Journal Issue: Volume: 56, No. 209, Jan-Feb, 2018
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Volume
Number
Issue Date
2018
Journal Title
Journal ISSN
JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
Journal Volume
Articles
Prevalence of organic colonic lesions by colonoscopy in patients fulfilling ROME IV criteria of irritable bowel syndrome
(Nepal Medical Association, 2018) Paudel, Mukesh Sharma; Mandal, Amrendra Kumar; Shrestha, Barun; Poudyal, Nandu Silwal; KC, Sudhamshu; Chaudhary, Sitaram; Shrestha, Ramila; Goel, Khushboo
Abstract
Introduction: Irritable bowel syndrome occurs as recurrent abdominal pain that is related to defecation and associated with change in frequency and/or form of stool. Few Patients with IBS may have organic lesions detectable at colonoscopy.
Methods: A cross sectional study was carried out in 140 consecutive patients of IBS fulfilling the ROME IV criteria. The study was conducted in Gastroenterology unit, Department of Medicine, Bir hospital, Kathmandu from July 2016 to September 2017. All patients underwent full colonoscopy along with biopsy from sigmoid colon and any visibly abnormal areas.
Results: The average age of patients was 37.5 years with 76 (52.8%) males. Forty-two (30%) had IBS-D, 36 (26%) had IBS-C, 31 (22%) had IBS-M and 31 (22%) had IBS-U. Dyspepsia was seen in 16 (11.4%) and fear of TB/Malignancy/IBD was seen in 27 (19.2%). Organic lesions were seen in 39 (27.85%) patients. Nonspecific colitis was seen in 10 (7.1%) followed by ileal erosions in 7 (5%), polyps in 8 (5.7%), hemorrhoids in 6 (4.2%) and diverticula in 3 (2.1%). Only one (0.71%) patient had microscopic colitis and one (0.71%) had malignant lesion seen at histopathological examination. Females with IBS-D had more organic findings than males (P=0.03, RR=4.13, 95% CI=1.21-15.71).
Conclusions: The prevalence of organic lesions in patients with IBS fulfilling ROME IV criteria is 27%. Dyspepsia is the most common comorbidity and fear of TB/malignancy/IBD is the most common reason for seeking health care. Females with IBS-D have a higher risk of detecting organic lesions by colonoscopy and histopathology examination.
Factors predicting mortality of variceal bleeding in liver cirrhosis
(Nepal Medical Association, 2018) Mandal, Amrendra Kumar; Paudel, Mukesh Sharma; KC, Sudhamshu; Chaudhary, Sitaram; Paudel, Bidhan Nidhi; Poudyal, Nandu Silwal; Shrestha, Barun; Kanth, Rajan; Kafle, Paritosh
Abstract
Introduction: Acute variceal bleeding in liver cirrhosis is an immediate life-threatening condition and amajor complication of portal hypertension associated with higher morbidity, mortality and hospital costs than any other causes of UGI bleeding. Therefore, early stratification and initiation of therapy based on several factors can reduce mortality associated with it. We aimed to study the predictors of mortality in acute variceal bleeding in LC.
Methods: An observational prospective study was conducted in Gastroenterology and Hepatology units of Bir Hospital, Kathmandu, Nepal from April 1, 2016 to May 30, 2017. Patients were included if they had underlying liver cirrhosis and presented upper GI bleeding which were proven to be secondary to variceal bleeding.
Results: Seventy-five patients with mean age of 52.5 years were available or the analysis. The M:F ratio was 2.1:1. There were 66 patients in mortality group and 9 in survivor group. The mean CTP and MELD score were 10.17±1.66 and 20.40±8.29 respectively. Among the predictors of the mortality studied, CTP score, MELD score, mean arterial pressure, Serum bilirubin, serum creatinine, need of FFP as well as PRP transfusion, presence of hepatorenal syndrome and hepatic encephalopathy were high in mortality group with statistical significance. On multivariate analysis, high CTP and high serum creatinine level were only significant predictors of mortality. Receiver operating curve for predicting accuracy of mortality was significant with higher MELD and higher CTP score.
