Prevalence of pulmonary hypertension in patients with chronic kidney disease on and without dialysis

Background: Pulmonary arterial hypertension is a newly recognized disease in patients with renal disease. In a recent review, the prevalence of PHT in ESRD patients was reported to be around 40-50%

Aim of the work: To evaluate the prevalence of primary pulmonary hypertension among CKD patients on and without dialysis and to compare clinical, hemodynamic, and metabolic variables among patients with and without PH to search for possible etiologic factors

Patients and methods: Our study included 99 CKD patients; 65 patients on hemodialysis, 12 on peritoneal dialysis and 22 on conservative management. Detailed medical history, examination, and complete laboratory investigations were obtained. Systolic PAP, EF% and cardiac output were evaluated by Doppler echocardiography and AVF flow by Doppler ultrasound

Results: A high prevalence of pulmonary hypertension was demonstrated among 27 patients [41.53%] receiving long-term hemodialysis with a mean systolic PAP of 49.33 +/- 9.18 mmHg; as well as in two patients [16.66%] receiving peritoneal dialysis 43 +/- 1.41 mmHg, and in five patients [[22.72%] receiving conservative management 44.8 +/- 5.89 mmHg

Conclusion: This study demonstrated a high prevalence of pulmonary hypertension among patients with CKD on and without dialysis. The prevalence was highest among patients with ESRD receiving long-term hemodialysis [41.53%] especially in patients with older age, longer duration of dialysis treatment, higher AV fistula flow, cardiac output

Giardia intestinalis in patients with nonulcer dyspepsia

Giardiasis may present with dyspeptic symptoms that may mimic other gastrointestinal and/or biliary disorders. The objective of this study was to determine the prevalence of giar-diasis in stool and duodenal aspirate of patients with NUD, assess symptomatic benefit of therapy, and compare the diagnostic tools for giardiasis utilizing stool and duodenal aspirates microscopic evaluation versus ELISA testing. 109 Patients with endoscopic diagnosis of NUD out of 278 consecutive patients with dyspepsia were included. The severity of dyspepsia and the quality of life were assessed utilizing Rome II criteria and SF-36 for Quality of Life and concomitant stool and/or duodenal aspirate samples were submitted for ELISA antigen test for Giardia intestinalis. Those who tested positive for giardiasis [Group 1] were assigned to receive Tinidazole 2.0 g. single dose plus omeprazole for 4 weeks and the remaining patients [Group 2] omeprazole alone for 4 weeks. One month after therapy, both groups were reassessed and Stool ELISA antigen test for G. intestinalis for Group 1, was performed. ELISA testing of stool [19%] and duodenal aspirates [19%] had significantly better results than microscopic ones in stool [11%] or duodenal aspirates [7%]. The two groups were well matched with respect to age, sex, initial results on the Glasgow Dyspepsia Severity Score, prevalence of previously prescribed antisecretory-drug therapy, prevalence of smoking, predominant symptom at presentation, and quality of life. The outcome of patients at 1 month, on an intention-to-treat basis, showed that the symptoms were resolved [defined as a score of 0 or 1] in 17 of 21 patients [81%] in Group 1 as compared with 31 of 88 patients [35%] in Group 2 P < 0.001. The scores in both groups were lower than those at base line and there was a highly statistically significant difference between both groups. G. intestinalis as a cause of dyspepsia should be considered in patients with negative endos-copy and in those who remain symptomatic in spite of adequate treatment for known upper G.I. disorders. NUD associated with the presence of Giardia, had better symptomatic benefit [81%] with specific treatment than controls [35%]. ELISA testing of stool [19%] and duodenal aspirates [19%] had significantly better results than microscopic ones in stool [11%] or duodenal aspirates [7%]

An evaluation of the effectiveness of skin-to-skin care for low-birth-weight in Egypt

Kangaroo Mother Care [KMC] or Skin-to-skin care [SSC] is a universal model of care for preterms. It involves continued skin-to-skin contact between mother and baby for 24 hours a day. Baby is placed in an upright position up on the mother's chest between her breasts and inclined in a position so as to facilitate breastfeeding. It is evidence based medical practice that has been shown to be safe and highly beneficial for the growth and development of babies, in addition to being cost-effective as apposed to incubators and nursing care. It place mothers at the center of care for her baby, enhances recovery and promotes breastfeeding thus reduces the cost of medications and long term complications. However this method is poorly accepted and not implemented in Egypt. Aim: The aim of this study was to assess the knowledge, attitudes and skills [KAS] of health staff with regards KMC; to identify ways to facilitate its introduction in Egypt and to assess the outcome of this intervention on the growth and health states of'infants exposed to this technique of care as compared to traditional care by incubators. Person to person interviews were conducted with 57 physicians and nurses in two neonatal intensive care units [NICUs] in a urban [Cairo University] and 2 regional situated university hospitals [Zagazig and Benha] before and after the intervention. The intervention in the urban university consisted of orientation seminars and on the job training by exposure to a trial of the procedure with 20 mothers-infant pairs. In the intervention unit staff showed a statistically significant improvement in relation to knowledge and attitudes at P<0.05 but not in practice of skills [P>0.05]. Babies exposed to KMC doubled their weights faster, shortened their stay in the NICU and had fewer morbidity problems. KMC is a safe and beneficial technique. Hands-on training of staff, mothers and families can make them more accepting to the technique and promote its implementation in NICUs and in the community

Hyperhomocysteinemia in chronic renal failure and its role in repeated vascular access thrombosis in patients on regular hemodialysis

This study was performed on 79 patients with chronic renal failure [CRF] in Assiut University Hospital through the year 2006-2007 in the dialysis unit and 20 apparently healthy subjects as a reference group, they were classified as following: Group I; 20 healthy subjects, Group II; 24 patients who will start dialysis for the first time, Group III; 55 patients on maintenance hemodialysis for more than 3 years. Group III was sub-classified according to the presence of repeated arterio-venous fistula occlusion and thrombosis into: Group III a; 25 patients without repeated arterio-venous fistula occlusion and, Group III b; 30 patients with repeated [3 or more] fistula occlusion. After careful history and clinical examination, the following was done: A] Routine investigations: Peripheral hemogram, serum glucose, urea and creatinine and creatinine clearance, total serum protein and serum albumin as well as serum lipidprofile. B] Special investigations: total plasma homocysteine. The results of this study showed no significant difference when comparing group IIlb with group IlIa regarding kidney function [serum urea, creatinine and creatinine clearance], serum total protein and albumin as well as all components of the lipid profile. Homocysteine showed highly statistically significant elevation when comparing each of groups II, IIIa and Illb with group I, but there was no statistically significant difference when comparing group II with group III. However, there was highly statistically significant elevation when comparing group III b with group III a. We concluded that hyper-homocysteinmia in patients with end stage renal disease could be considered a risk factor for the development of repeated vascular access thrombosis [VAT] or occlusion