We presented a patient who was first diagnosed, 2 years ago, with left nutcracker syndrome, May–Thurner syndrome, and pelvic compression syndrome. The patient’s symptoms returned despite the corrective surgery. Further investigation revealed right nephroptosis, and the patient underwent another corrective surgery.

End-stage renal disease patients often have tunneled catheters in the internal jugular veins as well as vascular access for hemodialysis. A 45-year-old man had been initiated on maintenance hemodialysis through a right internal jugular vein tunneled catheter. The patient presented with weakness of the left upper and lower limbs and aphasia of sudden onset. Cardiovascular system examination showed hyperdynamic apex beat with a loud S2 and the presence of S3 and S4. Echocardiography showed the presence of an oval right atrial, right ventricular thrombi and an atrial septal defect, ostium secundum type. A ventilation-perfusion scan of the lung and pulmonary angiogram confirmed pulmonary embolism. The internal jugular vein tunneled catheter was removed. Unfractionated heparin was initiated followed by warfarin with a Vitamin K-free diet. He was shifted to continuous ambulatory peritoneal dialysis.

Introduction The impact of switching to haemodialysis from peritoneal dialysis (PD) and the timing of this switch become more important to the long-term management of PD patients. We examined the following issues 1. The hazard of technique failure of PD on patient survival and the effect of the transfer to HD when compared to the patients continuing on PD and patients started on HD. 2. We investigated whether this hazard depends on the type of vascular access. Materials and Methods The study was as a retrospective single-centre cohort study. All ESRD patients who were on peritoneal dialysis at our centre between 01.01.2013 and 31.12.2022, were considered for inclusion in the study. Results During the study period, 677 patients were started on PD at our institute. In the present study, we did not find any significant difference in baseline characteristics between the patients who continued on PD and those who successfully switched to HD. The 90-day mortality after transfer to HD from PD was 20 patients (30.7%). The mortality was higher than the 90-day mortality in the matched 65 patients who were identified from the 372 patients who continued on PD. The significant risk factors for mortality identified after transfer to HD from PD were the absence of permanent of vascular access, lower ultrafiltration while on PD, lower serum albumin, and lower serum calcium. Discussion In our study, patients who continued on PD had a better survival than the patients transferred to HD. Other studies reported no difference in survival for patients staying on PD compared to patients with a successful switch to HD.

Abdominal wall calcification in a peritoneal dialysis patient has not previously been reported. We describe a 40-year-old lady, a type 2 diabetic and hypertensive for the past 14 years, who did not have any history, clinical features or laboratory results suggesting autoimmune disease, and had not suffered from tuberculosis in the past, but who had been diagnosed with chronic kidney disease in 2016. She had initiated peritoneal dialysis in December 2018.

Abstract A 20-year-old male patient presented with an alleged history of consumption of 80 mL of paraphenylenediamine (PPD) hair dye. At initial presentation, throat pain, anasarca and reduced urine output were evident. On general physical examination, tachycardia and tachypnoea were evident; blood pressure was 130/80 mm Hg. Oxygen saturation measured with a pulse oximeter (SpO 2 ) on ambient air was 98%. Laboratory investigations revealed haemoglobin (Hb) 14.7 g/dL, platelets 250,000/mm 3 , neutrophilic leucocytosis, total leucocyte count 23,600/mm 3 , 86% neutrophils) elevated serum creatinine (6.8 mg/dL), creatine phosphokinase levels (1466 IU/L), hyperkalaemia (6.2 mEq/L) and myoglobinuria. Abdominal ultrasonography revealed normal-sized kidneys and grade 2 renal parenchymal disease changes with maintained corticomedullary differentiation indicating acute kidney injury. Laboratory investigations done on day 7 of admission revealed anaemia Hb 9 g/dL, thrombocytopenia platelets 73,000/mm 3 , haemoglobinuria and elevated serum lactate dehydrogenase levels (3005 IU/L) with a negative direct and indirect Coombs test and schistocytes (5%) on peripheral smear suggesting microangiopathic haemolytic anaemia. Serum calcium, magnesium and phosphorous were within normal limits. Urinalysis showed plenty of red blood cells with dysmorphia. Haemolytic uraemic syndrome (HUS) was diagnosed and 15 sessions of haemodialysis as well as 7 sessions of plasma exchange were instituted. Clinical improvement was noted with improvement in urinary output; normalisation of laboratory parameters occurred over the next 3 weeks. He was discharged in a haemodynamically stable state. The present case highlights the unusual occurrence of HUS secondary to a hair dye (PPD) poisoning which responded to plasma exchange treatment.

