Pub Date : 2022-12-31DOI: 10.3126/jonmc.v11i2.50452
S. Maharjan, B. Khatri, Deepa Chemjong, Bijay Khatri, D. Shah
Background: Active tuberculosis in transplant recipients can result from latent infection with Mycobacterium Tuberculosis in the transplant recipients, donor tissue, or de novo post-transplant infection. This study aimed to determine the prevalence of latent tuberculosis infection in potential renal transplant recipients and live donors at a tertiary-level transplant center. Materials and Methods: This observational study was conducted from July to October 2020 among 72 potential kidney transplant recipients and their potential donors from the Department of Nephrology, Tribhuvan University Teaching Hospital. The biochemical parameters and health behaviors were measured to find the association with latent tuberculosis infection. Results: The prevalence of latent tuberculosis infection according to Mycobacterium tuberculosis-specific interferon-gamma release assays was 20.8% in potential recipients and 16.6% in potential donors, whereas the prevalence with tuberculin skin test was 9.7% in potential recipients and 33.3% in potential donors. Low levels of hemoglobin, calcium, albumin, vitamin D and history of smoking were associated with the development of latent tuberculosis infection among potential recipients. Alcohol drinking was significantly associated with the development of latent tuberculosis infection among donors. Conclusion: Potential renal transplant recipients and donors have a significant burden of latent tuberculosis in the pre-transplantation phase. Diagnosis and treatment of latent tuberculosis before transplantation can prevent ominous complications.
{"title":"Latent Tuberculosis Infection in Potential Renal Transplant Recipients and Live Donors in a Tertiary Level Transplant Center in Nepal","authors":"S. Maharjan, B. Khatri, Deepa Chemjong, Bijay Khatri, D. Shah","doi":"10.3126/jonmc.v11i2.50452","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50452","url":null,"abstract":"Background: Active tuberculosis in transplant recipients can result from latent infection with Mycobacterium Tuberculosis in the transplant recipients, donor tissue, or de novo post-transplant infection. This study aimed to determine the prevalence of latent tuberculosis infection in potential renal transplant recipients and live donors at a tertiary-level transplant center. \u0000Materials and Methods: This observational study was conducted from July to October 2020 among 72 potential kidney transplant recipients and their potential donors from the Department of Nephrology, Tribhuvan University Teaching Hospital. The biochemical parameters and health behaviors were measured to find the association with latent tuberculosis infection. \u0000Results: The prevalence of latent tuberculosis infection according to Mycobacterium tuberculosis-specific interferon-gamma release assays was 20.8% in potential recipients and 16.6% in potential donors, whereas the prevalence with tuberculin skin test was 9.7% in potential recipients and 33.3% in potential donors. Low levels of hemoglobin, calcium, albumin, vitamin D and history of smoking were associated with the development of latent tuberculosis infection among potential recipients. Alcohol drinking was significantly associated with the development of latent tuberculosis infection among donors. \u0000Conclusion: Potential renal transplant recipients and donors have a significant burden of latent tuberculosis in the pre-transplantation phase. Diagnosis and treatment of latent tuberculosis before transplantation can prevent ominous complications.","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":"48871475","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.v11i2.50438
Puspa Giri, S. Ranabhat, G. Bhandari, R. Sah
Background: Penetrating keratoplasty is commonly performed surgery in patients suffering from corneal blindness and visual impairment, where full thickness diseased cornea is replaced with healthy cornea. This study aims to outline indications of Penetrating keratoplasty and visual outcomes following the procedure. Materials and Methods: This retrospective, hospital-based study included 48 eyes of 48 subjects fulfilling inclusion criteria and underwent Penetrating keratoplasty from January 2017-2020 at Bharatpur Eye Hospital. General ophthalmologic examination was done preoperatively and postoperatively. Indication of the surgery along with demographic outline and requisite investigations were performed. Results: Mean age of the subjects was 47±1.83 years (13-74 years) where most of them were in 61-70years (23%) age group. Male subjects were more (62.5%) compared to females. Triple procedure was performed in 6.25 percent of patients. The most common indication was infective keratitis (52%) followed by corneal opacity/ scarring, regrafts, keratoconus and bullous keratopathy. Penetrating keratoplasty was performed slightly more for therapeutic purpose (52%) than optical. Intraoperative complications were observed in 16.7% of patients, positive vitreous pressure being the sole cause. Ameliorated visual acuity was observed in 71% of patients with43.75% of patients having VA of ≥3/60 Conclusion: Infective keratitis was the predominant indication followed by corneal opacity/ scarring. Penetrating keratoplasty helps in maintaining integrity of the globe along with restoration of vision
