Center In Nepal Research Articles

Penetrating Keratoplasty - Indications in a tertiary care center in Nepal.

Penetrating keratoplasty has become one of the most commonly performed transplant procedures where full thickness diseased host corneal tissue is replaced with healthy donor corneal tissue. Aims of penetrating keratoplasty include improvement in visual acuity, removal of infectious load, alleviate pain or even to simply save the anatomy of the eye. Visual improvement and removal of infection is the prime objective of majority of corneal grafts. The objective of the study was to evaluate various current indications of penetrating keratoplasty in central Nepal and its difference from the developed world. A hospital based study of 36 patients who underwent penetrating keratoplasty between January 2014 and June 2015 was carried out at B.P. Koirala Centre for ophthalmic studies. Following clinical examination and investigations, surgical intervention was done when required. The patient data were recorded and followed up. Indication for surgery, investigations and demographic profile were assessed. Mean recipient age was 46.56 years (+/- 16.02 years). The male: female ratio was 1.57:1. The most common indication for penetrating keratoplasty was infectious keratitis (44.44%), followed by corneal opacity or scarring (30.56 %), re-grafts (13.89%),bullous keratopathy (2.78%), keratoconus (2.78%) and others (2.78%) Introduction: Penetrating keratoplasty has become one of the most commonly performed transplant procedures where full thickness diseased host corneal tissue is replaced with healthy donor corneal tissue. Aims of penetrating keratoplasty include improvement in visual acuity, removal of infectious load, alleviate pain or even to simply save the anatomy of the eye. Visual improvement and removal of infection is the prime objective of majority of corneal grafts. The objective of the study was to evaluate various current indications of penetrating keratoplasty in central Nepal and its difference from the developed world. A hospital based study of 36 patients who underwent penetrating keratoplasty between January 2014 and June 2015 was carried out at B.P. Koirala Centre for ophthalmic studies. Following clinical examination and investigations, surgical intervention was done when required. The patient data were recorded and followed up. Indication for surgery, investigations and demographic profile were assessed. Mean recipient age was 46.56 years (+/- 16.02 years). The male: female ratio was 1.57:1. The most common indication for penetrating keratoplasty was infectious keratitis (44.44%), followed by corneal opacity or scarring (30.56 %), re-grafts (13.89%),bullous keratopathy (2.78%), keratoconus (2.78%) and others (2.78%) Conclusion: Though corneal diseases and indications for transplant surgery in developing countries are different from those in the western world, penetrating keratoplasty has emerged as one of the most successful way to reduce corneal blindness and to restore vision. Though corneal diseases and indications for transplant surgery in developing countries are different from those in the western world, penetrating keratoplasty has emerged as one of the most successful way to reduce corneal blindness and to restore vision.

Patterns of Rheumatic Heart Disease and Treatment Practices at Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study.

Rheumatic heart disease is a sequel of rheumatic fever which causes heart valve damage. This study was conducted to look at the pattern of valve lesions and treatment practices in patients with rheumatic heart disease. A cross-sectional study conducted at the tertiary care center with a diagnosis of rheumatic heart disease from July 2018 to January 2020 by convenient sampling. Ethical clearance was obtained from the Institutional Review Committee (ref no. 55/2018). Data were analyzed by using Statistical package for social sciences version 20. Out of 600 patients, 428 (71.3%) were female. The mean age was 44.24±14.24 years. The isolated mitral valve was affected in 280 (46.6%). Dual involvement of mitral and aortic valve was present in 294 (49%). Only 14 (2.3%) had involvement of isolated aortic valve involvement. Overall, mitral stenosis was the most common abnormality 508 (84.6%) followed by mitral regurgitation 418 (69.6%), aortic regurgitation 320 (53.3%), and aortic stenosis 63 (10.5%). Assessment of the severity of lesions showed that 247 (41.2%) patients had severe mitral stenosis, 119 (19.8%) severe mitral regurgitation, 14 (2.3%) severe aortic stenosis, and 11 (1.8%) severe aortic regurgitation. Majority 493 (82.2%) were treated with medical therapies. Surgical procedures were performed in 51 (8.5%). The use of anticoagulation was in 212 (35.3%) of eligible patients. Mitral valve was affected commonly both in isolation and combination. The majority of patients who were eligible for cardiac interventions were treated medically with suboptimal use of anticoagulation and secondary prophylaxis.

