Tribhuwan University Teaching Hospital Research Articles

The relationship of serum amylase levels in acute organophosphorus poisoning with its clinical severity and outcome: a cross-sectional study.

A cross-sectional study was carried out in the Maharajgunj Medical Campus, Tribhuwan University Teaching Hospital, Kathmandu, Nepal, after ethical approval [Ref: IRB/308 (6-11-E)]. We collected data from 172 participants with OP poisoning over the period of 2 years using nonprobability purposive sampling method. All patients with age group 16-75 years having a history of OP poisoning within the previous 24h with clinical features and physical evidence of poisoning were included in the study. Those participants with indications of exposure to an entirely different poisons, poisoning with multiple poisons, OP poisoning along with alcohol, chronic alcoholics, comorbid conditions, taking drugs that could affect serum amylase levels (azathioprine, thiazides, furosemide, etc.), and/or treated in other hospitals after poisoning were excluded from the study. Appropriate statistical calculations were made using the statistical package for social sciences (SPSS), version 21. The P-value of less than 0.05 was considered statistically significant. Metacid (53.5%, 92) was the most common OP poison. There were significantly higher mean values of serum amylase levels either within 12h of exposure (468.60 vs. 135.4IU/ml, P<0.001) or after 12h of exposure (152.0 vs. 58.9IU/ml, P<0.001) in dead participants than alive ones. The participants with initial and after 12h of exposure-serum amylase level 100 or more IU/ml had more than two-fold and 18-fold higher odds of severe/life-threatening severity (odds ratio=2.40, 95% CI: 1.28-4.52, P=0.007 and odds ratio=18.67, 95% CI: 8.02-43.47, P<0.001) respectively than those with less than 100IU/ml. The clinical severity of OP poisoning is directly related to serum amylase levels. Importantly, higher mean values of serum amylase levels were depicted in those participants with OP poisoning culminating to death. Thus, serum amylase level could be one of the easy measurable prognostic marker of OP poisonings.

Factors associated with final visual outcome in traumatic hyphema

Introduction: Hyphema is the accumulation of blood in anterior chamber of the eye that can directly affect our vision. Various factors play role in final visual outcome among patients with hyphema, and there are very few related studies. Therefore, this study aimed to determine the factors related to final visual outcome among patients with traumatic hyphema. Methods: This cross-sectional study was conducted among 62 cases of traumatic hyphema presenting to the emergency department of Tribhuwan University Teaching Hospital and outpatient department of Bisheshwar Prasad Koirala Lions Centre for Ophthalmic Studies from July 2018 to July 2019. A detailed clinical history was obtained, followed by an ophthalmic examination and relevant investigation. Data was analysed using descriptive and inferential statistics at 5% level of significance using IBM statistical package for the social sciences. Results: Projectile (54.8%) and fall injury (12.5%) were the most common mode and causes of trauma, respectively. The best visual acuity of the involved eye at presentation was 6/9 (6.5%), and the worst was non-perception of light (3.2%). At presentation, the most common grade of hyphema was grade I (48.4%), and the least common was microhyphema (6.5%). Grades of hyphema (p=0.014) were significantly associated with the final visual outcome. Anterior segment findings such as of lid (p&lt;0.001) and lens (p=0.014) and posterior segment findings such as of vitreous (p&lt;0.001) and retina (p=0.048) were also significantly associated with final visual acuity. Conclusions: For the most optimal visual outcome in traumatic hyphema, all associated periocular and intraocular findings must be prioritized and addressed accordingly.

