The problem of pulmonary arterial hypertension in end-stage renal disease: can peritoneal dialysis be the solution.

BACKGROUND: Pulmonary arterial hypertension (PAH) in the setting of end-stage renal disease (ESRD) has important prognostic and therapeutic consequences. We estimated the prevalence of PAH among patients with ESRD treated with automated peritoneal dialysis (APD), investigated the effect of different variables and compared pulmonary artery pressure and cardiac function at the beginning and end of the study. METHODS: This is a 5-year study in which 31 ESRD patients on APD were recruited after fulfilling inclusion criteria. Blood samples were collected from all patients for the biochemical and hematological data at the beginning of the study and every month and at the study termination. Total body water (TBW) and extracellular water (ECW) were calculated using Watson's and Bird's calculation methods. All patients were followed-up at 3-month interval for cardiac evaluation. Logistic regression analysis was used to assess the relation between different variables and PAH. RESULTS: The mean age of the study population (n = 31) was 51.23 ± 15.24 years. PAH was found in 24.2% of the patients. Mean systolic pulmonary artery pressure (sPAP) and mean pulmonary artery pressure (mPAP) were significantly higher in the APD patients at study initiation than at the end of the study (40.75 + 10.61 vs 23.55 + 9.20 and 29.66 + 11.35 vs 18.24 + 6.75 mmHg respectively, p = 0.001). The median ejection fraction was significantly lower in patients with PAH at zero point than at study termination [31% (27-34) vs 50% (46-52), p = 0.002]. Hypervolemia decreased significantly at the end of study (p <  0.001) and correlated positively with the PAP (r = 0.371 and r = 0.369), p = 0.002). sPAP correlated with left ventricular mass index, hemoglobin level, and duration on APD. CONCLUSIONS: Long term APD (> 1 years) seemed to decrease pulmonary arterial pressure, right atrial pressure and improve left ventricular ejection fraction (LVEF). Risk factors for PAH in ESRD were hypervolemia, abnormal ECHO findings and low hemoglobin levels. Clinical and echocardiographic abnormalities and complications are not uncommon among ESRD patients with PAH. Identification of those patients on transthoracic echocardiography may warrant further attention to treatment with APD.

Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study.

BACKGROUND: Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior. OBJECTIVE: The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation. METHODS: We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken. RESULTS: Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions. CONCLUSIONS: Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly against current behavioral support therapy interventions in smoking cessation and beyond.

Fecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in patients and asymptomatic healthy individuals.

Fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing organisms was assessed in 272 inpatients, 162 outpatients, and 426 asymptomatic healthy individuals. Of 860 stool samples cultured, 152 (17.7%) yielded ESBL-producing organisms. Isolates were recovered from 71 (26.1%) of the inpatients, 25 (15.4%) of the outpatients, and 56 (13.1%) of the healthy individuals. These findings suggest that the community could be a reservoir of ESBL-producing organisms.

Prevalence and antimicrobial susceptibility of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a general hospital.

BACKGROUND: The prevalence of extended-spectrum beta-lactamases (ESBLs) varies between countries and institutions. We studied the prevalence of ESBL among clinical isolates of Escherichia coli and Klebsiella pneumoniae and analyzed patterns of susceptibilities to different antimicrobial agents in a general hospital in Saudi Arabia over a 15-month period. METHODS: A total of 2455 clinical isolates of E. coli and K. pneumoniae were tested for ESBL production by double-disk diffusion. The minimum inhibitory concentration to imipenem, meropenem, piperacillin-tazobactam, cefepime, ciprofloxacin, gentamicin and amikacin were determined by the agar dilution method. RESULTS: Of the 2455 isolates of E. coli and K. pneumoniae tested, 268 (11%) produced ESBL. The ESBL phenotype was detected in 10.3% of 1674 E. coli isolates and 12.2% of 781 K. pneumoniae isolates. The majority of these isolates were from urine (57.5%) and wounds (17%). Only 7% of the blood culture isolates were ESBL-producing. Overall, carbapenems (imipenem and meropenem) had good activity against the ESBL-producing isolates tested (over 92% of isolates were susceptible). There was no difference in the activity of imipenem and meropenem against the ESBL-producing E. coli or K. pneumoniae. Over 66% of the isolates were susceptible to piperacillin-tazobactam. Susceptibilities of the isolates to amikacin varied, ranging from 72.8% for E. coli to 62% for K. pneumoniae. Gentamicin, ciprofloxacin and cefepime were active against 58.6%, 55% and 22.8% of the isolates, respectively. CONCLUSION: Our findings demonstrate the increasing incidence of infection with ESBL-producing bacteria, and the high rates of antimicrobial resistance encountered among them. Clinicians should be familiar with the clinical importance of these enzymes and potential strategies for dealing with them.

Antimicrobial resistance patterns of gram-negative bacteria isolated from urine cultures at a general hospital.

To evaluate the antimicrobial resistance patterns of the Gram-negative organisms isolated from urine culture, we retrospectively analyzed the urine cultures and antibiotic sensitivity tests of inpatients and outpatients in our hospital between 1999 and 2002. A total of 11,659 urine specimens were analyzed of which 2054(17.6%) showed significant growth; 1764 (85.9%) were Gram-negative organisms. The most frequently isolated Gram-negative organisms were Escherichia coli 1026 (58%) and Klebsiella pneumoniae 293 (16.6%). The resistance rates for strains of E. coli isolated from the hospitalized patients were 61% to amoxicillin, 35% to amoxicillin-clavulanate, 47% to trimethoprim, 38% to ciprofloxacin, 31% to cephalexin and 13% to gentamicin. These rates were higher than those from the outpatients (52%, 36%, 40%, 32%, 29% and 5%), respectively. Out of the 42(2%) multidrug resistant E. coli and K. pneumoniae, 23(1%) were found to be positive for extended spectrum beta lactamase (ESBL) including 14 isolates of E. coli and 9 of K. pneumoniae. We conclude that our findings demonstrate a significant increase of resistance to various groups of antimicrobial drugs in the urine culture isolated from both inpatients and outpatients.