Med Phoenix

Laboratory Aspects of Covid-19: Current Scenario

Sanjay Kumar Sah — Fri, 06 Jan 2023 00:00:00 +0000

N/A

Serum Carbohydrate Deficient Transferrin: A Sensitive Marker in Diagnosing Alcohol Abuse

Fri, 06 Jan 2023 00:00:00 +0000

Introduction: Alcohol is a psychoactive substance with dependence producing properties and the burden of disease and death related to alcohol consumption remains significant in most countries. Early detection and proper medication with counselling can restore the alcoholics to normalcy. There is a need for a specific assay procedure to detect alcoholics early, so that proper therapy can be instituted. The traditional biomarkers in liver function test (LFT) are more frequently used for diagnosing alcohol abuse but they have variable and limited sensitivity and specificity. Carbohydrate Deficient Transferrin (CDT) can be considered as a more sensitive and specific marker for diagnosing alcohol abuse. The aim of this study is to determine % CDT in alcoholics and compare it with other alcohol markers in respect with sensitivity and specificity. The results of the study will be helpful in assessment of the alcohol dependence patients and therefore in their early detection and management.

Materials and Methods: This is a hospital based comparative cross-sectional study carried out in Dharan. A total of 40 cases of alcohol abuse with ≥2 score in CAGE questionnaire and matched 40 subjects with no history of alcohol intake were enrolled in the study. Informed written consent and ethical approval were taken.

Result: Serum %CDT has the highest diagnostic efficacy followed by serum gamma glutamyl transferase (GGT), Aspartate Transaminase (AST), Alanine Transaminase (ALT), AST/AL, and ALP as a biomarker for diagnosing alcohol abuse. Serum %CDT has the highest sensitivity with 97.5% and specificity of 73% at a cut off value of 3.5% compared to serum GGT with the sensitivity and specificity of 87% and 73%, respectively at a cut off value of 33.5 U/L.

Conclusion: Serum %CDT is a better marker both in terms of sensitivity and specificity compared to other conventional markers and thus can be used as a tool to early diagnose the alcoholic cases and monitor the therapy and for early identification of the relapses in alcoholics during treatment.

Evaluation of Intrauterine Fetal Death at Tertiary Care Centre: A Descriptive Cross-Sectional Study

Fri, 06 Jan 2023 00:00:00 +0000

Introduction: Intrauterine fetal death (IUFD) is unpredictable despite of regular antenatal checkup. Early assessment and timely intervention may reduce the incidence of IUFD. This study aimed to find out the prevalence of IUFD among pregnant women at tertiary care center.

Materials and Methods: A descriptive cross-sectional study was conducted in a tertiary care center from 1^st November 2020 to 31^st October 2021. Ethical approval was obtained from the Institutional Review Committee (Registration number: F-NMC/515/076-077). Demographic data were collected using predesigned proforma in pregnant women with intrauterine fetal demise identified before, during labor and delivery.

Results: Among 1441 deliveries, IUFD was found in 81 (5.62%). The highest stillbirth rate occurred in the 3rd trimester between 37 - 42 weeks 41 (50.61%), 85.18% unemployed, 36% were primigravida, 46.91% in 20 – 24 years age group. The commonest obstetric complications encountered were hypertensive disorders at 14.81%, unexplained (13.58%). Macerated stillbirths accounted for 49 (60.49%. Over 85% of the mothers had vaginal delivery while 15% had cesarean section.

Conclusion: A significant portion of IUFD can be prevented by providing patient and community health education for regular antenatal care regarding warning signs during antenatal, hospital delivery, early referral.

Renal Cortical Thickness in Adult with Normal Renal Function Measured by Ultrasonography

Fri, 06 Jan 2023 00:00:00 +0000

Introduction: Renal cortical thickness is an important parameter for many renal pathologies. Ultrasonography has been an efficient tool for the measurement of different renal parameters. The objective of this study was to determine the renal cortical thickness in healthy adults without any renal impairments and to correlate it with age, sex, height, weight, BMI and side of the body.

