Detection and co-ordinated care management of chronic kidney disease at Kathmandu Medical College Teaching Hospital.

OBJECTIVE: The objective of our study was to analyze the detection parameters, categorization and co-ordinated management of Chronic Kidney Disease (CKD). The presenting clinical features, common lab investigations, applied treatment protocols and noticed complications were recorded. METHODOLOGY: A total of 40 patients of various stages of CKD on the basis of National Kidney Foundation (NKF), Kidney Disease Outcome Quality Initiative (K/DOQI) guideline were included in the study. RESULT: Out of them 24(60%) were males and 16(40%) were females. Constitutional symptoms like anorexia, nausea and generalized weakness were common presenting complaints present in 37(92.5%) patients and were associated with features of anaemia, metabolic acidosis and fluid overload in stage 5 CKD patients. The average age of presentation was 51.3 years. Among 40 patients 21(52.5%) were managed conservatively, 17((42.5%) were advised for Renal Replacement Therapy (RRT) through dialysis.2 (5%) patient expired during the treatment. The average duration of hospital stay was 5.6 days. Diabetes Mellitus was the most common cause 18 (45%), followed by Hypertension 14 (35%) and Chronic Glomerulonephritis (CGN) 5 (12.5%) leading to CKD. The patients were advised for regular follow up at Nephrology clinic.

Study of clinical profile and antibiotic sensitivity pattern in culture positive typhoid fever cases.

OBJECTIVES: The present study was designed to analyze the clinical profile and antibiotic sensitivity pattern in the cases of culture positive typhoid fever. METHOD: The study was conducted over a period of 1 year. Total of 46 culture positive cases of Typhoid fever were included in the study. The sensitivity pattern of isolates from blood culture was recorded. The modes of presentation, clinical course, lab investigation reports were also recorded. RESULTS: Out of 46 cases, 33 (71.7%) were males and 13 (28.3%) were females. Average age of presentation was 26.17 years. Fever was present in all patients. Resistance of S .typhi to amoxycillin, chloramphenicol and co-trimoxazole were significantly high. Ciprofloxacin showed resistance in 2 (4.3%) cases. Sensitivity to ceftriaxone was 100% in our study. CONCLUSION: Typhoid fever is one of the most common health problem in Nepal. Various drugs are being used in the treatment of typhoid fever, in the mean time resistance to many of them are emerging. An appropriate antibiotic has to be initiated only after culture sensitivity in typhoid fever.

Successful management of idiopathic rapidly progressive glomerulonephritis with corticosteroids and cytotoxic agent.

A 19 years old, male patient presented with symptoms of smoky urine for 2 weeks, puffiness of face and diminished urine output for 3 weeks associated with occasional lower abdominal and flank pain. Patient's history, clinical findings and available investigations were strongly suggestive of Idiopathic Rapidly Progressive Glomerulonephritis. The patient showed excellent response to glucocorticoid and cytotoxic agent.