Pub Date : 2020-12-31DOI: 10.3126/jngmc.v18i1.35206
Deepak Thapa Magar, K. Shrestha, D. Chapagain, K. Shrestha, S. Thapa
Introduction: End-stage renal disease requires treatment with dialysis or renal transplantation. For the dialysis, autologous radiocephalic (RC) or brachiocephalic (BC) arteriovenous fistula (AVF) is the better option for vascular access for hemodialysis. Aims: The aim of this study is to find out the outcome between RC AVF and BC AVF. Methods: This is the retrospective study, conducted for the period of 24 months from September 2017 to September 2019 in the department of Cardiothoracic and Vascular Surgery of Bir Hospital, Nepal. RC and BC AVF were created for the assess of hemodialysis. Outcome and different complications were taken into consideration. Results: The total number of patients included in this study was 400. The overall failure rate of autologous AV fistula was 12.75%. Out of these, the failure rate was more in RC AV fistula group, 34 (17%) than in BC AV fistula group, 17 (8.5%). The most common complication was bleeding in both groups having an overall rate of 39 (9.75%). The limb edema was more common in BC AV fistula group 16 (8.0%) then in RC AV fistula group 7(3.5%). The overall infection rate was 4.5%. Overall patency rate was 87.25%. Conclusion: Autologous RC AVF and BC AVF are the choices for vascular access for hemodialysis in patients with end-stage renal disease. BC AVF has a better patency rate than RC AVF but with the slight higher risk of complications.
{"title":"Comparative Study of Autologous Radiocephalic and Brachiocephalic Arteriovenous Fistula in Patients with End Stage Renal Disease","authors":"Deepak Thapa Magar, K. Shrestha, D. Chapagain, K. Shrestha, S. Thapa","doi":"10.3126/jngmc.v18i1.35206","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35206","url":null,"abstract":"Introduction: End-stage renal disease requires treatment with dialysis or renal transplantation. For the dialysis, autologous radiocephalic (RC) or brachiocephalic (BC) arteriovenous fistula (AVF) is the better option for vascular access for hemodialysis.\u0000Aims: The aim of this study is to find out the outcome between RC AVF and BC AVF.\u0000Methods: This is the retrospective study, conducted for the period of 24 months from September 2017 to September 2019 in the department of Cardiothoracic and Vascular Surgery of Bir Hospital, Nepal. RC and BC AVF were created for the assess of hemodialysis. Outcome and different complications were taken into consideration. \u0000Results: The total number of patients included in this study was 400. The overall failure rate of autologous AV fistula was 12.75%. Out of these, the failure rate was more in RC AV fistula group, 34 (17%) than in BC AV fistula group, 17 (8.5%). The most common complication was bleeding in both groups having an overall rate of 39 (9.75%). The limb edema was more common in BC AV fistula group 16 (8.0%) then in RC AV fistula group 7(3.5%). The overall infection rate was 4.5%. Overall patency rate was 87.25%.\u0000Conclusion: Autologous RC AVF and BC AVF are the choices for vascular access for hemodialysis in patients with end-stage renal disease. BC AVF has a better patency rate than RC AVF but with the slight higher risk of complications.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"14 37","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114052501","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35193
S. Bharti, Ankitkumar Sharma
Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting. Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound. Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence. Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of <0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0). Conclusion: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications
{"title":"A Prospective Study Comparing Continuous Versus Interrupted Suture Techniques in Midline Abdominal Wound Closure","authors":"S. Bharti, Ankitkumar Sharma","doi":"10.3126/jngmc.v18i1.35193","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35193","url":null,"abstract":"Introduction: Wound closure after midline laparotomy is an essential part of surgery to produce a healthy and a strong scar. There is an alternative interrupted method of closure as compared to conventional continuous method of closure. Many comparative studies have shown different outcomes. So, we wanted to evaluate the outcome of different techniques in our setting.\u0000Aims: To compare the outcome of Interrupted abdominal closure and continuous abdominal closure in midline laparotomy wound.\u0000Methods: This was a prospective comparative study conducted in the Department of Surgery of Nepalgunj Medical College Teaching Hospital, Kohalpur, Banke, Nepal for a duration of 1 year. A total of 60 patients were selected randomly to receive either continuous or interrupted abdominal closure in midline laparotomy wound. Wound was evaluated in terms of wound discharge, infection and wound dehiscence.\u0000Results: The mean age of the patients was 38.38 years. Most commonly, the patients presented with duodenal ulcer perforation with peritonitis. The average time taken for abdomen closure in group A (16.77 minutes) was significantly less as compared to group B (27.77 minutes). The average cost of sutures for group B (Rs 1322.97) was higher than that of sutures for group A (Rs 1118) with p value of <0.01. Wound infection and incidence of burst abdomen were similar in both groups after one month, suture sinus was seen in three patients of group A and four patients of group B (p = 1.0). Incisional hernia was seen in one patient of group A and in none of the patients of group B at three month’s follow-up (p = 1.0).\u0000Conclusion: Continuous technique of midline laparotomy wound closure is better in terms of time required for wound closure and costing of suture materials, while showing no difference in terms of wound infection, burst abdomen and late wound complications","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114799422","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35220
