Tribhuvan University Research Articles

Perceived Stress and Coping Strategies Utilized by Bachelor-Level Nursing Students During the COVID-19 Pandemic

Background: The COVID-19 global pandemic was challenging for the general population and the students as well. The classes moved to online and stayed at home with a safe execution was ordered. Many students faced distressing changes. Both behavioral and psychological coping strategies were employed to minimize stress. This study aimed to assess the perceived stress and coping strategies used during the COVID-19 pandemic by nursing students. Methods: A cross-sectional descriptive design was used. Nursing students studying bachelor level in the Constituent Colleges of Tribhuvan University were the study population. A structured self-administered online questionnaire containing demographic information, a perceived stress scale, and a modified brief cope scale was used. The obtained data were analyzed using SPSS version 16 using descriptive and inferential statistics. Results: The mean age of the respondents was 25.76+3.13 years, almost half (42.9%) were from Maharajgunj Nursing Campus. More than half (53.8%) were studying in a Bachelor of Nursing Science (BNS) in their third year, among them 9.2% had medical problems. Only a few (5.4%) suffered from COVID-19 during this study period. Around 14.7% perceived a high level, 61.4% moderate level and 23.9% perceived a low stress level. The mean scores of approach coping strategies and an avoidant coping strategies were found to be 35.2 and 23.1 respectively. No association existed between the respondents' stress levels and the selected demographic variables. Conclusion: Most of the respondents perceived a moderate level of stress and used a healthy coping strategies to minimize stress during the COVID-19 pandemic.

Publication Status of Theses among Post-graduate Students in Nursing from Institute of Medicine.

Publication of the research work done during the master's program is highly desirable. However, there is a paucity of data on the number of publications, especially from low-income countries. The objective was to find out the status of the publication of the theses of post-graduate students in Nursing from the Institute of Medicine, Tribhuvan University, Nepal from 2015-2019. Cross-sectional analytical design with a structured interview via telephone was done for data collection. Independent variables were age, marital status, current work status, current working organization, type of research, year of graduation, and facilitators and barriers to publication, whereas dependent was the publication status of the thesis. Two hundred five (76.2%) out of 269 participated in the study. The age group ranged from 27 to 50 years (mean ± SD = 36.6±4.8). The majority 89.3% were married. Currently working in academic institutions was 51.7%. One hundred ninety-eight (96.6%) respondents performed a cross-sectional descriptive study. Only 2.9% of studies were cross-sectional analytical and 0.5% were qualitative. Seventy-five (36.6%) respondents published their theses. Twenty-seven (36.0%) were published in PubMed-indexed journals. The most common facilitator for publication was academic satisfaction [59 out of 75(78.7%)] followed by encouragement from supervisors 52.0% and peers 40.0%, whereas the commonest barrier to publication was lack of interest [80 out of 124 (64.5%)] followed by lack of confidence 51.6%. Based on the results, more than one-third of the participants published their theses in national and international journals including those indexed in PubMed. Provision of university research grants, development of publication culture among post-graduate students, and making a provision of academic publication before degree awards should be encouraged for more academic publication.

The Impact of Demographical Variables on Organizational Commitment of Employees In Tribhuvan University

The Impact of Demographical Variables on Organizational Commitment of Employees In Tribhuvan University

