Sheikh Muhammad Ebad Ali, Badaruddin Sahito, Syeda Iqra Qadri, Hira Iqbal Naviwala, H. Khan, O. Awan, Muhammad Mohsin Mushtaq
Abstract:Perioperative anticoagulation has been recommended by AAOS, AACP, and ASH during orthopedic procedures of the lower limb. Guidelines show a difference of opinion regarding the optimum duration and drug of choice giving a way to use different methods of anticoagulation. This audit assessed the preferences for pharmacological anticoagulation in lower limb surgeries among orthopedic surgeons of Pakistan. Materials and Methods: An online questionnaire-based cross-sectional study was started from June-September 2021 in Dr Ruth K.M. Pfau Civil Hospital Karachi where Orthopedic surgeons (n=632) were invited to fill those questionnaires. A total of 85 orthopedic surgeons responded completely. An electronic eight-question survey was designed which included questions about demographics of surgeons, the drug of choice, perioperative duration, preferred surgeries, and average incidence of thromboembolism per year. Results: 12.9% surgeons use anticoagulation for all surgeries while 82.3% of orthopedic surgeons use anticoagulants in selective surgeries. LMWH (94.1%) and Rivaroxaban (17.6%) were the drug of choice for most surgeons. 70.6% of respondents never used anticoagulation preoperatively. 17.7% used it three days preoperatively. 28.24% of surgeons prescribed anticoagulation for 3 days postoperatively while 17.7% of surgeons prescribed anticoagulation for 2 weeks postoperatively. 10.6% of surgeons never used anticoagulation postoperatively. Arthroplasty (71.7%), trauma (55.3%), and pelvis and acetabulum (54.1%) were the subspecialties with routine anticoagulation. 81.2% and 17.7% of surgeons reported less than 1% and 1% to 3% incidence of thromboembolism, respectively. No surgeon reported any incidence of thromboembolism above 5%. Conclusion: Use of anticoagulation is prevalent among orthopedic surgeons in Pakistan. However, significant differences are observed regarding the perioperative duration. The surgeons need to prescribe DOAC such as Rivaroxaban and Dabigatran as agents of choice while extended postoperative pharmacological anticoagulation of 28-35 days needs to be adopted.
{"title":"Current Trends Regarding Perioperative Pharmacological Anticoagulation in Lower Limb Surgeries among Orthopedic Surgeons of Pakistan -An Audit","authors":"Sheikh Muhammad Ebad Ali, Badaruddin Sahito, Syeda Iqra Qadri, Hira Iqbal Naviwala, H. Khan, O. Awan, Muhammad Mohsin Mushtaq","doi":"10.21089/njhs.73.0124","DOIUrl":"https://doi.org/10.21089/njhs.73.0124","url":null,"abstract":"Abstract:Perioperative anticoagulation has been recommended by AAOS, AACP, and ASH during orthopedic procedures of the lower limb. Guidelines show a difference of opinion regarding the optimum duration and drug of choice giving a way to use different methods of anticoagulation. This audit assessed the preferences for pharmacological anticoagulation in lower limb surgeries among orthopedic surgeons of Pakistan. Materials and Methods: An online questionnaire-based cross-sectional study was started from June-September 2021 in Dr Ruth K.M. Pfau Civil Hospital Karachi where Orthopedic surgeons (n=632) were invited to fill those questionnaires. A total of 85 orthopedic surgeons responded completely. An electronic eight-question survey was designed which included questions about demographics of surgeons, the drug of choice, perioperative duration, preferred surgeries, and average incidence of thromboembolism per year. Results: 12.9% surgeons use anticoagulation for all surgeries while 82.3% of orthopedic surgeons use anticoagulants in selective surgeries. LMWH (94.1%) and Rivaroxaban (17.6%) were the drug of choice for most surgeons. 70.6% of respondents never used anticoagulation preoperatively. 17.7% used it three days preoperatively. 28.24% of surgeons prescribed anticoagulation for 3 days postoperatively while 17.7% of surgeons prescribed anticoagulation for 2 weeks postoperatively. 10.6% of surgeons never used anticoagulation postoperatively. Arthroplasty (71.7%), trauma (55.3%), and pelvis and acetabulum (54.1%) were the subspecialties with routine anticoagulation. 81.2% and 17.7% of surgeons reported less than 1% and 1% to 3% incidence of thromboembolism, respectively. No surgeon reported any incidence of thromboembolism above 5%. Conclusion: Use of anticoagulation is prevalent among orthopedic surgeons in Pakistan. However, significant differences are observed regarding the perioperative duration. The surgeons need to prescribe DOAC such as Rivaroxaban and Dabigatran as agents of choice while extended postoperative pharmacological anticoagulation of 28-35 days needs to be adopted.