Journal of Nepalgunj Medical College

Intra and Inter-Observer Variability in the Measurement of Anterior Chamber Depth Diameter Using B-Mode Ultrasonography

2024-02-12T09:08:17+00:00

Introduction: B-mode ultrasonography, a non-invasive imaging modality, plays a pivotal role in evaluating ocular structures such as anterior chamber depth. Its measurement is crucial for ocular health assessment and managing conditions like glaucoma cataract and refractive surgery planning. However, ultrasonography's operator-dependent nature impacts diagnostic sensitivity and specificity.

Aims: This study investigates intra-observer and inter-observer variability in ultrasonographic ACD measurements and its implications.

Methods: A prospective observational study was conducted at Nepalgunj Medical College and Teaching Hospital in September 2023. Healthy volunteers over 17 years of age were enrolled, with ethical approval and informed consent. Ultraso nography was performed using a 7.5 MHz linear transducer, involving a radiologist with over 5 years of experience and a radiology trainee. Reproducibility was assessed using intraclass correlation coefficients (ICC).

Results: The study included 150 participants (83 males, 67 females) with a mean age of 25.7 years. ACD demonstrated a linear correlation with age. The mean right ACD was 2.824 mm (range: 2.175 mm - 4.175 mm) and the mean left ACD was 2.826 mm (range: 2.20 mm - 4.175 mm). Age had a significant linear correlation with ACD (p <0.001). Intra-observer variability for both observers showed statistically significant linear correlations (p <0.001), with high Pearson correlation coefficients. Inter-observer variability in mean ACD also exhibited a significant correlation (p<0.01) with excellent agreement.

Conclusion: This study highlights the importance of assessing intra and inter-observer variability in ACD measurements by ultrasonography. The findings provide valuable insights for ocular health management, particularly in patients with elevated intraocular pressure. Standardizing measurement techniques can improve diagnostic accuracy and patient care.

Blood Donor’s Knowledge, Attitude and Practice Towards Blood Donation among Voluntary Blood Donors at Nepal Red Cross Society Central Blood Transfusion Service Centre

2024-02-12T09:28:47+00:00

Introduction: Blood donation is the major source of blood as well as components of blood worldwide. Even though there are lots of promising components to substitute blood, a true component for blood and blood components is not available. Donated blood is an essential component in the management of many diseases. It is the core lifesaving component for an individual with loss of large volumes of blood from accidents, hemorrhages, or surgery.

Aims: To evaluate the knowledge, attitude and practices of blood donors who visit blood bank.

Methods: A cross-sectional study was done among 227 voluntary donors during six different Blood Donation Campaigns from March to October 2023.

Results: A total of 227 blood donors participated in this research, with ages ranging from 19 to 60 years, and an average age of 34.7 years with a standard deviation of 8.77. Among all donors, the majority were male (71.4%), with females representing 28.6%. 1.3% of the donors were illiterate, while 26 % were literate. Additionally, 33% hold a secondary-level degree, 31.3 percent have a bachelor's degree, and 8.4 percent possess a master's degree or higher. The majority (46.7%) of the voluntary blood donors were from the service sector, 11% were students, 5.3% in business, 3.5%. were engaged in agriculture and 1.8% working in foreign employment. The remaining 31.7% were involved in various other occupations.

Conclusion: Almost 1/10^th, 5% had adequate knowledge and 72% showed positive attitude related to blood donation in our study the level of blood donation practice was in majority of donor about 89%.

Role of Image Guided FNAC in Assessment of Intra-Abdominal and Retroperitoneal Masses

2024-02-15T06:07:27+00:00

Introduction: Fine Needle Aspiration Cytology is a widely used method for palpable/nonpalpable masses. Radiological image guided Fine Needle Aspiration Cytology is less invasive, safe and cost effective method for diagnosis of masses in less accessible sites like intra-abdominal organs. Ultrasound or Computed Tomography guided methods are usually preferred.

Aims: This study was done to evaluate the diagnostic utility of image guided Fine Needle Aspiration Cytology in an intra-abdominal and retroperitoneal lesions and confirmation by histopathology whenever available.

Methods: This is a hospital based prospective study over a period of one year (October 2022 to September 2023) in department of Pathology, Nepalgunj Medical College, Kohalpur, Nepal. Patients who presented clinically and radiologically with intraabdominal or retroperitoneal masses were included in which direct Fine Needle Aspiration Cytology was not possible. A cytological opinion was made by correlating with clinical and radiological findings. Histological correlation was carried out in patients who went surgical excision or biopsy of lesion.

