Irfan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Hospital-acquired nephrotoxic exposures in the precipitation of acute kidney injury-A case series analysis and a call for more preventative nephrology practices

sicca commonly called 'dry eye' has many causative factors; and diabetes is identified as one of the etiology of dry eye syndrome worldwide. Diabetes is one of the leading causes of ocular morbidity and blindness in 20-74 years of age. 1 As it affect not only the anterior, posterior segment of the eye and lens, but also the retina leading to retinopathy. According to WHO, the prevalence of diabetes in Pakistan 2016 is 9.8%. The reported prevalence of dry eye syndrome is 15-33% in those of over 65 years of age. 2

In the cognate nephrology literature, a few recent publications from major academic centers in the United States have suggested that the incidence of contrast nephropathy was exaggerated and overstated. These investigators have concluded that intravenous contrast material administration was not associated with an increased risk of acute kidney injury (AKI), emergent dialysis, and short-term mortality in a cohort of patients with diminished renal function. As a contrarian opinion, we first describe a clear cut case of contrast-nephropathy resulting in AKI requiring hemodialysis treatment managed in the Renal Unit of the Mayo Clinic Health System, Northwestern Wisconsin, in the Spring of 2017. We subsequently revisit the overwhelming evidence-base in the English literature that supports the enormous impact of contrast-nephropathy as a clinical syndrome. We finally posit that these recent repudiations of the existence and significance of contrast-nephropathy as a significant clinical entity represent an overreach in statistical expertise. There is no basis for a requiem song over contrast-nephropathy

A 20 years old female came to our hospital with sudden painless loss of vision in her right eye for two days. She was diagnosed with dengue fever two and a half weeks back and was managed conservatively. Ocular examination showed mid-dilated pupils with sub-conjunctival hemorrhage, lens opacity, vitreous hemorrhage and haze, sub-retinal hemorrhage and retinal detachment. Visual acuity in right eye was perception of light only. Ultrasound revealed moderate number of low to moderately reflective vitreous echoes and a highly reflective membrane attached to the disc suggesting retinal detachment. An urgent ophthalmologist opinion was sought followed by pars plana vitrectomy with silicon oil. She was lost to follow up after surgery.

Introduction: To report the planning parameters, efficacy and toxicity of total body irradiation using volumetric modulated arc therapy (VMAT). Methods: From July 2019 till May 2021, nine patients treated with VMAT-based total body irradiation as a part of the myeloablative regimen for homologous stem cell transplant were evaluated. The CT acquisition, planning parameters, doses to target volume and critical structures were evaluated retrospectively. Results: Median age was 24 with median height 172 cm. Average Mean Lung dose was 9·5 Gy, mean dose to kidney was kidney dose 8·4 Gy, planning target volume (PTV) 95% was 98 % and mean heterogeneity index of PTV was 1·2 all patients. Total fraction delivery time including setup was 3·1 h while beam on time was 23 min. Main toxicity observed was mucositis and fatigue, while no Grade 3 or more acute radiation toxicity was observed. Conclusion: At our institution, high dose TBI performed with multi-isocentric VMAT is now a standard procedure. Though it is cumbersome and time-consuming process but VMAT offers an advantage of increased dose homogeneity in the target volume with reduction in doses to critical organs especially lungs and kidneys in comparison to standard source to skin distance technique, longer follow-up time is necessary to evaluate our method and long-term toxicity.

Proposed laboratory surrogate markers for the management of acute kidney injury in ethylene glycol poisoning in resource-challenged countries; a Mayo Clinic Health System, Wisconsin, case analysis

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