Socio-economic factors affecting quality of life of Hemodialysis patients and its effects on mortality

Objective: Many factors affect quality of life [QOL] of dialysis patients. This study was conducted to determine the effect of socio-economic factors effecting QOL of hemodialysis patients

Methods: This descriptive multi-centric, follow up study was conducted at Department of Nephrology, Mayo Hospital, Lahore, from February 2015 to August 2017. All patients who were on regular maintenance hemodialysis [MHD] for more than three months and able to read and understand Urdu version of Kidney Disease Quality Of Life [KDQOL] tool were included in the study. Patients were included from hemodialysis units of Mayo Hospital [MH], Shalamar Hospital [SH], and Shaikh Zayed Hospital [SZH], Lahore. Patients with less than three-month duration on dialysis, with cognitive impairment, dementia, active psychosis, non-Urdu readers/speakers were excluded. Demographic data and lab data was collected on predesigned pro forma. Patients were divided into different groups on the basis of education, monthly income, source of funding for treatment and employment. Patients were followed up for two years to determine the effect of QOL on mortality

Results: One hundred and thirty-five patients were included in the study. Socio-economic factors like education, employment, income, funding was compared with KDQOL sub scales and were found statistically significant [p-value [<0.05]. We found that patients with higher income had better work status [p=0.039] but social [0.04] and sexual function [p=0.029] were relatively better in patients with low income. Employed patients had better work status [p=0.01], ability to do social function [p=0.027] but they had more pain [0.049], symptoms/problems of disease [p=0.05] and effect of kidney disease [p=0.015]. Those patients whose dialysis were funded by their family could socially interact [p=0.012] better and deal more efficiently with effect of kidney disease [p=0.007]. Higher education was associated with better emotional well being [p=0.045], patient satisfaction [p=0.046] and staff encouragement [p=0.045] then patient with lower level of education. QOL had no effect on mortality

Conclusion: The socio-economic factors consisting of education, employment, income and funding are important parameters affecting QOL of kidney patients. QOL does not affect mortality of the dialysis patients

Granulomatous interstitial nephritis: a rare cause of acute kidney injury

Acute granulomatous interstitial nephritis [GIN] is a rare cause of acute kidney injury [AKI] but treatable. It is present in 0.5 to 0.9% of native renal biopsies. Treatment with moderate dosage of steroids is associated with good prognosis. We herein review a case of a 48-year lady having AKI following drug-induced damage [non-steroidal anti-inflammatory drugs [NSAIDs] and antibiotics]. Her renal functions did not improve after one month of drug withdrawal, so renal biopsy was done that showed acute GIN. She was treated with intravenous then oral steroids that completely resolved AKI

Factors affecting dermatological manifestations in patients with end stage renal disease

Objective: To determine skin changes in patients of End Stage Renal Disease [ESRD] on maintenance hemodialysis [MHD] and factors affecting these changes

Study design: Cross-sectional observational study

Place and duration of study: Nephrology Department, Mayo Hospital, Lahore in collaboration with Dermatology Department, King Edward Medical University, Lahore, from October 2015 to January 2016

Methodology: Two hundred patients who were undergoing MHD for more than three months were included in the study. Patients' demographic data, laboratory reports and dialysis records were noted in a predesigned questionnaire. Skin examination was carried out by consultant dermatologist after patient's permission

Results: Among 200 patients included in study, 105 were malesand rest of them were females. Major causes of ESRD were Diabetes Mellitus [n=83, 41.5%, followed by Hypertension [n=80, 40%], Nephrolithiasis [n=15, 7.5%] and Chronic glomerulonephritis [n=5, 2.5%]. At least one cutaneous finding was present in every patient. Common skin findings observed were pigmentation [86%], xerosis [83%], pallor [79%], pruritus [69%], acquired ichthyosis [50.5%], and bacterial skin infections [18.5%]. Among them, nail manifestations were half-and-half nails [52%], onychomycosis [30.5%], onycholysis [20.5%], subungual hyperkeratosis [23.5%], and Mee's lines [7.5]. Among hair changes were sparse scalp hair [38.5%], brittle and lustreless hair [28%]. The factors contributing to skin changes were patient's age, cause of ESRD, anti HCV positivity, high urea and creatinine levels, duration and frequency of hemodialysis, hemoglobin levels, calcium phosphate product and socioeconomic status. Some skin manifestations were interrelated with each other like xerosis with pruritus [p<0.001], pruritus with bacterial infection [p<0.022], acquired Ichthyosis [p=0.008] and hair changes [p=0.035]

