Journal of College of Medical Sciences-Nepal

Correlation of Total Serum Prostate Specific Antigen and Prostate Specific Antigen Density with subclinical inflammation in Benign Prostatic Hyperplasia

2024-01-21T04:34:58+00:00

Background
Serum PSA is an important tumor marker for diagnosis of prostate cancer. However, it can rise in some other benign conditions like benign prostatic hyperplasia (BPH), prostatitis, prostatic infarct, instrumentation, prostate manipulations like examination, transurethral resection and urinary tract infection (UTI). The aim of this study was to find correlation of total serum PSA and PSAD with extent and aggressiveness of subclinical inflammation in BPH.
Methods
This cross-sectional study was conducted on 25 cases of transurethral resection of prostate and open prostatectomy specimens diagnosed with BPH received in time period of July 2022 to June 2023. Cases with clinical signs and symptoms of prostatitis, positive urine culture, diagnosed as prostate cancer, cases with history of previous surgery of prostate and history of instrumentation of urinary tract were excluded. Total serum PSA and prostate weight were measured. PSAD was calculated. Histological inflammation was graded with respect to extent and aggressiveness. PSA and PSAD were correlated with extent and aggressiveness of inflammation.
Results
There was no statistically significant correlation between inflammation extent score and total serum PSA (p = 0.318). Also, there was no correlation between inflammation extent score and PSAD (p = 0.308). However, there was significant correlation between inflammation aggressiveness score and total serum PSA (p = 0.011). Similarly, there was also correlation between inflammation aggressiveness score and PSAD (p = 0.010).
Conclusions
Repeat unnecessary biopsies may be avoided in cases with high total serum PSA in presence of glandular epithelial disruption in histological prostatitis.

Utility of DECAF Score as A Bed Side Tool in Predicting Outcomes in Patient with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

2024-01-02T15:40:26+00:00

Background
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be fatal. It is the third leading cause of death worldwide, causing 3.23 million deaths in 2019. The DECAF (Dyspnea, Eosinopenia, Consolidation, Acidemia, Atrial Fibrillation) score is a widely used system for predicting the survival of patients with AECOPD. It uses Routinely available indices, is quick and can be easily used by clinicians to identify sick patients who need vigilant care.
Methods
A cross sectional study was conducted at College of Medical Sciences Teaching Hospital, Bharatpur for 6 months. Patients with COPD meeting inclusion Criteria were selected and the DECAF score at time of admission was calculated. Their duration of hospital stay, use of ventilator and final outcome were noted and its relation to the Decaf score was analysed.
Results
A total of 163 patients (Male-87, Female-76) were included in the study. The mean age of the patients was 70 ±10 years and mean duration of hospital stay was 5.91±2.19 days. There is significant relationship between DECAF score and the mortality (p-value < 0.001) with higher the score higher the chance of not improving. Analysis between the DECAF score and length of Hospital stay by regression equation found the regression coefficient 0.410 to be significant (p-value < 0.001) indicating that if DECAF score increases by one, the length of hospital stay will also increases by 0.41 day.
Conclusions
Patients with a DECAF score of four or higher have a significant risk of mortality as well as long duration of hospital stay. Thus, DECAF is a simple tool that incorporates routinely available indices to predict adverse outcomes in AECOPD.

Prevalence and Epidemiological Profile of Medico-legal Cases of Suicidal Autopsy at a Tertiary Care Hospital of Central Nepal

