Journal Issue: Volume: 55, No. 206, Apr-Jun (2017)
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JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
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Outcome of endoscopic variceal band ligation
(Nepal Medical Association, 2017) Shrestha, Barun; KC, Sudhamshu; Chaudhary, Sita Ram; Basnet, Bhupendra Kumar; Mandal, Amrendra Kumar; Poudyal, Nandu Silwal
Abstract
Introduction: Bleeding from esophageal varices in cirrhosis is an emergent condition with high mortality. One of the preferred modality of treating esophageal varices is EVL. We aimed to find out the outcome of EVL in controlling acute esophageal variceal bleeding, prophylactic banding to prevent future bleeding and the number of sessions required for complete eradication of varices.
Methods: This descriptive observational study was carried out in Gastroenterology and Hepatology unit of Bir Hospital, NAMS from June 2016 to May 2017. Consecutive cases who presented in emergency room with acute variceal bleeding due to liver cirrhosis and cases of liver cirrhosis with large varices and red color signs on endoscopic examination were enrolled. They underwent EVL and subsequent re-endoscope at one month interval till the eradication of varices was achieved.
Results: Among 83 patients, 15 (18.1%) were of Child Pugh class A, 29 (34.9%) B and 39 (47%) were of C. In 20 (24.1%) cases varices could be eradicated in one session of EVL while 57 (68.7%) required two sessions and in 6 (7.2%) cases it took three sessions. Total average EVL session required for obliteration of esophageal varices was 1.84±0.53. There was only one (1.2%) of early re-bleeding post EVL.
Conclusions: EVL is an effective modality of treatment in controlling acute esophageal variceal bleeding, in preventing future variceal bleeding as well as in eradicating esophageal varices, with very few complications.
Keywords: Acute variceal bleeding; Cirrhosis; Endoscopic variceal ligation; Large varices; Red color sign.
Colorectal cancer in different age groups in a tertiary hospital in Nepal
(Nepal Medical Association, 2017) Poudyal, Nandu Silwal; Chaudhary, Sitaram; Basnet, Bhupendra Kumar; Poudel, Bidhan Nidhi; Shrestha, Barun; Mandal, Amrendra Kumar; Sharma, Mukesh
Abstract
Introduction: Some studies have suggested that colorectal cancer at a younger age had distinct biological characteristics: different clinical presentations, more advanced stage at time of diagnosis and poorly differentiated carcinoma. The aim of the study is to analyze clinical and histopathological differences between younger (≤40 years of age) and older (>40 years of age) colorectal cancer patients.
Methods: A cross-sectional analysis was conducted amongst the colorectal cancer patients who visited Bir Hospital between July 2015 and April 2017. All colonoscopically diagnosed and histopathologically proven cases of colon cancer were included. Chi-square test and independent t – test was performed to analyze the difference between clinical presentations and histopathological findings among two groups of patients and p value of <0.05 was considered as significant.
Results: Thirty younger patients and thirty older patients were enrolled without any differences in gender proportion. There were no statistical differences between clinical presentation and histological grade and type in younger and older patients. The younger patients had more complaints of altered bowel habit (p <0.001) while older patients mostly presented with per rectal bleeding (p< 0.008).
Conclusions: In this study, colorectal cancer at younger ages showed similar characteristics to those of older patients except altered bowel habit was more common in younger patients while per rectal bleeding was more common in older patients. Although colorectal cancer incidence increases with age, younger patients with altered bowel habits, weight loss, anemia and anorexia should also be given due medical attention and undergo evaluation promptly.
Keywords: Carcinoma; Colon; Per rectal bleeding; Younger group.
Efficacy of prophylactic use of ciprofloxacin and metronidazole in mild and moderately severe acute pancreatitis
(Nepal Medical Association, 2017) Amrendra Kumar Mandal; Sitaram Chaudhary; Barun Shrestha; Mukesh Sharma Paudel; Nandu Silwal Paudel; Bidhan Nidhi Paudel; Bikash Bhattarai; Sunil Kumar Ray; Neetu Mandal Ray
Abstract
Introduction: There are new concepts and developments in the diagnosis and management of acute pancreatitis. Current evidence suggests that there is no role of prophylactic antibiotics use in acute pancreatitis. However, it is still a common practice to administer prophylactic antibiotics in a country like Nepal. So, we have conducted a study in mild and moderately severe acute pancreatitis to study the efficacy of prophylactic antibiotics.
Methods: A case control study was conducted among 76 patients comparing efficacy of prophylactic antibiotics versus no antibiotics in patients with mild and moderately severe acute pancreatitis.
