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High Serum Ferritin Levels among Blood Transfused Thalassemic Patients Admitted to the Department of Paediatrics in a Tertiary Care Centre: A Descriptive Cross-Sectional Study
(Nepal Medical Association, 2023) Tiwari, Damodar; Gupta, Sweta kumari; Thapa, Narayan Bahadur; Devkota, Kiran
Abstract Introduction: Raised serum ferritin levels often indicate iron overload, but they are not specific as the levels are elevated in inflammatory disorders, liver diseases, alcohol excess, or malignancy. If regular transfusions are required for the patient with thalassemia, this doubles the rate of iron accumulation leading to earlier massive iron overload and iron-related damage. The aim of this study aimed to find out the prevalence of high serum ferritin levels among blood-transfused thalassemic patients admitted to the Department of Paediatrics in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted at a tertiary care centre from 1 March 2022 to 31 December 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 078/79-017/HG). Children who were confirmed by haemoglobin electrophoresis on regular blood transfusion were included in the study. Those who did not gave consent were excluded from the study. Convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Results: Out of 53 cases, the prevalence of high serum ferritin level was seen in 46 (88.79%) (80.30-97.28, 95% Confidence Interval). Among 46, 34 (73.91%) had serum ferritin levels of more than 1000 to 2500 ng/ml whereas 12 (26.09%) had more than 25000 ng/ml. Conclusions: The prevalence of high serum ferritin levels among blood transfused thalassemic patients admitted to the Department of Paediatrics in a tertiary care centre was found to be higher than in other studies done in similar settings.
Metastatic Supraclavicular Lymph Nodes among Patients with Lung Carcinoma in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Lamichhane, Suman; Thapa, Ajit; Chataut, Dinesh; Suwal, Sundar; Ansari, Mukhtar Alam; Yadav, Birendra Kumar
Abstract Introduction: Metastatic spread of lung cancer to supraclavicular lymph nodes is considered distant metastasis for treatment purposes. Detection of supraclavicular lymph node metastasis in patients with lung cancer serves for tissue diagnosis by itself and also helps avoid more invasive biopsy from the primary lung mass itself. Ultrasonography of the lower neck can detect supraclavicular lymph nodes before they are palpable and can also be used for safe sampling of these lymph nodes. The aim of this study was to find out the prevalence of metastatic supraclavicular lymph nodes among patients with lung carcinoma in a tertiary care centre. Methods: A descriptive cross-sectional study done in a tertiary care center, carried out from 15 September 2019 to 14 September 2020. Ethical approval was obtained from the Institutional Review Committee (Reference number: 84(611)E2/076/077). The study was done among 92 patients with biopsy-proven lung cancer (lung mass or supraclavicular lymph node biopsy) who were referred for evaluation, and/or percutaneous transthoracic biopsy. Convenience sampling method was used. Point estimate and 90% Confidence Interval were calculated. Results: Among 92 patients with proven lung cancer, metastatic supraclavicular lymph nodes were seen in 13 patients (14.10%) (8.17- 19.73, 90% Confidence Interval). Among 13 patients with metastatic lymph nodes, 9 (69.23%) had palpable supraclavicular lymph nodes. The majority 11 (84.61%) had round-shaped lymph nodes. All metastatic lymph nodes showed loss of echogenic fatty hilum. A total of 12 (92.30%) metastatic lymph nodes showed a peripheral disorganized pattern of vascularity. Conclusions: The prevalence of metastatic supraclavicular lymph nodes was lower than in similar studies done in international settings.
Community-acquired Pneumonia among Elderly Patients Admitted to the Department of Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Karki, Lochan; Khadka, Milan; Joti, Santosh; Adhikari, Siddhant; Tamrakar, Rama; Oli, Milan Purna; K C, Poonam; Maharjan, Shrinkhala; Maharjan, Shristi; Basnet, Rabin; Chauhan, Shanta; Basnet, Prapti
Abstract Introduction: Community-acquired pneumonia is an acute infection of lung tissue in an immunocompetent patient who have not recently been hospitalized or has been hospitalized for less than 48 hours and acquired it in the community. It continues to have a substantial effect on the elderly, who are impacted more often and severely than younger groups. It is the third most common hospital diagnosis in adults over the age of 65 years, and the sixth major cause of mortality in developed nations. The aim of this study was to find out the prevalence of community-acquired pneumonia among elderly patients admitted to the Department of Medicine in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Medicine in a tertiary care centre where data were collected from 1 December 2021 and 1 December 2022 after obtaining ethical approval from the Institutional Review Committee (Reference number: 465/2079/80). Data on community-acquired pneumonia in the elderly was collected from the hospital records. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 385 patients, community-acquired pneumonia was seen in 14 (3.64%) (1.77-5.51, 95% Confidence Interval) with a mean age of 70.57±10.21 years. Conclusions: The prevalence of community-acquired pneumonia among elderly patients was found to be lower compared to other studies conducted in similar settings.