S. Tamrakar, R. Shrestha
Introduction: Ultrasound is a valuable diagnostic tool for detecting the congenital anomalies in the fetus. Congenital anomalies are detected in 14% of new born. Major anomalies are detected in 2 to 5% of new born. This accounts for 20 % to 30% of total perinatal deaths. Prenatal diagnosis provides variety of management options for the pregnant women ranging from termination of pregnancy, elective delivery or intrauterine manipulation of the anomalies. Aims: To determine the prevalence of the fetal congenital anomalies at 20- 24 weeks ultrasonography. Methods: This is prospective study conducted at Dhulikhel Hospital. Pregnant ladies with singleton pregnancy at 20 to 24 weeks were enrolled for transabdominal ultrasound for detecting congenital anomalies. Results: Of 1027 pregnant ladies screened, anomalies were detected in 31 ladies during mid trimester ultrasound. The overall prevalence of congenital anomalies detected in our study is 3.02% (31 cases), which has sensitivity of 87.8%, specificity of 99.7% and positive predictive values of 93.5%. In our study, mean gestational age during scan was 21+5 weeks of gestation. And 13 pregnant ladies pregnancies were terminated between 20-24 weeks for having major congenital anomaly in fetus. Conclusion: Mid trimester ultrasonography is a valuable method for pregnant ladies to detect the congenital anomalies in fetus. When major anomalies are detected, timely termination of pregnancy have saved the cost and tragedy of losing viable fetus.
{"title":"Mid-Trimester Scan is better for Detecting Congenital Anomalies: An Experience from Dhulikhel Hospital","authors":"S. Tamrakar, R. Shrestha","doi":"10.3126/jngmc.v18i1.35220","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35220","url":null,"abstract":"Introduction: Ultrasound is a valuable diagnostic tool for detecting the congenital anomalies in the fetus. Congenital anomalies are detected in 14% of new born. Major anomalies are detected in 2 to 5% of new born. This accounts for 20 % to 30% of total perinatal deaths. Prenatal diagnosis provides variety of management options for the pregnant women ranging from termination of pregnancy, elective delivery or intrauterine manipulation of the anomalies.\u0000Aims: To determine the prevalence of the fetal congenital anomalies at 20- 24 weeks ultrasonography.\u0000Methods: This is prospective study conducted at Dhulikhel Hospital. Pregnant ladies with singleton pregnancy at 20 to 24 weeks were enrolled for transabdominal ultrasound for detecting congenital anomalies.\u0000Results: Of 1027 pregnant ladies screened, anomalies were detected in 31 ladies during mid trimester ultrasound. The overall prevalence of congenital anomalies detected in our study is 3.02% (31 cases), which has sensitivity of 87.8%, specificity of 99.7% and positive predictive values of 93.5%. In our study, mean gestational age during scan was 21+5 weeks of gestation. And 13 pregnant ladies pregnancies were terminated between 20-24 weeks for having major congenital anomaly in fetus.\u0000Conclusion: Mid trimester ultrasonography is a valuable method for pregnant ladies to detect the congenital anomalies in fetus. When major anomalies are detected, timely termination of pregnancy have saved the cost and tragedy of losing viable fetus.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116162405","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35183
D. Dhami, S. Dhakal
Introduction: Self-medication is widely practiced among the nursing students because of easy availability and accessibility of the drugs. Inappropriate self-medication can leads to increased resistance among pathogens, wastage of resources, can cause serious harm and increase morbidity; which indicates needs of responsible self-medication. Aims: This study was to assess the self-medication knowledge, attitude and practice among nursing students. Methods: This was a questionnaire based descriptive cross sectional study conducted in Nursing students of Nepalgunj Nursing Campus, Kohalpur, on August 2019. Questions related to various aspects of self-medication was used for data collection. Results: Out of 120 students, 102 (85%) students were found practicing self-medication with reason of no need to visit the doctor for minor illness 78%, for quick relief 75% and for time saving 50%. Only 15% not taken self-medication reasoning there was risk of adverse effects 65% and risk of using wrong drugs 60%. The source of information of the drugs used for self-medication was previous prescription and text book was 50% and 35% respectively and the source of the drugs was medical store, 88.2%. Majority of 96% took for headache followed by fever 83.3%; menstrual symptoms 68.6%; and cough and cold 68.6% and dirrhoea 64.7%. Most of the students 96% took analgesics and antipyretics drugs. Conclusion: Our study shows that self-medication is significantly practiced by nursing students. There is need to aware them about advantages and disadvantages of self-medication in order to ensure safety and proper use of drugs.
