ABSTRACT
Background: Patients with chronic kidney disease (CKD) are at a common risk for contrast-induced acute kidney damage (CI-AKI) because of various complications. Intravenous N-acetylcysteine (NAC) in high doses (1200mg) is considered more effective than its conventional dose (600mg) to prevent CIN and related complications. Objective: The study aimed to compare the effectiveness of high dose versus standard dose of intravenous N-acetylcysteine (NAC) in the prevention of Acute Kidney Injury in patients with chronic kidney disease.Material & Methods:A total of 60 (sixty) patients diagnosed with CKD went to coronary angiography and/or percutaneous coronary intervention (PCI) were selected by simple random technique and categorized into two groups – Group A (30 patients) received high dose NAC (1200mg) and Group B (30 patients) – received standard dose NAC (600mg). For evaluation of renal damage serum creatinine level for at least >3 months, renal imaging revealed bilateral small echogenic kidneys, eGFR (<60 to 15ml/min/1.73m², measured by MDRD formula) and also by ACR >30 mg/gm, associated with IHD, admitted for percutaneous intervention (PCI) were taken in account. Statistical analysis was done by SPSS version 20 with taking 95% confidence interval. The quantitative data were expressed as mean and standard deviation and qualitative data were expressed as frequency distribution and unpaired t-test, Chi-square test, and Fisher exact analytic test were done.Results:The observed mean age group of the patients was 65 ± 8 years and 62 ± 7 years in group A and group B respectively with male predominance in both groups. Primary renal disease diabetic nephropathy (DN) more (36.66%) in group A than in group B (30.00%) but patients with Hypertensive nephropathy were the same (33.33%) in both groups. After interventions, S. Creatinine (mg/dl) level, e, GFR (ml/min/1.73m²), were statistically significant in cases of group A patients (P-value 0.001& 0.003 correspondingly) compared to group B Patients (P-value 0.075 & 0.001 respectively). Again, the mean of pre-intervention S. Creatinine was 1.7 ±0.5 in group A whereas this was 1.9 ± 0.8 (p-value, 0.599) in group B and after 48 hours of intervention this was 1.6 ± 0.5 and 2.0 ± 0.5 (p-value, 0.697) In group A and group B respectively. Overall, no patients were detected with nephropathy for high dose NAC whereas 27 (90%) out of 30 had developed CIN in standered dose.Conclusion:High-dose N-acetylcysteine (1200mg) is more potent and effective than the standard dose (600mg) in reducing contrast-induced acute kidney injury (CI-AKI) in patients with CKD.
ABSTRACT
Background: Anemia is one of the most common medical disorder during pregnancy and one of the important cause of maternal death in the third world countries. A sufficient supply of iron is also required for the proper development of the fetus and newborn baby. During pregnancy, iron deficiency and iron deficiency anemia (IDA) increase the risk of preterm birth and low birth weight. Iron is essential for the development of the fetal brain and the newborn’s cognitive abilities. Pregnant women receive oral iron prophylaxis have better iron status and are less likely to develop IDA. The aim of the study was to evaluate the effects of prophylactic oral iron therapy in pregnant women in terms of rise of haemoglobin level.Material & Methods:The present study was conducted at the department of obstetrics and gynecology, US-Bangla Medical College & Hospital, Dhaka, Bangladesh, from January 2020 to June 2021 with a sample size of 100 pregnant women. All the participants were non-anemic at the time of inclusion, and a proper follow-up was done. All the women were supplied with 60 mg dose of elemental iron prophylactic. During follow up haemoglobin level was measured and serum ferritin levelwas measured when anemia was found. The collected data were analyzed by using the Statistical Package for Social Science (SPSS-24) for windows version 10.0.Results:During the first follow-up, 89% were found non-anemic, 9% were mildly anemic and 2% were moderately anemic. S ferritin levels of the 11 anemic participants showed that 36.30% had <15 ng/mL ferritin levels, and 63.64% had 15-150 ng/mL ferritin levels. During the second follow-up, 86% were non-anemic, 1% was severely anemic, 4% were moderately anemic and 9% were mildly anemic. S. ferritin level test showed that among the 14 anemic women, 35.72% had <15 ng/mL, 57.14% had 15-150 ng/mL, and 7.14% had >150 ng/mL serum ferritin levels. During third follow up at 34-36 weeks, 81% were non-anemic, 1% were moderately anemic, 8% had mild anemia. S. ferritin levels of 9anamic women showed that 3 women (33.33%)had <15 ng/mL and 6 women (66.67 %) had between 15-150 ng/mL.Conclusions:Pregnancy produces relatively high iron demand. Iron requirements cannot be met merely through dietary iron intake. Even prophylacyic 60 mg elemental iron giving may not be sufficient to prevent maternal anemia. Regular follow up and monitoring is essential during whole pregnancy for better management of the patients.