Journal Issue: Volume: 37, No. 2 (2015) August
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2015
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Governing the medical research by ethical norms, a challenge !
(Institute of Medicine, 2015) Sherchand, JB
NA.
Spectrum of MRCP findings: An Initial Experience with 3.0 Tesla Magnetic Resonance Imaging System in Nepal
(Institute of Medicine, 2015) Gurung, GS; Subedi, K; Karki, DB
Abstract
Introduction: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive magnetic resonance imaging (MRI) examination used in the evaluation of hepatobiliary and pancreatic tree. It is a non-invasive alternative to endoscopic retrograde cholangiopancreatography (ERCP). Here we attempted to summarize the spectrum of MRCP findings in a cohort of patients undergoing MRCP examination in a 3.0 Tesla MRI system, the first of its kind in Nepal.
Methods: The study was carried among patients undergoing MRCP in a 3.0 Tesla MRI system from November 24, 2014 to June 29, 2015. 167 patients (73 male and 94 female, age range, 1-87 years, mean age, 49.8years) were identified who underwent MRCP. MRCP was performed on a 3.0 Tesla MR scanner (Ingenia, Philips Medical System) using a sixteen-element quadrature phased array body coil over the liver. The MRCP findings were reviewed and various imaging findings were recorded. The findings were analyzed using SPSS.
Results: MRCP was normal in 44(26.2%) patients. Various findings were found in the biliary ducts, liver, gall bladder, pancreas and outside the pancreas and liver. Commonest biliary duct pathology was choledocholithiasis (25.7%). Commonest liver pathology was chronic liver disease (3%). Commonest pancreatic parenchymal pathology was acute pancreatitis (4.2%). Commonest pancreatic duct pathology was dilated pancreatic duct (5.4%). Gall bladder was seen in 37 (22%) patients, and 30 patients were status post cholecystectomy (17.9%). Extra pancreaticobiliary findings included pleural effusion, ascites, splenomegaly, juxtapapillary duodenal diverticulum etc.
Conclusion: MRCP is the choice of investigation for the non-invasive diagnosis of pancreaticobiliary disorders. In the current review, we have summarized the spectrum of MRCP findings and shared an early experience with 3.0 Tesla MRCP system in Nepal. The findings are comparable to the existing literature in the subject.
Keywords: Bile ducts, Gall bladder, Magnetic resonance cholangiopancreatography (MRCP)
Detection of Cryptosporidium, Giardia, fecal Indicator bacteria, and total bacteria in commercial jar water in the Kathmandu Valley, Nepal
(Institute of Medicine, 2015) Malla, B; Ghaju, Shrestha R; Bhandari, D; Tandukar, S; Shrestha, S; Yoshinaga, H; Inoue, D; Sei, K; Nishida, K; Tanaka, Y; Sherchand, JB; Haramoto, E
Abstract
Introduction: Jar water is a convenient and common source of drinking water in the Kathmandu Valley. However, studies including detailed microbial analyses of this source of potable water are lacking. In this study, jar water samples were examined for the occurrence of Cryptosporidium, Giardia, fecal indicator bacteria, and total bacteria.
Methods: Thirty different brands of jars were collected in September 2014. Escherichia coli and total coliforms were determined using a Colilert reagent. Ten of the 30 brands were selected to test for Cryptosporidium, Giardia, and total bacteria. Bacterial DNA extraction from water samples was performed using the Cica Geneus DNA Extraction Kit, followed by quantitative polymerase chain reaction (qPCR) targeting the 16S rRNA gene of bacterial DNA. Protozoan detection was accomplished by concentrating the samples using the electronegative membrane vortex method. followed by immunomagnetic separation and fluorescent staining.
Results: E. coli was detected in 10% of the samples, with a maximum concentration of 2 most probable number (MPN)/100 ml., whereas total coliforms were detected in 97% of the samples, with a maximum and mean concentration of 7.3 x 102 and 3.8 x 10 MPN/100 ml., respectively. Total coliforms concentrations in 40% of the samples ranged from 10 to 10 MPN/100 ml. Cryptosporidium and Giardia were not detected in any of the tested samples. Concentrations of total bacteria in the samples ranged from 10 to 10 cells/100 ml.
Conclusions: Ninety-seven percent of the jar water brands were unsuitable for drinking without proper treatment based on the guideline values of the National Drinking Water Quality Standards (NDWQS) of Nepal. There is no guideline value for total bacteria in NDWQS however, high concentrations can be indicative of poor control on regrowth of bacteria and recontamination or inefficient water treatment methods.
Keywords: Cryptosporidium, Giardia, Jar water, qPCR, Total bacteria
Antithrombotic agents and Risk Profile of Patients with Atrial Fibrillation from Rural Part of Nepal
(Institute of Medicine, 2015) Dhungana, SP; Sherpa, K
Abstract
Introduction: Atrial fibrillation (AF) is an atrial tachyarrhythmia characterized by uncoordinated activation of atria with subsequent impairment of atrial mechanical function. Anticoagulation with warfarin decreases the ischemic stroke risk associated with AF. Although the trends of anticoagulation use and risk profiles of AF is available from different countries, but, there is scarcity of data from Nepal. Hence, the study was carried out to determine the current practices of antithrombotic use in rural Nepal.
Methods: A total of 240 patients from January 2012 to September 2014 with and without admitted but diagnosis of atrial fibrillation (AF) were enrolled from Lumbini Medical College, Palpa. Demographic information, clinical history, co-morbid conditions, use of anticoagulants and risk factors for stroke were obtained from questionnaire designated. Clinical examinations were performed along with electrocardiography and echocardiography from each patient.
Results: A total of 240 patients, diagnosis with atrial fibrillation (AF) from outpatient or admitted, the mean ranged was 63.3 years (20 to 90). Male: female ratio was 0.84. Majority of patients (60%) were of age >60 years. Mean heart rate was 98 bpm. Among risk factors for AF, hypertension, rheumatic heart disease, systolic and diastolic heart failure, dilated cardiomyopathy, ischemic heart diseases were common underlying problems. Ninety percent of patients had dilated left atrium (>40mm). Among patients with non-valvular AF. 39.1% had CHADS2 score of ≥ 2 who were eligible for oralanticoagulants and 18.9 % patients received it. Out of 44 with rheumatic heart disease and AF, 10(22.7%) patients obtained oral anticoagulants,
Conclusions: The findings highlight the need for improved treatments of underlying risk factors to prevent the onset of AF and adequate use of OACs to prevent stroke risk.
Keywords: Atrial fibrillation, clinical characteristics, risk factors