{"title":"Knowledge, Attitude and Practice of Self-Medication among Nursing Students of Nepalgunj Nursing Campus Kohalpur Banke","authors":"D. Dhami, S. Dhakal","doi":"10.3126/jngmc.v18i1.35183","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35183","url":null,"abstract":"Introduction: Self-medication is widely practiced among the nursing students because of easy availability and accessibility of the drugs. Inappropriate self-medication can leads to increased resistance among pathogens, wastage of resources, can cause serious harm and increase morbidity; which indicates needs of responsible self-medication.\u0000Aims: This study was to assess the self-medication knowledge, attitude and practice among nursing students.\u0000Methods: This was a questionnaire based descriptive cross sectional study conducted in Nursing students of Nepalgunj Nursing Campus, Kohalpur, on August 2019. Questions related to various aspects of self-medication was used for data collection.\u0000Results: Out of 120 students, 102 (85%) students were found practicing self-medication with reason of no need to visit the doctor for minor illness 78%, for quick relief 75% and for time saving 50%. Only 15% not taken self-medication reasoning there was risk of adverse effects 65% and risk of using wrong drugs 60%. The source of information of the drugs used for self-medication was previous prescription and text book was 50% and 35% respectively and the source of the drugs was medical store, 88.2%. Majority of 96% took for headache followed by fever 83.3%; menstrual symptoms 68.6%; and cough and cold 68.6% and dirrhoea 64.7%. Most of the students 96% took analgesics and antipyretics drugs.\u0000Conclusion: Our study shows that self-medication is significantly practiced by nursing students. There is need to aware them about advantages and disadvantages of self-medication in order to ensure safety and proper use of drugs.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117259682","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35152
N. Acharya, S. Poudel
Introduction: Preterm birth is defined as birth before 37 completed weeks of gestation. It is one of the leading cause of infant morbidity and mortality in the world. Aims: The study was aimed to find out the incidence, possible risk factors and outcome of inborn preterm babies till they were discharged from the hospital. Methods: This is a prospective hospital based study. A total of 100 preterm babies delivered in Nepalgunj Medical College Teaching Hospital, Kohalpur and admitted in Neonatal Intensive Care Unit (NICU) were studied. Preterms were divided into 2 groups extremely to very preterm (<32 weeks) and moderate to late preterm (≥ 32 weeks). The preterm babies were evaluated for various morbidities sand mortality till they were discharged from the hospital. Results: Data of 100 babies was analyzed. Out of 100 preterm babies 40 were extremely to very preterm babies (<32 weeks) and 60 were moderate to late preterm babies (≥32 weeks). Significant risk factors associated with preterm deliveries were inadequate antenatal visits (73%), primi gravidity (58%), preterm premature rupture of membrane (55%), urinary tract infection (54%), anemia (53%), teenage pregnancy (43%), antepartum hemorrhage (41%) and pregnancy induced hypertension (33%). The total mortality was higher in extremely to late preterm than in moderate to late preterm. The most common causes of mortality were Neonatal sepsis (NNS), Hyaline Membrane Disease (HMD) and Birth Asphyxia. Conclusion: The hospital incidence of preterm neonates is still very high. The major risk factor seen in the study was inadequate antenatal visit. Preventive measures, early identification of risk factors will improve the outcome.
