Vital sign variations with complications during dialysis among end-stage renal disease patients

Objective: To analyse the association of vital sign variations with complications during dialysis among end-stage renal disease patients

Study Design: Cross-sectional study

Place and Duration of Study: Dialysis Centre, Memon Medical Institute Hospital, Karachi, Pakistan, from December 2016 to February 2017

Methodology: Patients on regular hemodialysis with permanent vascular access were selected. Analysis was done during their regular hemodialysis session. Vital signs were measured before and after dialysis, and ultrafiltration [in litre] was recorded post-dialysis. Complications and the variations in vital sign during dialysis were documented as 'yes' or 'no' on the proforma. The association of vital sign on complications during dialysis was analysed by using Pearson Chi-square or Fisher Exact test. A p-value <0.05 was considered statistically significant

Results: Among the study participants, 250 [65.78%] were males and 130 [34.21] were females. Overall mean age and ultrafiltration rate were 51.89 +/-15.83 years and 2.11 +/-0.99, respectively. Most of the patients suffered with complications of cramps during dialysis, i.e. 151 [39.73%] followed by complication of hypotension 143 [37.63%]. Significant association was observed only in variation in systolic blood pressure with complication of hypotension [p<0.001], followed by variation in body weight with complication of cramps [p=0.016] and hypotension [p=0.037]

Conclusion: Vital signs variations, i.e. variation in systolic blood pressure and variation in body weight, are associated with intradialytic complications, i.e. hypotension and hypotension with cramps, respectively

importance of full spinal cord screening and assessment of trauma patients involved in motor vehicle accidents: a case report

Traumatic spinal cord injury due to motor vehicle accidents is the predominant reason for emergency room visits in central Saudi Arabia1 and developed countries.2 If head and neck trauma is suspected, then cervical spine imaging is commonly performed to rule out spinal fracture.3 But in instances where there seems to be mild trauma, the remainder of the spine is not imaged.3 The proceeding case is about a 45-year-old motor vehicle accident survivor with a history of ankylosing spondylitis. Initial clinical examination revealed an apparent mild traumatic spinal injury without a cervical-spine fracture. To the attending physicians, this finding did not warrant for a thorough neurological examination along with a full imaging scan. Radiography of the thoracic spine was not performed until it became clear that there were symptoms suddenly emerging after patient stabilization. By that time however, it was too late: an undisclosed thoracic spine fracture caused significant spinal cord compression, and this in turn led to complete paraplegia. We therefore emphasize that all trauma survivors of road traffic accidents undergo a comprehensive spinal cord scanning and assessment, regardless of the initial severity and symptomology of the injury