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Case Report on Pseudoaneurysm of Brachial Artery: A Rare Complication of Paediatric Supracondylar Humerus Fracture Pinning
(Institute of Medicine, 2019) Bhandari, Prawesh S; Bastola, Priska; Gurung, Dinesh
ABSTRACT Pseudoaneurysm (PA) of the brachial artery in pediatric supracondylar humerus fracture who have undergone closed reduction and percutaneous pinning is a rare complication. A few cases have been reported in medical literature. This case report sheds some insight into early identification and management outcome of such complication. Rapidly progressive swelling in antecubital fossa in cases of supracondylar fracture who have undergone pinning should arouse suspicion of vascular lesion. It should be timely intervened. Surgical intervention of pseudoaneurysm with reversed saphenous venous graft has shown to have no early vascular complication. Keywords: Case report, supracondylar fracture, pseudoaneurysm, supracondylar fracture
A Case Report of Recurrent Pyogenic Granuloma with Satellitosis
(Institute of Medicine, 2019) Parajuli, Sudip; Das, Anil K; Paudel, Upama
ABSTRACT Recurrent pyogenic granuloma with satellitosis is an uncommon condition with majority of cases resolving within one year after treatment. We report a case of recurrent pyogenic granuloma in a middle aged man who kept on relapsing at different point of time despite treatment with electrocoagulation, cryosurgery and oral methotrexate. The case highlights the unusual presentation of relatively common condition of pyogenic granuloma. Keywords: Electrocoagulation, pyogenic granuloma, satellitosis
Case of HER2-Enriched Multifocal Breast Cancer Associated with Pregnancy
(Institute of Medicine, 2019) Khanal, Suman; Singh, Yogendra P; Shrivastav, Shreya
ABSTRACT Pregnancy-associated breast cancer is less common and often presents in advanced stage. Management is similar to non-pregnant cases with trimester-specific considerations. In this case report, we present a case of worrisome mother with locally advanced multifocal pregnancy-associated breast cancer who was so much concerned about effects of neoadjuvant chemotherapy on fetus leading to its delayed initiation, and show why targeted therapy is still not within reach in a developing economy like Nepal. Short term data of chemotherapy though reveal relative safety, long term data are lacking. This may be a hindrance in counselling, when patients are more anxious and worrisome. Keywords: Breast cancer, chemotherapy, HER2-neu, pregnancy
Vein of Galen Aneurysmal Malformation Presenting with Obstructive Hydrocephalus: A Case Report
(Institute of Medicine, 2019) Khanal, Nischal; Rajbhandari, Binod; Sedain, Gopal; Shilpakar, Sushil K
ABSTRACT The prognosis for children harboring vein of Galen aneurysmal malformation (VGAM) has significantly improved over the last three decades due to refinements in the interventional endovascular techniques. It is now possible to obliterate the malformation with better results. Endovascular approaches evolved as the gold standard treatment option for this disorder. A few reports were published warning about the high rate of complications associated with ventriculoperitoneal shunting (VPS) in this setting. We present a pediatric case with VGAM where an emergency ventriculoperitoneal shunt procedure was required for symptomatic obstructive hydrocephalus (HCP) and management of the subsequent complications that followed it. Keywords: Complications, obstructive hydrocephalus, vein of Galen aneurysmal malformation, ventriculoperitoneal shunt
Drug Induced Sleep Endoscopy for Obstructive Sleep Apnea Syndrome: An Initial Experience in a Tertiary Level Centre
(Institute of Medicine, 2019) Parajuli, Bashu D; Mandal, Lokendra; Koirala, Megha; Bhattarai, Amit S; Neupane, Yogesh; Shrestha, Anil
ABSTRACT Drug induced sleep endoscopy (DISE) is a technique of performing endoscopy of the upper airway after inducing sleep by the use of anaesthetic agents in patients suffering from obstructive sleep apnea syndrome (OSAS). The main purpose of DISE is to detect the obstruction or collapse at one or more location in the upper airway, both for the successful diagnosis and management of OSAS. Here we discuss a case of OSAS who underwent DISE under novel anaesthetic agents midazolam and dexmedetomidine. Keywords: Dexmedetomidine, drug induced sleep endoscopy, obstructive sleep apnea syndrome, propofol
Knowledge Regarding Antibiotic Use, its Resistance and Consequences among Higher Secondary Students in Private Schools of Kathmandu Valley
(Institute of Medicine, 2019) Deo, Satish K; Gautam, Naveen; Gyawali, Siddinath; Shrestha, Deepti; Yadav, Shikha
