Pub Date : 2021-12-31DOI: 10.3126/jngmc.v19i2.42992
S. Ranjit, N. Katuwal
Introduction: Bloodstream Infection is one of the leading causes of mortality and morbidity among various groups of patients in a developing country like Nepal. Identification of the bacteria and their susceptibility to commonly used antibiotics is very essential for the treatment of the patients. Aims: This study aims to analyze current trends in bloodstream infection by accessing their bacteriological profile and antibiotic susceptibility. Methods: This is a hospital-based retrospective analysis of blood cultures of patients suspected with bloodstream infection. We conducted a three years (January 2018 to January 2021) retrospective analysis of blood culture reports from patients suspected with bloodstream infection. Data of the laboratory reports were used to determine bloodstream infection, blood culture contamination, pathogen profile and antimicrobial resistance patterns. Results: Out of 12811 blood samples that were sent to microbiology laboratory for culture, 438 were positive cultures. The most common etiological agent causing Bloodstream Infection was found to be Salmonella Typhi with129 isolates (29.6%) followed by Escherichia coli (21.9%). There was a significant rise in resistance to most of the frequently used antibiotics. Conclusion: Salmonella Typhi is the most frequent bacteria to be isolated in Bloodstream Infection. Resistance towards different etiological agents of Bloodstream Infection is alarmingly increasing every year. Resistance to frequently prescribed drugs should be of concern to the clinicians prescribing the drugs.
{"title":"Trends in Bloodstream Infection in Tertiary Care Hospital: A Retrospective Cross-sectional Study","authors":"S. Ranjit, N. Katuwal","doi":"10.3126/jngmc.v19i2.42992","DOIUrl":"https://doi.org/10.3126/jngmc.v19i2.42992","url":null,"abstract":"Introduction: Bloodstream Infection is one of the leading causes of mortality and morbidity among various groups of patients in a developing country like Nepal. Identification of the bacteria and their susceptibility to commonly used antibiotics is very essential for the treatment of the patients. \u0000Aims: This study aims to analyze current trends in bloodstream infection by accessing their bacteriological profile and antibiotic susceptibility. \u0000Methods: This is a hospital-based retrospective analysis of blood cultures of patients suspected with bloodstream infection. We conducted a three years (January 2018 to January 2021) retrospective analysis of blood culture reports from patients suspected with bloodstream infection. Data of the laboratory reports were used to determine bloodstream infection, blood culture contamination, pathogen profile and antimicrobial resistance patterns. \u0000Results: Out of 12811 blood samples that were sent to microbiology laboratory for culture, 438 were positive cultures. The most common etiological agent causing Bloodstream Infection was found to be Salmonella Typhi with129 isolates (29.6%) followed by Escherichia coli (21.9%). There was a significant rise in resistance to most of the frequently used antibiotics. \u0000Conclusion: Salmonella Typhi is the most frequent bacteria to be isolated in Bloodstream Infection. Resistance towards different etiological agents of Bloodstream Infection is alarmingly increasing every year. Resistance to frequently prescribed drugs should be of concern to the clinicians prescribing the drugs.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121787647","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}
Pub Date : 2021-08-09DOI: 10.3126/jngmc.v18i2.38898
Anshu Sharma, D. Paudel
Introduction: Laryngopharyngeal reflux is an extra esophageal variant of gastro esophageal reflux disease and is characterized by change in voice, recurrent throat clearing, chronic cough, discomfort in throat, globus. The larynx and pharynx are devoid of the normal acid clearance mechanism even three episodes of reflux per week seems to be associated with a significant disease. Aims: The aim of the study was to evaluate the correlation between the reflux symptom index and reflux finding score in patients with Laryngopharyngeal reflux. Methods: This prospective analytical study was conducted from November 2019 to October 2020 in total of 65 patients presented in department of Otorhinolaryngology, Nepalgunj Medcial College and Teaching Hospital, Nepalgunj. Reflux symptom index questionnaire with nine Questions were answered by patients on a 5 point scale. Reflux symptom index of more than 13 out of total score of 45 was considered to indicate Laryngopharyngeal reflux were as, reflux finding score was based on laryngoscopic findings after evaluating 8 items. Score more than 7 out of 26 was taken as an indicator for presence of Laryngopharyngeal reflux. Results: The reflux symptom index was more than 13 on 22 patients withmean11.85±3.48 and reflux finding score was more than 7 on 11 patients with mean 5.02±3.23 with statistically moderate correlation between reflux symptom index and reflux finding score (p=0.000,r=0.595). Conclusion: There is moderate correlation between the reflux symptom index and reflux finding score. The combined use of these questionnaires and laryngoscopic findings can be more precise, practical and cost effective in the diagnosis of laryngopharyngeal reflux.
