Dhulikhel Hospital-Kathmandu University Hospital Research Articles

Clinical Profile of Patients Presenting with Corneal Foreign Bodies: A Cross-Sectional Study Conducted in a Tertiary Hospital in Nepal.

Corneal foreign bodies are one of the commonest forms of ocular trauma, the majority of which occur due to occupational exposure. The aim of this study was to study the profile of patients with corneal foreign bodies. A hospital based prospective study was conducted among 60 patients presenting to the ophthalmology outpatient department in Dhulikhel Hospital-Kathmandu University Hospital (DH-KUH) over a time span of 6 months. Demographic data of patients, clinical characteristics of foreign bodies and associated complications were noted. Most of the patients were males (n=55) belonging to the 21-30 age group (n=24). Majority of them were workers in metal industries (n=26). Welding and cutting metal were implicated as the most common mode of injury (n=53). By virtue of this study, we identified the high risks associated with sustaining this form of ocular trauma. The incidence and hence the prevalence of corneal foreign body can be gradually levelled down if we aware the people about the associated complications and advise them to use protective eye wears (PEW).

Drug Utilization Study in Outpatient Department of Ophthalmology in Tertiary Care Hospital

Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use.
 Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH).
 Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation.
 Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%).
 Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs.

Study of Characteristic Retinal Findings among Hypertensive Population Attending a Tertiary Care Hospital in Nepal

Background Systemic hypertension is one of the most common chronic, debilitating diseases prevalent in the modern era, with many complications in terms of stroke, chronic kidney disease, coronary artery disease and retinopathy. When it comes to the eye, as a target organ damage, it leads to one of the many vision threatening conditions, hence degrading the quality of life. Early detection and subsequent management of patients at risk of hypertensive retinopathy serves to be a crucial panacea in the treatment course.
 Objective To investigate the characteristics retinal findings among hypertensive population and analyze the associated risk factors.
 Method A hospital based prospective study was conducted, among 250 patients presenting to ophthalmology outpatient department in Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH), over a time span of 6 months, to analyze hypertensive retinopathy and its implications. Fundus examination under mydriasis was done on all subjects and hypertensive retinopathy was graded according to the modified Scheie classification.
 Result Most patients belonged to age group of 56-65 years (30%). Nearly half (48%, N=120) of the hypertensive population had some forms of retinopathy. Grade II hypertensive retinopathy (24.8%) was the most common hypertensive change observed. Majority (55%) of the patients with retinopathy were smokers. About two-third of the subjects (67.5%) had been diagnosed to have hypertension and under treatment for over 5 years.
 Conclusion The occurrence of retinopathy among hypertensive patients attending ophthalmology department is higher. Awareness regarding systemic hypertension and its effect on ocular health is very important to be disseminated among public. Timely referral among medical specialities could diagnose and prevent curable blindness among hypertensive patients.

Effects of Domestic Violence During Pregnancy on Fetal Health in Tertiary hospital, Nepal

Domestic Violence against pregnant women is legally and socially punishable though the prevalence of such violence is reported in Nepal also. The study was conducted with the objective is to identify the effects of domestic violence during Pregnancy on fetal health(outcomes in newborns).The study was conducted among the 804 newborns of admitted Postnatal women who were interviewed about domestic violence during pregnancy in the Dhulikhel hospital-Kathmandu University Hospital in the Kavre district. A systematic random sampling technique was used to select the respondents 'babies and data obtained from newborns’ hospital records. The study found that the effects of economic violence were high on low birth weight followed by the effects of psychological violence. Though, there were no statistically significant effects of violence on fetal health of interviewees about domestic violence during pregnancy prematurity, post-maturity, low birth weight, Asphyxia, and other health problem. Future research can be done in other parts of Nepal covering the rural women who are from the poor and illiterate groups. Keywords: Domestic violence, Pregnancy, Effects on Fetal & Women’ Health.

