Medical Journal of Eastern Nepal

Prevalence and Antimicrobial Resistance Pattern of Pseudomonas Aeruginosa Isolated from Different Clinical Samples at Tertiary Care Hospital in Nepal

Rinku Sah — 2023-06-30

Background: Pseudomonas aeruginosa is one of the commonest organism causing different infections like wound infections, Lower Respiratory Tract Infection, Urinary tract infection, infections in burn patient in hospital setting. The increasing trend of antibiotic resistance in Pseudomonas aeruginosa poses a challenge to their empiric treatment with conventional agents. So, the objective of this study was to determine the prevalence and antimicrobial resistance pattern of Pseudomonas aeruginosa isolated from different clinical samples.

Methods: This was descriptive cross-sectional study carried out in the Microbiology laboratory, BPKIHS from March–August 2022. Identification of Pseudomonas aeruginosa was done by standard protocol and antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method following Clinical Laboratory Standard Institute guidelines

Results: A total of 16,950 clinical samples were processed of which 198 isolates of Pseudomonas aeruginosa were isolated mainly from urine, pus, blood, sputum, wound swab, BAL (broncho-alveolar lavage). Of the total Pseudomonas aeruginosa isolated 78.3% were resistant to ceftazidime, 71.2% were resistant to cefepime, 62.1% were resistant to ceftriaxone followed by Piperacillin 59%, ciprofloxacin 43.4%, levofloxacin 39.3%, Gentamicin 36.3%, Imipenem 31.3%. None of the isolates were resistant to colistin. This study shows that the organism was highly sensitive to Amikacin (76.7%), Tobramycin (74.7%) and Piperacillin+tazobactam (PIT-71.7%) which could be the good choice for the treatment of this organism.

Conclusion: Periodic antimicrobial surveillance is essential to update the data for the prevalence and changing susceptibility pattern of the antibiotics over the period of time as this will help in choosing appropriate antibiotics for the treatment.

Sinonasal Outcome Test (Snot-22) Scores as a Predictor of Outcome in Patients Undergoing Functional Endoscopic Sinus Surgery (FESS) for Chronic Rhinosinusitis (CRS) at a Tertiary Care Centre in Eastern Nepal

Sanjeev Kumar Thakur — 2023-06-30

Background: Sino nasal outcome test (SNOT) is a subjective tool in which both nasal and health-related symptomatic improvements are assessed in cases of Chronic Rhinosinusitis (CRS). We aim to report the demography of CRS patients and magnitude of symptoms, along with its improvement over time after the surgery, using SNOT questionnaire.

Methods: A hospital based prospective, descriptive study was done in 35 patients with medically refractory CRS cases who underwent Functional endoscopic sinus surgey (FESS), over one year. All patients were routinely examined the 1st week, the 4th week, and 3 months after surgery.

The cases were assessed preoperatively and then after surgery, using the Sino-nasal Outcome Test-22 (SNOT-22) questionnaire, for a maximum of 3 months period. The results were expressed in number and percentage. Mean and standard deviation were used to describe the findings and compare the initial and follow up values. Association between preoperative and postoperative symptoms was analyzed using paired sample t-test and p value less than 0.05 were considered significant.

Results: The age range was 14-64 years, with a mean age of 33.11 ± years. 12(34.28%) were male and 23(65.71%) were female. Polyps were present in 12 (34.28%). 23 (65.71%) cases were without polyp. The mean SNOT score overall preoperatively was 33.94±SD, while postoperative SNOT score was 19.05±SD. There was a significant improvement in nasal, ear and facial symptoms, quality of life symptoms and psychological symptoms.

Conclusion: There was an overall improvement in all the symptoms postoperatively, though the Cough and dizziness improvement was not statistically significant.

Soleus Muscle Flap for Coverage of Soft Tissue Defect of Leg

Nirajan Prasad Parajuli — 2023-06-30

Background: Open tibia fracture with soft tissue loss at the fracture site is and always a challenging problem for orthopedic surgeons to deal with. Soleus flap is an important option for such defects out of many other options.

Methods: Retrospective descriptive study in which twenty-one patients with open tibia fracture with soft tissue defect at fracture site requiring flap coverage were included in the study. In all 21 patients, the soleus muscle flap was done.

