Publications

Permanent URI for this collection

https://hdl.handle.net/20.500.14572/6

Browse

Now showing 1 - 20 of 3295

Urinary Tract Infection among Post-renal Transplant Patients in the Department of Nephrology of a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Khatri, Bikash; Maharjan, Suresh; Lamsal, Jagdish; Khatri, Bijay; Shah, Dibya Singh
Abstract Introduction: Urinary tract infection is the most common infection among renal transplant recipients and increases the risk of hospitalization or even death. The study aimed to find the prevalence of urinary tract infection among post-renal transplant patients in the Department of Nephrology of a tertiary care centre. Methods: This is a descriptive cross-sectional study which was conducted among 217 post-renal transplant patients at the Department of Nephrology of a tertiary care centre from 1st November, 2017 to 31st October, 2018. The study was approved by the Institutional Review Committee (Reference number: 245(6-11-E)2074-75). Convenience sampling was used. The data were entered in Microsoft Excel 2011 and analyzed using the Statistical Package for the Social Sciences version 20.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data and mean with standard deviation for continuous data. Results: Among 217 patients, urinary tract infection was seen in 27 (12.44%) (8.05-16.83 at 95% Confidence Interval). One (3.70%) patient had the infection within three months of transplant, and 17 (62.96%) had infection after more than a year of transplant. Conclusions: The prevalence of urinary tract infection among kidney transplant recipients in our study was lower than previous studies done in similar settings.
Congenital Hypothyroidism among Infants Undergoing Thyroid Function Test in a Tertiary Care Centre: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Mishra, Bijaya; Bhatta, Nisha Keshary; Regmi, Mohan Chandra; Das, Binod Kumar Lal; Khan, Seraj Ahmed; Gelal, Basanta; Niraula, Apeksha; Lamsal, Madhab
Abstract Introduction: Congenital hypothyroidism is the most preventable and treatable cause of mental retardation in newborns and infants. Screening for congenital hypothyroidism in newborns and infants is not a routine practice in our part of the world. This study aimed to find out the prevalence of congenital hypothyroidism among infants undergoing thyroid function test in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Biochemistry, from laboratory records starting 14th April, 2013 to 13th April, 2020 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 1502/019). Data of infants whose thyroid function tests were performed were obtained using convenience sampling. Thyroid-stimulating hormone was categorised per the European Society of Paediatric Endocrinology guidelines. Data were entered and analysed using Microsoft Excel 2011 and the Statistical Package for the Social Sciences version 11.5. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Among 1243 infants, 56 (4.50%) (3.35-5.65 at 95% Confidence Interval) infants were diagnosed with congenital hypothyroidism. Conclusions: The prevalence of congenital hypothyroidism was higher than other studies done in similar settings. An unexpected finding of treatment-induced hyperthyroidism was observed, indicating a lack of regular and timely follow-up of infants diagnosed with congenital hypothyroidism.
