Nepal Medical College Journal

Drug Induced Rowell’s Syndrome: A Rare Presentation

Tue, 02 Apr 2024 00:00:00 +0000

Rowell’s syndrome (RS) is a rare disorder characterized by Erythema multiforme (EM)-like lesions in a patient with lupus erythematosus, either systemic lupus erythematosus (SLE) or cutaneous lupus erythematosus (CLE). A 35 years old female presented in our dermatology outpatient department (OPD) with complaint of hemorrhagic crusting of lips and multiple discrete targetoid lesions over the chest, upper limb, and gluteal region. Investigations revealed a speckled pattern of antinuclear antibody (ANA), anti-Smith antibody, anti-ds DNA antibody, and strongly positive anti-Ro antibody. According to the clinical evaluation and investigations, the diagnosis of drug induced RS was made. The likely role of proton pump inhibitors, namely esomeprazole as a triggering factor is discussed. After stopping esomeprazole and starting medications with oral steroids and hydroxychloroquine, her good response to treatment was noted.

Post COVID-19 Infection in Subclinical Hyperthyroidism among Patients Attending a Tertiary Hospital in Kathmandu

Prabin Adhikari, Rasu Singh — Tue, 02 Apr 2024 00:00:00 +0000

Coronavirus disease 2019 (COVID-19) infection may induce thyroid dysfunction as Coronavirus 2 (SARS-CoV-2) can invade the human tissue cells through the cell receptor of angiotensin-converting enzyme 2 (ACE2), expression of which is high in thyroid tissue. The aim of the present study was to assess the subclinical hyperthyroidism post-COVID-19 effects on thyroid function in patients without history of thyroid disease after complete recovery from mild-to-severe COVID19 and find the prevalence of subclinical hyperthyroidism. A descriptive cross-sectional study was conducted in the Department of Internal Medicine, of tertiary care center from September 2022 to February 2023 after obtaining ethical approval from the Institutional Review Committee of Nepal Medical College (Ref. No.: 15-079/080). Convenience sampling method was used among patients who met the eligibility criteria. Point estimate at 95.0% confidence interval were calculated along with frequency and proportion for binary data. Out of 38 patients, 34 (89.5%) had thyroid dysfunction. Among them, 7 (20.6%) had subclinical hyperthyroidism, 2 (5.9%) had thyroiditis and 1 (2.9%) had Graves’ disease. Those who had thyroid dysfunction, 10 (29.4%) people were diagnosed with hyperthyroidism. The hyperthyroidism among COVID-19 patients is a common finding and subclinical hyperthyroidism was seen in 20.6% of patients post COVID-19. Therefore, while managing COVID-19, patients’ thyroid profile should be considered.

Influence of Fixed Orthodontic Treatment Duration on the Prevalence and Severity of Gingival Enlargement

Junima Rajkanikar, Samriddhi Vaidya, Anshu Piya — Tue, 02 Apr 2024 00:00:00 +0000

In patients undergoing fixed orthodontic therapy, favorable conditions for plaque stagnation as well as difficulty in performing usual oral hygiene measures have been associated with poorer periodontal health among orthodontic patients. So this study aims to assess the effect of the duration of fixed orthodontic treatment on presence of gingival enlargement in adolescents and young adults. This cross sectional descriptive study was conducted in the dental hospital of Nepal Medical College Teaching Hospital. Patients under fixed orthodontic therapy for at least 3 months were examined for the presence of gingival enlargement (GE). Demographic variables and the details of duration of the fixed orthodontic therapy was recorded along with presence of gingival enlargement and its grading. The oral hygiene habits like frequency of brushing, use of interdental cleaning aids were recorded along with plaque index. Gingival enlargement was present in 204 (63.7%) out of total 320 patients taken, among which 124 patients (38.8%) had gingival enlargement of score 1 and 80 (25.0%) patients had gingival enlargement of score 2. Gingival enlargement was observed in 101 (73.2%) in 20-30 years old patients which was more prevalent in this age group. Oral hygiene habits like frequency of brushing and use of interdental aids also seem to affect the occurrence of gingival enlargement in patients. Among those who were undergoing orthodontic therapy for more than 2 years, 48 (82.8%) had presence of gingival enlargement. Mean of plaque index was seen to be statistically associated with presence of gingival enlargement. Thus, this study showed that the duration of orthodontic treatment duration significantly influenced the occurrence of GE. Therefore, oral hygiene instructions and motivations should be reinforced for patients undergoing orthodontic treatment.

