Pub Date : 2023-12-22DOI: 10.3126/nmcj.v25i4.60931
Anu Khadka, S. Pudasaini, Shreesti Adhikari
Various types of lesion from inflammation to carcinoma can affect the breast. Some lesions are common in young age group while others are more common in elderly age group. Accurate diagnosis is essential to relieve anxiety of patients. In case of carcinoma, early and accurate diagnosis can save the patient from metastases thus reducing mortality and morbidity. Histopathology plays a major role in distinguishing benign lesions from malignant lesions. Hospital based descriptive study was carried out in the Department of Pathology of a tertiary care centre in Kathmandu over a period of eleven months (1st September 2022 to 30th July 2023). A total of 52 cases of breast lesions were included in the study. Among 52 cases, 17 (33%) were non-neoplastic and 35 (67.0%) were neoplastic. Among neoplastic, 21 (40.3%) were benign and 14 (26.9%) were malignant. Among non neoplastic lesions, inflammatory lesion (17.3%) was the most common diagnosis. Among neoplastic lesion, fibroadenoma (34.6%) was the most common diagnosis. All cases of malignant breast lesions (26.9%) were diagnosed as invasive breast carcinoma, no special type. This study helped us to analyze the histopathological spectrum and prevalence of breast lesions in this part of our country. It is well known fact that the histomorphological study of the breast lesions is an important aspect for the diagnosis, management and prognosis of breast diseases.
{"title":"Histomorphological study of breast lesion in a tertiary care centre in Kathmandu","authors":"Anu Khadka, S. Pudasaini, Shreesti Adhikari","doi":"10.3126/nmcj.v25i4.60931","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60931","url":null,"abstract":"Various types of lesion from inflammation to carcinoma can affect the breast. Some lesions are common in young age group while others are more common in elderly age group. Accurate diagnosis is essential to relieve anxiety of patients. In case of carcinoma, early and accurate diagnosis can save the patient from metastases thus reducing mortality and morbidity. Histopathology plays a major role in distinguishing benign lesions from malignant lesions. Hospital based descriptive study was carried out in the Department of Pathology of a tertiary care centre in Kathmandu over a period of eleven months (1st September 2022 to 30th July 2023). A total of 52 cases of breast lesions were included in the study. Among 52 cases, 17 (33%) were non-neoplastic and 35 (67.0%) were neoplastic. Among neoplastic, 21 (40.3%) were benign and 14 (26.9%) were malignant. Among non neoplastic lesions, inflammatory lesion (17.3%) was the most common diagnosis. Among neoplastic lesion, fibroadenoma (34.6%) was the most common diagnosis. All cases of malignant breast lesions (26.9%) were diagnosed as invasive breast carcinoma, no special type. This study helped us to analyze the histopathological spectrum and prevalence of breast lesions in this part of our country. It is well known fact that the histomorphological study of the breast lesions is an important aspect for the diagnosis, management and prognosis of breast diseases.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"18 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139164625","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 : 2023-12-22DOI: 10.3126/nmcj.v25i4.60878
D. P. Thapa, B. Amatya, Arnija Rana, Sumit Ray, Smriti Piya, Deeptara Pathak
Acne is a disease involving pilosebaceous unit commonly affecting adolescents. Acne has a multifactorial aetiology but in recent years, studies have shed some light in the relationship between cigarette smoking and acne. As previous studies linking cigarette smoking and acne had produced conflicting results, we conducted this study to provide comprehensive information of cigarette smoking and its association with acne in Nepalese population. The study comprised all participants who met the inclusion criteria as well as a control group that was age and sex matched. The demographic profile, smoking history, previous history, drug history, and examination results were entered into a pre-set proforma. There were a total of 100 cases of acne patients (Group A) with age and sex-matched 100 controls (Group B). There were 69% females and 31% males. The majority of the acne patients (Group A) were students in 65%, as compared to 42% in control group. In group A, 95% never smoked and 5% were smokers (cigarettes). In group B, 98% never smoked and 2% were smokers (cigarettes). The commonest site of acne lesions was in face 64. Among the acne patients there were 27% mild acne, 58% moderate acne and 15% severe acne. There was no association found between cigarette smoking and acne (OR- 2.57, 95% CI -0.4884 to 13.6173, P>0.05). There was no correlation between acne and smoking in Nepalese population. However, a larger sample size is recommended to confirm the correlation.
