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Introducing Clinical Pathology Course to Fourth Year Medical Students as a Bridge between Pre-clinical and Clinical Medical Sciences
(Kathmandu University, 2022) Upadhyaya Kafle, S; Singh, M; Kafle, N; Sinha, A; Guragain, P; Rimal, HS
ABSTRACT There isn’t any vertical integration of pre-clinical and clinical sciences subjects in the existing Kathmandu University MBBS curriculum. Many of the graduates are not able to correlate the clinico-pathological aspects of various diseases as a result the rational use of investigations for diagnosing various diseases is compromised. There are few published examples of implementation of pathology instruction courses during the clinical years of medical training but it is not universally practiced. This lack of exposure to pathology may lead to poor understanding of laboratory testing and the role of pathologists in patient care. To set and implement an exemplary vertical integration of pre-clinical science with clinical science. A 12 credit hours clinical pathology education course comprising clinical hematology, cytopathology and histopathology was developed. Students belonging from the ongoing fourth year MBBS course of Birat Medical College were enrolled in the course. All of the interactive lecture sessions were delivered via an e-learning interface, using the Zoom platform as the main teaching methods. Evaluation of students’ achievement of learning objectives was conducted through distributing pre and post-test online multiple-choice questionnaires. Chi-square tests were used to compare the variables between pre-test and post-test questionnaire responses. Results suggested that the designed clinical pathology course is valuable. The pre- test and post-test questionnaire responses revealed the positive impact regarding the importance of introducing clinical pathology courses within the clinical year of MBBS undergraduate curriculum. Response rate to the online session was 100%. The point of agreement between the pre-test and post-test questionnaire responses were highly achieved after intervention of the clinical pathology course. A statistically significant result (p < 0.05) between all of the pre-test and post-test questionnaire responses was noted. There was a strong positive recommendation for incorporating clinical laboratory medicine courses within the MBBS clinical science curriculum. The improvement observed among fourth-year MBBS students on learning the importance of clinical pathology courses was encouraging. This experience thus contributed to set and implement an exemplary vertical integration of pre-clinical science with clinical science. KEY WORDS Clinical pathology, Clinical sciences, Pre-clinical sciences, Vertical integration
Celiac Plexus Denudation in Triangle Dissection in Pancreatico Duodenectomy: Perioperative Anesthetic Implications
(Kathmandu University, 2022) Shrestha, BR; Sharma, M; Barahi Shrestha, S; Thapa, PB; Maharjan, DK
ABSTRACT This is a case report of inadvertent right celiac plexus denudation during triangle dissection during the surgery for carcinoma of pancreas under combined general epidural anaesthesia. Operative removal of the ganglia has its own autonomic effects, which are important to observe for anesthesiologists and perioperative critical care physicians alike. KEY WORDS Celiac plexus, Epidural, Hemodynamics, Pain, Triangle dissection
Photophobia as a Presenting Feature in Adie’s Tonic Pupil
(Kathmandu university, 2022) Parajuli, S; Sharma, S; Shrestha, R; Chapagain, S; Singh, P; Shrestha, R
ABSTRACT A 34 years old female presented with complains of photophobia since 6-7 months. On examination, she had anisocoria of 4 mm in room light which increased in bright light. The left pupil was dilated and unresponsive to direct and indirect light stimuli. It did however, constrict slowly on near fixation followed by slow re- dilatation on distance fixation. A diagnosis of Adie’s tonic pupil was made since left pupil constricted with instillation of dilute pilocarpine 0.1%. Her symptoms of photophobia and blurred vision immediately resolved. Photochromatic glasses and dilute pilocarpine 0.1% three times a day were prescribed. Prompt symptomatic relief of photophobia and blurred vision was observed. KEY WORDS Adie’s, Anisocoria, Dilated pupil
Morbidity Pattern and Hospital Outcome of Neonates Admitted in Tertiary Care Hospital, Nepal
(Nepal Paediatric Society (JNPS), 2020) Nepal, Deepeshwara; Agrawal, Sumit; Shrestha, Sushan; Rayamajhi, Ajit
