COVID-19 mortality and its associated factors in Nepal: A cross-sectional study.

Objectives: Reports from other countries have indicated that severe forms and fatal cases of COVID-19 in older adults and people with underlying comorbidities. The aim of this study was to assess the risk factors associated with COVID-19 mortality in Nepal. Methods: A cross-sectional study was conducted from April 12 to July 23, 2021 to identify the underlying factors associated with COVID-19 deaths. Our sample included all cases diagnosed and registered as COVID-19-related deaths at 30 hospitals of Nepal. Results: A total of 1459 COVID-19 hospital-based death records were collected from 30 hospitals. Mean age at death was 60.2 (±15.6) years. One-third of cases were admitted with fever, cough, and shortness of breath. The computerized tomography Severity Score showed that 7.3% of the individuals who underwent high-resolution computerized tomography chest had a severe form of lung involvement, and 3.6% had mild to moderate involvement. The most common comorbidities were hypertension (43.7%) followed by diabetes mellitus (25.8%). Among the deceased, 37.7% were diagnosed as cases of COVID-19 pneumonia. The most common recorded causes of death were respiratory failure followed by cardio-pulmonary arrest. Conclusions: Individuals with comorbidities including hypertension and diabetes mellitus were at greater risk of developing complications and had a higher rate of mortality.

Salmonella infection among the pediatric population at a tertiary care children's hospital in central Nepal: a retrospective study.

Background: Typhoid fever, an infective bacterial disease, is capable of causing fatal systemic infection in humans, and in an era of antimicrobial resistance, it has become of public health importance. This study aimed to investigate the laboratory diagnosis of Salmonella bloodstream infection, its serotype, antimicrobial resistance pattern, and seasonal variation at a tertiary care children's hospital. Methods: We undertook a retrospective, cross-sectional study by reviewing hospital-based laboratory records of patients whose blood culture samples were submitted from the outpatient department to the laboratory of a tertiary care children's hospital in Kathmandu, Nepal, from January 2017 to January 2019. Results: Among the total blood culture samples obtained (n = 39,771), bacterial isolates (n = 1,055, 2.65%) belonged either to the Genus Enterobacteriaceae or Genus Acinetobacter. Altogether (n = 91, 8.63%), isolates were positive for Salmonella spp., which were further identified as Salmonella enterica subsp. enterica ser. Typhi (n = 79, 7.49%), Salmonella enterica subsp. enterica ser. Paratyphi A (n = 11, 1.04%), and Salmonella enterica subsp. enterica ser. Paratyphi B (n = 1, 0.1%). The median age of patients was 6 years (IQR: 4-9), with male and female patients constituting (n = 53, 58.24%; OR, 1.0; 95% CI, 0.60-1.67) and (n = 38, 41.76%; OR, 0.98; 95% CI, 0.49-2.05) cases, respectively. The disease was observed throughout the year, with a high prevalence toward the spring season (March-May). An antibiogram showed resistance more toward nalidixic acid with S. Typhi, comprising half the isolates (n = 52, 65.82%; p = 0.11). Resistance toward ß-lactams with ß-lactamase inhibitors (amoxicillin/clavulanate; 1.27%) was seen in a single isolate of S. Typhi. The multidrug resistance pattern was not pronounced. The multiple antibiotic resistance (MAR) index was in the range between 0.14 and 0.22 in S. Typhi and 0.22 and 0.23 in S. Paratyphi. Conclusion: Salmonella Typhi was the predominant ser. Infection was common among children between 1 and 5 years of age, showing male predominance and with the spring season contributing to a fairly higher number of cases. Antimicrobial susceptibility testing of S. Typhi showed more resistance toward nalidixic acid, with only a single isolate resistant to ß-lactamase inhibitors (amoxicillin/clavulanate). Alarming multidrug resistance patterns were not observed. The MAR index in this study indicates the importance of the judicious use of antimicrobials and hospital infection prevention and control practices.

Pulmonary embolism at CT pulmonary angiography in patients with COVID-19 at a tertiary care center in Nepal: a cross-sectional study.

