ABSTRACT
Objective: To describe the causes, characteristics and factors associated with ascites in patients on maintenance hemodialysis
Study Design: Observational study
Place and Duration of Study: Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, from November 2007 to November 2014
Methodology: All patients on maintenance hemodialysis and age > 16 years with ascites were included. Frequencies and percentages were computed for different categorical variables. Chi-square or Fischer exact test were used to identify factors associated with ascites like frequency of hemodialysis, serum albumin and cardiac ejection fraction [EF]. Odds ratios were calculated for associated factors
Results: Ninety patients were included in this study; 55.5% were males. Median age was 33 years. Cause of ascites was nephrogenic in 77.8%, cardiac failure in 16.7%, hypothyroidism in 6.67%, liver cirrhosis in 4.4%, abdominal tuberculosis in 2.2%, and peritoneal carcinomatosis in 1.1% patients. The ascites was severe in 53.3% patients and severity was associated with serum albumin < 2.8 gm/dL [p=0.007] and cardiac EF < 40% [p=0.028]. The ascites was low serum ascites albumin gradient [SAAG], high protein type [LSHP] in 60% patients and associated with hemorrhage [p=0.040]. High SAAG, high protein [HSHP] ascites, found in 33.3%, was associated with cardiac EF < 40% [p=0.005] and portal hypertension [p=0.048]. High SAAG, low protein [HSLP] ascites, seen in 6.7%, was associated with portal hypertension [p=0.006]
Conclusion: The commonest cause of ascites in hemodialysis dependent patients is nephrogenic followed by cardiac failure. Low serum albumin and low cardiac EF predispose to severe forms of ascites
ABSTRACT
To determine aetiology, clinical presentation and predictors of survival in Budd Chiari Syndrome patients. The prospective observational study based on non-probability convenient sampling was conducted at the Sindh Institute of Urology and Transplantation [SIUT], Karachi, and comprised Budd Chiari Syndrome patients between January 2004 and December 2013. The patients were evaluated for onset of symptoms, causes, mode of presentation and predictors of survival. SPSS 20 was used for statistical analysis. Of the 25 patients, 16[64%] were males, and 16[64%] belonged to the paediatric age group. Overall age range was 2-50 years with a mean of 14.7 +/- 12.41 years. Presentation was chronic in 14[56%] patients, acute in 10[40%] and acute on chronic in 1[4%]. Commonest morphological abnormality involved was hepatic veins alone in 14[56%]. Probable aetiologies were hypercoagulable states in 21[84%] patients, infections in 2[8%] and malignancy in 1[4%]. Among hypercoagulable states, protein C deficiency was the commonest, affecting 9[36%] patients. Seven [28%] patients died; acute 4[16%] and chronic 3[12%]. Causes of death included sepsis 4[16%], fulminant hepatic failure 1[4%], gastrointestinal bleeding 1[4%], and bleeding from liver biopsy site 1[4%]. Poor survival was associated with bilirubin >5mg/dl [p<0.031], serum alanine transaminase >40U/L [p<0.005], serum albumin <2.8 g/dl [p<0.008], Child-Turcotte-Pugh score >10 [p<0.001] and absence of varices [p<0.025]. Cox regression analysis failed to show any significant independent predictors of survival. Budd Chiari Syndrome affected young patients more frequently and was associated with high mortality. The commonest aetiology was hypercoagulable state. Survival was poor in patients with decompensated liver disease and those with an acute clinical presentation
Subject(s)
Humans , Male , Female , Budd-Chiari Syndrome/mortality , Tertiary Care Centers , Prospective Studies , Survival AnalysisABSTRACT
The study was designed to identify the presence of Echocardiographic Left Ventricular hypertrophy [LVH] in incident cases of focal cerebral ischemia. A cohort of patients with diagnosis of stroke or TIA were included who were admitted at the Aga Khan University Hospital, a tertiary care hospital in Pakistan. All these patients had transthoracic echocardiogram [TTE] done during admission on the advice of the primary Neurologist. Data was collected for 12 months and analysis done on epi-info program, using level of significance as a statistical test. We correlated the presence of hypertension with Echo-LVH and ECG-LVH. Echo-LVH was reported in 77 patients [61%] as compared to ECG-LVH which was observed in only 5 patients [4%, according to Este's criteria]. A total of 23 patients had Echo-LVH without known hypertension and this figure is quiet alarming. Hypertension increases the risk of stroke and cardiovascular disease and LVH is a strong predictor of Cerebrovoscular event. The increased incidence of ECHO-LVH in known and unknown hypertensive patients identified the need towards health awareness program in general as well as in highly susceptible population