Journal Issue: Volume: 39, No. 1 (2017) April
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2017
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Mission of Institutional Review Board/ Ethical Review Committee
(Institute of Medicine, 2017) Sherchand, JB
NA.
Endothelial dysfunction in patients with coronary artery disease in tertiary level teaching hospital
(Institute of Medicine, 2017) Poudel, CM; Poudyal, RR; Sayami, A
Abstract
Introduction: Endothelial Dysfunction is a pathological condition characterized by reduction of bioavailability of vasodilators, in particular, nitric oxide whereas endothelium-derived contracting factors are increased resulting in an impairment of endothelium- dependent vasodilation. ED can be assessed by Brachial Artery Flow Mediated Dilatation (BAFMD). The study is to determine the prevalence of endothelial dysfunction in patients with coronary artery disease.
Methods: A total of 150 adult patients above 18 years both male and female diagnosed as CAD both stable and acute were enrolled. All patients were undergone ultrasound assessment of brachial artery diameter. Brachial artery flow mediated dilatation (BAFMD) was calculated as percentage increase in diameter from the baseline and after sphygmomanometer cuff inflation. BAFMD <10% was considered abnormal, signifying ED.
Results: Overall, the prevalence of ED determined by abnormal flow mediated dilatation of brachial artery (FMD<10%) in patients with CAD was found to be 66%. The prevalence of ED in patients with acute CAD and stable CAD was found to have 62.7% and 68.7% respectively. Eight risk factors analyzed were male sex, diabetes mellitus, hypertension, smoking, family history of CAD, age, hypercholesterolemia and low high density lipoprotein (HDL). When correlating the cardiovascular risk factors with ED, diabetes mellitus (p=0.031), smoking (p=0.026), and age >45yrs in male and >55yrs in female (p=0.013) was found to be statistically significant on univariate analysis by logistic regression. When undergoing multivariate analysis, age (p= 0.012) and smoking (p= 0 .024) were significantly associated with ED.
Conclusion: Overall the prevalence of ED in patients with CAD was found to be 66%. The prevalence of ED in patients with acute CAD and stable CAD was found to have 62.7% and 68.7% respectively.
Keywords: Endothelial dysfunction, Coronary artery disease Prevalence, Brachial artery flow mediated dilatation
A comparison of radiation dose in single and split bolus multidetector computed tomography urography
(Institute of Medicine, 2017) Joshi, BR; Jha, A
Abstract
Introduction: Routine multidetector computed tomography (MDCT) urography protocols include three phase scan with single bolus contrast material injection. To reduce the radiation dose a split bolus MDCT urography technique has been introduced.
Methods: Nephrographic phase in single bolus was obtained by injecting 90 ml of Ioversol (Optiray320mgI/ml) contrast at the rate of 3ml/s during the preset time of 90 second. The excretory phase was taken at the delay of 10 minutes after the contrast injection. For split bolus only two phases (unenhanced and combined) were scanned from the diaphragm to the base of the urinary bladder. The combined phase in split bolus was performed by injecting the contrast in two bolus in which 40 ml at 2ml/s was injected in the first bolus and after a delay of 9 minutes, 60 ml at a rate of 3ml/s was injected, then the scan was obtained 90 second after the second bolus. The volume CT dose index (CTDIvol) and CT dose length product (CTDLP) were assessed in CT work station.
Results: The mean effective radiation dose for single bolus MDCT urography was 40.5% more than the split bolus MDCT urography.
Conclusion: Split bolus MDCT urography protocol was significantly better in effective radiation dose reduction compared with the single bolus MDCT urography protocol.
Keywords: CTDIvol, DLP, MDCT urography, Radiation dose
Utility of Rapid Brilliant Cresyl Blue Stain in Routine Fine Needle Aspiration Cytology
(Institute of Medicine, 2017) Gurung, P; Hirachand, S; Thapa, R; Pradhanang, S; Kafle, N; Acharya, S; Sedhain, M
Abstract
Introduction: Rapid on-site evaluation is commonly performed by pathologists to check for cellular adequacy of fine needle aspirate smears to reduce hospital visits of patients and to make preliminary diagnosis. For rapid evaluation, laboratories use Romanowsky stain, Hematoxylin and Eosin stain, supravital stains and ultra-fast Papanicolaou stain. The aim of the study is to evaluate fine needle aspirate smears on-site for sample adequacy using supravital stain Brilliant Cresyl Blue (BCB), to make preliminary cytological diagnosis and to compare with the routine cytological Papanicolaou stain (Pap) and Giemsa stain.
