Browsing by Author "KC, R"
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Publication Diagnostic and Treatment Delays among the Tuberculosis Patients in the Urban Area of Western Nepal(Kathmandu University, 2018) KC, A; KC, R; Sharma, IABSTRACT Background Diagnosis and treatment of tuberculosis is vital for health system to identify, treat patients as early as possible and to reduce frequency of new cases of a disease among the contacts of known cases. Objective To determine the diagnostic and treatment delay in the urban population of the western, Nepal and factors associated to it. Method An institutional based cross-sectional study was conducted in urban area of Western Nepal. Category I 142 TB patients aged over 15 years visiting DOTs centre during period of three months were included in study. Interview schedule was designed to elicit information on socio- demographic characteristics and history of symptoms. Diagnostic and treatment delay was calculated, chi square test was applied to find associations and non – parametric tests (Mann Whitney U test and Kruskal Wallis H test) for evaluating group differences. Result Out of 142 TB clients, mean age was 38.12 years. Majority (58%) were males. Around 44% belong to upper, 30% middle and 26% lower economic class. Study showed median diagnostic delay 34 days (Q3=68 Days, Q1=19 Days), treatment delay less than a day (Q3=1 Day, Q1=0 Day) and total delay 33.50 days (Q3=71 Days, Q1=19 Days). Smear positive patients had significantly higher risk of diagnostic delay compared to negative (OR=2.18. P=0.035). However, no significant associations found between socio-economic/demographic classes with delay. Median delays was more amongst married (Q3=86 Days, Median =72 days, Q1=24 Days compared to single/separated (Q3=74 Days, Median =57 days, Q1=15 Days) and other socio-demographic variables had no significant differences. Conclusion Delay in diagnosis and treatment in Urban region of Western, Nepal was shorter compared to other places in Nepal and neighboring countries. Shorter delay for smear negative pulmonary tuberculosis raises doubt that cases are not examined according to the national TB control programs manual. KEY WORDS Diagnostic delay, DOTS, Treatment delay, TuberculosisPublication Laboratory parameters of β thalassemia minor patients visiting BPKIHS as diagnosed by Agarose Gel Electrophoresis(Institute of Medicine, 2013) Sherchand, O; KC, R; Lamsal, M; Baral, NAbstract Introduction: Thalassemia is one of the most common genetic disorders worldwide. The current study aims at various laboratory parameters including agarose gel electrophoresis (AGE) pattern of patients consistent with clinical symptoms of β thalassemia minor. Methods: A total of 78 blood samples collected from patients visiting BPKIHS, Dharan to workup for anemia and red blood cell indices. From these 78 patients, 8 samples were suspected of β thalassemia minor and were included in the study. The patients were divided in two groups, adult above 15 years of age and children less than 15 years of age. These samples were further investigated using various laboratory indices including electrophoresis. Results: β-thalassemia minor was detected in 8 cases with various hematological parameters and electrophortic mobilities. The electrophoretic mobility pattern revealed that the patient had increased HbA2 and HbF band and decreased HbA1 band. Among hematological parameters, the mean hemoglobin was 8.1± 2.3gm% in >15 years age group and 3.9± 1.7 in <15 years age group, Peripheral smear revealed microcytic, hypochromic, anisopoikilocytic, target cells and solubility test for sickle cell was negative for all samples. The median unconjugated bilirubin level was 1.95 (IQR: 1.6-2.1) in <15 yrs and 2.25 (IQR: 1.7-7.7) in >15 yrs, the median reticulocyte count was 1.65 (IQR: 0.55-2.3) in <15 yrs and 1.8 (IQR: 1-5) in >15 yrs, Reticulocyte production Index was less than two, median HbF was 7.5 (IQR: 4.2-25) in <15 yrs and 8 (IQR: 1.7-18) >15 yrs , median PCV was 23.4 (IQR: 19.5-25.9) in <15 yrs and 14.6 (IQR: 12.2-16.8) in > 15 yrs. The study also revealed that the β-thalassemia was predominant among Tharus (50%) compare to other ethnicity. Conclusion: Patients of β thalassemia minor showed decrease in hemoglobin, increased unconjugated bilirubin, abnormal peripheral smear, and abnormal hemoglobin pattern on electrophoretogram. Keywords: Beta thalassemia minor, agar gel electrophoresis, HbA2