Journal Issue: Volume: 25, No. 4 (2023)
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Volume
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Issue Date
2023
Journal Title
Journal ISSN
Online ISSN: 2676-1424; Print ISSN: 2676-1319
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Articles
Prevalence of fungal infection in clinically suspected cases of pulmonary tuberculosis visiting a tertiary care hospital
(Nepal Medical College Pvt. Ltd., 2023) Shrestha, Rajani; Nayak, Niranjan; Bhatt, Dharma Raj; Hamal, Deependra; Gokhale, Shishir
Abstract:
Pulmonary tuberculosis is the most important health concerns. Some fungi may acquire pathogenic potential in immunocompromised persons due to underlying diseases, use of prolonged antibiotics, chronic disease and malignancy. The presence of fungal pathogens in cases of pulmonary TB adds to the chronicity of the disease and being difficult to treat. This study aimed to evaluate tuberculosis (TB) status and coinfection of TB with pulmonary fungal infections. A total of 330 sputum samples were collected from suspected pulmonary TB and were examined using Ziehl-Neelsen (Z-N) staining method as per revised national tuberculosis control program (RNTCP) guidelines and GeneXpert assay procedure adopted, was in accordance with the WHO recommended guidelines. Those sputum samples were also processed for fungal culture. In case of any growth, this was identified by gram staining or by lactophenol cotton blue wet mount preparation and slide culture technique, if needed. A total of 29 (8.8%) samples out of 330 yielded tuberculosis by GeneXpert assay. Maximum positivity was noted among age group 31- 45 years (15.5%). In the present study, GeneXpert positivity for the Mycobacterium tuberculoris (MTB) detected rate remained to be 8.8% (29/330) detected as against smear positivity in only 5.4% (18/330) (P value: 0.001). Out of 18, Z-N smear positive samples, maximum i.e. 17, which had yielded either high or medium detected of TB bacilli in the GeneXpert assay. Whereas, out the rest 12 GeneXpert positive (low and very low) samples, only one sample showed acid fast bacilli in the smear. A significant correlation was found between GeneXpert and smear positivity (p<0.001). Overall, 90 (27.7%) Candida spp. were isolated. Interestingly, 7 of these 90 Candida positive samples were found to positive to MTB by GeneXpert test, accounting a prevalence rate of 24.1% (7/29) of Candida coinfection among TB cases. Tuberculosis remains a global threat despite effort to eradicate the disease and TB co-infection with Candida spp. may complicate infection and treatment. In this present study, although the prevalence rates of all the coinfections were low and statistically not significant. Being chronic in nature and with confusing clinical and radiological findings, these fungal infections are misdiagnosed as reactivation of tuberculosis. Screening for TB should be conducted to diagnose early and treat these opportunistic infections and decrease mortality and morbidity rates associated with fungal coinfection in tuberculosis patients.
Comorbid diabetes and hypertension: gender differences in prevalence and risk factors among adults (≥18 years) in an urban community in Kathmandu District in Nepal
(Nepal Medical College Pvt. Ltd., 2023) Silvanus, Vinutha; Dhakal, Nishchal; Shrestha, Niraj; Kafle, Phanindra Prasad
Abstract:
Chronic diseases such as diabetes and hypertension are often influenced by biological, behavioural, environmental and social factors in women and men. This study aimed to identify the gender differences in prevalence and risk factors of comorbid diabetes and hypertension (CM) among adults aged 18 years and above in an urban community in Kathmandu, Nepal. A community-based cross-sectional analytical study was carried out in Gokarneshwor Ward 1, 2 and 3 among adults aged 18 years and above from September 2020- May 2023. Diabetes (DM) was defined as persons previously diagnosed by a physician and/or on anti-diabetic medication. Hypertension (HTN) was defined as a systolic blood pressure (SBP) of ≥140 mm Hg or a diastolic blood pressure (DBP) of ≥90 mm Hg or those who were diagnosed by a physician and/or receiving antihypertensive medication. Comorbidity (CM) was defined as persons with diabetes and hypertension. Information regarding socio-demographic data, behavioural and biological risk factors, anthropometric assessment and morbidity were obtained from adults aged 18 years and above using a Family study proforma. Multinomial logistic regression analyses with the referent category being persons with no diabetes or hypertension (NDH) were performed for three categories HTN vs NDH, DM vs NDH and CM vs NDH. Among 1538 adults with 776 women, overall prevalence of comorbidity was 5.3% (95% CI: 4.3 – 6.5); among men 6.1% and 5.5% among women. After adjusting for age, for both women and men, being currently married, alcohol use, family history of diabetes and generalized obesity were associated with comorbidity. However, these associations were more robust for men. Moreover, measures of central obesity were associated with comorbidity for men alone. Though alcohol use was higher among men, the association with comorbidity was more robust for women. Paradoxically, lower educational status among women and higher education among men were associated with higher odds of comorbidity. In conclusion, prevalence of comorbid diabetes and hypertension may differ marginally among men and women. Though comorbidity rates appear to be lower in Nepal in comparison to other countries in South Asia, the rising burden emphasizes the need for tailored public health interventions that address modifiable risk factors among men and women. Further research may help to elucidate the role of gender on cardiovascular risk and hard outcomes such as cardiovascular events and mortality among persons with comorbid diabetes and hypertension.