Abstract: Introduction: The first 28 days of life, neonatal period is crucial as neonates are susceptible to sepsis, birth asphyxia, hypoxic injuries and its consequences which may lead to lifelong morbidity. Knowing the causes of morbidity and mortality is an essential step to improve neonatal health. The aim of this study is to describe the pattern and causes of neonatal admission, immediate hospital outcome in the form of improved, died or left against medical advice and factors associated with its outcome. Methods: This was a retrospective hospital based study carried out in Neonatal Intensive Care Unit (NICU) of Kanti Children’s Hospital, Kathmandu, Nepal over a period of six months (February 2019 to July 2019 AD). Neonatal details including age, sex, gestational age, birth weight, and maternal age and parity, mode of delivery, place of delivery, neonatal morbidities and neonatal outcomes were recorded in a predesigned performa. Results were expressed as mean, percentage and p value. P- value was calculated by using chi-square test. Results: A total of 163 neonates were admitted during the study period, among which 106 (65%) were males. The mean birth weight was 2483.96 ± 812.63 gm. Among admitted newborns 130 (79.8%) had good outcome, babies born to young mothers (< 20 years of age) had poor outcome which is statistically significant with p value of 0.002. Neonates whose birth weight were < 1000 gram had significantly poor outcome (0.001). Conclusion: Common causes of NICU admission were neonatal sepsis, neonatal hyperbilirubinemia, prematurity and perinatal asphyxia. Babies born to young primipara mothers, extremely low birth weight, extremely premature babies and babies undergoing mechanical ventilation had poor outcome.
Saree on Fireside: Fatal Burn in an Elderly Nepalese Female
(Kathmandu University, 2022) Atreya, A; Bashyal, G; Gyawali, L; Acharya, J; Nepal, S
ABSTRACT As winter approaches, people in the land of rural Himalayas commonly use fire as the source of heat. Many accidents occur in the process, and mostly the victims are among unattended children and the elderlies. We present a case from rural Nepal where an elderly female sustained fatal burn injuries. Advanced age, greater surface area, and secondary infection were the complicating factors. In the present case, the victim’s clad cloth (Saree) was the harbinger to death. Prevention of infection following burn and control of sepsis still remains the mainstay of treatment in burn victims. KEY WORDS Burn injury, Elderly, Nepal, Saree, Sepsis
Clip Migration in Common Bile Duct: An Uncommon Complication of Laparoscopic Cholecystectomy
(Kathmandu University, 2022) Pradhan, U; Gyawali, P; Dahal, R; Joshi Lakhey, P
ABSTRACT Laparoscopic cholecystectomy is the gold standard procedure for symptomatic cholelithiasis. During the procedure the cystic duct is ligated with titanium clips. Migration of these clips after cholecystectomy is a rare complication and may result in stone formation in common bile duct (CBD). We are here discussing a case of a 29 years female who presented with choledocholithiasis 10 years after laparoscopic cholecystectomy. The clip was incidentally discovered during endoscopic retrograde cholangiopancreatography (ERCP) and stone extraction. The patient was managed successfully at our center. KEY WORDS Clip migration, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectomy
Malignant Infantile Osteopetrosis with Bone Marrow Involvement
(Kathmandu University, 2022) Khadga, M; Rahman, AZM Raihanur; Benzamin, Md; Ahamed, N; Akter, S; Nahid-E-Subha; Hasan, M; Khan, LN; Rukunuzzaman,Md
ABSTRACT Osteopetrosis (Marble bone disease) is a very rare congenital genetic disease of skeleton, resulting from defective bone resorption, due to functionally defective osteoclast, leading to accumulation of excessive bone mass. Malignant infantile osteopetrosis (MIO) is one of the varieties of osteopetrosis, which is fatal and is diagnosed in early infancy. Malignant infantile osteopetrosis is present with abnormal bone remodeling, hematological abnormities, features of extramedullary hematopoiesis. Radiology is the key of diagnosis. In this case, we present a 5-month- old male infant diagnosed as malignant infantile osteopetrosis, who presented with bronchopneumonia, anemia, thrombocytopenia, hepatosplenomegaly, failure to thrive (FTT). KEY WORDS Fatal, Genetic, Malignant infantile osteopetrosis
Elevated Maternal Blood Lead Level - A Risk Factor for LBW - An Observational Study
(Nepal Paediatric Society (JNPS), 2020) Dhande, Leena; Waghmare, Kirankumar; Badhoniya, Neetu; Turankar, Avinash; Shetty, Ashwita
Abstract: Introduction: Lead exposure is common in women. Lead stored in bones is released during pregnancy and can potentially affect foetal growth. We conducted this study to estimate the effect of maternal blood Lead (BPb) status on Low Birth Weight (LBW) in newborns. Methods: 168 mothers were selected from Special Neonatal Care Unit (SNCU) and Postnatal care (PNC) wards of a tertiary care hospital from Central India and their BPb levels analysed by Graphite Furnace Atomic Absorption Spectrophotometer. Results: 22 (13.10%) mothers having BPb level ≥ 5μg/dL gave 23 births (one twins); of which 65.22% mothers delivered babies with birth weight < 2500gm (LBW) (p = 0.0007). The mean birth weight of newborns of mothers with high BPb levels was significantly lower by 269 gm (p = 0.0265). Mothers with BPb ≥ 5μg/dL delivered 39% premature babies as compared to 10 % mothers with BPb < 5 μg/dL (p < 0.003). Significantly more mothers exposed to kajal, nail polish, lipstick and paints had BPb levels ≥ 5μg/dL. Conclusion: Significant association is detected between maternal BPb and both LBW and prematurity in the given population.
