Evaluation of role of heart rate variability with holter monitoring in chronic kidney disease

Background: Chronic kidney disease is prevalent disease even in absence of diabetes and hypertension in 12% adults over 65 yrs of age. Autonomic imbalance is not studied in detail which could be a risk factor for chronic kidney disease.Methods: This Study was observational study in a tertiary care Hospital in pune, india and was conducted for a period of 1 year with sample size of 52. All subjects were known cases of chronic kidney disease from stage III to VD. All individuals of age >18yrs and eGFR ≤60ml/min/1.73m2 according to CKD- EPI equation were included in the study and who were not giving consent were excluded. 24 hrs Holter monitoring was done in stages from ckd stages III to V, for ckd stage VD on both Hemodialysis day and Non hemodialysis. Analysis was done using SPSS version 20 (IBM SPSS Statistics Inc., Chicago, Illinois, USA) Windows software program. The paired t test, analysis of variance (ANOVA) and Chi-square test were used. Level of significance was set at p≤0.05.Results: In this study when Heart rate variability (HRV) parameters were compared in different stages of ckd from stage III to VD (on Hemodialysis day) SDNN, SDNN Index were found to be statistically significant and on non Hemodialysis day SDNN Index was found to be statistically significant. In each subgroup of ckd stage V when diabetic subjects were compared with non-diabetic subjects, HRV parameters like ratio of P/S which was found to be low and significant in ckd stage V diabetic subjects.Conclusions: Chronic kidney disease itself can affect the HRV parameters. Causal relationship between HRV and chronic kidney diseases can be vice versa and further needs larger and prospective studies

Knotting of the guide wires: A rare complication during minimally invasive procedure on kidney-Lessons learnt

Guide wires are frequently used in various endourologic procedures to access the upper as well as lower urinary tract. Flexible guide wires have lesser complication rate of tissue injury as compared to stiff guide wires. Flexible guide wires are however more prone to bending and kinking due to their mechanical properties. We report an unusual complication of knotting of flexible guide wires during endourologic procedure and the trick to remedy this problem. We have also discussed the structural design and mechanical properties of commonly used guide wires

Knotting of the guide wires: A rare complication during minimally invasive procedure on kidney-Lessons learnt

Guide wires are frequently used in various endourologic procedures to access the upper as well as lower urinary tract. Flexible guide wires have lesser complication rate of tissue injury as compared to stiff guide wires. Flexible guide wires are however more prone to bending and kinking due to their mechanical properties. We report an unusual complication of knotting of flexible guide wires during endourologic procedure and the trick to remedy this problem. We have also discussed the structural design and mechanical properties of commonly used guide wires

A cluster of cases of Nocardiosis

Human Nocardiosis has become more common in last two decades due to increase in the number of immunocompromised states of patients and the availability of better detection methods. We report three cases of Nocardiosis in which one was a renal allograft recipient who had developed pneumonia due to a relatively uncommon pathogen Nocardia brasiliensis. Other two cases were seen in immunocompetent hosts where ophthalmic infection due to Nocardia farcinica and subcutaneous infection in the leg due to N. brasiliensis were reported. The patients responded well to treatment. High level of suspicion helped in the detection of these cases

Assessment of balance using bot-2 in age group 5-15 year school going children

Introduction: Motor development is the gradual process by which child gain balance and coordination of the large muscle of legs trunk and arm and small muscle of the hand. The bruininks-Oseretsky test of motor proficiency Test that uses engaging, goal-directed activities to measure a wide array of motor skills in individuals ages 4 through 12.Material and method: In this study cross sectional analytical study design was used study setting was in Pimpri chinchwad municipality, Pune. Sample population was 5-15 year school going male and female, multistage stratified sampling method was used, sample size was 516, inclusion criteria was 5-15 year children male and female and exclusion criteria was neurological trauma or deficit, visual problem and other diagnosed medical condition. Required material was ruler, marker, measuring tap, stop watch and balance beam of bot kit. Outcome measure was balance total point score and descriptive category. Conclusion: The study concludes that there is slight difference in population male and female. But male performance is better than female in balance. According to age groups, 1, 3, 4, 5 is consistently increasing, age group 2 has more good performance

Prospective long-term study of patency and outcomes of 505 arteriovenous fistulas in patients with chronic renal failure: Authors experience and review of literature

