Journal of Patan Academy of Health Sciences

Rationale for routine preoperative liver function tests before elective cholecystectomy

Jay Narayan Shah — Thu, 31 Aug 2023 00:00:00 +0000

Preoperative work-up before elective cholecystectomy often undergoes a range of routine investigations that includes liver function tests (LFTs). There is fear of concomitant common bile duct stones (CBDs) in patients with negative ultrasonography (USG) findings, i.e. with no dilatation of bile ducts or presence of stones in it or clinical features of hepatitis or jaundice. Studies show that clinical practice of preoperative workup of routine liver function tests for every elective cholecystectomy patient is questionable, possibly because of peer pressure or defensive medicine practices or simply a ‘copy-paste’ from the practices of seniors.^1,2 Preoperative blanket tests on the pretext of ‘finding any abnormalities’ has poor scientific merits. The preoperative LFTs for uncomplicated, elective cholecystectomy patients rarely add value and do not alter the already planned decision based on symptomatology, history, physical examination, and ultrasound diagnosis of cholelithiasis. The clinical pathway for the management in most cases remains unchanged. The practice of menu-style routine tests adds to the cost and rarely adds further useful information sufficient enough to alter the planned clinical pathway.³

Spontaneous bacterial peritonitis due to streptococcus pneumoniae: a case report

Bipin Poudel, Shubham Shrestha, Bimal Pandey, Pawan Acharya, Rabindra Raj Pandey — Thu, 31 Aug 2023 00:00:00 +0000

Despite not being a normal gastrointestinal flora, Streptococcus pneumoniae can be the causative agent of Spontaneous Bacterial Peritonitis (SBP) in clinical setting. Patient present with fever, progressive abdominal pain, swelling of limbs, abdomen or both. It is mainly diagnosed by ascitic fluid tapping and its cell count along with culture and sensitivity. This condition has very good response with antibiotics as per culture reports. Here, we present a common case of SBP caused by an uncommon pathogen Streptococcus pneumoniae.

Demographic profile of patient with acute watery diarrhea during monsoon 2022: Patan Hospital, Nepal

Thu, 31 Aug 2023 00:00:00 +0000

Introduction: Diarrhea is the passage of three or more loose or liquid stools per day or more. Acute watery diarrhea is a major public health problem worldwide. In Nepal, diarrhea is among the top 10 inpatient morbidity. This study’s objective is to monitor demographic characteristics and laboratory findings of stool specimens of diarrhea.

Method: This is a cross-sectional descriptive study done at Patan Hospital. Ethical approval was taken from the Ethical committee. Data for Monsoon 2022 (June to September 2022) were collected from the Patan Hospital record system. Cases from within the Lalitpur district were included.

Result: Out of 119 cases, 50(42%) were male and 69(58%) were female. The mean age±SD was 33.28±25.38 (p=0.083) with maximum cases observed during June and a peak observed during the fourth week of June. Out of 119, 4(3.3%) were stool culture positive. Two cases of Vibrio cholera, one case of Shigella sonnei, and one case of Salmonella parathypi B were isolated. In the etiological profile, 14 Entamoeba histolytica were isolated.

Conclusion: During the outbreak of diarrhea in Monsoon 2022, adults were affected most. The culture of acute watery diarrhea showed two cases of Vibrio cholera.

Prevalence of anemia and mortality among anemic patients with COVID-19 in a tertiary care setting in Nepal

Thu, 31 Aug 2023 00:00:00 +0000

Introduction: The COVID-19 pandemic first detected in December 2019 has claimed so many lives globally as well as in Nepal. Inflammatory changes in SARS-CoV-2 infection can lead to anemia. This study aims to find the prevalence of anemia and mortality among anemic patients in COVID patients admitted to a tertiary care centre in Nepal.

Method: A descriptive cross-sectional study with data collected retrospectively between May 2021 to February 2022 on patients with proven COVID-19 admitted to Patan Hospital.

Result: Among 890, anemia was prevalent in 296(33.25%) (CI 95%, 30.17-36.35) patients which was more among the female population. The mean hemoglobin was 10.68±1.62 g/dl in anemic patients. Mild anemia was present in 215(72.6%) patients followed by moderate in 64(21.6%) patients and severe in 17(5.8%) patients. The mortality in anemic patients was 43(14.5%).