Results: Among 52 cases studied, all were accessible via ultrasonography. Cytopathological diagnosis was obtained in 49 cases and three cases were unsatisfactory. Among them 44 were malignant, one was suspicious and seven were non-neoplastic. Liver was most frequently aspirated organ (23 cases) with commonest diagnosis being metastatic adenocarcinoma (17 cases). Cyto-histological correlation was available in 16 cases. This study shows 100% specificity and 93.3% sensitivity. Diagnostic accuracy was 94.2%.

Conclusion: Image guided Fine Needle Aspiration Cytology plays an important role in diagnosis of deep-seated nonpalpable lesions. It is safe and provides rapid diagnosis with minimal complications.

Prescribing Pattern of Antimicrobial Agents in Patients with Pelvic Inflammatory Disease in a Tertiary Care Hospital at Rural Part of Western Nepal

2024-02-15T06:22:24+00:00

Introduction: Antibiotics are the most frequently prescribed drugs in patients with Pelvic Inflammatory Diseases. Appropriate antibiotic prescriptions in health care institutions are an important element in quality of care, infection management and cost control.

Aims: To analyze prescription pattern of antimicrobial agents in patients with pelvic inflammatory diseases.

Methods: This quantitative cross-sectional study was conducted including 300 patients' prescriptions, at Karnali Academy of Health Sciences Jumla Nepal for period of six months during August 2021 to January 2022. This study was based on medication utilization form, which was designed on basis of World Health Organization core drug use indicator format.

Results: Females were in ages from 12 to 69 years, with mean of 30.46 ± 18.71 years. Chronic Pelvic inflammatory Disease was most prevalent in 20–29 age group (47%) while, lowest in 60–69 age group (1.67%). The total number of prescribed drugs was 796 averaging 2.65 drugs per prescription. The most commonly prescribed antimicrobials were azithromycin (30.15%), tinidazoles (25.25%) and ofloxacin (8.16%). Only 15.5% of drugs were prescribed with generic names and all were from essential list of medicines. 92.8% of prescriptions were administered orally, while 7.8% parenteral. However 76.34% of prescriptions were considered irrational.

Conclusion: The high prevalence of irrational prescriptions suggests need for interventions to improve healthcare provider's adherence to established treatment guidelines. Dominance of specific drug classes underscores importance of tailoring treatments to the specific pathogens involved in Pelvic Inflammatory Disease. Suggesting potential room for improvement inadherence to evidence-based guidelines.

Postoperative Analgesic Effect of Dexamethasone Added To Ropivacaine for Fascia Iliaca Compartment Block Following Femoral Fracture Surgeries

2024-02-15T09:31:50+00:00

Introduction: Pain is associated with higher perioperative morbidity in fracture patients. Fascia iliaca compartment block is a simple, inexpensive, and effective method of analgesia for femoral fracture surgeries. Many adjuvants have been used with local anaesthetics to prolong post-operative analgesia.

Aims: To assess the effects of dexamethasone as an adjuvant to fascia iliaca compartment block on prolongation of post-operative analgesia in patients undergoing femoral fracture surgeries.

Methods: Seventy patients aged, 18-65 years with American Society of Anaesthesiologist-Physical Status I and II, undergoing femoral fracture surgery, were randomly assigned to two groups, n=35 each, who received standard subarachnoid block. Ultrasound guided Fascia iliaca compartment block was given after completion of surgery with 20ml of 0.35% ropivacaine + 2ml normal saline to group one or 20ml of 0.35% ropivacaine + 2ml dexamethasone(4mg/ml) to group 2. Total duration of analgesia and total rescue analgesic requirement in the first post operative day were noted after successful block.

Results:The demographic information for the two groups was comparable. The duration of postoperative analgesia was prolonged in patients receiving dexamethasone adjuvant (541 ± 167 vs. 638± 165 mins, p = 0.018; Mean difference -97). Patients receiving dexamethasone adjuvant required significantly less postoperative rescue analgesics for the first 24 hours (tramadol 88 ± 32 vs 65 ± 23 mg, p = 0.001; Mean difference 23).

Conclusion: Dexamethasone, added to Fascia Iliaca Compartment Block, as an adjuvant, significantly prolongs the postoperative analgesic effect thereby, reducing the need for rescue analgesic in the first postoperative day.

Comparison of Neutrophil-Lymphocyte Ratio between Diabetic Nephropathy and Without Diabetic Nephropathy in Type 2 Diabetes Mellitus at a Tertiary Care Centre

2024-02-15T09:51:27+00:00

Introduction: Type 2 Diabetes mellitus is a kind of systemic disease with serious microvascular and macrovascular complications incorporate diabetic nephropathy. The Neutrophil lymphocyte ratio (NLR) is a simple and cheap laboratory tool used to predict the prognosis of many non-communicable diseases such as diabetic nephropathy.

