Vasodilatory edema is a frequently encountered side effect among hypertensive patients using antihypertensive drugs. Amlodipine and nifedipine are common drugs associated with vasodilatory edema. When used as monotherapy, calcium channel blockers (CCBs) are associated with a substantial risk of peripheral edema, including pedal edema, which is the most common reason for its discontinuation. 1 This is a dose-dependent adverse effect, so low-dose combination therapy is a preferred choice over high-dose monotherapy. It is less common with newer generation CCBs. 2 Reported rates of peripheral edema are dosedependent, ranging from 5% to 70% with a high dose. 3 Only 5% of pedal edema was seen with a 5 mg dose, 25% with a 10 mg dose, whereas >75% was seen with 20 mg of daily dose. 4 Ankle edema is developed mostly in women, elderly patients, those with heart failure, upright position, and those in humid environments. 5 CCB-related edema is caused by preferential arteriolar or precapillary dilation without commensurate dilation in the venous or postcapillary circulation. 3,6 The addition of an angiotensin 809005P MTXXX10.

Introduction: Globally, anemia is the burning health problem with significant disability associated with it. Iron deficiency anemia (IDA) is the commonest cause of anemia more so in developing and underdeveloped part of world. Normocytic anemia is the common finding following microcytic hypochromic and macrocytic in peripheral blood film study. To understand more about the type of anemia among anemic patients in our setting this study was carried out. Objectives: This study aims to see the prevalence and aetiology of anemia among Nepal army personnel and their families in a Kathmandu based tertiary level hospital. Methods: This cross-sectional study was conducted over a six months period through June 30th to December 31st 2017 among 342 anemic patients presented to hematology clinic of Shree Birendra Hospital in Kathmandu with the help of data collection tool. Etiology of anemia was worked out. The study was conducted after approval from local IRC. Collected data were entered in SPSS version 22 and analyzed. Result: Mean hemoglobin value was 8.45±1.61 gm/dL and the mean age of the patient was 52.04±18.32 years. Among the patients of anemia, generalized weakness was the commonest (159, 46.5%) presenting complaint followed by per vaginal bleeding and upper gastrointestinal bleeding. Moderately severe anemia was the commonest (159, 46.5%) laboratory finding. In peripheral blood film study, microcytic hypochromic picture was the commonest finding (169, 49.4%) favoring commonest cause of anemia as iron deficiency followed by anemia of chronic disease.70 % of the participants were female. Conclusion: The study identified nonspecific complaints like generalized weakness as the predominant presenting complaints of anemia which is commonly neglected. Further, noninvasive tests like peripheral blood film are an important diagnostic tool which can guide us to the possible aetiology of anemia. This study showed iron deficiency anemia and anemia of chronic disease as important differential diagnosis of anemia in our context. This was a small scale study conducted to access the prevalence of anemia among Nepal army personnel and their families. Hence a larger multicentric study is needed to make it more applicable.

ObjectiveTo estimate the prevalence of chronic kidney disease (CKD) among patients with type 2 diabetes mellitus (T2DM) and determine the sociodemographic and clinical risk factors associated with CKD.Design and settingsCross-sectional study among diabetic outpatients of a tertiary hospital in Nepal.Participants201 patients with T2DM above 18 years of age.InterventionParticipants completed a questionnaire regarding their socioeconomic information and underwent pertinent physical and haematological examinations.Primary and secondary outcomes measureThe prevalence and risk factors of CKD among patients with T2DM.ResultsThe prevalence of CKD in T2DM was 86.6%. In univariable analysis, the variables like age (p=0.026), hypertension status (p=0.002), duration of diabetes (p=0.009) and haemoglobin levels (p=0.027) were significantly associated with CKD among the participants with T2DM. Kruskal-Wallis H test showed that age was significantly different between various CKD stages. Multivariate analysis demonstrated a significant relationship between CKD with age (Adjusted odds ratio (AOR) 3, 95% CI 1.1 to 8.8) and literacy status (AOR 5.8, 95% CI 1.4 to 24.6)ConclusionAdvancing age, concomitant hypertension, increasing duration of T2DM and presence of anaemia were found to be important risk factors of CKD. Age is the most important predictor of CKD showing increasing prevalence in the elderly population. Periodic screening tests are essential at an early age to identify kidney diseases at incipient stages, thereby preventing progression to end-stage renal disease.