Conclusion: ESRD patients on hemodialysis develop various skin changes during the course of disease process, which contribute to increased morbidity. Different factors affecting skin changes were the cause of ESRD, adequacy and duration of dialysis, employment, financial status, anti HCV positivity, and metabolic factors

Outcome of chronic kidney disease patients on the basis of referral to nephrologist: a one-year follow-up study

Objective: To determine the outcome of chronic kidney disease [CKD] patients presenting for dialysis on the basis of referral to nephrologist. Study Design: Observational study. Place and Duration of Study: Nephrology Department of King Edward Medical University/Mayo Hospital, Lahore, from January 2014 to January 2016

Methodology: All patients who were presented in nephrology outpatients department and with the indication of dialysis were included in study. Patients who refused dialysis, and with acute kidney failure were excluded from the study. Proforma was designed for demographics, vital signs, volume status, and laboratory data [hemoglobin, urea, creatinine, albumin, bicarbonate etc.] of all the patients. On the basis of referral, patients were divided into two groups, i.e. early referral and late referral. Early referrals were those patients who were referred to a nephrologist more than three months before dialysis initiation. Late referrals were those patients who were referred to a nephrologist less than three months before dialysis initiation. Patients were followed up at one, three, six, and 12 months for outcome, i.e. still on dialysis or died

Results: One hundred and seventy-six patients were enrolled in the study, and 141 were followed up to one year. Seventy two [51.1%] patients were male, 69 [48.9%] were female and most [n=69, 48.9%] were in the middle age group. Major causes of end-stage renal disease [ESRD] were hypertension 70 [49.6%] and diabetes mellitus 66 [46.8%]. Seventy-six [53.9%] patients were in fluid overload and acidotic [n=123, 87.2%]. Twenty-seven [19.1%] patients were referred early and 114 [80.9%] were referred late. Overall mortality was 78 [55.3%] at one year. Factors affecting mortality were financial status and metabolic acidosis, but not referral. Temporary access for hemodialysis has 1.38 times more risk for mortality than the patients with permanent access

Conclusion: There is no difference on the outcome of dialysis patients on the basis referral to nephrologist. Factors affecting overall mortality in both groups were financial status, metabolic acidosis, and temporary access for dialysis. Most of the patients were referred late to the nephrologists

First report on molecular characterization of Leishmania species from cutaneous leishmaniasis patients in southern Khyber Pakhtunkhwa province of Pakistan

OBJECTIVE@#To report presence of Leishmania major in Khyber Pakhtunkhwa of Pakistan, where cutaneous leishmaniasis (CL) is endemic and was thought to be caused by Leishmania tropica only.@*METHODS@#Biopsy samples from 432 CL suspected patients were collected from 3 southern districts of Khyber Pakhtunkhwa during years 2011-2016. Microscopy on Giemsa stained slides were done followed by amplification of the ribosomal internal transcribed spacer 1 gene.@*RESULTS@#Leishmania amastigotes were detected by microscopy in 308 of 432 samples (71.3%) while 374 out of 432 samples (86.6%) were positive by ribosomal internal transcribed spacer 1 PCR. Subsequent restriction fragment length polymorphism confirmed L. tropica in 351 and L. major in 6 biopsy samples.@*CONCLUSIONS@#This study is the first molecular characterization of Leishmania species in southern Khyber Pakhtunkhwa. It confirmed the previous assumptions that anthroponotic CL is the major CL form present in Khyber Pakhtunkhwa province. Furthermore, this is the first report of L. major from a classical anthroponotic CL endemic focus identified in rural areas of Kohat district in southern Khyber Pakhtunkhwa.