{"title":"Incidence, Risk Factors and Immediate Outcome of Preterm Neonates: A Hospital Based Study","authors":"N. Acharya, S. Poudel","doi":"10.3126/jngmc.v18i1.35152","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35152","url":null,"abstract":"Introduction: Preterm birth is defined as birth before 37 completed weeks of gestation. It is one of the leading cause of infant morbidity and mortality in the world.\u0000Aims: The study was aimed to find out the incidence, possible risk factors and outcome of inborn preterm babies till they were discharged from the hospital.\u0000 Methods: This is a prospective hospital based study. A total of 100 preterm babies delivered in Nepalgunj Medical College Teaching Hospital, Kohalpur and admitted in Neonatal Intensive Care Unit (NICU) were studied. Preterms were divided into 2 groups extremely to very preterm (<32 weeks) and moderate to late preterm (≥ 32 weeks). The preterm babies were evaluated for various morbidities sand mortality till they were discharged from the hospital.\u0000Results: Data of 100 babies was analyzed. Out of 100 preterm babies 40 were extremely to very preterm babies (<32 weeks) and 60 were moderate to late preterm babies (≥32 weeks). Significant risk factors associated with preterm deliveries were inadequate antenatal visits (73%), primi gravidity (58%), preterm premature rupture of membrane (55%), urinary tract infection (54%), anemia (53%), teenage pregnancy (43%), antepartum hemorrhage (41%) and pregnancy induced hypertension (33%). The total mortality was higher in extremely to late preterm than in moderate to late preterm. The most common causes of mortality were Neonatal sepsis (NNS), Hyaline Membrane Disease (HMD) and Birth Asphyxia.\u0000Conclusion: The hospital incidence of preterm neonates is still very high. The major risk factor seen in the study was inadequate antenatal visit. Preventive measures, early identification of risk factors will improve the outcome.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129599728","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35204
S. Bk, Sumit Pandey, N. Poudel, S. Pandit, A. Sah, Hitesh Neupane
Introduction: At the end of 2019 a novel virus, named SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), expanded globally from China. A new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was identified as the cause of this outbreak of viral pneumonia that causes coronavirus disease 2019 (COVID-19). Aims: The aim of this study is to find out the chest radiological features of corona virus disease patients and correlate them with clinical outcome. Methods: This is a Hospital based study involving patients with clinical-epidemiological aspect of all reverse transcription polymerase chain reaction (RT-PCR) corona virus disease (COVID-19) positive patients, who performed Chest X-Rays at the emergency department of Nepalgunj Medical College, Teaching Hospital from March to June, 2020. All patients performed reverse transcription polymerase chain reaction from nasopharyngeal and throat swab, Chest X-Ray at the Emergency Department and clinical-epidemiological data. Results: Patients with a reverse transcription polymerase chain reaction positive results for corona virus disease infection were 32 out of these, 22 were females (68.75%) and 10 males (31.25%), with a mean age of 40.78 years (range 20–74 years). Only 2 Chest X-Rays were negative for radiological thoracic involvement (6.25%). The following alterations were more commonly observed among 30 patients: 18 patients with lung consolidations (56.25%), 19 (59.37%) with Ground Glass Opacities, 7 (21.87%) with nodules and 21 (65.6%) with reticular–nodular opacities. Patients with consolidations and Ground Glass Opacities coexisting in the same radiography were 34.37% of total. In reverse transcription polymerase chain reaction positive patients, we found also signs nonspecific for corona virus disease pneumonia as hilar or vascular congestion (37.5%), cardiomegaly (28.12%), pleural effusion (15.6%) and pneumothorax (3.12%). Peripheral (56.25%) and lower zone distribution (56.25%) were the most common predominance. Bilateral involvement (68.75%) was most frequent than unilateral one. Given the results, baseline Chest X-Rays sensitivity in our experience is about 65.62%. Conclusion: In this study, COVID-19 CXRs generally manifested a spectrum of pure ground glass, mixed ground glass opacities to consolidation in bilateral peripheral middle and lower lung zones. BSTI CXR reporting classification of COVID-19 is valid and sensitive in our patients with addition of middle zonal involvement in classical COVID-19 criteria as opposed to just lower zone involvement.
