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Perioperative Modification in Cirrhotic Patient Undergoing Pancreatoduodenectomy: A Case Report
(Institute of Medicine, 2022) Regmee, Sujan; Limbu, Yugal; Ghimire, Roshan; Maharjan, Dhiresh K; Shrestha, Suman K; Thapa, Prabin B
ABSTRACT Hepatic cirrhosis can be present in associated with patients undergoing pancreatoduodenectomy (PD). Many peri-operative measures need to be considered on such patients. A 83 years old gentleman presented with pain abdomen, Ultrasonographic evidence of dilated extrahepatic biliary system and distended gall bladder and contrast enhanced computed tomography (CECT) scan of the abdomen with features of a pancreatic head mass, further confirmed to be adenocarcinoma by endoscopic ultrasound (EUS) and biopsy. These findings were present on the background of Non-Alcoholic Steato-Hepatitis (NASH) associated liver cirrhosis, with Child–Turcotte–Pugh (CTP) score of 5 (CTP A) and Model For End-Stage Liver Disease- sodium (MELDNa) score of 13. The patient underwent PD. Histopathological evaluation showed a p T3 N2 moderately differentiated adenocarcinoma of the pancreatic head with Ishak scoring of liver biopsy 6. The postoperative course of the patient was uneventful and was discharged from the hospital on the 5th post-operative day. No readmission or re-operation was required. Keywords: Pancreatoduodenectomy, pancreatoduodenectomy in liver cirrhosis, pancreatoduodenectomy modification in cirrhosis
Characteristics of Articles Published in the Journal of Institute of Medicine Nepal: A Cross-sectional Study
(Institute of Medicine, 2022) Shrestha, Lava; Singh, Yogendra P; Sharma, Mohan R
ABSTRACT Introduction: Scholarly journals publish various types of manuscripts. The objective of this study was to analyze the types of articles published in the Journal of Institute of Nepal (JIOM Nepal) from 2019 April to 2021 April and describe bibliometric characteristics. Methods: Seven issues of JIOM Nepal published from April 2019 to April 2021 were analyzed for types of study, areas of medical science, the number of authors, gender of the primary author, contributing specialty, and author’s affiliation. Results: Total articles published were 139, with a mean number of 19.8±4.4 articles per issue. More than half of the published articles were cross-sectional studies (93, 66.9%), followed by case reports (25, 17.9%). The majority of primary authors (94, 67.6%) were faculty from constituent campuses of the Institute of Medicine (IOM) Tribhuvan University. Thirty-eight (27.3%) contributing authors were females. Fifty-three (38.1%) articles published were diagnosis-related. Authors from surgical specialties were the most common article contributors [67 (48.2 %)], while basic science specialties contributed 13 (9.4%) publications. Conclusion: Cross-sectional studies were the most commonly published articles and surgical specialties published more than half of the articles. The majority of the articles were related to diagnosis. Greater efforts are needed to produce further progress of the journal. A mixture of original articles, reviews, and case reports from different medical domains will be more interesting to the readers. Keywords: Article, authors, characteristics, journal
Etiology and Demographic Profile of Medico-legal Cases in Emergency of a University Hospital in Nepal
(Institute of Medicine, 2022) Khatri, Pratima; Munikar, Anita; Pandit, Pooja; Rai, Lalita; Maharjan, Ramesh K; Sharma, Mohan R
ABSTRACT Introduction: Any injury or ailment where investigations by the law-enforcing agencies are crucial are considered as medico-legal cases. The objective of this study was to describe the profile of medico-legal cases presenting to the Emergency Room (ER) of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. Methods: A retrospective review of medical records was done to include all medico-legal cases presented from July 2018 to June 2019. Results: Medico-legal cases comprised 1805 (3.8%) of all cases (47,289) in the study period. The category of 25- 39 years was the commonest age group involved [659 (36.5%)] followed by 15-24 years group [582 (32.2%)]. Males were almost twice (65.8%) in number compared to females (34.2%). The top three reasons for the ER visit were road traffic accidents (RTAs) [757(41.94%)], physical assaults [356 (19.72%)] and poisoning [239 (13.24%)]. Other causes were burns, falls, sexual assaults, hanging, injuries (gunshot, electrical and machinery) and drug overdose. Conclusion: There are significant numbers and wide varieties of medico-legal cases that present in the ER of TUTH. Young males are the most high-risk population and RTAs are the commonest etiology. This study will help the hospital in capacity strengthening of the ER, based on the volume of individual case types. Keywords: Emergency room, medico-legal cases, road traffic accidents, university hospital
COVID-19 Infection in Renal Transplant Recipients: Experience from a Tertiary Care Center in Nepal
(Institute of Medicine, 2022) Bhurtyal, Nishan; Shah, Dibya S