{"title":"Indications and Visual Outcome in Patients Undergoing Penetrating Keratoplasty","authors":"Puspa Giri, S. Ranabhat, G. Bhandari, R. Sah","doi":"10.3126/jonmc.v11i2.50438","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50438","url":null,"abstract":"Background: Penetrating keratoplasty is commonly performed surgery in patients suffering from corneal blindness and visual impairment, where full thickness diseased cornea is replaced with healthy cornea. This study aims to outline indications of Penetrating keratoplasty and visual outcomes following the procedure. \u0000Materials and Methods: This retrospective, hospital-based study included 48 eyes of 48 subjects fulfilling inclusion criteria and underwent Penetrating keratoplasty from January 2017-2020 at Bharatpur Eye Hospital. General ophthalmologic examination was done preoperatively and postoperatively. Indication of the surgery along with demographic outline and requisite investigations were performed. \u0000Results: Mean age of the subjects was 47±1.83 years (13-74 years) where most of them were in 61-70years (23%) age group. Male subjects were more (62.5%) compared to females. Triple procedure was performed in 6.25 percent of patients. The most common indication was infective keratitis (52%) followed by corneal opacity/ scarring, regrafts, keratoconus and bullous keratopathy. Penetrating keratoplasty was performed slightly more for therapeutic purpose (52%) than optical. Intraoperative complications were observed in 16.7% of patients, positive vitreous pressure being the sole cause. Ameliorated visual acuity was observed in 71% of patients with43.75% of patients having VA of ≥3/60 \u0000Conclusion: Infective keratitis was the predominant indication followed by corneal opacity/ scarring. Penetrating keratoplasty helps in maintaining integrity of the globe along with restoration of vision","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":"43847885","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.v11i2.50434
Saraswata Neupane, Indira Pokherel, Suja Khatri, N. Jha
Background: Self-esteem is the own judgment of a person about himself or herself and appreciation of his/her value. An individual with high self-esteem has many positive effects and benefits. It is suggested that self-esteem is one of the most influential factors in the occupational behaviors of nursing students. So, the aim of the study was to assess the perception of self-esteem among Nursing Students. Materials and Methods: A descriptive cross-sectional study was conducted among nursing students at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. The study was started after acquiring approval from the Institutional Review Committee of Nobel Medical College. Data was collected in the classroom through a self-administered questionnaire using the standardized tool Rosenberg Self-Esteem Scale (RSE) from July2021 to November 2021.A total of 238 students were taken as a sample by using the non-probability census method. Data analysis was done by descriptive study. Results: A total of 238 students participated in this study 79.4 percent had high self -esteem and 21.6 percent had low self-esteem. There was a statistically significant association between perception of self-esteem with the age of respondents, Current nursing programme and current nursing education. Conclusion: The study concluded that the majority of the respondents had high self-esteem. Acquisition of skill, knowledge, independence and acquire social, cultural and emotional adjustment increase high self-esteem.
{"title":"Perception of Self-Esteem among Nursing Students at Nobel Medical College Teaching Hospital","authors":"Saraswata Neupane, Indira Pokherel, Suja Khatri, N. Jha","doi":"10.3126/jonmc.v11i2.50434","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50434","url":null,"abstract":"Background: Self-esteem is the own judgment of a person about himself or herself and appreciation of his/her value. An individual with high self-esteem has many positive effects and benefits. It is suggested that self-esteem is one of the most influential factors in the occupational behaviors of nursing students. So, the aim of the study was to assess the perception of self-esteem among Nursing Students. \u0000Materials and Methods: A descriptive cross-sectional study was conducted among nursing students at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. The study was started after acquiring approval from the Institutional Review Committee of Nobel Medical College. Data was collected in the classroom through a self-administered questionnaire using the standardized tool Rosenberg Self-Esteem Scale (RSE) from July2021 to November 2021.A total of 238 students were taken as a sample by using the non-probability census method. Data analysis was done by descriptive study. \u0000Results: A total of 238 students participated in this study 79.4 percent had high self -esteem and 21.6 percent had low self-esteem. There was a statistically significant association between perception of self-esteem with the age of respondents, Current nursing programme and current nursing education. \u0000Conclusion: The study concluded that the majority of the respondents had high self-esteem. Acquisition of skill, knowledge, independence and acquire social, cultural and emotional adjustment increase high self-esteem.","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":"48273177","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.v11i2.50447
