Journal Issue: Volume: 22, No 4, Issue 88 (OCTOBER - DECEMBER) 2024
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Volume
Number
Issue Date
2024
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
Addressing Pediatric Hearing Impairment in Nepal: A Critical Public Health Concern
(Kathmandu University, 2024) Shrestha, BL
NA
Comparison of Ultrasonography with Computed Tomography in Diagnosis and Staging of Lung Cancer
(Kathmandu University, 2024) Paudel, S; Kayastha, P; Suwal, S; Nepal, B; Bhusal, KR; Bhusal, KR; Katwal, S; Regmi, PR
ABSTRACT
Background
Ultrasound (US) can aid in lung cancer diagnosis and staging in peripheral-based
lesions by demonstrating chest wall invasion, aiding as a guide to biopsy, and detecting
supraclavicular lymph nodes which are often missed by computed tomography (CT).
Objective
This study is to compare the ultrasound with computed tomography in the diagnosis
and staging of lung cancer.
Method
This was an observational prospective study conducted from October 2020 to April
2023 in patients with or suspected lung cancer sent for imaging assessment to the
Department of Radiology and Imaging. Out of 306 patients who underwent computed
tomography scan, a total of 234 patients with proven lung cancer were subjected
to ultrasound of the chest, liver, bilateral adrenal, and supraclavicular regions for
the evaluation of lung mass, pleural effusion, and metastasis in lung, adrenal, and
supraclavicular lymph nodes. Diagnostic values of ultrasound to detect peripheral
lung lesions, chest wall invasion, pleural effusion, liver and adrenal metastasis, and
supraclavicular lymph nodes were compared with contrast-enhanced computed
tomography scans. Ultrasound’s performance was evaluated against computed
tomography scans as the gold standard, using the chi-square test, z-test, and area
under the curve for comparison (p < 0.05 for significance).
Result
The majority of patients (53.8%, n=126) were aged 61-75, with 53% being male
and 89% smokers. Ultrasound was superior in detecting pleural effusion (sensitivity
80.3%, NPV 92.2%, AUC 0.860) and supraclavicular lymph nodes (sensitivity 72.2%,
NPV 91.6%, AUC 0.817).
Conclusion
In resource-constrained settings like Nepal, where advanced imaging may be limited,
integrating ultrasound with contrast-enhanced computed tomography significantly
improves lung cancer diagnosis. This non-radiation approach is particularly beneficial
for peripheral lesions, patients with renal function impairment and aiding effective
staging of lung cancer.
KEY WORDS
Computed tomography, Lung cancer, Role, Ultrasound
Platelet Count-to-platelet Distribution Width Ratio and other Platelet Indices as Cost-effective Markers of Preeclampsia: a case control study
(Kathmandu University, 2024) Bashyal, R; Singh, A; Maharjan, S; Tuladhar, S; Bhattarai, B; Sharma, PK
ABSTRACT
Background
Platelet indices, like platelet count (PC), plateletcrite, mean platelet volume (MPV)
and platelet distribution width (PDW), and their ratios have shown to be cost-
effective and better predictors of preeclampsia (PE). However, platelet count/platelet
distribution width ratio was not studied.
Objective
To compare platelet indices and their ratios between pregnant women with and
without predictors of preeclampsia.
Method
An analytical, comparative, case-control study. Two groups were compared; pregnant
women with preeclampsia (case, n=24) and without preeclampsia (control, n=72).
Multivariable linear regression analysis for hematological parameters was performed
to assess the effect of gestational age. Logistic regression was performed to calculate
odds ratio. Receiver operating characteristic curve was used to determine sensitivity,
specificity and cutoff values. P < 0.05 was considered significant.
Result
There was statistically significant reduction in values of platelet count, plateletcrit,
platelet count/mean platelet volume, and platelet count/platelet distribution width
among the pregnant women with preeclampsia compared to control group, while
significant increase was noticed in platelet distribution width and mean platelet
volume. platelet count/platelet distribution width had the highest area under the
curve (AUC) of 0.767, followed by platelet distribution width (AUC=0.752). At the
cutoff of 15.1 (p<0.001) for platelet count/platelet distribution width, sensitivity
was 70.8%, and specificity was 81.9%. The odds of diagnosing true positive cases of
preeclampsia was 11.02 (95% CI =3.79-31.99, p=<0.001) times higher compared to
values below it at this cutoff.