{"title":"Chest X-Ray in Coronavirus Disease 2019 (COVID-19) Infection: Findings and Correlation with Clinical Outcome at Level-3 Nepalgunj Medical College and Teaching Hospital Kohalpur","authors":"S. Bk, Sumit Pandey, N. Poudel, S. Pandit, A. Sah, Hitesh Neupane","doi":"10.3126/jngmc.v18i1.35204","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35204","url":null,"abstract":"Introduction: At the end of 2019 a novel virus, named SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), expanded globally from China. A new coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was identified as the cause of this outbreak of viral pneumonia that causes coronavirus disease 2019 (COVID-19).\u0000Aims: The aim of this study is to find out the chest radiological features of corona virus disease patients and correlate them with clinical outcome.\u0000Methods: This is a Hospital based study involving patients with clinical-epidemiological aspect of all reverse transcription polymerase chain reaction (RT-PCR) corona virus disease (COVID-19) positive patients, who performed Chest X-Rays at the emergency department of Nepalgunj Medical College, Teaching Hospital from March to June, 2020. All patients performed reverse transcription polymerase chain reaction from nasopharyngeal and throat swab, Chest X-Ray at the Emergency Department and clinical-epidemiological data.\u0000Results: Patients with a reverse transcription polymerase chain reaction positive results for corona virus disease infection were 32 out of these, 22 were females (68.75%) and 10 males (31.25%), with a mean age of 40.78 years (range 20–74 years). Only 2 Chest X-Rays were negative for radiological thoracic involvement (6.25%). The following alterations were more commonly observed among 30 patients: 18 patients with lung consolidations (56.25%), 19 (59.37%) with Ground Glass Opacities, 7 (21.87%) with nodules and 21 (65.6%) with reticular–nodular opacities. Patients with consolidations and Ground Glass Opacities coexisting in the same radiography were 34.37% of total. In reverse transcription polymerase chain reaction positive patients, we found also signs nonspecific for corona virus disease pneumonia as hilar or vascular congestion (37.5%), cardiomegaly (28.12%), pleural effusion (15.6%) and pneumothorax (3.12%). Peripheral (56.25%) and lower zone distribution (56.25%) were the most common predominance. Bilateral involvement (68.75%) was most frequent than unilateral one. Given the results, baseline Chest X-Rays sensitivity in our experience is about 65.62%.\u0000Conclusion: In this study, COVID-19 CXRs generally manifested a spectrum of pure ground glass, mixed ground glass opacities to consolidation in bilateral peripheral middle and lower lung zones. BSTI CXR reporting classification of COVID-19 is valid and sensitive in our patients with addition of middle zonal involvement in classical COVID-19 criteria as opposed to just lower zone involvement.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127915906","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35210
Piush Kanodia, Sameer Mahaseth, Vishnu Paranjuli
Introduction: For the effective management of these major childhood illnesses, WHO and UNICEF have developed the “Integrated Management of Neonatal and Childhood Illness” (IMNCI) Strategy. Aims: The aim of study is to evaluate the utility of the WHO/ UNICEF algorithm for Integrated Management of Neonatal and Childhood Illness (IMNCI) for jaundice up to two months of age. Methods: This is Prospective observational comparative study. Total of 300 subjects were taken from Emergency and Outpatient Department of Pediatrics. The treatment steps were identified as according to the ‘Assess and Classify’ module of IMNCI algorithm. All relevant investigations were performed, using appropriate methods. Blood sugar was done in all recruited children and serum bilirubin levels were done in all infants presented with jaundice. Based on this detailed clinical evaluation and relevant investigations, final diagnosis were made and therapies were given. These diagnosis and treatments were considered as the ‘Gold Standard’ for comparison. Results: There were 300 young infants, of whom 162(54%) were male and 138(46%) were female infants. Total of 146 infants were admitted, 24 from OPD and 122 from Emergency. 154 infants were sent home after initial management in hospital. Severe jaundice was present in 24 infants according to IMNCI and 12 infants according to Gold Standard in 0-2 months of age. The predictive utility of algorithm for the diagnosis of severe jaundice with a sensitivity of 100%, specificity of 75%, positive predictive value of 50% and negative predictive value of 100% in 0-2 months of age group. Conclusion: Algorithm performed well in identifying severe jaundice with the sensitivity of 100% and specificity of 95%.
