BACKGROUND: Organophosphorus (OP) are frequently used as pesticides and the most common agents of poisoning in developing countries including Nepal. There is paucity of data about characteristics of organophosphorus poisoning in our localities. Therefore, we aimed to evaluate its clinical pattern and factors affecting outcome. METHODS: It was a cross-sectional study conducted in Bheri Hospital Nepalgunj between 15th July 2019 to 14th July 2020. The hospital records of patients of acute organophosphorus poisonings were collected. Data regarding age, gender, predisposing factors, duration of hospitalization and outcome of the patients were recorded. Data was analyzed using SPSS 20. RESULTS: A total of 53 patients out of which 22(41.5%) were male and 31(58.49%) were female with F:M ratio of 1.40: 1. The maximum number of the patients 25(47.16%) were in the age group of 20 to 40 years. Incidence of poisoning was more common in married patients 36(67.92%) The suicidal motive for poisoning was found in 49 cases (92.45%). The most commonly used organophosphorus poison was Dichlorvos 32(60.34%) followed by methyl parathion 14(26.41%). Domestic quarrel was the most common predisposing factor 32(60.37%). 45(84.90%) of the patients were discharged after successful treatment while there was mortality of 3 patients (5.66%). CONCLUSIONS: Organophosphorus poisoning is a common mode of suicidal attempts leading to morbidity and mortality every year. Strict policies against the free availability and sale of insecticides is required to control organophosphorus poisoning. Mental health education programme should be conducted for the prevention of suicide and poisoning.
{"title":"Pattern and Outcome of Organophosphorus Poisoning Cases in Bheri Hospital, Nepal","authors":"R. Mandal, Nirmal Shakya, Sanket Kumar Risal","doi":"10.3126/nmmj.v2i2.41280","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41280","url":null,"abstract":"BACKGROUND: Organophosphorus (OP) are frequently used as pesticides and the most common agents of poisoning in developing countries including Nepal. There is paucity of data about characteristics of organophosphorus poisoning in our localities. Therefore, we aimed to evaluate its clinical pattern and factors affecting outcome. \u0000METHODS: It was a cross-sectional study conducted in Bheri Hospital Nepalgunj between 15th July 2019 to 14th July 2020. The hospital records of patients of acute organophosphorus poisonings were collected. Data regarding age, gender, predisposing factors, duration of hospitalization and outcome of the patients were recorded. Data was analyzed using SPSS 20. \u0000RESULTS: A total of 53 patients out of which 22(41.5%) were male and 31(58.49%) were female with F:M ratio of 1.40: 1. The maximum number of the patients 25(47.16%) were in the age group of 20 to 40 years. Incidence of poisoning was more common in married patients 36(67.92%) The suicidal motive for poisoning was found in 49 cases (92.45%). The most commonly used organophosphorus poison was Dichlorvos 32(60.34%) followed by methyl parathion 14(26.41%). Domestic quarrel was the most common predisposing factor 32(60.37%). 45(84.90%) of the patients were discharged after successful treatment while there was mortality of 3 patients (5.66%). \u0000CONCLUSIONS: Organophosphorus poisoning is a common mode of suicidal attempts leading to morbidity and mortality every year. Strict policies against the free availability and sale of insecticides is required to control organophosphorus poisoning. Mental health education programme should be conducted for the prevention of suicide and poisoning.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121281734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Kayastha, Shahjan Raj Giri, Bibek Gurung, O. Panta
INTRODUCTION: Fetal biometry is an important component of fetal growth surveillance and can detect small for gestation age fetuses. However, we use growth curves from studies done in other high-income countries and do not have a standard of our own. This study aims to study the deviation of biometry and expected fetal weight from these curves in pregnancy with normal birth weight term deliveries. METHODS: The study was a retrospective hospital record-based study including term delivery from 2018 May to 2020 January. All lowrisk patients visiting ultrasound OPD in our hospital in 3rd trimester were retrieved and included in the study. Patient with low AFI, major fetal anomaly, abnormal fetal heart rate, preterm delivery, birth weight less than 2500 gm (low birth weight), intrauterine fetal demise, preeclampsia or other complications were excluded from the study. Fetal biometry and expected fetal weight were evaluated. Data was entered in predesigned performa and analysis was performed with IBM SPSS 20.0. RESULTS: A total of 590 ultrasound examinations done in 372 patients were included in the study. Mean age of the patients was 30.78+/-3.98 years, median age was 30 years (IQ range-5). Approximately 316(53.6%) patients were under 30 years of age, 198(33.6%) patients were between 30-35 and 76(12.9%) patients were above 35 years. Median gestational age at birth was 39 weeks and median birth weight was 3120 grams. Median and percentile for various biometry was calculated. EFW was below 50th percentile in 424(71.9%) according to WHO chart. The median percentile for EFW was 30.6 (IQ-33.6). CONCLUSION: Expected fetal weight in Nepalese population is smaller than that predicted by WHO chart. Development of country specific fetal growth curve is recommended for accurate fetal growth surveillance.
