Fludrocortisone-a treatment for tubulopathy post-paediatric renal transplantation: A national paediatric nephrology unit experience.

Calcineurin inhibitors post-renal transplantation are recognized to cause tubulopathies in the form of hyponatremia, hyperkalemia, and acidosis. Sodium supplementation may be required, increasing medication burden and potentially resulting in poor compliance. Fludrocortisone has been beneficial in addressing tubulopathies in adult studies, with limited paediatric data available. A retrospective review of data from an electronic renal database from December 2014 to January 2016 was carried out. Forty-seven post-transplant patients were reviewed with 23 (49%) patients on sodium chloride or bicarbonate. Nine patients, aged 8.3 years (range 4.9-16.4), commenced fludrocortisone 22 months (range 1-80) after transplant and were followed up for 9 months (range 2-20). All patients stopped sodium bicarbonate; all had a reduction or no increase in total daily doses of sodium chloride. Potassium levels were significantly lower on fludrocortisone, 5.2 vs 4.5 mmol/L, P = .04. No difference was noted in renal function (eGFR 77.8 vs 81.7 mL/min/1.73 m2 , P = .45) and no significant increase in systolic blood pressure (z-scores 0.99 vs 0.85, P = .92). No side effects secondary to treatment with fludrocortisone were reported. A significant proportion of renal transplant patients were on sodium supplementation and fludrocortisone reduced sodium supplementation without significant effects on renal function or blood pressure. Fludrocortisone appears to be safe and effective for tubulopathies in children post-transplantation.

Unusual case of inhaled metallic dental bur during dental procedure in a healthy adult.

Bronchial foreign body aspiration (BFBA) is not a rare incident in children. It can be managed successfully with flexible bronchoscopy in most of the cases, except for some cases, which require rigid bronchoscopy or even surgical intervention such as thoracotomy. Here, we report an unusual case of BFBA of metallic dental bur in a healthy 24-year-old dental nurse assistant, who was herself undergoing a dental procedure to remove dental caries, and suddenly the foreign body which was "diamond metallic dental bur" has slipped into her mouth and was aspirated to the bronchial tree. It was successfully removed 5 days after the incident using rigid and fiberoptic bronchoscopy with full recovery.

Simultaneous detection of astrovirus, rotavirus, reovirus and adenovirus type I in broiler chicken flocks.

Enteric diseases cause substantial economic losses to the poultry industry. Astroviruses, rotaviruses, reoviruses, and adenovirus type 1 have been reported as a significant cause of intestinal symptoms in poultry. In the present study, intestinal samples from 70 commercial broiler chicken flocks were examined for the presence of astroviruses, rotavirus, and reovirus by reverse transcription-polymerase chain reaction, and for the presence of group I adenovirus by polymerase chain reaction. Astroviruses were identified in 38.6% of samples tested. Both avian nephritis virus and chicken astrovirus were identified in the astrovirus positive flocks, where 74.1% of these flocks were positive for only one type of astrovirus, whereas, 25.9% of these flocks were positive for both types of astrovirus. Reoviruses, rotaviruses, and adenoviruses were identified in 21.4, 18.6, and 14.3% of these flocks, respectively. Concomitant infection with two or more viruses in the same flock were also prominent, where 5.7, 5.7, 2.9, 2.9, 1.4, and 1.4% of these flocks were positive with both astrovirus and rotavirus; astrovirus and adenovirus; astrovirus and reovirus; rotavirus and adenovirus; rotavirus and reovirus; and reovirus and adenovirus respectively. Moreover, 4.3 and 2.7% of these flocks were positive for astrovirus, reovirus, and adenovirus; and astrovirus, reovirus, and rotavirus, respectively. Further studies will focus on identifying specific viral factors or subtypes/subgroups associated with disease through pathogenesis studies, economic losses caused by infections and co-infections of these pathogens, and the costs and benefits of countermeasures.

Ornithobacterium rhinotracheale and Mycoplasma synoviae in broiler chickens in Jordan.

A cross-sectional study was conducted from November 2008 to July 2010 in commercial broiler flocks in southern (n = 50) and northern (n = 50) areas of Jordan, to determine the flock-level prevalence of Ornithobacterium rhinotracheale (ORT) and Mycoplasma synoviae (MS) infections. Tracheal swabs were collected from commercial broilers with respiratory disease and tested by polymerase chain reaction. In total, 21% (95% CI: 18-45%) and 25% (95% CI: 20-51%) of commercial broiler flocks were positive for ORT and MS, respectively. In the southern areas the prevalence of flocks with positive tracheal swabs for ORT and MS was 16% and 10%; in the northern areas the prevalence was 26% and 40%, respectively. Of the flocks tested, 7% were infected with ORT and MS simultaneously. Further epidemiological studies are recommended to determine risk factors and evaluate the economic consequences of ORT and MS infections in the region. Furthermore, studies are required to isolate ORT and MS and develop vaccines against the local field isolates.

State-of-the-art measurements in human body composition: A moving frontier of clinical importance.

The measurement of human body composition allows for the estimation of body tissues, organs, and their distributions in living persons without inflicting harm. From a nutritional perspective, the interest in body composition has increased multi-fold with the global increase in the prevalence of obesity and its complications. The latter has driven in part the need for improved measurement methods with greater sensitivity and precision. There is no single gold standard for body-composition measurements in-vivo. All methods incorporate assumptions that do not apply in all individuals and the more accurate models are derived by using a combination of measurements, thereby reducing the importance of each assumption. This review will discuss why the measurement of body composition or human phenotyping is important; discuss new areas where the measurement of body composition (human phenotyping) is recognized as having important application; and will summarize recent advances made in new methodology. Reference will also be made to areas we cannot yet measure due to the lack of appropriate measurement methodologies, most especially measurements methods that provide information on kinetic states (not just static state) and metabolic function.