The Risk of COVID-19 in People Having a Particular Set of Gene
(Kathmandu University, 2021) Dhakal, B; Makaju, R; Dhakal, R
ABSTRACT These risk factors of advancing age, male gender and co-existing health conditions like cancer, cardiovascular diseases, diabetes and obesity do not fully explain why some people have no or mild symptoms whereas others have severe symptoms. Genomewide association study (GWAS) identify a 3p21.31 gene cluster as a genetic susceptibility locus in patients with COVID-19 with respiratory failure. They also found a higher risk among persons with blood group A and protective effect for blood group O than among patients with other blood groups. The particular haplotype in a region of chromosome 3 is contributed to modern humans by neandertals. Another Neanderthal haplotype on chromosome 12 is associated with a 22% reduction in relative risk of becoming severely ill with COVID-19. The ApoE e4e4 homozygous genotype was found to increase the risk of severe COVID-19. Change in angiotensin converting enzyme (ACE) 2 gene was also found to be associated with increased risk of COVID-19, cardiovascular and pulmonary conditions. KEY WORDS Blood group, Chromosome 3, Chromosome 12, Angiotensin converting enzyme
Sydenham’s Chorea with Silent Cardiac Lesions, Mimicking Encephalitis in a 13 Year Old Girl
(Kathmandu University, 2021) Shakya, KN; Bhatta, A; Yadav, A; Gautam, U; Basnet, S
ABSTRACT Sydenham’s chorea is an uncommon neurological manifestation of rheumatic fever and has many and varied differential diagnosis. It may mimic encephalitis when presents as an isolated feature even when silent cardiac lesions are present. Early diagnosis, treatment and penicillin prophylaxis prevents recurrence and progression of cardiac lesions. Prompt symptomatic relief and alleviation of distress is obtained with therapeutic intervention. A case of rheumatic chorea with silent cardiac valve lesions which mimicked herpes simplex encephalitis with choreoathetosis, in a 13 year old girl is presented along with review of literature. KEY WORDS Chorea, Encephalitis, Rheumatic fever, Silent carditis
Crown Lengthening Surgery for Enhancing Restorative Treatment in Esthetic Zone
(Kathmandu University, 2021) Dawadi, A; Humagain, M; Sapkota, B; Subba, M; Neupane, M; Lamichhane, S
ABSTRACT For obtaining adequate retention for restoring cases like subgingival caries or extensive caries that shortens the tooth, short clinical crown, and fractures, it is usually necessary to disclose more tooth structure. Crown lengthening procedure is done to increase the clinical crown length for restorative or esthetic reasons without breaching the biologic width. These procedures are also utilized to improve the appearance and retention of restorations placed within the esthetic zone. We report a case of crown lengthening surgery with an internal bevel gingivectomy which was done in our department without compromising tooth support and esthetics. KEY WORDS Crown lengthening, Esthetics, Gingivectomy
Multiple Epidermal Inclusion Cysts of Epiglottis
(Kathmandu University, 2021) KC, AK; Shrestha, BL
ABSTRACT Epiglottic cysts are benign laryngeal lesions. Though congenital cysts are often life-threatening, they are usually painless and symptomless in adults, or present with slight, though perceptible, interference with either swallowing or speaking or respiration. Early recognition and diagnosis by routine mirror laryngoscopy is advocated. Prompt removal or draining is the treatment. This is a case report of 42-year-old woman with complaints of feeling of something in throat, sleep apnoea and hoarseness, who on routine mirror laryngoscopy was found to have two large cysts arising from the free border of the epiglottis. The final histopathology reported the cysts as epidermal inclusion cysts. KEY WORDS Epidermal inclusion cyst, Epiglottic cysts, Mirror laryngoscopy
Laparoscopic Cholecystectomy and Common Bile Duct Exploration in Situs Inversus Patients
(Kathmandu University, 2021) Simkhada, S; Malla, B; Shrestha, R
ABSTRACT Situs inversus is a congenital condition in which the major visceral organs are reversed from their normal positions, estimated to occur in 1 in 5000–20,000 births. Incidence of gallbladder stone disease is same in these patients and normal patients. Laparoscopic cholecystectomy remains the treatment modality, and performing it successfully in these patients even rarer. We report a 54 years gentleman with gall stone, and 63 years lady who had both gall stone and common bile duct stone along with situs inversus. The mirror image reversibility of the abdominal viscera was seen in both cases. Ports were placed on the opposite side as the liver and the gallbladder were on the left side. Dissection was difficult because being a right- handed surgeon, the non-dominant hand would be the working hand. However, no perioperative complications occurred. It is technically challenging and requires a proper orientation of the left upperquadrant of abdomen. KEY WORDS Common bile duct exploration, Laparoscopic cholecystectomy, Situs inversus