Subclinical Hypothyroidism among Patients with COVID-19 Infection in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Adhikari, Prabin; Singh, Rasu
Abstract Introduction: Hypothyroidism occurs as a consequence of chronic autoimmune inflammation of the thyroid gland, which occurs due to the reduced function in the secretion of thyroid hormones. The coronavirus disease infection has shown many complications in all organic systems, during the acute phase of infection and in the post-COVID-19 period. SARS-CoV-2 may induce thyroid dysfunction that is usually reversible, including subclinical and atypical thyroiditis. The aim of this study was to find out the prevalence of subclinical hypothyroidism among patients with COVID-19 infection in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in the Department of Internal Medicine of a tertiary care centre from 1 September 2022 to 28 February 2023 after obtaining ethical approval from the Research and Institutional Review Committee (Reference number: 15-079/080). Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 38 patients with COVID-19, subclinical hypothyroidism was seen among 23 (60.53%) (44.99-76.07, 95% Confidence Interval). Conclusions: The prevalence of subclinical hypothyroidism among COVID-19 patients was found to be similar to other studies done in similar settings.
Postoperative Surgical Site Infection among Patients with Caesarean Delivery in the Department of Obstetrics and Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Koirala, Poonam; Koirala, Ishita; Bajracharya, Sunita; Rijal, Hima; Ghimire, Asmita; Chamlagain, Anita
Abstract Introduction: Surgical site infections are the commonest nosocomial infections following surgeries. They not only increase the morbidity and mortality following surgeries but also have a great impact both psychologically and financially. The aim of this study was to find out the prevalence of postoperative surgical site infection among patients with caesarean delivery in the Department of Obstetrics and Gynaecology in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynaecology of a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 495(6-11)E2 077/078). Data from 1 July 2021 to 1 July 2022 were collected between 1 September 2022 to 30 November 2022 from the hospital records. All the pregnant women undergoing caesarean delivery during the study period were included. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 1326 patients who underwent caesarean delivery, surgical site infection was seen in 38 (2.86%) (1.96-3.76, 95% Confidence Interval). Among 38 women, anaemia was seen in 11 (28.94%), diabetes mellitus in 6 (15.79%) and hypertension in 5 (13.16%). Conclusions: The prevalence of surgical site infection following caesarean delivery was found to be lower than other studies done in similar settings.
Writing an Abstract for a Scientific Conference
(Kathmandu University, 2013) Simkhada P; van Teijlingen, E; Hundley, V; Simkhada, BD
ABSTRACT For most students and junior researchers, writing an abstract for a poster or oral presentation at a conference is the first piece they may write for an audience other than their university tutors or examiners. Since some researchers struggle with this process we have put together some advice on issues to consider when writing a conference abstract. We highlight a number of issues to bear in mind when constructing one’s abstract. KEYWORDS Abstract writing, conference, oral presentation, poster, scientific writing
Antibiotics Use among Geriatric Patients Admitted in the Department of Medicine in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Shrestha, Ruchi; Pandey, Brijesh; Shrestha, Sony Shakya; Shrestha, Jyoti Tara Manandhar; Poudel, Pankaj
Abstract Introduction: Ageing predisposes to increased risk of infections which make these population vulnerable to high risk of various chronic co-morbidities, organ dysfunction and mortality. Increased frequency of infections has led to an increasing proportion of geriatric patient admission to hospitals, and antibiotics therapy has long been recognized as a cornerstone in the treatment of infections. The aim of this study was to find out the prevalence of antibiotic use among geriatric patients admitted to the Department of Medicine in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among geriatric patients admitted to Department of Medicine in a tertiary care centre from 1 May 2022 to 31 August 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 17/22). Patients with the age of ≥60 years, admitted to the Department of Medicine who stayed for at least 24 hours was included as the study population. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 520 geriatric patients, antibiotics was used in 252 (48.46%) (44.16-52.76, 95% Confidence Interval) patients. Ceftriaxone was the most common antibiotic used in 165 (65.48%) patients, followed by oral azithromycin in 72 (28.57%). The mean antibiotics used per patient was 1.59±0.73. Conclusions: The prevalence of antibiotic use in the geriatric population was found to be lower than in the other studies done in similar settings.