S. Singh, Vikash Sah, P. Dekate
Background: Procalcitonin is produced in response to endotoxin or mediators released in response to bacterial infections and are reported to be sensitive predictor of sepsis and multiple organ failure. The main aim of this study was to correlate procalcitonin levels with the severity of organ dysfunction in children with sepsis. Materials and Methods: A prospective observational study was done among children aged >1 month - 18 years admitted for sepsis in level 4 pediatric intensive care unit at Rainbow children Hospital, Hyderabad from July 2018 to January 2020. Children with sepsis due to burns and trauma were excluded. Procalcitonin levels were assessed on days 1 and 5 and were analyzed using descriptive statistics. P value of < 0.05 was considered significant wherever applicable. Results: Among 369 cases, procalcitonin levels showed positive correlation with severity of illness and multiorgan failure as evidenced by pediatric risk of mortality III score (mean score 6.44 ± 3.79) and worst sepsis-related organ failure assessment score (mean score 7.11 ± 4.27) respectively. Duration of non-invasive ventilation, invasive ventilation, pediatric intensive care unit stay, and mortality were significantly high in children with higher procalcitonin level. Mean procalcitonin level were significantly higher in culture positive cases (65.79 ± 77.10) compared to culture negative cases (37.99 ± 45.81). Conclusion: In this study, positive correlation was observed between procalcitonin level and multiple organ dysfunctions in sepsis and septic shock.
{"title":"Procalcitonin Level and Organ Dysfunction in Children with Sepsis: A Prospective Observational Study","authors":"S. Singh, Vikash Sah, P. Dekate","doi":"10.3126/jonmc.v11i2.50447","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50447","url":null,"abstract":"Background: Procalcitonin is produced in response to endotoxin or mediators released in response to bacterial infections and are reported to be sensitive predictor of sepsis and multiple organ failure. The main aim of this study was to correlate procalcitonin levels with the severity of organ dysfunction in children with sepsis. \u0000Materials and Methods: A prospective observational study was done among children aged >1 month - 18 years admitted for sepsis in level 4 pediatric intensive care unit at Rainbow children Hospital, Hyderabad from July 2018 to January 2020. Children with sepsis due to burns and trauma were excluded. Procalcitonin levels were assessed on days 1 and 5 and were analyzed using descriptive statistics. P value of < 0.05 was considered significant wherever applicable. \u0000Results: Among 369 cases, procalcitonin levels showed positive correlation with severity of illness and multiorgan failure as evidenced by pediatric risk of mortality III score (mean score 6.44 ± 3.79) and worst sepsis-related organ failure assessment score (mean score 7.11 ± 4.27) respectively. Duration of non-invasive ventilation, invasive ventilation, pediatric intensive care unit stay, and mortality were significantly high in children with higher procalcitonin level. Mean procalcitonin level were significantly higher in culture positive cases (65.79 ± 77.10) compared to culture negative cases (37.99 ± 45.81). \u0000Conclusion: In this study, positive correlation was observed between procalcitonin level and multiple organ dysfunctions in sepsis and septic shock. ","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":"49643241","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.v11i2.50802
S. Parajuli, Heera Kc, Anish Luitel, M. Shrestha, Baidehi Upadhyaya
Background: Understanding people’s awareness on snakebite management would be highly beneficial to develop strategic program at local levels of Nepal. We aimed to identity snakebite incidence, general awareness and beliefs of people regarding snakebite management in rural communities. Materials and Methods: A community-based cross-sectional study was conducted at Budhiganga Rural Municipality from September to November 2022 among 245 households. Ethical clearance was taken from institutional review committee of Birat Medical College. Microsoft Excel 2019 and SPSS software ver. 2025 were used for data analysis. Results: Annual snakebite incidence rate was 2332 per 100000 populations. Majority (71%) could not identify biting snake and attended traditional healers (70%). Among study participants, 25% had false belief that banded krait is not poisonous. Various false beliefs on snakebite first aid management were reported such as use of tourniquet (81%), washing bite sites (53.47%), cutting bite site (52%) and so on. Further, prevalent false beliefs on food-related practices were snake drinks milk (85.31%), giving victim water following the snakebite was beneficial (47%), giving chilly to those bitten was beneficial (41.63%) and so on. Conclusion: Despite the existing burden of snakebites, people are not aware about the correct ways to manage them and were still attending traditional healers as a means of treatment. The mis beliefs about snakebite first aid management are very much prevalent.