Differentiating Scrub Typhus, Dengue Fever and Typhoid Fever in Indian Children Presenting with Acute Febrile Illness
(Nepal Paediatric Society (JNPS), 2020) Chatterjee, Saheli Misra; Mondal, Suman; Mukhopadhyay, Kaushik; Das, Niloy Kumar
Abstract: Introduction: The disease spectrum of dengue, scrub typhus and typhoid presenting as acute febrile illness is often a diagnostic dilemma to the clinician. The purpose of this study is to compare the clinical features and laboratory parameters of children suffering from typhoid, dengue and scrub typhus and use these parameters in early identification of scrub typhus before conclusion is made from serological diagnosis. Methods: A retrospective observational analytical study was conducted among children presenting with acute febrile illness in a tertiary care level hospital. Over the period of one year 113 cases were identified of which 39 were dengue, 44 were typhoid and 30 were scrub typhus. Results: The mean age of the children was 7.45 ± 2.98 years, median was eight with an interquartile range of six to ten years. The male to female ratio was 1.3:1. Symptoms of vomiting (61.54%), headache (46.15%) and hepatomegaly (47.37%) were significantly higher among children with dengue fever. A significantly higher number of children with scrub typhus fever had temperature above 40°C. The incidence of low haemoglobin, raised C reactive protein, raised ALT and low albumin levels were significantly higher in them. Children with acute febrile illness having temperature > 40°C, absolute neutrophil/lymphocyte ratio > 2 early in the illness were more likely to suffer from scrub typhus with relative probability ratio (RPR) of 25.68 and 10.57 respectively (p < 0.001). Children with WBC < 5000/mm3 were more likely to be suffering from dengue with RPR of 10.60 (p < 0.001). Conclusion: Children with acute febrile illness with temperature > 40°C and absolute neutrophil/lymphocyte ratio > 2 early in the illness were more likely to be suffering from scrub typhus.
Diagnostic Yield of Upper Gastrointestinal Endoscopy in Children: A Three Years Experience
(Nepal Paediatric Society (JNPS), 2020) Joshi, Binita Gurubacharya; Ghimire, Madhu
Abstract: Introduction: Gastrointestinal disorders are very common in paediatric population. Upper Gastrointestinal Endoscopy procedures have increased dramatically worldwide and have contributed in identification of various gastrointestinal disorders along with therapeutic benefits. However, it is recently being established in paediatric population in Nepal and proper data is scarce. This study was aimed to assess upper gastrointestinal endoscopy with respect to its indications and diagnostic yield at a tertiary centre over a three years period. Methods: This is a retrospective observational study where data of all paediatric patients between the age group 0 - 15 years having various gastrointestinal problems who underwent upper gastrointestinal endoscopy from March 2013 - Feb 2016 in our centre were analysed. Results: Among 270 patients, males comprised 60% and females comprised 40%. Age range was 0 - 15 years and majority were from the age group between 10 to 15 years (66.2%). Most common indications for endoscopy were chronic abdominal pain (58.8%), acute epigastric pain (18.5%), followed by failure to thrive (7%). Abnormal findings were detected in 250 patients (92.5%); gastroduodenitis (28.14%), antral gastritis (18.51%), erosive gastritis (15.92%), duodenitis (9.25%), hiatus hernia (7.4%), varices (5.5%) were common findings. Histopathologically, chronic gastritis and duodenitis (72%) were common findings followed by acute gastritis and giardiasis. Among 80 patients who underwent RUT, 50% each had positive and negative results. Conclusion: Chronic abdominal pain remains common gastrointestinal problem in children. With the advent of upper gastrointestinal endoscopy various gastrointestinal problems can be identified and managed accordingly. Along with the facility of histopathology, diagnostic yield and outcome is further enhanced.