2024-03-17T06:56:03+00:00

Background
A medico-legal case (MLC) arises from an unnatural incident causing physical harm, necessitating intervention and legal resolution. MLCs integrate medical and legal aspects, requiring both a physician's assessment and an investigation by law enforcement, often involving autopsy. The objective of this study was to find the prevalence and epidemiological profile of medico-legal autopsy cases of suicide at a tertiary care hospital of central Nepal.
Methods
A retrospective cross-sectional study conducted at College of Medical Sciences, Bharatpur, Chitwan, Nepal, between December, 2023 and February, 2024 on suicidal autopsy cases. Suicidal autopsy data of last three years (from 2077/78 to 2079/80) were collected from the Bharatpur hospital's autopsy record file. Descriptive statistical tools were used for data analysis. For, categorical variables frequency and percentage were calculated while mean and standard deviation were used for continuous variables. Data was entered and analyzed by using SPSS-20.
Results
The prevalence of Medico-legal cases of suicidal autopsy in Chitwan district in last three year is 29.16% (with 95% CI as 27.23% to 31.16%). The trend of suicidal autopsy in last three year is in increasing trend in this area. Majority (21.86%) of suicidal cases were in the age group 46-60 years. Male (64.11%) cases dominated female cases in Suicidal autopsy. Majority (34.42%) of suicidal attempt was at 6-12:00 noon and the most common method of suicidal attempt cases were by hanging (81.57%). Most of the case were in Monday and in occurred in Ashoj.
Conclusions
The trend of suicidal autopsy in the last three year is in increasing trend in central Nepal. Among the total autopsy cases, prevalence of suicidal autopsy is one third. The burden of suicidal cases is significantly high among male

COVID-19 Vaccine Acceptance and Its Associated Factors Among Young Adults

2023-05-21T08:43:18+00:00

Background
COVID-19 pandemic, which has rapidly spread throughout the globe in several waves and mutations, was initially identified in Wuhan, China, in late 2019. Vaccines against this deadly virus were developed quickly in about a year. Despite the availability of vaccines, acceptance of the vaccines among the general population is influenced by various factors and are important to be identified for a successful vaccination program. The objective of this study was to evaluate the COVID-19 vaccine acceptance among young adults and its associated factors.
Methods
Nepalese young adults were surveyed online using a descriptive cross-sectional study approach. A bilingual, self-administered questionnaire consisting of six parts-socio-demographic information, health-related information, knowledge and attitude/ beliefs about COVID-19, perceived threat to COVID-19, beliefs about COVID-19 vaccination, and vaccine acceptability was used to collect data. The collected data was analysed using SPSS version 20.
Results
Out of the 467 participants surveyed, most of them (94.2%) were willing to take the vaccine. Among them, 80.5% were willing to take it immediately. The main reason for COVID-19 vaccine refusal was because of doubt about the safety of the COVID-19 vaccine. The regression results showed that healthcare-related professionals/students and perceived benefits of the COVID-19 vaccine were significantly associated with vaccine acceptance.
Conclusions
This study reflected the high acceptance of COVID-19 vaccination among Nepalese adults during the pandemic. Concerned authorities and health professionals should emphasize addressing concerns about vaccine safety and disseminating information about the benefits of vaccines to overcome vaccine hesitancy.

Clinico-Epidemiological Profile of COVID-19 of Patients Presenting to Emergency Department of a Tertiary Medical College of Central Nepal

2024-03-13T09:59:08+00:00

Background
Clinico-epidemiological profile of COVID-19 includes varied clinical symptoms like fever, cough, and fatigue, with a potential for rapid community spread through respiratory droplets. Understanding the clinical characteristics of patients is crucial for planning human resources and logistics support. This study aims to identify the clinical characteristics observed in patients suspected of having COVID-19 presenting to emergency department of College of Medical Sciences and Teaching Hospital.
Methods
This is a retrospective cross-sectional study conducted at Department of General Practice and Emergency Medicine of College of Medical Sciences, Bharatpur, Nepal from April 2020 to February 2021. Ethical approval was taken from institutional review committee of College of Medical Sciences. Data was collected from record file of emergency department. Data was entered and analyzed by using descriptive statistical tools in SPSS-20.
Results
Majority (25.2%) of them were in the age group 50-60 years. Mean±SD of age was 55.2±16.5 years. Majority (54.3%) respondents were male. In presenting complaints 71.42% had cough, 69.5% had fever, 62.9% had shortness of breath. Also, 34.28% had severe symptoms, and 33.34% had moderate symptoms, 20% were asymptomatic and 12.38% had mild symptoms. Finding showed that 69.52% of patients required oxygen supplementation. The motility of COVID-19 patients during emergency stay was 6.67% while 36.19% were admitted in ward and 31.43% were admitted in ICU, 20% patients were sent for home isolation.
Conclusions
Young adults were the most commonly affected age group and males showed a higher incidence of COVID-19. Since many patients were symptomatic with fever and cough as the typical presentations in the emergency department. Majority of patients during presentation had moderate and severe symptoms and needed oxygen supplementation.

