Comparison Of Efficacy Of High Dose Dexamethasone With Conventional Prednisolone In The Treatment Of Newly Diagnosed Adult Patients Of Immunthrombocytopenic Purpura.

BACKGROUND: Immune thrombocytopenic purpura with multimodal incidence having peaks in each age groups is a chronic clinical syndrome in adults, with disease more predominant in females in adults. The aim of the study was to compare the efficacy (response rate) of high dose dexamethasone with conventional prednisolone in the treatment of newly diagnosed adult patients of Immune thrombocytopenic purpura. It was a prospective quasi-experimental study, conducted at the Department of Medicine of a tertiary care hospital from Jan to Dec 2019. METHODS: The sample population comprised of 130 cases of newly diagnosed ITP patients, having platelet count <30,000/ul with or without bleeding symptoms who received either dexamethasone (40 mg/day for 04 days) or prednisolone (0.5-1 mg/kg PSL for 01 week). Treatment response was measured at day 7. RESULTS: Out of 130 patients 65 patients were treated with dexamethasone and 65 patients with prednisolone .83.08% (n=54) cases in Group-A and 33.85% (n=22) in Group-B had response while remaining 16.92% (n=11) in Group-A and 66.15% (n=43) in Group-B had no response. The p value was calculated as 0.000 which shows a significant difference. CONCLUSIONS: We concluded that high dose of dexamethasone shows a significantly higher response when compared with conventional prednisolone in the treatment of newly diagnosed adult patients of Immune thrombocytopenia purpura.

Comparison Of Vascular Calcification And Mineral Bone Disease In Non-Dialysis (CKD4/5ND) Vs Dialysis Dependent (CKD5D) Patients.

BACKGROUND: Chronic kidney disease (CKD) has been a highly prevalent medical condition in all parts of the world affecting the haemostasis of the body in number of ways. Epidemiological data suggest that no region of the world has been spared from this condition and both developing and developed countries equally share the burden of this disease. Objective was to compare the vascular calcification and mineral bone disease in non-dialysis vs dialysis patients suffering from chronic kidney disease at a tertiary care hospital of Pakistan. It is a Comparative study, conducted at the Department of nephrology Pak Emirates Military Hospital Rawalpindi. Four months from November 2020 to February 2021. METHODS: A total of 310 cases were included in the study, which were diagnosed as chronic kidney disease in nephrology department by a consultant nephrologist on basis of National Kidney Foundation/Kidney Disease Outcome Quality Initiative (NKF/KDOQI) 2002. They were divided into two equal groups by block randomization. Group I had the patients who were not dependent on dialysis (CKD4/5ND) while group II had dialysis dependent patients. Abdominal aorta, mitral and tricuspid valves were assessed to look for vascular calcification. Calcium, phosphate and parathyroid hormone levels were done to assess the mineral bone profile. RESULTS: Out of 310 patients, 192 (61.9%) patients were males and 118 (38.1%) were females. Ninty-eight (31.6%) had evidence of vascular calcification while 212 (68.4%) did not have vascular calcification. 147 (47.4%) had hypocalcaemia, 167 (53.8%) had hyperphosphatemia while 98 (31.6%) patients had raised Parathyroid hormone levels. Regression analysis revealed that vascular calcification and abnormal mineral bone profile was significantly present more among patients who were dependent on dialysis (p-value<0.05). CONCLUSIONS: Bone mineral disease and vascular calcification were consistent findings among patients suffering from chronic kidney disease. Patients who were dependent on dialysis were more prone to develop these complications as compared to those who were not dependent on dialysis.

Efficacy and Safety of Remdesivir in COVID-19 Positive Dialysis Patients.

