Nepal Journal of Medical Sciences

Barriers to Availability and Access to Sanitation Facilities in Tanzania

Joel Samson Ruvugo, Shyh Poh Teo — Tue, 31 Jan 2023 00:00:00 +0000

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Antibiotic Resistance Patterns of Bacterial Pathogens Associated with Lower Respiratory Tract Infections

Dharm Raj Bhatta, Deependra Hamal, Rajani Shrestha, Niranjan Nayak — Tue, 31 Jan 2023 00:00:00 +0000

Introduction: Respiratory tract infections are one of the most common and serious health problems in developing countries. Increasing incidences of multidrug-resistant isolates from cases of lower respiratory tract infections have been reported. This study was conducted to determine the bacterial pathogens associated with lower respiratory tract infections with their antibiotic resistance pattern in a tertiary care hospital in Western Nepal.

Methods: This hospital-based cross-sectional study was conducted among patients of Manipal Teaching Hospital, Pokhara, Nepal, from August 2022 to October 2022. A total of 376 specimens from the lower respiratory tract were included in this study. Processing of samples, isolation, identification and antibiotic sensitivity test of the bacterial pathogens was performed by standard methods.

Results: Respiratory pathogens were recovered in 68 samples. Gram-negative bacteria were isolated in 55 cases and Gram-positive bacteria in 13 cases. Acinetobacter species (42.6%), Staphylococcus aureus (16.9%) and Pseudomonas aeruginosa (13.9%) were the three most common pathogens isolated. The majority of the Gram-negative isolates were susceptible to tigecycline and colistin. Among S. aureus isolates, 54.5% (6/11) were methicillin-resistant Staphylococcus aureus.

Conclusion: Gram-negative bacteria were predominantly associated with lower respiratory tract infections with Acinetobacter species as the most common pathogen. Increasing antibiotic resistance was recorded among the pathogens and is alarming. Regular surveillance of pathogens and antibiotic resistance patterns is needed for better management of the patients.

Assessment of Anteroposterior Diameter, Interpedicular Distance and Cross-Sectional Area of the Lubar Spine in Patients Undergoing CT Scan in a Tertiary Care Center

Sabanam Acharya, Sunil Pradhan, Prakash Sharma, Neha Bajimaya — Tue, 31 Jan 2023 00:00:00 +0000

Introduction: Lumbar spinal stenosis is a frequent cause of low back pain. Decreased lumbar spinal canal parameters are major risk factors for canal stenosis. This study was done to assess anteroposterior diameter, interpedicular distance and cross-sectional area of the lumbar spinal canal on a CT scan.

Methods: It was a cross-sectional descriptive study conducted at Nepal Medical College Teaching Hospital. Anteroposterior diameter, interpedicular distance and cross-sectional area of the lumbar spinal canal were measured.

Results: A total of 171 subjects were selected. The mean of anteroposterior diameter from L1-L5 was 16.46 mm, 16.05 mm, 15.04 mm, 15.08 mm and 15.23 mm respectively. The means of interpedicular distance from L1-L5 were 22.71 mm, 23.20 mm, 24.52 mm, 26.29 mm and 29.90 mm respectively. The means of cross sectional area from L1-L5 were 288.79 mm², 2773.15 mm², 266.84 mm², 282.89 mm²and 317.04 mm² respectively. A statistically significant difference between sex and anteroposterior diameter was noted at L2 and the interpedicular distance was at L4 and L5 levels. The cross-sectional area has increased with increased age in all five vertebral levels but it showed statistically significant variation only at L1.

Conclusion: Anteroposterior diameter, interpedicular distance and cross-sectional area varies at each level on the lumbar vertebra and may vary according to age and sex.

Measurement of Foramen Magnum Dimensions in Computed Tomography of Head

Tue, 31 Jan 2023 00:00:00 +0000

Introduction: Dimensions of the foramen magnum are clinically important because of the vital structures passing through it and for sex determination of the skull. The objective of this study was to measure various dimensions of the foramen magnum in Computed Tomography (CT) and correlate them with sex.

Methods: Descriptive cross-sectional study was done on 120 CT head images in the Department of Radiology and Imaging, from July to October 2019. The shape of the foramen magnum (FM), anteroposterior diameter (APD), transverse diameter (TD), FM area and FM index were calculated. Statistical analysis was done with SPSS 25 and Excel 2016. Discriminant function analysis and binary logistic regression analysis were used for gender verification.

