Medical Journal of Eastern Nepal

Prevalence of Hyperuricemia at a Tertiary Care Centre of Jumla, Nepal: A Retrospective Study

Tirtha Narayan Shah — 2023-12-21

Background: Purines after its metabolism, gives rise to the formation of uric acid as an end product. More than 70% of its excretion is done by the renal system and lesser portion by intestinal and biliary system. Hyperuricemia is caused by the abnormalities in serum uric acid (SUA) metabolism and its impairment in renal function leading to the urate retention.

Methods: Observational descriptive cross sectional study (retrospective chart review) done from 16^th July 2021 to 15^th July 2022 to determine the prevalence of hyperuricemia. The data entered in Microsoft Excel 2007 and analyzed in SPSS (statistical package for social sciences) version 16.

Results: In this study, total participants were 1491 of which male was 553 (37.08%), and female was 938 (62.91%). Prevalence of hyperuricemia was 9.99% in the total population. 16.09% male and 6.39% female population were hyperuricemic.

Conclusions: Besides various factors of the health hazards, hyperuricemia is also one of them and sometimes may go undiagnosed. Timely diagnosis and its treatment may protect against cardiovascular events, hypertension, renal disorders, etc.

Pedicled Groin Flap for Coverage of Soft Tissue Defect of Hand

Nirajan Prasad Parajuli — 2023-12-21

Background: Distant pedicle flaps like groin flaps are still considered workhorse flaps for the coverage of soft tissue defects of the hand. In the era of free flaps pedicle flaps are still considered as primary flaps by many surgeons. Pedicle flaps are easy to raise, require less experience and microsurgical facility.

Methods: In this retrospective descriptive study, patients in whom groin flap was done for reconstruction of hand soft tissue defects were included from April 2017 to April 2022.

Results: Thirty-three flaps were included in this study with an average patients’ age of 34.6 years. There were 24 males and 9 females. All flaps survived and served the purpose of covering wounds. Complications like finger and shoulder stiffness were seen in 18 (54.5%), partial necrosis was seen in 4 (12.1%), marginal necrosis in 2 (6%), and infection was seen in 5 (15.2%) patients. Donor sites were healthy after insetting of the flap and did not show any sign of morbidities like infection or bad scarring.

Conclusion:
Groin flaps are versatile flaps. Where microvascular free flaps are not possible due to severity of injury or due to unavailability of the facility for microvascular free flap groin flap is an excellent option. With less complication, those flaps can be executed easily.

Management of Splenic Injury at B&C Medical College, Teaching Hospital and Research Centre

Bashu Dev Baskota — 2023-12-21

Background: In all blunt abdominal injuries splenic injury relates to about 40%. Splenectomy is the preferred treatment choice for blunt splenic injury in hemodynamically unstable patients. The low-grade splenic injuries and stable patients are mostly treated by non-operative management (NOM) at today era. Consensuses have not been yet formulated about the management of high-grade splenic injuries in hemodynamically stable patients. So, this study analyzes the treatment of patients with high-grade splenic injuries in our institution.

Methods: This study includes all the patients with splenic injuries presented to our hospital during the 5 years period from 2017 to 2022. The datas regarding primary baseline at emergency, complications and mortality were collected from the patient records at medical record section. Based on splenic injury and the treatment they received, they were grouped accordingly.

Results: In a total of 38 cases of spleen injuries, the most common mode of injury was a road traffic accident (RTA) 84% followed by fall injury (10%) spontaneous rupture of the spleen and blast injury 3% each. Sixty-six per cent of the cases underwent operative management out of which 96% cases had a splenectomy and 4% cases had a splenic repair. There was 5% mortality and 95% recovery without residual morbidity.

Conclusion: Most of the cases with spleen injury were managed with a favorable outcome. The careful patient selection for non-operative management will result in higher splenic salvage with close monitoring in an intensive care unit.

Microbiological Spectrum Causing Chronic Suppurative Otitis Media and Determination of the Antibiotic Sensitivity Pattern of Isolated Bacteria

Santosh Sharma — 2023-12-21

Background: The middle ear cleft is chronically inflamed in chronic suppurative otitis media (CSOM). It is one of the most prevalent hearing issues and, if unchecked, can lead to a number of difficulties. The most common bacteria causing CSOM are Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. This study was conducted to identify the typical bacteria and fungi that cause CSOM and to assess the susceptibility of bacterial isolates to various antibiotics.

Methods: From 119 patients, 125 ear pus samples from the ENT outpatient department of Devdaha Medical College were determined to be culture positive. The patients gave their written consent. There were two swabs taken from the discharged ear. Gram staining was done on the first swab, and culture and sensitivity were done on the second. Simple statistical techniques were used for the analysis of the results.

