Manipal Teaching Hospital Research Articles

Prevalence of Hypovitaminosis D and its Association with Serum Lipids in Patients with Type 2 Diabetes Mellitus

Background Hypovitaminosis D has become worldwide public health concern affecting all age groups and both genders. Its prevalence is very high in South Asia. Many studies reported that vitamin D deficiency is concerned with diabetes mellitus and impaired glucose tolerance. The aim of this research was to find the prevalence of hypovitaminosis D and its association with serum lipids among type 2 diabetic patients.MethodsA cross-sectional study, conducted among a total 162 patients with type 2 diabetes mellitus in Manipal Teaching Hospital, Pokhara. The serum level of FBS, PPBS, urea, creatinine, calcium and phosphorus, HbA1c, TG, TC, HDL-C, and vitamin D levels were measured. In the descriptive categorical data were reported in frequency with percentage and numerical data were presented as mean±SD while in inferential statistics to compare the value student t-test were used. p-value<0.05 was considered as statistically significant.ResultsThe mean±SD serum level of vitamin D was 24.48 ± 13.21 ng/mL in patients with type 2 diabetes. The prevalence of hypovitaminosis D was 69.14% (With 95% CI as 62.02 to 76.25%) and sufficient of vitamin D in 30.86% (With 95% CI as 23.74% to 37.97%) among patients with type 2 diabetes. The serum lipids showed statistically insignificant association between hypovitaminosis D with sufficient of vitamin D.Conclusions This research showed that only in one third of the patients had Vitamin D sufficiency. The serum lipids were slightly increased in patients who had hypovitaminosis D.

Clinical and Laboratory Characteristics of COVID-19 Patients Admitted in A Tertiary Hospital of Nepal

Background COVID-19 disease is a respiratory infection. The symptoms range from mild fever and bodyache to multiple organ dysfunction. It was first seen in Wuhan, China and later infected whole world in a very short period of time. The aim of this study was to find the clinical and laboratory Characteristics of COVID-19 patients admitted in tertiary hospital of Nepal.MethodsThis was a cross-sectional hospital based study conducted at Manipal Teaching Hospital, Pokhara, Nepal. The patients with confirmed COVID-19 were included in this study. Questionnaire was used to collect the clinical data and venous blood samples were collected for laboratory parameters. The numerical data were presented in Mean and SD while categorical data were in frequency and percentage.ResultsThe Major infected patient were male (67.9%). The major symptoms observed were shortness of breath (78.8%), dry cough (54.5%), chill (60.3%), wet cough (16.7%) and headache (25%). 60.9% COVID-19 patients were in moderate stage followed by severe stage (26.3%). The complication noticed were cardiac, bacterial infection, ARDS, septic shock and GI bleeding. The level of blood urea, creatinine, AST, ALT, serum ferritin and CRP were found high in COVID-19 patients. Similarly, the level of sodium, potassium, d-dimer, total protein, albumin, WBC and platelets were found within normal limits.Conclusions The common symptoms in COVID-19 patients were shortness of breath, dry cough, chill and headache. The blood level of AST, ALT, ferritin, CRP, urea and creatinine were high in COVID-19 patients.

Profile of Patients with Seizure Disorders in Adults Presenting to Manipal Teaching Hospital

Background
 Seizures can affect people of all ages, including adults. Symptoms of seizures can vary widely, including muscle convulsions, loss of consciousness, staring spells, confusion, repetitive movements, and sensory disturbances. Seizures can be caused by various factors, such as epilepsy, head injuries, brain infections, stroke, and other medical conditions. Diagnosis typically involves a thorough medical history, neurological examination, and sometimes ancillary tests. Treatment options depend on the underlying cause.
 Methods
 This was a prospective cross‑sectional hospital‑based study conducted on 63 cases presenting with adult onset seizures. Details of the patients of the age of 18 years and above were included and entered as per the structured performa. Statistical analysis was done by SPSS in terms of frequency and percentage.
 Results
 The mean age was with 46.84 years with male gender predominance. Adult onset seizures were most prevalent in the middle‑aged adults than elderly; generalized seizures were more common than focal seizures. Most common neuroimaging finding was infarct followed by neurocysticercosis and intracranial bleed.
 Conclusions
 Identification and awareness about the possible etiological factors and seizure type help in better management of seizure patients.