First report on molecular characterization of Leishmania species from cutaneous leishmaniasis patients in southern Khyber Pakhtunkhwa province of Pakistan

Objective To report presence of Leishmania major in Khyber Pakhtunkhwa of Pakistan, where cutaneous leishmaniasis (CL) is endemic and was thought to be caused by Leishmania tropica only. Methods Biopsy samples from 432 CL suspected patients were collected from 3 southern districts of Khyber Pakhtunkhwa during years 2011–2016. Microscopy on Giemsa stained slides were done followed by amplification of the ribosomal internal transcribed spacer 1 gene. Results Leishmania amastigotes were detected by microscopy in 308 of 432 samples (71.3%) while 374 out of 432 samples (86.6%) were positive by ribosomal internal transcribed spacer 1 PCR. Subsequent restriction fragment length polymorphism confirmed L. tropica in 351 and L. major in 6 biopsy samples. Conclusions This study is the first molecular characterization of Leishmania species in southern Khyber Pakhtunkhwa. It confirmed the previous assumptions that anthroponotic CL is the major CL form present in Khyber Pakhtunkhwa province. Furthermore, this is the first report of L. major from a classical anthroponotic CL endemic focus identified in rural areas of Kohat district in southern Khyber Pakhtunkhwa.

Translation, validation and reliability of the kidney diseases quality of life-short form [KDQOL-SF form] tool in Urdu

Objective: to translate, validate and assess the reliability of kidney disease quality of life - short form [KDQOL-SF-36] in Urdu, national language of Pakistan

Study Design: a multicentric descriptive cross-sectional study

Place and Duration of Study: department of Nephrology, Mayo Hospital, Lahore, from February to July 2015

Methodology: patients of end-stage renal disease [ESRD] on maintenance hemodialysis [MHD] for more than three months were included in the study. Patients of ESRD not on dialysis and those with acute renal failure were excluded. The English version of KDQOL-SF-36 was translated in Urdu and then translated back in English; further validation was done by a senior professor of Punjab University, Lahore

Results: one hundred and thirty patients were included in the study. Fifty patients were from Mayo Hospital, 35 from Shalamar Hospital and 50 from Shaikh Zayed Hospital, Lahore. The internal consistency reliability coefficient for overall scale was 0.84. Twelve sub-scales [symptoms, effect of kidney disease, and burden of kidney disease, cognitive function, and quality of social interaction, sexual function, social support, physical functioning, role physical, pain, emotional wellbeing and role emotional] had more than 0.70 internal consistency reliability coefficients. Overall mean score of the domains i.e kidney disease component score [KDCS], physical component score [PCS], and mental component score [MCS] was 60.62 +/-17.61, 43.12 +/-19.54, and 49.27 +/-14.52, respectively. A significant positive relationship was observed between KDCS and MCS domains, KDCS and PCS domains, PCS, and MCS domains

Conclusion: the Urdu version of KDQOL-SF-36 is a reliable and valid version to measure QOL in kidney disease patients on dialysis in Pakistan

Refractory myasthenia gravis; patient on rituximab with acute respiratory failuer: case report

Myasthenia gravis [MG] is prototypical neurological autoimmune disorder, characterized by limb and occulo-bulbular fragility. Our case study will facilitate the practitioners as well as the scientific community to consider other therapy plans with patients presented with acute respiratory failure due to the use of rituximab.A 25-year-old man presented with acute respiratory failure This case reporte sheds light on the importance of differential diagnoses of refractory myasthenia gravis for inexplicable acute respiratory failure upon rituximab treatment. The case study demonstrates the problems associated with use of rituximab in refractory myasthenia gravis. It can cause acute respiratory failure among the patients with relapse specially. Our case study will facilitate the practitioners as well as the scientific community to consider other therapy plans with patients presented with acute respiratory failure due to the use of rituximab.