Teachers’ Academic Behaviors on Students’ Academic Achievement

Teacher's behavior plays a vital role in academic achievement. A teacher's behavior can affect student's capacity to learn as well as others students' learning environment. Teachers are the role models for their students and their behavior meaningfully influence students’ personal and academic life. Keeping in view the significant influence of teachers on the students’ academic achievement, the study aimed to investigate the influence of teachers’ behavior on students’ academic achievement at affiliated campuses. This article explores the correlation between teachers' actions, methods, attitudes, and behaviors in the academic setting and how they impact students' academic performance and achievement. It delves into the importance of teacher-student interactions, instructional strategies, feedback mechanisms, and classroom management techniques in shaping students' learning outcomes. This research article discusses the Influence of Teachers’ Behavior on Students Academic Achievement of Higher Level. The respondents were the teachers and students were associated to the campuses affiliated to Tribhuvan University. From the 15 public colleges, 60 teachers and 600 students from five departments were selected as a sample. Two questionnaires were developed and validated through pilot testing and administered to the sample for the collection of data. The researcher personally visited the respondents, thus 100% data were collected. The collected data were tabulated and analyzed by using chi-square and Pearson's product moment coefficient of correlation (r). The major conclusions of the study were that teachers felt proud to be teachers; they adjusted themselves with the prevailing situation and circumstances, and they used different motivational techniques for teaching. Students were found to be satisfied with the positive behavior of their teachers. The relationship between the teachers' behavior and corresponding academic achievement (marks) revealed a highly positive significant correlation.

Storz professional image enhancement system (SPECTRA A) enhancing detection of carcinoma urinary bladder by white light cystoscopy

BackgroundSPECTRA A filters red light from white light through software to create contrast for better tissue visualization and light penetration. We aim to find whether the detection rate of bladder cancer is enhanced by SPECTRA A in adjunct to White Light Cystoscopy (WLC).MethodsThis was a prospective observational study among 66 patients in the Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital. All patients undergoing TURBT for suspected/diagnosed bladder tumor were evaluated with WL, followed by SPECTRA A mode, and findings were recorded using visual bladder mapping. Resection of the tumor was done on WL, margins were again reevaluated using SPECTRA A mode, and a biopsy was taken in cases of suspicious findings confirmed on SPECTRA A. Tumor detection rate (sensitivity), extra lesion detection, false positive rate, and margin status were evaluated through 2 × 2 tables, McNemar chi-square test on patient level as well as lesion level.ResultsA total of 64 patients were included in the study. The mean age was 62.20 ± 13.98 with a sex ratio of M:F 4.3:1. SPECTRA A and WL had a detection rate of 95.33% and 78.80% (p = 0.001), respectively, and positive biopsy of detected lesions was 78.8% and 84.13% (p = 0.041), respectively, for SPECTRA A and WL. The false positive rate of SPECTRA A and WL was 21.19% and 15.86% (p = 0.006), respectively, whereas the false negative rate was 4% and 19.2% (p = 0.001), respectively. The number of extra lesions detected by SPECTRA A was 39, out of which 29 were histologically proven tumors.ConclusionSPECTRA A enhances the detection rate of bladder cancer when used with WL. We can increase the detection of bladder cancer by using a combination of white light and SPECTRA A.

Preoperative Controlling Nutritional Status Score on Predicting the Postoperative Complications Following Major Hepatopancreatobiliary Surgery.

Introduction The prognostic significance of the controlling nutritional status (CONUT) score in hepatopancreatobiliary (HPB) surgery has been shown by many studies but the clinical significance of the CONUT score for postoperative short-term outcomes remains controversial. This study aimed to investigate the impact of the CONUT score on early postoperative outcomes in patients following major HPBsurgery. Method This was a prospective study of 57 patients who underwent major HPB surgery from November 2019 to January 2021 at the Department of Surgical Gastroenterology, Tribhuvan University Teaching Hospital, Nepal. Result A total of 57 patients, 25 males and 32 females, were operated on. The number of patients assigned to the normal, mild, and moderate malnutrition groups was 13, 41, and 3, respectively. The high CONUT group (CONUT ³ 2) consisted of 44 patients (77%) and the low CONUT group (CONUT <2) consisted of 13 patients (33%). The overall complications (Clavien-Dindo classification ³1) and major complications (Clavien-Dindo classification ³3) were present in 37 patients (64.9%) and 14 patients (24.6%), respectively. Increased operative time and intraoperative blood loss were associated with an increased incidence of major (OR: 1.01, p: 0.018) and overall (OR: 1.006, p: 0.039) postoperative complications, respectively, in univariate analysis. A high CONUT score was not associated with a higher incidence of overall and major postoperative complications. Conclusion In our study, the preoperative CONUT score did not predict the postoperative morbidity following hepatopancreatobiliary surgery.

