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Solid Pseudopapillary Neoplasm of the Pancreas: Case Series of a Rare Tumor
(Institute of Medicine, 2023) Sapkota, Simit; Pandit, Subhas; Shakya, Vikal C; Neupane, Sameer
ABSTRACT Solid pseudopapillary neoplasm is an infrequent type of pancreatic tumor that primarily occurs in young females. This retrospective case series analyzed three cases of SPN at Civil Service Hospital from 2012-2022. Patient’s median age was 18 years, and one of the patients presented with painless lump and other two had abdominal pain and dullness at presentation. Pre-operative investigations like CT/MRI and fine-needle aspiration cytology confirmed SPN in all cases. All patients received resection treatment, and no adjuvant therapy was administered. During follow-ups lasting 4-7 years, none of the patients experienced recurrence, indicating that surgical resection is the mainstay of treatment with excellent prognosis. Keywords: Solid pseudopapillary neoplasm; pancreatic tumor; case series; Whipple’s procedure
Surgeon-Powered Robotics in Minimally Invasive Surgery: Case Report from Nepal
(Institute of Medicine, 2023) Shrestha, Sujan; Gautam, Sujan; Shrestha, Sandip; Subedi, Sushil K; KC, Ajay; Pradhan, Susan
ABSTRACT Minimally-invasive surgery is the standard of care in many surgical diseases. Robotic surgery has mitigated nearly all limitations of laparoscopic surgery but with a big cost tag. Surgeon-powered robotic instruments were developed with the concept of providing similar advantages to the robotic platforms but with affordable costs. We report three cases of hernia, one hiatus hernia, and two inguinal hernias managed using surgeon-powered robotics platform. It provides additional maneuverability in minimal invasive surgical dissection and suturing. Surgeon powered robotic surgery may be a cost-effective viable alternative to robotic surgery in developing country like Nepal. Keywords: Hiatus hernia; inguinal hernia; Nissen fundoplication; robotic surgery; surgeon-powered robotic surgery
Surgical Management of Pediatric Urolithiasis: Descriptive Study from a Tertiary Care Center in Nepal
(Institute of Medicine, 2023) Guragain, Bipin; Phuyal, Anjit; Gyawali, Milan; Pandit, Durga; Parajuli, Purushottam; Pradhan, Manish M; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhojraj; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction: Urolithiasis is common in the pediatric population in low-resource countries but appropriate management is not available in all parts of the country. This study aimed to identify demographic parameters, clinical characteristics, and surgical management of pediatric urolithiasis in a tertiary care center in Nepal. Methods: This was a retrospective and descriptive study of pediatric patients (≤18 years) who underwent surgical management of urolithiasis in the Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital from January 2021 to December 2022. Results: Total 64 patients with Male: Female ratio 1.78:1 and mean age of 8.63±5.56 years presented mostly with pain abdomen (93.8%) followed by lower urinary tract symptoms (26.6%), hematuria (20.3%), and fever (14.1%). The mean number of calculi was 2.2±1.47 and the mean size was 13.97±8.30 mm. Most of the calculi (39.1%) were in the right system and 90.62% were in the upper tract. Only 15.62% of patients had calculi in the lower tract. Open surgeries were performed in only 10.93% and the rest were managed by minimally invasive procedures. Percutaneous nephrostomy tube insertion was done in 6 (9.37%) of patients and 1 (1.56%) underwent nephrectomy for nonfunctioning kidney. Conclusion: Pediatric urolithiasis patients presented with pain abdomen, lower urinary tract symptoms, or hematuria. Surgical management has shifted from open surgeries in the past to minimally invasive surgeries at present. Keywords: Minimally invasive surgery; pediatric; urolithiasis
Age and Caries Status of Children at the First Dental Visit in a Tertiary Care Hospital: A Cross-sectional Study
(Institute of Medicine, 2023) Malla, Manisha; Dikshit, Parajeeta; Limbu, Senchhema; Khanal, Sunita
ABSTRACT Introduction: Children's oral health is a vital part of their overall general health. Early first dental visit can influence the child's future oral health. The objective of this study was to assess the average age, reason, and caries status of children on their first dental visit at a tertiary care center in Kathmandu. Methods: A cross-sectional observational study was conducted among the children aged upto 14 years visiting the outpatient departments of Kantipur Dental College. A Validated questionnaire was provided to the parents visiting with the child and dental checkup was carried out in their first dental visit. Results: Out of 334 children a total of 43 (12.9%) visited by 3 years of age and only 9 (2.7%) children visited by 1 year of age. Majority of children were of age 4-6 years (n=127) with a mean age of 6.71±2.95. Most common chief complaint for their first dental visit was decayed tooth (n=95, 28.4%), followed by pain (n=93, 27.8%) and 4 of them (1.2%) visited for routine checkup. Conclusion: The majority of the children make their first dental visit too late. Children delaying their first dental appointment had much greater dental caries experience. Dental caries and associated complications were the primary reasons for the child's first dental appointment. Keywords: Age; children; dental caries; first dental visit