Quality of life and economic burden in patients with dermatophytosis in a tertiary level hospital of Kathmandu, Nepal

Background: Dermatophytosis is the infection of keratinized tissue (skin, hair, and nail) caused by various species of dermatophytes. Cutaneous lesions and pruritus caused by dermatophytosis are associated with significant morbidity and impairment of quality of life (QoL). Aims and Objectives: The aim of the study was to assess impairment in quality of life and economic burden in patients with dermatophytosis in Tertiary Level Hospital of Kathmandu, Nepal. Materials and Methods: The following is a hospital-based cross-sectional prospective study conducted in 150 tinea patients in the Department of Dermatology, Tribhuwan University Teaching Hospital from July 2019 to June 2020. Patient aged 18 years and above was assessed with history and examination and then asked to fill the printed validated DLQI questionnaire in Nepali to assess the impairment in quality of life. Average amount of money spent for over-the-counter medication before enrollment in the study was calculated and analyzed. Results: Out of 150 tinea patients, 68.6% were males and 31.4% were females. The mean age of patient with tinea was 29.58+10.174 and most patients were students (36.6%). The most common diagnosis was tinea cruris (26%) and median duration of illness was 3.5 months. The median DLQI score was nine, indicating “moderate effect on patient’s life.” The median amount spent in the management before visiting our center was NRs. 1500. Conclusion: The study showed that dermatophytic infections are associated with moderate impact in QoL and economic burden.

A Prospective Study on Neonatal Sepsis in a Tertiary Hospital, Nepal

About 20 % of neonates develop sepsis and among them approximately 1% die due to sepsis-related causes. Bacterial pathogens are the commonest cause of neonatal sepsis which is either early-onset (&lt;72 hours of age) or late-onset (&gt;72 hours). Little is known about the epidemiology and antimicrobial susceptibility pattern of sepsis causing bacterial pathogens in Nepal. A prospective study was carried out among neonates suspected to have sepsis and admitted to Tribhuwan University Teaching Hospital from January to December 2016. Clinical suspicion of sepsis was made based on clinical findings and laboratory parameters, later confirmed by isolation of organisms in blood culture. Drug resistance pattern of Gram-positive and Gram-negative bacteria were studied by standard methods. Meropenem resistant Gram-negative bacteria were processed for the detection of β-lactamases and resistant genes were detected by X-pert Carba-R (Cepheid) Assays. Of 372 neonates with clinically suspected sepsis, 132 (35.4%) had blood culture positivity, with 47% early-onset and 53% late-onset sepsis. Coagulase-negative Staphylococcus aureus (CONS) was the most common (37.9%) etiological agent followed by Klebsiella pneumoniae (12.9%). Of all 132 isolates, 81 (61.3%) were Gram-positive of which 22 (27.2%) were multi-drug resistant (MDR), three (3.7%) were methicillin-resistant S. aureus (MRSA), and 14 (17.2%) were methicillin-resistant CoNS; and 50 (37.8%) were Gram-negative of which 26 (52%) were MDR and 29 (58%) were resistant to β-lactamases. The blaKPC gene was detected in four isolates of K. pneumoniae, two of E. coli, one ABC (Acinetobacter baumanii complex), and one Enterobacter aerogenes whereas blaNDM gene was detected in one isolate of K. pneumoniae, two of E. coli, two Pseudomonas aeruginosa, one Acinetobacter baumanii complex, and one Enterobacter aerogenes. Overall mortality due to sepsis-related causes was 7.6% (10 of 132). One-third of clinically suspected neonatal sepsis cases were culture positive. Late-onset sepsis was more common than early onset. CoNS was the predominant bacterial isolate followed by Klebsiella pneumoniae, with high rates of multi-drug resistance.

Clinicopathological, Endoscopic and Radiological Evaluation of Intestinal Tuberculosis among Nepalese Patients at a Tertiary Care Center

