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Clinical Laboratory Profile of Blood Culture Proven Enteric Fever in Children
(Nepal Paediatric Society (JNPS), 2018) Shah, Subhash Chandra; Neupane, Prashank Shree; Guragain, Anusmriti; Dhakal, Ajaya Kumar
Abstract: Introduction: Enteric fever has diverse clinical presentations and laboratory findings and blood culture is gold standard for diagnosis in the children. This study was done to analyse clinical profile and laboratory findings in culture proven enteric fever. Material and Methods: The study was descriptive observational study carried out in the patient aged 14 years of age or less admitted with culture proven enteric fever admitted in a Paediatric ward of a tertiary medical centre in Lalitpur, Nepal from April 2009 to February 2018. Results: Forty children with blood culture proven were enrolled in the study. All children had fever with the mean duration of 5.3 days (1-14). The most common associated symptoms were gastrointestinal which included anorexia (47.5%), pain abdomen (37.5%), vomiting (37.5%), diarrhoea (15%) and constipation (5 %). Splenomegaly (25%) and hepatomegaly (17.5%) were the commonest signs. The majority of children (80%) had normal total leucocyte count and 32.5% of them had anaemia. There were no children with thrombocytopenia. Salmonella typhi and Salmonella paratyphi A were isolated in 70% and 30% of children respectively. None of the isolates showed drug resistance against ceftriaxone, chloramphenicol, cotrimoxazole, gentamicin, norfloxacin and ofloxacin. There was no mortality. Conclusions: Enteric fever should be suspected in all the children with fever for more than five days along with anorexia, gastrointestinal associated symptoms and normal white blood counts.
Applicability of Paediatric Index of Mortality 2 Score to Predict Outcome in Children Admitted to Paediatric Intensive Care Unit
(Nepal Paediatric Society (JNPS), 2018) Aroor, Shrikiran; Kumar, Sandeep; Kini, Pushpa; Mundkur, Suneel
Abstract: Introduction: Research on critically ill children admitted to the intensive care unit has shown the usefulness of Paediatric Index of Mortality 2 (PIM2) score at admission to predict outcome. This study was conducted to estimate PIM2 score in children admitted to Paediatric Intensive Care Unit and its correlation with clinical outcome. Methods: This prospective observational study was conducted in children of age group one month to 18 years admitted to the paediatric intensive care unit of a tertiary care hospital. Data including demographics, diagnostic categories, duration of hospital stay, predicted death rate (PDR) measured by PIM2 score was compared between survivors and non survivors. Logistic regression analysis was performed to arrive at a risk adjusted relationship between the different predictor variables and the probability of death. Results: Consecutive 130 children admitted to PICU during the study period were enrolled. The mean PDR (%) of the total study population was 22.4 ± 10.60. The mean PDR in survivors was 12.4 ± 7.80 while the PDR in non survivors was 44.2 ± 12.62 (p value < 0.001). Children with PDR < 1% had a mortality rate of 2.4% when compared to 71.4% in children with PDR > 5% (p value < 0.001). PDR by PIM2 score and the presence of hypo-albuminemia remained significant even after adjusting for age in multivariate logistic regression analysis. Conclusion: PDR measured by PIM2 score differentiated well between survivors and non survivors in PICU. The predicted death rate was less than the observed death rate. PIM2 score is a useful tool to assess the severity of illness and predict outcome.
Discover yourself: open up your “Johari window” with “Dohari” Feedback
(Kathmandu University, 2023) Shrestha, R
ABSTRACT The Johari window is a psychological matrix that is unique for each person. It is segmented into four panes: “things I know about me ”, “things I don’t know about me”; “things others know about me” and “things others don’t know about me”. The panes are not the same in all relationships and are dynamic. Everyone has a “blind spot”, that prevents us from advancing to the next level of development. We should help our students and peers to achieve the “ideal Johari window” with the widest “open area” and help them discover their “blind spot” which will lead them to success and innovations. With feedback culture and self-reflection this area may be discovered and become open which will disclose their inner potential. In this paper, the importance of bidirectional feedback “dohari” is illustrated through the concept of the Johari window. The tips for giving and receiving feedback are summarized. KEY WORDS Feedback, Formative assessment, Medical education, Reflection
Endoscopic Transcanal Atticoplasty: How we do it?