{"title":"Correlation between Reflux Symptom Index and Reflux Finding Score in Laryngopharyngeal Reflux","authors":"Anshu Sharma, D. Paudel","doi":"10.3126/jngmc.v18i2.38898","DOIUrl":"https://doi.org/10.3126/jngmc.v18i2.38898","url":null,"abstract":"Introduction: Laryngopharyngeal reflux is an extra esophageal variant of gastro esophageal reflux disease and is characterized by change in voice, recurrent throat clearing, chronic cough, discomfort in throat, globus. The larynx and pharynx are devoid of the normal acid clearance mechanism even three episodes of reflux per week seems to be associated with a significant disease. \u0000Aims: The aim of the study was to evaluate the correlation between the reflux symptom index and reflux finding score in patients with Laryngopharyngeal reflux. \u0000Methods: This prospective analytical study was conducted from November 2019 to October 2020 in total of 65 patients presented in department of Otorhinolaryngology, Nepalgunj Medcial College and Teaching Hospital, Nepalgunj. Reflux symptom index questionnaire with nine Questions were answered by patients on a 5 point scale. Reflux symptom index of more than 13 out of total score of 45 was considered to indicate Laryngopharyngeal reflux were as, reflux finding score was based on laryngoscopic findings after evaluating 8 items. Score more than 7 out of 26 was taken as an indicator for presence of Laryngopharyngeal reflux. \u0000Results: The reflux symptom index was more than 13 on 22 patients withmean11.85±3.48 and reflux finding score was more than 7 on 11 patients with mean 5.02±3.23 with statistically moderate correlation between reflux symptom index and reflux finding score (p=0.000,r=0.595). \u0000Conclusion: There is moderate correlation between the reflux symptom index and reflux finding score. The combined use of these questionnaires and laryngoscopic findings can be more precise, practical and cost effective in the diagnosis of laryngopharyngeal reflux.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130648637","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}
Pub Date : 2021-08-09DOI: 10.3126/jngmc.v18i2.38878
Jyoti Adhikari, D. Paudel
Introduction: Each year approximately 4 million babies are born asphyxiated, which results in 1 million deaths and an equal number of serious neurological sequelae. One of the commonest organs involved in birth asphyxia is brain which may lead to a syndrome of clinical manifestation called Hypoxic Ischemic Encephalopathy (HIE). Aims: To find out possible maternal and neonatal risk factors for Hypoxic Ischemic Encephalopathy, to analyze clinical presentations and outcome of HIE in asphyxiated newborns. Methods: Hospital based observational study was carried out among fifty newborns with Apgar score less than 7 at 1 minute of life admitted in Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke. Results: The incidence of birth asphyxia and birth asphyxia with HIE were 37.2 per 1000 live births and 14 per 1000 live births with male: female ratio of 1.27:1. Most of the neonates 22(44%) were in HIE stage II. Meconium stained amniotic fluid 18 (36%) was the most common intrapartum risk factor followed by maternal use of intrapartum medications 14 (28%), Premature Rupture of Membrane (PROM) 8 (16%), prolonged labor 5 (10%) and obstructed labor 6 (12%). Four (8%) asphyxiated neonates with HIE had cord prolapse and 7 (14%) had cord around the neck. The most common resuscitation done was bag and mask ventilation (56%) (P<0.05). Majority of the studied neonates were of normal birth weight (76%) and head circumference (84%) (P<0.05) with clinical presentations of respiratory distress (88%), seizures (44%), apnea (22%), bradycardia (8%), tachycardia (6%) and bulged anterior fontanel (6%). The overall mortality of neonates with HIE was 20% of which most were of HIE stage III. Conclusion: Certain measures could be taken to prevent birth asphyxia: early detection and intervention of high risk pregnancy, prompt and effective resuscitation of asphyxiates newborns.
