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Abstract
Volume status assessment is a critical but challenging clinical skill and is especially important for the management of patients in the emergency department, intensive care unit, and dialysis unit where accurate intravascular assessment is necessary to guide appropriate fluid management. Assessment of volume status is subjective and can vary from provider to provider, posing clinical dilemmas. Traditional non-invasive methods of volume assessment include assessment of skin turgor, axillary sweat, peripheral edema, pulmonary crackles, orthostatic vital signs, and jugular venous distension. Invasive assessments of volume status include direct measurement of central venous pressure and pulmonary artery pressures. Each of these has their own limitations, challenges, and pitfalls and were often validated based on small cohorts with questionable comparators. In the past 30 years, the increased availability, progressive miniaturization, and falling price of ultrasound devices has made point of care ultrasound (POCUS) widely available. Emerging evidence base and increased uptake across multiple subspecialities has facilitated the adoption of this technology. POCUS is now widely available, relatively inexpensive, free of ionizing radiation, and can help providers make medical decisions with more precision. POCUS is not intended to replace the physical exam, but rather to complement clinical assessment, guiding providers to give thorough and accurate clinical care to their patients. We should be mindful of the nascent literature supporting the use of POCUS and other limitations as uptake increases among providers and be wary not to use POCUS to substitute clinical judgement, but integrate ultrasonographic findings carefully with history and clinical examination.
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Affiliation(s)
- David Kearney
- Renal-Electrolyte Hypertension Division, University of Pennsylvania Philadelphia, PA
| | - Nathaniel Reisinger
- Renal-Electrolyte Hypertension Division, University of Pennsylvania Philadelphia, PA
| | - Sadichhya Lohani
- Renal-Electrolyte Hypertension Division, University of Pennsylvania Philadelphia, PA
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2
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Sharma SK, Kurmi OP, Lab B, Chappuis F, Heller O, Lohani S, Gautam P, Hall I, Bolton CE. Respiratory morbidity in Nepali communities: a cross-sectional analysis. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.pa3509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Reisinger N, Lohani S, Hagemeier J, Panebianco N, Baston C. Lung Ultrasound to Diagnose Pulmonary Congestion Among Patients on Hemodialysis: Comparison of Full Versus Abbreviated Scanning Protocols. Am J Kidney Dis 2021; 79:193-201.e1. [PMID: 34090905 DOI: 10.1053/j.ajkd.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 04/09/2021] [Indexed: 12/26/2022]
Abstract
RATIONALE & OBJECTIVE Pulmonary congestion contributes to morbidity and mortality in patients with kidney failure on hemodialysis, but physical assessment is an insensitive approach to its detection. Lung ultrasound is useful for assessing the presence and severity of pulmonary congestion, but the most widely validated 28-zone study is cumbersome. We sought to compare abbreviated 4-, 6-, and 8-zone studies to 28-zone studies. STUDY DESIGN Diagnostic test study. SETTING & PARTICIPANTS Convenience sample of 98 patients with kidney failure on hemodialysis presenting to an emergency department in the United States. TESTS COMPARED 4-, 6-, and 8-zone lung ultrasound studies versus a 28-zone lung ultrasound. OUTCOME Prediction of pulmonary congestion and 30-day mortality. RESULTS All patients completed a 28-zone lung ultrasound. Correlation coefficients (nonparametric Spearman) between each of the studies were high (all values > 0.84). Bland-Altman analysis showed good agreement. Each of the short-form studies discriminated well with area under the receiver-operator characteristic curve > 0.83 for no-to-mild versus moderate-to-severe pulmonary congestion. During a median follow-up period of 778 days, 46 (47%) died. Patients with moderate-to-severe pulmonary congestion on lung ultrasound had a 30-day mortality rate similar to that observed among patients with no-to-mild pulmonary congestion (OR, 0.95 [95% CI, 0.70-1.29]). LIMITATIONS Single-center study conducted in an emergency care setting, convenience sample of patients, and lack of long-term follow-up data. CONCLUSIONS Among hemodialysis patients presenting to an emergency department, 4-, 6-, or 8-zone lung ultrasounds were comparable to 28-zone studies for the assessment of pulmonary congestion. The mortality rates did not differ between those with no-to-mild and moderate-to-severe pulmonary congestion.
