disorders are the leading cause of death in patients with chronic renal insufficiency. Paraoxonase (PON1) gene variants have been identified as risk factors for cardiovascular disease (CVD). METHODS: We investigated the effect of PON1 192 polymorphisms on serum lipid profiles in 29 renal transplant recipients and 26 control subjects. Distribution of the PON1 192-gene polymorphism was determined by polymerase chain reaction-based restriction fragment length polymorphism. Serum lipid levels were measured enzymatically. RESULTS: Frequencies of PON1 192 AA, BB, and AB genotypes among the renal transplant recipients were 38.5%, 26.9%, and 34.6%, and among control subjects they were 35.75%, 17.9%, 46.4%, respectively. The genotype distribution for the PON1 192 polymorphism was not different between the two groups (P = NS, chi-square test). The PON1 192 polymorphisms failed to consistently influence the serum lipid profiles in renal transplant recipients. CONCLUSION: We have shown that the 192 polymorphism of the PON1 gene is not associated with increased cardiovascular risk in renal transplant recipients.

Cyclosporine-A induced nephrotoxicity is associated with decreased renal bone morphogenetic protein-7 expression in rats.

The aim of our study was to investigate bone morphogenetic protein-7 (BMP-7) expression in a rat model of chronic cyclosporine (CsA) toxicity compare with healthy controls, as well as the influence of treatment with the angiotensin-converting enzyme inhibitor (ACEI) quinapril. Twenty-four male Wistar rats were divided into groups of eight animals treated with CsA (15 mg/kg intraperitoneally) for 8 weeks (CsA group) without or with quinapril (10 mg/kg per day in the drinking water: CsA group + Q) for comparison with healthy controls (H group). The renal tissues were examined by light microscopy for CsA toxicity; specifically, tubulointerstitial damage and afferent arteriolopathy as well as BMP-7 expression were semiquantitatively scored by immunohistochemical staining. Mean CsA levels were 1982 ng/mL and 1968 ng/mL for the CsA and CsA + Q groups, respectively. At the end of the study period, the mean serum creatinine levels were 0.8 +/- 0.2 mg/dL, 1.6 +/- 0.8 mg/dL, and 1.4 +/- 0.8 mg/dL for the H, CsA, and CsA + Q groups, respectively. Interstitial fibrosis, tubular atrophy, and afferent arteriolar hyalinization were present in the CsA group and, to a lesser degree, in the CsA + Q group, compared with the H group. CsA-treated rats displayed significantly decreased BMP-7 expression compared with healthy controls (P <.0005). BMP-7 expression was higher among the CsA + Q group than the the group CsA group. In a rat model histologic changes characteristic of CsA-induced nephrotoxicity are associated with decreased expression of BMP-7, which seems to be at least partially restored by ACE inhibition.

Angiotension converting enzyme inhibition and calcium channel blockage improves cyclosporine induced glucose intolerance in rats.

The aim of this study was to evaluate the effects of quinapril, valsartan, and amlodipin on glucose tolerance in cyclosporine (CsA)-toxic rats. Among 40 male Wistar rats 32 were administered cyclosporine (CsA) (15 mg/kg) intraperitoneally for 6 weeks. Quinapril (10 mg/kg per day) (group Q), valsartan (40 mg/kg per day) (group V), and amlodipine (10mg/kg per day) (group A) were administered to individual sets of eight CsA-treated animals via the drinking water with the remaining untreated hosts followed as a control group (group C) and 8 healthy controls (group H). A Glucose-tolerance test was performed by administering oral glucose (2 g/kg) followed by blood samples obtained from the tail vein at baseline as well as 30,60,90, and 120 minutes after the glucose load. Glucose area under the curve (AUC) was calculated according to the trapezoidal rule. CsA levels were determined using an immunofluorescence method. Kruskal Wallis ANOVA test was used for statistical analysis. Median CsA levels were 1968 ng/mL, 1982 ng/mL, 1580 ng/mL, 1600 ng/mL; and glucose AUC, 232.4 +/- 130 mg/min per dL, 63.1 +/- 25 mg/min per dL, 115.0 +/- 90 mg/min per dL, 47.4 +/- 34 mg/min per dL 53.4 +/- 38 mg/min per dL for groups C,Q,V,A and H, respectively. Quinapril-treated and amilodipine-treated rats displayed a lower glucose AUC than group C (P <.01), which had higher glucose levels than healthy controls (P <.001). In summary, CsA treated rats show impaired glucose tolerance, which is improved by quinapril or amlodipine treatment. Angiotensin converting enzymes inhibitors and calcium channel blockers affect beta cell function rather than insulin sensitivity.

Is there additional effect of MTHFR C677T mutation on lipid abnormalities in renal allograft recipients?

