Birat Journal of Health Sciences

A Rare Case of Gastric Ectopic Pancreatic Tissue - An Incidental finding

Rajat Kumar Shah, Mrinalini Singh, Dipesh Mandal Dhanuk — Mon, 27 Nov 2023 00:00:00 +0000

Ectopic pancreas is an infrequent lesion presenting as a nodule or a submucosal mass in the gastrointestinal tract. Depending upon its anatomical location, it can cause clinical symptoms like abdominal pain, intussusceptions, or obstruction, or it can remain clinically silent. Though radiologic diagnostic tools are available, the preoperative diagnosis is tough and is seldom made. We report a case of a 61-year-old male with the chief complaint of pain in the abdomen for 15 days. Advanced diagnostic tools like Contrast enhanced CT scan can characterise the submucosal mass in the stomach and able to confirm the nature of the lesion, whether it was non-neoplastic, benign, or malignant. Therefore, surgical excision was done. The final confirmatory diagnosis of ectopic pancreas in the stomach was made on histopathologic examination.

Drug-Induced Gingival Enlargement- A Practical Insight Into its Etiopathogenesis and Management

Mon, 27 Nov 2023 00:00:00 +0000

Drug-induced gingival enlargements are a familiar finding in a dental setup. They are seen especially in the patient on anti-convulsant, immunosuppressive, and calcium channel blockers therapy. Amlodipine used primarily as a monotherapy or in combination therapy in the management of a trailing disease like hypertension is associated with gingival enlargement constantly. This case report unveils the management of amlodipine-induced gingival enlargement and accentuates the important considerations regarding etiopathogenesis and practical ways of managing the case on a daily basis.

Supraorbital and Auriculotemporal Nerve Entrapment: A Lesser-Known Cause of headache mimicking Migraine-like Symptoms

Anuj Jung Rayamajhi, Prajjwal Raj Bhattarai — Mon, 27 Nov 2023 00:00:00 +0000

Extracranial headaches, although not rare, can be a significant contributor to chronic headaches, affecting approximately 4% of individuals. Among the potential causes of these headaches, entrapment neuropathy in the facial area is a prominent factor, with supraoptic nerve entrapment being a leading cause. The resulting pain typically manifests in the frontal forehead regions that are innervated by this nerve. Ultrasound-guided supraoptic nerve interventions serve a dual purpose, acting as both a diagnostic tool and a therapeutic measure, offering valuable benefits in managing this condition.

Bridging Disparities: The Crucial Role of ICU Registries in Advancing Critical Care Research in LMICs

Diptesh Aryal — Mon, 27 Nov 2023 00:00:00 +0000

Prevalence of Covid-19 and Associated Co-Morbidities at a Tertiary Hospital in Eastern Nepal

Mon, 27 Nov 2023 00:00:00 +0000

Introduction: COVID-19 (coronavirus disease) manifests as asymptomatic, mild, or severe pneumonia-like symptoms. COVID-19 patients with diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), hypertension, malignancies, HIV, and other comorbidities could develop a life-threatening condition.

Objectives: To identify the various comorbid illnesses in COVID-19-positive patients along with its baseline characteristics in a tertiary hospital in eastern Nepal.

Methodology: A one-month observational study carried out in RT-PCR positive COVID-19 patients in Birat Medical College and Hospital (BMCTH) Molecular Laboratory from June to July 2021. All the data was entered in a pre-structured proforma. The data was then further entered and analyzed by using Microsoft Excel 2014.

Result: There were 354 (22.77%) RT-PCR positive COVID-19 cases and 1200 (77.22%) RT-PCR negative COVID-19 cases. More than half of the COVID-19 positive patients were males 211(59.60%). The most common symptoms were fever (92.3%), cough (83.5%) and tiredness (81.23%). Psycho-social stress such as anxiety, depression and insomnia 123 (34.74%) were common comorbidities followed by diabetes 91(25.70%) and hypertension 72(20.33%).

Conclusion: COVID-19 patients were mostly between the 20-30 years of age group. Fever, cough, and throat pain were the commonest presenting symptoms.

Outcome of Open Reduction and Internal Fixation with Interlocking Intra-Medullary Nail in the Treatment of Fracture of Shaft of Femur without Fluoroscopy

Mon, 27 Nov 2023 00:00:00 +0000

Introduction: Femoral shaft fractures are among the common fractures generally managed by close reduction and internal fixation (CRIF) with interlocking intramedullary nailing (ILIMN) as the nail provides the rotational as well as longitudinal stability along with good clinical and functional outcomes but requiring fluoroscopy guidance. Also, in delayed cases, the close reduction might not be possible intimidating the need of open reduction.