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127814139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Objectives: To determine etiology and spectrum of trauma in children and to make recommendations for its prevention. Materials and Methods: This Hospital based Retrospective observational study was conducted in Department of Pediatric Surgery King Edward Medical University / Mayo Hospital Lahore from March 2021 to February 2022. All patients presented in Pediatric Surgical emergency King Edward Medical University/ Mayo Hospital Lahore were included in this study. Data regarding age, gender, mechanism and severity of trauma and its management was analyzed and recorded on a prescribed Performa. Results: During the study period a total of 3850 patients having trauma were presented in pediatric surgical emergency. There were 2206 (57.3%) male patients and 1644 (42.7%) females with male to female ratio of 1.3:1. Majority of children affected were 8 to 10 years age. Burn trauma was noted in 2400 (62.3%) while 1450 (37.7%) patients have poly trauma due to different etiological factors. Regarding burn trauma, majority of patients 1620 (67.5%) were having scald burn injury. Pedestrians 260 (17.9%) hitting with motor vehicle was noted to be major mechanism of trauma. Conclusion: Motor vehicle collision is most common mechanism of pediatric trauma after pediatric burn injury. There is a need for parental education and strict implementation of traffic laws to prevent trauma at pediatric age group.
{"title":"Frequency and Etiology of Pediatric Trauma, Experience at Tertiary Care Hospital","authors":"M. Bashir, Aisha Ishtiaq, Shazia Bashir","doi":"10.21089/njhs.73.0121","DOIUrl":"https://doi.org/10.21089/njhs.73.0121","url":null,"abstract":"Abstract: Objectives: To determine etiology and spectrum of trauma in children and to make recommendations for its prevention. Materials and Methods: This Hospital based Retrospective observational study was conducted in Department of Pediatric Surgery King Edward Medical University / Mayo Hospital Lahore from March 2021 to February 2022. All patients presented in Pediatric Surgical emergency King Edward Medical University/ Mayo Hospital Lahore were included in this study. Data regarding age, gender, mechanism and severity of trauma and its management was analyzed and recorded on a prescribed Performa. Results: During the study period a total of 3850 patients having trauma were presented in pediatric surgical emergency. There were 2206 (57.3%) male patients and 1644 (42.7%) females with male to female ratio of 1.3:1. Majority of children affected were 8 to 10 years age. Burn trauma was noted in 2400 (62.3%) while 1450 (37.7%) patients have poly trauma due to different etiological factors. Regarding burn trauma, majority of patients 1620 (67.5%) were having scald burn injury. Pedestrians 260 (17.9%) hitting with motor vehicle was noted to be major mechanism of trauma. Conclusion: Motor vehicle collision is most common mechanism of pediatric trauma after pediatric burn injury. There is a need for parental education and strict implementation of traffic laws to prevent trauma at pediatric age group.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127271060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Congenital or inherited bone marrow failure syndromes are hereditary syndromes of diverse nature which are characterized by inadequate production of blood cells causing cytopenias. Failure of bone marrow can be limited to one or more lineages of blood cells, along with symptoms specified to lineage, through it can affect all cell lineages leading to clinical picture like aplastic anemia. These syndromes are genetic diseases of heterogenous nature caused by germline mutations affecting basic pathways of cell including telomerase biology, biogenesis of ribosomes, structural proteins, and repair of DNA. Common inherited bone marrow failure syndromes consist of Schwachman – Diamond syndrome, Diamond – Blackfan anemia, Fanconi anemia, and Dyskeratosis Congenita. These syndromes have different prognosis and tendency to develop solid or hematological malignancies. Therefore, the adequate diagnosis of these disorders and their differentiation from other bone marrow failure syndromes and/or other etiologies of the boe marrow failure is very significant for surveillance and management of patients. Acquired causes may also lead to bone marrow failure including radiations, chemicals, drugs, immune diseases, viral infections, myelodysplastic syndromes, large granular lymphocytic leukemia, or paroxysmal nocturnal hemoglobinuria (PNH). Inherited bone marrow failure syndromes are heritable and affects family members as well, therefore need genetic counselling. In this review, differential diagnosis, various causes, and their pathogenesis are discussed for better understanding of inherited bone marrow failure syndromes.