Preterm Birth, Exasperation to the South Asian Countries
(Kathmandu University, 2022) Acharya, R; Panthee, A; Basnet, R; Adhikari, S; Ghimire, N
ABSTRACT When a child is born before 37 weeks or 259 days of pregnancy, it is termed as pre- term birth. Pre-term birth is prevalent in both developed and developing country. However, difference lies in their survival. In lower and middle income countries, most preterm babies die due to lack of even simple interventions. India ranks top in the world for deaths due to complications of preterm birth. Similarly, other South Asian countries, Pakistan, Bangladesh, Afghanistan and Nepal rank 3rd, 6th, 9th and 20th in the same. The aim of this review paper is to provide a landscape analysis on the burden of pre-term birth and challenges in the context of South Asian region. Databases such as PubMed, Scopus and Google Scholar were searched from 2000 to 2020 and 27 articles are included in the study. It was found that pre-term birth causes huge burden in the form of morbidity, mortality as well as socio economic losses. Preterm birth was associated with increased sepsis, cardiovascular disease, respiratory illness, hypothermia, neurological and gastrointestinal complications. South Asian countries have distinct challenges in eliminating or reducing pre- term births which are: poor quality health surveillance data, inadequate trained health workforce, insufficient finance and funding, service delivery and other methodological challenges. Ending pre-term birth is important as it is directly related to Sustainable Development Goal 3. Therefore, there should be increase in priority given to increase financing, quality data gathering, adopting innovative measures as well as joint efforts of all the sectors to control the pre-term birth. KEY WORDS Burden, Challenges, Pre-term birth, South Asian countries
Diagnostic Accuracy of Drop Hydrogen Peroxide Test as a Novel Bedside Diagnostic Test to Differentiate Transudative and Exudative Pleural Effusion Against Light’s Criteria
(Kathmandu University, 2022) Vaidya, N; Sapkota, P; Chaurasia, S; Thapa, B; Bhandari, N; Bhattarai, I
ABSTRACT Background Diagnostic evaluation of pleural fluid according to Light’s criteria to differentiate between exudative and transudative fluid takes 1 or 2 working days. For rapid clinical management, especially in critically ill patients, a simpler bedside diagnostic test can be done which has similar diagnostic accuracy as that of Light’s Criteria. Objective To determine the diagnostic accuracy of Drop Hydrogen Peroxide test to differentiate exudative and transudative pleural effusion in comparison to Light’s criteria. Method A concurrent validity test was performed using a convenient sampling technique including patients presenting to the Department of Internal Medicine from January to September 2021, who had pleural effusion. Two milliliters of tapped pleural fluid of patients who underwent aseptic thoracocentesis was collected in a test tube to which one to two drops of 20% hydrogen peroxide was added. Presence of bubbles suggested an exudative type of fluid. Rest of the tapped pleural fluid was sent to the laboratory for further evaluation by Light’s criteria, which was compared with the results by Drop Hydrogen Peroxide Test. Result There were 83 patients who had pleural effusion, of them a total of 43 patients had transudative pleural effusion while 40 patients had exudative pleural effusion based on Light’s criteria and 37 patients had transudative pleural effusion while 46 patients had exudative pleural effusion based on drop hydrogen peroxide test. Conclusion The drop hydrogen peroxide test allows cost effective and prompt evaluation of the type of pleural effusion is exudative or transudative, thereby making it a convenient diagnostic bedside test. KEY WORDS Diagnostic tests, Exudates and Transudates, Hydrogen peroxide, Pleural effusion, Thoracocentesis
Periodontitis and Diabetes: How Well the Patients have Knowledge about the Established Interrelationship?
