Journal Issue: Volume: 46, No. 2 (2024)
Loading...
Volume
Number
Issue Date
2024
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Morphology and Morphometry of Thyroid Gland in Cadavers: A Descriptive Cross-Sectional Study
(Institute of Medicine, Tribhuvan University, 2024) Phuyal, Navindra; Shrestha, Anusuya; Bhandari, Rosha; Adhikari, Bidur; Gautam, Jyoti; Dhungel, Deepesh; Gautam, Subina; Ranjit, Nirju
Abstract:
Introduction
Variations in anatomy of thyroid gland include the occasional presence of a pyramidal lobe and a fibromuscular band called levator glandulae thyroideae. These variations affect the gland's morphometry and morphology. This study aimed to study morphometry and variation prevalence of thyroid gland.
Methods
This descriptive study examined adult cadavers from the Department of Forensic Medicine at Maharajgunj Medical Campus. Measurements of the length, breadth, and thickness of both lateral lobes and the isthmus were taken. The presence or absence of the isthmus, pyramidal lobe, and levator glandulae thyroideae was recorded, along with the origin and dimensions of the pyramidal lobe, if present.
Results
The mean dimensions of the right lobe were 43.88±6.88 mm (length), 23.93±4.76 mm (breadth), and 12.28±3.30 mm (thickness). For the left lobe, the measures were 40.47±7.26 mm, 21.95±4.22 mm, and 12.84±3.61 mm, respectively. The isthmus had mean dimensions of 18.12±5.52 mm, 16.65±5.51 mm, and 5.10±1.76 mm. The isthmus was absent in 7.2% of cases. The pyramidal lobe, present in 27.8% of cases, had mean dimensions of 19.17±8.26 mm, 11.64±3.47 mm, and 4.60±1.33 mm, typically originating from the center of the isthmus. The average weight of the thyroid gland was 16.19±5.22 g.
Conclusion
The thyroid gland's weight was higher in males and positively correlated with the individual's height. Also, thyroid gland's dimensions and weight were less than those described in standard texts. The relationship between body weight and thyroid gland weight warrants further investigation.
Factors Influencing Intraoperative Rupture of Intracranial Aneurysms
(Institute of Medicine, Tribhuvan University, 2024) Khadka, Namrata; Rajbhandari, Binod; Aryal, Sameer; Bhattarai, Sushil Mohan; Shrestha, Rajendra; Jha, Rajiv
Abstract:
Introduction
Intraoperative rupture (IOR) is the most anticipated yet dreaded complication during intracranial aneurysmal surgery, leading to severe adverse outcomes. This study aims to analyze various risk factors contributing to IOR.
Methods
It was an analytical study of 46 cases of intracranial aneurysms treated at Department of Neurosurgery, Bir Hospital including both ruptured (n=43) and unruptured (n=3) aneurysms. Incidence of IOR, demographic data, preoperative grading scales, aneurysm morphology, phases and severity of IOR along with postoperative complications and outcomes were assessed.
Results
IOR occurred in 28.26% (13/46) cases of intracranial aneurysms. Most common aneurysm was anterior communicating artery aneurysm (43.5%, 20/46) with majority of IOR (65.1%).Younger patients and males had higher rates of IOR, and early surgical intervention (within 72 hours) was associated with increased incidence (69.2%,9/13). Although preoperative factors showed no direct correlation with IOR, aneurysm size and morphology-dome width and height ratio (W/H) and irregular shapes of aneurysm emerged as critical risk factors (p<0.05). Temporary clipping during surgery appeared to reduce IOR, mostly mild (13.04%, 6/13) and occurred in second phase (17.39%; 8/13, during microdissection and neck preparation). However, IOR did not have adverse effects on postoperative complications and Glasgow Outcome Scale Extended (GOSE) at discharge.
Conclusion
Incidence of IOR was 28.65%. Younger age, males, higher Fisher score, early timing of surgery of aneurysms and larger size increased the risk, while use of temporary clip reduced the risk. Dome H/W ratio and irregular shapes of aneurysm were important factors predicting IOR in this study.
Diagnostic and Therapeutic Value of ERCP : Experience from a Tertiary Care Center
(Institute of Medicine, Tribhuvan University, 2024) Pathak, Rahul; Lamsal, Manoj; Jha, Anurag; Kafle, Brindeswari; Hamal, Rabin
Abstract:
Introduction
The role of ERCP to diagnose and manage biliopancreatic diseases is increasing since its inception with refinement of operator skill, technical advancement and better patient selection. The aim of the study was to explore common clinical and endoscopic characteristics, outcome, adverse events and safety profile of patients.