Cost Analysis of Antihypertensive Therapy in the Hypertensive Patients

2024-01-19T04:17:32+00:00

Background
Hypertension is an established chronic disease with a huge economic burden to society so choosing cost effective medication is essential. Several medications are available and the decision lies in the prescriber so the generation of evidence suggesting cost-effective medication is essential. The objective of the study was to explore cost effective treatment of hypertension.
Methods
A descriptive cross-sectional study was carried out among hypertensive patients of 20-69 years of age taking antihypertensive medicines for more than one year. Four commonly prescribed drug groups were included: calcium channel blocker, angiotensin receptor blocker, diuretics plus calcium channel blocker, and angiotensin receptor blocker plus calcium channel blocker. The direct medical cost, direct non-medical cost and overall cost of each class of antihypertensive medicine group was estimated as the median cost of that class. The cost-effectiveness relationship was described as a ratio of annual median cost to proportion of patients with controlled hypertension for each pharmacological group.
Results
Angiotensin receptor blocker was the group with lowest annual overall median cost (8915 NPR). Cost effectiveness relationship of calcium channel blocker group was the lowest (10537.83) followed by angiotensin receptor blocker (15115.25) and calcium channel blocker plus angiotensin receptor blocker (21305.69).
Conclusions
Calcium channel blocker was the most cost effective group of antihypertensive drugs. The direct medical costs accounted for high amount of costs for hypertensive patients in all four groups.

Prevalence and Pattern of Zygomatic Complex Fracture in a Tertiary Care Hospital of Central Nepal

2024-03-05T04:19:25+00:00

Background
Zygomatic complex fracture is one of the commonest fractures of face leading to facial asymmetry. Various classification systems describing the pattern have been reported. The aim of this study was to determine the prevalence and pattern of Zygomatic maxillary complex fracture in tertiary centre hospital of Nepal based on two different classifications.
Methods
A prospective observational study was conducted on College of Medical Sciences, Teaching Hospital, Chitwan from September 2021 to August 2023 with all cases of facial injuries. Computed Tomography scan of the cases were considered and 371 cases with Zygomatic maxillary complex fracture were studied. Apart from the demographic data, Knight and North classification and Zing Classification of the fractures were recorded. The data was tabulated and analysed using SPSS 20.
Results
Zygomatic maxillary complex fracture was prevalent in third decayed of life with mean age of 28.45 years. Male (286) were more affected. Road traffic accident is primary cause of the fracture in our study. Type III fracture (31.35%) on Knights classification is commonest pattern followed by type VI (18.65%), type V (13.99%) and type II (14.77%). On Zing classification type B (53.89%) of Zing classifications is more prevalent followed by type C (19.69%) and type A2 (17.36%).
Conclusions
The study describes the demographic distribution, aetiology and pattern of Zygomatic complex fracture in a tertiary hospital.

Relationship between Serum Ferritin and Thyroid Hormones: A Hospital Based Cross Sectional Study

2024-03-17T05:01:04+00:00

Abstract

Background: Thyroid gland is one of the major endocrine gland, which plays a key role in growth, differentiation, development, and maintenance of body homeostasis. Trace elements like iron, selenium, iodine and zinc are needed for the normal functioning of the thyroid glands. So, deficiencies of these elements can impair thyroid functions.

Objectives: The objective of our study was to assess the relationship between serum ferritin and thyroid hormones.

Materials and methods: A descriptive cross-sectional study was carried out in the department of Biochemistry of College of Medical Sciences in Bharatpur, Chitwan, Nepal, from 1^st June, 2023 to 1^st December 2023. The patient visiting to medicine OPD were included and patients with confirmed case of thyroid disorder and iron deficiency anemia were excluded from the study.

Conclusion: In our study there was statistically significant relationship between iron deficiency anemia and hypothyroidism. So, Ferritin level should be assessed in hypothyroid subjects.

