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Papers by Mahesh R Sigdel

Journal of Institute of Medicine, 2013

Introduction: A successful renal transplant program was started in Nepal on August 8, 2008 in Tri... more Introduction: A successful renal transplant program was started in Nepal on August 8, 2008 in Tribhuvan University Teaching Hospital; and since then more than 200 live renal transplants have been done in our center. Methods: A prospective analysis was done of 50 consecutive renal transplant recipients (performed from June 29, 2011 to May 16, 2012), with a minimum of 3 months of follow up. All recipients were on tacrolimus, mycophenolate mofetil, and steroids. The outcomes of the study were medical complications that occurred within the study period. Results: The mean age of the recipients and donors were 36.0 ± 1.1 (range 15-59) and 48.3 ± 1.1 (range 22-65) years respectively. The fatal complications were one case each of hospital acquired pneumonia leading to sepsis, delayed graft function secondary to acute tubular necrosis, and community acquired pneumonia. The most common non fatal infection in first month post transplant was urinary tract infection, 24 episodes were identified ...

Kidney360

This is an Early Access article. Please select the PDF button, above, to view it.

Case Reports in Urology, 2022

Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underly... more Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underlying comorbidities including both communicable and noncommunicable diseases. Solid organ transplant recipients under immunesupressive medication are also amongst the high risk group. There is only sparse data on immunity against SARS-CoV-2 infection among renal transplant recipients. In this case report, we present the level of anti-SARS-CoV-2 antibody of three kidney transplant recipients after vaccination against COVID-19 virus. All three cases had received two doses of Oxford-AstraZeneca COVID-19 vaccine AZD1222 (ChAdOx1). Serological analysis showed protective level of circulating antibodies in the blood of all three cases. Although two out of three patients in the study acquired COVID-19 infection after immunization, they recovered with mild clinical course. Hence, we conclude that despite immune-suppressed status of transplant recipients, COVID-19 vaccination could protect them agai...

Journal of Advances in Internal Medicine, 2013

The Nephrology unit got a call from Vascular Surgery department for evaluation and hemodialysis o... more The Nephrology unit got a call from Vascular Surgery department for evaluation and hemodialysis of a post operative patient. This was a 25 years lady on maintenance hemodialysis through radiocephalic arteriovenous fistula, prior to which she was hemodialysed through femoral access with multiple femoral punctures. She had complaint of painful and progressive right femoral swelling. At presentation, she was febrile with septic look, but systemic examination did not reveal source of infection. Local examination of right groin revealed a pulsatile, tender lump, 31 × 27 mm in size. Immediate surgical exploration and repair of the same was done. Patient became increasingly septic and uremic. She was managed with intensive hemodialysis and antibiotics. After a stay of > 3 weeks, she improved. She later on received renal allograft from her father and is doing fine till now. The attached image is of the groin wound. What was the underlying diagnosis? Figure 1. Surgical wound in the right groin Answer: Femoral artery pseudoaneurysm following inadvertent arterial puncture during femoral venous catheterization. Despite the fact that internal jugular access is preferred as temporary

Transplantation Journal, 2010

Kathmandu University Medical Journal, 2012

Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologicall... more Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologically mediated destruction of platelets and absence of other causes of thrombocytopenia. Treatment is required when the low platelet count entails risk of serious bleeding. Steroid is the first line of management. Acute refractory ITP with very low platelet count is variably treated with high dose steroid, intravenous immunoglobulin (IVIg), anti D or emergency splenectomy. Here, we present a case of steroid resistant ITP with severe thrombocytopenia treated with plasma exchange and low dose IVIg who responded dramatically to the therapy with maintained platelet count till one month from the institution of therapy. KATHMANDU UNIVERSITY MEDICAL JOURNAL VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 85-87 DOI: http://dx.doi.org/10.3126/kumj.v10i1.6922