Coronavirus disease 2019 (COVID-19) began to spread in December 2019 and was declared a pandemic by WHO on 11 March 2020. Pulmonary embolism (PE) is a known sequel to COVID-19 infection. Many patients showed worsened symptoms of thrombotic events of pulmonary arteries during the second week of the disease for which computed tomography pulmonary angiography (CTPA) is recommended. The most frequent complications in critically ill patients are prothrombotic coagulation abnormalities and thromboembolism. So, this study aimed to assess the prevalence of PE in patients with COVID-19 infection and to evaluate the relation to disease severity on CTPA findings. Methods: This cross-sectional study was performed to evaluate the patients who tested positive for COVID-19 and underwent CTPA. COVID-19 infection in participants was confirmed by a PCR of nasopharyngeal or oropharyngeal swab samples. Frequencies of computed tomography severity scores and CTPA were calculated and compared with clinical and laboratory findings. Results: The study included 92 patients with COVID-19 infection. Positive PE was found in 18.5% of the patients. The mean age of the patients was 59.83±13.58 years with an age range of 30-86 years. Among the total participants, 27.2% underwent ventilation, 19.6% died during treatment, and 80.4% of them got discharged. PE was developed in patients who did not receive prophylactic anticoagulation, which is statistically significant (P≤0.001). There was also a significant relationship between mechanical ventilation and CTPA findings. Conclusions: The authors conclude from their study that PE is one of the complications of COVID-19 infection. Rising D-dimer during the second week of disease alerts clinicians to do CTPA to exclude or confirm PE. This will help in the early diagnosis and treatment of PE.

Ultrasonography guided erector spinae block in spinal surgery for pain management with enhanced recovery: A comparative study.

Background: Improved and efficient management of pain can certainly aid enhanced recovery after spinal surgery. Our aim is to evaluate the effect of ESPB in thoracic and lumbar surgeries where we have evaluated VAS for pain, cumulative analgesics consumptions, length of hospital stay and post-operative complications. Methods: A cross-sectional comparative study done in HAMS among the erector spinae block group and control group. The analysis of different variable was done according to standard statistical analysis. For quantitative data, univariate and multivariate analysis was performed to determine statistically significant differences using student's t-test for continuous variables. Results: 60 patients were analyzed, 30 got spinae block and 30 in control group.The mean pain score for spinae block group were 1.90 ± 0.712 and 3.27 ± 1.230 for control group (p < 0.001). Cumulative mean analgesic consumption values for spinae block vs. control groups were 0.030 ± 0.042 mg vs. 0.091 ± 0.891 mg (p = 0.001) for fentanyl; 1.06E4 ± 2833.300 mg vs. 1.53E4 ± 2848.349 mg (p < 0.001) for paracetamol; 213 ± 64.656 mg vs. 494 ± 58.816 mg (p < 0.001) for ketorol; 5440.00 ± 2060.064 mg vs. 8667.50 ± 2275.006 mg (p < 0.001) for ibuprofen and 121.67 ± 31.303 mg vs. 185.00 ± 51.108 mg (p < 0.001) for tramadol. Conclusions: The ESPB technique shows early discharge from hospital and lower cumulative analgesics consumption which indicates enhanced recovery after spine surgery than control group. Improvement of pain using VAS shows immediate post-operative period recovery in those who receives spinae block.

Late Presentation of Hypoxic Injury of Brain in an Infant.

Perinatal asphyxia is one of the leading causes of hypoxic-ischemic encephalopathy. In a developing country like Nepal, home delivery is the leading cause of perinatal asphyxia. Neuroimaging remains the diagnostic modality of choice. We present a case report of a 10-month-old infant who presented to the pediatric Out-patient-department with complaints of being unable to hold his head and unable to sit without support. Detailed history, physical examination, and developmental assessment along with lab investigation flash visual evoked potentials and Magnetic Resonance Imaging of the brain was performed. Hypoxic ischemic injury has common five types of imaging patterns in neonates. There are a few imaging differentials to be considered while evaluating the case for hypoxic injury. Clinicians and radiologists must go hand in hand to narrow down the possibilities which can fasten the treatment thereby decreasing morbidity and mortality. Keywords: Hypoxic ischemic encephalopathy, Infant, Magnetic Resonance Imaging.

Significance of Hematological Biomarkers in Association to Syphilitic Patients.

