Assessing the Impact of Training on Healthcare Providers' Adherence to Infection Control Measures in Hemodialysis Services.

Background and objective Developing and implementing nursing interventions to educate nurses on infection control procedures in hemodialysis units is of utmost importance and offers significant benefits in enhancing the quality of care. This study aimed to assess the impact of training on nursing professionals' practices of hospital infection control measures in hemodialysis services. The research also intended to explore the potential association between these practices and various sociodemographic variables. Materials and methods This was a single-group, pre- and post-interventional study carried out in Haryana State, India. A pretested questionnaire consisting of 29 statements, the responses of which were measured on a 5-point Likert scale, was used as the study tool. Descriptive and statistical tests like paired-t-test were used to analyze the data. Results The practices section of the questionnaire comprised 29 statements, the responses to which were measured on a five-point Likert scale. The scoring ranged from 5 ("strongly agree", i.e., positive practice) to 1 ("strongly disagree", i.e., negative practice). The maximum achievable score was 145 and the minimum achievable score was 9. The pre-test group (i.e., before training intervention) had a mean practice score of 115.0945 [standard deviation (SD)=9.34, standard error of the mean (SE)=0.66]. However, the post-test group (i.e. after training intervention) had a mean score of 135.26 (SD=8.34, SE=0.59). The study found that structured training significantly increased the mean practice score (t=-33.70, p=0.001). In addition, the study also highlighted the significant association of mean practice scores with various demographic variables among the pre-test and post-test groups. The improvement in mean practice scores among the post-test group after the structured training program reveals that such interventions will ultimately lead to a decrease in central line-associated bloodstream infections (CLABSIs) among hemodialysis patients. Conclusions Our findings showed that the educational intervention led to significant improvements in the practices of the participants.

Prediction of Cirrhosis in Patients with Chronic Hepatitis C by Genotype 3.

BACKGROUND: Genotype 3 increases fibrosis in chronic hepatitis C (CHC). AIM: To evaluate the effect of the hepatitis C virus (HCV) genotype on prevalence and severity of liver disease in CHC. MATERIALS AND METHODS: Nine hundred and forty-nine individuals with positive anti-HCV from June 2016 to May 2017 were enrolled in the study. We compared biochemical and hematological parameters, HCV RNA load, transient elastography, and ultrasound, in genotype 3 and nongenotype 3 patients. Cirrhosis was diagnosed in patients with liver stiffness measurement (LSM) ≥13 kPa. RESULTS: Out of 835 CHC patients, overall, genotype 3 had higher LSM (11.3 vs 7.62, p = 0.01), higher aspartate aminotransferase (AST) (88.4 vs 68.6, p = 0.02), and low platelets (228.4 vs 261, p = 0.03) with higher prevalence of cirrhosis (115/415 vs 25/245, p = 0.01) than nongenotype 3. However, decompensation rates were not significantly different between two groups (32/115 vs 7/25, p = 0.98). The subgroup analysis revealed that cirrhotic genotype 3 had advanced age (50 vs 35, p < 0.01), male predominance, and higher AST (74.4 vs 57, p = 0.01) as compared to noncirrhotic genotype 3 patients. On multivariate analysis, age and AST values were higher in cirrhotic than noncirrhotic genotype 3 patients. CONCLUSION: Genotype 3 patients have higher prevalence of cirrhosis and fibrosis compared to nongenotype 3 patients; however, decompensation was not different between two groups. HOW TO CITE THIS ARTICLE: Gupta T, Aggarwal HK, Goyal S, et al. Prediction of Cirrhosis in Patients with Chronic Hepatitis C by Genotype 3. Euroasian J Hepato-Gastroenterol 2020;10(1):7-10.

Macrophage activation syndrome in a patient with systemic onset of the juvenile idiopathic arthritis.

Systemic onset juvenile idiopathic arthritis (sJIA) is defined as arthritis affecting one or more joint usually in the juvenile age group (< 16 years of age) with or preceded by fever of at least 2 weeks duration that is documented to be daily ("quotidian") for at least 3 days which may be associated with evanescent (non-fixed) erythematous rash or generalized lymph node enlargement or hepatomegaly/splenomegaly/both or serositis. Macrophage activation syndrome (MAS) is a life-threatening complication of sJIA marked by sudden onset of non-remitting high fever, profound depression in all three blood cell lines (i.e. leukopenia, anemia, and thrombocytopenia), hepatosplenomegaly, lymphadenopathy, and elevated serum liver enzyme levels. In children with systemic juvenile idiopathic arthritis, the clinical picture may mimic sepsis or an exacerbation of the underlying disease. We report a case of a 16-year-old female patient presenting with high grade fever with joint pains and generalized weakness which proved to be systemic onset juvenile idiopathic arthritis with macrophage activation syndrome after ruling out all other differential diagnoses and responded well to intravenous steroids.

Evaluation of spectrum of peripheral neuropathy in predialysis patients with chronic kidney disease.

INTRODUCTION: Neurological complications secondary to the uremic state, contribute largely to the morbidity and mortality in patients with renal failure. The prevalence of peripheral neuropathy remains high in advanced renal dysfunction. MATERIALS AND METHODS: The present cross-sectional study was conducted on 100 adult patients of chronic kidney disease between 18 and 75 years of age with serum creatinine greater than 2 mg/dL. Apart from routine examination and baseline investigations, detailed history was elicited pertaining to patients' neurological symptoms, and scored according to the Neurological Symptom Score. Motor nerve conduction velocity was measured from right median, ulnar, peroneal, and tibial nerves. RESULTS: It was observed that neurological symptoms increased steadily with raise in serum creatinine. The mean nerve conduction velocities (NCVs) of right median nerve, ulnar nerve, peroneal nerve, and tibial nerve were 51.34 ± 6.07, 53.04 ± 5.91, 44.72 ± 6.14, and 44.20 ± 5.17, respectively. The NCVs of all the tested nerves decreased significantly with increase in serum creatinine levels (p < 0.01): 70% of the patients had uremic polyneuropathy; 6% had asymptomatic neuropathy, 51% had symptomatic non-disabling neuropathy, while disabling neuropathy was seen in 13% of the patients. CONCLUSION: Our data suggests that NCV testing when complimented with meticulous neurological assessment can provide invaluable input. These tests apart from helping us detect neuropathy in advanced renal dysfunction; can also detect the disease in largely asymptomatic patients which avoids the necessity to order for detailed neurophysiological investigation.

Klippel-Trenaunay syndrome with a life-threatening thromboembolic event.

Klippel-Trenaunay syndrome is a congenital disorder characterised by the triad of cutaneous vascular nevi, soft tissue or bony hypertrophy, and varicose veins or venous malformations involving one or more extremities. An incidence of venous thromboembolism of up to 22% has been reported in this disorder. Also reported but rare is the development of trophic changes. Herein, we report the case of a male with Klippel-Trenaunay syndrome, deep vein thrombosis, venous ulceration, and death due to recurrent pulmonary embolism.