{"title":"Snakebite Incidence, General Awareness and Belief of Snakebite Management at a Rural Municipality of Eastern Nepal","authors":"S. Parajuli, Heera Kc, Anish Luitel, M. Shrestha, Baidehi Upadhyaya","doi":"10.3126/jonmc.v11i2.50802","DOIUrl":"https://doi.org/10.3126/jonmc.v11i2.50802","url":null,"abstract":"Background: Understanding people’s awareness on snakebite management would be highly beneficial to develop strategic program at local levels of Nepal. We aimed to identity snakebite incidence, general awareness and beliefs of people regarding snakebite management in rural communities. \u0000Materials and Methods: A community-based cross-sectional study was conducted at Budhiganga Rural Municipality from September to November 2022 among 245 households. Ethical clearance was taken from institutional review committee of Birat Medical College. Microsoft Excel 2019 and SPSS software ver. 2025 were used for data analysis. \u0000Results: Annual snakebite incidence rate was 2332 per 100000 populations. Majority (71%) could not identify biting snake and attended traditional healers (70%). Among study participants, 25% had false belief that banded krait is not poisonous. Various false beliefs on snakebite first aid management were reported such as use of tourniquet (81%), washing bite sites (53.47%), cutting bite site (52%) and so on. Further, prevalent false beliefs on food-related practices were snake drinks milk (85.31%), giving victim water following the snakebite was beneficial (47%), giving chilly to those bitten was beneficial (41.63%) and so on. \u0000Conclusion: Despite the existing burden of snakebites, people are not aware about the correct ways to manage them and were still attending traditional healers as a means of treatment. The mis beliefs about snakebite first aid management are very much prevalent.","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":"47040716","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 : 2022-06-29DOI: 10.3126/jonmc.v11i1.45733
Pratap Sagar Tiwari, S. Kc
Background: In patients with chronic liver diseases, liver and spleen stiffness measurement by elastography is the most recent available noninvasive tool. However, the accuracy for prediction of esophageal varices has been inconsistent across various studies. So, this study was done to evaluate the diagnostic performance of spleen stiffness measurement for detecting esophageal varices. Materials and Methods: This descriptive cross-sectional study was done from 19 March to 30 June 2019. Participants who met inclusion and exclusion criteria were consecutively enrolled for the study and underwent upper gastrointestinal endoscopic examination along with measurement of liver and spleen stiffness by fibroscan. Results: A total of 78 patients were enrolled. Mean age (±SD) was 49.79 (±10.92) years. Of 78 patients, 58 (74.4 %) had esophageal varices. Among patients with varices, Small esophageal varices were present in 44.8 % (26) and large esophageal varices were present in 55.2 % (32).Liver stiffness higher than 21.7 kPa was found to detect patients with large esophageal varices and the area under the receiver operating curve being 0.79 (95% confidence interval: 0.69 – 0.89); p<0.001. It had sensitivity of 100.0% and specificity of 63% in predicting the presence of large esophageal varices. While, spleen stiffness having a cutoff value of 40 kPa with the area under the receiver operating curve being 0.98 (95% confidence interval: 0.96 – 1.00); p<0.001, had sensitivity of 100.0 % and specificity of 87.0 % in predicting the presence of large esophageal varices. Conclusion: Spleen stiffness measurements by Transient Elastography predict large esophageal varices better than liver stiffness measurements.
