Journal Issue: Volume: 34, No. 3 (2012) December
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Volume
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Issue Date
2012
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Future Emerging Issues in waterborne diseases and microbial agent
(Institute of Medicine, 2012) Sherchand, J B
NA.
Hypertension, as an iceberg disease in the high hilly areas of Nepal
(Institute of Medicine, 2012) Lamsal, KS; Kafle, MP
Abstract
Introduction: Hypertension simply is usual blood pressure of 140/90 mm Hg or higher in otherwise normal individuals and even lower for certain high-risk patients. Its a common medical condition worldwide. It is the most important, commonest and correctible cardiovascular risk factor and one of the leading causes of death. Many factors like dietary, behavioral, psychological, environmental, genetic etc. have direct or indirect influence on hypertension. In this study we have analyzed the prevalence and different stages of hypertension in a remote and high hilly area of Nepal.
Methods: The study was conducted in high hilly area adjoined to Solukhumbu and Dolakha districts. Altogether 600 participants were enrolled in the study. Participants having age more 18 years, regardless of symptoms, willing to give consent were involved. Demograghic data and blood pressure was recorded twice. The 1st reading was taken by trained nursing staff using standard Riva Rocci Sphygnomanometer after five minutes rest. The 2nd reading was taken by Physician and mean was calculated from both readings.
Results: Among 600 patients involved in the study, the mean age was 48 years. Among them, 92 patients were having prehypertension including 53 male and 39 female. The stage I hypertension was found in 130 cases, out of them 77 were male and 53 were female. Whereas stage II hypertension was found in 84 cases, including 40 males and 44 females. Prehypertension was commonest among 40-49 years of age, stage I and stage II hypertension was commonest among 50-59 years. Systolic hypertension was more common in younger and elderly participants whereas diastolic hypertension was more common in middle age adults.
Conclusion: In the study, the incidence of hypertension increases whose age was found between 50-59 with age till 50-59 years age group. Systolic hypertension was more common than diastolic hypertension in less than 30 years age group where as between 30-59 years diastolic blood pressure was more commonly found than systolic blood pressure. In the elderly of more than 60 years, again systolic hypertension is more predominant than diastolic hypertension.
Keywords: hilly area, hypertension, prevalence, salt
Diagnostic efficacy of ultrasonography in acute appendicitis
(Institute of Medicine, 2012) Lohani, B; Gurung, G; Paudel, S; Kayastha, P
Abstract
Introduction: Acute appendicitis is the most common acute condition of the abdomen requiring surgery in both adults 1,2 and children. 3-5 The overall frequency of appendicitis for symptomatic patients younger than 20 years is 41%; the frequency for those older than 20 years is 59%.
Methods: This was a prospective cross-sectional study involving 104 patients aged between 8 and 68 years with clinical suspicion of acute appendicitis. Patients with suspected acute appendicitis were evaluated with high frequency linear transducer using graded compression technique. Per operative findings were noted and histopathological examination were carried out in all the cases for confirmation of acute appendicitis. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy of ultrasonography were calculated by using statistical method.
Results: Among 104 patients (61 males and 43 females) with clinical diagnosis of acute appendicitis, ultrasonography was positive for acute appendicitis in 79 patients (75.96%). On histopathological examination, 94 appendices (90.38%) were acutely inflamed. The sensitivity of ultrasonography for the diagnosis of acute appendicitis was 78.72% with specificity of 60%. Positive predictive value, negative predictive value and accuracy of ultrasonography were 94.87%, 23.07% and 76.92% respectively.
Conclusion: Ultrasonography is a useful method of diagnosing clinically suspected acute appendicitis especially in doubtful cases.
Keywords: Acute appendicitis, diagnosis of appendicitis, ultrasonography
Neurovascular injury in supracondylar fracture of Humerus
(Institute of Medicine, 2012) Shrestha, K R; Sapkota, R; Rajbhandari, N; Thapa, B; Shrestha, U K
Abstract
Introduction: Supracondylar fractures of the humerus are the commonest upper limb fractures in children, accounting for up to 70% of all pediatric elbow fractures. Supracondylar fractures of the humerus can be managed in outpatient setting but are often complicated by neurovascular injury.
Methods: Retrospective study including 187 patients who had presented with supracondylar fracture of humerus with 47 neurovascular injuries during the period of July 2007 to June 2011. Out of 142 patients with Gartland type III fracture 107 underwent immediate open reduction, exploration and internal fixation.
Results: Vascular injury is commonly associated with type II supracondylar fracture with posterior displacement. Twenty-two patients had vascular injury and all of them had satisfactory outcome after surgery.
Conclusion: A careful clinical evaluation, urgent surgical treatment and adequate fracture reduction can prevent lifelong handicap.
Keywords: P ulseless hand, Supracondy lar fracture, Vascular injuries
Rheumatic fever and rheumatic heart disease: how often we suspect infective endocarditis
(Institute of Medicine, 2012) Shrestha, P N; Das, A; Rayamajhi, A; Mahaseth, C
Abstract
Introduction: Rheumatic fever and rheumatic heart disease is a common problem in developing countries. Rheumatic valvular heart disease is one of the important risk factor for infective endocarditis.
Methods: Retrospective study was conducted among 56 children admitted in cardiology ward of Kanti children hospital with the diagnosis of rheumatic fever or rheumatic heart disease during May 2008 to M ay 2010.
Results: We found male to female ratio 2: 1, median age 12 (5- 14yrs) with the most affected age group of 11- 12 years. Common symptoms were fever (66%), dyspnea (68%), joint pain (50%), palpitation (30%), cough (16%) and chest pain (12%). Only 9% of patients had positive history of sore throat. Six ty percent patients were presented with features of congestive cardiac failure (CCF). A SO positive was found in 25 (44.6%) cases. The most common valvular lesion was mitral regurgitation (M R). Moderate to severe mitral regurgitation was found in 89% of cases. Tricuspid regurgitation (T R) was found in 57% of patients and aortic regurgitation (A R) in 55% of cases. Thirty-two patients (57%} had PA H in which 8 patients has severe PAH and 24 patients had mild to moderate PAH . Infective endocarditis was diagnosed in twenty patients (35.7%). Out of 20 patients 14 (70%) had vegetation in echocardiography. The mortality was 11% in this study.
Conclusion: Infective endocarditis is the major complication of rheumatic heart disease among children of Nepal and so clinical suspecian is important whenever patients with rheumatic heart disease present with fever.
Keywords: dyspnea, endocarditis, rheumatic fever, rheumtic heart disease