SILAR deposited iron phosphate as a bifunctional electrocatalyst for efficient water splitting.

The development of efficient and earth-abundant electrocatalysts for overall water splitting is important but still challenging. Herein, iron phosphate (FePi) electrode is synthesized using a successive ionic layer deposition and reaction (SILAR) method on a nickel foam substrate at room temperature and is used as a bifunctional electrocatalyst for water splitting. The prepared FePi electrodes show excellent electrocatalytic activity and stability for the oxygen evolution reaction (OER) and hydrogen evolution reaction (HER). The FePi electrode exhibits low overpotential of 230 mV and 157 mV towards the OER and HER, respectively, with superior long-term stability. As a result, an electrolyzer that exploits FePi as both the anode and the cathode is constructed, which requires a cell potential of 1.67 V to deliver a 10 mA cm-2 current density in 1 M KOH solution. The exceptional features of the catalyst lie in its structure and active metal sites, increasing surface area, accelerated electron transport and promoted reaction kinetics. This study may provide a facile and scalable approach to design a high-efficiency, earth-abundant electrocatalyst for water splitting.

Isolated Neurogenic Bladder Associated With Human T-Lymphotropic Virus Type 1 Infection in a Renal Transplant Patient From Central Australia: A Case Report.

BACKGROUND: Human T-lymphotropic virus type 1 (HTLV-1) is endemic amongst the Aborigines of the Northern Territory of Australia. HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been associated with this infection. In general population, isolated neurogenic bladder dysfunction in HTLV-1-infected individuals without HAM/TSP has been reported, and the HTLV-1 proviral load has been found to be higher in such patients compared with asymptomatic carriers. In solid organ transplantation, few cases of HAM/TSP have been reported worldwide, but not an isolated neurogenic bladder. CASE: A 50-year-old indigenous women from Alice Springs with end stage renal disease secondary to diabetic nephropathy with no prior history of bladder dysfunction received a cadaveric renal allograft following which she developed recurrent urinary tract infections. The recipient was seropositive for HTLV-1 infection. HTLV-1 status of donor was not checked. Urodynamic studies revealed stress incontinence and detrusor overactivity without urethral intrinsic sphincter deficiency. She had no features of myelopathy. There was elevation of the serum and cerebrospinal fluid HTLV-1 proviral load. The magnetic resonance imaging myelogram was normal. Pyelonephritis was diagnosed based on clinical features, positive cultures, and renal allograft biopsy. Continuous suprapubic catheter drainage helped preventing further episodes of allograft pyelonephritis in spite of chronic colonization of the urinary tract. CONCLUSION: Isolated bladder dysfunction is a rare manifestation of HTLV-1 infection and is probably associated with high proviral loads. This may adversely affect renal allograft and patient outcomes.

An Unusual Case of Pulmonary Mucormycosis.

Invasive fungal infections in solid organ transplant recipients are associated with significant morbidity and mortality. Of these fungal infections, mucormycosis presents as an aggressive, frequently fatal angioinvasive infection. Immunocompromised hosts and diabetes are important risk factors. These infections are frequently difficult to diagnose. A high index of suspicion in the appropriate setting and early, aggressive treatment with the newer antifungal agents have altered the previously grave prognosis. We present the first reported case of cavitating pulmonary mucormycosis in a renal transplant recipient caused by an unusual species of Mucorales. The patient was treated with a combination of lobectomy and antifungal treatment comprising of amphotericin B and posaconazole. He remains free of disease recurrence on monotherapy with posaconazole.

Extending the longevity of a complicated arteriovenous fistula using endovascular intervention.

A brachiocephalic arteriovenous fistula was complicated by a central venous stenosis, which could not be relieved. A cephalojugular bypass was performed using an interpositoned graft, which later developed tight stenoses at both ends of the graft. This was successfully treated with endovascular intervention, extending the longevity of the vascular access.

A case of fatal disseminated Apophysomyces elegans infection in a renal allograft recipient.

An unusual fatal infection with Apophysomyces elegans belonging to the fungal class Zygomycetes in a renal transplant recipient is presented.

A prospective study of cutaneous abnormalities in patients with chronic kidney disease.