(Kathmandu University, 2022) Ranjit, R; Bista, S; Manandhar, P; Subedi, S
ABSTRACT Background Type 2 diabetes is an escalating health problem in Nepal and it holds a strong bidirectional Inter relationship with periodontitis. However, lack of its knowledge and motivation among patients may deteriorate and complicate their condition. Objective To assess knowledge among general population regarding the relation between diabetes and periodontitis and to evaluate the role of dentists and physicians in suggesting the diabetic patients for oral health care. Method A cross-sectional study was conducted among the patients visiting Department of Periodontics, Gandaki Medical College. A total 422 patients were interviewed using a set of pretested questionnaire and at the end they were counselled about the impact of diabetes mellitus on periodontal status and vice versa. Result Majority of the patients 257 (60.9%) had no idea about the interrelation between periodontitis and diabetes mellitus. Almost all the patients 363 (86.02%) assumed that poor oral health cannot increase the risk of developing diabetes and amongst those who had knowledge about this relation, the major source of information was their diabetic friends and relatives 46 (10.9%) and other sources such as syllabus 46 (10.9%). Only handful of patients 30 (7.10%) were informed about the relation by their dentist. Ironically, none of them were provided information about the interrelation by their treating physician. Conclusion Overall, only few participants had knowledge about the bidirectional relation between periodontitis and diabetes. Hence, our findings support the greater need for more targeted and specific health education along with close collaboration between dentists and physicians. KEY WORDS Awareness, Diabetes, Knowledge, Oral Health, Periodontitis, Physician
Maternal and Perinatal Outcome of Urinary Tract Infection in Pregnancy at Dhulikhel Hospital, Kathmandu University Hospital
(Kathmandu university, 2022) Kayastha, B; Tamrakar, SR
ABSTRACT Background Urinary tract infection (UTI) is common in pregnancy and poses a great challenge because it has several adverse outcomes in both the mother and her unborn foetus. Objective This study aims to determine the incidence of culture positive urinary tract infection, culture and sensitivity of the common causative organisms and find out the maternal and perinatal outcomes in culture positive urinary tract infection. Method This prospective study was carried out in the Department of Obstetrics and Gynaecology at Dhulikhel Hospital over a period of one year. Urine routine and microscopy was done as a preliminary screening test for urinary tract infection and those with abnormal results were subjected to urine culture and sensitivity and ultrasonological evaluation. Result A total of 162 pregnant women were included in the study. Incidence of culture positive urinary tract infection was 25.9%, highest in age group 15-20 years (47.8%), more in primigravida (30.1%) and common at second trimester (40.4%). Escherichia coli (90.4%) was the commonest organism isolated and ceftriaxone was the most sensitive antibiotic. Patients with culture positive urinary tract infection had higher incidence of anaemia, preterm labour, need of surgical intervention. Such patients also had increased chances of preterm delivery, low birth weight babies and newborn intensive care unit (NICU) admission. Conclusion We conclude that urinary tract infection in pregnancy leads to adverse maternal and fetal outcomes. And we recommend urine culture and sensitivity at each trimester so that urinary tract infection can be diagnosed and treated on time. KEY WORDS Adverse maternal and perinatal outcomes, Culture positive urinary tract infection, Urine culture and sensitivity
Comparative Study about Impact of Inadequate Psychomotor Stimulation on Neuro-Development in Pre-School Children in Rural India
(Nepal Paediatric Society (JNPS), 2020) Chatterjee, Nandita; Basu, Swati
Abstract: Introduction: In a rural, underprivileged community, multiple factors including poverty, non-stimulating home environment and lack of parental awareness about early childhood development and early intervention lead to inadequate ‘nurturing care’ for young children, who with genetic predisposition for typical brain development may not reach their developmental potential. The present study attempts to compare and study the developmental differences between children who had adequate stimulation and those who did not during preschool period. Methods: Developmental assessment of 51 healthy children, aged 3.5 - 4.5 years with poor psychomotor stimulation (study group) and an age-matched group of 27 children attending pre-school (control group) from the same community was conducted and compared. Developmental screening was done using the DDST II screening tool. Results: The incidence of developmental delay in the study group was significantly higher; deficits were most marked in personal-social and language domain. Concept of colours, counting objects and drawing were conspicuously absent in most children. Conclusion: Improving home environment, provision of learning opportunity with available resources, and generation of awareness among parents regarding early child development and early intervention are simple, low-cost measures to improve the developmental trajectory in these children.