Comparison of awareness about nephrology and kidney diseases amongst doctors in institutes with and without nephrology departments

To compare the awareness about nephrology and kidney diseases in medical officers and postgraduate trainee doctors working in institutes with and without nephrology departments. This cross sectional study was conducted at Nephrology Department, Shalamar Hospital Lahore from 1[st] Jan to 31[st] Mar 2013. Doctors working on medical floor with more than one year experience after house job were included in the study. Each doctor was given questionnaire comprising of 28 questions. Two hundred and eleven doctors fulfilling the criteria were included in the study. Most of the doctors were male 150[71.1%]. Knowledge had strong correlation with practice [p= 0.001]. Knowledge regarding nephrology and chronic kidney disease [CKD] was found significantly different among doctors of different hospitals [[F=36.09, p=0.000]. Practice regarding nephrology and chronic kidney disease [CKD] was found significantly different [F= 7.222, p=0.000]] among doctors of different hospitals of Lahore. Doctors working in the Shaikh Zayed Hospital [SZH], Lahore were having maximum score in the components of the knowledge and practice than other hospitals. Awareness of the Medical Officers and postgraduate doctors is poor regarding nephrology and kidney diseases. Doctors working in institutes with established nephrology services have better knowledge than other units. Working experience of doctors improve the practice significantly

Restless legs syndrome in end stage renal disease patients on haemodialysis

This study was cross sectional survey conducted to find the prevalence of Restless legs syndrome [RLS] in end stage renal disease [ESRD] patients on haemodialysis [HD]. Data were obtained from 250 patients on chronic maintenance HD. To assess the prevalence of RLS, Clinical diagnostic criteria for RLS was used which is established by the International RLS Study Group. Total 250 patients were included in this study. 153 [61.2%] patients were male and 97 [38.8%] were females. Mean age of the patients was 45.27 years. Mean duration of HD was 26.10 months. Total162 [64.8%] patients were found to be suffering from RLS. Out of 153 males, 87 [56%] were suffering from RLS and among 97 females, 75 [77.3%] were suffering from RLS. In our study, gender was statistically significantly associated with RLS [p-value 0.001]. In age groups 159 [63.6%] patients were below 51 years; among them 102 [64.1%] were suffering from RLS; whereas 91 [36.4%] patients were equal or above 51 years of age and among this group 60 [65.9%] patients were suffering from RLS. There was no statistically significant association between RLS and age groups [p-value 0.776]. RLS is common in patients undergoing regular HD. It is more commonly seen in females

Demographic factors affecting quality of life of hemodialysis patients

Objective: The objective of the study was to determine the demographic factors affecting Quality Of Life [QOL] of hemodialysis [HD] patients

Methods: This observational study was conducted at Shalamar Hospital, Lahore. Patients of End Stage Renal Disease [ESRD] and on maintenance HD for more than three months were included during the period March to June 2012. Patient of ESRD not on dialysis and Acute Renal Failure were excluded. One hundred and twenty five patients who fulfilled the criteria were included. Demographic data containing age, sex, residence, socio economic status, education, mode of traveling for dialysis, total time consumed in dialysis were collected by the investigators. QOL index was measured using 26 items, WHO QOL BRER

Results: There were 89 [71.2%] male and 36[28.8%] female patients. Environmental domain score was highest [p=0.000] than all other domains in HD Patients. In overall analysis age, marital status and total time consumed in getting HD effect QOL significantly [p= < 0.05]

In domain wise analysis, male has better QOL in social relationship domain than female. Age has negative relationship with physical health and psychological health domain. QOL of unmarried and literate patients is significantly better [p= < 0.05] in physical health domain. Employed patients have better QOL in physical, psychological and social relationship domain [p= < 0.05] than unemployed patients. Patients of residence of rural areas have better QOL in physical and environment domain. Financial status of HD patients affect QOL in social domain. Distance covered to reach hospital effect QOL in psychological domain [p= < 0.05]

Patients traveling in private transport have better QOL in environmental domain [p=<0.05]

Total time consumed in getting HD effect social relation in QOL [p= < 0.05]

According to linear regression model, marital status is positive predictor and unemployment is negative predictor of QOL in physical health domain

Age is negative predictor of QOL in psychological domain, monthly income is positive predictor of QOL in domain. Unemployment is positive predictor of QOL in social relation domain. Monthly income and place of residence is positive predictor of QOL in environment domain

