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Aim: To compare the complications, clinical outcomes and cost effectiveness of Bedside Peritoneal dialysis catheter implantation versus Operation Theatre Implantation. Materials and Methods: Over 24-months period we compared 31 patients(male20, Female 11) on CAPD therapy, 18 were percutaneously placed by nephrology staff (Group P) and 13 were placed using conventional surgical techniques by surgical staff (Group S). In both groups swan neck Tenckhoff catheter was used. Patient was examined for feasibility of bed-side implantation on an OP basis and after counseling and consent the procedure is carried out under sterile technique in a clean room of our dialysis unit. Patient kept nil oral or light breakfast. Soap and water enema was given to patient prior to the procedure. Two hours before and 24 hours after implantation, Inj.Cefazolin 1 gm was given intravenously. Inj. Pentazocine lactate (30mg) and Inj. Promethazine Hcl (50mg) were given intramuscularly one hour before the procedure. Locally Inj. Xylocaine 2% was given subcutaneously 3cms below the umbilicus along the midline and further procedure for bed-side implantation technique was followed and procedure remained uneventful. PD Catheter was immobilized by adhesive plaster at the incision site. Prospective randomized studies have shown that PD catheters placed by nephrologists have lesser complications. In our patients there were no perforations, exit site infection, tunnel infection, pericatheter leak or peritonitis. This approach often introduces rapid initiation of PD, reduces the cost in utilizing an operating room as well as anesthesia services and reduces the morbidity and mortality risk associated with general anesthesia. Results: Total numbers of patients were 31, with 18 patients in Bedside PD catheter implanted group (Group P) and 13 in surgical PDC implanted group (Group S). Post procedure complications in Group P include 2 bleeding effluent and 1 catheter malposition versus 3 bleeding effluent, 2 pericatheter leak, 2 post operative peritonitis, 2 subcutaneous leak and 2 incision hernia in the Group S. Wound healing is better in Group P when compared to Group S. Total hospital stay in the Group P was 3±2 days when compared to 18±2 days in the Group S. Doctors charges for Group P was Rs. 7,500±2,000 when compared to Rs. 12,500±2,000 in the Group S. Bed charges for Group P was Rs. 1,000±500 when compared to Rs. 11,000±4,000. Conclusion: This approach allows rapid initiation of PD, minimizes patient discomfort, reduces hospital stay, surgery cost, bed charges, and operating room as well as anesthesia service charges and helps to reduce the morbidity and mortality associated with general anesthesia. In a resource scarce setting, bed-side implantation is a cheaper option and should be practiced in developing countries. [ABSTRACT FROM AUTHOR]

Aim: To study spectrum of Renal Disease among patients from Tribal areas of Chhattisgarh presenting to Medical College Hospital, Raipur. Materials and Methods: In this study, 1015 patients from tribal areas of Chhattisgarh who were admitted in Nephrology Unit, Department of Medicine, Pt.J.N.M. Medical College and B.R.A.M. Hospital, Raipur (C.G.) were studied. All patients were subjected to clinical examination, Complete Blood Count, renal function tests, Serum electrolytes and other relevant investigations. Results: 1015 patients were studied. Spectrum of Renal disease included Acute Renal Failure (17%), Chronic Kidney Disease (71%), Nephrotic Syndrome (10.3%), Sickle cell disease (0.9%), HIV (0.8%). Spectrum of renal disorders among Acute Renal Failure included Malaria (37%), AGE (39%), Septicemia (11%), Hypotensin (8%), Obstetrics/Gynaecology related ARF (5%). Spectrum of Chronic Kidney Disease included Chronic Glomerulonephritis (41.3%), Diabetic Kidney Disease (29%), Hypertensive Nephropathy (28.2%), Adult Polycystic Kidney Disease (1.3%), and HIV (0.2%). Conclusion: Chronic Kidney Disease was the most common presentation accounting for 71% of all patients followed by Acute Renal Failure (17%). Among Chronic Kidney Disease patients, the most common presentation was Chronic Glomerulonephritis (41.3%), followed by Diabetic Kidney Disease (29.0%) and Hypertensive nephropathy (28.2%). Among Acute Renal Failure, Acute Gastroenteritis (39%) accounted for most of the patients followed by malaria (37%). [ABSTRACT FROM AUTHOR]

