National Medical College Research Articles

Clinical Profile of Acute Pancreatitis

Background and objectives: Acute pancreatitis is a disorder that has a wide-ranging presentation, etiology, multifactorial pathogenesisandclinicalconsequencesfrommildselflimitingtoseverelife threatening. The aim of this study is to evaluate demographic characteristics, etiology, clinical presentation and its management.
 Materials and methods: This retrospective study was carried out in Department of Surgery of National Medical College and Teaching Hospital. A total of45 patients with diagnosis as acute pancreatitis over period of March 2020 to February 2022 were included in this study. History and detailed clinical examination was performed as per the working proforma which included. Chi square test were used for correlation analysis. Data analysis was done using SPSS (Statistical Package for social sciences), version 25.
 Results: Most of acute pancreatitis were seen in 20-39 years of age group with mean age of 39.7 years. 66.6% patients were female. Gall stone was the most common cause (71.1% patients) of pancreatitis. Abdominal pain was the most common mode of presentation, and tenderness the most common sign. Most of the patients were managed conservatively. Median hospital stay was 9 days.
 Conclusion: Acute pancreatitis is a common cause of acute abdomen in patients presenting to the emergency department. Gall stone is the most common cause of acute pancreatitis .Clinical diagnosis along with biochemical and radiological findings are required for diagnosis .The management is mainly conservative.

Functional and Radiological Outcomes with Intramedullary Interlocking Nailing of Tibial Shaft Fracture

Introduction: Tibia is the most common long bone involved in fracture during Road Traffic Accident (RTA) because of its subcutaneous location. Intramedullary nail fixation remains the treatment of choice for unstable and displaced tibial shaft fractures in the adult. The goals of surgical treatment are to achieve osseous union and to restore length, alignment, and rotation of the fractured tibia. Intramedullary nailing carries the advantage of minimal surgical dissection with appropriate preservation of blood supply to the fracture site. Materials and Methods: This is a prospective observational study conducted in the Department of Orthopedics, National Medical College and Teaching Hospital,Birgunj, Parsa, Nepal for the 1 year duration. Patients included in this study were above 16 years with Tibia shaft fracture with or without fibula fracture which includes Type I,II and IIIA of Gustilo-Anderson fracture. Patients with tibia shaft fracture were treated surgically by using intramedullary interlocking nail then follow up done in OPD at regular intervals during which radiographs was taken in appropriate views and diagnosis is established by functional and radiological means. Result: Out of 53 patients, 45 patients with Tibia shaft fracture are treated by closed intramedullary interlocking nailing in the National Medical College, Birgunj. Eight patients are lost during follow-up. In our study tibia shaft Fracture was more common in male (77.8%) than female which mostly involved 18-30 years of age group (62.2%) and most common cause was Road Traffic Accident (82.2%). Thirty cases (66.7%) had excellent and 10 cases (22.2%) had good healing and complication were seen in eight patients (17.7%). Conclusion: Closed interlocking tibia nailing allows earlier fracture union with less morbidity. Because of the high union rate and low infection rate, we consider closed interlocking nailing as the best mode of treatment for diaphyseal tibial fractures.

Internal jugular vein catheterization: A comparison between ultrasound guided technique with landmark guided technique

Introduction: Central venous cannulation is frequently performed procedures to gain access to the central vein. With increased use of ultrasonography to guide cannulation, the success rate has improved and it has decreased the time required for cannulation and complications. The aim of the study was to compare ultrasound guided technique (USG) and landmark technique (LMG) in Internal jugular vein. Materials and Methods: This study was conducted in National Medical College and Teaching Hospital, Birgunj from July 2019 to July 2020. Ethical clearance (NMC/420/075/076) was obtained from institutional review committee of NMC Birgunj. Total of 60 patients were randomly allocated into two groups; ultrasound group (USG) landmark group (LMG) underwent landmark guided catheterization. Access time, number of attempts for successful cannulation and incidence of various complications were compared between groups. Data analysis was done with Statistical Package for Social Science version 22. Result: The study was conducted on 60 patients, divided randomly into two groups with 30 patients in each group. The mean age for LMG was 48.57±16.08 years and for USG was 50.03±13.36 years. Out of 60 patients, 61.7% were male and 38.3% were female. The mean of neck dimension for LMG and USG was 35.95±6.327 and 35.67±6.194 cm respectively. The mean distance under LMG and USG was 19.07±1.780 and 18.33±2.368 cm respectively. The mean access time taken for LMG and USG was 403.10±98.111 and 217.57±75.408 seconds respectively (p<0.001). LMG technique showed total 5 cases (16.7%) of carotid artery puncture during procedure whereas there were no cases seen in USG (p value 0.05). Conclusion: This study has shown better result of ultrasound guided internal jugular cannulation when compared with landmark guided internal jugular vein cannulation technique by decreasing number of needle passes, access time, complication and giving least discomfort to the patient.

