Journal Issue: Volume: 26, No. 4 (2024)
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2024
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Online ISSN: 2676-1424; Print ISSN: 2676-1319
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Articles
Study of clinical and mycological patterns of dermatophytosis and sensitivity pattern of dermatophytes in Nepal
(Nepal Medical College Pvt. Ltd., 2024) Shrestha, Shristi; Adhikari, Ram Prasad; Joshi, Smita; Bhandari, Sajana; Pandey, Ritu
Abstract:
One of the most common reasons for outpatient visits to the dermatology departments are superficial fungal infections. There has been an emergence of chronic and recalcitrant superficial fungal infections not responding to conventional antifungal agents in our parts of the world. This has become a significant public health issue where patients spend their money first on over-the-counter topical Fixed Drug Combination (FDC) creams containing steroid and then on visiting numerous physicians and dermatologists due to the recalcitrant nature of infection. One of the ways of overcoming this problem would be to identify the causative agents and determine their sensitivity patterns to the common antifungal agents. This study, therefore, aims to counter this significant public health problem by providing information on identification of these dermatophytes and their sensitivity patterns to the routinely used antifungal agents. The results of this descriptive cross-sectional study done at Dermatology Department of Nepal Medical College in Kathmandu will provide a base for formulating new guidelines on the management of these conditions. The patients diagnosed to have dermatophytosis were registered by dermatologist. Skin scraping was taken from the rim of the skin lesion and further processed for potassium hydroxide (KOH) smear examination, culture and sensitivity test. Out of total 274 patients 150 were male and 124 were female. Most of the patients belonged to the age group 20 to 40 years. Tinea corporis was the commonest followed by tinea unguim, tinea pedis and cruris. KOH smear was positive in 60.94% and culture was positive in 47.4%. Trichophyton spp. was commonest (35.40%) followed by Microsporum spp. (7.67%) among the isolates. In Trichopyton spp. the mean minimum inhibitory concentration (MIC) of itraconazole, ketoconazole, terbinafine, griseofulvin and fluconazole was 0.25, 0.26, 0.32, 2.28 and 5.957μg/ml, respectively. In Microsporum spp., MIC of itraconazole, ketoconazole, terbinafine, griseofulvin and fluconazole was 0.41, 0.9, 0.05, 0.4 and 25.7μg/ml, respectively. Trichophyton spp. is the commonest causative agent of dermatophytosis in our part of the world. MIC of commonly used antifungal drugs like itraconazole and terbinafine are low which signifies that these fungi are still susceptible to these drugs. However, the MIC of fluconazole is high compared to other antifungal drugs.
Relationship of dermatoglyphics pattern and malocclusion among individual visiting a tertiary dental care center in Kathmandu
(Nepal Medical College Pvt. Ltd., 2024) Piya, Anshu; Shrestha, Bikash Veer; Khapung, Anju
Abstract:
Dermatoglyphics is used as diagnostic and research tool in many fields including forensics to identify the individuals by forensic experts and in association with various medical conditions. The development of teeth and its associated structures coincide with the development of epidermal ridges during the 6th to 13th week of intrauterine life. This forms the basis for studying the association of dental anomalies with fingerprint pattern, malocclusion being most commonly reported oral conditions and is widely prevalent. Individuals including students and interns within the age group of 18-24 years visiting Nepal Medical College and Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu from April 2024 - June 2024 were included after signing the written consent form. Malocclusion was assessed based on Angle’s classification according to which participants were grouped into Class I, Class II, and Class III malocclusion. The fingerprints of all ten fingers of both the hands of the participants were recorded with ink by using roller method as suggested by Cummins and Midlo. Descriptive statistics was presented in the form of frequency, percentage, mean and standard deviation. Chi square test was done to find out the association of dermatoglyphic pattern with malocclusion using SPSS- 17 software with significance level set at P <0.05. Most of the study participants (120, 71.4%) had Angle’s Class I malocclusion followed by Class II (26, 15.5%) and Class III (22, 13.1%). The most common dermatoglyphic pattern among all the fingers was the loop pattern seen in little finger of left hand of study participants with Class I malocclusion (88, 73.3%) and little finger of right hand among those with Class II malocclusion (22, 84.6%) and Class III malocclusion (17, 77.3%). There was no statistically significant association between dermatoglyphic patterns and type of malocclusion (p-value 0.156 for loop pattern, p-value 0.915 for whorl pattern and p-value 0.126 for arch pattern) dermatoglyphic investigation being convenient, cost effective and non invasive, had been applied in many fields including dentistry. It has been used as a diagnostic tool to unveil genetic factors related to many oral diseases, however, it cannot be relied upon as a sole factor.