{"title":"Inherited Bone Marrow Failure Syndromes – Challenges and Updates","authors":"S. A. Jiskani, Saleem Akhtar Shaikh, R. Talpur","doi":"10.21089/njhs.73.0129","DOIUrl":"https://doi.org/10.21089/njhs.73.0129","url":null,"abstract":"Abstract: Congenital or inherited bone marrow failure syndromes are hereditary syndromes of diverse nature which are characterized by inadequate production of blood cells causing cytopenias. Failure of bone marrow can be limited to one or more lineages of blood cells, along with symptoms specified to lineage, through it can affect all cell lineages leading to clinical picture like aplastic anemia. These syndromes are genetic diseases of heterogenous nature caused by germline mutations affecting basic pathways of cell including telomerase biology, biogenesis of ribosomes, structural proteins, and repair of DNA. Common inherited bone marrow failure syndromes consist of Schwachman – Diamond syndrome, Diamond – Blackfan anemia, Fanconi anemia, and Dyskeratosis Congenita. These syndromes have different prognosis and tendency to develop solid or hematological malignancies. Therefore, the adequate diagnosis of these disorders and their differentiation from other bone marrow failure syndromes and/or other etiologies of the boe marrow failure is very significant for surveillance and management of patients. Acquired causes may also lead to bone marrow failure including radiations, chemicals, drugs, immune diseases, viral infections, myelodysplastic syndromes, large granular lymphocytic leukemia, or paroxysmal nocturnal hemoglobinuria (PNH). Inherited bone marrow failure syndromes are heritable and affects family members as well, therefore need genetic counselling. In this review, differential diagnosis, various causes, and their pathogenesis are discussed for better understanding of inherited bone marrow failure syndromes.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125605733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Labial fusion is commonly seen in pre-pubertal girls but is rarely reported in adolescent females after menarche. Its main cause is low estrogen levels. A patient can be completely asymptomatic and self-limiting or present with a wide range of symptoms which can vary from urinary tract infection, urine retention, incontinence, dyspareunia, etc. We present a case of a 12-year-old female who presented in our department with a complaint of difficulty in voiding and lower urinary tract symptoms. After a detailed examination, she was diagnosed with labial fusion for which adhesiolysis was done and patient remained asymptomatic after it.
