Pub Date : 2022-12-31DOI: 10.3126/jonmc.v11i2.50429
Rekha Limbu, N. Limbu, R. Khadka, P. Subedi, D. Limbu
Background: Cardio respiratory fitness in terms of maximum oxygen uptake (VO2 max) reflects the physical fitness of a person. VO2max determines the capacity of an individual to perform sustained exercise. The present study is to assess and compare the cardiorespiratory fitness in terms of VO2 max between trained and untrained subjects. Materials and Methods: This cross-sectional study was conducted on 30 young adult males undergoing physical training for more than 3 months to join British army and age-sex matched 30 non-trained controls. VO2max was estimated indirectly by following the protocol of Queen’s College Step Test (QCT) method. Results: VO₂ max was found significantly higher in the trained males as compared to non-trained group (68.91± 4.42 vs. 50.31±4.80; p=0.02). On comparison of VO₂ max of our subjects with the standard VO₂ max classification, our trained and non-trained groups fitted into the category of high and average on cardiorespiratory fitness scale respectively. Conclusion: Physical training improves cardio respiratory fitness by increasing VO₂ max.
{"title":"Assessment of Cardio Respiratory Fitness of Trained and Non-Trained Young Adult Males","authors":"Rekha Limbu, N. Limbu, R. Khadka, P. Subedi, D. Limbu","doi":"10.3126/jonmc.v11i2.50429","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50429","url":null,"abstract":"Background: Cardio respiratory fitness in terms of maximum oxygen uptake (VO2 max) reflects the physical fitness of a person. VO2max determines the capacity of an individual to perform sustained exercise. The present study is to assess and compare the cardiorespiratory fitness in terms of VO2 max between trained and untrained subjects. \u0000Materials and Methods: This cross-sectional study was conducted on 30 young adult males undergoing physical training for more than 3 months to join British army and age-sex matched 30 non-trained controls. VO2max was estimated indirectly by following the protocol of Queen’s College Step Test (QCT) method. \u0000Results: VO₂ max was found significantly higher in the trained males as compared to non-trained group (68.91± 4.42 vs. 50.31±4.80; p=0.02). On comparison of VO₂ max of our subjects with the standard VO₂ max classification, our trained and non-trained groups fitted into the category of high and average on cardiorespiratory fitness scale respectively. \u0000Conclusion: Physical training improves cardio respiratory fitness by increasing VO₂ max.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43460057","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 : 2022-12-31DOI: 10.3126/jonmc.v11i2.50454
V. Sah, S. Yadav, A. Giri, S. Singh
Background: Neonatal sepsis is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first 28 days of life. Although, Positive blood culture is the gold standard for the diagnosis of neonatal septicemia, definitive culture results take at least 48–72 h, resulting in treatment delay. Hence certain rapid diagnostic tests such as C-reactive protein, micro erythrocyte sedimentation rate, total white blood cell count, absolute neutrophil count, and immature/total neutrophil count ratio collectively termed as the “Sepsis Screen” is used. The aim of this research is to study the relation between sepsis screen parameters and blood culture proven neonatal sepsis and to assess the clinical profile of neonates with culture-proven sepsis. Materials and Methods: This was a descriptive observational study conducted on 97 clinically suspected neonatal sepsis cases in the neonatal intensive care unit.. Sepsis screen tests were evaluated for sensitivity, specificity, positive predictive value and negative predictive value. The culture results were correlated with sepsis screen tests and p-value<0.05 was considered significant. Results: Early-onset sepsis was seen in 47.4% cases, while late-onset sepsis accounted for 52.6% cases. Immature to total neutrophil ratio was the single best reliable sepsis screen test with a high specificity, PPV, and negative predictive values of 93.8%, 85.7%, and 88.4% respectively. Conclusion: Most of the individual sepsis screen parameters showed statistical correlation with blood culture status, yet Immature to total neutrophil ratio had highest sensitivity, specificity, positive predictive value and proved to be a sensitive and responsive indicator of neonatal sepsis.
