Journal of Nepal Medical Association最新文献

Hypersensitivity to aspirin is rare disorder occurring in 1.88% of the patients. Aspirin-hypersensitive patients requiring single antiplatelet agent may be treated with clopidogrel, an alternative antiplatelet agent. However, aspirin desensitization is more cost-effective than the usage of clopidogrel in these patients. Furthermore, aspirin desensitization is of greater value in patients requiring dual antiplatelet therapy, for example following procedures like percutaneous transluminal coronary angioplasty (PTCA) instead of using non-aspirin-based combinations. Herein, we report a 74-year-old hypertensive male presented with features of acute coronary syndrome and planned for percutaneous transluminal coronary angioplasty of RCA followed by dual antiplatelet therapy. Since he had aspirin allergy, desensitization was done using rapid desensitization protocol for which he responded well. This case highlights the importance of aspirin-desensitization in patients with aspirin allergy instead of choosing non-aspirin based antiplatelet agents.

Abstract: A case of a 61-year male presented with chief complaints of fever for three months. Diagnosis of hemophagocytic lymphohistiocytosis was made after liver biopsy when Positron-Emission Tomography revealed multiple fluoro deoxy glucose avid lesions in the liver. The patient of this disease typically presents with fever, splenomegaly, hyperferritinemia, hypertriglyceridemia, raised liver enzymes, and marrow features suggestive of hemophagocytosis. The treatment is usually systemic corticosteroids, chemotherapy with etoposide, cyclosporine, or hematopoietic stem cell transplantation, depending on the cause. A diagnosis like hemophagocytic lymphohistiocytosis can easily be missed in developing countries with low resources like Nepal. Hence, this disease should be suspected in patients presenting with pyrexia of unknown origin by treating physicians.

Abstract: Developmental anomalies of genital tract result from defective fusion and absorption of various parts of Mullerian ducts in fetal life. Rudimentary horn pregnancy (RHP) is a rare occurrence of one in 76,000 and one in 160,000. We present a case of a 24-year-old primigravida with ruptured RHP initially managed in the line of an intrauterine pregnancy with severe anemia. Hemodynamic instability made us suspect ruptured RHP and lifesaving laparotomy was performed for the same. A 1.5-liter hemoperitoneum was encountered with a right RHP. Multiple adhesions were present with necrotic tissue adherent and clumped together as tubo-ovarian mass. Resection of rudimentary horn was performed. We report this case to emphasize the need to consider rare uterine anomalies as a possibility in patients presenting with acute abdomen in early pregnancy. So, Obstetricians can consider these rare entities in differential diagnosis and management.

Abstract: Legionella spp. is an underreported cause of Community Acquired pneumonia that affects significant population specially in urban areas and its prevalence is on an increasing trend. The routine practice of testing for urinary antigen of Legionella in all suspected cases of pneumonia is prevalent is resource rich western countries. Although several studies have shown no distinct advantage of performing routine urinary antigen testing, this practice continues to be preferred by clinicians. In this viewpoint, we have discussed the advantages and disadvantages of urinary antigen testing, its relevance in current practice and its impact on clinical outcomes.

Introduction: Ocular trauma stands as the leading preventable cause of monocular blindness worldwide. The aim of the study was to calculate the prevalence of ocular trauma and the circumstances, causes, and types of ocular injuries at emergency department of Community Eye Hospital.

Methods: This was a descriptive cross-sectional study conducted retrospectively on patientsvpresenting to the Emergency Department in the year 2020. Ethical clearance was received from the Institutional Review Board with reference number 12/2021. Data collection commenced in April 2021, following the approval in March 2021. Descriptive statistics with mean and frequency were used for analysis.

Results: Among the 6526 emergency cases visiting the emergency department of Hetauda community eye hospital the prevalence of ocular trauma was 2143 (32.83%; 95% CI: 31.69%-33.97%). The mean age among the 2143 trauma cases was 33.55±15.63 years. Among them, 1851 (86.40%) fell in the working age group. The male-to-female ratio was 3:1. Occupational injuries due to welding, agriculture and industries were in 604 (28.19%) of all ocular injuries.

Conclusions: The prevalence of ocular trauma in our study was higher than other studies. Occupational ocular trauma mainly welding injury, cement factory injury and agricultural injury are common cause of ocular trauma.

Introduction: Liver is most commonly affected in dengue often resulting in changes in the liver function test parameters. Alterations in hematological parameters are also reported which could serve as early prognostic markers especially in resource limited settings where serological tests for the diagnosis of dengue is not available. This study aims to analyze liver function test and hematological parameter changes in dengue infected patients.

Methods: A descriptive cross-sectional study was conducted from December 2022 to October 2023 in serologically dengue positive patients. Liver function parameters and blood parameters were analyzed from 220 patients. The purposive sampling technique was employed during the selection of participants.

Results: Out of 220 study participants, 113 (51.36%) were males and 107 (49.64%) were females. The median age of the participants was 35 years (IQR: 26 - 48 years). Elevated serum AST and ALT levels were present in 121 (55%) and 80 (36.36%) of the participants respectively. Thrombocytopenia and leukopenia were observed in 92 (41.82%) and 88 (40%) of the study participants respectively. The median hemoglobin level was 14.4 (IQR: 13-15.47) g/dl. Low hemoglobin level was found in 31 (14.09%) participants. The median red blood cell count was 4.91 (IQR: 4.49 - 5.28) millions/mm3 with decreased red blood cell count noted in 27 (12.27%) participants.

Conclusions: Increased serum transaminases levels, thrombocytopenia and leukopenia are common laboratory findings in dengue patients.