Isolated Leprosy of Bilateral Ear Lobes, A Rare Presentation of Leprosy
(Kathmandu University, 2021) Paudel, V; Chudal, D
ABSTRACT Hansen disease is a chronic infectious disease caused by Mycobacterium leprae. It can present with a variety of clinical manifestations depending on the immune status. Ear lobes are commonly involved in leprosy. However, isolated earlobe involvement of both ear lobes is rare. We present a case of a 25-year-old man who presented with isolated swelling of both pinna, which on slit skin smear turned to be multi-bacillary leprosy. The bilateral pinna swelling started as asymptomatic, multiple skin colored shiny papules which progressively became lobular over a period of a year. Isolated involvement of the pinna in a patient without lesions in other body parts is an unusual initial presentation of leprosy. However, leprosy should be kept as a rare differential diagnosis of isolated lesions on the ear in patients not responding to conventional treatment. KEY WORDS Hansen’s disease, Leprosy, Mycobacterium leprae
Comparative Efficacy and Safety of Diacerein in Patients with Knee Osteoarthritis: A Pilot Study
(Kathmandu University, 2021) Shakya Shrestha, S; Tamrakar, S; Shrestha, R; Shrestha, R; Basi, A; Malla, M; Khadka, SK
ABSTRACT Background Osteoarthritis (OA) is the most common chronic rheumatic disease. The prevalence of OA is skyrocketing with time. Providing a proper treatment regimen for OA is also growing as a major public health challenge. Conventional pharmacological treatments are mainly for alleviating pain and have some severe adverse effects. Diacerein is a new oral anti-inflammatory drug especially developed for the management of OA having only mild to moderate adverse effects. However, the evidence of efficacy and safety of Diacerein in OA is not well documented and yet to be explored. Objective To compare the efficacy and safety of Diacerein in knee OA with conventional non- steroidal anti-inflammatory drugs (NSAIDs). Method A comparative study was conducted among knee OA patients attending Out- Patient Orthopedic department in Dhulikhel Hospital, Nepal from December 2019 to September 2020, using self-structured and standard questionnaire. The patients were randomized to receive either a conventional standard treatment (Treatment Group I: NSAIDs) or alternative treatment regimen (Treatment Group II: NSAIDS+ Diacerein). Patients were followed-up after two months and data were analyzed using SPSS 21.0. Result Among 72 patients enrolled in this study, majority (44.44%) were between 51-60 years of age in which 81.94% of the patients were female. Post treatment data was collected from 15 participants. The mean KOOS-PS score of the participants in Treatment Group I decreased from 35.56 ± 14.33 to 35.14 ± 12.65 while that of the Treatment Group II participants reduced from 63.31 ± 12.08 to 49.99 ± 13.10 in two months. Similarly, the mean WOMAC score decreased from 46.87 ± 17.80 to 34.37 ± 16.83 in Treatment Group I and from 54.23 ± 14.66 to 46.22 ± 12.16 in Treatment Group II. The mean Lysholm score in Treatment Group I increased from 55.57 ± 8.16 to 60.86 ± 15.01 and in Treatment Group II, it increased from 46.62 ± 13.01 to 60.25 ± 17.598. Conclusion Diacerein treatment group had better functional outcome compared to the patients in the treatment group with conventionally used drugs. Also, the adverse effects faced by the patients were minor. The current study are suggestive of better efficacy and safety of Diacerein compared to other drugs. KEY WORDS Adverse effects, Diacerein, Efficacy, Osteoarthritis, Safety
Control of Dietary Salt Intake at Family Level by Housewives in Tripura, India: A Rural - Urban Comparison
(Kathmandu University, 2021) Karmakar, N; Datta, A; Nag, K
ABSTRACT Background Intake of excess salt can lead to high blood pressure a leading cause of cardiovascular diseases (CVDs). The behaviour risk factors for hypertension including high salt consumption, alcohol and tobacco use and physical inactivity; among them, salt intake reduction is one of the most cost-effective ways to control hypertension and CVD. Objective To find out the practice of salt intake control among rural and urban women of Tripura. Method This community based cross-sectional study was conducted among 400 housewives from rural and urban areas of Tripura, India for a period of ten months (June 2017-March 2018). A pre-tested, semi-structured interview schedule was used to collect required information regarding their socio-demographic, behavioural characteristics, family history and practice of salt intake control etc. The collected data was entered in SPSS version 16.0, represented in proportions and p<0.05 was considered as statistically significant. Result In present study, less than half of the participants (46% rural vs 41.5% urban) from both areas have good practice on control of salt intake. The mean control scores of rural and urban housewives were 9.7200±1.63246 and 9.4750±1.68927 respectively. Rural housewives had more control of extra salt intake in comparison to urban housewives but difference was not statistically significant (p>0.05). Majority Hindu housewives in rural areas had good control of salt intake than urban housewives (p<0.05). Conclusion The current study found less than half of the participants both in rural and urban areas have good control of dietary salt intake. This finding may provide an idea for development of intervention strategies aiming at increasing salt control-related awareness. KEY WORDS Cross-sectional studies, Female, Human, Hypertension, Rural