{"title":"Sepsis Screen Parameters in Blood Culture Positive Neonatal Sepsis","authors":"V. Sah, S. Yadav, A. Giri, S. Singh","doi":"10.3126/jonmc.v11i2.50454","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50454","url":null,"abstract":"Background: Neonatal sepsis is a clinical syndrome of bacteremia characterized by systemic signs and symptoms of infection in the first 28 days of life. Although, Positive blood culture is the gold standard for the diagnosis of neonatal septicemia, definitive culture results take at least 48–72 h, resulting in treatment delay. Hence certain rapid diagnostic tests such as C-reactive protein, micro erythrocyte sedimentation rate, total white blood cell count, absolute neutrophil count, and immature/total neutrophil count ratio collectively termed as the “Sepsis Screen” is used. The aim of this research is to study the relation between sepsis screen parameters and blood culture proven neonatal sepsis and to assess the clinical profile of neonates with culture-proven sepsis. \u0000Materials and Methods: This was a descriptive observational study conducted on 97 clinically suspected neonatal sepsis cases in the neonatal intensive care unit.. Sepsis screen tests were evaluated for sensitivity, specificity, positive predictive value and negative predictive value. The culture results were correlated with sepsis screen tests and p-value<0.05 was considered significant. \u0000Results: Early-onset sepsis was seen in 47.4% cases, while late-onset sepsis accounted for 52.6% cases. Immature to total neutrophil ratio was the single best reliable sepsis screen test with a high specificity, PPV, and negative predictive values of 93.8%, 85.7%, and 88.4% respectively. \u0000Conclusion: Most of the individual sepsis screen parameters showed statistical correlation with blood culture status, yet Immature to total neutrophil ratio had highest sensitivity, specificity, positive predictive value and proved to be a sensitive and responsive indicator of neonatal sepsis.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42782127","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 : 2022-12-31DOI: 10.3126/jonmc.v11i2.50464
V. Kaul, P. Rai, Sikha Upadhyaya, Arpan Pokhrel
Background: Benzodiazepines are regularly prescribed to treat patients in alcoholic withdrawal. After analyzing pharmacology of benzodiazepines, diazepam is faster metabolized and concentrated in the liver, as an active metabolite whereas lorazepam is metabolized in liver by conjugation and excreted in urine. lorazepam being a drug of choice used in patients with deranged liver functions is needed to be compared with that of diazepam. The objective of the study is the comparasion of two benzodiazepines in treatment of alcohol dependence syndrome in Nepal. Material and Methods: This was a prospective, open label study carried out in Department of Psychiatry, Nobel Medical College and Teaching Hospital, Biratnagar. 50 patients (25 in each) aged between 25 to 65 years diagnosed as alcohol dependent admitted and grouped in either diazepam or lorazepam alternatively. The doses prescribed to the diazepam group and lorazepam group are 30 mg/day and 8 mg/day respectively in divided doses. For both the treatment groups, the dose was tapered every alternate day for 10 days. The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-Ar) scale was used for withdrawal symptoms scoring on the baseline and day 10. Lab Investigations were performed but were not a part of the study. Results: Out of the Fifty patients included in the study, at day 0, the mean CIWA-Ar scores were similar in both the treatment groups: 24.38±5.03 in the diazepam group and 24.79±6.42 in the lorazepam group. There was a significant intragroup decrease in the CIWA-Ar scores measured from Day 0 to the end of 10 days (p<0.0001) in both treatment groups; there was no significant difference between the two groups Conclusion: Diazepam and lorazepam are equally effective in alcohol withdrawal detoxification.
{"title":"A Study on Comparison of Two Benzodiazepines in Treatment of Alcohol Dependence Syndrome in Nepal","authors":"V. Kaul, P. Rai, Sikha Upadhyaya, Arpan Pokhrel","doi":"10.3126/jonmc.v11i2.50464","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50464","url":null,"abstract":"Background: Benzodiazepines are regularly prescribed to treat patients in alcoholic withdrawal. After analyzing pharmacology of benzodiazepines, diazepam is faster metabolized and concentrated in the liver, as an active metabolite whereas lorazepam is metabolized in liver by conjugation and excreted in urine. lorazepam being a drug of choice used in patients with deranged liver functions is needed to be compared with that of diazepam. The objective of the study is the comparasion of two benzodiazepines in treatment of alcohol dependence syndrome in Nepal. \u0000Material and Methods: This was a prospective, open label study carried out in Department of Psychiatry, Nobel Medical College and Teaching Hospital, Biratnagar. 