ABSTRACT Introduction: COVID-19 pandemic has challenged the health system globally specially the low to middle income countries. Renal transplant recipient is at risk due to immunosuppressed state. The course of the disease and its outcome is not completely known and there is scarcity of information from developing world. Methods: The study was carried out at Tribhuvan University Teaching Hospital, Kathmandu from May 2020 till May 2021. All of the renal transplant recipients infected with COVID-19 virus were included in the study. Duration of transplantation, recipient’s comorbidities, clinical presentation including laboratory investigations and outcome in terms of hospitalization, need of intensive care, and need of mechanical ventilation, organ failure and mortality were studied. Results: There were 71 patients (male/female: 60/11, mean age 42.6±10.4) were included in the study. 72% patients (n=51) required hospitalization. There were 15 patients (21%) who expired. Patients requiring mechanical ventilation were 14 (19.7%), 24 (33.8%) required intensive care, 10 (14%) required hemodialysis support during admission. A prior history of rejection, presence of diabetes, graft dysfunction at baseline, and a higher creatinine at baseline was associated with mortality. Hypoxia, leucopenia, lymphopenia was predictive with mortality. Raised inflammatory markers as d-Dimer, LDH, development of acute kidney injury was associated with mortality. Presence of acute kidney injury was associated with increased risk of mortality, need of intensive care and prolonged hospitalizations. Conclusion: COVID-19 infection in renal transplant recipients carries a high risk for mortality. The factors that correlated with risk for mortality were hypoxia, leucopenia, high inflammatory markers and need of mechanical ventilation. Keywords:COVID-19, mechanical ventilation, mortality, renal transplantation
Motivations to Engage in Social Distancing and Depression, Anxiety, and Stress Among Adolescents During COVID-19 Pandemic
(Institute of Medicine, 2022) Shrestha, Satya B; Bhandari, Menuka; Rai, Munawatee; Khadgi, Karishma
ABSTRACT Introduction: The coronavirus disease 2019 (COVID-19) is a pandemic prevalent in most countries globally affecting people of all ages including adolescents. Social distancing was implemented to minimize the spread of the virus. The present study is aimed to determine the factors that motivate adolescents to engage in social distancing and find out the depression, anxiety and stress status of the adolescents during COVID-19 pandemic. Methods: A quantitative, descriptive cross-sectional study was conducted among 256 adolescents studying in classes 11 and 12 of four 10+2 schools in Biratnagar Metropolitan City. The study duration of this study was 6 months. A complete enumerative sampling technique was used to enroll students. Data was collected by the structured questionnaires containing sociodemographic variables and the Nepali version of the Depression Anxiety Stress 21-point Scale through an online google docs questionnaire. Results: The maximum number of respondents (61.8%) maintained a social distance of their own will, and 48.2% of respondents maintained social distance because of external factors. The prevalence of depression was 27.8%., anxiety was 18.5% and stress was 13.3%. No association was found between social distancing and the mental health of adolescents with demographic variables. Conclusion: The present study concluded that adolescents are self-motivated to comply with social distancing rules and there is no effect on their mental health status during the period of the COVID-19 pandemic. Keywords: Adolescence, anxiety, depression, motivation, social distancing, stress
Neonatal Surgery: A Four-year Experience in a Teaching Hospital of Birgunj
(Institute of Medicine, 2022) Rai, Binod K; Yadav, Dhirendra P; Ansari, Mohammad A; Raya, Akash; Alam, Mohammad S; Sah, Chandrika
ABSTRACT Introduction: Neonatal surgery is one of the most challenging issues in medical field. The outcome of neonatal surgery is still poor in developing countries. The aim of this study was to report our experience regarding the etiological spectrum of neonatal surgical conditions and their outcome after surgical management. Methods: A descriptive retrospective study which included all the neonatal cases that presented to Pediatric Surgery Department of National Medical College, Birgunj in the last four years. All the neonates that underwent surgery from April 2017 to March 2021 were included in the study. Results: A total of 68 neonates were operated during the analyzed time period. Male to female ratio was 2.2:1. The age at presentation varied from 2 to 28 days and birth weight from 1.2 to 3.4 kg. Anorectal malformation (32.3%) was the commonest cause of surgery followed by tracheo-esophageal fistula (14.7%) and pyloric stenosis (8.8%). Mortality rate was 20.5% with septicemia as the commonest post operative complication. Conclusion: The outcome of neonatal surgery in our center is not up to mark as compared with centers in developed countries. Early presentation of the patients, well equipped surgical neonatal intensive care facilities and trained manpower are needed to improve the outcome. Keywords: Complication, neonate, pediatric surgery, surgical management