Aims: To compare neutrophil-lymphocyte ratio between type 2 diabetes mellitus with diabetic nephropathy and without diabetic nephropathy.

Methods: An observational cross-sectional study was conducted at teaching hospital, Morang, Nepal. Non probability convenience sampling technique was used to collect data of 226 participants by using clinical and laboratory forms and formats. The data was analysed in SPSS version 21.00.

Results: Laboratory parameters were compared between two groups. High density lipoprotein (p=0.028) and low density lipoprotein (p<0.01) and glycaemic parameters fasting blood glucose (p=0.028), postprandial blood glucose (p=0.0005) and glycated haemoglobin (p=0.007) were found to be significantly raised in diabetic nephropathy patients as compared to without diabetic nephropathy patient. Renal function tests such as estimated glomerular filtration rate (p<0.01), serum creatinine (p<0.01), urine albumin-to-creatinine ratio (p< 0.01) showed high significant differences between two groups. Blood cell count, platelets (p<0.01) and white blood cell (p<0.01) were found to have statistically significant between patients with diabetic nephropathy and without diabetic nephropathy. Majority of individuals with smoking habit fell in diabetic nephropathy group as compared with individual without diabetic nephropathy. Neutrophil lymphocyte ratio was high in diabetic nephropathy group.

Conclusion: The neutrophil-lymphocyte ratio was significantly raised in type 2 diabetic patients with diabetic nephropathy. Based on above finding, neutrophil-lymphocyte ratio may be considered as a predictor and a prognostic biomarker of diabetic nephropathy.

Diagnostic Utility of Bone Marrow Aspiration Cytology- A Hospital Based Prospective Study at Nepalgunj Medical College

2024-02-15T10:22:02+00:00

Introduction: Hematological disorders are common in all age groups and are worldwide in distribution. At times, routine hematological tests are not sufficient to diagnose blood disorders. Bone marrow examination serves as an important diagnostic aid to evaluate various neoplastic and non-neoplastic hematological diseases.

Aims: To study role of Bone Marrow Aspiration Cytology in diagnosing hematological disorders.

Methods: This is a one-year hospital based prospective study done at Department of Pathology, NGMC, Kohalpur. It included 34 cases subjected to Bone marrow aspiration cytology. Correlation with Peripheral Blood Smear, Reticulocyte count, pearls iron stain and other parameters were done before giving the final diagnosis.

Results: Age of patients ranged from 10-82 years with equal gender distribution. Common indications for Bone marrow examination were pancytopenia (50%), followed by Anemia and Thrombocytopenia. Megaloblastic Anemia (n=10,29%) was the commonest Anemia followed by mixed nutritional deficiency and Iron Deficiency Anemia. Hematological Malignancy accounted for six cases, of which Acute Myeloid Leukemia was diagnosed in two cases. Infectious causes comprised of two cases of Visceral Leishmaniasis and one case of Bone Marrow Tuberculosis.

Conclusion: Bone marrow aspiration cytology serves as an important adjunct in diagnosing hematological disorders. More reproducible results are obtained if bone marrow biopsy is done in conjucntion with aspiration cytology.

Association between Cyclic Threshold Values and Clinical Symptoms in Patients with COVID-19 at Teaching Hospital, Jumla, Karnali, Nepal

2024-02-15T10:31:23+00:00

Introduction: The cyclic threshold (CT) value obtained in the reverse transcriptase polymerase chain reaction (RT-PCR) has been used as the surrogate marker of viral load. Therefore, to understand viral kinetics and evaluate the disease severity with clinical symptoms, it is necessary to evaluate cyclic threshold value in COVID-19-infected patients.

Aims: To assess association between cyclic threshold value and clinical symptoms in patients with COVID-19.

Methods: A descriptive cross- sectional study was conducted on PCR-positive patients (n=208) for six months at Karnali Academy of Health Science, Teaching Hospital Jumla. The RT-PCR was performed and data of the cyclic threshold value of PCR-positive patients was taken from the laboratory in predesigned study proforma. Data entry and analysis were done in SPSS version 20.0.

Results: A larger proportion of females (65.9%) than males (43.1%) had a COVID-19 infection symptoms of COVID-19 were present in about equal numbers of infected males (61%) and females (68.7%). Most of the individuals were in the age range of 19 to 39 years. A cyclic threshold value of less than 30 was present in the majority (49%) of patients. Symptoms were present in 65.9% of individuals. Symptoms were present in a large proportion of subjects with cyclic threshold values of 1–19 and 20–29, at 89.5% and 77.9%, respectively.