痤疮是一种常见于青少年的皮脂腺疾病。痤疮的病因是多因素的，但近年来的研究已经揭示了吸烟与痤疮之间的关系。由于以往有关吸烟与痤疮关系的研究结果相互矛盾，我们开展了这项研究，以提供有关尼泊尔人群吸烟及其与痤疮关系的全面信息。研究对象包括所有符合纳入标准的参与者，以及年龄和性别匹配的对照组。研究人员将人口统计学特征、吸烟史、既往史、用药史和检查结果输入预设的表格。共有 100 例痤疮患者（A 组）与 100 例年龄和性别匹配的对照组（B 组）。其中女性占 69%，男性占 31%。大多数痤疮患者（A 组）为学生，占 65%，而对照组为 42%。在 A 组中，95% 的人从不吸烟，5% 的人吸烟（香烟）。在 B 组中，98% 的人从不吸烟，2% 的人吸烟（香烟）。最常见的痤疮皮损部位是脸部 64.在痤疮患者中，27%为轻度痤疮，58%为中度痤疮，15%为重度痤疮。吸烟与痤疮之间没有关联（OR- 2.57，95% CI -0.4884-13.6173，P>0.05）。在尼泊尔人群中，痤疮与吸烟之间没有相关性。不过，建议采用更大的样本量来确认两者之间的相关性。
{"title":"Association between cigarette smoking and Acne Vulgaris","authors":"D. P. Thapa, B. Amatya, Arnija Rana, Sumit Ray, Smriti Piya, Deeptara Pathak","doi":"10.3126/nmcj.v25i4.60878","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60878","url":null,"abstract":"Acne is a disease involving pilosebaceous unit commonly affecting adolescents. Acne has a multifactorial aetiology but in recent years, studies have shed some light in the relationship between cigarette smoking and acne. As previous studies linking cigarette smoking and acne had produced conflicting results, we conducted this study to provide comprehensive information of cigarette smoking and its association with acne in Nepalese population. The study comprised all participants who met the inclusion criteria as well as a control group that was age and sex matched. The demographic profile, smoking history, previous history, drug history, and examination results were entered into a pre-set proforma. There were a total of 100 cases of acne patients (Group A) with age and sex-matched 100 controls (Group B). There were 69% females and 31% males. The majority of the acne patients (Group A) were students in 65%, as compared to 42% in control group. In group A, 95% never smoked and 5% were smokers (cigarettes). In group B, 98% never smoked and 2% were smokers (cigarettes). The commonest site of acne lesions was in face 64. Among the acne patients there were 27% mild acne, 58% moderate acne and 15% severe acne. There was no association found between cigarette smoking and acne (OR- 2.57, 95% CI -0.4884 to 13.6173, P>0.05). There was no correlation between acne and smoking in Nepalese population. However, a larger sample size is recommended to confirm the correlation.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"43 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163463","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 : 2023-12-22DOI: 10.3126/nmcj.v25i4.60924
Rojin Joshi, S. Gautam, Barsha Joshi
Among the oral ailments which are observed by dental practitioners in elderly, root caries is a significant one. It has been reported that about a third of older population bears most of the root caries burden. Root surface caries is one of the significant oral health problems in the elderly, and the incidence of root surface caries has been found to be one of the major risk factors for tooth loss. Limited studies have been carried out on root caries in elderly patients in context of Nepal. Hence, the objective of this study was to find the prevalence of root caries and its associated factors among the elderly population. This observational cross sectional study was done on 188 adult patients of 60 years and above. A specifically designed questionnaire was used to collect the following information: socio-demographic characteristics, use of medication, oral hygiene practices and oral health behaviour. Data were analyzed using Chi square test and descriptive statistics were calculated. It was found that the prevalence of root caries was 61.7% and it increased with age. There was an association between root caries and socioeconomic status which showed root caries was seen more in adults of upper middle class. More of root caries was seen in females, those who were unmarried, taking medications and non vegetarians. Oral hygiene habits and oral health behaviour had a positive impact on root caries. More of root caries was seen on buccal surface of molars.