BMC Nephrology, 2016

Background: The current standard for induction phase treatment of lupus nephritis is steroid comb... more Background: The current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. It is not known whether same cumulative dose of IVC would be effective when given over six months. Methods: We carried out a prospective, observational study on 41 patients of biopsy-proven lupus nephritis (class III, IV, V or mixed). For induction, patients received six pulses of monthly IVC (500 mg each), along with steroid. Patients were followed up monthly until one month beyond completion of the sixth pulse. The outcomes assessed were complete remission (proteinuria < 200 mg/day or urine albumin nil with serum albumin >35 gm/L, stable estimated glomerular filtration rate (eGFR) if normal at baseline or increase in eGFR by 25 % if abnormal at baseline and normal urinary sediment), response (complete or partial remissions), complications of therapy and death. Results: Twenty two patients (53.7 %) had class IV nephritis. Eighteen patients (43.9 %) achieved complete remission, 16 (39.0 %) achieved partial remission, yielding an overall response rate of 82.9 %. Nephrotic range proteinuria (UTP ≥ 3 g/ day) and severe hypoalbuminemia (serum albumin < 20 g/L) at baseline influenced remission (p <0.05). Infection, seen in 12 patients (29.3 %), was the most common complication. Four deaths (9.6 %) were observed, all due to infection. Conclusions: For induction phase treatment, Nepalese patients with lupus nephritis responded favorably to steroid and low dose IVC of 3 grams given as six monthly pulses.

Journal of Nepal Health Research Council, 2013

Wasp bite is an important occupational hazard in Nepal. Almost 25% of the victims die. This study... more Wasp bite is an important occupational hazard in Nepal. Almost 25% of the victims die. This study aimed to identify the demographics, clinical presentation, hospital course and outcome of wasp bite victims in a referral hospital in Nepal. A retrospective study was conducted in Tribhuvan University Teaching Hospital, Kathmandu. Medical records of patients admitted for wasp bite between January 2008 and December 2012 were reviewed. Demographic, clinical and laboratory data were collected and their effects on outcomes in the form of death, duration of hospitalization, number of dialysis sessions and time to resolution of oliguria were analyzed. All 18 patients came from rural areas, 13 (72%) were farmers, mean age was 39.6 ±16.7 years (range 7 to 69). Most bites occurred between August and November. Oliguria, vomiting, red urine and jaundice were the main presenting symptoms; oliguria developed within 48 hours of bite in 17 (94 %) cases. Nine patients (50%) required blood transfusion. ...

Transplantation Proceedings

Kidney International Reports

Introduction: Kidney transplantation is considered the most costeffective therapy for end-stage r... more Introduction: Kidney transplantation is considered the most costeffective therapy for end-stage renal disease. The objective of our study is to review early complications (during the first six months) of kidney transplantation in our center. Our main transplant origin is living donation. Methods: This was an observational descriptive study that included all patients who had underwent renal transplantation for at least six months, from January 2010 to September 2019. Results: A total of 43 cases were reviewed, 25 males and 18 females, the sex-ratio M/F was:(1,38). The Average age was: (30.13+/-9,5), 83,72% of our donors were living donors, mostly parents, indeterminate nephropathy was the etiology in 41.86% of cases, glomerular nephropathy in 32.55% of cases. Surgical complications occurred in 37% of cases, these include one case of thrombosis of the renal artery, one of arterial stenosis, one case of vein thrombosis and one case of pseudoaneurysm, one case of hematoma, and 8 cases of lymphoceles, and 1 case of urinoma due to ureteral necrosis. Immunological complications account 13,90% of all cases including 6 cases of T Cell mediated rejections, infectious complications occurred in 60,46% of cases, mostly urinary tract infections (39,53%), metabolic complications occurred in 5 patients, 4 patients had acute kidney injury secondary to renal toxicity of calcineurin inhibitors, one patient developed hypertension, one case of recurrence of primary nephropathy (primary hyperoxaluria type 1). Graft survival at 1 year was 88,37% with a 93% 1-year patient survival. Conclusions: Early identification and treatment of complications are critical for patient and graft survival.