Computer Vision Syndrome among Patients Attending the Outpatient Department of Ophthalmology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Computers and digital electronic devices have become an integral part of life. These devices have adverse effects and nowadays are considered leading occupational hazards. Computer vision syndrome comprises of all the ocular, visual and musculoskeletal symptoms secondary to long term computer use. The objective of this study is to determine the prevalence of computer vision syndrome among people attending the outpatient department of ophthalmology in the tertiary care center in Nepal. A descriptive cross-sectional study was done among 70 patients in a tertiary care hospital from January 2017 to June 2017 after obtaining ethical approval from the institutional review committee (Ref: 12042017). Convenient sampling method was applied and the point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Patients using computers for more than one hour were included in the study. All data were entered in Microsoft Excel and analyzed using statistical package for social sciences version 20. Among 70 patients, 67 (95.7%) (87.9-99.1 at 95% confidence interval) had one or more symptoms on computer use. The mean duration of computer use was 7.5±5.4 years and average hours of computer use among computer users were 6.9±3 hours. The most common symptom among computer users was headache seen in 46 (62.2%) patients. Our study showed that a significant number of people using a computer develop one or more symptoms on the long-term use of the computer. Therefore, it is very important to create awareness regarding computer vision syndrome and methods to prevent it among computer users.

Hematological and biochemical profile of person with macrocytic anemia in a tertiary health care centre of Nepal

Background: Anemia is a nutritional problem worldwide with an increased risk of morbidity and mortality in all age groups. Macrocytic anemia often originates from abnormalities that impair the erythroid precursor maturation in the bone marrow. Since the clinical manifestations of different types of anemias are similar, hematological parameters including hemoglobin, Red blood cell indices, and Peripheral Blood Smear examination are useful in the diagnosis of anemia.
 Materials and Methods: This was a cross-sectional study done in the Department of Pathology at Nepal Medical College Teaching hospital. A total of 42 patients between 14 to 62 years with low Hb concentration according to the World Health Organization criteria for anemia were selected and a mean cell volume > 100 fL was taken for study. Peripheral blood smear examination, Red blood cell indices, Vitamin B12, and Folic acid level were evaluated.
 Results: There were 42 patients with macrocytic anemia enrolled in the study with a mean age of 31.85±12.49 years and with female preponderance. Hemoglobin level was slightly low in males compared to females. Red blood cell indices were slightly higher in males. The difference of serum Vit B12 and Folic acid in male and female was found to be significant.
 Conclusions: It was concluded that for the diagnosis of a specific type of anemia, hemoglobin, Red blood cell indices, reticulocytes percent, and PBS examination were important parameters. Serum Folic acid and Vitamin B12 level estimation along with other hematological parameters are important for the diagnosis of macrocytic anemia and its correlation

Epidemiology of Gall Stone Diseases among Patients attending Surgical Department of a Tertiary Care Hospital in Nepal

Background and Objectives: Gallstone disease (GSD) is a chronic disease that consumes a lot of economic and medical resources. It not only affects patients’ life quality, but also is associated with the potential risks of the development of consequences of gallstone diseases. Therefore, the study is aimed to investigate the epidemiology and risk factors of gall stone diseases among patients attending tertiary care centre in Nepal.
 Material and Methods: A cross sectional study was conducted among patients attending surgical department of Janaki Medical College Teaching Hospital (JMCTH) over a period of one year from January 2019 to December 2019. Chi-square test was applied to show the association between the two groups. P-value < 0.05 was considered statistically significant.
 Results: In a total of 148 patients, 69.59% had mixed gallstone, 17.57% had cholesterol stone and 12.84% had pigment gallstone. Types of gallstone was found significant for age group (p=0.006), gender (p=0.027) and presence of diabetes (p=0.003) but insignificant with presence of hypertension (p=0.992).
 Conclusion: Age of the patients, gender and presence of diabetes were found significant for the all types of gall stone. Further large scale research need to be conducted.

