Functional Outcomes of Arteriovenous Fistulas Created by Nephrologist.

Background Nephrologists worldwide, after undergoing surgical training, have reported creating arteriovenous fistulas (AVFs). Objective To demonstrate the functional outcome of arteriovenous fistulas created by a trained Nepalese nephrologist. Method This was a cross sectional study. A convenient sampling method was used and all consecutive AVFs created by a single nephrologist from January 2016 to December 2018 were included to assess their functional status within 3 months of creation. Patients with incomplete data and no follow up for up to 3 months post surgery were excluded. Result One hundred sixty six (166) arteriovenous fistulas were created during the study period; mean age of the patients was 52 ± 14 years, 121 (75%) male and 65 (39%) were diabetic. The most common site of arteriovenous fistula creation was left radiocephalic (Lt RC) 69(41.5%), followed by left brachiocephalic (Lt BC) 66(39.7%). Other sites were left brachiobasilic (Lt BB) 10(6%), right brachiocephalic (Rt BC) 10(6%), right radiocephalic (Rt RC) 9(5.4%) and right brachiobasilic (Rt BB) 2(1.2%). 139 arteriovenous fistulas (83.7%) were functional within 3 months post creation. Functional outcomes of radiocephalic, brachiocephalic and brachiobasilic arteriovenous fistulas were 75.6%, 90.7% and 100% respectively at 3 months post creation. Lymphoceles developed in three Lt BC arteriovenous fistulas, thrombosis in two Lt BC arteriovenous fistulas and infection in two Lt BC arteriovenous fistulas with pseudoaneurysm formation. Conclusion The functional outcome of arteriovenous fistulas created by a trained Nepalese nephrologist is similar to that reported in the literature.

Effect of self-assembly on triiodide diffusion in water based polymer gel electrolytes: an application in dye solar cell.

The preparation of ordered polymer gels from the amphiphilic block copolymers, Pluronic® F77, P123 and polyethylene glycol in the presence of ionic liquid, iodine and organic additives is presented. At 35%(w/w) concentration these copolymers (F77 and P123) self-assembled into cubic liquid crystalline phase in aqueous solution and characterized by using SAXS and AFM measurements. The effects of micellar aggregation formed by polymers on the ionic transport and triiodide diffusion have been studied by electrochemistry and SANS experiments. The ionic migration or triiodide diffusion through these polymer gels is found to be affected by the PEO/PPO content in the polymer backbone. These gels were successfully employed as an electrolyte in a dye sensitized solar cell. A remarkable solar to electricity conversion efficiency and good stability was obtained using Pluronic® F77 based gel, which is attributed to its thermoreversible sol to gel transition.

Sex-based differences in lupus nephritis: a study of 235 Indian patients.

BACKGROUND: This study was carried out to analyze clinical presentation, laboratory parameters and histology in lupus nephritis in males in comparison with females. METHODS: Patients diagnosed with lupus nephritis between January 2001 and December 2005 were divided into 2 groups: males and females, and were analyzed with regard to clinical presentation, renal profile, serology and histology. All biopsies were reported by a single histopathologist as per WHO classification. Activity and chronicity indices were calculated. Comparison was made between the 2 groups. Statistical analysis was done using Strata version 6 software for Windows. RESULTS: Of the 235 patients diagnosed to have lupus nephritis, 35 were males (14.9%) and 200 females (85.1%). Males were younger (mean age 23.22 +/- 9.32 years, range 9-44) compared with females (mean age 24.7 +/- 8.93 years, range 5-55). Extrarenal manifestations such as joint pains, alopecia, rash, fever, serous effusions and oral ulcers were comparable in both groups, as were hypertension (68.5% vs. 67%), nephrotic proteinuria (40% vs. 36%) and hematuria (80% vs. 73%). Renal dysfunction was significantly more common in males (60% vs. 37.5%, p<0.05) with higher levels of mean serum creatinine (2.67 vs. 1.62 mg/dL, p<0.05) and blood urea (63.25 vs. 48 mg/dL, p<0.01). Histologically, class IV lupus was the most common lesion in both groups (71.4% in males, 60% in females). Membranous lupus nephritis was more common in females (22% vs. 5.7%, p<0.05). Activity index (8.51 vs. 6.76, p<0.05) was higher in males. CONCLUSIONS: Renal dysfunction and activity index are significantly higher in male patients with lupus nephritis.