Conclusion
Platelet indices are economical tests that can act as indicators of risk of preeclampsia.
Among these, platelet count/platelet distribution width has the highest sensitivity
and specificity in the detection of preeclampsia at the cutoff of 15.1 and has emerged
as better predictor of preeclampsia.
KEY WORDS
Platelet count, Platelet distribution width, Platelet indices, Preeclampsia
Outcome of Transurethral Vaporisation of Prostate in Small Volume Prostate: A prospective observational study
(Kathmandu University, 2024) Dahal, R; Adhikari, B; Mishra, U; Shah, AK; Basnet, RB; Shrestha, A; Shrestha, PM
ABSTRACT
Background
Benign Enlargement of Prostate is common in aging men. Transurethral vaporisation
of prostate is one modality of minimal invasive management of benign enlargement
of prostate. This study assesses the efficacy and safety of transurethral vaporisation
of prostate in small volume prostate.
Objective
To assess the efficacy and safety of bipolar plasma vaporisation of small volume
prostate (Prostate Volume less than 40 grams).
Method
A total of 40 patients with prostate volume less than 40 grams and indications for
operative management of benign enlargement of prostate were included. Patients
with prior prostate surgery, urethral stricture surgery, presence of vesical calculus,
urethral stricture and neurogenic bladder were excluded. Preoperative prostate
size was assessed by transrectal ultrasonography. Comparison of preoperative and
postoperative hemoglobin, sodium, international prostate symptom score and
maximum flow rate was done. Perioperative complications were documented.
Result
The mean age of patients was 66.88 ± 9.09 years and the mean size of prostate was
32.52 ± 4.66 grams. Significant improvement in IPSS (preoperative 22, postoperative
9) and Qmax (preoperative 8.4 ml/min, postoperative 18.5 ml/min) was noted.
There was significant drop in hemoglobin (p < 0.001) but no patients required
blood transfusion. There was significant drop in sodium (p < 0.001) but no patients
developed transurethral resection syndrome. Most complications were Clavien
grade I. Two patients required recatheterization and all were catheter free on follow
up. Two patients developed urethral stricture.
Conclusion
Bipolar transurethral vaporisation of Prostate is effective and safe treatment option
for prostate volume less than 40 grams.
KEY WORDS
Bipolar plasma vaporisation, Lower urinary tract symptoms, Prostate symptoms
Prevalence and Severity of Gingival Enlargement Among Antihypertensive Drug Users: A cross-sectional study
(Kathmandu University, 2024) Kafle, S; Shrestha, E; Dhital, BM
ABSTRACT
Background
Drug-induced gingival enlargement is a well-known consequence of the administration
of some antihypertensive drugs, including angiotensin-converting enzyme inhibitors,
beta-blockers, and calcium channel blockers.
Objective
To determine the prevalence and severity of antihypertensive drug-induced gingival
enlargement and to assess the probable risk factors associated with gingival
enlargement.
Method
A hospital-based cross-sectional study was conducted in patients attending the
Outpatient Department of Periodontology and Oral Implantology, Chitwan Medical
College and Teaching Hospital, Bharatpur, Chitwan, Nepal, from July 2023 to May
2024. A total of 246 patients of both genders taking antihypertensive medications for
a variable period and meeting all inclusion criteria were selected for the presence of
gingival enlargement and classified by severity. Descriptive analysis was performed in
the Statistical Package for the Social Sciences (SPSS, v.23.0.) using the chi-square test.
Result
A total of 210 (85.36%) subjects taking antihypertensive drugs appeared to have
gingival enlargement. Among them, 86 (40.95%), 69 (32.86%) and 55 (26.19%) were
taking calcium channel blockers, β-blockers and angiotensin-converting enzyme
inhibitors, respectively. Regarding its severity, a marked severity was observed in
patients taking calcium channel blockers followed by angiotensin converting enzyme
inhibitors and beta-blockers accounting for 51 (56.0%), 19 (29.7%) and 13 (14.3%),
respectively.
Conclusion
Patients taking antihypertensive medications are at high risk for gingival enlargement,
and inflammation is considered an important cofactor for the expression of this
effect.
KEY WORDS
Antihypertensive drugs, Drug-induced gingival enlargement, Prevalence, Severity