Journal Issue: Volume: 44, No. 3 (2022)
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2022
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Correlation of Differential Function and Glomerular Filtration Rate Estimated from Computed Tomography based Renal Volume and Diuretic Renogram in Living Renal Donor
(Institute of Medicine, 2022) Rai, Bipendra DK; Gnyawali, Diwas; Poudyal, Sujeet; Pradhan, Manish; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Gyawali, Prem R; Sharma, Uttam K; Nepali, Rabin; Gurung, Ghanashyam
ABSTRACT
Introduction: In renal transplant, serum creatinine and isotope studies are used for determination of donor glomerular filtration rate (GFR). Studies have shown computed tomography measured renal volume can also be used. Our main objective was to assess the accuracy of volume based estimated GFR (vGFR) with diethylene triamine penta acetic acid (DTPA) measured GFR in living kidney donors.
Methods: An observational analytical study was conducted from July 2018 to June 2019 in Department of Urology and Kidney Transplant Surgery and Department of Radiodiagnosis in Tribhuvan University Teaching Hospital where a total of 38 eligible potential donors were evaluated and serum creatinine level, computed tomography with contrast and DTPA renogram were used to measure GFR and differential function.
Results: The mean age of the donors were 42.8±10.9 years with 70% of donors being females. Renal volume was not statistically different between male and female donors. There was moderate correlation between volume based and DTPA based GFR (r=0.76) and differential function (r=0.71). Compared to creatinine, volume based GFR estimate showed better correlation to DTPA renogram. There was no significant difference in differential function estimated by DTPA and volume based estimates (p = 0.96). The upper and lower limit of agreement between the volume based and DTPA based differential function was –4.7 and 4.6 respectively.
Conclusion: GFR measurement by CT volume overestimates total GFR compared to DTPA renogram but it has better correlation than creatinine based estimates. It can be used to estimate the differential function of the donor kidney.
Keywords: Computed tomography, DTPA, glomerular filtration rate, renal transplant, renal volume
Outcomes of Anterior Urethral Stricture Management in a Tertiary Care Hospital in Eastern Nepal
(Institute of Medicine, 2022) Thakur, Dipak K; Agrawal, Chandra S
ABSTRACT
Introduction: The standard guidelines for the management of anterior urethral strictures categorizes as transurethral procedures like dilatation and urethrotomy; and open surgical procedures like urethroplasty. This study aims to find the extent and outcome of anterior urethral strictures managed in a tertiary care hospital in eastern Nepal.
Methods: It was a hospital-based cross-sectional study. Patients were evaluated preoperatively as per institutional protocol. The procedure was done either in local or spinal or general anesthesia with nasal intubation. At the end of the procedure, a 14 Fr Silicon catheter was inserted per urethra and removed either on the next day, 2 weeks or 4 weeks post operatively depending upon the type of procedure done. Patients were asked to follow up postoperatively at 6 weeks and three months.
Results: Thirty-six cases were eligible. The mean age of the patients was 39.25±14.02 years. According to the etiology; 36.1% were iatrogenic, 30.6% traumatic, 25% were balanitis xerotica obliterans or genital lichen sclerosus (BXO/LS) associated and 8.3% were infective respectively. Similarly, 61.1% of strictures were bulbar in location, 22.2% panurethral, 11.1% penile and 5.6% meatal. The mean length of the stricture was 4.26± 4.22 cm (range 1-14 cm). Similarly, Visual internal urethrotomy (VIU) was done in 47.2%, augmentation urethroplasty in 44.4% meatoplasty in 5.6% and anastomotic urethroplasty in 2.8% respectively. Complications occurred in 11.1% of cases.
Conclusion: Visual internal urethrotomy was the commonly performed procedure for the urethral stricture. Meatal stenosis was the most common complication.
Keywords: Catheters; urethral stricture
Intraoperative Neuromonitoring in Predicting Neurological Deficits in Patients with Intramedullary Lesions in a Tertiary Care Center in Nepal
(Institute of Medicine, 2022) Bhandari, Binod Raj; Kafle, Prakash; Pradhanang, Amit B; Sedain, Gopal; Shilpakar, Sushil K; Sharma, Mohan R
ABSTRACT
Introduction: Intramedullary spinal cord lesions (IMSCL) constitute 20%–30% of all spinal cord lesions. There is still uncertainty regarding the usefulness of intraoperative neuromonitoring (IONM) during spinal surgery. The purpose of this study is to determine the effectiveness of IONM in patients undergoing intramedullary spinal surgery.