Study on Clinical Profile and Impact of Septoplasty in Patients Attending National Medical College Birgunj for Deviated Nasal Septum

Introduction: A deviated nasal septum is a common anatomic disorder that presents in up to 62% of the population but, not all are symptomatic. However, it may play a critical role in nasal obstruction symptoms, aesthetic appearance of the nose, increased nasal resistance and sometimes snoring. This study was done with an aim to determine the profile of subjects having deviated nasal septum and assess the impact of septoplasty on them. Materials and Methods: A cross-sectional study was done at National Medical College, Department of Otorhinolaryngology, Head and Neck Surgery, Birgunj from January 2022 to June 2022. Total 30 cases with symptomatic deviated nasal septum were included. Ethical clearance (F-NMC/579/078-79) was obtained from institutional review committee of NMC Birgunj. Details of nasal patency test followed by anterior rhinoscopy and nasal endoscopy were noted. Patients were followed up on 1st, 7th and 30th day post operatively after septoplasty. Pre and post operative comparison was done by using NOSE questionnaire. Wilcoxon signed rank test was done. Results: The ratio of male to female being 1.1:1. The age of the patients varied between 18 to 55 years, and the mean age was 29.07±10.409 years. most common type of deviation seen was type IV (30%). Nasal obstruction was seen in all the study cases which was followed by headache (76.7%) There was decline in the Nose scoring gradually from preoperative period to postoperative period. In anterior rhinoscopy spur (73.3%) was the most common finding. A significant (p<0.001) improvement in nose score after septoplasty was seen. Conclusion: Significant improvement in NOSE score was seen in our study which was in accordance with similar studies conducted.

Evaluation of Tear Secretion and Tear Film Stability in Patients with Pterygium and Normal Individuals

Introduction: Abnormalities of any of the components of lacrimal function unit can lead to dysfunctional tear film and development of dry eye. Dry eye is a commonly encountered problem in general population.
 Materials and Methods: A hospital-based, case-control study was conducted at National Medical College and Teaching Hospital, Nepal from 1st August 2018 to 30th July 2019. A total of 279 participants: 93 cases of pterygium (Group A: case) and186 (Group B: control) normal individuals with no ocular surface disorder were enrolled. Objective analysis was done by Schirmer’s (SCH) without and with anesthesia and Tear Break up Time (TBUT). Dependent t test was used to analyze the data. P value <0.05 was considered statistically significant.
 Results: The mean age of the patients was 47.82 ±11.09 years (range 26-71) with male being 48 (51.6%) in Group A and in Group B, 101 (54.3%) were male with mean age being 42.16 ±13.13 years (range 32-75). The mean SCH without and with anesthesia and TBUT values were 16.94±5.61mm, 13.81±5.06mm, 10.14± 4.06 sec in Group A whereas in Group B, 20.39 ±6.08mm, 16.74 ±5.25mm and 13.05 ±4.32 sec respectively which was statistically significant (p < 0.05). Patients with pterygium had higher risk of having dry eye than normal individuals (Odd ratios: 2.69, 2.44 and 2.27 respectively).
 Conclusion: Pterygium is a common ocular surface disorder which could result in instability of tear film indices, dysfunctional tear film and thus dry eye.