An Experience as a Medical Support during the COVID-19 Pandemic
(Nepal Medical Association, 2022) Adhikari, Sachi; Shrestha, Saloni
Abstract In the midst of the COVID-19 pandemic, volunteering enabled us to support people facing difficulties in locating healthcare facilities. Working as a medical support volunteer allowed us to interact closely with patients. We assisted them by providing information on the availability of hospital beds, intensive care unit beds, ventilators and oxygen cylinders. We had numerous beautiful as well as dreadful experiences and learned valuable lessons during the process. We experienced a wide range of emotions, from the joy of informing about the availability of a vacant bed to the guilt and dilemma of having to prioritise in such a crisis. We learnt about how an empathetic approach and active listening helps to connect people.
Clinical profile of Thrombocytopenia in Acute Febrile Illnesses; a hospital-based study
(Kathmandu University, 2021) Dhunputh, P; Acharya, R; Umakanth, S; Shetty, SM; Mohammed, AP; Saraswat, PP
ABSTRACT Background Thrombocytopenia is a common haematological abnormality noted in clinical practice, however, it can be missed in cases where specific investigations are not asked for. Acute Febrile Illness with thrombocytopenia is a diagnostic and therapeutic challenge, as thrombocytopenia has an inverse relation to mortality and morbidity in various febrile illnesses. Vector-borne and zoonotic diseases (like malaria, dengue, scrub typhus, and leptospirosis), infections and sepsis are some of the common causes of fever with thrombocytopenia. Objective To identify the causes of fever with thrombocytopenia, assess the clinical complications associated with febrile thrombocytopenia, and overall study the clinical profile of thrombocytopenia in a tertiary care hospital Method Medical records of all adult patients, admitted to a tertiary level hospital, with fever and thrombocytopenia (platelet count < 1,00,000 /mm3) were assessed (from October 2009 to March 2011). Detailed case history, general physical examination findings, routine and specific examinations were recorded according to a pre-decided format. Data were analysed using SPSS 16.0 Result Acute febrile illness with thrombocytopenia was most commonly seen in Dengue patients. Headache and arthralgia were more commonly encountered in scrub typhus. Platelet transfusions were necessitated in a large number of patients, especially in scrub typhus. Malaria patients had the highest mortality rate. Conclusion Acute Febrile Illnesses (AFI) are of varied origins, and proper diagnosis is imperative. The degree of thrombocytopenia in infections has a prognostic value. It can also help in differential diagnosis and clear identification of aetiology of acute febrile illnesses. Timely identification and management of thrombocytopenia in acute febrile illness can positively impact the overall patient outcome. KEY WORDS Acute febrile illness, Bleeding tendencies, Fever, Thrombocytopenia, Vector-borne diseases
Modern Paediatric Radiology: Meeting the Challenges in CT and MRI
(Nepal Medical Association, 2022) Regmi, Pradeep Raj; Amatya, Isha; Paudel, Sharma; Kayastha, Prakash
Abstract Radiology plays a very important part in the diagnosis, treatment, and follow-up of children. Computed tomography and magnetic resonance imaging are the two most crucial developments in the modern era. However, the two modalities have their challenges to overcome. Radiation dose is the most unwanted side effect of computed tomography scans while longer scan time along with sedation is a major disadvantage in children during magnetic resonance imaging. Paediatric-specific protocol selection and limiting the exposure to the area of interest aid in reducing the dose during computed tomography scans. Faster scan protocols and sequences can result in imaging without sedation in magnetic resonance imaging. Considering the radiation exposure, "as low as reasonably achievable" principle should be followed strictly in the paediatric population. In this article, possible ways for minimising the radiation dose in computed tomography, as well as effective, short, and sedation-free magnetic resonance imaging, are discussed.