Results: Out of 21 patients, in 16 patients medial hemisoleus flap was done and in five composite soleus muscle flap was done. The average age of the patients was 37.8 years, and the right leg was more involved. In all patients, bone coverage was achieved. Three patients required debridement and mobilization of flap due to infective necrosis at the margin. The mean follow-up was 12 months.

Conclusion: Soleus muscle flap is a good and versatile flap for the coverage of soft tissue defects of the leg exposing bone or fracture.

Study of Serum Uric Acid Levels in Thyroid Dysfunctions

Anshu Bhattarai — 2023-06-30

Background: Hyperuricemia in thyroid dysfunctions has been linked to either impaired renal handling of uric acid or overproduction of uric acid. This study aimed to determine the serum uric acid levels in patients with thyroid dysfunction and to determine the link between thyroid dysfunction and hyperuricemia.

Methods: This prospective and quantitative study which was conducted at Department of Biochemistry, Manipal Teaching Hospital determined the serum uric acid concentrations of 30 years or older; male or female participants diagnosed with either hypothyroidism or hyperthyroidism. T3 and T4 was determined by chemiluminiscence immunoassay (CLIA) and OCD VITROS dry chemistry analyzer was used to determine serum uric acid level. Data entry and analysis was done using SPSS version 23. Descriptive statistics using frequency with percentage and inferential statistics using non-parametric tests were used.

Results: In a total of 100 participants, prevalence of hyperuricemia was 42% (31% in hypothyroidism and 11% in hyperthyroidism). The mean serum uric acid in overall participants was 6.25 ± 2.04 (6.55 ± 1.84 in hypothyroidism and 6.05 ± 1.71 in hyperthyroidism).Significant association was seen between thyroid status and hyperuricemia (p = 0.001).Also, significant difference (p = 0.02) was seen in serum uric acid between hyperthyroid and hypothyroid patients.

Conclusion: Higher prevalence rate of hyperuricemia was found among hypothyroid patients than in hyperthyroid subjects, and a significant association was found between thyroid dysfunction and hyperuricemia. This indicates need for more research to further uncover the mechanisms underlying it.

Vital Capacity in Different Body Postures among Medical Students

Nisha Ghimire — 2023-06-30

Background: Cross legged sitting posture (sukhasana, yogic) is normal sitting posture in India, Nepal and some neighboring countries. This posture is also claimed to deepen breath. However, not many studies have been documented to observe if there is any difference in vital capacity (VC) of lungs in standing, sitting erect posture in chair, and sitting erect in crossed legged posture. So, our aim is to compare the vital capacity in standing, sitting erect posture in chair, and crossed legged sitting posture.

Methods: Forty medical and paramedical students (20 males and 20 females) of Nobel medical college were selected for the study. After selecting the students as per selection criteria, vital capacity was measured with spirometer in standing, sitting erect on chair (palms facing up and down) and sitting erect in crossed legged posture (palms facing up and down). One way ANOVA followed by post hoc analysis was done to compare the vital capacity among different postures. Data were expressed as Mean ± SD. p value <0.05 was considered significant.

Results: Significant decrease in vital capacity was observed when posture changed from standing to erect sitting posture (sitting with palms facing up), {(2242.50ml ±155.830 vs 2095.0ml± 181.29) p=0.05} in females only. No significant changes were seen between erect sitting posture and crossed legged sitting posture in both palms facing up and down conditions.

Conclusion: Vital capacity was highest in standing posture and lowest in erect sitting posture with palms facing up only in females. Though statistically not significant, among sitting postures, the vital capacity was high in crossed legged posture compared to sitting erect in chair in both males and females.

Anthropometric Study of Facial Index and its Clinical Implications among Medical Students in Devdaha Medical College and Research Institute, Rupandehi, Nepal

Sanjay Kumar Yadav — 2023-06-30

Background: The human facial contour has always been an interesting subject for anatomists, anthropologists, plastic surgeons and artists. The purpose of study was to create and evaluate data on face anthropometry.

Methods: A descriptive cross-sectional study was conducted in 200 medical students studying at a tertiary care hospital during the period of 5^th September 2022 to 5th February 2023 after ethical clearance from the institutional review committee (Ref. No: 194/079/080). Simple random sampling was done. Data were collected, entered in Statistical Package for Social Sciences version 20.