{"title":"Prevalence of root caries and associated factors among elderly population visiting a dental teaching hospital in Kathmandu, Nepal","authors":"Rojin Joshi, S. Gautam, Barsha Joshi","doi":"10.3126/nmcj.v25i4.60924","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60924","url":null,"abstract":"Among the oral ailments which are observed by dental practitioners in elderly, root caries is a significant one. It has been reported that about a third of older population bears most of the root caries burden. Root surface caries is one of the significant oral health problems in the elderly, and the incidence of root surface caries has been found to be one of the major risk factors for tooth loss. Limited studies have been carried out on root caries in elderly patients in context of Nepal. Hence, the objective of this study was to find the prevalence of root caries and its associated factors among the elderly population. This observational cross sectional study was done on 188 adult patients of 60 years and above. A specifically designed questionnaire was used to collect the following information: socio-demographic characteristics, use of medication, oral hygiene practices and oral health behaviour. Data were analyzed using Chi square test and descriptive statistics were calculated. It was found that the prevalence of root caries was 61.7% and it increased with age. There was an association between root caries and socioeconomic status which showed root caries was seen more in adults of upper middle class. More of root caries was seen in females, those who were unmarried, taking medications and non vegetarians. Oral hygiene habits and oral health behaviour had a positive impact on root caries. More of root caries was seen on buccal surface of molars.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"70 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163746","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 : 2023-12-22DOI: 10.3126/nmcj.v25i4.60877
Srijana Pandey, Ishwori Lama
Cognitive impairment is debilitating condition for elderly in their activities of daily living which can cause problem to self, others and society. Therefore, the researcher aims to screen the cognitive impairment among elderly population at Tertiary Hospital. Cross sectional, descriptive and exploratory design with Purposive sampling technique was used among elderly population at OPD of Tertiary hospital. Mini-mental status examination, activities of daily living, instrumental activities of daily living were used for screening cognitive impairment and dementia. The interview dates were set up for 15 days. Sampling procedure included quota of 20 cases per day and thus, the sample was 300 elderly. Total sample after four persons denied to participate was 296. The mean age of elderly respondents were 71.58 (±5.09). The study revealed that there was no cognitive impairment among 67.6%, mild cognitive impairment among 25.7% and moderate cognitive impairment among 6.8%. The activities of daily living in majority of respondents were 95.3% in full function and least 1% were in severe functional impairment. Instrumental activities of daily living indicated that three-fourths of the respondents 76.7% had high function, 16.2% needed assistance and 7.1% had low function. Age, living with status is significantly associated with cognitive impairment. Screening of cognitive impairment is necessary to identify the impairment among elderly which enhances the awareness of cognitive impairment.
{"title":"Screening for cognitive impairment and dementia among elderly persons attending a tertiary hospital","authors":"Srijana Pandey, Ishwori Lama","doi":"10.3126/nmcj.v25i4.60877","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60877","url":null,"abstract":"Cognitive impairment is debilitating condition for elderly in their activities of daily living which can cause problem to self, others and society. Therefore, the researcher aims to screen the cognitive impairment among elderly population at Tertiary Hospital. Cross sectional, descriptive and exploratory design with Purposive sampling technique was used among elderly population at OPD of Tertiary hospital. Mini-mental status examination, activities of daily living, instrumental activities of daily living were used for screening cognitive impairment and dementia. The interview dates were set up for 15 days. Sampling procedure included quota of 20 cases per day and thus, the sample was 300 elderly. Total sample after four persons denied to participate was 296. The mean age of elderly respondents were 71.58 (±5.09). The study revealed that there was no cognitive impairment among 67.6%, mild cognitive impairment among 25.7% and moderate cognitive impairment among 6.8%. The activities of daily living in majority of respondents were 95.3% in full function and least 1% were in severe functional impairment. Instrumental activities of daily living indicated that three-fourths of the respondents 76.7% had high function, 16.2% needed assistance and 7.1% had low function. Age, living with status is significantly associated with cognitive impairment. Screening of cognitive impairment is necessary to identify the impairment among elderly which enhances the awareness of cognitive impairment.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163754","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 : 2023-12-22DOI: 10.3126/nmcj.v25i4.60871
R. Shrestha, N. Nayak, Dharm Raj Bhatt, D. Hamal, S. Gokhale
Pulmonary tuberculosis is the most important health concerns. Some fungi may acquire pathogenic potential in immunocompromised persons due to underlying diseases, use of prolonged antibiotics, chronic disease and malignancy. The presence of fungal pathogens in cases of pulmonary TB adds to the chronicity of the disease and being difficult to treat. This study aimed to evaluate tuberculosis (TB) status and coinfection of TB with pulmonary fungal infections. A total of 330 sputum samples were collected from suspected pulmonary TB and were examined using Ziehl-Neelsen (Z-N) staining method as per revised national tuberculosis control program (RNTCP) guidelines and GeneXpert assay procedure adopted, was in accordance with the WHO recommended guidelines. Those sputum samples were also processed for fungal culture. In case of any growth, this was identified by gram staining or by lactophenol cotton blue wet mount preparation and slide culture technique, if needed. A total of 29 (8.8%) samples out of 330 yielded tuberculosis by GeneXpert assay. Maximum positivity was noted among age group 31- 45 years (15.5%). In the present study, GeneXpert positivity for the Mycobacterium tuberculoris (MTB) detected rate remained to be 8.8% (29/330) detected as against smear positivity in only 5.4% (18/330) (P value: 0.001). Out of 18, Z-N smear positive samples, maximum i.e. 17, which had yielded either high or medium detected of TB bacilli in the GeneXpert assay. Whereas, out the rest 12 GeneXpert positive (low and very low) samples, only one sample showed acid fast bacilli in the smear. A significant correlation was found between GeneXpert and smear positivity (p<0.001). Overall, 90 (27.7%) Candida spp. were isolated. Interestingly, 7 of these 90 Candida positive samples were found to positive to MTB by GeneXpert test, accounting a prevalence rate of 24.1% (7/29) of Candida coinfection among TB cases. Tuberculosis remains a global threat despite effort to eradicate the disease and TB co-infection with Candida spp. may complicate infection and treatment. In this present study, although the prevalence rates of all the coinfections were low and statistically not significant. Being chronic in nature and with confusing clinical and radiological findings, these fungal infections are misdiagnosed as reactivation of tuberculosis. Screening for TB should be conducted to diagnose early and treat these opportunistic infections and decrease mortality and morbidity rates associated with fungal coinfection in tuberculosis patients.