{"title":"Validation of WHO-IMNCI Algorithm for Jaundice in 0-2 Months Aged Infants at Tertiary Level Hospital","authors":"Piush Kanodia, Sameer Mahaseth, Vishnu Paranjuli","doi":"10.3126/jngmc.v18i1.35210","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35210","url":null,"abstract":"Introduction: For the effective management of these major childhood illnesses, WHO and UNICEF have developed the “Integrated Management of Neonatal and Childhood Illness” (IMNCI) Strategy.\u0000Aims: The aim of study is to evaluate the utility of the WHO/ UNICEF algorithm for Integrated Management of Neonatal and Childhood Illness (IMNCI) for jaundice up to two months of age.\u0000Methods: This is Prospective observational comparative study. Total of 300 subjects were taken from Emergency and Outpatient Department of Pediatrics. The treatment steps were identified as according to the ‘Assess and Classify’ module of IMNCI algorithm. All relevant investigations were performed, using appropriate methods. Blood sugar was done in all recruited children and serum bilirubin levels were done in all infants presented with jaundice. Based on this detailed clinical evaluation and relevant investigations, final diagnosis were made and therapies were given. These diagnosis and treatments were considered as the ‘Gold Standard’ for comparison.\u0000Results: There were 300 young infants, of whom 162(54%) were male and 138(46%) were female infants. Total of 146 infants were admitted, 24 from OPD and 122 from Emergency. 154 infants were sent home after initial management in hospital. Severe jaundice was present in 24 infants according to IMNCI and 12 infants according to Gold Standard in 0-2 months of age. The predictive utility of algorithm for the diagnosis of severe jaundice with a sensitivity of 100%, specificity of 75%, positive predictive value of 50% and negative predictive value of 100% in 0-2 months of age group.\u0000Conclusion: Algorithm performed well in identifying severe jaundice with the sensitivity of 100% and specificity of 95%.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125259304","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35208
M. Belbase, Jyoti Adhikari
Introduction: Schizophrenia is a mental disorder characterized with disorganized thinking, perception, expression of reality with significant social and occupational dysfunction. Two groups of drugs are in recent use namely first generation (typicals) and second generation (atypical) antipsychotics. Risperidone is a broad spectrum antipsychotic and has a role as a first-line agent for first break, mild to moderately ill patients and for severely ill treatment–refractory patients. Aims: This article tries to compare the risperidone response in newly diagnosed schizophrenia patients versus old patients already on some antipsychotics other than risperidone. Methods: This is an experimental intervention study of patients attending to psychiatry OPD and indoor in Nepalgunj Medical College, Kohalpur. Total 40 patients (27 new and 13 old) were selected and sample was collected in one year from January 2018 till December 2018. Positive and negative syndrome scale questionnaire was used to record the positive and negative symptoms of schizophrenia on baseline (week 0). Patients were followed up on week 4 and week 8 and the same positive and negative syndrome scale questionnaire was applied to record the improvement. Risperidone was given in therapeutic dose (4-8mg) on the basis of symptoms and improvement. Results: The study subjects were divided into new N=27 (17 male and 10 female) and old N=13 (7 male and 6 female). Maximum number of schizophrenia cases were in age group 15-25 and 35-44 years comprising 30 % in each group. Mean total duration of illness in new group was 23.89 ± 29.51 months (median being 12.0 months) while in old group it was 123.69 ± 83.34 months (median being 96.0 months) with significant difference between two groups (p= <0.001).The mean risperidone dose in milligram on base line (week 0) was 4.15 ± 0.55 for old group while it was 4.04 ± 0.52 for new group. On week 4, the mean dose for old group was 5.08 ± 0.95 while for the new group it was 4.81 ± 1.08. On week 8, the dose for old group was 6.08 ± 1.32 while it was 5.15 ± 1.35 for new group. There was a significant difference in the drug dose on week 8 between old group and new group with p value of 0.047 (statistically significant). Conclusion: Our study suggests that schizophrenia is found in most productive age group. Risperidone is effective in both new and old schizophrenia patients however old patients need higher dose of risperidone than new patients.
