Although a rare diagnosis, encapsulating peritoneal sclerosis in patients undergoing CAPD has a high morbidity and mortality. Diagnosis is often delayed because clinical features are insidious and nonspecific. Radiologic imaging may be helpful in the early diagnosis of encapsulating peritoneal sclerosis and in facilitating timely intervention for CAPD patients with encapsulating peritoneal sclerosis.

Background Kidney disease accompanying coronavirus disease 2019 (COVID-19) is not well understood, and information about the presentation of acute kidney injury (AKI), its risk factors, and outcomes is scarce, particularly in Bahrain and the Gulf region. In this study, we aimed to determine the rate of AKI among patients hospitalized with COVID-19 pneumonia at a tertiary hospital in Bahrain and to describe the various aspects of AKI in these patients, including its relationship with respiratory failure and in-hospital mortality. Methods This retrospective observational cohort study of patients admitted with COVID-19 pneumonia from April 1 to May 31, 2020, excluded those aged less than 18 years, those with end-stage renal disease, and those with renal transplants. Clinical and laboratory patient data were collected. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI. Results The mean age across the 73 included patients was approximately 54 years; about 60% were men, and nearly 58% were Bahraini nationals. Of the patients, 39.7% (29) developed AKI during hospitalization, out of which 11.0% reached stage 1, 15.1% reached stage 2, and 13.7% reached stage 3. Of all patients, seven (9.6%) required hemodialysis. Chronic kidney disease conferred an increased risk for AKI (P = 0.003) as did critical COVID-19 status (P < 0.001) and the necessity for mechanical ventilation or intensive care admission (P < 0.001 for both). Additionally, AKI was significantly associated with a lower PaO 2 /FiO 2 (partial pressure of arterial oxygen/percentage of inspired oxygen) ratio (P < 0.001) and a greater number of medications for COVID-19 pneumonia (P = 0.003). Finally, in-hospital death tolls were remarkably higher in patients with AKI (P < 0.001). No association was found between AKI and each of the following therapies: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, tocilizumab, and convalescent plasma. Conclusions The rate of AKI in patients hospitalized with COVID-19 pneumonia at our institution is relatively high and is strongly associated with disease severity, respiratory failure, and in-hospital mortality. Awareness of kidney disease in COVID-19 patients is crucial and of vital importance.

BackgroundThe prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) has collected data since 2012 in all six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates). We report the relationship of PTH with mortality in this largest GCC cohort of patients on hemodialysis studied to date.MethodsData were from randomly selected national samples of hemodialysis facilities in GCC-DOPPS phases 5 and 6 (2012–2018). PTH descriptive findings and case mix–adjusted PTH/mortality Cox regression analyses were based on 1825 and 1422 randomly selected patients on hemodialysis, respectively.ResultsMean patient age was 55 years (median dialysis vintage, 2.1 years). Median PTH ranged from 259 pg/ml (UAE) to 437 pg/ml (Kuwait), with 22% having PTH <150 pg/ml, 24% with PTH of 150–300 pg/ml, 34% with PTH 301–700 pg/ml, and 20% with PTH >700 pg/ml. Patients with PTH >700 pg/ml were younger; on dialysis longer; less likely to be diabetic; have urine >200 ml/d; be prescribed 3.5 mEq/L dialysate calcium; had higher mean serum creatinine and phosphate levels; lower white blood cell counts; and more likely to be prescribed cinacalcet, phosphate binders, or IV vitamin D. A U-shaped PTH/mortality relationship was observed with more than two- and 1.5-fold higher adjusted HR of death at PTH >700 pg/ml and <300 pg/ml, respectively, compared with PTH of 301–450 pg/ml.ConclusionsSecondary hyperparathyroidism is highly prevalent among GCC patients on hemodialysis, with a strong U-shaped PTH/mortality relationship seen at PTH <300 and >450 pg/ml. Future studies are encouraged for further understanding this PTH/mortality pattern in relationship to unique aspects of the GCC hemodialysis population.

We report on 35 total hip replacement arthroplasties in 28 patients with avascular necrosis of the femoral head secondary to sickle cell disease (SCD). There were 15 men and 13 women with a mean age of 27.5 years. In all patients Harris hip scores improved from a mean of 36 pre-operative to 86 post-operative. However, at a mean follow-up of 9.5 (5-15) years six hips failed due to symptomatic aseptic loosening and one due to late deep infection. Our results support the decision to offer the procedure for patients with arthritic hips secondary to SCD. It is important that patients and surgeons should be aware of the wide varieties of complications.Résumè Nous rapportons sur 35 arthroplasties totales de la hanche dans 28 malades avec nécrose avasculaire de la tête fémorale secondaire à drépanocytose. Il y avait 15 hommes et 13 femmes avec un âge moyen de 27.5 années. Dans tout le score de la hanche de Harris amélioré d'une moyenne de 36 préopératoire à 86 postopératoire. Cependant, à une suite moyenne de 9.5 (5-15) années six hanches ont manqué dû à descellement aseptique symptomatique et un dû à infection profonde tardive. Nos résultats supportent la décision d'offrir la procédure pour les malades avec les hanches arthritiques secondaire à drépanocyt-ose. C'est important que les malades et chirurgiens doivent être informés des variétés larges de complications. IntroductionAvascular necrosis of the femoral head is one of the significant complications affecting the musculoskeletal system in patients with sickle cell haemoglobinopathy [6]. The reported incidence of femoral head necrosis varies from less than 10% to more than 30% [15,23]. In many patients both hips and other bones are affected [8].Improved medical care of children with sickle cell disease (SCD) has led to prolonged life span. In these patients many young adults will be seeking treatment for avascular necrosis of the femoral head. Review of the literature showed few reports on hip replacement arthroplasties in SCD, with the number of patients ranging from one [9] to 30 [1] and a high complication rate [7,12,16,22]. The incidence of sickle cell haemoglobinopathies presents major health care problems in Bahrain [18]. The aim of this report is to present our experience, and the problems encountered, with total hip replacement in avascular necrosis of the femoral head in SCD patients. Patient and methodsThirty-seven total hip replacements were performed between 1984 and 1995 for 30 SCD patients with avascular necrosis of the femoral head. One patient moved from the region and another died 3 years after hip replacement from acute pulmonary crisis. Thirtyfive hips in 28 patients were available for follow-up. There were 15 men and 13 women with a mean age of 27.5 (19-42) years. Seven patients, five of whom were women, had bilateral hip replacements. The second side was replaced within 2 years of the first operation. The mean number of previous admission to hospital for medical problems related to SCD was 6.5 (range 3-22 admissions). Blood group was A...

Our study reinforces the link between duration on PD and EPS. While mortality was high in our cohort, emerging surgical techniques demonstrate a favorable outcome that can be achieved even in severely affected cases.