Objective: To assess the clinical outcome of the treatment from Open Reduction and Internal Fixation (ORIF) technique as well as placement tricks of locking screws in the absence of a traction table and fluoroscopy.

Methodology: Fourteen cases of close femur fractures with transverse and oblique type in the middle 1/3 shaft coming to Koshi Hospital, Nepal, from June 2019 to December 2021 were included in this study. All patients were treated with ORIF with ILIMN technique without the use of a traction table and fluoroscopy. Data collection included demography, mechanism of injury, mobilization time, union rate, infection, and complication. The study was also designed to evaluate the method of our technique which could be helpful in case of dysfunction of fluoroscopy during intra-operative of CRIF in a resource-limited setting.

Results: The average age of patients was 39.86±14.93, the average hospital stay duration was 12 ± 8.60 days, full weight-bearing walking was around 11.64 ± 3.15 weeks and the average union time was observed to be 14.54 ± 3.36 weeks.

Conclusion: This technique was successful with an efficient duration of the surgery and satisfactory results in early mobilization and fracture union time. Thus, concluding it to be a safe procedure in situations like old fracture (more than 3 weeks), pelvic injury with urethral injury, lack of traction table, and dysfunction of fluoroscopy.

Comparison between two different doses of Norepinephrine infusion for preventing post spinal Anesthesia Hypotension during Cesarean section

Rupak Bhattarai, Amarendra Kumar Yadav, Parasmani Shah, Prabin Sharma — Mon, 27 Nov 2023 00:00:00 +0000

Introduction: Post spinal maternal hypotension is common complication during cesarean section. Norepinephrine is a vasopressor recently used in obstetrics anesthesia. However, there are less data available regarding its optimal dose.

Objective: The main objective of this study is to compare two doses of infusion of norepinephrine for post spinal hypotension during cesarean delivery.

Methodology: A prospective, randomized, double blinded study on full term pregnant patient scheduled for elective cesarean delivery. The infusion of Norepinephrine started after spinal anesthesia after patient randomly divided into two groups. Group A received norepinephrine infusion rate of 0.025ug/kg/min and Group B received at rate of 0.050ug/kg/min. The norepinephrine was continued till 5 minutes after the delivery of fetus and subsequently stopped. These two groups were compared with systolic blood pressure, mean arterial pressure, heart rate, intraoperative hypotensive episodes, Nausea and Vomiting, tachycardia and neonatal outcomes.

Results: Systolic blood pressure and mean arterial pressure was higher in group B when compared with group A at all time intervals intraoperatively. The minimum systolic blood pressure and mean arterial blood pressure in group A were 91.61±8.76 and 59.8±5.29 and group B were 90.67±1.21 and 65±3.46 respectively. No significant difference in heart rate between the two groups. In 0.025ug/kg/min group had 23 (46%) hypotensive episode whereas in 0.050ug/kg/min group had 6 (12%) hypotensive episodes (p<0.001). In group A 9 patient had nausea and vomiting. Bradycardia was seen in 2 % of patient in group A. Tachycardia was seen in 4% of patients in group B. Apgar score was comparable and significant (P<0.05) in 10 minutes.

Conclusion: In the present study, the infusion of 0.050ug/kg/min norepinephrine reduced the hypotensive episodes when compared with the infusion of 0.025ug/kg/min norepinephrine following spinal Anesthesia during cesarean delivery.

Cross Sectional study to evaluate Psychosocial impact of Covid 19 among medical students of BMCTH

Mon, 27 Nov 2023 00:00:00 +0000

Introduction: COVID-19, a profoundly contagious viral disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a devastating impact globally, leading to over 6 million fatalities worldwide. Covid 19 caused isolation, anxiety, grief, economic stress, and disrupted routines, leading to mental struggles, strained relationships, and increased demand for mental health services globally.

Objectives: The objectives of this study were to find out psychosocial impact of covid 19 among medical students of BMCTH and to assess the factors associated with psychosocial impact of covid 19.

Methodology: A cross-sectional study was carried out among all medical students of Birat medical college teaching hospital from August, 2022 to January 2023. Data was collected from 258 eligible participants using GHQ12 questionnaire. Chi-square test was applied for assessing association between dependent and independent variables and binary logistic regression analysis was used to find the determinants.

