Medical Journal of Pokhara Academy of Health Sciences

Levels of Ferritin in Females with Chronic Telogen Effluvium: A Cross-Sectional Study in Western Nepal

2023-07-09T06:16:56+00:00

Introduction: Telogen effluvium is one of the common causes of hair fall in women. It can be divided into acute and chronic; acute telogen effluvium lasts for a duration of less than 6 months while chronic telogen effluvium lasts for more than 6 months. Total body iron store is necessary for the growth and maintenance of hair follicles and their cycle. There seems to be some relationship between telogen effluvium and serum ferritin levels as many studies in past and recent years have shown.

Materials and Methods: The study is an analytical observational type of study and belongs to quantitative cross sectional prospective study. A total of 39 patients and equal number of controls were recruited for carrying out this study. All the patients were selected from the outpatient department of Manipal Teaching Hospital, Pokhara, Nepal where as the controls were selected partly from the outpatient department and partly from volunteers. For the statistical analysis of the study SPSS (Statistical Package for the Social Sciences) version 23 was used.

Results: The mean level of serum ferritin in patients was 23.53±28.66ng/ml and in controls it was 90.91±93.73ng/ ml. In order to find out the difference in significance we performed Independent t- test. After comparing the equality of means and variance, performing independent t- test, the p-value of <0.05 was observed, which meant that there was a significant difference between the serum ferritin levels of patients and controls.

Conclusion: There was a significant difference in the levels of serum ferritin when compared between telogen effluvium patients and controls. The findings of our study helped in consolidating our understanding of the diagnostic value of serum ferritin in cases of telogen effluvium.

Relationship between Lower Urinary Tract Symptoms measured by International Prostate Symptom Score and Prostate Volume

2023-07-09T06:16:56+00:00

Introduction: Incidence and progression rate of lower urinary tract symptoms rises steeply with age; the most significant cause is believed to be Benign Prostatic Hypertrophy. Subjective assessment with International Prostate Symptom Score/Quality of Life and objective measurement with Ultrasonography can be used for assessing the severity of lower urinary tract symptoms.

Materials and Methods: This was an observational study done at National Academy of Health Sciences, Bir Hospital from October 2020 to February 2021 which included ninety men above the age of 50 years presenting with lower urinary tract symptoms in Urology Unit. The initial evaluation was done with history taking, digital rectal evaluation to exclude tumor and brief neurological examination followed by scoring with International Prostate Symptom Score and International Prostate Symptom Score/Quality of Life score. The patients were advised for Transabdominal Ultrasonography to look for prostate volume and residual volume of urine.

Results: In this study 82.22 % of patients had International Prostate Symptom Score of more than 19 and 47.8 % of patients had quality of life score of 5 suggesting that most had severe symptoms. Prostate volume showed mild correlation with International Prostate Symptom Score (r=0.166) and with age group (r=0.088).

Conclusion: In the present study, prostate volume and lower urinary tract symptoms severity showed mild correlation suggesting that larger prostate volumes do not necessarily mean more severe symptoms. Hence International Prostate Symptom Score can be a better tool for assessing patients with lower urinary tract symptoms due to Benign Prostatic Hypertrophy and planning further treatment.

Meconium Aspiration Syndrome: Incidence, Risk Factors and Neonatal Outcome - A Prospective Study

2023-07-09T06:16:56+00:00

Introduction: Meconium aspiration syndrome is a serious condition in which a newborn breathes a mixture of meconium and amniotic fluid into the lungs. These infants are at risk of meconium aspiration pneumonia and must be observed closely for respiratory distress.

Materials and Methods: An observational study was conducted at Pokhara Academy of Health Sciences from 15 January 2022 to 16 November 2022. One hundred and fifty five babies born through the meconium-stained amniotic fluid within the study period were included in the study. Eighty four babies were diagnosed with meconium aspiration syndrome out of these babies. Data were analyzed with bivariate analysis.