50 patients (25 in each) aged between 25 to 65 years diagnosed as alcohol dependent admitted and grouped in either diazepam or lorazepam alternatively. The doses prescribed to the diazepam group and lorazepam group are 30 mg/day and 8 mg/day respectively in divided doses. For both the treatment groups, the dose was tapered every alternate day for 10 days. The Clinical Institute Withdrawal Assessment Alcohol Scale Revised (CIWA-Ar) scale was used for withdrawal symptoms scoring on the baseline and day 10. Lab Investigations were performed but were not a part of the study. \u0000Results: Out of the Fifty patients included in the study, at day 0, the mean CIWA-Ar scores were similar in both the treatment groups: 24.38±5.03 in the diazepam group and 24.79±6.42 in the lorazepam group. There was a significant intragroup decrease in the CIWA-Ar scores measured from Day 0 to the end of 10 days (p<0.0001) in both treatment groups; there was no significant difference between the two groups \u0000Conclusion: Diazepam and lorazepam are equally effective in alcohol withdrawal detoxification.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48049157","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 : 2022-12-31DOI: 10.3126/jonmc.v11i2.50441
O. Anil, N. Chaudhary, O. Nikhil, A. Tiwari, Gaurav Singh, Abhishek Thakur, Shuva Jung Rana, B. Khadka, Binod Khadka, D. Singh
Background: A prospective study was conducted to find distribution of the left ventricular mass in normal adult Nepalese population in order to establish the upper reference limit. Materials and Methods: A total of 100 consecutive male and 100 female participants of age 18 years and above visiting for cardiac checkup were enrolled prospectively in this study. Participants with hypertension, diabetes, obesity and significant cardiovascular disease were excluded. Results: Mean age of study population was 43 years. Mean left ventricular mass in total, male and female population was 127.45±29 gm, 136.48±30.64gm and 118.43±24.24 gm respectively. Mean left ventricular mass index (LVMI) in total, male and female population was 74.52±15.78 gm/m2, 80.04±16.5 gm/m2 and 69.17±13.05 gm/m2 respectively. Left ventricular mass and left ventricular mass index increased with age, Body Mass Index, Systolic and Diastolic Blood Pressure, and were statistically significant (p-value <0.05). Conclusion: Normal left ventricular mass in Nepalese Population was found to be lesser in female compared to male. Left ventricular mass increased with increasing Age and Body Mass Index.
{"title":"Study of Left Ventricular Mass in Normal Nepalese Population","authors":"O. Anil, N. Chaudhary, O. Nikhil, A. Tiwari, Gaurav Singh, Abhishek Thakur, Shuva Jung Rana, B. Khadka, Binod Khadka, D. Singh","doi":"10.3126/jonmc.v11i2.50441","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50441","url":null,"abstract":"Background: A prospective study was conducted to find distribution of the left ventricular mass in normal adult Nepalese population in order to establish the upper reference limit. \u0000Materials and Methods: A total of 100 consecutive male and 100 female participants of age 18 years and above visiting for cardiac checkup were enrolled prospectively in this study. Participants with hypertension, diabetes, obesity and significant cardiovascular disease were excluded. \u0000Results: Mean age of study population was 43 years. Mean left ventricular mass in total, male and female population was 127.45±29 gm, 136.48±30.64gm and 118.43±24.24 gm respectively. Mean left ventricular mass index (LVMI) in total, male and female population was 74.52±15.78 gm/m2, 80.04±16.5 gm/m2 and 69.17±13.05 gm/m2 respectively. Left ventricular mass and left ventricular mass index increased with age, Body Mass Index, Systolic and Diastolic Blood Pressure, and were statistically significant (p-value <0.05). \u0000Conclusion: Normal left ventricular mass in Nepalese Population was found to be lesser in female compared to male. Left ventricular mass increased with increasing Age and Body Mass Index.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43995150","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 : 2022-12-31DOI: 10.3126/jonmc.v11i2.50904
Shekhar Poudel, Rahul Devkota, Anubhav Sharma, R. Karna, S. Shrestha, S. Poudel
Background: Acute upper gastrointestinal bleeding is one of the common and life threatening condition presenting in emergency. The aim of the present study was to determine the clinical profile and in-hospital outcomes in these patients admitted at a tertiary care center in Kathmandu, Nepal. Materials and Methods: This is a descriptive, observational study conducted over 9 months (October 2021– July 2022). All consecutive patients aged 16 years and above admitted in the hospital ward with the history of acute bleeding were included in the study after informed consent. Demographic data, clinical, laboratory and endoscopic data were noted during the hospital stay. Statistical analysis was done used SPSS v.24. Results: The mean age of our study population (N = 132) was 46.92 years. Among 132 patients who underwent endoscopy, 43.9% had portal hypertension related bleeding, 41.7% had ulcer related bleeding, 5.3% had malignancies, 3% had corrosive intake. No etiology was found in 3 patients. Hematemesis with melena was the most common mode (53.8%) of presentation to the hospital.Shock was preset in 25% of patients at presentation to the hospital. In-hospital re-bleeding rate and mortality were 12.7% and 9.8% respectively. Conclusion: Portal hypertension related bleeding followed by ulcers related bleeding is the common cause of acute upper gastrointestinal bleeding. In-hospital mortality was 9.8%.