Burden of Care Among Mothers Having Children with Congenital Heart Diseases

Introduction: Congenital Heart Disease (CHD) is a problem with structure and function of the heart that is present at birth. Children with CHD require special care, treatment and follow up for a number of common conditions which may be quite straining to the care givers. The objective of the study was to find out the burden of care among mothers having children with CHD.
 Methods: This descriptive cross-sectional study was carried out in a cardiac centre of Nepal. A total of 95 mothers having children with CHD attending outpatient department of our institute were selected as the sample for the study using non-probability purposive sampling technique. A semi structured interview questionnaire consisting of the Modified Caregiver Strain Index was used to assess the burden of care among mothers having children with CHD. Frequency and percent were used to describe the variables and chi- square test at 0.05 significance level was used to analyse associations.
 Results: Most (77.9%) of the mothers were regularly strained to find that their children’s health condition was deteriorating due to CHD. Nearly half (44.2%) of the mothers always had financial constrain while giving care to the child, nearly half (40%) of the mothers had done emotional adjustments to take care of their children with CHD, another two-fifths (28.4%) of the mothers sometimes had disturbed sleep and almost half (46.3%) of the mothers were always upset due to some behaviour of their child with CHD. Half (50.5%) of the mothers had high level of burden of care. Statistically significant association were found between age of the mother and level of burden of care (p value = 0.05). Similarly, the type of family (p value = 0.005), age of the children (p value = 0.000) and type of CHD (p value = 0.002) were significantly associated with the level of burden of care among the mothers.
 Conclusion: The study concluded that mothers tend to feel less burden of care as the child grows older, mothers having children with cyanotic heart disease tend to experience more burden of care. Mothers of less than thirty years of age and living in a joint family also experience more burden of care. 

Clinical Characteristics and Management of the Hydatid Cyst of the Liver: A Study from a Tertiary Care Center in Nepal.

A hydatid cyst of the liver is a significant yet neglected public health problem in Nepal. The present study was carried out to evaluate the demographic characteristics, clinical presentations, and management of the patients of the hydatid cyst of the liver in the setting of a developing country. It was a retrospective, descriptive analysis of 53 patients admitted in the department of surgery with the diagnosis of hydatid cyst of the liver based on clinical manifestations, imaging studies, or serology between 2016 and 2019. The median age of the patients was 36 years, with the age group of 25-45 years being the most commonly affected (23, 43.4%). 58.5% of the patients were female. Abdominal pain (49, 92.5%) and a palpable liver (17, 32.1%) were the most common complaint and physical finding in our study population, respectively. Abdominal ultrasonography and computed tomography scan were the major imaging studies used to establish a diagnosis. A unilocular and anechoic cystic lesion was the most frequent imaging finding. The right lobe of the liver harbored the cysts in the maximum number of patients. Surgery was the preferred modality of treatment (23, 43.4%), with pericystectomy being the most common form of surgical intervention. The hydatid cyst of the liver is a common cause of morbidity in Nepal. Clinical evaluation supplemented by imaging studies is required for diagnosis, and surgery remains the treatment of choice in most cases. To explain the epidemiological pattern of the disease, multicentric studies involving a larger sample of patients should be conducted.

Pancreatic Configuration Index in Predicting Postoperative Pancreatic Fistula in a Tertiary Care Center in Nepal.