{"title":"Hypoxic Ischemic Encephalopathy in Neonates with Birth Asphyxia - A Hospital Based Study","authors":"Jyoti Adhikari, D. Paudel","doi":"10.3126/jngmc.v18i2.38878","DOIUrl":"https://doi.org/10.3126/jngmc.v18i2.38878","url":null,"abstract":"Introduction: Each year approximately 4 million babies are born asphyxiated, which results in 1 million deaths and an equal number of serious neurological sequelae. One of the commonest organs involved in birth asphyxia is brain which may lead to a syndrome of clinical manifestation called Hypoxic Ischemic Encephalopathy (HIE). \u0000Aims: To find out possible maternal and neonatal risk factors for Hypoxic Ischemic Encephalopathy, to analyze clinical presentations and outcome of HIE in asphyxiated newborns. \u0000Methods: Hospital based observational study was carried out among fifty newborns with Apgar score less than 7 at 1 minute of life admitted in Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke. \u0000Results: The incidence of birth asphyxia and birth asphyxia with HIE were 37.2 per 1000 live births and 14 per 1000 live births with male: female ratio of 1.27:1. Most of the neonates 22(44%) were in HIE stage II. Meconium stained amniotic fluid 18 (36%) was the most common intrapartum risk factor followed by maternal use of intrapartum medications 14 (28%), Premature Rupture of Membrane (PROM) 8 (16%), prolonged labor 5 (10%) and obstructed labor 6 (12%). Four (8%) asphyxiated neonates with HIE had cord prolapse and 7 (14%) had cord around the neck. The most common resuscitation done was bag and mask ventilation (56%) (P<0.05). Majority of the studied neonates were of normal birth weight (76%) and head circumference (84%) (P<0.05) with clinical presentations of respiratory distress (88%), seizures (44%), apnea (22%), bradycardia (8%), tachycardia (6%) and bulged anterior fontanel (6%). The overall mortality of neonates with HIE was 20% of which most were of HIE stage III. \u0000Conclusion: Certain measures could be taken to prevent birth asphyxia: early detection and intervention of high risk pregnancy, prompt and effective resuscitation of asphyxiates newborns.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126616963","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}
Pub Date : 2021-08-09DOI: 10.3126/jngmc.v18i2.38880
L. Verma, D. Paudel
Introduction: Tympanoplasty is typically performed in conjunction with a canal wall down mastoidectomy in patient with Chronic Otitis Media Squamous. The results from experimental and clinical studies of the type III stapes columellar reconstruction have shown that interposing a disk of cartilage between the graft and the stapes head improves hearing in the lower frequencies by 5 to 10 dB. They hypothesize that the cartilage acts to increase the “effective” area of the graft that is coupled to the stapes, which leads to an increase in the middle ear gain of the reconstructed ear. Aims: To assess the hearing improvement after cartilage augmented Type III Tympanoplasty in chronic otitis media squamous disease. Methods: This study was conducted in 44 patients with Chronic Otitis Media squamous in the patients attending the department of Otorhinolaryngology in NGMC teaching hospital from November 2018 to March 2020. Canal Wall Down mastoidectomy with cartilage augmented type III Tympanoplasty and was done. Augmentation was done with thin 3-4 mm conchal cartilage interposed between stapes and Temporalis fascia graft. Results: There were 11(25%) male and 33(75%) female, with mean age of 29.48 years, ranging from minimum of 15 years to maximum 56 years. The preoperative mean A–B gap was 21.82 and postoperatively means AB gap was 12.20 dB with overall AB gap gain was 9.64 dB. Conclusion: Significant hearing improvement is seen in Canal Wall Down mastoidectomy Chronic Otitis Media squamous after cartilage augmented type III tympanoplasty.