Menopausal Symptoms in Overweight and Obese Middle Aged Women: A Community Based Study
(Institute of Medicine, 2022) Ojha, Neebha; Koirala, Poonam; Shrestha, Srijana
ABSTRACT Introduction: Overweight and obesity is on the rise globally and women with higher body mass index at midlife have been found to suffer more from menopausal symptoms. This study aims to assess the menopausal symptoms in overweight and obese middle aged women using menopause rating scale (MRS) in the community setting. Methods: This descriptive cross-sectional study was conducted at Gokarneswore Municipality in Kathmandu district, from June to December, 2021. Women in the age group of 40-60 years were interviewed regarding the frequency and severity of menopausal symptoms using MRS. The collected data were entered and analyzed in SPSS 25. Results: Among the 378 women, 156 (41.3%) were premenopausal, 104 (27.5%) perimenopausal and 118 (31.2%) were postmenopausal women; and 176 (46.6%) were overweight and 87(23.0%) were obese. Overall, 38-68% suffered from different menopausal symptoms. Most of the menopausal symptoms were not significantly different among normal, overweight and obese middle aged women. Urinary symptom was more frequent in obese premenopausal, however the urogenital symptoms were significantly more in normal weight postmenopausal women (p <0.05). The mean MRS score was similar among normal, overweight and obese women, however according to the menopausal status the mean score was significantly higher among perimenopausal and post menopausal women (p <0.001). Conclusion: This study showed that among the middle aged women almost half were overweight and one-fourth was obese. Menopausal symptoms were similarly distributed in perimenopausal and postmenopausal women in overweight and obese middle aged women. It is important to assess the obesity and menopausal symptoms, which can be specifically targeted for treatment. Keywords: Menopausal symptoms, middle aged women, obese, overweight
Variations in Pancreatic Duct Course, Configuration and Pancreaticobiliary Junction on MRCP in 3-T MRI: A Descriptive Cross Sectional Study
(Institute of Medicine, 2022) Jha, Anamika; Tuladhar, Sasmita; Jha, Sujit K; Gurung, Ghanshyam; Karki, Dan B
ABSTRACT Introduction: Anomalies and anatomic variations of the pancreatic duct must be identified because they can predispose to conditions like pancreatitis, choledochal cysts, and cholangiocarcinoma, as well as increase surgical complications. In this study, we describe the course and configuration of pancreatic ducts and pancreaticobiliary confluence in cholangiopancreaticography on 3-Tesla magnetic resonance (3-T MR) scanner. Methods: This cross-sectional descriptive study was done after obtaining ethical clearance, and included 128 magnetic resonance cholangiopancreatography (MRCP). The MRCP image records from December 2015 to 2018 were retrospectively analyzed for pancreatic duct course, configuration, angle of pancreaticobiliary confluence and common channel. Obtained data was entered in previously prepared proforma. Statistical analysis was performed using SPSS v 16. Results: There were 56 (43.8%) males and 72 (56.2 %) females with mean age 48.72±18.05 years, ranging from 3 - 84 years. The most common pancreatic duct course was descending in 45 (36.3%) followed by sigmoid in 42 (33.9%) and vertical in remaining 37 (29.8%) patients. The most common ductal configuration was rudimentary non-dominant duct of Santorini in 88 (71%) patients followed by bifid configuration with dominant duct of Wirsung in 27 patients (21.8%). Pancreatico-biliary junction was more often acute angled than right or obtuse. The common indications for undergoing MRCP were pain abdomen (102, 82.8%), vomiting (53, 43%) and jaundice (36, 28.9%). Conclusion: In symptomatic patients undergoing MRCP, the common anomalies of the pancreatic duct observed were descending course, rudimentary non-dominant duct of Santorini configuration and acute pancreatico-biliary angle. Keywords: Duct of Santorini; duct of Wirsung; magnetic resonance imaging; pancreatic ducts
Pharmacological Treatment for the Management of COVID 19: A Narrative Review
(Nepal Medical Association, 2021) Dhakal, Neelam; Poudyal, Anil; Gyanwali, Pradip
Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections is alarming worldwide incurring tremendous loss of life and possession. Individuals are facing a terrible pandemic condition in the absence of appropriate medicines and vaccines to combat SARS-CoV-2 infection. This review aimed to provide details on potential treatment steps that can be taken in the current pandemic-fighting situation in Nepal. A massive review was performed including 60 articles from the relevant field. Preliminary results on the efficacy of some existing anti-viral agents were found, however, promising data on effective treatment regimen for COVID 19 are yet to be obtained. This review examines various drugs and their mechanism of actions which are currently used in clinical trials or may be used to treat COVID-19 in the near future.
