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Moinuddin Z, Wang K, Fullwood C, Wiredu E, Hutchison A, Vardhan A, Herrick SE, Summers A, Augustine T, van Dellen D. Renal hyperparathyroidism- a risk factor in the development of encapsulating peritoneal sclerosis. Front Endocrinol (Lausanne) 2024; 15:1282925. [PMID: 38567303 PMCID: PMC10985182 DOI: 10.3389/fendo.2024.1282925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is a rare complication of prolonged peritoneal dialysis (PD) exposure, characterised by peritoneal thickening, calcification, and fibrosis ultimately presenting with life-threatening bowel obstruction. The presence or role of peritoneal calcification in the pathogenesis of EPS is poorly characterised. We hypothesise that significantly aberrant bone mineral metabolism in patients on PD can cause peritoneal calcification which may trigger the development of EPS. We compared the temporal evolution of bone mineral markers during PD in EPS patients with non-EPS long-term PD controls. Methods Linear mixed model and logistic regression analysis were used to compare four-monthly serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase (ALP) over the duration of PD exposure in 46 EPS and 46 controls (PD, non-EPS) patients. Results EPS patients had higher mean calcium (2.51 vs. 2.41 mmol/L) and ALP (248.00 vs. 111.13 IU/L) levels compared with controls (p=0.01 and p<0.001 respectively, maximum likelihood estimation). Logistic regression analysis demonstrated that high serum calcium and phosphate levels during PD were associated with a 4.5 and 2.9 fold increase in the risk of developing EPS respectively. Conclusion High levels of calcium and phosphate in patients on PD were identified to be risk factors for EPS development. Possible reasons for this may be an imbalance of pro-calcifying factors and calcification inhibitors promoting peritoneal calcification which increases peritoneal stiffness. Mechanical alterations may trigger, unregulated fibrosis and subsequent development of EPS. Improved management of secondary hyperparathyroidism during PD may ultimately diminish the EPS risk.
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Affiliation(s)
- Zia Moinuddin
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Kelvin Wang
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Catherine Fullwood
- Department of Statistics, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Elizabeth Wiredu
- Medical Statistics, Data Solution Services, Liverpool, United Kingdom
| | - Alastair Hutchison
- Department of Nephrology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Anand Vardhan
- Department of Nephrology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Sarah E. Herrick
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Angela Summers
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - David van Dellen
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary (National Commissioning Group (NCG) funded United Kingdom Referral Centre for EPS Surgery), Manchester, United Kingdom
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Adewole IF, Abauleth YR, Adoubi I, Amorissani F, Anorlu RI, Awolude OA, Botha H, Byamugisha JK, Cisse L, Diop M, Doh S, Fabamwo AO, Gahouma D, Galadanci HS, Githanga D, Magure TM, Mabogunje C, Mbuthia J, Muchiri LW, Ndiaye O, Nyakabau AM, Ojwang SBO, Ramogola-Masire D, Sekyere O, Smith TH, Taulo FOG, Wewege A, Wiredu E, Yarosh O. Consensus recommendations for the prevention of cervical cancer in sub-Saharan Africa. Southern African Journal of Gynaecological Oncology 2015. [DOI: 10.1080/20742835.2013.11441209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
PURPOSE To explore the current system of medical rehabilitation services for persons with disabilities in a developing country (Ghana) and to identify future needs, opportunities, and barriers. METHODS Information was obtained through a literature review and through interviews with healthcare providers, disabled people's organizations, educators, government officials, and consumers. Direct observations were made of Ghana's capital city, Accra, and of a major tertiary medical center there, Korle Bu Teaching Hospital. RESULTS Ghana has virtually no medical rehabilitation and few laws to protect the disabled. There are no occupational therapists or physiatrists in the entire country, and only a handful of physical therapists, prosthetists, orthotists, and speech therapists. There are many barriers to the establishment of such services, including lack of funding, limited government support, cultural stigma of the disabled and poor utilization of existing resources. CONCLUSIONS A national model for sustainable medical rehabilitation is needed in Ghana and likely in other similar countries.
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Affiliation(s)
- M J Tinney
- Department of Physical Medicine and Rehabilitation, University of Michigan Hospital, Ann Arbor, Michigan, USA
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Nagarajarao HS, Kumar BN, Watt JWH, Wiredu E, Bhamidimarri K. Bedside assessment of sympathetic skin response after spinal cord injury: a brief report comparing inspiratory gasp and visual stimulus. Spinal Cord 2005; 44:217-21. [PMID: 16172628 DOI: 10.1038/sj.sc.3101821] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A case control study in five controls, and 20 tetraplegic and paraplegic patients, complete and incomplete. OBJECTIVE The aim was to assess the feasibility of a simple test for sympathetic system preservation after spinal cord damage in a pain-free manner and which could be undertaken worldwide without specialist equipment or manpower. SETTINGS Patients were attending the Southport Regional Spinal Injuries Centre, England, either as outpatients or as in-patients during rehabilitation. METHODS The sympathetic skin response (SSR) was recorded on a single-channel ECG recorder from the right hand and right foot in turn after inspiratory gasp (IG) or visual stimulation. RESULTS Unlike the visually evoked SSR, the gasp-evoked SSR was reliable, albeit of variable amplitude, and there was little difference between the hand and foot. Paraplegics had similar SSRs in the hands as the controls. There was minor insignificant habituation of response for the gasp reflex. There was occasional unexpected SSR distally in patients with complete lesions, and in patients with incomplete lesions the responses could not have been predicted from the sensory motor pattern. CONCLUSIONS Trained IG induces an SSR which is sufficient to elucidate sympathetic loss following spinal cord injury. It is superior to visual stimulation in this respect. Habituation is not a problem with at least 1 min between tests, and high doses of anticholinergics agents may impair the response.
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