{"title":"Hearing Status After Cartilage Augmented Type III Tympanoplasty: In Chronic Otitis Media Squamous Type","authors":"L. Verma, D. Paudel","doi":"10.3126/jngmc.v18i2.38880","DOIUrl":"https://doi.org/10.3126/jngmc.v18i2.38880","url":null,"abstract":"Introduction: Tympanoplasty is typically performed in conjunction with a canal wall down mastoidectomy in patient with Chronic Otitis Media Squamous. The results from experimental and clinical studies of the type III stapes columellar reconstruction have shown that interposing a disk of cartilage between the graft and the stapes head improves hearing in the lower frequencies by 5 to 10 dB. They hypothesize that the cartilage acts to increase the “effective” area of the graft that is coupled to the stapes, which leads to an increase in the middle ear gain of the reconstructed ear.\u0000Aims: To assess the hearing improvement after cartilage augmented Type III Tympanoplasty in chronic otitis media squamous disease.\u0000Methods: This study was conducted in 44 patients with Chronic Otitis Media squamous in the patients attending the department of Otorhinolaryngology in NGMC teaching hospital from November 2018 to March 2020. Canal Wall Down mastoidectomy with cartilage augmented type III Tympanoplasty and was done. Augmentation was done with thin 3-4 mm conchal cartilage interposed between stapes and Temporalis fascia graft.\u0000Results: There were 11(25%) male and 33(75%) female, with mean age of 29.48 years, ranging from minimum of 15 years to maximum 56 years. The preoperative mean A–B gap was 21.82 and postoperatively means AB gap was 12.20 dB with overall AB gap gain was 9.64 dB.\u0000Conclusion: Significant hearing improvement is seen in Canal Wall Down mastoidectomy Chronic Otitis Media squamous after cartilage augmented type III tympanoplasty.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"518 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116239976","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}
Pub Date : 2021-08-09DOI: 10.3126/jngmc.v18i2.38876
B. Yadav, G. J. Shah, Rahul Yadav, Rajendra K. Mahat, Aayush Joshi
Introduction: Mental health is an important aspect of overall health of a person. Depression is a common mental health problem all around the world. According to WHO, as many as 350 million people suffer from depression all over the globe. Medical studies are well known to be stressful for students and psychological problems like depression are quite common among medical students. Although many studies are done on mental health of students worldwide, studies on depression among medical students of Nepal are quite few. Aims: To find out the prevalence of depression among medical students in Nepalgunj Medical College. Methods: A descriptive study was done in the batch of 2016 with a Beck’s Depression Inventory (BDI) Questionnaire. Results: The prevalence of depression among the study subjects was found to be 25.9%. Bullying was found to be a strong factor responsible for depression among medical students. Conclusion: Depression was highly prevalent among the medical students. Students who were bullied and had appropriate pocket money suffered from higher levels of depression.
{"title":"Prevalence of Depression among the Medical Students in Nepalgunj Medical College","authors":"B. Yadav, G. J. Shah, Rahul Yadav, Rajendra K. Mahat, Aayush Joshi","doi":"10.3126/jngmc.v18i2.38876","DOIUrl":"https://doi.org/10.3126/jngmc.v18i2.38876","url":null,"abstract":"Introduction: Mental health is an important aspect of overall health of a person. Depression is a common mental health problem all around the world. According to WHO, as many as 350 million people suffer from depression all over the globe. Medical studies are well known to be stressful for students and psychological problems like depression are quite common among medical students. Although many studies are done on mental health of students worldwide, studies on depression among medical students of Nepal are quite few. \u0000Aims: To find out the prevalence of depression among medical students in Nepalgunj Medical College. \u0000Methods: A descriptive study was done in the batch of 2016 with a Beck’s Depression Inventory (BDI) Questionnaire. \u0000Results: The prevalence of depression among the study subjects was found to be 25.9%. Bullying was found to be a strong factor responsible for depression among medical students. \u0000Conclusion: Depression was highly prevalent among the medical students. Students who were bullied and had appropriate pocket money suffered from higher levels of depression.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127680649","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}
Pub Date : 2021-08-09DOI: 10.3126/jngmc.v18i2.38832
S. Shrestha, D. Shrestha, Dipendra Kc, P. Karki, Sushil Yogi
Introduction: Unstable distal radius fractures in children have more tendencies to get displaced with conservative management resulting into deformity. This Kapandji technique of K-wire fixation is on rise to reduce and maintain these fractures in recent days. Aims: The aim of this study was to evaluate the effectiveness of the K-wires fixation in unstable distal radius fracture with Kapandji techniques. Methods: A cross-sectional observational study was conducted in Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke in unstable distal radius fracture in children with K-wires fixation using Kapandji method. Results: Twenty eight unstable distal radius fractures in children between 6 to 14 years of age were treated with one intrafocal K-wire and one or two extra focal K-wires to augment fixation. Immobilization of forearm with above elbow slab/cast for four to six weeks was enforced. K-wires were removed between four to six weeks of operation depending upon the union and followed prospectively for four months. The mean age of patients presented was 8.57± 1.79 years. This technique brought near anatomical reduction in all fractures. There was no reduction loss or remanipulation in any case. All fractures achieved union and functional outcome was excellent in 24 cases based on Modified Mayo Wrist Score. There was fewer complications like pin tract infection. Conclusion: This Kapandji technique of K-wire fixation, leverage reduction method, being an additional tool helps to achieve near anatomical alignment, and maintain reduction throughout the duration of healing. So it is an advantageous technique.