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Affiliation(s)
| | | | - Jesper Hagemeier
- University at Buffalo, State University of New York, Buffalo, NY
| | | | - Cameron Baston
- Penn Medicine, University of Pennsylvania, Philadelphia, PA
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4
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Lohani S, Sadasivam M, Rabb H, Atta MG. Persistent Interferon Production by Double Negative T Cells and Collapsing Focal Segmental Glomerulosclerosis. Nephron Clin Pract 2020; 145:85-90. [PMID: 33059348 DOI: 10.1159/000510759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/08/2020] [Indexed: 12/18/2022] Open
Abstract
Collapsing glomerulopathy has multiple associations, including viral infections, medications like bisphosphonates and interferon, autoimmune diseases, and genetic predisposition. We report a case of collapsing focal segmental glomerulosclerosis associated with persistently high levels of interferon gamma produced by T-cell receptor αβ (+), CD4- CD8- (double negative) T lymphocytes that progressed despite treatment and improvement of other cytokine levels. Double negative T cells are elevated and activated in autoimmune lymphoproliferative syndrome (ALPS). Production of elevated interferon gamma levels from double negative T cells in ALPS despite treatment provides insight to the pathophysiology of collapsing glomerulopathy, guiding future research for collapsing glomerulopathy.
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Affiliation(s)
- Sadichhya Lohani
- Division of Renal electrolyte and hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohanraj Sadasivam
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hamid Rabb
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mohamed G Atta
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
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5
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Abstract
History of contrast dates back to the 1890s, with the invention of the radiograph. Nephrotoxicity has been a main limitation in ideal contrast media (CM). High-osmolar contrast media no longer are in clinical use due to overwhelming evidence supporting greater nephrotoxicity with these CM compared with current CM. Contrast-induced nephropathy (CIN) remains a common cause of in-hospital acute kidney injury. The choice contrast agent is determined mainly by cost and institution practice. This review focuses on the history, chemical properties, and experimental and clinical studies on the various groups of CM and their role in CIN.
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Affiliation(s)
- Sadichhya Lohani
- Renal-Electrolyte and Hypertension Division, Penn Presbyterian Medical Center, Perelman School of Medicine, University of Pennsylvania, 51N 39th Market Street, Suite 240, Philadelphia, PA 19104, USA.
| | - Michael R Rudnick
- Renal-Electrolyte and Hypertension Division, Penn Presbyterian Medical Center, Perelman School of Medicine, University of Pennsylvania, 51N 39th Market Street, Suite 240, Philadelphia, PA 19104, USA. https://twitter.com/MichaelRudnick7
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Mullangi S, Sozio SM, Hellmann DB, Martire C, Lohani S, Segal P, Shafi T. Integrative Point-of-Care Ultrasound Curriculum to Impart Diagnostic Skills Relevant to Nephrology. Am J Kidney Dis 2019; 73:894-896. [DOI: 10.1053/j.ajkd.2019.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/11/2019] [Indexed: 02/06/2023]
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Koirala S, Shrestha BK, Lohani S, Bishokarma S, Devkota UP. Postoperative Complications of Transsphenoidal Pituitary Adenectomy: A Single Institution Based Experience. Kathmandu Univ Med J (KUMJ) 2019; 17:123-125. [PMID: 32632059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Inside a cranium, pituitary gland seats in an area of complex anatomical construct. Further it holds a very important physiological role to maintain all bodily function. Pituitary adenoma being one of the commonest tumors of that intricate area is preferably tackled with transsphenoidal approach. However, as in any surgery, it is also not without postoperative complications. Objective To examine and categorize all the postoperative complications that we have encountered in our center after pituitary surgery. Method A retrospective study of patients who had undergone transsphenoidal pituitary adenectomy in past five years was conducted at a tertiary level neurosurgical center and various postoperative complications during hospital stay were noted and analyzed. Result In our series of 53 patients, we met different postoperative complications, out of which diabetes insipidus (DI) was the commonest. Other electrolyte abnormalities excluding diabetes insipidus was the second most common followed by Cerebrospinal fluid leak. Post-operative hematoma requiring re-exploration, panhypopituitarism, seizure and meningitis were among the rare complications. No statistically significant association was noted between tumor size, patient age and sex with surgical complications. Conclusion Postoperative complications should be anticipated in transsphenoidal pituitary surgery even though it is considered to be a relatively safe undertaking. Knowing about these complications is the first step in preventing them.
