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1.
Saudi J Kidney Dis Transpl ; 28(5): 1133-1137, 2017.
Article in English | MEDLINE | ID: mdl-28937074

ABSTRACT

A prospective observational study examining the incidence and microbiological aspects of peritonitis complicating acute intermittent peritoneal dialysis (IPD) was performed. A total of 145 acute IPD treatments were included involving 112 patients. The majority of patients suffered from acute kidney injury (72.3%) secondary to sepsis. Peritonitis occurred in 31 treatment sessions, giving a frequency of 21.4% of procedures performed. The mean interval between starting dialysis and the first sign of peritonitis was 2.9 days, with 58% of cases occurring in the Intensive Care Unit. Frequent catheter manipulation/repositioning and leakages were identified as significant predisposing factors for peritonitis, and the risk of peritonitis was increased with longer duration of IPD. Gram-negative infections were more common than Grampositive infections. The use of systemic antibiotics did not prevent the development of peritonitis.


Subject(s)
Acute Kidney Injury/therapy , Bacterial Infections/epidemiology , Bacterial Infections/microbiology , Peritoneal Dialysis/methods , Peritonitis/epidemiology , Peritonitis/microbiology , Acute Disease , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Adult , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/diagnosis , Bacterial Infections/prevention & control , Female , Humans , Incidence , India/epidemiology , Male , Middle Aged , Peritoneal Dialysis/adverse effects , Peritonitis/diagnosis , Peritonitis/prevention & control , Prospective Studies , Risk Factors , Time Factors , Treatment Outcome
2.
Saudi J Kidney Dis Transpl ; 27(5): 1026-1028, 2016.
Article in English | MEDLINE | ID: mdl-27752015

ABSTRACT

Gitelman's syndrome is an autosomal recessive renal tubular disorder characterized by hypomagnesemia, hypokalemia, hypocalciuria, and metabolic alkalosis. Hypocalcemic tetany as a presentation of Gitelman's syndrome has rarely been reported in literature. We report a rare case of Gitelman's syndrome presenting with hypocalcemic tetany along with hypokalemic periodic paralysis. A 17-year-old female was admitted to our hospital with a history of perioral numbness and carpal spasms of five days duration with progressive quadriparesis developing over a period of few hours. Past history was significant for three episodes of transient lower limb weakness. On examination, blood pressure was 110/70 mm Hg. Chvostek's sign and Trousseau's sign were positive. Neurologically, she was fully oriented. She had Grade 3 power in all the four limbs with intact sensation. Laboratory tests showed hypocalcemia (7.8 mg/dL), hypokalemia (2.2 mEq/L), hypomagnesemia (0.9 mEq/L), and hypocalciuria (104 mg/day). Arterial blood gas showed mild metabolic alkalosis with respiratory compensation. Thus, a clinical diagnosis of GS was made. The patient made a remarkable recovery after the correction of electrolyte imbalance. The aim of this case report is to re-emphasize the fact that hypocalcemia can rarely occur in Gitelman's syndrome.


Subject(s)
Gitelman Syndrome , Hypokalemic Periodic Paralysis , Tetany , Adolescent , Alkalosis , Bartter Syndrome , Female , Humans , Hypokalemia
4.
Saudi J Kidney Dis Transpl ; 24(1): 97-9, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23354201

ABSTRACT

Emphysematous pyelonephritis (EPN) is an acute necrotizing infection with evidence of gas inside the kidney, perinephric space, and/or urinary collecting system. This condition is usually encountered in an obstructed urinary system of diabetics or immunocompromised patients and carries poor prognosis. The gold standard for early diagnosis is computed tomography (CT) of the abdomen. Percutaneous/surgical drainage and urgent or delayed nephrectomy are the available treatment options. We report one case of EPN, which was diagnosed in an immunocompetent non-diabetic man with a non-obstructed urinary system.


Subject(s)
Emphysema/diagnostic imaging , Kidney/diagnostic imaging , Pyelonephritis/diagnostic imaging , Diabetes Mellitus , Diagnosis, Differential , Emphysema/etiology , Humans , Male , Middle Aged , Pyelonephritis/etiology , Tomography, X-Ray Computed
5.
Respirology ; 17(7): 1080-5, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22758397

ABSTRACT

BACKGROUND AND OBJECTIVE: The temporal profile of inflammatory markers during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and their relationship to clinical response are not well characterized. The aim was to assess the changes in levels of inflammatory markers in AECOPD and correlate these with clinical and laboratory indices of recovery. METHODS: Serum levels of C-reactive protein (CRP), interleukin (IL)-6 and fibrinogen were measured in patients with AECOPD within 24 h of hospitalization and pre-discharge (stable state). RESULTS: Ninety-seven patients were evaluated (79 males; mean (SD) age, 61.4 (10.3) years). Eighty eight (90.7%) were current or former smokers, with a median consumption of 15 (0-75) packs/year. The median duration of COPD was 8 (2-25) years. Forty-six patients (56.9%) required mechanical ventilation for a median of 5 days (1-34) while in hospital. The median duration of hospital stay was 13 days (1-77). At reassessment before planned discharge, the levels of dyspnoea, leucocyte counts, erythrocyte sedimentation rate, creatinine, partial pressure of oxygen, and albumin normalized. The levels of CRP, IL-6 and fibrinogen reduced significantly but did not reach the normal range. Changes in IL-6 and fibrinogen levels correlated significantly with the acute physiologic assessment and chronic health evaluation II score, smoking history, blood pressure and leucocyte counts. Baseline IL-6 and fibrinogen levels significantly predicted a prolonged duration of mechanical ventilation. CONCLUSIONS: During AECOPD, the inflammatory response lags behind clinical and biochemical improvement. Fibrinogen and IL-6 are potentially useful markers for monitoring clinical response following an acute episode.