Outcome of ABO-Incompatible Living Donor Kidney Transplantation: A Single Center Observational Study from Nepal
(Institute of Medicine, 2023) Hamal, Saurav S; Nepali, Rabin; Poudyal, Sujeet; Shah, Dibya S
ABSTRACT Introduction: Kidney transplantation is the most effective treatment for end-stage renal disease (ESRD) patients. However, the increasing number of ESRD patients and the limited availability of living and cadaveric donors has led to a growing waiting list for kidney transplantation. ABO-incompatible transplantation has emerged as an alternative for these patients in Nepal. Methods: This was an observational study of all the patients who underwent kidney transplantation from March 2017-Feb 2019. Data on demography of recipients and donor, blood group, human leukocyte antigen mismatch, induction agent, post-operative complications and creatinine clearance at discharge and one-year post-transplant were collected and analysed. Then we compared patient and kidney graft survival at one year between ABO incompatible and ABO compatible recipients. Results: During the study period, there were total of 124 kidney transplant recipients among them 12 were ABO incompatible and 112 were ABO compatible recipients. The study showed slightly lower patient and graft survival in ABO-incompatible recipients than ABO compatible recipients (83.3% vs 99.2%, p<0.001). However, death-censored graft survival were similar in both groups (100%,p<0.001). The graft function at one year measured by creatinine clearance was better in ABO-incompatible recipients than ABO-compatible recipients (67.1±11.75 vs 61.87±12.82, p<0.001). Postoperative complications were slightly higher, however, complications at one year were lower in ABO-incompatible recipients. Conclusion: The study showed that living donor ABO-incompatible kidney transplant recipients have a good outcome at one year but is associated with greater risks of patient and graft loss at early transplant period compared to ABO-compatible recipients. Keywords: ABO incompatible; graft survival; infection; kidney transplantation; patient survival; rejection
Cleft Lip and Palate Repair Surgeries in a Tertiary Care Center: A Descriptive Cross-Sectional Study
(Institute of Medicine, 2023) Rai, Sushant; Niraula, Himalaya; Sharma, Samit; Shrestha, Jayan M; Lohani, Ishwar
ABSTRACT Introduction: The burden of cleft lip and palate in Nepal is high. Surgeries should be performed at the right age and weight for the safety and optimal development. We aimed to identify the socio-demographic and peri-operative attributes of cleft lip and palate patients. Methods: A descriptive, cross-sectional study of cleft lip and palate surgeries conducted in Tribhuvan University Teaching Hospital, over a two-year period. Variables studied include age and weight at the time of surgery, gender, ethnicity, type of repair, other congenital defects, the length of stay, and complications. Results: Overall, 28 cleft lip and palate surgeries were performed. The median age at operation of cleft lip patients was six months and of cleft palate patients was 20.5 months. The median weight in kilograms of cleft lip patients was six, whereas of cleft palate patients was 10. The male-to-female ratio among all the patients was 1.2:1. The patients hailed from all seven provinces of Nepal. For cleft lip, Millard technique 13 (93%) was most commonly performed and for cleft palate, the Bardach repair 10 (71.4%) was mostly preferred. Only two patients suffered from peri-operative complications. Conclusion: Millard technique and Bardach repair were the most commonly performed surgeries for cleft lip and palate respectively. Two peri-operative complications were encountered. Keywords: Cleft lip; cleft palate; socio-demographic profile
Ultrasonographic Assessment of Renal Parameters in Apparently Healthy Medical Students of A University Hospital
(Institute of Medicine, 2023) Thapa, Sushma; Khanal, Ujjwal P; Paudel, Sharma; Sigdel, Mahesh R