Post-operative pancreatic fistula is the single most common and most significant cause of post-operative morbidity and perioperative mortality. Identification of at risk patient preoperatively help to take policy of extra vigilance to act on time. This study evaluated the predictive role and cut-off value of pancreatic configuration index to predict post-operative pancreatic fistula. This was a prospective observational study in patients who had undergone pancreaticoduodenectomy from March 2017 to June 2018 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The patients with age <16 years, those who underwent re-exploration or mortality before 3rd postoperative day, additional surgery besides pancreaticoduodenectomy were excluded from the study. Pancreatic configuration index was calculated as a ratio of pancreatic parenchymal thickness and pancreatic duct diameter. Predictive value of pancreatic configuration index in predicting post-operative pancreatic fistula was evaluated. Among 58 patients, 9 were excluded from study and 49 patients were included in the study. The mean age of the patients was 56.6 ± 13.9 years (21 to 79 years) and male to female ratio was 1.1:1 (26 vs 23). Post-operative pancreatic fistula developed in 13/49 (26.5%) patients. On both univariate and multivariate analysis, pancreatic texture (p = 0.022), main pancreatic duct diameter at neck (p = 0.002) and pancreatic configuration index (p = 0.001) were significantly associated with development of post-operative pancreatic fistula. The sensitivity and specificity of pancreatic configuration index to predict post-operative pancreatic fistula are 92.3% and 91.7% with positive predictive value of 80% and negative predictive value of 97.1%. Pancreatic configuration index is a useful preoperative predictor of post-operative pancreatic fistula after pancreaticoduodenectomy.

Cardiometabolic risk factors among patients with tuberculosis attending tuberculosis treatment centers in Nepal

BackgroundThe co-morbidity of cardiometabolic diseases in patients with Tuberculosis adds a significant burden in current health systems in developing countries including Nepal. The main objective of this study was to explore cardiometabolic risk factors among patients with Tuberculosis.MethodsThis was a cross-sectional study conducted among patients with tuberculosis in 12 tuberculosis treatment centers from eight districts of Nepal between May and July 2017. Interviews with participants were conducted using a structured questionnaire and were supplemented by anthropometric measurements and on-site blood glucose tests. Data were analyzed using descriptive and inferential statistics.ResultsAmong 221 study participants, 138 (62.4%) had new smear-positive pulmonary tuberculosis, 24 (10.9%) had new smear-negative pulmonary tuberculosis and 34 (15.4%) had new extra- pulmonary tuberculosis. Overall, 43.1% of the patients with tuberculosis had at least one cardiometabolic risk factor. The prevalence of at least one cardiometabolic risk factor was more in male than female (47.8% versus 33.8%). Prevalence of tobacco (18.9% versus 4.8%), and alcohol (12.6% versus 6.5%) use was proportionately higher in male compared to female. The prevalence of hypertension (17% vs. 21%) and obesity (11.9% vs. 12.9%) was lower in male compared to females. Female (AOR = 0.47; CI: 0.23–0.94), those from Gandaki Province (AOR = 0.32; CI: 0.13–0.79) and literate (AOR = 0.49; CI: 0.25–0.96) had reduced risk of cardiometabolic disease risk factors.ConclusionsThis study highlights the role of gender and socio-demographic characteristics associated with the risk of cardiometabolic diseases in patients with Tuberculosis. The findings from this study can guide medical practitioners and policy makers to consider clinical suspicion, diagnosis and treatment. National treatment guideline can benefit by integrating the management of non-communicable diseases in Tuberculosis treatment centers.

Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal

Introduction: Temporary transvenous pacemaker insertion is an emergency lifesaving procedure for patients with hemodynamically unstable and life-threatening bradyarrythmias. The aim of this study was to analyze demographics, indications, route of insertion and complications in patients undergoing temporary transvenous pacemaker implantation. Methods: This was a retrospective observational study conducted at a tertiary-care center in Nepal. The hospital records of patients who had undergone temporary transvenous pacemaker implantation between July 2015 and June 2019 were reviewed. Results: A total of 343 patients with mean age of 65.52±16.09 years received temporary transvenous pacing. Out of these 205 (59.8%) were males. Greater proportion of patients were between the age group of 70-80 years (n=76, 22.2%). Hypertension (n=97, 28.3%) was the most common comorbidity noted. The most common indication for temporary pacing was symptomatic complete heart block 165 (59.6%). Total of 288 (84%) patients received permanent pacemakers while 55(16%) had reversible cause so TPI was removed. Right Femoral vein was the most common (99%) venous access site. Among the 343 patients, complications were observed in 29 (8.4%) of cases during and after the temporary transvenous pacemaker insertion. The overall mortality stood low at 2% (n=7). Conclusion: Temporary transvenous pacemaker insertion is required in elderly population presenting with bradyarrythmias and occasionally in acute myocardial infarction presenting with bradyarrythmias as complication. Temporary pacemaker insertion was overall a safe procedure with infrequent serious complications; however, strategies to avoid and alleviate such complications (RV perforation) should be sought and implemented.

Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal

Introduction Temporary transvenous pacemaker insertion is an emergency lifesaving procedure for patients with hemodynamically unstable and life-threatening bradyarrythmias. The aim of this study was to analyze demographics, indications, route of insertion and complications in patients undergoing temporary transvenous pacemaker implantation.&#x0D; MethodsThis was a retrospective observational study conducted at a tertiary-care center in Nepal. The hospital records of patients who had undergone temporary transvenous pacemaker implantation between July 2015 and June 2019 were reviewed.&#x0D; ResultsA total of 343 patients with mean age of 65.52±16.09 years received temporary transvenous pacing. Out of these 205 (59.8%) were males. Greater proportion of patients were between the age group of 70-80 years (n=76, 22.2%). Hypertension (n=97, 28.3%) was the most common comorbidity noted. The most common indication for temporary pacing was symptomatic complete heart block 165 (59.6%). Total of 288 (84%) patients received permanent pacemakers while 55(16%) had reversible cause so TPI was removed. Right Femoral vein was the most common (99%) venous access site. Among the 343 patients, complications were observed in 29 (8.4%) of cases during and after the temporary transvenous pacemaker insertion. The overall mortality stood low at 2% (n=7).&#x0D; ConclusionTemporary transvenous pacemaker insertion is required in elderly population presenting with bradyarrythmias and occasionally in acute myocardial infarction presenting with bradyarrythmias as complication. Temporary pacemaker insertion was overall a safe procedure with infrequent serious complications; however, strategies to avoid and alleviate such complications (RV perforation) should be sought and implemented.

Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal

Introduction Hepatolithiasis is more prevalent in Far-East than in Middle-East countries. There are various treatment modalities available for hepatolithiasis like surgical and non-surgical procedures. Non-surgical procedures have higher recurrence rate.&#x0D; MethodsThis is a descriptive retrospective study of the clinical data of hepatolithiasis patients treated at Tribhuvan University Teaching Hospital (TUTH), Maharajgunj from April 2016 to October 2019.&#x0D; ResultsThere were 14 patients and mean age was 45.8±14.8 years. It was more common in female (F: M = 4:3). Left sided hepatolithiasis was the most common type (50%). One (7.1%) patient had bilateral hepatolithiasis associated with unresectable cholangiocarcinoma. Eight (57.1%) patients were treated with surgical procedures; four (28.6%) patients underwent interventional radiological procedures and remaining two (14.3%) patients had combined surgical and intervetional radiological procedures. Complete stone clearance was achieved in 11 patients (78.57%). In surgical therapy group, seven out of eight (87.5%) patients achieved the complete stone clearance; two out of four (50%) patients in interventional radiology group and all patients in combined therapy group achieved the clearance. There was no recurrence among those patients who had complete stone clearance and there was no mortality.&#x0D; ConclusionThe management of hepatolithiasis should involve multi-modality (surgical and non-surgical) therapeutic techniques available, in order to achieve complete stone clearance and prevent the complications.