Migraine Associated with Menstruation An Overlooked Trigger
(Nepal Medical Association, 2021) Chaudhary, Ashlesha
Abstract: Menstrual migraine is a condition in females, where headaches are linked with menstruation and may be debilitating. Hormonal fluctuations could have a key role in migraine etiopathogenesis, as several women experience that their migraine attacks correlate with their menstrual cycle. Estrogen withdrawal appears to have a significant role in migraine associated with menstrual cycles, despite the fact that its pathophysiology is not well known. The treatment method can also vary from that used to treat nonmenstrual migraines. However, with proper identification and management of the condition, it can be bearable. This article highlights some portions of what is known about migraine, its triggers including the experience of a sufferer and aims to provide readers with a better understanding of migraine in women by understanding these aspects of the condition.
Pneumothorax in a Preterm Neonate: A Case Report
(Nepal Medical Association, 2021) Phuyal, Rajan; Basnet, Ritika; Sapkota, Abhin; Gautam, Uttara; Chikanbanjar, Vijay Kumar
Abstract: A pneumothorax is an abnormal collection of air in the pleural space between the lung and chest wall. Although this condition commonly occurs in adults, it can also present as complication in neonates requiring assisted ventilation and has high morbidity and mortality. Chest tube placement and needle drainage are some common approaches in management. A late preterm infant born at 35+2 weeks of gestation was admitted in Neonatal Intensive Care Unit for the management of respiratory distress. He was kept on mechanical Continuous Positive Airway Pressure owing to worsening respiratory distress. Chest X-ray revealed pneumothorax that was successfully managed with venous catheter drainage on second intercostal space with underwater seal. He was discharge on 10th day of Neonatal Intensive Care Unit admission with stable vitals and normal breathing pattern.
Tolosa-Hunt Syndrome: A Case Report Authors
(Nepal Medical Association, 2021) K.C., Siddhanta; K.C., Shreeyanta; Kunwar, Prajjwal; Dhungana, Krishna
Abstract: Tolosa-Hunt Syndrome is a rare disease characterized by painful ophthalmoplegia affecting third, fourth, and/or sixth cranial nerve caused by non-specific inflammation in the cavernous sinus or superior orbital fissure of unknown etiology. We presented a 67-year-old female with Tolosa-Hunt Syndrome. She had a right-sided headache and periorbital pain with double vision. Examination showed right-sided ptosis, right-sided trochlear and abducens nerve palsy, and partial right-sided oculomotor nerve palsy with hypoesthesia in the area of the ophthalmic division of the trigeminal nerve. Magnetic resonance imaging of head and orbit showed altered signal intensity changes in the optic nerve and lateral rectus muscle. After steroid therapy, pain and ptosis were significantly improved in 72 hours. Tolosa-Hunt Syndrome is a diagnosis of exclusion, with clinical presentation, normal investigations, magnetic resonance imaging findings, and response to steroid therapy crucial in making the diagnosis.