Association of apolipoproteins A1 & B100 in subclinical hypothyroidism in patients attending endocrinology clinic at tribhuvan university teaching hospital

Association of apolipoproteins A1 & B100 in subclinical hypothyroidism in patients attending endocrinology clinic at tribhuvan university teaching hospital

Management And Early Outcomes of Bile Duct Injuries at University Teaching Hospital

Introduction Management of bile duct injuries is challenging and depends upon the type, clinical presentation, available resources and expertise. Some bile duct injuries may be managed with endoscopic intervention with Endoscopic Retrograde Cholangio-pancreaticography (ERCP), sphincterotomy and/or stenting while other BDI may require complex surgery and percutaneous interventions by interventional radiologists (IR). This study aimed to evaluate the management of bile duct injuries and its early outcomes at Tribhuvan University Teaching Hospital. Methods In this retrospective analysis, bile duct injuries in patients treated at Tribhuvan University Teaching Hospital, Kathmandu, Nepal over a period of two year were included (January 2020 to December 2022). The clinical characteristics, injury type (according to the Strasberg classification), management, early outcomes were described in this study. Number and percentages were calculated for categorical variables while mean and standard deviation (SD) was used for continuous data. Results Out of 26 bile duct injuries, 12 (46.2%) patients underwent surgical management, nine (34.6%) underwent percutaneous intervention and five (19.2%) underwent endoscopic intervention. Majority of the patient 15 (57.7%) had stricture as an indication for management. Patients who underwent surgical, endoscopic, and percutaneous management showed good early outcomes in 12, 5, and 8 patients respectively. The mean hospital stay was 11.8±5.2 days and CCI was 15.2±9.7, for patients with index presentation and underwent surgery. Conclusion Management of bile duct injuries require multidisciplinary team approach and favorable outcomes can be achieved when managed with expertise at tertiary centers. Surgical management remains essential for complex cases, while percutaneous and endoscopic interventions offer viable alternatives for less severe injuries.

Intranasal Corticosteroid Spray Usage in Patients with Allergic Rhinitis: Correctness in Technique and Compliance

Objective: To assess the correctness of technique and compliance of intranasal corticosteroid (INCS) spray usage in patients with allergic rhinitis. Methods: It was a cross-sectional study conducted in the Dept of ENT-Head and Neck surgery, Tribhuvan University Teaching Hospital from April to September 2023. Patients aged 18 or more with allergic rhinitis on INCS or had been on INCS in the past three months were assessed for INCS administration technique based on EPOS 2020 checklist and their compliance asked. Factors that could hinder the correct techniques and compliance were assessed. Results: A total of 138 patients, 71 males and 67 females, aged 18 to 55 years were included. Most of them (60/138; 43.5%) had completed secondary level education. 97.1% (134/138) had been prescribed INCS spray by ENT doctor and 89.13% (124/ 138) had received verbal instructions mostly by ENT doctor (91.1%). 7.2% (10/138) completed all the steps as per EPOS 2020 checklist whilst 25/138 (18.1%) completed five essential steps. The correctness of the INCS administration technique however did not differ with age, gender, academic qualification, prescriber or whether instructions were given or not. 119/138 (86.2%) patients reported being compliant. Conclusion. INCS spray was scarcely administered with the correct technique although the compliance was good. This study emphasizes the need for effective patient and healthcare worker education pertaining to correct INCS technique.