ABSTRACT Introduction: Ultrasonography is a commonly used medical imaging technique to evaluate the kidneys and has become the preferred modality for the assessment of renal pathology. However, limited data are available on the normal renal parameters in Nepalese adults. The aim of this study was to establish normal reference ranges for renal size in healthy medical students using ultrasonography. Methods: A total of 100 healthy undergraduate medical students (64 males; 36 females) between the first and internship years (age 19-29 years) were studied. Ultrasonography was performed using a single and specific ultrasound machine with 1-7MHz transducer. Results: The study showed the left kidney was slightly longer than the right (10.46 ± 0.68cm vs 10.13 ± 0.65cm; p=0.04), but the right kidney had a significantly larger thickness (2.80 ± 0.76cm vs 2.99 ± 0.68cm; p=0.01) and volume. A strong positive correlation was found between the renal parameters of one side with another side (Length: r=0.63,p<0.001; Breadth: r=0.42, p<0.001; Thickness: r=0.51, p<001; Volume: r=0.57, p<0.001). There were significant differences in renal length and volume based on sex, height, weight, and body mass index while other parameters were not significant. Weight was found to affect renal length more than height. Conclusion: The left kidney was slightly longer than the right kidney. There was a strong positive correlation between the right and left kidney parameters. The study also found significant associations between renal length and height, weight, and body mass index. Keywords: Renal size; ultrasonography
Assessment of Volume Status Using Body Composition Monitor for Blood Pressure Control in Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Trial
(Institute of Medicine, 2023) Dhakal, Niraj; Sapkota, Nisha K; Sigdel, Mahesh R
ABSTRACT Introduction: Optimal fluid balance and blood pressure control have been shown to improve outcomes in hemodialysis population. We investigated the effectiveness of body composition monitor (BCM) to target dry weight in maintenance hemodialysis (MHD) patients for blood pressure (BP) control and intradialytic adverse events. Methods: A total of 61 consenting adults under MHD were randomly allocated into either BCM group or Clinical Method group. Target dry weight was set every 4-weekly based on BCM report or clinical assessment; dry weight was adjusted with 200-500 ml/session reduction or increment of ultrafiltration in addition to interdialytic weight gain. Outcomes were analyzed in terms of BP control, anti-hypertensive medicine score, and intradialytic adverse events. Results: During 12 weeks of study period, systolic blood pressure (p<0.001), diastolic blood pressure (p=0.01) and mean arterial pressure (p<0.001) significantly decreased from baseline in BCM group but there were no significant changes in Clinical Method group. Lower blood pressure was achieved in BCM group as compared to Clinical Method group. There was a significant decrease from baseline in anti-hypertensive medicine score in the BCM group (p<0.001) but not in the clinical method group (p=0.34). There were significantly fewer events of cramps in the BCM group as compared to the Clinical Method group (p=0.04). Conclusion: BCM guided volume management in MHD patients was more effective than volume management based on clinical judgment only in controlling blood pressure and decreasing anti-hypertensive medicine burden and intradialytic cramps. Keywords: Body composition monitor; hemodialysis; hypertension
Road Traffic Regulation Awareness, Attitude and Practice among Public Health Students: An Observational Study
(Institute of Medicine, 2023) Shahi, Shirshak; Singh, Sarswoti; Sharma, Bimala; Shakya, Sujata
ABSTRACT Introduction: Road traffic accidents (RTAs) are the leading causes of premature deaths in Low and Middle Income Countries (LMICs). Public health students are the special cadre of human resources for addressing public health issues in the community including RTAs. This study aimed to assess the awareness, attitude, and practice of public health students of Kathmandu Valley regarding road traffic regulations. Methods: This was a cross-sectional study conducted among 395 undergraduate public health students of Kathmandu Valley using structured self-administered questionnaire via google forms. The study participants were selected through student networking and invitation through emails and phone calls. Descriptive statistics and inferential statistics: Mann-Whitney U test, Kruskall-Wallis H test, and spearman’s rank correlation were computed at 5% level of significance. Results: Majority of the participants had knowledge on causes of RTAs, rule for seat belt and not using mobile phone while driving. However, few knew about the maximum penalty for driving without a license and correct side for pedestrians to walk. The median knowledge score on road traffic regulations was 11 out of 14, attitude score 7 out of 7, practice score for pedestrians 10 out of 12 and for drivers/riders 16 of 18. No significant association was found between knowledge and any socio-demographic variables. Knowledge was weakly correlated with attitude. Conclusion: Majority of the participants had knowledge scores above average, while the attitude and practice percentages were higher. We found weak correlation of knowledge with attitude, and no correlation with practice. This indicates that there is still gap between knowledge and practice, which needs to be explored further. Keywords: Knowledge; road safety; public health graduate; road traffic accident; traffic regulation
