Journal Issue:
Vol. 20 No. 04 (2022): Issue 57 Oct-Dec

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Volume

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Issue Date

2023

Journal Title

Journal ISSN

1999-6217

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Journal Volume
Volume: 20

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Publication
Day One Drain Amylase as a Predictor of Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy
(Nepal Health Research Council, 2022) Pradhan, Sumita; Kandel, Bishnu; Bhandari, Ramesh Singh; Lakhey, Paleswan Joshi
Abstract Background: Postoperative pancreatic fistula remains the most challenging complication following pancreaticoduodenectomy. As per the definition by the International Study Group on Pancreatic Fistula, post operative pancreatic fistula is diagnosed on or after postoperative day 3. However, several studies have demonstrated that drain fluid amylase on postoperative day 1 may be a better predictor. This study was conducted to determine the diagnostic value of day one drain amylase in predicting the development of post-operative pancreatic fistula. Methods: This was a prospective observational study of patients, who underwent pancreaticoduodenectomy between April 2016 and May 2017. Post operative pancreatic fistula was defined by the International Study Group on Pancreatic Fistula (2005) criteria. The diagnostic value of day one drain amylase was determined by doing a receiver operating curve analysis and compared with the postoperative day 3 value. Results: A total of 49 patients were included. Post operative pancreatic fistula developed in 28 patients (Grade A - 40.8%; B - 12.2%; C - 4.1%). Receiver operating curve analysis confirmed the predictive relationship of day one drain amylase with an area under the curve of 0.79 and kappa 0.5. For clinically relevant postoperative pancreatic fistula, day 3 drain amylase was the better predictor (AUC for DFA3 was 0.73 while AUC for DFA1 was 0.51). A day one drain amylase cut-off value of 350 U/L demonstrated a sensitivity of 75% and specificity of 77.8% with an accuracy of 76.2%. Conclusions: Day one drain amylase predicts postoperative pancreatic fistula in patients following pancreaticoduodenectomy but for clinically relevant postoperative pancreatic fistula, day three drain amylase is a better predictor. Keywords: Amylase; drain fluid amylase; pancreaticoduodenectomy; Pancreatic fistula
Publication
Laparoscopic Appendectomy versus Open Appendectomy in Acute Appendicitis
(Nepal Health Research Council, 2022) Nepal, Yugal Jyoty; Paudyal, Sanjaya; Shah, Surendra; Giri, Niraj
Abstract Background: Appendectomy is the most common emergency surgical procedure performed. Appendectomy is performed by either open or laparoscopic methods. However, there is lack of consensus regarding the most appropriate method. This study aimed to compare the outcomes of laparoscopic and open appendectomy in the treatment of acute appendicitis. Methods: Fifty-two patients undergoing appendectomy were analyzed in this prospective comparative study, with 26 patients each in laparoscopic and open group. The outcomes were measured in terms of operative time, postoperative pain at 4, 6 and 12 hours, length of hospital stay, postoperative complications according to modified Clavien Dindo classification and cost analysis. Results: Laparoscopic group had longer time after completion of surgery till exit from operation theatre (30 min in laparoscopic and 20 min in open, p<0.01) and significantly higher cost (Nrs. 26295 for laparoscopic and Nrs. 19575 for open, p<0.01) than open appendectomy. Operative time, time from entering operation theatre till being kept in operation table, time from being kept in operation table till initiation of anesthesia, postoperative pain at 4,6 and 12 hours and postoperative complications were insignificant in both groups. Conclusions: The results suggest that laparoscopic appendectomy group had longer recovery time after operation and was costlier than open appendectomy. Thus, the decision of the operative procedure can be based on the patient’s preference. Keywords: Appendectomy; laparoscopic appendectomy; open appendectomy
Publication
Assessment of Thyroid Dysfunction During Different Trimester of Pregnancy
(Nepal Health Research Council, 2022) Prajapati, Sunita; Prajapati, Gayatri; Shrestha, Vikram; Shrestha, Sujata