{"title":"Prevalence of fungal infection in clinically suspected cases of pulmonary tuberculosis visiting a tertiary care hospital","authors":"R. Shrestha, N. Nayak, Dharm Raj Bhatt, D. Hamal, S. Gokhale","doi":"10.3126/nmcj.v25i4.60871","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60871","url":null,"abstract":"Pulmonary tuberculosis is the most important health concerns. Some fungi may acquire pathogenic potential in immunocompromised persons due to underlying diseases, use of prolonged antibiotics, chronic disease and malignancy. The presence of fungal pathogens in cases of pulmonary TB adds to the chronicity of the disease and being difficult to treat. This study aimed to evaluate tuberculosis (TB) status and coinfection of TB with pulmonary fungal infections. A total of 330 sputum samples were collected from suspected pulmonary TB and were examined using Ziehl-Neelsen (Z-N) staining method as per revised national tuberculosis control program (RNTCP) guidelines and GeneXpert assay procedure adopted, was in accordance with the WHO recommended guidelines. Those sputum samples were also processed for fungal culture. In case of any growth, this was identified by gram staining or by lactophenol cotton blue wet mount preparation and slide culture technique, if needed. A total of 29 (8.8%) samples out of 330 yielded tuberculosis by GeneXpert assay. Maximum positivity was noted among age group 31- 45 years (15.5%). In the present study, GeneXpert positivity for the Mycobacterium tuberculoris (MTB) detected rate remained to be 8.8% (29/330) detected as against smear positivity in only 5.4% (18/330) (P value: 0.001). Out of 18, Z-N smear positive samples, maximum i.e. 17, which had yielded either high or medium detected of TB bacilli in the GeneXpert assay. Whereas, out the rest 12 GeneXpert positive (low and very low) samples, only one sample showed acid fast bacilli in the smear. A significant correlation was found between GeneXpert and smear positivity (p<0.001). Overall, 90 (27.7%) Candida spp. were isolated. Interestingly, 7 of these 90 Candida positive samples were found to positive to MTB by GeneXpert test, accounting a prevalence rate of 24.1% (7/29) of Candida coinfection among TB cases. Tuberculosis remains a global threat despite effort to eradicate the disease and TB co-infection with Candida spp. may complicate infection and treatment. In this present study, although the prevalence rates of all the coinfections were low and statistically not significant. Being chronic in nature and with confusing clinical and radiological findings, these fungal infections are misdiagnosed as reactivation of tuberculosis. Screening for TB should be conducted to diagnose early and treat these opportunistic infections and decrease mortality and morbidity rates associated with fungal coinfection in tuberculosis patients.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"214 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139165716","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}
COVID-19 pandemic is significantly affecting the overall health and healthcare system globally. It has not shown mercy to Nepal either. All the health facilities are full of COVID-19 patients. Almost all death from COVID-19, has occurred in hospital. Adequate knowledge of nurses regarding the source, transmission, symptoms, and preventive measures of COVID-19 helps to provide effective care and prevent spreading infections from patients to patients, and nurses to patients. Therefore, this study aimed to identify the knowledge regarding COVID-19 and perceived barriers for care provision regarding COVID-19 patients among hospital nurses in Nepal. A cross-sectional descriptive study was conducted in different COVID-19 care designated hospitals of Nepal. Data were collected by using self-administered validated questionnaire through online survey. Descriptive analysis was done by using SPSS-16. More than 80% of nurses had adequate knowledge regarding symptoms, route of transmission, vulnerable population and preventive measures of COVID- 19 and only 15.0% had got training related to COVID-19 pandemic. Nurses perceived negligence of the patients and community people on COVID-19 prevention (84.6%), fear of being infected and carrier to family and community while contacting with patients (80.0%), long duty hour (75.0%), inadequately supply of personal protective equipment and insufficient institutional preparedness (74.0%) were the major barriers for providing care of COVID-19 patients. Thus, hospital authority, nursing administration and nursing professionals’ organizations should play an important role in organizing training to nurses and awareness program to community people. It is also essential in providing required supplies, and facilitates the motivating environment for effective care and prevention of COVID-19.