case reports in urology, 2022

Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underly... more Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underlying comorbidities including both communicable and noncommunicable diseases. Solid organ transplant recipients under immunesupressive medication are also amongst the high risk group. There is only sparse data on immunity against SARS-CoV-2 infection among renal transplant recipients. In this case report, we present the level of anti-SARS-CoV-2 antibody of three kidney transplant recipients after vaccination against COVID-19 virus. All three cases had received two doses of Oxford-AstraZeneca COVID-19 vaccine AZD1222 (ChAdOx1). Serological analysis showed protective level of circulating antibodies in the blood of all three cases. Although two out of three patients in the study acquired COVID-19 infection after immunization, they recovered with mild clinical course. Hence, we conclude that despite immune-suppressed status of transplant recipients, COVID-19 vaccination could protect them agai...

Journal of Advances in Internal Medicine, 2013

The Nephrology unit got a call from Vascular Surgery department for evaluation and hemodialysis o... more The Nephrology unit got a call from Vascular Surgery department for evaluation and hemodialysis of a post operative patient. This was a 25 years lady on maintenance hemodialysis through radiocephalic arteriovenous fistula, prior to which she was hemodialysed through femoral access with multiple femoral punctures. She had complaint of painful and progressive right femoral swelling. At presentation, she was febrile with septic look, but systemic examination did not reveal source of infection. Local examination of right groin revealed a pulsatile, tender lump, 31 × 27 mm in size. Immediate surgical exploration and repair of the same was done. Patient became increasingly septic and uremic. She was managed with intensive hemodialysis and antibiotics. After a stay of > 3 weeks, she improved. She later on received renal allograft from her father and is doing fine till now. The attached image is of the groin wound. What was the underlying diagnosis? Figure 1. Surgical wound in the right groin Answer: Femoral artery pseudoaneurysm following inadvertent arterial puncture during femoral venous catheterization. Despite the fact that internal jugular access is preferred as temporary

BMC Nephrology, Oct 7, 2016

Background: The current standard for induction phase treatment of lupus nephritis is steroid comb... more Background: The current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. It is not known whether same cumulative dose of IVC would be effective when given over six months. Methods: We carried out a prospective, observational study on 41 patients of biopsy-proven lupus nephritis (class III, IV, V or mixed). For induction, patients received six pulses of monthly IVC (500 mg each), along with steroid. Patients were followed up monthly until one month beyond completion of the sixth pulse. The outcomes assessed were complete remission (proteinuria < 200 mg/day or urine albumin nil with serum albumin >35 gm/L, stable estimated glomerular filtration rate (eGFR) if normal at baseline or increase in eGFR by 25 % if abnormal at baseline and normal urinary sediment), response (complete or partial remissions), complications of therapy and death. Results: Twenty two patients (53.7 %) had class IV nephritis. Eighteen patients (43.9 %) achieved complete remission, 16 (39.0 %) achieved partial remission, yielding an overall response rate of 82.9 %. Nephrotic range proteinuria (UTP ≥ 3 g/ day) and severe hypoalbuminemia (serum albumin < 20 g/L) at baseline influenced remission (p <0.05). Infection, seen in 12 patients (29.3 %), was the most common complication. Four deaths (9.6 %) were observed, all due to infection. Conclusions: For induction phase treatment, Nepalese patients with lupus nephritis responded favorably to steroid and low dose IVC of 3 grams given as six monthly pulses.

Journal of Nepal Medical Association

Chronic acidosis is an important, often overlooked cause of growth retardation. Here we present t... more Chronic acidosis is an important, often overlooked cause of growth retardation. Here we present the case of a girl with distal renal tubular acidosis who had visited multiple hospitals before the diagnosis was made. She presented to us in adolescence with non anion gap metabolic acidosis, hypokalemia, severe growth retardation and nephrocalcinosis. In 18 months follow up with alkali therapy, she had good weight gain and growth velocity. Keywords: growth retardation; hypokalemia; nephrocalcinosis; renal tubular acidosis.