Lived Experience of Breast Cancer Survivors: A Phenomenological Study
(Institute of Medicine, 2023) Lawot, Isabel; Gharti, Kamala; Singh, Shreejana; Sharma, Mohan R
ABSTRACT Introduction: Breast cancer (BrCa) is the most common cancer in women worldwide. The population who survive breast cancer is increasing; even so, they usually have to go through many problems in their life. Except for the diseased part, numerous socio-cultural factors may pose challenges for the survivors. Hence, the aim of this study was to explore the experiences of cancer survivors. Methods: A phenomenological qualitative design reseach was performed with eight BrCa survivors in Kaski district of Nepal. Data were collected through semi-structured in-depth interviews and analyzed using Colaizzi’s descriptive phenomenological method. Results: Two major themes were extracted from the in-depth interviews. One was the reaction to the diagnosis and another was fear of disease. Most participants lacked awareness of their cancer diagnosis, and nearly all of them experienced fear that persisted until death. They faced a multitude of physical issues throughout the treatment phase and subsequent years, including headaches, loss of appetite, anemia, gastritis, body pain, and swollen extremities. Additionally, they grappled with psychological challenges such as anxiety and depression, rendering them more susceptible. Financially, due to the exorbitant costs of treatment, they had to resort to borrowing money from others, with the burden primarily falling upon their families Conclusion: Most of the participants had fear regarding illness, treatments, recurrence, and death. Patients were worried about the cost of care. Therefore, it is imperative for family members and healthcare professionals to recognize the experiences of breast cancer survivors in order to optimize patient health during critical stages. Keywords: Breast cancer; fear; phenomenology
Maternal and Perinatal Outcome in COVID-19: A Hospital based Descriptive Study
(Institute of Medicine, 2023) Maskey, Suvana; Rijal, Hima
ABSTRACT Introduction: Since the declaration of the pandemic by World Health Organization (WHO), COVID-19 infection has affected worldwide including vulnerable pregnant women, who are at risk of increased maternal as well as neonatal morbidities and mortality. This study aimed to evaluate the prevalence of COVID-19 as well as maternal and perinatal outcomes in pregnancy with covid infection compared to pregnancy without infection. Methods: This hospital-based descriptive study was conducted in Tribhuvan University Teaching Hospital Obstetrics Department. All pregnant women delivered after the third trimester, positive for COVID-19 during the study period, were compared with age-matched control without infection for maternal outcomes in terms of morbidities, mode of delivery, complications as well as neonatal outcomes such as birth weight, Apgar score, intrauterine fetal demise (IUFD), Neonatal Unit (NNU), Neonatal intensive care unit (NICU) admission and neonatal death. Data were analyzed using Stata 14.1. Results: During the study period, total 59 women with COVID-19 infection (prevalence 2.23%) and 118 women without infection were included. Obstetric complications were seen significantly more in study group than control group (13.55% vs 3.38%; p-value 0.01). Cesarean section and intensive care unit admission were also significantly more in study group than control group (81.35% vs 51.7%; p-value <0.001, 22.03% vs 0.85%, p-value <0.001). Women with COVID-19 infection had significantly more hospital stay than control group (p-value 0.005). but no significant difference was observed in the neonatal outcome. Conclusion: Pregnancy with COVID-19 infection is associated with adverse obstetric complications, lower uterine segment Cesarean section and NICU admission but not with adverse neonatal outcomes compared to women without COVID-19 infection. Keywords: COVID-19; maternal outcome; perinatal outcome
Factors determining Outcomes in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
(Institute of Medicine, 2023) Bam, Niraj; Sapkota, Dharmendra; Kuikel, Sandip