Clinico-radiological presentation and outcome of brain abscess in congenital cyanotic heart disease

Introduction Patients with congenital cyanotic heart disease (CCHD) are at increased risk of developing brain abscesses. Having a brain abscess is itself a risk for the patient and concomitant cyanotic heart disease makes it a double jeopardy. The management of brain abscesses depends on the size, number, stage, and location of the abscess and can be medical and surgical. Methods This retrospective chart review was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal between January 2019 and December 2023. Demographic and clinical profiles, imaging studies, treatment modalities, and outcomes were analyzed. Results Out of 17 patients, 11 were males and six were females. The mean age of the study population was 13.41 +/- 11.08 years. The most common associated cardiac problem was Tetralogy of Fallot seen in six (35.3%) patients and the most common abscess site was the parietal lobe (38%). The most common presenting symptom was vomiting, seen in 76%. Twelve patients underwent burrhole and aspiration and 17.6% of patients underwent surgical excision of the abscess wall whereas 11.7% of the patients were managed conservatively. Positive culture was seen in 33.3%. S. aureus was the most common organism grown. There was no mortality. Conclusion High index of suspicion for brain abscess is necessary in patients with congenital cyanotic heart disease. Early diagnosis and treatment lead to a favorable outcome.

Clinical Profile of Leprosy in Post-elimination Era in a Tertiary Care Hospital

Introduction Leprosy is a chronic disease that primarily affects peripheral nerves and skin. It has a long incubation period and clinical presentations are variable leading to deformities and social stigma. Leprosy was eliminated in Nepal in 2010 AD. This study was undertaken to determine the demographic and clinical profile of Leprosy in the past three years. MethodsA retrospective observational study was conducted in the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital. Records of all the newly diagnosed leprosy patients attending the Out-Patient Department from April 2021 to March 2023 were reviewed retrospectively and analyzed. ResultsThere were 109 newly diagnosed leprosy cases among which majority were males. The maximum clinical diagnosis was lepromatous leprosy and 100 (91.74%) cases were multibacillary. Type 1 lepra reaction was seen in 11 (10.09%) patients and 12 (11%) patients had type 2 lepra reaction. Slit skin smear was positive in 75 (68.80%) patients. On clinical examination, peripheral nerves were palpable in 92 (84.4%) patients with ulnar nerve being the most common palpable peripheral nerve. Type 1 deformity was present in 55 (50.45%) patients and 18 (16.51%) patients had type 2 deformity. Claw hand was the most common type 2 deformity observed. ConclusionThough leprosy has been eliminated in Nepal, there are still considerable cases of Leprosy. Higher number of cases with multibacillary disease and increasing number of Lepra reaction is an alarming sign.

Empowering futures: A financial literacy assessment among graduate students at Tribhuvan university

The purpose of this study is to assess the level of financial literacy among graduate students. The focus is on exploring the relationship between financial literacy and three key factors: financial attitude, financial knowledge, and financial behavior. The study targeted graduate students at Tribhuvan University's Faculty of Management (FOM) in Kathmandu valley with 710 students receiving a structured questionnaire. Total of 427 valid responses were received, establishing the sample for analysis. Descriptive and relational research designs was adopted for the analysis. Data was collected through a structured questionnaire, reflecting participants' financial attitudes, knowledge, and behaviors. The study concludes that there exists a positive association between the levels of students' financial attitudes, knowledge, and behaviors with their financial literacy. Additionally, the research findings reveal a significant and positive impact of financial attitude, knowledge, and behavior on financial literacy. Government authorities will utilize findings of the study for the development of policies aimed at enhancing financial literacy programs in Nepal. Banking and Financial Institutions (BFIs), Microfinance Institutions (MFIs) as well as regulators can use the insights to modify financial literacy programs that address the specific needs identified in the study. Professors, teachers, and trainers can incorporate with the study's results for curriculum planning, designing courses to foster financial attitudes, knowledge, and behaviors among graduate and post-graduate students.