(1) Background: Immune compromised hemodialysis patients are more likely to develop COVID-19 infections, which increase the risk of mortality. The benefits of Remdesivir, despite less literature support on its effectiveness in dialysis patients due to renal toxicity, can outweigh the risks if prescribed early. The aim of this study was to evaluate the efficacy of Remdesivir on the 30-day in-hospital clinical outcome of hemodialysis population with COVID-19 infection and safety endpoints of adverse events. (2) Study design: A prospective quasi-experimental study design was used in the study. (3) Methods: The sample population consisted of 83 dialysis patients with COVID-19 who were administered Remdesivir at a dose of 100 mg before hemodialysis, as per hospital protocol. After the treatment with Remdesivir, we assessed the outcomes across two endpoints, namely primary (surviving vs. dying) as well as clinical and biochemical changes (ferritin, liver function test, C-reactive protein, oxygen requirements, and lactate dehydrogenase levels) and secondary (adverse effects, such as diarrhea, rise in ALT). In Kaplan-Meier analysis, the survival probabilities were compared between patients who received Remdesivir within 48 h of diagnosis and those who received it after 48 h. Cox regression analysis was employed to determine the predictors of outcome. (4) Results: Of the 83 patients, 91.5% survived and 8.4% died. Remdesivir administration did not reduce the death rate overall. Hospital stays were shorter (p = 0.03) and a nasopharyngeal swab for COVID-19 was negative earlier (p = 0.001) in survivors who had received Remdesivir within 48 h of diagnosis compared to those who had received Remdesivir after 48 h. The only variables linked to the 30-day mortality were serum CRP (p = 0.028) and TLC (p = 0.013). No major adverse consequences were observed with Remdesivir. (5) Conclusions: Remdesivir has the potential to shorten the recovery time for dialysis patients if taken within 48 h of onset of symptoms, without any adverse effects.

The Comparison Of Efficacy Between Losartan And Diltiazem As Antiproteinuric Agent In Non-Diabetic Renal Diseases.

BACKGROUND: Multiple options have been tried to counter the proteinuria secondary to renal diseases. Clinicians and researchers are trying to find the best option for this purpose. OBJECTIVE: To compare efficacy of Losartan and Diltiazem in management of proteinuria in nondiabetic renal diseases at a tertiary care hospital of Pakistan. It was a Quasi-experimental study, conducted at the Department of nephrology Pak Emirates Military Hospital Rawalpindi. Five months, November 2020 to March 2021. METHODS: A total of 122 patients of non-diabetic renal diseases with significant proteinuria were included in the study. They were randomly divided into two groups via lottery method. Group I received losartan while group II received Diltiazem in standard dose for three months. After three months they underwent 24 hours' urinary protein levels and divided into complete, partial and non-responders to treatment. Age, gender, duration of illness and type of antiproteinuric treatment was correlated with response to treatment among the study population. RESULTS: Out of 122 patients, 80 (65.6%) were males while 42 (34.4%) were females. Membranous nephropathy 20 (16.4%) was the commonest non-diabetic renal disease seen in our study participants. Thirty (24.5%) had complete remission after three months of treatment, 60 (49.2%) had partial response while 32 (26.3%) had no response to treatment. Chisquare test revealed that use of losartan had statistically significant relationship (p-value<0.001) with good response among the study participants. CONCLUSIONS: Membranous nephropathy leading to proteinuria was the commonest non-diabetic renal disease encountered in our setup. Around 2/3rd of our patients showed either complete or partial response to treatment and Losartan was superior to Diltiazem in achieving response in our study participants.

Outcomes and Predictors of In-hospital Mortality in Critically Ill Acute Kidney Injury Patients: A Tertiary Care Center Experience.