Results: Present study was conducted among 258 medical students. Among them 43.0% had normal psychological status, 27.5% were in borderline 15.5% showed evidence of psychological distress and 14.0% were experiencing severe psychological distress. Bivariate analysis between socio-demographic characteristics and psychosocial status showed gender, work overload, work hours in covid ward, exposure to false covid information and covid quarantine were significantly associated with psychological distress at p- value < 0.05. Further important variables were run for multivariate analysis which revealed age (B=3.46, CI:1.45-8.23 and P=0.005), gender (B=3.20, CI: 1.61-6.37 and P=0.001) and work overload (B=9.63, CI: 4.32-21.49 and P=0.000) were found as significant predictors/determinants of psychological distress. Age greater than 24 years, female gender and higher work load were significantly associated with psychological distress.

Conclusion: The psychological distress among the medical students due to covid 19 was in appalling situation. The study found age >24 years, female gender and higher workload were the predictor of the psychological distress Integrated efforts from medical college, parents, peers and faculties are to be initiated to address the existing problems.

Assessment of geneXpert test for diagnosis of pediatric pulmonary tuberculosis

Mon, 27 Nov 2023 00:00:00 +0000

Introduction: Pediatric tuberculosis is an infectious disease and is a leading cause of death in Nepal. The incidence of pediatric TB is a key tool of ongoing transmission of tuberculosis within the community and vital indicator of disease control. Its diagnosis is very much challenging and delay in diagnosis leads to mortality.

Objectives: This study was conducted to assess the utility of the gene Xpert test for diagnosis of pediatric pulmonary tuberculosis.

Methodology: A hospital based prospective study done at Pediatric department of a teaching hospital, Nepalgunj, Banke conducted over a period of 1 year from 1 January 2021 to 31 December 2021 with presumptive diagnosis of pediatric pulmonary tuberculosis. Chi-square test was used to determine the association between categorical variables and a receiver operating curve (ROC) analysis was performed to compare the performance of gene Xpert test with other lab parameters like sputum/gastric lavage sample microscopy for acid fast bacilli, erythrocytic sedimentation rate, Tuberculin test (TT) and chest X-ray.

Results: We enrolled a total of 294 patients in our study. Out of 294 samples 5.1% samples came out to be positive for gene Xpert for MTB. The sputum/gastric lavage samples for AFB showed both sensitivity and specificity of 100%. The tuberculin test showed a sensitivity of 80% and specificity of 37.3%. Chest X-ray showed a sensitivity of 66.7% and specificity of 43.7%. The area under the curve for acid fast bacilli in microscopy, tuberculin test and ESR was found to be 100% (95% CI: 100%-100%), 58.6% (95% CI: 44.9%-72.4%), and 52.6% (95% CI: 37%-68.3%) respectively.

Conclusion: This study highlights the utility of gene Xpert as a good diagnostic tool for rapid diagnosis of pulmonary tuberculosis in pediatric population.

Indications and Findings of Coronary Angiography: A Descriptive Cross-Sectional Study

Madhab Bista, Prashant Shah, Ram Kumar Mehta — Mon, 27 Nov 2023 00:00:00 +0000

Introduction: Coronary artery disease is an important subset of cardiovascular disease that requires timely, accurate, and cost-effective diagnosis. Among several modalities practiced to evaluate this disease; coronary angiography is the gold standard.

Objective: The objective of this study was to identify indications and findings of coronary angiography among patients admitted at Birat Medical College Teaching Hospital.

Methodology: A descriptive cross-sectional study conducted at Department of Cardiology, Birat Medical College Teaching Hospital from 1 September 2021 to 30 June 2022 after taking ethical approval from Institutional Review Committee (Ref No: IRC-PA-167/2078-79). A total of 202 patients were included through consecutive sampling. Data was collected on baseline characteristics, indications and findings of coronary angiography. Frequency, percentage, mean and standard deviation was calculated.

Result: Maximum percentage of patients were in the age group 60-69 years (20.8% males and 16.3% females) with mean± S.D(60.1± 11.1). The most common indication for coronary angiography was angina (34.1%) and treadmill test positive (24.3%). Nearly 62% had abnormal findings. Single vessel disease was present in 25.2%, double vessel disease in 5.9% and triple vessel disease in 20.6%. Other findings were cardiac bridging (2.9%), non-critical coronary artery disease (1.9%) and in-stent restenosis (0.5%).

Conclusion: The most common indication of coronary angiography was chronic stable angina and the majority had vessel diseases.

