Journal Issue: Volume: 44, No. 1 (2022)
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2022
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Transplant Renal Artery Stenosis in Living Donor Kidney Transplant Recipients: A Single Center Experience from Nepal
(Institute of Medicine, 2022) Dhakal, Niraj; Sigdel, Mahesh R; Chalise, Pawan R; Bhurtyal, Nishan; Shah, Dibya S
ABSTRACT
Introduction: Transplant renal artery stenosis (TRAS) is the most common preventable vascular complication in kidney transplantation with significant rates of graft loss and mortality. We aimed to study the demographics, prevalence, clinical presentation, and outcome of TRAS.
Methods: We retrospectively reviewed medical records of all living donor kidney transplant recipients at Tribhuvan University Teaching Hospital from August 2008 to May 2021. Cases diagnosed with TRAS by ultrasound Doppler and/or renal CT angiogram were included. Data on demographics, clinical presentation, management, and outcomes were collected and analyzed. Among patients who underwent revascularization, pre and post-procedure creatinine, blood pressure (BP), and antihypertensive medicine burden were compared.
Results: Among 620 living donor kidney transplantation, TRAS was present in 17 recipients (Male:Female = 16:1) (2.6%); mean age was 35.47±12.71 years. The median duration at diagnosis was one-month post-transplant (range: 5 days-9 months). The most common clinical features of TRAS were graft dysfunction and uncontrolled hypertension. Diagnosis of TRAS was confirmed with CT angiography in 13 patients. Ten patients underwent revascularization. Pre and post-revascularization mean serum creatinine was 356±210.49 μmol/L and 122.8±30.48 μmol/L (p=0.007) respectively, mean systolic BP was 200±12.47 mmHg and 133±13.38 mmHg (p=0.005) respectively and mean diastolic BP was 105±15.09 mmHg and 80±9.43 mmHg(p=0.005) respectively. Significant reduction in anti-hypertensive pill burden was achieved.
Conclusion: Prevalence of TRAS was 2.6%. Most cases presented early with hypertension and graft dysfunction. Revascularization of significant stenosis had a favorable outcome in terms of BP control, antihypertensive pill burden, and preservation of renal function.
Keywords: Renal allograft outcome, revascularization, TRAS
Central Macular Thickness in Uneventful Phacoemulsification Employing Optical Coherence Tomography
(Institute of Medicine, 2022) Ranabhat, Sudha; Byanju, Raghunandan; Pradhan, Sangita; Khadka, Simanta; Lamichhane, Benju
ABSTRACT
Introduction: Cataract is the most common cause of blindness affecting the global population which can be cured by phacoemulsification surgery. The study aimed to evaluate the central macular thickness following uneventful phacoemulsification surgery and analyze its relation to various factors.
Methods: This prospective study comprised of 63 subjects diagnosed as age-related cataract on the basis of lens opacities classification system III and undergoing uneventful phacoemulsification surgery with capsular bag intraocular lens implantation. The central macular thickness was evaluated using optical coherence tomography at preoperative period and postoperatively on 1st day, 1st week and 5th week. Effective phacoemulsification time was measured intraoperatively.
Results: The mean effective phacoemulsification time was 17.95±14.01 seconds. Best corrected visual acuity improved significantly postoperatively (p=0.03). Mean central macular thickness increased significantly on the 5th postoperative week compared to preoperative assessment (p=0.002). No significant association was detected between patient’s age and preoperative and postoperative central macular thickness. No correlations were observed between effective phacoemulsification time and central macular thickness. Significant association was not noted between central macular thickness and best corrected visual acuity on pre and postoperative examinations.
Conclusion: There was a decrease in central macular thickness on the 1st day and 1st week postoperatively followed by a significant increase on the 5th postoperative week compared to the preoperative period, which was independent of effective phacoemulsification time. Increase in central macular thickness in the postoperative period did not affect the quality of vision.
Keywords: Central macular thickness, effective phacoemulsification time, optical coherence tomography, phacoemulsification
Survival in Critical Care Patients with COVID-19 Pneumonia: A Single Center Based Observational Study
(Institute of Medicine, 2022) Bam, Niraj; Kuikel, Sandip; Sapkota, Dharmendra; Poudel, Sagar; Pant, Pankaj; Das, Santa K
ABSTRACT
Introduction: The severity of COVID-19 pneumonia ranges from asymptomatic to requiring mechanical support for survival. This observational study describes the demographic, management, vaccination status and outcome in Nepalese patients with COVID-19 who were admitted to critical care settings .
Methods: Single center based cross sectional study was conducted. All the patients admitted to critical care of Tribhuvan University Teaching Hospital (TUTH) were eligible subjects for this study. Demographic, clinical details and vaccination status of respective patients was obtained from interview and chart review. Data was collected in Microsoft Excel 2016 and statistical analysis was performed using statistical software SPSS 21.