Subject(s)
Acute-Phase Proteins/metabolism , Cytokines/blood , Pulmonary Disease, Chronic Obstructive/blood , Pulmonary Disease, Chronic Obstructive/physiopathology , Acute Disease , Aged , Biomarkers/blood , Disease Progression , Female , Hospitalization , Humans , Length of Stay , Male , Middle Aged , Prognosis , Prospective Studies
7.
Trop Gastroenterol ; 32(1): 45-9, 2011.
Article in English | MEDLINE | ID: mdl-21922856

ABSTRACT

INTRODUCTION: Adult intussusception is a rare clinical entity in contrast to pediatric intussusception. Varied and non-specific clinical features, delayed presentation, and lack of awareness among attending surgeons to consider it as differential diagnosis complicates the clinical course of the disease. METHODS: A retrospective study was conducted in a tertiary care teaching hospital in north India. Nine adult patients who presented with intussusception over a period of six years were analyzed. Their clinical profile, management and underlying pathology were studied. RESULTS: Five out of nine patients had acute presentation while remaining four presented with subacute/chronic symptoms. Median duration of presentation was 8 days (range 2-180 days). Clinical diagnosis of intussusception was considered in only one patient. Ultrasonography clinched the diagnosis in all four patients who presented with subacute/chronic symptoms. Ileo-ileal intussusception was present in five patients, with one having associated jejuno-jejunal intussusception. Other four patients had ileo-colic intussusception. Seven of the 9 patients (77%) were found to have associated bowel gangrene. Resection of the bowel segment having intussusception was done in all patients. Five patients had associated benign intestinal pathology while idiopathic intussusception was present in four patients. CONCLUSION: The patients presented in the series are distinct from cases reported earlier in literature in term of late presentation, manifesting as acute intestinal obstruction, high frequency of associated intestinal gangrene, and absence of associated intestinal malignancy. Patients presenting with features of intestinal obstruction and abdominal lump should be subjected to urgent imaging studies to examine the possibility of intussusception. The high frequency of bowel gangrene encountered in patients of adult intussusception mandates prompt surgical intervention soon after diagnosis.


Subject(s)
Gangrene/complications , Intussusception/complications , Adolescent , Adult , Female , Gangrene/diagnosis , Gangrene/surgery , Humans , Intussusception/diagnosis , Intussusception/surgery , Male , Middle Aged , Retrospective Studies
8.
Saudi J Kidney Dis Transpl ; 22(3): 549-51, 2011 May.
Article in English | MEDLINE | ID: mdl-21566318

ABSTRACT

Nephrobronchial fistula is a rare complication seen in association with renal infections, trauma or stone disease. Xanthogranulomatous pyelonephritis (XGP) is an infectious disease with a potential for fistulization to lung, skin, colon and other organs. We present a case of nephrolithiasis complicated by obstruction leading to pyonephrosis and nephrobronchial fistula, treated successfully by nephrectomy and excision of fistulous tracts. Nephrobronchial fistula, although a rare complication of longstanding renal stone, should be considered when a patient presents with perirenal suppurative process. This clinical case illustrates the natural history of nephro-bronchial fistula and the relevance of early treatment of nephrolithiasis.


Subject(s)
Bronchial Fistula/complications , Kidney Diseases/complications , Nephrolithiasis/complications , Pyelonephritis, Xanthogranulomatous/complications , Urinary Fistula/complications , Adolescent , Bronchial Fistula/diagnostic imaging , Bronchial Fistula/surgery , Female , Humans , Kidney Diseases/diagnostic imaging , Kidney Diseases/surgery , Nephrolithiasis/diagnostic imaging , Nephrolithiasis/surgery , Pyelonephritis, Xanthogranulomatous/surgery , Radiography , Urinary Fistula/diagnostic imaging , Urinary Fistula/surgery
9.
Hernia ; 15(5): 587-9, 2011 Oct.
Article in English | MEDLINE | ID: mdl-20617448

ABSTRACT

Abdominoscrotal hydrocele is an hourglass hydrocele with both an inguinoscrotal and abdominal component. It is a rare surgical entity with few cases reported in the literature. We report a case of abdominoscrotal hydrocele that gives an insight into its pathogenesis.


Subject(s)
Abdomen , Testicular Hydrocele/etiology , Adult , Humans , Male , Testicular Hydrocele/diagnosis , Testicular Hydrocele/surgery , Young Adult
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