Sandip T. Chaudhari ¹, Ashwin V. Sadavarte ¹, Deodatta Chafekar ¹

Affiliations
1 Department of General Medicine, Dr. Vasantrao Pawar Medical College and Research Centre, Nashik - 422207, Maharashtra, IN

Abstract

Context: Chronic kidney disease is an increasing health problem worldwide and in its final stage (stage V) can only be treated by renal replacement therapy, mostly hemodialysis. Hemodialysis has a major influence on the everyday life of patients and many patients report dissatisfaction with treatment. Objectives: To study the clinical profile of patients with ESRD undergoing hemodialysis and to find out possible etiology which may have led to ESRD in these patients? Settings and Design: This is a prospective, observational study carried out in a tertiary care hospital. Methods and Material: 50 patients, older than 15 years who were on maintenance hemodialysis in this hospital on outpatient basis for more than 3 months were selected for the study. Detailed clinical history, general and systemic examination of all patients was performed. Two manifestations pertaining to each system was taken for study. Statistical Analysis Used: Descriptive as well as inferential statistics were used to analyze the data. Results: Most patients were in the age group of 51-60 with male: female ratio of 1.77:1. Diabetes and hypertension were most common causes for ESRD. Anemia and electrolyte disturbances like hyperkalemia along with hypocalcemia, hyperphosphatemia and hyperuricemia have common associations with ESRD. Conclusions: Lack of health awareness and lack of regular health checkup in general population is one of the culprit factor for progression of renal disease. Health awareness in general population may decrease the incidence of ESRD or postpone the development of ESRD.

Keywords

Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD).

Full Text

   

Umang Patil ¹, Jitendra Kodilkar ¹, Neelima Chafekar ¹, Deodatta Chafekar ¹, Gauri Anand Diwan ²

Affiliations
1 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra, IN
2 Department of Anaesthesia, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik – 422003, Maharashtra, IN

Abstract

Aim: To study clinical profile, laboratory features and importance of rehydration in patients admitted with acute kidney injury due to gastroenteritis. Materials and Methods: The study was carried out as a prospective observational study of 70 patients at medicine department of a medical college and tertiary health care center, over a period of two years that included cases of acute kidney injury due to gastroenteritis in the age group of 18-40 years. Results: Study showed male predominance (72.86%) in elderly age group. Prerenal type was more common (75.71%) as compared to acute tubular necrosis. Duration and frequency of diarrhea was associated with severity of the disease. Mortality was high (100%) in those who required more time (>12 hours) to achieve normal mean arterial pressure. Maximum deaths (93.33%) were observed in anuric patients. Most common complication observed was septicemia in 20% of patients. Overall mortality observed in our study was 21.43%, while 78.57% patients survived. Mortality was high in those having severe dehydration, high baseline creatinine, who received dialysis. Conclusion: Acute kidney injury due to gastroenteritis is preventable if presented early and adequate hydration can decrease mortality.

Keywords

Acute Kidney Injuries, Acute Tubular Necrosis Gastroenteritis, Mean Arterial Pressure.

Full Text

   

Mohammad Sultan ¹, Vipul Gattani ², Deodatta Chafekar ³, Neelima Chafekar ³

Affiliations
1 PG Resident, Department of Medicine, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra, IN
2 Assistant Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra, IN
3 Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College, Nashik – 422003, Maharashtra, IN

Abstract

Background: Atypical Haemolytic Uremic Syndrome (aHUS) is a genetic or acquired disorder of regulatory component of the complement system. It is associated with mutations in genes coding for complement components. The abnormality in components of complement makes it susceptible and predispose to chronic uncontrolled hyperactivation of the alternative complement pathway, which results in endothelial damage and microvascular thrombosis. This case report describes a patient diagnosed with Thrombotic Microangiopathy (TMA) due to factor H autoantibody having haemolytic anemia, thrombocytopenia and acute kidney injury. Patient’s anemia and renal parameters improved after treatment with plasma exchange therapy. Conclusion: Atypical HUS must be strongly suspected in any patient who presents with nonspecific abdominal or respiratory symptoms along with anemia and thrombocytopenia. As extrarenal involvement is a rare entity of aHUS, the clinician should also keep a high index of suspicion to the possibility of thrombotic microangiopathy manifestation in almost any organ system. In a suspected or diagnosed case of aHUS, the development of new non renal symptoms and signs should prompt clinician for further evaluation to rule out ongoing thrombotic microangiopathy process.