{"title":"Ultrasound fetal biometry in third trimester in urban Nepalese population","authors":"B. Kayastha, Shahjan Raj Giri, Bibek Gurung, O. Panta","doi":"10.3126/nmmj.v2i2.41274","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41274","url":null,"abstract":"INTRODUCTION: Fetal biometry is an important component of fetal growth surveillance and can detect small for gestation age fetuses. However, we use growth curves from studies done in other high-income countries and do not have a standard of our own. This study aims to study the deviation of biometry and expected fetal weight from these curves in pregnancy with normal birth weight term deliveries. \u0000METHODS: The study was a retrospective hospital record-based study including term delivery from 2018 May to 2020 January. All lowrisk patients visiting ultrasound OPD in our hospital in 3rd trimester were retrieved and included in the study. Patient with low AFI, major fetal anomaly, abnormal fetal heart rate, preterm delivery, birth weight less than 2500 gm (low birth weight), intrauterine fetal demise, preeclampsia or other complications were excluded from the study. Fetal biometry and expected fetal weight were evaluated. Data was entered in predesigned performa and analysis was performed with IBM SPSS 20.0. \u0000RESULTS: A total of 590 ultrasound examinations done in 372 patients were included in the study. Mean age of the patients was 30.78+/-3.98 years, median age was 30 years (IQ range-5). Approximately 316(53.6%) patients were under 30 years of age, 198(33.6%) patients were between 30-35 and 76(12.9%) patients were above 35 years. Median gestational age at birth was 39 weeks and median birth weight was 3120 grams. Median and percentile for various biometry was calculated. EFW was below 50th percentile in 424(71.9%) according to WHO chart. The median percentile for EFW was 30.6 (IQ-33.6). \u0000CONCLUSION: Expected fetal weight in Nepalese population is smaller than that predicted by WHO chart. Development of country specific fetal growth curve is recommended for accurate fetal growth surveillance. ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125319821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Sharma, S. Aryal, R. Shrestha, A. Deo, R. Pathak
We report a rare case of multiple meningiomas in a 74 year old female who was brought to the hospital with spastic paraparesis and MRI of spine and brain revealed multiple enhancing meningiomas in brain and spines. The spinal intradural extramedullary (IDEM) meningioma at C7-D1 level was excised which had caused paraparesis and postoperatively patient became symptom free. We will discuss about the incidence, symptomatology, investigations and management of multiple meningiomas in different neuroaxial compartments at the same period of time and will review the literature.
{"title":"Multiple meningiomas in different neuroaxial locations: report of a rare case","authors":"G. Sharma, S. Aryal, R. Shrestha, A. Deo, R. Pathak","doi":"10.3126/nmmj.v2i2.41284","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41284","url":null,"abstract":"We report a rare case of multiple meningiomas in a 74 year old female who was brought to the hospital with spastic paraparesis and MRI of spine and brain revealed multiple enhancing meningiomas in brain and spines. The spinal intradural extramedullary (IDEM) meningioma at C7-D1 level was excised which had caused paraparesis and postoperatively patient became symptom free. We will discuss about the incidence, symptomatology, investigations and management of multiple meningiomas in different neuroaxial compartments at the same period of time and will review the literature.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121783156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Mahaseth, B. Nepal, B. Karki, J. Ghimire, N. Pandey, P. Shah, P. Karki
BACKGROUND: Lead avR is a valuable but mostly ignored lead in clinical electrocardiography. Recently, ST-segment depression in lead aVR during an inferior wall myocardial infarction has been suggested as a predictor of LCX artery involvement. METHODS: This study was a single centre cross sectional observational study done in BPKIHS, Dharan from February 2018 to January 2020. Patients presenting to the OPD or emergency room of BPKIHS diagnosed as acute inferior wall myocardial infarction based on clinical symptoms, ECG and/or Cardiac tropinin I levels, and planned for coronary angiography, meeting the inclusion and exclusion criterias were included. RESULTS: Among 134 cases, male:female ratio was 1.3:1. Overall, 38 patients (28.4%) were found to have aVR depression and 96 patients (71.6%) were without aVR depression. The culprit artery was found to be the right coronary artery in 95 patients (70.9%), the LCx in 39 patients (29.1%). The sensitivity and specificity of ST-segment depression in lead aVR for LCx as the culprit artery were 92.3% and 97.9% respectively. Positive predictive and Negative predictive value for LCx as the culprit arteries were 94.74% and 96.87%. The sensitivity, specificity, positive predictive value and negative predictive value for RCA as the culprit artery were 97.89%, 92.3%, 96.89% and 94.73% respectively. CONCLUSION: Significant ST depression in aVR is associated with a higher specificity and good sensitivity for LCX lesions, the ST changes in this lead should be carefully examined in all patients who are suspected of having inferior wall myocardial infarction.