Possession Syndrome at High Altitude (4575 m/15000 ft)
(Kathmandu University, 2013) Khan, ID; Sahni, AK
ABSTRACT In a first of its kind, a 20 year old Hindu, highlander, working girl presented with abnormal behavior, unrelenting symptoms, had limited benefit by usual treatment and was diagnosed as Possession syndrome. Exorcism offered symptomatic relief. The girl resumed normal activities with no recurrence in a 12 month follow up. Possession syndrome is explained in both medical and theological perspectives. Modern medicine associates it with a mental illness though True Possession syndrome without associated mental illness has been reported. Theological perspective can be amalgamated with current scientific theory and practice, thereby complimenting existing concepts. KEY WORDS Abreaction, acclimatization, exorcism, high altitude, possession
Fallopian Tube Papilloma – Case Report of a Rare Tumor
(Kathmandu University, 2013) Narasimhaiah, A; Ansari, M; Haritwal, A; Awasthi, S
ABSTRACT Fallopian tube neoplasms are rare. We report a rare case of fallopian tube papilloma discovered incidentally in a 45 year old female, operated for procidentia. Right tube was dilated at the infundibular region, with friable grey white tissue in the lumen. Microscopy showed delicate branching papillae lined by a single layer of epithelium resembling tubal lining. There were no features to suggest a reactive hyperplasia in response to inflammation or of aggressive behaviour. KEY WORDS Epithelial lesions, fallopian tube papilloma, metaplastic papillary tumor, proliferative
Traumatic Brain Injury among Patients Admitted in Neurosurgical Unit in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Shrestha, Ajit; Paudel, Nimesh; Adhikari, Ganesh; Shrestha, Swikriti; Lamichhane, Sandesh; Subedi, Subash; Jaishwal, Neelam
Abstract Introduction: Traumatic brain injuries are one of the leading causes of mortality, morbidity, and economic burden in context to Nepal. Non-contrast computed tomography is used for rapid diagnosis and repeat computed tomography helps to detect the progression and complications of cerebral injury. The aim of this study was to find out the prevalence of traumatic brain injury among patients admitted in the neurosurgical unit in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients admitted to the neurosurgery unit in the tertiary care centre from 1 August 2019 to 29 August 2020. Ethical approval was taken from Institutional Review Committee (Reference number: CMC-IRC/075/076-156). Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 350 patients admitted in the neurosurgical unit, the prevalence of traumatic brain injury was 140 (40%) (34.87-45.13, 95% Confidence Interval). Change in management was required among 28 (20%) when computed tomography was done within 12-24 hours. Among them, 27 (19.29%) underwent surgical intervention after a repeat computed tomography scan. Conclusions: The prevalence of traumatic brain injury was found to be higher than similar studies done in similar settings.
Surgical Removal of Traumatic Herniation of Buccal Fat Pad in Young Children
(Kathmandu University, 2013)
ABSTRACT Intraoral herniation of the buccal fat pad is traumatic lesion of oral cavity occurring in young children. It frequently presents as an expanding pedunculated mass of soft tissue emanating from the buccal mucosa following a minor trauma to the buccal soft tissues. This article aims to report an interesting and rare lesion, wherein a tiny traumatic perforation of the buccal mucosa and buccinator muscle forced a large portion of the buccal fat pad to extrude into the oral cavity in a young boy. Such a situation can alarm any clinician and reinforces the importance of careful history taking and thorough examination, before treating patients. KEY WORDS Buccal fat, herniation, suctorial pad, surgical removal, trauma
Dengue Fever among Patients Visiting the Outpatient Department of Dermatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Aryal, Eliz; Bista, Raunak; Shrestha, Prashanna Raj; Regmi, Garima
Abstract Introduction: Dengue is in an increasing trend in our part of the world mostly due to global warming, It can present with various manifestations including cutaneous manifestations. The main objective of our study was to find out the prevalence of dengue fever among patients visiting the Outpatient Department of Dermatology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the Outpatient Department of Dermatology in a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 09092022\04). Data from 1 June 2022 to 8 September 2022 were collected between 1 December 2022 to 20 February 2023 from the hospital records. The laboratory data of individuals were analyzed to find out the prevalence of dengue fever. A Visual Analogue Scale was used to assess the severity of pruritus. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 7442 patients, dengue fever was found to be in 202 (2.71%) (2.34-3.08, 95% Confidence Interval) patients. The mean duration of fever was 3.02±2.960 days. The mean duration of onset of rash after having a fever was 2.56±2.032 days. The most common cutaneous manifestation was maculopapular rash 70 (34.65%). Conclusions: The prevalence of dengue fever was found to be lower than in the studies done in similar settings.