Background: Intestinal tuberculosis is often difficult to diagnose due to its insidious onset and nonspecific and protean manifestations. Delay or failure of diagnosis is associated with significant complications like perforation, abscess, fistula and strictures. The objective of the study was to provide a descriptive analysis of clinical, endoscopic, radiological and pathological findings in these patients. Methods: A prospective study including 52 hospitalized patients was done between April 2018 to 2020 at Tribhuwan University Teaching Hospital. Statistical analyses were done by Microsoft excel version 16. Results: Males were 63% while females were 37 %. The average age was 37 years. 84% had abdominal pain followed by abdominal distension (50%), chronic diarrhea (51%) and cough (21%). Abnormal chest X-Ray was found in (37%) among whom (53%) had sputum positive for tubercular Bacilli. Common CT scan findings were thickening and heterogenous enhancement of bowel loops (79%), lymphadenopathy (56%) and ascites (44%). Endoscopically, commonly involved sites were terminal Ileum (95%), cecum (77%) and ascending colon (42%). Frequent finding were ulcers (83%), patulous and deformed Ileocecal valve (33%), mucosal nodularity (38%), hypertrophic mucosa (21%) and strictures (11%). Biopsies revealed granulomas in (77%) specimens. (65%) of them had central caseous necrosis. Among 10 subjects undergoing needle aspiration of lymphnodes, (70%) had central caseous necrosis. Those with coexisting peritoneal involvement had a mean ascitic fluid adenosine deaminase level of 73 ± 8 IU/L. Conclusion: Intestinal tuberculosis remains a major concern in developing countries. A composite analysis of the clinical manifestations, CT scan, endoscopic findings and pathological examination of the biopsies aid in making a proper and timely diagnosis so as to prevent complications and mortality.

Comparison of Outcome of Borderline and Normal Amniotic Fluid Index in Term Pregnancy

Background Determination of Amniotic Fluid Index (AFI) is an important component of antepartum assessment of all normal pregnancies.&#x0D; Objective To compare the obstetric interventions and neonatal outcomes in term pregnancies with borderline Amniotic Fluid Index versus normal Amniotic Fluid Index.&#x0D; Method This hospital based prospective study was conducted at Tribhuwan University Teaching Hospital over 1 year between 2017 and 2018 in 128 women having uncomplicated term pregnancy admitted in labor ward. Of the 128 women, 64 women had borderline Amniotic Fluid Index (5.1-8 cm) and 64 normal AFI (8.1 - 24 cm). Parameters studied were induction of labor, cesarean section, instrumental delivery, intrapartum abnormal fetal heart rate, meconium staining of liquor, APGAR score at 5 and 7 minutes, birth weight, neonatal intensive care unit (NICU) admission and neonatal death. Data was analyzed using software OpenEpi.&#x0D; Result Statistically significant difference in result was obtained in the two groups in terms of rate of induction of labor (73.4% vs 35.9%, p = 0.0001, OR = 4.9), rate of cesarean section (42.1% vs 28 .1%, p = 0.04, OR = 1.8), tachypnea (50% vs 11.1%, p = 0.01) and low birth weight (9.1% vs 4.5%, p = 0.04). No statistical significance was found in meconium staining of liquor (33% vs 38.3%, p = 0.3) and APGAR score of &lt;7 at 5 minutes (3.1% vs 1.5%, p = 0.06). There were no neonatal intensive care unit admissions and neonatal mortality in any of the babies.&#x0D; Conclusion Detection of amniotic fluid volume at term is important for timely maternal interventions to improve the overall fetal outcome.

Incidence of Congenital Fetal Malformation Abnormalities in Tribhuban University, Teaching Hospital, Kathmandu, Nepal: a Hospital Based Study

Background : Birth defects are defined as abnormalities of structure or function, which are present at birth. Major birth defects are abnormalities that lead to developmental or physical disabilities or require medical or surgical treatment and they're the leading cause of death in the first year of life. The objective of this study is to find the incidence of congenital abnormalities in this institution.&#x0D; Methods: This was a prospective study conducted in Institute of Medicine, Maharajgunj Medical Campus, Tribhuwan University Teaching Hospital from 14th April 2015 to 11th Feb ,2016 . All the delivered babies in this hospital during the study period were included. All the birth cases of gross congenital fetal malformation were identified and carefully studied and were classified according to the International Classification of diseases (ICD-10).&#x0D; Results: Total number of congenital fetal malformation abnormalities (CMF) delivered during this period was 94 (1.13%) in total 8300 birth /7868 live birth. CMF were categorized as, Musculoskeletal - 25.55%, CNS - 17.02%, Gastrointestinal -13.33%, Renal 14.25%, Cardiac -10.63%, Respiratory -10.6%, craniofacial - 9.57%, Genitouriary - 8.51%, and Miscellaneous - 9.57%.&#x0D; Conclusion: Birth abnormalities incompatible to life needs to be timely diagnosed and terminated, whereas as those compatible to life should be given a chance to be born and cared thereafter. All the mothers who have, had previous malformed babies must undergo preconceptional counseling, before planning next pregnancy in order to avoid recurrent mishap.&#x0D;

