Study of risk factors in progression of chronic kidney disease (CKD)

Chronic kidney disease is a growing epidemic, with at least 10 million people with kidney damage. Diabetic kidney disease is the most common cause of  ESRD worldwide. The rate of decline of GFR is variable, especially in diabetics, ranging from 2 to 20 ml/min/1.73 m2/yr. The reasons for these differences in the rate of disease progression are multifactorial, including both non-modifiable and modifiable factors. Aim is to retard progression of disease as cost of therapy is high.  The study was planned to identify progression factors

Single stage: dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures using perineal route

ABSTRACT Objective To assess the outcome of single stage dorsolateral onlay buccal mucosal urethroplasty for long anterior urethral strictures (>4cm long) using a perineal incision. Materials and Methods From August 2010 to August 2013, 20 patients underwent BMG urethroplasty. The cause of stricture was Lichen sclerosis in 12 cases (60%), Instrumentation in 5 cases (25%), and unknown in 3 cases (15%). Strictures were approached through a perineal skin incision and penis was invaginated into it to access the entire urethra. All the grafts were placed dorsolaterally, preserving the bulbospongiosus muscle, central tendon of perineum and one-sided attachement of corpus spongiosum. Procedure was considered to be failure if the patient required instrumentation postoperatively. Results Mean stricture length was 8.5cm (range 4 to 12cm). Mean follow-up was 22.7 months (range 12 to 36 months). Overall success rate was 85%. There were 3 failures (meatal stenosis in 1, proximal stricture in 1 and whole length recurrent stricture in 1). Other complications included wound infection, urethrocutaneous fistula, brownish discharge per urethra and scrotal oedema. Conclusion Dorsolateral buccal mucosal urethroplasty for long anterior urethral strictures using a single perineal incision is simple, safe and easily reproducible by urologists with a good outcome

Vascular Factors Affecting Outcomes of Snuffbox AV Fistula with Side-to-Side Anastomosis: A Single Institutional Observational Study

Background: Angioaccess is considered the "Tendon of Achilles" for hemodialysis. Arteriovenous fistula (AVF) is the commonly entailed vascular access for hemodialysis. Objectives: The present study evaluates the outcomes of anatomical snuffbox AVF by preoperative and postoperative color Doppler scans. It also determines the anatomical snuffbox AVF maturation rate concerning preoperative radial artery diameter (RAD), cephalic vein diameter (CVD), cephalic vein distensibility, and peak systolic velocity (PSV). Methods: This study was conducted from April 2020 to January 2021 on end-stage renal diseases (ESRD) patients undergoing an operation for anatomical snuffbox AVF creation at our center after taking permission from the institutional ethics committee and written informed consent from patients. Results: Thirty-five ESRD patients underwent snuffbox arteriovenous fistula (SBAVF) creation, including 68% males and 32% females. Diabetes mellitus was noted in 40% and hypertension in 80%. Successful AVF maturation was noted in 92% (69.57% of males and 30.43% of females). The mean RAD assessed on color Doppler ultrasonography (CDUS) preoperatively was 1.79 mm, while the peak velocity of the radial artery at the snuffbox was 23.80 cm/s. Conclusions: We recommend applying the side-to-side configuration as its anastomosis angle is less owing to the lesser kink on the anastomotic site. A longer segment of anastomosis is achieved, and better fluid dynamics and WSS profiles are seen in this configuration with good outcomes.</jats:p

Extensive emphysematous pyelonephritis in association with hepatic portal venous gas and emphysematous gastritis: A rare case

Although emphysematous pyelonephritis is recognized from more than hundred years, the etiology is still controversial. Glucose fermentation is the proposed possible mechanism for gas fermentation. The extension of emphysematous pyelonephritis into portal vein and stomach is a rare condition. We present a 52-year-old woman with uncontrolled diabetes who was admitted with sepsis and left flank pain. She was investigated, and results revealed gas in the left renal system with extension into portal vein and stomach. She was resuscitated and managed with percutaneous drainage, DJ stenting, and broad spectrum antibiotics, she did not improve and hence nephrectomy was done. Prompt diagnosis, early and aggressive treatment is crucial because of high mortality

