The spontaneous development of a nasal septal abscess in patients with chronic kidney disease is hardly described in the literature. A 58-year-old man with long-standing type 2 diabetes mellitus and a history of rectal adenocarcinoma was admitted for resection of tumor recurrence. He was initiated on hemodialysis post-operatively due to worsening kidney function. He was discharged on thrice-weekly dialysis but was readmitted two months after for progressive shortness of breath. Further examination revealed severe nasal congestion from a nasal septal abscess which prompted mouth-breathing. Incision and drainage and anterior nasal packing were done, and the patient was discharged improved on broad-spectrum oral antibiotics. This case report highlights the possibility of developing nontraumatic nasal infections in patients with chronic kidney disease due to compromised host defenses.
Renal Insufficiency, Chronic ; Renal Dialysis ; Diabetes Mellitus

Objectives: In the Philippines, patients on chronic hemodialysis with COVID-19 remain admitted in hospitals despite clinical recovery because most free-standing dialysis units require proof of negative conversion via Reverse Transcriptase – Polymerase Chain Reaction (RT-PCR). This study aims to determine the time to negative conversion of COVID-19 RT-PCR testing among adult patients on chronic hemodialysis with COVID-19 admitted at the Philippine General Hospital (PGH) and bring insight in using the symptom or time-based procedure as recommended by local guideline, and ultimately, to ensure delivery of adequate hemodialysis despite being infected with COVID-19, shorten isolation period, and conserve resources especially in resource-limited settings. Methods: This is a retrospective cohort study on all adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19 by RT-PCR between March 2020 and February 2021. Descriptive statistics was used in summarizing the data. Results: A total of 90 patients on chronic hemodialysis who tested positive for COVID-19 via RT-PCR admitted at PGH were included in the study. Most of these patients had moderate COVID-19 at 53.3%. The median number of days from onset of symptoms to clinical recovery was 14.5 days. The median time to first negative conversion was 18 days. Most of these patients had negative conversion at the second week. The correlation coefficient between time to clinical recovery and negative conversion was 0.214. Conclusion Among adult patients on chronic hemodialysis who were admitted in PGH after the diagnosis of COVID-19, the time to negative conversion was longer compared to the time to clinical recovery with a very weak correlation between the two.
COVID-19 ; Renal Dialysis ;

Background: Contrast-induced nephropathy (CIN) is a complication that occurs in patients undergoing an imaging procedure with intravenous injection of contrast media, most notably iodinated dyes. Fluorescein angiography is a diagnostic procedure performed by ophthalmologists to determine abnormalities in retinal blood vessels. It uses sodium fluorescein, an organic dye, to capture and visualize these blood vessels. There have been conflicting data and practices on how to approach the procedure especially in patients with renal insufficiency. Objective: To determine the risk of CIN among patients undergoing fluorescein angiography. Methods: We searched PubMed, HerdIn, Cochrane Library, and Google Scholar, for published articles on the topic. Other sources were searched for unpublished data or ongoing clinical trials. All research articles pertaining to fluorescein angiography and its effect on renal function with serum creatinine monitoring were included. Two independent authors separately screened records, assessed full texts, and extracted data. We used RevMan computer software to analyze data from the included studies. The primary outcome was the risk of CIN among patients undergoing fluorescein angiography based on the differences on serum creatinine levels and estimated glomerular filtration rates pre- and post-angiography, while the secondary outcome included risk factors for CIN. Results: A total of 6 studies were included in the meta-analysis. Four studies had poor quality as assessed using the Newcastle-Ottawa Scale. One study was deemed to have good quality. Data analysis showed that hemoglobin (p = 0.002) and albumin (p < 0.001) levels may be associated with CIN using sodium fluorescein but were not independent risk factors for CIN (multivariable logistic regression, p = 0.648 and p = 0.069, respectively); while sex, diabetes mellitus and chronic kidney disease were not significantly associated. As a primary outcome, only 6.8% of included patients had CIN with serum creatinine levels post-exposure showed significant differences from baseline values (mean difference 0.05; 95% CI 0.02, 0.07; I2 = 49%), but translating it to eGFR yielded non-significant differences (mean difference -0.37; 95% CI -2.33, 1.59; I2 = 0%). Conclusion Among patients undergoing fluorescein angiography, sodium fluorescein does not pose an increased risk for CIN.
fluorescein angiography ; renal function

OBJECTIVE: To determine the effects of arginine in the rates of sputum conversion in patients with drug-sensitive pulmonary tuberculosis.

METHODS: Studies from PubMed, Medline, EMBASE, and Cochrane were reviewed and appropriate studies were included. Randomized controlled trials comparing arginine with placebo in adult patients with drug-sensitive pulmonary tuberculosis were included. The risk of bias was assessed using the Cochrane Risk of Bias tool. A meta-analysis of the rate of sputum conversion at 8 weeks, was conducted. Post hoc analyses of sputum conversion at 4 weeks and cough reduction at 4 and 8 weeks were done.

RESULTS: Three articles included in this study had a pooled population of 452 participants. This meta-analysis showed no significant difference in the sputum conversion at 4 and 8 weeks, with a relative risk of 0.96 (95% CI 0.77-1.20) and 1.07 (95% CI 0.96-1.19), respectively. However, the cough was significantly reduced at 4 and 8 weeks, with subtotal relative risks of 0.91 (95% CI 0.82-1.00) and 0.43 (95% CI 0.22-0.81), and total relative risk for cough reduction of 0.83 (95% CI 0.73-0.93).

CONCLUSION: While arginine may not significantly reduce sputum conversion rates, it may be used as an adjunct to decrease cough in patients with tuberculosis.