Pediatric Percutaneous Nephrolithotomy in a Peripheral Tertiary Care Center in Nepal

Introduction: Pediatric nephrolithiasis though uncommon, poses clinical management dilemma due to anatomical and physiological factors. Percutaneous Nephrolithotomy (PCNL) is well established in adults and miniaturization of the instruments has helped to expand its indication for uses in pediatric population with equivalent results. The aim of our study is to evaluate the application of the procedure in our settings. Methods: This was a retrospective study done at Nepalgunj Medical College teaching hospital from June 2017 to April 2020. Total of 75 patients with 76 renal units under 18 year of age were evaluated. PCNL was done in prone position in all patients using fluoroscopy for initial puncture and subsequently for clearance. The size of the tract varying from 15 Fr to 24 Fr was decided based on the degree of hydronephrosis. Results: Mean stone volume was 372 mm2. With mean operative time of 58 min, 96% of stone clearance rate was achieved. Mini PCNL was done in most of the cases. Single tract was used in 84% cases mostly with subcostal puncture. Major complications were pelvic perforation in 4% cases and two patients required restaging. Conclusion: PCNL in pediatric population is safe with good stone free rate with minimal complications. Application of miniaturized instruments has further improved the outcome with comparable morbidity.

Pediatric Percutaneous Nephrolithotomy in a Peripheral Tertiary Care Center in Nepal

Introduction Pediatric nephrolithiasis though uncommon, poses clinical management dilemma due to anatomical and physiological factors. Percutaneous Nephrolithotomy (PCNL) is well established in adults and miniaturization of the instruments has helped to expand its indication for uses in pediatric population with equivalent results. The aim of our study is to evaluate the application of the procedure in our settings.&#x0D; MethodsThis was a retrospective study done at Nepalgunj Medical College teaching hospital from June 2017 to April 2020. Total of 75 patients with 76 renal units under 18 year of age were evaluated. PCNL was done in prone position in all patients using fluoroscopy for initial puncture and subsequently for clearance. The size of the tract varying from 15 Fr to 24 Fr was decided based on the degree of hydronephrosis.&#x0D; ResultsMean stone volume was 372 mm2. With mean operative time of 58 min, 96% of stone clearance rate was achieved. Mini PCNL was done in most of the cases. Single tract was used in 84% cases mostly with subcostal puncture. Major complications were pelvic perforation in 4% cases and two patients required restaging.&#x0D; ConclusionPCNL in pediatric population is safe with good stone free rate with minimal complications. Application of miniaturized instruments has further improved the outcome with comparable morbidity.

Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal

Introduction: Hepatolithiasis is more prevalent in Far-East than in Middle-East countries. There are various treatment modalities available for hepatolithiasis like surgical and non-surgical procedures. Non-surgical procedures have higher recurrence rate. Methods: This is a descriptive retrospective study of the clinical data of hepatolithiasis patients treated at Tribhuvan University Teaching Hospital (TUTH), Maharajgunj from April 2016 to October 2019. Results: There were 14 patients and mean age was 45.8±14.8 years. It was more common in female (F: M = 4:3). Left sided hepatolithiasis was the most common type (50%). One (7.1%) patient had bilateral hepatolithiasis associated with unresectable cholangiocarcinoma. Eight (57.1%) patients were treated with surgical procedures; four (28.6%) patients underwent interventional radiological procedures and remaining two (14.3%) patients had combined surgical and intervetional radiological procedures. Complete stone clearance was achieved in 11 patients (78.57%). In surgical therapy group, seven out of eight (87.5%) patients achieved the complete stone clearance; two out of four (50%) patients in interventional radiology group and all patients in combined therapy group achieved the clearance. There was no recurrence among those patients who had complete stone clearance and there was no mortality. Conclusion: The management of hepatolithiasis should involve multi-modality (surgical and non-surgical) therapeutic techniques available, in order to achieve complete stone clearance and prevent the complications.

