Nepal Journal of Medical Sciences

Post COVID-19 Late Hemoptysis Managed with Bronchial Artery Embolization

2021-10-17T09:21:38+00:00

SARS-COV-2 has been one of the most massive pandemics in modern history with typical radiological findings. As the follow up on patients who have survived this infection has been rising, newer studies have emerged detailing the long term sequelae of this disease and well as its complications. Few of the long term sequelae of COVID-19 pneumonia are lung fibrosis and bronchiectasis. Bronchiectatic changes in the lungs can lead to hemoptysis in the patient. We present you the case of a patient who recovered from COVID-19 pneumonia and presented with hemoptysis after 2 months secondary to bronchiectatic changes in lung fields. Patient underwent bronchial artery embolization as few studies have shown bronchial artery embolization to be effective and feasible management even on patients with history of COVID-19 pneumonia.

Monkeypox is Now a Public Health Emergency of International Concern

2022-08-03T07:05:03+00:00

Monkeypox is a viral zoonosis caused by an orthopoxvirus. Although monkeypox and smallpox share many clinical features, monkeypox is generally less severe than smallpox. Recently, we have been encountering monkeypox outbreaks outside the non-endemic countries. WHO has now declared the global monkeypox outbreak as a public health emergency of international concern. Surveillance and rapid identification of new cases is the key step for outbreak containment.

Role of the American College Of Radiology –Thyroid Imaging Reporting and Data System (ACR TI-RADS) in Differentiating Benign and Malignant Thyroid Nodules

2022-08-03T07:11:17+00:00

Introduction: Thyroid nodule is commonly detected while performing an ultrasound of the neck. American College of Radiology, Thyroid imaging reporting and data system (ACR-TIRADS) is a classification used to characterize thyroid nodules based on ultrasound findings. The objective of this study is to evaluate the role of ACR-TIRADS classification in differentiating benign and malignant thyroid nodules.

Methods: This is a prospective study conducted at Manipal Teaching Hospital. A total of 70 patients presenting to our radiology department for fine needle aspiration cytology (FNAC) of thyroid nodule were enrolled in the study. Thyroid nodules were grouped as 1- 5 according to the ACR-TIRADS. The ACR-TIRADS findings were correlated with FNAC and or biopsy findings as available. Subsequently; sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ACR-TIRADS in differentiating benign from malignant nodules were assessed.

Results: Mean age of patients in our study was 52.16 years (18-89 years). Male patients were 11 (15.7 %) and female were 59 (84.30 %). According to Ultrasonography; 1.4% of thyroid nodules were labelled as ACR-TIRADS 1; 21.4% as ACR-TIRADS 2; 32.85% as ACR- TIRADS 3; 28.6 % as ACR-TIRADS 4 and 15.7 % as ACR-TIRADS 5. ROC curve analysis showed AUC of 0.78 (95% CI). ACR-TRIADS had sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy of 87.5%, 68.5 %, 45.16 %, 94.87 %, 72.86 % respectively.

Conclusion: ACR- TIRADS has high sensitivity and accuracy in differentiating benign and malignant thyroid nodules.

Correlation of Maternal Serum Uric Acid Level and Feto-maternal Outcome in Hypertensive Disorder of Pregnancy: A Prospective Study

2022-08-03T07:36:11+00:00

Introduction: Hypertensive disorder of pregnancy complicates around 5-10% of all pregnancies. Hyperuricemia is one of the common findings in pre-eclampsia. The uric acid level in pre-eclamptic women is increased before the onset of hypertension and proteinuria. The increase in serum uric acid is associated with an increased risk of adverse fetal outcomes like IUGR, prematurity, IUFD and increased severity of maternal hypertensive disorders like pre-eclampsia, severe pre-eclampsia, and eclampsia and HELLP syndrome.

Methods: This was an observational, prospective cross-sectional study. One hundred and twenty women fulfilling the inclusion criteria were included in the study. Maternal uric acid was grouped into two groups i) <5.5mg/dl and ii) ≥ 5.5 mg/dl. A Pearson’s Chi-Squared test was carried out to assess whether maternal serum uric acid level and maternal and fetal complications were related.

Results: A total of 120 women fulfilling the inclusion criteria were included in the study. Seventy-six women (63.3%) had serum uric acid levels <5.5mg/dl and forty-four (36.7%) women had serum uric acid levels≥ 5.5 mg/dl. In women with serum uric acid levels of 5.5 mg/dl and more, 21 fetuses with complications like IUFD, IUGR, prematurity and those whose serum uric acid level was less than 5.5 mg/dl, 16 fetuses had complications. There was a significant association between maternal serum uric acid levels and maternal complications like pre-eclampsia, severe pre-eclampsia, eclampsia and HELLP syndrome (p=0.004).