ABSTRACT Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is frequently accompanied by increased local and systemic inflammation brought on by airway infection, pollution, or other airway insults. This study aimed to find the factors determining outcomes in patients hospitalized with acute exacerbation of COPD. Methods: An analytical study among diagnosed cases of AECOPD was conducted. Bivariate regression model followed by Multinomial logistic regression (MNLR) was used to contrast outcome variables. A p-value less than 0.05 was considered statistically significant in all analyses. Results: A total of 126 patients with a mean age of 72.04±9.75 years were included in the study. Most of the patients were current smokers or past smokers, cor-pulmonale was present in 34.9% of patients. The most common co-morbidity was hypertension (41.2%). Most (55.6%) patients had early discharge, 31.7% (40) patients had late discharge and 12.7% (16) patients had mortality as the outcome. After bivariate analysis, among all variables of the study qualified to be included in the multivariate MNLR model, Neutrophil Lymphocyte ratio (NLR) was found to be a significant predictor of late discharge in comparison with early discharge while Age and NLR were found to be a significant predictor of Mortality in comparison with late discharge among patients with AECOPD. Conclusion: Older age and higher NLR predicted mortality in comparison to longer hospital stay (>5days). Since NLR is a common variable in both the outcome (early vs late discharge and late discharge vs mortality), NLR can be used to predict the outcome (early discharge, late discharge, and mortality) of patients with AECOPD. Keywords: AECOPD; chronic obstructive pulmonary disease; factors; outcomes; predictors
Liver and Spleen Stiffness as Predictors of Esophageal Varices in Patients with Liver Cirrhosis
(Institute of Medicine, 2023) Jaishi, Shila; Pathak, Rahul; Bhandari, Brindeswari Kafle; Jha, Anurag; Hamal, Rabin; Koirala, Dinesh; Gyawali, Susmita
ABSTRACT Introduction: The risk for the occurrence of esophageal varices in a cirrhotic patient is assessed by two gold standard invasive tests: hepatic venous pressure gradient measurement and esophagogastroduodenoscopy. We aim to find the association between spleen and liver stiffness with the occurrence of esophageal varices in our settings. Methods:This was a prospective cross-sectional study. In the study duration of one year, 94 cirrhotic patients who met the inclusion and exclusion criteria were included. All patients were subjected to transient elastography for measuring liver and spleen stiffness and endoscopy. Results: Of 94 patients, only 77 (81.9%) had esophageal varices. The mean liver stiffness in patients with and without varices was 19.46±4.9SD kPa and 12.92±1.52 SD kPa respectively. The difference was statistically significant, p<0.001. The mean spleen stiffness in patients with and without varices was 22.26±4.6 SD kPa and 14.08±1.20 SD kPa respectively. The difference was statistically significant, p<0.001. The optimal cut-off value of liver and spleen to detect patients with any grade of esophageal varices was 14 and 16.15 kPa respectively. Conclusion: The stiffness of liver and spleen using transient elastography can be considered an equivalent method for screening cirrhotic patients for esophageal varices in clinical settings. Keywords: Cirrhosis; esophageal varices; liver stiffness; spleen stiffness
Health Journalism: A Unique Specialty in Nepal
(Institute of Medicine, 2023) Singh, Yogendra P
NA
Compliance of WHO Surgical Safety Checklist at a Pediatric Surgical Unit in a Tertiary Level Hospital: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Bajracharya, Jasmine; Shrestha, Ritesh; Karki, Deepika; Shrestha, Asim
Abstract: Introduction: The Surgical safety checklist by World Health Organization has been used for the last two decades. There is every chance of unwanted expected disasters in Operating-Room in Pediatricsurgical cases. Our study is to observe the utilization of the safety checklist and evaluate occurrence of never-events in Tertiary Level Pediatric Surgery Unit in Nepal. Methods: A descriptive cross-sectional study was done at Nepal Medical College Teaching Hospital from January 2021-June 2021 with record-based data of children from 0-15 years operated in Pediatric Surgery unit from March 2017-July 2018. Ethical approval (Reference number: 049-077-078) was taken from the Institution review committee of the institute. Convenience sampling was done. Self-designed Pro-forma with demographic data along with World Health Organization-Surgical-safety-checklist used was collected and entered in Microsoft-Excel. Data were analyzed using Statistical-Package-for-the-Social-Sciences-version-25. Point estimate at 95% Confidence Interval was done along with frequency and proportion for binary data. Results: Out of 267 cases enrolled, 103 (38.6%) (35.6-41.6 at 95% Confidence Interval) were fully compliant with the checklist, 69 (25.8%) partially compliant. Among compliant cases, 148 (55.4%) Sign-in part, 128 (47.9%) cases -Time-out part and 152 (56.9%) cases Sign-out part were complete. Conclusions: Compliance with World Health Organization-Surgical-safety-checklist has a major role in preventing morbidity and mortality in Pediatric surgical cases. With proper use of the checklist, the unwanted never-events can be prevented with better surgical outcomes.