Non Medical Interventions for Childhood Diarrhoea Control:Way Forward in Nepal
(Kathmandu University, 2013) Khanal, V; Bhandari, R; Karkee, R
ABSTRACT Background Diarrhoeal diseases remain a major cause of mortality of children aged under-five years in the developing countries including Nepal. The transmission of diarrhoea mostly caused by biological agents and is facilitated by the behavioural, social and environmental factors. More recently, the concept of prevention altering these factors is getting momentum. Objective To recommend the most effective non medical intervention that can prevent and control childhood diarrhoeal disease in Nepal. Methods Litrature review was conducted to analyse the successful interventions in developing countries. Peer review articles were accessed from “Science direct”, “Google Scholar”, and “Pubmed”. Interventions focussing on social and environmental determinants of diarrhoea were included. Results Four interventions (with primary focus in social and environmental determinants of diarrhoeal disease) were purposively selected, summarized and discussed. Saniya programme (Burkina Faso 1995 to 1998) is considered successful in modifying the risk behaviours. Intensive hand washing programme (Pakistan 2002 to 2003), a cluster randomized controlled trail, was not sustainable as the results did not last long once the free supply of soap was stopped. School Led Total Sanitation (Nepal 2006) is a participatory, community centred program whose focus is on local ownership. This program approach is effective and feasible for scaling up in Nepal. Global Public Private Partnership for Hand washing with Soap (Ghana 2002) was based on the marketing researches and hence yielded effective results. Conclusion Combination of School Led Total Sanitation and Global Public Private Partnership for hand washing with soap suits Nepal. These interventions focus on creating demand, changing behaviour and thereby, improving the sanitation status. KEYWORDS Burning mouth syndrome, idiopathic, stomatodynia, xerostomia
Prelabour Rupture of Membranes among Pregnant Women Visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Dwa, Yam Prasad; Bhandari, Sunita; Bajracharya, Manisha
Abstract Introduction: Prelabour rupture of membranes is a common obstetrics problem associated with maternal and perinatal morbidity and mortality. The exact cause is not known although various factors are found to be related to this condition. Hence, the objective of this study was to find out the prevalence of prelabour rupture of membranes among pregnant women in a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted from 1 November 2021 to 30 November 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/79/49). A structured proforma was filled out after taking a detailed history from each pregnant woman. Convenience sampling method was used. Point estimate and 99% Confidence Interval were calculated. Results: Among 700 pregnant women, the prevalence of prelabour rupture of membranes was 56 (8%) (5.36-10.64, 99% Confidence Interval). Among them, 40 (71.43%) occurred in the term, while preterm (before 37 weeks) occurred in 16 (28.57%) of all pregnancies. Previous miscarriage occurred in 15 (26.78%) followed by gestational diabetes mellitus 8 (14.28%). Conclusions: The prevalence of prelabour rupture of membranes was found to be lower than other studies done in similar settings.