{"title":"Profiles and Inhospital Outcomes of Patients with Acute Upper Gastrointestinal Bleeding in a Tertiary Care Center","authors":"Shekhar Poudel, Rahul Devkota, Anubhav Sharma, R. Karna, S. Shrestha, S. Poudel","doi":"10.3126/jonmc.v11i2.50904","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50904","url":null,"abstract":"Background: Acute upper gastrointestinal bleeding is one of the common and life threatening condition presenting in emergency. The aim of the present study was to determine the clinical profile and in-hospital outcomes in these patients admitted at a tertiary care center in Kathmandu, Nepal. \u0000Materials and Methods: This is a descriptive, observational study conducted over 9 months (October 2021– July 2022). All consecutive patients aged 16 years and above admitted in the hospital ward with the history of acute bleeding were included in the study after informed consent. Demographic data, clinical, laboratory and endoscopic data were noted during the hospital stay. Statistical analysis was done used SPSS v.24. \u0000Results: The mean age of our study population (N = 132) was 46.92 years. Among 132 patients who underwent endoscopy, 43.9% had portal hypertension related bleeding, 41.7% had ulcer related bleeding, 5.3% had malignancies, 3% had corrosive intake. No etiology was found in 3 patients. Hematemesis with melena was the most common mode (53.8%) of presentation to the hospital.Shock was preset in 25% of patients at presentation to the hospital. In-hospital re-bleeding rate and mortality were 12.7% and 9.8% respectively. \u0000Conclusion: Portal hypertension related bleeding followed by ulcers related bleeding is the common cause of acute upper gastrointestinal bleeding. In-hospital mortality was 9.8%.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48635729","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 : 2022-12-31DOI: 10.3126/jonmc.v11i2.50459
S. Rizal, M. Acharya, S. Regmi, B. Joshi, S. Jha, Dikshya Rana
Background: Depression is one of the most common psychiatric disorders with substantial morbidity and mortality. It is known to be associated with changes in the hypothalamic-pituitary-thyroid axis, thus may be accompanied by subtle thyroid dysfunction. Thus, our study aims to determine the prevalence and characteristics of thyroid dysfunction in newly diagnosed depressive patients. Materials and Methods: A prospective descriptive cross sectional study was conducted among 130 patient diagnosed as depression from December 2020 to June 2022 after taking the ethical approval. The patients in the symptomatic phase and above 18 years was recruited in our study. Thyroid profile consisting of free tri-iodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) was estimated by chemiluminescence immunoassay in the central laboratory of Nobel Medical College Teaching Hospital. Results: Out of 130 depressive patients recruited in our study, 44 patients had abnormal thyroid function test showing a prevalence of 33.84%. The most common form was moderate depression which was 39.99% of our study population. The commonest thyroid abnormality was subclinical hypothyroidism (15.38%) followed by overt hypothyroidism (14.61%). Thyroid abnormality was more common among the severe form of depression (46.66%). The comparison of means of fT3, fT4 and TSH between different grades of depression was statistically significant for fT3 (p=0.048) and TSH (p=0.001). Conclusion: Thus, the most common thyroid function abnormalities in our study include subclinical and overt hypothyroidism, with associated lower level of fT4 and higher level of TSH.