Effects of Momordica Charantia (Karela/bitterguord) in Type 2 Diabetic Patients Taking Allopathic Drugs: A pilot study
(Kathmandu University, 2021) Rauniyar, GP; Sinha, R; Chapagain, K; Maskey. R; Pandey, DR
ABSTRACT Background Momordica charantia is evoloving as supplementary therapy in type 2 diabetes mellitus. Animal studies reveal its anti-diabetic and lipid lowering property. However, clinical studies with human subjects are very few. Objective To find out the effects of Momordica charantia supplements on glycemic and lipid profile among type 2 diabetes mellitus patients taking allopathic drugs. Method A comparative study was conducted in internal medicine department of B P Koirala Institute of Health Sciences, Dharan from July 2015 to May 2016 after ethical clearance. Twenty two uncomplicated type-2 diabetes mellitus patients were enrolled. Group A patients were supplemented with allopathic drug (oral anti-diabetic agents) only and Group B with add on treatment of 200 ml juice of Momordica charantia along with allopathic drug daily for ninety days. Fasting, post prandial blood sugar and lipid profile levels were compared between baseline and ninety days post supplementation. Data was collected and entry was done in Statistical Packages for Social Services version 20.0, using independent t test with p < 0.05. Result Add on treatment with 200 ml of Momordica charantia along with anti-diabetic drug daily significantly reduced fasting (p= < 0.0001) and post prandial blood sugar (p=< 0.0001). Treatment with anti-diabetic drugs only reduced fasting (p = 0.0008) and post-prandial blood sugar but the reduction was not significant ((p =0.0001). There was improvement in lipid profile by both anti-diabetic drugs alone and Momordica charantia along with anti-diabetic drug, but it was not significant. Conclusion Add on treatment with 200 ml/day juice of Momordica charantia is effective in glycaemic control in type-2 diabetes mellitus patients as compared to the allopathic treatment alone. KEY WORDS Blood sugar, Momordica charantia, Supplementation
Unicystic Ameloblastoma of Mandible: A Case Report
(Nepal Medical Association, 2022) Rayamajhi, Sushil; Shrestha, Sunita; Shakya, Samata; Bhandari, Sagar; Twayana, Anu Radha; Shahi, Kopila
Abstract Ameloblastomas of jaws are benign odontogenic tumors of epithelial origin with four clinical variants: solid multicystic type, unicystic type, desmoplastic type, and extraosseous type. The incidence rate of ameloblastoma is 0.92 per million person-years. Unicystic ameloblastoma refers to those cystic lesions that show clinical and radiologic characteristics of an odontogenic cyst but shows a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor proliferation on histological examination. Here is a unique case of unicystic ameloblastoma involving the mandible in a 70-year-old patient. The case was managed by segmental mandibulectomy and flap repair. Unicystic ameloblastoma accounts for only 13% of all known cases in scientific literature. Considering the rarity of the lesion, the purpose of presenting this report on a clinical case is to emphasize the importance of radiological evaluation and histopathological examination for the diagnosis of ameloblastoma.
