Med Phoenix

Correlation of Glycated Hemoglobin with Serum Triglyceride to High Density Lipoprotein Ratio in Type 2 Diabetes Mellitus Patients

Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Diabetes mellitus is an endocrine disorder characterized by hyperglycemia. It may be due to a defect in insulin secretion or action or both. Importantly, lipid metabolism is also abnormal in diabetes such as an increment of TG level and reduction in plasma HDL level which is the major cardiovascular risk. Glycated hemoglobin is measured to monitor the long-term glycemic status of the patients.
Materials and Methods: The current study is designed retrospectively to find out the correlation between HbA1C and TG to HDL ratio. The data onthe lipid profile of newly diagnosed diabetes mellitus were retrieved from the laboratory software of National Medical College, a tertiary care hospital in Madhesh province, Nepal. The categorical data were expressed in frequency and percentage and continuous data were expressed in mean and standard deviation depending on their distribution. Pearson correlation analysis was used to correlate the glycated hemoglobin and TG to HDL ratio.
Results: The current study investigated the diabetic and lipid profile in 604 retrospectively enrolled patients. Out of which 358 (59.3%) were diabetic and 246 (40.7%) were healthy subjects.The comparison of serum lipid levels between diabetes and healthy subjects revealed a significant difference concerningTriglycerides, total cholesterol, HDL, LDL, and VLDL (P value less than 0.05). The correlation analysis revealed a significant positive correlation betweenTG/HDL ratio and glycated hemoglobin (0.09, 0.02).
Conclusion: Our results revealed the correlation between HbA1C and TG/ HDL ratio in the Nepalese diabetic population. Hypertriglyceridemia was common in diabetic patients. Elevation of the TG/HDL ratio aggravates the cardiovascular risks in the diabetic patients.

Functional Outcome of Locking Compression Plate in Distal Femur Fractures

Gaurav Gupta, Rabins Kumar Sah, Prashant Thakur, M. Ruhullaha, Subash Thapa — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Distal femur fracture is common in young people with high velocity injury. Management of distal femur fractures is a therapeutic challenge in orthopedics practice due to its extensive soft tissue injuries, bone loss, comminution, articular extension, instability.Open reduction with internal fixation replaces previous trend of closed conservative management and external fixation. Distal femoral locking compression plate (DF-LCP) requires both locking and compression screw fixation of the femur shaft. DF-LCP has been rapidly adopted as an alternative to intramedullary nails, blade plates and non-locking condylar screw.
Materials and Methods: Prospective interventional study was done in department of orthopedics at National Medical College and Teaching Hospital, Birgunj for one year among 45 patients of age more than 18 years with post traumatic closed or open GA Type I, II distal femur fractures, AO Muller type A and C fractures. Ethical approval was obtained from institutional review committee and proper informed consent was taken. Type of implant used was DF-LCP.NEER’S scoring system was used for
functional outcome.
Results: Out of 45 patients, 42 patients with distal femur fracture were treated by DF-LCP.Three patients lostduring follow up hence removed from study. Out of 42 patients, mean age of the patients was 36.62 years. Most of them 31, (73.8%) were male. Predominant fracture was on right side 29 (69%).The study finding showed that 30 (71.4%) sustained injury due to road traffic accidents. Most of the patients 18 (42.9%) had type A2 fracture according to AO Muller distal femur fracture classification. Complications like surgical site infection observed in 3 cases. 100% union rate achieved with an average union time of 17.26 weeks. On evaluation according to Neer’s criteria mean score was 82.1 (Range: 48-96). Out of 42 patients 24 (57%) had excellent, 14 (33%) had good, 3 (7.2%) had fair and 1 (2.4%) had poor result.
Conclusion: The study concluded DF-LCP is effective treatment for distal femur fracture. It provides stable construct for fracture union with excellent functional outcome.