Conclusion: This study provides valuable insights into the association between cyclic threshold values and clinical symptoms of COVID-19 in patients. It also explores the underlying factors like gender disparities and age-specific disease severity. Patients showing symptoms of COVID-19 typically had a cyclic threshold value below 30 and carry a higher amount of the virus compared to those who don't show symptoms. The association between signs and symptoms and the cyclic threshold is highly significant.

Evaluation of Bronchoalveolar Lavage Cytology and Comparison with Endobronchial Biopsy

2024-02-15T10:52:30+00:00

Introduction: Early diagnosis of infective etiology and lung cancer plays a vital role in reducing mortality rate of lower respiratory tract disease. Different modalities can be applied for early diagnosis e.g. bronchoalveolar lavage and endobronchial biopsy. Cytological and histopathological diagnostic techniques are safer, economical and provide appropriate results.

Aims: To find out diagnostic yield of bronchoalveolar lavage cytology in diagnosing lung pathology and to determine its sensitivity, and specificity in malignant cases considering endobronchial biopsy as the gold standard.

Methods: This hospital based analytical study was carried out in the Department of Pathology at Nepalgunj medical college, Nepalgunj during the period from January 2023 to September 2023 with a total of 50 participants.

Results: 29(58%) patients were male and 21(42%) female; the mean age was 53.16 ± 19.9 years. Considering histopathological findings, maximum patients of malignant cases had squamous cell carcinoma 3(6%), then adenocarcinoma 1(2%). The sensitivity, specificity, positive and negative predictive value of bronchoalveolar lavage in malignant cases were 75%, 100%, 100% and 50% respectively.

Conclusion: Bronchoalveolar lavage fluid cytology is a useful tool for diagnosis of lung cancer. It has good sensitivity, and specificity, and shows nearly identical information as biopsy.

Analysis of Cesarean Section using Robsons classification at Teaching Hospital of Eastern Nepal

2024-02-15T10:59:16+00:00

Introduction: Cesarean section is an operative procedure for delivery of fetus and placenta by making an incision over abdomen and uterus after period of viability.

Aims: The aim of study is to analyze rate of cesarean section and perform an analysis based on Robsons ten group classification.

Methods: A cross sectional study was conducted at Department of Obstetrics and Gynecology of a teaching hospital of eastern Nepal, over a period of one year from October 2022 to September 2023. All details regarding demography, obstetric history, medical history, labor status, indication of cesarean section, etc. were collected. Then all pregnant ladies were assigned to one of Robsons ten group classification systems and recorded into labor confinement book. The statistical analysis was performed using Statistical Package for Social Sciences version 21. Descriptive statistical tools were used to express the results. All tests were done with a significance level of 5% (p-value <0.05) and 95% confidence Interval.

Results: The overall rate of cesarean section was 1,829(46.93%). Majority 1323(72.30%) were in age group 20-30 years. Maximum 1,629(89.10%) delivered at>37 weeks of gestation. Majority 789(43.10%) of cases had lower segment cesarean section because of previous cesarean delivery. According to Robsons classification system, Group 5 has highest cesarean section rate 725 (39.60%) followed by Group 2(A+B), 334(18.21%).

Conclusion: Implementing Robsons Ten Group Classification System at our setting has helped us to identify major contributor of overall cesarean section rate. Group 5 was at top followed by group 2. Thus with adequate trial of labor after cesarean, proper labor monitoring and judicious use of induction protocol can significantly reduce rate of cesarean section.

Uterine Cervix Rhabdomyosarcoma : A Case Report

2024-02-16T09:04:53+00:00

Rhabdomyosarcoma is a malignant tumor that arises from embryonal skeletal muscle cells. It is responsible for 3% of cancer cases among children aged from 0 to 14 and 1% among adolescent and young adult aged from 15 to 19. Embryonal Rhabdomyosarcoma is the most prevalent subtype in the female genital tract and Botryoid sarcomas being a polypoid variant. In young patients, the majority of genital tract rhabdomyosarcomas occur in vagina; however, the most common site being cervix followed by uterine corpus, in adults. We hereby report a case of 24 years lady P2L2 diagnosed as Botryoid Embryonal Rhabdomyosarcoma with evidence of anaplasia without extrauterine metastasis. Embryonal cervical rhabdomyosarcoma is a rare malignant tumor and its typical manifestations are vaginal bleeding and a pelvic mass. However, attention should also be paid to any abnormal vaginal discharge in young unmarried women. Diagnosis of pure rhabdomyosarcoma in uterus involves perfect sampling and histopathological evaluation.