Whole Genome Sequence Analysis to Identify SARS-CoV-2 Variant in Nepal
(Kathmandu University, 2021) Shrestha, R; Katuwal, N; Adhikari, N; Vanaerschot, M; Tamrakar, D; Dhimal, M; Gyanwali, P; Bhattarai, S; Madhup, SK; Devkota, B
ABSTRACT Background The spread of SARS-CoV-2 has become a global public health crisis. Nepal is facing the second wave of COVID-19 pandemic but, there is still a limited data on the genomic sequence of SARS-CoV-2 variants circulating in Nepal. Objective The objective of this study is to sequence the whole genome of SARS-CoV-2 in Nepal to detect possible mutation profiles and phylogenetic lineages of circulating SARS- CoV-2 variants. Method In this study, swab samples tested positive for SARS-CoV-2 were investigated. After RNA extraction, the investigation was performed through real-time PCR followed by whole genome sequencing. The consensus genome sequences were, then, analyzed with appropriate bioinformatics tools. Result Sequence analysis of two SARS-CoV-2 genomes from patient without travel history (Patient A1 and A2) were found to be of lineage B.1.1. Similarly, among other four samples from subjects returning from the United Kingdom, genomes of two samples were of lineage B.1.36, and the other two were of lineage B.1.1.7 (Alpha Variant). The mutations in the consensus genomes contained the defining mutations of the respective lineages of SARS-CoV-2. Conclusion We confirmed two genomic sequences of variant of concern VOC-202012/01 in Nepal. Our study provides the concise genomic evidence for spread of different lineages of SARS-CoV-2 – B.1.1, B.1.36 and B.1.1.7 of SARS-CoV-2 in Nepal. KEY WORDS COVID-19, Nepal, SARS-CoV-2, Variant of concern, Whole genome sequencing
Mothers’ Perception of Their Children’s Play in Dhulikhel Hospital, Nepal
(Kathmandu university, 2021) Karki, S; Shrestha, S; Shrestha, K
ABSTRACT Background Play is a cherished part of childhood that offers children holistic developmental benefits and parents the opportunity to fully engage with their children. However, modern-day children are spending significantly less time in outdoor play due to a number of factors including technological advancements, more time involved in structured activities, and a greater emphasis on early cognitive learning. Objective To assess perception of mothers on their children’s play. Method This was a descriptive cross-sectional study was carried out among the 228 mothers having at least one child children who attended in Paediatric OPD of Dhulikhel hospital of Nepal from 21st June, 2018 to 16th July, 2019. Ethical approval was obtained from the Institutional Review Committee (IRC) of Kathmandu University School of Medical Sciences (KUSMS). Research instrument was developed by Barnett and was adopted for this study with permission from the author. Systematic random sampling technique was used to select mothers and face to face interview was carried out to collect information. Result Perception on play of children in the mothers was varied. Most of mothers agreed on different sub scales of play with mean range 2.07-3.01 in which they were agreed on freedom play with mean score 3.01±0.40, importance of play with mean score 2.93±0.37 and nearly agreed on maternal rule with mean score 2.89±0.50, play safety with mean score 2.92±0.36, child’s choice with mean score 2.96±0.49 and disagreed on imaginative play with mean score 2.42±0.59 and gender typing with mean score 2.07±0.51. Conclusion Although almost all respondents had positive attitudes towards different component of the play, they disagreed on gender typing and imaginative play which is very important for developing problem solving skill of children based on their gender. So, nursing faculties, pediatricians and nurses can use the findings to develop awareness on importance of gender typing and imaginative play among mothers. KEY WORDS Children, Mothers, Play, Perception
Does the Preoperative Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio Associate with Clinic-pathological Characteristics in Papillary Carcinoma of Thyroid
(Kathmandu University, 2021) Shrestha, BL; KC, AK; Rajbhandari, P; Dhakal, A; Shrestha, KS
