An Atypical Cause of Hoarseness in a Patient With Thyroid Nodules.

Hoarseness due to vocal fold paresis (VFP) has a multitude of etiologies including systemic lupus erythematosus (SLE). During a clinical evaluation of a 58-year-old woman with long-standing hoarseness, an incidental finding of thyroid nodules was found to have VFP. Direct laryngoscopy and vocal fold biopsy confirmed the source was an inflammatory process involving the cricoarytenoid joint of the right hemilarynx. A presumptive diagnosis of SLE was made 3 years before meeting the clinical criteria of overt SLE. The VFP debut of SLE is extremely rare, and a literature review includes a handful of case reports (4 of a total of 37) since 1959. Only partial recovery of laryngeal function using glucocorticoids and Plaquenil was accomplished in the current case.

Lipid Profile Changes Associated with SGLT-2 Inhibitors and GLP-1 Agonists in Diabetes and Metabolic Syndrome.

The introduction of sodium glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in type 2 diabetes mellitus treatment has shown an unexpectedly significant improvement in heart disease outcome trials. Although they have very different modes of action, a portion of the salutary cardiovascular disease improvement may be related to their impact on diabetic dyslipidemia. As discussed in this focused review, the sodium glucose transporter-2 inhibitors as a class show a mild increase in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels, while triglycerides (TG) decrease inconsistently. In particular, the rise in LDL appears to be related to the less atherogenic, large buoyant LDL particles. The glucagon-like peptide-1 receptor agonists show more of an impact on weight loss and improvement in the underlying low HDL and high TG dyslipidemia. The effect of sodium glucose transporter-2 inhibitors and glucagon-like peptide 1 receptor agonists when used in combination remains largely unknown. Also unexplored is difference in effect of these medications among various ethnicities and metabolic syndrome.

Test anxiety and procrastination in physiotherapy students.

BACKGROUND: Short-term academic procrastination may be accompanied by negative outcomes such as anxiety, stress, and depression. The current study aims to evaluate the two parameters of procrastination and test anxiety in physiotherapy students and explore whether a relationship exists between them. MATERIALS AND METHODS: A descriptive, cross-sectional survey with a prospective study design was carried out over a period of 6 months. The study used a two-staged cluster sampling method: 220 undergraduate and postgraduate physiotherapy students from colleges in Mumbai and Navi Mumbai participated in the study, ensuring participation of students from each year of the course. The Westside Test Anxiety Scale was administered to evaluate test anxiety, and the Academic Procrastination Scale was used to evaluate procrastination. To illustrate the basic demographics of the participants, descriptive statistics were used. A correlation matrix was used to analyze the correlation between the two parameters. RESULTS: The mean procrastination score of the physiotherapy students was 74.1. Amongst undergraduates, the highest procrastination was seen in the 3rd Bachelor of Physiotherapy students (mean = 76.7), whereas among postgraduates, the highest procrastination was seen in Master of Physiotherapy 1 students (mean = 75.7). The mean test anxiety score was 3, indicating moderately high test anxiety among students. There was a statistically significant, positive correlation between test anxiety score and procrastination score (P value = 0.000, Pearson's correlation co-efficient = 0.383). CONCLUSION: Both test anxiety and the tendency to procrastinate were present among undergraduate and postgraduate physiotherapy students, in varying degrees. There was a positive correlation between the two factors.

Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation - a prospective single-center cohort study.

Recent reports suggest that bridge-donor reneging is rare (1.5%) in non-simultaneous kidney exchange chains. However, in developing countries, the non-directed donors who would be needed to initiate chains are unavailable, and furthermore, limited surgical space and resources restrain the feasibility of simultaneous kidney exchange cycles. Therefore, the aim of this study was to evaluate the bridge-donor reneging rate during non-simultaneous kidney exchange cycles (NSKEC) in a prospective single-center cohort study (n = 67). We describe the protocol used to prepare co-registered donor-recipient pairs for non-simultaneous surgeries, in an effort to minimize the reneging rate. In addition, in order to protect any recipients who might be left vulnerable by this arrangement, we proposed the use of standard criteria deceased-donor kidneys to rectify the injustice in the event of any bridge-donor reneging. We report 17 successful NSKEC resulting in 67 living-donor kidney transplants (LDKT) using 23 bridge-donors without donor renege and no intervening pairs became unavailable. We propose that NSKEC could increase LDKT, especially for difficult-to-match sensitized pairs (25 of our 67 pairs) in countries with limited transplantation resources. Our study confirms that NSKEC can be safely performed with careful patient-donor selection and non-anonymous kidney exchanges.