Results: Patients between the ages of 11 and 30 were frequently affected, with the left ear predominating. Staphylococcus aureus and Pseudomonas aeruginosa were the most frequently isolated microorganisms, followed by Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. Most of the bacteria were highly sensitive to, Amikacin, Vancomycin, Piperacillin/Tazobactam and developing resistance to Amoxicillin/Clavulanic acid, Ciprofloxacin and Tetracycline.

Conclusion: The most frequent bacteria found were Staphylococcus aureus, which was also the most responsive to Amikacin (96.22%) and Ciprofloxacin (26.41%). In the view of developing antibiotic resistance, and extra- and intracranial complications in improperly treated cases, judicial use of antibiotics is necessary.

Echocardiography as a Simple Test to Detect Diastolic Dysfunction in Normotensive Diabetes Mellitus Patients

Dhiraj Tamrakar — 2023-12-21

Background: Diabetes mellitus may develop left ventricular diastolic dysfunction which may cause diabetic cardiomyopathy even in the absence of atherosclerosis. The aim of our study is to look for the prevalence of diastolic dysfunction in diabetes mellitus patients with normal blood pressure.

Methods: Our study was cross sectional which included 50 patients who were normotensive diabetic with no evidence of coronary artery disease, thyroid or renal disease. 2D echocardiography was done to look for LVDD and its prevalence.

Results: LVDD was present in 32 patients (64%). It was found more in the females as compared to men and more in the 60-79 years age.There was more number of patients with diastolic dysfunction in those with more years of diabetes duration. It was also found that LVDD was more in those with HbA1c of 6.5% or more.

Conclusion: LVDD cause heart failure in diabetic patients. Thus, echocardiography is a simple noninvasive method to detect diabetic cardiomyopathy.

Competency-Based Medical Curriculum: A Resurgent Paradigm for Medical and Dental Graduates

Rajeshwar Reddy Kasarla — 2023-12-21

Present society is characterized by its growing complexity, dynamics and knowledge intensity, which requires professionals who are able to face new situations and problems confidently and expertly. Education faces the problem that knowledge acquisition does not necessarily mean the successful application of the same knowledge. In case of academic professionals, they should possess a broad and profound domain-specific knowledge and skills, the capability to acquire knowledge expeditiously and know-how where and when needed. Learning in a professional context has, therefore, become more important and general academic education is becoming more professional oriented. Medical education is changing to meet the demands of ever evolving health care system. One of these changes is the development and implementation of competency-based medical education (CBME). Competency-based learning and training is an approach to teaching and learning more often used in learning concrete skills than abstract learning. It differs from other non-related approaches in that the unit of learning is extremely fine-grained. Rather than a course or a module, every individual skill or learning outcome (known as a competency) is one single unit. Learners work on one competency at a time, which is likely a small component of a larger learning goal. The student is evaluated on the individual competency and can only move on to other competencies after they have mastered the current skill being learned. After that, higher or more complex competencies are learned to a degree of mastery and are isolated from other topics. Another common component of competency-based learning is the ability to skip learning modules entirely if the learner can demonstrate mastery. This can be determined through prior learning assessment or formative testing. This article pertaining to the discipline of medical education gives a broad overview and elaborates on this emerging competency based medical education approach and its related concepts.

Brown Tumor, a Deceptive and Rare Entity: A Case Report

Monasha Vaidya — 2023-12-21

A case of 27 years old male from Jhapa district, who presented to Oral and Maxillofacial department of B&C hospital with firm, non-tender swelling over buccal vestibule for 2 months. Computed tomography (CT) revealed an expansile lytic bony lesion with soft tissue component at the right hemimandible with cortical destruction. Provisional diagnosis of ameloblastoma was made.

Incisional biopsy done and specimen was sent to the Pathology department. Haematoxylin and Eosin- stained slides revealed disorderly, fascicular architecture exhibiting clustered distribution of osteoclastic giant cells, surrounded by fibroblastic stromal cells along with reactive new bone formation. The differentials considered were CGCG (Central giant cell granuloma), GCT (Giant Cell tumor), ABC (Aneurysmal Bone Cyst) and Brown tumor. Serum Calcium and Serum PTH (Parathyroid hormone) were advised to ruleout brown tumor in histopathology report and for rest of the differentials excisional biopsy was suggested.

Serum calcium and serum PTH were found to be raised. On further probing, the patient has been having right lower back pain and thin urine stream on and off for few months. USG abdomen was done for the same which revealed bilateral nephrolithiasis with left sided PUJ calculus causing gross hydronephrosis along with bilateral medullary nephrocalcinosis. DJ stenting was thus advised by the nephrologist.

On identifying the primary cause, hemithyroidectomy with parathyroid removal was done. The decrease in parathyroid hormone level was drastic after the surgery. His urine stream was normal during his post –op stay at the hospital. The patient was advised for regular follow up.