Conclusions: Strong predictors of mortality in patients with cirrhosis presenting with variceal bleeding are CTP score and high serum creatinine level.
Prevalence of non-communicable diseases and its associate factors among government employees in Biratnagar, Nepal
(Nepal Medical Association, 2018) Neupane, Roshan; Bhandari, Tulsi Ram
Abstract
Introduction: Non-communicable diseases have along duration and slow progression. It is estimated that the attribution of NCDs in mortality has been rising gradually in Nepal. This study aimed to estimate the prevalence and factors associated with NCDs in Biratnagar, Nepal.
Methods: A cross-sectional study was conducted among government employees in Biratnagar, Nepal from August to December 2016. We used self-administrated modified WHO STEPS survey questionnaire and distributed to all government employees of Biratnagar Sub-Metropolitan. We used complete filled 323 questionnaires to analyze and draw the results.
Results: The prevalence of NCDs was found 72 (22.3%). Hence, 322 (99.6%)government employees had exposed at least one established risk factor of the NCDs. The prevalence of use of any type of tobacco products was 60 (18.5%) and consumption of alcoholic products was 187 (57.9%). More than two-thirds respondents answered that they consumed fruits once a week. Most government employees consumed vegetable regularly.The majority 193 (59.6%) respondents used motorcycle and electric rickshaw as means of transportation. Out of the total participants 60 (18.6%), 19 (5.9%), and 6 (1.9%) reported hypertension, diabetes, and cardiovascular diseases respectively.
Conclusions: Prevalence of Non-Communicable Diseases has been seen in Government Employees in Biratnagar, Nepal. Most of them had at least one associated factor related to NCD was found.
Appropriateness of indications of upper gastrointestinal endoscopy and its association with positive finding
(Nepal Medical Association, 2018) Bohara, Tanka Prasad; Laudari, Uttam; Thapa, Abishek; Rupakheti, Shail; Joshi, Mukund Raj
Abstract
Introduction: Upper Gastrointestinal Endoscopy(UGIE) is a frequently advised investigation for upper abdominal symptoms. Studies have questioned the appropriateness of indications for UGIE and have shown that inappropriate indications range from 5% to 49%. The unnecessary UGIE expose patients to the risk. The number of UGIE is rising in our region and we assume so is the number of unnecessary UGIE. With an aim to evaluate the appropriateness of the indications of UGIE and compare its association with positive findings, we conducted a cross-sectional descriptive study.
Methods: All patients undergoing diagnostic UGIE during the study period were included in the study. Appropriateness of indications for UGIE was defined as per American Society for Gastrointestinal Endoscopy(ASGE) criteria as “appropriate†and “inappropriateâ€. UGIE endoscopy findings were classified as “significant†and “insignificant†based on endoscopy findings. The extent of this association between the appropriateness of indications and UGIE findings was expressed as the odds ratio (OR) of finding a relevant diagnosis in patients with an ‘‘appropriate’’ indication compared with those with an ‘inappropriate’’ indication.
Results: Seventy-nine patients were included in the study. Fifty- two (65.8 %) of the indications were considered appropriate as per ASGE guidelines. Thirty-three (63.5%) of the appropriate indications has clinically significant finding as compared to seven (25.9%) of inappropriate indication with an odds ratio of 4.962 (95%CI:1.773 – 13.890, p=0.002) which is statistically significant.
Conclusions: Appropriate indications have significantly higher rates of clinically significant findings. Use of guidelines may decrease the number of unnecessary procedures.
Clinico-radiological observations in meconium aspiration syndrome
(Nepal Medical Association, 2018) Lama, Susana; Mahato, Shyam Kumar; Chaudhary, Nagendra; Agrawal, Nikhil; Pathak, Santosh; Kurmi, Om Prakash; Bhatia, Baldev; Agarwal, Kailash Nath
Abstract
Introduction: To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal.
Methods: An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied.
Results: Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02)
Conclusions: Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.