Keywords: Serum Ferritin, Thyroid hormones, Hypothyroidism,

Choosing Retrograde Intrarenal Surgery Versus Mini-Percutaneous Nephrolithotomy in Proximal Ureteric Stones

2024-03-03T08:27:56+00:00

Background
Proximal ureteric stone is one of the common presentations in renal stones disease. Safety, efficacy and stone free rate of retrograde intrarenal surgery and mini percutaneous nephrolithotomy are controversial. Thus, we aim to compare the efficacy, safety and stone free rates of two procedures.
Methods
This was a retrospective observational study including 60 cases divided into group A (Retrograde-intrarenal Surgery) and Group B (Mini-Percutaneous Surgery) between September 2022 to August 2023. Ethical approval was obtained from Institutional review Committee (Reference number: CMC-IRC/079/080-100). Convenience sampling was done.
Results
The mean age in group A was 43.83 ± 16.92 years and in group B was 46.33 ± 15.78 years with no significant p value (p = 0.112). Post operative haemoglobin changes in group A was 0.266 ± 0.279 gram% and in group B was 1.493 ±0.360 gram% with significant P value of 0.001. Similarly the duration of operation in Group A was 42.43± 13.783 minutes and in group B was 36.30 ± 7.173 minutes with significant P value 0.035. However the stone free rate was higher in group B than Group A without significant P value of 0.064. Both of the groups have minor post operative complication of fever and mild haeamaturia.
Conclusions
The stones clearance rate of mini percutaneous nephrolithotomy is better than retrograde intrarenal surgery and the safety of retrograde intrarenal surgery is higher than of mini percutaneous surgery.

Prevalence and Anatomical Variations of Middle Hepatic Artery: A Cadaveric and Radiological Study

2023-12-05T06:49:25+00:00

Introduction

Middle Hepatic Artery is a hilar artery that supplies segment IV of the left hemi-liver. Anatomical Variations of this hilar artery has led to its classification into various sub-types based on its origin. Many studies have elucidated the surgical importance of MHA and in-depth knowledge of its variations is essential to minimize the morbidity during liver surgeries. In LDLT and during hepatic resections any injury to MHA and vascular compromise to Segment IV can bring in catastrophic consequences such as reduction in functional volume of left lobe in right allograft, possible graft loss in left allograft and ischemic cholangiopathy at all cases.

Methods

This is a cross-sectional study on 25 cadaveric Livers and 25 CECT- Abdomen arterial phase, a total of 50 Liver specimens at our center. The origin and course of MHA was accessed and characterized after meticulous dissection of cadavers and 3D reconstruction of CECT-Abdomen arterial phase. Collected data was entered and analyzed by using IBM SPSS STATISTICS 16.

Results

MHA was present in 76% of cases. MHA originated from RHA in 34% of cases; from LHA in 24% of cases; from RHA in presence of replaced LHA in 6%; from LHA in presence of replaced RHA in 8% and from non-left non-right hepatic artery along the axis of CHA in 4% of cases.

Conclusion

MHA is a hilar artery that predominately originates from RHA. It is very important for a surgeon to meticulously study the course of MHA in patients prior to liver surgeries using 3D-reconstruction of radiological images to minimize morbidities.

Impact of Academic Stress on Help-Seeking Attitudes Among Nursing Students of Kathmandu District

2023-12-11T16:10:56+00:00

Background
Depression, anxiety and stress are treatable conditions. However, a vast majority of people avoid seeking professional help. Interventions aiming to improve help-seeking attitudes among affected individuals, particularly within academic settings, often demonstrate limited efficacy. This study explores the relationship between academic stress and help-seeking attitudes among nursing students.
Methods
A descriptive cross-sectional study was conducted among 300 nursing students in Kathmandu district using simple random sampling. Data were collected using the Depression Anxiety and Stress Scale (DASS21) and additional survey questions. Statistical analysis employed chi-square tests to explore relationships between variables.
Results
Findings indicated that 14% of respondents had mild depression, 30% moderate depression, and 8.7% severe depression. Similarly, levels of anxiety and stress were observed, with significant associations between depression and stress related to academics (p-value 0.002). Help-seeking preferences revealed that students were more inclined to seek support from friends or intimate partners.
Conclusions
This study highlights the prevalence of depression, anxiety, and stress among nursing students with notable associations to their academia. Importantly, the findings emphasize the need for tailored interventions to address mental health concerns and foster proactive help-seeking attitudes among students. Further research and targeted strategies are warranted to enhance the effectiveness of interventions in this context.