Outcomes of Endoscopic Myringoplasty

Introduction: The endoscope has diagnostic and therapeutic role in different otological surgeries. It has excellent view of images where there are difficult nooks and corners. The use of tragal cartilage in the repair of tympanic membrane perforation has its own benefit in graft uptake and hearing results whether long term or short term. The main purpose of the present study was to evaluate the long‑term hearing results in patients who underwent endoscopic sandwich myringoplasty with National Medical college & Teaching Hospital, Birgunj. Objective: To evaluate the graft success rate and postoperative hearing gain for central perforations using endoscopic myringoplasty Materials and Methods: This study is a prospective study in 60 patients with central perforations who underwent endoscopic myringoplasty using tragal cartilage. The hearing was assessed by comparing pre‑. with post‑operative air‑bone gap (ABG) and ABG closure in speech frequencies (0.5 kHz, 1 kHz, 2 kHz, and 4 KHz). Results: Of the 60 patients with central perforation included in this study, the graft success rate was 95% (57/60). The graft uptake in 6 months of follow‑up. The postoperative ABG (13.77 ± 4.94dB) was lesser than preoperative ABG (22.38 ± 6.93 dB) with statistically significant results. Conclusion: Endoscopic myringoplasty is a safe procedure with high‑graft uptake rate and good long‑term hearing results.

Assessment of Physical Activity and Cardiorespiratory Fitness in Medical Students

Introduction: Cardiorespiratory fitness is an indicator of cardiovascular health, usually expressed as VO2max. VO2max is the capacity of our body to transport and utilize oxygen during maximal exertion. The present study attempts to assess the level of physical activity and cardiorespiratory fitness in medical students and compare VO2max between physically active and insufficiently active students.
 Materials and Methods: An observational cross sectional study was conducted in 246 medical students (123 males and females each) of age between 18 to 23 years in National Medical College, Birgunj. After obtaining ethical clearance, screening was done with American College of Sports Medicine participants screening questionnaire. Students were classified as physically active and insufficiently active by using Global Physical Activity Questionnaire. VO2max was calculated from recovery heart rate counted from fifth to twentieth second of recovery after step test. Finally, subjects were categorized into different level of cardiorespiratory fitness based on their VO2max values.
 Results: Present study found 33.6% of insufficiently physical active students. Females had higher prevalence of insufficient physical activity (40.6%) than males (26.8%). The VO2max of male and female was 46.79 ± 8.98 and 36.15 ± 4.66 ml/Kg/min respectively. Majority of female participants had ‘average’ VO2max whereas in male, distribution is almost equal in ‘excellent’, ‘good’ and ‘fair’ category.
 Conclusion: Around one-third of medical students did not meet the level of physical activity recommended by WHO for health. Majority of them had ‘average’ level of VO2max and those physically active had better cardiorespiratory fitness.

Anthropometric Study of External Ear: A Comparative Study

Introduction: Ear is the most defining feature of the face and its structure shows the signs of age and sex. The external ears consist of the auricle and the external acoustic meatus. This study was specifically under taken to study the variations in the auricle dimensions, specially height and width, amongst Nepalese medical and nursing students and compare them. Materials and Methods: This study was conducted on medical and nursing students of National Medical College, Birgunj, Nepal, with no evidence of congenital ear anomalies or previous ear surgeries. The study consisted of 110 females and 110 males, aged 18–25 years. Results: The descriptive statistics of the ear variables evaluated and measured on both right and left sides. The ear length ranged from 6.31- 6.30 cm with the right ear length being significantly larger than the left ear length (p=0.010). Similarly, the right ear breadth was significantly wider in comparison to the left ear breadth, range from 3.39- 3. 38 cm (p=0.084). The lobular length range 2.38- 2.36 cm (p=0.001) and the lobular breadth range 1.96- 1.93 cm (p=0.000) which were also larger in the right ear compared with the left ear and the differences reached the level of statistically significant. Conclusion: The ear anthropometric measurements of male students showed higher value when compared to the female nursing students. These results support the findings that the sexual dimorphism does exit and showed the statistically significant differences between the sexes. The length of the ear was found to be higher when compared to the width of the ear in both sexes.