Two Decades of Deceased Donor Kidney Transplantation at Ahmedabad, India.

OBJECTIVES: Gujarat, Tamil Nadu, Telangana, Maharashtra, Kerala, Chandigarh, and Karnataka are states in India with active programs for deceased donor kidney transplant. We report our experience of 2 decades of deceased donor kidney transplant at the Institute of Kidney Diseases and Research Center, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India. MATERIALS AND METHODS: This single-center retrospective study comprised data from 831 deceased donor kidney transplant recipients between January 1, 1997 and December 31, 2018. Mean recipient age was 38 ± 14 years; 564 were male, and 267 were female. Mean donor age was 45.3 ± 17.13 years; 565 were men, and 266 were women. RESULTS: Between January 1, 1997 and March 15, 2020, 5838 kidney transplants were completed, including 4895 living donor kidney transplants, 943 deceased donor kidney transplants, and 440 kidney paired donation transplants. Over the mean follow-up time of 8 ± 5.4 years, patient survival rate was 70% (n = 581) and death-censored graft survival rate was 84% (n = 698). Delayed graft function was shown in 210 patients (25%) and biopsy-proven acute rejection rate in 180 patients (21%). Our experience of favorable outcomes with deceased donor kidney transplants has expanded the donor pool in many ways, including transplant from expanded criteria donors to younger recipients; transplant from older donors to older recipients; donation after cardiac death; successful intercity organ procurement; dual-kidney transplant; en bloc transplant from a pediatric deceased donor; and transplant from brain death deceased donors who died from neurotoxic snakebite, recurrent primary brain tumor, bacterial meningitis, or head injury, or with disseminated intravascular coagulation and deranged renal functions. The pathway to increase organ donation was investigated. CONCLUSIONS: Deceased donor kidney transplant can achieve acceptable graft function with patient/graft survival, which may encourage the use of this approach to increase the number of available organs.

Pure retroperitoneoscopic donor nephrectomy in duplication of inferior vena cava: A series of four cases.

AIM: Complex vascular anatomy poses a major challenge to the donor surgeon. Here, we have described the technical nuances in retroperitoneoscopic living donor nephrectomy for the left kidney in the situations of a rare vascular anomaly of duplication of inferior vena. MATERIALS AND METHODS: Between September 2005 and June 2016, 1460 retroperitoneoscopic living donor nephrectomy were carried out in single surgical unit of our institution. Out of these four donors were found to have duplication of inferior vena cava (IVC). We retrospectively analyzed the prospectively collected data of these donors and studied the operative details for managing the duplicated limb of the IVC. RESULTS: The mean age of the donors was 42.5 (range 30-54) years. Mean body mass index was 26.9 (range 25.2-28.6) kg/m2. Mean operative time (defined as between giving skin incision to the skin closure [O. T]), was 230 (range 185-310 min). Mean Warm ischemia time (defined from clamping of the renal artery to the starting of the cold HTK perfusion, [WIT]) was 136 s (range 105-178 s). In two cases, the renal vein could be controlled distal to the duplicated limb. In one case, the duplicated limb was clipped while in another a stapler was used to take a cuff of IVC. CONCLUSION: Retroperitoneoscopic donor nephrectomy can be performed safely in cases of duplication of IVC. Preoperative computerized tomography angiography with vascular reconstruction and surgical expertise is desirable in carrying out the procedure.

Role of CT scan in diagnosis of renal lymphangiectasia: our single-center experience.