Superficialization of the Basilic Vein in Brachiobasilic Arteriovenous Fistula: An Alternative Vascular Access for Hemodialysis- A Single Center Experience

Sun, 31 Dec 2023 00:00:00 +0000

Introduction: The use of basilic vein to create brachiobasilic arteriovenous fistula (BBAVF) is the vascular access option of choice for hemodialysis when cephalic veins are not available. To create BBAVF, the basilic vein should be superficialized and lateralized. The study aims to highlight the outcome and morbidity of BBAVF at the tertiary referral center and aims to improve the results of the procedure in patients with chronic renal failure.
Materials and Methods: This is prospective, descriptive study conducted at College of Medical Sciences Teaching Hospital from January 2019 to December 2022.The demographic data, morbidities, results were analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0 (SPSS).
Results: We evaluated outcome of total forty patients who underwent BBAVF with transposition of basilic vein. The mean age of patients was 61 ± 10.85 years and male:female ratio was 2.07:1. The mean size of basilic vein was 3.05 ± 0.84mm and brachial artery was 4.11 ± 0.99mm. The most common co-morbidities in this study was Diabetes Mellitus and hypertension both was present in 52.5% of patients, only hypertension in 27.5%, only Diabetes Mellitus in 5%, HTN with PVD in 2.5% and HTN, Diabetes Mellitus with PVD in 2.5% of patients. The postoperative complications were bleeding in 25% (10), infection 10% (4), primary failure 7.5% (3), pseudoaneurysm 5% (2), and oedema 7.5% (3).Total 82.5% (33) of cases were able to start dialysis in 45 days. The failure rate was 12.5% (5) due to thrombosis and pseudoaneurysm.
Conclusion: BBAVF is a suitable option for vascular access in patients with failed previous AVF or patients with small cephalic vein. Relocation of basilic vein for AVF is feasible, safe and with good patency and complication rates are acceptable.

Assessment of Functional Outcome of Humeral Diaphyseal Fractures Treated with Dynamic Compression Plate at National Medical College and Teaching Hospital, Birgunj, Nepal

Mukesha Prasad Kushwaha, Vandana Mourya, Sandip Kandel — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Fractures of the humeral shaft account for roughly 3-5% of all fractures and result from direct and indirect trauma. Common mechanism for this fractures include fall on the motor vehicle accidents, fall on out stretched hand and direct loads to the arm. The shaft of humerus fracture is managed largely conservatively, but with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, more time consuming with conservative management, many surgeon are increasingly likely to consider surgical management. The aim of our study is to assess the functional outcome of dynamic compression plate in shaft of humerus fracture.
Materials and Methods: This is a prospective observational study conductedm in department of orthopedic surgery, NMCTH, Birgunj among 45 patients from 17 years and above presenting with shaft of humerus fracture. The fracture was classified according to AO classification. The patients were treated with open reduction and internal fixation with dynamic compression plate and followed up at 2 weeks, 6 weeks, 12 weeks and 24 weeks till the radiological union was achieved. American shoulder and elbow surgeon’s scoring system was used to assess the final outcome of the study.
Results: 45 patients meeting inclusion criteria were included in the study, 3 patients lost follow up hence removed from study. Out of 42 patients, mean age of the patient was 31.95 years. Most of them 27(64.3%) were male. Predominant fracture was on left side 73.8% (31 patients). The study finding showed that 31(73.8%) sustained injury due to road traffic accidents. Majority of the fractures 32(76.20%) were in middle 1/3rd. Most of the patient had A3 type of fracture according to AO classification. The mean post-operative immobilization was 15 years. Forty one (97.61%) fracture united with one (2.39%) fracture going into non-union with mean time of 16.04 weeks. Thirty-seven (88.10%) patients has excellent range of motion of elbow and shoulder while 3(7.10%) had good and 2(4.8%) patient had poor functional outcome. The average ASES score obtained at 24 weeks was 47.07.
Conclusion: From our study, it is concluded that open reduction and internal fixation with DCP in shaft of humerus fracture provides excellent functional outcome.