Keywords

Acute Kidney Injury, aHUS, Complement, Dialysis, Plasma Exchange, Thrombotic-Microangiopathy (TMA)

Full Text

   

Vivek Chaurasia ¹, Deodatta Chafekar ², Neelima Chafekar ³

Affiliations
1 Former PG Resident, Department of Medicine, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nashik – 422003, Maharashtra, IN
2 Associate Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nashik – 422003, Maharashtra, IN
3 Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nashik – 422003, Maharashtra, IN

Abstract

Introduction: Upper endoscopy, also referred to as Esophagogastroduodenoscopy (EGD), is performed by passing a ­flexible endoscope through the mouth into the esophagus, stomach, and duodenum. The gut is accessible with endoscopy, which can diagnose causes of pain, nausea and vomiting, bleeding, weight loss, altered bowel function, and fever1 . Aims and Objectives: To study indications and findings of patients undergoing upper gastrointestinal (GI) endoscopy, to make association of endoscopic findings in these patients presenting with different upper GI symptoms and to document the demographics of subjects undergoing upper GI endoscopy at a tertiary care centre. Materials and Methods: It was a prospective observational study carried out at the Department of Medicine at Dr Vasantrao Pawar Medical College and Hospital, with due permission from the ethics committee for the period of August 2017 to November 2019. All the patients who were found with upper GI symptoms and underwent endoscopy after giving informed consent were included in the study. Total of 136 patients presenting with upper GI symptoms fulfilling the criteria were included in the study and their endoscopic findings were associated. Results: Out of total 136 patients, maximum number of the patients belonged to 51-60 years age group (21.3%). There was male preponderance (61.8% were male 38.2% were female). The most common GI symptom was hemetemesis/malena (40.4%) followed by nausea/vomiting (27.9%). Esophagitis (37%) was the most common endoscopic finding followed by esophageal varices (33%). Out of 45 patients who had esophageal varices 32 (71%) were treated with Endoscopic Variceal Ligation (EVL) and they responded well. Conclusion: Through this study it was concluded that most of the patients presenting with upper GI symptoms were among the elderly age group (51-60 years). Upper GI bleed was the most common symptom and indication for endoscopy followed by nausea/vomiting. The common endoscopic finding among hematemesis/malena patient was esophageal varices and most of them responded well to Endoscopic Variceal Ligation.

Keywords

Endoscopic Variceal Ligation, Gastrointestinal Endoscopy, Hematemesis, Malena, Upper Gastrointestinal Symptoms

Full Text

   

Satish Kamthe ¹, Deodatta Chafekar ², Neelima Chafekar ³

Affiliations
1 Former PG Resident, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422203, Maharashtra, India ., IN
2 Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, India ., IN
3 Professor, Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422203, Maharashtra, India ., IN

Abstract

Background: To study the comparative outcome between resolved an unresolved ST segment in ST Segment Elevation Acute Myocardial Infarction (STEMI), after thrombolytic therapy. Method: A study was carried out on patients admitted with 1st episode of ST elevated myocardial infarction in MICU of a tertiary health care center of a teaching hospital. On admission detailed history was taken and a complete clinical examination was done. Thrombolysis was done using streptokinase, 2D ECHOs were performed before and after thrombolytic therapy. Result: Most of the study population in both the group (Unresolved STEMI and Successful thrombolysis), belonged to the age group of 41 to 50 years. Co-morbidities like hypertension were present in 83% of Unresolved STEMI and 53% of Resolved STEMI. Comorbidities like diabetes were present in 66.7% of Unresolved STEMI and 52.6% of Resolved STEMI. RWMA on 2D-Echo before thrombolysis was present in 58.3% of Unresolved STEMI and 47.4% of Resolved STEMI. RWMA on 2D-Echo after thrombolysis was present in 66.7% of Unresolved STEMI and 18.5% of Resolved STEMI. Conclusion: Symptom to needle time is an important predictor of whether thrombolysis will be successful or not in acute myocardial infarction patients. Hence it is important to educate the public about prompt recognition of symptoms and seeking medical help urgently. As the rate of unsuccessful thrombolysis is higher in patients with old age, diabetes, hypertension and dyslipidemia, such patients should be monitored and treated aggressively.

Keywords

Diabetes, Hypertension, RWMA - Regional Wall Motion Abnormalities, STEMI - ST Segment Elevation Myocardial Infarction, Thrombolysis

Full Text