Histopathological Study of Cystoscopic Bladder Biopsies in a Tertiary Care Center

Introduction: Non-neoplastic urinary bladder lesions are not life threatening, but are an important source to cause clinical symptoms and signs. However, neoplasms of the bladder are a source of morbidity, mortality, and exhibit more clinical challenges. Cystoscopy provides overall information about an anatomical/pathological condition of the urinary bladder which will be helpful for patients' management. A cystoscopic biopsy is a primary diagnostic tool for diagnosing urinary bladder cancer.
 Objectives: The objective of the study was to find the frequency and histomorphological characteristics of urinary bladder lesions in Dhulikhel Hospital, to find the clinical presentation of urinary bladder lesions and to grade the urothelial tumors based on the World Health Organization (WHO)/ International Society of Urological Pathology (ISUP) classification 2004.
 Methodology: This was a retrospective, cross-sectional, observational study carried out in the Department of Pathology, Dhulikhel Hospital-Kathmandu University Hospital. Convenient sampling was done. All cystoscopy biopsies received from January 2014 to December 2018 were studied. All tissue blocks were retrieved, cut, and stained with Hematoxylin and Eosin. The stained slides were examined under a light microscope by the primary investigator.
 Result: A total of 70 cystoscopic biopsies were analyzed. The majority of patients 20 (28.6%) were in the age group between 60 and 69 years and males were predominant 43 (61.4%). The neoplastic lesions constituted 40 (57.1%) of all bladder lesions, among them urothelial carcinoma accounted for 38 (54.2%). Similarly, chronic cystitis 27(38.6%) was the most common non-neoplastic lesion.
 Conclusion: The study found that the neoplastic lesions were commonly encountered in urinary bladder lesions. Among them, lowgrade urothelial carcinoma was the most common bladder tumor. However, most of the non-neoplastic lesions were inflammatory in origin. Cystoscopy combined with histomorphological examination helps in the early detection of bladder lesions.

Correlative Analysis of Atherogenic Dyslipidemia among the Patients with Non Alcoholic Fatty Liver Disease Visiting Tertiary Care Center

Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most prominent causes of chronic liver disease. It is known that dyslipidemia in NAFLD patients may have more severe atherogenic potential with high triglyceride and low density lipoprotein (LDL) as well as less high density lipoprotein (HDL) level.
 Objective: To determine the atherogenic dyslipidemia and associated factors among patients with NAFLD, Visiting Tertiary Care Center
 Methodology: Prospective cross-sectional study was conducted at Dhulikhel Hospital-Kathmandu University Hospital (DH-KUH) from January, 2016 to December, 2016. All the patients (n= 973) diagnosed to have fatty liver during this study period were initially enrolled in this study. Patients were further asked to fill up the questioner. Out of total 973 cases, 169 patients were identified as NAFLD. Fasting blood sample and anthropometric measurements (BMI, WHR) were taken. After adjusting exclusion criteria, refusal to participate and dropout from the study, 101 patients and 92 apparently healthy age sex matched control group was selected for the study. Blood sugar level and lipid profile were analyzed to assess the risk of athrogenicity among the NAFLD.
 Result: High total cholesterol was found in 64.4 %, High LDL was found in 20.8 %, Low HDL is present in 72.2% and high triglyceride is present in 65.8 % patients with NAFLD. Non-HDL cholesterol was significantly higher in NAFLD compared to control group (116.75 ± 34.38 vs. 137.63 ± 39.76, p=0.00). Similarly, calculated cardiac risk ratio (TC/HDL) was significant higher (4.15 ± 1.18 vs. 5.25 ± 1.78, p=0.00) whereas atherogenic index of plasma (AIP) was higher (0.30 ± 0.13 vs. 0.33 ± 0.19, p=0.37).
 Conclusion: NAFLD is significantly associated with atherogenic dyslipidemia. Calculated cardiac risk and AIP is higher in patients with NAFLD. Therefore it may be helpful to assess dyslipidemia among the patients with NAFLD to prevent cardiovascular events.