Correlation Between Serum Prostatic Specific Antigen and Prostatic Volume in Prostatic Hyperplasia

2023-12-28T07:49:23+00:00

Background
Prostate specific antigen (PSA) is a serine protease produced by the prostate epithelium and per urethral glands in male. Serum PSA elevation occurs as a result of disruption of normal prostatic architecture that allows PSA to diffuse into prostatic tissue and gain access to the circulation. Prostatic hyperplasia is a progressive condition characterized by prostate enlargement accompanied by lower urinary tract symptoms (LUTS).
Methods
The objective is to investigate the correlation between serum PSA levels and trans abdominal USG prostate volume in clinically diagnosed cases with prostatic hyperplasia. This is a hospital based study conducted in the Department of Radiology and Medicine at Bharatpur Hospital. All cases diagnosed clinically underwent USG by radiologist and serum PSA estimation was done in the lab by Elisa method. 150 cases were studied.
Results
Age of 51-60 years with a percentage of 29.30%, consisted of 67 patients with a volume of 20.00-39.99 cc (44.7%), 87 patients with PSA levels of <2.6 ng/mL (58.0%), prostate volume is 20.00-> 80 cc at the age of 51-60 years, PSA levels <2.6->20 ng / mL at the age of 51-60 years and value of p = 0,000 (p<0.05) and the value of r = 107.57, implying that prostate volume and PSA levels has a significant and strong correlation.
Conclusions
There is a significant association between prostate volume and PSA levels in BPH patients in our study, with p = 0,000 and r =107.59 showing a strong positive correlation.

Burden of Care Among Caregivers of Mentally Ill Patient at Tertiary Level Hospital

2022-09-21T14:30:24+00:00

Abstract

Introduction

Caregivers of people with mental illnesses are a key support system. The caregivers suffer significant burden as a result of the care giving role. The level of burden of caregivers among people with mental illness is considered to be a negative impact on the care provided by the family to their patient.

Methods

A descriptive cross sectional research design was used. A total of 96 care givers were selected using purposive sampling technique. The purpose of the study was to assess the burden of care of mentally ill patient among care givers in a selected hospital. The Zarit Burden Interview Scale was use to assess burden care. All the collected data were analyzed by using descriptive statistical method such as frequency, mean, percentage, standard deviation and chi square test to find out the association with level of burden of care and selected demographic variables.

Results

Nearly one third (31.3%) of caregivers had moderate level of burden and 9.4% of them had severe burden of care. There was significant association between the level of burden of care with sex of the caregivers and their educational level.

Conclusion

Caregivers had moderate level of burden of care while caring their mentally ill patient. In order to reduce their burden of care, self-help and psycho-educational programs will be effective. This action addresses to improve their perceived knowledge on mental illness and develop coping skills to deal with their patient’s behavior.

Key Words: Burden; Caregivers; Mentally ill patient.

Clinical and Laboratory Characteristics of COVID-19 Patients Admitted in A Tertiary Hospital of Nepal

2024-02-11T18:51:10+00:00

Background
COVID-19 disease is a respiratory infection. The symptoms range from mild fever and bodyache to multiple organ dysfunction. It was first seen in Wuhan, China and later infected whole world in a very short period of time. The aim of this study was to find the clinical and laboratory Characteristics of COVID-19 patients admitted in tertiary hospital of Nepal.
Methods
This was a cross-sectional hospital based study conducted at Manipal Teaching Hospital, Pokhara, Nepal. The patients with confirmed COVID-19 were included in this study. Questionnaire was used to collect the clinical data and venous blood samples were collected for laboratory parameters. The numerical data were presented in Mean and SD while categorical data were in frequency and percentage.
Results
The Major infected patient were male (67.9%). The major symptoms observed were shortness of breath (78.8%), dry cough (54.5%), chill (60.3%), wet cough (16.7%) and headache (25%). 60.9% COVID-19 patients were in moderate stage followed by severe stage (26.3%). The complication noticed were cardiac, bacterial infection, ARDS, septic shock and GI bleeding. The level of blood urea, creatinine, AST, ALT, serum ferritin and CRP were found high in COVID-19 patients. Similarly, the level of sodium, potassium, d-dimer, total protein, albumin, WBC and platelets were found within normal limits.
Conclusions
The common symptoms in COVID-19 patients were shortness of breath, dry cough, chill and headache. The blood level of AST, ALT, ferritin, CRP, urea and creatinine were high in COVID-19 patients.