{"title":"Socio Demographic Profile and Risperidone Response in New Versus Old Schizophrenia Patients","authors":"M. Belbase, Jyoti Adhikari","doi":"10.3126/jngmc.v18i1.35208","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35208","url":null,"abstract":"Introduction: Schizophrenia is a mental disorder characterized with disorganized thinking, perception, expression of reality with significant social and occupational dysfunction. Two groups of drugs are in recent use namely first generation (typicals) and second generation (atypical) antipsychotics. Risperidone is a broad spectrum antipsychotic and has a role as a first-line agent for first break, mild to moderately ill patients and for severely ill treatment–refractory patients.\u0000Aims: This article tries to compare the risperidone response in newly diagnosed schizophrenia patients versus old patients already on some antipsychotics other than risperidone.\u0000Methods: This is an experimental intervention study of patients attending to psychiatry OPD and indoor in Nepalgunj Medical College, Kohalpur. Total 40 patients (27 new and 13 old) were selected and sample was collected in one year from January 2018 till December 2018. Positive and negative syndrome scale questionnaire was used to record the positive and negative symptoms of schizophrenia on baseline (week 0). Patients were followed up on week 4 and week 8 and the same positive and negative syndrome scale questionnaire was applied to record the improvement. Risperidone was given in therapeutic dose (4-8mg) on the basis of symptoms and improvement.\u0000Results: The study subjects were divided into new N=27 (17 male and 10 female) and old N=13 (7 male and 6 female). Maximum number of schizophrenia cases were in age group 15-25 and 35-44 years comprising 30 % in each group. Mean total duration of illness in new group was 23.89 ± 29.51 months (median being 12.0 months) while in old group it was 123.69 ± 83.34 months (median being 96.0 months) with significant difference between two groups (p= <0.001).The mean risperidone dose in milligram on base line (week 0) was 4.15 ± 0.55 for old group while it was 4.04 ± 0.52 for new group. On week 4, the mean dose for old group was 5.08 ± 0.95 while for the new group it was 4.81 ± 1.08. On week 8, the dose for old group was 6.08 ± 1.32 while it was 5.15 ± 1.35 for new group. There was a significant difference in the drug dose on week 8 between old group and new group with p value of 0.047 (statistically significant). \u0000Conclusion: Our study suggests that schizophrenia is found in most productive age group. Risperidone is effective in both new and old schizophrenia patients however old patients need higher dose of risperidone than new patients.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131908834","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.35181
L. Verma, D. Paudel
Introduction: Role of cortical mastoidectomy in tympanoplasty for Chronic Otitis Media Mucosal inactive disease is controversial. Some arguments are in favor and suggest that cortical mastoidectomy increases the air reservoir in the mastoid and also help in achieving the patency of aditus but others believe that the ingrowths of squamous epithelium, potential for injury to the inner ear structures and facial nerve during mastoid surgery outweighs the beneficial effects on tympanic membrane healing. Aims: To assess the hearing improvement and graft uptake in patients undergoing Tympanoplasty and Tympano-mastoidectomy in chronic otitis media mucosal inactive disease. Methods: This was a comparative study comprises of 50 patients with Chronic Otitis Media Mucosal inactive ear, conducted in the patients attending the department of ENT in NGMC teaching hospital from Nov 2017 to May 2019. All cases were operated during a period of one half year. 25 patients were selected for tympanoplasty (Group A) and 25 patients were selected for Tympanoplasty with cortical mastoidectomy (Group B). Results: There were 14(28%) male and 36(72%) female, with mean age of 28. 36 years, ranging from minimum of 13 years to maximum 56 years. The postoperative audiograms were recorded after 3 months. Type I tympanoplasty with cortical mastoidectomy has better graft uptake (96%) as compared to without mastoidectomy (84%). Post-operative hearing improvement is almost equal in tympano-mastoidectomy (13.24 dB) and tympanoplasty (13.04 dB). Conclusion: Post-operative hearing gain almost equal in both study group but graft uptake was better with tympano-mastoidectomy then tympanoplasty alone in present study.
