Prevalence and risk factors associated with depressive symptoms among end-stage renal disease patients undergoing hemodialysis in Indian setting

Background: This study aimed to evaluate the prevalence of depressive symptoms among the patients with end-stage renal disease (ESRD) on hemodialysis and to explore associated risk factors.Methods: A prospective observational study of patients with ESRD undergoing hemodialysis were included in the study. Data was collected based on questionnaire created by the study team, and by verbal interviews with patients. The questionnaire consisted of two parts, which included demographic data (gender, age, sleep quality, duration of sleep, appetite pattern, and duration of dialysis) and evaluation of the severity of depressive symptoms by using the depression, anxiety and stress scale-21.Results: Out of total 93 patients with ESRD on hemodialysis majority of patients belonged to the age group of >60 to ≤80 years (47.8%) and age group >40 to ≤60 years (40.0%). Patients had a higher incidence of severe anxiety (38.7%) than depression (34.4%), and stress (22.6%). The proportion of patients diagnosed with depression (50.0%) and stress (57.1%) was higher in the older age group (>60 to ≤80 years); while the proportion of patients having severe anxiety was similar in both adult (>40 to ≤60 years) and older (>60 to ≤80 years) age group (38.9%). More than 50% of patients with depressive, anxiety, and stress symptoms had insufficient sleep (≤1 to ≤4 h). The present study could not predict the risk factors of depressive symptoms in patients with ESRD on hemodialysis.  Conclusions: Depression and anxiety symptoms were more frequent among patients with ESRD undergoing hemodialysis in Indian settings

Risk factors and clinical profile in patients of acute kidney injury

Background: Acute kidney injury (AKI) is an outcome of multiple etiologies and is mostly reversible. This hospital based cross-sectional observational study was aimed to study the risk factors and clinical profile in patients of AKI. Methods: Sixty AKI patients diagnosed by acute kidney injury network criteria as suggested by kidney disease improving global outcomes clinical practice guidelines were enrolled. Patients with preexisting chronic kidney disease were excluded. Relevant data was recorded and analyzed statistically. Data were compiled using the Statistical Package for the Social Sciences version 17. Regression analysis was done for determining the association of various variables for mortality. P<0.05 was considered statistically significant. Results: The mean age of patients was 52.63±15.58 years with male:female ratio of 2:1. 20% of cases had co-morbidities, the most common co-morbidity being diabetes mellitus with hypertension in 15% of cases. The most common presenting symptom was vomiting (63.3% of patients); sign was hypotension and tachycardia (46.7% each). sepsis was the most common cause of AKI affecting 38 (63.33%) cases. Majority of the cases were non oliguric 81.7%. Pre-renal variety was found in 41.7% patients in this area. Hence, this study suggested a scope for reducing morbidity and mortality associated with AKI if these preventable factors leading to Pre-Renal AKI and sepsis, being an important risk factor for AKI are controlled and prevented as far as possible. Conclusions: The study concluded that sepsis was the most common cause of AKI.

A prospective study to evaluate the effects of acute normovolemic hemodilution on perioperative homologous transfusion requirements in patients undergoing major surgery

Background: Acute Normovolemic Hemodilution (ANH) and autologous transfusion can mitigate the harmful effects of banked blood intraoperatively. This study was planned to evaluate its effects on perioperative transfusion requirement, hemodynamic stability and safety profile.Methods: Hundred patients were randomized to Group 1, where assigned patients received ANH and autologous transfusion after hemostasis; and Group II where assigned patients received homologous transfusion. In group I, 350 to 700 ml of patient's blood was collected before induction of anaesthesia and was kept in the operation theatre at room temperature. This was followed by rapid infusion of calculated Hetastarch. Intraoperative blood loss, amount of transfused blood, serial haemoglobin (Hb) assessment, and change in hemodynamics were carefully monitored. The blood was reinfused once hemostasis was secured at the end of surgery.Results: It was observed that hemodynamic stability was maintained in both the groups during and after haemodilution. There was no significant change in bleeding and clotting time due to haemodilution. The mean intra-operative blood loss in both groups was comparable. 350 mL and 700 mL blood withdrawn in 27 and 23 patients and 500mL and 1000 mL HES infused respectively. There was an average fall in the mean Hb level by 1.74 gm % and in the mean haematocrit (Hct) level by 6.4 % after haemodilution. The mean 12th and 24th hour Hb and Hct levels were comparable. The requirement of homologous blood transfusion in group I was significantly low (p<0.0001). Need for homologous transfusion was 0.72 per patient treated in the Group I.Conclusions: Acute normovolemic hemodilution is a simple, safe and effective modality to reduce perioperative transfusion of banked blood and should be considered in patients undergoing surgical procedures where major blood loss is expected

Comparative Evaluation of Smear Layer Removal Using Four Different Irrigation Techniques: An in-vitro Study

INTRODUCTION: Irrigation is the vital part of root canal debridement. Usually post biomechanical preparation, the canal walls are covered by smear layer. It is important to remove this layer before obturation for better bond between the filling and walls. Conventional needle irrigation doesn’t give us adequate cleaning, therefore, new irrigation techniques are being tried to facilitate better smear layer removal. AIM: The aim was to evaluate and compare the smear layer removal by PATS,&nbsp; EndoActivator device, Passive ultrasonic irrigation and side vent needle irrigation from canal walls. MATERIALS AND METHODS: &nbsp;60 extracted mandibular premolars were instrumented up to 35/.04 with Heroshaper files. Samples were divided into 4 groups randomly before final irrigation as follows: Group I (n=15): Irrigation with side vent needles (Nexus ltd.,India), Group II (n=15): Irrigation with EndoActivator (Advanced Endodontics, Santa Barbara, CA ) Group III (n=15): Irrigation with PATS ( InnovationsEndo,India), Group IV (n=15): Irrigation with ultrasonic tips (Mani inc.). Teeth were split and one-half of each tooth was chosen for SEM examination. &nbsp;The images were taken at apical third and scoring was done according to criteria by Torabinejad et al in 2003. Data obtained were analyzed using Kruskal-Wallis analysis of variance followed by Mann–Whitney U-test for individual comparison. RESULTS: All irrigating systems remove smear layer but PUI has better cleaning ability as compared to other groups. CONCLUSION: Passive ultrasonic irrigation shows better smear layer removal as compared to other technique