Annapurna Journal of Health Sciences

Adherence to the Use of Compressive Therapy in Varicose Veins: A Review Article

Robin Man Karmacharya — 2023-08-23

Varicose veins (VV) are engorged veins mainly found in the peripheral regions. The presence of varicosities is not only a cosmetic problem but results in discomfort, loss of working days, disability, and health-related quality of life. Compression therapy is the most widely used conservative treatment for VV. Its effectiveness depends upon patient adherence. Here, we discuss the various modes of compression therapy and the factors affecting its adherence among varicose veins patients.

Medicinal Plants and Traditional Medical Practices in Nepal

Krishna K. Shrestha — 2023-08-23

The World Health Organization has encouraged using indigenous and traditional medical practices of their own which have been practicing since many centuries. As a result, the medicinal plants of Nepal are nowadays revalued by extensive researches on medicinal plant species and their therapeutic principles, to ascertain safety and efficacy of traditional medicines and admit the benefits of medical pluralism. We reviewed the therapeutically useful plant species and assessed their value to consider them as a potential resource for complementary and alternative medicine in Nepal. Medicinal plants used for top ten disorders of Nepal followed by medicinal plants prioritized for conservation by Herbs and NTFPs Coordination Committee, selection criteria for DNA barcoding of plants in Nepal, and frequently referred to the earlier literature were reviewed and presented 100 highly valued medicinal plant species. The species are being used in rural and local pharmacopoeias, and they are potential in bioprospecting and pharmacology and drug discovery in Nepal. Different therapeutic traditions coexist in Nepalese medical system where people can opt medicine based on their preferences, cultural backgrounds and their specific illnesses, which we admit as a win-win situation for well-being of citizens. Communication of traditional useful medicinal plant species and their scopes of primary health care abridges traditional and modern medicines, and lay ground for medical pluralism.

Future of Medicine with Artificial Intelligence

Sambardhan Dabadi — 2023-08-23

Artificial Intelligence (AI) is one of the fastest growing technologies around the world. AI based system are capable of learning through various inputs provided to them and generate output based on their own analysis. These systems are substituting human effort and workload in various sectors, one of these sectors is healthcare and medicine as well. The use of such technologies have made decision making easier in some way, however there has been issues and problems associated with AI being used in medicine.

Neurosurgeons as Researchers in Developing Countries

Mohan Raj Sharma — 2023-08-23

Not Available.

Chronic Lymphocytic Leukaemia/Small Lymphocytic Lymphoma with Hyperleukocytosis: A Case Report

Ankit Kumar Mandal — 2023-08-23

Chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL/SLL) is a B-cell lymphocytic neoplasm with indolent clinical course. Author describes a 55-yearold male presenting with fever and generalized lymphadenopathy, found to have white cell count of 576000/mm³ and subsequently was diagnosed with CLL/SLL. The patient received systemic chemotherapy in our department, got clinically improved and on follow-up clinic visit documented normalisation of his white cell counts. The case report brings up a rare presentation of CLL/SLL with such high white cell count and being reported from Nepal. We don't have such cases reported in our literature.

Thromboangiitis Obliterans (Buerger’s disease): A Case Report

Aadhar Oli — 2023-08-23

Thromboangiitis obliterans (TAO) is an occlusive vascular disease characterized by segmental nonatherosclerotic inflammatory disorder of the small and medium arteries, veins, and nerves of the upper and lower extremities. Also known as Buerger’s disease it is frequently found in men who smoke. Tobacco smoking is central to the initiation and progression of the disease. Here we present a case of a 56- years-old male smoker with complaints of numbness, pain, and discoloration of digits in his right leg for 1 year.

