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Objectives: The aim of our study is to determine the prevalence of depression among the patients with end stage renal disease and their care givers, and its associated factors at a tertiary care hospital in Karachi Pakistan
Methodology: The type of study is a cross sectional study, conducted for a period of 6 months from June 2015 to November 2015, at a tertiary care hospital in Karachi, Pakistan. The study population consisted of n= 400 individuals [n=200 patients, n=200 attendants]. Beck's Depression Inventory questionnaire was employed to the study participants. Various factors such as gender, education level, employment and marital status, and various co morbidities were studied for their association with depression
Results: The prevalence of severe and moderate depression among the patients undergoing dialysis was 72.5%, and it was 35% among the caregivers having a p value of less than 0.001. The patients at the highest risk of depression were married, unemployed and with an income of less than Rs. 5000/-. The factors that had a positive association with depression were marital status [p value of less than 0.001], employment status [p value 0.01] low level of income [p value of 0.061], females [p value of 0.045], level of education below grade 10 [p value of 0.045]. Anemia showed an association with depression [p value of 0.023]
Conclusion: According to the results of our study a significant number of patients who were undergoing maintenance hemodialysis were depressed, and were two times likely to be depressed when compared to their care givers. Marriage and unemployment were the factors most associated with symptoms of depression. Household income showed a negative relation, but gender and education level were found to be not related to the incidence of depression
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Objectives: The aim of our study is to determine the prevalence of pulmonary hypertension in patients who undergo dialysis on a regular basis, as it has been associated with increased morbidity and mortality is the patient population
Methodology: The type of study is a cross sectional study conducted for a period of one year duration from April 2014 to March 2015, at a tertiary care hospital in Karachi, Pakistan. The study population consisted of n=90 patients with end stage renal disease, who undergo regular dialysis on maintenance basis, and had trans thoracic echocardiography performed, various parameters including the systolic pulmonary arterial pressure were recorded. A pulmonary arterial pressure greater than 30mm of Hg at rest was defined as pulmonary hypertension, and it was further divided into three sub categories mild [ btw 30-40mm of Hg ], moderate [ btw 45-65mm of Hg ], severe [ greater than 65 mm of Hg ]. Variables such as age, gender, duration on maintenance dialysis, vascular access utilized were recorded. Data was analyzed using SPSS version 20
Results: Out of the total n=90 patients, n= 40 were males, and n= 50 were females, the mean duration of time duration of dialysis was 16.29 +/- 12.1 months. N= 52 patients were found to have pulmonary hypertension, and the mean value for the pulmonary arterial pressure was 38.4 +/- 19.18 mm of Hg, the mean age of patients having pulmonary hypertension was 53.45 +/- 12.4 years. Pulmonary hypertension was more common in the females as compared to the males [ n= 32 versus n= 19 ], Pulmonary hypertension was found to be greater in patients who had been on dialysis for less than 20 months duration, and it was also noticed that the longer the duration of hemodialysis the more severe the pulmonary hypertension
Conclusion: According to the results of our study patients on maintenance hemodialysis are at an increased risk of developing pulmonary hypertension, it is more common in the females, and has a strong correlation with the duration of maintenance hemodialysis and the arteriovenous access utilized
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Introduction: urinary tract infections are common in women of developing countries which results in substantial morbidity and health care cost. The Urogenital fistula is frequently related to gynecological conditions
Material and Methods: this is a prospective study was carried out in the Department of Nephrology, Abbasi Shaheed Hospital from March 2011 to May 2014. 79 patients with urogenital fistula, irrespective of cause of the fistula, with ages between 18-60 years were included in this study. Patients were referred to nephrology clinic. A detail medical history was taken from each patient for episodes of urinary tract infection and the treatment given during the last six months. Patients were educated how to collect midstream morning urine sample. Urine sample were taken from all symptomatic and asymptomatic patients for culture examination and send to laboratory within an hour
Results: we have found that out of 72 patients studied for UTI, 89 percent of the studied patients had culture proven UTI. Recurrent UTI is very common in patients with uro-genital fistulas and 72 percent of patients experienced an average of 03 episodes of symptomatic UTIs during last six months. Relapses are more frequent than re-infections. Culture proven but asymptomatic infections were seen in 39 percent of patients. Mean infectious episodes rate during last six months was 3. 73 percent of the observed episodes were symptomatic, while asymptomatic bacteriuria was seen in 27 percent of patients. The most frequent Bacteria is E. coli followed by Pseudomonas aerugenosa and Enterobacter species. These were the most common pathogen isolated which are highly resistant to Amoxicillin, Cotrimoxazole, Fluoroquinolones and Cephalosporins. We found that the isolated pathogens are mostly sensitive to Piperacillin- Tazobactam and Carbepenem groups of Drugs
Conclusion: we concluded that Urogenital fistula in developing countries are most regularly linked to Gynecological surgery whereas in developing countries, complicated childbirth is the most common cause. Recurrent infections are more frequent in patients with urogenital fistula and mostly represent relapse rather than re-infection. Relapsing infection warrants extensive evaluation of urinary tract and extended period of antimicrobial therapy with appropriate antibiotics
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Present study assesses the therapeutic effectiveness of Hijama [blood letting] inpatients of chronic renal failure undergoing hemodialysis for past several years with almost no urinary output.24 patients from Sindh Government Qatar Hospital Karachi were selected randomly under going dialysis 2-3 times/week for an average of 3 years under supervision of Dr. Khurram Danial, in-charge nephrologist at dialysis Centre Sindh Government Qatar Hospital Karachi after the written consent from patients. Each patient was subjected to Hijama session once a week after dialysis for a period of one year in a nearby hospital Aligarh Shifa with the consent of the ethical committee of the hospital. Serum urea, creatinine, complete blood count and electrolytes were determined prior to hijama as baseline values and were again recorded on monthly basis for twelve months of Hijama sessions. The patient's feedback regarding quality of life after each hijama session shows that almost all the patients reported a significant recovery from severe fatigue which they used to face during the interval between the dialysis sessions. There was significant recovery in all patients from anorexia and insomnia with the improvement in quality of life as compared to patients not undergoing hijama. Both systolic and diastolic blood pressures were shifted towards normal in almost all patients after Hijama. Serum Creatinine level was declined significantly, while electrolyte and hematological parameters were also improved significantly. The hemoglobin of all patients undergoing hijama was maintained near normal without any blood transfusion, which was frequently needed in patients not undergoing hijama sessions. There was insignificant improvement in Urinary output in 2 out of 24 patients. Results of the present study suggest that hijama may be performed safely in patients of chronic renal failure on dialysis with overall improvement in quality of life, since there was reduction in fatigue, improvement in appetite, quality of sleep and platelet count