Journal of Nepal Health Research Council

Medically important insects of the order Hymenoptera comprise-Apoidae (bees), Vespoidae (wasps, h... more Medically important insects of the order Hymenoptera comprise-Apoidae (bees), Vespoidae (wasps, hornets and yellow jackets) and Formicidae (fire ants). 1 Wasp or bee stings occur as accidents or occupational exposure, especially in rural areas, in proximity of forests, all over the world. 2-6 Wasp stings are common form of envenomation in the tropics including Nepal and Northern India, especially for farmers in hilly regions. 6-8 Although there are no official records from Nepal, there are accounts in many villages of casualties from wasp bite. At another tertiary care hospital in Nepal, 11 patients with wasp stings were seen over 21 months. 9 The clinical manifestations of wasp bite range from local to systemic and benign to life threatening multisystem involvement, each resulting from allergic and/or anaphylactic to toxic reactions. 1,10 Life threatening anaphylaxis begins within 10 minutes to four hours; systemic reactions may develop within 24 hours or

Kathmandu University medical journal (KUMJ)

Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologicall... more Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologically mediated destruction of platelets and absence of other causes of thrombocytopenia. Treatment is required when the low platelet count entails risk of serious bleeding. Steroid is the first line of management. Acute refractory ITP with very low platelet count is variably treated with high dose steroid, intravenous immunoglobulin (IVIg), anti D or emergency splenectomy. Here, we present a case of steroid resistant ITP with severe thrombocytopenia treated with plasma exchange and low dose IVIg who responded dramatically to the therapy with maintained platelet count till one month from the institution of therapy.

Journal of Institute of Medicine, 2020

Journal of Institute of Medicine, 2013

Introduction: A successful renal transplant program was started in Nepal on August 8, 2008 in Tri... more Introduction: A successful renal transplant program was started in Nepal on August 8, 2008 in Tribhuvan University Teaching Hospital; and since then more than 200 live renal transplants have been done in our center. Methods: A prospective analysis was done of 50 consecutive renal transplant recipients (performed from June 29, 2011 to May 16, 2012), with a minimum of 3 months of follow up. All recipients were on tacrolimus, mycophenolate mofetil, and steroids. The outcomes of the study were medical complications that occurred within the study period. Results: The mean age of the recipients and donors were 36.0 ± 1.1 (range 15-59) and 48.3 ± 1.1 (range 22-65) years respectively. The fatal complications were one case each of hospital acquired pneumonia leading to sepsis, delayed graft function secondary to acute tubular necrosis, and community acquired pneumonia. The most common non fatal infection in first month post transplant was urinary tract infection, 24 episodes were identified ...

Kidney360

This is an Early Access article. Please select the PDF button, above, to view it.

Case Reports in Urology, 2022

Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underly... more Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underlying comorbidities including both communicable and noncommunicable diseases. Solid organ transplant recipients under immunesupressive medication are also amongst the high risk group. There is only sparse data on immunity against SARS-CoV-2 infection among renal transplant recipients. In this case report, we present the level of anti-SARS-CoV-2 antibody of three kidney transplant recipients after vaccination against COVID-19 virus. All three cases had received two doses of Oxford-AstraZeneca COVID-19 vaccine AZD1222 (ChAdOx1). Serological analysis showed protective level of circulating antibodies in the blood of all three cases. Although two out of three patients in the study acquired COVID-19 infection after immunization, they recovered with mild clinical course. Hence, we conclude that despite immune-suppressed status of transplant recipients, COVID-19 vaccination could protect them agai...