RESULTS: The mean values of the APD, TD, area and FM index in males and females were 33.56 ± 4.30 mm, 29.76 ± 4.10 mm, 792.94 ± 191.60 mm², 85.01 ± 8.67 and 30.01 ± 2.04 mm, 25.33 ± 4.6 mm, 599.63± 128.13 mm², 83.17 ± 7.78 respectively. All dimensions were significantly greater in males (r = 0.906, P<0.001). The most common shape of the foramen magnum was oval (40.8%). The accuracy of sex identification was 68.3% using dimensions of the foramen magnum.

Conclusion: There was sexual dimorphism in the diameter and area of the foramen magnum which can be used for sex determination.

Radiological Evaluation of Uncinate Process Variations using Multidetector Computed Tomography

Roshana Khadka, Manish Raj Pathak, Bipin Khanal, Rajeev Kumar Shah — Tue, 31 Jan 2023 00:00:00 +0000

Introduction: Functional endoscopic sinus surgery has emerged as a superior technique in sinus surgery with a lower incidence of associated complications as compared to traditional surgeries; however, it still carries risks of possible complications, some of which could be attributable to the variations that exist in the nose and paranasal sinus anatomy. Variations in the uncinate process, one of the important structural landmarks in functional endoscopic sinus surgery can have implications during sinus surgery. Therefore, identifying the variations in the uncinate process becomes a very important consideration. The objective of this study was to identify the variations of the uncinate process on Multidetector Computed Tomography of paranasal sinuses

Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis, Birat Medical College and Teaching from December 2021 to June 2022 after obtaining ethical clearance from IRC. A total of 240 participants referred to the Department of Radiodiagnosis for CT of paranasal sinuses were included in the study.

Results: The most frequent superior attachment of uncinate was found to be Type I and the least common was Type IV. The least frequent variation was UP pneumatisation. Most of the cases showed typical angulation followed by medial orientation and lateral orientation.

Conclusion: Variations in the uncinate process exist and Multidetector CT is a commendable tool for identifying these variations.

A Retrospective Study of Missed Fractures and Injuries in Orthopedics

Krishna Sapkota, Niraj Ranjeet — Tue, 31 Jan 2023 00:00:00 +0000

Introduction: Common Orthopedics injuries may result in long-term disability when they are treated lately. Simple fractures may require surgeries when they are missed and neglected. Most musculoskeletal injuries are seen in emergencies, some injuries may be missed when life-threatening conditions require attention, especially in poly-trauma patients. Certain injuries are difficult to recognize and some fractures may not visible in initial x-rays. A high index of suspicion is required to diagnose such cases.

Methods: We conduct a retrospective study in which missed fractures, dislocations, and injuries were diagnosed and noted by consultant Orthopaedic surgeons from 2013 to 2022.

Results: There were 76 missed diagnosed cases noted from 2013 to 2022. The patient’s ages range from 2 years to 63 years. Altogether 42(55.3%) were missed fractures, 23 (30.3%) were missed dislocations, and 11(14.5%) were tendon and ligament injuries cases. The common reason for the error was related to radiological error found in 62 (81.6%) cases. Misreading of X-rays was seen in 22 (28.9%) cases, poor quality x-rays in 17 (22.4%) cases, improper x- rays in 10 (13.2%) cases, and failure to order for x-rays in 16 (21.1%) cases.

Conclusions: Good history and clinical examinations are essential. Proper x-rays should be taken and poor-quality x- rays should not be accepted but repeated. Most injuries missed on radiographs are not difficult to diagnose. Re-evaluation of patients should be done in an emergency, and with poly-trauma patients.

Association between Alopecia Areata and Thyroid Dysfunction in Western Nepal

Pratistha Shrestha, Meera Shrestha, Sabhayata Gurung — Tue, 31 Jan 2023 00:00:00 +0000

Introduction: Alopecia areata is an autoimmune disease characterized by patchy loss of hair. The etiopathogenesis of the disease is still unclear, but the role of autoimmunity is strongly suggested. Alopecia areata is associated with autoimmune thyroiditis and diabetes mellitus. So the main aim of this study is to study the association between alopecia areata and thyroid dysfunction.