Factors Related to Late Intrauterine Fetal Death in a Tertiary Referral Center: A Retrospective Study

Backgroun: Intrauterine fetal death (IUFD) is a contributor of perinatal outcome and is an important indicator of the quality of antenatal care. Despite efforts, risk factors cannot be identified in cases of intrauterine fetal deaths. This study aims to identify the maternal, fetal, placental and cord related factors related to it. &#x0D; Methods: It is a retrospective cross-sectional study conducted analyzing patients admitted with IUFDs after 28 weeks of pregnancy at Tribhuwan University Teaching Hospital from April 2019 to March 2020. It was conducted after taking ethical approval from Institutional Review Committee (IRC) of Institute of Medicine. Data were collected from review of charts of individual patients in MS Excel and was analyzed using SPSS.&#x0D; Results: There were 5496 births and 46 intrauterine fetal deaths during the study period giving stillbirth rate of 8 per 1000 births. It was common in the age group of 26-30 years (34.8%), 62.2% were from inside Kathmandu valley,43.5% were just literate, 13% were illiterate, 84.8% were housewives, 56.5% were primigravida and 69.57% of the babies were preterm. Only four percent had previous history of intra uterine fetal deaths. Hypertensive disorders complicating pregnancy were found in 30.5% followed by heart disease in 10.9% of the mothers. There were no known co-morbidities in 26.1% of the patients. Out of total 46 cases, 62% were female. Two had Rh isoimmunization and four had congenital malformations. Placenta previa was seen in four percent and abruptio placenta in two percent. Twin pregnancy with diamniotic dichorionic placenta was present in four percent. Seventeen percent of the babies had cord around the neck and two percent had thrombosis of the umbilical cord. &#x0D; Conclusion: Low level of maternal education and maternal comorbidities like hypertensive disorders complicating pregnancy were found to be most common factors seen in cases of intrauterine fetal deaths.

Burnout Among Postgraduate Medical Students in Tertiary Hospital

Medical education is highly stressful, stepping into a new environment, huge course syllabus which has to be mastered in a short period of time besides continuous assessments, examinations and other social and personal issues makes medical student prone to develop negative emotional symptoms. Burnout is a type of psychological stress. Occupational burnout or job burnout is characterized by exhaustion, lack of enthusiasm and motivation, feelings of ineffectiveness, and also may have the dimension of frustration or cynicism, and as a result reduced efficacy within the workplace. To assess the burnout of postgraduate medical students of tertiary level hospital. A cross sectional study was conducted on 198 medical students at Tribhuvan University Teaching Hospital (TUTH) in Kathmandu. Socio- Demographic Performa and Maslach Burnout Inventory were psychometric tools used. Statistical Package for Social Sciences (SPSS), Inc., and Chicago, IL, USA version 21 for windows was used. Among 198 postgraduate medical students, 52% (N= 112) had severe level of burnout present. Burnout was divided into respective sub- scale of personal accomplishment, depersonalization and emotional exhaustion, where 29% had severe level of depersonalization, 28% had severe level of emotional exhaustion and 25% of them had higher level of personal accomplishment. These measures were administered to 198 post graduate medical students (male=107, female=91) at Tribhuwan University Teaching hospital. Among the participants, more than half of them had been burnout.