{"title":"A Study of the ST Changes in the aVR Lead on 12-Lead ECG to Identify Infarct - Related Artery (IRA) in Patients With Acute Inferior Wall Myocardial Infarction","authors":"A. Mahaseth, B. Nepal, B. Karki, J. Ghimire, N. Pandey, P. Shah, P. Karki","doi":"10.3126/nmmj.v2i2.41273","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41273","url":null,"abstract":"BACKGROUND: Lead avR is a valuable but mostly ignored lead in clinical electrocardiography. Recently, ST-segment depression in lead aVR during an inferior wall myocardial infarction has been suggested as a predictor of LCX artery involvement. \u0000METHODS: This study was a single centre cross sectional observational study done in BPKIHS, Dharan from February 2018 to January 2020. Patients presenting to the OPD or emergency room of BPKIHS diagnosed as acute inferior wall myocardial infarction based on clinical symptoms, ECG and/or Cardiac tropinin I levels, and planned for coronary angiography, meeting the inclusion and exclusion criterias were included. \u0000RESULTS: Among 134 cases, male:female ratio was 1.3:1. Overall, 38 patients (28.4%) were found to have aVR depression and 96 patients (71.6%) were without aVR depression. The culprit artery was found to be the right coronary artery in 95 patients (70.9%), the LCx in 39 patients (29.1%). The sensitivity and specificity of ST-segment depression in lead aVR for LCx as the culprit artery were 92.3% and 97.9% respectively. Positive predictive and Negative predictive value for LCx as the culprit arteries were 94.74% and 96.87%. The sensitivity, specificity, positive predictive value and negative predictive value for RCA as the culprit artery were 97.89%, 92.3%, 96.89% and 94.73% respectively. \u0000CONCLUSION: Significant ST depression in aVR is associated with a higher specificity and good sensitivity for LCX lesions, the ST changes in this lead should be carefully examined in all patients who are suspected of having inferior wall myocardial infarction.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117034042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Gyawali, A. Shrestha, P. Sharma, B. Shrestha, S. Bhattarai
BACKGROUND: Acute pancreatitis (AP) is a common cause of acute pain abdomen. Contrast-enhanced Computed Tomography (CECT) of the abdomen is the imaging method of choice in acute pancreatitis. Ultrasonography can be used as the first, easily available imaging modality for the assessment of the pancreas. This study aims to study the transabdominal USG findings in patients with acute pancreatitis. It will also compare USG findings with CT findings in acute pancreatitis. METHODS: A hospital-based cross-sectional, prospective study comprising of consecutive 55 patients with acute pancreatitis was conducted over a study period of 15 months. Trans abdominal USG findings and CECT abdominal findings in acute pancreatitis were studied and compared. Data analysis was done using SPSS version 20 and a p-value of ≤0.05 was considered significant. RESULTS: Pancreas was visualized by USG in only 69%. Ultrasonography had some pancreatic and/or extrapancreatic findings in patients with acute pancreatitis in 84.2% of patients in whom the pancreas was visualized, whereas, it was 98.2% by CECT abdomen. USG was unable to demonstrate findings in 75% of patients with mild acute pancreatitis. CONCLUSION: Transabdominal ultrasonography detection of pancreatitis was inferior to the CECT. It had a limited role in detecting mild acute pancreatic cases. Nonetheless, detection of etiological factor such as gallstones, and assessment of extra pancreatic fluid collection like ascites and pleural effusion were better visualised with ultrasound. USG is readily available, cheap, noninvasive, and can be utilized as an initial diagnostic tool for acute pancreatitis and ruling out other causes of acute abdomen.
