BackgroundMost patients with end-stage kidney disease begin hemodialysis (HD) in an unplanned fashion at a late stage, necessitating the commencement of HD with a temporary venous catheter, the least favorable option. Alternative modalities of kidney replacement therapy (KRT), peritoneal dialysis (PD), and preemptive transplant offer similar or better outcomes than HD at a lower overall cost, and yet they remain underutilized in Saudi Arabia. Early education may help prepare patients with advanced chronic kidney disease (CKD IV and V) to accept their disease and choose a KRT modality that minimizes complications and matches their lifestyle.The aim of the study is to assess the impact of a pilot educational class on therapy choices and outcomes. MethodologyIn a cross-sectional study, we conducted phone interviews and reviewed medical records of 81 attendees of the multidisciplinary monthly educational class about KRT that was held at the King Abdulaziz Medical City (KAMC) from January 2017 to October 2021. The interview was conducted at least one year after the participants attended the class. The study proposal, consent, and questionnaire were approved by the King Abdulaziz International Medical Research Center. Patient data was retrieved from KAMC electronic medical record system. ResultsVolunteer participation in the survey was high (62/81). For the respondents, a preemptive kidney transplant was the most preferred (48/62, 77%) option for KRT. Among the preferred fallback options, HD was the most frequently chosen (29/62, 47%) compared to PD (26/62, 41.9%). At the time of the interview, a great majority of the patients (54/62, 87%) was already on KRT, including about half (26/54, 48%) on HD via a catheter, and the rest about equally divided between those on HD via an arteriovenous (AF) fistula (13/54, 24%) and those on PD (15/54, 28%). Thus, half of the respondents on KRT (28/54, 51%) avoided urgent HD catheter commencement. However, because of an unfortunate shortage of donors, only a small minority (2/62, 3%) of patients received preemptive transplantation. ConclusionThe KAMC CKD education class helped boost the fraction of patients, significantly above the national average, who accepted the diagnosis of kidney failure and pursued preemptive native HD access or enrolled in PD.
According to WHO statistics, over 300,000 people die each year by burns, and more dying from electric burns, scalds or other causes of burns. Burn injuries and wounds are typically fatal. And they can cause serious long-term implications for victims. The most important aspect in reducing the morbidity and mortality associated with burns is to prevent them. Exposure of tissue to an external high temperature source causes thermal burns. Burns that occur at greater temperatures or over longer periods of time cause deeper and more serious injuries. Because burn patients are the most common trauma patients, the initial step in treating them should be to assess and stabilize their airway, breathing, and circulation according to ATLS standards. Supportive care should include crystalloid resuscitation, blood composition, and potentially endotracheal intubation. In this review we will be looking at thermal burns epidemiology, etiology, pathophysiology and most importantly management.
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