Journal of Lumbini Medical College (JLMC)
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Comparison of Fine Needle Aspiration Cytology in Thyroid Lesions using The Bethesda System for Reporting Thyroid Cytopathology with Ultrasonography using Thyroid Imaging Reporting and Data System
Get PDFIntroduction: Thyroid nodule is a common presentation. The estimated prevalence of thyroid nodules is 4-7% by clinical examination and 50-60% on ultrasonographic (USG) evaluation. Most are benign without any symptoms or cosmetic concerns. Only around 5% are found to be malignant. Methods: This prospective study evaluated a total of 54 patients with thyroid lesions presenting to Otorhinolaryngology, Surgery and Internal Medicine out-patient departments of a tertiary hospital for a period of nine months. The thyroid lesions were categorized into different categories using Thyroid Imaging Reporting and Data System (TIRADS) by USG and The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) by fine needle aspiration (FNA). The agreement between TIRADS and TBSRTC was evaluated using Cohen\u27s kappa statistics. Results: By FNA, 68.5% were benign lesions whereas 7.4% were malignant. Follicular Neoplasm (FN) or Suspicious for FN and Suspicious for Malignancy category comprised 5.6% each. 1.9% of the lesions showed Atypia of Unknown Significance (AUS). 11.1% of the lesions were non-diagnostic or unsatisfactory for evaluation. Overall agreement between the cases by USG and FNA using the TIRADS and TBSRTC respectively was 77.77%. There was a substantial agreement between the diagnosis made by these systems, kappa (κ)= .633 (95% CI, 0.41 to 0.85, p<0.05). Conclusion: This study observed a substantial agreement between the diagnosis made by TIRADS on USG and TBSRTC on FNA. Our study advocates the stratification of thyroid lesions according to TIRADS so that only suspicious lesions undergo FNA
Knowledge and Practice of Self-medication among Undergraduate Medical Students
Get PDFIntroduction: Self-medication is an important aspect of self-care. It is a common practice in society and medical students are no exception. The aim of this study was to explore the knowledge and practice of self-medication among students of a medical school in Western Nepal.
Methods: A cross sectional study was conducted among basic science and clinical students after obtaining prior consent from those willing to participate. Respondents’ degree of agreement with a set of 25 statements was noted using Likert scale to assess their knowledge. The practice of self-medication was studied by asking about the use of selected groups of medicines during the past one-year period and noting the pattern of use.
Results: Three hundred and thirty of the 356 students (92.6%) participated in the study. Mean knowledge score was 93.2 (SD = 8.1). Self-medication was practiced by 83.3% (n = 275) of respondents. Knowledge about self-medication differed among respondents according to gender (p = 0.03) and nationality (p = 0.04) but not other variables. Practice of self-medication was associated with father’s profession (p = 0.03) and nationality of the respondents (p = 0.04).
Conclusions: Students’ knowledge about self-medication was good and they commonly practiced self-medication. Pain-killers were the most commonly used drug
Prevalence and Outcome of Preterm Neonates Admitted to Neonatal Unit of a Tertiary Care Center in Western Nepal
Get PDFIntroduction: Preterm deliveries contribute to major morbidity and mortality in developing countries. They are a leading cause of admission in neonatal care units. Advances in the management have ensured better survival of preterm births, however cost, care and resource limitations influence the outcome.This study was conducted to determine the prevalence, risk factors, morbidity patterns and outcome of preterm admissions to a neonatal unit of a tertiary care center. Methods: This was a retrospective study where all preterm admissions over a period of two years were evaluated for maternal risk factors and morbidity pattern. Outcome was measured in terms of survival rate and case fatality rate. Mann Whitney U test and Fisher\u27s Exact test were used to see the association between various parameters and clinical outcome. Results: Preterm admissions constituted16.48% of all neonatal unit admissions with a male to female ratio of 1.32:1. Common risk factors for preterm births were Prelabour Rupture of Membrane (31.2%) followed by Hypertensive Disorders in Pregnancy (15.1%) and Antepartum Hemorrhage (8.6%). Common morbidities were Sepsis (40.9%), Jaundice (28%) and Respiratory Distress Syndrome (RDS) (14%). Case fatality rate was significantly high in RDS (45.1%) and perinatal asphyxia (11.1%). Overall survival rate was 75.26%. Conclusion: Preterm births were an important cause for admissions in neonatal unit. Sepsis, jaundice, RDS and necrotizing enterocolitis were common morbidities observed. Since clinical outcome was related to gestational age, improving antenatal care, timely interventions and early referral of high risk pregnancies to tertiary level centers might improve the survival rat
Knowledge and Perception of Public Towards Medico Legal Autopsy in Nepal
Get PDFIntroduction:
Autopsy is an important tool to determine the cause of death. This study was conducted with the objectives to assess the knowledge and perception of Nepalese people towards medico legal autopsy.