{"title":"Knowledge and perceived barriers for care provision regarding COVID-19 among hospital nurses in Nepal","authors":"Bijaya Adhikari, Anju Mahato, Tara Acharya, Bhagawaty Kalikote","doi":"10.3126/nmcj.v25i4.60921","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60921","url":null,"abstract":"COVID-19 pandemic is significantly affecting the overall health and healthcare system globally. It has not shown mercy to Nepal either. All the health facilities are full of COVID-19 patients. Almost all death from COVID-19, has occurred in hospital. Adequate knowledge of nurses regarding the source, transmission, symptoms, and preventive measures of COVID-19 helps to provide effective care and prevent spreading infections from patients to patients, and nurses to patients. Therefore, this study aimed to identify the knowledge regarding COVID-19 and perceived barriers for care provision regarding COVID-19 patients among hospital nurses in Nepal. A cross-sectional descriptive study was conducted in different COVID-19 care designated hospitals of Nepal. Data were collected by using self-administered validated questionnaire through online survey. Descriptive analysis was done by using SPSS-16. More than 80% of nurses had adequate knowledge regarding symptoms, route of transmission, vulnerable population and preventive measures of COVID- 19 and only 15.0% had got training related to COVID-19 pandemic. Nurses perceived negligence of the patients and community people on COVID-19 prevention (84.6%), fear of being infected and carrier to family and community while contacting with patients (80.0%), long duty hour (75.0%), inadequately supply of personal protective equipment and insufficient institutional preparedness (74.0%) were the major barriers for providing care of COVID-19 patients. Thus, hospital authority, nursing administration and nursing professionals’ organizations should play an important role in organizing training to nurses and awareness program to community people. It is also essential in providing required supplies, and facilitates the motivating environment for effective care and prevention of COVID-19.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"109 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163569","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}
Over two million people undergo sternotomy worldwide for heart surgery each year, and post operative sternal pain may last for months or reappears a long time after sternotomy. The exact etiology of post sternotomy pain is unknown. We aim to find out the association of peri-operative factors with chronicity of sternal pain after open-heart surgery. This is a retrospective observational study on 121 patients who underwent open heart surgeries for various cardiac problems from January 2020 to July 2022 at a tertiary care center. Convenient sampling was performed. Data were analyzed using SPSS-17. Male to female ratio similar with male 60 (49.6%) and female 61 (50.4%), and 95.0% had body mass index (kg/m2) <30. Ninety (76.9%) were individuals without diabetes, 75 (62.0%) were non-hypertensive, 97 (80.2%) were nonsmokers and 22 (18.2%) had abnormal thyroid function. Only 2 (1.7%) had chronic obstructive airway disease and 1 (0.8%) had renal failure. Majority was in sinus rhythm 88 (72.7). Forty (33.1%) had valvular and 53 (43.8%) had ischemic etiology. Majority 110 (90.9%) were ventilated for less than 6 hours and 15 (9.4%) had surgical site infection. Peri-operative risk factors like age of patient, etiology, hypertension, operative procedure, ventilator hours, cardiopulmonary bypass time, intensive care unit stay, and total hospital stay had a significant association with chronicity of pain.
