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TITLE:

BILATERAL CHYLOTHRAX IN A 5-YEAR-OLD MALE WITH END STAGE RENAL DISEASE

AUTHORS:

Kholoud Aser, Rehab Aser, Hatun N Shualuwalah, Nada Danish, Rahaf K AlThomali, Rahaf F Alturkistani, Baraah AlSawaf,Lamees H Aldoobie , Lujain Hefni1 Yara Felimban, Osama Safdar

ABSTRACT:

The binding characteristics of ribavirin to human serum albumin (HSA) have been studied using fluorescence technique under in vitro disease mimetic conditions of uremia and diabetes. Ribavirin is found to bind moderately (Kb-104) with glycated and native HSA. There is decrease in binding both in glycated human serum albumin and with human serum albumin in presence of urea. Ribavirin binding leads to intrinsic fluorescence quenching of HSA, glycated albumin and HSA in presence of urea indicating ribavirin binding to transport protein. Binding constant values decreased with increasing temperatures suggesting the quenching mode operating in the binding interaction of ribavirin with HSA and GHSA is static. Binding process was found to be spontaneous and exothermic. Analysis of the quenching and thermodynamic parameters of protein ligand system suggested the change in intermolecular interactions between ribavirin and HSA upon protein modification by glycation and in presence of urea leading to loss in ligand binding. Keywords: Glycated human serum albumin; uremia; fluorescence spectroscopy; ligand binding; ribavirin Background: Chylothorax is a rare but serious complication of chronic venous lines. Here we are presenting a 5-year old with End stage renal disease who developed bilateral cylothorax secondary to right internal jugular and left subclavian vein due to the use of central hemodialysis lines Case presentation: This s a 5 year old mare witj ESRD secondary to alport syndrpme who presented to emergency department with shortness of breath. Chest X ray showed right sided plural effusion and chemical analysis indicated that it's a chylothoax . Patient improved clinically and discharged in a good condtion.One month later he presented again to emergency department with severe shotnss of breath and chest X ray and plural fluid analysis indicted a bilateral chylothorax. Bilateral pigtail inserted. Patient managed conservatively with total parental nutrition. Conclusion: Although Chylothorax is a rare but it is serious diagnosis that's require an attention. Patients on chronic venous lines are at particular risk to develop such a complication Background: Chylothorax is an accumulation of chyle fluid in the plural cavity. It is are complication thats can develop secondary to venous stenosis or obstruction. Underlying mechanisms include developing of a thrombosis intitmal injury (1). Another potential mechanism for chylothorax is injury to thoracic duct in open heart surgery (1). Paints with chronic kidney disease are at particular rsil becuase of chonic use of central venous lines to undergo hemodialsysis Here we are presenting a first case in the literature for child with ESRD who developed a bilateral cylothorax. Key words: Chylothorax, Alport syndrome , End stage renal disease

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