Prevalence of Diabetes and Dyslipidemia in Hypertensive Young Adults in a Tertiary Care Centre in Nepal, a Cross Sectional Study

Introduction Diabetes mellitus (DM) and lipid disorders (LD) in hypertensive patients are associated with increased risk of cardiovascular complications requiring close follow-up and more aggressive treatment. Hence, the present study was done to study the prevalence of diabetes and dyslipidemia in young hypertensive patients i.e. &lt;40 years in a tertiary care hospital, Nepal.&#x0D; MethodsThis is a hospital based cross-sectional study carried out in Civil Service Hospital, Kathmandu. Study included 165 patients of &lt;40 years who had hypertension, either newly diagnosed or undergoing antihypertensive treatment from September 2018 to September 2019. Blood pressure was measured two times on right upper arm in sitting position at interval of 30 minutes and the aver­age was taken. Fasting Lipid Profile and Fasting Blood Glucose was measured after 12 hours of fasting and the prevalence of dyslipidemia and diabetes were analyzed from the data collected. All calculations and statistical analyses are processed by the SPSS 25.0.&#x0D; ResultsAmong 165 patients included, majority of patients, 107 (64.8%) were among 31-39 years, followed by 53 (32.1%) patients among 21-30 years. In total, 98 (59.4%) were male and 67 (40.6%) female. The prevalence of diabetes was 24 (14.5%) and pre-diabetes was 49 (29.7%). The prevalence of dyslipidemia was 125 (75.6%), high triglyceride being the most common disorder followed by low HDL in 87 (52.1%). Elevated total cholesterol was found in 53 (32.1%) patients and 48 (29%) had high LDL cholesterol level.&#x0D; ConclusionA high prevalence of diabetes, pre-diabetes and dyslipidemia was observed in the hypertensive patients &lt;40 years of age.

Prevalence of Diabetes and Dyslipidemia in Hypertensive Young Adults in a Tertiary Care Centre in Nepal, a Cross Sectional Study

Introduction: Diabetes mellitus (DM) and lipid disorders (LD) in hypertensive patients are associated with increased risk of cardiovascular complications requiring close follow-up and more aggressive treatment. Hence, the present study was done to study the prevalence of diabetes and dyslipidemia in young hypertensive patients i.e. &lt;40 years in a tertiary care hospital, Nepal. Methods: This is a hospital based cross-sectional study carried out in Civil Service Hospital, Kathmandu. Study included 165 patients of &lt;40 years who had hypertension, either newly diagnosed or undergoing antihypertensive treatment from September 2018 to September 2019. Blood pressure was measured two times on right upper arm in sitting position at interval of 30 minutes and the average was taken. Fasting Lipid Profile and Fasting Blood Glucose was measured after 12 hours of fasting and the prevalence of dyslipidemia and diabetes were analyzed from the data collected. All calculations and statistical analyses are processed by the SPSS 25.0. Results: Among 165 patients included, majority of patients, 107 (64.8%) were among 31-39 years, followed by 53 (32.1%) patients among 21-30 years. In total, 98 (59.4%) were male and 67 (40.6%) female. The prevalence of diabetes was 24 (14.5%) and pre-diabetes was 49 (29.7%). The prevalence of dyslipidemia was 125 (75.6%), high triglyceride being the most common disorder followed by low HDL in 87 (52.1%). Elevated total cholesterol was found in 53 (32.1%) patients and 48 (29%) had high LDL cholesterol level. Conclusion: A high prevalence of diabetes, pre-diabetes and dyslipidemia was observed in the hypertensive patients &lt;40 years of age.