BACKGROUND: Renal lymphangiectasia is rarely reported benign renal disorder of lymphatic malformation. Though found incidentally; it presents with nonspecific symptoms and shows characteristic findings in radiological imaging studies. AIM: Here, we report eight patients with symptoms, laboratory and imaging findings compatible with renal lymphangiectasia. This report describes clinical and laboratory characteristics, treatment, Imaging findings and outcome of a series of patients with renal lymphangiectasia and reviews the literature. METHODS AND MATERIAL: Eight patients (mean age 45 years, male:female ratio 3:1) from 1st January 2011 to 30th June 2016; showing renal lymphangiectasia as incidental finding on CT IVP were included in the series. Imaging and laboratory findings were reviewed. Two out of eight patients (25%) underwent aspiration of collection and laboratory findings confirmed the diagnosis of renal lymphangiectasia. Four out of eight patients (50%) did not undergo aspiration of fluid and were offered conservative treatment. Two out of eight patients (25%) were donors for renal transplantation who were managed conservatively. RESULTS: Renal lymphangiectasia was diagnosed on CT IVP. In each case, where aspiration of collection fluid was offered, the laboratory diagnosis of renal lymphangiectasia was confirmed and patients were managed conservatively. However, large collection in one patient was relieved by percutaneous aspiration. CONCLUSIONS: Renal lymphangiectasia can be diagnosed with CT scan and confirmed by laboratory tests. As it may be confused with other cystic lesions of kidney; proper diagnosis and exclusion of other differentials can be effectively offered by CT scan IVP, which can avoid unnecessary invasive treatment options.

Radial artery pseudoaneurysm: A rare complication after a single arterial puncture for blood-gas analysis.

With a reported incidence of 0.048%, radial artery pseudoaneurysm (PA) is a rare but serious complication of arterial cannulation. We report a case of PA developing after a single puncture of the right radial artery for arterial blood-gas analysis diagnosed by Doppler ultrasound in young male patient. The development of PA after puncture of radial artery for continuous blood pressure monitoring and serial blood-gas analysis has been reported in the past; however, to the best of our knowledge, there is only one case report of development of PA after a single arterial puncture for blood-gas analysis is reported in the past.

Bilateral Renal Lymphangiectasia.

Renal Lymphangiectasia (RLM) is very rare benign lymphatic malformation. It can be misdiagnosed for other cystic renal masses, most commonly polycystic kidneys. Though incidentally found in most cases, it may be the cause for hypertension and renal failure in undiagnosed patients. Here, we report a case of an adult asymptomatic male with bilateral RLM which was detected as an incidental finding on ultrasound. Confirmation by CT-scan and laboratory diagnosis of aspirated fluid was done, and patient was managed conservatively.

Portal Vein Thrombosis and Arterioportal Fistula in Post Liver Transplant Recipient: A Case Report.

An intrahepatic Arterioportal Fistula Refers (APF) to abnormal shunt or fistulous connection between the portal venous system and a hepatic arterial system within the liver. Here, we present a case of portal vein thrombosis with APF in post-transplant liver, developed 2 years and 6 months after transplantation. The condition was diagnosed by Triphasic CT angiography. In this case report we have discussed various causes and pathophysiology of APF with its imaging findings.

Evaluation of renal vascular anatomy in live renal donors: Role of multi detector computed tomography.

BACKGROUND: Evaluation of renal vascular variations is important in renal donors to avoid vascular complications during surgery. Venous variations, mainly resulting from the errors of the embryological development, are frequently observed. AIM: This retrospective cross-sectional study aimed to investigate the renal vascular variants with multidetector computed tomography (MDCT) angiography to provide valuable information for surgery and its correlations with surgical findings. MATERIALS AND METHODS: A total of 200 patients underwent MDCT angiography as a routine work up for live renal donors. The number, course, and drainage patterns of the renal veins were retrospectively observed from the scans. Anomalies of renal veins and inferior vena cava (IVC) were recorded and classified. Multiplanar reformations (MPRs), maximum intensity projections, and volume rendering were used for analysis. The results obtained were correlated surgically. RESULTS: In the present study, out of 200 healthy donors, the standard pattern of drainage of renal veins was observed in only 67% of donors on the right side and 92% of donors on the left side. Supernumerary renal veins in the form of dual and triple renal veins were seen on the right side in about 32.5% of donors (dual right renal veins in 30.5% cases and triple right renal veins in 2.5% cases). Variations on the left side were classified into four groups: supernumerary, retro-aortic, circumaortic, and plexiform left renal veins in 1%, 2.5%, 4%, 0.5%, cases respectively. CONCLUSIONS: Developmental variations in renal veins can be easily detected on computed tomography scan, which can go unnoticed and can pose a fatal threat during major surgeries such as donor nephrectomies in otherwise healthy donors if undiagnosed.

High prevalence of chronic kidney disease in a semi-urban population of Western India.