The Outcome of Trauma Patients in the Mixed Semi-closed Intensive Care Unit

INTRODUCTIONNepal due to its geographical condition, inadequate resuscitation on time, and lack of full-time intensivist in a trauma team is a cause of trauma-related morbidity and mortality. MATERIAL AND METHODSIt was a prospective, descriptive observational cross-sectional study in a level three intensive care unit of National Medical College for six month. All patients >18 years with a history of road traffic accidents, falls, drowning, physical assaults, and self-inflicted violence admitted to the mixed intensive care unit of a tertiary care hospital were included in this study. RESULTSOne hundred and ninety-one patients were included in this study. 152(79.5%) were males and 39(20.4%) were females. A road traffic accident was the most common mode of injury in 166(86.9%) patients. 178(93.1%) patients survived and went home, 10(5.3%) expired, 2(1%) left the hospital against medical advice (LAMA) and 1(0.5%) gave do not resuscitate orders (DNR). The mean days on the mechanical ventilator was 3.39±2.57 days. Mortality in an intubated patient was 8.6%. Mean LOS in the ICU was 4.28±4.12 days. SOFA and APACHE II scores were a good predictor of outcome, with the SOFA score being the most effective Injury severity score predicted mortality with a sensitivity of 88.9%, a specificity of 22%, with an AUROC curve of 0.543±0.092 with cut off score of 5.5. CONCLUSIONRaising public awareness, and strictly following the traffic rules can help in reducing the incidence of trauma. Trauma team consisting of full-time intensivists should be established to decrease the mortality in the intensive care unit.

Relation of Cholelithiasis and Body Mass Index among Different Age Groups

INTRODUCTIONCholelithiasis is a common presentation in the department of surgery. One of the potential risk factors of cholelithiasis is obesity, which is a common problem faced by most adult population. The aim of this study is to see the association of cholelithiasis with body mass index among different age groups. MATERIAL AND METHODSThis cross-sectional study was done in the Department of General Surgery of National Medical College, Birgunj. Ethical clearance (Ref. F-NMC/565/078-079) was obtained from the institutional review committee. Total of 75 subjects were included in the study. Subjects presenting with cholelithiasis in the out-patient department of Surgery were included in the study. Height and weight of the subjects were recorded along with age and other parameters. Body mass index (BMI) was calculated using the Quetelet’s formula, weight in kg/ height in m2. The body mass index was than categorized according to World Health Organization. RESULTSThe mean age of the total participants was 43.85±11.82 years. The mean BMI was 25.81±9.95 kg/m2. Among the age group 20 – 35 years 30% were overweight and 15% were obese where as in age group 36 – 50 years 44.4 % were overweight and 11.2 % were obese. Similarly in participants above 50 years 32.1% were overweight and only 3.6% were obese. CONCLUSIONCholelithiasis is one of the common surgical problems. Number of patients with gallstones increases with increasing age. In this study, more number patients are seen with normal BMI. However, higher number of patients are found having overweight or obesity in the age group of 36-50 years.

Clinicopathological Features of Alopecia With an Emphasis on Etiology and Histopathological Characteristics of Scarring Alopecia.

IntroductionAlopecia is a common dermatological condition with varied etiologies based on age, gender and geographic location. Non-cicatricial (non-scarring) alopecia is more common but often not biopsied. Alternatively, primary cicatricial (scarring) alopecia is diagnostically more challenging and more commonly biopsied to determine the etiology. In this study, we evaluated the clinicopathological characteristics of alopecia in our population.MethodsWe conducted a retrospective study at the Department of Histopathology, Liaquat National Hospital and Medical College, Pakistan. A total of 104 patients were enrolled in the study who underwent scalp biopsy for alopecia over a period of 11 years. Clinical data were obtained from clinical referral forms, which included age, sex of the patients and duration of the lesions. Three hematoxylin and eosin-stained tissue sections, along with periodic acid-Schiff (PAS), PAS with diastase and collagen stains were examined, and histopathological diagnosis was rendered.ResultsOur study demonstrated that alopecia was more prevalent among females, accounting for 73.1% of cases. Most of the patients belonged to the age group of <35 years (53.8%). The type of alopecia in 88.5% of the cases was scarring, while there were 11.5% cases of non-scarring alopecia. The most common diagnoses were discoid lupus erythematosus (DLE) (23.1%) and pseudopelade of Brocq (PB) (23.1%), followed by lichen planopilaris (LPP) (15.4%). A significant association was noted between the histological features and the diagnosis, as epidermal atrophy was the most common histological feature in most cases of DLE, followed by periadnexal infiltrates, lymphocytic infiltrates, follicular plugging and basement membrane thickening. In LPP, the most common histological features were perifollicular infiltrates and fibrosis. In PB, the frequently recurring histological features in most cases were the loss of sebaceous glands, dermal fibrosis and epidermal thinning.ConclusionIn this study, we demonstrated the key role of skin punch biopsy and histology in determining the accurate etiology of scarring alopecia. We found discoid lupus erythematosus and pseudopelade of Brocq to be the most common causes of scarring alopecia, followed by lichen planopilaris.

