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E. Temmy, M.A., M.D., Ph.D.
Vice Chair, Dell Medical School at The University of Texas at Austin
Pulse pressure is a significant risk factor of cardiovascular disease and death in general and dialysis population. Aldosterone (aldo) exerts potent non-genomic hypertensive effects via its arterial aldo receptor & enhanced sympathetic nervous system activity. Poster Thursday Hemodialysis and Frequent Dialysis - 1 Conclusions: We demonstrated feasibility and success of sustaining a simple and efficient treatment of infected water for entire villages in absence of available electricity. The continuous function over >11 months indicates low cost of the device over time. The reduction in diarrhea from before to after initiation of the hemodialyzer filtration device is large. The simplicity of hemodialyzer filtration by gravitational feed, low cost and relative ease suggest wider application to other needy villages. Circuit clotting complications occurred at low rates during evocit sessions and did not have clinically significant repercussions on dialysis efficacy. Background: Contaminated water supplies for drinking water are a source of health problems in poor communities. Methods: Data were collected monthly regarding the incidence of diarrhea and death in households of 8 villages that have no electricity during February to November 2018. In 4 "study" villages the main source of drinking water (river), was processed after the first 5 (pre) months through a set of 8 hemodialyzers that produced purified water at ~250 L per hour. River water was pumped weekly into an elevated holding tank to be drawn by gravity through the dialyzers whenever the faucet was opened. Manual back flushes (4x/ day) by trained villagers maintained high output of clean water. The same data collection in 4 "control" villages where the polluted water was not (yet) treated during the same 10 month period. Results: [1] Monthly rates of diarrhea in the study villages decreased from 18 to 5 per 100 villagers from the pre to the post period for a rate reduction by 72 % (rate ratio = 0. In the control group the average monthly rate during the same calendar months decreased by 23% (p >0. After >11 months of daily filtration in 9 villages (population ~2000) none of the filters had to be replaced, suggesting that daily back-flush management prevented hemodialyzer clogging. We used risk-set sampling and matched on the following: (1) duration of follow-up (a same number of days), (2) time on dialysis (1 year, >1 year), (3) age (+/- 1 year), and (4) sex. The biomarkers associated with iron metabolism and inflammation at 12 weeks were compared between groups. From the time series of weekly admission risks, we fit an autoregressive integrated moving average model, both overall and within strata defined by concurrent enrollment in Medicaid. Results: From 2014 to 2017, mean weekly incidence of acute care admission increased from 5. In patients with Medicare coverage alone and patients with concurrent enrollment in Medicaid, mean weekly incidence of acute care admission increased to 5. The association between vitamin K status and vascular calcification is non-affirmative in clinical observations. A cohort of 553 controls (median 51 age years, 45% males) was referred to estimate vitamin K status in healthy subjects. Poster Thursday Hemodialysis and Frequent Dialysis - 1 the iron metabolism regulatory pathwayBlue arrows indicate dominant effects. There are no public reports summarizing the composite rate of these encounters among dialysis patients. We used claims data to estimate rates of acute care admissions in dialysis patients with Medicare fee-for-service coverage. Methods: Using Medicare Limited Data Sets, we identified all patients with Medicare Part B claims documenting outpatient dialysis from January 2014 to December 2017.
In southern Asia larvae are common in fish ponds which have had manure added to them. Culex quinquefasciatus, and many other culex species, bite humans and other hosts at night. Some species, such as, culex quinquefasciatus commonly rests indoors both before and after feeding, but they also shelter in outdoor resting places. Biting Nuisance In several areas of the world a lot of money is spent on mosquito control, not so much because mosquitoes are vectors of disease but because they are such truoublesome bitters. Distribution It is endemic in over 80 countries in Africa, Asia, South and Central America and the Pacific Islands. Causative agent It is caused by parasitic nematode worms of the family filariidae. Transmission It is transmitted via the bite of blood-feeding female mosquitoes, which transmit immature, larval forms of the parasitic worms from human to human. Culex quinquefasciatus mosquitoes and some species of Anopheles mainly transmit Bancrofti parasites. In humans, adult worms can live for many years, producing large numbers of larval forms (known as microfilariae), which circulate in the lymphatics and blood where they can be ingested by blood-feeding mosquitoes, so completing the transmission cycle. The nocturnal periodic forms in which the microfilariae are in the peripheral blood only at night. During the day the microfilariae are in the blood vessels supplying the lungs and are not available to be taken up by mosquitoes. Bancroftian filariasis Wuchereia bancrofti occurs throughout much of the tropics (central and south America, Africa, Asia, Pacific areas) and also in subtropical countries in the Middle East. Bancroftian filariasis is essentially an urban disease, there are no animal reservoirs and the parasites develop in only mosquito and humans. The nocturnal periodic form is transmitted by various anopheles species and throughout much of its distribution also by culex quinquefasciatus. This mosquito is wide poured in the tropics and breeds mainly in waters polluted with human or animal feaces or rotting vegetation and other filth; larvae are found in septic tanks, cesspools, pit