Autoimmune Encephalitis as a Differential Diagnosis of Auditory Hallucination: A Case Report

Pranav Joshi — 2023-08-23

Autoimmune encephalitis, specifically associated with anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibodies, presents with a range of neuropsychiatric symptoms including personality changes, cognitive decline, memory loss, and perceptual disturbances. While the condition is more commonly observed in adults and associated with paraneoplastic conditions, its diagnosis can be challenging in the pediatric population due to a lack of strong associations with specific antibodies and cancer. This case report presents the clinical manifestation, diagnosis, and management of a 14-year-old boy with autoimmune encephalitis presenting with excessive thoughts, forgetfulness, and auditory hallucinations.

Study of Serum Tumor Marker Requisition Pattern in Tertiary Hospital of Nepal

Saroj Thapa — 2023-08-23

Introduction: Tumor markers are substances that may be present in higher than normal levels in the body fluids, tissue, serum, or urine of individuals with cancer. Requesting of multiple markers is rarely of use. The aim of the present study is to know the pattern of tumor marker prescription in our tertiary hospital.

Methods: The medical record of common tumor marker prescription viz. Total PSA, AFP, CEA, CA-125, CA 19-9 and CA 15-3 was reviewed over a period of one year (January 2021 to December 2021).

Results: A total of 1157 markers were requested from 535 patients. The most frequently prescribed marker was CA-125 and the least prescribed marker was CA 15-3. It was found that 219 (18.9%) markers were above the reference range, while 938 (81.07%) were within the reference range. Out of 535 patients, single tumor marker was prescribed for 261 (48.7%), dual markers for 49 (9.1%), triple markers for 117 (21.8%), quadruple markers for 93 (17.4%), and five or more markers for 15 (2.8%) patients. PSA was most commonly (98.47%) prescribed as a single marker, while other tumor markers were commonly prescribed in multiple pattern. The most common combination was that of CA 19.9, CA 125, and CEA in a triple prescription pattern, and AFP was added to these three markers in a quadruple combination.

Conclusion: Multiple tumor marker prescription is common in our setting. This might be due to unavailability of local guidelines and regular audit. Tumor markers should be used appropriately otherwise it may have many ill consequences.

Understanding Psychosocial Distress and the Distressing Items on the Distress Thermometer Problem List: A cross-sectional Study from Nepal

Roshan Prajapati — 2023-08-23

Introduction: Psychosocial distress is common in cancer patients and there are various risk for it. Unfortunately, the prevalence and risk of psychosocial distress are not uniform within the studies. Understanding the prevalence and risk of psychosocial distress could be an effective for its prevention and management. The objective of this study is to evaluate the prevalence and most distressing items for psychosocial distress.

Methods: This descriptive cross-sectional study was done in a tertiary cancer center. A total of 253 heterogeneous cancer patients were enrolled in this study. Information regarding socio-demographic and clinical characteristics, psychosocial distress and source of most distressing problems were collected subjectively. Distress thermometer accompanied with problem checklist described their perceived distress and sources of distressing problems respectively. Descriptive statistics was used to analyze the variables. Statistical analysis was done using SPSS version 20.

Results: 51.8% of study cohorts were distressed. Among the problems category, most frequent were physical and emotional domains. The most distressing items were fatigue, worry, financial constraints and family health issue.

Conclusion: Psychosocial distress is commonly prevalent among cancer patients. These patients need regular screening and appropriate intervention for psychosocial concerns accordingly. Healthcare professionals should prioritize and address vulnerable issues that could be beneficial for preventing psychosocial distress.

Testicular Pathology: A Four Years Study at BP Koirala Memorial Cancer Hospital

Shankar Bastakoti — 2023-08-23

Introduction: Cancer of testes are relatively rare cancer accounting around 1 % cancer in male. The commonest presentation of testicular tumor is a nodule or painless swelling of one or both testicle.

Methods: Retrospective study was performed in the Department of Pathology, BP Koirala Memorial Cancer Hospital from January 2016 to December 2019 (4 years). Tumour typing and subtyping was done according to WHO classification. The objective of the study was to assess clinico-pathological spectrum of testicular disease and to evaluate histopathological diagnosis and subtypes in Prime Oncology Centre of Nepal. All data were entered in MS excel and descriptive analysis was done.