{"title":"Kirschner’s Wires Fixation of Unstable Distal Radius Fractures in Children with the Kapandji Technique","authors":"S. Shrestha, D. Shrestha, Dipendra Kc, P. Karki, Sushil Yogi","doi":"10.3126/jngmc.v18i2.38832","DOIUrl":"https://doi.org/10.3126/jngmc.v18i2.38832","url":null,"abstract":"Introduction: Unstable distal radius fractures in children have more tendencies to get displaced with conservative management resulting into deformity. This Kapandji technique of K-wire fixation is on rise to reduce and maintain these fractures in recent days.\u0000Aims: The aim of this study was to evaluate the effectiveness of the K-wires fixation in unstable distal radius fracture with Kapandji techniques.\u0000Methods: A cross-sectional observational study was conducted in Nepalgunj Medical College and Teaching Hospital, Kohalpur, Banke in unstable distal radius fracture in children with K-wires fixation using Kapandji method.\u0000Results: Twenty eight unstable distal radius fractures in children between 6 to 14 years of age were treated with one intrafocal K-wire and one or two extra focal K-wires to augment fixation. Immobilization of forearm with above elbow slab/cast for four to six weeks was enforced. K-wires were removed between four to six weeks of operation depending upon the union and followed prospectively for four months. The mean age of patients presented was 8.57± 1.79 years. This technique brought near anatomical reduction in all fractures. There was no reduction loss or remanipulation in any case. All fractures achieved union and functional outcome was excellent in 24 cases based on Modified Mayo Wrist Score. There was fewer complications like pin tract infection.\u0000Conclusion: This Kapandji technique of K-wire fixation, leverage reduction method, being an additional tool helps to achieve near anatomical alignment, and maintain reduction throughout the duration of healing. So it is an advantageous technique.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"153 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120949169","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}
Pub Date : 2021-08-09DOI: 10.3126/jngmc.v18i2.38911
N. Sharma, Durga Bc
Introduction: Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance of variable severity or hyperglycemia occuring for the first time during pregnancy but the glucose intolerance reverting back to normal after the puerperium. According to American Diabetic Association, approximately 7% of all pregnancy are complicated by Gestational Diabetes Mellitus, resulting in more than two lakhs cases annually and the prevalence may range from 1-14% of all pregnancies. Gestational Diabetes Mellitus usually develop in the second trimester and carries grave prognosis both for mother and fetus. So screening of diabetes is necessary for early detection of diabetes and prevention of further progression. Aims: Screening of impaired glucose tolerance and gestational diabetes mellitus by glucose challenge test (GCT) and oral glucose tolerance test (OGTT) at 24-28 weeks of pregnancy. Methods: This study was conducted in Nepalgunj Medical College Teaching Hospital over one year period taking 98 pregnant women who came to ANC (Antenatal Check up) out patient department. Screening for diabetes was done giving 50 gm of oral glucose (glucose challenge test) to the pregnant women at 24-28 weeks of gestational age. Results: The incidence of Impaired glucose tolerance and gestational diabetes in this study population was 4.1% and 1% respectively. Conclusion: Screening of Diabetes mellitus in Second trimester of pregnancy is important investigation to be done to prevent the mother and the fetus from many upcoming complications of diabetes.