BACKGROUND: Venereal syphilis is a sexually transmitted disease, involving pathological activities mediating tissue destruction by extensive tissue necrosis. As such, the goal amongst researchers has been set to the identification of effective laboratory biomarkers that can reflect the broad spectrum of disease and ultimately aid in timely diagnosis and effective treatment of syphilis. This research aimed to study the applications of hematological biomarkers associated with syphilitic patients visiting a tertiary care hospital. METHODS: A retrospective cross-sectional study was conducted in the syphilitic patients attending KIST Medical College and Teaching Hospital, Lalitpur, Nepal. A total of 25 syphilitic patients and 41 non-syphilitic participants were included. The rapid plasma reagin test and Treponema pallidum hemagglutination assay were used for the screening and confirmation of syphilis respectively. The hematological investigation was performed using a hematology analyzer. Statistical Package for Social Science version 17.0 was used for data analysis. A P value <0.05 was considered significant. RESULTS: Syphilitic patients showed significantly elevated levels of lymphocytes (39.8±11.5) (p=0.025), monocyte (1.9±0.8) (p=0.002), mean corpuscular volume (MCV) (92.6±12.9) (p=0.005), and mean corpuscular hemoglobin (MCH) (31.9±4.6) (p=0.008) and lowered levels of red blood cell (RBC) (4.2±0.3) (p=0.005) and platelets (237.2±628.6) (p=0.048) as compared to the lymphocytes (32.9±11.9), monocyte (0.6±1.2), MCV (83.9±8.8), MCH (34.3±1.5), RBC (4.6±0.7), and platelets (280.9±113.3) of the non-syphilitic participants. CONCLUSIONS: The results showed that the elevated levels of lymphocyte, monocyte, MCV, and MCH and lowered levels of RBC and platelets are highly specific hematological biomarkers for the diagnosis of patients with syphilis.

Correlation of Multidetector Computed Tomography Peripheral Angiography with Color Duplex Sonography in Peripheral Arterial Disease.

BACKGROUND: With aging of the global population peripheral arterial disease is increasingly common. Arteriography, computed tomography angiography and magnetic resonance angiography are common modalities used for evaluation of peripheral arterial disease. However, they have limitations of being invasive, costly, limited availability or contraindicated in patients with renal impairment or contrast allergy. Duplex imaging, a method of evaluation of peripheral arterial disease is cost effective, widely available and safe even in patients with renal impairment and contrast allergy. METHODS: A prospective cross sectional descriptive study involving 114 patients was conducted from November 2015 to October 2016. The patients were evaluated by Doppler ultrasound following multi-detector computed angiography in Department of Radiology, Tribhuvan University Teaching Hospital. The lower limb arteries were divided into 10 segments and stenosis or occlusion of each segment in Computed Tomography angiography were compared with findings in Doppler, Computed Tomography angiography being considered the gold standard. Data was collected in predesigned proforma in Microsoft Excel spread sheet. RESULTS: Duplex imaging showed sensitivity 94.94%, specificity 98.54%, accuracy 97.54%, positive predictive value 96.15 % and negative predictive value 98.06 %. In assessment of 22 segments, partial stenosis seen in Computed Tomography angiography was overestimated as complete stenosis in Doppler. There was significant positive correlation of velocity ratio with degree of partial occlusion (r=0.918 for right lower limb and r=0.895 for left lower limb, p <0.01). CONCLUSIONS: Duplex imaging is safe cost effective and reliable method of evaluation of patients with peripheral arterial diseases.

Functional Outcome of Proximal Femoral Nailing in Intertrochanteric Fracture.

BACKGROUND: Intertrochanteric fracture of femur is one of the commonest fracture seen in elderly, osteoporotic female. The main stay of treatment is fixation with dynamic hip screw or intramedullary device like Proximal Femoral Nail. Intramedullary devices are found to be more biomechanically advantageous. The functional outcome of these fractures depends on the type of fixation, age and stability of fracture. The objective of this study is to assess the functional outcome of Proximal Femoral Nail in intertrochanteric fracture. METHODS: An observational study was conducted in Kathmandu Medical College, Sinamangal from January 2018 to May 2019. 32 patients with intertrochanteric fracture were treated with proximal femoral nail during this period. The functional outcome was measured at 6 weeks, 12 weeks and 6 months using Harris hip score. RESULTS: There were 46.9% males and 53.1% females with mean age of 71.09 ±12.35 years. Most of the patients sustained injury after falling from standing height (53.1%). The functional outcome measured at final follow up (6 months) with Harris hip score was good in 62.5% and excellent in 28.1% patients likewise follow up in 12 weeks was good in 15.6%. CONCLUSIONS: Proximal Femoral Nail in trochanteric fractures seem to provide a good functional outcome at 6 months follow up. This technique, therefore appears to be a viable option in the management of intertrochanteric fracture of femur.

