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> en-US <p>© Medical Journal of Pokhara Academy of Health Sciences</p> (Dr. Bhogendra Bahadur KC) (Sioux Cumming) Fri, 25 Oct 2019 15:34:42 +0000 OJS 60 Correlation of serum thyroid stimulating hormone with body mass index in healthy adults <p><strong>Background: </strong>Obesity, a chronic disease that is increasing in prevalence in adults, adolescents and children, is now considered a global epidemic. Thyroid dysfunction contributes to the pathogenesis of obesity. Many clinical studies raise the questions of whether thyroid-stimulating hormone (TSH) changes in physiological limits is associated with obesity and whether there is a link between adipose tissue and hypothalamo-thyroidal axis.</p> <p><strong>Materials and Method: </strong>This was a cross-sectional study. All clinically euthyroid patients and healthy volunteer adults of age 18 to 60 years of either gender were included in the study. Fasting blood sample was taken for thyroid function evaluation, which included Free T3, Free T4 and thyroid stimulating hormone. Height, weight, waist circumference and hip circumference were measured. The results were compared with calculated Body Mass Index (BMI).</p> <p><strong>Results: </strong>61 patients who met the inclusion criteria were studied. Among 61 patients 16 had subclinical hypothyroidism, 2 patients had hypothyroidism and 43 were euthyroid. Similarly, 2 underweight patients were observed, 7 had normal weight, 13 were over weight and 39 were obese. The mean TSH according to BMI were 3.8, 4.04, 3.88 and 6.19 respectively.</p> <p><strong>Conclusion: </strong>The result in this study showed that the mean TSH increased as BMI increased with significant relationship between serum TSH and BMI (p &lt;0.001). Thus thyroid dysfunction mainly subclinical hypothyroidism and hypothyroidism could be found in association with increased body weight.</p> Bishow Raj Baral, Manoj Koirala, Buddhi Sagar Lamichhane, Suresh Raj Paudel, Laxman Banstola, Anand Nepal, Swasti Sharma ##submission.copyrightStatement## Fri, 25 Oct 2019 13:07:32 +0000 Clinical significance of serum amylase and glucose level in organophosphorus poisoning <p>Background: Organophosphorous (OP) poisoning is a common problem in country like Nepal where agriculture is the backbone of the economy. The primary mechanism of action is inhibition of acetylcholinesterase (ACHE). Organophosphorus poisoning is a possible cause of acute pancreatitis along with alternation of glucose metabolism.</p> <p><strong>Materials and Method: </strong>This was a hospital based cross-sectional comparative study. The level of serum amylase and glucose were measured in thirty-eight OP poisoned patients at the time of admission, before discharge and were compared.</p> <p><strong>Results: </strong>Amongst 38 patients, Majority had mild OP poisoning 27(71.1%) as per Peradeniya Organophosphorus Poisoning (POP) score whereas 9(23.7%) had moderate and 2(5.2%) had severe poisoning. The mean initial serum amylase level in patients with mild poisoning was 152±73.92 (IU/L)(p=0.000), in moderate poisoning was 213.38±69.39 (IU/L) (p=0.223) and in severe poisoning was 171.33±107.22(IU/L) (p=0.259). There was increase in serum amylase level in all patients with poisoning but level did not increase in proportion to increase with severity of POP score. The mean initial serum glucose level in mild poisoning was 132.48±37.73 (Mg/dl) (p=0.024), in moderate poisoning was 139±44.59 (Mg/dl) (p=0.033) and in severe poisoning was 174±23.38 (Mg/dl) (p=0.22). The serum glucose level increased as the severity of POP score increased. The serum amylase and glucose levels in recovering patients showed a tendency to decrease to their normal values. No patient had developed acute symptomatic pancreatitis.</p> <p><strong>Conclusion: </strong>Serum amylase and glucose level were increased in all patients with OP poisoning but didn’t correlate with the clinical severity. Routine measurement of serum amylase in patients of OP poisoning has little value in the absence of clinical acute pancreatitis.