Contrast of Laryngeal Mask Airway Versus Endotracheal Tube for Early Postoperative Recovery Following Laparoscopic Cholecystectomy

Aim: To assess the difference between laryngeal mask airway versus endotracheal tube for early postoperative recovery following laparoscopic cholecystectomy Study design: A randomized controlled trial Place and Duration: This study was conducted in Liaquat National Hospital and Medical College Karachi from June 2020 to June 2021 Methodology: Overall, 60 individuals were assigned to airway management utilizing either the laryngeal mask airway(LMA) group or endotracheal tube (ETT) group. All the patients went under sevoflurane-based general anesthesia and all of them had a laparoscopic cholecystectomy. Three things were recorded before and after carbo peritoneum that was blood pressure, heart rate and peak airway pressure. The first hour after surgery and the first postoperative day were used to assess postoperative pain and analgesic needs, as well as hoarseness, nausea, sore throat, and dysphonia. Results: Two attempts were made to have a successful Laryngeal mask airway or endotracheal tube placement. During carbo peritoneum, both of the groups, LMA and ETT had similar highest average peak airway pressure (LMA: 17.8 [2.9], ETT: 18.2 [4.1], with a p-value of 0.159). The incidence of bradycardia and elevated systolic blood pressure was higher in the LMA group. The LMA group had lower pain scores one hour postoperatively and on a postoperative day 1 than the ETT group (LMA: 3.9 [2.0], ETT: 5.4 [2.3], with a p-value of 0.017 and LMA: 5.6 [1.9], ETT: 6.7 [1.7], with a p-value of 0.042). Both the groups had the same analgesic requirements. Until postoperative day 1, the LMA group had a lower incidence of nausea than the ETT group (LMA: 4/28 [14%], ETT: 12/28 [43%], with a p-value of 0.032). Conclusion: The Laryngeal Mask Airway Protector proved to be a successful ventilator device which showed lesser intraoperative hemodynamic stress responses. It also enhanced the early recovery standard following laparoscopic cholecystectomy. Keywords: Endotracheal tube, laparoscopic cholecystectomy, Laryngeal mask airway

Study of cardiovascular dysfunction in chronic liver disease in a tertiary care hospital in eastern India

Background: Chronic liver disease (CLD) exhibits characteristic hemodynamic changes along with pathological changes in the myocardium. Compensated by the decreased systemic vascular resistance, overt heart failure is usually not seen, and thus cardiac pathology is frequently overlooked. Aims and Objectives: The objectives of the study were to study the presence, types, and severity of cardiovascular (CV) dysfunction in patients of CLD. Materials and Methods: An observational cross-sectional study on 50 patients of CLD at Calcutta National Medical College and Hospital, with all relevant investigations. Results: Out of a sample of 50 patients, of which 14.3% were mild, 34.3% moderate and 51.4% severe CLD (by Child-Pugh Class), 28.6% had a high normal heart rate (90 to 100/min), 45.7% had increased stroke volume index, and 42.9% increased cardiac index, reflecting hyperdynamic circulation. In 42% cases, left ventricular ejection fraction was increased more than 65%, reflecting hyperdynamic circulation, but decreased &lt;55% in 23% cases, which may be an indicator of cirrhotic cardiomyopathy. Ejection fraction is significantly (P=0.016) increased after paracentesis in 33.3% patients, reflecting the mechanical effect of ascites on cardiac function. Diastolic dysfunction was present in 60% (P=0.012) and left ventricular mass index was increased in 45.7% cases. All the parameters correlated with increasing Child-Pugh Class severity of CLD. Conclusion: A high level of awareness is needed to take into account the presence of CV dysfunction and cirrhotic cardiomyopathy in patients of CLD and predict the risk of adverse cardiac events. Specific treatment modalities need further study to improve prognosis in these patients.