(Kathmandu University, 2023) Shrestha, BL; KC, AK; Karmacharya, S
ABSTRACT Endoscopic otological surgery has revolutionized ear surgery. Endoscopes are frequently used in myringoplasty and tympanoplasty, and their use in attic reconstruction (atticoplasty) is gaining popularity. While microscopic surgery for limited attic cholesteatoma and attic retraction (grade III and IV) is difficult especially anterior area, the endoscope has emerged as a new treatment option, offering a 360-degree view of the attic and facilitating the complete removal of diseased tissue.1 We had performed atticoplasty with rigid nasal endoscopes (Karl Storz) of 4 mm diameter and 18-cm length. Our preliminary results showed that transcanal endoscopic atticoplasty is a reliable and safe technique for the surgical management either attic retraction pocket (grade III or IV) or limited attic cholesteatoma. KEY WORDS Atticoplasty, Attic retraction, Endoscope, Ear surgery
Participant’s Knowledge and Perception of Health Research Methodology before and after a Hands-on Workshop in a Medical College in Lalitpur, Nepal
(Kathmandu University, 2023) Jha, N; Dhakal, AK; Singh, N; Pandey, S; Mukhia, R; Acharya, G; Bajracharya, S; Sharma, MR; Shankar, PR
ABSTRACT Background The basic principles of research methodology are very important for the successful conduct of research. Objective To evaluate the knowledge and perceptions before and after a three-day workshop on health research methodologies conducted at a medical college in Lalitpur, Nepal. Method The pre-post study was conducted during the workshop. There were 31 participants comprising of doctors (interns and residents), medical officers and dental surgeons and faculties. A questionnaire containing two sections related to various themes of the workshop was developed to measure the respondents’ knowledge and perception of different concepts. Feedback regarding each session was also obtained. The median knowledge and perception scores before and after the workshop were compared using appropriate statistical tests (p < 0.05). Result More than half of the participants, [18 (58.1%)] were of 20-30 years of age. The total knowledge scores improved significantly after the workshop. The increase in the perception scores after the workshop was also significant. Feedback was positive. The highest feedback score was for the session on critical analysis of a published article. Conclusion Knowledge and perceptions increased significantly indicating such workshops can be effective and contribute to the capacity building of the early-stage researchers. KEY WORDS Ethics, Medical research, Publication
Central Pancreatectomy for Bilobed Solid Pseudopapillary Tumor of Pancreas
(Kathmandu University, 2023) Jha, MK; Ramtel, R; Adhikari, B; Laudari, U; Thapa, A; Rawal, SB
ABSTRACT Solid-pseudopapillary tumor of pancreas is a rare pancreatic tumor that occurs predominantly in a young female with only a small minority concerning children. These tumors have low malignant potential, found incidentally which are usually single lobed. Surgical resection remains the mainstay of treatment. Our case is 26 years female with vomiting and abdominal pain localized to the right upper quadrant. Computerized tomography scans showed two well-defined hypodense lesions at neck and body of the pancreas with greatest diameter of six centimeter. The patient underwent central pancreatectomy and histopathology confirmed solid-pseudopapillary tumor with complete resection with all resected margin free of tumor. Symptoms may be present such as abdominal pain or vomiting due to compression, mainly in large tumors. In benign cases parenchyma sparing surgery such as central pancreatectomy can preserve the exocrine and endocrine function of pancreas which helps patient to have better postoperative quality of life. KEY WORDS Bilobed mass, Central Pancreatectomy, Solid-pseudopapillary tumor
Laryngeal Paraganglioma - A Rare Entity
(Kathmandu University, 2023) Ghimire, SB; KC, AK; Karmacharya, S; Shrestha, BL
ABSTRACT Laryngeal paragangliomas are neural crest derived rare neuroendocrine tumors which originates from either superior or inferior laryngeal paraganglia. It arises most commonly in supraglottis with mean age of 44 years and it is three times more common in females. This is a case of 39 years female who underwent endoscopic debulking and excision of tumor for histopathological examination which proved to be poorly differentiated squamous cell carcinoma and received a cycle of chemotherapy that probably resulted in complete resolution of initial mass which was confirmed in subsequent follow up. Futher immunohistochemistry examination diagnosed the case as Laryngeal paraganglioma. With this consideration, how effective is the role of chemotherapy in the management of proven case of Laryngeal paragangliomas? KEY WORDS Chemotherapy, Immunohistochemistry, Laryngeal paraganglioma
