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Introduction Chronic kidney disease (CKD) carries a significant association with cardiac diseases, which suggests a minor reduction in the glomerular filtration rate (GFR) can act as an independent risk factor for causing cardiovascular abnormalities. Patients of CKD having cardiovascular disease (CVD) had three to thirty times higher risk of mortality as compared to the general population. In addition, mortality among cardiovascular patients has been found to be twofold higher in CKD stage 2 patients and three-fold higher in patients with stage 3 CKD, when collated to patients with normal renal function. Furthermore, cardiomyopathy among hemodialysis (HD) is due to the presence of coronary artery obstruction, reduction in coronary reserves, and left ventricular (LV) physiological-structural abnormalities secondary volume and pressure overload. Echocardiography is a gold standard diagnostic modality for the identification of cardiac structural and functional abnormalities. Therefore, the evaluation of echocardiographic parameters in patients of CKD can help to determine the risk and prognosis of CVD in patients of CKD. In the present study, we evaluated the echocardiographic findings in patients of CKD on maintenance hemodialysis. Methods This cross-sectional study was conducted in the nephrology unit of Jinnah Postgraduate Medical Center between March 2019 to October 2019. A total of 100 patients who were on maintenance for more than one year were included in the analysis. Two-dimensional transthoracic echocardiography was done in each patient for the determination of cardiac structural and functional parameters such as LV hypertrophy, LV systolic dysfunction, and LV diastolic dysfunction. Results The mean age of the patients was 46.9±12.8 years. There was male dominance with male/female ratio 63/37. There were 39% hypertensive and 62% anemic patients. LV dysfunction was diagnosed in 31% of patients, LV diastolic dysfunction in 47% patients, and left ventricular hypertrophy (LVH) in 55% of patients. LVH was found in 74.3% hypertensive patients versus only 42.6% non-hypertensive patients (p-value 0.001). LV systolic dysfunction was also high in hypertensive patients, 46.1% versus 21.3% patients in non-hypertensive patients (p-value 0.008). Conclusion There is a high frequency of cardiac functional and structural abnormalities in CKD patients on HD especially in patients having concomitant hypertension. LVH is the most common structural defect and LV diastolic dysfunction is the most common functional cardiac defect in CKD patients on hemodialysis.
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INTRODUCTION: Midfoot injuries involving naviculocuneiform and calcanealcuboid joints are very rare. These injuries result from high-energy crushing trauma and most often causes dislocation of the midfoot in plantar direction. CASE REPORT: A 30-year-old female sustained an injury to the left foot after a fall from a very low height. A radiograph of the left foot demonstrated naviculocuneiform joint and calcaneocuboid joint fracture-dislocation. This unusual pattern of injury required open reduction and internal fixation with K-wires after a failed attempt of closed reduction. K-wires were removed after 8 weeks. At 24 months follow-up, she achieved a complete range of movements of left foot and ankle without any complications. CONCLUSION: Injuries involving naviculocuneiform and the calcaneocuboid joint can occur following low-energy impact. Such complex injuries should be diagnosed and treated as early as possible. Initial open reduction and stable anatomical fixation are the keys to achieve a good functional outcome in such kind of injuries.