Methods: The study was carried out in the Department of Pathology, Kathmandu Medical College Teaching Hospital from 1st December, 2014 to 31st December, 2015. A total of 115 cases referred from OPD for FNAC were included in the study. FNA was performed under aseptic conditions with a 23-guage needle. Samples were collected for routine stains (Papanicolaou and Giemsa stain) and one air-dried slide was stained with Brilliant Cresyl Blue and examined immediately while patient was in waiting room.
Results: Of the 115 cases, the age of patients ranged from 15 to 83 years in which male and female ratio was 1.5:1. There were 35 (30.4%) cases of enlarged lymph nodes, 28 (24%) cases of thyroid lesions, 20 (17.3%) cases of breast lesions, 7 (6%) cases of soft tissue lesion, 3 (3%) cases of salivary gland lesions, 1 (1%) case of lung mass, 1 (1%) case of epididymal swelling and others 20 (17.3%) cases. On rapid staining with brilliant cresyl blue, case sample adequacy was 104 (90%). Repeat aspiration was done in 11 (10%) of cases .Upon rapid staining, 92 (80%) of the cases were benign, 19 (17%) cases were malignant, 4 (3%) cases were inconclusive. After observation of papanicolaou and giemsa stains, there were 94 (82%) benign cases and 21 (18%) malignant cases.
Conclusion: On-spot Brilliant Cresyl Blue staining is a good stain to check for sample adequacy and to reduce reaspirations. It is as good as the conventional stains in exhibiting cytomorphology of cells.
Keywords: Brilliant Cresyl Blue, cytomorphology, fine needle aspiration cytology, Giemsa stain, Papanicolaou stain
Prevalence and types of corneal astigmatism in patients undergoing cataract surgery
(Institute of Medicine, 2017) Chaudhary, M; Dahal, HN
Abstract
Introduction: Cataract surgery is one of the most commonly performed ophthalmic surgical procedures worldwide, with a high rate of successful and rapid anatomical and functional visual recovery. Goal of cataract surgery is to achieve a desirable induction of refractive outcome with minimal astigmatism after surgery. This brings to interest the question of influence of preoperative and surgically induced corneal astigmatism on the final postoperative unaided visual acuity. Pre-existing corneal astigmatism is an important limiting factor for optimal results of cataract surgery in a significant number of patients. It has been estimated that 15% to 29% of patients with cataract have more than 1.50 dioptres (D) of pre-existing astigmatism.
Methods: Prospective study was carried out to investigate the prevalence and pattern of pre-existing corneal astigmatism in patients undergoing cataract surgery at B.P. Koirala Lions Center for Ophthalmic Studies, T.U. Teaching Hospital for a period of 2 years. All patients underwent complete ophthalmic examination including visual acuity, refraction, slit lamp examination, applanation tonometry and dilated fundus evaluation, biometry and ultrasound B-scan examination. Corneal astigmatism was measured by Keratometer at least two times for each patient. Astigmatism was calculated from dioptric difference between vertical reading and horizontal reading. With the rule (WTR) astigmatism was considered when steep meridian was at 900 ± 300. Against the rule (ATR) astigmatism was considered when steep meridian was at 1800 ± 300.
Results: Study included 225 eyes of 185 subjects, out of which 38.7% were male eyes and 61.3% were female eyes. The mean age of the subjects was 64.45±12.89 years. Mean amount of corneal astigmatism in our study was 0.84±0.80 D. 16.9% had no significant corneal astigmatism while 65.3% had corneal astigmatism between 0.25 and 1.50 diopter and 17.8% had corneal astigmatism of 1.50D or higher. With-the-rule astigmatism (axis of correcting cylinder 180±30 degrees) was present in 44.4% eyes, 40.04% of the eyes had against-the-rule (ATR) astigmatism (correcting minus cylinder 90±30 degrees), and 12.9% of the eyes had oblique astigmatism.
Conclusion: Approximately two thirds of pre-operative cataract patients had 1D or less astigmatism. Corneal astigmatism increases with age. Hence, it is important to analyze the magnitude and pattern of pre-existing corneal astigmatism in aging population due to higher demand for improved vision and use of suitable methods for best visual results.
Keywords: Cataract, corneal astigmatism, Keratometer, with the rule, against the rule