On March 11, 2020, the World Health Organization recognized a new highly infectious-contagious SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection for humans as a pandemic.[1] Our tertiary care hospital of a medical university in South India started to function as hospital for COVID-19 patients on March 13, 2020. The aim of this article is to describe the clinical profile and outcomes of the end-stage renal disease patients on maintenance hemodialysis with COVID-19 disease at our center. Till December 31,2021, we had admitted and managed 15,719 COVID-19 disease patients. The overall mortality rate in all COVID-19 patients was 18.3% (2,878 deaths in 15,719 patients). We admitted all patients with end-stage renal disease (ESRD) on maintenance hemodialysis (MHD) who were –positive for SARS-CoV-2 by RT-PCR (reverse transcription polymerase chain reaction). These patients were both from our institute’s dialysis unit and patients referred to us from other dialysis centers. From March 2020 to March 1, 2021, we admitted 269 MHD patients, out of whom the patient files were available for 210 patients. From March 1, 2021 to till December 31, 2021, we admitted MHD 445 patients, out of whom the patient files were available for 385 patients. The total number of patients was 714. The patient files were available for 595 patients (83.3%). The minimum and maximum ages of the patients were 10 and 89 years, respectively[Supplementary Table 1]. The number of males was 435 (60.9%).Supplementary Table 1The etiology of ESRD comprised diabetes mellitus in 229 (38.4%) patients, hypertension in 126 (21.1%) patients, and other etiologies accounted for 240 (40.3%) patients. However hypertension was documented either at admission or during hospital stay in 392 patients. At admission, the mean systolic and diastolic blood pressures were 133.8 and 81.5 mm Hg. Majority of patients (606 out of 714/84.8%) were on MHD with an arteriovenous fistula. For 108 patients (out of 714/15.1%), femoral vein catheters were placed for these patients required initiation of MHD for the first time. In no patient, internal jugular vein catheterization was done. Out of 595 patients, noninvasive ventilation at admission was necessitated in 68 (11.4%) patients, and 253 (42.5%) patients required oxygen. However, 145 (out of 595/24.3%) patients required NIV in hospital stay (NIVh). This group included the patients transferred onto NIV from oxygen or admitted without oxygen requirement. The number of patients of ESRD on MHD with COVID-19 disease who expired in the hospital was 203 (34.1%). The age-wise mortality was compared in Supplementary Table 1. The data of the analysis of the mortality risk factors are described in Tables 1 to 2 and in Supplementary Tables 2–6. A table of comparison between the patients admitted in 2020 and 2021 is given in Supplementary Table 7.Table 1: NIV patients only versus non-NIV patientsTable 2: Risk factors for mortality: Multivariate regression analysis (variables in the equation)Supplementary Table: s 2Supplementary Table: s 3Supplementary Table: s 4Supplementary Table: s 5Supplementary Table: s 6Supplementary Table: s 7The number of deaths reported was 2,878 (18.3%) out of the total 15,719 COVID-19 disease patients managed. As of December 31,2021, the mortality percentage worldwide 1.9% and in our country was 1.38%. The mortality rate in ESRD patients on MHD with COVID-19 disease at our institution was 34.1%. We identified age, SpO2 at admission, number of dialysis sessions, total leucocyte count, neutrophils, lymphocytes, blood urea, aspartate aminotransferase (AST), alanine aminotransferase (ALT), C-reactive protein (CRP), serum ferritin, serum lactate dehydrogenase (LDH), male, diabetes mellitus, oxygen requirement at admission, NIV at admission, and NIV in hospital are significant risk factors for mortality. On multivariate analysis age, NIV in hospital stay and serum LDH remained significantly associated with mortality. We also identified that oxygen-requiring patients by non rebreather masks or simple masks, not by NIV, were 6.51 times more at risk of mortality than patients not requiring oxygen, NIV patients were 9.78 times more at risk of mortality than others, and NIV andoxygen-requiring patients were 8.621 times more at risk of mortality than patients not requiring oxygen. Non oxygen requirement at admission had a significant favorable impact on the outcome, P < 0.001 OR: 0.116 (0.07–0.178). The admission of ESRD patients on MHD was universal at our institute so as to isolate them from the non-COVID-19 ESRD patients. Therefore, the admission happened within few hours of diagnosis or onset of symptoms. The mean duration of hospital stay was 8.5 days. The median length of stay before death was six days. The length of hospital stay was reported as 11.4 days after admission by Goicoechea et al.[2] and as 12 days by Alberici et al.[3] Goicoechea et al.[2] reported that the median length of stay before death was 9.3 days. The mortality rate of hospitalized ESRD patients on MHD with COVID-19 disease in the study from Turkey was six times higher than the general population.[4] The mortality rate of COVID-19 MHD patients in a few more published studies was higher than the non dialysis COVID-19 patients. The significant risk factors for the higher mortality in the studies of our nation and the international studies are listed in Supplementary Tables 8 and 9.[S1-S12]Supplementary Table: s 8Supplementary Table: s 9Supplementary Material and Methods Supplementary tables Supplementary references Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The authors declare no conflict of interest. Figure S1: Trophic ulcer on the right foot Table S1: Investigations Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Burkitt's lymphoma (BL) is a highly aggressive type of B-cell non-Hodgkin lymphoma. BL commonly occurs in children of age 4-7 years and is uncommon in adults, with a worse prognosis. Patients often present with a rapidly growing mass typically involving the abdomen (liver and spleen) and head and neck (nodes, jaw, and facial bones). Pancreas involvement is very rare and very few case reports have been documented so far. Fluorine-18 positron emission tomography/computed tomography (F-18 PET/CT) is a whole-body survey commonly used for initial staging evaluation. Here, we present an interesting case of BL in an adult female of 43 years, who presented with swelling in the left submandibular region after tooth extraction with multiorgan involvement found on F-18 fluorodeoxyglucose PET/CT.