{"title":"Study of perioperative factors in postoperative chronicity of sternal pain","authors":"Lokesh Yadav, Praman Sharma, Afroz Ansari, Nabin Paudyal","doi":"10.3126/nmcj.v25i4.60920","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60920","url":null,"abstract":"Over two million people undergo sternotomy worldwide for heart surgery each year, and post operative sternal pain may last for months or reappears a long time after sternotomy. The exact etiology of post sternotomy pain is unknown. We aim to find out the association of peri-operative factors with chronicity of sternal pain after open-heart surgery. This is a retrospective observational study on 121 patients who underwent open heart surgeries for various cardiac problems from January 2020 to July 2022 at a tertiary care center. Convenient sampling was performed. Data were analyzed using SPSS-17. Male to female ratio similar with male 60 (49.6%) and female 61 (50.4%), and 95.0% had body mass index (kg/m2) <30. Ninety (76.9%) were individuals without diabetes, 75 (62.0%) were non-hypertensive, 97 (80.2%) were nonsmokers and 22 (18.2%) had abnormal thyroid function. Only 2 (1.7%) had chronic obstructive airway disease and 1 (0.8%) had renal failure. Majority was in sinus rhythm 88 (72.7). Forty (33.1%) had valvular and 53 (43.8%) had ischemic etiology. Majority 110 (90.9%) were ventilated for less than 6 hours and 15 (9.4%) had surgical site infection. Peri-operative risk factors like age of patient, etiology, hypertension, operative procedure, ventilator hours, cardiopulmonary bypass time, intensive care unit stay, and total hospital stay had a significant association with chronicity of pain.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"33 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139164857","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 : 2023-12-22DOI: 10.3126/nmcj.v25i4.60926
K. Shrestha, A. Dhungana, A. S. Rijal, Rupesh Raj Joshi
Nasal endoscopy (NE) is an office procedure done to look at the nasal and sinus passages using an endoscope which could be either rigid or flexible. It allows the clinician to characterize the intranasal anatomy better compared to the conventional techniques of headlight, speculum and mirror thus aiding the diagnosis. Therefore its popularity has increased recently and is one of the most frequently performed diagnostic procedures in Otorhinolaryngology and Head and Neck Surgery OPD. A unanimous consensus has not been reached regarding the best method for preparing the patients for NE. This study compares two methods of nasal preparation; cotton pledget packing and topical spray. A total of 100 patients were randomised into two groups of 50 each (A and B). In Group A, the nasal cavity was packed with a cotton pledget soaked in 4% lignocaine and xylometazoline nasal drops. Whereas in Group B, xylometazoline nasal drops were instilled and nasal cavity was sprayed with 10% lignocaine spray. After performing rigid nasal endoscopy, a proforma based on the patients’ and consultant’s response was filled. Patients in the cotton pledget group experienced more discomfort during packing (p=0.04), during the waiting time (p=0.001) and also during the endoscopic procedure. From the clinician’s perspective, the duration for the overall endoscopic procedure was significantly less in the spray group (p<0.001). Visualisation of structures was comparable in both groups. Less bleeding was experienced in the spray group. We concluded that nasal spray is a better alternative to nasal packing for preparation of nose prior to nasal endoscopy.
鼻内窥镜检查（NE）是一种使用内窥镜检查鼻腔和鼻窦的诊疗方法，内窥镜可以是刚性的，也可以是柔性的。与头灯、窥镜和镜子等传统技术相比，鼻内窥镜能让临床医生更好地描述鼻腔内的解剖结构，从而帮助诊断。因此，该技术近来越来越受欢迎，成为耳鼻喉科和头颈外科门诊中最常用的诊断程序之一。关于为鼻内窥镜检查患者做准备的最佳方法，目前尚未达成一致共识。本研究比较了两种鼻腔准备方法：棉质填塞和局部喷雾。100 名患者被随机分为两组，每组 50 人（A 组和 B 组）。在 A 组中，用蘸有 4% 木酚卡因和二甲甲唑啉滴鼻液的棉签填塞鼻腔。而在 B 组中，则滴入西甲唑啉滴鼻液，并在鼻腔中喷洒 10%的木质素喷雾剂。在进行硬质鼻内窥镜检查后，根据患者和顾问的反应填写一份表格。棉签组患者在包装过程中（P=0.04）、等待时间（P=0.001）和内窥镜检查过程中都感到更多不适。从临床医生的角度来看，喷雾组患者的整个内窥镜手术时间明显更短（p<0.001）。两组的结构可视度相当。喷雾组出血较少。我们的结论是，在鼻内窥镜检查前的鼻腔准备中，喷鼻剂是鼻腔填料的更好替代品。
{"title":"Nasal preparation prior to nasal endoscopy: a comparison of cotton pledget packing versus topical spray","authors":"K. Shrestha, A. Dhungana, A. S. Rijal, Rupesh Raj Joshi","doi":"10.3126/nmcj.v25i4.60926","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60926","url":null,"abstract":"Nasal endoscopy (NE) is an office procedure done to look at the nasal and sinus passages using an endoscope which could be either rigid or flexible. It allows the clinician to characterize the intranasal anatomy better compared to the conventional techniques of headlight, speculum and mirror thus aiding the diagnosis. Therefore its popularity has increased recently and is one of the most frequently performed diagnostic procedures in Otorhinolaryngology and Head and Neck Surgery OPD. A unanimous consensus has not been reached regarding the best method for preparing the patients for NE. This study compares two methods of nasal preparation; cotton pledget packing and topical spray. A total of 100 patients were randomised into two groups of 50 each (A and B). In Group A, the nasal cavity was packed with a cotton pledget soaked in 4% lignocaine and xylometazoline nasal drops. Whereas in Group B, xylometazoline nasal drops were instilled and nasal cavity was sprayed with 10% lignocaine spray. After performing rigid nasal endoscopy, a proforma based on the patients’ and consultant’s response was filled. Patients in the cotton pledget group experienced more discomfort during packing (p=0.04), during the waiting time (p=0.001) and also during the endoscopic procedure. From the clinician’s perspective, the duration for the overall endoscopic procedure was significantly less in the spray group (p<0.001). Visualisation of structures was comparable in both groups. Less bleeding was experienced in the spray group. We concluded that nasal spray is a better alternative to nasal packing for preparation of nose prior to nasal endoscopy.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139164802","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 : 2023-12-22DOI: 10.3126/nmcj.v25i4.60872