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Affiliation(s)
- S Koirala
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - B K Shrestha
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - S Lohani
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - S Bishokarma
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
| | - U P Devkota
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal
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Hagaman AK, Khadka S, Lohani S, Kohrt B. Suicide in Nepal: a modified psychological autopsy investigation from randomly selected police cases between 2013 and 2015. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1483-1494. [PMID: 28856382 PMCID: PMC5705471 DOI: 10.1007/s00127-017-1433-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Yearly, 600,000 people complete suicide in low- and middle-income countries, accounting for 75% of the world's burden of suicide mortality. The highest regional rates are in South and East Asia. Nepal has one of the highest suicide rates in the world; however, few investigations exploring patterns surrounding both male and female suicides exist. This study used psychological autopsies to identify common factors, precipitating events, and warning signs in a diverse sample. METHODS Randomly sampled from 302 police case reports over 24 months, psychological autopsies were conducted for 39 completed suicide cases in one urban and one rural region of Nepal. RESULTS In the total police sample (n = 302), 57.0% of deaths were male. Over 40% of deaths were 25 years or younger, including 65% of rural and 50.8% of female suicide deaths. We estimate the crude urban and rural suicide rates to be 16.1 and 22.8 per 100,000, respectively. Within our psychological autopsy sample, 38.5% met criteria for depression and only 23.1% informants believed that the deceased had thoughts of self-harm or suicide before death. Important warning signs include recent geographic migration, alcohol abuse, and family history of suicide. CONCLUSIONS Suicide prevention strategies in Nepal should account for the lack of awareness about suicide risk among family members and early age of suicide completion, especially in rural and female populations. Given the low rates of ideation disclosure to friends and family, educating the general public about other signs of suicide may help prevention efforts in Nepal.
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Affiliation(s)
- Ashley K Hagaman
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - S Khadka
- Research Department, Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - S Lohani
- Nobel College, Pokhara University, Kathmandu, Nepal
| | - B Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
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Lohani S, Golenbiewski J, Swami A, Halalau A. A unique case of nephrogenic systemic fibrosis from gadolinium exposure in a patient with normal eGFR. BMJ Case Rep 2017; 2017:bcr-2017-221016. [PMID: 29025775 PMCID: PMC5652398 DOI: 10.1136/bcr-2017-221016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2017] [Indexed: 11/04/2022] Open
Abstract
A 57-year-old woman presented with swelling and thickening of the skin of the lower extremities. Three months prior to presentation, patient had MRI with gadolinium as part of an evaluation for suspected pancreatic malignancy. Creatinine levels at the time of gadolinium exposure were 0.9-1.2 mg/dL, with a corresponding estimated glomerular filtration rate of 64 mL/min/1.73m2 by modification of diet in renal disease equation. Twenty-four-hour urine creatinine clearance was performed as an outpatient following development of symptoms. This revealed a creatinine clearance of 23 mL/min, suggestive of advanced chronic kidney disease despite an estimated glomerular filtration rate of 64 mL/min/1.73m2 Skin biopsy was positive for sclerosing dermopathy. These findings, in addition to the temporal association with gadolinium exposure, led to the diagnosis of nephrogenic systemic fibrosis.