Conclusion: Gender, age, marital status, unemployment, residence of rural area, economical status, distance covered to reach hospital, mode of transport, total time consumed in getting HD, effect QOL in HD patient. Education level is a positive factor for improving QOL of HD patients

Patterns of prescription writing in psychiatric clinics

To screen the prescription-writing pattern of psychiatrists in private clinic in Peshawar for the essential elements of prescriptions and to investigate the prescribing trends at Peshawar. This observational study was carried out at LRH Peshawar on 602 prescriptionsin 5 months duration. The prescriptions were collected from the patients admitted to LRH and the variables were checked and noted directly into electronic form. Averagely 3.34 drugs were prescribed per prescription, in which drug-related variables: [i] strength of medication was indicated for all drugs in 409 [67.94%] of the prescriptions and were missing for some drugs in 177 [29.4%] prescriptions, [ii] total quantity of a drug to be dispensed was indicated for any drug in just over 111[18.43%] of prescriptions, [iii] The instructions for taking the medication were complete in only 301 [50%] of prescriptions. Fluoxetine alone or in combination [8.4%] was the most commonly prescribed antidepressant. There were 319 [15.8%] non-steroidal anti-inflammatory drugs [NSAIDs] and/or analgesics. Vitamin preparations accounted for 4.02% of all drugs dispensed. SSRI's were the most frequently prescribed medication in majority of prescriptions. Inconsistency regarding different prescription components was observed, such as strength of medication, frequency or instruction for medication use etc

Substance abuse in patients with co-morbid adhd

To study the tendency of occurrence of attention-deficit hyperactivity disorder [ADHD] with substance abuse. A cross-sectional, hospital based study. The study was carried out at Lady Reading Hospital and Khyber Teaching Hospital, Peshawar, Pakistan from 4th April 2012 to 29th August 2012. A sample of 110 adult patients with 53 heroin dependents, 23 THC, 15 opium, 11 poly drug and 8 alcohol dependents were analyzed that whether they were ADHD and that childhood problem continues to manifest symptoms in adults. For retrospective assessment of childhood ADHD, the Wender Utah Rating Scale [WURS] as well as the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] symptom checklist for ADHD was used. The Conners' Adult ADHD Rating Scales [CAARS] was used to assess the persisting symptoms of ADHD in adults.Patient diagnosed with drug and alcohol dependence according to DSM-IV were included in the study whereas patient co-morbid with any other psychiatric illnesses were excluded. Heroin dependent showed 41.5% [WURS] and 37.7% [DSM-IV diagnostic criteria], whereas THC validated 34.7% [WURS] and 30.4% [DSM-IV], opium demonstrated 46.6% [WURS] and 40%[DSM-IV], poly drug dependence established 63.6% [WURS] and 54.5% [DSM-IV] and alcohol dependent showed 50% [WURS] and 37.5% [DSM-IV] indicated evidence of retrospective ADHD affliction in childhood. CAARS was presented in 35.8% heroin dependent, 34.7% THC, 46.6% opioid, 33.3% poly drug dependence and 37.5% alcohol dependent; and exhibited a substantiation of ADHD persistent in adulthood. The difference between the mean score of WURS and CAARS of ADHD patients were significantly greater [P = 0.029], than the normal patients. Pese results revealed that ADHD is a risk factor associated with substance dependence, expressed in the form of heroine, THC, opioid, alcohol dependence and also in poly drug dependence

Dialysis-related factors affecting quality of life in patients on hemodialysis

Treatment modalities for end-stage renal disease affect quality of life [QOL] of the patients. This study was conducted to assess the QOL of patients on hemodialysis and compare it with caregivers of these patients. Cause of ESRD and dialysis-related factors affecting QOL were also examined. This cross-sectional study was conducted on patient on maintenance hemodialysis for more than 3 months at 3 dialysis centers of Lahore. Fifty healthy individuals were included as controls from among the patients' caregivers. The QOL index was measured using the World Health Organization QOL questionnaire, with higher scores corresponding to better QOL of patients. Eighty-nine patients [71.2%] were men, 99 [79.2%] were married, 75 [60.0%] were older than 45 years, and 77 [61.6%] were on dialysis for more than 8 months. Patients on hemodialysis had a poorer QOL as compared to their caregivers in all domains except for domain 4 [environment]. There was no difference in the QOL between the three dialysis centers of the study, except for domain 3 [social relationship] of the patients at Mayo Hospital [a public hospital], which was significantly better. Nondiabetic patients had a better QOL in domain 1 [physical health] as compared to diabetic patients. Duration of dialysis had a reverse correlation with the overall QOL. We found that QOL of hemodialysis patients was poor as compared to caregivers of the patients, especially that of diabetics. Also, duration of dialysis had a reverse correlation with QOL