Obstetric Near Miss Events at a Tertiary Care Centre, Birgunj

Pravin Shah, Ravi Kumar Shah, Rehana Mushtaq, Sana Ansari, Ruby Shrestha — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Near miss cases are the ones who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Near-miss is recognized as the predictor of the level of care and maternal deathand thereforea review of near-miss obstetric eventsis useful to investigate maternal mortality. The study was meant to determine the ratio and nature of near-miss obstetric cases and associated factors.
Materials and Methods: This was a prospective observational study done in the Department of Obstetrics and Gynaecology at National Medical College and Teaching Hospital from 1st February 2022 to 31st January 2023. Ethical approval was obtained from IRC (Ref. F-NMC/537/077-078).The near-miss cases were identified among the admitted obstetric cases using the five-factor scoring system and followed till their discharge or death.The assessment of the causes of near-miss cases was done.
Results: During the study period, 1163 live births, 33 near-miss cases, and5 maternal mortalities were recorded. The incidence of near-miss was 28.37 per 1000 live births, the mortality index was 13.16% and the near-miss to maternal mortality ratio was 6.6: 1. Haemorrhage (39.39%) was the most common event responsible for near-miss, followed by hypertensive disorders (24.24%). Similarly, cardiovascular (78.79%) was the most common organ dysfunction recorded, followed by hepatic (33.33%).
Conclusion: Haemorrhage and hypertensive disorders are the major causes of near-miss events. Identification and evaluation of the factors of near-miss cases can reduce maternal morbidity and mortality, as special preventive actions for the management of its complications can be planned. It is also worth presenting near-miss cases in national indices.

A Comparative Study of Bupivacaine and Bupivacaine with Fentanyl for Subarachnoid Block

Rajesh Yadav, Niraj Kumar Keyal, Rupesh Mahato — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Subarachnoid block (SAB) is the anesthesia of choice for lower abdominal and lower limb surgeries. The objective of the study was to evaluate and compare the onset, duration, recovery of neural blockade, hemodynamic changes and side effects of bupivacaine alone with fentanyl added to bupivacaine.
Materials and methods: This cross sectional comparative study was conducted in Department of Anaesthesia at National Medical College in 82 patients from April 2023 to September 2023 . Patients of either sex as per American Society of Anaesesiologists, Physical Status I-II between age 20- 60 years were randomly allocated to one of two groups of 41 each.
Results: This study showed that there was highly significant difference in the highest level of sensory block achieved between mthe two groups (p < 0.001 ) and motor blockade. Most of patients receiving bupivacaine alone (Group B) had achieved T6 dermatomal sensory level block and Bromage score of 4, while patients receiving fentanyl with bupivacaine (Group F) achieved T8 and also Bromage score of 3 respectively. The mean duration for highest sensory level in group F and group B was 7.76 and 9.66 minutes, respectively. The mean duration for 2 segment regression in group F and group B was 95.28 and 67.24 minutes respectively. Hypotension was significantly high in Group B.
Conclusion: Fentanyl added to bupivacaine has an earlier onset of action, prolonged sensory analgesia but earlier motor recovery compared to bupivacaine alone but a comparatively lower sensory dermatomal level without complete motor blockade, adequate for surgical procedures.

Prevalence of Stress and Anxiety among Oral Healthcare Workers during COVID-19 Pandemic: Cross-Sectional Study

Saroj Prasad Deo, Bharat Kumar Goit, Dharnidhar Baral — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: The COVID-19 pandemic has significantly affected oral health care workers’ lives in all dimensions. They face mental health challenges due to public health actions, such as physical distancing and quarantine, which can make us feel isolated and lonely and increase stress and anxiety. This study aimed to find the prevalence of stress and anxiety among online respondent oral healthcare workers during the COVID-19 pandemic.
Materials and Methods: This prospective descriptional cross-sectional study was conducted from 24 June 2020 to 13 July 2020 among oral health care workers in a tertiary care centre. Ethical approval was taken from the Ethical Review Board (Reference number: 2710). A convenience sampling method was used. The data were collected using a questionnaire through Google Forms. Point estimate and 95% Confidence Interval were calculated.
Results: Among 133 oral health care workers, the prevalence of anxiety and stress was found to be 32(24.06%) (17.96 30.16 at 95% Confidence Interval) and s 11(8.27 %) (4.34 12.20, 95% Confidence Interval), respectively.
Conclusion: The prevalence of anxiety among oral health care workers was slightly lower, but higher stress was observed than in similar studies done in similar settings and methods. Further research in this field is needed.