Restoration of Severely Damaged Tooth by Zirconia based Endocrown: Case Series
(Kathmandu University, 2023) Huong, CQ; Duc, NM; Hai, TD
ABSTRACT Following endodontic (root canal) treatment, teeth loss their mechanical properties, and the teeth become fragile because of the removal of pulp and dentin. Hence, prosthetic restoration of root canal-treated teeth is a challenge. Endocrown is a single restoration, and it is considered an excellent alternative restoration for teeth with large coronal destruction and root canal treatment difficulties. Zirconia endocrowns are reliable materials for root canal-treated molars with extensive loss of crown structure. This case series presents four cases of restoration of severely damaged molars presenting various symptoms and prosthetic restorations were done by zirconia-based endocrown. The prognosis in all patients was good. KEY WORDS Crowns, Endocrown, Root canal treatment, Zirconia
Pagetoid Squamous Cell Carcinoma In-Situ of Esophagus
(Kathmandu University, 2023) Priyadarshinee, A; Bhattacharya, B
ABSTRACT Squamous cell carcinoma (SCC) is the most common malignant tumor of the esophagus, however, pagetoid SCCIS is an extremely rare condition in esophagus.1 Pagetoid Squamous Cell Carcinoma In-Situ (SCCIS) has been described in skin and external genitalia frequently.2 Herein we report a case of pagetoid squamous cell carcinoma in-situ in a 50-year-old male with clinical information, histopathological and immunohistochemical findings. The patient was a 50 years male with dyspepsia,refractory to proton pump inhibitors (PPIs). In upper gastroduodenal endoscopy, there was no obvious lesion in the esophagus and only mild erythema was noted. Biopsy showed a surprising finding of full thickness high grade squamous dysplasia in the lining squamous epithelium with scattered single large atypical cells. These cells were present away from the foci of dysplasia. The cells were large and showed marked pleomorphism, vesicular nuclei, prominent nucleoli and abundant pale to eosinophilic cytoplasm. Immunohistochemistry (IHC) was positive for p63 and p53, which confirmed the diagnosis of pagetoid SCCIS. Pagetoid squamous cell carcinoma in-situ is one of the rare entities with subtle clinical presentation and endoscopic findings. Evaluation of this case signifies the importance of taking biopsies in the lesions which shows minimal mucosal change in the endoscopy. KEY WORDS Dysplasia, Endoscopic esophageal biopsies, Immunohistochemistry, Pagetoid, Squamous cell carcinoma in-situ
Fahr’s Disease: A Rare Neurological Disorder Associated with Secondary Cause
(Kathmandu University, 2023) Bhatta, Y; Malla, A; Chaurasiya, AK; Pokharel, BR
ABSTRACT Fahr’s disease is characterized by idiopathic bilateral deposition of calcium in the striopallidodentate area. We are presenting 83-year-old female, who failed responding while having lunch around 10 AM soon after she lost consciousness for an hour. It was associated with difficulty in walking, mood disturbances, fatigability, blurring of vision and occasional dizziness since past 4 months. Her neurological examination revealed Parkinsonian features. Her computed tomography of head report showed bilateral, symmetrical, large area of calcification over the basal ganglia, the thalamus and the cerebellum. To rule out the seizure disorder we have done an electroencephalogram and some laboratory test including calcium, Phosphorus, Parathyroid hormone and magnesium, vitamin D which were suggestive of Fahr’s disease. KEY WORDS Basal ganglia diseases, Calcinosis, Fahr’s disease, Neurological disorder
Application of hAMRonization Tool in Investigating Anti-microbial Resistance Genes to Generate Harmonized Reports
(Kathmandu University, 2023) Katuwal, N; Tamrakar, D; Shrestha, R
ABSTRACT Background Antimicrobial resistance has become a serious threat to global public health, with the potential to cause significant morbidity and mortality. Therefore, the detection and surveillance of antimicrobial resistance genes are critical to monitor the prevalence of resistance and to guide appropriate treatment decisions. Several bioinformatics tools have been developed to facilitate the detection and investigation of antimicrobial resistance genes from sequencing data. However, these tools often require a significant amount of manual curation and provide results which can limit their intra-operability, accessibility and usability. This lack of standardization in the reporting of antimicrobial resistance genes investigation greatly hinders the comparison of results across the public health sector. Method This study focuses on the application of hAMRonize tool developed by Public Health Alliance for Genomic Epidemiology. In this study, we