Mohammad Hussham Arshad

Acute Kidney Injury Recognition and Management: A Review of the Literature and Current Evidence.

Acute renal failure is defined as a rapid decrease in the glomerular filtration rate, occurring over a period of hours to days and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. AKI is a catastrophic, life-threatening event in critically ill patients. AKI can be divided into pre-renal injury, intrinsic kidney disease (including vascular insults) and obstructive uropathies. The prognosis of AKI is highly dependent on the underlying cause of the injury. Children who have AKI as a component of multisystem failure have a much higher mortality rate than children with intrinsic renal disease. Treatment of AKI is subjected to risk stratification and ongoing damage control measures, such as patients with sepsis, exposure to nephrotoxic agents, ischemia, bloody diarrhea, or volume loss, could be helped by optimizing the fluid administrations, antibiotics possessing least nephrotoxic potential, blood transfusion where hemoglobin is dangerously low, limiting the use of nephrotoxic agents including radio contrast use, while maximize the nutrition. Acute kidney injury remains a complex disorder with an apparent differentiation in pathology between septic and nonseptic forms of the disease. Although more studies are still required, progress in this area has been steady over the last decade with purposeful international collaboration.

Sociodemographic Pattern of Depression in Urban Settlement of Karachi, Pakistan.

INTRODUCTION Depression is a global issue prevalent among developing countries like Pakistan as compared to developed countries. We conducted a study to assess the prevalence and identify the significant predictors of depression in an elite urban settlement in Karachi, Pakistan. MATERIALS AND METHODS This cross-sectional study was done in the elitist residential area of Karachi; Defence Housing Authority (DHA). Four hundred and twenty three participants were included by going to their residences. Self-administered questionnaires were handed out after taking informed consent. Level of depression was assessed by Patient Health Questionnaire (PHQ-9). Data were entered and analysed in Predictive Analytical Software v. 18.0. RESULTS The mean and median total score of the scale were 5.9 ± 5.4 and 4 (7) respectively with minimum score 0 and maximum 27. In this sequence, 139 (32.86%) respondents were identified to be depressed. It was found that females were slight more depressed than males (p = 0.063). Regression Model identified only gender and marital status as significant predictors of depression. Having a female gender increased 0.658 times chance of being depressed (p = 0.047). Unmarried person had 0.296 times more likely to be depressed (p = 0.019). Boredom was considered as significant factor of depression by the participants (p< 0.0001). Odds ratio signified depression occurred 0.310 times more if one was bored. DISCUSSION Depression should be considered as a major public health issue for the city. Public awareness should be done in all parts of the city in an attempt to reduce depression especially among the female gender.

Use of Cyclosporine Therapy in Steroid Resistant Nephrotic Syndrome (SRNS): A Review

A chronic, progressive disorder Steroid Resistant Nephrotic Syndrome (SRNS) accounts for 10-20% of all children with Nephrotic Syndrome. It is a heterogeneous disorder comprised of persistent edema, proteinuria, hypoalbuminemia and hyperlipidemia. Treatment for steroid-resistant nephrotic syndrome (SRNS) is challenging and children who suffer from SRNS require aggressive treatment to achieve remission. Calcineurin inhibitors have been used more in an empirical manner than on the basis of clear rationale. It was in 1984 when cyclosporine was first considered for the treatment of steroid resistant nephrotic syndrome. Cyclosporin is a calcineurin inhibitor that suppresses immune response by downregulating the transcription of various cytokine genes. Till now many studies have been conducted to determine dosages, duration of therapy, side effects and advantages of cyclosporine. Treatment of SRNS remains a difficult challenge in pediatric nephrology. Treatment should be individualized according to the underlying histopathology, and clinical and environmental conditions of the children. There is an urgent need to distinguish as soon as possible those patients who may benefit from prolonged immunosuppressive treatment from those who will not benefit from such treatment and who will just suffer from its major side effects. The emerging evidence that the majority of genetic forms of SRNS should receive symptomatic treatment only, should also be clinically tested and studies baring its significance should be evaluated in the future.

Comparison of the Postprocedural Quality of Life between Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention: A Systematic Review

The treatment of choice between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) has remained unclear. Considering quality of life (QOL) increases life expectancy, we believe QOL should be important in determining the optimum treatment. Thus the objective of this review was to illustrate the comparative effects of CABG and PCI on postprocedural QOL. Methods. We searched PubMed (Medline) and Embase from inception of the databases to May 2014 using “PCI versus CABG quality of life”, “Percutaneous Coronary intervention versus Coronary artery bypass graft surgery Quality of life”, “PCI versus CABG health status”, “Angioplasty versus CABG”, “Percutaneous coronary intervention versus coronary artery bypass surgery health status”, and different combinations of the above terms. 447 articles were found. After applying strict exclusion criteria, we included 13 studies in this review. Results. From the 9 studies that compared QOL scores at 6 months after procedure, 5 studies reported CABG to be superior. From the 10 studies that compared QOL among patients at 1 year after procedure, 9 reported CABG to be superior. Conclusion. It can be established that CABG is superior to PCI in improving patients QOL with respect to all scales used to determine quality of life.

