Medical Journal of Pokhara Academy of Health Sciences <p>Medical Journal of Pokhara Academy of Health Sciences is published and distributed by Pokhara Academy of Health Sciences Pokhara which was established in 2016 A.D. and is in the process of starting academic activities.</p> Pokhara Academy of Health Sciences en-US Medical Journal of Pokhara Academy of Health Sciences 2631-2018 <p>© Medical Journal of Pokhara Academy of Health Sciences</p> Short term outcome in severe alcoholic hepatitis patients treated with Methylprednisolone plus N acetylcysteine or Pentoxifylline plus N acetylcysteine <p><strong>Introduction: </strong>Severe Alcoholic hepatitis (AH) is an acute form of alcohol induced liver injury. Often it present as fetal diseases with very high (30-50%) short term (28 days) mortality. This study was conducted from period May 2016 to July 2017 in Liver unit, Bir hospital. The main objective was to find out 28 days mortality&nbsp;in patients with severe alcoholic hepatitis who had Discriminant function (DF) ≥ 32. This was a prospective, comparative, randomized interventional hospital based study.</p> <p><strong>Methodology: </strong>Hundred and ten diagnosed patients of severe alcoholic hepatitis who fulfilled the criteria were enrolled and randomized into two groups (odd number and even number). Group 1 received methylprednisolone and group 2 received pentoxifylline for 28 days. In both groups N acetylcysteine were added. Lille score was calculated in methylprednisolone group at day 7 and patients with score of ≤ 0.45 were continued methylprednisolone for total 28 days otherwise stopped. Data were recollected at day 28. They were compared in relation to survival, complications of drugs and causes of mortality.</p> <p><strong>Results: </strong>Mean age of presentation were 40.21±10.5 yrs in methylprednisolone and 42.1±12.1 yrs in pentoxifylline group. In both groups complications were nausea, vomiting, bloating, anorexia and swelling of limb. However, hyperglycemia (16.4%) and renal impairment (9.1%) were more common in methylprednisolone&nbsp;group. Mortality rates were 34.5% in methylprednisolone and 37.8% in pentoxifylline group within 28 days. Common causes of death in both groups were hepatic encephalopathy, hepatorenal syndrome, sepsis or the cause was undetermined.</p> <p><strong>Conclusion: </strong>Alcoholic hepatitis is common manifestation of alcoholic liver disease with high short term mortality in both the groups however adverse effects of drugs are more common in methylprednisolone groups.</p> Kiran Regmi Anil Kumar Mishra Sudhamshu KC Dilip Sharma Jeetendra Kaji Shrestha Sushil Prajapati Dipendra Khadka ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 51 55 10.3126/mjpahs.v1i2.23389 Spectrum of paediatric orthopaedic injuries in Patient attending emergency department of Gandaki Medical College of Pokhara, Nepal <p><strong>Background: </strong>Children are vulnerable to musculoskeletal injuries both at home and on the street for various reasons. Morbidity and disabilities resulting from these, mostly preventable, injuries, make them a burden to their families and society. The role of various factors associated with injuries is often not documented.</p> <p><strong>Methods: </strong>This prospective, cross sectional study was done on 80 children aged below 16 years with musculoskeletal trauma, data were collected and analysis was done using Microsoft excel and frequency table. The various modes of injuries, place of injuries, pattern of injuries and regional distribution of injuries were analyzed.</p> <p><strong>Results: </strong>One in every four to five patient was a child below 16 years of age. Boys were injured more than girls. Injuries, especially fractures, were most common in the extremities, the upper limb more commonly injured than the lower limb. Most of the injuries occurred at home. The most common mode of injuries was falls that happened while playing both within and outside the home, followed by road traffic accidents. Most injuries occurred during daytime.</p> <p><strong>Conclusions: </strong>Many injuries in children were found to be preventable. Small interventions and modification while constructing homes and surroundings can contribute tremendously to injury prevention and control in children. Parental awareness about the various modes of injury, role of supervised playing and their responsibility towards injury prevention can play a key role in reducing the morbidity associated with childhood fractures.</p> Ishwor Sharma Kandel Karuna Acharya Sandip Gupta Bhola Shrestha ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 56 60 10.3126/mjpahs.v1i2.23390 Patient satisfaction in middle ear surgery under monitored anaesthesia care <p><strong>Background: </strong>Monitored anaesthesia care is a specific anaesthesia service for diagnostic or therapeutic procedures performed under local anaesthesia along with sedation and analgesia titrated to a level with the provision to convert into general anaesthesia when required. We conducted a retrospective study to determine patient satisfaction in middle ear surgery under monitored anaesthesia care.