Materials and Methods: A total of 150 healthy adults with normal renal function were included in this study. A detailed clinical history of all the patients were taken. Basic investigations, clinical and ultrasonography examination were performed. Informed written consent and ethical approval were taken.

Results: The study included 150 participants (67 male & 83 female) with mean age of the participants 33.0±9.5 years. The mean renal cortical thickness was found to be 8.3±0.69mm. There was significant correlation between RCT and gender (p=0.013). However, no such correlation was observed between (renal cortical thickness) RCT and age, height, weight and BMI of the participants.

Conclusion: Ultrasonographic measurement of renal cortical thickness plays a vital role in identification of many renal diseases. Thus, the result of this study can be used for evaluation of renal cortical thickness to determine abnormal renal conditions.

Intraoperative findings during Open mastoido-epitympanectomy at a tertiary center

Fri, 06 Jan 2023 00:00:00 +0000

Introduction: Chronic otitis media is a common entity in our country. Surgical eradication of disease is the treatment of choice for squamous chronic otitis media. The objective of this study was to assess the pathology, its extent and associated complications in patients who underwent open mastoido-epitympanectomy for chronic otitis media squamous at a tertiary care center (Dhulikhel Hospital) in Nepal.

Materials and methods: Medical records of 111 patients who underwent OMET at our center from June 2017 to June 2021 were analyzed retrospectively. Demographic parameters, clinical presentation, audiometric data, intraoperative pathology and their distribution, involvement of bony landmarks and ossicular chain status were recorded and analyzed.

Results: There were 64 male and 47 female patients included in our study. Their age ranged from 6 to 69 years. The commonest finding during examination under microscopy was posterosuperior retraction pocket (42.3%). Cholesteatoma was the commonest intraoperative pathology (86.5%), majority with cholesteatoma widespread involving both tympanic and mastoid cavities. Ossicular chain erosion was reported in 96.4% patients.

Conclusion: Squamosal otitis media is common in our setup, with extensive distribution of pathology in middle ear cleft, and possible bony landmarks erosion.

Fetomaternal Outcome in Eclampsia at Tertiary Care Centre: A Descriptive Cross-Sectional Study

Fri, 06 Jan 2023 00:00:00 +0000

Introduction: Eclampsia is a life threatening emergency condition that remains a leading cause of maternal and perinatal mortality. It is one of the causes of preventable maternal mortality. There are specific risks for the mother as this condition lead to seizure and may cause woman to lose consciousness and if the fetus is not delivered, this condition can cause the death of the mother and or the fetus. This study was conducted to evaluate the fetomaternal outcome in eclampsia.

Materials and Methods: This is a descriptive cross sectional study done at National Medical College Teaching Hospital from 1st February 2021 to 31st January 2022. Ethical approval was obtained from IRC (regd no.
F-NMC/518/076-77). During the study period 1496 women delivered. Out of this, 44 patients with generalized tonic-clonic convulsions during pregnancy / labour / within 7 days of delivery were included in the study criteria. The data analyzed included various maternal parameters, fetal parameters and pregnancy outcomes.

Result: Among 1496, 44 patients (2.94%) developed eclampsia, 38.63% in age group of < 20 years, 59.09% were primigravida, 84.09% unbooked, 63.63% presented with antepartum eclampsia, delivered by caesarean 63.63%. There was 2.26% maternal mortality due to cerebrovascular accident. Perinatal mortality was 11.36% which included stillbirth 6.81%nand neonatal death 4.54%.

Conclusion: Regular antenatal checkup, early detection of disease, timely referral, and early initiation and treatment in patients with eclampsia improve outcomes. Treatment of these patients should be carried out in tertiary care centers where intensive care units, NICU facilities, and multidisciplinary units are available.