Perceived Employability Variations Across Specializations Subjects in the Faculty of Education at Tribhuvan University

This study explores the level of perceived employability among education students, examining the multifaceted dimensions of skills and competencies crucial for success in the professional realm. Employability extends beyond technical proficiency, encompassing a range of attributes contributing to adaptability and effectiveness. Perceived employability, a subjective assessment of one's ability to secure and maintain employment, plays a pivotal role in shaping individuals' career approaches. A quantitative and exploratory approach was employed, utilising a cross-sectional survey and questionnaire within the context of Nepal's Faculty of Education at Tribhuvan University. The study involved 271 final-year students, employing proportional random sampling and statistical analyses. While education students express high confidence in various employability dimensions, a nuanced categorisation reveals a dual nature of 'presence' and 'consolidation' levels across competencies. Furthermore, specialisation subjects significantly influence perceived employability, with science majors showing higher levels. The study underscores the imperative for a comprehensive understanding of employability factors, emphasising the substantial impact of major subject choice on education students' confidence and readiness for future careers. The findings provide insights for academic institutions, policymakers, and students to enhance strategies for bridging the gap between education and employability in the Nepalese context.

Factors associated with depression among Type-2 Diabetic Patients in Nepal

Background: The worldwide health scenario is undergoing a shift from infectious diseases to non-communicable ones, and diabetes is now the seventh major contributor to global mortality. Depression, anticipated to be the second-highest contributor to Disability Adjusted Life Years by 2020, presents a notable public health challenge. The probability of experiencing depression is elevated two to three times in individuals with diabetes, particularly those diagnosed with Type 2 diabetes. Objectives: To assess the prevalence of depression and associated factors in Type 2 diabetic patients in Tribhuvan University Teaching Hospital. Methods: An analytical cross-sectional study was conducted among 151 Type 2 diabetic patients visiting Tribhuvan University Teaching Hospital, Nepal. Patients were selected by systematic random sampling at an interval of every third diabetic patient attending the Out-Patient Department. Depression was assessed using the Beck Depression Inventory. Data was analyzed using STATA-14 where logistic regression was performed to ascertain associations (P value &lt;0.05) of sociodemographic, behavioral and clinical characteristics with depression. Results: The prevalence of depression among Type 2 diabetic patients was 28.5%. Among them, 15.2% had mild depression, 11.9% had moderate depression and 1.4% had severe depression. The odds of having depression was 1.24 times higher with 1 unit increase in HbA1C level (AOR=1.24, 95%CI:1.09-1.42, P-value=0.001), 4.62 times higher in patients having retinopathy as comorbidity (AOR=4.62, 95%CI:1.63-13.11, P-value=0.04) and 6.36 times higher in patients taking insulin for treatment (AOR=6.36, 95%CI:1.79-22.53, P-value=0.004) after adjusting for age, sex, occupation, marital status, ethnicity income and education. Conclusion: The study revealed that more than a quarter of Type 2 diabetic patients in this sample experienced depression. Factors such as HbA1C, treatment by insulin and retinopathy as comorbidity were identified as significant contributors. These findings highlight the emerging problem of depression among diabetic patients, emphasizing the need for integrated mental health services in diabetes care.

Clinico-radiological correlation with outcome in acute epidural haematoma: a tertiary centre experience from Nepal.

Epidural haematoma (EDH) accounts for up to 15% of severe traumatic brain injury (TBI) cases and remains the most common cause of mortality and disability. Several clinical and radiological factors affect patient outcomes. This study aims to correlate patients' clinical and radiological profiles with acute EDH outcomes. A retrospective, single-centred, consecutive case series was conducted on the patients diagnosed with an acute EDH admitted to Tribhuvan University Teaching Hospital (TUTH) between May 2019 and April 2023. The modified Rankin scale (mRS) was used to assess the outcome. Univariate analysis and Kruskal-Wallis H test with Dunn-Bonferroni post-hoc test was conducted. There were 107 patients diagnosed with EDH, of which 52.3% were less than 20 years old with male preponderance. Falls were the most common mechanism of injury (64.5%), and most cases were referred to, not brought directly. The majority had a GCS score greater than or equal to 13 (85%) at presentation, and only 5.5% had a GCS score less than or equal to 8. According to the mRS, most patients had favourable outcomes, with 88.7% having no significant disability and 11.3% having a slight disability. This case series is the largest and most recent report from Nepal and demonstrated that GCS, pupillary response, skull fracture, neurological symptoms, pre-hospital and intra-hospital delay, and management modalities are critical factors in determining the total hospital and ICU stay but did not have an impact on the mRS scores.