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Affiliation(s)
- Sadichhya Lohani
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Jon Golenbiewski
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Abhishek Swami
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
- Department of Nephrology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Alexandra Halalau
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
- Oakland University, William Beaumont School of Medicine, Rochester, Michigan, USA
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10
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Bhandari SS, Koirala P, Lohani S, Phuyal P, Basnyat B. Breathlessness at High Altitude: First Episode of Bronchoconstriction in an Otherwise Healthy Sojourner. High Alt Med Biol 2017; 18:179-181. [PMID: 28398844 DOI: 10.1089/ham.2017.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bhandari, Sanjeeb Sudarshan, Pranawa Koirala, Sadichhya Lohani, Pratibha Phuyal, and Buddha Basnyat. Breathlessness at high altitude: first episode of bronchoconstriction in an otherwise healthy sojourner. High Alt Med Biol.. 18:179-181, 2017-High-altitude illness is a collective term for less severe acute mountain sickness and more severe high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema, which we can experience while traveling to high altitude. These get better when we get down to the lower altitudes. People with many comorbidities also have been traveling to high altitudes from the dawn of civilization. Obstructive airway diseases can be confused with HAPE at high altitude. Asthma is one of those obstructive pulmonary diseases, but it is shown to get better with travel to the altitudes higher than the residing altitude. We present a case of 55-year-old nonsmoker, athletic, female, a lowland resident who developed difficulty breathing for the first time at high altitude. She did not get better with the descent to lower altitude and timely intake of acetazolamide. Her pulmonary function test showed obstructive airway pattern, which got better with salbutamol/ipratropium nebulization and oxygen.
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Affiliation(s)
| | - Pranawa Koirala
- 2 Mountain Medicine Society of Nepal, VT Carilion Clinic , Roanoke, Virginia
| | - Sadichhya Lohani
- 3 Mountain Medicine Society of Nepal, William Beaumont Hospital , Royal Oak, Michigan
| | - Pratibha Phuyal
- 4 Mountain Medicine Society of Nepal, Saint Vincent Medical Center , Bridgeport, Connecticut
| | - Buddha Basnyat
- 5 Oxford University Clinical Research Unit-Nepal, Centre for Tropical Medicine and Global Health, University of Oxford , Oxford, United Kingdom .,6 Nepal International Clinic , Kathmandu, Nepal
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11
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Abstract
A 53-year-old man presented with fevers, productive cough and decreased appetite. He emigrated from Iraq 4 years ago. Chest x-ray revealed a left lung consolidation. Respiratory cultures and two sets of blood cultures grew out pan-susceptible Klebsiella pneumoniae Liver ultrasound revealed a 6.4-cm complex lesion in the left hepatic lobe. A biopsy of the liver lesion produced bloody purulent aspirate; abscess cultures yielded a highly viscous pan-susceptible K. pneumoniae Klebsiella pneumoniae liver abscess syndrome is a newly described invasive syndrome due to a hypermucoviscous phenotype associated with serotypes K1 and K2 of Klebsiella. Although it is more commonly endemic to the Asian-Pacific region, it has been increasingly reported as an emerging global disease. We present the first case of this syndrome in a patient of middle-eastern descent. We also present pictorial evidence of the microbe's unique viscous, muculent texture grown on agar.
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Affiliation(s)
- Noora Kazanji
- From the Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA Address correspondence to Noora Kazanji, Department of Internal Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Rachel E Klein
- From the Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA Address correspondence to Noora Kazanji, Department of Internal Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Sadichhya Lohani
- From the Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA Address correspondence to Noora Kazanji, Department of Internal Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Amy N Mertens
- From the Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA Address correspondence to Noora Kazanji, Department of Internal Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
| | - Julie Le
- From the Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA Address correspondence to Noora Kazanji, Department of Internal Medicine, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, MI 48073, USA.