Insights into Cardiovascular Disease Risk Based on Platelet Indices and Lipid Ratios in Reference to Glycemic Control and Duration of Diabetes

Background: Diabetic patients are at the risk of untimely atherosclerotic cardiovascular disease. The level of blood lipids, their ratios, glycosylated hemoglobin, and platelet indices are potential markers for the assessment of cardiovascular disease risk in diabetic patients. This study aims to insights into cardiovascular disease risk among diabetic patients in reference to glycemic control and duration of diabetes on the basis of lipid ratios and platelet indices by comparing with healthy controls.
 Materials and Methods: A case control study was carried out among the patients, diagnosed as type 2 diabetes mellitus at Dhulikhel hospital-Kathmandu University hospital. Socio-demographic questionnaire, anthropometric measurements, and biochemical tests was performed. Descriptive analysis and independent T-test for the testing relationship between categorical variables along with correlation was done.
 Results: Nearly one-third of diabetic patients were under poor glycemic control with high risk of cardiovascular diseases on the basis of blood lipid ratios and platelet indices. Cardiac risk ratio, Atherogenic Index of Plasma, and Atherogenic Coefficient was found to be significantly high in diabetic compared to the control group (5.22±1.54 vs. 3.71±0.99, p <0.05), (0.33±0.18 vs. 0.22±0.14, p <0.05), (4.22±1.54 vs. 2.71±0.99, p <0.05) respectively. Similarly Mean Platelet Volume was also significantly higher in diabetic compared to the control group (10.16±1.43 vs. 9.06±0.81, p <0.05).
 Conclusion: Poor glycemic control seems riskier than prolonged diabetes on the basis of blood lipids, their ratios and platelet indices.

Diagnostic performance of the extended focused assessment with sonography for trauma (EFAST) patients in a tertiary care hospital of Nepal

BackgroundThoracoabdominal trauma presents a diagnostic challenge for the emergency physician. The introduction of bedside ultrasonography (USG) provides a screening tool to detect hemoperitoneum, hemothorax, pneumothorax and pericardial effusion in torso...

Study of dental disease pattern and drug utilization evaluation among patients visiting dental outpatient department of tertiary care center

Background: Oral health has been an integral component of general health, with a serious impact on the quality of life and the overall well-being. Limited availability and accessibility of oral health services are risk factors for poor oral health and diseases. This study aimed to observe common dental disease pattern and to evaluate drug utilization pattern among patients visiting Dental Outpatient Department of Dhulikhel Hospital- Kathmandu University Hospital.
 Methods: A descriptive, cross-sectional study was conducted from October 2018 to January 2019 in Dental Outpatient Department of Dhulikhel Hospital-Kathmandu University Hospital. Two hundred forty prescriptions were collected and analyzed. Descriptive statistical analysis was carried out to find out common dental disease pattern and to evaluate drug utilization pattern.
 Results: Total 240 prescriptions were analyzed. Pulpitis 54 (22.5%) was the most common diagnosis, followed by periapical abscess 34 (14.16%). Out of 411 drugs prescribed, 166 (40.38%) were analgesics, 116 (28.22%) were antibiotics and 93 (22.62) were topical agents. Combination of paracetamol with ibuprofen was most commonly prescribed analgesics 133 (80.12%) and combination of amoxicillin with clavulanic acid was most commonly prescribed antibiotics 51 (43.97%). Out of all drugs prescribed, fixed dose combination was given in 194 (47.20%). Only 260 (63.26%) drugs were given by generic name and 133 (32.36%) drugs were from National List of Essential Medicines-Nepal.
 Conclusions: Awareness among dental doctors for prescribing drugs by generic name and from essential drug lists should be encouraged.