Impact on Quality of Life in Chronic Pruritus in a Tertiary Level Hospital in Kathmandu

Introduction: Chronic pruritus is a common complaint in various dermatologic as well as non-cutaneous conditions, and it leads to significant impairment in the quality of life of the individuals suffering from it. The 5-D Itch Scale is an internationally validated multidimensional tool for the assessment of the burden of itching, localization patterns, pruritus intensity and evolution, as well as impaired sleep, difficulty in performing daily household activities, and social obligations and responsibilities in school and work. Objective: To assess the impact on various aspects of quality of life in chronic pruritus in a tertiary level hospital in Kathmandu. Materials and Methods: This was a hospital-based descriptive cross-sectional study conducted in the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, over a period of one year (October 2020 through September 2021), involving 180 participants. The impact on quality of life was measured with the 5-D Itch Scale. Results: The mean total 5-D score was 17.06 ± 2.697 (range 8 to 25), showing a severe impact on the quality of life of participants. Pruritus was unbearable in 22.2% and of severe intensity in 47.8% of participants. The impairments in sleep were found to be the most disabling by 40.5% of participants, while the majority of participants (93.9%) had developed some form of disability in leisure or social activities due to chronic pruritus. Conclusion: Individuals suffering from chronic pruritus face severe deterioration in various aspects of quality of life.

Clinico-Histopathological Consistency in Dermatological Disorders in a Tertiary Care Hospital of Kathmandu

Introduction: A skin biopsy for histopathological examination is one of the most reliable investigations for confirming clinical diagnosis. When there is alignment of clinical and histopathological diagnosis, it demonstrates clinico-histopathological consistency. There is limited reported data on clinico-histopathological concordance in the context of Nepal. Objectives: To determine the consistency of clinical and histopathological diagnosis of dermatological disorders. Materials and Methods: A retrospective study was conducted on 551 patients who underwent skin biopsy at the Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, for a period of 1 year. Both inpatients and outpatients who had undergone a skin biopsy were included in the study. Demographic data, clinical and histopathological diagnoses were noted on a proforma sheet. Histopathological diagnoses, both definitive and descriptive, were deemed consistent when they aligned with the clinical diagnoses. Conversely, if either definitive or descriptive histopathological diagnoses were not concordant with the clinical diagnoses, they were categorized as inconsistent. Results: The mean age of patients was 41.42 (±18.42) years. The male to female ratio was 1:1.5. Out of 551 cases who underwent skin biopsy, clinico-histopathological consistency was found in 64.43% of cases (355), whereas clinico-histopathological inconsistency was present in 35.57% (196). The maximum concordance was present in eczematous disorders (58.06%), followed by immunobullous disorders (47.22%), and vasculitis (45.45%). Conclusion: The overall clinico-histopathological consistency was 64.43%. Both experienced dermatologists and pathologists need to assist each other in providing a better understanding of the diagnostic process. This study emphasizes need for this cooperation and will aid in evaluating clinico-histopathological consistency.