{"title":"Complete Labial Fusion in a Post Menarche Adolescent Girl","authors":"Anum Fatima Parekh, Ayesha Khan, S. Ali","doi":"10.21089/njhs.73.0139","DOIUrl":"https://doi.org/10.21089/njhs.73.0139","url":null,"abstract":"Abstract: Labial fusion is commonly seen in pre-pubertal girls but is rarely reported in adolescent females after menarche. Its main cause is low estrogen levels. A patient can be completely asymptomatic and self-limiting or present with a wide range of symptoms which can vary from urinary tract infection, urine retention, incontinence, dyspareunia, etc. We present a case of a 12-year-old female who presented in our department with a complaint of difficulty in voiding and lower urinary tract symptoms. After a detailed examination, she was diagnosed with labial fusion for which adhesiolysis was done and patient remained asymptomatic after it.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"413 2-3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131400315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Badaruddin Sahito, Sheikh Muhammad Ebad Ali, Mustafa Saleem, N. Soomro, M. Katto, Asif Jatoi
Abstract: Background: The study aims to assess the non-compliance rate along with the factors affecting the non-compliance among osteosarcoma patients presenting in our institution. Materials and Methods: Osteosarcoma patients who were treated at our institution between January 2014 to December 2020 were included in this study. Records were searched from Departmental Cancer Registry for details regarding treatment plans and follow-ups. The data of outcomes were compared with the standard guidelines. Patients who did not attend follow-ups, surgery or chemotherapy were termed as non-compliant. The patients or their next of kins were inquired about the factors behind non-compliance. Results: The study sample included 46 participants where 34 (74.9%) and 12 (26.1%) were male and females, respectively with a mean age of 19.7± 9.7 years. 11 (23.91%) participants were compliant with the prescribed treatment plans that included surgery, neoadjuvant, and adjuvant treatments whereas 35 (76.1%) of the participants were non-compliant either with surgery or chemotherapy. Amongst all included participants, the neoadjuvant chemotherapy plan was followed by 18 (39.13%) and adjuvant chemotherapy was followed by 10 (21.74%) candidates. Surgery was performed in 22 (44.9%). The patients who did not received chemotherapy was attributed to affordability (P=0.008) and patients’ or next to kins’ choices (P=0.02) while age (P=0.039), patients’ consent not given (78.3%; P=0.05), and stage II (52.2%; P=0.048) were predictors of surgical non-compliance. Conclusion: We conclude that the care deferred significantly from the guidelines regarding surgery and chemotherapy. Age, affordability, late stage, and personal choices are the significant predictors for non-compliance for chemotherapy and surgery.
{"title":"A Retrospective Audit of Treatment Non-Compliance among Osteosarcoma Patients from a Developing Country","authors":"Badaruddin Sahito, Sheikh Muhammad Ebad Ali, Mustafa Saleem, N. Soomro, M. Katto, Asif Jatoi","doi":"10.21089/njhs.73.0110","DOIUrl":"https://doi.org/10.21089/njhs.73.0110","url":null,"abstract":"Abstract: Background: The study aims to assess the non-compliance rate along with the factors affecting the non-compliance among osteosarcoma patients presenting in our institution. Materials and Methods: Osteosarcoma patients who were treated at our institution between January 2014 to December 2020 were included in this study. Records were searched from Departmental Cancer Registry for details regarding treatment plans and follow-ups. The data of outcomes were compared with the standard guidelines. Patients who did not attend follow-ups, surgery or chemotherapy were termed as non-compliant. The patients or their next of kins were inquired about the factors behind non-compliance. Results: The study sample included 46 participants where 34 (74.9%) and 12 (26.1%) were male and females, respectively with a mean age of 19.7± 9.7 years. 11 (23.91%) participants were compliant with the prescribed treatment plans that included surgery, neoadjuvant, and adjuvant treatments whereas 35 (76.1%) of the participants were non-compliant either with surgery or chemotherapy. Amongst all included participants, the neoadjuvant chemotherapy plan was followed by 18 (39.13%) and adjuvant chemotherapy was followed by 10 (21.74%) candidates. Surgery was performed in 22 (44.9%). The patients who did not received chemotherapy was attributed to affordability (P=0.008) and patients’ or next to kins’ choices (P=0.02) while age (P=0.039), patients’ consent not given (78.3%; P=0.05), and stage II (52.2%; P=0.048) were predictors of surgical non-compliance. Conclusion: We conclude that the care deferred significantly from the guidelines regarding surgery and chemotherapy. Age, affordability, late stage, and personal choices are the significant predictors for non-compliance for chemotherapy and surgery.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115147194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Introduction: The prevalence of diabetes mellitus is rising rapidly in Egypt with major health and socioeconomic consequences. The shortage of endocrinologists is another important issue in Egypt that must be taken into consideration. Objective: To review and discuss the epidemiology, risk factors, and different ways of diabetes care in Egypt. In addition, the aim is also to analyze the problem of the shortage of endocrinologists and how it can be solved. Methods: Searching and reviewing medical literature using PubMed, Google scholar, and some other gray literature from the World Health Organization (WHO), International Diabetes Federation (IDF), and Centers for Disease Control and Prevention (CDC). Results: Egypt is ranked ninth in the prevalence of diabetes worldwide according to IDF with a prevalence of 15.2% in the adult population in early 2020. The prevalence is expected to continue rising to more serious levels. This high prevalence is attributed to common risk factors in Egypt such as obesity, physical inactivity, chronic hepatitis C infection, pesticides, smoking, and bad eating habits. Moreover, we are in an increased demand for more endocrinologists in the Egyptian health care system. Conclusion: Understanding and avoiding the risk factors of diabetes is a crucial step towards reducing its prevalence and minimizing its healthcare and socioeconomic burdens in Egypt. Effective strategies should be applied for proper diabetes management and improving the quality of life in diabetic patients. Increasing the number of endocrinologists is also a key element for better diabetes care. Keywords: Diabetes in Egypt, Diabetes epidemiology, Hepatitis C virus, Obesity, Smoking, Pesticides.