Determination of different adiposity indices among students of a medical college of Nepal: A cross-sectional study

Background : The prevalence of overweight and obesity is on an increasing trend these days. Adverse effect of obesity can be seen in different physiological functions. This study aimed to see the fat distribution among students using different markers of obesity. Methods : A cross sectional observational study was carried out in the Department of Physiology, National Medical College, which included 250 students. Body fat percentage was measured using Omron body composition monitor and waist circumference was measured using non-stretchable tape. Body Mass Index, Body Adiposity Index, Fat Mass and Waist Hip Ratio were calculated. Results : Among 127 male subjects 8.7% were overweight and 18.1%, 47.2%, and 33.1% had high and 7.9%, 15%, 10.2% had very high fat percentage which was obtained from Body Fat Percentage, Body Adiposity Index, and Fat Mass respectively. Similarly, 4.7% and 48.8% had high Waist Circumference and Waist Hip Ratio respectively. Among 123 female subjects 9.8% were overweight and 1.6% were obese. 21.1%, 5.7% and 28.5% had high and 4.1%, and 0.8% had very high fat percentage which was obtained from Body Fat Percentage, and Body Adiposity Index respectively. Also 5.7% and 38.2% had high Waist Circumference and Waist hip Ratio respectively. Conclusion : The study showed high prevalence of overweight and obesity when measured by other adiposity indices than by body mass index.

A descriptive cross-sectional study on knowledge of Hand washing among health professionals in a medical college

Introduction: Nosocomial infection is common due to poor practice of hand hygiene. There is a variation in the level of knowledge of handwashing among different health professionals.&#x0D; Objectives: The aim of the study was to assess the basic knowledge of handwashing among health professionals.&#x0D; Methodology: This cross-sectional study was done in 370 healthcare professionals like doctors, nurses, health assistants of a National medical college. The questionnaire used was adapted from the World Health Organization about hand hygiene knowledge for health professionals. There were 18 questions assessing the basic knowledge and practice of handwashing. The level of hand hygiene knowledge was calculated by dividing the responses into four groups based on score more than 90% as excellent, 75-90% considered as good, 50-74% moderate, and less than 50% considered as low.. All data was transferred to the excel sheet and transferred to a statistical package for the social sciences-17. The result was presented using frequency tables, graphs, and charts.&#x0D; Result: Out of 370 participants, 318(85.9%) were females, and 52(14.1%) males. The mean age was 24.59±4.48 years. Of all the respondents, 24% had low, 30% moderate, 26% good, and 21% had excellent knowledge of hand hygiene. In terms of practice, only 34% had a moderate level of practice of hand hygiene.&#x0D; Conclusion: Regular training and re-training through simulations of hand hygiene will lead to an improvement in the knowledge and practice of handwashing.

THE EFFECTS OF BETAHISTINE IN ADDITION TO EPLEY MANEUVRE IN THE POSTERIOR CANAL BPPV MANAGEMENT

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that accounts for one fth of all admissions to hospital due to vertigo although it is commonly undiagnosed.5 The most common form is idiopathic, and BPPV tends to occur at a higher rates in women than in men.6 The main mechanism underlying BPPV is accumulation of otoconia (calcium carbonate structures) in the lumen (canalolithiasis) or in the cupula (cupulolithiasis) of the semicircular canal, resulting in impaired uid dynamics of the semicircular canal. This randomized controlled trial and hospital based study was conducted at calcutta national medical college and hospital ENT OPD on July 2020 to June 2021. Total 75cases were taken in our study. Group A (Epley maneuver only) Group B (Epley maneuver only+ Tab Pentoprazol 40) Group C: Epley maneuver with betahistine (16mg TDS) Our study showed that in A Group, 10 patients had previous vertigo attack. In B Group, 13 patients had previous vertigo attack. In C Group, 11 patients had previous vertigo attack. Rest of the patient in our study presented with vertigo attack for 1st time in their life. Association of previous vertigo attack with group was not statistically signicant (p=0.290). In A Group, the mean visual vertigo analog scale Baseline (mean± s.d.) of patients was 6.98 ± 2.133. In B Group, the mean visual vertigo analog scale Baseline (mean± s.d.) of patients was 6.27 ± 2.148. In C Group, the mean visual vertigo analog scale Baseline (mean± s.d.) of patients was 6.21+/- 2.133. Difference of mean visual vertigo analog scale Baseline with Group was not statistically signicant (p=0.100). We concluded that group-C was better result in comparison with group-B and group-A respectively. So in our study it is found that patients treated with Epley's maneuver and Betahistine got better result than the patients treated with only Epley's maneuver.