Thyroid Peroxidase Autoantibody in Subclinical and Overt Hypothyroidism: A Hospital Based Retrospective Study

Fri, 06 Jan 2023 00:00:00 +0000

Introduction:Thyroid peroxidase (TPO) is a key enzyme of thyroid hormone biosynthesis as it catalyzes the iodination and the coupling steps. Subclinical hypothyroidism is the condition of increased Thyroid Stimulating Hormone (TSH) and normal levels of serum free thyroxine (ft4) and free triiodothyronine (ft3) levels. Subclinical hypothyroidism can be progressed to overt hypothyroidism in which ft3 and ft4 levels are decreased along with an increment of TSH levels.

Materials and methods: This was the hospital-based retrospective study conducted on the patients who had undergone thyroid function test measurements along with thyroid peroxidase autoantibody level in serum. The study duration was eight months (January 2022 to August 2022). All the data were entered in Microsoft Excel version 10 and analyzed in SPSS version 22 accordingly.

Results: In the study among 424 patients, 73.8% were female and 26.2% were male. Firstly, our study revealed subclinical hypothyroidism was predominant (41.7%), followed by euthyroidism (34.7%) overt hypothyroidism (20.3%), and overt hyperthyroidism (3.3%). Secondly, there was no statistically significant difference in age (P value: 0.26) and gender (0.64) between subclinical and overt hypothyroidism. There was no statistically significant difference in serum anti-TPO antibodies level between subclinical (median 6.25) and overt hypothyroidism (median 6.12) (P value: 0.92) when median and interquartile ranges were compared. Correlation analysis revealed a significant positive correlation of TPO antibodies with TSH (0.27, 0.00) and no significant negative correlation with fT4 (-0.02, 0.46) and fT3 (-0.05, 0.37).

Conclusion: The current study revealed the elevation of thyroid peroxidase autoantibodies in both subclinical and overt hypothyroid patients though subclinical hypothyroidism was predominant.

Cardiac Surgery in Birgunj: Early Experience

Md. Afroz Ansari, Kush Bahadur Rana, Sanjiv Kumar Shahi — Fri, 06 Jan 2023 00:00:00 +0000

Introduction: Cardio-vascular diseases are growing up in developing countries and they are the leading cause of deaths in the world, especially in low- and middle-income population. Various procedure were included such as open thoracotomy, CABG, Mitral valve repair aortic valve repair, however we aimed to study difficulties in performing cardiac surgery and complication related to cardiac surgery.

Material & Methods: This retrospective study was carried out in Department of Surgery of National Medical College and Teaching Hospital, Birgunj, Parsa, Nepal. A total of 18 patients were included over period of 2019 to 2022 in this study. History and detailed clinical examination was performed as per the working proforma. Data analysis was done using SPSS (Statistical Package for social sciences), version 25.

Result: Most of Coronary heart disease was seen in 40-59 years of age group with mean age of 48.2 years. A total of 83% patients were male. Triple vessel disease was the most common diagnosis (38.3% patients). Coronary artery bypass surgery (CABG) was most common surgery performed. 44.4% of patient develops complication out of which mortality occured in 11.11% of patient.

Conclusion: To conclude, elective cardiac surgery is challenge in center like ours. Coronary heart disease (Triple vessels disease) was the most common indication of surgery.

Hematological Changes in Whole Blood Stored in Blood Bags Containing CPDA-1 Over a Period of 28 Days

Fri, 06 Jan 2023 00:00:00 +0000

Introduction: Blood storage is needed to ensure a readily available and safe blood supply. During blood storage in blood bank, biochemical and physical properties of RBCs are altered because of storage conditions. In normal conditions in the body circulation, these do not occur as optimum pH, temperature, nutrient concentration and waste products removal are maintained. The aim of this study was to observe the changes in whole blood stored in blood bags containing CPDA-1 over a period of 28 days.