ABSTRACT Background Thyroid cancer is associated with local and systemic inflammatory activities. Many systemic inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) had shown credible and independent prognostic biomarkers in different malignant conditions. These markers are easy to reproduce, measure and inexpensive also. So, the preoperative evaluation of NLR and PLR is helpful in evaluating tumor growth and prognosis of papillary carcinoma of thyroid. Objective To evaluate the association of pre-operative NLR and PLR with clinic-pathological characteristic in papillary carcinoma of thyroid. Method This was a retrospective study performed in thirty one patients with the diagnosis of papillary carcinoma of thyroid. Preoperative NLR and PLR values were correlated with the clinical parameters like age, gender, lymph node metastasis, tumor size and pathological features (e.g., multifocality, bilaterality, extrathyroidal spread). Result There were thirty one patients, amongst which 13 were male and 18 were female. Similarly, the age distribution ranges from 27-68 years. The value of NLR was 2.37±1.09, and the value of PLR was 96.69±49.53.The increase in NLR was associated with increase in tumor size with statistically significant results. Similarly, increase in PLR was associated with increase in tumor size and multifocality with statistically significant results. Conclusion Increase NLR and PLR is associated with lymph node metastasis, extra thyroidal extension, multifocality of tumor and also bilaterality, so the risk can be stratified beforehand with measurement of NLR and PLR. KEY WORDS Lymph node metastasis, Neutrophil-to-lymphocyte ratio, Papillary carcinoma of thyroid, Platelet-to-lymphocyte ratio
Loss of Consciousness and Cardiac Arrest as an Atypical Presentation of Tubercular Meningitis: A Case Report
(Nepal Medical Association, 2022) Yadav, Saroj; Acharya, Santosh; Thapa, Astha; Hirday, Aditya; Dahal, Agnimshwor
Abstract Tubercular meningitis is a devastating presentation of extra pulmonary tuberculosis, with fatality in each case without treatment. A 39 years male, a regular consumer of alcohol and a known case of major depressive disorder, presented with the alleged history of using an electric heater in a closed room, and presented to emergency with unconsciousness and cardiac arrest. As his neurological status didn’t improve over 72 hrs, a magnetic resonance imaging brain was done which was non-conclusive. Electroencephalogram revealed diffuse right fronto-parietal seizure activity ceasing with midazolam injection, hence levetiracetam was started. Lumbar puncture revealed increased adenosine deaminase and nil white blood cells. Repeat lumbar puncture showed lymphocytic–predominant pleocytosis, elevated protein and low glucose. The patient was started on anti-tubercular therapy and an injection of dexamethasone was added. Repeat electroencephalogram didn’t show any seizure-like activity. It is important to be aware of variety of presentations of tubercular meningitis. Delay in treatment leads to irreversible neurological damage and even death.
Correlation between Invasive Intracranial Pressure Monitoring and Optic Nerve Sheath Diameter in Patients with Traumatic Brain Injury
(Kathmandu University, 2021) Shrestha, B; Shrestha, P; Ghale, P; Lakshmipathy, G
ABSTRACT Background In management of patients with traumatic brain injury, intracranial pressure holds an important place. Any untoward rise in intracranial pressure portends dreaded complications. Hence, any delay in detecting the issue is considered unacceptable. Objective This study focuses on analyzing the correlation between ultrasound derived optic nerve sheath diameter and intracranial pressure values derived from invasive intracranial pressure monitoring system in a neurosurgical patient with severe traumatic brain injury. Method A prospective observational study was performed using a convenience sample technique including all adult patients with traumatic brain injury who had invasive intracranial monitors placed as part of their clinical care. Ocular ultrasound was performed with 5 - 7.5 MHz linear probe of ACUSON X300 ultrasound system while simultaneous intracranial pressure readings were obtained directly from an invasive intracranial pressure monitoring system. The association between optic nerve sheath diameter and invasive intracranial pressure reading was assessed with the Pearson’s correlation coefficient and a receiver operator characteristic curve was created to determine the optimal optic nerve sheath diameter cutoff to detect intracranial pressure > 15 mm of Hg. Result One hundred and fifteen ocular ultrasounds were performed on 30 individual patients. The mean age of the population involved in this study is 42.13 years ± 1.89 with male preponderance in the ratio of 6:1. Pearson’s correlation coefficient of optic nerve sheath diameter and intracranial pressure was found to be 0.844 (p < 0.000) demonstrating a significant positive correlation. The area under the receiver operating characteristic curve was found to be 0.961 (95% confidence interval = 0.93 to 0.99). Based on analysis of the receiver operating characteristic curve, optic nerve sheath diameter > 4.85 mm performed best to detect intracranial pressure > 15 mm of Hg. with a sensitivity of 93.5% and specificity of 83%. Conclusion Optic nerve sheath diameter is a dependable screening tool to evaluate for elevated intracranial pressure among patients with traumatic nerve injury. KEY WORDS Intracranial pressure, Optic nerve sheath diameter, Screening

Browse

Recent Submissions