A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area
(Kathmandu University, 2013) Shrestha, R; Shrestha, SK; Kayastha, SR; Parajuli, N; Dhoju, D; Shrestha, D
ABSTRACT Background Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. Objective This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Methods Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. Result In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Conclusion Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma. KEY WORDS Emergency department, outreach centers, physical trauma, trauma center
Role of Ultrasound as Compared with ERCP in Patient With Obstructive Jaundice
(Kathmandu University, 2013) Karki, S; Joshi, KS; Regmi, S; Gurung, RB; Malla, B
ABSTRACT Background The diagnosis of obstructive jaundice relies on proper history taking, clinical examination, laboratory investigations and different non invasive imaging modalities like Ultrasonography (USG), Cholangio Computed Tomography (CCT), Magnetic resonance Imaging (MRI) with Magnetic Resonance Cholangio Pancreatography (MRCP) and invasive modalities like endoscopic retrograde cholangiography (ERCP) and percutaneous trans hepatic cholangiography (PTC). Objective To compare the role of ultrasound with endoscopic retrograde cholangiography and to determine the major causes of obstructive jaundice in our prospect. Methods This was a prospective, analytical study conducted on 88 patients presenting to Department of Radiodiagnosis and Imaging at Dhulikhel Hospital-Kathmandu University hospital from March 2011 to August 2012 with clinical diagnosis of obstructive jaundice. Sonographic evaluation was performed in Siemens acusion x-150 and x-300. The final diagnosis was made by endoscopic retrograde cholangiography and /or surgery and confirmed histopathologically. Results The most common benign causes of obstructive jaundice were choledocholithiasis (63%), CBD stricture (12.3%), cholangitis (8%) and pancreatitis (6.85%) whereas cholangio carcinoma (6.85%) and carcinoma head of pancreas (4%) comprised of the malignant causes . Ultrasonography had sensitivity of 100% and specificity of 89% in detecting choledocholithiasis. It was found to be 98.78% sensitive and 83.33% specific in cholangiocarcinoma. Similarly in pancreatitis, the sensitivity of ultrasonography was 97.59% and sensitivity was 66.67%. Conclusion Ultrasonography acts as a valuable diagnostic imaging modality in detecting the causes of obstructive jaundice. Due to its easy availability, non invasive nature and cost effectiveness, it can be considered as the first line imaging technique/ tool. ERCP is the invasive imaging tool and can be used for both diagnostic and therapeutic purpose. KEY WORDS ERCP, obstructive jaundice, ultrasonography
The Ratio of Aspartate Aminotransferase to Alanine Aminotransferase (AST/ALT): the Correlation of Value with Underlying Severity of Alcoholic Liver Disease
(Kathmandu University, 2013) Gurung RB; Purbe, B; Gyawali, P; Risal, P
ABSTRACT Background Alcoholic liver disease is one of the most frequently diagnosed liver problems in the hospitalized patients in most tertiary care hospitals all over the world .The diagnosis of alcoholic liver disease is most of the time clinical. The AST/ALT ratio is a useful and reliable biochemical marker of liver injury due to alcohol. Whether the value of AST/ALT ratio correlates with clinical severity has not been studied. Objectives To study values of AST/ALT ratio in correlation with clinical severity of illness due to alcoholic liver disease using Child-Pugh’s grading. Methods This is a retrospective study. Inpatient records of all the patients admitted with diagnosis of alcoholic liver disease from July 2009 to 2011 June were analyzed. Data from 174 patients with the diagnosis of alcoholic liver disease - alcoholic hepatitis or alcoholic cirrhosis were retrieved; out of 174 patients, 138 were eligible for the study. The AST/ALT ratio and Child’s grading of all the patients were calculated from the documented biochemical and clinical parameters on admission. Demographic profile of all the patients were also recorded and analyzed. The data was analyzed using software SPPSS 16 version. Results A total of 138 patients diagnosed as alcoholic liver disease since July 2009 to June 2011 were analyzed. The male-female ratio was found to be 5.34: 1.The mean age of the patients at diagnosis was found to be 47.58 ± 12.83 years. Among 138 patients, Mongolian were found to have the highest prevalence of alcoholic liver disease (38.8%), followed by Newars ( 33.6%), Brahmin and Chhetri (19.1%) and Dalit (7.2%). With respect to AST/ALT ratio and Child’s grading of ALD, the mean AST/ALT ratio was found to be 3.03 ± 2.24 in those patients who had Chlild’s grade C; likewise the mean AST/ALT ratio was 2.28 ± 1.14, and 1.68 ± 0.83 in patients with Child B and Child A respectively. Conclusion The higher value of AST/ALT ratio is indicative of more severe liver damage due to alcohol. KEY WORDS Alcoholic liver disease, AST/ALT ratio
Hip-Spine Discordance in Bone Mineral Densities in Patients Undergoing Dual Energy X-Ray Absorptiometry Scan in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2023) Chaudhary, Rajesh Kumar; Regmi, Subhash; Shah, Niraj; Banskota, Bibek; Barakoti, Ram Krishna; Banskota, Ashok Kumar
Abstract Introduction: The discordance in the diagnosis of osteoporosis is characterized by the variation in bone mineral density measurements at different skeletal sites. The presence of discordance significantly alters the treatment plan as different treatment is required for different skeletal sites. The aim of this study was to find out the prevalence of hip-spine discordance in bone mineral densities in patients undergoing dual-energy x-ray absorptiometry scans for suspected osteoporosis. Methods: A descriptive cross-sectional study was conducted among patients undergoing dual-energy x-ray absorptiometry scans from 1 December 2020 to 30 October 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: IRC-2020-11-18-08). Patients undergoing dual-energy x-ray absorptiometry scans for suspected osteoporosis were included. Patients aged less than 50 years, already diagnosed and under treatment for osteoporosis, and incomplete information about T-scores of hips and spine were excluded. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among 1028 patients, 602 (58.56%) (55.55-61.57, 95% Confidence Interval) had discordance in hip and spine bone mineral densities. The majority of them, 570 (94.68%) were female and 32 (5.71%) were male. Major discordance was observed in 101 (16.77%) patients and minor discordance was observed in 501 (83.22%) patients. Conclusions: The prevalence of discordance in hip and spine bone mineral densities in patients undergoing dual-energy x-ray absorptiometry scans was higher than that reported in other similar studies done in similar settings.