{"title":"Screening of Diabetes in Pregnancy at Nepalgunj Medical College Teaching Hospital Kohalpur","authors":"N. Sharma, Durga Bc","doi":"10.3126/jngmc.v18i2.38911","DOIUrl":"https://doi.org/10.3126/jngmc.v18i2.38911","url":null,"abstract":"Introduction: Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance of variable severity or hyperglycemia occuring for the first time during pregnancy but the glucose intolerance reverting back to normal after the puerperium. According to American Diabetic Association, approximately 7% of all pregnancy are complicated by Gestational Diabetes Mellitus, resulting in more than two lakhs cases annually and the prevalence may range from 1-14% of all pregnancies. Gestational Diabetes Mellitus usually develop in the second trimester and carries grave prognosis both for mother and fetus. So screening of diabetes is necessary for early detection of diabetes and prevention of further progression.\u0000Aims: Screening of impaired glucose tolerance and gestational diabetes mellitus by glucose challenge test (GCT) and oral glucose tolerance test (OGTT) at 24-28 weeks of pregnancy.\u0000Methods: This study was conducted in Nepalgunj Medical College Teaching Hospital over one year period taking 98 pregnant women who came to ANC (Antenatal Check up) out patient department. Screening for diabetes was done giving 50 gm of oral glucose (glucose challenge test) to the pregnant women at 24-28 weeks of gestational age.\u0000Results: The incidence of Impaired glucose tolerance and gestational diabetes in this study population was 4.1% and 1% respectively.\u0000Conclusion: Screening of Diabetes mellitus in Second trimester of pregnancy is important investigation to be done to prevent the mother and the fetus from many upcoming complications of diabetes.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"125 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127376240","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}
Pub Date : 2021-08-09DOI: 10.3126/jngmc.v18i2.38897
S. Bk, S. Baral, N. Paudel, Hitesh Neupane
Introduction: Incidence of stroke increases with age and growing elderly population worldwide, the number of patients with stroke are likely to increase. It is the third most common cause of death in world in that 85% are ischemic in nature. Atherosclerosis is a major risk factor in cerebrovascular diseases. Carotid Intima Media thickness (CIMT) is a surrogate marker of atherosclerosis and provides a non-invasive method for the risk assessment of cerebrovascular diseases. Aims: To study the atherosclerotic risk profile of patients admitted with ischemic stroke in medical ward with study of the carotid artery intima-media thickness in patients with acute ischemic stroke. Methods: 92 patients with ischemic strokes were studied in this observational study. Carotid Doppler was performed in all patients with emphasis on carotid artery stenosis and intima thickening. Analysis of Association of various risk factors was done in detail. Study period was from June 2019 to May 2020. Results: Higher degree of stenosis was associated with hypoechoic plaques and cortical strokes. Hypertension was the most common and most significant risk factor. Multiple risk factors also appear to have synergistic actions. Conclusion: Various modifiable risk factors provide valuable target for primary and secondary prevention of stroke. Carotid Doppler is a very cheap and highly effective tool for further management of stroke patients. Most of the asymptomatic patients, risk factors may warrant precautionary carotid Doppler, and may result in significant reduction in disease burden on the families and the community and should be encouraged.
