CKD-MBD spectrum at the time of initiation of hemodialysis in Pakistani chronic kidney disease patients

Chronic kidney disease (CKD) is associated with mineral and bone disorder (MBD), which results in significant morbidity and mortality. To determine the spectrum of CKD- MBD in the Pakistani population, we performed a retrospective review of the medical records of 63 native Pakistani CKD stage-5 patients at our unit at the initiation of hemodialysis from March 2009 to September 2011. The cohort included 28 males and 35 females, with an age range of 18- 87 years (mean age 51 years). We reviewed the serum parathormone (PTH) levels along with other serum biochemical markers according to the KDIGO 2009 guidelines. There were 25 (40%) patients who had PTH 300 pmol/L. Subgroup analysis and follow-up of patients with initial PTH >300 pmol/L (n = 24) showed treatment response in nine patients (38%). We conclude that at initiation of hemodialysis, a significant number of patients had low PTH and a similar percentage of high PTH in our population states. Therefore, we recommend early assessment of renal bone disease spectrum to prevent morbidity and mortality associated with mineral bone disorder in CKD patients

Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: a case series and guidelines

Background & Objective: COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues.Methods: We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers.Results: Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse.Conclusion: The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers.</div