Knowledge, Attitude and Practice (KAP) of Women towards Cervical Cancer Screening at A Tertiary Care Institute in Kathmandu, Nepal

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: Cervical cancer is one of the most common cancers among women worldwide. It is preventable by early detection of precancerous lesions by various screening techniques. Considering the importance of the perceptions and practices of the women about the disease and its screening, this study was conducted with an aim to determine the knowledge, attitude and practice of women towards cervical cancer and its screening among Nepalese women visiting a tertiary care institute in Kathmandu.&#x0D; Methods: A cross-sectional descriptive study was conducted among 390 outpatients in the gynaecological outpatient department of Tribhuwan University Teaching Hospital for a span of six months. Data were collected after obtaining ethical clearance from the institutional review board. A structured questionnaire covering the socio-demographic characteristics and knowledge, attitude and practice on cervical cancer and its screening was used.&#x0D; Results: Among the 390 women who were interviewed, the mean age was 41.9 years, 37% of the respondents had an average knowledge and 16.5% had a good knowledge about cervical cancer and its screening. There was a positive attitude among 70% of the respondents, however the uptake of screening among them was less than 25% only. Embarrassment (72%), pain (71%) and lack of privacy (65.9%) were the main barriers of screening.&#x0D; Conclusions: Knowledge regarding cervical cancer screening was found to be good and the attitude to undergo screening was positive. However, a significant number of barriers refrain women from seeking this service which is shown by the poor practice for screening.&#x0D; &#x0D; &#x0D; &#x0D;

Fetomaternal Outcome in Second Stage Caesarean Section

Introduction: Second stage caesarean section is usually associated with the deeply engaged head, less liquor, and thinned out the lower uterine segment. This can lead to a high risk of maternal morbidities like an extension of the lower uterine segment incision, uterine atony, and injury to urinary bladder as well as neonatal morbidities such as birth asphyxia, NICU admission, and meconium aspiration syndrome. This study aims to observe the maternal and neonatal outcomes of caesarean delivery performed in the second stage of labor.&#x0D; Materials and Methods: This was a retrospective study of the fetomaternal outcome of all women with singleton, a cephalic fetus at term delivered by caesarean section in the second stage of labor over one year at Tribhuwan University Teaching Hospital.&#x0D; Results: During this study period, there were 4653 deliveries. A total of 2274(48.88%) were born by caesarean section, out of which 1739 (76.5%) were elective and 535(23.5%) were emergency. Among emergency LSCS 36(6.72%) were performed in the second stage of labor. Most of the indications were nondescent of head 34(93.5%) followed by intraoperative maternal complications (hematuria; n=14; 38.88%). Postoperative maternal who had complications were prolong catheterization: 14(38.88%), postoperative fever : 10 (27.77%), prolong hospitalization: 5(13.88%). In perinatal complications meconium stain liquor : 10(27.77%), NNU admissions : 5(13.88%), Apgar score &lt;5 at 5 min : 5 (13.55%), NICU admission : 2(5.54%), fresh stillbirth : 1(2.77%) were observed.&#x0D; Conclusions: Caesarean sections done in the second stage of labor are associated with severe maternal and neonatal complications.

A Comparative Study of Lipid Profile among Smokers and Non Smokers

Introduction: Smoking is a risk factor for the development of cardiovascular diseases and many other diseases. Smoking is found to alter lipid profile and poses a risk for atherosclerosis. This study aims to compare lipid profile between smokers and non smokers.&#x0D; Methods: Hospital based observational study was carried out in Tribhuwan University, Teaching hospital(TUTH), Kathmandu, Nepal on 90 smokers and 90 non smokers who were apparently healthy. Data on socio demographic variables were collected using a questionnaire and lipid profile was estimated on fasting venous blood in an auto-analyzer. The lipid levels of smokers and non smokers were compared using t-test.&#x0D; Results: Most of the smokers were daily wagers and they consumed alcohol and high fat food compared to non smokers. The serum levels of HDL were significantly lower in smokers compared to nonsmokers.LDL level was positively correlated with numbers of cigarettes/ beedi smoked. The LDL level was significantly high in those who smoked more than 10 cigarettes or beedis. The duration of smoking had no significant effect on lipid profile. LDL and VLDL were significantly high among those with pack years more than 3. LDL levels positively correlated with pack year.&#x0D; Conclusion: Tobacco smoking is associated with dyslipidemia (increased LDL-c and decrease HDL-c level.