Burden of Vitamin D Deficiency in Patients of Chronic Liver Disease

Objective: To determine the frequency of vitamin D deficiency in chronic liver disease patients.&#x0D; Study design: Cross-sectional study.&#x0D; Place and Duration of Study: Gastroenterology Department, Liaquat National Hospital and Medical College, Karachi Pakistan, from Jan to Dec 2020.&#x0D; Methodology: Patients between the age of 18 to 50 years, of either gender, already diagnosed case of chronic liver diseases for 6 months and had sun exposure of at least 15 minutes twice weekly were included in this study. History was taken after taking informed written consent, the clinical assessment was done, and blood samples were sent for serum vitamin D levels to determine the results.&#x0D; Results: The study included 177 patients with chronic liver disease. One hundred eleven patients (62.7%) were males and 66 patients (37.3%) were females, with the mean age of 45.0 ± 6.306 years. Vitamin D deficiency was observed in 100 patients (56.5%).&#x0D; Conclusion: The frequency of vitamin D deficiency was quite high. It increases with age and body mass index and is predominant in the male gender, while no association was noted with sun exposure time.

Neonatal Surgery: A Four-year Experience in a Teaching Hospital of Birgunj

Introduction: Neonatal surgery is one of the most challenging issues in medical field. The outcome of neonatal surgery is still poor in developing countries. The aim of this study was to report our experience regarding the etiological spectrum of neonatal surgical conditions and their outcome after surgical management. Methods: A descriptive retrospective study which included all the neonatal cases that presented to Pediatric Surgery Department of National Medical College, Birgunj in the last four years. All the neonates that underwent surgery from April 2017 to March 2021 were included in the study. Results: A total of 68 neonates were operated during the analyzed time period. Male to female ratio was 2.2:1. The age at presentation varied from 2 to 28 days and birth weight from 1.2 to 3.4 kg. Anorectal malformation (32.3%) was the commonest cause of surgery followed by tracheo-esophageal fistula (14.7%) and pyloric stenosis (8.8%). Mortality rate was 20.5% with septicemia as the commonest post operative complication. Conclusion: The outcome of neonatal surgery in our center is not up to mark as compared with centers in developed countries. Early presentation of the patients, well equipped surgical neonatal intensive care facilities and trained manpower are needed to improve the outcome.

Cardiorespiratory Fitness and its Relationship with Adiposity Indices

Introduction: The cardiorespiratory fitness (CRF) and obesity greatly influence the cardiovascular health. Decrease in maximal oxygen consumption (VO2max) and increase in fat mass can be used as an early marker for cardiovascular disease risk. The objective of this study was to assess the CRF and observe the relationship between CRF and adiposity indices. Methods: A cross sectional observational study was performed in 174 students (87 males and females each) of National Medical College. The subjects were assessed for different adiposity indices; BMI, body adiposity index (BAI), total body fat percentage (BF %) and waist circumference (WC). VO2max was calculated from recovery pulse rate after Queen's College Step Test. VO2max was correlated separately with each parameter of body composition using Pearson’s correlation test. Results: The VO2max of male and female participants were 47.22 ± 9.09 and 35.67 ± 5.36 ml/kg/min respectively. The correlation of VO2max was significant with all the studied adiposity indices. WC (r= - 0.41, p&lt; 0.001) and BF% (r= -0.38, p&lt; 0.001) correlation with CRF was highly significant in male whereas in female correlation was highly significant with BMI (r= 0.49, p&lt; 0.001), WC (r= -0.40, p&lt; 0.001) and BF% (r= -0.56, p&lt;0.001). VO2max correlated best with waist circumference in male (r= - 0.41, p&lt; 0.001) and BF% in female (r= -0.56, p&lt;0.001). Conclusion: This study concludes that there is an adverse relationship between CRF and adiposity indices and females have low level of cardiorespiratory fitness.

Protocol for a prospective, hospital-based registry of pregnant women with SARS-CoV-2 infection in India: PregCovid Registry study

IntroductionPregnant women are at increased risk of contracting COVID-19 due to several factors and therefore require special attention. However, the consequences of the COVID-19 pandemic on pregnant women and their...