Articles

An Adaptive Approach to Recurrent Pseudomonas Cellulitis and Bacteremia in Patients with Comorbid Complexities

Pseudomonas aeruginosa has become increasingly difficult to manage due to its acquired antibiotic resistance and patient specific complications. The objective of this case study was to help guide management of resistant Pseudomonas in patients with complex comorbidities such as chronic kidney disease, recurrent cellulitis, venous insufficiency and more. Initial measures for treatment included Ciprofloxacin, Doxycycline, Levofloxacin and Vancomycin, but the patient either responded poorly with recurrent infections or did not respond at all to the treatment regiments. The patient felt relief and held the longest period of resolution when the treatment regimen included Daptomycin and Meropenem.

Biochemical Assessments of Thyroid Profile and Renal Function Test in Chronic Kidney Disease

Introduction: CKD is a clinical syndrome which occurs due to irreversible loss of renal function leading to metabolic, endocrine, excretory and synthetic function resulting in accumulation of non – protein nitrogenous substances which leads to metabolic derangements and ends up with distinct clinical manifestations.

Aim: To study thyroid function abnormalities in patients with chronic kidney disease. To correlate the thyroid function abnormalities with severity of renal failure. To differentiate primary hypothyroidism from thyroid dysfunction due to chronic kidney disease.

Methodology: After selection of patients, fulfilling the above criteria, about 5 ml of blood sample is collected in non-heparinised serum bottle and sent for thyroid profile test. Components of thyroid profile included in our study and Quantitative determination of T3, T4 and TSH is done by Enzyme Linked Immunosorbent Assay.

Result: In our study out of 50 patients, 33 patients had low serum T3 levels . 4 patients among low serum T3 value, they also had low T4 and high TSH suggesting primary hypothyroidism. So excluding 4 patients of hypothyroidism 29 patients had low T3 syndrome in our study. Low T4 levels in our study, out of which 4 patients had low T3 and high TSH suggesting primary hypothyroidism.

Conclusion: In my study population, 50 CKD patients who were on conservative management were studied. Among them 66% of the patients had low T3 values. The change in the serum levels of T3 and T4 in patients with CKD can be considered as being protective, promoting conservation of protein. There is increase in incidence of hypothyroidism in patients with chronic kidney disease.