have implemented hAMRonization to evaluate antimicrobial resistance genes in Salmonella and compared to the results from other tools (ARIBA, RGI, amrfinderplus and abricate). Result We observed that hAMRonize was more comprehensive than other tools in predicting genes, including information on antimicrobials, drug classes, and start and end base pair of genes, among others. The hAMRonize tool also provided results in an interactive Hypertext Markup Language format. Conclusion hAMRonization is an innovative tool for investigating and sharing antimicrobial resistance data in the current field of research, where scientists use a plethora of prediction tools that provide different results and subsequent interpretations. KEY WORDS Antimicrobial resistance, Gene-prediction, hAMRonize
Outcome Analysis of Termination of Pregnancy in Second Trimester
(Kathmandu University, 2023) Rijal, H; Koirala, P
ABSTRACT Background Second-trimester abortions, constitute 10-15% of global annual abortions, leading to two-thirds of major abortion-related complications. Recognizing the elevated risk, the WHO recommends diverse methods for safe termination. Surgical and medical approaches, particularly using drugs like Mifepristone and Misoprostol, show promising success rates. Objective To analyze the outcomes of second-trimester termination using Mifepristone or PG analogues alone or in combination. Method This is a one-year retrospective study at Tribhuvan University Teaching Hospital analyzing second-trimester terminations, collecting data on demographics, medical history, period of gestation, doses of abotificient drugs, complications, and management. Result In a study of 66 second-trimester abortions, mean age was 28.8±4.96 years, gestational age 20.07±4.3 weeks. Mifepristone and Misoprostol combination succeeded in 66.7% of cases, while 42.2% required repeated Mifepristone doses. Misoprostol use was significantly higher in patients without medical comorbidities (p=0.018), but Mifepristone requirement didn’t differ significantly based on medical conditions. Combined Mifepristone and Misoprostol were used more for fetal indications. Notably, the use of Mifepristone and Misoprostol didn’t significantly differ for live and intrauterine fetal death cases. Conclusion Mifepristone and Misoprostol effectively terminate second-trimester pregnancies. In high-risk cases, cautious Prostaglandin use is crucial and Mifepristone alone, in divided doses, reduces complications with high success. KEY WORDS Abortion, Mifepristone, Misoprostrol, Second trimester, Termination
Thyroid Hormone Abnormalities and Associated Risk Factors among Acute Coronary Syndrome Patients at a Tertiary Care Hospital
(Kathmandu University, 2023) Shreewastav, RK; Dhungana, SP; Pokhrel, S; Jayshwal, R; Pandey, H
ABSTRACT Background Thyroid dysfunction and associated factors like age, sex, diabetes mellitus, hypertension, smoking, family history of coronary artery disease and dyslipidemia contributes the risk for acute coronary syndrome. Objective To find out the prevalence of thyroid dysfunction and associated risk factors among acute coronary syndrome patients at this tertiary care hospital in eastern Nepal. Method A descriptive cross-sectional study was carried out prospectively among acute coronary syndrome patients at a tertiary care Hospital. Diagnosis of acute coronary syndrome was made based on the medical history, Electrocardiogram abnormalities, and cardiac markers. Thyroid function test and estimation of other blood parameters were done in the blood of the patients. Other relevant information and medical history of the patients were collected by using proforma. Result Out of 186 total acute coronary syndrome patients, 127 (68.28%) were male and mean age of all patients was 60.0 ± 13.7 years. Thyroid dysfunction was observed in 52 (27.95%) patients, out of that subclinical hypothyroidism was mostly seen in 30 (16.12%) patients followed by hypothyroidism in 13 (6.98%). The number of patients with hyperthyroidism and subclinical hyperthyroidism was 6 (3.23%) and 3 (1.62%) respectively. Associated factors like hypertension, diabetes mellitus, smoking, family history of coronary artery disease and dyslipidemia was observed in 80 (43.01%), 42 (22.58%), 83 (44.62%), 11 (5.91%) and 79 (42.47%) patients. Conclusion Acute coronary syndrome was predominantly seen in male and subclinical hypothyroidism was a major thyroid dysfunction observed among the patients. Hypertension, dyslipidemia, diabetes mellitus and smoking was found to be associated in a proportion of patients with acute coronary syndrome. KEY WORDS Acute coronary syndrome, Diabetes mellitus, Hypertension, Risk factors, Thyroid function test
Prevalence, Pattern and Risk Factors of Oral Cancer -A single institute-based study from Nepal
