Pachydermoperiostosis Presenting With End-Stage Kidney Disease.

Pachydermoperiostosis, also known as Touraine-Solente-Golé syndrome, is an uncommon hereditary condition. This condition includes skin thickening (pachydermia), abnormalities of the bones (periostosis), and digital clubbing (acropachy). We present a case of complete pachydermoperiostosis who presented with end-stage kidney disease. Chronic tubulointerstitial disease secondary to long-term analgesics and complementary and alternative medications was considered the likely etiology for renal dysfunction. The patient underwent serial hemodialysis followed by arteriovenous fistula surgery. In view of significant synovial inflammation, he was also given a selective COX-2 inhibitor. Pachydermoperiostosis is a rare condition, and although there is no therapy for the condition itself, medicinal or surgical interventions can effectively control its secondary effects.

Association Between Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score and Arteriovenous Fistula Failure in Patients on Maintenance Hemodialysis.

BACKGROUND: Arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis in end-stage renal disease (ESRD) patients but has a significant failure rate. Atherosclerotic cardiovascular disease (ASCVD) is a major cause of mortality in ESRD patients. Atherosclerosis of the peripheral vessels may contribute to poor maturation of AVF leading to the exploration of the ASCVD score as a prognostic tool for AVF failure. METHODS: This study included 110 hemodialysis patients with AVFs and aimed to examine the association between ASCVD score and AVF failure. Participants were categorized into the presence of vascular access failure (N=12) and absence of vascular access failure (N=98), and demographic and clinical data were collected.  Results: The study comprised predominantly male patients (63.6%), with a notable prevalence of hypertension and diabetes. Twelve patients experienced AVF failure, with pseudoaneurysms and thrombosis being the predominant causes. The ASCVD risk group at intermediate and high stages exhibited a statistically significant risk (relative risk (RR)=1.403; 95% CI, 1.041-1.904) of AVF failure in comparison to the low and borderline ASCVD risk groups. There was no association of age, gender (male and female), body mass index (BMI), serum calcium, serum phosphorus, intact parathyroid hormone (iPTH), and serum albumin with AVF failure. CONCLUSION: The ASCVD score emerges as a potential prognostic tool to identify dialysis patients at high risk of AVF failure, suggesting avenues for targeted interventions and improved patient care. However, limitations of the ASCVD risk estimator and study limitations, such as small sample size and absence of mortality data, warrant cautious interpretation and necessitate further exploration in larger patient populations.

Pulmonary renal syndrome secondary to malignant hypertension.

A man in his early 30s presented with sudden-onset respiratory distress, haemoptysis and reduced urine output. He was in volume overload with a blood pressure recording of 240/180 mm Hg. Pulmonary renal syndrome was suspected and he was initiated on plasmapheresis, followed by steroid pulse therapy. Chest radiography and the presence of fragmented red cells on the peripheral smear were unexplained. These were later explained by hypertensive nephropathy and thrombotic microangiopathy changes on renal biopsy. His respiratory and haematological parameters improved with blood pressure control. Malignant hypertension closely resembles pulmonary renal syndrome, which must be remembered in order to avoid plasmapheresis and high-dose immunosuppressive therapy.

Antimicrobial, antioxidant, cytotoxicity and photocatalytic performance of Co doped ZnO nanoparticles biosynthesized using Annona Muricata leaf extract.

In the present study, ZnO nanoparticles doped with 3%, 5% and 7% of cobalt have been synthesized by green method using Annona muricata leaf extract. The obtained nanopowder was characterised by XRD, FTIR, XPS, HRTEM, SAED, SEM, EDAX and UV-Visible spectroscopy techniques. XRD patterns confirm the formation of pure and Co doped ZnO nanoparticles with a hexagonal wurtzite structure with high phase purity. FTIR spectra indicate the stretching vibration of Zn-O at 495 cm-1. The incorporation of Co2+ ions into the ZnO lattice was identified by XPS analysis. EDX spectra confirm the existence of Co, Zn and O elements. The SEM and HRTEM micrographs show morphology of nanoparticles. The optical study specifies a decrease in energy band gap with an increase in Co-doping concentration. The photocatalytic performance of ZnO and Zn0.93Co0.07O has been examined for the degradation of methylene blue (MB) under sunlight irradiation. The antimicrobial activity of synthesized nanoparticles against s.aureus, p.aeruginosa, b.subtilis bacterial strains c.albicans and a.niger fungal strains as investigated. The Zn0.93Co0.07O nanoparticles exhibit good antioxidant properties. Moreover, the cytotoxicity of ZnO nanoparticles was evaluated against L929 normal fibroblast cells. So, this work suggests that Annona muricata leaf extract mediated pure and Co-doped ZnO nanoparticles are a potential candidate for biomedical and photocatalytic applications.