</p> Manoj Koirala, Bishow Raj Baral, Buddhisagar Lamichanne ##submission.copyrightStatement## Fri, 25 Oct 2019 00:00:00 +0000 Pre-peritonial Repair for Recurrent Inguinal Hernia after Tension free Hernioplasty <p><strong>Background: </strong>Inguinal herniorrhaphy is a common general surgical operation. The repair of recurrent hernia is difficult surgery due to obscured and distorted anatomy and risk of further recurrence. The aim of this study is to determine the outcome in terms of operative time, hospital stay, return to work, complications and recurrence of open pre-peritoneal repair for recurrent inguinal hernias after Lichtenstein tension-free hernioplasty.</p> <p><strong>Materials and Method</strong>: It is a prospective observational study conducted at Western Regional Hospital, Pokhara from 2013 to 2016. A total of eight patients including referred from other centers were included. Pre-peritoneal repair was performed on recurrent hernias after Lichtenstein tension-free hernioplasty. Age, sex, operating time, hospital stay, time to return work, postoperative complications and recurrence of patients were noted. Statistical analysis was done using SPSS- 21. Patients were called for follow up in 2 weeks, 3 months and 12 months time.</p> <p><strong>Results</strong>: Out of eight patients, seven were male, one was female with mean age of 59.5 years. Recurrence was common on direct inguinal hernia (six patients) who had previous Lichtenstein hernioplasty. Mean operative time was 43.13 minutes (35 to 50 minutes), mean hospital stay was 2.5 days (2 to 4 days) and mean time to return to work was 8.12 days (7 to 10 days). There was hematoma formation in one patient.</p> <p><strong>Conclusion</strong>: Pre-peritoneal mesh repair is easy, safe, with less operative time, short hospital stay, low recurrence and complication rate for recurrent inguinal hernia after Lichtenstein hernioplasty. &nbsp;</p> Suresh Raj Poudel, Narendra Vikram Gurung, Dhruba Bahadur Adhikari, Arjun Acharya, Santosh Shrestha, Amar Gurung, Debendra Shrestha, Amrita Ghimire Poudel, Bishwo Raj Baral, Dilip Baral ##submission.copyrightStatement## Fri, 25 Oct 2019 13:26:53 +0000 Serum Magnesium, Calcium and Phosphorus status in Heart Failure patients attending tertiary care center of Nepal <p><strong>Background: </strong>Lack of proper diet and use of different medications in heart failure contributes to electrolyte imbalance. Due to absence of routine measurement, their abnormalities are not recognized. This study is an attempt to portrait a picture of serum levels of electrolytes in heart failure patients</p> <p><strong>Materials and Methods: </strong>102 heart failure patients were enrolled in this study over 6 months period. Serum levels of magnesium, calcium, phosphorus, sodium and albumin were measured. SPSS ver. 20.0 was used to analyze the data. Analysis of Variance was used to find mean differences and Pearson’s correlation was used to establish the correlation.</p> <p><strong>Results: </strong>Majority of patient fell under New York Heart Association (NYHA) class II and had isolated systolic heart failure. Mean serum values of sodium and magnesium were below the reference range. Mean values of serum sodium, magnesium and corrected calcium was less in patients receiving diuretics and digitalis. Likewise, serum phosphorus was more with diuretics and digitalis use. Also, serum sodium was less in Acetylcholine Eseterose (ACE) inhibitors use. Isolated diastolic heart failure patients had least serum calcium values. Although, serum sodium and magnesium value in heart failure patients was positively correlated, was not statistically significant.