Outcome of Real Time Self-visualization of Rigid Cystoscopy Procedure on Procedural Pain in Male Patients

Tue, 02 Apr 2024 00:00:00 +0000

Comparison of Post-operative Pain with and without Infiltration of Bupivacaine Hydrochloride in Tonsillectomy

Alina Acharya, Meera Bista — Tue, 02 Apr 2024 00:00:00 +0000

Tonsillectomy is the complete removal of a tonsil from its bed and is one of the most common procedures in Otorhinolaryngology. The intensity of post-operative pain is severe enough to cause dysphagia which subsequently leads to infection of the fossa and other complications. Several studies on pain management have been conducted but not a single standard protocol currently exist. This study aims to evaluate the intensity of post tonsillectomy pain and to assess the efficacy of infiltration of Bupivacaine on the tonsillar fossa following tonsillectomy. A comparative study was conducted at Kathmandu Medical College, ENT-HNS department for a period of 18 months (January 2018 to June 2019). Ninety three patients were included. 2.5 ml of 0.5% Bupivacaine was infiltrated in right tonsillar fossa after tonsillectomy in all patients. The lateralization and intensity of pain at various post-operative period was assessed using visual analogue scale. The requirement of extra analgesics at various post-operative period was recorded. The pain score on the Bupivacaine side on the first and second post-operative day was decreased as compared to the other side. The pain score on the fourth hour and third post-operative day on Bupivacaine side was more than that of the other side. Infiltration of Bupivacaine over the tonsillar fossa has provided a good result with a significant reduction of pain in first post-operative day and in early post-operative period. However, other multi-centered and double blinded study is requires to provide better results.

Prevalence and Causes of Blindness and Visual Impairment in Sudur Paschim Province of Nepal

Suresh Raj Pant, Ramesh Chandra Bhatta, Subash Bhatta, Yuddha Dhoj Sapkota — Tue, 02 Apr 2024 00:00:00 +0000

Hematological and Biochemical Profiles of Patients with Dengue Virus Infection in Lalitpur, Nepal

Indira Rai, Subash Paudel, Santosh Shrestha, Debbie Manandhar, Shiba Kumar Rai — Tue, 02 Apr 2024 00:00:00 +0000

Dengue viral infection is a disease transmitted by mosquitoes of the Aedes genus, and it arises as a result of being bitten by mosquitoes that are carrying the virus. This infection induces a wide range of changes in the body’s immune system. Thus serological evaluation together with hematological and biochemical parameters in cases of dengue viral infection make an accurate clinical diagnosis. The main objective of this study was to study the serological, hematological, and biochemical parameters among patients infected with Dengue virus. A total of 102 blood samples were collected at Asrik Diagnostic Lab, Lalitpur during the period of August to October 2022. Samples were analyzed by following methods: hematological tests were done by coulter counter, Biochemical tests were done by fully automated analyzer and serological tests were done by ELISA. Of the 102 blood samples NS1 antigen was detected in 62 (60.9%) whereas anti-dengue IgM antibody was detected in 10 (9.8%). Leukopenia and thrombocytopenia were present in 33 (53.1%) and 32 (51.6%) of the 62 NS1 positive samples, respectively. Of the 62 cases, only 16 samples were tested for the alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Out of 16 samples, ALT and AST level were significantly higher in 11 (68.8%) and 14 (87.5%) positive cases, respectively. The statistical analysis showed that there was no significant association between NS1 and IgM. It can be concluded that the investigation of leukocytes, thrombocytes, ALT, and AST helps to diagnose the dengue efficiently.

Comparison of Efficacy and Safety of Intrauterine Balloon Tamponade Versus Uterovaginal Packing in Females Presenting with Postpartum Hemorrhage after Normal Vaginal Delivery

Subhadra Agrawal, Shamila Ijaj Munir — Tue, 02 Apr 2024 00:00:00 +0000

To compare the efficacy and safety of intrauterine balloon tamponade with uterovaginal roll gauze packing in patients presenting with primary postpartum hemorrhage after normal vaginal delivery. This randomized controlled trial, conducted at Department of Obstetrics and Gynecology, Lady Willingdon Hospital, Lahore, from December 2015 to November 2016. Two hundred and twelve patients presenting with primary postpartum hemorrhage who did not respond to medical treatment following normal vaginal delivery were included. They were randomly divided in two groups. The first group underwent balloon tamponade using condom and second group underwent intrauterine packing using roll gauze. Both interventions were removed after 24 hours. All females were kept under observation with antibiotic coverage in ward to prevent infection. If bleeding was stopped within 15 minutes and the patient remained hemodynamically stable, then efficacy was labeled and if no complications occur while applying or removing, safety was labeled. Mean age group of women using balloon tamponade and intrauterine packing was used was 28.25±4.672 and 28.30±4.613 years. The mean gestational age of patients using balloon tamponade and intrauterine packing was 38.57±1.36 and 38.63±0.62 years. Mean blood loss in patients using balloon tamponade and intrauterine packing was 600.28±25.338 and 699.21±70.176 ml. Efficacy of intrauterine packing was 94 (88.7%) and balloon tamponade was 104 (98.1%). Safety of intrauterine packing was 83 (78.3%) and that of balloon tamponade was 97 (91.5%). Thus, treatment of balloon tamponade was more effective and safer than intrauterine packing in female presenting with postpartum hemorrhage after normal vaginal delivery.

