Impact of a Short Educational Session on Early Diagnosis and Management of Acute Kidney Injury for Different Specialties.

AIM AND OBJECTIVE: This questionnaire study aimed to evaluate the impact of a short educational session on the early diagnosis and management of acute kidney injury (AKI) among doctors specializing in fields other than nephrology, assessed through pre- and post-test scores. This educational study included resident doctors from various specialties for assessment. MATERIALS AND METHODS: The study enrolled different specialty resident doctors' departments and assessed them through questionnaires and assessment scores. The pre-test questionnaires were first distributed and collected after 20 minutes. This was followed by a 30-minute short educational lecture on AKI by the nephrology faculty about its early diagnosis and management as per the Kidney Disease Improving Global Outcomes guidelines. Immediately post continuing medical education, the same questionnaires were distributed along with feedback forms and collected after 10 minutes. RESULTS: A total of 110 residents participated in the study. All participants showed significant improvement in the post-lecture questionnaires compared to pre-lecture scores. For medicine and allied branch residents, the pre- and post-lecture scores were significantly higher than those of the surgical and allied branch residents. The lowest score was observed in residents of orthopedics. The improvement scores of all departments also showed significant differences. The highest improvement was seen in the department of gynecology, followed by residents of the critical care unit and the department of anesthesia. The residents of those departments with high pre- and post-test scores had lower improvement scores. CONCLUSION: The study found a significant knowledge gap in different sister specialties in diagnosing and managing AKI. Short educational sessions showed significant improvement in AKI understanding by addressing the knowledge gaps.

Outcome of COVID-19 infection and the impact of COVID-19 vaccination in chronic kidney disease patients: A single-center study.

Introduction: Chronic kidney disease (CKD) patients have increased vulnerability to infections including Covid-19. There is limited availability of antiviral in CKD patients. All guidelines have prioritized vaccinations for CKD patients. The variability in immunogenic response is multifactorial in CKD group. We have tried to analyze the outcome of Covid-19 infection and the impact of COVID-19 vaccination [COVAXIN / COVISHIELD] in our cohort. Materials Methods and Statistical Analysis: In a retrospective observational study, 73 cases of Covid-19 positive CKD patients were selected, who were managed as per MOFHW guidelines. The data of first laboratory values and radiological findings were evaluated. Their treatment outcome and stay during hospitalization were studied. All data were later analyzed using STATA 16.1 software. Results: In this study, 73 cases of CKD with Covid-19 were included. There were 38 patients who were vaccinated with at least one dose of the Covid-19 vaccine, while there were 35 patients who were unvaccinated. Out of 38 patients, 20 were vaccinated with 2 doses of Covid-19 while 18 received only one dose. The unvaccinated group was having more hypoxia and raised inflammatory markers, and had more lung involvement [i.e. higher CT severity value] [p value for CTSS-0.0765]. There was a higher mortality rate observed in the unvaccinated group [i.e-65.71%] than the vaccinated group [39.47%] [p-value 0.0249]. Dialysis was needed in 57.50% of the study population either due to failure of conservative management for renal failure or due to maintenance dialysis. The mean duration of hospitalization was 11.47 days with a mortality rate of 52% which is much higher than the reported average data in CKD patients. Conclusion: Vaccination seems to be very helpful in combating the adverse effect of Covid-19 in CKD patients. It also reduces mortality significantly in Covid-19 infected CKD patients.