Serum zinc and copper levels in nephrotic syndrome patients

To determine the serum zinc and copper levels in patients of nephrotic syndrome and healthy subjects. Forty patients of nephrotic syndrome, fulfilling the pentad criteria [proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria and edema] were included in this study. Proteinuria was more than 3.5g per 24 hour in adults and more than 1000 mg/m2 in children. Ten healthy subjects were included as control. Patients on dialysis, pregnancy and with proteinuria of less than 3.5g per 24 hour were excluded from the study. Patients were selected from Nephrology outpatient department of Shalamar Hospital Lahore and Children hospital and Institute of child Health Lahore. The trace metals were measured on continuous source Atomic Absorption Spectrophotometer [ContrAA700] using flame mode for Zn and Cu. The levels of serum Zn and Cu were significantly lower [28.61 +/- 24.07, 47.62 +/- 34.1 microg/dl] as compared to controls [100.8 +/- 14.8, 112.3 +/- 10.6 microg/dl] respectively. Serum Zn level and 24 hour urinary protein had negative correlation with each other which was statistically significant [r= -0.442, p= 0.021]. There was positive and significant correlation / [[r= 0.712, p= 0.001], [r=0.612, p=0.002]/ ] between serum albumin and serum Zn and serum Cu levels. The results of the present study showed that there was high prevalence of Zn and Cu deficiency in patients suffering from nephrotic syndrome. Causes of hypozincemia and hypocuperemia were hypoalbuminemia and increased twenty four hour urinary protein losses. Other probable factors were decreased dietary intake and increased loss of trace metals in urine

Anemia and hypoalbuminemia at initiation of hemodialysis as risk factor for survival of dialysis patients

To determine the survival of patients undergoing chronic maintenance hemodialysis by determining the relative risk [RR] of anemia and hypoalbuminemia at initiation of dialysis on survival. Cohort study. Hemodialysis Unit of Shalamar Hospital, Lahore, from June 2003 to October 2006. This study was conducted on all patients of end stage renal disease who presented in Accident/Emergency Department of the hospital for the first time or received calls from other departments in getting dialysis. Patients with acute renal failure and those lost to follow-up were excluded from the study. At presentation, a history and examination was done and recorded. At the same time a blood sample was sent for routine hematological parameters [hemoglobin, total leucocyte count [TLC], biochemical [urea, creatinine, serum potassium and albumin] and viral markers [anti-HCV and HbsAg]. Patients were followed up for outcomes. The outcomes of the study were continued dialysis, death and renal transplant. Kaplan-Meier and log Rank tests were used for determining survival. Relative risk was assessed on medical 9.2. One hundred and eighty five patients were studied including 99 [52.8%] males and 86 [47.2%] females. Major causes of renal failure were Diabetes mellitus in 125 [67.6%], chronic glomerulonephrotis in 31 [16.8%] and hypertension in 18 [9.7%]. Most of the patients - 105 [60%] were euvolemic. Sixty percent of patients had very high urea [> 200 mg/dl] and creatinine [> 8.0 mg/dl]. The mortality of haemodialysis patients was seventy four percent per 100 patients per year, 62.24% being in the initial 6 months. One hundred and sixty four patients [91.1%] were anemic [hemoglobin < 11 gm/dl] and 124 [67%] were hypoalbuminemic [serum albumin < 4 gm/dl] on first presentation. Patients with group 1 have hemoglobin less than 11gm/dl [7.83 +/- 1.51], group 2 had hemoglobin of equal to more than 11 gm/dl [11.56 +/- 0.64] which was statistically significant [t = - 9.54, p= 0.000]. The survival freedom in group 2 [Hb > 11 gm/dl] was higher than group 1 [Hb < 11 gm/dl] which is statistical significant [p = 0.023]. On the basis of serum albumin [S.Alb], patients were divided into two groups i.e S.Alb less than 4 [3.15 +/- 0.38 gm/dl] was group 1, and more than or equal to 4 [4.23 + 0.28 gm/dl] was group 2, which were statistically significant [t = - 11.58, p < 0.001]. The overall survival time was significantly shorter in group 1 patients than group 2 [p = 0.037]. RR for low albumin was 1.27 and for low hemoglobin, it was 1.30. Mortality of haemodialysis patients was seventy four percent per 100 patients per year. Amongst these 62.24% were in the initial 6 months. The mean survival time was 296 days. Patients with very low hemoglobin and albumin are at more risk for early deaths than patients with normal hemoglobin and albumin on first presentation for dialysis