Acute kidney injury (AKI) is associated with high mortality and morbidity risk. Factors predictive of mortality can guide in early identification of high-risk patients and escalation of therapy to improve outcomes. There is a paucity of data on AKI in Pakistan, and this study was done to determine in-hospital AKI mortality and the associated predictors of mortality. This was a prospective observational study conducted in the Acute Medical Unit and High Dependency Unit of Pak Emirates Military Hospital, Rawalpindi, from June to December 2018. Based on the Kidney Disease Improving Global Outcomes (KDIGO) AKI definition, 130 critically ill patients were included, while patients with chronic kidney disease were excluded. Data were collected on demographic profile-morbid conditions, etiology, laboratory values, and outcomes. The overall mortality was 45.4% (59/130) and varied with the stage of AKI, as it was 21.6%, 36.0%, and 61.8% in KDIGO stages 1, 2, and 3, respectively (P <0.05). There was a significant association (P <0.001) between sepsis, age >65 years, and mortality. Patients with inhospital mortality had higher median serum creatinine and mean potassium levels (P <0.01), with lower mean sodium levels and bicarbonate levels <10 mmol/L. However, on multivariate analysis using variables age >65 years, AKI stage 3, oliguria, bicarbonate <10 mmol/L, and sodium levels <130 mmol/L, only age [odds ratio (OR): 3.16, confidence interval (CI) 95%: 1.40-7.15), AKI stage 3 (OR: 3.12, CI 95%: 1.32-7.38], and low sodium levels <130 mmol/L (OR: 4.52, CI 95%: 1.40-14.61) were found to be independent predictors of mortality. Diabetes mellitus need for vasopressors, oliguria, hemodialysis requirement, and mean leukocyte counts had no significant association with mortality. AKI was associated with high in-hospital mortality in critically ill patients. Sepsis, hypertension, older age, Stage 3 AKI, higher mean creatinine, and potassium were predictive of increased mortality risk.

Ultrasound Guided Tunnelled Cuffed Catheter Placement Without Fluoroscopic Guidance By Anatomical Landmarks; Accuracy And Safety.

BACKGROUND: Chronic kidney disease is a growing disease with high morbidity and mortality. Haemodialysis remains the most common option available for all those not planning for renal transplantation. Vascular access is the most important aspect of haemodialysis. Though not recommended but central venous catheters remain the most common vascular access in starters on haemodialysis. There is a growing trend towards placement of tunnelled cuffed catheters (TCC). Tunnelled cuffed catheters placement requires fluoroscopic guidance which is not available in all centres. The rationale of this study was to describe safety and accuracy of a catheter placement technique not dependent on fluoroscopic guidance for resource limited settings. METHODS: Dialysis dependent patients of a single hospital without long term vascular access were selected over a period of 15 months after getting informed written consent. A new technique was described in which depth of catheter was estimated by superficial anatomical and ultrasound guided measurements for TCC placement which were checked by conventional chest radiography post procedure. RESULTS: A total of 209 catheters were placed over a period of 15 months, 189 males and 30 females. Various sites were used predominantly right Internal jugular vein (IJV) (85.6%). Overall success rate was 97.1% (98.3% males, 90% females, p=0.08). Right IJV was successful 98.9%, left IJV 87.5% (p<0.001). Multiple thrombosed/stenosed veins were associated with higher failure rate (p<0.001). CONCLUSIONS: Tunnelled cuffed catheters can be placed successfully and safely in right IJV under ultrasound guidance using anatomical landmark measurement technique without fluoroscopic guidance.

HCV-RNA Pcr Positivity In Hcv Antibody Negative Patients Undergoing Haemodialysis.