BACKGROUND: Globally there is an increase in incidence of chronic kidney diseases (CKDs). Diabetes mellitus (DM), hypertension and stone diseases are the major risk factors for CKD. We organized kidney disease screening camps in a semi-urban population of Gujarat, India on the occasion of World Kidney Day (WKD). METHODS: Voluntary participants from six towns were screened. Estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease formula and CKD was defined as an eGFR <60 mL/min/1.73 m(2) or albuminuria ≥1+. Urogenital ultrasonography was performed with emphasis on stone burden. Participants with known diabetes, stone diseases, hypertension, kidney/liver/cardiac disease, hepatitis, HIV, transplant recipients, pregnant women and those <18 years were excluded from the study. RESULTS: Of the 2350 participants (1438 men), CKD was found in 20.93% and eGFR <60 mL/min/1.73 m(2) was noted in 8.29% of participants. The prevalence of CKD peaked after the seventh decade of life in both genders. There was no significant difference in the prevalence of CKD between coastal and non-coastal regions, however, obesity, hypertension and diabetes were more common in the coastal belt, whereas stone burden was greater in the non-coastal region. CONCLUSIONS: The prevalence of CKD in a semi-urban apparently healthy Indian population was higher than the reported prevalence in developed countries. Significant differences between regions point to the need to evaluate and correctregion-specific risk factors.

Rare Anatomical Variation of Dual IVC with Left Sided IVC Draining into Hemiazygous Vein- A Case Report.

Congenital anomalies of the Inferior Vena Cava (IVC) result from the persistence of the embryonic venous system. Knowledge of such anomaly is of great importance during abdominal surgery, liver and kidney transplantation, renal venous sampling and in the treatment of thromboembolic diseases. Here, we report a rare anatomical variation of dual IVC with normal course of right sided IVC and hemiazygous continuation of left sided IVC with interiliac communication in potential renal donor. Congenital abnormalities of the inferior vena cava are easily identified on Computed Tomography (CT) and should be considered when interpreting any CT of the abdomen or chest.

Role of 64 slice multidetector computed tomography and angiography to establish relationship between tumor size, aneurysm formation and spontaneous rupture of renal angiomyolipomas: Single center experience.

OBJECTIVE: To evaluate the role of computed tomography (CT) angiography using 64 slice multidetector CT scan to establish relationships among tumor size, aneurysm formation, and spontaneous rupture of renal angiomyolipomas (AML). MATERIALS AND METHODS: Total 27 patients were diagnosed as having renal angiomyolipoma (AML) at institute of kidney disease and research center from June 2008 to June 2015. All patients with renal AML underwent contrast-enhanced CT (CECT) with CT angiography with 64 slice multidetector CT scan. RESULTS: Total 34 kidneys were found to be affected by AML. Out of which 6 AML were ruptured and remaining 28 were unruptured. If tumor size of 4 cm or larger is used as predictor of rupture; sensitivity 20%, specificity 89%, positive predictive value 83.3%, and negative predictive value 28.5%; and If aneurysm size >5 mm is used as predictor of rupture; sensitivity 75%, specificity 90%, positive predictive value 50%, and negative predictive value 96.4% was found. CONCLUSION: Tumor size, aneurysm size and tumor multiplicity cannot use as a predictor of spontaneous rupture of the tumor.

Comparison between doppler ultrasound resistive index, serum creatinine, and histopathologic changes in patients with kidney transplant dysfunction in early posttransplantation period: A single center study with review of literature.

To determine the relationship between resistive index (RI) measured by Doppler ultrasound, serum creatinine (SCr), and histopathological changes on biopsy during kidney trans- plant dysfunction in early postoperative period, we studied 47 kidney transplant patients; 61% of the patients had acute transplant rejection, 19% had acute tubular necrosis, 4% had calcineurin inhibitor toxicity, 11% had normal morphology in biopsy, and 5% had changes compatible with pyelonephritis. None of the study patients had interstitial fibrosis or tubular atrophy on biopsy. We found that the sensitivity and specificity of RI in diagnosing transplant dysfunction was highly variable depending on the selected cutoff value. Sensitivity of RI decreased and its specificity increased with increasing the RI thresholds. Using an RI threshold of 0.7 resulted in a high sensitivity of 78% at a cost of very low specificity 40%, whereas using an RI threshold of 0.9 resulted in 100% specificity at a cost of very low sensitivity 16%. Acceptable specificity was only achieved at the expense of very low sensitivity, resulting in poor utility of RI as a screening tool for dysfunction. We found that there were no significant differences in the mean RI value between patients with and without biopsy-proven transplant dysfunction. However, we found a significant correlation between SCr value and RI of 0.383, P = 0.007.