Redesigning Kidney Care for the Anthropocene: A New Framework for Planetary Health in Nephrology.

Climate change is one of the greatest threats to human health in the 21st century. The human health impacts of climate change contribute to approximately 1 in 4 deaths worldwide. Health care itself is responsible for approximately 5% of annual global greenhouse gas (GHG) emissions. Canada is a recent signatory of the 26th United Nations Climate Change Conference (COP26) health agreement that is committed to developing low carbon and climate resilient health systems. Kidney care services have a substantial environmental impact and there is opportunity for the kidney care community to climate align clinical care. We introduce a framework of redesigned kidney care and describe examples of low carbon kidney disease management strategies to expand our duty of care to the environment which completes the triple bottom line of optimal patient outcomes and cost effectiveness in the Anthropocene.

Onabotulinum toxin A Injections in Men With Refractory Idiopathic Detrusor Overactivity.

OBJECTIVE: To establish the effectiveness and safety profile of Onaboulinum toxin A (BTX-A) in men with idiopathic detrusor overactivity and compare with the outcomes observed in women. Several randomized trials have demonstrated the effectiveness of intradetrusor BTX-A injections in improving symptoms and quality of life in patients with overactive bladder (OAB) symptoms. Most trials however contained relatively few men or excluded men altogether. MATERIALS AND METHODS: Data patient undergoing BTX-A for refractory OAB with idiopathic detrusor overactivity on urodynamics were extracted from our center's prospectively maintained database. Incontinence impact questionnaire-7 and urogenital distress inventory-6 scores were collected at baseline and 4-12 weeks together with data regarding urinary retention requiring clean intermittent self-catheterization (CISC) and urinary tract infection (UTI). Urodynamic studies were assessed where available to see if voiding dysfunction and CISC were predictable. RESULTS: Sixty-five men received 133 BoNT-A treatments in the 15-year period representing 27.8% of those with refractory OAB. Baseline urogenital distress inventory-6 and incontinence impact questionnaire-7 fell by 4.2 (P = .00) and 6.0 (P = .00) points for men and by 6.0 (P = .00) and 11.1 (P = .00) for women, respectively. De novo CISC was required in 46 (42.6%) men and 107 (35.3%) women (P = .10). UTI was reported in 36 (29.0%) men and 86 (27.0%) women (P = .73). The bladder outflow obstruction index and the bladder contractility index did not reliably predict CISC requirement. CONCLUSION: Men with refractory OAB experience significant improvement in quality of life scores following BTX-A, though the benefit appears greater in women. The requirements for CISC and UTI rates were similar between sexes.

Successful Treatment of PD Peritonitis Due to Morganella morganii Resistant to Third-Generation Cephalosporins - A Case Report.

Morganella morganii is a rare cause of peritonitis in patients on peritoneal dialysis (PD). Most of the reported cases have resorted to a switch to hemodialysis. We herein report a case of peritonitis due to M. morganii resistant to third-generation cephalosporins, which was treated successfully with intraperitoneal (IP) tobramycin followed by oral ciprofloxacin. Early microbiologic diagnosis is essential in the treatment of peritonitis from rare microorganisms such as Morganella morganii, and appropriate antibiotic therapy is the key to avoiding catheter loss and subsequent switch to hemodialysis.

Prevalence of variant brachial-basilic vein anatomy and implications for vascular access planning.

OBJECTIVE: To describe and increase understanding of the brachial-basilic vein anatomy that could impact planning of long-term hemodialysis access procedures. METHODS: Preoperative vein mapping was conducted in a cross-sectional, observational study in end-stage renal disease patients from August 2005 to May 2010. "Traditional" anatomic description with basilic-brachial junction at the axillary level with paired brachial veins was classified as "Type 1." Junctions observed at the mid or lower portions of the upper arm with duplication of the brachial vein above that level were classified as "Type 2." Junctions at the mid and lower portions of the upper arm with no duplication of the brachial vein above that level were classified as "Type 3." RESULTS: Two hundred ninety patients (mean age, 56 ± 17 years; 52% men) were observed and 426 arms mapped (221 right, 205 left). The prevalence of variations in venous arm anatomy was as follows: Type 1: 66%; Type 2: 17%; and Type 3: 17%. CONCLUSIONS: This study underscores the need for heightened awareness of upper arm venous variations and advocates the regular use of preoperative ultrasound imaging. We propose that recognition of Type 3 anatomy may have implications in access algorithm and planning.

RIDES: Robust Intrusion Detection System for IP-Based Ubiquitous Sensor Networks.

The IP-based Ubiquitous Sensor Network (IP-USN) is an effort to build the "Internet of things". By utilizing IP for low power networks, we can benefit from existing well established tools and technologies of IP networks. Along with many other unresolved issues, securing IP-USN is of great concern for researchers so that future market satisfaction and demands can be met. Without proper security measures, both reactive and proactive, it is hard to envisage an IP-USN realm. In this paper we present a design of an IDS (Intrusion Detection System) called RIDES (Robust Intrusion DEtection System) for IP-USN. RIDES is a hybrid intrusion detection system, which incorporates both Signature and Anomaly based intrusion detection components. For signature based intrusion detection this paper only discusses the implementation of distributed pattern matching algorithm with the help of signature-code, a dynamically created attack-signature identifier. Other aspects, such as creation of rules are not discussed. On the other hand, for anomaly based detection we propose a scoring classifier based on the SPC (Statistical Process Control) technique called CUSUM charts. We also investigate the settings and their effects on the performance of related parameters for both of the components.