(Kathmandu University, 2023) Chaurasia, NK; Upadhyaya, C; Dulal, S; Shakya, M; Adhikari, BR; Upreti, S
ABSTRACT Background Cancer of lip and oral cavity is the most common type of cancer in male population in South East Asia. Although it is a multifactorial disease, tobacco and alcohol use are the most common risk factors involved. Oral cancer has a direct relationship with deleterious habits. Inadequate knowledge about the disease and lack of awareness about its risk factors play vital role in increasing incidence of oral cancer. Objective To determine the prevalence and pattern of oral cancer as well as to find out the risk factors associated with development of oral cancer. Method The hospital records of the patients with histo-pathologically confirmed oral cancer between November 2011 to December 2021 were studied. Data regarding age, sex, associated risk factors and pattern of oral cancer were recorded. Descriptive statistics were obtained and recorded in tabulated form. Result Total of 312 (53.6%) cases out of 582 biopsies turned out to be histo-pathologically confirmed oral cancer. Out of 312 cases of oral cancer, 294 (94.27%) were squamous cell carcinoma. Total number of males were 196 (66.7%) and females were 116 (37.1%). The mean age was 56.2±13.4 years. Smoking (34.7%) was the most common risk factor and gingiva (42.6%) was the most common site of involvement. Conclusion Squamous cell carcinoma is the most common type of oral cancer and gingiva is the most common site of involvement. Tobacco smoking is the major risk factor for developing oral cancer. KEY WORDS Oral cancer, Risk factors, Smoking, Tobacco
Prescribing Practices of QT Interval Prolonging Drugs in Critically Ill Older Adults in South India
(Kathmandu University, 2023) Moolambally, SR; Malik, A; Boloor, A
ABSTRACT Background It was Dissertenne who first described a cardiac phenomenon known as the Torsades de Pointes (TdP). QT prolongation caused by drugs is one of the most important causes for acquired QT prolongation syndrome. Objective To observe the prescribing practices of QT interval prolonging drugs among a high- risk population of critically ill older adults in a tertiary care hospital in South India The objectives were to identify the most commonly prescribed QT prolonging drugs, to analyse types of QT prolonging drugs based on risk of causing QT prolongation, to study the frequency of occurrence of common risk factors for QT prolongation and to identify presence of any significant relationships among the study variables. Method We have conducted a one-year cross-sectional descriptive study of the prescribing practices of QT interval prolonging drugs among 319 critically ill older adults in a tertiary care hospital in South India. Data was analysed to categorize the most common drugs which prolong QT interval; the type and frequency of use of QT interval prolonging drugs and to find the most common risk factors for QT prolongation in this study population. Result In this study, ondansetron, clarithromycin, azithromycin,and amiodarone were the most prescribed among the drugs with known risk of QTc (Corrected QT interval) prolongation. Among the drugs with conditional risk of QTc prolongation, pantoprazole, frusemide, piperacillin-tazobactam and esomeprazole were the most prescribed. The most common risk factors for QTc prolongation that were identified in this study were bradycardia, acute kidney injury, chronic kidney disease and low serum potassium. Conclusion This study helps to inform our physicians regarding the commonly prescribed QT interval prolonging drugs so that they may reduce co prescription of multiple QT prolonging drugs in high-risk patients. It identifies kidney injury, low potassium, and bradycardia as common risk factors for QT interval prolongation in these patients. KEY WORDS Long QT syndrome, Physician prescribing pattern, Torsades de pointes
Association of Waist Circumference and Body Mass Index among the Students of a Medical College
(Kathmandu University, 2023) Sharma, K; Mansur, DI; Shakya, R; Maskey, S; Shrestha, A; Nepal, O
ABSTRACT Background Obesity and overweight have emerged as significant public health concerns on a global scale. In the pursuit of evaluating body composition and identifying potential health risks, two widely utilized measures are Body Mass Index and waist circumference. These anthropometric indicators are considered economical, practical, and also crucial for screening, monitoring the individual’s nutritional status, and anticipating future disease risk. Objective To explore the correlation between waist circumference and Body Mass Index and find out its significance as indicators of health and nutritional status in young adults. Method The study comprises 260 healthy young adults, aged 18-25 years from pre-clinical sciences, Kathmandu University School