背景:急性胰腺炎(AP)是引起急性腹痛的常见原因。腹部对比增强计算机断层扫描(CECT)是急性胰腺炎的首选成像方法。超声检查可以作为评估胰腺的第一种、容易获得的成像方式。本研究旨在探讨急性胰腺炎患者经腹超声心动图的表现。它还将比较急性胰腺炎的USG表现和CT表现。方法:一项基于医院的横断面前瞻性研究，包括连续55例急性胰腺炎患者，研究时间为15个月。研究并比较急性胰腺炎的经腹USG表现和CECT表现。数据分析采用SPSS version 20, p值≤0.05为显著性。结果:胰腺超声显像率仅为69%。84.2%的急性胰腺炎患者在超声检查中发现胰腺和/或胰腺外，而CECT腹部检查的这一比例为98.2%。USG无法证实75%的轻度急性胰腺炎患者的发现。结论:经腹超声对胰腺炎的诊断效果优于CECT。它在检测轻度急性胰腺病例中的作用有限。尽管如此，超声检查可以更好地发现病因，如胆结石，以及评估额外的胰液收集，如腹水和胸腔积液。USG很容易获得，便宜，无创，可以作为急性胰腺炎的初步诊断工具，并排除其他原因的急腹症。
{"title":"Trans abdominal Ultrasonography in Acute Pancreatitis: a cross sectional study","authors":"M. Gyawali, A. Shrestha, P. Sharma, B. Shrestha, S. Bhattarai","doi":"10.3126/nmmj.v2i2.41278","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41278","url":null,"abstract":"BACKGROUND: Acute pancreatitis (AP) is a common cause of acute pain abdomen. Contrast-enhanced Computed Tomography (CECT) of the abdomen is the imaging method of choice in acute pancreatitis. Ultrasonography can be used as the first, easily available imaging modality for the assessment of the pancreas. This study aims to study the transabdominal USG findings in patients with acute pancreatitis. It will also compare USG findings with CT findings in acute pancreatitis. \u0000METHODS: A hospital-based cross-sectional, prospective study comprising of consecutive 55 patients with acute pancreatitis was conducted over a study period of 15 months. Trans abdominal USG findings and CECT abdominal findings in acute pancreatitis were studied and compared. Data analysis was done using SPSS version 20 and a p-value of ≤0.05 was considered significant. \u0000RESULTS: Pancreas was visualized by USG in only 69%. Ultrasonography had some pancreatic and/or extrapancreatic findings in patients with acute pancreatitis in 84.2% of patients in whom the pancreas was visualized, whereas, it was 98.2% by CECT abdomen. USG was unable to demonstrate findings in 75% of patients with mild acute pancreatitis. \u0000CONCLUSION: Transabdominal ultrasonography detection of pancreatitis was inferior to the CECT. It had a limited role in detecting mild acute pancreatic cases. Nonetheless, detection of etiological factor such as gallstones, and assessment of extra pancreatic fluid collection like ascites and pleural effusion were better visualised with ultrasound. USG is readily available, cheap, noninvasive, and can be utilized as an initial diagnostic tool for acute pancreatitis and ruling out other causes of acute abdomen.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124025104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Malla, S. Singh, Brajesh Raj Chaudhary, Nabal Kishore Ray, Shivani Singh
BACKGROUND: Urinary Tract infections [UTI] often presents with fever and nonspecific findings in infants less than one year. So urine sample collection is mandatory for diagnosis or exclusion. Collecting Urine sample is very challenging in infants and choosing the method of collection must balance the reliability, speed and contamination. Clinical guidelines have different recommendations so there is a need for reliable collection method. Therefore this study was conducted to determine if a simple stimulation method (Quick–wee Method) increases the rate of clean catch voiding of urine within five minutes. METHODS: A prospective age and sex matched case control study in 1-12 months children conducted from June 2017 – June 2018 in Pediatric ward of Manipal college of medical sciences, Pokhara, after Ethical clearance from Institutional review Board [IRB]. The study population was randomized to either clean catch midstream urine with stimulation [Quick–Wee method] or without stimulation [Standard method]. The primary outcome was voiding of urine within 5 minute. Secondary outcome were waiting time for voiding, successful collection, parental satisfaction, and contamination. The analysis was done using SPSS version 20 and a ‘p’value <0.05 was considered statistically significant. RESULTS: Waiting time for voiding in Quick wee group was less and statistically significant compared to standard group. There was 10% increment in voiding within 5 minutes in Quick wee group . It had higher successful urine collection rate (91.4%), slightly higher contamination rate (14.28%) but better parental satisfaction. CONCLUSIONS: Quick wee method is easy, reliable, successful method of urine collection in infants with better parental satisfaction and slightly higher contamination rate.