Moderate Hydronephrosis among Acute Ureteral Calculus on Ultrasonographic Imaging in a Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study Authors
(Nepal Medical Association, 2021) Paudel, Dipesh; Adhikari, Deepak; Dhakal, Radha Devi
Abstract: Introduction: Ureteric calculi are lying at any point of ureter from the pelvic ureteric junction to the vesicoureteral junction. If left untreated, ureteropelvic junction obstruction can lead to hydronephrosis. With the improved availability of computed tomography and ultrasound scanning, hydronephrosis is being diagnosed more frequently. The main aim of this study is to find out the prevalence of moderate Hydronephrosis among ureteral calculus on ultrasonography imaging in a tertiary care center of Nepal. Methods: A descriptive cross-sectional study was conducted among 110 acute ureteral calculus cases at Radiodiagnosis and Imaging Department of Chitwan Medical College and Teaching Hospital, Bharatpur from 15th August 2020 to 15th May 2021. The ethical approval was taken from the Institutional Review Committee of same institution. Convenient sampling technique was used to select the participant. . The collected data was entered in excel 16 and analysed in Statistical Package for Social Sciences. Point estimate at 95% Confidence Interval was done and frequency and percentage were calculated Results: Out of the 110 cases of acute ureteral calculus, 31 (28.2%) (19.79-36.60 at 95% Confidence Interval) has moderate hydronephrosis in the ultrasonographic imaging. The mean age of participants was 31.61±8.51 years and male to female ratio was 1.97:1. Vesicoureteric junction was the most common site for ureteric calculus 39 (35.5%). Conclusions: The ultrasound is an easy method to be applied, and a fast one to help and diagnose obstructive hydronephrosis. The main causes of hydronephrosis are kidney stones, followed by ureteral stones, with a moderate degree of hydronephrosis.
C-reactive Protein to Albumin Ratio among Patients Admitted to Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Crosssectional Study Authors
(Nepal Medical Association, 2021) Gyawali, Pratiksha; Shrestha, Himal; Pant, Vivek; Risal, Prabodh; Gautam, Sharad
Abstract: Introduction: Sepsis is the most common cause of mortality among patients admitted to intensive care unit. There is emerging evidence on the role of C-reactive protein to albumin ratio (C-reactive protein/Albumin) in predicting outcomes in patients with critical illness and sepsis, admitted to intensive care unit. We aimed to find out the median value of C-reactive protein/Albumin ratio among patients admitted to intensive care unit of a tertiary care hospital. Methods: We conducted a descriptive cross-sectional study of 110 critically ill patients (>18 years old) admitted to intensive care unit of Dhulikhel Hospital from April, 2014 to June, 2016. The ethical approval (Reference number.51/16) was obtained from Institutional Review Committee at Kathmandu University School of Medical Sciences. C-reactive protein/albumin ratio was calculated from records of patients admitted to the intensive care unit. Convenience sampling was done. Data were entered into Microsoft Excel and analysed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequencies and percentages for binary data. Results: Among 110 patients admitted to the intensive care unit, the median value of C-reactive protein/Albumin ratio was found to be 3.4 (Interquartile range: 3.1-4.5). Out of these patients, 44 (39.5%) patients were septic and their median C-reactive protein/albumin ratio was 3.4 (Interquartile range: 3.1-4.5). Conclusions: Our study showed higher median C-reactive protein /Albumin similar to other studies. Sepsis is a common finding among patients admitted to intensive care unit. Monitoring of C-reactive protein/albumin level in a patient admitted to intensive care unit could be useful for stratifying patients with a high risk of developing sepsis.