{"title":"An Overview of Diabetes Mellitus in Egypt as a Major Public Health Problem","authors":"M. Riad, Shorouk M Elshafei","doi":"10.21089/njhs.62.0080","DOIUrl":"https://doi.org/10.21089/njhs.62.0080","url":null,"abstract":"Abstract: Introduction: The prevalence of diabetes mellitus is rising rapidly in Egypt with major health and socioeconomic consequences. The shortage of endocrinologists is another important issue in Egypt that must be taken into consideration. Objective: To review and discuss the epidemiology, risk factors, and different ways of diabetes care in Egypt. In addition, the aim is also to analyze the problem of the shortage of endocrinologists and how it can be solved. Methods: Searching and reviewing medical literature using PubMed, Google scholar, and some other gray literature from the World Health Organization (WHO), International Diabetes Federation (IDF), and Centers for Disease Control and Prevention (CDC). Results: Egypt is ranked ninth in the prevalence of diabetes worldwide according to IDF with a prevalence of 15.2% in the adult population in early 2020. The prevalence is expected to continue rising to more serious levels. This high prevalence is attributed to common risk factors in Egypt such as obesity, physical inactivity, chronic hepatitis C infection, pesticides, smoking, and bad eating habits. Moreover, we are in an increased demand for more endocrinologists in the Egyptian health care system. Conclusion: Understanding and avoiding the risk factors of diabetes is a crucial step towards reducing its prevalence and minimizing its healthcare and socioeconomic burdens in Egypt. Effective strategies should be applied for proper diabetes management and improving the quality of life in diabetic patients. Increasing the number of endocrinologists is also a key element for better diabetes care. Keywords: Diabetes in Egypt, Diabetes epidemiology, Hepatitis C virus, Obesity, Smoking, Pesticides.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129855830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The lives of billions in the world have become to change by the end of 2019, almost two years ago, after novel coronavirus (Covid-19) infection emerged in Wuhan, China. Covid-19 caused about 33 millions of infection and 1000040 deaths worldwide within 10 months of the pandemic [1]. By December 18th of 2021, number of the infected subjects and deaths rose up to 274 million and 5364119, respectively [2]. Despite its devastating effect on human life, not even a single drug has shown significant enough efficacy against Covid-19 to change the course of the pandemic. However, some new agents and repurposed drugs were able to show efficacy to some extent. In the past 2 years, we have noticed that many Covid-19 cases have actually recovered without any treatment other than general measures. Indeed, most young and middle-aged people survive the disease mildly, yet the disease can be severe in people with advanced age and who have significant additional comorbidities. That’s why, one of the most important things to do while waiting for the pandemic to end is to take and maintain measures to prevent the spread of Covid-19 in societies. Nevertheless, as the outbreak progressed, we began to consider Covid-19-related deaths as ordinary. Unfortunately, we also loosen the tight measures to control the disease.