of Medical Sciences (KUSMS). Anthropometric measurements of height (m), weight (kg), and waist circumference (cm) were recorded. Body Mass Index was calculated by using the formula as body weight (kg) divided by the square of body height (m2). Demographic factors such as age, sex, obesity, and life style factors like smoking, alcohol consumption, and physical activity were noted. Result The study found a positive correlation between Body Mass Index, waist circumference (WC) and weight. However, no association was found between waist circumference and height. The findings also indicated a notably high percentage of 17.69% participants, who were categorized as overweight, while a 9.23% fell into the underweight category. The study confirms that 83.08% of the students have moderate physical activity whereas 14.62% have insufficient and 2.31% have heavy physical activity. Conclusion The study shows a positive correlation between body mass index (BMI) and waist circumference (WC) in young adults aged 18-25 years. KEY WORDS Anthropometric measurement, Body mass index , Obesity, Waist circumference
Public Awareness and Attitude towards COVID-19 Infection and Vaccines: A cross-sectional national survey in Nepal
(Kathmandu University, 2023) Pant, S; Bhattarai, S; Ranabhat, K; Dumre, SP; Rajbhandari, B; Mudvari, A; Bista, B; Bhandari, R; Adhikari, SK; Dhimal, M; Gyanwali, P
ABSTRACT Background To combat COVID-19, high vaccination rates are essential. However, challenges such as vaccine denial, lack of knowledge, and negative attitudes hinder progress. Assessing public understanding of vaccination is crucial to promote acceptance and reducing reluctance. Objective To understand people’s awareness and attitude regarding COVID-19 infection and vaccines in Nepal. Method A cross-sectional web-based survey was conducted among the Nepali population of age 18 years and above in April 2021 during the early phase of vaccination deployment. A structured questionnaire was used to collect awareness data, and a five-point Likert scale was employed to assess participants’ attitudes. The survey categorized participants into two groups based on whether their awareness level or attitude score was above or below the mean. The secondary outcome was the association between socio-demographic factors and COVID-19 awareness or attitude. Result Of 475 eligible participants, 46% had a low level of awareness on COVID-19 infection whereas 56% had low awareness on COVID-19 vaccines. Every six out of ten participants had a positive attitude towards the national COVID-19 vaccination program. Most of the participants had high awareness of COVID-19 symptoms and preventive measures (hand hygiene, physical distancing, mask), but two-thirds had a false perception of vaccine safety and contraindications. People’s education status, occupation, province, and current/prior COVID-19 infection status were found to be significantly associated with their awareness regarding COVID-19 disease or vaccines. Conclusion The study revealed limited COVID-19 awareness among the Nepali population but a positive attitude toward the national vaccination program. Regular updates on COVID-19 and vaccines are important as new variants and vaccines emerge. KEY WORDS Attitude, COVID-19 virus, Public awareness, Vaccination
Knowledge, Attitude and Practice in Recurrent Shoulder Dislocation: an analysis of patients presenting at a tertiary referral centre
(Kathmandu University, 2023) Joshi, A; Gurung, S; Basukala, B; Rijal, N; Sharma, R; Bista, R; Singh, N; Pradhan, I
ABSTRACT Background Early diagnosis and treatment of recurrent shoulder dislocation are crucial to avoid complications associated with multiple dislocations. Little is known about knowledge, attitude, and practice of recurrent shoulder dislocation among patients. Objective To assess the knowledge, attitude, and practice among patients regarding recurrent shoulder dislocation. Method A retrospective study of prospectively collected data from December 2019 to November 2022 among patients seeking treatment for recurrent shoulder dislocation at a tertiary care centre was conducted. A 16-item questionnaire, including 5 items regarding patients’ knowledge, 2 items regarding attitude, and 2 items regarding practice on recurrent shoulder dislocation, was devised and responses were recorded. Continuous data were reported as mean ± standard deviation and categorical data were reported as number (percentage). Comparative analysis was done using student t-test. Result A total of 220 patients completed the questionnaire. Out of 220, 159 (72.27%) were not informed about recurrence after first dislocation, 146 (66.36%) felt that they were not properly counselled regarding treatment, and 172 (78.18%) responded that they did not know that recurrent shoulder dislocation can be treated. Among 220 patients, 171 (77.73%) responded that their quality of life was affected by recurrent shoulder dislocation, and first dislocation was relocated by doctors in 116 (52.73%), self in 78 (35.45%), and relatives in 26 (11.82%). The number of dislocations was significantly higher among patients who did not visit the hospital after their first dislocation. Conclusion Majority of the patients have positive attitude, but poor knowledge and practice regarding recurrent shoulder dislocation. The findings would be useful for planning strategies to improve patients counselling regarding recurrent shoulder dislocation. KEY WORDS Knowledge gap, Practice gap, Recurrent shoulder dislocation
