ABSTRACT
Background and objectives The frequency of COVID-19-positive or suspicious patients grew steadily, and these patients were received in emergency and outpatient departments at an unprecedented pace for the need of an elective or emergent surgical assessment. We conducted this survey to document the number of surgeries performed on COVID-19-positive patients during the ongoing pandemic at a tertiary care center in Pakistan. Materials and methods A retrospective clinical audit was conducted in a tertiary care hospital that receives surgical cases from almost all over the country. Ethical approval was granted prior to the execution of this intra-departmental audit. Both patients who were admitted to general surgery and visited on a consultative basis in other departments during the year 2020 were evaluated, and only those having COVID-19 polymerase chain reaction (PCR)-positive were included. Those with PCR-negative were omitted from the analysis. All the surgical procedures performed in these patients, along with those managed conservatively, were analyzed. Basic and demographic data of all patients were collected from electronic medical records. The data were defined as either mean and standard deviation or frequency and relative percentages. The normality of the data was verified by the Shapiro-Wilk test. Parametric analysis was used to interpret the disparity in descriptive statistics. Although the categorical results were compared by cross-tabulation, the degrees of significance were calculated either by chi-square test or Fisher's exact test according to the distribution of the data. A p value of less than 0.05 was considered significant (two-tailed). Results A total of 79 COVID-19-positive patients were provided with surgical services and subsequently analyzed. The mean age of those patients was 48.88 ± 16.62 years. The mean length of stay in the hospital was 2.10 ± 3.52 with indifference among gender and mode of treatment (either surgical or conservative). The study participants were 59.5% males and 40.5% females, and only 6.3% had a past surgical history. Most patients were admitted through the outpatient department (65.8%), and only a few were referrals from other departments (10.1%); 64.5% of patients were managed in general wards, 24.0% in critical care units, and 11.4% in intensive care units. Surgical intervention was done in 60.8% of the COVID-19-positive patients, while the rest 39.2% were conservatively managed. Among whom, 63.3% were discharged, 29.1% of them left against medical advice (LAMA), with a 7.6% death rate during the hospital stay. The frequent comorbidities were diabetes (27.8%) and hypertension (26.6%), although most patients had no comorbidities (49.3%). Symptomatic gall stones were the most frequent reason for surgical admission in COVID-19-positive patients, while the most frequent surgical intervention performed was laparoscopic cholecystectomy. Males were comparatively managed more frequently by surgical intervention and females been more conservatively managed (p = 0.037). Out of the six mortalities, five were surgically managed. Seventy seven percent of the surgically managed patients were discharged, and the majority of LAMA patients were being conservatively managed (p < 0.001). Conclusion This study was done to analyze the demographic factors associated with the outcomes of surgical interventions performed on COVID-19-positive patients.
ABSTRACT
Background and objectives Sleep disorders are prevalent in end-stage renal disease (ESRD) involving the majority of patients undergoing hemodialysis. The main objective of treating sleep disorders in patients of ESRD is to correct subjective and objective sleep quality, decrease fatigue and daytime sleepiness, and enhance daytime functioning. Irrespective of the adverse effects reported, benzodiazepines are widely utilized among patients with sleep disorders in end-stage renal disease. Melatonin is a newer agent being studied for use in hemodialysis patients for improvement of sleep quality. The aim of our observational study is to witness the effectiveness of both benzodiazepine and exogenous melatonin as a treatment of sleep disorders in patients undergoing hemodialysis. Materials and methods We conducted a comparative, observational study in ESRD patients who are on hemodialysis. These patients were selected from attendees of the hemodialysis unit, nephrology department of a tertiary care hospital, including those who were on regular hemodialysis, thrice-weekly in frequency for at least once per year, and taking regular sleep medications for at least three months with frequently reported drug dosages of alprazolam 0.5 mg once daily or melatonin 3 mg once daily (before bedtime). The subjective sleep assessment was done by utilizing four scales, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS). Results A total of 117 hemodialysis-dependent patients met the inclusion criteria, among whom 79 patients were using alprazolam while 38 were using melatonin for their disturbed sleep. The mean age of the study participants was 49.12 ± 12.75, comprising 72 males (61.53%) and 45 females (38.46%). The duration of the diagnosis of chronic kidney disease (CKD), duration of onset of hemodialysis, and estimated glomerular filtration rate (eGFR) was comparable in both groups. Both groups had similar laboratory markers except for higher hemoglobin in the melatonin group (p=0.028) and high parathyroid hormone (PTH) levels in the alprazolam group (p=0.001). PSQI scores were 8.76 ± 3.09 in the alprazolam group and 7.32 ± 2.65 in the melatonin group (p=0.015). In the sub-scores, there were no differences in sleep latency (p=0.481) and daytime dysfunction (p=0.662) while sleep efficiency (p=0.167) and subjective sleep quality (p=0.132) were not statistically significant. The significant differences were lower scores of sleep duration (p=0.040) and sleep disturbance (p=0.003) in the melatonin group. The ESS scores revealed no significant difference in either group (p=0.074). With respect to the ISI and SSS, higher scores were obtained in the alprazolam group. Overall, 89 study participants had reported poor sleep quality, out of which 81% were using alprazolam, and 65% were using melatonin (p=0.071). A total of 50 study participants exhibited excessive daytime sleepiness with 45% of them were using alprazolam and 36% were using melatonin. About 54% of the alprazolam using hemodialysis patients had moderate insomnia while 50% of the melatonin using patients had sub-threshold insomnia (p=0.062). Conclusion As melatonin use has shown better sleep quality and less insomnia severity as compared to alprazolam use in our study, it is postulated that the sleep-wake cycle should be commonly targeted by pharmacological therapy in ESRD.
