ABSTRACT
Introduction: Continuous Ambulatory Peritoneal Dialysis (CAPD) was first introduced in 1990. It is now being considered at per or even better than MHD in many centers in India. Regional Institute of Medical Sciences (RIMS),Imphal is a tertiary care hospital in Northeastern part of India which is surrounded by neighboring states and border states of Myanmar where communication, transport, renal health care system is least developed. Many patient used to die due to lack of availability of hemodialysis facility. Since September 2001, CAPD programme was started at RIMS hospital, Imphal to treat the patient of CKD in Manipur, other neighboring states and Myanmar. It has been already more than 21 years and 736 number of PD catheter insertion is done at RIMS till September 2022. Method(s): Tenckhoff catheters were implanted either trans-peritoneally by surgeon or percutaneously by the nephrologist under local anaesthesia. All the details data about the patients were collected and accumulated. Accumulation and collection of data is constantly done by designated analyzers in RIMS centers in order to be continually updated on the demographics of renal patients using PD. These data were constantly documented and analyzed to assess the outcome and complications of PD. A total of 736 CKD patients were implanted with CAPD catheter between September 2001 to September 2022 and their detail data were analysed. Result(s): Out of total 736 PD cases there were 276 episodes of peritonitis. 58.6% cases had single episode of peritonitis as in Table -1. Out of 276 episodes of peritonitis 27 cases were culture positive.The leading causative agent of peritonitis was Staphylococcus aureus (37% of culture positive cases). Staphylococcus epidermidis was responsible for 18.5% of culture positive episodes as shown in Table-2. The incidence of ESI was 0.03 per person-years.The most common infective organism was S. aureus which was responsible for 12 (52%) of cases Table-3. Out of total 736 PD cases 72 patients were shifted to HD over the twenty one -year period, refractory peritonitis was the most common cause of technique failure ( 41.6 %) (Table- 4). A total of 125(16.9%) patients among 736 had PD catheter tip migration of which 46% were surgically removed and re-inserted. Omentectomy was require in 14.4 % of patient due to omental wrap around PD catheter (Table 5). There were 443 admissions to the hospital by these PD patients during the study period, of which 173(39%)were due to peritonitis. Non-peritoneal infections were the second most common cause responsible for 98(22.1%) hospital admissions. The non-peritoneal infections included covid 19 pneumonia in 5 patients (Table 6). Out of 736 patients, 145 patients(14.7%) were continuing on PD and12 patients (1.6%)underwent renal transplantation(Table-8). Conclusion(s): Our study suggests that there has been considerable improvement in overall outcome and mortality in patients on PD over the 20 years period. Peritonitis is the most common complication associated with PD. Having a well-trained staff will decrease the complications. This modality of renal replacement therapy in terms of long-term survival and quality of life and should be encouraged at the national level. No conflict of interestCopyright © 2023
ABSTRACT
Background : COVID-19 outbreak caused by SARSCOV-2 which primarily targets lungs causing other organs dysfunction including liver have been reported .However studies on liver function in COVID 19 patients are limited. Hence, this study aimed to evaluate the Liver enzymes in COVID-19 cases admitted in RIMS, Imphal. Methodology: We performed a cross sectional study on the liver function parameters of 488 COVID-19 positive patients admitted in RIMS, Imphal during April 2020 to September 2020. The COVID-19 positivity was determined on basis of RNA real time PCR. Serum samples were analyzed using Randox Auto analyzer. Results: Out of 488 patients with COVID-19, 431cases (88.32%) had abnormal LFTs and 57 cases (11.68%) had normal LFTs. Out of these 431 cases 330 (76.57%) were males and 101 (23.43%) were females. Median age of abnormal LFTs cases was 35 years. The primary liver enzymes;AST, ALT, ALKP and GGT were found to be elevated in 79.3%, 78.1%, 30.8% and 25.5% cases respectively. However, serum albumin levels were low in 24.1% cases. Conclusion: The prevalence of abnormal LFTs in COVID-19 patients is relatively high (88.31%).Abnormal liver enzymes may be a frequent finding in COVID-19 cases. These patients may be at a higher risk of progressing to severe diseases and therefore they should be observed and evaluated frequently for further treatment.