Incidence and risk factors of meconium stained amniotic fluid in newborn at a Tertiary care centre of Nepal: a retrospective study
(Nepal Medical College Pvt. Ltd., 2024) Tamang, Poonam Bodh; Shrestha, Sabina; Lama, Lopsang; Shrestha, Mandira; Bajgai, Arun; Rijal, Tara
Abstract:
Meconium stained amniotic fluid (MSAF) is a common cause of perinatal morbidity and mortality in neonates. Meconium has been considered as a sign of fetal distress occurring due to hypoxia which remains a major concern for obstetricians and Neonatologists. Good intrapartum care, timely interventions of all babies and selective approach of endotracheal intubation can reduce its complications to a greater extent. This was a hospital based retrospective cross-sectional study of neonates admitted at Nepal Medical College Teaching Hospital (NMCTH) during the period of January 2021 to Dec 2022. A total of 4171 deliveries was conducted during the study period. Only 265 (6.35%) cases were with meconium stained amniotic fluid. Among them, 74 (27.9 %) cases were vaginal deliveries and 191 (72.1 %) cases born via caesarian section. Out of 265 babies with MSAF, 165 (62.3%) and 100 (37.7%) were male and female respectively. Baby’s weight range was 2.5 to 3.5 kg. Among 265 neonates, two hundred and thirty-five newborns (88.7%) were vigorous and thirty neonates (11.3%) were non -vigorous and required resuscitation. Maternal risk factors for MSAF in increasing frequency were thick meconium, oligohydramnios, intrauterine growth restriction, diabetes mellitus, premature rupture of membrane (PROM) and post term pregnancy. Babies with APGAR scoring less than 7 had Odds ratio (95% Cl): 9.31 (3.54- 24.43) that is babies had 9.31 times more risk of developing meconium aspiration syndrome than with babies of APGAR score more than 7. Out of 265 cases, 88.3% required resuscitation in the form of orogastric suction at birth followed by bag and mask ventilation in 9.8 % cases. 117 (44.1%) babies were put on respiratory support. Out of 265 cases, 261 (98.5%) babies were discharged, 2 (0.8%) cases died and 2 (0.8 %) babies were left against medical advice.
Indications, diagnostic yield and appropriateness of gastrointestinal endoscopic procedures in children: experience of a tertiary level teaching hospital of Nepal
(Nepal Medical College Pvt. Ltd., 2024) Dhungel, Amrit; Shrestha, Sabina; Shrestha, Mandira; Tamang, Poonam Bodh; Chimoriya, Romila
Abstract:
Gastrointestinal (GI) endoscopy has been a key diagnostic tool from the past in adult patients, but its usefulness has been increasing in pediatric cases also. With development of technologies, these procedures have been relatively safer than in the past and have increased the yield in the diagnosis of GI diseases. Nepal being a developing country, it still has lesser pediatric GI cases and the outcomes of such cases are also limited. This retrospective study aimed to assess the types of GI procedures done along with their indications and diagnostic yields of these procedures which were conducted by reviewing data of all the patients between the ages of 0-18 years who underwent endoscopy in our center from January 2018 to December 2022. Overall, 82% of the 323 procedures performed in 268 patients during this study period (mean age 10 years) had a positive endoscopic finding, among which gastritis/duodenitis was the commonest (32.1%). Most common indication for the endoscopic procedures was pain abdomen (28%) followed by vomiting (25.7%). Rectal bleeding (24.3%) was the most common indication for doing lower GI procedures. Based on ESGE and ESPGHAN guidelines, 98.15% of the procedures done were considered appropriate. Histopathologically 27 out of 65 (41.5%) cases had Helicobacter pylori positive gastritis while 28 (43.0%) had no abnormalities detected. No major procedural and post procedure complications were noted in any of the study children indicating safety of such GI procedures under proper sedation. General practitioners and pediatricians should be encouraged to refer such children for the diagnosis and proper management as there procedures have been accessible and considered safe nowadays.
Role of ureteric DJ stenting following ureteroscopic removal of stone with pneumatic lithoclast for mid and lower ureter stones
(Nepal Medical College Pvt. Ltd., 2024) Ansari, Wesh; Dhakal, Prakrit; Bogati, Ananya Singh
Abstract:
It is traditional way to place DJ stent following ureteroscopic removal of stones (Ureterorenoscopy lithotripsy). DJ stenting prevents formation of stricture in ureter and has a protective function on kidney/ ureter. However use of DJ stent can result in pain and lower urinary tract symptoms (LUTS). There is no consensus on placing a ureteral catheter after uncomplicated ureteroscopy and it is still controversial. A cross sectional observational study was conducted in Urology Department of Nepal Medical College Teaching Hospital, Attarkhel, Kathmandu from 1st January 2024 to 31st July 2024. The purpose of this study was to see the role of DJ stenting in patients undergoing intra- corporeal pneumatic lithotripsy for mid and distal ureteric stone. Along with VAS SCORE (Pain) post-operative, need for analgesic, stone clearance and complications following pneumatic lithotripsy. A total 64 patients were included in our study. They were randomly allocated to two groups; A and B. Group A included all patients with DJ stent (6 FR) and group B include patients without DJ stents. Post-operative care was carried out for about 24 to 48 hours. Oral analgesic 50 mg Diclofenac was given as per need. All the patients were followed up at the interval of week 1st, 4th, 8th and 12 th week. The outcomes were measured on the basis of postoperative pain, analgesic dose and stone clearance at the end of the study. Mean of post-operative pain at 12th week was 5.93 in group A and 1.06 in group B. Stone clearance in group A was 81.3%, and group B was 75%. Use of additional analgesia in group A shows 34.4% and 18.8% in group B, P value was 0.157.