Results: A total of 342 patients with mean age 53.95±15.6 years were included in the study. The mean duration of stay in critical care was 6.74±4.43 days. Fever and shortness of breath was the predominant symptom present in the studied patients with all patients having shortness of breath. Out of the 342 patients, 20.2% (n=69) were intubated at least once during their critical care stay, 57.89%(n=198) received only non-invasive ventilation and 21.9% (n=75) received oxygen via other means. The overall survival rate of patients admitted to critical care of TUTH was 60.53% with very low survival rate in intubated patients. Only 8.8% of the included patients had received at least one dose of vaccine.
Conclusion: Our study suggest that the prognosis of critical care COVID-19 patients is poor with highest mortality in patients receiving mechanical ventilation. Delay in intubation may contribute to this worse outcome in intubated COVID-19 patients.
Keywords: Corona virus, COVID-19, critical care, SARS, survival
Histopathological Spectrum of Renal Tumors in Adults in Nephrectomy Specimens in a Tertiary Care Center
(Institute of Medicine, 2022) Sharma, Nisha; Maharjan, Daisy
ABSTRACT
Introduction: Renal neoplasms are heterogeneous tumors with clinical picture, prognosis and therapeutic implications differing with the various histological subtypes. There are limited studies on adult renal tumors conducted in Nepal so far. This study aims to provide a better assessment on the histopathological spectrum of renal neoplasms in adult population.
Methods: This is a descriptive study of all the nephrectomy specimens of adults received at Department of Pathology, Tribhuvan University Teaching Hospital from January 2013 to January 2020.
Results: There were 75 males and 35 females with mean age being 51.8 years. Malignant tumors (99 cases, 90%) were more common than benign tumors (11 cases, 10%). Renal cell carcinoma (RCC) was the most common malignant tumor consisting of 91 cases (82.72%) followed by 6 cases of urothelial carcinoma (5.45%) and 2 cases of primitive neuroectodermal tumor. (PNET) (1.8%). Clear cell RCC (78 cases, 70.90%) was the commonest histological subtype of RCC followed by papillary RCC (8 cases, 7.2%) and chromophobe RCC (2 cases, 1.8%). 42.65% of the cases of clear cell RCC were of WHO/ISUP grade 2, whereas, most of the cases of papillary RCC were of low grade (Grade 1, 37.5%). Majority of Renal cell carcinomas were in stage pT1a (28 cases, 34.56%).
Conclusion: Clear cell RCC was the most common renal tumor in adults comprising the majority of cases. These tumors mostly demonstrated WHO/ISUP Nuclear grade 2 and early stage of presentation (pT1). Papillary RCC was the second commonest RCC and mostly presented at lower nuclear grade (WHO/ISUP Nuclear grade 1). Urothelial carcinomas demonstrated higher nuclear grade and stage compared with RCC.
Keywords: Grade, histologic subtypes, renal neoplasms, staging
Cardiorespiratory Fitness and its Relationship with Adiposity Indices
(Institute of Medicine, 2022) Ghimire, Dayaram; Aryal, Vibina; Majumder, Anirban; Manna, Sourav
ABSTRACT
Introduction: The cardiorespiratory fitness (CRF) and obesity greatly influence the cardiovascular health. Decrease in maximal oxygen consumption (VO2max) and increase in fat mass can be used as an early marker for cardiovascular disease risk. The objective of this study was to assess the CRF and observe the relationship between CRF and adiposity indices.
Methods: A cross sectional observational study was performed in 174 students (87 males and females each) of National Medical College. The subjects were assessed for different adiposity indices; BMI, body adiposity index (BAI), total body fat percentage (BF %) and waist circumference (WC). VO2max was calculated from recovery pulse rate after Queen's College Step Test. VO2max was correlated separately with each parameter of body composition using Pearson’s correlation test.
Results: The VO2max of male and female participants were 47.22 ± 9.09 and 35.67 ± 5.36 ml/kg/min respectively. The correlation of VO2max was significant with all the studied adiposity indices. WC (r= - 0.41, p< 0.001) and BF% (r= -0.38, p< 0.001) correlation with CRF was highly significant in male whereas in female correlation was highly significant with BMI (r= 0.49, p< 0.001), WC (r= -0.40, p< 0.001) and BF% (r= -0.56, p<0.001). VO2max correlated best with waist circumference in male (r= - 0.41, p< 0.001) and BF% in female (r= -0.56, p<0.001).
Conclusion: This study concludes that there is an adverse relationship between CRF and adiposity indices and females have low level of cardiorespiratory fitness.
Keywords: Body adiposity indices, cardiorespiratory fitness, Queen's college step test, total body fat percentage