</p> <p><strong>Materials and Methods: </strong>The number of patients undergoing middle ear surgery under monitored anaesthesia care, over a period of one year were included. They received sedation with midazolam 0.02 mg/kg and fentanyl 1 mcg/kg along with local anaesthetic infiltration. Patient’s satisfaction was measured using a five point Likert scale. Intraoperative pain, nausea, vomiting and other discomforts were inquired.</p> <p><strong>Results: </strong>The total number of patients was 64. Fifty-one patients (79.7%) were satisfied, 10 were neutral (15.6%) and 3 patients (4.7%) were dissatisfied with the technique. Earache (4.7%), followed by dizziness (3.1%) and bodyache (3.1%) were the most common cause of discomfort. Nausea occurred in 6 patients (9.4%) and vomiting in 5 patients (7.8%).</p> <p><strong>Conclusion: </strong>Middle ear surgeries can be performed under monitored anaesthesia care with good patient satisfaction.</p> Maya Lama Rohini Sigdel Sanish Gurung Krishna Bogati Bibek Ranjit ##submission.copyrightStatement## 2019-03-31 2019-03-31 1 2 61 65 10.3126/mjpahs.v1i2.23391 Evaluation of Pregnancy Outcomes in Gestational Diabetes Mellitus <p><strong>Objectives: </strong>To evaluate the pregnancy outcomes in the patients diagnosed with Gestational Diabetes Mellitus.</p> <p><strong>Materials and Methods: </strong>A retrospective study conducted on ninety-two patients, delivered in the First Affiliated Hospital of Liaoning Medical University, China from February 2014 to June 2015.</p> <p><strong>Results: </strong>The rate of Cesarean section was 36.95%, polyhydramnios 27.17%, macrosomia 21.73% and preterm delivery was14.13% respectively.</p> <p><strong>Conclusion: </strong>Gestational Diabetes Mellitus is recognized to be associated with increased rate of adverse pregnancy outcomes. This study demonstrated that the GDM has higher risk for polyhydramnios and macrosomia.</p> Lakshmi Sunar Zhu Yan ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 66 69 10.3126/mjpahs.v1i2.23393 Hemodynamic effects of right pelvic wedge in patients undergoing elective cesarean section under spinal anesthesia <p><strong>Background: </strong>Several methods have been used to prevent post spinal hypotension including preloading, co-loading, use of vasopressors, placement of pelvic wedge, lumbar wedge and tilting of operating table in parturients undergoing cesarean section. We conducted a randomized controlled study to determine the hemodynamic effects of a standard pelvic wedge placed below the right hip immediately after the spinal block till the delivery of baby.</p> <p><strong>Methods: </strong>One hundred consenting women undergoing elective cesarean section under spinal anesthesia were randomly allocated to wedge group (N=50) and control group (N=50). A standard wedge was placed under the right pelvis soon after spinal anesthesia till the delivery of baby in wedge group whereas the control group remained supine. Hemodynamic parameters including blood pressure, heart rate, vasopressor consumption, other side effects like nausea, vomiting and neonatal outcome were also recorded.</p> <p><strong>Results: </strong>The incidence of hypotension and bradycardia was similar between groups (Wedge group 60% vs Control group 75.51%, p=0.125) before the birth of baby. The use of vasopressors (p=0.212), incidence of nausea (p=0.346) and Apgar score at 1 and 5 minutes (p=0.629, p=0.442) were also not statistically significant. None of the patients had&nbsp;vomiting.</p> <p><strong>Conclusion: </strong>In our study, the use of right pelvic wedge immediately after spinal anesthesia was not effective in preventing post spinal hypotension in elective cesarean section.</p> Rohini Sigdel Maya Lama Sanish Gurung Bishal Gurung Anil Prasad Neupane Asha Pun Saindra Shrestha ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 70 74 10.3126/mjpahs.v1i2.23394 Metabolic Syndrome in Subclinical and Overt Hypothyroidism <p><strong>Background: </strong>Sub-clinical hypothyroidism (SCH), overt hypothyroidism and metabolic syndrome (MetS) are recognized risk factors for atherosclerotic cardiovascular disease and Type 2 diabetes mellitus (DM- II).Thyroid function affects MetS parameters including&nbsp;blood pressure (BP), fasting blood sugar (FBS), serum triglycerides (TG) and high density lipoprotein cholesterol (HDL-C). But the relationship between MetS and thyroid functions is yet to be identified clearly. The present study is to investigate the frequency of MetS in patients of SCH and overt hypothyroidism.