Hospital admissions and the financial cost incurred by the elderly patients at a tertiary care centre in Gokarneshwor Municipality, Kathmandu, Nepal
(Nepal Medical College Pvt. Ltd., 2023) Shrestha, Niraj; Paudel, Leepy; Baral, Prakriti
Abstract:
Population ageing is a global phenomenon and proportion of elderly people is also increasing in Nepal. However, the increased burden of chronic disease as a result of population ageing, along with medical cost incurred during hospital stay is yet to be explored in Nepal. With the aim of studying these, data of 527 patients 70 years of age and above admitted to Nepal Medical College Teaching hospital, the largest tertiary care center in Gokarneshwor Municipality, was collected from November 2021 to November 2022 and analyzed. Seventy-four percent of the patients were of 70-80 years of age and male: female ratio was almost equal to 1:1. The most common cause of admission was respiratory problems. The cost was not more than Nepali rupees 19,200 for 82% of the patients and the duration of stay was less than 6 days for 75% of the patients. No significant association was found between duration of hospital stay and the age group or the gender. Similarly, no significant association was found between the medical cost incurred during hospital stay and the age group. However, association was found between the hospital cost and gender with males more likely to have higher cost.
Study on item analysis of multiple – choice questions amongst the undergraduate dental students
(Nepal Medical College Pvt. Ltd., 2023) Acharya, Sulav; Bhandari, Sabin; Bhandari, Sushmita
Abstract:
Assessments are powerful tools for bringing on the achievement of educational goals and one of the tools for bringing it rightly is “item analysis.” Multiple - Choice Questions (MCQs) are one of the most common methods of assessing the knowledge capabilities of undergraduate and postgraduate medical students. The main objective of this study was to analyze the quality of MCQs and to assess the relationships of items having good difficulty and discrimination indices with their distracter efficiency. After getting an ethical approval from Institutional Review Committee of Nepal Medical College Teaching Hospital a cross – sectional study was conducted over a period of one year from January 2022 to December 2022 in the Department of Human Anatomy of Nepal Medical College. The difficulty index (DIF I), discrimination index (DI) and distracter efficiency (DE) were calculated and analyzed. The results obtained revealed that the mean and standard deviation of DIF I, DI and DE were 56.75±22.6, 0.3±0.2 and 43.24±25.66 respectively. The items analyzed were neither too easy and nor too difficult (DIF I = 62.8%). The majority of items fulfilled the criteria of acceptable difficulty and good discrimination index and the maximum number of items were found to have 2 NFDs (DE = 33.33 %). The present study was hence undertaken as it assists to evaluate the MCQ items to discern its effectiveness in assessing the knowledge of students as well as it plays a vital role in developing a question bank having valid MCQs.
Screening for cognitive impairment and dementia among elderly persons attending a tertiary hospital
(Nepal Medical College Pvt. Ltd., 2023) Pandey, Srijana; Pandey, Srijana; Lama, Ishwori
Abstract:
Cognitive impairment is debilitating condition for elderly in their activities of daily living which can cause problem to self, others and society. Therefore, the researcher aims to screen the cognitive impairment among the elderly population at Tertiary Hospital. Cross sectional, descriptive and exploratory design with Purposive sampling technique was used among elderly population at OPD of Tertiary hospital. Mini-mental status examination, activities of daily living, instrumental activities of daily living were used for screening cognitive impairment and dementia. The interview dates were set up for 15 days. Sampling procedure included quota of 20 cases per day and thus, the sample was 300 elderly. Total sample after four persons denied to participate was 296. The mean age of elderly respondents were 71.58 (±5.09). The study revealed that there was no cognitive impairment among 67.6%, mild cognitive impairment among 25.7% and moderate cognitive impairment among 6.8%. The activities of daily living in majority of respondents were 95.3% in full function and least 1% were in severe functional impairment. Instrumental activities of daily living indicated that three-fourths of the respondents 76.7% had high function, 16.2% needed assistance and 7.1% had low function. Age, living with status is significantly associated with cognitive impairment. Screening of cognitive impairment is necessary to identify the impairment among elderly which enhances the awareness of cognitive impairment.