Knowledge, Awareness and Self-Care Practices of Hypertension among Cardiac Hypertensive Patients

Introduction: The most prevalent form of hypertension is systolic blood pressure (SBP) and it is considered to be predisposing risk factor for cardiovascular disease. The objective of the study was to assess self-care practices, knowledge and awareness of hypertension, especially related to SBP among cardiac hypertensive patients. Methodology: A Cross sectional study was conducted on 664 cardiac hypertensive patients, which were selected by non-probability convenience sampling from cardiology outpatient department of three tertiary care hospitals. Face to face interviews were conducted using a pre designed questionnaire. Data was entered and analyzed by SPSS (V17). Results: 81.8%, did not know that hypertension is defined as high blood pressure. 97.1% of the sample population did not know that top measurement of blood pressure was referred to as systolic and only 25.0% correctly recognized normal systolic blood pressure to be less than 140mmHg. 7.4% of the patients consulted their doctor for hypertension once or twice in a month. Risk factor for high blood pressure most commonly identified by the participants was too much salt intake Conclusions: The results state that there is an inadequate general knowledge of hypertension among cardiac patients and they do not recognise the significance of elevated SBP levels. There is a need to initiate programs that create community awareness regarding long term complications of uncontrolled hypertension, particularly elevated SBP levels so that there is an improvement in self-care practices of the cardiacpatients.

On Pump Coronary Artery Bypass Graft Surgery Versus Off Pump Coronary Artery Bypass Graft Surgery: A Review

There are two basic ways of performing coronary artery bypass graft surgery (CABG): on pump CABG and off pump CABG. Off pump CABG is relatively a newer procedure to on-pump CABG and does not require the use of the cardiopulmonary bypass machine. On pump CABG is the more traditional method of performing bypass surgery. However its resultant inflammatory effects cause renal dysfunction, gastrointestinal distress and cardiac abnormalities which have forced the surgeons to look for alternatives to the procedure. An extensive literature search revealed that on pump CABG causes better revascularization as compared to off pump CABG while off pump CABG has a much lower post operative morbidity and mortality especially in high risk patients. We suggest that the technique used should depend on the ease of the surgeon doing the operation as both the methods seem almost equally efficient according to the review.

Prevalence and characteristics of resistant hypertensive patients in an Asian population

Background Resistant hypertension is a well-recognized clinical challenge yet there are no reported data on its prevalence in Pakistan. These patients are subjected to a higher risk of developing hypertensive complications. The objective of our study was to evaluate the prevalence and determinants of resistant hypertension in an Asian cohort of hypertensive patients. Methods This cross-sectional study was carried out among hypertensive patients visiting a tertiary care hospital in Karachi from September-December 2015. Patient data and characteristics were recorded using a pre-coded questionnaire. Morisky and Berlin questionnaires were used to assess compliance to medications and determine the risk of developing obstructive sleep apnea, respectively. Pearsons chi-square test was used to analyze statistical differences between hypertensive patients and related factors. Results A total of 515 patients were included in the study. Overall, 12% of the total patients (n = 62) were resistant hypertensives and 25% (n = 129) had pseudo-resistant hypertension. Resistant patients were more often females, older and had a higher body mass index (all P < 0.001). Use of painkillers and noncompliance to dietary recommendations were found to be significant determinants of resistant hypertension. Prevalence of comorbid conditions, including diabetes (p = 0.33), hyperlipidemia (p = 0.46), and chronic kidney disease (p = 0.23), was not significantly higher in patients with resistant hypertension. Conclusion Nearly one in ten hypertensive patients had true resistant hypertension, and twenty-five percent of patients had pseudo-resistance. Resistance hypertensions is significantly associated with female gender, older age, obesity, dietary noncompliance and increased use of NSAIDs.