Methods:
It was a questionnaire based cross sectional study performed among the general public of Nepal. A standard pretested questionnaire was used to collect the responses on knowledge and perception of the people about medico legal autopsy. Independent samples t-test was used to compare the mean score of knowledge among the various groups. P value of < 0.05 was considered significant.
Results:
Mean age of the respondents was 29.06 years (SD = 10.50) and 72.31% were male (n = 188, N = 260). Mean score of knowledge was 6.65 (SD = 1.76) out of a total ten. The score was significantly higher (p = 0.02) among the respondents whose relatives had undergone an autopsy than those whose were not. It was comparable among the educated and uneducated groups. A total of 75.77% respondents (n = 197, N = 260) would not reject the autopsy of their relatives.
Conclusion:
People lack knowledge mostly in basic elements of medico legal autopsy. Most of the people showed positive perception towards autopsy and those who were negative, feared of disfigurement of the bodies after an autopsy
Pattern of Lumbar MRI Changes in Patients with Chronic Low Back Pain in a Tertiary Care Center
Get PDFIntroduction: Chronic low back pain (LBP) is a common cause of disability worldwide. Magnetic resonance imaging (MRI) is an excellent non-invasive imaging modality for morphologic evaluation of the lumbar spine in patients with chronic low back pain because of its high contrast resolution and lack of ionizing radiation. This study was done to see the patterns of MRI changes in patients with chronic low back pain in a tertiary care center in Western Nepal. Methods: This was a cross-sectional study conducted on patients presenting with chronic low back pain. Eleven MRI parameters were noted and analyzed. Chi square test and Fisher’s Exact test were employed to see the associations between the various MRI findings. Results: A total of 108 patients were evaluated during the study period. MRI changes were noted in over 95% of the cases. Degenerative changes were the most common cause of low back pain, disc bulge being the most common MRI finding. A significant association was found between radiculopathy and decreased lumbar lordosis and vertebral endplate changes. Conclusion: MRI is an invaluable tool in the evaluation of chronic LBP because of its high resolution and lack of ionizing radiation. Significant MRI findings are noted in most of the cases of chronic LBP, degenerative changes being the most common and ranging from congenital to malignant lesions
Ectopic Eyelid Cilia in a 15 years old Girl: A Rare Presentation
Get PDFByIntroduction: Eyelashes are unique hair follicles normally found at the eyelid margin. The spectrum of cilial anomalies includes cilial row duplication, agenesis and ectopic placement. Ectopic cilia are the rarest of cilial anomalies.
Case Report: A 15 years old girl presented with the complaints of eyeache and headache for three months. She also complained of extra lashes over left upper eyelid with secretion of tears while crying from the area of extra lashes. She was a diagnosed case of epilepsy under treatment for three months.
On examination, visual acuity was 6/6p in right eye and 6/6p in left eyewith best corrected visual acuity being 6/6 with -0.25DS in both the eyes. The anterior and posterior segment findings were normal except for presence of extra bunch of cilia on the temporal side of the left upper eyelid two mm above the upperlid crease with dimpling of the underlying skin.
Conclusion: Ectopic cilia,a rare congenital condition, is asymptomatic and surgical treatment can be done for cosmetic correction
Pattern, Management, and Outcome of Poisoning in a Tertiary Care Hospital
Get PDFIntroduction: Poisoning is a significant global public health problem. The appropriate management of poisoning at emergency needs accurate assessment and immediate treatment. The immense chance for better outcomes occurs with early diagnosis and treatment. This study was conducted to assess pattern, management, and outcome of poisoning in tertiary care hospital.
Methods: An observational cross-sectional study was conducted in which records of patients with a diagnosis of poisoning over a period of four years were reviewed.
Results: A total of 138 patients were included in the study. A majority (63%) of them were females. Most (67.4%) were managed by general or supportive measure only. Gastric lavage was done in 60% of total patients while 52.9% patients received activated charcoal. Pralidoxime and atropine was received by 51.1% of patients treated with specific antidote. All the antidotes were administered through intravenous route. Regarding outcome, 89.9% were completely recovered. Suicidal poisoning was significantly higher in married as compared to unmarried patients (p = 0.029). Similarly, there was a significant relationship between occupation of the patients and manner of poisoning (p = 0.003). Outcome of treatment had a significant association with the manner of poisoning (p < 0.001). Further analysis revealed that the patients who expired in the hospital were more likely to ingest poison accidentally.
