Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI.
In this retrospective study an attempt is made to document the stage at initial presentation of prostatic cancer. Of the 142 patients seen, 84% presented in an advanced stage and this explains why radical prostatectomies are rarely done in India. Hence efforts are required to screen the population for early diagnosis of the disease.
Introduction:
Left ventricular assist devices (LVAD) improve survival in patients with advanced heart failure however their use in patients with concomitant end stage renal disease (ESRD) is limited. Previous studies demonstrate higher mortality and morbidity in this subset of patients. Our aim was to assess in-hospital outcomes in patients who undergo LVAD implantation with and without ESRD in a national cohort.
Methods:
Using Nationwide Inpatient Sample (NIS) for years 2015-2018, all patients who underwent LVAD implantation during the hospitalization were identified. Cohort was divided into two groups, with and without ESRD. Baseline characteristics, comorbidities, in-hospital outcomes were compared between both the groups. Statistical significance was assigned at p<0.05. Analysis was performed using STATA.
Results:
A total of 7185 patients underwent LVAD implantation between 2015-2018. 150 patients (2.09%) had ESRD at baseline. Despite having similar baseline characteristics and comorbidities in both groups (Table 1), the in-hospital mortality was significantly higher in patients with ESRD (43.33% vs 7.46% p-value: 0.001). Similarly, patients in ESRD group had longer length of stay (92.56 ±11.6 days vs a 33.72±0.73 days, p=0.001) and their cost of stay was also significantly higher ($2,179,827 vs $915,699, p=0.001). After multivariable analysis, ESRD remained an independent predictor of inpatient mortality (OR: 3.68, 95% CI (1.06-12.6), p=0.03). The bleeding, infectious and thromboembolic outcomes (Table 2) were also significantly higher in patients with ESRD undergoing LVAD implantation.
Conclusions:
Patients who are ESRD and receive LVAD during their admission are at higher risk of mortality, bleeding, infectious and thromboembolic events. More studies are required to improve management strategies and identify specific subgroup of patients who would benefit from LVAD implantation in this subset.
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