latrines, drain and ditches, and in water-storage jars if they contain organically polluted water. It is mosquito that has increased in number in many town due to rapid and increasing urbanization and the resultant proliferation of in sanitary collections of water. In New Guinea, mansonia uniformis and night- biting culex species are also vectors. In China, and formally Japan, Aedes togoi, which 47 breeds in rock-pools containing fresh or brackish water and in rainfilled receptacles such as pots and cisterns, is also a vector of nocturnal periodic bancroftian filariasis, although it is more usually known as a vector of brugian Filariasis. Adults bite in the early part of the night, mainly in doors but also sometimes outdoors. The diurnal subperiodic form occurs in the Polynesian region from where the nocturnal periodic form is absent. Polynesiensis, a day-biting mosquito which feeds mostly outdoors but may enter houses to feed; adults rest almost exclusively out of doors. Larvae occur in natural containers such as split coconut shells, leaf bracts and crab-holes, and also in man made containers such as discarded tins, pots, vehicle tyres and canoes. Aedes Pseudoscutellaris is another out of doors day-biting mosquito that is a vector of diurnal subperiodic W. It breeds maninly in tree- holes and bamboo stumps but larvae are also found in crab-holes. It should be noted that although several Aedes mosquitoes are vectors of filariasis, especially the bancroftian form, Ae. Chronic: may cause elephantiasis and hydrocoele (swelling of the scrotum) in males or enlarged breasts in females. Prevention and control Transmission can be reduced by avoiding mosquito bites in endemic areas. Mosquito vectors often breed in polluted urban waters (such as blocked drains and sewers) so good sanitation and environmental management to minimize mosquito breeding places can play a major role in reducing the risk of the disease. Ivermectin has also been registered for treatment of filariasis, and albendazole was shown to have additional antifilarial effects. Encephalitis this is an arthropod-borne viral infection that attacks the central nervous system and causes inflammation of the brain.
This transmission cycle, occurring in clearings at the edge of the forest involving monkeys, Ae. When people return to their villages they get bitten by different mosquitoes, including Ae. Aegypti, a domestic species breeding mainly in man made containers such as water-storage pots, abandoned tin cans and vehicle tyres. There is increasing evidence in West Africa that in rural areas other Aedes species spread the virus from monkeys to people. In some areas for example, yellow fever may be circulating among the monkey population yet rarely gets transmitted to humans because local vector mosquitoes are predominantly zoophagic. Other primates in Africa such as bush56 babies (Galago species) may also be reservoirs of yellow fever. There is some evidence from West Africa that yellow fever virus may be trans-ovarially transmitted in Aedes species, as males have been found infected with the virus. Thus, after 4 or 5 days the virus appears in the peripheral blood, that is viraemia is produced, and this occurs irrespectively of whether monkeys or humans are showing overt symptoms of the disease. Viraemia lasts only 2-3 days, after which the virus disappears from the peripheral blood never to return and the individual is immune. Monkeys and people are therefore infective to mosquitoes for only about 2-3 days in their entire lives. A relatively high titre of yellow fever (and also any other arbovirus) is needed before it can pass across the gut cells of the mosquito into the haemolymph, from where it invades many tissues and organs, including the salivary glands, where virus multiplication occurs. This is the extrinsic cycle of development and can take 5-30 days, depending on temperature, the type of virus and the mosquito species, but in yellow fever, and most other mosquito-borne viral infections, the incubation period is typically 12-15 days. A mosquito must therefore live a sufficiently long time before it becomes infective and capable of transmitting an arbovirus-or malaria or filariasis. It is characterized by a sudden high fever, severe headache, backache and pain in the joints. There are four strains or types 58 and at least one or all four are found throughout much of the world. Recovering victims are generally immune to future infections, but only from the strain they were infected with. Therefore, a person can potentially experience all four different strains of dengue. Important Species of Aedes Aedes aegypti is a small dark species easily identified by the lyreshaped, silvery-white lines on the thorax and the white bands on the tarsal segments. It is a vector of urban yellow fever and dengue, and it is a pest when present in large numbers. Aedes aegypti is essentially a tropical species, probably introduced into the Western World from Africa. This is a thoroughly domesticated mosquito and breeds almost exclusively in artificial containers in and around human habitations. The females lay their eggs singly on the water just at the margin, or on the sides of the container above the water line. They prefer human blood to that of other animals and readily enter homes to find suitable hosts. It attacks quietly, preferring to bite around the ankles, under shirt sleeves, or on the back of the neck. Adults can have a golden-brown color on top of the thorax and a longitudinal stripe of white or yellowish-white scales on the abdomen. Females lay their eggs singly on the mud of salt marshes where they remain until 59 flooded by high tides or rains. They usually use pot holes and depressions of various sizes, but they may also lay eggs over rather extensive level areas. After having been dry for a week or two, they will hatch in a few minutes when water covers them. Aedes sollicitans adults are strong fliers and often migrate in large swarms from marshes to cities and towns many miles away.
