ABSTRACT
Objectives This study aims to compare the severity of chronic rhinosinusitis (CRS) symptoms pre- and post-COVID-19 infection and estimate the impact of the COVID-19 pandemic on the use of intranasal corticosteroids (ICS) among adult CRS patients. Methods This was an observational retrospective cohort study conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between July 2022 and October 2022. Adult CRS patients with sino-nasal outcomes test-22 (SNOT-22) scores documented prior to March 2020, marking the occurrence of Saudi Arabia's initial reported case of COVID-19, were requested to complete the SNOT-22 questionnaire following COVID-19 infection. A comparison was subsequently made between the two scores obtained. Results The study enrolled a total of 33 patients, with 16 assigned to the control group and 17 with a history of COVID-19 infection. The mean age of the patients was 43 years, and the majority (52%) were males. Statistical analysis did not reveal any statistically significant differences in the total SNOT-22 scores or domain-level scores between the two groups. Furthermore, the use of ICS during the COVID-19 pandemic did not show any significant associations, except for patients with asthma, where 80% of them used ICS during the pandemic (p=0.0073). Conclusion There was no statistically significant disparity observed in the SNOT-22 scores between patients who tested positive for COVID-19 and those who did not. The use of corticosteroids during the COVID-19 pandemic was found to be more prevalent in this study compared to previous studies conducted before the pandemic, particularly among patients with asthma. The use of ICS during the pandemic was not associated with the presence of polyps, functional endoscopic sinus surgery (FESS), allergic rhinitis, or eczema.
ABSTRACT
Introduction: Kuwait has a large expatriate community, representing almost two thirds of the total population of 4,464,100. They are non-citizens with a temporary residency permit and have a limited access to public health care provided by ministry of health compared to Kuwaiti citizens. We examined differences in basic characteristics, management, and outcomes between Kuwaitis and non-Kuwaitis who developed acute kidney injury (AKI) Methods: Demographics, comorbidities, dialytic and non-dialytic management data, and kidney and patient outcomes at 30 days from nephrology consultation for all nephrology consultations for AKI in seven public hospitals in Kuwait, from January 1 to June 30, 2021, were prospectively collected and analyzed Results: The total number of AKI referrals was 3749 (hospital-acquired AKI: 50%;males: 59%;mean age: 63 years;patients with eGFR < 60: 42%). Patients with baseline eGFR < 60 were older than patients with eGFR of >= 60 (mean age: 68 vs. 59 years), had lower mean initial Hgb (10.1g/dL vs. 10.8g/dL) and had higher rates of DM (83% vs. 60%), HTN (86% vs. 62%), and cardiac disease (60% vs 38%). More than 50% of AKI cases were due to ATN. Non-Kuwaitis had a small but statistically significant higher rates of COVID-19 related AKI (9% vs 7% of AKI in Kuwaitis were related to COVID-19). During the course of AKI, 80% received fluids, 45% received diuretics and 42% received vasopressors. Expatriates represent two thirds of the total population of Kuwait;however, they accounted for only 43% of all AKI cases. They were younger than Kuwaitis (58 vs 67), had more male involvement (72% were men vs 50% men in the Kuwaiti group), had higher mean baseline eGFR (73 mL/min vs 62 mL/min for Kuwaitis), and higher mean baseline Hgb (10.8g/dL vs 10.3g/dL). More hospital acquired AKI than community acquired AKI in expatriates (54% vs 46%), whereas the opposite seen in Kuwaiti patients (53% community acquired vs 47% hospital acquired), and more AKI in the summer than the winter (62% in summer vs 38% in winter). However there was no seasonal difference for Kuwaiti patients. No difference in the need for invasive ventilation Dialysis was needed for 33.5% of the total cohort, significantly higher utilization for expatriates (35% vs 32% of Kuwaitis requiring dialysis). Continuous dialysis was the initial modality in 90% of cases. However, no difference at 30 days in percentage of patients still on dialysis At 30 days, 41% of the total cohort died with significantly higher death rates in Kuwaitis (39% of expatriates vs 43% of Kuwaitis died). Kuwaiti patients who died were older (69 years vs 58 years for expatriates). Of patients who needed dialysis, 55% died while on dialysis Mean final eGFR at 30 days for those who survived and were off dialysis was 49 mL/min, and was significantly higher for expatriates (54 mL/min vs 46 mL/min for Kuwaitis) Conclusion(s): Despite being two thirds of the population, expatriates accounted for only 43% of AKI case, since they were younger with higher baseline eGFR. However, they had higher rates of AKI in Summer (probably due to increased risk of lack of air conditioning where they work or live), higher rates of COVID-19 related AKI (probably due to delayed vaccination of expatriates compared to Kuwaitis) and higher need for dialysis. However, at 30 days, they had lower rates of mortality, similar rates of recovery from dialysis and higher mean final eGFR No conflict of interestCopyright © 2023
ABSTRACT
Introduction: Fasting during Ramadan from dawn to sunset is one of the 5 pillars of Islam. Islamic lunar calendar is 11 days shorter than the Gregorian solar calendar, so the start of Ramadan changes every year and hours spent on fasting vary from 12 hours in Australia, to 21 hours in Sweden, with most countries have 11-16 hours of fasting on average. Patients with certain medical illness are exempted from fasting, however, many such patients partake in fasting. 1,2The long hours of fasting may be a risk factor for AKI in certain populations. We assess AKI in Ramadan of 2021, where the weather was moderately hot. Methods: Demographics, comorbidities, treatment, and 4 weeks outcome data for all nephrology consultation for AKI in four public hospitals in Kuwait during Ramadan of 2021 (13/April to 12/May/2021) prospectively collected and analyzed. We compare AKI in people fasting prior to admission to non-fasting. Results: Total number of AKI cases during Ramadan was 158, 55% males, mean age 64, and 61% were Kuwaiti citizens. Community acquire cases were 15%. DM affected 75%, HTN 72%, and cardiac disease 25% of patients. Median baseline eGFR before AKI was 66.5. Baseline eGFR < 60 seen in 43%, and those compared to patients with eGFR > 60, had median baseline eGFR of 37.5 (vs 92), were older (69 vs 62), 87% had DM (vs 66%) and 87% had HTN (vs 61%). Cause of AKI was pre-renal / ischemic ATN in 69%, COVID-19 related in 17%. Many had more than one possible cause. IV fluids used in 76%, IV diuretics in 39%, IV vasopressors in 31%, and steroids in 21.5%. KRT needed in 27%. Volume overload and electrolytes / acid-base disorders were most common indication (21% and 19% respectively and 15% had more than one indication. Death within 30 days occurred in 11.4%. Of the total AKI cases, 24% were fasting before admission, with mean age of 56 (compared to 63 for non-fasting). No significant difference in baseline eGFR between fasting and non-fasting, nor in use of IV fluids, IV diuretics, or IV vasopressors. Dialysis needed in 21% of the fasting group, not significantly different from non-fasting group. Mortality rates were lower in the fasting group but not statistically significant (8% vs 12.5%). Conclusions: AKI affect both fasting and non-fasting population similarly, with no increased risk of need for dialysis or mortality. Conflict of interest Potential conflict of interest: This has been accepted for ASN Kidney Week 2021 ( Number 3600035 )