{"title":"Role of Cortical Mastoidectomy in the Management of Safe Chronic Otitis Media","authors":"L. Verma, D. Paudel","doi":"10.3126/jngmc.v18i1.35181","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.35181","url":null,"abstract":"Introduction: Role of cortical mastoidectomy in tympanoplasty for Chronic Otitis Media Mucosal inactive disease is controversial. Some arguments are in favor and suggest that cortical mastoidectomy increases the air reservoir in the mastoid and also help in achieving the patency of aditus but others believe that the ingrowths of squamous epithelium, potential for injury to the inner ear structures and facial nerve during mastoid surgery outweighs the beneficial effects on tympanic membrane healing.\u0000Aims: To assess the hearing improvement and graft uptake in patients undergoing Tympanoplasty and Tympano-mastoidectomy in chronic otitis media mucosal inactive disease.\u0000Methods: This was a comparative study comprises of 50 patients with Chronic Otitis Media Mucosal inactive ear, conducted in the patients attending the department of ENT in NGMC teaching hospital from Nov 2017 to May 2019. All cases were operated during a period of one half year. 25 patients were selected for tympanoplasty (Group A) and 25 patients were selected for Tympanoplasty with cortical mastoidectomy (Group B).\u0000Results: There were 14(28%) male and 36(72%) female, with mean age of 28. 36 years, ranging from minimum of 13 years to maximum 56 years. The postoperative audiograms were recorded after 3 months. Type I tympanoplasty with cortical mastoidectomy has better graft uptake (96%) as compared to without mastoidectomy (84%). Post-operative hearing improvement is almost equal in tympano-mastoidectomy (13.24 dB) and tympanoplasty (13.04 dB).\u0000Conclusion: Post-operative hearing gain almost equal in both study group but graft uptake was better with tympano-mastoidectomy then tympanoplasty alone in present study.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128298333","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 : 2020-12-31DOI: 10.3126/jngmc.v18i1.34717
Niju Niroula
Introduction: Although cognitive and functional impairment are the hallmark features of Dementia but it is often undetected and neglected as a normal part of aging. So we conducted this study on clinical profile of dementia patients. Aims: The aim of this study is to evaluate the Patient’s cognitive impairment, functional capacities, and stages of severity of dementia. Methods: A descriptive cross sectional study was conducted among 50 patients aged 60 years and above, of both sexes with the diagnosis of Dementia, admitted in Medicine ward of Nepalgunj Medical College, Nepalgunj, Nepal. The screening of dementia was done using Mini-Mental State Examination tool and the diagnosis of Dementia was confirmed using the International Classification of Disease-10 Diagnostic Criteria for Research. Cognition, functionality and stages of severity of dementia were assessed using Hierarchic Dementia Scale, Functional Autonomy Measurement System, Functional Assessment Staging Test tools respectively. Results: Among a total of 50 dementia patients, the mean and standard deviation of age was 82.4±6.1 years, majority of cases 60 % were in the age group ≥85 years and most patients were female 56%. The mean Mini-Mental State Examination score was 9.6±3.0, and 50 % had severe impairment of cognition on Hierarchic Dementia Scale. Stage 7 dementia 32 % was most prevalent stage on Functional Assessment Staging and severe deterioration in the functional autonomy was seen in 54% dementia patients (score ≥41 on Functional Autonomy Measurement System). Conclusion: This study concludes that significant number of elderly patients attending tertiary care hospital suffers from dementia with severe impairment in cognition and functionality in various stages of dementia in the elderly patients.
{"title":"Clinical Spectrum- Cognition, Stages, Functionality among Elderly with Dementia: A Cross-Sectional Study","authors":"Niju Niroula","doi":"10.3126/jngmc.v18i1.34717","DOIUrl":"https://doi.org/10.3126/jngmc.v18i1.34717","url":null,"abstract":"Introduction: Although cognitive and functional impairment are the hallmark features of Dementia but it is often undetected and neglected as a normal part of aging. So we conducted this study on clinical profile of dementia patients.\u0000Aims: The aim of this study is to evaluate the Patient’s cognitive impairment, functional capacities, and stages of severity of dementia.\u0000Methods: A descriptive cross sectional study was conducted among 50 patients aged 60 years and above, of both sexes with the diagnosis of Dementia, admitted in Medicine ward of Nepalgunj Medical College, Nepalgunj, Nepal. The screening of dementia was done using Mini-Mental State Examination tool and the diagnosis of Dementia was confirmed using the International Classification of Disease-10 Diagnostic Criteria for Research. Cognition, functionality and stages of severity of dementia were assessed using Hierarchic Dementia Scale, Functional Autonomy Measurement System, Functional Assessment Staging Test tools respectively.\u0000Results: Among a total of 50 dementia patients, the mean and standard deviation of age was 82.4±6.1 years, majority of cases 60 % were in the age group ≥85 years and most patients were female 56%. The mean Mini-Mental State Examination score was 9.6±3.0, and 50 % had severe impairment of cognition on Hierarchic Dementia Scale. Stage 7 dementia 32 % was most prevalent stage on Functional Assessment Staging and severe deterioration in the functional autonomy was seen in 54% dementia patients (score ≥41 on Functional Autonomy Measurement System).\u0000Conclusion: This study concludes that significant number of elderly patients attending tertiary care hospital suffers from dementia with severe impairment in cognition and functionality in various stages of dementia in the elderly patients.","PeriodicalId":166882,"journal":{"name":"Journal of Nepalgunj Medical College","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125491968","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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