ABSTRACT Introduction The lack of awareness on the appropriate use of antibiotics, its dose and duration is one of the leading causes of global antimicrobial resistance (AMR). AMR poses a growing threat to public health, as infections from resistant strains of microbes become increasingly difficult to treat, resulting in prolonged illness and greater risk of death. Hence, this study would be an important reference for determining the scope of the problem which will be essential for formulating and monitoring an effective response to antibiotic use and its problem of resistance. Methods A descriptive cross-sectional study was done among higher secondary level students from selected schools in Kathmandu valley. Baseline data was collected after a tutorial session through semi-structured questionnaires which was based on past researches and verified using expert consultation. Ethical consideration was maintained throughout the study. Descriptive statistics was used to find out the KAP level including knowledge score and attitude-practice score of the selected population. Results Among 465 participants conducted in our research, the overall average knowledge score of the participants was found to be 73.3% while the attitude-practice score was 60.53%. It was found that 80.86% of the participants had heard the term “antibiotic resistance”. The knowledge score percentage among the students of grade 10 and 11 had no significant difference (p value= 0.592). Conclusion Our study concludes that if topics like antibiotics and their judicial use is well covered in school curriculum, it can produce measurable change in knowledge, attitude and practice level of the students. Keywords: Attitude, antibiotics, antimicrobial resistance, knowledge, practice
Blood Groups and their Association with Academic Performance among Medical Students in a Nepalese Medical College
(Institute of Medicine, 2019) Mahat, Barun; Shrestha, Lava; Adhikari, Shailesh; Thapa, Bikalp; Limbu, Prakesh; Banstola, Dinesh; Dhungel, Sunil
ABSTRACT Introduction Knowing a person’s blood type is not only important in transfusion medicine and forensic medicine but is also useful for predicting a person’s characteristics including intelligence, knowledge, skill and behavior. It is recognized that intelligence, knowledge and skill are assessed by performance in examination. The objective of this study was to determine distribution of blood groups among students and its association with their academic performance. Methods This was an analytical study that was conducted among the medical students of Nepalese Army Institutes of Health Sciences (NAIHS) in Department of Clinical Physiology from June 2014 to April 2019. This study was conducted among 738 students by using convenient sampling method. Blood group was determined on the basis of agglutination reaction. Academic performance of students was assessed by the marks obtained by them in annual final examination. Results Blood group O was the most prevalent at 33.5%, followed by B at 29.5%, A at 29% and AB at 8%. Distribution of Rh positive and Rh negative were 96.6% and 3.4% respectively. The mean scores obtained in final university examination were highest in blood group A (62.9%) and lowest in blood group AB (60.3%) but the difference between different blood groups was not statistically significant. Conclusion Blood group O was the most common blood group. Rh positive was present in 96.6%. Though mean score was highest in blood group A, significant association between blood groups and academic performance was not seen in our study. Keywords: ABO, academic performance, blood groups, medical college, Nepal, Rh
Role of Preoperative CEA, CA 19-9, NLR and PLR as Predictors of Adverse Prognostic Pathological Features of Gastric Carcinoma Patients in a Tertiary Centre of Nepal
(Institute of Medicine, 2019) Mandal, Rajesh K; Bhandari, Ramesh S; Lakhey, Paleswan J; Singh, Yogendra P; Vaidya, Pradeep; Kansakar, Prasan BS; Ghimire, Bikal; Kandel, Bishnu P
ABSTRACT Introduction According to GLOBOCAN 2018, gastric carcinoma is the fifth most common cancer (5.7%) and third most common cause of cancer related death (8.2%) worldwide. Delayed presentation and advanced disease at diagnosis, owing to the overlapping symptoms, can be attributed to its high mortality. Gastrectomy is one of the most commonly performed surgery at our centre. This study aims to study the role of pre-operative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as predictors of adverse prognostic pathological features of gastric carcinoma patients who were considered for surgery at our centre. Methods This is a retrospective analysis of prospectively maintained database of all operated gastric carcinoma patients since June 2016 to January 2019. Various