Results: The incidence of meconium aspiration syndrome was 11.8 per 1000 live births. 61.3% of babies born through meconium-stained amniotic fluid were post-term. Spontaneous vaginal delivery increased the risk of meconium aspiration syndrome (OR = 3.86; 95% CI: 1.84–8.09). The thick consistency of meconium, Apgar scores less than 7 at 1 and 5 minutes, and need for resuscitation at birth increased the risk. It had a twofold risk for pre-discharge mortality (odds ratio = 2.06; 95% CI: 1.735–2.44). Factors associated with mortality were small for gestation age, APGAR less than 7 at 1 and 5 minutes, Downe score of ≥ 4, and the need for resuscitation and mechanical ventilation.

Conclusion: Meconium aspiration syndrome has a high risk of neonatal mortality and morbidity. Monitoring during pregnancy and labour is crucial for identifying high-risk conditions. Newborn care plays an important role to reduce neonatal mortality.

Clinico-Etiological Profile of Neonatal Seizures in a Tertiary Care Hospital, Kaski, Nepal

2023-07-09T06:16:56+00:00

Introduction: Neonatal seizure is the most frequent neurological symptom occurring during the neonatal period. The present study was done to determine the clinical types and the etiological factor of neonatal seizures.

Materials and Methods: This was a prospective, cross-sectional study done at Pokhara Academy of Health Sciences including 162 neonates admitted with a diagnosis of neonatal seizure inside the Neonatal Intensive Care Unit during a period of one year. The neonatal seizure was classified and the possible cause for the seizure was noted in proforma.

Results: The most common type of seizure was a generalized tonic-clonic seizure (38.27%) followed by subtle (35.18%). The common cause of neonatal seizure was hypoxic ischemic encephalopathy (50.61%) followed by sepsis (24.69%) and hypocalcemia (5.55%).

Conclusion: Hypoxic Ischemic Encephalopathy was the commonest cause of seizure in neonates followed by infection. Early detection of the risk factors causing perinatal asphyxia can lead to a decrease in the occurrence of neonatal seizures.

Incidence and Outcome of Systemic Inflammatory Response Syndrome Among Post-Operative Patients of Elective Surgery Under General Anaesthesia

2023-07-09T06:16:56+00:00

Introduction: Signs and symptoms of Systemic Inflammatory Response Syndrome are frequently observed in post-operative and surgery wards. Inflammation and infection after major operations may lead to organ dysfunction and failure. When Systemic Inflammatory Response Syndrome progresses to multiple organ failure, the mortality is significantly high, depending on the number of failed organs. This study emphasizes to focus on Systemic Inflammatory Response Syndrome and sepsis in postoperative patients, so that timely care to such patients leads to decreased hospital stay. Financial to the patient can also be reduced.

Materials and Methods: This is a prospective observational study. Patients in surgical and post-operative wards were categorized as having systemic inflammatory response syndrome, if following two or more criteria were present: pulse rate: >90 beats/min, respiratory rate: >20 breaths/min, temperature: > 38°C or < 36°C, total leucocytes count: > 12,000/μL or < 4,000/μL. Patients with Systemic Inflammatory Response Syndrome were compared with outcomes of surgery like length of hospital stay and mortality with other similar patients.

Results: There were 120 post-operative cases of elective surgeries under general anaesthesia with 42 males and 78 females. Eighteen (15%) had Systemic Inflammatory Response Syndrome. No mortality was recorded due to the syndrome. Among total patients with the inflammatory syndrome, 61.11% were males compared to 38.89% females. Duration of the surgery was significantly associated with the syndrome, as 66.67% of those who developed Systemic Inflammatory Response Syndrome had undergone surgery for more than an hour.

Conclusion: Incidence of Systemic Inflammatory Response Syndrome among elective post-operative patients was greater in males and it increased with the total duration of the surgery

Incidence of Post Dural Puncture Headache and its Management at Manipal Teaching Hospital, Pokhara, Nepal

2023-07-09T06:16:56+00:00

Introduction: Postdural puncture headache is the most common complication after spinal anaesthesia. In about 85%, it resolves without any specific treatment but sometimes it leads to serious complications such as subdural haematoma and seizures, which could be fatal. Spinal anaesthesia is the most popular anaesthesia technique for Cesarean section. Emphasis on prevention and optimal treatment of postdural puncture headache is very important. This study is aimed to determine the incidence of postdural puncture headache following Cesarean section via spinal anaesthesia and evaluate the different methods of management so as to prevent the complications.