Combinatorial Effect of Antibiotics on Prevalent Microorganisms Causing Urinary Tract Infection

Introduction: Urinary tract infection (UTI) is a common medical condition of urinary tract detected by the presence of threshold number 105 Colony Forming Unit per millilitre of pathogenic bacteria in the urine. This study aimed to determine the combinatorial effect of antimicrobials on the most prevalent microorganism causing UTI along with antibiotic susceptibility pattern. Methods: Thirty-five bacterial isolates from patients diagnosed with UTI were collected from Manipal Teaching Hospital, Pokhara. The isolates were investigated using Standard Laboratory Procedures followed by Kirby-Bauer disc diffusion method for antibiotic susceptibility test and Double disc diffusion method for combinatorial effect. Results: Out of 35 bacterial isolates, 30 (85.71%) isolates showed resistance pattern to the antibiotics where ampicillin and amoxicillin were the most resistant drug (82.9% each) in 29 isolates and the most sensitive drug was imipenem (82.9%) followed by amikacin (80.0%). The combinatorial effect of antibiotics against resistant isolates was observed using double disc diffusion method in which 10 (33.3%) Escherichia coli isolates out of 30 showed positive result against combination of cefotaxime+amoxicillin, levofloxacin amoxicillin, levofloxacin gentamicin and cefotoxamine+levofloxacin. Conclusion: This study revealed that E. coli, the most prevalent bacteria causing urinary tract infection was highly resistant to ampicillin and amoxicillin. The resistant antibiotics showed positive result in combination with other antibiotics using double disc diffusion method. This study could be useful for future studies in the therapeutic uses of combination of antibiotics.

Analysis of Ear, Nose, Throat and Head & Neck Surgery Consultations and Diagnostic Accuracy in a Tertiary Care Hospital of Western Nepal

IntroductionENT cases are very common accounting for 25-40% of all hospital patient. Subspecialty consultations are a necessary part of comprehensive medical care that provide an opportunity for interactions between doctors and the exchange of knowledge and expertise that helps in quality patient management. MethodsA descriptive cross-sectional study was conducted among patients asked for consultation in the Department of ENT and Head & Neck Surgery, Manipal Teaching Hospital from March 2022 to November 2022. Diagnosis made by ENT surgeon after relevant investigations was recorded. Analysis of diagnostic accuracy by non-ENT surgeons was carried out. ResultsOut of 8019 cases seen in the department of ENT and Head & Neck Surgery from 15th March 2022 to 25th November 2022, 400 cases were asked for consultations. Consultations were more frequently asked from Internal medicine and subspeciality followed by Emergency and Pediatrics department. The most common complaint in consultation sheet was throat pain. The commonest ENT and Head & Neck Surgery diagnosis was Allergic Rhinitis, followed by Presbyacusis and Acute Tonsillitis. Two hundred and twenty cases were asked for consultations with diagnosis from the primary department, out of which 183 had correct diagnosis. Conclusions Different departments do have difficulties in identifying and addressing ENT and Head & Neck Surgery cases and there is benefit from ENT and Head & Neck Surgery consultations. Furthermore, ENT and Head & Neck Surgery consultations do have high educational value for other departments and plays a vital role in patient management.