Neurological Outcome of Early versus Late Surgery Following Cervical Spinal Cord Injury
(Kathmandu University, 2022) Kafle, P; Chaudhary, PK; Thapa, J; Sharma, MR
ABSTRACT Background There are numerous retrospective studies and a few prospective studies to determine the neurologic outcome after early versus late surgical treatment for cervical spinal cord injury. Objective To compare the neurological outcome between early (within 72 hours after injury) and delayed (≥ 72 hours after injury) surgery in patients with cervical spinal injury. Method This is a retrospective analysis of the neurological outcome of early versus late surgery following cervical spinal cord trauma. Patients meeting appropriate inclusion criteria were divided into an early or a late surgical treatment group. The neurologic outcomes and other complications were recorded up to six months of follow-up. Result Overall, there was a significant difference in neurological status at presentation and at follow-up (p < 0.001). However, there was no statistically significant difference between the early versus late surgery groups (p-value 0.261) in terms of neurological outcome. Complications were found to be higher among those undergoing posterior surgical approach (OR = 23.75; 95% CI 2.65, 212.98) than those with anterior or combined approach (p=0.005). However, multivariate analysis of these variables failed to show any statistically significant difference between the two groups. Conclusion The timing of surgery does not alter the neurological outcomes and the development of complications significantly. The American Spinal Cord Injury Association (ASIA) status at the time of presentation is found to be the single most important factor correlating with the neurological outcome. KEY WORDS American spinal cord injury association, Cervical spine, Spinal decompression, Spinal injury, Road traffic accident
Visual Evoked Potentials (VEPs) in Patients with Type 2 Diabetes Mellitus
(Kathmandu University, 2022) Subedi, P; Limbu, N; Maskey, R; Baral, DD
ABSTRACT Background Type 2 diabetes constitutes about 85-95% of all diabetes in developed countries, and accounts for an even higher percentage in developing countries. Diabetic retinopathy is probable the most characteristic, easily identifiable and treatable complication of diabetes, but remains an important cause of visual loss. Objective To study P100 latencies and inter ocular latency difference in diabetic group and compared it with a control group and study the correlation between P100 and inter ocular latency difference with the duration of disease in diabetic group. Method A comparative, cross sectional study was done from September 2016 to January 2018 in Neurophysiology Lab, Basic and Clinical Physiology, BP Koirala Institute of Health Sciences. The sample size was 64 and random sampling technique was used. Subjects were divided into three groups according to the duration of disease. Anthropometric and visual evoked potentials were recorded. Descriptive analysis, analysis of covariance and Post Hoc multiple comparison analyses were done using SPSS 11.5. Pearson’s correlation was applied between P100 latency and inter ocular latency difference with the duration of disease. Result On using analysis of covariance, P100 latencies were significantly prolonged in diabetic as compared to healthy controls (p < 0.001). Post Hoc multiple comparison showed significant differences in both left and right P100 latencies within diabetic groups and between diabetic groups and healthy controls. Left inter ocular latency difference showed positive correlation with the duration of disease. Conclusion P100 latencies are significantly prolonged in diabetes patients and is positively correlated with duration of disease. Visual evoked potential test can be useful for detecting retinal dysfunction before the appearance of symptoms of retinopathy. KEY WORDS P100 latencies, Type 2 diabetes, Visual evoked potentials
Burden of Care Among Mothers Having Children with Congenital Heart Diseases
(Nepal Paediatric Society (JNPS), 2020) Sharma, Nita; Sharma, Pratima; Mishra, Tulashi Adhikari
Abstract: Introduction: Congenital Heart Disease (CHD) is a problem with structure and function of the heart that is present at birth. Children with CHD require special care, treatment and follow up for a number of common conditions which may be quite straining to the care givers. The objective of the study was to find out the burden of care among mothers having children with CHD. Methods: This descriptive cross-sectional study was carried out in a cardiac centre of Nepal. A total of 95 mothers having children with CHD attending outpatient department of our institute were selected as the sample for the study using non-probability purposive sampling technique. A semi structured interview questionnaire consisting of the Modified Caregiver Strain Index was used to assess the burden of care among mothers having children with CHD. Frequency and percent were used to describe the variables and chi- square test at 0.05 significance level was used to analyse associations. Results: Most (77.9%) of the mothers were regularly strained to find that their children’s health condition was deteriorating due to CHD. Nearly half (44.2%) of the mothers always had financial constrain while giving care to the child, nearly half (40%) of the mothers had done emotional adjustments to take care of their children with CHD, another two-fifths (28.4%) of the mothers sometimes had disturbed sleep and almost half (46.3%) of the mothers were always upset due to some behaviour of their child with CHD. Half (50.5%) of the mothers had high level of burden of care. Statistically significant association were found between age of the mother and level of burden of care (p value = 0.05). Similarly, the type of family (p value = 0.005), age of the children (p value = 0.000) and type of CHD (p value = 0.002) were significantly associated with the level of burden of care among the mothers. Conclusion: The study concluded that mothers tend to feel less burden of care as the child grows older, mothers having children with cyanotic heart disease tend to experience more burden of care. Mothers of less than thirty years of age and living in a joint family also experience more burden of care.