</p> <p><strong>Conclusion: </strong>This study showed that low serum sodium and magnesium values are frequently associated in heart failure. Disturbances in other serum electrolytes could also be other cause of complications in heart failure which are not under routine investigation. Identification and correction of these disturbances could have significant impact. However, further studies are required to reinforce this idea. &nbsp;</p> Bijaya Gautam, Laxman Banstola, Ritu Bashyal ##submission.copyrightStatement## Fri, 25 Oct 2019 13:33:15 +0000 A prospective study on effectiveness of drotaverine in acceleration of labor <p><strong>Background: </strong>Labor is a naturally occurring physiological process associated with uterine contractions, effacement, dilatation of cervix and descent of presenting part. Drotaverine hydrochloride is a non-anticholinergic isoquinoline derivative which acts by elevating intracellular cyclic Adenosine Mono Phosphate (cAMP) and cyclic Guanosine Mono Phosphate (cGMP) promoting smooth muscle relaxation.</p> <p><strong>Materials and Method: </strong>This was a hospital based prospective study on effectiveness of Drotaverine Hydrochloride on enhancing dilatation of cervix and acceleration of active phase of labor. The sample size was 100. Fifty cases of women in active phase of labor received injection drotaverine hydrochloride 40 mg (group i) and fifty cases of women did not receive any drug (group ii) among those at term with singleton pregnancy and vertex presentation. Variables like maternal age, interval between administration of drug and delivery, mode of delivery, apgar score at 5 minutes, NCU (Neonatal Care Unit) admission and neonatal outcomes were recorded. Data analysis was done with the help of SPSS program.</p> <p><strong>Results: </strong>The mean interval between drug administration to delivery in primipara and multipara in group i was 3.05 hours and 2.31 hours while in group ii was 4.5 hours and 3.75 hours respectively. The mean interval between drug administration and delivery was shorter in both groups of multipara. In group i, 96% had normal delivery and 4 % had vacuum delivery and in group ii 90% and 10% had normal delivery and vacuum delivery respectively. None of the participants had caeserian section. There were no perinatal mortalities.</p> <p><strong>Conclusion: </strong>The administration of drug Drotaverine Hydrochloride is effective in shortening duration of labor with favorable feto-maternal outcome. &nbsp;</p> Padma Raj Dhungana, Rajesh Adhikari, Prem Raj Pageni, Apsara Koirala, Anand Nepal ##submission.copyrightStatement## Fri, 25 Oct 2019 14:03:40 +0000 Comparison of Ondansetron with Gabapentin for prevention of intrathecal morphine induced pruritus <p><strong>Background: </strong>Ondansetron has been used successfully for prophylaxis and treatment of intrathecal morphine induced pruritus. Gabapentin has anxiolytic, antiemetic, antipruritic effects and has also been shown to potentiate the analgesic effect of intrathecally or epidurally administered opioids.</p> <p><strong>Materials and method: </strong>We compared the effectiveness of oral gabapentin with intravenous ondansetron to prevent incidence of intrathecal morphine induced pruritus. In a prospective, double-blind study, sixty patients aged 18-65 years with ASA physical status I and II undergoing surgery under subarachnoid block were randomized to receive placebo tablets (ondansetron group) or gabapentin 1200 mg (gabapentin group) 2 hours before surgery. Patients receiving placebo tablets received 8 mg of intravenous ondansetron and those receiving gabapentin received 4 ml of intravenous normal saline just prior to subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine plus 0.2 mg morphine. The incidence, onset, severity, location of pruritus and incidence of side effects were studied for next 24 hours.</p> <p><strong>Results: </strong>The overall incidence of pruritus was 48.3%. The incidence, severity, location of pruritus was comparable between the two groups. There was significant difference between the onset of pruritus between groups (p=0.009). The incidence and grade of nausea vomiting, requirement of intraoperative sedation was comparable between groups. The incidence of urinary retention was significantly high in gabapentin group (p=0.020). Respiratory depression was observed in one patient.