Knowledge, Attitudes and Perceptions Among Non-Blood Donor Female Health Care Professionals

Introduction: Blood donation is necessary in order to maintain an adequate supply of blood to patients who are suffering from any kind of disease or trauma, which requires them to have blood transfusion. Female non-blood donors are generally low in number. Therefore, this research was carried out to assess the main reasons behind the lack of blood donations made by females, and their knowledge, attitude and perceptions towards voluntary blood donation. Methodology: A cross-sectional study was conducted on 664 female health professionals, who were selected by non-probability convenience sampling from two tertiary care hospitals. A pretested questionnaire was presented to the sample population, and the data was entered and analyzed on SPSS (V17). Results: 94.6 % were aware with the fact that blood is screened for AIDS, Hepatitis B and C before transfusion. Moreover, 83.7% said that they will only donate blood if a family, relative or friend would need it and similarly 83.4% suggested that they would donate blood if blood donation camps are arranged in hospital premises. 81.8 % thought that blood donors can contract Hepatitis B after donation whereas only 29.5% did not blood due already blood loss in menstrual cycle. Conclusion: The participants had adequate knowledge about the benefits of blood donation. The most important reason identified for not donating blood is the lack of facilities within the workplace or lack of approach by responsible authorities. The results of the study may help in minimizing the misconceptions of the participants about blood transfusion, which would increase their contribution towards blood donation.

Knowledge, Attitudes, and Practices Among Nurses in Pakistan Towards Diabetic Foot

Introduction Diabetic foot ulcers are a pressing complication of diabetes mellitus. Wound care requires a significant proportion of healthcare resources. It is imperative, therefore, for healthcare professionals to possess sound knowledge of the disease along with a positive attitude to ensure better clinical practice. Our literature search revealed a scarcity of data pertaining to diabetic foot ulcers. Therefore, this study aims to evaluate the knowledge and attitudes of nurses regarding diabetic foot care. Methods A cross-sectional study design was employed, a pre-validated and pre-tested questionnaire was used to collect data from a sample size of 250 nurses working at two tertiary care hospitals in Karachi, Pakistan. The study was conducted over a period of three months (January to March 2018) and included all nurses who possessed at least one year of clinical experience in diabetic ulcer care. The statistical software employed was SPSS version 19 (IBM Corp., Armonk, NY, US). Non-parametric tests and descriptive statistics were used for data analysis and statistical significance was assumed at a p-value of less than 0.5. Results Only 54% of the nurses in our study possessed adequate knowledge of diabetic foot ulcers. The mean score of knowledge was 74.9 (±9.5). Macdonald’s standard criteria for learning outcomes was used to gauge the knowledge levels of our study population. Nurses performed best in the domain of ulcer care with 65.3% of the participants possessing good knowledge of the topic. The overall attitude of nurses towards patients with diabetic ulcers was positive. Conclusion This study highlights important gaps in nurses’ knowledge and sheds light on the lack of evidence-based practice. Poor knowledge can compromise healthcare standards, even with the presence of positive attitudes. Hence, a comprehensive revision of nursing curricula across local tertiary hospitals for allowing nurses to update their knowledge is warranted.

Frequency and Determinants of Inappropriate Use of Treadmill Stress Test for Coronary Artery Disease

Background In developing countries like Pakistan, treatment is mediated by private and public healthcare setups with a limited budget for health facilities. Moreover, the inappropriate use of treadmill tests imposes a burden on healthcare resources and leads to unwarranted interventions. Our aim is to assess the prevalence and predictors of inappropriate referrals for the exercise tolerance test (ETT) to diagnose coronary artery disease (CAD) while taking public and private healthcare settings into consideration. Methods A cross-sectional study was conducted to find the prevalence of the inappropriate use of ETT to diagnose obstructive CAD and to determine the factors responsible for it. A total of 264 patients were enrolled from outpatient departments in Karachi. The inclusion criterion was the referral of treadmill testing for the diagnosis of CAT. The analysis was performed by logistic regression models to ascertain independent predictors of inappropriate use. Results Exercise stress tests were found to be inappropriate in 209 (79%) patients. The study indicated that the majority of patients had a low or very low pre-test probability of CAD. Diabetes, hypertension, and dyslipidemia were less frequent in the inappropriate as compared to the appropriate referrals (10%, 45%, and 16% versus 20%, 69%, and 32%). Both public and private sectors showed a high prevalence of inappropriate testing, but it was much higher in the latter (27% versus 73%, P < 0.001). In all regression models, the private healthcare system was the major independent predictor for inappropriate indications of ETT with an average odds ratio of 4.9 (P < 0.001). Conclusion The high prevalence of ETT referrals was found for the diagnosis of CAD. This result was consistent with both public and private healthcare systems, but it was considerably higher in private setups. Comorbidities, number of risk factors, and cardiovascular risk were not associated with the inappropriate use of ETT.