Journal Issue: Volume: 45. No. 1 (2023)
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2023
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ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
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Articles
Liver and Spleen Stiffness as Predictors of Esophageal Varices in Patients with Liver Cirrhosis
(Institute of Medicine, 2023) Jaishi, Shila; Pathak, Rahul; Bhandari, Brindeswari Kafle; Jha, Anurag; Hamal, Rabin; Koirala, Dinesh; Gyawali, Susmita
ABSTRACT
Introduction: The risk for the occurrence of esophageal varices in a cirrhotic patient is assessed by two gold standard invasive tests: hepatic venous pressure gradient measurement and esophagogastroduodenoscopy. We aim to find the association between spleen and liver stiffness with the occurrence of esophageal varices in our settings.
Methods:This was a prospective cross-sectional study. In the study duration of one year, 94 cirrhotic patients who met the inclusion and exclusion criteria were included. All patients were subjected to transient elastography for measuring liver and spleen stiffness and endoscopy.
Results: Of 94 patients, only 77 (81.9%) had esophageal varices. The mean liver stiffness in patients with and without varices was 19.46±4.9SD kPa and 12.92±1.52 SD kPa respectively. The difference was statistically significant, p<0.001. The mean spleen stiffness in patients with and without varices was 22.26±4.6 SD kPa and 14.08±1.20 SD kPa respectively. The difference was statistically significant, p<0.001. The optimal cut-off value of liver and spleen to detect patients with any grade of esophageal varices was 14 and 16.15 kPa respectively.
Conclusion: The stiffness of liver and spleen using transient elastography can be considered an equivalent method for screening cirrhotic patients for esophageal varices in clinical settings.
Keywords: Cirrhosis; esophageal varices; liver stiffness; spleen stiffness
Factors determining Outcomes in Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
(Institute of Medicine, 2023) Bam, Niraj; Sapkota, Dharmendra; Kuikel, Sandip
ABSTRACT
Introduction: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is frequently accompanied by increased local and systemic inflammation brought on by airway infection, pollution, or other airway insults. This study aimed to find the factors determining outcomes in patients hospitalized with acute exacerbation of COPD.
Methods: An analytical study among diagnosed cases of AECOPD was conducted. Bivariate regression model followed by Multinomial logistic regression (MNLR) was used to contrast outcome variables. A p-value less than 0.05 was considered statistically significant in all analyses.
Results: A total of 126 patients with a mean age of 72.04±9.75 years were included in the study. Most of the patients were current smokers or past smokers, cor-pulmonale was present in 34.9% of patients. The most common co-morbidity was hypertension (41.2%). Most (55.6%) patients had early discharge, 31.7% (40) patients had late discharge and 12.7% (16) patients had mortality as the outcome. After bivariate analysis, among all variables of the study qualified to be included in the multivariate MNLR model, Neutrophil Lymphocyte ratio (NLR) was found to be a significant predictor of late discharge in comparison with early discharge while Age and NLR were found to be a significant predictor of Mortality in comparison with late discharge among patients with AECOPD.
Conclusion: Older age and higher NLR predicted mortality in comparison to longer hospital stay (>5days). Since NLR is a common variable in both the outcome (early vs late discharge and late discharge vs mortality), NLR can be used to predict the outcome (early discharge, late discharge, and mortality) of patients with AECOPD.
Keywords: AECOPD; chronic obstructive pulmonary disease; factors; outcomes; predictors
Maternal and Perinatal Outcome in COVID-19: A Hospital based Descriptive Study
(Institute of Medicine, 2023) Maskey, Suvana; Rijal, Hima
ABSTRACT
Introduction: Since the declaration of the pandemic by World Health Organization (WHO), COVID-19 infection has affected worldwide including vulnerable pregnant women, who are at risk of increased maternal as well as neonatal morbidities and mortality. This study aimed to evaluate the prevalence of COVID-19 as well as maternal and perinatal outcomes in pregnancy with covid infection compared to pregnancy without infection.
Methods: This hospital-based descriptive study was conducted in Tribhuvan University Teaching Hospital Obstetrics Department. All pregnant women delivered after the third trimester, positive for COVID-19 during the study period, were compared with age-matched control without infection for maternal outcomes in terms of morbidities, mode of delivery, complications as well as neonatal outcomes such as birth weight, Apgar score, intrauterine fetal demise (IUFD), Neonatal Unit (NNU), Neonatal intensive care unit (NICU) admission and neonatal death. Data were analyzed using Stata 14.1.
Results: During the study period, total 59 women with COVID-19 infection (prevalence 2.23%) and 118 women without infection were included. Obstetric complications were seen significantly more in study group than control group (13.55% vs 3.38%; p-value 0.01). Cesarean section and intensive care unit admission were also significantly more in study group than control group (81.35% vs 51.7%; p-value <0.001, 22.03% vs 0.85%, p-value <0.001). Women with COVID-19 infection had significantly more hospital stay than control group (p-value 0.005). but no significant difference was observed in the neonatal outcome.
Conclusion: Pregnancy with COVID-19 infection is associated with adverse obstetric complications, lower uterine segment Cesarean section and NICU admission but not with adverse neonatal outcomes compared to women without COVID-19 infection.
Keywords: COVID-19; maternal outcome; perinatal outcome
Lived Experience of Breast Cancer Survivors: A Phenomenological Study
(Institute of Medicine, 2023) Lawot, Isabel; Gharti, Kamala; Singh, Shreejana; Sharma, Mohan R
ABSTRACT
Introduction: Breast cancer (BrCa) is the most common cancer in women worldwide. The population who survive breast cancer is increasing; even so, they usually have to go through many problems in their life. Except for the diseased part, numerous socio-cultural factors may pose challenges for the survivors. Hence, the aim of this study was to explore the experiences of cancer survivors.
Methods: A phenomenological qualitative design reseach was performed with eight BrCa survivors in Kaski district of Nepal. Data were collected through semi-structured in-depth interviews and analyzed using Colaizzi’s descriptive phenomenological method.
Results: Two major themes were extracted from the in-depth interviews. One was the reaction to the diagnosis and another was fear of disease. Most participants lacked awareness of their cancer diagnosis, and nearly all of them experienced fear that persisted until death. They faced a multitude of physical issues throughout the treatment phase and subsequent years, including headaches, loss of appetite, anemia, gastritis, body pain, and swollen extremities. Additionally, they grappled with psychological challenges such as anxiety and depression, rendering them more susceptible. Financially, due to the exorbitant costs of treatment, they had to resort to borrowing money from others, with the burden primarily falling upon their families
Conclusion: Most of the participants had fear regarding illness, treatments, recurrence, and death. Patients were worried about the cost of care. Therefore, it is imperative for family members and healthcare professionals to recognize the experiences of breast cancer survivors in order to optimize patient health during critical stages.
Keywords: Breast cancer; fear; phenomenology