Bilateral Symmetrical Soft-tissue Sarcoma at the Thigh in a Renal Transplant Patient

Cancer is now the third leading cause of death among kidney transplant recipients and is projected to surpass cardiovascular disease within the next two decades. Soft-tissue sarcomas (STS) are rare, accounting for <1% of all adult malignancies. Bilateral synchronous STS of the extremities is exceptionally uncommon. This report highlights the critical need for a high index of suspicion for malignancies in renal transplant recipients and outlines the diagnostic and management challenges posed by STS in this vulnerable population. We describe the case of a 37-year-old male renal transplant recipient who developed bilateral symmetrical pleomorphic sarcomas in the thighs 3 years posttransplant and unfortunately succumbed to complications within 15 days of diagnosis. To the best of our knowledge, this is the first documented case of bilateral synchronous undifferentiated pleomorphic sarcoma in a renal transplant patient. The brief interval between transplantation and malignancy underscores the aggressive nature of this disease and reinforces the necessity for timely recognition and intervention

Staged buccal mucosa urethroplasty in reoperative hypospadias

Introduction : Repeated attempts at surgical repair of serious complications involving either the partial or complete breakdown of the hypospadias repair are less likely to succeed because the penis is densely scarred, or significantly shortened, and the skin over the penis is immobile and hypovascular. Buccal mucosa (BM) has become the preferred material for reconstruction, whenever a child with skin-deficient hypospadias needs reoperation. We report the results of our surgical experience with staged reoperation using BM, in the repair of hypospadias in children with complications after multiple failed repairs. Materials and Methods : Children needing reoperation for hypospadias underwent a staged repair using buccal mucosa. The complications were noted. Results : Twenty-one children aged 3 - 16 years underwent this staged repair during the period May 2000 - April 2010. Two of these 21 children had a failed first stage. One child developed a urethro-cutaneous fistula following the second stage, which was corrected in an additional stage. Conclusions : The use of the buccal mucosa graft for urethral reconstruction in a child with hypospadias, needing a reoperation, is a successful method, with a low incidence of complications

Clinical profile and complication of malaria hepatopathy

SummaryBackgroundThis study was designed to study the patient characteristics, presenting features and complications of malaria in patients with elevated liver enzymes and to compare these data to those of patients with normal liver enzymes.MethodsA convenient sample of 100 patients with malaria was selected from three tertiary care referral hospitals. Study subjects were divided into two groups: (1) patients (controls) with normal liver enzymes and (2) patients (cases) with >3 times the normal liver enzymes in the absence of an alternate explanation for such elevation. Patient characteristics, presenting features and complications of malaria in these two groups were studied. Data were collected using a semi-structured pretested proforma and were analyzed using the statistical analysis program SPSS, version 11.5 (SPSS, Inc., Chicago, IL).ResultsThe mean ages were 38.12 years for the cases and 35.20 years for the controls with a non-significant p value of 0.289. Males composed 82% of the cases that were diagnosed with malarial hepatopathy; the remaining 18% were females. Falciparum malaria was present in 56% of the cases, compared to 12% of the controls. Icterus was present in 66% of cases of malarial hepatopathy, compared to 32% of the controls. Of the 66% of these cases, 18.18% had serum bilirubin >3mg%, whereas out of the 32% of the controls presenting with icterus, only 5.55% had serum bilirubin >3mg% (p=0.003). Of the cases with malarial hepatopathy, 38% suffered from hypoglycemia, compared to 0% of the controls (p<0.001); 84% of the cases presented with thrombocytopenia, compared to 70% of the controls (p<0.001); 12% of the cases suffered from renal failure with serum creatinine levels >2mg%, compared to 2% of the controls (p=0.060).ConclusionPlasmodium falciparum infection (either alone or along with P. vivax) is the leading cause of malarial hepatopathy. Jaundice is a common clinical manifestation among these patients. Patients with malarial hepatopathy have increased incidences of hypoglycemia and thrombocytopenia. Malarial hepatopathy occurs in relation to severe infection, most of which are treated with parenteral artesunate