Background: End stage renal disease patients are treated with dialysis in Nepal. But there is no renal registry to indicate the burden of disease in the country. Objectives: The objective of this study is to find out the incidence of ESRD on renal replacement therapy and their out come. Materials and methods: It is a retrospective analysis (audit) of all ESRD patients who had received dialysis inside Nepal and had under gone transplantation from 1990 to 1999. The haemodialysis (HD) registry, HD patients file, intermittent peritoneal dialysis (IPD) registry of Bir Hospital, Shree Birendra Hospital, Tribhuwan University Teaching hospital and National Kidney Center were reviewed. Acute renal failure and acute on chronic renal failure were excluded and the demographic profile, dialysis session, dialysis duration and outcome of all ESRD patients were computed. One patient was counted only once in spite of attending more than one center for dialysis. SPSS package was used for analysis. Results: Total number of 1393 ESRD patients received renal replacement therapy (RRT) in the decade. Mean age of patients were 46.7 ± 16.7 with 70% of ESRD were between 20-60 years age with male: female ratio of 1.8:1. Initial mode of RRT was IPD in 58.2%, HD in 41.7% and pre-emptive transplantation in 0.1% patients. Records of 189 patients could not be found and out of remaining 1208 patients, 85.8% received dialysis for < 3 months, 6% received dialysis for more than a year and 9.5% had undergone kidney transplantation. The incidence of ESRD had increased gradually with 3.4 per million populations (pmp) in 1990 to 11.89 pmp in 1999 with an average annual incidence of 6 pmp and only 0.31% of expected ESRD patients received RRT. Conclusion: The incidence of ESRD is increasing but majority discontinue or die within 3 months. Dialysis centers needs to be expanded to different parts of country and prospective studies have to be carried out to find out of cause of ESRD and to institute preventive measures.Key words: End stage renal disease; Renal replacement therapy; Haemodialysis; Intermittent peritoneal dialysis; Incidence of end stage renal disease; Nepal. DOI: 10.3126/kumj.v7i3.2742 Kathmandu University Medical Journal (2009) Vol.7, No.3 Issue 27, 302-305

An Approach to Aplastic Anemia

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.

Management of Septicaemia

Introduction  Stroke is the sudden death of brain cells that occurs due to lack of oxygen, caused by blockage of blood flow or rupture of an artery to the brain leading to permanent disability or death. Diabetes mellitus has been established as a major risk factor for stroke. However, this study was conducted to incorporate glycemic status and its correlation with severity of stroke. Materials and Methods A cross-sectional observational study was conducted in the Department of Internal medicine, Neurosurgery, Emergency and Endocrinology of Bir Hospital. Ethical clearance was granted by Institutional Review board of National academy of medical sciences. A total of 50 patients with stroke presented within 72 hours of symptoms of stroke was included in the study. Data was collected and stored in MS-EXCEL sheet and analyzed using SPSS. Results Among 50 patients with stroke enrolled for the purpose of this study, 54% had ischemic and 46% hemorrhagic stroke. Patient pool was predominantly 51-60 years of age. Majority of the patients were euglycemic, of these 56.67% suffered hemorrhagic stroke, while known diabetics predominantly suffered ischemic stroke. Euglycemic patients had CT lesion measuring 5-10mm compared to larger lesions of  >10mm in known diabetics. Euglycemic patients had better outcome in contrast to newly diagnosed and known diabetics. Conclusion The study found that patients with higher glucose levels had increased severity of stroke. Increased morbidity was documented among known diabetics and newly diagnosed cases of DM in comparison to euglycemics and patients with stress hyperglycemia.