A Comparative Analysis of Extracted Human Teeth Sterilization by Using Distinctive Sterilizing Agents

2023-10-04T16:42:19+00:00

Background
Regular use for practice and educational purposes of Extracted human teeth in dental institutions at undergraduate and postgraduate levels is a necessity. Individuals who collect extracted teeth must decontaminate and then handle teeth. Different materials and methods are used for sterilizing extracted teeth to avoid infection from them.
Methods
Total of 50 freshly extracted human teeth that were intact, non-carious and extracted due to periodontal disease or orthodontic purpose were divided randomly into 5 groups consisting of 10 teeth in each group.These were stored in sterile saline till tested and will randomly be divided into one of the following 5 groups of sterilizing agents consisting of 5.25% sodium hypochlorite, 10% formalin, 2% glutaraldehyde, Microwave Radiation and a control group with normal saline. All teeth will be immersed in separate bottles. Samples were collected with the help of inoculating loop and then streaked over the surface of Mc-conkey agar medium. The media was incubated at 37 degree C for 24 h. Sterilization was determined based on the growth of micro-organisms on culture medium. Evidence of growth was observed after 24 hour of inoculation. Absence of any visible growth in the media was the indicator of an effective sterilization.
Results
This research showed that, 10% formalin, 5.25% sodium hypochlorite could be efficiently used for sterilization and disinfectionof extracted human teeth.
Conclusions
Extracted teeth are potential source of infection hence should be disinfected before any use in the laboratories.

Morphometric Measurements of Root Anatomic Areas of Maxillary First Premolar Teeth in a Representative Nepalese Population

2024-03-13T16:55:11+00:00

Background
The prognosis of furcation involved maxillary first premolar is typically guarded to poor. The presence of concavities in the root trunk and the positioning of the roots in the buccal and palatal regions of the teeth are responsible for its challenges during instrumentation and control plaque. We aimed to access the presence of concavities on the root surface as well as morphometric measurement of the root trunk dimensions in the maxillary first premolar teeth in Nepalese population.
Methods
A cross-sectional quantitative study was conducted in the Department of Periodontics and Oral Implantology, College of Medical Sciences (CoMS). Extracted Maxillary first premolar teeth were evaluated for the number of roots, morphometric measurement of the root trunk, root divergence, and root length. The presence of concavities was recorded on the mesial and distal root surface at cervical, middle, and apical thirds of the root.
Results
The overall mean root trunk length was less on the mesial aspect than on the distal aspect (6.39 ± 2.54 and 8.08 ± 3.48 respectively). The prevalence of root surface concavity on the cervical third at the mesial aspect (90 %) was found to be higher than in the distal aspect (15%)
Conclusions
Owing to the higher prevalence of root surface concavity on the cervical third of mesial aspect, use of mini-bladed curettes is recommended for the effective root surface debridement of the periodontally involved maxillary first premolar tooth. Patients with periodontally involved maxillary first premolar should be advised to use interdental brushes rather than dental floss.

Profile of Patients with Seizure Disorders in Adults Presenting to Manipal Teaching Hospital

2023-08-18T09:52:48+00:00

Background

Seizures can affect people of all ages, including adults. Symptoms of seizures can vary widely, including muscle convulsions, loss of consciousness, staring spells, confusion, repetitive movements, and sensory disturbances. Seizures can be caused by various factors, such as epilepsy, head injuries, brain infections, stroke, and other medical conditions. Diagnosis typically involves a thorough medical history, neurological examination, and sometimes ancillary tests. Treatment options depend on the underlying cause.

Methods

This was a prospective cross‑sectional hospital‑based study conducted on 63 cases presenting with adult onset seizures. Details of the patients of the age of 18 years and above were included and entered as per the structured performa. Statistical analysis was done by SPSS in terms of frequency and percentage.

Results

The mean age was with 46.84 years with male gender predominance. Adult onset seizures were most prevalent in the middle‑aged adults than elderly; generalized seizures were more common than focal seizures. Most common neuroimaging finding was infarct followed by neurocysticercosis and intracranial bleed.

Conclusions

Identification and awareness about the possible etiological factors and seizure type help in better management of seizure patients.

