Objective: Prolonged intensive care unit stay not only increases hospital cost but it also prevents hospital equipment to be used by other patients who need them. The aim of this study was to identify factors that affect the duration of intensive care unit stay in post coronary artery bypass grafting patients with chronic kidney disease. Method: This is a single centered observational prospective study done on 191 post coronary artery bypass grafting patients from June 2018 to April 2019 at Cardiac Surgery Unit of Doctor’s hospital and medical center, Lahore, Pakistan. Patients above 18 years with and without chronic kidney disease were included. Results: Mean age of the patients was 57.83 years (± 9.862 SD. Logistic regression analysis shows that patients with post op arrhythmias had the strongest positive association with prolonged intensive care unit stay (OR:11; p value :<0.01), followed by recent myocardial infarction less than 90 days pre coronary artery bypass grafting (OR:5.93; p value:<0.01), shock (OR:3.93;p value:0.04) and acute kidney injury (OR :2.08;p value:0.04). 37.5% chronic kidney disease patients with recent myocardial infarction less than 90 days pre coronary artery bypass grafting and 51.4% patients of chronic kidney disease found with acute kidney injury, showed significant association with p values less than 0.05. Conclusion: Post op arrhythmias, recent myocardial infarction, shock and acute kidney injury are independent risk factors causing prolonged intensive care unit stay in post coronary artery bypass grafting patients. doi: https://doi.org/10.12669/pjms.39.2.6735 How to cite this: Zartash SH, Saleem S, Rasool Z, Mansur A. Risk factors associated with prolonged intensive care unit stay in post coronary artery bypass grafting patients with chronic kidney disease. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.6735 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.
The idea behind this research is to empirically examine relationship between causes (Work-Family Conflict & Job Stress) and consequences (Job Satisfaction & Turnover Intention) of Job Burnout along with its mediating effects in higher educational context of Punjab, Pakistan. The professors, associate professors, assistant professors and lecturers that belongs to different universities in province Punjab of Pakistan were targeted population. Structured and self-administered questionnaire was used to collect the data from six hundred and ten teachers. SEM (Structural Equation Modeling) was used to analyze data. The current study concludes significant relationships between all the aforesaid causes and consequences of Job Burnout except relationship between Job Satisfaction and Job Stress. Furthermore, Job Burnout portrayed its mediating effects between them. This study imparts the management and administration of the higher education institutions in uncovering and eliminating the harms of Job Burnout.
Objectives: The aim of this study is to correlate the dose of dialysis delivered by both methods in the dialysis population in our developing country. Study Design: Cross Sectional study. Setting: Dialysis Centre at Doctor’s Hospital and Medical Center Lahore. Period: February 1, 2018 to April 30, 2018. Material & Methods: Using Fresenius 4008S machines equipped with OCM, we prospectively studied 41 hemodialysis patients. All patients were on hemodialysis for more than three months. Pre and post dialysis urea samples were collected for estimation of single pool Kt/V and compared with OCM. Results: The average age of the patients was 56.46 ± 13.82 years and the mean duration of dialysis was 28.9 ±35.22 months. Mean blood flow rate was 309.27 ±46.06 mL/min. The mean Kt/V was 1.51 ±0.216 (<p=0.001) and the mean OCM was 1.47 ±0.191 (<p=0.001). We found a positive correlation between the two parameters i.e a Pearson’s Correlation: 0.83 (<p=0.001) and an R square value of 0.645.We found that OCM is a good indicator of Kt/V. However, it underestimated Kt/V by 2.07%±8.53%. Conclusion: Online Kt/V calculated by ionic dialysance is a useful method to estimate dialysis dose without the need of blood samples. In clinical practice Kt/V is done on a monthly basis. Any change in the dialysis prescription would entail repeat labs. OCM can be performed at each dialysis session at no extra cost and in real time. Thus, it can prove to be a helpful and economical tool in the assessment of dialysis adequacy in the low income countries with limited resources.
Introduction: Hyperphosphatemia has been found to be consistently associated with increased chances of secondary hyperparathyroidism, vascular and valvular calcification, calciphylaxis and cardiovascular morbidity and mortality in end stage renal disease (ESRD) patients. Dialysis dose, nutritional practices and patients' level of education have an impact on maintaining serum phosphate levels and despite all available strategies, controlling serum phosphate levels remains challenging for nephrologists. In our study we assessed the effect of dietary phosphate intake, delivered dialysis dose (Kt/V, online clearance monitoring (OCM), urea reduction ratio (URR) and total weekly hemodialysis (HD) duration on phosphate levels and other factors affecting its clearance. Methods: This study was carried out on 34 ESRD patients on maintenance hemodialysis through an arteriovenous fistula or permanent central venous catheter at our diaysis center in our hospital in Lahore. Patients' name, age, gender, type of dialyzer, membrane surface area, effective blood flow rate and ultrafiltration volume were all recorded. Questionnaires were filled regarding daily phosphorus intake. Blood samples were collected from the arterial end before connecting the arterial line and rinsing the puncture needle; specimens after HD were collected from the arterial line at the end of dialysis; before collection the blood flow rate was reduced to 50 mL/min. Data analysis was done using SPSS version 25. Results: Out of 34 hemodialysis patients, 41% (14/34) of patients were compliant to thrice weekly hemodialysis. There were 16 (47.1%) females and 18 (52.9%) males, age ranging from 17 to 87 and mean age of 59.6 years, with maintenance hemodialysis vintage ranging from half a month to 79 months with a mean vintage of 33.9 months. Mean pre-& post-HD phosphate were 6.01mg/dl and 2.59mg/dl, respectively. There was a significant mean difference in pre-and post-dialysis phosphate levels (p< 0.01). Mean Phosphate Reduction Ratio (PRR) was 55.6%. Patients with a higher PRR had a higher predialysis serum phosphate and urea (r ¼ 0.608, p <0.01 and r ¼ 0.379, p ¼ 0.027 respectively). PRR had a negative correlation with daily phosphate intake (r ¼ -0.377, p ¼0.028). PRR had no significant association with Kt/V, OCM, URR and blood volume passing through the dialyzer, UF volume, residual urine output, use of phosphate binders or hematocrit. The post-dialysis phosphate was lower in patients with higher Kt/V, URR and OCM (r ¼ -0.417 p ¼0.014, r ¼ -0.307 p ¼0.07, r ¼ -0.295 p ¼0.091 respectively).Patients who had a longer weekly time on dialysis had a lower predialysis phosphate levels (r ¼ -0.34, p ¼ 0.049). High pre-dialysis phosphate had a positive correlation with pre-dialysis urea (r ¼ 0.568, p < 0.01) and a negative correlation with serum bicarbonate (r ¼ -0.363, p ¼0.041). Pre-dialysis phosphate was not significantly related to dietary intake or use of phosphate binders. Conclusions: The predialysis phosphate inversely correlated to total weekly dialysis time ra...
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