Study of Serum Uric Acid Levels in Thyroid Dysfunctions

Background: Hyperuricemia in thyroid dysfunctions has been linked to either impaired renal handling of uric acid or overproduction of uric acid. This study aimed to determine the serum uric acid levels in patients with thyroid dysfunction and to determine the link between thyroid dysfunction and hyperuricemia. Methods: This prospective and quantitative study which was conducted at Department of Biochemistry, Manipal Teaching Hospital determined the serum uric acid concentrations of 30 years or older; male or female participants diagnosed with either hypothyroidism or hyperthyroidism. T3 and T4 was determined by chemiluminiscence immunoassay (CLIA) and OCD VITROS dry chemistry analyzer was used to determine serum uric acid level. Data entry and analysis was done using SPSS version 23. Descriptive statistics using frequency with percentage and inferential statistics using non-parametric tests were used. Results: In a total of 100 participants, prevalence of hyperuricemia was 42% (31% in hypothyroidism and 11% in hyperthyroidism). The mean serum uric acid in overall participants was 6.25 ± 2.04 (6.55 ± 1.84 in hypothyroidism and 6.05 ± 1.71 in hyperthyroidism).Significant association was seen between thyroid status and hyperuricemia (p = 0.001).Also, significant difference (p = 0.02) was seen in serum uric acid between hyperthyroid and hypothyroid patients. Conclusion: Higher prevalence rate of hyperuricemia was found among hypothyroid patients than in hyperthyroid subjects, and a significant association was found between thyroid dysfunction and hyperuricemia. This indicates need for more research to further uncover the mechanisms underlying it.

Maternal Complications and Perinatal Outcome in The Booked and Unbooked Cases of Pregnancy at Manipal Teaching Hospital

Introduction: The use of prenatal care prevents maternal complications and perinatal adverse outcomes by early identification of high risk pregnancies, assessment of growth and well being of the fetus, prompt diagnosis and management of complications, with safe delivery.
 Objectives: This study aims at comparing the obstetrical complications and perinatal outcomes in delivered booked and unbooked mothers to determine the correlation of booking status and maternal and perinatal outcome.
 Methodology: In this prospective study, 350 patients admitted for delivery at Manipal Teaching Hospital, Pokhara during March 2014 to May 2015 were included. Antenatal complications of the mothers, postnatal complications, neonatal outcome and the mode of delivery were compared amongst the booked and unbooked cases.
 Results: There was an increased prevalence of preeclampsia (6.3% in unbooked vs. 1.6% in booked); eclampsia (2.5% in unbooked vs. nil in booked); antepartum haemorrhage (5.06% in unbooked vs. 2.1% in booked); Preterm premature rupture of membrane (5.1% in unbooked vs. 2.1% in booked); Rh-isoimmunization (06% in unbooked vs. nil in booked); Intrauterine growth restriction (5.7% in unbooked vs. 3.6% in booked ); and Intrauterine fetal death (7.6% in unbooked vs. 0.5% in booked) in unbooked mothers as compared to booked mothers. The unbooked mothers were prone to postpartum hemorrhage (6.9% vs 2.6% in booked mothers). Assisted breech delivery and ventouse delivery were recorded higher in unbooked cases than in booked case (3.2% vs. 0.5% and 3.8% vs. 3.1% respectively).
 Conclusion: The poorer maternal and fetal outcome in unbooked cases in comparison to booked cases can be reduced with the best utilization of the prenatal care.

Prevalence of Bacterial Vaginosis in Preterm Labour and Its Fetal and Maternal Outcome

Introduction: Preterm births accounts for about 11.1 % of births worldwide. Infection accounts for 20% – 40% of these cases and Bacterial vaginosis has been found in 15 % of preterm labor group.
 Objective: To find the prevalence of Bacterial vaginosis among the cases who presented with preterm labour and to determine its maternal and neonatal outcome.
 Methodology: A prospective cross- sectional analytical study on 100 preterm labour cases conducted over a year in the obstetric ward in Manipal Teaching Hospital. Three high vaginal swabs from posterior fornix were taken and tested in Microbiology laboratory. The maternal and neonatal outcome of women with preterm labour due to bacterial vaginosis were noted. The data were analyzed using SPSS 21. Chi2 test was used for comparing maternal and neonatal complications positive or negative with Bacterial Vaginosis.
 Results: In the study period, 584 women had preterm deliveries. The total deliveries during that period was 2,531. The prevalence of Bacterial vaginosis in PTB was found to be 17 %.The accuracy of Gram stain was found to be 90% (sensitivity-57%, specificity-92%, PPV-36%, NPV-96%). The accuracy of wet mount was 90 % (sensitivity-42.85%, specificity-93.5%, PPV-33.3%, NPV95.6%). There were increased cases of chorioamnionitis among women who were BV positive (p-value=0.02). Newborn born to women with BV positive had increased chance of poor Apgar score at 5 minutes (p-value <0.05).
 Conclusion: Maternal and neonatal complications were more common in women with preterm labour associated with Bacterial Vaginosis. Gram stain and wet mount are fairly accurate and can be used as an adjunct to culture for the diagnosis of Bacterial Vaginosis.