pre-operative variables including serum CEA level, serum CA 19-9 level, NLR and PLR were collected. Intra-operative surgical procedures performed and post-operative pathologic variables like tumor size, stage, grade, lymph node ratio (LNR), lymphovascular invasion (LVI) and perineural invasion (PNI) were collected. Results A total 60 patients were planned for surgical intervention over this duration. Mean age of the population was 56.8±12.5 years with slight male predominance (i.e. 55%). Mean CEA level was 6.17 ng/ml and CA 19-9 level was 72.1 U/ml. The mean NLR and PLR of the study population was 3.4 and 200 respectively. Fifty four patients had distal tumors and six had proximal tumors. Curative surgery was performed in 40 patients out of which 37 underwent subtotal gastrectomy and three underwent total gastrectomy. D2 gastrectomy was performed in 55% patients treated with curative intention. Advanced disease (T2 and above) was seen in 86.7% of patients. Preoperative CEA, CA 19-9, NLR, PLR were evaluated for association with pathologic features like tumor size, T stage, grade of tumor, LNR, LVI, and PNI but statistical analysis failed to show any significant association. Conclusion Advanced disease at presentation is common in gastric carcinoma. Preoperative clinical parameters including tumor markers CEA, CA 19-9, NLR and PLR may not be useful to diagnose the advanced disease in gastric carcinoma patients. Keywords: Gastric carcinoma, gastrectomy, CEA, CA 19-9, NLR, PLR
Outcome of Endoscopic Sphenopalatine Artery Cauterization for Posterior Epistaxis
(Institute of Medicine, 2019) Kharel, Bijaya; Gurung, Urmila; Tripathi, Prashant; Rayamajhi, Pabina; Silwal, Priyansha
ABSTRACT Introduction Epistaxis is a common otorhinolaryngology emergency condition. Majority of it is anterior epistaxis which usually improves with conservative management. However, for posterior epistaxis, apart from posterior nasal packing, endoscopic sphenopalatine artery cauterization (ESPAC) is considered an effective measure for its control. Hence, this study was conducted to evaluate the outcome of endoscopic sphenopalatine artery cauterization for posterior epistaxis. Methods Retrospective medical chart review of patients who underwent endoscopic sphenopalatine artery cauterization for posterior epistaxis from January to December 2018 at Ganesh Man Singh Memorial Academy of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results A total of 31 patients (21 males and 10 females) underwent ESPAC during the one-year period. Twenty-seven of them were unilateral whilst four were bilateral. Four of them rebled, of which two bled within 48 hours and the remaining two after two months. The overall success rate of ESPAC was 87.1% (27/31). Conclusion Endoscopic sphenopalatine artery cauterization is an effective measure to control posterior epistaxis. Keywords: Endoscopy, epistaxis, nasal packing, sphenopalatine artery cauterization
Antimicrobial Susceptibility Pattern of Acinetobacter calcoaceticus-Acinetobacter baumannii Complex Isolated from Sputum in a Tertiary Care Hospital
(Institute of Medicine, 2019) Sapkota, Jyotshna; Sharma, Manisha; Shrestha, Deepti; Jha, Beena
ABSTRACT Introduction Acinetobacter calcoaceticus-Acinetobacter baumanni (ACB) complex is one of the commonest cause of hospital acquired and ventilator associated pneumonia. Multidrug resistant Acinetobacter species have become a matter of huge concern. This study was done to find out the antibiotic susceptibility pattern of Acinetobacter calcoaceticus-Acinetobacter baumanii complex from sputum samples. Methods This descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from July 2018 to Jan 2019 after ethical approval. Acinetobacter calcoaceticus-Acinetobacter baumannii complex was identified on the basis of its microscopy and morphological characteristics followed by biochemical tests. Antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method. Results Of the 384 culture positive sputum specimen, 76 (19.80%) were Acinetobacter calcoaceticus-Acinetobacter baumannii complex. Most of the isolates were resistant to commonly used antibiotics, 72.36% of the isolates were multidrug resistance and 3.95% isolates were resistant to tigecycline. Conclusion This study provides valuable information regarding prevalence of Acinetobacter calcoaceticus-Acinetobacter baumannii complex from sputum specimen. The alarming number of Multidrug resistance isolates is worrisome finding. Antibiotics like Tigecycline and Colistin which is still sensitive to isolates should be cautiously used only in MDR cases. Keywords: Acinetobacter, ACB complex, antibiotic resistance, MDR, Nepal
Association of ABO Blood Groups with Craniofacial Morphology among Orthodontic Patients in Selected Private Clinics of Kathmandu
