Carotid Intima-media Thickness in Patients with Non-alcoholic Fatty Liver Disease Attending a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Non-alcoholic fatty liver disease is fatty infiltration of the liver in the absence of other causes of steatosis. It is strongly associated with central adiposity, high body mass index, insulin resistance states, hypertension, hyperlipidemia which are features of metabolic syndrome. The objective of study is to find out the carotid intima-media thickness of non alcoholic fatty liver disease patients attending a tertiary care center. METHODS: This was a descriptive cross sectional study conducted at National Academy of Medical Sciences, Bir Hospital from July 2018 to June 2019 among 70 diagnosed cases of non alcoholic fatty liver disease based on ultrasound findings. Data collection was started after receiving ethical approval from Institutional Review Board of the Institute. Convenience sampling method was used. Data were entered using Microsoft Excel. The carotid intima-media thickness of both sides were measured by ultrasound. Statistical Package for Social Sciences version 20 was used for analysis. RESULTS: Out of 70 cases, the mean carotid intima-media thickness was 0.7140±0.1796mm on right and 0.7161±0.1828mm on left side. Among 70 cases 45 (64.3%) were Grade II non alcoholic fatty liver disease and 25 (35.7%) were Grade I. It was 0.5720±0.1275mm and 0.7929±0.1546mm in Grade I and II non alcoholic fatty liver disease cases respectively on right side whereas it was 0.5676±0.1259mm and 0.7987±0.1557mm respectively on left side. CONCLUSIONS: This study showed increased carotid intima-media thickness in non alcoholic fatty liver disease cases.

Frontline Healthcare Workers' Knowledge and Perception of COVID-19, and Willingness to Work during the Pandemic in Nepal.

This study investigated the contextual factors associated with the knowledge, perceptions, and the willingness of frontline healthcare workers (FHWs) to work during the COVID-19 pandemic in Nepal among a total of 1051 FHWs. Multivariable logistic regression analysis was applied to identify independent associations between predictors and outcome variables. Of the total study subjects, 17.2% reported inadequate knowledge on COVID-19, 63.6% reported that they perceived the government response as unsatisfactory, and 35.9% showed an unwillingness to work during the pandemic. Our analyses demonstrated that FHWs at local public health facilities, pharmacists, Ayurvedic health workers (HWs), and those with chronic diseases were less likely, and male FHWs were more likely, to have adequate knowledge of COVID-19. Likewise, nurses/midwives, public health workers, FHWs from Karnali and Far-West provinces, and those who had adequate knowledge of COVID-19 were more likely to have satisfactory perceptions towards the government response. Further, FHWs-paramedics, nurse/midwives, public health workers, laboratory workers-FHWs from Karnali Province and Far-West Province, and those with satisfactory perceptions of government responses to COVID-19 were predictors of willingness to work during the COVID-19 pandemic. These results suggest that prompt actions are required to improve FHWs' knowledge of COVID-19, address negative perceptions of government responses, and motivate them through specific measures to provide healthcare services during the pandemic.

Correlation of Ultrasonographic Parameters with Serum Creatinine and Estimated Glomerular Filtration Rate in Patients with Echogenic Kidneys.

BACKGROUND: Ultrasonography is widely used to evaluate the kidney status. Serum creatinine and glomerular filtration rate assess the functional status of the kidney. This study tried to find the association between renal parameters in ultrasonography, serum creatinine and estimated glomerular filtration rate in patients with echogenic kidneys. METHODS: Study was done in 61 patients. Four sonographic renal parameters (renal echogenicity grade, renal length, cortical thickness, parenchymal thickness) were obtained from patients showing echogenic kidneys irrespective of cause during ultrasonography of abdomen. Glomerular filtration rate was calculated using Modified Diet in Renal Disease formula after obtaining patient's serum creatinine level. Sonographic renal parameters were compared with serum creatinine and estimated glomerular filtration rate using Pearson's correlation coefficient and one-way ANOVA tests. RESULTS: The study showed significant correlation of only renal echogenicity grade and parenchymal thickness with eGFR. However, all four sonographic renal parameters showed significant correlation with serum creatinine level. Renal echogenicity grading had strongest correlation with both serum creatinine (r=0.571, p=0.000) and estimated glomerular filtration rate (r= -0.349, p=0.006). Mean serum creatinine (in mg/dL) ± standard deviation was 1.9(±1.5), 4.0(±3.7), 5.8(±3.7), and 15.4(±5.3) for grade I, II, III, and IV echogenic kidneys respectively. Similarly, mean eGFR (in ml/min/1.73m2) ± standard deviation was 50.2(±22.9), 35.9(±40), 15.7(±13.4), and 3.4(±1.1) for Grade I, II, III, and IV echogenic kidneys respectively. CONCLUSIONS: Renal echogenicity is a better sonographic parameter that correlated well with both eGFR and serum creatinine. Renal ultrasound should be routinely used for early diagnosis, grading and monitoring of kidney disease.