ABSTRACT
Background Cancer patients are at increased risk of multi-organ failure due to either the primary disease burden or certain non-cancer-related risk factors. Among the most common complications is acute kidney injury (AKI), which is frequently seen in cancer settings. Among patients with cancer, the incidence of renal injury reaches up to 12.5%. However, critical care units have a much higher incidence, up to 50%. This study aimed to describe the characteristics of Asian populations with AKI with a background of malignancy, along with risk factors and outcomes. Materials and methods A retrospective tertiary-care single-center study was conducted in the intensive care unit (ICU). It included 182 cancer patients with AKI who were followed over a 36-month period. Results Our results revealed a mortality rate of 50.5% among cancer patients with AKI, with the highest mortality rate being among those with solid and hematologic malignancies. Common predisposing factors were sepsis (28%), dehydration (18.1%), and hypotension (9.9%). Several drugs were found to be among the most toxic agents, including vancomycin, colistin, nonsteroidal anti-inflammatory drugs, angiotensin receptor blockers, amphotericin, and certain chemotherapeutic drugs (especially cisplatin). A strong association was found between the length of ICU stay and mortality (p=<0.05), indicating a reduced survival rate with prolonged hospital stay even in critical care settings. Conclusion In summary, AKI in cancer patients increases their mortality due to a variety of risk factors. However, the early involvement of onconephrology and a multidisciplinary approach will result in better outcomes.
ABSTRACT
Introduction: Rheumatoid arthritis (RA) is a common autoimmune illness that manifests mostly as chronic, symmetric, and progressive polyarthritis with a global frequency of 0.3−1.0%. RA is a disease that affects people all over the world. In India, the prevalence is estimated to be 0.7%, with around 10 million persons suffering from RA. Most people with rheumatoid arthritis experience fatigue on most days, with over 70% experiencing symptoms similar to chronic fatigue syndrome. Patients rate fatigue as a top priority and believe this unmanageable symptom is ignored by clinicians; a systematic review shows the biological agents for RA inflammation have only a small effect on fatigue. Fatigue predicts and reduces the quality of life, and it is as difficult to cope with as pain. Physicians have traditionally concentrated on the inflammatory aspects of the illness (e.g., synovitis), whereas RA patients have prioritized pain, exhaustion, sleep difficulties, and other quality-of-life issues. Aims and Objectives: The basic aim of the study was to access the incidence of fatigue in rheumatoid arthritis and evaluate its impact on the quality of life in these patients using the MAF scale (multidimensional assessment of fatigue) after prior permission for the first time in an Asian population. Results: A total of 140 subjects and 100 controls were included in the study. Age was closely matched between the study subjects and controls. Among study subjects with the disease, 94 (67%) had a disease duration ≤ 5 years, 26 (19%) had a disease duration between 6−10 years, 10 (7%) had a duration of 11−15 years and 10 (7%) had >10 years disease duration. Among the sample, 31 (25%) study subjects had a DAS score ≤ 4.0, 63 (50%) study subjects had a DAS score (disease activity score) between 4.01 and 6.0, and in the remaining 31 (25%) study subjects, the DAS score was >6.0. The mean DAS score among study subjects was 4.96, and the study subjects had a mean activity of daily living (ADL) score of 11.64; controls had a mean score of 2.42 with a statistically significant p-value. The global fatigue index was higher in study subjects, with a mean of 33.16 in contrast with a mean of 14.41 in the controls with a significant p-value. Conclusion: Our study fatigue was a persistent problem, despite treatment. The median level of fatigue experienced by study subjects with RA was high. Therefore, as persistent fatigue is associated with functional loss, fatigue in RA remains an 'unmet need' and continues to be ignored by clinicians.