Trend of Antihypertensive Use and Blood Pressure Control Among Hypertensive Patients in a Tertiary Care Hospital of Kathmandu
(Institute of Medicine, 2022) Shrestha, Deepti; Shrestha, Shirish L; Poudel, Rekha; Gurung, Rashmi Shakya; Yadav, Radhay Shyam; Shrestha, Lava
35ABSTRACT Introduction: Hypertension is a global burden and prevalence of hypertension increases with age. Various antihypertensive drugs are available for the management of hypertension. The aim of this study is to assess the trend of antihypertensive drugs used and blood pressure (BP) control among patients with hypertension. Methods: A cross sectional study was conducted among patients with hypertension prescribed with antihypertensive drugs in Department of Medicine, Nepal Medical College Teaching Hospital. Antihypertensive drugs, number of antihypertensive drugs prescribed in each individual and BP were analyzed. Results: Out of 218 patients, 61.5% were female and 38.5% were male. Common age group range from 51-60 years in 28.4% of patients. Diabetes mellitus (23.4%) was the most common comorbid condition. Dual therapy (47.6%) followed by monotherapy (45.9%) was the most common therapy prescribed for patients with hypertension. Most commonly prescribed antihypertensive as monotherapy was Calcium Channel Blockers (CCBs), 29.4% and in dual therapy, CCBs and Angiotensin Receptor Blockers (ARBs), 38.6% were the most commonly prescribed medications. Fixed dose combination of antihypertensive drugs were prescribed in 81.4% patients receiving multiple therapy. Good BP control was observed in 61.2% of patients with hypertension. Conclusion: Dual therapy followed by monotherapy was the most common therapy prescribed for the management of hypertension. Calcium channel blockers as monotherapy and CCBs and ARBs as combination therapy were the most common antihypertensive drugs prescribed for hypertension. More than half the patients had controlled BP. A therapeutic audit with more parameters of analysis to provide regular feedback to researchers and prescribers may encourage rational prescribing in hypertension. Keywords: Antihypertensives, blood pressure, hypertension
Comparison of Ultrasonography with Cole’s Formula to Determine Appropriate Endotracheal Tube Size in Pediatric Population
(Institute of Medicine, 2022) Shaheed, Asadh M; Shrestha, Bibhush; Pradhan, Bishwas; Shrestha, Anil; Parajuli, Bashu D
ABSTRACT Introduction: Recently, ultrasonography (USG) has gained popularity in perioperative airway management . One of the commonest method to select endotracheal tube in pediatric patients is Cole’s formula. Our study was conducted to assess if there was a measurable difference in the appropriateness of the endotracheal tubes as selected by the two methods. Methods: The study group included 68 children scheduled for elective surgeries under general anesthesia with endotracheal intubation in an randomized prospective manner. The size of endotracheal tube was calculated using Cole’s formula in group A. In group B, ultrasound was done to measure the subglottic transverse diameter at the level of cricoid to find the largest outer diameter of tube . Results: Ultrasonography group measuring the subglottic diameter was found to have more appropriately sized tubes than age-based Cole's formula (76.5% Vs 58.8% p=0.007). The pressure equilibrated measured (13.2 ± 5.2 cm of H2O in age based group and 17 ± 4.5 cm of H2O in ultrasonography group) was statistically significant (p= 0.002). Also the incidence of selecting an inappropriately small sized ET tube was lower in the ultrasound group (5.9% Vs 35.3%).There were no significant differences in the number of intubation attempts and mean time required for intubation between the two groups. Conclusion: Ultrasonographic method is a suitable alternative tool in predicting the size of uncuffed endotracheal tube in pediatric population than age-based Cole’s formula. Keywords: Age-based formula, cricoid ring, pediatric, subglottic diameter, tracheal intubation
Cardiorespiratory Fitness and its Relationship with Adiposity Indices
(Institute of Medicine, 2022) Ghimire, Dayaram; Aryal, Vibina; Majumder, Anirban; Manna, Sourav