Results: The two most common etiology of acute pancreatitis in AG and NAG were alcohol 21 (55.2%) vs. 24 (63.1%) and biliary 10 (26.3%) vs. 4 (10.5%) respectively. Pancreatic necrosis was seen in five (13.1 %) in AG and four (10.5%) in NAG. Four (10.5%) developed extra pancreatic complications in AG and five (13.1%) in NAG. There was one (2.6%) death in AG and no death in NAG. Abdominal pain improvement seen in AG vs. NAG was 3.2 days vs. 2.4 days (p =0.002). The hospital stay was 7.7±2.23 days in AG and 7.5±1.85 days in NAG (p=0.65).
Conclusions: The routine use of prophylactic antibiotics for mild and moderately severe acute pancreatitis is not associated with improvement in meaningful clinical outcomes.
Keywords: Atlanta classification 2012; Mild acute pancreatitis; Moderately severe acute pancreatitis; Prophylactic antibiotic.
Acute upper gastrointestinal bleeding in a tertiary care centre of Nepal
(Nepal Medical Association, 2017) Paudel, Mukesh Sharma; KC, Sudhamshu; Mandal, Amrendra Kumar; Poudyal, Nandu Silwal; Shrestha, Ramila; Paudel, Bidhan Nidhi; Chaudhary, Sitaram
Abstract
Introduction: AUGIB is characterized by hematemesis or melena or both. Peptic ulcers and variceal bleed account for majority of cases. Use of proton pump inhibitors in current era is associated with a gradual reduction in burden of peptic ulcer disease. We conducted this study to look into the cause of AUGIB in our community.
Methods: We studied 100 patients in one year period who presented to us with hematemesis or melena. The study was conducted in department of Gastroenterology, Bir hospital, Kathmandu. We identified the culprit lesions by upper gastrointestinal endoscopy.
Results: The average age of patients with AUGIB was 51.6 years with 59 (59%) males. Duodenal ulcers are most common 29 (29%), followed by varices 23 (23%) and gastric ulcers 14 (14%). More than one lesion was identified in 38 (38%) patients. Patients with variceal bleed were more likely to present with hematemesis alone as compared to those with ulcer bleed (p=0.005). Variceal bleed patients presented earlier to the hospital (p=0.005), had lower MAP at presentation (p=0.0002), had lower hemoglobin level (p=0.0001) and higher serum creatinine level at presentation (p=0.001). Patients with variceal bleed were more likely to have consumed alcohol 20 (86.9%) and patients with ulcer bleed were more likely to be smokers 29 (67.4%) or consume tobacco 14 (32.5%) (p=0.006).
Conclusions: Ulcer related bleeding is still the most common cause of AUGIB. Many patients with AUGIB have more than one lesions identified during upper gastrointestinal endoscopy.
Keywords: Bleeding; Endoscopy; Peptic ulcer; Upper gastrointestinal;Varices.
Correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters in Nepalese male patients with lower urinary tract symptoms
(Nepal Medical Association, 2017) Bhomi, Krishna Kaji; Subedi, Neeraj; Panta, Prem Prasad
Abstract
Introduction: International prostate symptom score is a validated questionnaire used to evaluate the lower urinary tract symptoms in benign prostatic hyperplasia. Visual prostate symptom score is a new simplified symptom score with pictograms to evaluate the same. We evaluated the correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters in Nepalese male patients with lower urinary tract symptoms.
Methods: Male patients aged ≥40 years attending the Urology clinic were enrolled in the study. They were given international prostate symptom score and visual prostate symptom score questionnaires to complete providing assistance whenever needed. Demographic data, examination findings and uroflowmetry parameters were noted. Correlation and regression analysis was used to identify correlation of the two scoring systems and uroflowmetry parameters.
Results: Among the 66 patients enrolled, only 10 (15.15%) patients were able to understand English language. There was a statistically significant correlation between total visual prostate symptom score and international prostate symptom score (r= 0.822; p<0.01). The correlations between individual scores of the two scoring systems related to force of urinary stream, frequency, nocturia and quality of life were also statistically significant. There was also a statistically significant correlation of both scores with maximum flow rate and average flow rate.
Conclusions: There is a statistically significant correlation of visual prostate symptom score with international prostate symptom score and uroflowmetry parameters. IPSS can be replaced with simple VPSS in evaluation of lower urinary tract symptoms in elderly male patients.
Keywords: Correlation; International prostate symptom score; Lower urinary tract symptoms; Uroflowmetry; Visual prostate symptom score.