V. Silvanus, Nishchal Dhakal, Niraj Shrestha, P. Kafle
Chronic diseases such as diabetes and hypertension are often influenced by biological, behavioural, environmental and social factors in women and men. This study aimed to identify the gender differences in prevalence and risk factors of comorbid diabetes and hypertension (CM) among adults aged 18 years and above in an urban community in Kathmandu, Nepal. A community-based cross-sectional analytical study was carried out in Gokarneshwor Ward 1, 2 and 3 among adults aged 18 years and above from September 2020- May 2023. Diabetes (DM) was defined as persons previously diagnosed by a physician and/or on anti-diabetic medication. Hypertension (HTN) was defined as a systolic blood pressure (SBP) of ≥140 mm Hg or a diastolic blood pressure (DBP) of ≥90 mm Hg or those who were diagnosed by a physician and/or receiving antihypertensive medication. Comorbidity (CM) was defined as persons with diabetes and hypertension. Information regarding socio-demographic data, behavioural and biological risk factors, anthropometric assessment and morbidity were obtained from adults aged 18 years and above using a Family study proforma. Multinomial logistic regression analyses with the referent category being persons with no diabetes or hypertension (NDH) were performed for three categories HTN vs NDH, DM vs NDH and CM vs NDH. Among 1538 adults with 776 women, overall prevalence of comorbidity was 5.3% (95% CI: 4.3 – 6.5); among men 6.1% and 5.5% among women. After adjusting for age, for both women and men, being currently married, alcohol use, family history of diabetes and generalized obesity were associated with comorbidity. However, these associations were more robust for men. Moreover, measures of central obesity were associated with comorbidity for men alone. Though alcohol use was higher among men, the association with comorbidity was more robust for women. Paradoxically, lower educational status among women and higher education among men were associated with higher odds of comorbidity. In conclusion, prevalence of comorbid diabetes and hypertension may differ marginally among men and women. Though comorbidity rates appear to be lower in Nepal in comparison to other countries in South Asia, the rising burden emphasizes the need for tailored public health interventions that address modifiable risk factors among men and women. Further research may help to elucidate the role of gender on cardiovascular risk and hard outcomes such as cardiovascular events and mortality among persons with comorbid diabetes and hypertension.
{"title":"Comorbid Diabetes and Hypertension: Gender differences in prevalence and risk factors among adults (≥18 years) in an urban community in Kathmandu District in Nepal","authors":"V. Silvanus, Nishchal Dhakal, Niraj Shrestha, P. Kafle","doi":"10.3126/nmcj.v25i4.60872","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60872","url":null,"abstract":"Chronic diseases such as diabetes and hypertension are often influenced by biological, behavioural, environmental and social factors in women and men. This study aimed to identify the gender differences in prevalence and risk factors of comorbid diabetes and hypertension (CM) among adults aged 18 years and above in an urban community in Kathmandu, Nepal. A community-based cross-sectional analytical study was carried out in Gokarneshwor Ward 1, 2 and 3 among adults aged 18 years and above from September 2020- May 2023. Diabetes (DM) was defined as persons previously diagnosed by a physician and/or on anti-diabetic medication. Hypertension (HTN) was defined as a systolic blood pressure (SBP) of ≥140 mm Hg or a diastolic blood pressure (DBP) of ≥90 mm Hg or those who were diagnosed by a physician and/or receiving antihypertensive medication. Comorbidity (CM) was defined as persons with diabetes and hypertension. Information regarding socio-demographic data, behavioural and biological risk factors, anthropometric assessment and morbidity were obtained from adults aged 18 years and above using a Family study proforma. Multinomial logistic regression analyses with the referent category being persons with no diabetes or hypertension (NDH) were performed for three categories HTN vs NDH, DM vs NDH and CM vs NDH. Among 1538 adults with 776 women, overall prevalence of comorbidity was 5.3% (95% CI: 4.3 – 6.5); among men 6.1% and 5.5% among women. After adjusting for age, for both women and men, being currently married, alcohol use, family history of diabetes and generalized obesity were associated with comorbidity. However, these associations were more robust for men. Moreover, measures of central obesity were associated with comorbidity for men alone. Though alcohol use was higher among men, the association with comorbidity was more robust for women. Paradoxically, lower educational status among women and higher education among men were associated with higher odds of comorbidity. In conclusion, prevalence of comorbid diabetes and hypertension may differ marginally among men and women. Though comorbidity rates appear to be lower in Nepal in comparison to other countries in South Asia, the rising burden emphasizes the need for tailored public health interventions that address modifiable risk factors among men and women. Further research may help to elucidate the role of gender on cardiovascular risk and hard outcomes such as cardiovascular events and mortality among persons with comorbid diabetes and hypertension.