BACKGROUND: The MTHFR C677T mutation and elevated atherogenic lipoprotein levels are known as cardiovascular risk factors in patients with renal transplantation treated with cyclosporine (CsA). The aim of the present study was to eveluate the contribution of MTHFR C677T mutation to the risk of dyslipidemia in renal transplant recipients. We also studied the effect of the MTHFR-C677 T genotype on transplant survival. METHODS: The study included 29 nondiabetic renal transplant recipients and 27 healthy controls. MTHFR C677T genotypes were determined by PCR and RFLP techniques. Biochemical parameters were measured in a computerized autoanalyzer. RESULTS: In the patient group, the distribution of the CC, CT, and TT genotypes was 44.8% (n = 13), 37.9% (n = 11), and 17.2% (n = 5), respectively. The frequencies of the C and T alleles were 0.64 and 0.36, respectively. Subjects with the T allele had the highest levels of TC (P <.05) and LDL-C (P <.05); subjects with the CC genotype had the lowest. CONCLUSIONS: We observed that the MTHFR T allele has an unfavorable effect on serum lipid profile, leading to a rise in the total and LDL cholesterol concentrations. Thus, we believe that MTHFR C allele has a protective effect and MTHFR T allele has a detrimental effect on the serum lipid profile.

Night-time blood pressure load is associated with higher left ventricular mass index in renal transplant recipients.

The absence of nocturnal fall in blood pressure (BP) is named as nondipper status, which has been shown to be an additional risk factor for the development of left ventricular hypertrophy and cardiovascular events in several high-risk groups. The aim of this study was to determine the influences of the nondipper status and nocturnal blood pressure loads on left ventricular mass index (LVMI) in renal transplant recipients. A total of 35 nondiabetic renal transplant recipients were included into the study. A 24-h ambulatory blood pressure monitoring (ABPM) was performed for all recipients. The nondipper status was defined as either an increase in night-time mean arterial pressure (MAP) or a decrease of no more than 10% of daytime MAP. LVMI was measured by using two-dimensional guided M-mode echocardiography. The night-time systolic blood pressure (SBP) load was defined as the percentage of the time, during which SBP exceeded 125 mmHg during night time. The nondipping was common among renal transplant recipients, of whom 60% were nondipper in our study. LVMI was significantly higher in the nondipper group vs the dipper group (133 +/- 35 g/m(2) vs 109 +/- 26 g/m(2), P = 0.04). A fall in MAP at night time was 14.5 +/- 4.3% in the dipper group, while it was 1.4 +/- 6.1% in the nondipper group (P < 0.001). On stepwise multiple regression analysis, night-time SBP load and haemoglobin were independent predictors of LVMI (R(2) = 0.53). In conclusion, nondipping is common after renal transplantation. Night-time SBP load and low haemoglobin are closely related to the increase in LVMI in renal transplant recipients. ABPM may be a more useful tool in optimizing treatment strategies to reduce cardio-vascular events in renal transplant recipients.

QT dispersion in hemodialysis and CAPD patients.

Prolongation of repolarization dispersion (QT interval dispersion) measured from the 12-lead surface ECG has been associated with sudden cardiac death and ventricular tachyarrhythmias in a variety of cardiac disorders. The aim of our study was to assess the effects of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) on QT dispersion in end-stage renal disease patients. 20 chronic HD patients (mean age 57.75 +/- 13.79 years) and 20 CAPD patients (mean age 50.79 +/- 14.94 years) who had no complaints and symptoms of cardiac arrhythmias as well as 20 healthy volunteers (mean age 48.74 +/- 10.88 years) underwent ECG testing. All HD patients were on bicarbonate three times weekly with cuprophane capillaries. 12-lead ECGs were recorded on the day after HD. The CAPD patients were on a standard CAPD program (four times daily with 2,000 cm(3) peritoneal fluid). ECGs were recorded when the patients were receiving their regular standard CAPD program. All ECGs were analyzed manually by one observer. There were no statistically significant differences in dialysis duration, blood urea nitrogen, creatinine, sodium, calcium, and parathormone values between the HD and CAPD patients. The serum potassium values were significantly higher in HD patients when compared to CAPD patients. There was no difference in the mean of maximal QT among all three groups. The rate of QT interval dispersions was significantly higher in HD and CAPD patients as compared with healthy controls (p < 0.05). There was no statistically significant difference in the QT dispersion rates between HD and CAPD patients. In conclusion, there is a tendency to cardiac arrhythmias in HD patients during the postdialysis period. Although CAPD patients are receiving dialysis daily, they also have higher rates of QT dispersions and accordingly a tendency to arrhythmias.

The Marmara earthquake: epidemiological analysis of the victims with nephrological problems.