Comparative Study of Clinical Outcome of Low Pressure Versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy at Birat Medical College Teaching Hospital (BMCTH)

Shivraj Sharma, Bhupendra Charan Shrestha, Dhurba Narayan Shah, Ismita Sharma — Mon, 27 Nov 2023 00:00:00 +0000

Introduction: Laparoscopic cholecystectomy at standard pressure pneumoperitoneum ( 12-15 mmHg of Co2) is standard of practice among surgeons. The increase in intraabdominal pressure by insufflation of carbon dioxide during laparoscopy brings certain changes in function of cardiopulmonary systems and also leads to postoperative pain due to stretching of the diaphragm.

Objective: To minimise this impact on human physiology there is increasing effort of performing laparoscopic cholecystectomy at low pressure pneumoperitoneum (8mm Hg) however its safety has not been established. This study aims to compare outcomes of laparoscopic cholecystectomy at low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in people undergoing laparoscopic cholecystectomy in terms of intraoperative time, postoperative pain including shoulder tip pain and length of hospital stay.

Methodology:
This descriptive randomised prospective study was conducted from Feb 2023 to Aug 2023 in the department of general surgery, BMCTH in patients diagnosed with symptomatic gallstone disease meeting inclusion criteria and willing for laparoscopic cholecystectomy. All patients were prospectively randomized into two groups randomly by the lottery method. A convenient sampling method was used. Group A odd number patients underwent surgery under low pressure (LPPLC group), Group B patients at standard pressure pneumoperitoneum (SPPLC).

Results:
A total of 145 patients (114 female and 31 male) with mean age 44.99 years of presentation. 73 patients underwent surgery under LPPLC group and 72 under SPPLC group. Mean pain recorded as per VAS score at 6, 12, 24 and 36 hours postoperatively showed no significant difference in pain among two groups with p value 0.972,0.121,0.212,0.072 respectively. Shoulder tip pain and additional need of analgesia was significantly less in LPPLC group, p value 0.002 and 0.015 respectively. No significant difference was observed in terms of operating time p value 0.151.Conversion between two groups p value 0.494 suggested no significant difference between two group.

Conclusion:
LPPLC is feasible, safe and can be considered over SPPLC. LPPLC is non inferior to SPPLC in terms of postoperative pain including shoulder tip pain and additional need of analgesia.

Comparison between clinical and ultrasonographic parameters in predicting difficult airway: An observational prospective study

Mon, 27 Nov 2023 00:00:00 +0000

Introduction : Various clinical tests are applied at the bedside to predict difficult airway during the pre-anaesthetic examination. Ultrasonography can be used to evaluate the airway and predict difficulty in laryngoscopy and endotracheal intubation.

Objective : To compare the various clinical and ultrasonographic parameters in predicting difficult airway.

Methodology: This prospective observational study was carried out at Birat Medical College and Teaching Hospital. The clinical parameters obtained were Modified Mallampati Grade (MMP), Upper Lip Bite Test (ULBT) and Thyromental Distance (TMD) and the ultrasonographic (USG) parameters used were Tongue Volume (TV), Hyomental Distance Ratio (HMDR) and distance of soft tissue from skin to hyoid bone (DSHB).These results were correlated with Cormack-Lehane (CL) grade during laryngoscopy of 200 patients. The sensitivity, specificity, Receiver Operating Characteristic (ROC) curve along with Area under the curve (AUC) was calculated for each parameter.

Result: Incidence of difficult airway was 15.5%. The sensitivity and specificity of ultrasonographic tongue volume (TV) was higher among all parameters in predicting difficult airway. The specificity of HMDR and DSHB were better compared to clinical parameters.

Conclusion: The use of ultrasound in pre-anaesthetic examination can be a viable tool along with clinical parameters for prediction of difficult airway.

Measurement of Serum Vitamin D Level and its association with Rheumatoid Arthritis, A prospective study at eastern region of Nepal.

Mithilesh Kumar Gupta, Pradeep Kumar Gupta, Rajan Panthee — Mon, 27 Nov 2023 00:00:00 +0000

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by synovitis. The etiology and pathogenesis of RA remain obscure and many factors may be associated with its pathogenesis. Recent findings support that low levels of serum Vitamin D is associated with an increased risk for the development of RA. Recently, the role of vitamin D deficiency in the pathogenesis of RA, as well as the relationship between vitamin D deficiency and the activity of RA has also been an area of interest for many researchers.

Objectives: The objectives of this study is to analyse the vitamin D levels in RA patients and investigate the association between the serum levels of vitamin D and disease activity of RA patients from Eastern region of Nepal.