{"title":"Ischemic Stroke and its Association with Risk Factors at Nepalgunj Medical College Teaching Hospital Kohalpur","authors":"S. Bk, S. Baral, N. Paudel, Hitesh Neupane","doi":"10.3126/jngmc.v18i2.38897","DOIUrl":"https://doi.org/10.3126/jngmc.v18i2.38897","url":null,"abstract":"Introduction: Incidence of stroke increases with age and growing elderly population worldwide, the number of patients with stroke are likely to increase. It is the third most common cause of death in world in that 85% are ischemic in nature. Atherosclerosis is a major risk factor in cerebrovascular diseases. Carotid Intima Media thickness (CIMT) is a surrogate marker of atherosclerosis and provides a non-invasive method for the risk assessment of cerebrovascular diseases. \u0000Aims: To study the atherosclerotic risk profile of patients admitted with ischemic stroke in medical ward with study of the carotid artery intima-media thickness in patients with acute ischemic stroke. \u0000Methods: 92 patients with ischemic strokes were studied in this observational study. Carotid Doppler was performed in all patients with emphasis on carotid artery stenosis and intima thickening. Analysis of Association of various risk factors was done in detail. Study period was from June 2019 to May 2020. \u0000Results: Higher degree of stenosis was associated with hypoechoic plaques and cortical strokes. Hypertension was the most common and most significant risk factor. Multiple risk factors also appear to have synergistic actions. \u0000Conclusion: Various modifiable risk factors provide valuable target for primary and secondary prevention of stroke. Carotid Doppler is a very cheap and highly effective tool for further management of stroke patients. Most of the asymptomatic patients, risk factors may warrant precautionary carotid Doppler, and may result in significant reduction in disease burden on the families and the community and should be encouraged.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128218504","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}
Pub Date : 2021-08-09DOI: 10.3126/jngmc.v18i2.38895
S. Bharti, Anup Sharma
Introduction: Acute pancreatitis a disorder that has numerous causes and an obscure pathogenesis. It can be a serious abdominal emergency associated with significant morbidity and mortality. Cholelithiasis is most common cause of acute pancreatitis and excessive alcohol consumption is second most frequent cause which together account for approximately 80% of underlying etiology. The detection of biliary etiology is crucial to delivery of definitive therapy to prevent repeated attacks of acute pancreatitis. During an attack of acute pancreatitis, elevation of alanine aminotransferase to >150 IU/L is a predictive factor for biliary cause of acute pancreatitis. Aims: To investigate the predictive value of raised alanine aminotransferase in determining biliary etiology in patients presenting with acute pancreatitis. Methods: A prospective study was done among 70 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. Peak alanine aminotransferase within 48 hours of presentation was recorded. The diagnosis was based on typical clinical presentation of acute pancreatitis combined with an increase in serum amylase levels ≥ 3 times the upper limit of the laboratory reference value. All biliary cases were confirmed by abdominal ultrasonography. Results: The mean age of the patients was 47.9 ±15.7 years (19-88 years). Acute pancreatitis was common in 31-40 years of age group. Among them, 40(57.1%) were male and 30(42.9%) were female. Forty two (60%) patients had biliary pancreatitis, 20(28.5%) had alcoholic pancreatitis, 2(2.8%) patients had drug induced pancreatitis and 6(8.5%) patients had idiopathic pancreatitis. Mean alanine aminotransferase for biliary pancreatitis was 205.9U/L, while cases with other etiologies (alcoholic 58.4U/L; drug induced 62.6 U/L; and idiopathic 48.3 U/L) showed significantly lower values (p=0.001). Conclusion: An elevated alanine aminotransferase strongly supports a diagnosis of gallstones in acute pancreatitis.
{"title":"Role of Alanine Aminotransferase in Determining the Biliary Etiology in Acute Pancreatitis","authors":"S. Bharti, Anup Sharma","doi":"10.3126/jngmc.v18i2.38895","DOIUrl":"https://doi.org/10.3126/jngmc.v18i2.38895","url":null,"abstract":"Introduction: Acute pancreatitis a disorder that has numerous causes and an obscure pathogenesis. It can be a serious abdominal emergency associated with significant morbidity and mortality. Cholelithiasis is most common cause of acute pancreatitis and excessive alcohol consumption is second most frequent cause which together account for approximately 80% of underlying etiology. The detection of biliary etiology is crucial to delivery of definitive therapy to prevent repeated attacks of acute pancreatitis. During an attack of acute pancreatitis, elevation of alanine aminotransferase to >150 IU/L is a predictive factor for biliary cause of acute pancreatitis. \u0000Aims: To investigate the predictive value of raised alanine aminotransferase in determining biliary etiology in patients presenting with acute pancreatitis. \u0000Methods: A prospective study was done among 70 patients who were admitted in surgery department over a period of one year with diagnosis of acute