STUDY OF DENTAL DISEASE PATTERN AND DRUG UTILIZATION EVALUATION AMONG PATIENTS VISITING DENTAL OUTPATIENT DEPARTMENT OF TERTIARY CARE CENTER

Background: Oral health has been an integral component of general health, with a serious impact on the quality of life and the overall well-being. Limited availability and accessibility of oral health services are risk factors for poor oral health and diseases. This study aimed to observe common dental disease pattern and to evaluate drug utilization pattern among patients visiting Dental Outpatient Department of Dhulikhel Hospital- Kathmandu University Hospital.
 Methods: A descriptive, cross-sectional study was conducted from October 2018 to January 2019 in Dental Outpatient Department of Dhulikhel Hospital-Kathmandu University Hospital. Two hundred forty prescriptions were collected and analyzed. Descriptive statistical analysis was carried out to find out common dental disease pattern and to evaluate drug utilization pattern.
 Results: Total 240 prescriptions were analyzed. Pulpitis 54 (22.5%) was the most common diagnosis, followed by periapical abscess 34 (14.16%). Out of 411 drugs prescribed, 166 (40.38%) were analgesics, 116 (28.22%) were antibiotics and 93 (22.62) were topical agents. Combination of paracetamol with ibuprofen was most commonly prescribed analgesics 133 (80.12%) and combination of amoxicillin with clavulanic acid was most commonly prescribed antibiotics 51 (43.97%). Out of all drugs prescribed, fixed dose combination was given in 194 (47.20%). Only 260 (63.26%) drugs were given by generic name and 133 (32.36%) drugs were from National List of Essential Medicines-Nepal.
 Conclusions: Awareness among dental doctors for prescribing drugs by generic name and from essential drug lists should be encouraged.
 
 Conclusions: Awareness among dental doctors for prescribing drugs by generic name and from essential drug lists should be encouraged. Use of fixed dose combination should be minimized.

Drivers of healthy eating in a workplace in Nepal: a qualitative study

ObjectiveTo explore the perceptions, enablers and barriers to employees’ healthy eating in a hospital site.DesignA qualitative study including focus group discussion and in-depth interview, data were analysed using thematic analysis...

Histopathological Changes in the Chorionic Villi and Endometrial Decidual Tissues in the Product of Conception of Spontaneous Abortion Cases.

Background Spontaneous abortion refers to a pregnancy that ends spontaneously before the fetus has reached a viable gestational age or expulsion or extraction of an embryo or fetus weighing 500 g or less from its mother. The Maternal Mortality Morbidity Survey of Nepal 2008/09 reported that 7% of maternal deaths in Nepal were due to complications related to abortion. Objective The main objective of this study was to examine the histopathological changes in the chorionic villi and endometrial decidual tissue in products of conception obtained from women with spontaneous abortion. Method This is a retrospective study of 111 patients admitted in the Department of Obstetrics and Gynecology at Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH) with the diagnosis of spontaneous abortion during the period of January 2013 to January 2014. Result Among 111 cases of spontaneous abortions, products of conception was seen in 73 (65.77%) and with only one cases of choriocarcinoma. Majority of cases belongs to age group 21-30 years. The most common decidual changes were inflammation (41.4%) followed by fibrin deposition 29.7%. Majority of the cases shows hydropic changes as histopathological changes in chorionic villi. In the present study, minimum age of lady was 15 years and the maximum age was 45 years and the mean age was 25.09±5.58 years at the time of abortion. Among the cases, maximum 69 (62.2%) of them belonged to age group 21-30 years. Correlating the age group with number of abortions was found to be significantly different (Chi-square= 92.35, df= 3, p < 0.001) among four different age groups. Conclusion The histopathological diagnosis of spontaneous abortion will help in further management of the patient. Further study is required to know the cause of different histopathlogical changes in villi as well as in the decidua.