Methods: We conducted a cross-sectional observational study involving 105 patients with alopecia areata. Thyroid function tests (free T3, T4, TSH ) were performed in all the patients with alopecia areata. Data were analyzed using SPSS, version 20. A p-value of less than 0.05 was considered statically significant.

Results: Within alopecia areata patients, in only one male patient (1.9%) T3 was abnormal, in four female patients (7.5%) and six male patients (11.5 %) T4 was abnormal, and in six female patients (11.3%) and three male patients (5.8%) TSH was abnormal.

Conclusion: In our study, there was no significant association between alopecia areata and thyroid function tests.

Evaluation of Cesarean Deliveries by using Ten Group Classification System in a Tertiary Care Centre: A Cross-Sectional Study

Anjali Subedi, Junu Shrestha, Krishna Murari Adhikari, Sudhikshya Thapa — Tue, 31 Jan 2023 00:00:00 +0000

Introduction: Cesarean section has three times increased risk of maternal and fetal morbidities compared to vaginal delivery. The rising trend of cesarean deliveries across the globe led the WHO to recommend the use of the Ten Group classification system to monitor cesarean rate over time as well as between facilities. The cesarean section rate is increasing in our centre, so the study was conducted to evaluate the cesarean deliveries and identify the group with a major contribution to the cesarean rate so that policies could be formulated to decrease it in our centre.

Method: It was a cross-sectional descriptive study conducted in the Department of Obstetrics and Gynecology, Manipal Teaching Hospital, Nepal for six months after ethical approval. All women who delivered at or beyond 28 weeks were included in the study after their consent and were classified according to Robson's classification based on their obstetric parameters. The total cesarean section rate, the size of each group, the cesarean rate in each group and the absolute contribution of each group to the overall cesarean rate were calculated and analyzed.

Results: Out of 711 deliveries during the study period, the cesarean rate was 51% (n=362). Group 1(26%) was the major obstetric population followed by Group 3(20%) and Group 2(16%). Group 5(10.97%) had a major contribution to the overall cesarean rate followed by Group 1(10.68%) and Group 2 (9.7%).

Conclusion: The cesarean rate in our study was high and it could be decreased by encouraging the trial of labor after cesarean and revisiting the indication of induction and cesarean in Group 1 and Group 2.

Quality of Life of Pregnant Women Attending Antenatal Clinic in a Teaching Hospital, Pokhara

Anju Regmi, Pankaj Baral, Puskar Poudel — Tue, 31 Jan 2023 00:00:00 +0000

Introduction: Although changes occur in various dimensions in quality of life and it plays a significant role in the health of pregnant women, there are limited data on the quality of life of pregnant women. The objective of the study was to identify the quality of life of pregnant women.

Methods: We conducted a descriptive cross-sectional study in Gandaki Medical College Teaching Hospital and Research Centre, Pokhara in 167 pregnant women attending an antenatal clinic over one month period, selected by nonprobability purposive sampling technique. Data collection was done using the RAND SF-36 questionnaire. Descriptive statistics were used to describe the quality of life. Inferential statistics were used to compare two independent groups and three or more independent groups respectively.

Results: The Mean±SD score for the quality of life of pregnant women was 73.08±14.95 with 62.80±19.14 in the physical component and 83.35±10.76 in the mental component. The score was highest in role limitation due to emotional health and lowest in role limitation due to physical health domain. Women who had planned pregnancies had better scores in the general health domain (p=0.005) and emotional wellbeing domain (p=0.011) compared to those who had an unplanned pregnancies.

Conclusion: Since the quality of life scores are lower in physical health domains than in mental health domains, special attention should be given to the physical health of pregnant women.

Anaesthetic Management of Patient with Limb Girdle Muscular Dystrophy Scheduled for Laparoscopic Cholecystectomy

Bigen Man Shakya, Shrastha Shrestha — Tue, 31 Jan 2023 00:00:00 +0000

The multiple anaesthetic concerns in a patient with Limb-Girdle muscular dystrophy make the anaesthetic management of the patient difficult. It can be safely managed with adequate pre-operative assessment and careful choice of anaesthetic agents. Our case was managed with general anaesthesia using a short-acting opioid, total Intravenous anaesthesia with propofol and dexmedetomidine avoiding muscle relaxant.

Social Media Use and Negative Health Impacts

Prakash Sharma — Tue, 31 Jan 2023 00:00:00 +0000

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