背景:尿路感染[UTI]通常表现为发烧和非特异性的发现在一岁以下的婴儿。因此，尿样采集是诊断或排除的必要条件。婴儿尿样采集是一项具有挑战性的工作，采集方法的选择必须在可靠性、速度和污染之间取得平衡。临床指南有不同的建议，因此需要可靠的收集方法。因此，本研究旨在确定一种简单的刺激方法(Quick-wee method)是否能提高5分钟内尿的干净排尿率。方法:经机构审查委员会(IRB)的伦理许可，于2017年6月至2018年6月在博卡拉马尼帕尔医学院儿科病房进行了一项年龄和性别匹配的1-12个月儿童的前瞻性病例对照研究。研究人群随机分为两组:有刺激的中游尿液(Quick-Wee法)和无刺激的中游尿液(Standard法)。主要终点为5分钟内排尿。次要结果为排尿等待时间、成功收集、家长满意度和污染。使用SPSS version 20进行分析，p值<0.05被认为具有统计学意义。结果:快速尿组等待排尿时间少于标准组，且差异有统计学意义。快尿组5分钟内排尿次数增加10%。收集成功率较高(91.4%)，污染率略高(14.28%)，但家长满意度较高。结论:快速尿法是一种简便、可靠、成功的婴儿尿液收集方法，家长满意度较高，污染率略高。
{"title":"Quick-Wee method Versus Standard method for urine collection in infants 1-12 month old","authors":"K. Malla, S. Singh, Brajesh Raj Chaudhary, Nabal Kishore Ray, Shivani Singh","doi":"10.3126/nmmj.v2i2.41276","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41276","url":null,"abstract":"BACKGROUND: Urinary Tract infections [UTI] often presents with fever and nonspecific findings in infants less than one year. So urine sample collection is mandatory for diagnosis or exclusion. Collecting Urine sample is very challenging in infants and choosing the method of collection must balance the reliability, speed and contamination. Clinical guidelines have different recommendations so there is a need for reliable collection method. Therefore this study was conducted to determine if a simple stimulation method (Quick–wee Method) increases the rate of clean catch voiding of urine within five minutes. \u0000METHODS: A prospective age and sex matched case control study in 1-12 months children conducted from June 2017 – June 2018 in Pediatric ward of Manipal college of medical sciences, Pokhara, after Ethical clearance from Institutional review Board [IRB]. The study population was randomized to either clean catch midstream urine with stimulation [Quick–Wee method] or without stimulation [Standard method]. The primary outcome was voiding of urine within 5 minute. Secondary outcome were waiting time for voiding, successful collection, parental satisfaction, and contamination. The analysis was done using SPSS version 20 and a ‘p’value <0.05 was considered statistically significant. \u0000RESULTS: Waiting time for voiding in Quick wee group was less and statistically significant compared to standard group. There was 10% increment in voiding within 5 minutes in Quick wee group . It had higher successful urine collection rate (91.4%), slightly higher contamination rate (14.28%) but better parental satisfaction. \u0000CONCLUSIONS: Quick wee method is easy, reliable, successful method of urine collection in infants with better parental satisfaction and slightly higher contamination rate.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129286647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Acute upper gastrointestinal bleeding (AUGIB) is a potentially life-threatening condition that requires rapid assessment in the emergency department. The current available scores are complex and have not been widely used in clinical practice. AIMS65 score is a simple score that can be used to risk stratify patients with AUGIB. METHODS: This was a descriptive cross-sectional study done at a single tertiary centre, NAMS, Bir Hospital among the patients presenting with AUGIB from August 2018 to January 2019. AIMS65 scores were calculated in patients presenting with acute UGIB by allotting 1 point each for albumin level < 3g/dl, INR > 1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission. RESULTS: A total of 84 patients consisting of 68 males and 16 females were enrolled in our study, with age ranging from 27 to 80 years. ICU admission, endoscopic therapy and blood transfusion were required in 22,44 and 49 patients respectively. In-patient mortality, the need for blood transfusion, endoscopic therapy or ICU admission were higher in those with AIMS65 score ≥ 2 showing statistically significant positive association (p=0.000). CONCLUSION: AIMS65 score is a simple non-endoscopic risk score that can be applied in patients of acute upper gastrointestinal bleeding to risk stratify and to predict in-patient mortality, the need for blood transfusion, endoscopic therapy or ICU admission.