A comparative study between extracorporeal shock wave lithotripsy and ureterorenoscopic lithotripsy in the management of upper ureteric calculus

Introduction and Objective: A stone in the ureter usually comes from the kidney. Urolithiasis is the third most common disease of the urinary tract which is surpassed only by urinary tract infections and pathologic conditions of prostate. There are some controversies on the effectiveness of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URSL) in ureteral stones. We aim to compare the efficacy of ESWL and URSL in the management of upper ureteric stones in terms of stone clearance.Materials and Methods: This prospective hospital based study included patients with upper ureteric calculus managed with URSL with DJ stenting or ESWL at Dhulikhel Hospital-Kathmandu University Hospital from August 2014 to December 2015. Stone size, stone clearance, number of sittings, complications and need of other procedure were recorded.Results: Total number of patients undergone ESWL was 49 and URSL was 48. There was no difference in male/ female ratio, age and stone diameter between two groups (P&gt;0.05). Total stone-free ratio was 85.71%(42/49) for ESWL and 81.25%(39/48) for URSL, partial fragmentation requiring shift of modality of treatment was 12.24%(6/49) for ESWL and 12.5%(6/48) for URSL, failed procedure was 2.04%(1/49) for ESWL and 6.25%(3/48%) for URSL(P= 0.577).Conclusion: ESWL is as effective as URSL in the management of upper ureteric calculus with no significant difference in age, male/female ratio, stone diameter and stone free ratio

Role of Ultrasound as Compared with ERCP in Patient With Obstructive Jaundice

The diagnosis of obstructive jaundice relies on proper history taking, clinical examination, laboratory investigations and different non invasive imaging modalities like Ultrasonography (USG), Cholangio Computed Tomography (CCT), Magnetic resonance Imaging (MRI) with Magnetic Resonance Cholangio Pancreatography (MRCP) and invasive modalities like endoscopic retrograde cholangiography (ERCP) and percutaneous trans hepatic cholangiography (PTC). To compare the role of ultrasound with endoscopic retrograde cholangiography and to determine the major causes of obstructive jaundice in our prospect. This was a prospective, analytical study conducted on 88 patients presenting to Department of Radiodiagnosis and Imaging at Dhulikhel Hospital-Kathmandu University hospital from March 2011 to August 2012 with clinical diagnosis of obstructive jaundice. Sonographic evaluation was performed in Siemens acusion x-150 and x-300. The final diagnosis was made by endoscopic retrograde cholangiography and /or surgery and confirmed histopathologically. The most common benign causes of obstructive jaundice were choledocholithiasis (63%), CBD stricture (12.3%), cholangitis (8%) and pancreatitis (6.85%) whereas cholangio carcinoma (6.85%) and carcinoma head of pancreas (4%) comprised of the malignant causes . Ultrasonography had sensitivity of 100% and specificity of 89% in detecting choledocholithiasis. It was found to be 98.78% sensitive and 83.33% specific in cholangiocarcinoma. Similarly in pancreatitis, the sensitivity of ultrasonography was 97.59% and sensitivity was 66.67%. Ultrasonography acts as a valuable diagnostic imaging modality in detecting the causes of obstructive jaundice. Due to its easy availability, non invasive nature and cost effectiveness, it can be considered as the first line imaging technique/ tool. ERCP is the invasive imaging tool and can be used for both diagnostic and therapeutic purpose.

Post-Operative Drop in Hemoglobin and Need of Blood Transfusion in Cesarean Section at Dhulikhel Hospital, Kathmandu University Hospital

Cesarean section has been identified as one of the commonest indication for blood transfusion in obstetric practice because it involves risk of major intra-operative blood loss. Different figures varying from less than 500 ml to more than 1000 ml have been quoted as estimated blood loss associated with caesarean section. There is also a wide variation in blood ordering practices for this surgery. The objective of this study is to evaluate the blood ordering practice and transfusion for cesarean sections at our institute, to see post-operative drop in hemoglobin and hematocrit and to correlate those parameters with the duration between uterine incision and repair. In this prospective observational study, non-randomised purposive sample was taken from 121 ladies who underwent elective and emergency cesarean section at the department of obstetrics of Dhulikhel Hospital-Kathmandu University Hospital. Post-cesarean drop in hemoglobin and hematocrit and their relation with duration of uterine manipulation was calculated. Cross-match to transfusion (C/T ratio) ratio, transfusion probability (%T) and transfusion index (Ti) were also calculated. Most frequent blood group was found to be O positive (38%) among those ladies. Average post-cesarean drop in hemoglobin was 1.52±1.27 gm/dl and drop in haematocrit was 5.49±4.1%. Post-operative drop in hemoglobin and haematocrit had weak and positive linear relation with duration between uterine incision and repair. Cross-match to transfusion ratio was 1, transfusion probability 100% and transfusion index was 2. There is no need of routine cross-matching of blood for cesarean section. Only grouping with confirmation of availability should be done for emergency situation.