Conclusion: Raised serum uric acid is associated with an increased risk of the feto-maternal outcome.

Knowledge Attitude and Practice of Cervical Cancer Screening Among the Healthcare Workers of Western Region, Nepal

2022-08-03T07:49:58+00:00

Introduction: Cancer cervix being the only preventable cancer in the world is still the leading cause of cancer-related death in developing countries. Awareness and screening programs are a must for health care workers whose direct impact goes on society. Healthy people are found to be given services, but their health is often neglected. This study highlights health care workers' knowledge, attitude and practices on cervical cancer screening. This study aims to assess healthcare workers' knowledge, attitude and practice toward cervical cancer screening in the western region, of Nepal.

Methods: A semi-structured questionnaire was distributed to health care workers from September 2020 to March 2021 eligible to participate in the study were included. A total of 115 participants were enrolled in the study. A descriptive measure for socio-demographic data was done. Determinants of knowledge and practice for screening were determined using the Chi-square test.

Results: The mean age of the participant was 27.92±5.49 (SD). More than half had poor knowledge (51%), followed by moderate knowledge (37%) and less than one eight had good knowledge (12%). 92 % know that cervical cancer is preventable but very less have undergone screening tests.

Conclusion: There is an urgent need for educational intervention to change their attitude towards HPV vaccination and encourage cervical cancer screening program that helps in the prevention of cervical cancer. HPV vaccination should be kept in the immunization schedule and made easily available at a low cost.

Intra and Interobserver Reliability of Optic Nerve Sheath Diameter in Normal Nepalese Adults using Transorbital Ultrasound

2022-08-04T06:16:59+00:00

Introduction: Transorbital sonographic measured optic nerve sheath diameter (ONSD) has turned into a promising screening and monitoring tool lately. Nonetheless, the test qualities of this procedure require to be addressed to be feasible to use in clinical practice. This study aims to assess the intra and interobserver reliability of transorbital ultrasound.

Methods: A prospective observational study was conducted on 37 healthy adults. Three serial ONSD of both the eyes were measured using ultrasound by two investigators independently.

Results: The age of the participants ranged from 20 to 30 years with a mean age of 23.86 ± 2.35 years with 54.1% male and 17 45.9% female. The mean ONSD of both eyes was 4.15 ± 0.38 mm for investigator 1 and 4.11 ± 0.37 mm for investigator 2. The mean ONSD of the two investigators was 4.13 ± 0.37 mm with a mean difference of -0.036 ± 0.118 mm (at 95% confidence interval, -0.003 - 0.075 mm). For intra-observer reliability, Intraclass correlation analysis for investigator 1 showed 0.995 for the right eye and 0.995 for the left eye and investigator 2 showed 0.993 for the right eye and 0.997 for the left eye. Interobserver intraclass correlation analysis showed 0.973. In addition, Bland-Altman plots were drawn to see the interobserver limit of agreement using mean ONSD (4.13 ± 0.37 mm) and mean difference (-0.036 ± 0.118) of two investigators.

Conclusion: Measurement of ONSD by transorbital ultrasound is a feasible method to assess intracranial pressure noninvasively with high intra and interobserver agreement.

Cardiac Evaluation of Chronic Kidney Disease Patients under Maintenance Hemodialysis

2022-08-04T08:50:52+00:00

Introduction: Chronic kidney disease (CKD) patients are at increased risk of morbidity and mortality because of their native disease progression. Accumulation of other atherosclerotic risk factors associated with CKD multiplies their risks. This study aimed to evaluate cardiac structural and functional abnormalities in CKD patients undergoing Maintenance Hemodialysis (MHD) using Electrocardiography (ECG) and Echocardiography (Echo).

Method: It was a prospective cross-sectional study containing all CKD patients undergoing MHD at Pokhara Academy of Health Sciences, Pokhara, Nepal was conducted between August 2020 to December 2020. All the relevant data were entered in Statistical Package for Social Science (SPSS) for analysis.

Results: There was a total of 115 patients with a male: female ratio of 1.8:1 and a mean age of 47.25 ± 15.20 years. The mean duration of dialysis was 36 months and hypertension was the prime risk factor. Common ECG abnormalities were left ventricular hypertrophy, left ventricular strain pattern and poor R wave progression. Common Echo abnormalities were left ventricular diastolic dysfunction, left ventricular hypertrophy and regurgitation. Left ventricular systolic dysfunction was present in 20% of the patients.