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"39 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139166190","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 : 2023-12-22DOI: 10.3126/nmcj.v25i4.60875
S. Acharya, Sabin Bhandari, Sushmita Bhandari
Spinal anaesthesia using hyperbaric bupivacaine is the most popular method for caesarean section. Adjuvents like fentanyl which enhances the sensory block and provide stable haemodynamics are usually premixed with bupivacaine in a single syringe. Fentanyl when added to hyperbaric bupivacaine, decreases the density of solution to extent of 0.0006 which alters the spread of local anesthetics in CSF. If we inject both the drugs separately in different syringe, it may minimize the effect of the changes in densities and PH of both the drugs and produce their maximum effect with minimal haemodynamic alteration. Therefore this study was conducted to see the quality of sensory block and haemodynamic response by sequential intrathecal administration of fentanyl and hyperbaric bupivacaine in two different syringe for patients undergoing caesarian section. This interventional study was carried out in Seventy nine Patients undergoing caesarean section under spinal anesthesia with 0.5% hyperbaric bupivacaine 9mg (1.8 ml) and fentanyl 20 mcg in two different syringe administered sequentially. Out of 79 parturients only 22 (27.85%) had hypotension requiring vasopressor treatment during caesarean section and maximum amount of vasopressor used was 15 mg of mephentermine. The mean level of maximum sensory block after 20 mins of spinal anaesthesia was T2 in 20 (25.32%) patients, T3 in 19 (24.05%) patients, T4 in 32 (40.51%) patients, T5 in 1 (1.27%) patient and T6 in 7 (8.86%) Patients. Intraoperative quality of surgical anaesthesia was very satisfactory to the patients. Only 6 (7.59%) patients had mild discomfort whithout requirement of any medical treatment. The result of this study concluded that separate intrathecal injection of fentanyl and hyperbaric bupivacaine provides better haemodynamic stability, improves quality of surgical anaethesia allowing it to work at higher levels in the spinal cord with minimal other side effects in patient undergoing caesarean section.
{"title":"Study of effectiveness of two syringe spinal anaesthesia technique for caesarean section","authors":"S. Acharya, Sabin Bhandari, Sushmita Bhandari","doi":"10.3126/nmcj.v25i4.60875","DOIUrl":"https://doi.org/10.3126/nmcj.v25i4.60875","url":null,"abstract":"Spinal anaesthesia using hyperbaric bupivacaine is the most popular method for caesarean section. Adjuvents like fentanyl which enhances the sensory block and provide stable haemodynamics are usually premixed with bupivacaine in a single syringe. Fentanyl when added to hyperbaric bupivacaine, decreases the density of solution to extent of 0.0006 which alters the spread of local anesthetics in CSF. If we inject both the drugs separately in different syringe, it may minimize the effect of the changes in densities and PH of both the drugs and produce their maximum effect with minimal haemodynamic alteration. Therefore this study was conducted to see the quality of sensory block and haemodynamic response by sequential intrathecal administration of fentanyl and hyperbaric bupivacaine in two different syringe for patients undergoing caesarian section. This interventional study was carried out in Seventy nine Patients undergoing caesarean section under spinal anesthesia with 0.5% hyperbaric bupivacaine 9mg (1.8 ml) and fentanyl 20 mcg in two different syringe administered sequentially. Out of 79 parturients only 22 (27.85%) had hypotension requiring vasopressor treatment during caesarean section and maximum amount of vasopressor used was 15 mg of mephentermine. The mean level of maximum sensory block after 20 mins of spinal anaesthesia was T2 in 20 (25.32%) patients, T3 in 19 (24.05%) patients, T4 in 32 (40.51%) patients, T5 in 1 (1.27%) patient and T6 in 7 (8.86%) Patients. Intraoperative quality of surgical anaesthesia was very satisfactory to the patients. Only 6 (7.59%) patients had mild discomfort whithout requirement of any medical treatment. The result of this study concluded that separate intrathecal injection of fentanyl and hyperbaric bupivacaine provides better haemodynamic stability, improves quality of surgical anaethesia allowing it to work at higher levels in the spinal cord with minimal other side effects in patient undergoing caesarean section.","PeriodicalId":506882,"journal":{"name":"Nepal Medical College Journal","volume":"81 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139163292","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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