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Meckel’s cave and bilateral internal auditory canal metastasis of adenocarcinoma of unknown primary
(Institute of Medicine, 2017) Gurung, U; Tse, A; Corbridge, R
Abstract Adenocarcinoma of unknown primary presenting as metastasis to Meckel’s cave and bilateral internal auditory canals is rare. We report a case of a 65-year-old chronic smoker presenting with ontological symptoms and trigeminal neuralgia who, on neuroimaging, revealed metastatic deposits to bilateral internal auditory meatus (IAM) and also Meckel’s cave.
Zolpidem dependence
(Institute of Medicine, 2017) Tulachan, P; Pant, SB; Chapagai, M; Dhungana, S; Ojha, SP
Abstract Recently, Zolpidem dependence is rising in clinical practice. It was once thought to have low addictive potential due to its selective affinity to α1-GABAA receptors. However, contemporary studies have shown that Zolpidem may lack selectivity when used at high dose for extended periods of time and may show addictive potential similar to that of the benzodiazepines. We hereby report a case of Zolpidem dependence in a physician with insomnia, which was successfully detoxified with Diazepam to emphasizethe caution while prescribing it. Keywords: Dependence, Zolpidem
Submental endotracheal intubation: an alternative to short-term tracheostomy
(Institute of Medicine, 2017) Koirala, M; Shrestha, A
Abstract Patients with pan facial trauma require maxillomandibular wiring in the intraoperative period to check the alignment of the fractured segments. So oral intubation is not possible in these cases. Associated nasal bone and base of skull fracture in these patients make nasal intubation unsuitable. The submental route of endotracheal intubation provides a secure airway, an unobstructed intraoral surgical field and allows maxillomandibular fixation. It is the preferred mode of intraoperative airway management in cases where maxillomandibular fixation is required but the non-invasive methods of airway management are contraindicated Keywords: Intermaxillary fixation, Maxillofacial trauma, Submental intubation
Spontaneous Dissection of Right Coronary Artery and It’s Surgical Management
(Institute of Medicine, 2017) Timala, RB; Sharma, J; Rajbhandari, R; Limbu, Y
Abstract Primary spontaneous coronary artery dissection (SCAD) as a cause of acute myocardial infarction is rare entity with complex pathophysiology. SCAD must be considered every time that a healthy young patient presents with an onset of acute myocardial ischemic syndrome or sudden death. Mostly it appears in young women without traditional risk factors for coronary artery disease and a significant proportion of them are diagnosed during the peripartum or early postpartum period. SCAD is frequently fatal and a great number of known cases have been diagnosed at autopsy. The quick recognition of SCAD as a cause of acute myocardial ischemia in a young patient is important to establish the best medical/surgical treatment between the different therapeutic attitudes.
Pulmonary Rehabilitation in COPD-An Important Non-pharmacological Treatment
(Institute of Medicine, 2017) Shrestha, KD
Abstract Pulmonary rehabilitation (PR) is a non-pharmacological therapy that has emerged as a standard of care for patients with chronic obstructive pulmonary disease. It is an integral part of the clinical management and health maintenance of those patients with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It aims to reduce symptoms, decrease disability, increase participation in physical and social activities, and improve the overall quality of life (QOL) for patients with chronic respiratory disease. Currently, the focus of treatment is appropriate bronchodilator therapy but much like bronchodilator therapy, non-pharmacological therapy provides symptomatic improvement and better quality of life. Pulmonary rehabilitation is a comprehensive, multidisciplinary, patient-centered intervention that includes patient assessment, exercise training, self-management education, and psychosocial therapy delivered by an interdisciplinary team of therapists and it last for 6-8 weeks. The benefits of pulmonary rehabilitation as a non-pharmacological treatment include decreased dyspnoea, improved health-related quality of life, fewer days of hospitalization, and decreased health-care utilization. This article aims to highlight the pulmonary rehabilitation, its indication, contraindication, benefits, component of PR and health care providers’ role in successful PR.
