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Introduction: Upper limb surgeries frequently use the brachial plexus block for anesthetizing the limb. The conventional approach by eliciting paresthesia is a blind procedure that may have a higher failure rate and cancause damage to the nerves and nearby structures. Peripheral nerve stimulator and ultrasound techniques were introduced to aid in better localization of the nerve/plexus avoiding tissue damage. With excellent localization and increased safety margin, ultrasound has increased the success rate of supraclavicular brachial plexus block. The purpose of this study was to compare the effectiveness of a Peripheral nerve stimulator with Ultrasound for giving Supraclavicular brachial plexus block. Material and Methods: After obtaining the Institutional ethical committee approval and patient consent, a total of 60 patients were enrolled in this prospective randomized study which were randomly divided into two groups in whom Supraclavicular brachial plexus block was given using either Peripheral nerve stimulator (Group PNS) or Ultrasound (Group USG). Both groups received 15 ml 0.5% Bupivacaine and 10 ml Lignocaine with Adrenaline {2%}[1;200,000]. The chiefparameters considered were time of onset of sensory and motor block, duration of analgesia, block failure and complications following block. Results: Demographic data was comparable in both the groups. The mean time of onset of motor block and sensory blockwas found to be more in Group PNS as compared to Group USG. The duration of sensory and motor blockade was more in group PNS ascompared to group USG. The success rate of the block was higher in ultrasound group than inPNSgroup however it wasstatisticallyinsignificant. No complications occurred in either group. Conclusion: Ultrasound guidance is a safe and effective method for giving supraclavicular brachial plexus block with faster onset and more lasting duration of motor and sensory blockade. [ABSTRACT FROM AUTHOR]

Context: Graves' disease is the commonest cause of hyperthyroidism. Other common causes include toxic multinodular goiter, thyroiditis etc. Clinical manifestations of thyrotoxicosis in cases of thyroiditis and early or mild Graves' disease may be difficult to differentiate. Although persistence of symptoms and signs in Graves' disease can distinguish it from other etiologies, it is prudent to distinguish between various etiologies of hyperthyroidism because of disease-specific management. Aims: To evaluate role of ultrasound in differential diagnosis of hyperthyroidism and propose a cut-off value of Inferior thyroid artery for differentiation of Graves Disease and destructive thyroiditis. Settings and Design: A cross-sectional study done in a tertiary care hospital. Methods and Material: Ultrasound evaluation of thyroid gland was performed in 100 patients of hyperthyroidism for the possible etiology of hyperthyroidism. Statistical analysis used: IBM Statistical Package for the Social Sciences (SPSS) software for Windows, Version 26.0. Armonk, NY: IBM Corp was used for analysis. Chi-square test was used for the comparison of categorical variables. P-values < 0.05 was considered statistically significant. Results: Ultrasound was found to be highly sensitive and specific in diagnosing the various etiologies of hyperthyroidism. A cut-off value of 40 cm/sec of peak systolic velocity of inferior thyroid artery was found to be statistically significant to differentiate between Graves' disease and destructive thyroiditis (p-value 0.000). Conclusion: In order to optimize diagnostic workup of hyperthyroidism, thyroid ultrasound being readily available, inexpensive and radiation free modality, can act as an effective diagnostic tool in differential diagnosis of hyperthyroidism. [ABSTRACT FROM AUTHOR]

The most common glomerulonephritis seen in the world is immunoglobulin A nephropathy (IgAN). It can be primary or secondary associated with various conditions like Chronic Liver disease, Crohn's disease, neoplasms, etc. However, IgAN secondary to Wilson's disease is very rare. A 9 year old boy presented with gross hematuria and proteinuria. He had a history of recurrent jaundice in the past. Ultrasonography (USG) whole abdomen showed altered echotexture of the liver with normal-sized kidneys. An extended workup for liver disease was done, and the diagnosis of Wilson's disease was confirmed with decreased serum ceruloplasmin levels, increased urinary copper, and the Kayser--Fleischer ring. Urine routine microscopy showed numerous red blood cells, few red blood cell casts, and mild proteinuria. Renal biopsy showed IgAN. The patient was started on D-penicillamine. On follow-up at 3 months, he showed complete resolution of proteinuria and hematuria. Thus, we suggest that Wilson's disease should be considered as one of the causes of secondary IgAN in pediatric patients with hematuria, proteinuria with liver dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 has gripped the whole world and patients with comorbidities especially kidney ailments are at higher risk of developing severe disease. Among kidney disease, transplant patients are the most vulnerable group. Information on coronavirus disease 2019 (COVID-19) in kidney transplant patients is very limited. Methods: An observational study was conducted on 20 kidney transplant patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction from April to June 2020. Results: The majority of cases were males (85%). The median age of the patients was 50 years (interquartile range [IQR] 40.75-60.75). Diabetes and hypertension were present in 55% and 95% of patients, respectively. Coronary artery disease was present in three patients (15%). The median time from transplant to COVID-19 testing was 54 months (IQR 36-105). Chronic allograft nephropathy was found in 35% of patients. The mean baseline creatinine was 1.71 mg/dL. The most common symptom was fever (80%). Acute Kidney Injury was seen in 60% of patients with a mean creatinine of 2.60 mg/dL. Based on severity, 50% of patients had mild disease, 25% moderate disease, and the remaining 25% had severe disease. All 20 patients were on oral steroids, calcineurin inhibitors (18 on tacrolimus and two on cyclosporine), and antimetabolite (19 on mycophenolate mofetil and one on azathioprine). Antimetabolite agents were stopped in all patients and tacrolimus was stopped in severe cases (25%). Hydroxychloroquine was given in 15 patients (75%). Fifteen patients (75%) recovered while five (25%) died. Conclusion: Kidney transplant recipients infected with COVID-19 have high mortality. [ABSTRACT FROM AUTHOR]

Chylous ascites refers to the accumulation of chyle in the abdominal cavity. Postoperative chylous ascites is most commonly associated with abdominal aortic surgeries. However, it is a rare complication following laparoscopic nephrectomy. It causes loss of fat, protein, and antibodies causing malnutrition and immunodeficiency. Thus, it is important to treat it as early as possible. We hereby report a case of chylous ascites following laparoscopic donor nephrectomy. A 55-year-old female was admitted at our center 2 weeks after undergoing left laparoscopic donor nephrectomy with abdominal distension and constipation. USG abdomen revealed free fluid in the abdomen. Paracentesis revealed chylous ascites. The patient was started on conservative treatment, including a diet rich in proteins and low in fats; conservative treatment, however, was unsuccessful. Lymphangiography and subsequent embolization of the defect were done, and she made a full recovery. [ABSTRACT FROM AUTHOR]