{"title":"Thyroid Dysfunction Associated with Depressive Disorder: A Descriptive Cross-Sectional Study Done in a Tertiary Care Center of Eastern Nepal","authors":"S. Rizal, M. Acharya, S. Regmi, B. Joshi, S. Jha, Dikshya Rana","doi":"10.3126/jonmc.v11i2.50459","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50459","url":null,"abstract":"Background: Depression is one of the most common psychiatric disorders with substantial morbidity and mortality. It is known to be associated with changes in the hypothalamic-pituitary-thyroid axis, thus may be accompanied by subtle thyroid dysfunction. Thus, our study aims to determine the prevalence and characteristics of thyroid dysfunction in newly diagnosed depressive patients.\u0000Materials and Methods: A prospective descriptive cross sectional study was conducted among 130 patient diagnosed as depression from December 2020 to June 2022 after taking the ethical approval. The patients in the symptomatic phase and above 18 years was recruited in our study. Thyroid profile consisting of free tri-iodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) was estimated by chemiluminescence immunoassay in the central laboratory of Nobel Medical College Teaching Hospital.\u0000Results: Out of 130 depressive patients recruited in our study, 44 patients had abnormal thyroid function test showing a prevalence of 33.84%. The most common form was moderate depression which was 39.99% of our study population. The commonest thyroid abnormality was subclinical hypothyroidism (15.38%) followed by overt hypothyroidism (14.61%). Thyroid abnormality was more common among the severe form of depression (46.66%). The comparison of means of fT3, fT4 and TSH between different grades of depression was statistically significant for fT3 (p=0.048) and TSH (p=0.001).\u0000Conclusion: Thus, the most common thyroid function abnormalities in our study include subclinical and overt hypothyroidism, with associated lower level of fT4 and higher level of TSH.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49585101","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 : 2022-12-31DOI: 10.3126/jonmc.v11i2.50379
B. Gajurel, R. Karn, R. Rajbhandari, R. Ojha
Background: Age is the most important prognostic factor in ischemic stroke. Thisstudy was carried out in patients with ischemic stroke to describe the association of age of the patients with stroke severity at presentation and at three months. Materials and Methods: The data, which were collected retrospectively from hospital records, we reanalyzed by using the Statistical Package for the Social Sciences (SPSS) version 26. Age was divided into younger (≤ 50 years) and older (> 50 years) based on standard definition. Age was also divided into younger (< 60 years) and older (≥ 60 years) based on the Senior Citizens Act of Nepal. The associations were analyzed by using Chi-square test. Results: One hundred and fifty-three patients were included in the study. The mean age of the patients was 60.9 years. There was no statistically significant association between baseline stroke severity and the age groups defined both ways. More younger patients had good outcomes (44.4% good outcome vs 25.6% poor outcome in patients ≤ 50 years, p= 0.03; 52.8% good outcome vs 31.6% poor outcome in patients < 60 years, p=0.02). More older patients had poor outcomes (74.4% poor outcome vs 55.6% good outcome in patients > 50 years, p = 0.03; 68.4% poor outcome vs 47.2% good outcome in patients ≥ 60 years, p= 0.02). Conclusion: There was no significant association between young and old patients and the baseline stroke severity; however, more younger patients had good outcomes compared to older patients at three months, the differences being significant.
{"title":"Patient Age and Outcome in Ischemic Stroke","authors":"B. Gajurel, R. Karn, R. Rajbhandari, R. Ojha","doi":"10.3126/jonmc.v11i2.50379","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50379","url":null,"abstract":"Background: Age is the most important prognostic factor in ischemic stroke. Thisstudy was carried out in patients with ischemic stroke to describe the association of age of the patients with stroke severity at presentation and at three months. \u0000Materials and Methods: The data, which were collected retrospectively from hospital records, we reanalyzed by using the Statistical Package for the Social Sciences (SPSS) version 26. Age was divided into younger (≤ 50 years) and older (> 50 years) based on standard definition. Age was also divided into younger (< 60 years) and older (≥ 60 years) based on the Senior Citizens Act of Nepal. The associations were analyzed by using Chi-square test. \u0000Results: One hundred and fifty-three patients were included in the study. The mean age of the patients was 60.9 years. There was no statistically significant association between baseline stroke severity and the age groups defined both ways. More younger patients had good outcomes (44.4% good outcome vs 25.6% poor outcome in patients ≤ 50 years, p= 0.03; 52.8% good outcome vs 31.6% poor outcome in patients < 60 years, p=0.02). More older patients had poor outcomes (74.4% poor outcome vs 55.6% good outcome in patients > 50 years, p = 0.03; 68.4% poor outcome vs 47.2% good outcome in patients ≥ 60 years, p= 0.02). \u0000Conclusion: There was no significant association between young and old patients and the baseline stroke severity; however, more younger patients had good outcomes compared to older patients at three months, the differences being significant.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44904479","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 : 2022-12-31DOI: 10.3126/jonmc.v11i2.50906
Bishomber Neupane, Ipsa Shakya, Rajiv Neupane, B. Khanal, P. Kafle, E. Gandham
Uncontrolled hypertension being the most important risk factor for intracerebral hemorrhage (ICH) often leads to solitary hematoma whereas multiple spontaneous simultaneous ICH is not common, and occurrence of bilateral hemorrhage is a rare entity with normal bleeding parameters with very few case reports so far. Here, we report a 67-year-old man with a past medical history of uncontrolled hypertension who was brought to the emergency department due to severe headache, worsening confusion for 1 day. An urgent non-contrast brain Computed Tomography (CT) performed immediately revealed bilateral intracerebral hemorrhage (ICH) of the same age in the right putamen and left thalamus. Our patient had a non-traumatic ICH, with low GCS (5/15) at presentation. He was managed conservatively with antihypertensives and antiedema measures. He was discharged in stable condition GCS 14/15 with left hemiparesis (3/5). At last follow up he was recovering well.Due to the rarity of spontaneous intracranial bleed in patient with normal bleeding parameters, it is particularly interesting to report this rare case presentation.