Ultrasound elastography of liver: How Radiologist can help
(Institute of Medicine, 2017) Maharjan, S; Panta, OB; Lohani, B; Pathak, YR; Ansari, MA
Abstract Conventional Ultrasonography imaging does not provide information on mechanical properties of body tissues. Advances in ultrasound like contrast enhanced ultrasound, multiplaner 3D ultrasound and elastography have improved the performance of ultrasound in detection and characterization of pathologies and also has added a new dimension to conventional imaging technique. At this time, the use of elastography is not recommended for characterization of focal liver lesions, however in diffuse liver diseases Ultrasound elastography finds a role in identifying, classifying and grading fibrosis. Liver biopsy has been regarded as the gold standard to detect and classify liver fibrosis. However, due to high cost, inherent complications, invasive nature and its observer and sampling inadequacy, alternative methods to biopsy like Ultrasound elastography might have a role to play in detecting and grading liver fibrosis. This review focuses on the type of elastography and its role and applicability in various liver pathologies. Keywords: Elastography, Liver fibrosis, Stiffness, Ultrasonography
Consequences of Teenage Pregnancy in Kathmandu Valley
(Institute of Medicine, 2017) Prasai, S; K.C., N
Abstract Introduction: Teenage pregnancy has emerged as one of the major public health problem in Nepal. The aim of this study was to explore the consequences of teenage pregnancy in Kathmandu Valley. Methods: A Descriptive Cross-Sectional study was adopted. The population of the study were Teenage and non-teenage (20-25 years) postnatal mothers admitted in Paropakar Maternity and Women's Hospital (PMWH).Non-probability purposive sampling was used for the selection of mothers. Hundred postnatal mothers were included. Ethical approval was taken from the research committee NINE and from concerned authorities of PMWH, Thapathali. Formal permission was taken from hospital administrator of PMWH for data collection. Thorough out the study precautions were taken to safeguards the rights of the mother. Informed verbal consent was obtained from all the participants. Liberty was given them to discontinue the study at any time if they wished. SPSS version 16 was used and chi-square test value was applied for statistical analysis. P value < 0.005 was considered in statistically significant. Results: This study showed no association between teenage pregnancy and accessibility and utilization of health services, many of the maternal outcomes studied viz. eclampsia, preterm labor, premature rupture of membranes, prolonged labor, obstructed labor and post-partum hemorrhage and all of the fetal outcomes viz. preterm birth, low APGAR score and low birth weight (p>0.05). However, this study showed significant association of teenage pregnancy with occupation, educational level of the women, use of contraceptive devices, type of contraceptive devices used, gestational hypertension, anemia and type of delivery (p<0.05). Conclusion: Teenage pregnancy is less likely to have adverse fetal outcomes while adverse maternal outcomes like anemia and pre-eclampsia are more likely to be faced by them. And, teenage women are more likely to have vaginal delivery with episiotomy. Keywords: Fetal outcomes, Maternal outcomes, Teenage pregnancy
Assessment of the level of knowledge regarding safe abortion among reproductive age group women, a short cross sectional study in lekhnath, kaski
(Institute of Medicine, 2017) Acharya, A; Bhattarai, S
Abstract Introduction: Overall situation of reproductive health and the quality of life of females are not satisfactory in developing countries. Complications from unsafe abortion result in maternal deaths and abortion-related morbidities worldwide, placing high strain on limited health system resources and leading to severe physical, psychological, and financial consequences for women1. Methods: A cross sectional descriptive study carried out in 50 reproductive age group women living in Lekhnath municipality-12 at Kaski, Nepal and sample size was determined by using non probability purposive sampling where data were taken under the consent of individual using semi structured interview schedule and were analyzed using SPSS version 11.5. Result: Regarding the type of the abortion, 40% knew about induced abortion, 16% knew about spontaneous abortion whereas 44% knew about both induced and spontaneous abortion. Among the respondents who heard about safe abortion, only 28% gave the correct meaning about safe abortion whereas rest 72% gave incorrect meaning about the safe abortion. The respondents who heard about safe abortion, there was only 51% knows about the legal period of safe abortion for women and remaining 49% of them did not have any idea for legal time of legal abortion. In addition, 40% of respondents had high as well as fair level of knowledge about safe abortion and 20% of the respondents had low level of knowledge regarding safe abortion. Conclusion: Reproductive rights are the rights of individuals to decide whether to reproduce and have reproductive health. The present study highlights the knowledge on reproductive age group women of Lekhnath, Kaski and knowing about safe abortion is important as it helps to enhance equity and gender equality, share the burden of preventing diseases and health complications, promote satisfying sexual lives for men and women. Keywords: Safe Abortion, Reproductive Age, Nepal