Materials and Methods: This is a cross sectional study done in post natal ward of Manipal Teaching Hospital conducted for six months. Total of 261 pregnant women who underwent Cesarean section under spinal anaesthesia were taken and were observed for symptoms of postdural puncture headache. Medications were prescribed for the treatment of the same. Data was collected and analysed using various statistical tools.

Result: Of the total 261 patients, there were 28 (10.8%) cases with postdural puncture headache. Patients were managed by both conservative and pharmacological methods. Commonly used analgesics were combination of paracetamol and ibuprofen in 6(35.3%) patients. Conservative management included bed rest, supine positioning, adequate hydration and intake of coffee.

Conclusion: It was observed that use of small gauze needle size (25G) significantly reduced the chance of postdural puncture headache. Commonly used analgesics like paracetamol and ibuprofen combination, diclofenac could cure the headache.

Efficacy of Intralesional Purified Protein Derivative (PPD) in the Treatment of Cutaneous Warts

2023-07-09T06:16:56+00:00

Introduction: Warts caused by human papilloma virus are common problem. Various methods of treatment are available including immunological methods. In this study we aim to measure the efficacy of immunologic treatment of cutaneous warts with intralesional injection of purified protein derivative.

Materials and Methods: All the patients presenting to the Out-patient Department of Dermatology and willing to participate for the treatment of warts and not falling under the exclusion criteria were included as study cases. Each of them were given the injection into the largest lesion every fortnightly for total 3 injections. Length, breadth, number of lesions and any local changes at the site of injection were recorded in each visit.

Results: There was significant decrease in number of warts and length as well as breadth of the largest wart at the time of final assessment. Minimal and minor adverse events were noted during assessments post injection.

Conclusion: Intralesional immunotherapy with purified protein derivative is a safe, effective and tolerable therapeutic modality for the treatment of common warts at low cost.

Chronic Kidney Disease (Stage 5) on Maintenance Hemodialysis at Pokhara Academy of Health Sciences

2023-07-09T06:16:56+00:00

Introduction: Chronic Kidney Disease stage 5 is diagnosed when glomerular filtration rate is <15.0ml/ min/1.73m2 . Chronic kidney disease is an increasingly recognized major public health problem. The aim of our study was to estimate the socio-demographic profiles, etiologies and complications of chronic kidney disease stage 5 and associated co-morbidities in patients attending a referral hospital of Gandaki Province.

Materials and Methods: An observational cross sectional study was carried out in the Department of Medicine, Pokhara Academy of Health Sciences, during the period from August 2020 to February 2021. Chronic kidney disease patients undergoing maintenance hemodialysis in dialysis unit willing to participate were included. The data were collected and were analyzed using SPSS version 25.0 software.

Results: Hundred patients were taken into study. Most common causes of chronic kidney disease were chronic glomerulonephritis followed by diabetes mellitus and hypertension. Most common complications during dialysis were chills and rigor followed by muscle cramps, hypotension, backache, hypertension and hypoglycemia. Most common complications of chronic kidney disease were anemia (91%) followed by cardiovascular diseases and hypertension. It was observed that a proportion (5%) of patients developed stroke.

Conclusion: Chronic glomerulonephritis was found to be the most frequent cause of CKD, followed by diabetes and hypertension. Anemia was found to be most common feature among CKD patients.

Intrathecal Bupivacaine with Fentanyl versus Bupivacaine alone in Cases undergoing Elective Cesarean Section: Comparison of Hemodynamics

2023-07-12T06:45:24+00:00

Introduction: Fentanyl has been used in various doses intrathecally as an adjunct to local anesthesia in Cesarean section. It has been shown to increase the analgesic effect and prolong sensory blockade without increasing the side effects in the mother and the neonate. We conducted a study to compare hemodynamics of patients receiving 10 mcg fentanyl with 0.5% bupivacaine with those receiving bupivacaine alone.

Materials and Methods: Hundred women undergoing elective Cesarean section under spinal anesthesia were randomly divided into group F (fentanyl) and group C (control). Group F received 10 mcg of fentanyl with 2ml of 0.5% hyperbaric bupivacaine whereas Group C received 2.2ml of 0.5% hyperbaric bupivacaine. Hemodynamic parameters including blood pressure and heart rate, use of vasopressors, incidence of nausea, vomiting, pruritus, shivering, visceral pain, discomfort and neonatal outcome were recorded.