</p> <p><strong>Materials and Methods: </strong>A hospital based cross–sectional study was conducted at Swastik referral laboratory and research centre. In this study, 50 patients with overt hypothyroidism, 50 patients with SCH and 129 euthyroid controls were enrolled. National Cholesterol Education Program- Adult Treatment Panel III (NCEP-ATP III; 2005) revision criteria were used to diagnose metabolic syndrome. Thyroid function test (TFT: FT3, FT4 and TSH) was done by using chemiluminescence immunoassay (CLIA) and other tests by using a semi-auto analyzer. ANalysis Of VAriance (ANOVA) test was performed using SPSS (version 16.0).</p> <p><strong>Result: </strong>There was a significant difference in the mean of the waist circumference (p=0.031), BP systolic (p=0.010), BP diastolic (p&lt;0.001)), FBS (p=0.001), serum HDL-C (p=0.031) and serum TG (p=0.003) between control, subclinical and overt hypothyroidism group (p&lt;0.001). Prevalence of MetS was 25.6 % in euthyroid controls whereas 44.0% in the SCH group and 62.0% in the overt hypothyroid group (p&lt;0.001).</p> <p><strong>Conclusion: </strong>Thyroid dysfunction may be responsible for the development of metabolic syndrome.</p> Buddhi Bahadur Thapa Madhav Tiwari Sailesh Gurung Man Bahadur Gurung Mukunda Kalauni Bhup Dev Bhatta ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 75 78 10.3126/mjpahs.v1i2.23396 Study of Prevalence, Risk Factors and Hematological Parameters in Children Suffering from Iron Deficiency Anemia in a Tertiary Care Centre in Pokhara <p><strong>Introduction</strong>: Iron deficiency anemia (IDA) is the most common anemia worldwide. It adversely affects the physical growth, cognition, behavior and the immune status of infants and children. There are limited number of studies in Nepal analyzing its prevalence, risk factors and diagnosis in pediatric population. Restriction of analgesics intake, increased intake of iron rich food and deworming are important determinants in the disease management.</p> <p><strong>Methods: </strong>Hospital based prospective comparative study was conducted in the Department of Pediatrics in Manipal Teaching Hospital from December 2014 to December 2016 enrolling all children aged 6 months to 5 years with anemia. Demographic profile, clinical features and information regarding risk factors were noted along with detailed physical examination. Iron profile was done to confirm diagnosis of IDA. Data was analyzed using SPSS 21.</p> <p><strong>Results: </strong>Out of 168 anemic children, 110 (65.45%) children were diagnosed as IDA. Dietary factors, pica and intake of analgesics/antipyretics were major risk factors. Serum iron, serum ferritin, transferrin saturation were low whereas total iron binding capacity was high in IDA.</p> <p><strong>Conclusion: </strong>Iron deficiency anemia is a common, preventable and easily treatable disease which has potentially serious consequences if not treated. Non compliance to exclusive breastfeeding in the first 6 months of life, introduction of cow’s/buffalo’s milk in the first year, pica and rampant use of analgesics/antipyretics are major risk factors. &nbsp;</p> Amrita Ghimire Paudel Kalpana Karmacharya Malla Shree Krishna Shrestha Suresh Raj Paudel Deepak Raj Paudel Ramchandra Bastola Yagya Raj Sigdel Rupa Gurung ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 79 82 10.3126/mjpahs.v1i2.23397 Fine needle Aspiration Cytology of various Head and Neck Swellings <p><strong>Background: </strong>Head and neck swelling is a frequently encountered complaint in the outpatient department. A wide plethora of conditions give rise to head and neck lumps. Sometimes the diagnosis of these lesions is apparent from the site and associated features, while at other times the cause for mass in this region can be confusing. Fine needle aspiration cytology has emerged as a reliable tool for clinching the diagnosis in head and neck swellings.</p> <p><strong>Methods and Materials: </strong>A retrospective study was conducted in the department of Pathology, Pokhara Academy of Health Sciences, Western Regional Hospital, Pokhara. Details of diagnosed cases of HN swellings from the period of November 2015 to February 2018 were obtained from recorded data. Descriptive statistics was applied from the data collected for analysis.</p> <p><strong>Results: </strong>Out of total 456 patients included from a period of 28 months, female patients outnumbered male patients by 1.5 times. The most common age group of presentation for head and neck swellings was observed to be 20-29 years, with 93 patients which comprised of 20.39% of total. Highest incidence was that of lymph node swellings (55.04%) followed by thyroid swellings (21.49%).</p> <p><strong>Conclusion: </strong>Lymph node pathology was determined to be the commonest cause for head and neck mass. FNAC is a reliable and inexpensive means in investigating such lesions, which provides immense help in treatment of patients.