Results: A total of 69 cases of orchidectomy with age ranges from 2 years to 84 years were included. 83% of cases are neoplastic and most common was Germ cell tumor. In our study, testicular tumors showed a diverse histopathology features and Germ cell tumors were the dominating ones. Among the individual germ cell tumors, Seminoma were the most common followed by Mixed GCT. Testicular tumors were the most common in third and fourth decades of life.

Conclusion: Most common neoplasm in testes was germ cell tumor and of which Seminoma was most frequent.Histopathological examination is necessary to execute an accurate diagnosis of testicular swellings and further treatment.

Effect of Xingnao Kaiqiao (Brain Awakening through Opening Orifices) Acupuncture Method in Restoring Lower Limb Muscle Strength & Functions in Individuals with Acute Stroke

Pradeep K.C. — 2023-08-23

Introduction: Stroke is a major cause of disability in adults worldwide. "Xingnao Kaiqiao" XNKQ or "awakening brain and opening orifices" acupuncture method is a therapeutic principle and acupuncture method for the basic pathogenesis of stroke. Yin and Du meridian acupoints are the main acupoints, and the quantitative norms of needling manipulation are emphasized, which are different from the traditional methods of Acupuncture. The main purpose of this study was to explore the effect of Xingnao Kaiqiao Acupuncture Method on recovery of lower limb muscle function in patients with acute stroke.

Methods: It was a prospective, single blinded randomized controlled trial. Fifty patients with acute stroke and hemiplegia who met the diagnostic criteria were randomly divided into treatment group and control group with 25 cases in each group. The main acupoints used were Renzhong (DU 26), Neiguan (PC 6), Jiquan (HT 1), Chize (LU5), Weizhong (BL 40) and Sanyinjiao (SP 6). The differences between the two groups before and after treatment were compared, with statistical significance set at p-value less than < 0.05.

Results: In our study, the mean age in intervention group was 55.68±14.23 years and in and control group it was 56.32±12.03 years. After intervention there was significant improvement in MTS, MMT, FMA-LE and MRS within and between groups (p=0.001). Difference in differences was evaluated and there was significant difference in intervention group after the end of session in each variable (MTS: p=0.001, MMT: p= 0.03, FMA-LE: p=0.021 and MRS: p=0.001).

Conclusion: XNKQ Acupuncture method can significantly improve lower limb muscle strength and motor function in patients with acute stroke which is safe, low-cost, highly acceptable and effective treatment in Stroke

Efficacy of Platelet Rich Plasma in Treatment of knee Osteoarthritis: General Survey of Cases at Tertiary Center in Kathmandu, Nepal

Manish Bikram Shah — 2023-08-23

Introduction: Knee osteoarthritis (OA) is a common degenerative disease of knee caused by disruption of cartilage and joint inflammation. Mostly affecting the people above the age of 60, OA is one of the topmost disease causing disability in elderly population. The prevalence of OA in Nepal is also high. Traditional treatment protocols including analgesics, steroid, and physiotherapy are refractory after certain level and knee replacement is highly expensive in Nepal. Platelet Rich Plasma (PRP) therapy has emerged as one of the convincing treatment method for OA.

Methods: This prospective cross sectional study was conducted at Annapurna Neurological Institute and Allied Sciences, Kathmandu, Nepal which included total of 203 patients with knee OA, they were treated with PRP injection and the results were evaluated using Ms excel and SPSS.

Results: The results demonstrated, the pain subsided by 57.72% after administration of 3rd dose of PRP. The WOMAC scoring before PRP was 80 (mean value), which reduced to 72, 52 and 34 after the first, second and third dose respectively.

Conclusion: Platelet-Rich Plasma (PRP) therapy has shown promising results as a potential treatment option for knee osteoarthritis. The results proved PRP as an effective, minimally invasive, and relatively cheaper treatment option for patients with knee OA.