Journal of Advances in Internal Medicine, 2013

The Nephrology unit got a call from Vascular Surgery department for evaluation and hemodialysis o... more The Nephrology unit got a call from Vascular Surgery department for evaluation and hemodialysis of a post operative patient. This was a 25 years lady on maintenance hemodialysis through radiocephalic arteriovenous fistula, prior to which she was hemodialysed through femoral access with multiple femoral punctures. She had complaint of painful and progressive right femoral swelling. At presentation, she was febrile with septic look, but systemic examination did not reveal source of infection. Local examination of right groin revealed a pulsatile, tender lump, 31 × 27 mm in size. Immediate surgical exploration and repair of the same was done. Patient became increasingly septic and uremic. She was managed with intensive hemodialysis and antibiotics. After a stay of > 3 weeks, she improved. She later on received renal allograft from her father and is doing fine till now. The attached image is of the groin wound. What was the underlying diagnosis? Figure 1. Surgical wound in the right groin Answer: Femoral artery pseudoaneurysm following inadvertent arterial puncture during femoral venous catheterization. Despite the fact that internal jugular access is preferred as temporary

Transplantation Journal, 2010

Kathmandu University Medical Journal, 2012

Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologicall... more Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologically mediated destruction of platelets and absence of other causes of thrombocytopenia. Treatment is required when the low platelet count entails risk of serious bleeding. Steroid is the first line of management. Acute refractory ITP with very low platelet count is variably treated with high dose steroid, intravenous immunoglobulin (IVIg), anti D or emergency splenectomy. Here, we present a case of steroid resistant ITP with severe thrombocytopenia treated with plasma exchange and low dose IVIg who responded dramatically to the therapy with maintained platelet count till one month from the institution of therapy. KATHMANDU UNIVERSITY MEDICAL JOURNAL VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 85-87 DOI: http://dx.doi.org/10.3126/kumj.v10i1.6922

BMC Nephrology, 2016

Background: The current standard for induction phase treatment of lupus nephritis is steroid comb... more Background: The current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. It is not known whether same cumulative dose of IVC would be effective when given over six months. Methods: We carried out a prospective, observational study on 41 patients of biopsy-proven lupus nephritis (class III, IV, V or mixed). For induction, patients received six pulses of monthly IVC (500 mg each), along with steroid. Patients were followed up monthly until one month beyond completion of the sixth pulse. The outcomes assessed were complete remission (proteinuria < 200 mg/day or urine albumin nil with serum albumin >35 gm/L, stable estimated glomerular filtration rate (eGFR) if normal at baseline or increase in eGFR by 25 % if abnormal at baseline and normal urinary sediment), response (complete or partial remissions), complications of therapy and death. Results: Twenty two patients (53.7 %) had class IV nephritis. Eighteen patients (43.9 %) achieved complete remission, 16 (39.0 %) achieved partial remission, yielding an overall response rate of 82.9 %. Nephrotic range proteinuria (UTP ≥ 3 g/ day) and severe hypoalbuminemia (serum albumin < 20 g/L) at baseline influenced remission (p <0.05). Infection, seen in 12 patients (29.3 %), was the most common complication. Four deaths (9.6 %) were observed, all due to infection. Conclusions: For induction phase treatment, Nepalese patients with lupus nephritis responded favorably to steroid and low dose IVC of 3 grams given as six monthly pulses.

Journal of Nepal Health Research Council, 2013

Wasp bite is an important occupational hazard in Nepal. Almost 25% of the victims die. This study... more Wasp bite is an important occupational hazard in Nepal. Almost 25% of the victims die. This study aimed to identify the demographics, clinical presentation, hospital course and outcome of wasp bite victims in a referral hospital in Nepal. A retrospective study was conducted in Tribhuvan University Teaching Hospital, Kathmandu. Medical records of patients admitted for wasp bite between January 2008 and December 2012 were reviewed. Demographic, clinical and laboratory data were collected and their effects on outcomes in the form of death, duration of hospitalization, number of dialysis sessions and time to resolution of oliguria were analyzed. All 18 patients came from rural areas, 13 (72%) were farmers, mean age was 39.6 ±16.7 years (range 7 to 69). Most bites occurred between August and November. Oliguria, vomiting, red urine and jaundice were the main presenting symptoms; oliguria developed within 48 hours of bite in 17 (94 %) cases. Nine patients (50%) required blood transfusion. ...