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Buttle T, Chreif H, Woods H, Lohani S. P38 Improved mortality and outcomes for patients requiring non-invasive ventilation managed in a dedicated hyper acute medical unit. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Simpson TRG, Constantinescu G, Mellor P, Lohani S, Khan B, Mushtaq M, Abdelhadi I, Bhattacharjee B, Serafimov V. P196 Percutaneous Ultrasound-Guided Biopsy of Intrathoracic Parietal Masses – a Safe Alternative to CT-Guided Biopsy? Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Barber-Meyer SM, Jnawali SR, Karki JB, Khanal P, Lohani S, Long B, MacKenzie DI, Pandav B, Pradhan NMB, Shrestha R, Subedi N, Thapa G, Thapa K, Wikramanayake E. Influence of prey depletion and human disturbance on tiger occupancy in Nepal. J Zool (1987) 2012. [DOI: 10.1111/j.1469-7998.2012.00956.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - S. R. Jnawali
- National Trust for Nature Conservation; Lalitpur; Nepal
| | - J. B. Karki
- Department of National Parks and Wildlife Conservation; Kathmandu; Nepal
| | | | | | | | | | - B. Pandav
- WWF International; Gland; Switzerland
| | | | | | - N. Subedi
- National Trust for Nature Conservation; Lalitpur; Nepal
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Abstract
BACKGROUND Lumbar disc surgery has come a long way since its fi rst description by Dandy in 1929. Evolving through the transdural approach and a laminectomy for the removal of a disc, it now surpasses the primal technique with essentially a minimally invasive procedure, an extradural approach without laminectomy. OBJECTIVE The objective of this study is to ascertain the effectiveness of Minimally Invasive Open Lumbar Discectomy in the treatment of lumbar disc prolapse. MATERIALS AND METHODS It is a descriptive study entailing the patients with paramedian or central disc prolapse at single or two consecutive lumbosacral levels undergoing surgery at the National Institute of Neurological and Allied Sciences, Bansbari, Nepal, over a period of one and a half years. Patients who underwent either laminectomy or bilateral fenestration were excluded. Results of surgery were measured prospectively in terms of primary outcome measure (outcome at six months follow up as measured with Prolo Functional and Economic Scale) and secondary outcome measures (radicular pain relief, mobilisation, complication, and residual disc). RESULTS In the series of 137 consecutive patients, 120 fulfilled the criteria. 98.33 % of patients had an improvement in the radicular pain and ambulation was commenced from the fi rst post-operative day. There were three instances of inadvertent dural tear without fascicle injury, and one instance of residual disc requiring reoperation. At 6 months, 97.5 % had good to excellent (grade 4, or 5) results reaching the premorbid states in the Prolo Functional and Economic Scale. CONCLUSION The results of Minimally Invasive Open Lumbar Discectomy compare favourably with those of a microlumbar discectomy, and could therefore be an alternative to the latter in resource deprived circumstances.
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Affiliation(s)
- Upendra P Devkota
- National Institute of Neurological and Allied Sciences, Bansbari, Nepal.
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Lohani S, Devkota UP. Hearing preservation in 2.7 cm vestibular schwannoma. JNMA J Nepal Med Assoc 2009; 48:158-161. [PMID: 20387360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Hearing preservation is exceedingly difficult in vestibular schwannoma surgery, especially with increasing tumor size. We herein report a case of hearing preservation in a 2.7 cm vestibular schwannoma, where the patient maintained her pre-operative hearing threshold of 55 dB till a year after surgery. Hence, it appears that an attempt at hearing preservation is worth pursuing.
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Affiliation(s)
- S Lohani
- National Institute of Neurological and Allied Sciences, Bansbari, Kathmandu, Nepal.
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Lohani S, Varma R, Leahy B. A case of pulmonary sequestration with Aspergillus species infection presenting as an enlarged right paratracheal mass. J Thorac Cardiovasc Surg 2005; 129:1459-60. [PMID: 15942604 DOI: 10.1016/j.jtcvs.2004.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S Lohani
- Wythenshawe Hospital, Manchester, United Kingdom.
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Karki DB, Lohani S. ELECTOCARDIOGRAPHIC INTERVALS, DURATIONS AND AXIS OF HEALTHY NEPALESE DOCTORS WITH NORMAL ELECTROCARDIOGRAM. JNMA J Nepal Med Assoc 2003. [DOI: 10.31729/jnma.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
ABSTRACT
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