Browsing by Author "Sigdel, Mahesh R"
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Publication Assessment of Volume Status Using Body Composition Monitor for Blood Pressure Control in Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Trial(Institute of Medicine, 2023) Dhakal, Niraj; Sapkota, Nisha K; Sigdel, Mahesh RABSTRACT Introduction: Optimal fluid balance and blood pressure control have been shown to improve outcomes in hemodialysis population. We investigated the effectiveness of body composition monitor (BCM) to target dry weight in maintenance hemodialysis (MHD) patients for blood pressure (BP) control and intradialytic adverse events. Methods: A total of 61 consenting adults under MHD were randomly allocated into either BCM group or Clinical Method group. Target dry weight was set every 4-weekly based on BCM report or clinical assessment; dry weight was adjusted with 200-500 ml/session reduction or increment of ultrafiltration in addition to interdialytic weight gain. Outcomes were analyzed in terms of BP control, anti-hypertensive medicine score, and intradialytic adverse events. Results: During 12 weeks of study period, systolic blood pressure (p<0.001), diastolic blood pressure (p=0.01) and mean arterial pressure (p<0.001) significantly decreased from baseline in BCM group but there were no significant changes in Clinical Method group. Lower blood pressure was achieved in BCM group as compared to Clinical Method group. There was a significant decrease from baseline in anti-hypertensive medicine score in the BCM group (p<0.001) but not in the clinical method group (p=0.34). There were significantly fewer events of cramps in the BCM group as compared to the Clinical Method group (p=0.04). Conclusion: BCM guided volume management in MHD patients was more effective than volume management based on clinical judgment only in controlling blood pressure and decreasing anti-hypertensive medicine burden and intradialytic cramps. Keywords: Body composition monitor; hemodialysis; hypertensionPublication Ultrasonographic Assessment of Renal Parameters in Apparently Healthy Medical Students of A University Hospital(Institute of Medicine, 2023) Thapa, Sushma; Khanal, Ujjwal P; Paudel, Sharma; Sigdel, Mahesh RABSTRACT Introduction: Ultrasonography is a commonly used medical imaging technique to evaluate the kidneys and has become the preferred modality for the assessment of renal pathology. However, limited data are available on the normal renal parameters in Nepalese adults. The aim of this study was to establish normal reference ranges for renal size in healthy medical students using ultrasonography. Methods: A total of 100 healthy undergraduate medical students (64 males; 36 females) between the first and internship years (age 19-29 years) were studied. Ultrasonography was performed using a single and specific ultrasound machine with 1-7MHz transducer. Results: The study showed the left kidney was slightly longer than the right (10.46 ± 0.68cm vs 10.13 ± 0.65cm; p=0.04), but the right kidney had a significantly larger thickness (2.80 ± 0.76cm vs 2.99 ± 0.68cm; p=0.01) and volume. A strong positive correlation was found between the renal parameters of one side with another side (Length: r=0.63,p<0.001; Breadth: r=0.42, p<0.001; Thickness: r=0.51, p<001; Volume: r=0.57, p<0.001). There were significant differences in renal length and volume based on sex, height, weight, and body mass index while other parameters were not significant. Weight was found to affect renal length more than height. Conclusion: The left kidney was slightly longer than the right kidney. There was a strong positive correlation between the right and left kidney parameters. The study also found significant associations between renal length and height, weight, and body mass index. Keywords: Renal size; ultrasonography