Conclusion: One third of COVID-19 patients admitted to Patan Hospital had anemia which was found to be similar to studies done in similar setting. One in four COVID-19 patients with anemia had died was found to be lower than other studies done in similar settings.

Detection of RSV in children ≤2 years from SARS CoV-2 negative samples at National Public Health Laboratory, Nepal

Runa Jha, Priya Jha, Lok Bandhu Chaudhary, Lilee Shrestha — Thu, 31 Aug 2023 00:00:00 +0000

Introduction: Respiratory syncytial viruses also known as human Respiratory syncytial viruses (HRSV) are highly transmissible respiratory pathogens & the leading cause of hospitalization due to lower respiratory infection, especially in the pediatric population. This study is intended to determine the RSV positivity in SARS-CoV-2 negative samples obtained from patients ≤ 2 years, collected from September 2021 to December 2021, when RSV infection is more common.

Method: SARS-CoV-2 negative archived nasopharyngeal samples of children ≤2 years from September 2021 to December at National Public Health Laboratory were tested for RSV by real-time reverse transcriptase Polymerase Chain Reaction (RT-PCR) using CDC RSV Kit. The Pan -RSV primer/probe set used for the universal detection of RSV and duplex RSV subgroup primer/probe set used for the detection and subgroup-specific identification of RSV A and B.

Result: A total of 294 SARS- CoV-2 negative samples from children less than 2 years were tested. RSV A was identified in 100/294 (34%) and RSV B was detected in 6/294 (2%) samples. In all, 106/294 (36%) samples were positive for RSV. Here we report RSV positivity rate of 36% in SARS-CoV-2 negative samples which were left undiagnosed during the surge of COVID-19 cases.

Conclusion: Our study thereby highlights the need for an accurate and rapid differential or multiplex kits for screening respiratory disease for the effective disease management in the pediatric population.

Assessment of metered dose inhalation technique in patients with chronic lung disease at a tertiary health care center

Deveshree Dongol, Samita Acharya, Yogendra Amatya — Thu, 31 Aug 2023 00:00:00 +0000

Introduction: Poor inhalation technique among patients using Metered Dose Inhaler (MDI) is one of the most common causes of increased acute exacerbations and hospital visits and leads to poor health outcome. Hence, the purpose of this research is to evaluate the correctness of inhalation steps in patients using MDI visiting Patan Hospital.

Method: A total of 128 patients participated in the research. The study involved collection of basic sociodemographic information and visual observation of the inhalation technique of the patients using a standard checklist. Any mistakes made during the procedure were recorded. They were also asked to say each step as they performed it so that all of the steps could be clearly observed.

Result: Out of 128 participants, only 3(2.34%) of the participants were able to perform all the eight steps correctly. Holding breath for five second was the most commonly made mistake 80(62.7%) followed by failure to exhale to residual volume 74(57.7%). Majority of participants were able to perform five steps correctly 29(22.6%). There seemed to be no association of inhalation technique with age, sex and educational status of the patient.

Conclusion: Majority of the patients were unable to perform the inhalation steps correctly indicating the need for regular training programs to improve the inhalation technique and improve health outcome.

Evaluation of effectiveness of locking compression plates in internal fixation of proximal humerus fractures: a prospective study

Shreel Koirala — Thu, 31 Aug 2023 00:00:00 +0000

Introduction: Locking compression plate (LCP) provides significant biological and biomechanical advantages in the management of proximal humerus fracture (PHF) by providing greater stability, vascular preservation, superior healing, and fewer complications. However, the translation of these properties to functional benefits for patients remains to be elucidated. The objective of the study was to evaluate the effectiveness of LCP in internal fixation of PHF in terms of rate of healing and functional outcomes.

Method: This prospective study enrolled 30 Proximal Humerus Fracture patients aged >18 years, from both genders, and treated them with LCP. They were followed up regularly for 1 year and assessed clinically and radiologically using Neer’s criteria and Constant-Murray score. Results were analysed using Chi-square test, p≤0.05 indicated statistical significance.