Conclusion: Suicidal poisoning is common and females are more susceptible. Insecticide and rodenticide are the commonly ingested poisons. Treatment outcome of poisoning cases is generally favorable
A Comparative Analysis Between RIPASA and Alvarado Scoring Systems for the Diagnosis of Acute Appendicitis- A Nepalese Perspective
Get PDFIntroduction: Various diagnostic criteria have been described for acute appendicitis. For decades the most commonly used one has been Alvarado score. RIPASA scoring system has also been developed for Asian population which has shown highest sensitivity and diagnostic accuracy. This study aimed to compare these two diagnostic criteria in Nepalese population attending a tertiary center. Methods: Patients with clinically suspected acute appendicitis were classified according to both Alvarado and RIPASA scoring systems before undergoing surgery. Histopathological examination was taken as the gold standard for diagnosis. Statistical analysis was done using McNemar\u27s test as applicable. Results: Ninety nine (90 %) patients had histologically confirmed appendicitis. With the cut-off value greater than 7.5 for RIPASA score; sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 94.5%, 27.27 %, 92.16 %, 37.5 %, 88.18% and 7.84% respectively. With the cut-off value greater than 7 for Alvarado score, sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and negative appendectomy rates were 71.72%, 72.73 %, 95.95 %, 22.22%, 71.82 %, and 4.05 % respectively. 94.5% of patients were correctly stratified by RIPASA under higher probability group while only 71.8 % were classified by Alvarado (p value= 0.0001). Conclusion: RIPASA scoring system showed high sensitivity and diagnostic accuracy in comparison to Alvarado scoring system. So, this method can be applied in Nepalese setting for the diagnosis of acute appendicitis
Metabolic Syndrome and Benign Prostatic Hyperplasia: A Nepalese Perspective
Get PDFIntroduction: Metabolic syndrome is defined as the presence of at least 3 of the following parameters: (1) waist circumference ≥ 90 cm, (2) triglycerides > 150 mg/dl or treatment for hypertriglyceridemia, (3) HDL-cholesterol < 40 mg/dl or treatment for reduced HDL-cholesterol, (4) blood pressure ≥ 130/85 mmHg or current use of antihypertensive medications, (5) fasting blood glucose ≥ 110 mg/dl or previous diagnosis of type-2 diabetes mellitus. It is closely associated with many diseases and recent studies have also shown its association with benign prostatic hyperplasia and lower urinary tract symptoms. Our study aimed to investigate association between metabolic syndrome and its components with benign prostatic hyperplasia among patients managed surgically in a tertiary centre in Western Nepal.
Methods: One hundred and four patients above 50 years with benign prostatic hyperplasia managed in the department of Surgery over one year were included in the study.
Results: Twenty-seven patients had metabolic syndrome (25.96%). There was association between metabolic syndrome and mean prostate size and among components of metabolic syndrome, high serum triglyceride and low HDL Cholesterol were found to be associated. There was increase in mean prostate size with increase in number of metabolic syndrome components which was statistically significant.
Conclusion: Metabolic syndrome along with its two components, serum triglyceride and HDL Cholesterol were associated with increase in mean prostate size
Etiological Profile of Neonatal Seizures and Prognostic Factors for Adverse Outcome: A Single Center Prospective Study
Get PDFIntroduction: Neonatal seizure is the most common manifestation and an important determinant of outcome of neurological disorders in newborn period. This study aims to delineate the etiological profile and neurodevelopmental outcome of neonatal seizures and also to identify predictors for adverse outcome.Methods: One hundred and seventeen neonates with clinically proven seizures admitted in Dhulikhel Hospital from February 2014 to February 2016 were recruited. All of them underwent necessary neurological diagnostic tests. The survivors were followed up for at least three times within the first 18 months of life. Prognostic value of factors for adverse outcomes were analyzed with Chi square test and binary logistic regression analysis.Results: Among a total of 954 neonates admitted, 117 (12.26%) developed clinical seizures. The most common cause of neonatal seizure was hypoxic ischemic encephalopathy (n=69, 59%), followed by infection (n=20, 17.09%), and metabolic disturbances (n=16, 13.7%). The outcomes were mortality (n=16, 13.7%), post neonatal seizure (n=18, 15.4%), developmental delay (n=31, 26.5%), vision impairment (n=19, 16.2%) and hearing impairment (n=26, 22.2%). Low Apgar scores at one minute (p=0.03) and five minutes (p=0.001), early onset seizure (p<0.001), and more than one drug used for seizure control (p=0.001) were early prognostic factors for adverse outcome.Conclusion: Birth asphyxia followed by infection and transient metabolic disturbance were common etiologies for neonatal seizures. Low Apgar scores at one and five minutes, early onset seizure, multiple episodes of seizures and requirement of multiple anti-epileptics to control seizures were found to be significant predictors for adverse neurodevelopmental outcome