{"title":"Spleen Stiffness Measurement as Non-Invasive Surrogate for Esophageal Varices in Chronic Liver Disease","authors":"Pratap Sagar Tiwari, S. Kc","doi":"10.3126/jonmc.v11i1.45733","DOIUrl":"https://doi.org/10.3126/jonmc.v11i1.45733","url":null,"abstract":"Background: In patients with chronic liver diseases, liver and spleen stiffness measurement by elastography is the most recent available noninvasive tool. However, the accuracy for prediction of esophageal varices has been inconsistent across various studies. So, this study was done to evaluate the diagnostic performance of spleen stiffness measurement for detecting esophageal varices. \u0000Materials and Methods: This descriptive cross-sectional study was done from 19 March to 30 June 2019. Participants who met inclusion and exclusion criteria were consecutively enrolled for the study and underwent upper gastrointestinal endoscopic examination along with measurement of liver and spleen stiffness by fibroscan. \u0000Results: A total of 78 patients were enrolled. Mean age (±SD) was 49.79 (±10.92) years. Of 78 patients, 58 (74.4 %) had esophageal varices. Among patients with varices, Small esophageal varices were present in 44.8 % (26) and large esophageal varices were present in 55.2 % (32).Liver stiffness higher than 21.7 kPa was found to detect patients with large esophageal varices and the area under the receiver operating curve being 0.79 (95% confidence interval: 0.69 – 0.89); p<0.001. It had sensitivity of 100.0% and specificity of 63% in predicting the presence of large esophageal varices. While, spleen stiffness having a cutoff value of 40 kPa with the area under the receiver operating curve being 0.98 (95% confidence interval: 0.96 – 1.00); p<0.001, had sensitivity of 100.0 % and specificity of 87.0 % in predicting the presence of large esophageal varices. \u0000Conclusion: Spleen stiffness measurements by Transient Elastography predict large esophageal varices better than liver stiffness measurements.","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48188785","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 : 2022-06-29DOI: 10.3126/jonmc.v11i1.45720
Aditi Mishra, S. Shrestha, Shekhar K.C., D. Karn
Background: Multiple treatment options are available for verruca, however none is completely effective. Conventional modalities such as salicylic acid, cryotherapy have inconsistent treatment efficacies. Newer modalities such as immunotherapy, bleomycin and lasers have shown higher clearance rates of warts in recent studies. Immunotherapy is an innovative approach to treat warts which relies on the principle of enhancement of cell-mediated immunity. This study was done to evaluate the efficacy of immunotherapy with Tuberculin Purified Protein Derivative injection in palmoplantar verruca in our context. Materials and Methods: This is an open labelled, prospective interventional study. Patients with palmoplantar verruca enrolled in the study were injected with purified protein derivative intralesionally by an insulin syringe at a dose of 10 IU (0.1 mL) in the largest wart every 2 weeks until all lesions disappeared or for a maximum of six sessions. They were followed up for 3 months after final treatment session. Results: A total of 54 patients, 34 males and 20 females, were enrolled in the study. Commonest distribution of palmoplantar verruca was in plantar distribution (48.1%). Among them, 12 (22.2%) patients had periungual warts. Complete clearance of warts without any scarring was seen in 66.7% (36) patients with palmoplantar verruca at the end of 6th session whereas 33.3% (18) patients did not respond. Adverse effects noted were erythema, edema and pain at injection site. Conclusion: Intralesional injection of purified protein derivative is an effective and inexpensive treatment option for palmo-plantar verruca with good outcome.
背景:疣有多种治疗方案，但没有一种是完全有效的。常规疗法如水杨酸、冷冻疗法的治疗效果不一致。在最近的研究中，免疫疗法、博莱霉素和激光等较新的治疗方式显示出更高的疣清除率。免疫疗法是一种治疗疣的创新方法，它依赖于增强细胞介导免疫的原理。本研究旨在评估结核菌素纯化蛋白衍生物注射免疫治疗掌足底疣的疗效。材料和方法:这是一项开放标记的前瞻性干预性研究。参与研究的手掌足底疣患者每2周在最大的疣内用胰岛素注射器注射10 IU (0.1 mL)的纯化蛋白衍生物，直到所有病变消失或最多注射6次。治疗结束后随访3个月。结果:共纳入54例患者，其中男性34例，女性20例。掌足底疣以足底分布最常见(48.1%)。其中，12例(22.2%)患者有甲周疣。在第6次治疗结束时，66.7%(36例)的掌足底疣患者的疣完全清除，没有任何疤痕，而33.3%(18例)的患者没有反应。不良反应为注射部位出现红斑、水肿和疼痛。结论:病灶内注射纯化蛋白衍生物是治疗掌足底疣的一种有效且经济的方法，疗效良好。