Pattern of Inappropriate use of Topical Corticosteroid and Cutaneous Adverse Effects at a Tertiary Level Hospital in Kathmandu

Introduction: Topical corticosteroids are anti-inflammatory, immunosuppressive, and anti-proliferative drugs with profound efficacy. As it provides rapid relief, it is used for a wide spectrum of dermatological conditions. Rampant use of topical corticosteroids due to their easy availability gives rise to difficult-to-treat cutaneous adverse effects. Objectives: To determine the pattern of inappropriate use of topical corticosteroids and cutaneous adverse effects Materials and Methods: This was a hospital based cross-sectional prospective study conducted among 84 participants in the Department of Dermatology, Tribhuvan University Teaching Hospital, Kathmandu, from October 2020 to September 2021. Ethical clearance was obtained from the Institutional Review Committee. The participants fulfilling the inclusion criteria were included in the study. Results: Out of 84 cases, 59.5% were females and 40.5% were males. The mean age of participants was 30.4±9.1years. Dermatophytoses (71.4%) were the most common cause of inappropriate use of topical corticosteroids. The most common adverse effect was tinea incognito (23.8%). The most potent class (60%) of topical corticosteroids were misused. Most of the participants used topical steroids either for the duration of 1 week to 1 month ( 23.8%) or for more than 12 months (23.8%). Conclusion: Inappropriate topical corticosteroid use is a common problem due to its easy accessibility, resulting in several difficult-to-treat cutaneous adverse effects. So, awareness-raising activities regarding the proper use of corticosteroids have to be conducted.

SOFA and APACHE II scoring systems for predicting outcome of neurological patients admitted in a tertiary hospital intensive care unit.

The field of neurology encompasses the study and treatment of disorders that affect the nervous system, and patients with neurological conditions often require specialized care, particularly in the ICU. Predictive scoring systems are measures of disease severity used to predict patient outcomes. The aim of this study was to compare the discriminative power of commonly used scoring systems, namely the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) in the ICU of a tertiary care hospital. This retrospective study included patients with neurological disorders in the ICUs of Tribhuvan University Teaching Hospital from 1 January 2022 to 31 December 2022. A total of 153 patients were included. The mean age of the patients was 54.76 ± 17.32 years with higher male predominance (60.78%). Ischaemic stroke was the most common neurological disorder. There were 58 patients (37.9%) who required mechanical ventilation and all-cause mortality was 20.9%. The mean SOFA score was significantly higher (P=0.002) in survivors, whereas the mean APACHE II did not show a significant difference (P=0.238). Receiver operating characteristic (ROC) analysis showed the area of curve (AUC) of SOFA score was 0.765 and of APACHE II was 0.722. SOFA score had comparatively higher discriminative power than APACHE II. Assessment of the performance of scoring systems in a specific ICU setting improves the sensitivity and applicability of the model to these settings.

Diagnostic Accuracy of Fine Needle Aspiration Cytology as Compared to Histopathology in Parotid Gland Swelling.

The diagnosis of parotid swelling is challenging and investigations like imaging and needle aspiration cytology are helpful. The objective of this study was to determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) as compared to the histopathology in parotid gland swelling. It was a descriptive cross sectional study carried out in the Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu by reviewing the medical record charts of the patients who had undergone surgery for parotid lesions during the study period of seven and half years. All patients whose fine needle aspiration cytology and histopathology reports were available were included in the study. The data were presented as mean, standard deviation, ratio and percentages. Microsoft excel was used for data analysis. There were 75 patients included in the study. The age ranged from nine years to 78 years and the mean age being 38.3 17.42 years. The male to female ratio was 1:1.78. The concordance rate between fine needle aspiration cytology and histopathology was 82.7%. The sensitivity and specificity of the fine needle aspiration cytology were 80% and 95% respectively. Similarly, the positive predictive and negative predictive values were 84% and 93% respectively. The diagnostic accuracy of the fine needle aspiration cytology was 91% for the parotid swelling in our study. The diagnostic accuracy of fine needle aspiration cytology for parotid swellings in our study was excellent. The result of fine needle aspiration cytology is helpful in deciding management plan for parotid lesions.