Evaluation of Effectiveness of Sinus Surgery in Chronic Rhinosinusitis Patients using Sinonasal Outcome Index-22, modified Lund Mackay Score and Rhinosinusitis Disability Index

Apar Pokharel, P Jaya Mayya, Chhanya Bhandari, Bibek Sharma — Tue, 02 Apr 2024 00:00:00 +0000

Functional endoscopic sinus surgery (FESS) is done in patients with chronic rhinosinusitis (CRS) not responding to medical therapy. This study aims to evaluate the subjective, objective and overall quality of life improvement in CRS patients following FESS surgery. Sinonasal outcome index-22, modified Lund-Mackay score and Rhinosinusitis Disability Index were used to evaluate subjective, objective and overall quality of life in patients with CRS. The questionnaires were asked before the surgery and three months after surgery. A total of 110 patients were enrolled in the study. All three types of evaluation showed improvement following FESS surgery. FESS in CRS patients refractory to medical management caused significant improvement in symptom intensity, endoscopic score and overall quality of life.

Pattern of ABO and Rh Blood Groups among Voluntary Blood Donors at Nepal Red Cross Society Central Blood Transfusion Service Centre, Kalimati, Kathmandu

Smriti Singh, Barsika Katwal, Tara Devi Rijal — Tue, 02 Apr 2024 00:00:00 +0000

Blood is a circulatory fluid, responsible for the transport of hormones, nutrients, and enzymes all over the body. It consists of a protein-rich fluid known as plasma, in which are suspended cellular elements: white blood cells (WBC), red blood cells (RBC), and platelets. ABO blood grouping and cross-matching are commonly tested for transfusion of blood and its components, organ transplantation, genetic studies, forensic determinations, as well as for medico-legal issues such as paternity disputes. A descriptive cross-sectional study was conducted in Nepal Red Cross Society Central Blood Transfusion Service Centre, Kalimati, Kathmandu from January 1st 2023 to June 2023 done in 187 donors. Among 187 donors, the age of the donors ranged from 18 years to 55 years, with an average age of 35±0.58 years. The above figure showed that the majority (65.0%) fell into the age group of 26-40 years, followed by those aged 41-55 years, and finally, those aged 18-25 years, respectively. Among all voluntary donors, the majority (71.0%) were male, while 29% were female donors. Data analysis was done by using SPSS and MS-Excel. The result showed maximum number of voluntary donors to be of blood group O, followed by B, A and AB.

Evaluation of Medical Management of Phimosis in Pediatric Patients: A Descriptive Cross Sectional Study

Jasmine Bajracharya, Bineet Thapa, Kaushal Oli, Deepika Lamichhane, Rit Shrestha — Tue, 02 Apr 2024 00:00:00 +0000

Phimosis is considered virtually universal in newborn males. Circumcision is mostly done for unresolved phimosis. There is a stream of evidence that suggests steroid cream application is effective in these children prior to any surgical decision. A cross-sectional descriptive study from October 2021 to November 2022, was designed to include all cases of phimosis in male children up to 15 years of age. Caregivers of the patients were counseled and advised for management with hydrocortisone 1.0% ointment twice a daily and follow up in 2 weeks. The resolution rates were noted in 2 weeks and 4 weeks and unresolved children were counseled for either continuation of medical management or circumcision. Electronic registry was used to enroll all the cases and note the outcomes. A total of 146 boys were evaluated. Median age of presentation was 4 years, 113 children (77.4%) were successfully treated with medical therapy and only 33 children (22.6%) had failed medical therapy requiring circumcision. A total of 66 children (58.4%) required only 1 followup for resolution of phimosis. By contrast, 47 children (41.6%) required more than 1 follow-up for resolution. Topical steroid in treatment of phimosis is a very safe, effective, inexpensive and easy approach that attenuates the need for surgical intervention. The response rate is very high and adverse effects are minimal. In the developing world, medical therapy can thus be more feasible of an option as compared to surgery.