Transplantation Proceedings

Kidney International Reports

Introduction: Kidney transplantation is considered the most costeffective therapy for end-stage r... more Introduction: Kidney transplantation is considered the most costeffective therapy for end-stage renal disease. The objective of our study is to review early complications (during the first six months) of kidney transplantation in our center. Our main transplant origin is living donation. Methods: This was an observational descriptive study that included all patients who had underwent renal transplantation for at least six months, from January 2010 to September 2019. Results: A total of 43 cases were reviewed, 25 males and 18 females, the sex-ratio M/F was:(1,38). The Average age was: (30.13+/-9,5), 83,72% of our donors were living donors, mostly parents, indeterminate nephropathy was the etiology in 41.86% of cases, glomerular nephropathy in 32.55% of cases. Surgical complications occurred in 37% of cases, these include one case of thrombosis of the renal artery, one of arterial stenosis, one case of vein thrombosis and one case of pseudoaneurysm, one case of hematoma, and 8 cases of lymphoceles, and 1 case of urinoma due to ureteral necrosis. Immunological complications account 13,90% of all cases including 6 cases of T Cell mediated rejections, infectious complications occurred in 60,46% of cases, mostly urinary tract infections (39,53%), metabolic complications occurred in 5 patients, 4 patients had acute kidney injury secondary to renal toxicity of calcineurin inhibitors, one patient developed hypertension, one case of recurrence of primary nephropathy (primary hyperoxaluria type 1). Graft survival at 1 year was 88,37% with a 93% 1-year patient survival. Conclusions: Early identification and treatment of complications are critical for patient and graft survival.

case reports in urology, 2022

Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underly... more Globally, SARS-CoV-2 has caused significant public health burden, mainly in patients with underlying comorbidities including both communicable and noncommunicable diseases. Solid organ transplant recipients under immunesupressive medication are also amongst the high risk group. There is only sparse data on immunity against SARS-CoV-2 infection among renal transplant recipients. In this case report, we present the level of anti-SARS-CoV-2 antibody of three kidney transplant recipients after vaccination against COVID-19 virus. All three cases had received two doses of Oxford-AstraZeneca COVID-19 vaccine AZD1222 (ChAdOx1). Serological analysis showed protective level of circulating antibodies in the blood of all three cases. Although two out of three patients in the study acquired COVID-19 infection after immunization, they recovered with mild clinical course. Hence, we conclude that despite immune-suppressed status of transplant recipients, COVID-19 vaccination could protect them agai...

Journal of Advances in Internal Medicine, 2013

The Nephrology unit got a call from Vascular Surgery department for evaluation and hemodialysis o... more The Nephrology unit got a call from Vascular Surgery department for evaluation and hemodialysis of a post operative patient. This was a 25 years lady on maintenance hemodialysis through radiocephalic arteriovenous fistula, prior to which she was hemodialysed through femoral access with multiple femoral punctures. She had complaint of painful and progressive right femoral swelling. At presentation, she was febrile with septic look, but systemic examination did not reveal source of infection. Local examination of right groin revealed a pulsatile, tender lump, 31 × 27 mm in size. Immediate surgical exploration and repair of the same was done. Patient became increasingly septic and uremic. She was managed with intensive hemodialysis and antibiotics. After a stay of > 3 weeks, she improved. She later on received renal allograft from her father and is doing fine till now. The attached image is of the groin wound. What was the underlying diagnosis? Figure 1. Surgical wound in the right groin Answer: Femoral artery pseudoaneurysm following inadvertent arterial puncture during femoral venous catheterization. Despite the fact that internal jugular access is preferred as temporary