</p> Laxman Banstola Swasti Sharma Bijaya Gautam ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 83 86 10.3126/mjpahs.v1i2.23398 Non-locking buttress plate in distal tibial metaphyseal fractures <p><strong>Background: </strong>Treatment of distal tibial metaphyseal fractures is often challenging and no single technique has been unanimously advocated. Open reduction and internal fixation with plates and screws allows better restoration of anatomical alignment but with more soft tissue complication. Simultaneous fixation of the fibula is not universally carried out. This study aims at evaluation of the outcome of plating technique and the effect of fixation of fibula fracture in treatment of distal tibial metaphyseal fractures.</p> <p><strong>Material and methods: </strong>Thirty-one cases (14 cases in Group A with concomitant distal fibula fracture and 17 cases in Group B without distal fibula fracture) were analyzed retrospectively for the mean duration of full weight bearing, mean union time and complications, and compared.</p> <p><strong>Results: </strong>The mean time for full weight bearing and radiological union in our study was 14.2 weeks (15.9 in Group A and 13.1 in Group B) and 23.8 weeks (26.6 in Group A and 21.5 in Group B) respectively. 16.1% of cases had post-operative complications including one case of deep infection and malalignment of 6 degree varus (following delayed union) was seen in one case of Group A. Range of motion (ROM) at ankle was not problem in any of the cases except the one delayed union which had 5 degrees of dorsiflexion and 15 degrees of plantiflexion.</p> <p><strong>Conclusion: </strong>Open reduction and internal fixation with plate and screws in distal tibial metaphyseal fracture is more economic means of treatment modality with comparable incidence of post-union malalignment and union time,though more soft tissue complications compared to other modalities. Fixation of fibula fracture aids in reducing the incidence of malalignment.</p> Norman Lamichhane Bhogendra Bahadur KC Chandra Bahadur Mishra Sabita Dhakal ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 87 91 10.3126/mjpahs.v1i2.23401 Decreased fetal movement: Is it an alarm to Obstetrician and Pregnant Lady? <p><strong>Introduction: </strong>Fetal activity serves as an indirect measure of the fetus central nervous system integrity and function. Regular fetal movement can be regarded as an expression of fetal wellbeing. Maternal perception of decreased fetal movement is associated with poor feto-maternal outcome. This study is to find out feto-maternal outcome in cases of decreased fetal movement, done by assessing fetal heart rate (FHR) correlating with cardiotocography (CTG) and USG (ultrasonography) findings, Apgar score and meconium in amniotic fluid.</p> <p><strong>Materials and method: </strong>This was a hospital based, prospective comparative study done in Patan Academy of Health Sciences, Lalitpur, Nepal. The sample size was 200; 100 cases of decreased fetal movement versus 100 cases of good fetal movement at same gestational age in weeks. Data processing was done in SPSS version 20.0 (SPSS, Chicago, IL, USA) and calculated by chisquare test. P value less than 0.05 was considered significant.</p> <p><strong>Results: </strong>Significant difference was found in fetal kick chart counting. In the decreased fetal movement group, 16% had oligohydraminos, 3% had polyhydraminos and 5% had non reassuring CTG and 4% had abnormal heart rate detected clinically. There was statistically significant difference observed between the two groups in labor induction, cesarean section, meconium stain liquor, cord around the neck and different neonatal morbidities.</p> <p><strong>Conclusion</strong>: Decreased fetal movement is associated with poor fetomaternal outcome. Improved vigilance, early identification, further evaluation with CTG, USG and proper management of these pregnancies have favourable pregnancy outcome.</p> Padma Raj Dhungana Rajesh Adhikari Prem Raj Pageni Apsara Koirala ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 92 97 10.3126/mjpahs.v1i2.23402 A Comparative Study of Single Layer Versus Double layer Intestinal Anastomosis <p><strong>Objective: </strong>To determine the efficacy of single layer intestinal anastomosis to&nbsp;double layer technique in terms of anastomotic healing.</p> <p><strong>Materials and Methods: </strong>Fifty patients who underwent intestinal anastomosis in the Department of Surgery, Western Regional Hospital from June 2014 to May 2016 were taken for this comparative study and divided equally in two groups, 25 each (single layer and double layer).</p> <p><strong>Results: </strong>Of the total fifty cases, twenty-five cases included in each group, there was no leakage in single layer group while 1 patient had leakage in double layer group which was statistically insignificant.