Sensitivity and Specificity of Nepali Version of Quantitative Androgen Deficiency in Aging Males (qADAM) Questionnaire in Diabetic Patients
(Kathmandu University, 2023) Bhatt, RD; Risal, P; Maharjan, A; Timalsina, D; Qiqiang, HE
ABSTRACT Background Diabetes mellitus (DM) is a chronic disorder with hyperglycemia that affects multiple systems with hypogonadism and erectile dysfunction some common issues affecting their quality sexual life. Quantitative androgen deficiency in aging males (qADAM) questionnaire is a trusted tool to assess hypogonadism and erectile dysfunction among diabetic patients and has been commonly used in Nepal too. However, the accuracy, sensitivity, and specificity of its Nepali version are yet to be tested. Objective To assess the accuracy, sensitivity, and specificity of the Nepali version of the quantitative androgen deficiency in aging males questionnaire among diabetic patients. Method A cross-sectional study was conducted among diabetic patients attending Dhulikhel Hospital, Kathmandu University Hospital. The Patients were asked to complete the valid Nepali translated version of quantitative Androgen Deficiency in Aging Males questionnaire. Participants’ serum total and free testosterone, lipid profile, fasting blood glucose, HbA1c and Sex Hormone Binding Globulin (SHBG) were measured in clinical biochemistry laboratory and the accuracy, sensitivity and specificity of Nepali version of quantitative androgen deficiency in aging males were analyzed. Result The translated Nepali version of quantitative androgen deficiency in aging males questionnaire showed 61.9% sensitivity, 45.5% specificity, and 56.7% accuracy in diagnosing hypogonadism in reference to serum testosterone level. Conclusion This Nepali translated version of quantitative androgen deficiency in aging males questionnaire can be a noninvasive tool to assess hypogonadism and erectile dysfunction. KEY WORDS Diabetes, Hypogonadism, Nepali Translation, Quantitative androgen deficiency in aging males
Predicting Complicated Appendicitis Based on Neutrophil to Lymphocyte Ratio, A Study in University Hospital of Nepal
(Kathmandu University, 2023) Shrestha, B; Koju, R; Makaju Shrestha, S; Shrestha, K; Hada, G; Shakya, YR; Karmacharya, RM; Malla, BR
ABSTRACT Background Acute appendicitis is one of the most common causes of acute abdomen requiring surgical treatment. Accurately diagnosing appendicitis and identifying complicated appendicitis can be difficult at times. Objective To evaluate the ability of the neutrophil-to-lymphocyte ratio (NLR) to differentiate between uncomplicated and complicated appendicitis. Method This was a prospective hospital-based observational study conducted at the Department of Surgery, Dhulikhel Hospital, Kathmandu University Hospital from July 2021 to December 2022. Patients with the clinical diagnosis of acute appendicitis who had undergone emergency appendectomy were included in the study. Informed consent was taken from each patient and data collection was done by filling the proforma. Result A total of 218 patients were included in the study. Male: female ratio was 1.18:1. Mean age of patients was 28.58 ± 16.65 (3-78) years. A significant correlation was found between increasing neutrophil count and neutrophil-to-lymphocyte ratio with complicated appendicitis. However, no significant correlation was found between White Blood Cell counts and complicated appendicitis. Neutrophil-to-lymphocyte ratio > 12.6 was found to be associated with complicated appendicitis. Conclusion A simple, cost-effective, and yet perfect test is not available for identifying complicated appendicitis. Increased Neutrophil count and neutrophil-to-lymphocyte ratio can indicate complicated appendicitis. Elevated WBC counts alone has no role in differentiating complicated appendicitis. According to the results of our study, an neutrophil-to-lymphocyte ratio of 12.6 can help to differentiate complicated from uncomplicated appendicitis. KEY WORDS Appendectomy, Appendicitis, Lymphocyte count, Neutrophils, Receiver operating characteristic curve

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