Conclusion: A spectrum of structural and functional cardiac abnormalities is common in CKD patients undergoing MHD. Early measures should be adopted to mitigate the risk.

Systematic Review – Knowledge, Attitudes and Practices of Healthcare Workers in Reporting Adverse Drug Reactions in Sub-Saharan Africa for Pharmacovigilance

2022-08-04T10:16:14+00:00

Introduction: This study aims to assess intra and interobserver reliability of transorbital ultrasound. To review the knowledge, attitude and practices of health care workers, including doctors, nurses, pharmacists and health officers in reporting adverse drug reactions (ADRs) for pharmacovigilance in sub-Saharan Africa.

Methods: PubMed, Google Scholar and Trip databases were used to identify papers relevant for the review. Search results were narrowed down through a manual review of titles and abstracts based on inclusion criteria.

Results: There were 35 articles included in this review. It was found that generally, healthcare workers had inadequate knowledge regarding reporting of ADRs and pharmacovigilance. While private practice doctors have heard of pharmacovigilance and could define ADRs correctly, more than half did not know how or where to report them. The majority of healthcare workers had positive attitudes toward reporting ADRs. However, there was unwillingness in some settings due to concerns that it reflected poor clinical care on their part. All the studies identified consistently underreporting of ADRs admitted by healthcare workers.

Conclusion: While HCWs have positive attitudes regarding ADR reporting, there were significant knowledge deficits, particularly regarding how to report ADRs. This contributes to the under-reporting of ADRs, which may have implications for drug safety surveillance.

Prescribing Pattern of Antibiotics in Respiratory Tract Infections in the Pediatric Indoor Patients at Manipal Teaching Hospital

2022-08-04T23:22:16+00:00

Introduction: Respiratory tract infections are the most frequently occurring illness in childhood and antibiotics are the key drugs for its treatment which account for three-quarters of all antibiotics prescriptions. Injudicious use of antibiotics leads to the development of resistance, patients are at high risk for opportunistic infections or prolonged hospitalization. This study aimed to assess the prescribing pattern of antibiotics for respiratory tract infections in the pediatric indoor patients of Manipal Teaching Hospital.

Methods: This study is a prospective cross-sectional study done in the paediatrics ward of Manipal Teaching Hospital Pokhara, conducted for six months. Patients aged range from 1 day to 14 years who meet the inclusion criteria were taken in this study. Data were collected from the inpatient ward and analysed using various statistical tools.

Results: Among 170 patients, a maximum(43.3%) were in the age group of 1 day to 11 months with male predominance(74.1%). Bronchopneumonia was the most common respiratory tract infection (51.8%) followed by bronchiolitis (13%). Chest x-ray was done in all patients however blood culture was done only in 60.6% and an antibiotic sensitivity test (27.6%) before prescribing antibiotics. Cefotaxime was prescribed in maximum patients (62.4%) followed by ceftriaxone (17.1%). All the patients received at least one antibiotic by i.v route during the hospital stay.

Conclusion: Since culture and sensitivity tests were not carried out on most of the patients before prescribing antibiotics in this study, which might lead to an increased chance of bacterial resistance and treatment failure in the future.

The Contribution of Alvarado Score and Ultrasonography to the Diagnosis of Childhood Appendicitis during and before COVID-19 Pandemic Period

2022-08-04T23:32:18+00:00

Introduction: This study aimed to evaluate the changes made by the pandemic in pediatric appendicitis, the Alvarado score and the contribution of ultrasonography to the diagnosis.

Methods: This study was conducted on patients who underwent surgery for appendicitis to compare the COVID-19 pandemic period versus the same period the year before. Data regarding demographics, age, the time between symptom onset and admission to hospital, laboratory, ultrasonography and pathology results and Alvarado score were considered.

Results: A total of 211 patients were operated on for appendicitis, 132 patients in the control group and 79 patients in the COVID-19 group. No significant differences between the groups in terms of age, gender and the distribution of appendicitis severity were found. The median time between the onset of symptoms and admission to the hospital was 2.72 days during the COVID-19 pandemic period and there was a significant difference between the two groups(p=0.043). Alvarado score and ultrasonography were evaluated together, in the control group sensitivity 98.4%, specificity 87.5%, PPV 96.9% and NPV 93.3%; if in the COVID-19 group were 94.5%, 88.8%, 97.2% and 80%, respectively.

Conclusions: This study has shown that the evaluation of the Alvarado score and ultrasonography together, increases both sensitivity and specificity for the diagnosis of childhood appendicitis. That's why the combination of these tests becomes more important in special situations such as the COVID-19 period.