ABSTRACT
Background: COVID-19 infection has varying grades of mortality worldwide. Multi-organ injury, not uncommonly associated with AKI, portends a poor outcome. We studied AKI needing hemodialysis (HD) in the context of COVID-19 infection Methods: From March 15th to May 25th 2020, for consecutive COVID-19 infections AKI needing HD in a large dialysis network age, gender, payer type, days:admission to HD start, urine output, S. Cr, comorbidities, other organ injuries, length of stay & outcome, dialysis session details: blood flow rate(BFR), dialysis flow rate(DFR), ultafiltration volume were reviewed. We compared survivors and non survivors using Mann Whitney/ Wilcoxon 2 sample test for medians and Fisher exact 2 tailed for association Results: n = 20. Mean age: 56. 7 + 3.93 years. M:F 17:3, 9 survived, 11 expired. HD sessions=51;CRRT: 4, duration: 29.2 ± 25.4 hours. 47 sessions: Duration: 4.87 ± 1.11 hours, BFR: 195 ± 43 ml/min, DFR: 389 ±99 ml/mn, UF: 437ml/hour. No clotting reported. Conclusions: AKI needing HD in COVID-19 infection is associated with significant multiorgan injury and high mortality;middle aged male predominate. No significant clinical characteristics were predictive of survival in a sample size.
ABSTRACT
Background: The COVID-19 pandemic has special significance for Chronic Kidney Disease patients on HD. Clinical characteristics and outcome from low resource settings are not well known Methods: From March 15 2020 until May 20, 2020, quality managers reviewed all patients with confirmed COVID-19 infections in 200 HD centres among MHD patients. For patients with COVID-19 infections: age, gender, geographical zone, type of Insurance, continuity of care was noted, HD characteristics and outcome were reviewed. Comparison of median was done with Mann Whitney/Wilcoxon 2 sample test and proportion with Fisther exact test. All patients were transferred to public hospital for regulatory compliance limiting follow up of HD sessions. Results: 39 out of 18402 patients developed COVID-19 infection. M: F: 28: 11, Age;54.62 + 14.92 years. Geographically: East zone:3(7%), North:12(31%), South:5(12%), West:19(50%). Payers: self pay:19(49%), government insurance:15 (38%) and private Insurance:5(13%). 32(82%) hypertensives, 23(59%)diabetics. Outcome: 8(20%) expired, 18(46%) discharged, 12(31%) in hospital and 1 at home. Mean Hb (77%) : 9.81 ±1.71 g%, Adequacy (74%): 1.30 ± .44, Vascular access (72%): 75% permanent access, 7% temporary catheter, 18% tunneled catheter, Albumin (64%): 3.69 ±.31. Conclusions: Maintenance HD patients have increased mortality as compared to reports in normal population and is associated with need for intensive care, steroid use and ventilatory support.
ABSTRACT
Objective: Due to Covid-19 pandemic, the oncologists and cancer patients are in a dilemma, whether they should continue with the planned treatment or wait till the pandemic is over. This review is intended to explore the management options for gynaecological cancers during the pandemic. Data sources: We searched for literature from Pubmed database and oncological socities pertaining to the management of gynaecological cancers and Covid-19 pandemic. Study Selection: For such once in a century pandemic, there is a paucity of evidence based literature. Therefore, to address this issue all the available relevant studies were reviewed. Results: Definitely, a deviation from a standard care for a longer period i.e. beyond 4-6 weeks may lead to a significant impact on over all outcomes. As this current scenario is one of the first after the advent of modern medicine, there are no clear-cut evidence based suggestions to adopt for clinicians. Various organizations like NCCN, ACS, SGO, ESMO have suggested few recommendations for present situation. Here again, a role of multidisciplinary team is of pivotal importance and every case merits discussion by multi-disciplinary team (MDT) before finalizing a strategy. We share our perspective on the issue, which is based on currently available evidences as well as the practices we intend to follow at our centre. We agree that the quality of evidence remains of low grade and are mostly based on expert recommendations with an aim to tide over this period of around 4-12 weeks. Conclusion: Precise triage of patients will play a pivotal role in preserving resources and protecting health care workers and patients. The expertise at the respective oncology centres, prevalence/incidence of COVID-19 cases in that area, the support system of the hospital and the patient profile should direct the changes in practices. We also recommend that the standard therapy should be resumed as soon as the situation improves.