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

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

To determine the outcome and progression of patients presenting with acute severe asthma at a tertiary care hospital in Karachi, Pakistan

Objectives: The aim of our study is to determine the outcome and progression of patients presenting with acute severe asthma [status asthmaticus] at a tertiary care hospital in Karachi, Pakistan. Setting: The type of study is a cross sectional study. Period: Two years from January 2013 to December 2015. Place of study: Tertiary care hospital in Karachi Pakistan

Methods: Consisted of 40 patients who were all admitted to the hospital with acute severe asthma. All the patients underwent strict clinical evaluation to assess the various aspects of the illness including the severity and complications. Data was analyzed using SPSS version 23

Results: Of the total n= 40 patients included in our study, 8 [20%] were males and 32 [80%] were females having a mean age of 52.5 +/- 20.4 years, Hypertension was the most common underlying co morbidity observed in 10 [25%] patients. The mean blood pH was found to be 7.33 +/- 0.12 at the time of presentation with a range of 6.96 to 7.57 respectively, respiratory acidosis was found in 17 [42.5%] of the patients. A total of 29 [72.5%] patients required ventilator support out of which 14 [35%] required invasive ventilator support and 15 [37.5%] required a noninvasive ventilator support. Acidaemia was found to have a significant association with the requirement for invasive mechanical ventilation [p value of less than 0.033] also the mean duration of hospital stay was also higher in patients who required ventilator support

Conclusion: According to the results of our study, acidemia is the most severe complication of acute severe asthma, and has a significant association with increased rate of need for artificial ventilation, complication and mortality respectively

Prevalence of pulmonary hypertension in patients undergoing regular maintenance hemodialysis due to end stage renal disease

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