</p> <p><strong>Conclusion: </strong>A single dose of 1200 mg oral gabapentin 2 hours before, is as effective as prophylactic intravenous ondansetron 8 mg for prevention of intrathecal morphine induced pruritus. </p> Rohini Sigdel, Anil Shrestha, Roshana Amatya ##submission.copyrightStatement## Fri, 25 Oct 2019 14:11:03 +0000 Penile squamous cell carcinoma :a three-year study at BP Koirala Memorial Cancer Hospital <p><strong>Background: </strong>Penile cancer is an aggressive and mutilating disease which deeply affects self-esteem and daily life of the patient. Penile cancer mostly affects the elderly, seen in people in their sixties and seventies. Occurrence in younger age is a need of research of penile neoplasia in young non-circumcised patients.</p> <p><strong>Materials and Method: </strong>This is a three-year retrospective study. Data was extracted from the Department of Pathology and Medical Record section of B.P. Koirala Memorial Cancer Hospital. All histologically proven cases were included. The objective of this study was to assess clinical histopathological profile of penile carcinoma.</p> <p><strong>Results. </strong>A total of 114 malignant cases were included out of which most common age group involved was 50-60 years with mean age of presentation being 51.6 years. Glans was the commonest site of involvement in 59 cases (51.7%). Well-differentiated squamous cell carcinoma was the most common type (71%). Forty nine patients (43%) presented when the mass size was 4-6 cm and 44 (39%) came with 2-4cm and rest less than 2 cm. Lymphvascular invasion was seen in 15 (13%) out of 114 cases and perineural invasion was seen only in 5 (4.3%) cases. 20 cases (17.5%) had lymphnodes positive which are less than 5 lymphnode positive and five (4.3%) had more than 5 lymphnodes positive.</p> <p><strong>Conclusion. </strong>Early diagnosis and intervention of the patient ensure high probability of getting cured because the stage at presentation appears to be the most vital prognostic indicator for survival. &nbsp;</p> Shankar Bastakoti, Ranjan Raj Bhatta, Nandita Jha, Sadina Shrestha, Amrita Paudel ##submission.copyrightStatement## Fri, 25 Oct 2019 14:18:26 +0000 Cervical Cancer screening in a tertiary care centre by Pap smear and its clinical correlation <p><strong>Introduction: </strong>Cervical cancer is one of the common cancers in women and is a major public health problem all over the world. It has significant contribution to high mortality and morbidity. Preinvasive lesions spontaneously regress to normal, remain stable for a long time or progress to higher degree of dysplasia followed by carcinoma cervix.</p> <p><strong>Materials and Method </strong>This was a hospital based retrospective study where 456 patients’ records were reviewed. Pap smear was used as the screening tool for the detection of precancerous lesion among the women visiting Western Regional Hospital (WRH), Department of obstetrics and gynecology.</p> <p><strong>Results</strong>: Among 456 patients screened, most of them were in the age group of 30-39 years (42.8%) and were of parity 3 (42.8%). Most of them had no risk factors for carcinoma cervix (54.4%). Early marriage accounted for the highest risk of developing precancerous lesion (32.7%). There were no carcinoma detected by Pap smear. The test was negative in 68.9%, Low-grade Squamous Intraepithelial Lesion (LSIL) was detected in 5.9% and 2.9% had High-grade Squamous Intraepithelial Lesion (HSIL). Pap smear was sent for screening purpose in asymptomatic women (37.1%) and among the symptomatic patients vaginal discharge was the most common indication of pap test (34.6%).