Private production of human resources for health: geographic distribution, students intake and course fees
(Institute of Medicine, 2017) Sigdel, R
Abstract Introduction: After 1990 change of government in Nepal, private sector's role in health care system became increasingly prominent. However, in absence of scientific evidence doldrums and conundrums characterised major debates around the perceived and projected roles of the sector. This work reflects on the findings of a research commissioned by the Ministry of Health and Population as part of the private health sector assessment. Here three aspects of the private sector's role in production of human resources for health - geographic distribution, students’ intake and course fees are reported. Methods: A stratified random sample of 44 out of 122 private Health Science Institutes was taken for inclusion in the study. Telephone contact with the principals and administrative chiefs of the selected Institutes was followed by data collection using structured interviews based on questionnaires developed through a consultative process. Guided conversation with officials of professional councils and policy makers in the Ministry of Health and Population was conducted. Data were quantitatively analysed to calculate summary measures and distribution. Results: A third (36.89%) of Institutes was in Kathmandu valley, with 23.77% within Kathmandu city area of the valley, exlcuding parts of Bhaktapur and Lalitpur. Next was Parsa and Chitwan (15.57%), followed by Morang (9.02%) and Kaski (7.38%). Rest of the country had less than a third of total Institutes (31.14%). More than a half (59.84%) were in central region, 17.21% in eastern region, 13.11 % in western region, 7.38 in far western region and 2.46% in mid-western region. A dominant fraction of the Institutes fed on fees by domestic students only (79.55%), with only a fifth (20.45%) of the Institutes having domestic as well as foreign students. Among this fifth of the Institutes foreign students were enrolled only in Bachelor of Medicine and Bachelor of Surgery and Bachelor of Homeopathic Medicine and Surgery. Tuition fees among the Institutes had two-fold gap between the lowest and the highest for the same degree programmes ranging from auxiliary to masters levels. Conclusions: We urge the government to utilise scientific evidence coming from this work and previous local and international examples in prioritising the revision of existing policies, plans and regulations regarding private sector's role in the development of human resources for health. We also recommend further research to contest, verify or extend the knowledge coming from this work. Keywords: health profession education, health policy and systems research, Low and middle income countries (LMIC), private sector, public health education, public private partnership
Mortality in Emergency Department of Nepal Medical College Teaching Hospital, a tertiary care centre in Kathmandu, Nepal
(Institute of Medicine, 2017) Bharati, U; Shrestha, S
Abstract Introduction: There are limited literatures regarding mortality studies in emergency department of different hospitals of Nepal. The objectives of this study were to review and highlight the demographic patterns of mortality and to determine the frequency and causes of accident and emergency deaths. Methods: This was a retrospective study carried out in emergency department of Nepal Medical College Teaching Hospital, Kathmandu for a period of 3 years from April 2013 to 14th April 2016. The study variables were analyzed with descriptive statistics using software SPSS 16. Results: A total of 35,734 cases attended the emergency department during this period with mortality rates of 0.19%, 0.21% to 0.35% on consecutive 1st, 2nd, and 3rd year of study. There were 51(56%) males and 40(44%) females. The age of the cases ranged from 1month 23days to 86years old. Highest number of mortality (30.8%) was seen in the age group of more than 70 years old. Medical causes for death was far more common than surgical causes (83.5% versus 16.5%), Cardiac arrest being the commonest (n=19, 20.9%). Maximum number of cases (n=44, 48.4%) died within 1 to 6 hours of arrival to the emergency department. Conclusions: This study on mortality patterns highlights the causes of common mortalities in one of the emergency department of tertiary care centre in Nepal. This study will provide a basic data to develop competent manpower and good infrastructure with latest equipments in order to optimize positive outcome and to strengthen the emergency setting. Keywords: Emergency, Mortality, Patterns