BMC Nephrology, Oct 7, 2016

Background: The current standard for induction phase treatment of lupus nephritis is steroid comb... more Background: The current standard for induction phase treatment of lupus nephritis is steroid combined with mycophenolate mofetil or pulse intravenous cyclophosphamide (IVC). The lowest dose of IVC recommended for induction therapy is that used in the Euro-Lupus Trial. It is not known whether same cumulative dose of IVC would be effective when given over six months. Methods: We carried out a prospective, observational study on 41 patients of biopsy-proven lupus nephritis (class III, IV, V or mixed). For induction, patients received six pulses of monthly IVC (500 mg each), along with steroid. Patients were followed up monthly until one month beyond completion of the sixth pulse. The outcomes assessed were complete remission (proteinuria < 200 mg/day or urine albumin nil with serum albumin >35 gm/L, stable estimated glomerular filtration rate (eGFR) if normal at baseline or increase in eGFR by 25 % if abnormal at baseline and normal urinary sediment), response (complete or partial remissions), complications of therapy and death. Results: Twenty two patients (53.7 %) had class IV nephritis. Eighteen patients (43.9 %) achieved complete remission, 16 (39.0 %) achieved partial remission, yielding an overall response rate of 82.9 %. Nephrotic range proteinuria (UTP ≥ 3 g/ day) and severe hypoalbuminemia (serum albumin < 20 g/L) at baseline influenced remission (p <0.05). Infection, seen in 12 patients (29.3 %), was the most common complication. Four deaths (9.6 %) were observed, all due to infection. Conclusions: For induction phase treatment, Nepalese patients with lupus nephritis responded favorably to steroid and low dose IVC of 3 grams given as six monthly pulses.

Journal of Nepal Medical Association

Chronic acidosis is an important, often overlooked cause of growth retardation. Here we present t... more Chronic acidosis is an important, often overlooked cause of growth retardation. Here we present the case of a girl with distal renal tubular acidosis who had visited multiple hospitals before the diagnosis was made. She presented to us in adolescence with non anion gap metabolic acidosis, hypokalemia, severe growth retardation and nephrocalcinosis. In 18 months follow up with alkali therapy, she had good weight gain and growth velocity. Keywords: growth retardation; hypokalemia; nephrocalcinosis; renal tubular acidosis.

Journal of Nepal Health Research Council

Medically important insects of the order Hymenoptera comprise-Apoidae (bees), Vespoidae (wasps, h... more Medically important insects of the order Hymenoptera comprise-Apoidae (bees), Vespoidae (wasps, hornets and yellow jackets) and Formicidae (fire ants). 1 Wasp or bee stings occur as accidents or occupational exposure, especially in rural areas, in proximity of forests, all over the world. 2-6 Wasp stings are common form of envenomation in the tropics including Nepal and Northern India, especially for farmers in hilly regions. 6-8 Although there are no official records from Nepal, there are accounts in many villages of casualties from wasp bite. At another tertiary care hospital in Nepal, 11 patients with wasp stings were seen over 21 months. 9 The clinical manifestations of wasp bite range from local to systemic and benign to life threatening multisystem involvement, each resulting from allergic and/or anaphylactic to toxic reactions. 1,10 Life threatening anaphylaxis begins within 10 minutes to four hours; systemic reactions may develop within 24 hours or

Kathmandu University medical journal (KUMJ)

Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologicall... more Immune thrombocytopenic purpura (ITP) is a hematological disorder characterized by immunologically mediated destruction of platelets and absence of other causes of thrombocytopenia. Treatment is required when the low platelet count entails risk of serious bleeding. Steroid is the first line of management. Acute refractory ITP with very low platelet count is variably treated with high dose steroid, intravenous immunoglobulin (IVIg), anti D or emergency splenectomy. Here, we present a case of steroid resistant ITP with severe thrombocytopenia treated with plasma exchange and low dose IVIg who responded dramatically to the therapy with maintained platelet count till one month from the institution of therapy.

Journal of Institute of Medicine, 2020