pancreatitis. Peak alanine aminotransferase within 48 hours of presentation was recorded. The diagnosis was based on typical clinical presentation of acute pancreatitis combined with an increase in serum amylase levels ≥ 3 times the upper limit of the laboratory reference value. All biliary cases were confirmed by abdominal ultrasonography. \u0000Results: The mean age of the patients was 47.9 ±15.7 years (19-88 years). Acute pancreatitis was common in 31-40 years of age group. Among them, 40(57.1%) were male and 30(42.9%) were female. Forty two (60%) patients had biliary pancreatitis, 20(28.5%) had alcoholic pancreatitis, 2(2.8%) patients had drug induced pancreatitis and 6(8.5%) patients had idiopathic pancreatitis. Mean alanine aminotransferase for biliary pancreatitis was 205.9U/L, while cases with other etiologies (alcoholic 58.4U/L; drug induced 62.6 U/L; and idiopathic 48.3 U/L) showed significantly lower values (p=0.001). \u0000Conclusion: An elevated alanine aminotransferase strongly supports a diagnosis of gallstones in acute pancreatitis.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133700292","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}
Pub Date : 2021-08-09DOI: 10.3126/jngmc.v18i2.38913
S. Mathema, P. Kayastha, P. Sharma
Introduction: Research demonstrates the importance of key interventions in reducing mortality rates of pediatric patients with sepsis. Of health care practitioners, nurses typically spend the most time with patients, and they must be knowledgeable in recognizing the SIRS and sepsis while also being aware of the importance of prompt intervention. Aims: The purpose of this study is to assess the knowledge of pediatric nurses of SIRS and reassess their knowledge after a sepsis training program. Methods: This time-series design study from February 2017 to February 2019 included 24 nursing staff involved in taking care of pediatric patients. The nurses were divided into two groups and they underwent a one-day training on sepsis. They were the evaluated periodically on their knowledge on pediatric sepsis at four different time points. The retention of knowledge was calculated based on the change in scores, as per mean numeric scores, immediately after the training compared to 12 and 24 months after the training. Results: In the thematic area ‘Early recognition of signs/symptoms of SIRS’ and ‘Assessment of application of knowledge’, there was a significant change (<0.001) from baseline in the mean scores once the nurses underwent training. The KAP assessment revealed a low total score of 14.5 out of 25 prior to the SIRS/Sepsis training There was a significant change (<0.001) in the mean knowledge score after the one-day training, 14.5 compared to 22.3, and the knowledge was retained 12 months after the training 19.2, whereas after 24 months post-training was 15.9. Conclusion: There is an urgent need to train and constantly re-train our nursing staff to ensure their ability of to accurately and efficiently recognize sepsis and hence help prevent pediatric morbidity and mortality.
{"title":"The Impact of Systemic Inflammatory Response Syndrome (SIRS) and Sepsis Training on Pediatric Nurses","authors":"S. Mathema, P. Kayastha, P. Sharma","doi":"10.3126/jngmc.v18i2.38913","DOIUrl":"https://doi.org/10.3126/jngmc.v18i2.38913","url":null,"abstract":"Introduction: Research demonstrates the importance of key interventions in reducing mortality rates of pediatric patients with sepsis. Of health care practitioners, nurses typically spend the most time with patients, and they must be knowledgeable in recognizing the SIRS and sepsis while also being aware of the importance of prompt intervention. \u0000Aims: The purpose of this study is to assess the knowledge of pediatric nurses of SIRS and reassess their knowledge after a sepsis training program. \u0000Methods: This time-series design study from February 2017 to February 2019 included 24 nursing staff involved in taking care of pediatric patients. The nurses were divided into two groups and they underwent a one-day training on sepsis. They were the evaluated periodically on their knowledge on pediatric sepsis at four different time points. The retention of knowledge was calculated based on the change in scores, as per mean numeric scores, immediately after the training compared to 12 and 24 months after the training. \u0000Results: In the thematic area ‘Early recognition of signs/symptoms of SIRS’ and ‘Assessment of application of knowledge’, there was a significant change (<0.001) from baseline in the mean scores once the nurses underwent training. The KAP assessment revealed a low total score of 14.5 out of 25 prior to the SIRS/Sepsis training There was a significant change (<0.001) in the mean knowledge score after the one-day training, 14.5 compared to 22.3, and the knowledge was retained 12 months after the training 19.2, whereas after 24 months post-training was 15.9. \u0000Conclusion: There is an urgent need to train and constantly re-train our nursing staff to ensure their ability of to accurately and efficiently recognize sepsis and hence help prevent pediatric morbidity and mortality.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125165907","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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