(Institute of Medicine, 2019) Gupta, Sanjay P
ABSTRACT Introduction The craniofacial morphology and blood groups both are related to genetic components, hence it can be hypothesized that blood groups have an association with craniofacial morphology. Some studies showed the relationship whereas others could not find any relationship in different population. The aim of this study was to find out the relationship between ABO blood groups and craniofacial morphology among orthodontic patients of Kathmandu district. Methods In this cross sectional analytical study, 385 participants (age range from 13-45 years) were selected among the orthodontic patients who came for orthodontic treatment in private orthodontic clinics. After obtaining written consent, all the patient’s demographic information were recorded and lateral cephalograms were obtained from the patient’s record. Blood group of all the participants was recorded. Results Among 385 participants, 162 (42.07%) were male while 223 (57.93%) were female and the mean age was 16.31±4.38 years. Twenty cephalometric parameters depicting craniofacial morphology were digitally analyzed using lateral cephalograms. The prevalence of blood group O patients was highest (32.20%) followed by blood group B (30.64%), blood group A (29.88%) and blood group AB (7.28%). Statistical analysis with ANOVA revealed nine out of twenty cephalometric parameters were statistically significant among different blood groups (p<0.05). Tukey post hoc test was done to find out the difference among the groups. Conclusion The evaluation of relationship between blood group and craniofacial morphology revealed that blood groups have association with some craniofacial parameters. This suggests, there may be some genetic influence of ABO blood group on craniofacial morphology. Keywords: ABO blood groups, association, craniofacial morphology, orthodontic patients
Factors Predicting Mortality in Perforation Peritonitis at a Tertiary Care Center in Nepal
(Institute of Medicine, 2019) Kansakar, Prasan; Ghimire, Bikal; Mishra, Parashuram
ABSTRACT Introduction: Perforation peritonitis is a common surgical emergency. Despite advances in surgical techniques, antimicrobial therapy and intensive care support, mortality due to this illness still remains high. To analyze various demographic and clinical parameters associated with mortality in patients undergoing surgery for hollow viscus perforation peritonitis. Methods: A prospective observational study was conducted at the Surgical Gastroenterology Unit, Department of Surgery, Tribhuvan University Teaching Hospital, in patients undergoing surgery for perforation peritonitis over a period of 18 months. Demographic characteristics, physiological variables and laboratory values were obtained. End point of the study was patients’ condition at discharge or in-hospital mortality. Univariate and multivariate analysis of various demographic, clinical and laboratory parameters were performed. Results: Among 121 patients, mean age was 41.5±18.9 years (range of 16 to 87 years). There was a male preponderance (74.1%). In-hospital mortality was seen in 19 patients (17.0%). Age, female sex, pulse rate, blood pressure, white blood cell count, urea and creatinine were significant parameters associated with mortality. Multivariate logistic regression analysis of the variables found to be of significance from univariate analysis showed that only pulse, systolic blood pressure and creatinine were the independent variables associated with mortality. Conclusion: Higher mortality was seen in elderly patients. Despite of male preponderance, larger proportion of females succumbed to their disease. Derrangement in vital parameters like pulse and blood pressure and renal function test had negative impact in survival. Keywords: Hollow viscus, mortality, perforation peritonitis
Awareness Regarding Child Abuse among Mothers Attending a Paediatric Clinic of a Tertiary Level Hospital, Kathmandu
(Institute of Medicine, 2019) Mishra, Tulashi Adhikari; Bhattarai, Tilarupa