Background: Patients with stage 5 chronic kidney disease (CKD) have an increased atherosclerotic burden. Several radiological methods have been used to investigate aortic calcification. Such methods are costly and are primarily used for clinical research purposes. Noninvasive imaging techniques may be used to monitor the progression and/or regression of coronary atherosclerosis and thus possibly to evaluate its effectiveness. Aim and Objectives: Cardiovascular (CV) risk assessment with the help of imaging modalities (abdominal aortic calcification (AAC) scoring, carotid intima-media thickness (CIMT), cardiac valvular calcifications (CVCs)) in patients with stage 5 CKD and comparison with patients with stage 5 CKD receiving hemodialysis. Materials and Methods: This study included 30 patients with stage 5 CKD not on dialysis (Group 1) and 30 patients with stage 5D CKD receiving hemodialysis. Results: The prevalence of AAC scoring, CIMT, and CVCs in the present study was more in the stage 5D CKD receiving hemodialysis group as compared to the stage V CKD group. Conclusion: The present study findings conclude lateral abdominal x-ray to measure aortic calcification can be used to assess vascular calcification (intimal and medial) in patients with CKD.

Wasp stings are not uncommon, particularly in the warmer climates, as people tend to spend longer times outside. A 49-year-old healthy gentleman had suffered multiple wasp stings all over his body. At the primary health centre, he was documented to have had flaccid quadriparesis with serum potassium of 2.3 mEq/L. At our institute, we diagnosed distal renal tubular acidosis. With history and investigations, we have excluded the major causes of distal renal tubular acidosis. We concluded that the wasp sting was responsible for distal renal tubular acidosis. The bradykinin contained in the wasp venom inhibits the basolateral 40-pS K + channel activity in the distal convoluted tubules and stimulates potassium excretion.

Of the more than 20 studies published on SLE patients with COVID-19, none of the studies focused on lupus nephritis. We report the outcomes of renal biopsy-proven systemic lupus erythematosus (SLE) nephritis patients after COVID-19 disease. Our institute has been declared as a state COVID-19 hospital in the last week of March 2020. From then till now, we have admitted and managed COVID-19 patients from several districts of Andhra Pradesh and neighbouring states. We collected the data of patients with SLE nephritis contemporaneously from admission to the outcomes on a computerised proforma. We had identified sixteen patients with SLE nephritis who were admitted with COVID-19 disease. Of them, fourteen were females and two were males. The mean age was 29.3 years. Out of sixteen patients, seven required a mechanical ventilator and dialysis and eventually succumbed. One more patient died due to disseminated tuberculosis. Our results suggested that with an approximately 50% mortality rate, the COVID-19 disease had a calamitous effect on SLE nephritis patients. Key Points • We identified the significant risk factors for mortality: younger age, higher serum creatinine at presentation, higher CT severity score and lower serum albumin. • After the analysis done for this article, we decided to reduce the medications for SLE nephritis to prednisolone 10 mg/day when COVID-19 disease is contracted.

