Comparative Study of Hemodialysis in Arteriovenous Fistulas in Low Versus High Blood Flow Rate.

BACKGROUND AND OBJECTIVE: Arteriovenous Fistula (AVF) is an essential requirement in Hemodialysis (HD) to remove toxins and excess fluid from the blood of patients with Chronic Renal Failure (CRF). The Blood Flow Rate (BFR) in AVF is an important factor in the success of HD. Due to a lack of studies of low BFR during HD, this study was conducted. The objective of this study was to compare the success rate of HD in patients with a BFR = 400-500 mL min-1 (group-2), in comparison to those of higher BFR (group-1). MATERIALS AND METHODS: This prospective cohort study was conducted at the ultrasound Doppler (USD) unit in King Fahad Hospital in Almadinah from July to December, 2019. In this study, 44 patients underwent AVF for HD and were assessed by USD for 2 consecutive visits at 3 months intervals. The success rate of HD was measured in patients with a BFR = 400-500 mL min-1 and in those with BFR>500 mL min-1. A comparison of the success rate in the 2 groups was done. RESULTS: Among the 44 patients, 59% were males and 41% were females. The age of participants ranged from 20-80 years (mean: 46.75±13.67 years). The patients underwent HD 3 or 2 session's week-1 for 3 or 4 hrs (mean 3.84±0.36 h) per session. In the first assessment, the success rate was 100% in both groups but it was 88.24% in group-1 and 70% in group-2 in the second assessment. CONCLUSION: The success rate of hemodialysis in patients with BFR 400-500 mL min-1 in AVF was acceptable in comparison to that in patients with BFR>500 mL min-1.

Khat Chewing Effect on the International Normalized Ratio in Patients with Mechanical Heart Valves under Warfarin Therapy.

BACKGROUND AND OBJECTIVE: Khat is a plant that contains the alkaloids cathine and cathinone which have some amphetamine-like properties. It is cultivated and it's leaves chewed for their euphoric effect. This study intended to elucidate the effect of khat chewing on blood coagulation by using the International Normalized Ratio (INR) value as a calculable benchmark. MATERIALS AND METHODS: In this cohort study, 146 patients with Mechanical Heart Valves (MHV) were assessed for two consecutive visits at one-month intervals. For each visit, the date of surgery, the patient's compliance, the dose of warfarin and the INR reading were assessed by the researcher. RESULTS: Out of 146 patients with MHV, the mean age was 33.72±12.43 years (range, 14-65 years); 82 (56.2%) were female and 64 (43.8%) were male. The results revealed that the mean of absolute INR readings was lower in khat-chewers than non-chewers by average 0.2 on the first and second visits (p = 0.038 and 0.002, respectively). CONCLUSION: Khat chewing has a significant coagulant effect. There was a significant decrease in the value of INR for khat chewers patients with MHV when compared to non-khat chewers.

A Case Report of a Tragic Story of Pott's paraplegia Cured after Four Years.

Pott's disease is a form of spondylodiscitis caused by mycobacterium tuberculosis. It is a serious form of spinal infections that can lead to terrible disabilities in case of undiagnosed and treated early. To document a case of Pott's paraplegia cured after four years. This report details the case of a patient with an undiagnosed case of spinal tuberculosis in a 55-year-old man who had complained of lower back pain and tenderness over the course of several months. The case progressed to the point that he had difficulty standing and numbness, then weakness, of the lower limbs. This patient was only treated with analgesics and antibiotics. Herbal remedies, massage and amulets also played a major role in his treatment. The patient remained bed-bound and paraplegic for four years, after which, he was referred for a thoracolumbar Magnetic Resonance Imaging (MRI) and was diagnosed with tuberculous spondylodiscitis. The patient underwent decompression surgery and started anti-tuberculous drugs. He regained his ability to walk. His lifestyle has improved and he has been living independently for eight years. In conclusion, diagnosis and correct treatment can result in a patient who was previously handicapped becoming independent once again. Medical imaging using MRI can play an essential role in the diagnosis of spinal lesions, including those present in cases of Pott's disease.