Results: We observed that mean indices of the facial height was10.43± 0.84, facial width was 12.40±0.68,range of facial height was 9.31-13.01 and range of facial width was11.10-15.13 cm. Mesoprosopic face was predominant among female whereas leptoprosopic face type was more common among male population of the study. The most common face type was mesoprosopic and the uncommon was hyperleptoprosopic. The least common face among men was Europrosopic while among women was hyperleptoprosopic type. There was significant difference in the male and the female facial index.

Conclusions: A higher index for all the parameters was seen among males than females. The data obtained may be useful in anthropological research, forensic, genetic research, as well as in medical clinical practice.

Frontoethmoid and Intraorbital Meningoencephalocele: A Case Report

Umesh Kumar Sharma — 2023-06-30

A 12 month old infant with progressive left sided proptosis was evaluated by ultrasound and computed tomography (CT). A diagnosis of congenital frontoethmoid and left intraorbital meningocele was made, which is very rare.

Double Outlet Right Ventricle with Pentalogy Physiology in Adult Women: A Case Report

R.Vijaya Lakshmi — 2023-06-30

Double right ventricle outlet (DORV) is a rare cardiac abnormality, especially in adult life. DORV is a rare and complex congenital heart disease that has a high rate of genetic anomalies and extracardiac pathologies. Echocardiography plays an important and cost-effective role in the diagnosis of complex congenital cardiac diseases and assists in surgical planning. Here, we present a case of 38 years old woman who came to our outpatient department with shortness of breath which was progressive during exertion but relief on rest. Clinical examination showed low oxygen saturation of 70% without clubbing of fingers and toes. Holosystolic murmur and diastolic regurgitant murmur were audible along the left Sternal border. Chest X-ray showed cardiomegaly and enlarged pulmonary trunks. Electrocardiography showed right axis deviation and biventricular hypertrophy. After the echocardiogram, it turned out she had DORV. The study emphasizes the role of echocardiography in evaluating DORV.

Diagnostic Dilemma of Hemolytic Anemia: A Reveal Secondary to Gastric Adenocarcinoma

Prerana Gautam — 2023-06-30

Here is a case report of a 62-year-old female who presented to our hospital with complaints of abdominal pain, unresolving severe anemia, bleeding per rectum with history of multiple blood transfusions at outside hospital. On initial investigations, the findings directed towards case of hemolytic anemia. The cause of hemolytic anemia was still unknown even after extensive clinical and laboratory investigations. Bone marrow biopsy was done, which revealed metastatic adenocarcinoma and diagnosis of cancer-related microangiopathic haemolytic anaemia (CR-MAHA) was established. Endoscopic biopsy was done from gastric growth which revealed gastric adenocarcinoma and final diagnosis of microangiopathic hemolytic anemia secondary to gastric adenocarcinoma was made.

The patient’s haematological parameters improved with chemotherapy directed against the gastric adenocarcinoma. Our case supports the findings of various literature which indicates that the gastric cancer-associated MAHA responds well to the treatment with chemotherapy for primary carcinoma.

A Continuing Global Threat of a Neglected Tropical Disease: Dengue

Rahul Reddy Kasarla — 2023-06-30

Dengue fever is one of the most important mosquito borne neglected tropical disease of major public health concern. The disease may be asymptomatic or may give rise to undifferentiated fever, dengue fever, dengue haemorrhagic fever, or dengue shock syndrome. This review outlines the current knowledge of the dengue virus, mosquito vector, transmission, immune pathogenesis, clinical manifestations, diagnosis, and the treatment and management and prevention and control of these infections and recent advances in vaccine development.

Ocular Manifestations of Diabetes Mellitus: It’s Remedies and Prevention

Sanjeev Bhattarai — 2023-06-30

Diabetes mellitus which is a multi systemic disease is a common public health problem which can affect children, young people, adults and older people due to uncontrolled hyperglycemia. Ocular and other systemic complications of diabetes are becoming the most significant cause of visual impairment and other morbidities and are either preventable or curable with early detection and prompt treatment. Its prevalence is increasing globally with sight threatening ocular manifestations. The most of the published articles highlighted that the common ocular manifestations were diabetic retinopathy, snow flake cataract, primary open angle glaucoma, corneal lesions, recurrent stye, Chalazion and extraocular muscle palsies. Treatment options for diabetic retinopathy are laser photocoagulation and intravitreal injection of steroids. Expert opinion is always required in a case with glaucoma, cataract, optic nerve disorders and cranial nerve palsies. Control of blood sugar level, proper nutrition and adequate physical exercise and periodic eye examination can play a crucial role for its prevention.