Methods
An observational study was conducted on patients undergoing ERCP in Department of Gastroenterology, Tribhuvan University Teaching Hospital, for management of biliopancreatic diseases from April 2023 to March 2024 after taking approval from IRC-IOM. Patient demographics, clinical characteristics, ERCP findings and post procedure outcome data were collected and analyzed using SPSS version 26.
Results
A total of 200 patients were included with mean age 52.36±17.04 years and female:male ratio of ~3:2. Elective procedures were done in 182 (91%) patients and in 18 (9%) as urgent procedure (within 48 hours). The most common indications were choledocholithiasis (157, 78.5%) followed by benign biliary stricture (12, 6%). The most frequent papilla was type 1 papilla (normal variant) in 48% followed by type 3 papilla (protruding) in 30%. Difficult cannulation was encountered in 130 (51.5%) cases. Post ERCP pancreatitis (8, 4%) and hypoxia (9, 4.5%) were the most common procedure and anesthesia related adverse events respectively. Common therapeutic interventions included sphincterotomy (176, 88%), CBD stenting (154, 78.5%) and precut sphincterotomy (45, 22.5%).
Conclusion
ERCP was mostly done for benign diseases like CBD stone and benign biliary strictures. Common therapeutic procedures were sphincterotomy and CBD stenting. Complications related to procedure and anesthesia though occured, their rate was low.
Emergency Heart Failure Mortality Risk Grade-7 Score Performance in Patients with Acute Heart Failure admitted at a Tertiary Care Center
(Institute of Medicine, Tribhuvan University, 2024) Shrestha, Bikesh; Poudel, Chandra Mani; Gajurel,Ratna Mani
Abstract:
Introduction
Heart failure is a major cause of morbidity and mortality worldwide with annual mortality of 8-9%. Acute heart failure patients require frequent Emergency Department visits and hospitalization.Emergency Heart Failure Mortality Risk Grade (EHMRG) score helps to risk stratify such patients. We aimed to study its performance at a tertiary care centre in Nepal.
Methods
This is an analytical, study involving 175 acute heart failure patients admitted at Emergency department over 1 year. The score was calculated for each patient and they were followed up for 30 days post discharge for readmission. The primary outcome studied was 7 day mortality.
Results
The median age was 66 years with 94 (53.7%) of the patients being male. Ischemic (38.3%) and dilated (25.1%) cardiomyopathies were the most common etiologies. Twenty seven (15.3%) of the patients required re-hospitalization within 1 month.There was statistically significant association (p<0.001) between 7-day mortality and high EHMRG scores (Class 5 and 4). No 7-day mortality was observed in the very low, low, and intermediate-risk groups. In the high-risk group (Class 4), 1 patient died while 15 survived. In the very high-risk group (Class 5), 29 patients died compared to 45 who survived.
Conclusion
Mortality within 7 days and readmission rates were higher in patients with high EHMRG scores. No mortalitites were encountered in patients with low scores. EHMRG can be a valuable tool to stratify acute heart failure patients as it can identify patients with high risk of 7 day mortality. It can help physician in deciding whether to discharge or admit the patients from Emergency rooms.
Renal Function Evaluation Following Donor Nephrectomy in Tertiary Kidney Transplant Center of Nepal
(Institute of Medicine, Tribhuvan University, 2024) Gyawali, Milan; Luitel, Bhojraj; Pradhan, Manish Man; Chalise, Pawan Raj; Chapagain, Suman; Gyawali, Prem Raj
Abstract:
Introduction
Live kidney transplant is the standard of care for patients requiring renal replacement therapy. Donors with increasing age and comorbid conditions such as obesity and hypertension are now included for transplant. This study was performed to evaluate the change in renal function of kidney donors over a period of one year.
Methods
This was an analytical study of patient’s who underwent donor nephrectomy from January 2022 to June 2023 at Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Nepal. Renal function of donors in terms of serum creatinine, glomerular filtration rate, size of kidney and general physical examination including blood pressure pre-donation were compared with post donation period at three, six and twelve months.
Results
There were total of 76 cases available for analysis. Mean age of the donors was 44.6±10.1 years, ranging from 22 to 67 years, with male: female ratio of 1:2.45. There was no significant change in post donation blood pressure and kidney size. There was increase in serum creatinine level from baseline 70.47±14.96 to 93.20±17.61 (p<0.001) at three months follow up. Post donation glomerular filtration rate (GFR) of remnant kidney had increased significantly.
Conclusion
Post donation GFR of remnant kidney as well as serum creatinine level in live donor nephrectomy including the expanded criteria donors had increased significantly. Short-term deleterious effects in renal function post donation were not seen.