{"title":"Current Situation in the Struggle against Novel Coronavirus Infection (Covid-19)","authors":"G. Aktas","doi":"10.21089/njhs.62.0044","DOIUrl":"https://doi.org/10.21089/njhs.62.0044","url":null,"abstract":"The lives of billions in the world have become to change by the end of 2019, almost two years ago, after novel coronavirus (Covid-19) infection emerged in Wuhan, China. Covid-19 caused about 33 millions of infection and 1000040 deaths worldwide within 10 months of the pandemic [1]. By December 18th of 2021, number of the infected subjects and deaths rose up to 274 million and 5364119, respectively [2]. Despite its devastating effect on human life, not even a single drug has shown significant enough efficacy against Covid-19 to change the course of the pandemic. However, some new agents and repurposed drugs were able to show efficacy to some extent. In the past 2 years, we have noticed that many Covid-19 cases have actually recovered without any treatment other than general measures. Indeed, most young and middle-aged people survive the disease mildly, yet the disease can be severe in people with advanced age and who have significant additional comorbidities. That’s why, one of the most important things to do while waiting for the pandemic to end is to take and maintain measures to prevent the spread of Covid-19 in societies. Nevertheless, as the outbreak progressed, we began to consider Covid-19-related deaths as ordinary. Unfortunately, we also loosen the tight measures to control the disease.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133914072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Introduction: Red Cell Distribution width (RDW) is found to be related with mortality in hemodialysis patients. In December 2019, a new corona virus spread was detected in China, which turned into a pandemia with significant mortality. Both RDW and chronic kidney disease were found to be related with mortality in COVID-19 patients. This study investigated if the association of RDW and mortality in hemodialysis patients still existed in the COVID-19 era. Materials and Methods: This single center study included 117 hemodialysis patients. They were followed for 20 months (between December 2019 and July 2021) or until death. The relation of RDW with all-cause mortality and COVID-19 related deaths were studied. Results: 21 (17.9%) out of 117 patients died during the follow-up. RDW was found to be an independent risk factor for all-cause mortality (HR:1.35, p=0.009). In post-hoc analyzes, RDW was significantly higher in non-COVID-19 related and cardiovascular deaths. Conclusion: RDW was found to be an independent and powerful risk factor of all-cause and cardiovascular mortality even in the mortal COVID-19 era. Keywords: Red cell distribution width, Hemodialysis, Mortality, COVID-19, Chronic kidney disease, Rheumatoid arthtritis.
{"title":"Red Cell Distribution Width and Mortality in Hemodialysis Patients: A Single Center Experience in COVID-19 Era","authors":"M. Topal, I. Guney","doi":"10.21089/njhs.62.0061","DOIUrl":"https://doi.org/10.21089/njhs.62.0061","url":null,"abstract":"Abstract: Introduction: Red Cell Distribution width (RDW) is found to be related with mortality in hemodialysis patients. In December 2019, a new corona virus spread was detected in China, which turned into a pandemia with significant mortality. Both RDW and chronic kidney disease were found to be related with mortality in COVID-19 patients. This study investigated if the association of RDW and mortality in hemodialysis patients still existed in the COVID-19 era. Materials and Methods: This single center study included 117 hemodialysis patients. They were followed for 20 months (between December 2019 and July 2021) or until death. The relation of RDW with all-cause mortality and COVID-19 related deaths were studied. Results: 21 (17.9%) out of 117 patients died during the follow-up. RDW was found to be an independent risk factor for all-cause mortality (HR:1.35, p=0.009). In post-hoc analyzes, RDW was significantly higher in non-COVID-19 related and cardiovascular deaths. Conclusion: RDW was found to be an independent and powerful risk factor of all-cause and cardiovascular mortality even in the mortal COVID-19 era. Keywords: Red cell distribution width, Hemodialysis, Mortality, COVID-19, Chronic kidney disease, Rheumatoid arthtritis.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133513914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Uduagbamen, M. Sanusi, O. Udom, S. Ahmed, O. Ehioghae, Olutomiwa Omokore