BACKGROUND: It's estimated that almost 2.2% of the world's inhabitants suffer from hepatitis C virus (HCV). The most common cause of chronic liver disease in haemodialysis centres is due to HCV. In 1993, it was first described by Bukh and colleagues that HCV viremia can occur without any detectable antibodies to the HCV. Keeping this in mind the purpose of this cross-sectional study was to assess the frequency of HCV in haemodialysis patients by PCR who are serologically negative for HCV. METHODS: This cross-sectional study was conducted from 1st June to 31st December 2016 on all haemodialysis patients at MH Rawalpindi. Epidemiological data for gender, age, duration on haemodialysis, cause of chronic renal failure and any associated risk factor for acquiring hepatitis C infection was asked. Patients undergoing haemodialysis were investigated by fourth generation ELISA for Anti HCV antibodies, HCV DNA polymerase chain reaction, HCV genotype (where required) and liver function test were also done. RESULTS: A total of 201 patients were undergoing haemodialysis. Among these patients 73 were hepatitis "C" negative and 128 were hepatitis "C" positive. Among the 73 patients who were hepatitis C negative by ELISA method 17 (23%) were PCR positive. Of the 17 patients 13 (76.5%) were men and 4 (23.5%) were women. The mean age of the patients was 49.7±18.0 years and mean duration of haemodialysis was 4.4±4.1 months. The most common cause of CKD requiring haemodialysis was hypertension (64.7%). The most common genotype was type 1 (58.8%) followed by genotype 3 (41.2%). The mean viral load was 23583615.70 IU. CONCLUSIONS: HCV-RNA detection by PCR should be used as standard of care to detect HCV infection in patients undergoing haemodialysis.

Assessment of Quality of Sleep and its Relationship with Psychiatric Morbidity and Socio-Demographic Factors in the Patients of Chronic Renal Disease Undergoing Hemodialysis.

OBJECTIVE: To assess the subjective sleep quality and its relationship with the presence of psychiatric morbidity in the patients suffering from chronic kidney disease (CKD) and undergoing the procedure of hemodialysis (HD); and analyze the associated socio-demographic factors. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Nephrology Department, Military Hospital, Rawalpindi, from July to December 2016. METHODOLOGY: Patients of CKD undergoing the HD were included in the final analysis. Quality of sleep was determined by using the Pittsburgh Sleep Quality Index (PSQI). Psychiatric morbidity was determined by the General Health Questionnaire 12 (GHQ-12). Relationship of education, BMI, gender, age, duration of dialysis, dialysis count per week, marital status, level of family income, psychiatric morbidity, occupation, biochemical markers (urea, creatinine, BUN, albumin, calcium, phosphorous and hemoglobin), tobacco smoking, and use of naswar was determined with the sleep quality. RESULTS: One hundred and forty patients were screened through the PSQI; 44 (31.4%) had good quality of sleep while 96 (68.6%) had poor sleep quality. Statistical analysis revealed that presence of psychiatric morbidity, increasing age, female gender, being unmarried, low family income, and low frequency of dialysis had significant association with the poor sleep quality. CONCLUSION: Poor sleep quality was highly prevalent among the patients of CKD receiving the hemodialysis. The patients with low family income, more age, and with two or less dialysis sessions per week should be screened thoroughly for the sleep problems. Presence of psychiatric morbidity emerged as an independent factor responsible for the poor sleep quality in our target population.

Association Of Quality Of Sleep With Cognitive Decline Among The Patients Of Chronic Kidney Disease Undergoing Haemodialysis.

BACKGROUND: This study was conducted to determine the association between the subjective quality of sleep and cognitive decline among the patients of chronic kidney disease (CKD) undergoing haemodialysis. METHODS: In this cross-sectional study 106 patients of chronic kidney disease (CKD) undergoing haemodialysis at a tertiary care hospital in Rawalpindi, Pakistan were included in the final analysis. Cognitive decline was measured by British Columbia Cognitive Complaints Inventory (BC-CCI). Sleep quality was measured by using the Pittsburgh Sleep Quality Index (PSQI). Relationship of age, gender, marital status, education, occupation, BMI, duration of dialysis, dialysis count per week, family income, tobacco smoking and use of naswar was assessed with the cognitive decline.. RESULTS: Out of 106 patients screened through BC-CCI and PSQI, 13.1% had no cognitive decline while 86.9% had significant cognitive decline. Relationship between quality of sleep and cognitive decline was significant on binary logistic regression.. CONCLUSIONS: This study showed significant relationship between the sleep quality and cognitive decline among the patients of CKD undergoing haemodialysis. The findings of our study also call for a greater degree of understanding of the physical and psychological state of patients of CKD undergoing haemodialysis.