Methodology: A prospective study was conducted at Birat Medical college teaching hospital, Tankisinwari from September 2022 to August 2023. A total of 150 patients, after fulfilling exclusion and inclusion criteria were enrolled with convenience sampling technique. A control group (n=97) of patients were also enrolled for comparison. After collection of all data, ANOVA test was used to compare continuous variables between control and vitamin D groups.

Results: Vitamin D deficiency was found in 35 patients (23.3%), Vitamin D insufficiency found in 94 patients (62.6%), and is normal in only 21 patients (14%). Also patients with RA had significantly lower vitamin D levels in comparison to patients with control activity. The difference between these two groups was statistically significant (P<0.05).

Conclusion: Our study finds a significant inverse relationship between blood vitamin D levels and RA activity. However, due to the small number of patients included in the current study, further research with a larger sample size is needed to gain a better understanding of the relationship between RA activity and vitamin D.

Clinical Characteristics and Mortality Predictors of Acute Respiratory Distress Syndrome Patients in ICU- an Observational Study

Lalit Kumar Rajbanshi, Batsalya Arjyal — Mon, 27 Nov 2023 00:00:00 +0000

Introduction Adult respiratory distress syndrome (ARDS) is an inflammatory lung condition characterized by a sudden onset of severe oxygen deficiency, bilateral chest infiltrates, and high morbidity and mortality rates. The causes and prognostic factors for ARDS may vary in tropical regions.

Objective This study aimed to investigate the causes, clinical characteristics, and outcomes of ARDS patients admitted in ICU.

Methodology We conducted a prospective observational study involving 92 ARDS patients admitted to the medical and surgical intensive care units of a tertiary care hospital in eastern Nepal from 2021 to 2023. We included patients aged 15 years and above who met all the Berlin criteria for ARDS. Patients with burns, end-stage renal disease, hepatic disease, head injuries, congestive cardiac failure, and postoperative patients were excluded. We assessed demographic parameters, initial clinical presentations, causative agents, ventilation parameters, organ failure during the ICU stay, and factors influencing patient mortality.

Result Our cohort had a mean age of 45.71 ± 20.02 years, with a predominance of male patients. The majority of patients presented with fever and shortness of breath. Approximately 26.1% had mild ARDS, while 25% had severe ARDS. The initial Sequential Organ Failure Assessment (SOFA) score was 10.11 ± 6.07, with most patients having a lung injury score of less than 2.5. Higher lung injury scores and low PaO2/FiO2 ratios were associated with increased mortality (P<0.05). The overall mortality rate in our study was 33.6%.

Conclusion Pneumonia emerged as the most common cause of ARDS in our region. Low PaO2/FiO2 ratios and higher lung injury scores significantly influenced ARDS mortality.

Correlation of Body Mass Index with Blood Pressure in School Going Children Aged 6 To 14 Years in Ramdhuni Municipality of Eastern Nepal

Mon, 27 Nov 2023 00:00:00 +0000

Introduction: Children of school age groups in developing countries are facing the problem of overweight and obesity. Childhood obesity continues as obesity in adulthood. The chance of high blood pressure (BP) in overweight and obese children is more than healthy weight children. However, in Nepal, data on the relationship between hypertension and obesity, and disease burden in children at the national level are limited. To overcome these diseases and to develop effective prevention strategies, knowing the prevalence of the disease is a priority. Thus, this study aims to determine the prevalence and the relationship between overweight/obesity with BP in school going children aged 6-14 years, living in Ramdhuni municipality of eastern Nepal.

Objective: To find prevalence and the association of BMI with blood pressure in school going children aged 6 to 14 years in Ramdhuni municipality of eastern Nepal.

Methodology: This was a school based cross-sectional prospective study conducted at various schools in Ramdhuni municipality from February -March 2022. A total of 490 apparently healthy students of age group 6-14 years of both boys and girls were enrolled. Measurement of height and weight was done by standard procedure. The data was entered into Microsoft offices excel and analyzed using a statistical package for social sciences (SPSS 20.0).

Results: In this present study, data of 490 students aged between 6 and 14 years were evaluated. Of them, 77.8% (n=381) were normal weight, 10.6% (n=52) were overweight and 5.9% (n=29) were obese. The prevalence of hypertension and prehypertension was 0.8% (n=4) and 0.6% (n=3), respectively. The body mass index was statistically significant as an explanatory variable of hypertension for both genders.

Conclusion: This study concludes that overweight and obese children are at a significantly higher risk for hypertension than are normal weight children. Blood pressure measurement should be routine and frequent in children, especially overweight and obese children.