By April 26, 2020, infections related to coronavirus disease 2019 (COVID-19) affected people from 210 countries and caused 203,818 reported deaths worldwide. A few studies discussed the outcome of COVID-19 in kidney transplant recipients. This short series demonstrates our experience in managing COVID-19 disease in renal transplant patients in the absence of strong evidence. We report 8 cases of kidney transplant recipients infected with COVID-19 (median age = 48.5 years; range = 21–71 years), including 4 males and 4 females. The most frequently associated comorbidity was hypertension. The most common presenting features were fever and cough. The main radiological investigation was a portable chest X-ray. Other common features included lymphopenia, high C-reactive protein, and a very high ferritin level. Overall, 1 patient was managed as an outpatient, the remaining 7 required hospital admission, 1 of them referred to the intensive therapy unit. Management included supportive treatment (intravenous fluid therapy, monitoring renal function, and symptomatic treatment with or without ward-based oxygen therapy depending on oxygen saturation) and discontinuation of the antiproliferative immunosuppressive drugs. Seven patients recovered and discharged home to self-isolate. One patient required intensive care treatment and mechanical ventilation. Supportive treatment could be sufficient for the management or to be tried first. We also found that short hospital stay with self-isolation on discharge reduces the burden on the health service and protect the staff and the public.
SLF was strongly supportive of successful fistula maturation. A "thrill" was characteristic of spiral rather than turbulence. The mechanism of this apparent beneficial effect of this pattern of flow requires further investigation.
Type of article for submission Original manuscript ABSTRACT Purpose:Efforts to promote arteriovenous fistulas (AVFs) have been successful in increasing the prevalence of AVF use as the primary vascular access for haemodialysis HD.Sustained preference for AVF use may not be the most appropriate vascular access choice for all patient groups. Arteriovenous grafts (AVGs) offer advantages of earlier use and lower primary failure rates compared to AVFs so may be preferable for patients where short term vascular access is needed. This study was designed to assess comparative mortality in different age groups following AVF formation. Methods:A prospective cohort of patients having AVF creation was recruited. Patients were subdivided into three age groups; Group A: < 50 years; Group B: 50-74 years and Group C: 75 years. Survival curves and Cox regression analysis was performed on each of these groups. Results:One hundred and thirty-four patients (n=134) were recruited into the study. The prevalence of diabetes increased significantly with age. As expected, mortality was higher in older age groups (log rank (mantel cox) 19.227; p = 0.0001). Mortality rates at one year were 0% in group A, 12.5% in group B and 29.1% in group C. Medium term mortality at four years was 7.9% in group A, 39.1% in group B and 54.8%% in group C. Conclusions:We found a significantly higher mortality rate in patients ≥75 years in comparison to those <75 years. The choice of vascular access modality should be tailored to the individual with particular reference to the patient's expected survival.
Transplant renal artery (TRA) pseudoaneurysm can result in bleeding, infection, graft dysfunction and graft loss. We report the management of a renal transplant recipient who presented five months after renal transplantation with deterioration of renal function, who was found to have TRA pseudoaneurysm and TRA stenosis. Both were treated radiologically by using expandable hydrogel coils (EHC) in combination with stenting. Improvement in clinical, biochemical and radiological parameters were observed after the intervention. To our knowledge, this is the first report in the transplant literature on the use of EHC for the treatment of a TRA pseudoaneurysm.
Conclusions:In the UK National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programs are effective in detecting AAA and lead to effectively treating men with AAA.Summary: Approximately 3000 to 4000 people die from ruptured AAA each year in England and Wales. Most of the deaths occur in men over 65 years of age. Population screening of men $65 years of age for AAA in the UK began in 2009 and was implemented in all of England by April 2013. The current study presented here reviews the results of the first 5 years of screening among 65 year old men who had attended an ultrasound screening and the first cohort of men referred for treatment of a large aneurysm over 5.47 cm. The goal was to check the systems and processes of the AAA screening program. In the program men aged 65 years were invited for a single abdominal ultrasound scan. Data were entered into a bespoke database (AAA SMaRT). This paper represents a planned analysis after the first 5 years of the program. Summation analysis involves the first 700,000 men screened and the first 1000 men with a large AAA referred for possible treatment. The prevalence of AAA defined as an aortic diameter larger than 2.9 cm in 65 year old men was 1.34%. The mean uptake was 78.1% and varied from 61.7 to 85.8% across the UK. Based on the index of multiple deprivation, uptake was 65.1% in the most deprived vs 84.1% in the least deprived areas. Of the first 1000 men referred for possible treatment of an AAA the false positive rate was 3.2%. 770 men underwent a planned AAA intervention (non-intervention rate 9.2%) with 7 deaths for a perioperative mortality rate of 0.8%.Comment: Use of the screening program varied among regions in the UK with those from less affluent areas and having to travel greater distances making less use of the screening program (Crilly M, et al Br J Surg 2015;102:916-23). Perhaps patients who place a less priority on their own health have an increased prevalence of AAA so the prevalence of AAA may be higher than indicated. False negative rates of screening are unknown. Nevertheless, at the moment it appears from this analysis, screening for AAA is effective both from a medical and cost effectiveness point of view.
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