Abstract: Introduction: Intraoperative hypotension in cardiac surgery could be complicated by acute kidney injury (AKI), cardiac arrest and death due to poor organ perfusion. We studied intraoperative hypotension (IOH) and its immediate and short term relationship with post-operative mortality. Materials & Methods: A retrospective study of participants, 16-86 years old who underwent cardiac and vascular surgery at Tristate Heart and Vascular Center, Ilishan-Remo, Nigeria, a high dependency cardiac and vascular surgical center between January 2015 and March 2021. Study participants were grouped into three cohorts and primary outcome was all-cause post-operative death. Results: The records of four hundred and fifteen (258 males and 157 females) cohorts were studied, with mean age of 56.6 ± 5.4 years, 14.69% of the participants were 65 years or older. The surgeries were coronary artery bypass graft (CABG) alone (26.03%), CABG with valve surgery (38.31%) and, valves surgery alone (35.66%). The mean arterial pressure (MAP) pre-induction, and intra-operative and immediate post-op were 71.37 ± 14 09 mmHg, 68.6 ± 11.24 mmHg and 72.24 ± 33 mmHg respectively. The incidence of IOH was 86.30%, prevalence of background kidney dysfunction was 29.40% and incidence of AKI was 25.54%. Eleven (2.65%) participants died, all (100%) had IOH, 1 (9.09%) was intradialytic. The predictors of mortality were aging (aOR-4.23, 1.65-5.85), IOH (aOR-1.55, CI-0.34-1.96), background kidney disease (aOR-3.96, CI-1.43-4.78), comorbidity (aOR-2.77, CI-0.87-3.17), emergency surgery (aOR-4.62, CI-1.35-5.12), pre-induction MAP (aOR-4.22, CI-3.15-6.49) and, combined CABG and valve surgery (aOR-2.17, CI-1.69-4.57)). Conclusion: Intraoperative hypotension commonly results from cardiac and vascular surgeries and could be complicated by AKI, cardiac arrest and death. The risk of these complications is increased by background kidney disease, comorbidities and episodes of IOH. Keywords: Intraoperative hypotension, Coronary artery bypass graft, Acute kidney injury, Cardiac arrest, Mortality, Mean arterial pressure.
{"title":"Intraoperative Hypotension: Immediate and Short Term Impact on Mortality. Findings from a High Dependency Cardiac and Vascular Surgical Center in Nigeria","authors":"P. Uduagbamen, M. Sanusi, O. Udom, S. Ahmed, O. Ehioghae, Olutomiwa Omokore","doi":"10.21089/njhs.62.0067","DOIUrl":"https://doi.org/10.21089/njhs.62.0067","url":null,"abstract":"Abstract: Introduction: Intraoperative hypotension in cardiac surgery could be complicated by acute kidney injury (AKI), cardiac arrest and death due to poor organ perfusion. We studied intraoperative hypotension (IOH) and its immediate and short term relationship with post-operative mortality. Materials & Methods: A retrospective study of participants, 16-86 years old who underwent cardiac and vascular surgery at Tristate Heart and Vascular Center, Ilishan-Remo, Nigeria, a high dependency cardiac and vascular surgical center between January 2015 and March 2021. Study participants were grouped into three cohorts and primary outcome was all-cause post-operative death. Results: The records of four hundred and fifteen (258 males and 157 females) cohorts were studied, with mean age of 56.6 ± 5.4 years, 14.69% of the participants were 65 years or older. The surgeries were coronary artery bypass graft (CABG) alone (26.03%), CABG with valve surgery (38.31%) and, valves surgery alone (35.66%). The mean arterial pressure (MAP) pre-induction, and intra-operative and immediate post-op were 71.37 ± 14 09 mmHg, 68.6 ± 11.24 mmHg and 72.24 ± 33 mmHg respectively. The incidence of IOH was 86.30%, prevalence of background kidney dysfunction was 29.40% and incidence of AKI was 25.54%. Eleven (2.65%) participants died, all (100%) had IOH, 1 (9.09%) was intradialytic. The predictors of mortality were aging (aOR-4.23, 1.65-5.85), IOH (aOR-1.55, CI-0.34-1.96), background kidney disease (aOR-3.96, CI-1.43-4.78), comorbidity (aOR-2.77, CI-0.87-3.17), emergency surgery (aOR-4.62, CI-1.35-5.12), pre-induction MAP (aOR-4.22, CI-3.15-6.49) and, combined CABG and valve surgery (aOR-2.17, CI-1.69-4.57)). Conclusion: Intraoperative hypotension commonly results from cardiac and vascular surgeries and could be complicated by AKI, cardiac arrest and death. The risk of these complications is increased by background kidney disease, comorbidities and episodes of IOH. Keywords: Intraoperative hypotension, Coronary artery bypass graft, Acute kidney injury, Cardiac arrest, Mortality, Mean arterial pressure.