Hearing loss: an unusual presentation of neurobrucellosis: a case report

IntroductionBrucellosis is a zoonotic disease, caused by a Gram-negative coccobacillus of Brucella genus, transmitted to humans by animals, especially cattle. It rarely involves the nervous system (neurobrucellosis); only a few cases present with hearing loss. We report a case of neurobrucellosis, that presented with bilateral sensorineural hearing loss and mild to moderate persistent headache. To the best of our knowledge, this is the first well-documented case from Nepal.Case presentationThe patient was a 40-year-old Asian male shepherd from the western mountainous region of Nepal who came to the emergency department of Manipal Teaching Hospital, Pokhara in May, 2018 and did a follow-up for 6 months. He presented with high-grade fever, profuse sweating, headache, myalgia, and bilateral sensorineural hearing loss. His history of consuming raw milk of cattle, symptoms including persistent mild to moderate headache, bilateral hearing loss, and serological findings were suggestive of neurobrucellosis. Following treatment, the symptoms improved, including the complete recovery of hearing loss.ConclusionHearing loss may be the manifestation of neurobrucellosis. Physicians should know about such presentations in brucella endemic areas.

Evaluation of Cesarean Deliveries by using Ten Group Classification System in a Tertiary Care Centre: A Cross-Sectional Study

Introduction: Cesarean section has three times increased risk of maternal and fetal morbidities compared to vaginal delivery. The rising trend of cesarean deliveries across the globe led the WHO to recommend the use of the Ten Group classification system to monitor cesarean rate over time as well as between facilities. The cesarean section rate is increasing in our centre, so the study was conducted to evaluate the cesarean deliveries and identify the group with a major contribution to the cesarean rate so that policies could be formulated to decrease it in our centre.
 Method: It was a cross-sectional descriptive study conducted in the Department of Obstetrics and Gynecology, Manipal Teaching Hospital, Nepal for six months after ethical approval. All women who delivered at or beyond 28 weeks were included in the study after their consent and were classified according to Robson's classification based on their obstetric parameters. The total cesarean section rate, the size of each group, the cesarean rate in each group and the absolute contribution of each group to the overall cesarean rate were calculated and analyzed.
 Results: Out of 711 deliveries during the study period, the cesarean rate was 51% (n=362). Group 1(26%) was the major obstetric population followed by Group 3(20%) and Group 2(16%). Group 5(10.97%) had a major contribution to the overall cesarean rate followed by Group 1(10.68%) and Group 2 (9.7%).
 Conclusion: The cesarean rate in our study was high and it could be decreased by encouraging the trial of labor after cesarean and revisiting the indication of induction and cesarean in Group 1 and Group 2.

Antibiotic Resistance Patterns of Bacterial Pathogens Associated with Lower Respiratory Tract Infections