Methods: Twenty-three patients who underwent surgery at the Department of Neurosurgery, Tribhuvan University Teaching Hospital from January 2017 to December 2020 were included. Somatosensory evoked potential, transcranial motor evoked potentials and electromyography were recorded. Patients were divided into three groups based on IONM parameters: 1. one with no drop 2. one with a decrease and a recovery during surgery, and 3. one with a decrease but no recovery. The duration of follow-up was six months.
Results: Neurological improvement was noted in 14 patients, stable in 4, and worse in 5. Out of 14 patients with clinical improvement, 9 had no decrease in IONM, while 5 had a temporary decrease. Among 4 patients whose postoperative status remained unchanged, 2 had no decrease in IONM, while one had a temporary decrease and one has a sustained decrease. Among 5 patients who deteriorated postoperatively, 1 had no decrease in IONM, and 4 had a decrease without recovery. During surgery, patients who demonstrated monitoring alterations but reverted to baseline had better neurological outcomes than those who did not (p=0.045).
Conclusion: Our findings support that IONM is an effective tool for the safe resection of IMSCL. Further multi-centric larger studies are recommended to gain more insight into IONM.
Keywords: Electromyography, intramedullary spinal cord lesions, intraoperative neuromonitoring, somatosensory evoked potential, transcranial motor evoked potential
Impact of COVID-19 Pandemic on Pregnant Mothers
(Institute of Medicine, 2022) Kapali, Gayetri Darshandhari; Koirala, Manisa; Katuwal, Neeta; Thapa, Sangita; Adhikari, Anuradha; Gachhadar, Rashmi; Neupane, Sharmila; Panta, Ganga
ABSTRACT
Introduction: The COVID pandemic has detrimental impact on physical and psychological wellbeing of expectant mothers. Fear and worry during pregnancy amplifies risks and can have negative physical and psychological consequences for mother and newborn outcomes. So this study intended to assess the impact of COVID-19 pandemic on pregnant mothers during pregnancy.
Methods: Descriptive cross-sectional study design was applied among 123 pregnant mothers who visited antenatal OPD of Tribhuvan University Teaching Hospital. Data were collected through non-probability purposive sampling technique by using interview schedule. Descriptive statistic and inferential statistics were used to analyze the collected data.
Results: Pregnant mothers faced difficulties to maintain physical wellbeing, 84 (68.3%) did not perform any physical exercise, 96 (78%) were physically inactive, 107(87%) stated absence of sound sleep during pregnancy. Majority i.e. 111 (90.2%) of pregnant mothers perceived fear on outcome of newborn. Likewise, 11(8.9%) had severe impact on their psychological wellbeing during COVID-19 pandemic. Place of residence, number of children and trimester of pregnancy were found to be the strong predictors of psychological impact among pregnant women.
Conclusion: The impact was seen on exercise, sleep, physical wellbeing whereas pregnant mothers seemed more attentive on healthy diet. They expressed more fear on obstetric or newborn outcome and uncertainty on mode of delivery with this panic situation.
Keywords: COVID-19, impact, mothers, pandemic, pregnancy
Maternal Satisfaction towards Spinal Anesthesia for Cesarean Section
(Institute of Medicine, 2022) Thapa, Chitra; Gauchan, Sabin; Bimali, Sneha; Bhusal, Srijana
ABSTRACT
Introduction: Patient satisfaction has become an important parameter to assess an overall quality of health care. We conducted this study to evaluate the level of maternal satisfaction with our anesthetic technique and to identify factors that compromise maternal satisfaction.
Methods: A descriptive cross-sectional study was conducted in two hundred patients who underwent cesarean section under spinal anesthesia after receiving ethical approval from the Institutional Review Committee. Preset questionnaires were asked in a face-to-face interview within 6 to 24 hours of cesarean section. Descriptive statistics was used to show frequency distribution and percentage of variables.
Results: The overall satisfaction level was 99%, with the lowest satisfaction level reported for pain therapy (88.5%). Subscale-wise, 90.5% of the patients were satisfied with the preoperative assessment and evaluation, 95% of the patients were satisfied with the intraoperative care and attention they received from their anesthetist, 97% of the patients were satisfied with their relationship with the anesthetist. More than 97% of the patients were satisfied with the level of care they received from their anesthetist.
Conclusion: In general, the overall maternal satisfaction towards spinal anesthesia was high in our population. To further increase our patient satisfaction we need to extend our services to the postoperative period as well.
Keywords: Cesarean section, maternal satisfaction, spinal anesthesia