Diabetes mellitus and Urinary Tract Infection: Spectrum of Uropathogens and their Antibiotic Sensitivity

The incidence of urinary tract infections (UTIs) is common in both diabetic and non diabetic patients. Since the microorganisms causing UTI vary in their susceptibility to antimicrobials from place to place and time to time, hence constant screening of trends and susceptibility pattern of predominant organisms against antimicrobials is essential. The study aims to determine the spectrum of ropathogens and antibiotic sensitivity pattern in both diabetic and non diabetic patients with clinically suspected UTI .A prospective cross sectional study was conducted during period of February 2013 to July 2013 among 90 diabetic and 90 non diabetic patients attending Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre (DH-KUH). All samples and isolates were investigated by standard laboratory rocedures. A total of 55 (30.5%) samples showed significant growth. No significant difference among culture positivity rate was noted between diabetic and non diabetic patients (34.5% Vs 26.7%). Escherichia coli was the most frequent organism (64.5% in diabetic and 66.7% non diabetic) followed by Klebsiella sps (22.6% in diabetic and 12.5% in non diabetic). Gentamycin and nitrofurantoin were highly sensitive to E. coli isolated in diabetic patients among the tested antimicrobials followed by otrimoxazole, norfloxacin and ciprofloxacin. Least sensitivity rate was observed with ampicillin and cephalexin. However, no difference was noted on the sensitivity pattern of the antimicrobials among E. coli isolated between diabetic and non diabetic patients. In this study high proportion of gram negative bacilli with predominant uropathogen being E. coli was noted. Irrespective of the status of diabetes, Staphylococcus sps and Pseudomonas sps were not isolated from UTI patients in our study. The isolation of organisms and their resistance pattern was almost similar between diabetic and non diabetic patients.DOI: http://dx.doi.org/10.3126/jmmihs.v1i4.11998Journal of Manmohan Memorial Institute of Health SciencesVol. 1, Issue 4, 2015Page : 24-28

Pattern of thyroid dysfunction in patients with metabolic syndrome and its relationship with components of metabolic syndrome.

BackgroundThyroid dysfunction (TD) and metabolic syndrome (MetS) are known risk factors for atherosclerotic cardiovascular disease (ASCVD). TD is risk factor for ASCVD mediated by the effects of thyroid hormones on lipid metabolism and blood pressure hence the components of MetS. It is possible that coexistence of these two disease entities and unrecognized TD in patients with MetS might substantially increase ASCVD risk. Moreover, little is known about the relationship between TD and the components of MetS. Thus, the purpose of this study was to evaluate the pattern of TD in patients with MetS and its relationship with components of the MetS.MethodsA total of 358 previously diagnosed patients with MetS were recruited in the study. The thyroid function test parameters were measured to classify TD at Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Nepal. Statistical analyses were performed using SPSS version 16.0 to evaluate pattern and relationship.ResultsThe overall prevalence of TD in patients with MetS was 31.84% with high prevalence of subclinical hypothyroidism (29.32%). We found no evidence of a relationship between TD and components of MetS, although there was significant difference in waist circumference between four groups of TD.ConclusionPatients with MetS had subclinical hypothyroidism greatly. Although there was no evidence of any relationship between thyroid status and all components of MetS, TD should be taken into account when evaluating and treating patients with MetS to reduce the impending risk.