Lived Experiences of Clients with Total Knee Replacement Residing in Kathmandu

Introduction: Total Knee Replacement (TKR) is an increasingly common treatment for severe knee osteoarthritis and the main indication is pain. Subjective factors affect the way in which individuals express their real-life experiences thus, this study aimed in bringing to the fore the personal perspective and interpretation of clients with (TKR). The objective of this study was to explore the lived experiences of clients with total knee replacement.&#x0D; Methodology: Phenomenological qualitative research design was used where participants were selected from hospital record of Tribhuwan University Teaching Hospital and Nepal Orthopedic Hospital of Kathmandu. Based on the lived phenomenon, similar sharing of experiences from seven among nine participants with the in-depth interview was obtained. The data was collected for 2 months period where data analysis went simultaneously to reveal the concepts. Then the interview was transcribed manually following the thematic analysis phases of Gibson.&#x0D; Results: The results indicated that most (5/7) expressed their ability to walk independently. Four clients (4/7) reported they could perform household chores and had no difficulty travelling in vehicles. Despite those positive results, all respondents (7/7) after TKR faced difficulties sitting down and the majority (6/7) faced difficulty climbing stairs. Four had difficulty in standing up and lying. Three had queries about the treatment process; swelling of lower legs and life of the implant.&#x0D; Conclusion: The emerged five themes: impact of the treatment regimen, mobility issues, treatment modalities, supportive environment and inadequate health counselling revealed that although there is mixed result of treatment outcome, all respondents are satisfied as they got rid of the continued severe knee pain; hence, the respondents are following some safety and precaution measures for the better outcome. Adequate health counselling emphasizing in the rehabilitation programmes after TKR should be prioritized.

Clinical Profile of Critically Ill Patients Presenting to Emergency Department of Tertiary Level Hospital of Nepal

Introduction: Among critically ill patients presenting to Emergency Room (ER) of Tribhuwan University Teaching Hospital (TUTH), a number of patients have to either remain in ER or have to be referred outside due to unavailability of critical care beds. Studies have shown significant association between delayed admission and mortality rates along with increased length of stay and higher cost. This study aimed to present an audit of critically ill patients presenting to ER of TUTH.&#x0D; Methods: This was a prospective study conducted over a period of one month. All patients presenting to ER of TUTH were triaged and critically ill patients were shifted to Red area of the ER. All patients ≥16 years of age shifted to Red area during the study period were enrolled in our study.&#x0D; Results: Out of 3718 patients presenting to ER during the study period, the number of critically ill patients ≥16 years of age was 526 i.e. 14.14% of total patients. Among them, the common diagnosis were Cerebrovascular Accidents (CVA) followed by Intoxication, Acute Exacerbation (AE) of Chronic Obstructive Pulmonary Disease (COPD), Pneumonia and Chronic Kidney Disease (CKD) respectively. Almost 20% of these patients were admitted, 31% were referred and 40% were shifted for observation. The median length of ER stay was 6 hours (Mean: 8.5 hrs; Range: 20 min to 70 hr 15 min).&#x0D; Conclusion: Among critically ill patients presenting to our ER, almost 1/5th of the patients were admitted whereas more than 2/3rd were either referred or remained in our ER. This data highlights the need for solutions to provide optimal care for the acute phase management of the critically ill patients.

Clinical Profile of Critically Ill Patients Presenting to Emergency Department of Tertiary Level Hospital of Nepal

Introduction: Among critically ill patients presenting to Emergency Room (ER) of Tribhuwan University Teaching Hospital (TUTH), a number of patients have to either remain in ER or have to be referred outside due to unavailability of critical care beds. Studies have shown significant association between delayed admission and mortality rates along with increased length of stay and higher cost. This study aimed to present an audit of critically ill patients presenting to ER of TUTH. Methods: This was a prospective study conducted over a period of one month. All patients presenting to ER of TUTH were triaged and critically ill patients were shifted to Red area of the ER. All patients ≥16 years of age shifted to Red area during the study period were enrolled in our study. Results: Out of 3718 patients presenting to ER during the study period, the number of critically ill patients ≥16 years of age was 526 i.e. 14.14% of total patients. Among them, the common diagnosis were Cerebrovascular Accidents (CVA) followed by Intoxication, Acute Exacerbation(AE) of Chronic Obstructive Pulmonary Disease(COPD), Pneumonia and Chronic Kidney Disease(CKD) respectively. Almost 20% of these patients were admitted, 31% were referred and 40% were shifted for observation. The median length of ER stay was 6 hours (Mean: 8.5 hrs; Range: 20 min to 70 hr 15 min). Conclusion: Among critically ill patients presenting to our ER, almost 1/5th of the patients were admitted whereas more than 2/3rd were either referred or remained in our ER. This data highlights the need for solutions to provide optimal care for the acute phase management of the critically ill patients.

