Journal Issue: Volume: 41, No. 2 (2019) August
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Volume
Number
Issue Date
2019
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient
(Institute of Medicine, 2019) Parajuli, Pawan; Bhandari, Ramesh S; Pathak, Rahul; Sharma, Shashi; Khadga, Prem K; Jha, Anurag; Hamal, Rabin; Kafle, Brindeswari
ABSTRACT
Introduction
Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology.
Methods
Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis.
Results
Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy.
Conclusion
Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain etiology.
Keywords: Ascites, peritoneal carcinomatosis, peritoneoscopy
Challenges of Sustaining Elimination Status of Leprosy in Nepal
(Institute of Medicine, 2019) Parajuli, Sudip; Pokhrel, Dinesh B; Baskota, Rabindra; Poudyal, Amod; Paudel, Upama
ABSTRACT
Introduction
The number of leprosy patients is increasing in Nepal even after declaration of elimination in 2010. The objective of this study was to review the status of leprosy after declaration of elimination in Nepal and to identify challenges to sustain elimination.
Methods
This was retrospective study conducted by reviewing the annual data published by Department of Health Services, Ministry of Health, Government of Nepal from 2010 through 2018. In addition, one year hospital based data (2017/18) was retrieved from records of Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Results
The prevalence of leprosy was found to be 0.77/10,000 population in 2010 and 0.99/10,000 in 2018. The numbers of multibacillary (MB) cases (remained more than 50%) outnumbered paucibacillary (PB) cases throughout eight years.
Conclusion
The prevalence of leprosy is gradually increasing in Nepal with more number of multibacillary cases detected in post-elimination era.
Keywords: Leprosy, multibacillary, paucibacillary
Serum Vitamin D Level in Chronic Obstructive Pulmonary Disease and its Relation with Severity: A Single Centre Study
(Institute of Medicine, 2019) Pant, Pankaj; Thapa, Shovit; Das, Santa K; Bam, Niraj
ABSTRACT
Introduction
Chronic obstructive pulmonary disease (COPD) is a public health problem of epidemic proportion. Several studies have shown low serum vitamin D levels in patients with COPD. The aim of this study was to compare serum vitamin D level in patients with Global Initiative for Chronic Obstructive Lung Diseases (GOLD) COPD stage II, III and IV with controls and correlate serum vitamin D level with severity of COPD.
Methods
A cross sectional study was conducted from June 2014 to November 2015 at Tribhuvan University Teaching Hospital (TUTH). A total of 154 subjects were enrolled for study that consisted of 77 cases of COPD and 77 controls for comparison. Participants were taken from medical wards and outpatient department. COPD staging was done as per GOLD guidelines and stage II, III and IV were labeled as advanced COPD cases. Both descriptive and inferential statistics were performed in SPSS version 20.
ResultsStage
II, III and IV COPD were 30%, 36% and 34% respectively. Mean serum vitamin D level was 15.16±7.19 ng/ml in COPD cases and 33.99±12.37 ng/ml in healthy controls showing statistically significant relation of low serum vitamin D in patients with advanced COPD (p <0.0001). Serum vitamin D was found to be in decreasing trend with increasing severity of COPD.
Conclusion
Patients with advanced COPD (GOLD stage II, III and IV) had low serum vitamin D levels compared to normal population and serum vitamin D level correlated with GOLD severity in Nepalese patients with COPD.
Keywords: Chronic obstructive pulmonary disease; global initiative for chronic obstructive lung diseases; vitamin D
Knowledge and Practice on Prevention of Complications of Diabetes Mellitus among Patients with Diabetes in a Tertiary Hospital
(Institute of Medicine, 2019) Acharya, Om K; KC, Takma; Shrestha, Krishna D
ABSTRACT
Introduction
Diabetes is a major contributing factor for overall health status, morbidity, mortality and quality of life. Adequate knowledge and sufficient practice can prevent many possible diabetic complications. Hence, the objective of this study was to find out the knowledge and practice regarding prevention of complications of diabetes among diabetic patients.
Methods
A descriptive, cross sectional design was carried out in Tribhuvan University Teaching Hospital Kathmandu (TUTH). A total 124 diabetic patients who came for follow-up in endocrine Out Patient Department were selected through purposive sampling technique by using pre-tested structured interview schedule during four weeks. Data was analyzed by using the descriptive and inferential statistics with the help of Statistical Package of Social Science (SPSS) version 16.
Results
The study findings showed that 24.2% respondents had adequate knowledge about complications . More than half of the respondents had sufficient practice (52.4%) regarding prevention of diabetic complications. Association between knowledge and selected variables showed that sex and education level tends to be significantly associated and regarding practice, area of residence and duration of illness were significantly associated (p<0.05). There was a statistically significant (p<0.001) and average positive relationship (r=0.605) was found between knowledge and practice.
Conclusion
The study concluded that though only few respondents had adequate knowledge, more than half of the respondents had sufficient practice regarding preventing complications. This finding suggests awareness program regarding prevention of compilcations of diabetes mellitus should be launched periodically to increase knowledge and sufficient practice on prevention of diabetic complications.
Keywords:Diabetic complications, diabetes mellitus, knowledge, practice