Mean Carotid Intima-Media Thickness in Patients with Type 2 Diabetes Mellitus Attending Tertiary Care Center: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Kayastha, Prakash; Paudel, Sharma; Gurung, Ghanshyam; Kumar, Pradeep; Upadhyaya, Rudra Prasad; Tuladhar, Sasmita; Adhikari, Govinda; Maharjan, Santosh
Abstract: Introduction: Sonographic carotid intima media thickness measurement in diabetic patients is an important tool for estimating the risk of cardiovascular and cerebrovascular events. It is a simple, noninvasive and widely available tool which can give idea of further treatment needed. The objective of this study was to determine the mean intima media complex thickness in patients with type II diabetes mellitus attending a tertiary care center. Methods: This was a descriptive cross-sectional study done in 64 patients with the type II diabetes mellitus patients visiting diabetic clinic of Tribhuvan University Teaching Hospital, sent for carotid Doppler examination in the department of radiology and imaging. Ethical approval was taken from the Instituitonal Review Board. Convenient sampling method was used. Carotid intima media thickness was measured on both sides and mean intima media thickness was calculated. Mean intima media thickness for male and female diabetic patients was also calculated separately. Statistical Package for Social Sciences version 25 was used for data analysis. Results: The mean carotid intima media thickness was 0.86±0.13mm with range from 0.7mm to 1.3mm. Mean intima media thickness in male was 0.832±0.094mm and in female it was 0.904±0.144mm. Among 64 patients, 30 (46.8%) were female and 34 (53.3%) were male. Age of the patients ranged from 35 years to 68 years with mean age of 52.4±6.54 years. Conclusions: Carotid intima media thickness in patients with type II diabetes mellitus showed higher values than that of mean value from study done in similar study. Female had higher mean intima media thickness than male.
Anemia among Patients Attending Anti-retroviral Therapy at a Tertiary Care Center: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) Shah, Bibhant; Karki, Lochan; Mandal, Rajesh Kumar
Abstract: Introduction: Hematologic abnormalities are among the most common complications of infection with Human Immunodeficiency Virus. These abnormalities are due to: impaired hematopoiesis, immune mediated cytopenias and altered coagulation mechanisms. Anemia is the most frequent,however, leukopenia, lymphopenia, and thrombocytopenia have also been observed. The aim of the study was to find the prevalence of anemia in patients attending anti-retroviral therapy at a tertiary care center of Nepal. Methods: The study was a descriptive cross-sectional study conducted from August 2018 to August 2019 in patients attending anti-retroviral therapy at a tertiary care hospital. Ethical approval was obtained from the Institutional Review Board of National Academy of Medical Sciences before starting the study (Reference number 267). Convenient sampling was used for this study. Data were analysed using the Statistical package for Social Sciences version 20. Point estimate at 90% confidence interval was calculated along with frequency and proportion for the binary data. Results: The prevalence of anemia among patients attending anti-retroviral therapy centers in our study was found in 29 (58%) (46.55-69.45 at 90% Confidence Interval). Out of those patients, 20 (63%) were male and 9 (50%) were female. The mean hemoglobin value was 11.946±2.51g/dl. Conclusions: The prevalence of anemia among patients attending antiretroviral therapy in our study was found to be high which is consistent with the findings of other similar international studies. These patients should be routinely monitored and treated for the occurrence of hematological abnormalities.
Total Knee Arthroplasty in Moderate to Severe Fixed Flexion Deformity in a Tertiary Care Center: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2021) KC, Kapil Mani; RC, Dirgha Raj; Marahatta, Suman Babu; Pangeni, Bandhu Ram
Abstract: Introduction: Performing the total knee arthroplasty in moderate to severe fixed flexion deformity, appropriate resection of bone from distal femur along with proper ligament balancing is mandatory in order to get the reasonable intraoperative correction. The aim of our study is to find out the prevalence of total knee arthroplasty among knees with moderate to severe fixed flexion deformity in a tertiary care center. Methods: This is a descriptive cross-sectional study conducted from hospital records of 2013 to 2019 in elderly patients with moderate to severe fixed flexion deformity in a Tertiary Care Hospital. Ethical clearance (14/2020) was taken from Institutional Review Board. Convenience sampling was used and statistical analyses were performed using the Statistical Package for the Social Sciences software (version 16.0). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 400 knees with moderate to severe fixed flexion deformity, the prevalence of total knee arthroplasty was found to be 80 knees (20%) (16.08-23.92 at 95% Confidence Interval). Conclusions: The prevalence of total knee arthroplasty is comparable to other study. In our study total knee arthroplasty can be performed successfully with excellent functional outcomes in patients with moderate to severe fixed flexion deformity of knee joint provided the joint stability is maintained by appropriate ligamentous balancing.

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