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Calciphylaxis is a life threatening disease for which patients with chronic kidney disease, particular those on dialysis, are at increased risk. As it is a rare condition, treatment options are limited and duration of treatment is not clear, especially when it comes to patients on renal replacement treatment with peritoneal dialysis. We report a case of a 55 year-old woman with end stage renal disease on renal replacement treatment with peritoneal dialysis for five months that presented with severe calciphylaxis of both legs. She had started haemodialysis at the age of 31 and 3 later she received a cadaveric renal transplant that lasted for 20 years. She was treated with warfarin due to atrial fibrillation diagnosis. The treatment approach was multimodal and multidisciplinary and included treatment with sodium thiosulfate and hyperbaric oxygen, warfarin suspension and maintenance of optimized peritoneal dialysis prescription. Additionally, wound dressings were done every other day and antibiotics started whenever there were signs of infection and pain was managed with high doses of opiates and pain adjuvants. There was significant improvement and the patient kept peritoneal dialysis treatment with preserved residual renal function. This raises the question, if there is a need to transition calciphylaxis patients on peritoneal dialysis to haemodialysis, as it is possible to ensure a high efficiency dialysis program with automated peritoneal dialysis., Bulletin de la Dialyse à Domicile, Vol. 2 No 4 (2019): Bulletin de la Dialyse à Domicile

This study aims to assess the under-reporting and misclassification of the traffic injury severity reported by the police for the first time in Portugal. The non-fatality traffic injuries classified by the police are compared with the information recorded by the hospitals using linked data. The underreporting in the police data was found to be of 29%. Therefore, a significant number of road traffic casualties admitted in the hospitals were not known by the police. Taking advantage of the linked information on accident injuries, the misclassification in the police reports is assessed considering two criteria: the length of hospital stay (LS) and the maximum abbreviated injury scale (MAIS). The latter criterion corresponds to the common definition recently established by the European Commission, which has the advantage of representing the medical conditions of the casualty. The comparison between police classification and LS indicates that a discrepancy between the police reports and the established police definition exists. On the other hand, the police classification shows a tendency to overclassify the injury severity regarding the MAIS. A remarkable proportion of severe injuries reported by the police are, in fact, slight injuries. Additionally, using univariate and multivariate analyses, factors contributing to the misclassification of casualties by the police are identified. Finally, similarly to the fatality adjustment coefficient used in Portugal and in other countries in the past, non-fatality adjustment coefficients were computed to estimate the total casualties taking into account the under-reporting and misclassification phenomena. These adjustment factors are compared with other countries.