Evaluation of intrathoracic lesions by image guided fine needle aspiration cytology

Background: Fine needle aspiration cytology has become an indispensable tool for diagnosis of intrathoracic lesions. The purpose of this study was to evaluate the spectrum of intrathoracic lesions by image guided fine needle aspiration cytology.&#x0D; Materials and Methods: This was a prospective study of 100 patients, who underwent image guided fine needle aspiration cytology of intrathoracic lesions from December 2015 to November 2016 in the Department of Pathology, Institute of Medicine, Tribhuwan University Teaching Hospital.&#x0D; Results: Of the 100 cases, diagnostic material was obtained in 86 cases, which included 69 cases (80.23%) from lung, 7 cases (8.13%) from pleura and 10 cases (11.62%) from mediastinum. Lung lesions constituted of 61 neoplastic lesions (88.40%), 3 cases (4.34%) suspicious of malignancy, 3 cases (4.34%) negative for malignancy and 2 non- neoplastic lesions (2.89%). Squamous cell carcinoma was the most common lesion of the lung. Pleural lesions consisted of 5 neoplastic cases (71.42%), 1 non- neoplastic case (14.28%) and 1 negative for malignancy (14.28%). Mediastinal lesions consisted of 7 neoplastic lesions (70.00%) and 3 non- neoplastic lesions (30.00%). Biopsy for histopathological examination was available in 30 cases. The concordance of diagnosis of lung lesions by fine needle aspiration cytology and histopathology was 90.90%. Image guided FNAC had sensitivity of 95.83% and specificity of 50.33% in diagnosing intrathoracic lesions. The positive predictive value of image guided FNAC in diagnosis of intrathoracic lesions was 92.00% and negative predictive value of 66.67 percent.&#x0D; Conclusions: Image guided fine needle aspiration cytology of intrathoracic lesions permits categorization and distinction between non- neoplastic and neoplastic lesions.

Placental Pathology in Severe Pre-eclampsia and Eclampsia

Introduction: Hypertensive disorders complicating pregnancy contribute significantly to maternal and perinatal morbidity and mortality. Since placenta is the functional unit between the mother and fetus examination of placenta can give an idea about prenatal experience of fetus. The aim is to observe the morphology and histopathology of placenta in pregnancy with severe preeclampsia / eclampsia between 20-42 weeks of gestation.Materials and Methods: This was a prospective, descriptive study carried out in the Department of Obstetrics and Gynaecology and Department of Pathology at Institute of Medicine, Tribhuwan University Teaching Hospital, TUTH for one year, starting from 15th May 2015 - 14th May 2016. A total 55 placentas, 48 of severe preeclampsia and 7 of eclampsia were collected and placental morphometric parameters, gross and histopathological features were examined.Results: It was found that placental morphometric parameters were significantly reduced. Histopathological study showed significant number of syncytial knots, areas of fibrinoid necrosis, hyalinization and calcification. These placental findings were associated with significantly decreased weight of fetus at birth.Conclusions: Preeclampsia and eclampsia cause significant placental morphometric and histological changes which in turn adversely affects neonatal birth weight.Nepalese Medical Journal, vol.1, No. 1, 2018, page: 32-35

Serum Lactate Albumin Ratio as a Predictor of Mortality in Severe Sepsis and Septic Shock at Tribhuwan University Teaching Hospital, Kathmandu