</p> <p><strong>Conclusion: </strong>A Pap smear is reliable, simple, non-invasive, cost effective, and easy screening tool for detection of precancerous lesions in a woman. &nbsp;</p> Gir Dhari Sharma, Rajesh Adhikari, Shyam Sundar Parajuly, Kalpana Gautam Adhikari ##submission.copyrightStatement## Fri, 25 Oct 2019 14:27:12 +0000 Autopsy findings in Fatal neck Compression cases at Western Regional Hospital, Pokhara, Nepal <p><strong>Background: </strong>Violent asphyxial deaths chiefly include death due to hanging, strangulation, suffocation and drowning. Deaths resulting from hanging and ligature strangulation both show similar type of findings in which the ligature marks at the neck is very important characteristic finding. That’s why it is a challenge for forensic experts and needs thorough knowledge and experience to differentiate between them. Some of the typical autopsy findings help autopsy surgeon in such dilemma. Objective of Present study is about the external and internal autopsy findings in fatal neck compression cases specially focusing on hanging and ligature strangulation cases to differentiate and clear the dilemma in such cases.</p> <p><strong>Materials and Methods: </strong>Current study was conducted among 103 corpses with compression of neck by ligature materials brought for autopsy examination at Mortuary of Forensic Medicine Department of Western Regional Hospital Pokhara from February2017 to January 2018.</p> <p><strong>Conclusion: </strong>In fatal neck compression cases external autopsy findings like dribbling of saliva from angle of mouth, facial pallor, urine and fecal material discharge were common finding in 99 cases of hanging where as it was variable in ligature strangulation cases. Similarly fracture of hyoid bone and thyroid cartilage was found in hanging cases with age greater than 38 years but not in any ligature strangulation cases as an internal autopsy finding. &nbsp;</p> Madan Prasad Baral ##submission.copyrightStatement## Fri, 25 Oct 2019 15:16:05 +0000 Outcome of Continuous Peritoneal Dialysis in Patient with Acute Kidney Injury <p><strong>Background: </strong>Though peritoneal dialysis has several limitations, it is still used in acute kidney injury (AKI) patients as an alternative method of Renal Replacement Therapy (RRT), especially in low socioeconomic countries.</p> <p><strong>Materials and Method: </strong>This study included thirty patients diagnosed as AKI. Peritoneal access was established through flexible Tenckhoff catheter for Continuous Peritoneal Dialysis (CPD) and 6-8 exchanges were done in 24 hours.</p> <p><strong>Results: </strong>Among 30 patients mean age was (mean±SD) 49.93±14.42 years. Seven (23.33%) patients were hemodynamically unstable. The cause of AKI was drug induced in 6(20.7%), hypovolemia/Acute Tubular Necrosis in 6(20.0%), sepsis in 5(16.7%), heart failure in 2(6.7%) and 11(36.7%) had multiple causes. In initial presentation, mean serum creatinine was 683.42 μmol/L, and the number of sessions required for stabilization of serum creatinine was 7.5±1.43, sessions required for correction of hyperkalemia and metabolic acidosis were 2.15±0.69 and 2.5±0.76 respectively. The delivered Kt/V urea was 1.95±0.14 weekly. Six (20.0%) patients had peritonitis, five (16.7%) had pericatheter leakage and four (13.33%) had catheter blockage. Among 30 patients, three patients (10%) had died, sixteen (59.3%) had recovery of renal function and rest did not recover renal function.</p> <p><strong>Conclusion: </strong>CPD was effective for correction of metabolic and electrolyte imbalance. &nbsp;</p> Amrit KC, Rahman Tanvir, Alam Muhammad Rafiqul, Ahmed A.H. Hamid, Noor Towhida ##submission.copyrightStatement## Fri, 25 Oct 2019 15:25:00 +0000 Prosthetic rehabilitation of enucleated eye with semi-customized ocular prosthesis: A case report <p>Eye is a vital organ not only for vision but it is also important component of facial expression. The disfigurement associated with loss of eye can cause significant physical and emotional problem. There are several techniques documented in the literature for fabricating the artificial eye. This is a case report of fabricating ocular prosthesis with stock iris and custom made sclera to provide aesthetically satisfactory result and better fit. &nbsp;</p> Indra Kumar Limbu, Bishal Babu Basnet, Sandhya Paudel ##submission.copyrightStatement## Fri, 25 Oct 2019 15:31:22 +0000