ABSTRACT Introduction: Child abuse constitutes all forms of physical as well as emotional maltreatment resulting in harm to the child’s health and overall development. Parental awareness plays a significant role in the prevention of child abuse. The objective of this study was to find out the awareness of mothers regarding child abuse. Methods: This descriptive cross sectional study was carried out among mothers attending a Pediatric Outpatient Department of Tribhuvan University Teaching Hospital Kathmandu, Nepal. A total of 162 mothers having their children of aged one to 16 years were selected as a sample using non-probability convenient sampling technique. Data was collected by face to face interview using semi-structured interview schedule. Results: Findings of the study revealed that majority of mothers could state different types of abuse as physical abuse (72.8%), psychological abuse (78.4%), sexual abuse (71.6%), but 53.1% of mothers were aware about neglect, 48.8% of mothers considered that relatives could abuse their child. In total, 49.1% of mothers had moderately adequate, 26.4% had inadequate and 23.9% had adequate level of awareness regarding child abuse. No significant association was noted between the level of awareness and mothers’ age, ethnicity, religion and occupation. The level of awareness of mothers was significantly associated with nuclear family type (p=0.03). Conclusion: The mothers are aware of child abuse at moderate level. Conducting awareness programmes in community, regarding child abuse focusing on child neglect is recommended. Keywords: Awareness, child abuse, knowledge, mother, parent
Early Post-Operative Outcome and Complication of Arteriovenous Fistula Creation under Regional Anesthesia
(Institute of Medicine, 2019) Shrestha, Kajan R
ABSTRACT Introduction: Arteriovenous fistula (AVF) is the commonest vascular access for patients with end stage renal disease (ESRD) undergoing hemodialysis, however there is no consensus regarding mode of anaesthesia for creation of AVF. Mode of anaesthesia may have effect on outcome and complication of AVF. Methods: This is a retrospective descriptive study conducted on the basis of data collected from patients undergoing AVF under brachial plexus block (BPB) from January 2018 to December 2018 at Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Data regarding demographics, results and complications have been analyzed. Results: A total of 79 patients (male: female=45:34) underwent AVF under BPB during one year period at University teaching hospital with a mean age group of 56.76±11.65 years (24-86 years). In three patients, the brachial plexus block failed and was substituted with general anaesthesia while 21 patients needed some adjuncts with block to create fistula. In 38 patients (48.10%) brachiocephalic fistula was created and in 48 patients (60.76%), plan to make fistula at proximal site was changed after application of block to more distal level. All fistulas were patent at 24 hours (100%, 79 patients) and the rate was 93.67% (74 patients) at 6weeks. The complications seen post procedure were limb oedema in five patients (6.33%), thrombosis and infection in one patient each, hematoma in two patients and bleeding in three patients. Conclusion: Brachial plexus block is effective modality of anaesthesia to create AVF for hemodialysis as it increases chances of creating distal fistula and also increases the effectiveness of it. Keywords: Arteriovenous fistula, brachial plexus block, hemodialysis
Correlation between Iron Parameters and Platelet Parameters in Iron Deficiency Anemia
(Institute of Medicine, 2019) Chalise, Sanat; Acharya, Nishant; Pradhan, Sailesh B
ABSTRACT Introduction: Iron deficiency anemia is the most common type of anemia and is diagnosed by iron studies. Reactive thrombocytosis is usually seen in iron deficiency anemia. The objectives of the study is to correlate between iron parameters and platelet parameters in patient with iron deficiency anemia. Methods: This was a cross-sectional study done in Department of Pathology at Kathmandu Medical College, Sinamangal between December 2018 to May 2019. Blood samples of 81 iron deficiency anemia patients were analysed to determine iron parameters and platelet parameters. SPSS version 20 was used to analyse the data. Results: Thrombocytosis was seen in 62 (76.5%) patient with iron deficiency anemia. Platelet count was negatively correlated with serum iron, percentage saturation and platelet distribution width (p˂0.001, for all) while positive correlation was obtained between platelet count and plateletcrit (p<0.05). Plateletcrit showed negative correlation with serum iron (p˂0.001) and platelet distribution width (p<0.05) while positive correlation was obtained with mean platelet volume, total iron binding capacity and platelet (p<0.05, for all). There was negative correlation between mean platelet volume and platelet count (p<0.001). Positive correlation was obtained between mean platelet volume and plateletcrit (p<0.05). Correlation was not found between mean platelet volume and iron parameters (p>0.05). Platelet distribution width showed negative correlation with total iron binding capacity, platelet (p˂0.001, for both), plateletcrit (p<0.05). Conclusion: Thrombocytosis is more commonly observed as compared to thrombocytopenia in patient with iron deficiency anemia. Serum iron and percentage saturation are the most important parameters affecting the platelet count. Keywords: Iron deficiency anemia, platelet parameters, thrombocytosis