Abstract Background: Thyroid dysfunction is frequently seen in pregnant women and is associated with complications like miscarriage, gestational hypertension, placental abruption, pre mature delivery and fetal growth retardation and even causes impaired neuropsychological development of fetus. This study is carried out to assess the prevalence of thyroid disorder during different trimester of pregnancy. Methods: Serum samples were collected from 124 pregnant women attending Patan Academy of Health Science for ante natal visit. Free thyroxine free triiodothyronine and thyroid stimulating hormone were performed by chemiluminescent assay. Results: Out of 124 pregnant women, euthyroidism was seen in 79% (n =98) followed by subclinical hypothyroidism (10%, n=13) and primary hypothyroidism (8%, n=10). Subclinical hyperthyroidism and primary hyperthyroidism accounts for 1% (n=1), and 2% (n=2) respectively. Although, thyroid disorder was found to be more prevalent in third trimester (38.4%, n=10) but the distribution in first and second trimester (34.6%, n= 9, 27%, n= 7 respectively) were also significant. Mean fT3 and fT4 level were found to be negatively correlated with trimester (r=-0.19, p=0.027 and r=-0.29, p=0.001 respectively) whereas positive correlation of trimester was seen with TSH (r=0.08, p=0.35). Conclusions: Hypothyroidism is more common in pregnant women visiting tertiary care hospital. Different complication can be minimized if diagnosis is done early. Keywords: Hypothyroidism; pregnant; thyroid stimulating hormone; trimester, gestational week
Publication
Genotype-Phenotype Profile of Beta-thalassemia
(Nepal Health Research Council, 2022) Roma, Km; Pande, Rajan; Shrestha, Durga Laxmi
Abstract Background: Beta thalassemias are extremely heterogenous hereditary monogenic blood disorders and preventable genetic hemolytic anemia caused by >200 mutations in HBB gene. In Nepal, it is more prevalent in Tharu tribe but it seen in other communities as well. Out of more than 200 mutations of beta globin gene, approximate 20 different alleles are responsible for >80% of the mutations. Mutations vary in different geographic population and are responsible for manifestation of different phenotypes. This study was done to find common mutations of HBB gene in Nepal which were responsible for different phenotypic manifestations and to know clinical severity according to the mutations. Methods: This was a descriptive, cross sectional study conducted in the pediatric and medicine department of Nepalgunj Medical College and Bheri Zonal Hospital, Nepalgunj from January 2020 to December 2020. The genotype and phenotype profiles of thalassemia cases were reported. The data was analyzed by SPSS 20. Results: The results obtained showed that clinical presentation differed with different ?-globin gene mutations present. Individuals with HBB:c.47G>A and HBB:c.20A>T/ c.79G>A mutations showed milder presentation than those with HBB:c.47G>A/-619del and HBB:c.20A>T/c.47G>A. Conclusions: Therefore, these findings can be used to predict clinical severity so that we can take appropriate measures by early genotype identification for prenatal diagnosis of beta thalassemia. Keywords: Genotype phenotype; prenatal diagnosis; thalassemia
Publication
Prevalence of Microalbuminuria in Non-diabetic Hypertensive Patients and its Correlation with Changes in Left Ventricular and Left Atrial Characteristics
(Nepal Health Research Council, 2022) Bhusal, Khema Raj; Devkota, Surya; Pathak, Surya; Khanal, Pratik; Khanal, Umesh; Thapalia, Poojan; Neupane, Srijana; Gyanwali, Pradip; Simkhada, Rabindra; Oli, Krishna Kumar
Abstract Background: Microalbuminuria is urinary albumin excretion in the range of 30-300 mg per 24 hours and is considered as an abnormal albumin excretion rate. Microalbuminuria is associated with epithelial dysfunction and have a high risk for target organ damage resulting in stroke, retinopathy and adverse cardiovascular events. The objective of the study was to determine the prevalence of microalbuminuria in non-diabetic hypertensive patients and its correlation with cardiovascular changes. Methods: A quantitative cross-sectional study was done in 107 participants diagnosed as non-diabetic hypertensive patients visiting to Manmohan Memorial medical college and Teaching hospital and Manmohan Cardio-thoracic Vascular and transplant Centre. The assessed parameters were basic metabolic profile, urine evaluation and Echocardiography. Results:The results showed microalbuminuria in 28 study participants and not seen in 79 participants. Similarly, microalbuminuria was observed more comparable in those with presence of left ventricular hypertrophy as compared to the absence of left ventricular hypertrophy (29.3% versus 22.8%) (p value 0.469); those with presence of left ventricular diastolic dysfunction as compared to the absence of left ventricular diastolic dysfunction (31.1% versus 19%) (p value 0.170) and those with dilated left atrium as compared to normal left atrium (26.7% versus 23.9%) (p value 0.820). In case of left ventricular ejection fraction, those with normal left ventricular ejection fraction (26.3%) had slightly higher proportion of micro-albuminuria than those with mild to moderate left ventricular systolic dysfunction (20%) (p value= 0.755) Conclusions: There was no significant difference in the level of micro-albuminuria between non-diabetics, hypertensive patients with cardio vascular changes compared to patients with no cardiovascular changes. Keywords: Hypertension; microalbuminuria; non-diabetic

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