Result: With a mean age of 45.20±15.02 y and M:F ratio of 2.3:1, most patients showed right-sided injuries 18(60%) and Neer 4-part injuries 13(43.33%), predominantly due to road traffic accidents 19(60%), with a satisfactory Neer’s score 26(86.67%) and a good Constant-Murray score 16(53.33%). The mode of injury showed significant association with age (p=0.013) but not with gender (p=0.866). Over follow up, 27(90%) patients maintained humeral head height and 24(80%) patients showed good humeral neck-shaft angle. Radiological union of PHF took 12 weeks in 12(43.33%) of patients with no dislocation in 27(90%) of patients. However, 1(3.3%) patient showed no union.

Conclusion: LCP is associated with favorable clinical, functional and radiological outcomes in PHF patients by providing rapid healing and good rigidity, angular stability, and torsional strength.

Postpartum hemorrhage: clinical features and management in a tertiary care center of Nepal

Anagha Pradhan Malla, Swikrity Acharya, Bijay Thapa — Thu, 31 Aug 2023 00:00:00 +0000

Introduction: Obstetric haemorrhage continues to account for a substantial proportion of maternal deaths in Nepal, despite implementation of different strategies. The most common type of obstetric haemorrhage is postpartum hemorrhage (PPH), mainly primary. Understanding its burden in the health care setting was the objective of this study by assessing its prevalence, associated factors and management.

Method: This was a retrospective study conducted at Patan Academy of Health Sciences from Mar 2019 to Mar 2022. Demographic, obstetrical, medical factors and management of primary PPH was collected from medical record. Statistical analysis was done using Statistical Packages for Social Sciences (SPSS-20). Results were expressed using frequencies, tables and figures.

Result: From a total 17,770 deliveries, primary PPH was seen in 84(0.47%). Most of them 49(58.3%) were multipara. The frequency and impact of PPH can be effectively reduced by reducing avoidable risk factors, especially those related to obstetric interventions as increased caesarean section rate which was 48(57.1%) among primary PPH. Other associated risk factors were induction of labor 32(38.1%), pre-existing medical diseases 32(38.1%), history of antepartum hemorrhage 15(17.9%), previous caesarean section 19(22.6%). Uterine atony 43(51.2%), abnormal placentation disorder 16(19%), genital trauma 9(10.71%), retained tissue 5(5.95%) were the leading causes of PPH. PPH in morbidly adherent placenta like placenta accreta spectrum was 8(9.5%) and placenta increta 1(1.2%). PPH was controlled by conservative management in 24(28.6%). Surgical intervention was required in 34(40.5%) including hysterectomy in 14(16.7%).

Conclusion: PPH can be minimized by extra vigilance and planned conjoined management.

Cause of hospitalization and its outcome in patient with chronic myeloid leukemia in Patan Hospital

Abhishek Tiwary, Mipsang Lama, Kripa Maharjan — Thu, 31 Aug 2023 00:00:00 +0000

Introduction: Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm characterized by dysregulated proliferation of granulocytes because of reciprocal translocation of chromosome 9 and 22. Despite the advances in treatment of CML, it still has a significant burden in patients’ life because of cost of medication, frequent hospitalization and effect on quality of life. The aim of this study is to find out the cause of hospitalization and its outcome in patient with CML.

Method: It is a retrospective cross-sectional study conducted at Patan Hospital. The study included data of hospitalization of CML patients over a period of 3 years from April 2020 to April 2023 which was obtained from the record files and discharge notes of the patients. The data included information regarding age and sex of the patients, phase of disease, name of Tyrosine kinase inhibitor (TKI) used, cause of hospitalization and outcome of the hospitalization.

Result: There were total of 102 admissions of which 82 admissions were analyzed. The mean age was 49 y, 56% were male, 70.7% were in chronic phase of disease and imatinib was the commonest TKI used (51.2 %). Disease related events were the most common cause of hospital admission (61%); 70 patients (85.4%) improved and were discharged whereas 12 patients (14.6 %) died during hospitalization.

Conclusion: The commonest cause of hospitalization in CML patient was disease related events i.e., disease progression, drug related adverse effects and new diagnosis. Transformation to blast crisis had worst prognosis with increased mortality.

Types and outcome of patients with acute poisoning presenting to emergency department of Patan Hospital, Nepal

Kripa Maharjan, Abhishek Tiwary, Arpana Chhetri Budhathoki — Thu, 31 Aug 2023 00:00:00 +0000

Introduction: Poisoning poses major health and health related issues with the burden of mortality and morbidity in people. Pesticides ingestion poses major burden in our part of world whereas carbon monoxide, prescribed medication overdose is more common in developed regions. This study aimed at finding the type and outcome of patients with poisoning landing in emergency room of Patan Hospital.