Introduction: Respiratory tract infections are one of the most common and serious health problems in developing countries. Increasing incidences of multidrug-resistant isolates from cases of lower respiratory tract infections have been reported. This study was conducted to determine the bacterial pathogens associated with lower respiratory tract infections with their antibiotic resistance pattern in a tertiary care hospital in Western Nepal.
 Methods: This hospital-based cross-sectional study was conducted among patients of Manipal Teaching Hospital, Pokhara, Nepal, from August 2022 to October 2022. A total of 376 specimens from the lower respiratory tract were included in this study. Processing of samples, isolation, identification and antibiotic sensitivity test of the bacterial pathogens was performed by standard methods.
 Results: Respiratory pathogens were recovered in 68 samples. Gram-negative bacteria were isolated in 55 cases and Gram-positive bacteria in 13 cases. Acinetobacter species (42.6%), Staphylococcus aureus (16.9%) and Pseudomonas aeruginosa (13.9%) were the three most common pathogens isolated. The majority of the Gram-negative isolates were susceptible to tigecycline and colistin. Among S. aureus isolates, 54.5% (6/11) were methicillin-resistant Staphylococcus aureus.
 Conclusion: Gram-negative bacteria were predominantly associated with lower respiratory tract infections with Acinetobacter species as the most common pathogen. Increasing antibiotic resistance was recorded among the pathogens and is alarming. Regular surveillance of pathogens and antibiotic resistance patterns is needed for better management of the patients.

CORRELATION OF SERUM ELECTROLYTES IN PATIENTS WITH THYROID DYSFUNCTION

Background: The thyroid hormone is a central regulator of body functions; disorder of thyroid functions is considered to cause electrolytic disorders. Thus the main objective of this study is to assess the correlation of thyroid dysfunction with serum electrolyte levels. Methods: In this prospective cross-sectional study,100 patients who attended Manipal Teaching Hospital having thyroid hormones disarrangement were included. Estimation of serum electrolytes were also done in those patients. Patients with subclinical hypothyroidism and subclinical hyperthyroidism were excluded. Thyroid hormones were estimated by electrochemiluminiscence immunoassay (eCLIA) and Serum sodium and potassium was estimated by ion selective electrode (ISE) method. Data was entered and analyzed using SPSS 23 by Spearman’s correlation test and Chi square test. A p-value of < 0.05 was considered as statistical significance. Results: The 75% of total patients were found to be having hypothyroidism and 25% to have hyperthyroidism. Spearman’s correlation coefficient for Na+ and K+ vs fT3, fT4 showed positive correlation (p-value<0.001) and Na+ and K+ vs TSH showed negative correlation. There was significant association between Na+ and thyroid hormones (p-value<0.001) but no association between K+ and thyroid hormones. (p-value>0.001). Conclusions: The current study reveals that decrease in thyroid hormones may lead to hyponatremia. Knowledge of this significant association will be worthwhile value for clinicians, to manage their patients optimally.

Analysis of the Factors leading to Severe Acute Maternal Morbidity and Maternal Mortality during COVID 19 Pandemic

Aims: To determine prevalence, causes and factors leading to severe acute maternal morbidity and mortality during COVID 19 pandemic.
 Methods: The was a cross sectional observational study conducted in the department of Obstetrics and Gynaecology of Manipal teaching hospital from March 2020 to February 2022 amid COVID 19 pandemic. Women who sustained severe acute maternal morbidity (according to World health organization organ system criteria) and maternal deaths during pregnancy, labour and six weeks postpartum were included. Maternal characteristics, total live births, pregnancy outcome, causes and factors leading to morbidity and mortality were noted. The acquisitioned data was analyzed using Statistical Package for Social Sciences version 21.
 Results: There were 37 cases of severe acute maternal morbidity and 2 cases of maternal deaths. The severe acute maternal morbidity ratio was 9.4 per 1000 live births and maternal mortality ratio was 51 per 100,000 live births. Therefore, severe acute maternal morbidity mortality ratio was 18.5:1 and mortality index 5.1%. Haematological and coagulation system (45.9%) and neurological system (29.7%) were the common organ systems involved. Hypertensive disorders (40.5%) and haemorrhage (32.4%) were the main causes of severe acute morbidity. Both maternal deaths occurred due to eclampsia. There was no severe acute maternal morbidity or mortality due to COVID infection in pregnancy. Delay in seeking and reaching to the health centre (65%) was major delay leading to severe morbidity and mortality.
 Conclusions: Indices and causes of severe acute maternal morbidity and mortality during COVID 19 pandemic was not worse compared to those prior to COVID 19 pandemic. Primary delay in seeking and reaching health care was the main factor leading to severe morbidity and mortality.