背景:急性上消化道出血(AUGIB)是一种潜在的危及生命的疾病，需要在急诊科快速评估。目前可用的评分是复杂的，并没有广泛应用于临床实践。AIMS65评分是一种简单的评分方法，可用于对AUGIB患者进行风险分层。方法:这是一项描述性横断面研究，于2018年8月至2019年1月在Bir医院单一三级中心NAMS对AUGIB患者进行研究。对急性UGIB患者进行AIMS65评分，白蛋白水平< 3g/dl, INR > 1.5，精神状态改变，收缩压≤90 mm Hg，年龄≥65岁，各1分。在入院的最初12小时内进行风险分层。结果:共纳入84例患者，其中男性68例，女性16例，年龄27 ~ 80岁。住院22例，内镜治疗44例，输血49例。AIMS65评分≥2的患者住院死亡率、输血需要量、内镜治疗或ICU入院率均较高，呈统计学显著正相关(p=0.000)。结论:AIMS65评分是一种简单的非内镜风险评分方法，可用于急性上消化道出血患者的风险分层，预测住院死亡率、是否需要输血、内镜治疗或是否入住ICU。
{"title":"Clinical application of AIMS65 score to predict outcome in patients with acute upper gastrointestinal bleeding","authors":"K. Maharjan, R. Mandal, Sanjay Shrestha","doi":"10.3126/nmmj.v2i2.41281","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41281","url":null,"abstract":"BACKGROUND: Acute upper gastrointestinal bleeding (AUGIB) is a potentially life-threatening condition that requires rapid assessment in the emergency department. The current available scores are complex and have not been widely used in clinical practice. AIMS65 score is a simple score that can be used to risk stratify patients with AUGIB. \u0000METHODS: This was a descriptive cross-sectional study done at a single tertiary centre, NAMS, Bir Hospital among the patients presenting with AUGIB from August 2018 to January 2019. AIMS65 scores were calculated in patients presenting with acute UGIB by allotting 1 point each for albumin level < 3g/dl, INR > 1.5, alteration in mental status, systolic blood pressure ≤90 mm Hg, and age ≥65 years. Risk stratification was done during the initial 12 hours of hospital admission. \u0000RESULTS: A total of 84 patients consisting of 68 males and 16 females were enrolled in our study, with age ranging from 27 to 80 years. ICU admission, endoscopic therapy and blood transfusion were required in 22,44 and 49 patients respectively. In-patient mortality, the need for blood transfusion, endoscopic therapy or ICU admission were higher in those with AIMS65 score ≥ 2 showing statistically significant positive association (p=0.000). \u0000CONCLUSION: AIMS65 score is a simple non-endoscopic risk score that can be applied in patients of acute upper gastrointestinal bleeding to risk stratify and to predict in-patient mortality, the need for blood transfusion, endoscopic therapy or ICU admission. ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126536051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Coronavirus disease or Covid-19 has caused more than 30 million documented infections and 1 million deaths worldwide as of Oct 2020. It was shown that several sociodemographic factors play a significant role in shaping the Covid-19 outcome and associated death rates across the globe. Thus the present study aims to study the sociodemographic parameters associated with the Covid-19 cases in Canada. MATERIAL AND METHODS: In this retrospective study, the data was collected from the Official data repository present in Canada. The patients' data were evaluated and sociodemographic parameters were checked and recorded. After the data was recorded they are categorized based on the different states and statistical analysis was done. RESULT:The present study reported that in Canada total cases as reported in the repository are 1,253,519 cases. This result indicates that maximum of the patients suffering from Covid-19 belonged to the younger age category. Compared to the males, females were more to suffer from Covid-19. Most of the patients who required hospitalization were in the 80+ year age group (28.5%). Only 1.7% of patients in the age group below 19 years are required to be hospitalized. The regional data variation showed that in Alberta female patients were more in all the age groups compared with the male patients. Saskatchewan also reported a higher number of death cases in older people. In Manitoba, in the younger age category (0-29 years) less number of female patients suffered Covid-19. Interestingly, this number reversed as the age group increased. In Ontario, 72.1% of people reported being admitted to ICU and required a ventilator. In British Columbia, the gender distribution showed no such difference among all the Covid-19 positive cases. In Quebec among the covid-19 positive cases, 47.2% were male and 52.8% were females. CONCLUSION: Age is a significant predictor of Covid-19 mortality and patients from both genders aged more than 75 years and more need to provide more care and increased medical supervision to decrease the Covid-19 casualty.