Changes in the Quality of Life of Outpatients in Methadone Maintenance Treatment Clinics in Kathmandu Valley
(Institute of Medicine, 2019) Sapkota, Basanta; Tulachan, Pratikchya; Ojha, Saroj P; Chapagai, Manisha; Dhungana, Saraswati
ABSTRACT Introduction: Methadone maintenance treatment (MMT) is widely accepted treatment option for the opioid dependent individuals. The evaluation of the quality of life represents the assessment of the effectiveness of the treatment program. The study aimed to explore the impact of MMT program on clients’ quality of life in the first 6 months of treatment. Methods:A total of 63 patients were recruited from the 5 different methadone clinics of Kathmandu valley. A prospective follow-up design was used. The semi-structured pro forma was filled up. To assess quality of life, WHO Quality of Life questionnaire (WHOQOL-BREF, 26-item version) was used. The tool was used to assess the quality of life at the baseline and after 6 months of enrollment in MMT program. Results: Following 6 months of methadone maintenance treatment of opioid dependent individuals, significant improvements (P<0.001) were observed in all measured domains of quality of life i.e. physical, psychological, environmental and social. The least improvement was noted in the social domain. Conclusion: Methadone maintenance treatment is helpful in improving the quality of the life of the opioid dependent individuals in MMT clinics. Keywords: Kathmandu valley, methadone, methadone maintenance treatment, quality of life
Awareness Regarding Hypertension among Adults in a Community of Bhaktapur, Nepal
(Institute of Medicine, 2019) Pokhrel, Sanju; KC, Tulza
ABSTRACT Introduction: Hypertension is a common global health problem with significant morbidity and mortality. Various preventive life style practices play significant role in controlling it. The objective of this study was to identify awareness regarding hypertension among the adult people in a community of Bhaktapur, Nepal. Methods: A descriptive cross-sectional study was conducted among 138 adults aged 20-59 residing in Bhaktapur, selected through non probability purposive sampling technique. The data was collected by face to face interview method through semi structured questionnaire. Data was analyzed by using descriptive and inferential statistics. Results: The study showed that 58.7% of adults had adequate awareness regarding hypertension. About 35.5% knew the range of value of high blood pressure and nearly half (47.8%) answered heart as the organ primarily related to hypertension. Stress was identified as a risk for hypertension by 96.4%, 92% specified headache as main symptom and only 31.9% knew about the asymptomatic nature of hypertension. Nearly 90% were aware that management of hypertension includes all: medicine, diet and exercise. Almost 99% of the respondents mentioned about restricting alcohol for BP control and 93.2% mentioned heart attack as the complication of hypertension. Conclusion: The study concluded that only half of adults have adequate awareness regarding hypertension. It also showed that there is statistically significant association of awareness level with age, religion, educational status, occupation, economic status, family history and diagnosis of hypertension. Thus, it could be recommended that health personnel should provide education and information covering all aspects of hypertension to adults residing in community. Keywords: Adult people, awareness, hypertension
Profile and Outcome of Patients Admitted to Pediatric Intensive Care Unit at a General Referral Hospital
(Institute of Medicine, 2019) Sharma, Arun K; Gurung, Binay
ABSTRACT Introduction: Nepal has made substantial progress in child health primarily through preventive care. There is an increasing need for critical care services across the country which is highly resource-intensive. Periodic data of critical care admissions help plan the utilization of scarce resources in a low-income country like Nepal. This study aimed to analyze the epidemiologic patterns of critically ill pediatric patients admitted to the pediatric intensive care unit (PICU). Methods: This descriptive study of all children admitted to PICU at Tribhuvan University Teaching Hospital for 18 months between October 2017 and April 2019 was conducted by a retrospective review of hospital records. Demographic data, etiologies of PICU admissions and outcomes of children admitted to the PICU were analyzed. Results: PICU admitted 413 children during the study duration from all over the country. Children