Comparative evaluation of geneXpert MTB/RIF assay and Ziehl-Neelsen staining for the diagnosis of tuberculosis

Background: Ziehl-Neelsen (ZN) staining for the diagnosis of tuberculosis is frequently used. Since ZN smear technique has poor sensitivity, molecular tool like GeneXpert assay have recently been introduced in Nepal. This study compared GeneXpert MTB/RIF assay with ZN stain microscopy for the diagnosis of tuberculosis. Objectives: To compare and evaluate GeneXpert MTB/RIF assay and Ziehl-Neelsen staining for the diagnosis of tuberculosis. Methods: An analytical observational study was conducted in Manipal Teaching Hospital, Pokhara from February 2020 to August 2021 after ethical clearance. A total of 355 clinical specimens (Sputum, Broncho-alveolar lavage, pus, lymph node aspirate etc) were collected and processed for Zeihl-Neelson staining and GeneXpert assay as per the recommended guidelines. Results: Zeihl-Neelson staining detected acid-fast bacilli (AFB) in 17 (4.78%) specimens, while GeneXpert assay showed positivity in 37 (10.42%). All the 17 smear positive sputum samples yielded positive result by GeneXpert also. AFB were not detected in any of the 318 samples negative by GeneXpert. Fifteen (83.3%) of the 18 specimens that showed high to medium density of bacilli by GeneXpert were positive by Ziehl-Neelsen staining. Only two (10.5%) of the 19 specimens with low bacillary density by GeneXpert were positive by Ziehl-Neelsen Staining. These differences were statistically significant (p <0.001). Out of 37 positive specimens, one yielded rifampicin resistant Mycobacterium tuberculosis. Conclusion: ZN smear, though, rapid, lacks sensitivity. GeneXpert, on the other hand, can be relied upon, as it detected significantly higher number of cases, demonstrated bacillary density and drug resistance.

Association between clinical, radiological, and hematological profile of children with pneumonia

Background: Patients with pneumonia present with varying symptoms, X-ray features and changes in the blood parameters. Objectives: To find out the association between clinical, radiological, and haematological profile of children with pneumonia. Methods: An analytical cross-sectional study was conducted in 130 children aged two to 60 months admitted to the paediatric ward of Manipal Teaching Hospital, who were chosen by convenience sampling technique from December 2019 to November 2020, and clinical, radiological and haematological parameters compared. The observed data were analysed using SPSS 20. Results: . Of the 130 children studied, 80 (61.5%) were male and 50 (38.5%) were female. History of prior admission for respiratory illness was seen in 75 (57.7%) patients Bronchopneumonia was seen in 72 (55.4%) patients and lobar pneumonia in 37 (28.5%) patients. Cough 122 (93.8%), Noisy breathing 86 (66.15%), Fever 70 (53.84%) and Fast breathing 67 (51.54%) were the most common presenting complaints. Patients with lobar pneumonia were more likely to present with fever than those with Bronchopneumonia (p-value 0.015). Those with history of prior admission were more likely to present with wheeze (p-value 0.035) and crepitations (p-value 0.024) than those admitted for the first time. Also, those presenting with crepitations as lung finding, were found to present with significantly lower total White blood cells (WBC) counts (p-value 0.012). Conclusion: There seems to be a significant association between fever as presenting complaint and lobar pneumonia. Also, those with history of prior admission are more likely to have lung signs (wheeze/crepitations) at presentation.

A prospective study comparing the efficacy of proximal femoral nail antirotation device with dynamic hip screw fixation in management of unstable pertrochanteric fractures