Evaluation of the Diagnostic Potential of Liver Aminotransferases and Alkaline Phosphatase in Patients with Cardiovascular Diseases
(Kathmandu University, 2022) Yadav, NK; Pokharel, DR; Kathayat, G; Sigdel, M; Hussain, I
ABSTRACT Background Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality, particularly in developing countries. Early diagnosis with the best diagnostic marker is highly desired for the prevention and timely treatment of CVDs. However, there is still a dearth of an ideal marker for the detection of CVDs. Objective To explore the diagnostic potential of liver aminotransferases (AST and ALT), and alkaline phosphatase for the diagnosis of CVDs without liver involvement. Method This was a cross-sectional study conducted among 200 adult patients with CVDs, who visited the cardiology and emergency units of Manipal Teaching Hospital, Pokhara, Nepal. The study was conducted from January 2018 to December 2020. The baseline data on family history, anthropometry, baseline biochemical parameters, liver enzymes, and cardiac biomarkers were collected using standard and validated methods. The data were analyzed using SPSS version 21 and MedCalc software 2021. Result The diagnostic sensitivity of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were 53.7%, 52.6%, and 33.7% and specificity were 99%, 90%, and 90% respectively. The area under the curve (AUC) of AST, ALT, and ALP were 0.78, 0.73, and 0.52 respectively. ROC curve indicated that serum AST and ALT activity was a better reliable marker than the serum ALP activities. Conclusion Our study suggests that serum aspartate aminotransferase and alanine aminotransferase but not alkaline phosphatase could have some diagnostic potential to diagnose the risk of CVDs. However, they could not replace the currently adopted cardiac biomarkers such as cTnI and CK-MB. KEY WORDS Alkaline phosphatase, Aminotransferases, Cardiovascular diseases, Diagnostic potential
Comparative Study of Common Bile Duct Diameter between Normal and Post Cholecystectomy Cases Using Trans-abdominal Ultrasonography
(Kathmandu University, 2022) Paudel, RC; Karki, S; Suwal, S; Palikhe, A; Mandal, D; Manandhar, M
ABSTRACT Background Increase in common bile duct diameter can occur because of different causes. Post cholecystectomy status is one of the potential causes. Many studies done in the past show different results and are hence inconclusive. Objective To see if the post cholecystectomy cases would have a statistically significant change in common bile duct diameter. Method We carried out a study in 100 cases (46 post cholecystectomy cases and 54 cases with intact gall bladder, measuring their common bile duct diameters and performing an unpaired t test to see if the mean in common bile duct among these two groups of cases was statistically significant. Result One hundred cases, 46 post cholecystectomy cases and 54 cases with intact gall bladder were included in our study. An unpaired t-test was used to compare the common bile duct diameters in these two groups. Our findings showed that the difference in common bile duct diameter between the cases with intact gall bladder and those who underwent cholecystectomy was significant for both one tailed and two tailed studies (p < 0.001). Hence, it can be stated that post cholecystectomy status increases the common bile duct diameter. Conclusion An increased Common bile duct diameter in post cholecystectomy case could be because of the post cholecystectomy status itself and not due to some other obstructive cause. So careful decision is necessary before subjecting the patient to further invasive/non-invasive investigations and treatments. KEY WORDS Cholecystectomy, Common bile duct, Diameter, Dilatation, Ultrasonography

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