under the age of 2 years (36%) were admitted in the largest number and boys outnumbered girls (65.1%). Respiratory illnesses, neurosurgical and neurological problems, infectious disorders and airway foreign bodies were the most common etiologies for admission. The average length of ICU stay was around 4.4 days. Almost one-third of patients required circulatory and respiratory support. At the time of exit from PICU, 14.3% of patients died; 4.3% patients had opted for withdrawal of life support or decided to leave hospital against medical advice. Conclusion: Patients with diverse etiologies were admitted to ICU from all over the country. A similar analysis from PICUs across the country can serve as the basis for development of newer intensive care facilities in the country, developing dedicated protocols for critical care and redistributing the ICUs’ available resources for optimal efficiency. Keywords: Critical illness, intensive care unit, outcome, PICU, profile
Screening of Kidney Disease in Asymptomatic Female College Students by Urine Dipstick Method
(Institute of Medicine, 2019) Chhetri, Santosh; Shah, Dibya S
ABSTRACT Introduction: Urine examination by urine dipstick method is a useful tool to identify asymptomatic individual for kidney disease. A urine dipstick analysis was conducted on world kidney day to determine the urine abnormalities among asymptomatic female college students. Methods: A cross-sectional study was carried out in a government female college in Kathmandu Nepal. Three hundred asymptomatic female students participated in this study. Fresh midstream urine samples were obtained and tested by urine dipstick method. Random Blood glucose was monitored with glucometer. Blood pressure was measured by manual sphynomanometer. Results: The mean age of the female students was 22.62±2.686 years. Fifteen participants (5%) were found positive for proteinuria and only 1% of participants had glycosuria. The systolic blood pressure of >120 mm Hg was present in 14% of participants while 5% of participants had diastolic blood pressure of >90mm Hg. Participants who were found to have urinary proteinuria detected had both systolic and diastolic blood pressure increased. Only 8% of the participants had random blood sugar of >140 mg/dl. Conclusion: Urinary abnormalities like proteinuria and glycosuria in asymptomatic female students has significant prevalence. Systemic prehypertension and hypertension has alarming rates among adolescents. Hence, screening for blood pressure and early detection of renal disorders will lead to effective interventions and possibly reduce the burden of renal diseases. Keywords: Female adolescents, glycosuria, proteinuria, screening, urinalysis
Prevalence of Laryngopharyngeal Reflux in Patients with Gastroesophageal Reflux Disease Undergoing Upper Esophagogastroduodenoscopy
(Institute of Medicine, 2019) Chalise, Sangita R; Khadka, Subash; Mukhia, Rupesh; Thapa, Abishek; Gautam, Santosh; Sah, Mukesh; Ranjan, Rashmi
ABSTRACT Introduction: Gastroesophageal reflux disease (GERD) has been defined as the retrograde flow of gastric contents into the esophagus. Laryngopharyngeal reflux (LPR) is one of the manifestations of GERD which can be diagnosed clinically by Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). The aim of this study was to find the prevalence of laryngopharyngeal reflux in patients with GERD undergoing upper esophagogastroduodenoscopy. Methods: This was a prospective cross sectional study and all the patients visiting author’s institute with GERD undergoing upper esophagogastroduodenoscopy were included. All the relevant data on history, examination, RSI scores, RFS scores and upper esophagogastroduodenoscopy findings were recorded in the standard proforma and data were analysed. Results: A total of 205 patients with GERD and undergoing upper esophagogastroduodenoscopy were included whose mean age was 46.1 years. The female to male ratio was 1.3:1. The most common presenting symptoms in our study was hoarseness (97%) followed by coughing (90.7%). The mean RSI score was 11.6. The symptom prevalence of LPR was 23.4%. The prevalence in between age groups and gender was not significantly different. The mean RFS score was 9.5. The prevalence of LPR by RFS assessment was 64.4%, which is significantly more than the prevalence assessed by RSI (23.4%). Conclusion: The prevalence of LPR in patients with GERD by RSI was less than the prevalence by RFS. So both the tools need to be used simultaneously to make the diagnosis and not recommendable to use independently. Keywords: Gastroesophageal reflux disease, laryngopharyngeal reflux, reflux finding score, reflux symptom index

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