There are diverse ways in which the skin is affected by chronic kidney disease (CKD). Various specific and nonspecific skin abnormalities are observed in patients with CKD. The aim of the study was to document the prevalence of skin diseases that commonly occur in patients with CKD on medical treatment and dialysis. A total of 99 patients with CKD were examined for evidence of skin diseases. Ninety-six had at least one cutaneous abnormality attributable to CKD. The most prevalent finding was xerosis (66.7%), followed by pallor (45.45%), pruritus (43.4%), and cutaneous pigmentation (32.3%). Other cutaneous manifestations included dermatitis (27.27%); Kyrle's disease (17.17%); fungal (8.08%), bacterial (11.1%), and viral (5.05%) infections; purpura (10.1%); gynecomastia (4.04%); and yellow skin (5.05%). The common nail changes were half and half nails (36.36%) and onycholysis (13.13%). CKD is associated with various cutaneous abnormalities caused either by the disease or by treatment, the most common being xerosis and pruritus. The dermatologic complications can significantly impair the quality of life in certain individuals; therefore, earlier diagnosis and treatment is important to improve their quality of life.

Is soluble transferrin receptor a good marker of iron deficiency anemia in chronic kidney disease patients?

Anemia in patients with chronic renal failure is multifactorial with an absolute or functional iron deficiency present in 60-80% of patients. In this study, 102 patients of stage 5 chronic kidney disease (CKD) were enrolled. Thirty six age- and sex-matched anemic patients without any known renal disease were taken as controls. Their sTfR levels were measured with anemia profile.(Fe, TIBC, Ferritin, TSAT). The patients were followed up twice, at four weeks and six months. There was a significant statistical difference in the mean sTfR levels in patients when compared to controls (P < 0.01).The mean level of sTfR in CKD patients was 3.23 +/- 2.07 mg/l while in controls this was 5.16 +/- 3.64 mg/l. sTfR had no statistically significant correlation with the levels of hemoglobin, iron, ferritin, TIBC and TSAT. We conclude that owing to complexity of iron metabolism in CKD, sTfR can not be used as a reliable marker of iron deficiency anemia.

Inferior vena cava thrombosis following rectus sheath haematoma.

Inferior vena cava thrombosis following benign extrinsic compression has been infrequently described. It responds well to early recognition and management. A rare presentation of inferior vena cava thrombosis following a rectus sheath haematoma, and successful management, in a 46-year-old woman is reported.

All that is swollen and red is not infection!

Unilateral upper limb extremity swelling and pain are common presentations in clinical practice whose differential diagnoses include cellulitis, abscess, lymphoedema, and venous thrombosis. We report here the case of a renal transplant recipient with an unusual cause of upper extremity swelling and pain. His condition of native radiocephalic, arteriovenous (AV), fistula-related, venous hypertension was misdiagnosed and managed as cellulitis. This case illustrates the importance of an index of suspicion and careful clinical examination for diagnosis and thus, avoid potentially dangerous and distressing symptoms. The patient improved with a surgical AV fistula ligation.

Type 1 diabetes mellitus in a routine diabetes clinic: the association of psycho-social factors, diabetes knowledge and glycaemic control to insulin regime.

In controlled trials intensified diabetes therapy including multiple insulin injection regimes has been shown to improve glycaemic and microvascular disease outcomes in insulin dependent diabetes but this is not clear in routine outpatient practice. We undertook a pragmatic cross sectional study of 200 patients with Type 1 diabetes aged 18-50 years. There were 108 on two insulin injections/day (conventional) and 92 on four injections/day (multiple) with no significant difference for age, sex, social class, body mass index, diabetes duration, hypoglycaemia rate or complications prevalence. The relationship of insulin injection regime used with diabetes knowledge, psychological factors and glycaemic control outcomes was evaluated. Percent glycated HbA1c concentrations (normal range < 5.5%) were worse in the multiple injection group (7.5 +/- 1.7 vs. 6.8 +/- 1.4%, P < 0.001) (mean +/- SD). Their scores for diabetes knowledge (72.5 +/- 8.2 vs. 69.0 +/- 9.8, P < 0.01) were better but treatment satisfaction (29.9 +/- 5.1 vs. 28.5 +/- 6.1, ns) and well-being (49.1 +/- 10.7 vs. 46.5 +/- 12.7, ns) scores were not. Parameters of perceived locus of control were (multiple v conventional): personal (self), 24.5 +/- 5.0 vs. 22.3 +/- 5.9, P < 0.05; medical (doctor), 11.8 +/- 5.1 vs. 10.8 +/- 5.8, ns; situational (chance), 7.9 +/- 5.1 vs. 8.9 +/- 5.9, ns. In multiple regression of HbA1c versus multiple variables only insulin regime (P < 0.001) was significant. We conclude that in routine clinical practice the use of intensive insulin regimes are associated with worse glycaemic control despite patients being marginally more knowledgeable and self directed.

Acute renal failure secondary to myoglobinuria.

Acute Renal Failure (ARF) secondary to rhabdomyolysis and myoglobinuria was seen in four patients. In three, this was secondary to trauma and the fourth patient had an inflammatory myositis. All 4 patients had total recovery of renal function.