Background: Pertrochanteric femoral fracture is the most common fractures of the hip especially in the elderly patients with osteoporotic bone, usually due to low-energy trauma like simple falls. Dynamic hip screw (DHS) is still considered the gold standard for treating such factures. Not many studies compare DHS with Proximal Femoral Nail Antirotation (PFNA). We try to compare the efficacy of PFNA with DHS in management of unstable pertrochanteric factors. Aims and Objectives: We aimed to evaluate and compare the clinical and functional outcomes of DHS and PFNA treatment of unstable pertrochanteric femoral fractures in elderly patients. Materials and Methods: This study was a prospective study which included total of 39 patients, 25 patients treated with PFNA and 14 patients with DHS. The study was conducted in Manipal Teaching Hospital from March 1, 2019, to August 1, 2021. All the patients were clinically evaluated and detail history was obtained. After the anesthesia clearance, the patients were operated. Length of skin incision, operating time, intraoperative blood loss, and complications were noted. Postoperatively, the duration of hospital stay, time of partial and full weight-bearing, time for radiological union, and complications were noted. Functional outcome was assessed using Harris hip score at 3 months and 6 months follow-up. Results: The mean age of the patient in this study was 74.68 years for PFNA and 75.57 years for DHS. The average time to complete the surgery was 71 min for PFNA and 92.86 min for DHS. The average blood loss was 162 ml for PFNA and 403 ml for DHS which was found to be statically significant. Partial weight-bearing on axillary crutches was started at the mean time of 3.7 weeks for PFNA and 8.1 weeks for DHS, whereas full weight-bearing was done at the mean of 8.2 weeks for PFNA and 12.1 weeks for DHS. Radiological union was seen at the average of 18.72 weeks for PFNA and 20.14 weeks for DHS which was not statically significant. The mean Harris Hip score at 3 months and 6 months follow-up was 63.84 and 88 for PFNA and 48.50 and 81.43 for DHS, respectively, which showed significantly better result with PFNA. Conclusion: Compared to DHS treatment, PFNA treatment in unstable pertrochanteric femoral fracture is associated with reduced blood loss, shorter operative time, and hospital stay with few intraoperative and post-operative complication. Post-operative rehabilitation with the early mobilization and return to pre-injury status was better with PFNA.

Prescribing Pattern of Antibiotics in Respiratory Tract Infections in the Pediatric Indoor Patients at Manipal Teaching Hospital

Introduction: Respiratory tract infections are the most frequently occurring illness in childhood and antibiotics are the key drugs for its treatment which account for three-quarters of all antibiotics prescriptions. Injudicious use of antibiotics leads to the development of resistance, patients are at high risk for opportunistic infections or prolonged hospitalization. This study aimed to assess the prescribing pattern of antibiotics for respiratory tract infections in the pediatric indoor patients of Manipal Teaching Hospital.
 Methods: This study is a prospective cross-sectional study done in the paediatrics ward of Manipal Teaching Hospital Pokhara, conducted for six months. Patients aged range from 1 day to 14 years who meet the inclusion criteria were taken in this study. Data were collected from the inpatient ward and analysed using various statistical tools.
 Results: Among 170 patients, a maximum(43.3%) were in the age group of 1 day to 11 months with male predominance(74.1%). Bronchopneumonia was the most common respiratory tract infection (51.8%) followed by bronchiolitis (13%). Chest x-ray was done in all patients however blood culture was done only in 60.6% and an antibiotic sensitivity test (27.6%) before prescribing antibiotics. Cefotaxime was prescribed in maximum patients (62.4%) followed by ceftriaxone (17.1%). All the patients received at least one antibiotic by i.v route during the hospital stay.
 Conclusion: Since culture and sensitivity tests were not carried out on most of the patients before prescribing antibiotics in this study, which might lead to an increased chance of bacterial resistance and treatment failure in the future.

Role of the American College Of Radiology –Thyroid Imaging Reporting and Data System (ACR TI-RADS) in Differentiating Benign and Malignant Thyroid Nodules