Background This study presents our data on mortality in end stage renal disease (ESRD) patients on peritoneal dialysis (PD) who developed COVID-19. Materials and methods Sri Padmavathi Medical College Hospital, Sri Venkateswara Institute of Medical Sciences University, was designated the State COVID Hospital in March 2020. In a retrospective observational study, we collected the data of ESRD patients on PD and identified the risk factors for mortality. Results Prior to the pandemic, 136 patients with ESRD were on peritoneal dialysis at our Institute. Among them, 27 (19.8%) eventually developed COVID-19, and 14 of them (51.8%) died. Serum albumin levels were lower and D-dimer levels were significantly higher in deceased patients than in survivors. Discussion The mortality rate in ESRD patients on PD with COVID-19 at our institution was higher than in other published studies.

Even though a small number of published single patient reports have more recently reported pulmonary cavitation in COVID-19 disease, it is still considered a rare radiology feature. We report a 45-year-old man with COVID 19 disease and a pulmonary cavity.

The multiorgan deleterious effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) are now well known. Although COVID-19 disease is a hypercoagulable state and thrombotic complications occur in about one-third of critically ill patients with COVID-19, thrombosis is not typically a presenting symptom. We report the case of a patient presented with the complaints of abdominal pain due to renal vein thrombosis as the first feature of the COVID-19.

Serum phosphate level reference range in adults is 2.5 mg/dL to 4.5 mg/dL and in children is 3 mg/dL to 6 mg/dL. The causes of hyperphosphatemia fall into four categories. These are decreased renal excretion of phosphorus, exogenous phosphorus administration, redistribution of phosphorus, and pseudohyperphosphatemia. We report a 69-year-old gentleman presented with the history of swelling of feet and facial puffiness of 1 month duration. He had renal failure with normal sized kidneys. Serum phosphorus was high. Advanced investigations revealed plasma cell proliferative disorder (clonal bone marrow plasma cells >10%) on bone marrow examination, presence of M band at the junction of beta-2 and gamma region, and elevated serum IgG and serum beta-2 microglobulin. Hyperphosphatemia in multiple myeloma may be true, or pseudohyperphosphatemia. Diligent history, examination, and investigations have yielded the possibility of pseudohyperphosphatemia owing to multiple myeloma in our patient. The interference with the phosphomolybdate ultraviolet assay for serum phosphorus estimation is one of the reasons of pseudohyperphosphatemia in multiple myeloma. The other mechanism of pseudohyperphosphatemia could be the direct binding of paraprotein to phosphorus.

Scrub typhus caused by organism Orientia tsutsugamushi and transmitted to humans by the bite of a leptotrombidium mite (chigger). Although eschar formation is one of the important signs that aid in diagnosis, multiple eschar formation is a rare presentation. Although scrub typhus causes multiple organ dysfunction, the pancreas involvement is rare. Here, we describe a patient with scrub typhus with multiple eschars complicated with acute pancreatitis and acute kidney injury.

A 54-year-old man with hypertension, end-stage renal disease (ESRD) who was receiving thrice-weekly haemodialysis for the past 3 years, developed breathlessness after a session of haemodialysis. Oxygen saturation by pulse oximetry (SpO2) was 88% and he was admitted for evaluation. Nasopharyngeal swab real time-polymerase chain reaction (RT-PCR) had tested positive for SARS-CoV-2. He was started on intravenous azithromycin, dexamethasone 8 mg, and subcutaneous heparin. On the 8th day after admission, he had painful swelling, redness and watering of the left eye. Within hours, he also complained swelling of the left half of the face, diminished vision and reduced eye movements of the left eye. Magnetic resonance imaging (MRI) and magnetic resonance angiography of the brain revealed left orbital cellulitis. angioinvasive fungal sinusitis. Laboratory testing confirmed the diagnosis. The patient was treated with intravenous ammphotericin B and surgery.

Drugs associated with gingival overgrowth fall into three broad categories – anticonvulsants, immune suppressants and calcium channel blockers. Amlodipine is a third-generation dihydropyridine. The prevalence of amlodipine-induced gingival hyperplasia is 4.2%. We report two patients with the amlodipine-induced gingival hyperplasia.