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7- Health-Related Quality of Life in Chronic Kidney Disease Patients: A Cross-Sectional Study
Aly A, Kharshid A, Syed Sulaiman SA, Al Draimly M, and Al Boghdadly A
Objectives: To evaluate the influence of non-dialysis-dependent chronic kidney disease (ND-CKD) on the health-related quality of life (HRQOL) of ND-CKD patients.
Methods: A cross-sectional study design was utilized to assess the effect of ND-CKD on HRQOL measures of ND-CKD patients at Penang General Hospital in Penang, Malaysia. A total of 526 CKD patients who fulfilled the inclusion criteria were asked to fill the 36-item short-form health survey (SF-36). SF-36 instrument measures health based on eight multiple-item dimensions that cover functional status, wellbeing and overall health evaluation. The English version of SF-36 was translated into Malay language, validated and administered to the subset of participants who don’t speak English.
Results: Nearly 67% of participants were Females, and the mean (± SD) age of respondents was 70 (±10.4) years. The Chinese race represented 53.2% of participants, 59% of respondents earned less than 2000 Malaysian Ringgit (MYR) a month, and 42% of them were stage III ND-CKD patients. The HRQOL scores were significantly affected by the severity of ND-CKD, as it were consistently lower at advanced ND-CKD stages especially in elderly patients. Female gender was associated with lower HRQOL in all scales except the bodily pain (P) one. Patients with higher monthly income showed significantly higher role-function (RF) score than their counterparts.
Conclusion: These observations highlight the strong impact of ND-CKD on HRQOL that needs to be appropriately considered and addressed. Further studies to design and evaluate potential interventions for improvement of HRQOL in ND-CKD patients are warranted
8- Mobile Atherosclerotic Aortic Plaque with Multiple Infarctions: Case Report
AbdulRahman Samy Ismaiel
Introduction : One of the most important causes of stroke and peripheral embolization is the presence of atherosclerotic lesions of the aorta which may lead to severe neurological damage as well as multi-organ failure and death. The modality of choice for the diagnosis of these atheroma’s is Transesophageal echocardiography (TEE) although other investigations such as computed tomography, magnetic resonance imaging and intraoperative epiaortic ultrasound remain complementary.
Case Description: A 61-year-old female with a history of DM type II, hypertension, dyslipidemia and porcelain gallbladder diagnosed 1 month prior to her admission but refused surgical treatment presented to the hospital complaining of severe epigastric pain and vomiting. Her home medications included oral hypoglycemic agents, antiplatelet agent, anti-hypertensive medications and a statin. She was investigated using CT abdomen with contrast and was incidentally found to have an acute total left kidney infarction that was confirmed by DMSA scan. Chronic splenic infarcts were also seen. Transthoracic echocardiography was performed and was unremarkable. The patient later developed a left arm tremor so a CT and MRI brain without contrast were done which showed a subacute ischemic insult with advanced atherosclerotic changes seen at the Vertebrobasilar, cavernous, supraclinoid internal cerebral artery as well as the left proximal anterior cerebellar and middle cerebellar arteries. TEE was performed and showed a moderate size complex atherosclerotic plaque with a mobile elongated component at the aortic arch and descending aorta. The patient was offered endovascular treatment but refused. Therefore, the patient was started on anticoagulants and was scheduled for regular follow up.
Discussion: espite antiplatelet therapy, the risk of stroke and peripheral embolization remains high in such patients. The information provided by TEE includes the composition, mobility, ulceration and the anatomic relationship of the plaque to the origin of the great vessels. Oral anticoagulation therapy may be considered in stroke patients with aortic arch atheroma in order to prevent further recurrent strokes and embolization.
9- Analgesia in Day-Case ENT Surgery: The Efficacy of lornoxicam
Mohammed Daabiss, Medhat Al- Sherbiny, Rashed Al-Otibi, and Rima Al Nimer
Objectives: Pain management is important to facilitate early mobilization after surgery. It results in a shorter hospital stay therefore leading to an early discharge and patient satisfaction which are important goals in day-case surgery. The aim of this study was to demonstrate the perioperative analgesic efficacy of lornoxicam in minor to moderate day-case ENT surgical procedures.
Study design: Hundred and five (105) patients aged between 18 to 52 years (yr) were scheduled for day-case ENT surgery and were enrolled in this randomized, double-blind study. They were divided into three equal groups to receive intravenous (IV) lornoxicam 8 mg (group l 8) or lornoxicam 16 mg (group l 16) half an hour before induction or fentanyl 100 mg (group F) at induction of anesthesia. Mean arterial pressure (MAP), heart rate (HR), electrocardiography (ECG), oxygen saturation (SpO2) and end-tidal capnography (EtCO2) were recorded during the procedure. Pain, additional perioperative analgesic requirements, the incidence of postoperative nausea and vomiting (PONV) and any adverse events were recorded at 0.5, 1, 2, 3 and 4 hours postoperatively.
Results: There were no significant demographic differences between groups. Intra-operatively, the time to first analgesic requirement in group L8 was shorter compared to other groups, while postoperatively it was shorter in group F and group L8. Visual analog scale (VAS) was significantly greater at 40 minutes postoperatively in group F and in group L8. The incidence of PONV was significantly higher in group F and group L8.
Conclusion: Lornoxicam 16 mg is comparable to fentanyl as intra-operative IV analgesia but more effective than fentanyl in preventing early postoperative pain in patients undergoing minor to moderate day-case ENT surgical procedures.
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