Results: There was similarity in incidence of hypotension and bradycardia before birth of baby between the two groups (Fentanyl group 69.39% vs Control group 66%, (p=0.830) and 0.02% vs 0.02%,p=1.00).The use of vasopressors (p=0.264), incidence of nausea, vomiting (p=0.318) and Apgar score at 1 and 5 minutes (p=0.919, p=0.952) were also not statistically significant. One patient in the fentanyl group complained of itching intraoperatively whereas four patients in each group complained of visceral pain during surgery. Two patients in fentanyl group experienced shivering intraoperatively.

Conclusion: Our study demonstrated that hemodynamic profile of patients undergoing elective Cesarean section under spinal anesthesia with use of 10 mcg fentanyl plus 0.5% hyperbaric bupivacaine was similar to those receiving hyperbaric bupivacaine alone.

Congenital hypothyroidism among infants undergoing Thyroid Function Test: A cross-sectional study for prevalence in Gandaki Province

2024-01-18T06:57:59+00:00

Introduction: Congenital hypothyroidism, associated
with developmental disabilities, is a treatable condition.
Initiation of treatment within the first two weeks of life is
crucial for optimal outcomes but goes undiagnosed at birth
many times due to lack of newborn screening program.
This study aimed to find the prevalence of congenital
hypothyroidism and age of the diagnosis so that evidence
could be generated for the need of newborn screening
program.
Materials and Methods: This is descriptive crosssectional
retrospective study. Database of Department of
Biochemistry, Western Regional Hospital was accessed to
retrieve the report of thyroid function test of 1122 infants
who had undergone the test between 1st June 2022 and 31st
May 2023. As per the Guidelines of European Society of
Paediatric Endocrinology (ESPE), biochemical criteria
of TSH and/or FT4 concentration was used to categorise
the infant positive for congenital hypothyroidism which is
used for initiation of treatment.
Result: Prevalence of the disease was 2.4% out of which
1.7% had TSH >20mU/L. Most common age when infants
were diagnosed with congenital hypothyroidism was seven
to nine months when 1.07% of the infants were diagnosed.
Prevalence of the disease was greater among male infants.
Conclusion: Prevalence of congenital hypothyroidism
among infants undergoing thyroid function test is 2.4%.
New-born screening should be introduced in medical
practice and in health policy because many infants go
undiagnosed at time of birth and diagnosed late.
Keywords: Congenital hypothyroidism; new-born
screening; thyroid function tests.

Experience of Hospital Staffs during the COVID-19 Pandemic: Phase of Initial Crisis to Phase of Adaptation

2024-01-17T16:35:03+00:00

Introduction: Across the globe, health care staffs on the
frontlines of battle against COVID-19 faced a multifaceted
challenges. The situation was more critical for resource
constraint countries. Although, the concern was focused
in providing protective devices and vaccination, it is more
important to take account of mental health of the hospital
staff. Therefore, this study was aimed to explore the
experience of staff working in a tertiary level government
hospital during the pandemic.
Material and Methods: The study was conducted among
29 staffs of Bheri hospital, Nepalgunj. Data was collected
from 23 to 25 July, 2022 through three focus group
discussions using semi structured focus group discussion
guideline. Qualitative content analysis method was used to
analyze the data.
Results: Content analysis of the data revealed the in-depth
experiences of hospital staff i.e., from the initial stage
of crisis and chaos to the final stage of acceptance and
adaptation. Four main themes were generated: 1) crisis
and fearful working environment; 2) impact on personal,
family, social and professional life; 3) stage of acceptance
and adjustment; 4) future recommendations.
Conclusion: The whole story started with a journey from
the stage of extreme fear, stress, feeling of threats, and
anxiety to the final stage of acceptance and adaptation
including feeling pride and satisfaction. Lack of knowledge
about newly emerged disease and uncertainty of its
prognosis was the reason behind intense fear among the
hospital staffs. Therefore, the support to staffs including
addressing the emotional wellbeing and mental health of
healthcare staffs during any pandemic is very crucial.
Keywords: adaptation, COVID-19, hospital staff, impact,
pandemic