ABSTRACT Introduction: The cardiorespiratory fitness (CRF) and obesity greatly influence the cardiovascular health. Decrease in maximal oxygen consumption (VO2max) and increase in fat mass can be used as an early marker for cardiovascular disease risk. The objective of this study was to assess the CRF and observe the relationship between CRF and adiposity indices. Methods: A cross sectional observational study was performed in 174 students (87 males and females each) of National Medical College. The subjects were assessed for different adiposity indices; BMI, body adiposity index (BAI), total body fat percentage (BF %) and waist circumference (WC). VO2max was calculated from recovery pulse rate after Queen's College Step Test. VO2max was correlated separately with each parameter of body composition using Pearson’s correlation test. Results: The VO2max of male and female participants were 47.22 ± 9.09 and 35.67 ± 5.36 ml/kg/min respectively. The correlation of VO2max was significant with all the studied adiposity indices. WC (r= - 0.41, p< 0.001) and BF% (r= -0.38, p< 0.001) correlation with CRF was highly significant in male whereas in female correlation was highly significant with BMI (r= 0.49, p< 0.001), WC (r= -0.40, p< 0.001) and BF% (r= -0.56, p<0.001). VO2max correlated best with waist circumference in male (r= - 0.41, p< 0.001) and BF% in female (r= -0.56, p<0.001). Conclusion: This study concludes that there is an adverse relationship between CRF and adiposity indices and females have low level of cardiorespiratory fitness. Keywords: Body adiposity indices, cardiorespiratory fitness, Queen's college step test, total body fat percentage
Histopathological Spectrum of Renal Tumors in Adults in Nephrectomy Specimens in a Tertiary Care Center
(Institute of Medicine, 2022) Sharma, Nisha; Maharjan, Daisy
ABSTRACT Introduction: Renal neoplasms are heterogeneous tumors with clinical picture, prognosis and therapeutic implications differing with the various histological subtypes. There are limited studies on adult renal tumors conducted in Nepal so far. This study aims to provide a better assessment on the histopathological spectrum of renal neoplasms in adult population. Methods: This is a descriptive study of all the nephrectomy specimens of adults received at Department of Pathology, Tribhuvan University Teaching Hospital from January 2013 to January 2020. Results: There were 75 males and 35 females with mean age being 51.8 years. Malignant tumors (99 cases, 90%) were more common than benign tumors (11 cases, 10%). Renal cell carcinoma (RCC) was the most common malignant tumor consisting of 91 cases (82.72%) followed by 6 cases of urothelial carcinoma (5.45%) and 2 cases of primitive neuroectodermal tumor. (PNET) (1.8%). Clear cell RCC (78 cases, 70.90%) was the commonest histological subtype of RCC followed by papillary RCC (8 cases, 7.2%) and chromophobe RCC (2 cases, 1.8%). 42.65% of the cases of clear cell RCC were of WHO/ISUP grade 2, whereas, most of the cases of papillary RCC were of low grade (Grade 1, 37.5%). Majority of Renal cell carcinomas were in stage pT1a (28 cases, 34.56%). Conclusion: Clear cell RCC was the most common renal tumor in adults comprising the majority of cases. These tumors mostly demonstrated WHO/ISUP Nuclear grade 2 and early stage of presentation (pT1). Papillary RCC was the second commonest RCC and mostly presented at lower nuclear grade (WHO/ISUP Nuclear grade 1). Urothelial carcinomas demonstrated higher nuclear grade and stage compared with RCC. Keywords: Grade, histologic subtypes, renal neoplasms, staging
A Paraurethral Vaginal Mass in Rural Setting: A Case Report
(Nepal Medical Association, 2021) Thapa, Niresh; Basnyat, Subi; Roka, Dilsahi
Abstract: Paraurethral vaginal leiomyoma is the infrequent case to be described. Approximately 300 cases have been described so far. Imaging modalities aid in identifying the morphological, structural characteristics of the mass and its relationship to the surrounding structures. Thirty-six years old married women presented with a vulvar mass of (3x5) cm2. Her associated complaints were left shift of the urinary stream and dyspareunia. Ultrasonography and cystography revealed a mass with no relationship with bladder or uterine structure. Surgical excision was performed. The histopathological report confirmed the diagnosis of paraurethral vaginal leiomyoma. Surgical excision is the treatment of choice and diagnosis is confirmed by histopathological examination.
