Clinical outcomes of hemodialysis patients in a public-private partnership care framework in Italy: a retrospective cohort study

Chronic kidney disease and gut microbiota

Chronic kidney disease (CKD) refers to a range of various pathophysiological processes correlated with abnormal renal function and a progressive loss in GFR. Just as dysbiosis and altered pathology of the gut are accompanied with hypertension, which is a significant CKD risk factor. Gut dysbiosis in CKD patients is associated with an elevated levels of uremic toxins, which in turn increases the CKD progression. According to research results, the gut-kidney axis has a role in the formation of kidney stones, also in IgAN. A number of researchers have categorized the gut microbiota as enterotypes, and others, skeptical of theory of enterotypes, have suggested biomarkers to describe taxa that related to lifestyle, nutrition, and disease status. Metabolome-microbiome studies have been used to investigate the interactions of host-gut microbiota in terms of the involvement of metabolites in these interactions and are yielded promising results. The correlation between gut microbiota and CKD requires further multi-omic researches. Also, with regard to systems biology, studies on the communication network of proteins and transporters such as SLC and ABC, can help us achieve a deeper understanding of the gut-liver-kidney axis communication and can thus provide promising new horizons in the treatment of CKD patients. Probiotic-based treatment is an approach to reduce uremic poisoning, which is accomplished by swallowing microbes those can catalyze URS in the gut. If further comprehensive studies are carried out, we will know about the probiotics impact in slowing the renal failure progression and reducing inflammatory markers.

Hospital services under public-private partnerships, outcomes and, challenges: A literature review

Public-private partnerships (PPP) is used to advance health service access and quality. PPP implementation in hospitals is vital to shorten the service and quality gap. Hospitals are the most significant health budget spender, and this study aimed to identify the PPP effect on hospital performance indicators and its implementation challenges. Thirty-three inclusive articles were filtered and collected from Pubmed, ScienceDirect, Medline, and Sage Publication databases. Results showed that various articles succeeded in implementing PPP and improving the access and quality of health services. Several hospital performance indicators such as diagnosis, therapy, service waiting time, length of stay, referral rate, mortality rate, and patient satisfaction were reported to show better results. However, there was insufficient evidence to say the same on related financial indicators. Policy, resource, communication and trust, risk, and evaluation monitoring were considered challenges in PPP implementation. Its success was not only influenced by major factors such as governance model, finance, politics, and social but also was influenced by the medical practice model applied within the organization. This study contributed to whether PPP affects the hospital performance indicators.

Clinical and ultrasonographic screening for carpal tunnel syndrome in hemodialysis patients

Background

Carpal tunnel syndrome (CTS) is one of the most common complications among hemodialysis (HD) patients. This study aimed to assess the prevalence of CTS in HD patients using clinical and noninvasive ultrasound (US) criteria.

Methods

A cross-sectional, observational study was conducted on 94 HD patients to evaluate CTS manifestations and demographic, clinical, and laboratory data. The median nerve (MN) cross sectional area (CSA) (MN-CSA) was estimated by US examination at the pisiform and hamate levels. Both hands were evaluated, and the higher MN-CSA was considered.

Results

Neuropathic pain and nocturnal numbness at MN distribution were present in 40.4% and 18.1%, respectively, while Tinel’s test was positive in 25.5% of patients. A MN-CSA ≥ 11.5 mm² identified the probability of CTS with 63% sensitivity and 80% specificity. Patients with CTS had higher serum calcium (P = 0.02) and lower parathyroid hormone (PTH) (P = 0.02). CTS was frequently developed on the same side of an arteriovenous fistula. The MN-CSA had positive correlations with age, serum phosphorus, and visual analogue scale (VAS) score (P = 0.01, 0.01, and 0.03 respectively) and a negative correlation with PTH level (P = 0.007). Serum phosphorus level (P = 0.015) and VAS (P = 0.04) were the significant predictors of MN-CSA.

Conclusion

CTS appears to frequently occur in HD patients. US examination may be helpful in detection of CTS and can be an alternative to electrodiagnostic studies in HD patients.