Coconut oil even though rich in saturated fatty acids in comparison to sunflower oil when used as cooking oil media over a period of 2 years did not change the lipid-related cardiovascular risk factors and events in those receiving standard medical care.

A 36-year-old male was transferred to our hospital from another hospital on a ventilator. He was a known case of Berger's disease (IgA nephropathy) and was on maintenance haemodialysis for the past 3 months. He was undergoing haemodialysis by jugular venous catheter after creating Arteriovenous (AV) fistula on the left hand. One month ago, the patient was admitted at a local hospital with jugular venous catheter related infection. During his stay in the hospital, the patient had septic shock followed by resuscitated cardiac arrest. He was shifted to another secondary care hospital after resuscitation. His blood culture showed P. aeruginosa growth. He was initiated on intravenous antibiotics as per sensitivity and stabilized. Subsequently, the patient developed septic emboli and dry gangrene in both the lower limbs and was advised amputation however the patient refused. Following this the patient developed severe pain in the left upper limb. Doppler imaging showed brachial artery thrombosis at the site of AV fistula. He was advised to undergo angioplasty, but the patient and bystanders refused further treatment in the hospital. He was discharged against medical advice. However, he was admitted again after three days at the same hospital with septicaemia and altered sensorium. He underwent surgical embolectomy of the left brachial artery. Magnetic Resonance Imaging (MRI) brain showed bilateral infarcts. Immediately, the patient was shifted to our hospital in the state of sepsis and encephalopathy. He was admitted to critical care unit and a bed-side Transthoracic Echocardiogram (TTE) was performed, which suggested large vegetation attached to the interventricular septum. Blood cultures were directed for evaluation. While awaiting the blood culture report, the patient was started on antibiotics that included meropenem and cefepime for P. aeruginosa based on previous sensitivity. Simultaneously, an ophthalmology consultation was sought in a view of redness of both eyes. The patient was diagnosed with bilateral endophthalmitis after thorough ophthalmoscopic examination [Table /Fig-1b]. Next day, a Transesophageal Echocardiogram (TEE) was performed to confirm the diagnosis. It showed large vegetation on the interventricular septum and on the descending aortic wall [Table /Fig-2a,b]. The patient subsequently suffered a cardiac arrest, and could not be revived. Keywords: Arteriovenous fistula infections, Embolectomy, Endophthalmitis, Gangrene ABSTRACTNosocomial catheter-related and Arteriovenous fistula (AV)-related infections are significant concern in patients undergoing haemodialysis. These infections are associated with multiple complications as well as mortality and demands immediate and appropriate management. While coagulase-negative staphylococci, S.aureus, and Escherichia coli are the most common causes of catheter-related infections in haemodialysis patients, such infections caused by Pseudomonas aeruginosa are relatively rare. Here, we present an unusual case of 36-year-old male patient with chronic renal f...

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