Marilyn Rogers

Seasonal variation in the peritoneal dialysis-related infections : a single center experience in the Mediterranean

Seasonal variation in the incidence of peritoneal dialysis‐related infections (PDRI) has been sparingly investigated, especially in the Mediterranean. Our aim was to explore this association in Malta. All PDRI occurring between Jan‐2008 and Dec‐2012 were retrospectively studied.A total of 137 patients were followed‐up for a median time of 32.5 months (range: 2‐81). During this time, 19% never had PDRI, 11.7% transferred permanently to hemodialysis and 6.6% received a kidney transplant. A total of 279 PDRI were identified, equating to 145 catheter‐related infections (CRI) and 144 peritonitis episodes (including 10 catheter related peritonitis). A spring peak in the overall gram positive PDRI (0.61 vs. 0.34/patient‐year‐at‐risk, P=0.05), together with a peak in gram negative peritonitis in the warm period (0.13 vs. 0.07/patient‐year at risk, P=0.04) was identified. The incidence rate ratios (Confidence Interval) involving the overall gram positive PDRI, gram positive peritonitis, coagulase‐negative Streptococci (CoNS) and Streptococci were 1.82 (1.18‐2.82, P=0.007), 2.20 (1.16‐4.16, P=0.02), 2.65 (1.17‐6.02, P=0.02] and 3.18 (1.03‐9.98, P=0.04) in spring when compared to winter. No significant difference in the overall PDRI, peritonitis or CRI rates between seasons or warm/cold period was identified.To our knowledge, this is the first study which examines the effect of seasons on the incidence of PDRI in the Mediterranean basin. Findings suggest that spring confers a higher risk for gram positive PDRIs, gram positive peritonitis, CoNS and Streptococcus, whilst the warm period was associated with a peak in the gram negative peritonitis.

Pharmaceutical Care Issues of Rheumatoid Arthritis Patients

Along the years, pharmacy as a profession has come a long way. It has grown from the traditional role of the pharmacist-compounder, preparing and dispensing extemporaneous preparations within community pharmacies, to the role of the pharmacist dispensing ready-made medicines within community pharmacies [1–6]. This move from product focus to patient focus brought to the forefront the pharmacist intervention as an advisor and coordinator of care. The profession has expanded also within the pharmaceutical industry where pharmacists contribute at various levels within the pharmaceutical industry ranging from research and development for innovative drugs, quality control to pharmacovigilance and pharmaceutical regulatory affairs personnel. The pharmacy profession has made major strides within the hospital setting with clinical pharmacists participating as the fulcrum of a multidisciplinary team and contributing to the decision-making for patient care. In this evolution of the pharmacy profession, the patient’s well-being is the focus of pharmacist’s activities in whichever setting they are practising, and this is what makes a pharmacist a unique player in the different settings.

Back pain in a young adult

A 32 year old man was referred to the emergency department with a one week history of worsening mid-thoracic back pain. The pain radiated bilaterally and he occasionally felt it anteriorly in the chest. It was constant in nature and there were no associated symptoms. He did not look unkempt and was accompanied by his girlfriend and brother. He had no medical history of note but was a known intravenous drug user. He admitted to injecting drugs through “a vein in his armpit” and claimed that the last time he had heroin it looked “thicker” than usual. His physical examination was unremarkable and the following blood test results were obtained: white blood cell count 11.0×109/L (reference range 4.3-11.4), haemoglobin (11.9 g/L (14.1-17.2), and troponin <0.01 µg/L (0.006-0.04). A chest radiograph was normal. He was sent home with advice about back pain and analgesia. The pain persisted and he re-presented to the emergency department but was discharged again after a normal physical examination and thoracic spine radiography, which was reported as normal. Two days later he returned with worsening back pain, which was now waking him up at night. On percussion of the spine he was tender over the mid-thoracic area. At this stage he was febrile and had a wide based gait, with his left lower limb being spastic when compared with the right. Tone was increased on the left, whereas his lower limb power was decreased on the left (4/5) compared with the right. Sensation to light touch and pin prick was decreased (but present) from the nipple downwards on both sides. Joint position sense was present at both ankles and vibratory sensation was decreased but present at both big toes and normal at the ankles. Knee and ankle jerks were increased on the left more than …