Journal Issue: Volume: 45, No. 3 (2023)
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2023
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Metabolic Syndrome in patients with Urinary Tract Stone Disease: A Hospital based Single Center Study
(Institute of Medicine, 2023) Ali, Rushudulla; Sigdel, Mahesh R
ABSTRACT
Introduction; Patients with urinary tract stones (UTS) are at increased risk of developing metabolic syndrome (MetS). Assessment for MetS could be useful for patients presenting with UTS. We assessed the prevalence of MetS and each of its components in patients with UTS. Correlation of 24-hour urinary, serum calcium and uric acid levels with components of MetS were also done.
Methods: A cross-sectional study was conducted at Tribuvan University Teaching Hospital, Institute of Medicine from August 2021 to July 2022. After the approval from the Institutional Review Committee, 118 consenting adult patients with unilateral or bilateral UTS who fulfilled inclusion criteria were studied.
Results: Thirty-five (29.7%) stone formers had MetS. Among them, 23 (65.7%) were males, and 12 (34.3%) females. The mean body mass index of patients with MetS was 25.96 ± 4.62 kg/m2. In patients with MetS, 24 (68.8%) had high blood pressure and impaired plasma FBS. Twenty-one (60.0%) patients had increased serum triglyceride levels, and 54.3% had reduced HDL-cholesterol. Systolic blood pressure had a significant correlation with hypercalciuria (P=0.01) and hyperuricemia (P=0.046). Serum triglyceride levels were significantly correlated with hypercalcemia (P=0.045). The mean estimated glomerular filtration rate (eGFR) of the study population was 83.48 ± 32.37 mL/min/1.73 m2.
Conclusion: Urinary tract stone disease are associated with metabolic syndrome. Assessment for metabolic syndrome should be considered in patients with urinary tract stone disease.
Keywords: Hypercalciuria; hypercalcemia; hyperuricemia; hypertension; metabolic syndrome; Renal stone disease
Surgery for Solid Pseudopapillary Neoplasm: Observational Study at a Nepalese Tertiary Center
(Institute of Medicine, 2023) Sah, Dhruba N; Bhandari, Ramesh S; Kansakar, Prasan BS; Ghimire, Bikal; Lakhey, Paleswan Joshi
ABSTRACT
Introduction: Solid pseudopapillary neoplasms (SPN) are rare, relatively indolent tumors with potential malignant behavior. This study aimed to analyze the clinicopathological details, surgical management, and short- and long-term outcomes of operated cases of SPN.
Methods: This was an observational descriptive study of diagnosed SPNs confirmed histopathologically after surgical resections at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from 2006 November to 2019 January. Patient’s clinical details, surgical procedures, perioperative outcomes, and follow-up were recorded. Long-term follow-up was evaluated for a minimum of three years post-surgery.
Results: Over 13 years, a total of 15 cases with a median age of 22 years (11-52) were encountered and had female predominance (14, 93.3%). Five cases were diagnosed incidentally, while pain abdomen (5, 33.3%) was the most common presentation followed by lump (4, 26.7%). There were four tumors in the head of the pancreas, two in the uncinate process, two in the neck, four in the body, and three in the tail of the pancreas. Four cases underwent pancreaticoduodenctomy, three cases underwent enucleation, and four cases underwent central pancreatectomy. Similarly, one patient underwent spleen preserving distal pancreatectomy and three patients underwent distal pancretosplenectomy. Postoperatively, 20% developed major complications with Clavien-Dindo (grade III & above) out of which one patient had mortality. Over the median follow-up of 72 months, no recurrences were noted.
Conclusion: Solid pseudopapillary neoplasms were relatively rare. Complete surgical resection was the most commonly used surgical management, post-operative complications were minimal and survival rate was excellent.
Keywords: Pancreas; solid pseudopapillary neoplasm; surgery
Factors Associated with Antenatal Care Visit Dropout among Mothers attending Immunization Clinic
(Institute of Medicine, 2023) Subedi, Sabitra; Mandal, Punam K; Mahato, Anju K; Basnet, Bidhya; Rai, Munawatee; Khadgi, Deepika
ABSTRACT
Introduction: Developing nations continue to have high maternal mortality rates. Prenatal care helps to improve the mother's and the unborn child's health. The purpose of this study was to identify the variables linked to mothers' antenatal care visit droput.
Methods: A cross-sectional study was carried out using the multi-stage sampling technique in the four urban and four rural randomly chosen municipalities of Morang district. In total, 134 postnatal mothers who skipped four focused ANC visits were chosen as study group and 266 postnatal mothers who completed four focused ANC visit from the same vaccination facilities were chosen as control group. Using a semi-structured questionnaire and the consecutive sampling approach, data were gathered through interviews. The final model was chosen by employing the backward elimination technique after doing bivariate and multivariate analysis.