Evaluation of arterial phase images with 90vp in multiphase abdominal CT scan
(Institute of Medicine, 2017) Chapagain, KM; Humagain, M; Lohani, B; Shrestha, SL; Thapa, N
Abstract Introduction: CT scan of abdomen is usually performed in 120-140 kVp and such high ranges of kilovoltage in all phases will increases the radiation dose many fold. The purpose of the study was to qualitatively and quantitatively assess image quality with low kVp in arterial phase of examination of multiphasic abdominal CT study. Methods: A prospective cross-sectional study was done in 206 participants of age 18 to 88 years who were undergoing multiphase CT studies of the abdomen in Neusoft 16 detector MDCT. After performing non contrast scan, arterial phase study of limited region of abdomen (diaphragm to infrarenal margins) was obtained with 90 kVp. The portovenous phase scan with standard protocol was obtained (120kVp). All other scanning parameters were kept same for two phases. Images were rated on 5 point scale (1-worst, 2-Suboptimal, 3-adequate,4-very good,5-excellent) based on visualization of boundaries, anatomical details of the organs and visualization of noise and artifact by two radiologists. Patient weight, abdominal circumference (AC), height and BMI were recorded and correlated with the image quality score. Statistical analysis was done with Wilcoxon’s signed ranks test k test and descriptive analysis. Results: Overall the image quality of portovenous phase was significantly better (p<0.005) than low kVp arterial phase. Image quality score correlated best with abdominal circumference in standard dose technique (r=0.54) and patient weight in reduced dose technique (r=0.44). Arterial phase scanning had acceptable image quality score for patient weight of <60 kg, AC <80cm and BMI<25 kg/m2. The CTDIvol was 7.71 with reduced kVp protocol and 20.02 with standard resulting significant reduction in radiation dose of about 61% Conclusions: The image quality of arterial phase images with 90kVp tube potential is acceptable in thin and average built patients. Hence reduction in radiation dose is possible if arterial phase scanning is done with reduced kVp except in patients with large anthropometric parameters. Keywords: Arterial phase, CT, Image quality, Low kVp, Radiation dose
New onset diabetes after transplant in renal transplant recipients
(Institute of Medicine, 2017) Nepali, R; Shah, DS
Abstract Introduction: New onset diabetes after transplantation (NODAT) is a common complication of renal transplantation. Despite its prevalence and importance, the data on NODAT and its risk factors in Nepalese population are lacking and the incidence and risk factors for NODAT in Nepalese population who underwent renal transplantation at Tribhuvan University Teaching Hospital. Methods: All the patients who underwent living donor kidney transplantation at Tribhuvan University Teaching Hospital between August, 2008 and February, 2016 were included in this study. Patients who were diagnosed with diabetes mellitus before transplantation were excluded from the study. Patients were divided into NODAT and Non-NODAT groups. Then, risk factors were compared between the two groups. Results: A total of 350 patients who underwent living donor renal transplantation at our hospital during the study period were included. 23 patients who were diagnosed cases of Diabetes Mellitus before transplantation were excluded. In the remaining 327 cases, the incidence of NODAT was 19.57% (64 patients). Most of them (95.31%) occurred within the first 12 months’ post transplantation. The mean duration of onset of NODAT was 121.46 ± 275.58 days post transplantation. Age of the recipient greater than 45 was significantly associated with NODAT than non-NODAT patients. However, there was no statistical difference in sex between NODAT and non-NODAT patients. Conclusion: NODAT is common complication after renal transplantation. Age of recipient > 45 years is a significant risk factor for the development of NODAT. So, we have to be more vigilant in these patients Keywords: Renal transplantation, NODAT, Age
Factors Associated with Health-Related Quality of Life among Nepalese Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study
(Institute of Medicine, 2017) K.C, Tulza
Abstract Introduction: Diabetes is a chronic disease with a considerable impact on the health status and quality of life. Studies have shown that health-related quality of life (HR-QoL) among diabetics is much lower than those reported among non-diabetics. The aim of this study was to find out factors influencing the HR-QoL among diabetic people. Methods: A descriptive, cross-sectional study was done in Tribhuvan University Teaching Hospital, Kathmandu. A total of 108 adult diabetic clients were selected using non-probability purposive sampling and information on quality of life (QoL) collected by using World Health Organization Quality of Life Questionnaire through interview method. Descriptive and inferential statistics [independent sample t test, one way ANOVA and Post hoc analysis (LSD)] were done to describe the respondent’s QoL scores. Results: According to scoring manual of QoL scores, higher the score better the QoL. The study revealed client of young age group had scored significantly higher score (65.9±8.9, 62.9±12.6, 69.9±11.7) in three domains i.e. physical, psychological, and social domain respectively. Educated clients with higher secondary and above level scored significantly higher score (61.7±16.5, 57.0±16.7, and 61.8±11.8) in three domains i.e. physical, psychological, and environmental domain respectively. Unmarried clients scored significantly higher score (65.7±10.8) in social domain only. Clients with duration for 6 months to one year of diagnosis of diabetes and higher economic class scored significantly higher score (61.4±10.1, 57.0±13.2, 64.5±16.2, 60.4±11.2 & 59.5±16.2, 57.9±16.2, 68.2±18.4, 56.8±13.5 &) in entire four domains respectively. Equally, clients with none of diabetes related complications scored higher (58.7±12.3, 55.5±15.0, 63.3±16.9 & 56.1±10.3) in all four domains. Conclusion: Study concludes that factors related to lower quality of life among diabetic clients included: older age, less educated, lower economic class, longer duration of diagnosis, type of complications, and counseling on diabetes. Thus, diabetes management should not only focus mainly on clinical outcomes but also on patients’ perceived outcomes, which reflect a person’s quality of life and a better compliance with the diabetes management. Keywords: DM, health-related quality of life (HR-QoL), QoL scores
Management of Hospital Solid Wastes: A study in Pokhara Sub- Metropolitan City
(Institute of Medicine, 2017) Bastola, D; Bastola, R; Nepal, D; Baral, P
Abstract Introduction: Hospital waste can be defined as the total waste stream that is generated from health care establishments. Health care wastes usually consist of sharps, human or animal tissues or body parts, their body fluids and other infectious materials produced during the course of treatment. Methods: For the purpose of the study, population was defined in terms of the medical hospital, having inpatient facilities located within Pokhara Sub-Metropolitan City (PSMC). The total numbers of health care institutions (HCIs), having inpatient facilities, were 14 and all were sampled for the study. Questionnaires were prepared to meet the objectives of the study. Results: Various categories of health care waste have been generated in the health care institutions of PSMC which depend on size of individual health care facility, types of medical specialties practiced, and nature of HCIs. Waste generated from health care activities have been categorized as general or non-hazardous waste, and hazardous waste and are separately segregated into 4 different categories, like general waste, infectious wastes, sharps, and saline bottles. Conclusion: Most health care institutions in Pokhara Sub-Metropolitan City depend upon the municipality services for the disposal of health care waste materials collected. The municipality disposed the waste without any segregation and treatment in the sanitary land fill site treating them as a municipal solid waste. There is no separate mechanism for the proper treatment of medical wastes. There should be integrated waste management system and centralized waste management system managed by the municipality under health care waste management act to solve the gravity of problems. If it is not improved the problem of serious environmental health problem will arise in future thus an appropriate management of hospital solid waste should be undertaken. Keywords: hospital waste, health care institution, waste management
Comparison of Different Estimating Equations for Prediction of Glomerular Filtration Rate in Living Kidney Donors
(Institute of Medicine, 2017) Poudyal, S; Pradhan, M; Chapagain, S; Luitel, BR; Chalise, PR; Sharma, UK; Gyawali, PR
Abstract Introduction: Assessment of renal function is a crucial step in evaluation of living kidney donors. The standard method for determining renal function is measurement of glomerular filtration rate (GFR) using I-123 iothalamate, Tc-99m Diethylene Triamine Pentaacetic Acid (DTPA) and 51Cr-Ethylene Diamine Tetraacetic Acid. As these methods are expensive and cannot be used in all clinical settings, it is common practice to estimate GFR by creatinine-based equations. The objective of this study is to compare commonly used estimating equations for the prediction of GFR in Living Kidney Donors. Methods: In 75 healthy kidney donors, GFR estimated by Modification of Diet in Renal Disease Study equation (MDRD), Cockcroft-Gault formula(CG), Chronic Kidney Disease Epidemiology Collaboration(CKD- EPI) equation and 24 hour urinary creatinine clearance were compared to GFR measured by Tc-99m DTPA. Statistical analysis was done using Dunnett’s test and Bland-Altman plot. Similarly, accuracy, precision and bias of each equation were assessed. Results: Mean GFR calculated by DTPA clearance, CG, MDRD, CKD-EPI equations and 24 hour urine creatinine clearance were 83.35±8.59, 78.99±17.17, 93.30±17.12, 96.34±13.36 and 137.96±43.65 ml/min/1.73m2 respectively. Applying Dunnett’s test, GFR by CG equation minimally underestimated GFR measured by DTPA (p=0.612) whereas GFR estimated by MDRD (p=0.034), CKD-EPI(p=0.03) and 24 hour urine creatinine clearance(p<0.001) were statistically significant. CG equation had the highest accuracy. Using Bland-Altman plot, the precision of CKD-EPI equation was the highest among all. Conclusion: There is no single creatinine-based estimating equation to assess GFR with utmost accuracy and precision at the same time. Keywords: creatinine clearance, Diethylene Triamine Pentaacetic Acid, living kidney donors