Introduction: Thyroid nodule is commonly detected while performing an ultrasound of the neck. American College of Radiology, Thyroid imaging reporting and data system (ACR-TIRADS) is a classification used to characterize thyroid nodules based on ultrasound findings. The objective of this study is to evaluate the role of ACR-TIRADS classification in differentiating benign and malignant thyroid nodules.
 Methods: This is a prospective study conducted at Manipal Teaching Hospital. A total of 70 patients presenting to our radiology department for fine needle aspiration cytology (FNAC) of thyroid nodule were enrolled in the study. Thyroid nodules were grouped as 1- 5 according to the ACR-TIRADS. The ACR-TIRADS findings were correlated with FNAC and or biopsy findings as available. Subsequently; sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ACR-TIRADS in differentiating benign from malignant nodules were assessed.
 Results: Mean age of patients in our study was 52.16 years (18-89 years). Male patients were 11 (15.7 %) and female were 59 (84.30 %). According to Ultrasonography; 1.4% of thyroid nodules were labelled as ACR-TIRADS 1; 21.4% as ACR-TIRADS 2; 32.85% as ACR- TIRADS 3; 28.6 % as ACR-TIRADS 4 and 15.7 % as ACR-TIRADS 5. ROC curve analysis showed AUC of 0.78 (95% CI). ACR-TRIADS had sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy of 87.5%, 68.5 %, 45.16 %, 94.87 %, 72.86 % respectively.
 Conclusion: ACR- TIRADS has high sensitivity and accuracy in differentiating benign and malignant thyroid nodules.

Validation of TIMI risk score for STEMI patients visiting a tertiary care hospital of western Nepal

Introduction: Cardiovascular disease is the leading cause of death globally, and ST elevation myocardial infarction remains main contributor to this mortality. Thrombolysis in myocardial infarction risk score which was derived from randomized clinical trials has been validated in non-selected western patient populations. The objective of this study was to find out the applicability of Thrombolysis in myocardial infarction risk score in our study population. Methods: A prospective observational study was conducted in admitted patients of cardiology unit, Manipal teaching hospital from February 25, 2020 to December 31, 2021. All consecutive patients admitted with diagnosis of acute ST elevation myocardial infarction were selected. Patients admitted with diagnosis of ST segment elevation myocardial infarction and undergone either primary, rescue or elective coronary reperfusion therapy were included for analysis. Results: Total of 339 cases with mean age of 60.62 ±12.64 were diagnosed to have acute ST elevation myocardial infarction and undergone coronary reperfusion therapy. Nearly two third cases were male and majority (61.35%) cases were below age of 65 years. Age of 65 years and above, Killip class III-IV [OR:20.54 (CI: 8.63–48.87), p<0.001], low HDL [(OR:0.481 (CI: 0.23 – 0.97) p= 0.038], heart rate >100 beats/ min [(OR: 5.79 (CI: 2.81 – 11.92), p<0.001] and anterior wall involvement [(OR: 2.8 (CI: 1.39–6.41), p=0.004] were significantly associated with 30 days mortality. Conclusions: Thrombolysis in myocardial infarction risk score is applicable in clinical practice for better risk stratified treatment in our setting.

Anatomical Variation of Colon Detected on Abdominal Computed Tomography Correlated with Gender

Introduction: Anatomical variation of the colon can cause diagnostic dilemmas and pose a problem while radiological interpretation and during various procedures. Radiologists and clinicians should exert much caution during the procedures in such patients. This study was done to study the anatomical variation of the colon in abdominal CT scans and correlated the variations with gender. 
 Methods: It was a cross-sectional study done at the Department of Radiology and Imaging of Manipal Teaching Hospital from September 2020 to March 2021. Abdominal CT was obtained and colonic position was evaluated. The Chi-square test was applied to assess the correlation between colonic variations and gender.
 Results: There were 388 patients in total. The age of the patients ranged from 3 years to 94 years. The mean age of the patients was 44.8±18.6 years. There were 166 (42.8%) females and 222 (57.2 %) males. Out of 388 patients, 170(43.8) had some colonic anatomical variations. Sixteen (4.1%) patients had retro gastric colon. Around 6% had a right retrorenal colon and 30(7.7%) had a left retrorenal colon. Seven (1.8%) patients had anterolateral hepatodiaphragmatic interposition. Forty-two patients (10.8%) had high positioned caecum. The redundant sigmoid colon was present in 38(9.8%) patients. There was no significant correlation between the colonic variation and gender.
 Conclusion: Different variations in the colon exist even in the Nepalese population, of which the radiologists, as well as the surgeons, should be aware.