Results: This study found that the majority (56.0%) of cases was from the age group of 21-30 years and 35.1% of cases were janajatis. The number of factors were linked to ANC dropout, including age (OR 2.49, 95% CI 1.07-5.82), ethnicity (OR 2.29, 95% CI 1.05-4.99), education (OR 4.64, 95% CI 1.99- 10.81), income (OR 3.49, 95% CI 1.75- 6.95), and the existence of complications (OR 1.15, 95% CI 0.54-2.44).
Conclusion: The risk factors for ANC dropout were age, ethnicity, education, income, and the presence of complications during previous pregnancy. It suggests that efforts should be made to spread the information about the value of four focused ANC visits.
Keywords: ANC dropout, factors, immunization center, mothers
Incidence and Outcomes of Re-Exploration in Adult Cardiac Surgery at A Tertiary Care Hospital
(Institute of Medicine, 2023) Pradhan, Ashok; Pokharel, Rojina; Kadel, Prashiddha B; Bashyal, Krishna prashad; Khakural, Prabhat; Baral, Ravi K; Bhattarai, Anil; Koirala, Bhagawan
ABSTRACT
Introduction: Postoperative bleeding is a significant complication following cardiac surgery, with a global re-exploration incidence of 2-5%. This study aims to investigate re-exploration rates, risk factors, and outcomes within the unique context of a tertiary care center in Nepal.
Methods: In this retrospective, single-center study, we analyzed all consecutive adult patients (≥18 years) who underwent cardiac surgery with cardiopulmonary bypass (CPB) at the Manmohan Cardiothoracic Vascular and Transplant Centre (Nepal) between 2018-2021. Data on demographics, clinical characteristics, operative details, re-exploration, and outcomes were extracted from medical records. Statistical analysis included descriptive statistics, chi-square tests, independent samples t-tests, and logistic regression.
Results: Of 720 patients, 56 (7.8%) required re-exploration for bleeding. Emergency procedures were strongly associated with higher re-exploration (p<0.05). Non-surgical bleeding was the primary cause in 42.9% of cases. Independent risk factors included preoperative deranged LFTs (OR=2.1, 95% CI: 1.2-3.7), elevated creatinine (>1.5 mg/dL, OR= 3.2, 95% CI: 1.8-5.6), prolonged CPB time (>120 min), and substantial transfusion requirements. Modified Bentall's procedures had the highest re-exploration rate (21.4%). Re-explored patients experienced higher AKI rates (87.5%), longer hospitalizations (13.6 vs. 7.2 days, p<0.001), and increased in-hospital mortality confined to emergency cases (1.94%).
Conclusion: Emergency procedures had higher rate of re-exploration. Preoperative deranged LFTs, elevated creatinine, prolonged CPB time, and substantial transfusion requirements were independent risk factors for re-exploration. Re-explored cases experienced higher complication. In-hospital mortality were confined to emergency cases only.
Keywords: Bleeding; cardiac surgery; emergency surgery; modified Bentall’s procedure; re-exploration
Assertiveness of Nursing Professionals Working in a University Hospital of Nepal
(Institute of Medicine, 2023) Shrestha, Romina; Mishra, Tulashi Adhikari; Banstola, Ratna S; Joshi, Sarala
ABSTRACT
Introduction: To provide patients with appropriate treatment and foster therapeutic interactions, nurses must possess assertiveness. The study objective was to find out the assertiveness of nurses.
Methods: In this cross-sectional study, 272 nurses were recruited using a proportionate stratified random sampling at Tribhuvan University Teaching Hospital (TUTH), Nepal. Assertiveness was measured with a self-administered questionnaire, 30-item Simple Rathus Assertiveness Schedule. Data analysis was done in SPSS version 16. Independent Sample t-test, Pearson Chi-square test, Fisher’s Exact test, and odds ratio were used to examine the association.
Results: Among nurses, 192 (70.6%) were assertive with a mean assertiveness score of 18.1±14.7. There was a significant association of nurses’ assertiveness with their marital status (p = 0.02), nursing degree (p=0.03), professional designation (p=0.04), employment type (p= 0.03), and additional training (p=0.004). Nurses with bachelor-level nursing degrees were 1.8 times more assertive (95% CI = 1.05-3.07) than those nurses with certificate-level nursing degrees. Nursing officers were 2.1 times more assertive (95% CI = 1.02 – 4.2) than staff nurses. Further, permanently employed nurses were 2.63 times more assertive (95% CI = 1.35-5.12), and nurses who received additional training were 2.2 times more assertive (95% CI = 1.29-3.83).
Conclusion: More than two-thirds of nurses working in the university hospital were assertive. Nurses with bachelor-level nursing degrees, with professional designation as “nursing officers”, with permanent employment, and those who received additional training were more assertive. These things should be taken into consideration by the hospital administration to increase assertiveness among nurses.
Keywords: Assertiveness, nurses, university hospital