Objective: To compare hemodialysis (HD) internal jugular vein (IJV) versus subclavian vein (SCV) catheters in terms of procedural complications, patients’ comfort, tolerance and cost effectiveness. Methods: Sixty six consecutive eligible adult patients planned for hemodialysis @ 3 sessions/ week for maximum 42 days in a private hospital at Sialkot, Pakistan were documented between March 2017 and April 2018. A group, IJV or SCV catheter was allotted to alternate subjects. The catheters were inserted as per practice guidelines. Record of catheter-related complications (CRCs) was computerized. Similarly, patients’ uncomfortability and expenditures on management of CRCs were recorded. Results: Of 66 cases, 62 (93.9%, 31/group) successfully completed the study. Baseline information showed male predominance (n = 47, 75.8%), age (M = 47, range 24-75 years) or catheter stay time (M = 40 days). The rate of vein damage or artery puncture was found higher in IJV than SCV group [(13.9 vs. 6.5%) or (9.7 vs. 3.2%), respectively] during catheterization. The difference also existed in late CRCs such as bacterial infection (32.3 vs. 16.1%), or device dysfunctioning (9.7 vs. 3.2%) with an exception of mechanical kinking. All the patients of IJV or SCV group with missed (19.4 vs. 6.5%) or shortened HD sessions (22.6 vs. 12.9%) reported CRCs-based discomfort as a cause of the regularity. Moreover, the participants of IJV group consumed 69% of the total expenditures on CRCs management. Conclusion: SCV is a better site for HD catheterization as it has comparatively lesser likelihood of complications, patients’ feel comfortable and it is also cost-effective.than IJV. How to cite this:Shafique MN, Akhtar SH, Mahnoor M, Hussain M. Hemodialysis Internal jugular vein versus Subclavian vein Catheters: Complications, patients’ comfort, tolerance and cost-effectiveness. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.249 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.
Objective:To see whether phloroglucinol-added tamsulosin therapy exhibits better efficacy than tamsulosin alone in medical expulsion of lower ureteral stone (LUS).Methods:Sixty four consecutive adult patients presented in a urological setting at Sialkot, Pakistan between January 2015 and December 2016 with solitary, unilateral 3-8mm sized lower ureteral stone (reported by noncontrast computed tomography of the kidney-ureter-bladder) were documented. Group either study or control was allotted, randomly. Same 0.4 mg tamsulosin, once daily was given to all the participants. However, additional 40 mg phloroglucinol, thrice daily was advised for study group (n = 32). The therapy terminated on confirmation of stone expulsion otherwise continued for 6 weeks. Patients were asked to use 50 mg diclophenac Na on colic episode.Results:Demographic characteristics revealed 81.2% (n = 52) male patients while age statistics as M = 42.3, SD = 5.93 (range 32-60) years. The study group showed higher stone expulsion rate (100%) and time to expulsion (M = 10.34 days) than control. The values were statistically significant (p = .02 and p = .0001; χ2 test in SPSS). Similarly, combination therapy had advantage on mono therapy for reporting statistically lesser numbers of colic episode (p = .03) and consumption of analgesic (p = .02). A marked difference in rate of adverse effects i.e. 68.8 vs. 90.6% was observed in study and control groups.Conclusion:Phloroglucinol-added therapy is a better choice for expulsion of LUS than tamsulosin alone with reference to stone expulsion rate and medication time.
Method: Calculation of sample size using p = 0.5 (inavailability of secondary data) in n = z 2 pq/d 2 was followed by convenience samplingbased recruitment of the specialists. An indigenously developed questionnaire (Cronbach's α = 0.79) was administrated to each subject for recording sociodemographic and professional information; and self-reporting to 12 close-ended items on Zika virus infection (ZVI) in women; and microcephaly in newborns. The knowledge was categorized as adequate/inadequate. Results: Overall 172 respondents included (response rate = 97.2%); and substantially higher rate i.e. ≥ 91.9% was found against each of the correct options. Consequently, 94.8% (n = 163) of them showed adequate knowledge (score 10-12 out of possible total = 12) on the infection and microcephaly. The knowledge had insignificant association with any of the sociodemographic/professional variables e.g. specialty (p ˃ 0.05; χ 2 test). Similarly, post hoc multiple comparisons using Tukey's HSD test revealed insignificant difference among the mean values of score (p ˃ 0.05) in 3 occupational positions viz. Foundation doctors (M = 11.29, SD = 1.13), trainee doctors (M = 11.26, SD = 0.81), and consultants (M = 11.40, SD = 0.82). Conclusion: Gynecologists and pediatricians had adequate level of the infection and microcephaly-related knowledge; though lack disease-oriented attitude and practical handling.
Objective: To assess the knowledge of Zika virus infection in gynecologistsand pediatricians Study Design: Cross sectional. Setting: Tertiary care public hospitalsincluding Sardar Begam, and Allama Iqbal Memorial Hospitals, Sialkot; Services Institute ofMedical Sciences and Jinnah Hospital, Lahore; and Pakistan Air Force Hospital, Islamabad(Pakistan). Period: July to December, 2016. Method: Calculation of sample size using p =0.5 (inavailability of secondary data) in n = z2pq/d2 was followed by convenience samplingbasedrecruitment of the specialists. An indigenously developed questionnaire (Cronbach’s α= 0.79) was administrated to each subject for recording sociodemographic and professionalinformation; and self-reporting to 12 close-ended items on Zika virus infection (ZVI) in women;and microcephaly in newborns. The knowledge was categorized as adequate/inadequate.Results: Overall 172 respondents included (response rate = 97.2%); and substantially higherrate i.e. ≥ 91.9% was found against each of the correct options. Consequently, 94.8% (n= 163) of them showed adequate knowledge (score 10-12 out of possible total = 12) onthe infection and microcephaly. The knowledge had insignificant association with any of thesociodemographic/professional variables e.g. specialty (p ˃ 0.05; χ2 test). Similarly, post hocmultiple comparisons using Tukey’s HSD test revealed insignificant difference among themean values of score (p ˃ 0.05) in 3 occupational positions viz. Foundation doctors (M =11.29, SD = 1.13), trainee doctors (M = 11.26, SD = 0.81), and consultants (M = 11.40, SD= 0.82). Conclusion: Gynecologists and pediatricians had adequate level of the infection andmicrocephaly-related knowledge; though lack disease-oriented attitude and practical handling.
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