Listening to music during arteriovenous fistula surgery alleviates anxiety: A randomized single-blind clinical trial

Background Each year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras. Methods This retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group. Results Of the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 ± 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K⁺, and creatinine kinase levels averaged 2.59 ± 2 mg/dl, 5.1 ± 1 mmol/L 38,305 ± 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%. Conclusion Earthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols. Graphical abstract

Objective Older adults with comorbidities have been reported to be at higher risk for adverse outcomes of Coronavirus disease 2019(COVID-19). The characteristics of COVID-19 in older patients and its clinical outcomes in different kidney disease groups are not well known. Methods Data were retrieved from a national multicentric database supported by Turkish Society of Nephrology, which consists of retrospectively collected data between April 17, 2020, and December 31, 2020. Hospitalized patients aged 18 years or older with confirmed COVID-19 diagnosis suffering from stage 3-5 chronic kidney disease(CKD) or on maintenance hemodialysis(HD) treatment were included in the database. Non-uremic hospitalized patients with COVID-19 were also included as the control group. Results We included 879 patients [388(44.1%) female, median age: 63(IQR:50-73) years]. The percentage of older patients in the CKD group was 68.8%(n=188/273), in HD group was 49.0%(n=150/306) and in the control group was 30.4%(n=70/300). Comorbidities were higher in the CKD and HD groups. The rate of presentation with severe-critical disease was higher in the older CKD and HD groups (43.6%, 55.3%, 16.1%, respectively). Among older patients, the intensive care unit(ICU) admission rate was significantly higher in the CKD and HD group than in the control group (38.8%, 37.3%, and 15.7%, respectively). In-hospital mortality or death and/or ICU admission rates in the older group were significantly higher in the CKD (29.3% and 39.4%) and HD group (26.7% and 30.1%) compared to the control group (8.6% and 17.1%). In the multivariate analysis, in-hospital mortality rates in CKD and HD groups were higher than control group [Hazard ratio(HR): 4.33([95% confidence interval(CI): 1.53-12.26] and HR: 3.09(95%CI: 1.04-9.17), respectively]. Conclusion Among older COVID-19 patients, in-hospital mortality is significantly higher in those with stage 3-5 CKD and on maintenance HD than older patients without CKD regardless of demographic characteristics, comorbidities, clinical and laboratory data on admission.

By FATMA AYERDEN EBİNÇ, GÜLAY ULUSAL OKYAY, SERPİL MÜGE DEĞER, et al., Published on 01/01/22