Comparison of Radial and Femoral Percutaneous Coronary Intervention.

BACKGROUND: The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention. METHODS: This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding. RESULTS: Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629.  The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290). CONCLUSIONS: Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal.

Community-based screening for chronic kidney disease, hypertension and diabetes in Dharan.

INTRODUCTION: Nepal cannot afford renal replacement therapy for End Stage Renal Disease due to lack of resources. Early diagnosis of Chronic Kidney Disease and its risk factors may reduce the need of renal replacement therapy. METHODS: A community-based screening on, 3218 people ≥20 years were assessed by door-to-door survey in Dharan, Nepal. Health status, lifestyle habit, physical examination and blood pressure were evaluated. Spot urine was examined for proteins and glucose by dipstick. Fasting blood glucose and serum creatinine were measured in a subset of 1000 people and the prevalence of Chronic Kidney Disease was evaluated. RESULTS: Overweight, obesity, hypertension, diabetes and proteinuria were found in 20%, 5.0%, 38.6%, 7.5%, and 5.1% respectively. In the subset group, Chronic Kidney Disease was detected in 10.6%. Multivariate analysis indicated age (P <0.0001) and diabetes (P = 0.027) as statistically significant predictors for Chronic Kidney Disease. Total of 848 patients entered the management program of lifestyle modification and pharmacologic intervention. Glycemic and blood pressure control was achieved in 60% and 72%, respectively. Regression or stabilization of proteinuria was reported in 52% of patients. CONCLUSIONS: Burden of Chronic Kidney Disease and cardiovascular risk factors are high in Dharan. Reasonable control of blood sugar, hypertension and proteinuria was achieved in this program. Findings indicate that activation a large prevention and intervention program to tackle Chronic Kidney Disease and Cardiovascular Disease in Nepal is needed.

Budd-Chiari syndrome--a case report.

A 21year old male presented with abdominal pain for 2 months and abdominal distension and swelling of lower limbs for 1 month. Ultrasonography of abdomen showing coarse echotexture of liver and intraluminal filling defect of inferior vena cava (IVC) and CT scan confirming the USG finding and showing enlarged caudate lobe of liver and thrombus in proximal IVC suggested the possibility of Budd-Chiari syndrome. Confirmation of diagnosis was done by inferior venacavography. The patient had nephrotic syndrome as the risk factor for thrombosis. The patient was portally decompressed by portocaval shunt with significant symptomatic relief.