{"title":"Sociodemographic factors associated with Covid-19 in Canada","authors":"S. Mathew, Shadi Zain","doi":"10.3126/nmmj.v2i2.41275","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41275","url":null,"abstract":"BACKGROUND: Coronavirus disease or Covid-19 has caused more than 30 million documented infections and 1 million deaths worldwide as of Oct 2020. It was shown that several sociodemographic factors play a significant role in shaping the Covid-19 outcome and associated death rates across the globe. Thus the present study aims to study the sociodemographic parameters associated with the Covid-19 cases in Canada. \u0000MATERIAL AND METHODS: In this retrospective study, the data was collected from the Official data repository present in Canada. The patients' data were evaluated and sociodemographic parameters were checked and recorded. After the data was recorded they are categorized based on the different states and statistical analysis was done. \u0000RESULT:The present study reported that in Canada total cases as reported in the repository are 1,253,519 cases. This result indicates that maximum of the patients suffering from Covid-19 belonged to the younger age category. Compared to the males, females were more to suffer from Covid-19. Most of the patients who required hospitalization were in the 80+ year age group (28.5%). Only 1.7% of patients in the age group below 19 years are required to be hospitalized. The regional data variation showed that in Alberta female patients were more in all the age groups compared with the male patients. Saskatchewan also reported a higher number of death cases in older people. In Manitoba, in the younger age category (0-29 years) less number of female patients suffered Covid-19. Interestingly, this number reversed as the age group increased. In Ontario, 72.1% of people reported being admitted to ICU and required a ventilator. In British Columbia, the gender distribution showed no such difference among all the Covid-19 positive cases. In Quebec among the covid-19 positive cases, 47.2% were male and 52.8% were females. \u0000CONCLUSION: Age is a significant predictor of Covid-19 mortality and patients from both genders aged more than 75 years and more need to provide more care and increased medical supervision to decrease the Covid-19 casualty.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127067743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pregnant women when infected with SARS-CoV-2 infection are more at risk of having severe outcomes including ICU admission, adverse cardiac and thromboembolic events and preterm delivery. Immunization in pregnancy has certain ethical dilemmas and vaccination seems to be challenging. Preliminary data regarding the use of mRNA based vaccines against this virus in pregnant women is promising. Recently, RCOG and WHO have widened the scope of use of vaccines among pregnant women against COVID-19. Similarly, ACOG has also given the go-ahead to the use of two mRNA based and one viral vector based vaccine in pregnant women. The scope of vaccination among pregnant and lactating women being realized in developed part of world is a promising prospect in prevention of COVID-19 infections. However, developing nations require attention from private stakeholders, health and social care organizations to ensure right of health for all.