Medication Adherence to Oral Hypoglycemic Agents Among Type II Diabetic Patients and Their Clinical Outcomes with Special Reference to Fasting Blood Glucose and Glycosylated Hemoglobin Levels
(Kathmandu University, 2013) Shrestha, SS; Shakya, R; Karmacharya, BM; Thapa, P
ABSTRACT Background Oral hypoglycemic agents (OHAs) are the major treatment for people with type 2 diabetes mellitus (DM2). However, non-adherence to OHAs remains as one of the main reasons for poor glycemic control. Objectives To assess the adherence pattern to OHAs and clinical outcomes with special reference to fasting blood glucose (FBG) level and glycosylated hemoglobin (HbA1c) levels. Methods Informed consent was obtained from patients fulfilling the criteria and from the patient party in case of incapacitated patients. Information was obtained by interviewing them and filled in the appropriate questionnaire. All the medical information of the patients was obtained from the medical case records and laboratory reports. Results OHAs had been discontinued by 25% of patients. Overall 38% had ever discontinued and/ or often missed OHAs. Intentional discontinuation of OHAs attributed for 72% of the patients, followed by forgetfulness (42.9%), carelessness (30.6%), and hypoglycemia, (24%). There were 50.50% patients who had uncontrolled FBG (>130 mg/dl) level and 39% had uncontrolled HbA1c (≥ 7%) level. Taking reference age group 51-60 years, control of FBG level was found to be statistically associated with the decreasing age group (p = 0.006, OR = 4.8) as well as increasing age group (p = 0.008, OR = 4.034). There was significant association between controlled HbA1c level and patients’ knowledge about the precautions to be taken while using OHAs (p = 0.044, OR = 4). However, there was no significant association between glycemic control and OHAs adherence. Conclusion Majority of the patients who had missed OHAs attributed it to forgetfulness. Hypoglycemia may also be one of the contributing factors for poor adherence to OHAs. However no association was found between adherence and various other factors like age groups, treatment complexity, health literacy and social or family support. KEY WORDS Adherence, diabetes, HbA1c, hypoglycemia, non-adherence
Ultrastructure of Chondrocytes in Osteoarthritic Femoral Articular Cartilage
(Kathmandu University, 2013) Goyal, N; Gupta, M; Joshi, K
ABSTRACT Background Osteoarthritis (OA) is a common problem in elderly, but it is not an inevitable feature of ageing. About 80-90% of individuals of both sexes have radiographic evidence of OA by the time they reach an age of 65. But not all of them have the symptoms like pain and decreased joint motion. Objective The objective of the present study was conducted to find out whether the osteoarthritic changes in human articular cartilage are similar to the ageing process or not. Methods Femoral articular cartilage specimens obtained from 13 osteoarthritic patients (52-80years) undergoing total knee replacement and 9 cadavers of same age group (50-80years) (control) were processed and studied under electron microscope. The ultrastructure of the cartilage from the two groups was compared with each other. Results Under the electron microscope, articular cartilage from control group had chondrocytes having a secretary cell characteristic with prominent nucleus and well developed organelles. In osteoarthritic cartilage, degenerating or necrotic chondrocytes were found. Nuclei of these chondrocytes appeared lobulated or indented. Chondrocytes below the fibrillated surface had dilated and irregular endoplasmic reticulum. Electron dense lipid deposits in the extracelluar matrix as well as intracytoplasmic glycogen deposits were much increased in osteoarthritic cartilage as compared to the control group. Amount of perinuclear intracytoplasmic fine filaments was also increased in the chondrocytes of osteoarthritic cartilage. Conclusion Ultrastructural findings of the osteoarthritic articular cartilage were much different from the ageing non-osteoarthritic cartilage. Hence, OA should be considered a specific process and not simply an inevitable feature of ageing. KEY WORDS Chondrocyte, fibrillation, necrotic cells, osteoarthritis

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