Résumé Introduction: Il existe une différence entre les sexes dans les caractéristiques démographiques, cliniques et les résultats des patients atteints d'IRA associée à une chirurgie cardiaque et vasculaire. Méthodes: Cette étude rétrospective a eu un total de 88 participants pour lesquels les données socio-démographiques, cliniques et de laboratoire (électrolytes sériques, numération globulaire complète, analyse d'urine et volume d'urine, taux de créatinine et de filtration glomérulaire) des participants ont été prises avant et après l'opération. jours 1, 7 et 30. Résultats: Au total, 88 participants (66 hommes et 22 femmes) ont été étudiés. Les maladies des valves cardiaques étaient plus fréquentes chez les femmes que chez les hommes. L'âge moyen des participants était de 65,9 ± 6,9 ans, avec des hommes de 65,1 ± 7,6 ans et des femmes de 68,3 ± 8,4 ans, P = 0,02. Avant la chirurgie, une proportion significativement plus élevée de femmes avaient un dysfonctionnement rénal par rapport aux hommes, P = 0,003. La chirurgie valvulaire et le pontage coronarien étaient les chirurgies les plus courantes. La proportion de chirurgies d'urgence et d'admissions de moins de 7 jours était significativement plus élevée chez les femmes que chez les hommes, P = 0,04 et P = 0,02 respectivement. La récupération complète de l'IRA était significativement plus élevée chez les hommes, car la récupération partielle et la mort étaient significativement plus faibles chez eux, P = 0,02. Sur les 35 (39,8%) qui ont été dialysés, 85,7% se sont complètement rétablis, 5,7% sont devenus dépendants de la dialyse tandis que 8,6% sont décédés. Conclusion: Les hommes atteints d'IRA étaient plus jeunes que les femmes. Les chirurgies valvulaires étaient les plus courantes. Le dysfonctionnement rénal de base et l'âge avancé étaient des facteurs de risque d'IRA. Après l'opération, l'IRA était plus fréquente chez les hommes qui étaient plus susceptibles de récupérer une fonction rénale complète. L'optimisation de la préparation des patients pourrait réduire l'incidence de CVS-AKI. Mots-clés: Chirurgie cardiaque et vasculaire associée insuffisance rénale aiguë, dialyse, récupération de la fonction rénale, chirurgie valvulaire.

Co-existence of Thrombotic Thrombocytopenic Purpura and Megaloblastic Anaemia: A Case-Based Review.

Introduction: Thrombotic thrombocytopenic purpura is a rare and fatal thrombotic microangiopathy characterised by a pentad of microangiopathic haemolytic anaemia, thrombocytopenia, renal abnormalities, neurological abnormalities, and fever. Due to ineffective erythropoiesis, vitamin-B12 deficiency may rarely present as haemolytic anaemia. Case report: We report a case of a 42-year-old vegetarian female presenting as vitamin B12 deficiency anaemia found to have concomitant TTP, responding to plasmapheresis, corticosteroids, and rituximab therapy. Discussion: In this case of vitamin B12 deficiency with co-existent TTP, we hypothesise vitamin B12 deficiency as a contributory or precipitating factor for TTP. We reviewed similar cases in the literature to support this hypothesis. Timely detection of TTP and the initiation of treatment is of utmost importance as TTP has a high mortality when left untreated. The possible relationship with Vitamin B12 deficiency needs further exploration.

A Study on Correlation of Neutrophil to Lymphocyte Ratio and Red Cell Distribution Width with Microalbuminuria in Type 2 Diabetes Mellitus.

Diabetes mellitus (DM) is a systemic disease having serious microvascular and macrovascular complications. DM is one of the most common causes of chronic kidney disease CKD, end-stage renal disease (ESRD). Chronic inflammation has an important role in the development and progression of type 2 diabetes through immunologic inflammatory mechanisms. Simple new inexpensive inflammatory markers may contribute to the detection of microalbuminuria. Our aim is to study the correlation of neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) with microalbuminuria in type 2 diabetic patients. MATERIAL: This was a single-center, cross-sectional study and was conducted from November 2020 to October 2021 in a tertiary care center in Eastern Odisha. Study subjects were patients with type 2 Diabetes Mellitus. A total of 90 patients with type 2 diabetes mellitus were classified into gender- and BMI-matched three groups according to hemoglobin A1c and microalbuminuria: Group A: 30 patients with controlled diabetes, without microalbuminuria Group B: 30 patients with uncontrolled diabetes, without microalbuminuria, and Group C: 30 patients with uncontrolled diabetes with microalbuminuria. Levels of NLR and RDW between the study groups were examined and compared. OBSERVATION: A significant difference in NLR was found between Group C and groups A and B (P <.001, P =.008, respectively). A statistically significant difference in RDW was found between groups B and C (P =.015). Receiver operating characteristic curve analysis of inflammatory markers and microalbuminuria prediction showed an area under the curve (AUC) of 0.69 for NLR and 0.61 for RDW. CONCLUSION: NLR and RDW have a positive correlation with urine ACR and have PPV for microalbuminuria in diabetic patients. NLR and RDW are cheap and inexpensive methods for detecting nephropathy early in diabetes patients.