{"title":"Availability and Use of Vaccines against COVID-19 in Pregnancy","authors":"Saugat Koirala, S. Pant, B. Chaudhary","doi":"10.3126/nmmj.v2i2.41285","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41285","url":null,"abstract":"Pregnant women when infected with SARS-CoV-2 infection are more at risk of having severe outcomes including ICU admission, adverse cardiac and thromboembolic events and preterm delivery. Immunization in pregnancy has certain ethical dilemmas and vaccination seems to be challenging. Preliminary data regarding the use of mRNA based vaccines against this virus in pregnant women is promising. Recently, RCOG and WHO have widened the scope of use of vaccines among pregnant women against COVID-19. Similarly, ACOG has also given the go-ahead to the use of two mRNA based and one viral vector based vaccine in pregnant women. The scope of vaccination among pregnant and lactating women being realized in developed part of world is a promising prospect in prevention of COVID-19 infections. However, developing nations require attention from private stakeholders, health and social care organizations to ensure right of health for all.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127956396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
U. Laudari, Rosi Pradhan, D. Shrestha, B. Timilsina, S. Sapkota, D. Karki, Suraj Lamichhane, A. Parajuli
INTRODUCTION: Laparoscopic cholecystectomy is the most commonly performed general surgical procedure. During the COVID-19 pandemic, general recommendation worldwide is to postpone elective surgeries as far as possible to decrease the resource utilization and also aerosol-related transmission among hospital staff and patients. We conducted this study to see the burden of gallbladder disease, their management and outcomes of all patients who presented to our centre during first wave of COVID-19 pandemic. METHODS: We conducted a retrospective analysis of all patients who underwent laparoscopic cholecystectomy at the Hospital for Advanced Medicine and Surgery (HAMS) after the commencement of strict lockdown in the first wave of the COVID-19 pandemic. Ethical approval for the study was taken from Nepal Health Research Council. All the surgeries were performed as per HAMS interim policy for infection prevention and control during the COVID-19 pandemic. Data were extracted from the discharge sheet and outcomes in terms of duration of hospitalization, morbidity, mortality, and COVID -19 infection among patient and operating team staff after surgery were assessed. RESULTS: Out of 110 cases operated for gallbladder disease, 90 patients were included in the study with complete data. The most common presentations were dyspepsia (28) and biliary colic (22). Patients were managed with laparoscopic cholecystectomy (79), percutaneous cholecystostomy (4), laparoscopic subtotal cholecystectomy (5), open cholecystectomy (1). The median duration of hospitalization 22 hours. There was no COVID-19 transmission among staff and patients. CONCLUSIONS: Laparoscopic cholecystectomies are feasible during COVID-19 pandemic and safely performed following infection prevention guidelines. It can be still be performed in day case basis to decrease the bed occupancy and avoiding crowd in hospitals.
{"title":"Laparoscopic cholecystectomy during COVID-19 pandemic- Retrospective analysis of tertiary care centre","authors":"U. Laudari, Rosi Pradhan, D. Shrestha, B. Timilsina, S. Sapkota, D. Karki, Suraj Lamichhane, A. Parajuli","doi":"10.3126/nmmj.v2i2.41282","DOIUrl":"https://doi.org/10.3126/nmmj.v2i2.41282","url":null,"abstract":"INTRODUCTION: Laparoscopic cholecystectomy is the most commonly performed general surgical procedure. During the COVID-19 pandemic, general recommendation worldwide is to postpone elective surgeries as far as possible to decrease the resource utilization and also aerosol-related transmission among hospital staff and patients. We conducted this study to see the burden of gallbladder disease, their management and outcomes of all patients who presented to our centre during first wave of COVID-19 pandemic. \u0000METHODS: We conducted a retrospective analysis of all patients who underwent laparoscopic cholecystectomy at the Hospital for Advanced Medicine and Surgery (HAMS) after the commencement of strict lockdown in the first wave of the COVID-19 pandemic. Ethical approval for the study was taken from Nepal Health Research Council. All the surgeries were performed as per HAMS interim policy for infection prevention and control during the COVID-19 pandemic. Data were extracted from the discharge sheet and outcomes in terms of duration of hospitalization, morbidity, mortality, and COVID -19 infection among patient and operating team staff after surgery were assessed. \u0000RESULTS: Out of 110 cases operated for gallbladder disease, 90 patients were included in the study with complete data. The most common presentations were dyspepsia (28) and biliary colic (22). Patients were managed with laparoscopic cholecystectomy (79), percutaneous cholecystostomy (4), laparoscopic subtotal cholecystectomy (5), open cholecystectomy (1). The median duration of hospitalization 22 hours. There was no COVID-19 transmission among staff and patients. \u0000CONCLUSIONS: Laparoscopic cholecystectomies are feasible during COVID-19 pandemic and safely performed following infection prevention guidelines. It can be still be performed in day case basis to decrease the bed occupancy and avoiding crowd in hospitals. ","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129759713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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