Background: This study describes our experience of arteriovenous fistula (AVF) creation as vascular access for haemodialysis. Materials and Methods: This study has been carried out in our hospital from January 2004 to December 2012. A total of 505 AVFs were created in 443 patients. Maximum follow-up was 8 years, and minimum was 6 months. Observations and Results: In this study of 505 cases of AVFs, primary patency rates by Kaplan - Meier analysis showed 78.81% patency of fistulas at the end of 1 year and patency dropped to 14.81% at the end of 5 years. Our primary failure rate was 21.2%. Basilic vein was used in 26.35% cases, cephalic vein in 63.5%, and antecubital vein in 9.75% cases. On table, bruit was present in 459 (90.9%) and thrill in 451 (89.3%) cases. During dialysis, flow rate >250 ml/min was obtained in 150 (29.9%) cases. In complications, 2 (0.4%) patients developed distal oedema, 33 (6.5%) developed steal phenomenon. Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is <2 mm, chances of AVF failure are high. Flow rates in patients with vein diam. >2 mm were significantly higher as compared with patients with vein diam. <2 mm (P < 0.001). Flow rates are higher in non-diabetic patients as compared to diabetic patients (P < 0.001). Average blood urea and serum creatinine values are significantly lesser in patients undergoing dialysis through successful fistulas as compared to patients with failed fistulas. Correspondingly, incidence of deaths is significantly lesser in patients with successful fistulas. During proximal side-to-side fistula between antecubital/basilic vein and brachial artery, dilating of the first valve toward wrist helps to develop distal veins in the forearm by retrograde flow. This technique avoids requirement of superficialization of basilic vein in the arm

Study of efficacy and functionality of modified technique of proximal arteriovenous fistula as a vascular access for hemodialysis: A retrospective analysis of 171 cases

Background: Vascular access is the lifeline for a patient on hemodialysis. An arteriovenous fistula is the gold standard for hemodialysis access. The order of preference as given by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines suggests radiocephalic, brachiocephalic, and brachiobasilic transposition fistulae and then prosthetic grafts as vascular access options. Brachiobasilic transposition fistulae are associated with multiple challenges and complications. By our modified technique of brachiobasilic fistula, we have overcome the challenges posed by the conventional technique. In this study, we have evaluated the results of our modified technique and compared them with conventional technique. Materials and Methods: A retrospective analysis was done, in which all cases of proximal fistula for hemodialysis performed in our institute by the modified technique from January 2010 to December 2014 were included in the study. Result: Of the 171 patients, 136 (79.5%) were successful. The primary failure rate was 20.5%. Maturation time required for the fistula to develop was 46.7 (±4.17) days. Flow rates of more than 250 ml/min could be maintained in 58.8% of patients. Patency rates were 79% at the end of 1st year, 74.2% at the end of 2nd year, 45.7% at the end of 3rd year, and 40.2% at the end of 5th year. Ease of access was determined by a number of pricks required to gain access and development of forearm veins. Of the 136 successful cases, 110 (80%) could be cannulated with ease in the first prick itself. Access over forearm was possible in 117 (86.1%) cases. Conclusion: The modified technique of brachiobasilic fistula overcomes the risk of complications and morbidity of conventional brachiobasilic transposition fistula and is equally effective as vascular access

Prevalence and severity of metabolic acidosis in patients on maintenance hemodialysis in India

Aim: Metabolic acidosis is a feature of chronic kidney disease (CKD) due to the reduced capacity of the kidney to synthesize ammonia and excrete hydrogen ions. Among the many goals of hemodialysis (HD), the role in correction of metabolic acidosis is an important one. To assess the prevalence and severity of metabolic acidosis in the Indian patients of CKD, who are on maintenance HD (MHD). Methods: This is a cross-sectional study on 35 patients conducted at two centers in Western part of India. The demographic, clinical, and laboratory assessments were done on chronic stable patients receiving MHD. The prevalence and severity of metabolic acidosis were evaluated. Results: Metabolic acidosis was found in 22 out of 35 patients (62.85%), with mean predialysis serum pH and HCO3 of 7.32 ± 0.083 and 20.37 ± 4.94 mmol/L, respectively. Conclusion: Metabolic acidosis is significantly prevalent in patients on MHD in India