Sex hormones and erectile dysfunction in hemodialysis patients

To determine the prevalence of Erectile Dysfunction [ED] in hemodialysis patients [HD] and to study the associated changes in sex hormones in these patients. This is a hospital based cross sectional study conducted at hemodialysis units of Shalamar and Mayo Hospitals, Lahore from January to March 2008. All male patients with ESRD on maintenance [HD], whose spouses were alive and able to perform intercourse, were included in the study. Patients with cognitive and communication deficits were excluded from study. International index of erectile function-5[IIEF-5], adopted in Urdu was used for determination of prevalence of ED. Demographic data was collected and sex hormones [total testosterone, Dihydroepiandrosteronediones [DHEA], Follicle Stimulating Hormone [FSH], Leutinizing Hormone [LH] and serum Prolactin] were measured. A total number of fifty patients were included in the study. The major cause of ESRD was diabetes mellitus 28 [56%]. The prevalence of ED was 86% with a mean IIEF-5 score 10.36 +/- 7.13. The majority of patients, 33 [66%], were suffering from a severe degree of ED. The total testosterone level was low in 30 [60%] patients and DHEA were low normal in most of patients, 46 [92%]. Compared to patients with non-ED, those with ED had a significantly lower DHEA [1.93 +/- 0.73 vs 0.81 +/- 0.11, p value = 0.007]. Total testosterone and DHEA had a negative correlation with age and diabetes mellitus. FSH showed a variable response in these patients, it was low [< 1.55 mIU/ml] in three, normal [1.55 +/- 9.74 mIU/ml] in 39 and high [> 9.74 mIU/ml] in eight patients. LH was low [< 1.2 mIU/ml] in two, normal [1.2 +/- 7.8 mIU/ml] in thirty three and high [> 7.8 mIU/ml] in fifteen patients. FSH and LH showed a positive correlation with duration of dialysis. Prolactin level was low in 21[42%] patients. Total testosterone, FSH, LH and Prolactin had no association with ED. The majority of the patients suffering from ESRD, on maintenance HD had ED. DHEA was significantly lower in patients with ED, compared to those with no-ED. Total testosterone and DHEA had an inverse relationship with diabetes and age of the patients. Total testosterone, FSH, LH and prolactin did not affect erectile function

Multiple myeloma in younger age

A Multiple Myeloma [MM] is rare in younger age group. We report MM in a 30-year-old female, who presented with multiple lytic areas upon skeletal survey, but with negative Bence Jones protein. Bone marrow biopsy confirmed it to be a case of multiple myeloma. Patient was put on chemotherapy and radiography to which she responded and now is ambulatory

Depression in hemodialysis patients

To measure the frequency of depression and its risk factors in patients under going hemodialysis. It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1[st] January 2006 to 30[th] April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory- II [BDI-II; adapted in Urdu] was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers [Anti HCV and HbsAg]. Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition [DSM IV] for correlation of psychological variables with clinical, hematological and biochemical parameters. Eighty nine patients were enrolled which included fifty two [58.4%] were male and seventy seven [86.5%] were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 +/- 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty [56.1%] were moderately to severely depressed and there was no gender difference in the prevalence of depression. Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters