Manipal Teaching Hospital Research Articles

Effects of anemia on pregnancy outcomes at Manipal Teaching Hospital

Introduction: Anemia is one of the most common disorders affecting the pregnant women in the developing countries like Nepal. Anemia during pregnancy is commonly associated with adverse pregnancy outcomes. Identifying anemia in pregnancy and knowing its common complications will help improve maternal quality care.
 Objectives: The objective - was to assess the effects of anemia on pregnancy outcome at Manipal Teaching Hospital
 Methodology: This cross sectional study was conducted in Manipal Teaching Hospital from September 2019 to April 2020. A total of 200 anemic pregnantladies attending obstetrics Out Patient Department were selected.Hemoglobinlevel was taken as criteria for deciding anemia and to classify severity of anemia.Anemia in pregnancy is defined by World Health Organization as hemoglobin level less than 11 gm/dl, and hemoglobin concentration of 10–10.9 g/dl, 7–9.9 g/dl, and <7 g/ dl was considered as mild, moderate, and severe anemia, respectively . All were treated depending on severity of anemia and followed up for maternal and perinatal outcome.Data was collected in Microsoft Excel and analyzed by using SPSS version 16.
 Result: We found moderate anemia in 129 (64.5%) cases followed by mild in 61(30.5%) and severe in 10(5%) cases. Common maternal complications in anemic patients werepremature rupture of membranein 30 (15%) cases and Urinary Tract Infection in 30(15%) cases.During puerperiumPostpartum Hemorrhage was observed in 12(6%) and wound infection in 9 (4.5%) cases of anemic patient. High incidence of adverse fetal outcome in the form of preterm in 39 (19.5%), Intrauterine growth restrictionin 23(11.5%), Intensive Care Unitadmission in28(14%),low birth weight in41(20.5%) and Intrauterine Death in4(2%) cases of anemic patients were seen.
 Conclusion: Maternal infection and adverse perinatal outcome in form of intrauterine growth restriction, Intensive Care Unitadmission, low birth weight and perinatal death were significantly associated with anemia in pregnancy.

Correlation between Expulsion of Distal Ureteric Calculus with CRP Level, WBC Count and Neutrophil Percentage among the Patients attending on Manipal Teaching Hospital, Pokhara (Retrospective Study)

Introduction: Urolithiasis is a common medical diagnosis that doctor encounters in the outpatients and emergency departments. The prevalence of renal stone disease has increased steadily over the past decades. There are different modalities of treatment of ureteric calculus. However, most of the distal ureteric calculus passes spontaneously thus the application of invasive procedure at the early stage can be considered overtreatment.Methods: The 68 patients of the surgical department, Manipal teaching hospital, Pokhara, with distal ureteric calculus of ≤ 8mm, who were under the treatment Tamsulosin Hydrochloride 0.4mg once daily for 2 weeks or till the expulsion of stone from 1st October 2017 to 30th September 2018 (one year period) were retrospectively evaluated for the spontaneous stone expulsion rate and its association with serum CRP level, WBC count and Neutrophil percentage. The patients were divided into 2 groups i.e. spontaneously ureteric stone expelled group and non expelled group. Furthermore, for statistical analysis, each group were subdivided according to normal and elevated serum CRP level, white blood cell count and neutrophil percentage. The associations between these factors and ureteral stone passage were then examined.Results: Most of the cases were in the age group of 21-40 years with the mean age of 40.09 ± 16.11, where 57.4% of patients were male. Among all mean duration of symptoms was 6 days. The ratio of left to right stone was 1.26:1. Out of 68 patients, 80.9% of the patient’s distal ureteric stone was passed out spontaneously with medical expulsion therapy. There were statistically significant (p<0.001) association between normal serum CRP level, White cell counts and neutrophil percentage with the expulsion of distal ureteric calculus with size ≤ 8mm.Conclusion: There is a higher expulsion rate of distal ureteric calculus of size ≤ 8mm with the patient of the normal level of serum CRP level, White cell counts and neutrophil percentage than that of abnormal level.

Pre-existing Corneal Astigmatism in patients undergoing Cataract Surgery in Western Nepal; A hospital-based Unicentered, Comprehensive, Prospective Observational Study

Introduction: Cataract surgery is one of the most commonly performed surgical procedures worldwide. The final postoperative visual acuity is dependent on the pre-existing corneal astigmatism, accurate biometry and surgically induced astigmatism. Because of the increase in the patient’s demand for better postoperative visual acuity, it becomes important to evaluate the distribution of pre-existing corneal astigmatism in different populations. The objective of the study was to analyze the magnitude and pattern of pre-existing corneal astigmatism in cataract surgery patients in Western Nepal.Methods: A hospital-based cross-sectional descriptive study was carried out in the Department of Ophthalmology, Manipal Teaching Hospital, Pokhara. Three hundred and two patients undergoing routine cataract surgery between February 2016 and January 2018 were recruited in the study. Keratometric data from these patients were collected and were analyzed using the statistical software SPSS version 21.Results: The mean age of the subjects was 70.25 ± 10.97 years (range 35 to 94 years). There was a preponderance of females (62%) over males (38%). The mean corneal astigmatism was 0.78 ± 0.59 D (range 0.00 to 5.00 D). The pre-existing corneal cylinder ≥ 1.00 D was seen in 40.06% of patients. The corneal astigmatism was mainly against the rule (65.56%). The amount of corneal astigmatism and corneal steepness increased with age.Conclusion: Corneal astigmatism of 1.00 D or more was seen in 40.06% of the patients undergoing cataract surgery which should be corrected to meet the patient’s expectation for good, unaided visual acuity after cataract surgery.

Uremic Pruritus and associated factors in Chronic Dialysis Patients: An Observational Study in Western Nepal

Introduction: Pruritus is one of the well-recognized major skin derangements in patients with advanced renal failure and are usually without visible skin lesions. Only few studies have addressed this issue in Nepalese population.
 Objective:.The present study aims to identify the prevalence and associated factors of uremic pruritus in chronic dialysis patients in western Nepal.
 Methodology:A prospective observational study was conducted to include all chronic dialysis patients with uremic pruritus at the Manipal Teaching Hospital, Pokhara, Nepal over a period of one year (June 2018 and May 2019).
 Results: During the study period, a total of 59 patients were included in the study with mean age of 55.8±15.8years,of which 37 (63%) patients developed uremic pruritus.
 Statistically significant relationship betweenpresence of pruritus and pruritus severity with frequency of itching grade and sleep disturbance score among elderly (p=0.001) were observed
 The serum urea can predict uremic pruritus among elderly patients with a good diagnostic value. The multivariate analysis showed male gender, hypertension, elevated serum albumin and random blood sugarwere independent predictors of pruritus in patients undergoing chronic dialysis.
 Conclusions: Our findings demonstrate that higher proportion ofpatients undergoing chronic dialysis werediagnosed with uremic pruritus (63%) and occurrence of pruritus had association with frequency of itching grade and sleep disturbance score .The serum levels of urea may predict the occurrence of pruritus among elderly patients.Furthermore, a large multicenter study is warranted with longer follow up which may provide robust information on the burden of pruritus and its associated factors to guide appropriate management among elderly.

Fluoroquinolones Resistance Among Bacterial Uropathogens In A Tertiary Care Hospital Of Western Nepal

Introduction: Urinary tract infections are one of the most common clinical illnesses in developing countries. Most of the infections are treated empirically due to unavailability of laboratory facilities. Fluoroquinolones are frequently used for empirical treatment of UTIs.
 Objectives: This study was aimed to determine prevalence and antibiotic resistance pattern of bacterial uropathogens, especially to fluoroquinolones.
 Methodology: This hospital based cross sectional study was carried out at Manipal Teaching Hospital, Pokhara, Nepal. A total of 2450 mid stream urine samples were included in this study. Isolation, identification and antibiotic susceptibility testing of the isolates was performed by standard microbiological techniques.
 Results: Significant bacteriuria was detected in 258 (10.5%), insignificant bacteruria in 614 (25%), growth of multiple organisms in 238 (9.7%) while no growth was recorded in 1340 (54.7%) samples. E coli was the commonest isolate followed by Klebsiella species. Fluoroquinolones resistance among Gram negative isolates was high. Most of the Gram negative isolates were susceptible to amikacin, gentamicin, nitrofurantoin and imipenem.
 Conclusion: High resistance to fluoroquinolones, cotrimoxazole and cephalosporins dictates these to be unsuitable for empirical treatment of UTIs. Amikacin, gentamicin, nitrofurantoin and imipenem were the most effective antibacterials.

Drug therapy and cost analysis of urinary tract infections in a tertiary care teaching hospital in Nepal

<p class="abstract"><strong>Background:</strong> Urinary tract infection (UTI) is the most common infection caused by the presence and growth of pathogenic microorganisms within the human urinary system into the lower and upper genito-urinary tract. UTI continues to be major health problems in developing countries like Nepal.</p><p class="abstract"><strong>Methods:</strong> A prospective observational study was conducted from June 2019 to November 2019 in the outpatient and inpatient department of Manipal teaching hospital. The face-to-face interview was adopted in 137 UTI patients with the census sampling technique. </p><p class="abstract"><strong>Results:</strong> A total of 137 patients (121 out-patients and 16 in-patients), 82 (59.85%) female, and 55 (40.15%) males were enrolled in which UTI was observed in more than half of the sample in the aged group of 25-54. <em>Escherichia coli</em> was the most common uropathogens isolated whereas dysuria was the most common presenting symptom among the patients. Cefixime 200 mg followed by nitrofurantoin 100 mg was the most commonly prescribed medicine for UTI. Disodium hydrogen 1.40 g oral liquid, pantoprazole 40 mg tablet, and multivitamins were commonly prescribed supportive medications. The empirically prescribed average cost was Nepalese rupee (NRs.) 820.44 whereas the total definitive average cost was NRs. 305.54. The average cost of medical management for in-patients was NRs. 2316.55 including registration, urine analysis, investigation bed charge, and other consumable charges as well as discharge medicine cost.</p><p class="abstract"><strong>Conclusions:</strong> With lower cost, higher sensitivity, and high prescription, cefixime, and nitrofurantoin could be better drugs for the management of UTI among outpatient department (OPD) patients while ceftriaxone could be better for in-patients.</p><p> </p>

STUDY OF METABOLIC SYNDROME IN SCHIZOPHRENIC PATIENTS TREATED WITH ANTIPSYCHOTICS

Background: There are limited data on the prevalence of metabolic side effects with the anti­psychotic drugs in Nepal. The objective was to study the prevalence of metabolic syndrome in schizophrenia patients treated with antipsychotics drugs. The second objective was to test the relationship of metabolic syndrome with different socio-demographic and clinical variables Methods: This was hospital based cross sectional study conducted in the outpatient’s unit of De­partment of Psychiatry, Manipal Teaching Hospital, Pokhara. Ethical approval was taken from the Institutional Review Committee of Manipal College of Medical Sciences, Pokhara. A total of 60 patients (age between 16 and 65 years) who had fulfilled the diagnostic criteria of schizophrenia according to International Classification of Disease – 10 guidelines and who had taken a single antipsychotic drug for at least 6 months were enrolled after taking informed written consent. Data were collected from April 2020 to July 2020.Patients were diagnosed to have metabolic syndrome according to adapted National Cholesterol Education Program Adult Treatment Panel III criteria by the American Heart Association (NCEP ATP III-A). Data entry and analysis was done using SPSS ver­sion 16.0. The statistical method used were percentage and chi-square test. Results: The prevalence of metabolic syndrome was 30%. There was association of metabolic syn­drome with socioeconomic status. There was no statistical association of metabolic syndrome with gender, residence, type and duration of antipsychotics use. Conclusions: The prevalence of metabolic syndrome was high. Therefore, proper monitoring of metabolic syndrome and adequate treatment of cardio-metabolic risk factors are required for op­timum long-term management.

Evaluation of the Appendicitis Inflammatory Response Score against Alvarado Score in Diagnosis of Acute Appendicitis

Background Patients presenting with suspected appendicitis pose a diagnostic challenge. Various scoring systems have been designed to aid in the clinical assessment of these patients. Widely applied was Alvarado score and best performed in validating studies, but was observed with few drawbacks. Appendicitis inflammatory response (AIR) score was designed to overcome the drawbacks associated with the implementation of Alvarado scoring system. Objective The main objective of this study was to evaluate the Appendicitis inflammatory Response Score and compare its performance in predicting risk of appendicitis with the Alvarado score. Method Appendicitis inflammatory response score and Alvarado scores were calculated prospectively on patients suspected of acute appendicitis presenting to Manipal Teaching Hospital, Pokhara, Nepal between July 2017 and June 2019. Diagnostic performance of the two scores was compared. Statistical analysis was done using SPSS 21 and p value < 0.05 was considered significant. Result The study included 217 patients with 109 (50.2%) males and 108 (49.8%) females. The mean age of patients was 25.77±15.54. The results analyzed showed better sensitivity of Appendicitis Inflammatory Response score (96.91%) as compared to 94.30% of Alvarado score. The positive and negative predictive values of Alvarado score were 74.87% and 50%, as compared to 79.70% and 72.20% for AIR score. Furthermore, the area under receiver operating curve of the appendix inflammatory response score was better (0.701) than that of Alvarado score (0.580). Conclusion Appendicitis Inflammatory Response (AIR) scoring performed well and more accurate than Alvarado scoring system with high specificity and high negative predictive value preventing negative appendectomies.

Study of prescription of injectable drugs and intravenous fluids to inpatients in a teaching hospital in Western Nepal

Unnecessary, excessive and poor injection practices in the South East Asia region (including Nepal) have been observed previously. The authors aim to study prescription of injectable drugs to inpatients in a teaching hospital in Western Nepal. Prescription of injectable drugs (IDs) and intravenous fluids (IVFs) to inpatients discharged from the wards of the Manipal Teaching Hospital during 1st January to 30th June 2006 was studied. The mean number of drugs, IDs and IVFs administered, median cost of drugs and of IDs/IVFs per prescription calculated. Comparison of ID/IVF use in the four major hospital departments (Medicine, Obstetrics and Gynecology, Pediatrics and Surgery) was done. The administration of IDs/IVFs and injectable antimicrobials were measured in Defined Daily Dose (DDD)/100 bed-days and of Intravenous fluid in Liters (L)/100 bed-days. Of the 1131 patients discharged, 938 (82.94%) patients received one or more IDs/IVFs. The mean number of drugs, IDs and IVFs prescribed were 8.75, 4.72 and 1.42. Median cost of drugs and IDs/IVFs per prescription were 8.26US$ and 5.12US$ respectively. IDs/IVFs accounted for 81.37% of total drug cost. The most commonly used ID, injectable antimicrobial and IVF were Diclofenac (19.3 DDD/100 bed-days), Metronidazole (7.68 DDD/100 bed-days) and Dextrose normal saline (8.56 L/100 bed-days), respectively. The total IVF consumption was 24.25 L/100 bed-days. Significant differences between departments were observed (p<0.05). In conclusion, the use of IDs/IVFs was higher compared to other studies. Interventions to improve IDs/IVFs prescribing practices may be required.

Morbidity profile and prescribing patterns among outpatients in a teaching hospital in Western Nepal

Recent studies on prescribing among outpatients in hospitals in Western Nepal are lacking. The main objectives of the study were to obtain information on the morbidity pattern among outpatients and to analyze prescribing using drug use indicators. A retrospective hospital record based study from 01.01.2004 to 31.12.2004 was carried out among individuals attending the outpatient department (OPD) of the Manipal Teaching hospital, Pokhara, Western Nepal. A total of 32,017 new patients attended the OPD during the study period. Systematic random sampling (1 in every 20 patients) was done and 1600 patients selected. After excluding patients visiting the emergency department, those who got admitted and whose records were not available, 1261 cases were analyzed. The demographic details, morbidity pattern, average number of drugs prescribed, percentage of drugs prescribed by generic names and from the Essential drug list of Nepal (Essential drugs are those which satisfy the priority healthcare needs of the population), percentage of encounters with an antibiotic and an injection prescribed were noted. 1261 patients made 1772 visits. Upper respiratory tract infection and acid peptic disease were the most common diagnoses. The mean number of drugs was 1.99. Only 19.5% and 39.6% of drugs were prescribed by generic name and from the Essential drug list. Antibiotics and injections were prescribed in 26.4% and 0.96% of encounters. Cetrizine, vitamins, amoxicillin, the combination of paracetamol and ibuprofen and ranitidine were most commonly prescribed. Upper respiratory tract infections and acid peptic disease were the common illnesses. Generic prescribing and use of essential drugs were low. Some of the drug combinations being used were irrational. Prescriber education may be helpful in encouraging rational prescribing.

Anticoagulant Utilization and Cost Analysis among Cardiology Inpatients in a Tertiary Care Teaching Hospital of Western Nepal

Introduction Anticoagulants have a wide spectrum of use and risks associated with their therapy due to their narrow therapeutic range. This study aimed to evaluate the anticoagulant utilization and cost analysis in patients admitted to the cardiology ward of a tertiary care hospital in western Nepal. Methods A prospective cohort study was conducted in patients admitted to the cardiology ward of Manipal Teaching Hospital (MTH), Pokhara, Kaski, Nepal, from August to November 2019. All patients (n = 132) aged ≥18 years of either gender receiving anticoagulants for any indication in the cardiology ward were included in the study. Anticoagulant utilization, the average prescribed daily dose (PDD/DDD) and the cost of anticoagulant per patient were calculated. Descriptive statistics were performed using IBM-SPSS 20.0. Results Acute coronary syndrome (66.67%) was a common indication, unfractionated heparin + enoxaparin (45.45%) and enoxaparin (27.3%) were the most frequently prescribed anticoagulants. The performance of monitoring parameters such as international normalized ratio (INR), prothrombin time (PT), activated partial thromboplastin time (aPTT), and renal function test were consistent with the American College of Chest Physician (ACCP) guidelines. The average prescribed daily dose of anticoagulants was 1.3 (unfractionated heparin), 2.25 (enoxaparin), 0.5 (warfarin), and 1.0 (dabigatran). Heparin was associated with the majority of cases of drug interactions (52 cases). Enoxaparin was the most expensive of all the anticoagulant drug classes. The median (IQR) cost of anticoagulants used per patient was US$79.92 ($46.32). Conclusion Our study suggests that the utilization of unfractionated heparin and enoxaparin and the cost of anticoagulants per patient were higher in the patients admitted to the cardiology ward of the hospital.

Prevalence of Gastric Cancers among Patients Undergoing Upper Gastrointestinal Endoscopies in a Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study.

Gastric cancer is a common malignancy of the upper gastrointestinal tract. Gastric cancer is a common cause of death worldwide. This research aimed to study the prevalence of gastric cancer among patients undergoing upper gastrointestinal endoscopies. A descriptive, cross-sectional study was conducted in the Department of Medicine at Manipal Teaching Hospital, Nepal, from January 2018 to June 2020. A total of 2640 subjects underwent upper gastrointestinal endoscopies over the study period. Ethical approval was taken from the institutional review committee of Manipal College of Medical Sciences (MEMG/ IRC/ 383/GA). Data were analyzed by SPSS version 20. The prevalence of gastric cancer among patients undergoing UGI endoscopies was 2.4%. The mean age of subjects was 58±12.35 years (range of 31 to 96 years) with male predominance (M:F=1.9:1). Antrum was the most common site for gastric carcinoma. The most common morphology was ulcerative growth (61.6%). Adenocarcinoma (98.4%) was the most common histology, and the majority was of intestinal subtype (56.3%). Gastric cancer is not an uncommon finding in patients undergoing UGI endoscopies. Gastric cancers were commonly seen above 50 years of age and predominant in males. Patients with gastric carcinoma usually present late with advanced disease stages and unfavorable histopathology.

Prevalence of Myocardial Infarction with Non-Obstructive Coronary Arteries in Western Nepal

Background and Aims: It is well known that ST segment elevation myocardial infarction results from complete occlusion of a coronary artery supplying that area. However, in up to 15% of patients with clinical diagnosis of myocardial infarction, early angiography reveal either non-obstructive or normal coronary artery. This subgroup of disease, myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), represent a diagnostic and therapeutic challenge to clinicians. We aimed to determine prevalence and clinical profile of patients with MINOCA in current study.&#x0D; Methods: This is a retrospective, observational study conducted in cardiology department of Manipal Teaching Hospital, Pokhara, Nepal from 6th April 2014 to 5th April 2019. Patients with age ≥18 years and clinically diagnosed acute myocardial infarction who underwent coronary angiography without prior use of thrombolytic agents were selected. Data were analyzed using the software SPSS for windows version 18.&#x0D; Results: A total of 177 patients’ underwent early coronary angiography without prior use of thrombolytic agent. The prevalence of MINOCA was 13.5% (n=24) in our study population. MINOCA patients were younger (p&lt;0.001) compared to non-MINOCA. Smoking, systemic hypertension, access through femoral route and depressed left ventricular ejection fraction were significantly lower in MINOCA patients (p&lt;0.05, for all).&#x0D; Conclusion: The prevalence of MINOCA was high (13.5%) in our study. Prospective studies are needed to conclude its high prevalence and to look for other associated factors and etiology.

Study of Retinal Nerve Fiber Layer Thickness by Optical Coherence Tomography in Primary Open Angle Glaucoma, Glaucoma Suspect and Normal Nepalese Population

The measurement of retinal nerve fiber layer thickness can help significantly in the early diagnosis of glaucoma and monitoring of its progression. The objective of this study was to compare the retinal nerve fiber layer (RNFL) thickness by optical coherence tomography in primary open angle glaucoma, glaucoma suspects and normal Nepalese population. This was a hospital based cross-sectional study conducted in the Ophthalmology Out Patient Department of Manipal Teaching Hospital, Pokhara. Total 100 numbers of subjects (40 primary open angle glaucoma, 30 glaucoma suspects and 30 normal people) were evaluated. Complete ophthalmological examinations including tonometry, gonioscopy, optical coherence tomography, perimetry were performed. Statistical analysis was carried out using Epi-info 7. The result showed that the average retinal nerve fiber layer (RNFL) thickness was 70.22±12.07μm in right eye and 69.42±11.53μm in left eye in primary open angle glaucoma (POAG), 88.87±10.39μm in right eye and 88.73±9.59μm in left eye in glaucoma suspects (GS) and 94.40±9.21μm in right eye and 94.73±6.76μm in left eye in normal group respectively. The mean RNFL thickness was statistically significant in all three comparison groups except in nasal quadrant. The mean RNFL thickness was statistically significant in two comparison groups except in GS-Normal (nasal and temporal quadrant), GS-POAG (left nasal quadrant) and Normal-POAG (left nasal quadrant). The study concluded that the RNFL thickness is lower in POAG as compared to glaucoma suspects and normal group in the Nepalese population.

Histopathological Spectrum of Non-Neoplastic and Neoplastic Lesions of Thyroid: A Descriptive Cross-sectional Study.

Thyroid gland lesions are the most common endocrine disorders encountered globally. Diseases of the thyroid gland present with either an alteration of hormone secretion or as an enlargement of the thyroid gland. The objective of the study is to find the frequency of different thyroid lesions. A descriptive cross-sectional study was conducted at Manipal Teaching Hospital, Pokhara from Jan 2005 to Jan 2020. Ethical approval was taken from the Institutional Review Committee (Ref: 330). Patients who had undergone thyroidectomy procedures for both non-neoplastic and neoplastic thyroid lesions were enrolled. Convenient sampling was done. IBM Statistical Package for Social Sciences version 21 and Microsoft Excel were used. Out of 345 thyroidectomy specimens, 246 (71.3%) cases of non-neoplastic lesions, and 99 (28.69%) cases of neoplastic lesions were present. There were 54 males and 291 females with a male to female ratio of 1:5.4. The age ranged from 9 to 76 years with a mean age of 43.67 years. In non-neoplastic lesions, the predominant lesion was the colloid goiter with 205 (83.33%) cases followed by Grave's disease and lymphocytic thyroiditis with 14 (5.69%) cases each. In neoplastic lesions, papillary carcinoma was the commonest lesion with 56 (56.56%) cases followed by follicular carcinoma with 14 (14.14%) cases and follicular adenoma with 13 (13.13%) cases. There were also 9 (9.09%) cases of anaplastic carcinoma in neoplastic lesions. Colloid goiter and papillary carcinoma was the most commonly encountered non-neoplastic and neoplastic lesion with a female predominance. Rare tumors like anaplastic carcinoma, papillary carcinoma, and follicular carcinoma with anaplastic transformation were also encountered.

Fine needle aspiration cytology diagnostic accuracy corelation to histopathology of head and neck swelling in Manipal teaching hospital

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Palpable neck swelling is a common clinical manifestation in otolaryngology. Rapid, inexpensive and simple method of examination for the diagnosis of such superficial masses is fine needle aspiration cytology (FNAC). Objectives were to evaluate the usage of fine needle aspiration cytology as a first-line tool for diagnosis, accuracy compared with histopathology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method&lt;/strong&gt;: A hospital based prospective cross sectional was conducted by taking 65 patients with neck swelling presentation thyroid swelling were highest in number followed by lymph node and salivary, in which female were 43 (66.15%) and male were 22 (33.85%), the age group ranged from 6 to 75 years in ear, nose, throat (ENT) OPD of Manipal teaching hospital between 15&lt;sup&gt;th &lt;/sup&gt;November 2015 to 15&lt;sup&gt;th&lt;/sup&gt; May 2017. FNAC along with histopathological examination (HPE) were done and compared. For data analysis SPSS 20 version was used. The sensitivity, specificity and accuracy rates were calculated. The Cohen’s Kappa statistical test was employed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;The overall sensitivity and specificity of FNAC was 90.76% and 98.075% respectively in determining the various pathologies. The diagnostic accuracy of FNAC in comparison to histopathology was 92.25%. This study showed almost perfect correlation (measure of agreement) between FNAC and final histopathology diagnosis of neck swellings from Cohen’s Kappa test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FNAC is a safe, simple and rapid method with a high sensitivity and specificity that can be done in diagnosing wide range of neck swellings.&lt;/p&gt;

Study of Cutaneous Manifestations in End Stage Kidney Disease Undergoing Hemodialysis

Introduction: The prevalence of cutaneous manifestations in hemodialysis patients is increasing.&#x0D; Objectives: The aim of this study was to determine the prevalence and pattern of various cutaneous manifestations in patients undergoing maintenance hemodialysis.&#x0D; Material and Methods: A hospital based cross sectional study was conducted in patient undergoing maintenance hemodialysis at least for three months in dialysis unit of Manipal Teaching Hospital Pokhara, Nepal during the period from August 2018 to January 2019. A demographic questionnaire and a checklist about cutaneous disorders were used for data collection. Patients with cholestatic liver disease or acute hepatitis, active infection, active malignancy, patient with acute kidney injury, patient undergoing peritoneal dialysis and renal transplant recipient were excluded from study.&#x0D; Results: Total 80 patients undergoing maintenance hemodialysis were included. Among them, 52 (65%) patients were male. The mean age of study population was 51.95±14.96 years. The mean duration of dialysis was 40.28±11.09 months. The most common cause of end stage kidney disease was diabetic nephropathy. The most common cutaneous manifestations were pigmentation (82.5%), nail changes (75%), xerosis (70%) and pruritis (50%).&#x0D; Conclusions: The results of this study revealed that patients on hemodialysis were associated with multiple cutaneous symptoms, the most prevalent of which were pigmentation and nail disorders. Therefore, early diagnosis of these problems is a major step in improving the quality of life in these patients.

Variation in spirometry parameters in children with and without recurrent respiratory problems

Background: Children having recurrent episodes of respiratory symptoms account for a major source of hospitalization. These children have increased morbidities and if not identified in time can have impaired lung function as adults. &#x0D; Objectives: The aim of our study was to compare the spirometry parameters and bronchodilator reversibility in children with and without recurrent respiratory problems.&#x0D; Methodology: This was a prospective observational study conducted in the Pediatric department of Manipal Teaching Hospital comparing 35 children with recurrent respiratory problems and 35 children with no history of recurrent respiratory problems. After thorough instructions, baseline spirometry was done in all children and recordings were noted. Thereafter they were given two puffs of salbutamol (100 µg) and repeat testing was done 20 minutes later. Bronchodilator reversibility was calculated according to standard formula. Various statistical tests were used to compare the findings between the two groups.&#x0D; Results: The recurrent respiratory problem group had 31 (88%) cases of bronchial asthma, two (5.7%) bronchiolitis obliterans, one (2.8%) pulmonary eosinophilia, and one (2.8%) common variable immunodeficiency syndrome. The median values of FEV1 (p=&lt;0.001), FVC (p=0.007), FEV1/FVC (p=0.005), PEF (p=0.042) and FEF25-75(p=0.026) were lower in the group with recurrent respiratory problems. Post-bronchodilator reversibility of FEV1 (p=0.001), FVC (p=&lt;0.001) and FEF25-75 (p=0.026) was higher in the groups with recurrent respiratory problems&#x0D; Conclusion: We found that lung function parameters in children with recurrent respiratory problems show features of obstructive defect. The post-bronchodilator response is higher in the group with recurrent respiratory problems as compared to normal children.

The Status of Serum Amylase among type 2 Diabetes Patients in Pokhara

Introduction: Diabetes Mellitus has become one of the common metabolic disorders characterized by hyperglycemia, associated with deficiency or resistance to insulin and shows abnormality in exocrine activity of pancreas. Pancreas is mixed gland that is both an endocrine and an exocrine gland with clusters of endocrinal, islet cell dispersed among exocrine acinar cells. Defects in islets cells in diabetes effect the exocrine secretion of the pancreas.&#x0D; Methods: Hospital based case-control study was conducted. Total sample size was 388. Out of which 194 were known cases of type 2 diabetic patients attending Manipal Teaching Hospital for medical checkup whereas 194 were Non Diabetic individuals with age and sex matched. Self-administer question was used to collected data from case and control. Three ml fasting blood samples were collected and centrifuged. Serum amylase was analyzed by using a semi automated analyzer. All estimates data were analysis statistically by using SPSS 22.0 full version.&#x0D; Results: Serum amylase levels were found significantly low in diabetic patients as compared to the Non-Diabetic&#x0D; (r = -0.313, p-value &lt;0.001). Similarly, present study also showed negative correlation between serum amylase levels and duration of diabetes with Non-Diabetic (r = -0.388, p &lt;0.001). Status of serum amylase and fasting sugar level was found to different among age groups, sex and ethnic groups.&#x0D; Conclusions: The increasing in duration of diabetes decreases the level of serum amylase which suggests a possible exocrine-endocrine relationship in this disease. Similarly, the level of serum amylase and fasting blood sugar vary among age group, sex and ethnicity. Thus, measurement of serum amylase can be an additional informative parameter for the assessment of chronicity and progress of the illness as well as the response to therapy.

Cancellation of Elective General Surgical Operations on the Day of Surgery.

Unanticipated cancellation of scheduled elective operations decreases theatre efficiency and is inconvenient to the patients, their families and the medical teams. It creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations. The aim of this study is to determine the incidence and causes of cancellation of surgical operations in our centre and make recommendations to reduce it. This was a prospective cross-sectional study carried out over a period of one year in Manipal Teaching Hospital, Pokhara from July 12017 to June 2018. Consecutive sampling method was used. All patients booked for elective surgical procedures were enrolled in the study. The age, gender, diagnosis, proposed surgery and reasons for cancellation were documented and analysed. A total of 794 patients were scheduled for elective surgical operations during the study period and 86 (10.83%) patients' operations were cancelled. There were 54(62.79%) males and 32 (37.20%) females. Recent change in the medical status of the patient (n=18; 20.9%) was the main reason for cancellation of operation followed by overbooking (n=11; 12.7%), change in plan of management (n=9,10.4%). Avoidable factors are mainly responsible for cancellation of surgeries. Efficient management, pre-operative assessment, utilization of the few available hospital resources, improvement in communication between medical teams and patients would reduce the rate of cancellation of booked surgical procedures.