IntroductionSevere sepsis and septic shock, is a common cause of emergency room admission and is associated with high morbidity and mortality worldwide. This study inspects the prediction of mortality in severe sepsis and septic shock with increased lactate/albumin ratio.Objective The objective of the study was to predict the serum lactate albumin ratio as an indicator of mortality in severe sepsis and septic shock.MethodologyIt was a hospital based cross sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from November 2015 to October 2016. The consent was taken from patients. Acute Physiology and Chronic Health Evaluation II score, serum lactate and serum albumin levels on first day of arrival in emergency room were calculated. Patients were classified as severe sepsis and septic shock and treated according to Surviving Sepsis Campaign 2012 guideline. The patient were follow up at 28 day, The associations of 28-day outcome with Acute Physiology and Chronic Health Evaluation II score, serum lactate value, serum albumin value and serum lactate albumin ratio value were derived.ResultsOut of total 240 severe sepsis and septic shock patients it is found that increased serum lactate/albumin ratio was an independent predictor of the mortality with cut off value of 0.07. Furthermore serum lactate albumin ratio shows strong correlation with APACHE 2 score in predicting mortality in severe sepsis and septic shock.ConclusionIncreased lactate/albumin ratio predicts mortality in patients with severe sepsis and septic shock. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 191-195

Obstetric outcome in patients with rheumatic heart disease: experience of a tertiary hospital.

Background and Aims: Pregnancy in patients with rheumatic heart disease has always been challenging. Haemodynamic changes in pregnancy with diseased heart may cause adverse maternal and fetal outcome.Methods: A prospective study was done in pregnant women with rheumatic heart disease over a period of 2 years from 2015 to 2016 at Tribhuwan University Teaching Hospital, Kathmandu. Baseline data collected at antenatal period were analyzed with obstetric outcomes.Results: A total of 85 women were enrolled in this study. Sixty percent of the women were primigravida. Mitral stenosis was the commonest lesion (69.41%), followed by mitral regurgitation (25.88%) and aortic stenosis (4.71%). Cardiac events were noted in 32 patients out of which 11 developed pulmonary oedema and 6 had new onset of atrial fibrillation. Vaginal delivery (58.82%) was the commonest mode of delivery followed by cesarean section (24.7%). Eighty percent of women remained in NYHA functional class I and II, whereas 20% had deterioration of functional class. There were more maternal and fetal complications in women with NYHA III or IV in comparison to women with NYHA I or II. Low birth weight infants were found in 37.64% of cases. There was one maternal death in a lady with severe mitral stenosis with moderate mitral regurgitation due to congestive heart failure at 34 weeks of gestation. There were 8 fetal and 11 neonatal deathConclusions: Functional cardiac status during pregnancy has a major impact on maternal and fetal outcome. Rheumatic heart disease diagnosed before pregnancy may improve the outcome.Nepalese Heart Journal 2017; 14(2): 31-34

Determinants of Anemia Among Pregnant Women Attending in a Tertiary Level Hospital, Kathmandu

Background: Anemia is a common problem in pregnancy, particularly in developing countries which causes low birth weight and increased risk of maternal and perinatal morbidity and mortality.Methods: A descriptive cross-sectional study was adopted to determine the factors associated with anemia among pregnant Systematic Random Sampling technique was used and sample size was 280 pregnant women who visited the antenatal clinic of the Tribhuwan University Teaching Hospital, Kathmandu. Data was collected by face to face interview technique by pretested questionnaire. Chi-square, bivariate, multivariate logistic regression model was used, and statistical significance was determined with a 95% confidence level.Results: Mean age of respondents was 25.86±4.191 years. Anemia among pregnant women was 22.1%.The significant determinants associated with anemia were pregnant women who had not taken iron regularly (AOR=18.380, 95% CI=3.687-91.624, p=0.005).Conclusion: The results indicate that anemia is still prevalence in pregnant women in tertiary level hospital at Kathmandu. Irregular intake or discontinuation of iron was significant factor for anemia. Therefore, pregnant women and their family members need counseling about the importance of regular intake of iron during pregnancy.Med Phoenix Vol.2(1) July 2017, 24-33