Background. Acute kidney injury (AKI) is a common but least studied complication of lymphoma. Objective. To determine the frequency and predictors of AKI in lymphoma and to study the impact of AKI on hospital stay and mortality. Methods. Retrospective review of medical records of hospitalized lymphoma patients aged ≥14 years between January 2008 and December 2011 was done. Results. Out of 365 patients, AKI was present in 31.8% (116/365). Multivariate logistic regression analysis showed that independent predictors for AKI included sepsis (odds ratio (OR) 3.76; 95% CI 1.83–7.72), aminoglycosides (OR 4.75; 95% CI 1.15–19.52), diuretics (OR 2.96; 95% CI 1.31–6.69), tumor lysis syndrome (OR 3.85; 95% CI 1.54–9.59), and R-CVP regimen (OR 4.70; 95% CI 1.20–18.36). AKI stages 2 and 3 was associated with increased hospital stay (OR 2.01; 95% CI 1.19–3.40). Conclusion. AKI was significantly associated with sepsis, aminoglycoside, diuretics, presence of tumor lysis syndrome, and use of R-CVP regimen. Presence of AKIN (Acute Kidney Injury Network) stages 2 and 3 AKI had increased hospital stay. AKI was also associated with increased mortality.
Objective:To determine association of in-hospital outcome of AKI with etiology in newborns at a tertiary care hospital.Methods:This descriptive cross-sectional study was conducted at Department of Pediatric Neonatology, The Children's Hospital and Institute of the Child Health, Multan by using non-probability purposive sampling technique from June 2016 to June 2017. A total of 101 newborns diagnosed with acute kidney injury were registered. Etiological factors were assessed and these patients were followed till discharge to monitor in-hospital outcomes.Results:Of these 101 newborns, 75 (74.3%) were boys while 26 (25.7%) were girls. Mean age of these newborns was 7.59 ± 6.13 days (range; 1 day to 28 days). Mean age of the boys was 5.73 ± 7.20 days while that of girls was 6.77 ± 6.16 days. (p=0.515). Mean weight of these neonates was 2545.05 ± 600.42 grams (range; 1000 grams to 4000 grams). Mean serum potassium level was 4.94 ± 0.92 mgEq/L ranging from 3.1 mgEq/L to 7.0 mgEq/L. Mean urea level was 73.35 ± 27.65 mg/dl ranging from 18 mg/dl to 206 mg/dl. Mean serum creatinine level was 1.98 ± 0.27 mg/dl, ranging from 1.6 mg/dl to 2.8 mg/dl. Mean serum sodium level was 145.72 ± 12.64 mgEq/L ranging from 126 to 166 mEq/L. Eighty one (80.2%) were term babies while 20 (19.8%) were pre-term babies. Of these 101 study cases, 29 (28.7%) delivered vaginally while 72 (71.3%) through cesarean section. Delayed crying was noted in 48 (47.5%), dehydration 13 (12.9%), sepsis in 36 (35.6%) and renal malformation in only 4%. Neonatal mortality in these patients was 15 (14.9%) while 86 (85.1%) were discharged from hospital after recovery.Conclusion:Acute kidney disease in newborns is associated with significant disease morbidity and mortality with asphyxia and sepsis are the main etiological factors responsible. It is predominantly more common in boys compared with girls. Mortality rate was high in our study and it was significantly associated with female gender. Mortality was also associated with elevated serum sodium and urea level.
Aeromonas hydrophila (AH) is an aquatic bacterium. We present a case of fifty-five-year-old gentleman with chronic kidney disease (CKD) due to crescentic IgA nephropathy who presented to us with fever. He was recently pulsed with methyl prednisolone followed by oral prednisolone and discharged on maintenance dialysis through a double lumen dialysis catheter. Blood culture from peripheral vein and double lumen dialysis catheter grew AH. We speculate low immunity due to steroids and uremia along with touch contamination of dialysis catheter by the patient or dialysis nurse could have led to this rare infection. Dialysis catheter related infection by AH is rare. We present our case here and take the opportunity to give a brief review of AH infections in CKD patients.
Objective: To determine the incidence of acute bilirubin encephalopathy (ABE) and its risk factors in neonates presenting with hyperbilirubinemia in a tertiary care children hospital. Methods: This descriptive observational study was conducted from June 2018 to June 2019. A total of 300 infants who were admitted in neonatal ICU with diagnosis of hyperbilirubinemia in The Children’s Hospital & The Institute of Child Health, Multan, Pakistan were included in this period. Incidence of ABE was noted. ABE was divided into two categories on the basis of severity of symptoms; mild ABE and moderate to severe ABE. Total serum bilirubin (TSB) in all neonates was measured in all patients in hospital laboratory using colorimetric method. ABO incompatibility and Rh factor incompatibility was also noted for each neonate. Results: Out of 300 neonates who presented with hyperbilirubinemia, ABE was diagnosed in only 42 (14.0%) neonates (mild ABE in 17 (5.7%) and moderate in 25 (8.3%). Out of 42 neonates of ABE, total serum bilirubin levels were 20-29.9 mg/dL in 24 (40.5%) neonates, and >30 mg/dL in 18 (42.8%) neonates. Pre-term birth was a significant risk factor of ABE; 23.8% in ABE and 10.70% in non-ABE (p-value 0.01). During treatment, 02 (4.76%) neonates expired due to ABE. Conclusion: In present study, ABE was diagnosed in 14.0% neonates who presented with hyperbilirubinemia. We found pre-term delivery as a significant risk factor of ABE. doi: https://doi.org/10.12669/pjms.36.6.2222 How to cite this:Ahmad M, Rehman A, Adnan M, Surani MK. Acute bilirubin encephalopathy and its associated risk factors in a tertiary care hospital, Pakistan. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2222 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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