BACKGROUND: Crush syndrome resulting from earthquakes is a major cause of morbidity and mortality, as seen during the catastrophic Marmara earthquake that struck Northwestern Turkey in August 1999. This report analyzes the epidemiological characteristics of the crush syndrome victims of this disaster. METHODS: In order to analyze the nephrological problems caused by this earthquake, questionnaires were prepared within the first week of the disaster and sent to 35 reference hospitals that treated the victims. Data obtained by these questionnaires are the subject of this report. RESULTS: Of the 5302 hospitalized patients in reference hospitals, 639 (12.0%) suffered from nephrological problems, and 477 (9.0%) needed dialysis support. Considering the patients with renal problems, there was not any significant difference in gender; however, the incidence of children younger than 10 years and the older population (older than 60 years of age) was significantly lower as compared with the resident population of the affected area (P < 0.001). Nonsurvivors were older (34.5 +/- 16.1 years) than survivors (31.2 +/- 14.4 years, P = 0.048), while no deaths were recorded under the age of 10. Most patients (70.1%) were admitted within the first three days after the earthquake, and the mortality rate among these victims was higher (17.7%) as compared with victims admitted thereafter (10.0%, P = 0.016). The average time period under the rubble was 11.7 +/- 14.3 hours, which was not significantly different between survivors and nonsurvivors, while the victims who required dialysis support spent shorter durations under the rubble, as compared with the ones who were not dialyzed at all (10.3 +/- 9.5 vs. 15.9 +/- 23.1 hours, P < 0.001). CONCLUSION: Victims of catastrophic earthquakes are characterized by a high incidence of renal problems and the need for dialysis support. The incidence of nephrological problems is lower in children, while the period of time under the rubble is not a prognostic indicator of survival.

Technical survival of CAPD catheters: comparison between percutaneous and conventional surgical placement techniques.

BACKGROUND: Percutaneous peritoneal dialysis catheter (PDC) placement is a well-tolerated, rapidly performed bedside procedure that allows a rapid initiation of CAPD. We compared the technical survival of PDCs while comparing the mode of insertion. METHODS: We retrospectively reviewed 215 PDCs inserted over a 60-month period in 191 patients on CAPD therapy. Of these, 133 were placed percutaneously by nephrology staff (group P) and 82 were placed using conventional surgical techniques by surgical staff (group S). The total experience accumulated was 4000 patient-months: 2260 patient-months in group P and 1740 patient-months in group S. RESULTS: The incidence of complications in PDCs did not differ between the groups (1 episode/33 patient-months in group P and 1 episode/29 patient-months in group S). Two episodes of early leakage and 9 episodes of late leakage were observed in group P compared with one early leakage and 4 episodes of late leakage in group S. Of the mechanical complications in group P, 8.86% were due to catheter malfunction, including catheter tip migration and obstruction, compared with 12.63% in group S. The incidence of catheter infections was 1 episode/73 patient-months in group P and 1 episode/62 patient-months in group S. Significantly more catheters were removed in group S compared with group P (40% vs 16%, P<0.001). One-year and 2-year technical survivals were 90% and 82% in group P, and 73% and 60% in group S (P=0.0032), respectively. CONCLUSIONS: Percutaneous bedside placement of PDCs by nephrologists provides a safe and reliable access for peritoneal dialysis.

Diagnostic value of effluent endotoxin level in gram-negative peritonitis in CAPD patients.

OBJECTIVE: To evaluate the diagnostic usefulness of effluent endotoxin by Limulus amoebocyte lysate (LAL) assay in gram-negative peritonitis patients on continuous ambulatory peritoneal dialysis (CAPD) therapy. DESIGN: Prospective study with patients serving as their own controls. Standard microbiologic work up and endotoxin analysis of effluents (night dwell) were done during the pre- and posttreatment phases. SETTING: Specimens from three teaching hospitals were processed and tested at a common center. Patients were left for treatment at their respective centers without intervention. PATIENTS: 32 clinical peritonitis and 40 infection-free CAPD patients were studied. RESULTS: 75% (n = 24) of cultures were positive: 41.6% (n = 10) gram-negative and 58.4% (n = 14) gram-positive bacteria. Effluents of pre- and posttreated gram-negative cultures had endotoxin levels of 1.53 +/- 0.169 and 0.214 +/- 0.085 endotoxin units (EU)/mL, respectively (p < 0.0001); pre- and posttreated gram-positive levels of 0.102 +/- 0.06 and 0.122 +/- 0.052 EU/mL, respectively (p > 0.05); pre- and posttreated culture-negative peritonitis levels of 0.110 +/- 6.025 and 0.087 +/- 0.031 EU/mL, respectively (p > 0.05); peritonitis-free effluents contained 0.117 +/- 0.079 EU/mL. The diagnostic specificity and the sensitivity of LAL assay were 100% and 98.2% respectively. CONCLUSION: Where initial microbiological work-up cannot demonstrate a pathogen, effluent endotoxin determined by quantitative LAL assay is a useful marker for diagnosis and management, within safe time limits, of gram-negative peritonitis in CAPD patients.