Materials and Methods: This was a hospital based observational study conducted in Blood Bank, National Medical College and Teaching Hospital (NMCTH), Birgunj. A total of 450 ml blood was drawn from 50 healthy volunteer donors into blood bags containing CPDA–1 anticoagulant and placed on the quarantine shelf of the blood bank refrigerator maintained at 2-8^o centigrade. The blood bags were screened for HCV, HBsAg, syphillis and HIV. Ten milliliters blood was withdrawn from the blood bags on 1^st, 7^th, 14^th, 21^st, and 28^th day and tested for hematological parameters using Yumizen H550 (HORIBA) fully automated hematology analyzer.

Results: At the end of 28 days, whole blood storage in CPDA-1 revealed significant decrease in WBC (T = 4.79, p < 0.01) and platelets count (T=180.09, p < 0.01). Hematocrit increased significantly after 21 days of storage (T = 40.86, p < 0.01). MCHC and MCH also demonstrated significant increase during the storage period (T = 37.32, p < 0.01) and (T = 29.38, p < 0.01), respectively.

Conclusion: WBC and platelets are significantly altered (decreased) when stored in blood bags containing CPDA- 1 after one week period. The study recommends whole blood transfusion before seventh day of donation in order to avoid the adverse outcome of hematological changes in stored blood. In case it has to be used beyond one week, then it should be leukodepleted before storage.

Accidental Migration of a Guide Wire During Haemodialysis Catheter Insertion Through Right Internal Jugular Vein

Niraj Kumar Keyal, Manbodh Kumar Sah, Ujjwal Deo, Rupesh Chaurasia — Fri, 06 Jan 2023 00:00:00 +0000

Introduction: Intensivist and Nephrologist generally place the dialysis catheter to obtain vascular access for immediate and short-term haemodialysis. We hereby present a case of a 54 years male with a past history of diabetes mellitus, hypertension, and chronic kidney disease stage four who was planned for immediate haemodialysis for severe hyperkalaemia and metabolic acidosis. A haemodialysis catheter was inserted under ultrasound guidance through the right internal jugular vein, but during the procedure, the guidewire was pushed into vein. The chest X-ray showed the looping of the tip of a guidewire. It was successfully surgically extracted, haemodialysis was done through the right femoral vein successfully, and the patient was discharged. From this, we want to emphasize that accidental migration is a fatal, avoidable, preventable complication. Simple measures like holding the guidewire until removal from vessels, vigilant supervision of the trainees, avoidance of vigorous force during insertion of guidewire may prevent this complication.

Unusual Presentation of Thelazia callipaeda in the Anterior Chamber of a Human Eye

Sweta Singh, Saurav Piya, Jeena Gurung, Shristi Raut — Fri, 06 Jan 2023 00:00:00 +0000

Introduction: We presented a 53 years old female with redness and pain of right eye for the past 3 months. Slit-lamp biomicroscopy revealed circumciliary congestion with a mobile, curved, white, rod-shaped parasite in the anterior chamber (AC) on the inferior surface of iris. For definitive diagnosis and management, we removed the parasite from the AC through limbal incision. Microbiological examination identified “Thelazia callipaeda”. Thelazia callipaeda is usually detected in the conjunctival sac and lacrimal sac. However, in this case from Lumbini Eye Institute and research centre, Western Nepal, the parasite was found in the anterior chamber of a human eye which is an unusual location.

A 19 Days Old Neonate with Congenital Pulmonary Airway Malformation: A Case Report

Fri, 06 Jan 2023 00:00:00 +0000

Congenital Pulmonary Airway Malformation (CPAM), previously known as Congenital Cystic Adenomatoid Malformation (CCAM) is a rare dysplastic lesion of the fetal tracheobronchial tree. Here we report a 19 days male child with respiratory distress. Right sided Congenital Pulmonary Airway Malformation Type 1 was diagnosed. Right thoracotomy with upper and middle lobectomy was carried out with successful management of the child.