Acute renal failure in a patient with non-fulminant hepatitis A infection.

Acute viral hepatitis A is a common cause of jaundice with a very low mortality. Acute renal failure occurs very rarely in hepatitis A. We report a case of non-fulminant hepatitis A in a 45-year-old man complicated by acute renal failure. The patient was treated successfully with hemodialysis resulting in complete recovery. Kidney biopsy was not performed in view of improving clinical picture.

Quantitative SAXS analysis of the P123/water/ethanol ternary phase diagram.

The ternary phase diagram of the amphiphilic triblock copolymer PEO-PPO-PEO ((EO)(20)(PO)(70)(EO)(20) commercialized under the generic name P123), water, and ethanol has been investigated at constant temperature (T = 23 degrees C) by small-angle X-ray scattering (SAXS). The microstructure resulting from the self-assembly of the PEO-PPO-PEO block copolymer varies from micelles in solution to various types of liquid crystalline phases such as cubic, 3D hexagonal close packed spheres (HCPS), 2D hexagonal, and lamellar when the concentration of the polymer is increased. In the isotropic liquid phase, the micellar structural parameters are obtained as a function of the water-ethanol ratio and block copolymer concentration by fitting the scattering data to a model involving core-shell form factor and a hard sphere structure factor of interaction. The micellar core, the aggregation number, and the hard sphere interaction radius decrease when increasing the ethanol/water ratio in the mixed solvent. We show that the fraction of ethanol present in the core is responsible for the swelling of the PPO blocks. In the different liquid crystalline phases, structural parameters such as lattice spacing, interfacial area of PEO block, and aggregation number are also evaluated. In addition to classical phases such as lamellar, 2D hexagonal, and liquid isotropic phases, we have observed a two-phase region in which cubic Fm3m and P6(3)mmc (hexagonally close packing of spheres (HCPS)) phases coexist. This appears at 30% (w/w) of P123 in pure water and with 5% (w/w) of ethanol. At 10% (w/w) ethanol, only the HCPS phase remains present.

Delineation of clinical privileges in rehabilitation medicine.

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) in 1995 developed a list of 75 clinical privileges (in laundry-list format) that are typical of physiatric practice. This list has been used by some hospitals as a template for physiatric staff privileging. The National Association of Medical Staff Services has advocated a short list of core privileges, supplemented by a list of highly specialized procedures. To assess current practices in physiatric privileging, we surveyed 35 rehabilitation facilities. Results showed that 66% (20/30) of the respondents were not aware of the AAPM&R recommendations. Furthermore, we found an almost even split between facilities using core (16/30) versus laundry list (14/30) privileges. We also found evidence that the Joint Commission on Accreditation of Healthcare Organizations has recommended both types of approaches to different facilities in the recent past.

Effects of central-nervous-system irradiation on neuropsychologic functioning of children with acute lymphocytic leukemia.

Two neuropsychologic studies were performed to determine the long-term effects of "prophylactic" cranial or craniospinal irradiation on the psychologic and neurologic functions of children with acute lymphocytic leukemia. In a prospective study, 34 patients with leukemia who received either craniospinal irradiation or cranial irradiation combined with intrathecal methotrexate were evaluated by standardized neurologic and psychologic examinations before and after irradiation. Their performance was compared with that of 27 controls who received irradiation to parts of the body other than the cranium. In a retrospective study, 11 patients with leukemia receiving prophylactic craniospinal irradiation and 12 controls with the disease not receiving such therapy were followed from the second year after either irradiation or the initial hematologic remission. Eighteen months after irradiation in the prospective study and four years after irradiation in the retrospective study, no noteworthy neurologic or psychologic differences were found between subjects and controls.