Comparison Between Supraclavicular and Infraclavicular Approach in Subclavian Vein Catheterization in Tertiary Center of Nepal

Introduction: Central vein catheterization can be introduced in subclavian vein (SCV), internal jugular vein or femoral vein for volume resuscitation and invasive monitoring technique. Due to anatomical advantage and lesser risk of infection subclavian vein is preferred. Either supraclavicular (SC) or infraclavicular (IC) approach could be used for subclavian vein catheterization. The aim of the study was to compare SC and IC approach in ease of catheterization of SCV and record the complications present if any.&#x0D; Methods and materials: This was a hospital based comparative, interventional study conducted from November 2016 to October 2017 in Operation Theater in Bir Hospital. In this study, 70 patients for elective surgical cases meeting the inclusion criteria were randomly enrolled. Then samples were equally divided by lottery into either supraclavicular or infraclavicular approach groups. The Access time, cannulation success rate, attempts made for successful cannulation of vein, easy insertion of catheter and guide wire, approximate inserted length of catheter and associated complications in both groups were recorded. Data was entered in statistical software SPSS 16. Chi-square test was used. P value &lt; 0.05 was considered significant.&#x0D; Results: The mean access time in group SC for SCV catheterization was 2.12 ± 0.81 min compared to 2.83 ± 0.99 min in group IC (p-value= 0.002). The overall success rate in catheterization of the right SCV using SC approach (34 / 35) was better as compared with group IC (33 / 35) using IC approach. First successful attempt in the SC group was 74.28% as compared with 57.14% in the IC group.&#x0D; Conclusion: The SC approach of SCV catheterization can be considered alternative to IC approach in terms of landmark accessibility, success rate and rate of complications.

Complications and Mortality in Hospitalised Patients With Decompensated Cirrhosis of Liver in a Tertiary Care Centre in Nepal.

BackgroundPatients with decompensated cirrhosis present with various complications and are associated with increased inpatients mortality. This study aimed to evaluate the complications and mortality in hospitalised patients with decompensated cirrhosis of liver.MethodsThis descriptive, cross-sectional, hospital-based study included 754 decompensated cirrhotic patients. The primary endpoints were mortality and hospital stay. The data analysis was done using Statistical Product and Service Solutions (SPSS) version 20 (IBM Corp., Armonk, NY). The chi-square test was used to compare the differences between different predictors of mortality with p<0.05 considered significant.ResultsA total of 754 patients (mean age 54±11.51 years; male/female ratio of 3.6:1) were studied. Ascites was the most common complication (99.2%) followed by upper gastrointestinal (UGI) bleed (42.3%), hepatic encephalopathy (32.5%), rebleeding (33.2%), spontaneous bacterial peritonitis (26%), and hepatorenal syndrome (19.1%). Inpatient mortality was 19.8%. The most common causes of mortality were rebleeding (21.5%) followed by hepatic encephalopathy (HE) (18.7%), hepatorenal syndrome (HRS) (14.7%), and spontaneous bacterial peritonitis (SBP) (12.1%). The presence of Grades IV HE, the presentation with shock, Child Turcotte Pugh (CTP) C, rebleeding, variceal bleed, HRS, hyponatremia (<130 mEq/L), the requirement of ≥3 units of blood and blood products, co-existence of hepatocellular carcinoma (HCC), and multiple comorbidities and complications in a single patient were strong predictors of mortality (p≤0.05).ConclusionsAscites followed by UGI bleed, hepatic encephalopathy, rebleeding, spontaneous bacterial peritonitis, and hepatorenal syndrome were common complications among the admitted decompensated cirrhotic patients. Inpatient mortality was high. The most common cause of mortality was rebleeding followed by hepatic encephalopathy, HRS, and SBP.

Clinical profile of thyroid cancer patients attending a tertiary endocrine center in Nepal

Clinical profile of thyroid cancer patients attending a tertiary endocrine center in Nepal