Method: This is a retrospective observational study conducted at Patan Hospital. This study included data of patients with acute poisoning over a period of 3 years from Apr 2020 to Apr 2023, which was obtained from the nursing register books and record section. The data included information regarding demographic profile of the patient (age and sex), type of poison and outcome of the patient namely admission, referral and mortality.

Result: A total of 189 cases of acute poisoning were included in the study over a period of 3 y. Female outnumbered the male with female: male ratio of 1.14:1; 90(47.61%) were seen in age group between 18-29 y. Out of them 112(59.26%) were admitted whereas 70(37.04%) were referred and 7(3%) had mortality. Organophosphate poisoning was the most common form of poison used by the patients 116(61.38%).

Conclusion: Pesticides are the most common cause of acute poisoning. Most of the cases were admitted and managed in hospital, however it still poses risk of death. Early identification of the type of poisoning will help in prompt diagnosis, standard management and patient safety.

Pattern of coronary artery occlusion in patients undergoing coronary angiography at Birat Medical College Teaching Hospital

Prashant Shah, Madhab Bista, Heera KC — Thu, 31 Aug 2023 00:00:00 +0000

Introduction: Coronary artery disease (CAD), is the leading cause of death globally. Among different diagnostic and treatment procedures, coronary angiography is considered the gold standard. Birat Medical College Teaching Hospital (BMCTH) is also providing cardiovascular services to people from eastern Nepal and from the neighboring country India. We aim to analyze the pattern of coronary artery occlusion in patients undergoing coronary angiography.

Method: A hospital based observational cross-sectional study was conducted at BMCTH from 10 Sep 2022 to 10 Jan 2023. A total of 220 patients were enrolled by consecutive sampling techniques. Ethical approval was obtained from the Institutional Review Committee of BMCTH. Data was collected on baseline characteristics, risk factors, clinical presentation and degree of coronary artery occlusion. Collected data was entered in Microsoft Excel and analyzed by Statistical Package for Social Sciences version 23. Frequency, mean, percentage were calculated.

Result: Nearly half (49.1%) patients had significant, 6(2.7%) had intermittent CAD and 14(6.4%) had non critical CAD. Three patients (1.4%) had left main coronary artery disease. Left anterior descending artery 66(30%) was the most commonly involved. Single vessel disease was present in most patients 49(22.27%). Double vessel disease 15(46.8%) and triple vessel disease was more common 14(51.8%) in above 65 y of age.

Conclusion: The coronary angiography revealed presence of significant coronary artery disease and multiple vessel involvement with increasing age.

Pattern of malocclusion in orthodontic patients at a tertiary care centre

Bishnu Prasad Sharma, Bikash Desar — Thu, 31 Aug 2023 00:00:00 +0000

Introduction: Malocclusion is the most common dentofacial abnormality in human population, which can cause dental caries, periodontal disease and aesthetic problems. It is closely related to psychosocial wellbeing. The prevalence of malocclusion varies among different age and ethnic groups. The aim of this study was to assess the pattern of malocclusion occurring in orthodontic patients.

Method: A 4-year data from 14 Apr 2018 to 13 Apr 2022 were collected retrospectively by the principal investigator (PI) from the pre-treatment record and an acceptable study cast from the Dental Department at Patan Hospital, Patan Academy of Health Sciences. Angle’s classification of malocclusion was used to classify malocclusion. The collected data were entered, and statistical analysis was carried out by using SPSS version 25. Chi-square test was applied to test the significant differences. The comparison was made between male and female and age group 6-12 years and 13 years and above for the Angle’s classification.

Result: A total of 384 patients included in the study, female patients were 263(68.5%). Prevalence for malocclusion was 267(69.5%) of Angle’s class I, while Class II and Class III were 111(28.9%) and 6(1.6%) respectively. The study revealed not statistically significant. Majority 372(96.9%) belong to 13 y and above age group while only 12(3.1%) belong to 6-12 y age group.

Conclusion: Angle’s Class I malocclusion was most prevalent with the least common being Angle’s Class III malocclusion. No statistically significant relationship was found. Almost all subjects were 13 years and above age group.