{"title":"A Prospective Clinical Study for Safety and Efficacy of Intralesional Tuberculin Purified Protein Derivative in Treatment of Palmoplantar Verruca","authors":"Aditi Mishra, S. Shrestha, Shekhar K.C., D. Karn","doi":"10.3126/jonmc.v11i1.45720","DOIUrl":"https://doi.org/10.3126/jonmc.v11i1.45720","url":null,"abstract":"Background: Multiple treatment options are available for verruca, however none is completely effective. Conventional modalities such as salicylic acid, cryotherapy have inconsistent treatment efficacies. Newer modalities such as immunotherapy, bleomycin and lasers have shown higher clearance rates of warts in recent studies. Immunotherapy is an innovative approach to treat warts which relies on the principle of enhancement of cell-mediated immunity. This study was done to evaluate the efficacy of immunotherapy with Tuberculin Purified Protein Derivative injection in palmoplantar verruca in our context. \u0000Materials and Methods: This is an open labelled, prospective interventional study. Patients with palmoplantar verruca enrolled in the study were injected with purified protein derivative intralesionally by an insulin syringe at a dose of 10 IU (0.1 mL) in the largest wart every 2 weeks until all lesions disappeared or for a maximum of six sessions. They were followed up for 3 months after final treatment session. \u0000Results: A total of 54 patients, 34 males and 20 females, were enrolled in the study. Commonest distribution of palmoplantar verruca was in plantar distribution (48.1%). Among them, 12 (22.2%) patients had periungual warts. Complete clearance of warts without any scarring was seen in 66.7% (36) patients with palmoplantar verruca at the end of 6th session whereas 33.3% (18) patients did not respond. Adverse effects noted were erythema, edema and pain at injection site. \u0000Conclusion: Intralesional injection of purified protein derivative is an effective and inexpensive treatment option for palmo-plantar verruca with good outcome. ","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44438993","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 : 2022-06-29DOI: 10.3126/jonmc.v11i1.46065
Sanzida Khatun, D. K. Shah, Nischal Shrestha, A. Yadav
Background: The placenta is a uterine organ in pregnancy which facilitates exchange of materials between maternal and fetal circulation. Decreased maternal hemoglobin decreases oxygen supplementation to fetus among anemic mothers which may cause low birth weight. The aim of this study was to compare the ratio of placenta to birth weight among anemic and non-anemic mothers. Materials and Methods: A comparative cross-sectional study was conducted in 82 anemic pregnancies and 203 non-anemic pregnancies in Department of Obstetrics & Gynecology, Nobel Medical College Teaching Hospital, Biratnagar. Participants with haemoglobin concentration lower than 11 g/dl were included in anemic group and 11g/dl or more in non-anemic group. The difference of means of placental weight, birth weight and placenta to birth weight ratio in anemic and non-anemic groups was determined by Student’s t-test. Results: In anemic group, mean placental weight was 578.78±141.80 g, mean birth weight was 2973.17±680.97 g and mean placenta to birth weight ratio was 0.20±0.05. In non-anemic group, mean placental weight was 575.96±128.88 g, mean birth weight was 3125.91±590.89 g and mean placenta to birth weight ratio was 0.19±0.05. Significant difference was observed in means of placenta to birth ratio in anemic and non-anemic groups (p-value 0.05). Conclusion: Mean placental weight and mean ratio of placenta to birth weight was higher in pregnant women with anemia than in non-anemic pregnant women and significant difference was observed in means of placenta to birth ratio between anemic and non-anemic groups.
{"title":"Ratio of Placenta to Birth Weight in Anemic and Non-Anemic Mothers","authors":"Sanzida Khatun, D. K. Shah, Nischal Shrestha, A. Yadav","doi":"10.3126/jonmc.v11i1.46065","DOIUrl":"https://doi.org/10.3126/jonmc.v11i1.46065","url":null,"abstract":"Background: The placenta is a uterine organ in pregnancy which facilitates exchange of materials between maternal and fetal circulation. Decreased maternal hemoglobin decreases oxygen supplementation to fetus among anemic mothers which may cause low birth weight. The aim of this study was to compare the ratio of placenta to birth weight among anemic and non-anemic mothers. \u0000Materials and Methods: A comparative cross-sectional study was conducted in 82 anemic pregnancies and 203 non-anemic pregnancies in Department of Obstetrics & Gynecology, Nobel Medical College Teaching Hospital, Biratnagar. Participants with haemoglobin concentration lower than 11 g/dl were included in anemic group and 11g/dl or more in non-anemic group. The difference of means of placental weight, birth weight and placenta to birth weight ratio in anemic and non-anemic groups was determined by Student’s t-test. \u0000Results: In anemic group, mean placental weight was 578.78±141.80 g, mean birth weight was 2973.17±680.97 g and mean placenta