</p> <p><strong>Conclusion: </strong>Single layer interrupted intestinal anastomosis is simple to carry&nbsp;out and is as efficacious as double layer anastomosis in terms of postoperative anastomotic leak.</p> Amar Gurung Santosh Shrestha Devendra Shrestha Suresh Raj Paudel David Shrestha Anup Shrestha Dilip Baral ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 98 101 10.3126/mjpahs.v1i2.23403 Extracorporeal shock wave lithotripsy in the management of upper urinary tract stone: a single institute experience <p><strong>Introduction: </strong>The aim of the study was to observe the success rate of extracorporeal shock wave lithotripsy (ESWL) in the management of upper urinary tract stones.</p> <p><strong>Materials and Methods: </strong>This retroprospective study was conducted in Pokhara Kidney stone Centre, Pokhara, Kaski, Nepal from January 2017 to January 2018. Seventy nine patients were selected in this study with upper urinary tract stone, size less than 20 mm.</p> <p><strong>Results: </strong>Seventy four (93.67%) patients were successfully treated in initial use of shock wave and 5 (6.32%) patients required repetition.</p> <p><strong>Conclusion: </strong>Overall satisfactory success rate was observed using ESWL for the upper urinary tract stone. Careful selection of patient, stone size and Hounsfield unit (HU) is advisable.</p> Dhruba Bahadur Adhikari David Shrestha Anup Shrestha ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 102 104 10.3126/mjpahs.v1i2.23405 Outcome of Intra Uterine Insemination in Sahara International Fertility Centre Pokhara, Nepal <p><strong>Introduction: </strong>The incidence of infertility is about 10 to 15 % among reproductive age group. The cause of infertility may be either due to male factor or female factor or both. The main aim of this study was to evaluate the success rate of intrauterine insemination (IUI) in a private centre of Pokhara.</p> <p><strong>Materials and Methods: </strong>This was a centre based retrospective study done in private fertility centre. Sub-fertile couples who were treated from January 1st 2015 to December 31st 2016 were enrolled for the study. Couples with unexplained male factor, ovulatory dysfunction, unilateral tubal occlusion and ejaculatory dysfunction were included in this study. Three hundred and eighty IUI cases were retrospectively reviewed. Clinical pregnancy rate was the primary outcome.</p> <p><strong>Result: </strong>The success rate of IUI was 15.7%. It was higher among unexplained infertility cases. Clinical pregnancy rate was directly associated with the age of the patients, indications of infertility and number of cycles.</p> <p><strong>Conclusion: </strong>Success rate of IUI in infertile couples who had unexplained infertility, tubal factor, ovulatory dysfunction was higher than male factor infertility and ejaculatory dysfunction.</p> Gir Dhari Sharma Rajesh Adhikari Shyam Sundar Parajuly Kalpana Gautam Adhikari ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 105 109 10.3126/mjpahs.v1i2.23407 Is Urine dipstick as accurate as 24 hour urine protein? A Comparative Study <p><strong>Introduction: </strong>Hypertensive disorder in pregnancy (HDP) is one of the most common medical complications affecting approximately 5-10% of pregnancies. It remains a major cause of maternal/perinatal mortality and morbidity. Proteinuria is a sign of preeclampsia where there is &gt;300 mg of protein in 24 hour urine collection. This usually correlates with 30mg/dl or 1+ reading in a random urine specimen. The main objective of this study is to find out whether urine dipstick&nbsp;correlates with 24 hour urine protein.</p> <p><strong>Methodology: </strong>This is a hospital based comparative study, where proteinuria by&nbsp;dipstick method was compared with 24 hour urinary protein in 60 cases of pre eclampsia at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu.</p> <p><strong>Results: </strong>The dipstick method of detecting proteinuria significantly correlated with the total 24 hour urine protein excretion by Esbach Albuminometer. A dipstick factor of ≥300mg/24 hour indicates proteinuria with sensitivity of 97.5%, specificity of 65%, positive predictive value of 84.78% and negative predictive value of 92.85%. 3+ value in dipstick had high significance with 24 hour urine protein by Esbach’s Albuminometer (R=0.983 ). The cost of dipstick was Nepalies Rs (NPR) 14 in comparison to 24 hour dipstick which cost NPR 80.Time needed to get report was immediate in case of dipstick but takes 48-50 hour in case of 24 hour urine protein.</p> <p><strong>Conclusion: </strong>Timely collection of six hourly urine for detection of proteinuria by&nbsp;dipstick is comparable to 24 hour urinary protein determination in laboratory by Esbach Albuminometer, which is more time consuming and expensive.</p> Rajesh Adhikari Gir Dhari Sharma Padma Raj Dhungana Kalpana Gautam Adhikari ##submission.copyrightStatement## 2018-12-31 2018-12-31 1 2 110 115 10.3126/mjpahs.v1i2.23408