Knowledge, Attitude and Practice on Ocular Tuberculosis and Sarcoidosis Amongst Chest Physicians in Chitwan, Nepal

2024-03-04T10:07:58+00:00

Background: Tuberculosis (TB) is considered an endemic disease in Nepal with predominantly chest related signs and symptoms. Sarcoidosis is a disease with similar clinical presentation. This study was conducted to detect the level of awareness amongst chest physicians, including cardiologists, pulmonologists and internists regarding the ocular manifestations of these diseases.

Methodology: 40 internal medicine practitioners were asked to fill a KAP questionnaire regarding ocular TB and sarcoidosis as part of an interactive awareness session on systemic and ocular forms of these diseases. The questionnaire was validated and pretested by both ophthalmologists and internal medicine practitioners.

Results: Among the 40 practitioners surveyed, only six were able to answer all knowledge-based questions correctly. The majority of practitioners (27) exhibited a favorable attitude toward disease management, while a considerable number (30 out of 40) expressed hesitancy in utilizing immunomodulators according to practice-based inquiries.

Conclusion: It is necessary to raise awareness amongst treating chest physicians regarding the ocular features of TB and Sarcoidosis so that adequate systemic treatment may be initiated and sight threatening complications do not occur. Collaboration between treating physicians and ophthalmologists is a dire necessity to achieve this goal.

Overview of Ventilator-Associated Pneumonia in Traumatic Cervical Spinal Injury in Trauma Center of Nepal

2023-09-10T16:38:53+00:00

Background
Cervical spine, crucial for nerve innervation and head and neck motion, is vulnerable to injury due to its over-reliance on ligaments. This study examines the increasing incidence of traumatic spinal cord injuries, particularly in fall and traffic accidents, with respiratory complications being the leading cause of morbidity and mortality, with VAP being a significant complication.
Methods
A retrospective cross-section study involving 52 patient data, using self-prepared proforma. The patient’s age, sex, injury severity, and CPIS score were used to determine VAP.
Results
The study involved 52 patients with a mean age of 50.96. Of these, 67.3% were male and 11.5% female, with 45-60 years being the most common age group. The most severe spinal injury patients, i.e., ASIA A Neurology, developed VAP. Patients with prolonged ICU stay and intubation days also developed VAP, but no statistical significance was seen (P-value: 0.3941 and 0.4751). Mortality had a significant association with VAP (P-value: 0.023). Acinetobacter Baumann was the most common microorganism causing VAP, while Staphylococcus aureus was the least common. The most sensitive antibiotics for isolated organisms were Polymyxin B, Amikacin, Colistin, and Levofloxacin.
Conclusions
The study found a high prevalence of ventilator association pneumonia (VAP) in cervical spine fracture patients, with mortality associated with the most common organism being Acinetobacter, sensitivity to Polymyxin b. Further monitoring and implementation of VAP prevention strategies are recommended.

Appendicular Perforation in Pregnancy

2024-02-27T14:56:01+00:00

In this case study, a third-trimester primigravida faced the rare challenge of a perforated appendix followed by successful perinatal outcome. Despite inconclusive imaging results from ultrasound and MRI, clinical progression guided the diagnosis. Timely intervention via emergency laparotomy, involving obstetric and gastro-surgical teams, averted further complications, ensuring a favorable outcome for both mother and baby. The complexities of diagnosing appendicitis during pregnancy, particularly when perforated, were emphasized. This instance underscored the pivotal role of a multidisciplinary approach, meticulous surgical planning, and attentive postoperative care, showcasing how prompt intervention and holistic management are paramount in navigating such intricate scenarios during pregnancy.

Twinning Involving Primary Maxillary Lateral Incisor

2022-02-07T11:40:52+00:00

Developmental anomalies in the hard tissue are seen frequently in dental practice. Gemination and fusion are the most commonly encountered anomalies, and distinction between the two is always difficult. Gemination, also known as double tooth, is an anomaly exhibiting two joined crowns and usually a single root. It represents an incomplete attempt of a single tooth germ to split. It is considered multifactorial in etiology, with genetic and environmental causes. This paper discusses a rare example of bilateral gemination (prevalence 0.04%) of maxillary central incisors with completely separated roots. Multidisciplinary care ensured a successful esthetic and functional outcome.