to birth weight ratio was 0.20±0.05. In non-anemic group, mean placental weight was 575.96±128.88 g, mean birth weight was 3125.91±590.89 g and mean placenta to birth weight ratio was 0.19±0.05. Significant difference was observed in means of placenta to birth ratio in anemic and non-anemic groups (p-value 0.05). \u0000Conclusion: Mean placental weight and mean ratio of placenta to birth weight was higher in pregnant women with anemia than in non-anemic pregnant women and significant difference was observed in means of placenta to birth ratio between anemic and non-anemic groups. ","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45940752","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 : 2022-06-29DOI: 10.3126/jonmc.v11i1.45783
B. Ghimire, M. Basnet, Nischal Shrestha, Satish Amatya, Suju Bhattarai
Background: A solitary thyroid nodule is a discrete swelling that is palpable in apparently normal thyroid gland. It can be identified clinically as well as radiologically. This study aims to find the prevalence of malignancy in clinically detected solitary thyroid nodule and to compare the findings in pre-operative fine needle aspiration cytology test with post-operative histopathological examination to assess the accuracy of the test. Materials and Methods: A descriptive cross sectional study was done in patients attending the Otorhinolaryngology outpatient department in our hospital from January to December 2021 with clinically diagnosed solitary thyroid nodules. Ethical approval was taken from the Institutional Review Committee ofNobel Medical College and Teaching Hospital (58412021). The collected data were collected in Microsoft Excel 2013and was analyzed in Statistical Package for the Social Sciences version 21. Point estimate at 95% ConfidenceInterval and descriptive statistics were interpreted as frequency, percentage, or as mean and standarddeviations. Results: Among 37 patients with clinically detected solitary thyroid nodules, malignancy was found in 12 (32.43%) (17.35-47.51 at 95% Confidence Interval).The mean age of presentation was 34 ± 13 years with male female ratio of 1:8.Fine needle aspiration cytology had 64.00% sensitivity and 75.68% specificity in detecting benign lesions and 100% both in detecting malignancy. Conclusion: The prevalence of malignancy by fine needle aspiration cytology among clinically detected solitary thyroid nodules was high as compared to other similar studies done in similar settings
背景:孤立性甲状腺结节是在表面正常的甲状腺中可触及的离散性肿胀。它可以在临床和放射学上被识别。本研究旨在了解临床发现的孤立性甲状腺结节中恶性肿瘤的发生率，并比较术前细针穿刺细胞学检查与术后组织病理学检查的结果，以评估检查的准确性。材料与方法:对2021年1月至12月在我院耳鼻喉科门诊就诊的临床诊断为孤立性甲状腺结节的患者进行描述性横断面研究。伦理批准由诺贝尔医学院和教学医院机构审查委员会(58412021)。收集到的数据在Microsoft Excel 2013中收集，并在Statistical Package for The Social Sciences version 21中进行分析。95%置信区间的点估计和描述性统计被解释为频率、百分比或平均值和标准差。结果:37例临床发现的孤立性甲状腺结节中，有12例(32.43%)为恶性肿瘤(95%可信区间为17.35 ~ 47.51)。平均发病年龄34±13岁，男女比例1:8。细针吸细胞学检查良性病变的敏感性为64.00%，特异性为75.68%，恶性病变的敏感性和特异性均为100%。结论:细针穿刺细胞学检查在临床上检测到的孤立性甲状腺结节中，恶性肿瘤的患病率高于在类似环境下进行的其他类似研究
{"title":"Diagnosing Malignancy by Fine Needle Aspiration Cytology in Cases of Solitary Thyroid Nodules","authors":"B. Ghimire, M. Basnet, Nischal Shrestha, Satish Amatya, Suju Bhattarai","doi":"10.3126/jonmc.v11i1.45783","DOIUrl":"https://doi.org/10.3126/jonmc.v11i1.45783","url":null,"abstract":"Background: A solitary thyroid nodule is a discrete swelling that is palpable in apparently normal thyroid gland. It can be identified clinically as well as radiologically. This study aims to find the prevalence of malignancy in clinically detected solitary thyroid nodule and to compare the findings in pre-operative fine needle aspiration cytology test with post-operative histopathological examination to assess the accuracy of the test. \u0000Materials and Methods: A descriptive cross sectional study was done in patients attending the Otorhinolaryngology outpatient department in our hospital from January to December 2021 with clinically diagnosed solitary thyroid nodules. Ethical approval was taken from the Institutional Review Committee ofNobel Medical College and Teaching Hospital (58412021). The collected data were collected in Microsoft Excel 2013and was analyzed in Statistical Package for the Social Sciences version 21. Point estimate at 95% ConfidenceInterval and descriptive statistics were interpreted as frequency, percentage, or as mean and standarddeviations. \u0000Results: Among 37 patients with clinically detected solitary thyroid nodules, malignancy was found in 12 (32.43%) (17.35-47.51 at 95% Confidence Interval).The mean age of presentation was 34 ± 13 years with male female ratio of 1:8.Fine needle aspiration cytology had 64.00% sensitivity and 75.68% specificity in detecting benign lesions and 100% both in detecting malignancy. \u0000Conclusion: The prevalence of malignancy by fine needle aspiration cytology among clinically detected solitary thyroid nodules was high as compared to other similar studies done in similar settings","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48416795","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 : 2022-06-29DOI: 10.3126/jonmc.v11i1.45735