Syndromes
- Nausea and vomiting
- Runny nose
- Restlessness, nervousness
- Men most often have the "classic" heart attack signs: tightness in the chest, arm pain, and shortness of breath.
- Benign skin growths such as seborrheic keratoses or neurofibromas
- Small scars, usually in an area where they do not show much
- Small scrotum, with a line down the middle (bifid) or incompletely closed
- Inserting cotton swabs, toothpicks, pins, pens, or other objects into the ear.
- Abrupt mood changes
- Periods that become heavier and last longer than usual
Fellows reported enhanced knowledge regarding both private and academic nephrology careers and most established lasting relationships with colleagues from across the country which they intend to maintain throughout their careers. Conclusions: Nephrology fellows report a significant need for business and leadership education which is currently lacking from fellowship programs. Empowering nephrology trainees on the verge of entering the workforce has the power to strengthen the field as these early career nephrologists inspire other trainees to join this challenging yet fulfilling field. The care team updates patient progress and the platform highlights patients who have had no recent care actions. The major negative perceptions included: inability to perform procedures, financial compensation, and patient population. This suggests that negative factors such as inadequate financial compensation, inability to perform procedures, lack of innovation, and a difficult patient population largely outweigh the positives. In order to attract more candidates, the nephrology community should highlight the innovations and policy initiatives such as the Kidney Precision Medicine Project, the Kidney Innovation Accelerator, and the Advancing American Kidney Health initiative. Nephrologists should also consider creating/expanding interventional nephrology programs and increasing resident exposure to outpatient nephrology. Background: the main challenges that nephrologists are facing worldwide are lower income, dissatisfactory payment models, long work hours and burnout. Methods: An online survey was sent to all 250 Lebanese and Jordanian nephrologists, including data on demographics, education, academic activities, job satisfaction, burnout, workload and reimbursement. Respondents reported low rates of satisfaction in job opportunities (20%), income (25%) and administrative support (32%). High satisfaction rates were found in relationship with patients (78%) and colleagues (73%). Satisfaction towards income was significantly lower in females, mean score difference 0. A greater proportion of male over female practitioners wanted to follow above the 40-dialysis-patient regulation (p<0. Satisfaction with income and work-life balance was positively correlated with age and young nephrologists had significantly lower satisfaction with job opportunities (11%). Driving over 1 hour daily to work was significantly associated with dissatisfaction in work-life balance (p=0. Using regression analysis, longer delay in payment predicted worse work-life balance among Lebanese nephrologists (p=0. Compared to male practitioners, female practitioners spent more time on teaching (p < 0. Conclusions: Unfair and delayed reimbursement is associated with dissatisfaction among the surveyed nephrologists. Gender differences are very significant with lower income and satisfaction rates among women. We quantified nephrologist demand as a ratio of consult volume per nephrologist at the Census Division level using data from the 2014 American Medical Association Masterfile. Background: General pediatricians may be the first-line providers to care for children with kidney disease, however studies suggest they find nephrology to be a difficult subject. This study aimed to identify areas of lowest perceived competency and importance within nephrology for general pediatricians. Methods: A web-based survey was distributed to general pediatricians through the Paediatricians of Ontario network, to all Pediatrics Residency Program Directors in Canada and to Pediatric Nephrologists in the Canadian Association of Paediatric Nephrologists. Pediatricians were asked to rate nephrology objectives of training on a 5-point Likert scale for perceived competence and importance. Program Directors and Nephrologists were asked for perceived importance of each objective for general pediatricians. Knowledge Gap scores were calculated as the difference between perceived importance and competence scores. Hypertension is the area with the largest knowledge gap, which also raises concerns due to its rising prevalence in pediatrics. Educational interventions are needed to address deficits in these crucial domains of renal health in general pediatrics. The virtual workshops were easily implemented, wellreceived, and should be considered as an alternative training format, especially when inperson workshops cannot be conducted. Future trainings can incorporate communication challenges that arise during telemedicine video or telephone encounters. Background: E-learning is gaining popularity in medical education and offers several advatages.