{"title":"Concurrent Eloquent Area Bleeds in a Patient with Uncontrolled Hypertension","authors":"Bishomber Neupane, Ipsa Shakya, Rajiv Neupane, B. Khanal, P. Kafle, E. Gandham","doi":"10.3126/jonmc.v11i2.50906","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50906","url":null,"abstract":"Uncontrolled hypertension being the most important risk factor for intracerebral hemorrhage (ICH) often leads to solitary hematoma whereas multiple spontaneous simultaneous ICH is not common, and occurrence of bilateral hemorrhage is a rare entity with normal bleeding parameters with very few case reports so far. Here, we report a 67-year-old man with a past medical history of uncontrolled hypertension who was brought to the emergency department due to severe headache, worsening confusion for 1 day. An urgent non-contrast brain Computed Tomography (CT) performed immediately revealed bilateral intracerebral hemorrhage (ICH) of the same age in the right putamen and left thalamus. Our patient had a non-traumatic ICH, with low GCS (5/15) at presentation. He was managed conservatively with antihypertensives and antiedema measures. He was discharged in stable condition GCS 14/15 with left hemiparesis (3/5). At last follow up he was recovering well.Due to the rarity of spontaneous intracranial bleed in patient with normal bleeding parameters, it is particularly interesting to report this rare case presentation.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41393956","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 : 2022-12-31DOI: 10.3126/jonmc.v11i2.50377
G. Baral
Research finds out new or additional knowledge or information that needs to be published in order to make it scientifically visible. Publication criteria should meet and manuscript format should be as recommended for the publication.
{"title":"Research and Publication","authors":"G. Baral","doi":"10.3126/jonmc.v11i2.50377","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50377","url":null,"abstract":"Research finds out new or additional knowledge or information that needs to be published in order to make it scientifically visible. Publication criteria should meet and manuscript format should be as recommended for the publication.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42544979","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 : 2022-12-31DOI: 10.3126/jonmc.v11i2.50439
A. Koirala, Ram Sagar Shah, Sachidanand Shah, D. Adhikari, A. Bhattarai, Richa Niraula, A. Yadav
Background: Laparoscopic Cholecystectomy is considered as a gold standard treatment for symptomatic cholelithiasis. The timing of surgery for acute Cholecystitis is still controversial, weather to go early surgery or wait for six to eight weeks after conservative management. Therefore, the aim of this study is to compare the clinical outcomes of early versus delayed laparoscopic cholecystectomy for acute Cholecystitis. Materials and Methods: A prospective study was conducted in Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Total of 80 patients with the diagnosis of acute Cholecystitis were enrolled in the study. The patients were equally divided in two groups: 40 underwent early laparoscopic cholecystectomy within 72 hours of admission (Group A) and next 40 underwent delayed laparoscopic cholecystectomy after 6-8 weeks of conservative management (Group B). Results: Out of 80 patients of acute Cholecystitis, mean age of the patients in Group A was 43.40±13.45 years and that in Group B was 44.80±14.36 years. The mean operative time in Group A was 90.22±2.81 minutes whereas in Group B it was 80.97±4.47 minutes. Mean duration of Hospital stay in Group A was 2.02±0.15 days whereas in Group B it was 2.15±0.36 days. Two patients in Group A and one patient in Group B converted to open cholecystectomy. Three patients of Group A and one patient of Group B landed in outpatient department with superficial surgical site infection. Group B patients underwent second hospital admission compared to Group A patients. Conclusion: Early Laparoscopic cholecystectomy for acute cholecystitis is almost comparable with delayedLaparoscopic cholecystectomy. However, early laparoscopic cholecystectomy reduces the morbidity of patients as well as it is cost-effectiveness.
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