Success of Using Iodopovidone as a Sclerosing Agent for Chemical Pleurodesis in a Tertiary Care Center: A Descriptive Cross-Sectional Study.

INTRODUCTION: Pleurodesis is a procedure to achieve symphysis between the two layers of pleura aimed at preventing the accumulation of either air or fluid in the pleural space. In Nepal, intrapleural instillation of the chemical sclerosing agent is more commonly done as  thoracoscopy facility is not easily available. However, iodopovidone is rarely used for this purpose in Nepal. The study aims to find the prevalence of success using iodopovidone as the chemical sclerosing agent. METHODS: The study included cases undergoing pleurodesis over a two-year period. The clinicodemographic data, diagnosis, treatment effect and treatment response were analyzed. The treatment response was graded as Treatment Success (Complete Response or Partial Response) and Treatment Failure. RESULTS: Pleurodesis was done in a total of 54 cases. Of those, 39 cases were Secondary Spontaneous Pneumothorax, 11 were Malignant Pleural Effusion, 3 were Primary Spontaneous Pneumothorax, and 1 was a case of Hepatic Hydrothorax. Among Secondary Spontaneous Pneumothorax, Pleurodesis was successful in 37 (95%) out of 39 cases, with 35 (90%) having a Complete Response and 2 (5%) having a Partial Response while 2 (5%) had Treatment failure. Among Malignant Pleural Effusion, treatment success was achieved in 6 (55%) out of 11, whereas 5 (45%) failed the treatment. The commonest complication was burning sensation, and the commonest pain scale was "distressing." CONCLUSIONS: This study highlights the safety and ease of use of iodopovidone as an agent for chemical pleurodesis. It confirms the high rate of success of pleurodesis in cases of pneumothorax as found in other studies. In contrast, the success rate is understandably lower in cases of Malignant Pleural effusion.

Dyslipidemia in Patients with Type 2 Diabetes Mellitus in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Dyslipidemia is highly prevalent among type 2 diabetic patients. It increases the risk of atherosclerosis and consequent mortality in diabetic patients. The aim of this study was to find out the prevalence of dyslipidemia among type 2 diabetic patients. METHODS: This was a descriptive cross-sectional study in 355 type 2 diabetic patients at tertiary care hospital from 15th May, 2020 to 15th November, 2020 after taking ethical clearence from Institutional Review Committee (Reference no. IRC-PA-052/2077-78). Convenience sampling was done. Demographic and lipid profile variables were recorded based on the structured questionnaires. Data were analyzed by Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: Out of total 355 cases of type 2 Diabetes mellitus, prevalence of dyslipidemia was 224 (63.1%). It was more prevalent in male 145 (69.4%) than female 79 (54.1%). Increased Low density Lipoprotein (94.2%) was the most prevalent type followed by mixed dyslipidemia (91.1%). CONCLUSIONS: Dyslipidemia was common among type 2 diabetic patients and was higher in male gender, older age, obesity and longer duration of diabetes. Hence type 2 diabetic patient should undergo the routine monitoring of blood sugar and lipid profile so that any abnormalities can be identified and preventive measures along with interventions can be initiated at the earliest.

Air due to Glue: Spontaneous Pneumothorax in a Young Adult with Glue Sniffing.

Solvent abuse, as inhalant specially, in the form of low cost adhesives like dendrite is common in low income countries among children and the teens. This habit is often a stepping stone to harder drugs. The neurological and neuropsychological effects of solvent abuse are well explored. But the respiratory effects are often overlooked. In this report, we present a case of a 19 year old gentleman, with regular history of sniffing of commercial "glue" compounds. This patient presented with right sided chest pain and chest x-ray showed a right sided pneumothorax. The pulmonary barotrauma, possibly due to increased intra-alveolar pressure, during the sniffing process can lead to alveolar rupture and in turn, pneumothorax. In the absence of other risk factors for Pneumothorax, the link between inhalant abuse and respiratory complications has to be explored in patients with history of such abuse. Keywords: inhalant abuse; pneumothorax; solvent.

Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study.

BACKGROUND: Chronic kidney disease is an important cause of global mortality and morbidity. Data for epidemiological features of chronic kidney disease and its risk factors are limited for low-income and middle-income countries. The International Society of Nephrology's Kidney Disease Data Center (ISN-KDDC) aimed to assess the prevalence and awareness of chronic kidney disease and its risk factors, and to investigate the risk of cardiovascular disease, in countries of low and middle income. METHODS: We did a cross-sectional study in 12 countries from six world regions: Bangladesh, Bolivia, Bosnia and Herzegovina, China, Egypt, Georgia, India, Iran, Moldova, Mongolia, Nepal, and Nigeria. We analysed data from screening programmes in these countries, matching eight general and four high-risk population cohorts collected in the ISN-KDDC database. High-risk cohorts were individuals at risk of or with a diagnosis of either chronic kidney disease, hypertension, diabetes, or cardiovascular disease. Participants completed a self-report questionnaire, had their blood pressure measured, and blood and urine samples taken. We defined chronic kidney disease according to modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria; risk of cardiovascular disease development was estimated with the Framingham risk score. FINDINGS: 75,058 individuals were included in the study. The prevalence of chronic kidney disease was 14·3% (95% CI 14·0-14·5) in general populations and 36·1% (34·7-37·6) in high-risk populations. Overall awareness of chronic kidney disease was low, with 409 (6%) of 6631 individuals in general populations and 150 (10%) of 1524 participants from high-risk populations aware they had chronic kidney disease. Moreover, in the general population, 5600 (44%) of 12,751 individuals with hypertension did not know they had the disorder, and 973 (31%) of 3130 people with diabetes were unaware they had that disease. The number of participants at high risk of cardiovascular disease, according to the Framingham risk score, was underestimated compared with KDIGO guidelines. For example, all individuals with chronic kidney disease should be considered at high risk of cardiovascular disease, but the Framingham risk score detects only 23% in the general population, and only 38% in high-risk cohorts. INTERPRETATION: Prevalence of chronic kidney disease was high in general and high-risk populations from countries of low and middle income. Moreover, awareness of chronic kidney disease and other non-communicable diseases was low, and a substantial number of individuals who knew they were ill did not receive treatment. Prospective programmes with repeat testing are needed to confirm the diagnosis of chronic kidney disease and its risk factors. Furthermore, in general, health-care workforces in countries of low and middle income need strengthening. FUNDING: International Society of Nephrology.