Risk Factors for Temporary Vascular Access Infection in Patients with End-Stage Renal Disease Undergoing Hemodialysis in Cipto Mangunkusumo Hospital.

BACKGROUND: Temporary vascular access is used to provide adequate hemodialysis for patients who are initiating dialysis or are awaiting maturation of a more permanent vascular access. However, infection is one of the most frequent complications of using temporary vascular access and is the second leading cause of death in patients undergoing hemodialysis after cardiovascular events. There has been no research on the risk factors for the incidence of infection in patients using temporary vascular access in Indonesia. METHODS: This is a retrospective cohort study utilizing secondary data from medical records of 318 subjects aged 18 years and older with end-stage renal disease and undergoing hemodialysis using temporary vascular access at Cipto Mangunkusumo Hospital. RESULTS: Temporary vascular access infection was found in 125 of 318 subjects (39.3%). The risk factors of temporary vascular catheter infection in the multivariate analysis were females (OR 1.731; 95% CI 1.050-2.854; p=0.032), low hemoglobin levels (OR 2.293; 95% CI 1.353-3.885; p=0.002), presence of diabetes mellitus (OR 2.962; 95% CI 1.704-5.149; p<0.001) and duration of catheter insertion (OR 5.322; 95% CI 1.871-15-135; p=0.002). The association between ferritin and catheter insertion site was not analyzed as a risk factor because it was not performed in all subjects. CONCLUSION: The incidence of infection in patients with end -stage renal disease undergoing hemodialysis using temporary vascular access at Cipto Mangunkusumo Hospital was 39.3%. Female gender, low hemoglobin level, diabetes mellitus, and duration of catheter insertion were risk factors for temporary vascular access infection.

Impact of COVID-19 on the Gut: A Review of the Manifestations, Pathology, Management, and Challenges.

SARS-CoV-2 is a virus that can enter its hosts through the Angiotensin Converting Enzyme-2 (ACE2) receptor. ACE2 is mainly expressed in cells of the gastrointestinal tract, such as the esophageal epithelium and enterocytes from the ileum-colon. Coronavirus Disease 2019 (COVID-19) has varying clinical symptoms and presents differently in individuals, ranging from asymptomatic carriers to moderate clinical spectrum with mild pneumonia clinical features, and to a severe clinical presentation with dyspnea and hypoxia, leading to death due to respiratory or multi-organ failure. COVID-19 infection can also manifest themselves in the form of gastrointestinal symptoms such as diarrhea, vomiting, nausea, and abdominal pain. Severe complications of gastrointestinal COVID-19 infections include hemorrhage or perforation of the gastrointestinal tract and severe inflammation, which can adversely affect the intestinal immune system, and therefore the systemic immune system of the host. Furthermore, COVID-19 has also shown to affect microbiota homeostasis in the digestive tract. To date, no clear explanation is available regarding the pathophysiology of gastrointestinal SARS-CoV-2 infection, fecal RNA detection, and the possibility of fecal-oral transmission of SARS-CoV-2. This review aims to discuss the effects of SARS-CoV-2 infection on the digestive tract, microbiota, and lung, and the possibility of fecal-oral transmission in COVID-19.