Introduction: Respectful maternity care (RMC) is a fundamental human right for women globally. Providing respectful care during labor and postpartum is crucial for the health and well-being of both mothers and newborns. The interactions between healthcare providers and women play a significant role in shaping their future healthcare decisions. Therefore, this research aims to evaluate the prevalence of RMC during labor and postpartum from the patient's perspective at a tertiary care center.

Methods: We conducted a descriptive cross-sectional study at a tertiary center from February 20, 2023, to September 30, 2023. Ethical approval was obtained from the Institutional Review Committee of the same institution. A total of 217 patients were included using consecutive sampling techniques. Data were collected through interviews using a structured questionnaire on respectful maternity care. The point estimate was calculated with a 95% Confidence Interval.

Results: The prevalence of overall respectful maternity care (RMC) score was 81%. The score for right to confidentiality and privacy during labor was 91.7%, treated with dignity and respect was 90.87%, received equitable care free of discrimination was 86.41%, protection from physical harm and ill treatment was 84.02%, while protection of right to information/informed consent and choice'preference was 72.55%.

Conclusions: This study demonstrated a high prevalence of respectful maternity care, with most patients experiencing protection of confidentiality, dignity, equitable treatment, safety, and informed consent, indicating effective implementation of RMC practices at our tertiary care center. Keywords: labour; maternity care; postpartum; prevalence; tertiary hospital.

Introduction: Variations in the branching pattern of the Arch of Aorta (AoA) are common in patients undergoing contrast-enhanced Multidetector Computed Tomography, the identification of which is crucial in managing patients undergoing cardiovascular/neck surgeries and interventions.

Methods: This prospective cross-sectional study involved 513 patients who were sent to the Department of Radiology for evaluation of various pathologies of chest and neck between August 2018 and July 2019. After approval from the Institutional Review Committee {Reference No: 11(6-11) E2/075/076}, contrast-enhanced computed tomography images were evaluated with variations in branches of the left-sided arch of the aorta and symptoms associated.

Results: Variations in branches of the arch of aorta were seen in 69 (13.45%; 95% CI: 10.60%-16.71%) of cases, left common carotid artery and brachiocephalic trunk having common origin or common trunk was 51(9.94%). The mean age was 52.4±20 years (Range 3 months to 92 years) with male to female ratio of 1.3:1.

Conclusions: Contrast-enhanced computed tomography is the modality of choice for the detection of the variations in branches of AoA, recognition of which is crucial in vascular intervention and surgical procedures to reduce the postoperative morbidity and mortality of the patients.

Introduction: Problem-based learning is a student-centered learning method. Assessing students' understanding, settled way of thinking and interpretation towards problem-based learning is essential. The objective of the study was to understand the attitude and perception of preclinicalM.B.B.S. students about problem-based learning.

Methods: A descriptive cross-sectional study was conducted from July 5, 2023 to September 4, 2023 for the duration of two months after duly approval from Institutional Review Committee (Protocol No: IRC-LMC-04/Q-23). First and second year M.B.B.S. students who had good experience of attending problem-based learning sessions in integrated basic science subjects were included in the study. Fifteen close-ended questions related to attitude and perceptions were designed in Google Form. The responses were taken on five point Likert scale ranging from strongly disagree (1), disagree (2), neutral (3), agree (4), and strongly agree (5). Data were expressed as frequency and percentage.

Results: Among 164 participants, 92 (56.09%) strongly agreed and 67 (40.87%) agreed that problem based learning enhances self-directed learning on the topic. Similarly, 103 (62.80%) strongly agreed and 59 (35.98%) agreed that problem based learning improves communication skills. Likewise, 78(47.57%) agreed and 53 (32.32%) strongly agreed that this learning method improves confidence in decision-making. Moreover, 89 (54.28%) agreed and 58 (35.36%) strongly agreed that tutors motivate students to learn themselves through problem based learning.

Conclusions: Majority of the students have positive attitude and good perception towards problem based learning. This method helps in generating skills like communication skills, group discussion, constructive critical reasoning, decision-making.

Introduction: Children are at greatest risk for severe illness from Respiratory Syncytial Virus (RSV). The aim of the study was to find out the knowledge of RSV, practice and knowledge about vaccination during pregnancy and the willingness to accept vaccines against RSV during pregnancy in the future among mothers needs to be understood which would add up information for stakeholder and policy makers.

Methods: A preformed Performa was used for face-to-face interview was conducted among 340 pregnant women who visited the Antenatal clinic from 15-Oct-2023 to 30-Nov-2023 in their second and third trimester. Socio-demographic characteristics, knowledge and the attitude concerning antenatal vaccination affecting the acceptance of RSV vaccine were evaluated from the interview.

Results: The mean age was 28.4 years, with 310 (91.18%) already having at least one child. Six (1.76%) participants had previously heard about RSV, and 325 (95.59%) were aware of the problem caused by RSV after they were briefly explained about it in their local language. A total of 246 (72.35%) of the mothers expressed willingness to be vaccinated themselves rather than vaccinating their children if such an option existed. Only 2 (0.59%) participants were familiar with nasal vaccines, and only 18 (5.29%) believed in such vaccines being effective. Despite this, almost all participants 339 (99.71%) in the study demonstrated willingness to receive additional antenatal vaccines if approved for use in future.

Conclusions: The study showed a limited understanding of RSV in children among pregnant women in Nepal. However, they are aware of the impact of bronchiolitis and expressed a strong willingness to undergo maternal vaccination against RSV.