B. Bista, N. Karmacharya, Ram Hari Ghimire, P. Shrestha, D. Poudel, Janer Kurumbang, M. Mahato, Deebya Raj Mishra
Background: Early diagnosis of pulmonary tuberculosis is difficult but dreaded complications like cavitations, abscess, disseminations and fibrosis of lung parenchyma can be avoided. Sputum microscopy is still the most available test for diagnosis of pulmonary tuberculosis but sustainable number of active cases remains undiagnosed via this method alone. In strong clinico-radiological pulmonary tuberculosis patients who are sputum scarce or sputum microscopy and sputum Xpert MTB/Rif negative broncho-alveolar lavage may provide superior sample for Gene Xpert MTB/Rif in diagnosis of Pulmonary Tuberculosis. Materials and Methods: Over 2 years period, patients with strong clinico-radiological suspicion of pulmonary tuberculosis who had sputum microscopy and sputum Xpert MTB/Rif negative were included in the study. Fibro-optic bronchoscopy was done for BAL Xpert MTB/Rif test. Base line demographic, clinical and radiological data were systematically analysedby SPSS software version 17. Results: 64 patients were included in the study with mean age 41 ± 10.52 years. The most common symptoms were cough, sputum production and weight loss with frequency of 58 (90.6%), 31 (48.4%) and 21 (32.11%) patients respectively. The most common CT scan findings were consolidation, cavitation and tree in bud pattern. BAL Xpert MTB/Rif was positive in 11 (17.18%) patients. According to the CT findings BAL Xpert MTB/Rif was most commonly present in patients presenting with cavitary lung disease. Conclusion: Eleven patients had BAL gene Xpert/Rif positive out of 64 patients who were sputum scarce or had both microscopy and sputum gene Xpert/Rif negative. Bronchoscopy BAL Xpert/Rif could provide an additional diagnostic test in these groups of patients.
{"title":"Diagnostic Yield of Bronchoscopic Alveolar Lavage Gene Xpert MTB/Rif in Smear Negative Clinico-Radiologically Suspected Case of Pulmonary Tuberculosis","authors":"B. Bista, N. Karmacharya, Ram Hari Ghimire, P. Shrestha, D. Poudel, Janer Kurumbang, M. Mahato, Deebya Raj Mishra","doi":"10.3126/jonmc.v11i1.45735","DOIUrl":"https://doi.org/10.3126/jonmc.v11i1.45735","url":null,"abstract":"Background: Early diagnosis of pulmonary tuberculosis is difficult but dreaded complications like cavitations, abscess, disseminations and fibrosis of lung parenchyma can be avoided. Sputum microscopy is still the most available test for diagnosis of pulmonary tuberculosis but sustainable number of active cases remains undiagnosed via this method alone. In strong clinico-radiological pulmonary tuberculosis patients who are sputum scarce or sputum microscopy and sputum Xpert MTB/Rif negative broncho-alveolar lavage may provide superior sample for Gene Xpert MTB/Rif in diagnosis of Pulmonary Tuberculosis. \u0000Materials and Methods: Over 2 years period, patients with strong clinico-radiological suspicion of pulmonary tuberculosis who had sputum microscopy and sputum Xpert MTB/Rif negative were included in the study. Fibro-optic bronchoscopy was done for BAL Xpert MTB/Rif test. Base line demographic, clinical and radiological data were systematically analysedby SPSS software version 17. \u0000Results: 64 patients were included in the study with mean age 41 ± 10.52 years. The most common symptoms were cough, sputum production and weight loss with frequency of 58 (90.6%), 31 (48.4%) and 21 (32.11%) patients respectively. The most common CT scan findings were consolidation, cavitation and tree in bud pattern. BAL Xpert MTB/Rif was positive in 11 (17.18%) patients. According to the CT findings BAL Xpert MTB/Rif was most commonly present in patients presenting with cavitary lung disease. \u0000Conclusion: Eleven patients had BAL gene Xpert/Rif positive out of 64 patients who were sputum scarce or had both microscopy and sputum gene Xpert/Rif negative. Bronchoscopy BAL Xpert/Rif could provide an additional diagnostic test in these groups of patients. ","PeriodicalId":52824,"journal":{"name":"Journal of Nobel Medical College","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42890465","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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