RESUMEN
Objective: To determine the efficacy of doxycycline as pleuridising agent in cases of malignant pleural effusions (MPE). Subject and methods: This was a descriptive case series that was conducted at Medical and Pulmonology Department of Combined Military Hospital Lahore from January 2018 to August 2018. In this study, the cases of malignant pleural effusion assessed on history and proven by histopathology on any biopsy of either gender falling in range of 30 years or more were included. The pleural fluid was drained by appropriate size intercostal chest tube (ICT). These cases then underwent pleurodesis with Doxycycline. For pleurodesis 10 capsule of Doxycycline each carrying 100 mg in it were taken and mixed with 50 ml of normal saline. A repeat chest X-ray and USG chest was done to see for presence of fluid, complete absence of fluid was labelled as efficacious pleurodesis. Results: In this study, there were total 60 cases of malignant pleural effusion (MPE) included, out of which 35 (58.33%) were females and 25 (41.67%) females. The mean age of the subjects was 57.32 ± 7.28 years. There were 29 (48.33%) cases with CA breast, 22 (36.67%) with CA lung and 9 (15%) had the other miscellaneous malignancies. The efficacy of pleurodesis with Doxycycline was seen in 26 (43.33%) of cases. There was significant better efficacy (p=0.001) in cases that had pleural effusion less than 1 liter at presentation where it was seen in 14 (63.64%) of cases as compared to 12 (31.58%) cases that had effusion less than 1 liter. There was no significant difference in terms of duration of pleural effusion with p=0.21. Conclusion: Doxycycline is efficacious in almost half of the cases and it is significantly better in cases that had effusion less than 1 liter.
RESUMEN
Introduction: We conducted this study to determine the awareness of usage of estimated GFR/creatinine clearance formulas while dealing with patients in various wards and outpatient departments of different tertiary hospitals in Lahore in doctors who are not working or trained in nephrology, it was done by using a questionnaire in between January 2019 to May 2019. It was found that good percentage of doctor is not using basic formulas and need education by fellow nephrology colleagues for basic patient management, drug dosing, and referral. Objective: To study the awareness and usage of creatinine clearance calculations in doctors not trained in nephrology. Study design: Descriptive, cross-sectional study. Methodology: The cross-sectional observational study was conducted. A questionnaire was designed which included questions about knowledge of estimated GFR/creatinine clearance, calculation methods, use of these formulas while dealing with patients for defining and diagnosing AKI and CKD, medicine dosage adjustment according to creatinine clearance and referral to nephrologists. Results: A total of 170 doctors working in different specialties were contacted and all of them filled questionnaire. 56 (32.9%) doctors answered that they know and calculate eGFR in routine practice while 114 (67.1%) were not performing eGFR while encountering patients. 80 (47.1%) were confident in staging chronic kidney disease and 90 (52.9%) were unable to stage chronic kidney disease on basis of eGFR. In routine patients dose and adjustment according to GFR was documented by 39 (22.9%) doctors and 131 (77.1%) doctors were not practicing dose adjustments for different medicines after calculating GFR. Referral to nephrologist was being done 99 (58.2%) doctors and 71 (41.8%) were not referring patients to nephrologists. Conclusion: Several considerable challenges remain regarding CKD and AKI early diagnosis and management and referral in Pakistan including inadequate knowledge and training systems, and needs education in this regard.