Premature Menopause and its Association with Dyslipidemia

Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Premature Menopause is defined as premature ovarian failure before the age of 40 years with a consecutive 12 months of amenorrhea. Menopause affects 1% of women under the age of 40 years. It is seen in 10‑28% of primary amenorrhea and 4‑18% of secondary amenorrhea. Estrogen deficiency occurring during premature menopause causes decrease in HDL level and increase in LDL, cholesterol and triglycerides levels thus causing dyslipidemia. Regardless of cause, women who experience estrogen deficiency at an early age before the natural menopause are now considered to be at increased risk for premature morbidity and mortality. The current study is aimed to find out the impact of premature menopause on the blood lipid level in the current population.

Materials and Methods: Ninety-six cases of premature menopause women were enrolled retrospectively for the study. Complete Lipid profile – Serum Total Cholesterol, Serum Triglyceride, Serum HDL, were measured in fully automated biochemistry analyzer and Serum VLDL and Serum LDL were estimated by Friedewald's Formula.

Results: The current study revealed the lipid profile status of premenopausal women. The prevalence of dyslipidemia was observed in 57 cases (59.4%) and remaining 39 cases (40.6%) were having normal lipid levels. On comparing the serum lipid levels statistical significance were observed in Total cholesterol (P value: 0.00), Triglyceride (P value: 0.00), LDL-C (P value: 0.00), and VLDL-C (P value: 0.00). However, no statistically significant difference was observed in HDL cholesterol (P value: 0.15).

Conclusions: Serum Lipid levels is deranged in the women with premature menopause (Age < 40 years) and thus dyslipidemia, particularly noticed with the Total cholesterol and triglyceride levels. The path-physiology lying behind dyslipidemia can be correlated to the premature ovarian failure and estrogen deficiency.

Quality of Work life of Nurses in a Government Hospital, Chitwan

Aakriti Rai, Shila Lamichhane, Tanuja Kumari Chaudhary, Beth A Brooks — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Work is an integral part of life where employees spend about one third of their entire life in workplace, thus working environment must be favorable. When the quality of work-life is stable, productivity is bound to increase. It seeks to benefit employees, their families, and the organization as well. The objective of the study is to identify the quality of work life of nurses working in Bharatpur hospital, Nepal.
Materials and Methods: A descriptive cross sectional study design was used. The total number of 84 nurses from Bharatpur Hospital were purposively selected. Non-probability convenience sampling techniques was used to select a nurse working in Bharatpur Government hospital, Bharatpur, Chitwan having maximum of 6months job experience. Data were collected using standardized Brooks’ Quality of Nursing Work Life Survey tool. Data were analyzed using the statistical package of social science(SPSS) version 20.0. Inferential statistic was used to measure the association between quality of life of nurse and selected variables.
Results: The study revealed that overall quality of work life were moderate (79.8%) of respondents. The findings on dimension wise quality of work life of nurses were 83.3%, 67.3% and 65.5% of respondents had moderate level of quality in work design, home life/ work life and work world dimension respectively, while 57.1% of respondents had high level of quality of work life of nurses in work context dimension. The Quality of Work Life of nurses was associated with level of education (χ2=11.027, p= 0.004).
Conclusions: The majority of nurse had moderate level quality of work life. The authorities in the health care system should develop strategies for improving the nurses work conditions and their quality of work life so that, nurses will be able to perform quality care for their patients.

To Assess the Knowledge and Determinants Associated with Blood Donor at National Medical College & Teaching Hospital, Birgunj

Sun, 31 Dec 2023 00:00:00 +0000

Introduction: In clinical practice, the two most crucial systems of blood grouping are ABO and Rh. There exist four primary blood types, namely A, B, AB and O. World Health Organization advocates for the compulsory screening of all blood donations prior to usage, with HIV, hepatitis B and C, as well as syphilis being mandatory. The aim of the study is to assess the knowledge and determinants associated with blood donors at National Medical College & Teaching Hospital, Birgunj.
Materials and Methods: Proposal was reviewed by the Institutional Review Committee of National Medical College and approved on 9th July 2023. (Ref. F-NMC/662/079-080). A descriptive cross-sectional study was done in the blood donation programs organized in the premises of National Medical College. Sampling method used was census.
Results: Of the total particiants, 41.3 % were overweight followed by 39.1 % who showed the normal weight and 7.6 % of the people were found to be underweight. The upper middle-class group accounted for 71.7 % of the total respondents, knowledge about how frequently a person can donate the blood were in 38(41.31%), the volume of blood collected in one pint at the time of donation was 33(35.86%), time taken nearly 5-8 minutes were 64 (69.56%). Among the donors 17(18.47%) had donated for first time in their life similarly for second time and more than three times were 38(41.31%), 38(41.31%), 26(28.26%) and 11(11.95%), respectively.
Conclusion: The overall level of knowledge was satisfactory. Male participants had more practice regarding blood donation rather than females. Community shall be benefited by similar set up as made by health workers, blood bank and hospital.