Prevalence of Helicobacter pylori in children with recurrent abdominal pain
(Institute of Medicine, 2017) Wagle, B; Shrestha, M; Shrestha, L
Abstract Introduction: Recurrent abdominal pain (RAP) in children is defined as at least three episodes of abdominal pain during three month period and severe enough to affect their activities. It is frequent diagnostic problem faced by Pediatricians. Helicobacter pylori (HP) is a pathogen of human gastric mucosa and is considered to be one of the major cause of RAP. The prevalence of HP infection increases with age. The study is to determine the prevalance of HP seropositivity, and the cause of RAP in children aged between 5-16 yrs. Methods: It was a prospective observational study conducted in department of child health, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu. A total of 60 patients of aged between 5-16 years diagnosed with RAP were enrolled. Detailed history, physical examination and relevant laboratory investigations including USG abdomen and HP antibody Enzyme linked immunosorbent assay( ELISA) were performed. Results: The prevalence of H Pylori seropositivity in patient with RAP was found to be 16.7%. Among the total 60 patients enrolled in this study with RAP 35 patients (58.34%) the cause was unknown. Conclusion: In majority of patients with RAP, the cause was not found (58.3%) and the organic causes were found in 38.41% of the patients. The most common cause of organic origin was Hpylori infection (16.7%). Keywords: Prevalence, H. Pylori, Recurrent abdominal pain
Assessment of anatomical variations of nose and paranasal sinuses in multidetector computed tomography
(Institute of Medicine, 2017) Yadav, RR; Ansari, MA; Humagain, M; Mishra, D
Abstract Introduction: Paranasal sinuses are a group of air filled spaces developed as an expansion of the nasal cavities, eroding the adjacent bone structures. Conventional radiology does not permit a detailed study of anatomical variations of nose and paranasal sinuses. Currently, MDCT scanning is the standard imaging modality in the evaluation of the paranasal sinuses and anatomical variations. Methodology: A cross-sectional hospital based study of 128 patients referred for CT scan of PNS was conducted from October 2015 to February 2016. CT scan was done in 128 slice Siemens Somatom Definition AS+ CT scanner machine applying standard protocol set by the department of radiology and imaging, Tribhuvan University Teaching Hospital, Maharajgunj. The images were evaluated for presence of any anatomical variants in paranasal sinuses. Results: The absolute frequency of anatomical variations are Agger Nasi cell (75.8%) and DNS (68%) along with Concha Bullosa (35.9%), Paradoxical middle turbinate (26.6%), Haller’s cell (15.7%) and Onodi cell (18.8%). In this study the most frequent type of olfactory fossa was Keros type 2 (63.3%). The typical orientation of uncinate process was found in both sides 199 (77.73%) whereas medial deviation in left side (20.3%) and right side was (18.8%) along with lateral deviation in left side was (3.9%) and right side was found in (1.6%) only. Conclusion: Anatomical variations of nose and paranasal sinuses are best depicted on MDCT scan of PNS on coronal plane with thin slice (3.0 mm) section along with bone algorithm. Agger nasi cell is the commonest anatomical variation (75.8%) followed by DNS, Concha bullosa, Paradoxical middle turbinate, Onodi cells and Haller’s cells. Keywords: Concha bullosa, Multidetector CT, Osteomeatal complex, Paranasal Sinuses
Frequency and Severity of Portal Hypertensive Gastropathy in Cirrhosis
(Institute of Medicine, 2017) Poudyal, S; Sharma, S; Khadga, PK; Pathak, R; Jha, A; Shrestha, R