Laser Lithotripsy for the Management of Ureteric Calculus

Neeraj Subedi, Mohan Khadka, Hemant Pun, Prakrit Dhakal, Ananya Singh Bogati — Tue, 02 Apr 2024 00:00:00 +0000

Urinary calculi are important problem in urology field. Ureteral stones can cause obstructive uropathy and subsequent deterioration of renal function. The minimal invasive approaches become the major source of treatment modalities with the development of lithotripsy technology. A prospective cross sectional hospital study was conducted in the Urology Department of a tertiary care hospital in Kathmandu for a period of one year (September 2022 to August 2023). A total of 118 patients attending Urology OPD and undergoing laser lithotripsy were included in the study. Ureteroscopic procedure was done using a 6.5 Fr (Wolf Inc., Germany) semirigid ureteroscope under direct endoscopic vision and once the stone was visible, fragmentation was done using Ho-YAG laser. The mean age of the patients was 35.36 ± 11.65 years with male preponderance (58.5%). The common presenting symptom was flank pain and ureteric calculus was more common in the left side (49.2%). Upper ureteric calculus (60.2%) and single stone (83.9%) were more common. Stone size <10 mm (54.2%) and density more than 1000 HU (87.3%) were more common. Stone retropulsion was seen in 16.1% cases and 78% had no post operative complications. SFR in Xray KUB was 94.9% and in USG was 78.8%. The association of SFR in Xray KUB and USG among different variables - male and female patients, patients with stone size < and ≥ 10 mm, stone density < and ≥ 1000 HU and sites (upper, middle and lower) was statistically not significant. The laser lithotripsy technique was found to be effective and safe for ureteric calculus with high SFR.

Clinicopathological Study of Helicobactor Pylori Infection and Gastric Carcinoma at a Tertiary Care Hospital in Kathmandu

Rakesh Pathak, Sujata Pudasaini, Manjila Basnet — Tue, 02 Apr 2024 00:00:00 +0000

Effectiveness of Health Education Intervention on Knowledge Regarding Prevention of Cervical Cancer among Women in a Selected Community of Kathmandu, Nepal

Binu Gorkhali, Mrigendra Amatya — Tue, 02 Apr 2024 00:00:00 +0000

Cervical cancer is considered a cancer that is preventable by means of vaccination against human papilloma virus (HPV) and early detection by screening. Its incidence is decreasing in developed countries but not in developing countries, including Nepal. Disease ignorance and low awareness about available preventive health services are the main causes for cervical cancer still being a leading cause of death by cancer. We evaluated the effectiveness of a health educational intervention in improving women’s knowledge about cervical cancer and its prevention in a semi-urban community of Kathmandu. Health education was provided in an interactive lecture for women of reproductive age in various wards of Shankarapur Municipality, Kathmandu. Its effectiveness was assessed by comparing the level of knowledge before and four weeks after the intervention, by interviewing participants based on a questionnaire consisting of 48 questions. The study was completed in 126 women (mean age 33.5 years). The mean pre-test and post-test correct scores were 10.2 and 42.13 respectively (p <0.001). Initially, 96.8% had poor knowledge (score <60.0% of total); post-intervention, 87.3% had good knowledge (score ≥80.0%, p <0.001). Knowledge before intervention was especially poor among older age, less educated, housewives or doing small business, and married women (p <0.001). Knowledge of cervical cancer and its prevention is poor among community women. A health education is very effective in improving women’s knowledge and should be implemented as a policy to achieve the goal of eliminating cervical cancer as a public health issue.

Prevalence of Thyroid Disorders among Pregnant and Non-Pregnant Women Attending a Tertiary Care Center in Kathmandu

Tue, 02 Apr 2024 00:00:00 +0000

Thyroid hormones are crucial for the overall development of the fetus, and their impact on the pregnancy outcomes needs to be considered seriously. Hence, universal screening for thyroid disorders is recommended in the first trimester of pregnancy. One hundred pregnant women in their first trimester and 100 non-pregnant women of the reproductive age group were screened for thyroid function test. The prevalence of thyroid disorders among the total participants was 32.0% of which 23.5% were hypothyroid and 8.5% were hyperthyroid. Pregnant females had a significantly higher prevalence of thyroid disorders (46.0%) than non-pregnant counterparts (18.0%; P <0.001). Pregnant females had significantly higher odds of hypothyroid disorders than non-pregnant females (OR 3.95; P <0.001). The prevalence of subclinical hypothyroidism among pregnant and non-pregnant was 34.0% and 12.0% respectively which makes it the most common thyroid disorder in both study groups. The median values of FT3, FT4, and TSH levels were, however, not significantly different between the study groups. After adjusting for the confounding effect of age, the odds of thyroid disorders were still significantly higher in pregnant women than in non-pregnant (p =0.001). The prevalence of thyroid disorders, specifically hypothyroidism, is higher in pregnant women compared to non-pregnant counterparts. And this emphasizes on the need of antenatal thyroid screening to be made mandatory in the health policy.