Survival in Critical Care Patients with COVID-19 Pneumonia: A Single Center Based Observational Study
(Institute of Medicine, 2022) Bam, Niraj; Kuikel, Sandip; Sapkota, Dharmendra; Poudel, Sagar; Pant, Pankaj; Das, Santa K
ABSTRACT Introduction: The severity of COVID-19 pneumonia ranges from asymptomatic to requiring mechanical support for survival. This observational study describes the demographic, management, vaccination status and outcome in Nepalese patients with COVID-19 who were admitted to critical care settings . Methods: Single center based cross sectional study was conducted. All the patients admitted to critical care of Tribhuvan University Teaching Hospital (TUTH) were eligible subjects for this study. Demographic, clinical details and vaccination status of respective patients was obtained from interview and chart review. Data was collected in Microsoft Excel 2016 and statistical analysis was performed using statistical software SPSS 21. Results: A total of 342 patients with mean age 53.95±15.6 years were included in the study. The mean duration of stay in critical care was 6.74±4.43 days. Fever and shortness of breath was the predominant symptom present in the studied patients with all patients having shortness of breath. Out of the 342 patients, 20.2% (n=69) were intubated at least once during their critical care stay, 57.89%(n=198) received only non-invasive ventilation and 21.9% (n=75) received oxygen via other means. The overall survival rate of patients admitted to critical care of TUTH was 60.53% with very low survival rate in intubated patients. Only 8.8% of the included patients had received at least one dose of vaccine. Conclusion: Our study suggest that the prognosis of critical care COVID-19 patients is poor with highest mortality in patients receiving mechanical ventilation. Delay in intubation may contribute to this worse outcome in intubated COVID-19 patients. Keywords: Corona virus, COVID-19, critical care, SARS, survival
Hereditary Vitamin-D Dependent Rickets Type II: A Case Report
(Nepal Medical Association, 2021) Sunuwar, Neela; Gautam, Swotantra; Twayana, Anuradha; Yadav, Saroj Adhikari; Anjum, Firoz; Kandel, Kriti
Abstract: Hereditary vitamin D dependent rickets type II is a rare genetic disorder in children characterized by early onset of rickets and deranged biochemical parameters. Low serum calcium level, high alkaline phosphatase, high parathyroid hormone, and high values of 1,25-dihydroxy vitamin D are characteristic biochemical findings. We are reporting a rare case of Vitamin D Dependent Rickets and subsequent improvement after addition of cinacalcet. This is a case report of a 2.5-year-child with Hereditary Vitamin D Dependent Rickets type II receiving cinacalcet as adjunct to oral calcium and calcitriol. Oral cinacalcet (0.25mg/kg/day) was added to the regimen as an adjunct after treatment failure with high dose of oral calcium and calcitriol. A significant improvement in radiological findings and normal homeostasis of calcium, phosphate and parathyroid hormone was achieved after initiation of cinacalcet.
Central Macular Thickness in Uneventful Phacoemulsification Employing Optical Coherence Tomography
(Institute of Medicine, 2022) Ranabhat, Sudha; Byanju, Raghunandan; Pradhan, Sangita; Khadka, Simanta; Lamichhane, Benju
ABSTRACT Introduction: Cataract is the most common cause of blindness affecting the global population which can be cured by phacoemulsification surgery. The study aimed to evaluate the central macular thickness following uneventful phacoemulsification surgery and analyze its relation to various factors. Methods: This prospective study comprised of 63 subjects diagnosed as age-related cataract on the basis of lens opacities classification system III and undergoing uneventful phacoemulsification surgery with capsular bag intraocular lens implantation. The central macular thickness was evaluated using optical coherence tomography at preoperative period and postoperatively on 1st day, 1st week and 5th week. Effective phacoemulsification time was measured intraoperatively. Results: The mean effective phacoemulsification time was 17.95±14.01 seconds. Best corrected visual acuity improved significantly postoperatively (p=0.03). Mean central macular thickness increased significantly on the 5th postoperative week compared to preoperative assessment (p=0.002). No significant association was detected between patient’s age and preoperative and postoperative central macular thickness. No correlations were observed between effective phacoemulsification time and central macular thickness. Significant association was not noted between central macular thickness and best corrected visual acuity on pre and postoperative examinations. Conclusion: There was a decrease in central macular thickness on the 1st day and 1st week postoperatively followed by a significant increase on the 5th postoperative week compared to the preoperative period, which was independent of effective phacoemulsification time. Increase in central macular thickness in the postoperative period did not affect the quality of vision. Keywords: Central macular thickness, effective phacoemulsification time, optical coherence tomography, phacoemulsification

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