Bs Lakshmi

Employment status of patients receiving maintenance dialysis – peritoneal and hemodialysis: A cross-sectional study

The long-term dialysis therapy for end-stage renal disease takes a heavy toll of quality of life of the patient. Several factors such as fatigue and decreased physical capability, impaired social and mental functioning, contribute to this forlorn state. To meld maintenance dialysis treatment with a regular employment can be a serious test. A cross-sectional study of employment of patients on hemodialysis and peritoneal dialysis in a state government tertiary institute in South India was performed between June 2015 and December 2015. Patients who completed 3 months of regular dialysis were only included in the study. The number of patients on hemodialysis was 157 and on peritoneal dialysis was 69. The employment status before the initiation of dialysis was 60% (93 out of 155) and 63.7% (44 out of 69) in hemodialysis and peritoneal dialysis, respectively. After initiation, the loss of employment was observed in 44% (41 out of 93) in hemodialysis and 51.2% (26 out of 44) in peritoneal dialysis (P = 0.2604). Even though there was fall of absolute number of job holders in both the blue and white collar jobs, the proportion of jobholders in the white collar job holders improved. On univariate analysis, the factors which influenced the loss of employment were males, age between 50 and 60 years, number of comorbidities >2, illiteracy and blue collar versus white collar job before the initiation of dialysis. The majority of patients had the scores above 80 on Karnofsky performance scale and the majority belonged upper and middle classes than lower classes on modified Kuppuswamys socioeconomic status scale; however, the loss of employment was also disproportionately high. There appeared a substantial difference in the attitude of the patients toward the employment. There was no difference between hemodialysis and peritoneal dialysis in the loss of employment of our patients.

The veiled right kidney sign

The “veiled right kidney sign” is an uncommon entity in which the right kidney is masked by the collection of air around it in the retroperitoneum.1,2 A 20 year-old male presented with vomiting and distension of the abdomen following an accidental fall on a rock, sustaining a blunt injury over his abdomen. Hematological and routine blood biochemistry tests did not reveal any abnormalities. A plain skiagram of the abdomen (an anteroposterior (AP) view) showed the presence of air in the right perinephric region masking the right kidney. Contrast computed tomography of the abdomen revealed the presence of air in the right perinephric space and a moderate amount of fluid in the peritoneum [Fig. 1]. Laporotomy showed an injury in the third part of the duodenum. Closure of the duodenal laceration, gastrojejunostomy, and a decompression tube duodenostomy were performed after which the patient was discharged on recovery. Fig. 1 Contrast-enhanced computed tomography axial section at the level of the lower pole of the kidneys showing evidence of foci of air in the mesentery and air collection around the right kidney Traumatic blunt duodenal injury is associated with about 12% mortality. Morbidity and mortality from duodenal wounds may be reduced by early hospitalization, early diagnosis, and consequently, earlier surgical repair.3 The presence of air in the right perinephric region—“the veiled right kidney sign” —helps in this situation as an invaluable pointer towards appropriate management.1,2