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132053680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Introduction: Despite improvements in hemodialysis delivery, acid base imbalance is still common in the dialysis population and it is associated with intradialysis blood pressure changes, dialysis termination, inadequacy and poor treatment outcome. We studied acid base imbalance in maintenance hemodialysis, its determinants and relationship with intradialysis blood pressure changes. Materials & Methods: A prospective study carried out at Babcock University Teaching Hospital, Ilishan-Remo between May 2019 and April 2021 that involved 298 participants who had 1642 hemodialysis sessions. Results: The mean age was 51.44 + 7.31 years, with the females been older than males, P=0.04. The mean predialysis and post dialysis serum bicarbonate were 18.41 ± 3.63 mmol/l and 20.61 ± 6.26 mmol/l (P<0.001). The prevalence of pre and post dialysis metabolic acidosis were 79.0% and 38.3% (P<0.001) and of intradialysis hypotension and hypertension were 19.1% and 25.0% (P=0.02). The risk of intradialysis hypotension was negatively correlated with predialysis bicarbonate while intradialysis hypertension was positively correlated with predialysis bicarbonate. The mean dialysis dose was higher in males (P=0.03). Metabolic acidosis was commoner in elderly and females, and was associated with intradialysis hypotension, dialysis termination and inadequacy. Aging and infrequent dialysis, predicted metabolic acidosis. Conclusion: Metabolic acidosis is common in maintenance hemodialysis, particularly in females, aged and infrequent dialysis, and leads to intradialysis hypotension, dialysis termination, inadequacy and poor treatment outcome. Keywords: Metabolic acidosis, Maintenance hemodialysis, Dialysis dose, Intradialysis hypotension, Intradialysis hypertension, Predialysis bicarbonate, Poor treatment outcome.
{"title":"Acid Base Imbalance in Dialysis: Risk Factors and Impact on Intradialysis Blood Pressure Changes. Findings from a Single Center Prospective Study in Nigeria","authors":"P. Uduagbamen","doi":"10.21089/njhs.62.0053","DOIUrl":"https://doi.org/10.21089/njhs.62.0053","url":null,"abstract":"Abstract: Introduction: Despite improvements in hemodialysis delivery, acid base imbalance is still common in the dialysis population and it is associated with intradialysis blood pressure changes, dialysis termination, inadequacy and poor treatment outcome. We studied acid base imbalance in maintenance hemodialysis, its determinants and relationship with intradialysis blood pressure changes. Materials & Methods: A prospective study carried out at Babcock University Teaching Hospital, Ilishan-Remo between May 2019 and April 2021 that involved 298 participants who had 1642 hemodialysis sessions. Results: The mean age was 51.44 + 7.31 years, with the females been older than males, P=0.04. The mean predialysis and post dialysis serum bicarbonate were 18.41 ± 3.63 mmol/l and 20.61 ± 6.26 mmol/l (P<0.001). The prevalence of pre and post dialysis metabolic acidosis were 79.0% and 38.3% (P<0.001) and of intradialysis hypotension and hypertension were 19.1% and 25.0% (P=0.02). The risk of intradialysis hypotension was negatively correlated with predialysis bicarbonate while intradialysis hypertension was positively correlated with predialysis bicarbonate. The mean dialysis dose was higher in males (P=0.03). Metabolic acidosis was commoner in elderly and females, and was associated with intradialysis hypotension, dialysis termination and inadequacy. Aging and infrequent dialysis, predicted metabolic acidosis. Conclusion: Metabolic acidosis is common in maintenance hemodialysis, particularly in females, aged and infrequent dialysis, and leads to intradialysis hypotension, dialysis termination, inadequacy and poor treatment outcome. Keywords: Metabolic acidosis, Maintenance hemodialysis, Dialysis dose, Intradialysis hypotension, Intradialysis hypertension, Predialysis bicarbonate, Poor treatment outcome.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132937668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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