Abstract Introduction: Portal hypertensive gastropathy (PHG) is a common endoscopic finding in patients with Cirrhosis. The pathophysiology of PHG was not clearly understood. It was thought that Portal Hypertension was an important triggering factor for the development of PHG but the other factor must be considered for its progression. It is one of the clinically important gastric mucosal lesions because it may cause acute and chronic gastrointestinal blood loss leading to anemia. The aim of our study is to determine the frequency and severity of PHG in patient with Cirrhosis. Methods: This was a Cross-sectional observational study involving 61 consecutive Cirrhotic Patients, who attended Upper GI endoscopy were enrolled in this study as per inclusion and exclusion criteria in the Department of Gastroenterology Tribhuvan University Institute of Medicine. Child-Pugh’s score and MELD score was determined at the entry to determine the severity of liver disease. Data regarding clinical and laboratory investigations were collected. Variceal size was measured endoscopically and the severity of PHG was graded according to Mac Cormack Classification. Results: Out of total 61 patients, the frequency of PHG was found to be 47.5% among them where 44.2% patients had mild PHG and 3.3% patients having severe PHG. There were 29.5% patients in child pugh A, 39.3% in child pugh B and 31.2% in child pugh C. During analysis insignificant relation was found between the PHG with Child pugh score (ρ=0.4) and MELD score (ρ=0.7).When PHG frequency was related to alcohol intake the relations were statistically not significant. There was no association found between portal hypertensive gastropathy with esophageal varices and gender of the patient. Conclusion: Our data showed that the frequency and the severity of PHG are not influenced by the Gender of the patient, etiology and severity of cirrhosis or by presence of esophageal varices. Keywords: Cirrhosis, Portal hypertensive gastropathy, esophageal varices
Measurement of Portal Vein Diameter, Peak Systolic Velocity and Pulsatility Index by Ultrasound Doppler Evaluation in Asymptomatic Nepalese Population
(Institute of Medicine, 2017) Songmen, S; Panta, Om B; Neupane, NP; Ghimire, RK
Abstract Introduction: Portal vein diameter and Doppler studies give hemodynamic information that can correlate with disease status. Their normal values are not established in Nepalese population. This study aims to establish the normal values of portal vein diameter, PSV and PI in Nepalese population and study their variability with age, gender and ethnicity. Methods: Cross-sectional hospital based study. All adults more than 20 years of age attending ultrasound OPD of Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu for general health checkup were included. Patients with liver disease, cardiac disease and ascites were excluded. A single observer took all measurements. Data were entered in a predesigned proforma and analysis was performed with SPSS 21.0. Results: Two hundred patients were included in the study. The mean age was 44.34+12.9 years. The mean portal vein diameter was 10.41+1.18mm. The mean portal vein PSV was 33.35+9.3cm/s and PI was 0.76+0.07. There was a positive correlation of portal vein diameter with age (r=0.345; p<0.001). Also, mean portal vein diameter was significantly higher in males (10.9+0.99mm) than in females (9.9+1.1mm). PSV and PI did not differ with age, gender or ethnicity. Conclusions: Mean portal vein diameter in this study is comparable with previous standards. Keywords: Peak systolic velocity, portal vein diameter, pulsatility index
Psychiatric mobility among repatriated Nepalese foreign labor migrants-a hospital based study
(Institute of Medicine, 2017) Chapagai, M; Pant, SB; Tulachan, P; Dhungana, S
Abstract Introduction: International migration for employment has burgeoned in Nepal in the recent decade, and now it is an important factor of social transformation across most societies all over the country. Various factor associated with migration and working in a foreign land can affect mental health of migrating individuals. The purpose of the study was to explore psychiatric morbidity among repatriated Nepalese foreign labor migrants who visited psychiatric services at a tertiary level hospital in Kathmandu. Methods: Repatriated Nepalese foreign labor migrants (n=51) having symptoms of mental illness at a foreign country, visiting psychiatric services at Tribhuvan University Teaching Hospital were enrolled in the study. A self- designed semi structured proforma was devised to obtain the socio- demographic characteristics of the study population and diagnosis was made using International Classification of Disease-10- Diagnostic criteria for research (ICD-10 DCR). Results: The age range of the repatriated population was 21-45 years. Most of the cases were males (n=46) and only five were female. Majority of the subjects were literate but only 27.45% had education level above secondary level. Greater number of respondents worked in the gulf countries (66.66%) followed by Asian countries (25.49%). The most common psychiatric morbidity among repatriated Nepalese foreign labor migrant was depressive disorders (29.41%) followed by Anxiety disorder (25.49%). Conclusion: There is a growing need to enhance our understanding about psychiatry co morbidity among repatriated Nepalese migrant workers so as to promote mental well-being at their working foreign country. A wide range of psychiatry morbidity, predominantly depression and anxiety was found among them which if addressed timely would prevent many migrant workers from returning back prematurely. Keywords: ICD-10 DCR, Nepal, psychiatric diagnosis, migration

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