Aim: To study the status of inflammatory markers among patients of Diabetic Kidney Disease from Tribal areas of Chhattisgarh presenting to Medical College Hospital, Raipur. Materials and Methods: 66 patients with Diabetic Kidney Disease admitted in Nephrology Unit, Department of Medicine, Pt.J.N.M. Medical College and B.R.A.M. Hospital, Raipur (C.G.) were studied. All patients were subjected to Renal Function Tests, serum electrolytes, complete blood count, C Reactive Protein, Serum Albumin, Serum Cholesterol and all other relevant routine investigations. Results: 66 patients of Diabetic Kidney Disease were studied of which 58%were males and 42% females. The mean age of the patients was 51±11.53 years. The mean value of Hemoglobin was 9.56±2.45 gm/dl. 66% patients had Hemoglobin less than 10 gm/dl while 34% had Hemoglobin more than 10 gm/dl. 58.33% patients had serum cholesterol more than 200 mg/dl while 41.67% had serum cholesterol less than 200 mg/dl. 74.6% patients were found to be C Reactive Protein (CRP) positive while 25.4% patients were CRP negative. 83.33% patients had serum Albumin less than 3.5 gm/dl ,while 16.67% patients had serum albumin more than 3.5 gm/dl. Conclusion: Majority of patients with Diabetic Kidney Disease were males. Diabetic Kidney Disease is more common in age more than 50 years. 66% patients were found to be anemic having hemoglobin less than 10 gm/dl. A high rate of CRP positivity (74.6%) is found in Diabetic Kidney Disease patients. Most of the Diabetic Kidney Disease patients are malnourished. 83.33% patients with Diabetic Kidney Disease had serum albumin less than 3.5 gm/dl. 58.33% patients with Diabetic Kidney Disease had hypercholesterolemia. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence of complications (Retinopathy, Nephropathy, Neuropathy, Dermatopathy) in 50 patients with Type II Diabetes Mellitus. Materials and Methods: 50 patients with Type II Diabetes Mellitus hospitalized in Department of Medicine, Pt.J.N.M. Medical College and B.R.A.M. Hospital, Raipur were studied and were subjected to complete hematological examination, Renal Function Tests, Electrolytes, Urinalysis, Neurological and Fundus Examination. Results: 70% patients were males and 30% patients were females. The prevalence of any of the complications of Diabetes was 77% in males and 66% in females. 30% patients were less than 50 years of age and 70% patients were more than 50 years of age. Among patients less than 50 years age, 73% had one of the complications and among more than 50 years age, 91% had one of the complications. 62% of patients had duration of diabetes less than 15 years and 90% of them had one of the complications. 38% of patients had duration of diabetes more than 15 years and 94% of them had one of the complications. 36% of patients were non proteinuric and 64% were proteinuric (>200 mg per 24 hours). 70%patients had Retinopathy, of which 86% were proteinuric and 14% non proteinuric. 14% patients had neuropathy, of which 71% were proteinuric and 29% non proteinuric. 16% patients had dermatopathy, of which 75% were proteinuric and 25% non proteinuric. 32% patients had hypertension, of which 75% were proteinuric and 25% non proteinuric. 4% patients had amputation and all of them were proteinuric. 64% patients had diabetic kidney disease. Conclusion: The complications of Diabetes Mellitus (Type II) are more common in males as compared to females. The prevalence of complications of Diabetes is higher in patients more than 50 years of age. 94% of patients with duration of Diabetes more than 15 years had one of the complications. Proteinuria is more commonly associated with Diabetic patients having retinopathy as compared to those having neuropathy or dermatopathy. The most common complications is retinopathy followed by nephropathy. The prevalence of diabetic kidney disease in Diabetes Mellitus (Type II) was found to be 64%. Prevalence of other complications of Diabetes is more common in proteinuric patients. 1. The degree of MA at the end of the first day may delineate the critically ill patients with sepsis, where prompt and targeted therapy is of utmost importance. 2. Serial measurements of MA, a simple and inexpensive test, is of help in stratifying patients according to severity of illness (assessed by the APACHE IV scoring system), in the ICU. 3. Trend of MA may help to predict mortality in critically ill patients. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the prevalence of dyslipidemia in chronic kidney disease patients (not on dialysis) from Tribal areas of Chhattisgarh. Materials and Methods: All Chronic Kidney Disease patients from tribal areas of Chhattisgarh admitted in Nephrology Unit, Department of Medicine, Pt.J.N.M.Medical College and B.R.A.M.Hospital Raipur (C.G.) during the year 2007 were studied. All patients were subjected to Fasting Lipid Profile analysis. Patients already on lipid lowering therapy or with thyroid or liver diseases were excluded from the study. Results: 61 patients were studied of which 57% were males and 43% females. Serum Total Cholesterol (>200 mg/dl) was found in 56.6% while 43.4% had S.Cholesterol (<200 mg/dl). (P value 0.05) 14.82%patients had HDL level <35 mg/dl, while 85.18% had HDL >35 mg/dl. Serum Triglyceride level >150 mg/dl was found in 54.25% patients (P=0.02). LDL level > 100 mg/dl was found in 61.39% (P=0.05). In diabetic patients, the mean total cholesterol level was 184.29 and mean LDL 105.2 mg/dl. In non diabetics, the mean total cholesterol level was 105.2 and mean LDL 97.10 mg/dl. (P= 0.05) The mean cholesterol level was 192.39 mg/dl in patients with glomerular disease and 164.13 mg/dl in patients with non glomerular disease (P=0.02). The LDL level was 107.0 mg/dl in patients with glomerular disease and 96.82 mg/dl in patients with non glomerular disease (P=0.05). Conclusion: Increased LDL level was the most common lipid abnormality encountered in the study (61%). Increased Triglycerides level was found in 54.25% patients and the p value (0.02) was found to be statistically significant. Increased Total Cholesterol level was found in 56.6% patients. Decreased HDL was found in 14.82%. Mean cholesterol and LDL levels were significantly different in diabetics and non diabetics (184.29 vs 169.32 mg/dl) and (105.2 vs 97.10 mg/dl) Mean cholesterol and LDL levels were higher among patients with glomerular disease versus non glomerular disease and the p value (0.02) was found to be statistically significant. [ABSTRACT FROM AUTHOR]

Aim: To study the prevalence and impact of metabolic syndrome on Hospital outcomes among patients with Chronic Kidney Disease from Tribal areas of Chhattisgarh, presenting to a Tertiary care hospital. Materials and Methods: All patients with Chronic Kidney Disease getting admitted in Nephrology Unit, Department of Medicine, Pt.J.H.M.Medical College and B.R.A.M. Hospital, Raipur (C.G.) in the year 2007 were evaluated for metabolic syndrome as per the NCEP / ATP III criteria (three or more criteria): Fasting Blood Sugar > 110 mg/dl; Serum Triglycerides > 150 mg/dl; Serum HDL level < 50 in females and less than 40 in males; Blood Pressure < 130/85 mmHg; Abdominal Circumference > 88 cm in females and > 102 cm in males. Patients with stage 2 to stage 5 of Chronic Kidney Disease having GFR < 60 ml/min/1.73m² body surface area (as per K/DOQI guidelines) were included in the study. Results: A total of 146 patients were studied of which 64% were males and 36% females. The mean age was 51±11.53 years. Fasting Blood Sugar > 110 mg/dl was found in 36.8% while < 110 mg/dl found in 63.2. Serum Triglyceride level > 150 mg/dl found in 54.25% while < 150 mg/dl in 45.75%. Serum HDL level (< 50 in females and < 40 in males) found in 14.82% while normal levels were found in 85.18% patients. Abdominal circumference (> 88 cm in females and > 102 cm in males) was found in 40.4% while 59.8% had normal Abdominal circumference. Blood Pressure > 130/85 mmHg was found in 65.8% while normal in 34.2%. Percentage of Patients having three or more criteria for metabolic syndrome was 52.6% while 47.4% did not have metabolic syndrome. Among the 146 patients studied, 20% expired of which 88.2% had metabolic syndrome. Among the patients having metabolic syndrome, the mortality rate was 26%. 80% of patients suffering from mortality were diabetics. Conclusion: Metabolic syndrome was encountered in 52.6% of patients with Chronic Kidney Disease. Hypertension was the most consistent and common factor in patients with metabolic syndrome followed by serum Triglyceride level. Majority of the deceased patients were diabetics. Mortality is much more in patients having metabolic syndrome. [ABSTRACT FROM AUTHOR]

Aim: To study the thyroid profile in patients with Chronic Kidney Disease from tribal areas of Chhattisgarh presenting to Medical College Hospital, Raipur. Materials and Methods: The study was conducted on 50 patients of Chronic Kidney Disease admitted in Nephrology Unit, Department of Medicine, Pt.J.N.M. Medical College and B.R.A.M. Hospital, Raipur (C.G.) in 2007. All patients were subjected to routine investigations and Thyroid Function Tests. Results: The mean age of the patients was 49.5±10.2%. 66% patients were males and 34% females. Mean Hemoglobin was 9.5±2.1 gm/dl. Abnormal thyroid function tests were found in 22% patients. The mean age of the patients having abnormal thyroid function tests was 42.6±2.3 years. A decrease in serum TSH level was found in 22% patients. Among patients having abnormal Thyroid Function Tests, 36% were females and 64% males. Among patients having abnormal Thyroid Function Tests, 82% were non diabetic and 18% diabetic. Conclusion: The most common thyroid function test abnormality found was a Decrease in Serum TSH level. Of the patients having abnormal Thyroid Function Tests, 18% patients were having Diabetes Mellitus (Type II). 82% patients were non diabetic among the group having abnormal thyroid function tests. Thyroid function test abnormality was more common in patients with age 42.6±2.3 years. The prevalence of Thyroid function test abnormality among Chronic Kidney Disease patients was found to be 22%. [ABSTRACT FROM AUTHOR]