Correlation of Arterial and Venous pH and Bicarbonate in Patients With Renal Failure

Background and objective

Blood gas analysis plays a pivotal role in the management of various respiratory and metabolic disorders. Both arterial and venous samples can be used for blood gas analysis. Arterial blood sampling is technically difficult and is associated with more complications as compared to venous sampling. Many studies have shown the correlation of arterial and venous pH and bicarbonate levels in sepsis, diabetic ketoacidosis (DKA), chronic obstructive pulmonary disease (COPD), and circulatory failure. But, there is a paucity of data, pertaining specifically to the correlation of arterial blood gas (ABG) analysis and venous blood gas (VBG) analysis in patients with renal failure. The objective of this study was to look for any possible correlation between arterial and venous pH and bicarbonate values in patients with renal failure.

Methods

This cross-sectional study was carried out at a large tertiary care hospital in Rawalpindi, Pakistan. Over a period of eight months, 101 patients with renal failure were enrolled after obtaining informed consent. Arterial and venous samples from the patients were obtained, analyzed, and compared.

Results

Out of the total 101 patients, 53 (52.5%) were male while 48 (47.5%) were female. The mean age of the patients was 46.23 ±15.54 years. Mean arterial pH and venous pH were 7.35 and 7.28 respectively. The Pearson correlation coefficient between arterial and venous pH was found to be 0.857 (p<0.001). The mean arterial and venous bicarbonate values were 14.47 mEq/L and 15.51 mEq/L respectively. And the Pearson correlation coefficient between arterial and venous bicarbonate was found to be 0.842 (p<0.001). 

Conclusion

Venous pH and bicarbonate levels correlate strongly with arterial pH and bicarbonate levels, respectively, in patients with renal failure.

Presenting characteristics, comorbidities, and outcomes among COVID-19 patients hospitalized in twin cities of Pakistan

Background

COVID-19 became a pandemic rapidly after its emergence in December 2019. It belongs to the coronavirus family of viruses, which have struck a few times before in history. Data based on previous research regarding etiology and epidemiology of other viruses from this family helped played a vital role in formulating prevention and precaution strategies during the initial stages of this pandemic. Data related to COVID-19 in Pakistan were not initially documented on a large scale. In addition, due to a weak health care system and low economic conditions, Pakistan’s population, in general, already suffers from many comorbidities, which can severely affect the outcome of patients infected with COVID-19.

Objective

COVID-19 infections are coupled with a manifestation of various notable outcomes that can be documented and characterized clinically. The aim of this study was to examine these clinical manifestations, which can serve as indicators for early detection as well as severity prognosis for COVID-19 infections, especially in high-risk groups.

Methods

A retrospective observational study involving abstraction of demographic features, presenting symptoms, and adverse clinical outcomes for 1812 patients with COVID-19 was conducted. Patients were admitted to the four major hospitals in the Rawalpindi-Islamabad region of Pakistan, and the study was conducted from February to August 2020. Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, intensive care unit (ICU) admission, ventilator aid, and mortality. The study not only relates COVID-19 infection with comorbidities, but also examines other related factors, such as age and gender.

Results

This study identified fever (1592/1812, 87.9%), cough (1433/1812, 79.1%), and shortness of breath (998/1812, 55.1%) at the time of hospital admission as the most prevalent symptoms for patients with COVID-19. These symptoms were common but not conclusive of the outcome of infection. Out of 1812 patients, 24.4% (n=443) required ICU admission and 21.5% (n=390) required ventilator aid at some point of disease progression during their stay at the hospital; 25.9% (n=469) of the patients died. Further analysis revealed the relationship of the presented symptoms and comorbidities with the progression of disease severity in these patients. Older adult patients with comorbidities, such as hypertension, diabetes, chronic kidney disease, and asthma, were significantly affected in higher proportions, resulting in requirement of ICU admission and ventilator aid in some cases and, in many cases, even mortality.

Conclusions

Older adult patients with comorbidities, such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease, are at increased risk of developing severe COVID-19 infections, with an increased likelihood of adverse clinical outcomes.

Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: A Multicountry Retrospective Study

BACKGROUND

The establishment of empirical evidence in the Eastern Mediterranean Region (EMR) necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of COVID-19 patients.

OBJECTIVE

This study aimed to assess the patterns of COVID-19 severity and mortality in seven countries and to determine the risk factors of COVID-19 severity and mortality.

METHODS

This multi-country study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study included data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors.

RESULTS

A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (HT) (24.7%) and diabetes (22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity.

CONCLUSIONS

The study confirmed the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.

Taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan

The present study was conducted for the taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan. The study area was divided into three sites along the water course namely Dargai Stream, Sakhakot Stream and Shergarh Stream. Fish samples were collected randomly during January to August 2017 with the help of fish gears. A taxonomic key was designed for the collected fish specimens. Ten fish species were identified belonging to 3 orders and 4 families. Family Cyprinidae was the dominant family with seven representative species while families Siluridae, Nemacheilidae and Mastacembelidae were represented by one species each. Lower mean total length and standard length was recorded in Puntius conchonius (Hamilton, 1822) as 9.2 ± 0.6 cm and 7.3 ± 0.6 cm respectively, while highest mean total length and standard length was recorded in Mastacembelus armatus (Lacepede, 1800) as 28.1 ± 1.7 cm and 15.9 ± 2.4 cm respectively. Mean pH of the water ranged from 6.1 at Shergarh Stream in August to 8.7 at Sakhakot Stream in January. Average temperature range was recorded from 10.9 °C in January at Dargai Stream to 18.7 °C in August at Shergarh Stream. No statistically significant difference was found for temperature (p = 0.96) and pH (p = 0.14) in the three water streams. The present study will provide a baseline for the rearing and enhancement of wild stock of the commercially important ichthyofauna in the field of aquaculture and fisheries.

Assessment of exposure to chemical agents and ergonomic stressors in tanneries in Kanpur, India

In developing countries qualitative assessment of exposure at the workplace may be an essential tool in evaluating hazardous working conditions. This survey reports on qualitative assessment of exposure to chemicals, dust, and ergonomic stressors among 298 workers in 15 tanneries in Kanpur, India. In general, chemical exposure and dermal exposure were highest among beamhouse workers, less for workers involved in dry finishing activities, and lowest for those performing the wet finishing of hides. Dermal exposure was rated as high to very high during beamhouse activities, reflecting direct contact with wet hides and manual handling of hides in soak tanks. Relevant dust exposure was observed only during dry finishing activities. Most workers experienced severe postural load due to working in trunk flexion and rotation for more than 50% of their daily work time. In addition, manual materials handling with loads over 20 kg frequently occurred. The size of the tannery, in general a reflection of state of technology, showed no systematic influence on exposure profiles. The survey suggested that mechanization of material transfer and application of trolleys reduced the work time with trunk flexion and rotation and implied less manual lifting. The presence of local exhaust ventilation in large tanneries seemed to reduce the chemical exposure. This survey has demonstrated the importance of rapid appraisal techniques for evaluating hazardous conditions at the workplace. In developing countries this approach may facilitate occupational hygiene research and practice.

Respiratory disorders, skin complaints, and low-back trouble among tannery workers in Kanpur, India

In a cross-sectional survey health complaints among 418 laborers in 15 Indian tanneries were studied. Low-back pain (61%), asthma (38%), dermatitis (23%), and chronic bronchitis (14%) were the most frequently reported complaints in the 12 months prior to the survey. In general, beamhouse workers reported the highest prevalence but only chronic low-back pain was significantly elevated compared with workers in the finishing departments. When using individual exposure estimates, clear associations were presented among manual lifting over 20 kg and low-back pain (OR = 3.5) and skin exposure and dermatitis (OR = 2.6). Frequent lifting of loads was also associated with self-reported asthma. About 44% of the laborers reported at least one period of sickness absence, and 17% were involved in a serious occupational accident that required a visit to the local physician. Logistic regression analysis showed that sickness absence occurred more often in small tanneries (OR = 2.7) and also was significantly associated with low-back pain (OR = 3.3) and occupational accidents (OR = 2.2). This epidemiologic survey on health complaints in tannery workers is among the few in occupational populations in low-income countries. For many reasons these populations are easily overlooked. The results of this descriptive study indicate that there is a clear need for epidemiologic surveys in these countries to obtain information on working conditions and associated health problems.

Industrial Counseling: Linking Occupational and Environmental Health in Tanneries of Kanpur, India

This paper describes an occupational health program in tanneries in Kanpur, India. The program was instituted as part of a bilateral cooperative effort of India and The Netherlands focusing on providing engineering solutions to prevent industrial waste and community sewage from polluting the Ganges river. The occupational health program was linked to the environmental activities by adopting the concept of industrial counseling. This method aims to increase production and product quality of enterprises and at the same time improve working conditions in these enterprises. The tanneries in Kanpur were targeted for industrial counseling by the Indo-Dutch Environmental and Sanitary Engineering Project Kanpur- Mirzapur under the Ganga Action Plan. Recovery of chrome from wastewater, automation of hydraulic press machines, use of an air-pollution-prevention system in the spray-painting section, and automation of transport are examples of measures used to increase productivity and improve leather quality. Working conditions were improved by adding local exhaust ventilation, mechanizing material transfer, instituting safer procedures for storage and use of toxic materials, and introducing breathing apparatus for operations done in confined spaces to prevent hydrogen sulfide intoxication. The linkage of occupational health problems to environmental issues proved to be effective in drawing attention to working conditions. Also, the application of simple survey techniques to identify and evaluate environmental and occupational hazards substantially increased awareness of these hazards and comprehension of the need to adopt changes among employers, workers, and occupational health professionals. The article discusses the core elements of this successful program.