A Study of Tuberculous Pleural Effusion in Province 2, Southern Nepal

Roshan Kurmi, Anand Chaurasiya, Sudhakar Jha, Sanjay Kumar Sah — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Tuberculosis (TB) is a major public health problem in developing countries. Tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis (TB) (after lymphatic involvement) and is the most common cause of pleural effusion in areas where TB is endemic. The aim of this study is to depict the pattern of the Tuberculous Pleural Effusion (TPE) with its clinical presentation and diagnosis along with the different laboratory parameters of the TB patients at a tertiary care center of the Southern Nepal.
Materials and Methods: A prospective hospital based cross-sectional study enrolling 107 subjects diagnosed as TBPE presenting to the Department of Internal Medicine, National Medical College was carried out from 15th March, 2023 to 14th October, 2023 (7 months). The different data collected were put in Excel Sheet and analyzed using SPSS version 26. The formal written and verbal consent was taken from the participants and ethical clearance was taken from Institutional Review Committee (IRC), National Medical College, Birgunj (Ref. F-NMC/633/079-080).
Results: A total of 107 subjects diagnosed with TBPE showed 67.3 % (n=72) male and 32.7% (n=35) female participants. Majority of the participants (88.8%) presented with fever, and approximately 59% of the participants had chest pain. Almost 65% of them had dyspnea and 77% presented with frank cough. Majority of the participants had right sided effusion. Pleural ,fluid examination showed increased total leukocyte count (mean 3191 cells/cu mm) and with lymphocytic predominance and increased protein content (5.07±0.91 g/dL). Pleural fluid Adenosine Deaminase (ADA)was found to be elevated (86.5±26.4 U/L).
Conclusion: The common presentation of the Tuberculous pleural effusion is deranged laboratory parameters of pleural fluid with increased fluid total leukocyte count having lymphocytic predominance and increased protein content along with high ADA levels.

Panhypopituitarism due to Sheehan’s Syndrome in a Patient with Recurrent Hyponatremia: Case Report from Nepal

Sudip Niroula, Anil Kumar Shah — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Panhypopituitarism, deficiency of all pituitary hormones (anterior pituitary hormones: adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, growth hormone; posterior pituitary hormones: oxytocin, vasopressin). Sheehan’s syndrome also known as postpartum hypopituitarism is one of the causes of panhypopituitarism, which is characterized by hypopituitarism due to necrosis of pituitary gland secondary to massive postpartum hemorrhage. In this case, a 50 years female presented with the history of vomiting and loss of appetite since 2 years with severe hyponatremia, and decreased pituitary hormones levels in laboratory findings with significant obstetric history is diagnosed with Sheehan’s Syndrome.

Clinical, Radiographic and Analytical Findings of Atypical Rabies Encephalitis in a Five-Year-Old Boy: A Case Report

Manoj Kumar Gupta, Prakriti Acharya, Aman Jha, Prabin Paudel — Sun, 31 Dec 2023 00:00:00 +0000

Introduction: Rabies is an almost always fatal disease that doctors and patients fear because of its bleak prognosis and limited treatment choices. In the absence of special laboratory investigations at the point-of-care facility, the diagnosis is usually clinical. We present a case of rabies encephalitis with a dog bite history and standard MRI findings that can be used for early identification in the absence of usual clinical signs and specialized diagnostic testing.

Effect of Vitamin A Deficiency in Thyroid Health

Sanjay Kumar Sah, Brijesh Shrestha, Pradeep Kumar Chaudhary — Sun, 31 Dec 2023 00:00:00 +0000