Modern Paediatric Radiology: Meeting the Challenges in CT and MRI.

Radiology plays a very important part in the diagnosis, treatment, and follow-up of children. Computed tomography and magnetic resonance imaging are the two most crucial developments in the modern era. However, the two modalities have their challenges to overcome. Radiation dose is the most unwanted side effect of computed tomography scans while longer scan time along with sedation is a major disadvantage in children during magnetic resonance imaging. Paediatric-specific protocol selection and limiting the exposure to the area of interest aid in reducing the dose during computed tomography scans. Faster scan protocols and sequences can result in imaging without sedation in magnetic resonance imaging. Considering the radiation exposure, "as low as reasonably achievable" principle should be followed strictly in the paediatric population. In this article, possible ways for minimising the radiation dose in computed tomography, as well as effective, short, and sedation-free magnetic resonance imaging, are discussed. Keywords: computed X-ray tomography; magnetic resonance imaging; pediatrics; radiation exposure; X-ray.

Perceptions of Adolescents Regarding Breast Cancer.

BACKGROUND: Breast cancer in women is a major health burden. In Nepal, most common cancer in female is breast cancer. Knowledge plays an important role in improvement of health seeking behavior. Knowledge may positively affect attitude and practice. So, this study aims to assess the knowledge and attitude regarding breast cancer among the adolescents. METHODS: A cross-sectional study was done among students of 23 randomly selected highher secondary schools of Bhaktapur district. Total 990 participant were assessed with questionnaire regarding knowledge and attitude towards breast cancer. RESULTS: Out of total 400 participants, 89.6% of male and 88.5% of female respondents had poor knowledge regarding breast cancer. 63.2% of the female and 50.9% of the male respondents had good attitude towards breast cancer. Religion, education of parents and ethnicity of respondents showed positive association with respondent's knowledge of breast cancer. Gender, education and ethnicity of respondents showed positive association with respondent's attitude of breast cancer. CONCLUSIONS: Majority of the respondents had poor knowledge and half of respondents had good attitude towards breast cancer. Therefore, educational programs and awareness campaigns that target adolescents to improve their knowledge and attitude regarding breast cancer must be encouraged.

Alteration of Thyroid Hormone among Patients with Ischemic Stroke visiting a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Stroke is broadly classified as cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage. Neuroendocrine profile is altered in acute ischemic stroke and there is a link between hypothyroidism and atherosclerosis which in turn may lead to stroke. The objective of this study was to find out the prevalence of alteration of thyroid hormones in patients with ischemic stroke in a tertiary care center. METHODS: This descriptive cross-sectional study was conducted from June to December 2019 in a tertiary care center. Ethical approval was taken from Institutional review board of National Academy of Medical Sciences (reference number: IM 175). Patients with a diagnosis of stroke, without evidence of cardioembolic source, history of liver disease, renal failure and thyroid disease and who do not use thyroidal supplementation within 180 days prior the event were included. Convenience sampling was done. Data was entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 22. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data. RESULTS: The prevalence of altered thyroid levels among 73 patients was 13 (17.8%) (90% Confidence Interval= 10.44-25.16). Among them 11 (15.1%) were hypothyroid and 2 (2.7%) were hyperthyroid. Among severity of hypothyroid cases, subclinical hypothyroidism grade IA was seen in 51 (70%), subclinical hypothyroidism grade IB was seen in 22 (30%). CONCLUSIONS: The prevalence of altered thyroid levels among patients undergoing ischemic stroke was similar to the findings of other international studies.

Pediatric Radiology in Era of COVID-19, International Consensus and What Lies Beyond Pneumonia: A Review.

Diagnostic radiology plays a crucial role in children. The pediatric population has been less studied than the adult population since the initial period of the COVID-19 pandemic to date. Realizing the potential utility of structured reporting, different guidelines and international consensus statements regarding COVID-19 in the pediatric population have been released in recent times. Different clinical and radiological manifestations in children have been evolving in this period of uncertainty and are different from the adult population in certain aspects. Apart from the involvement of lungs, a multisystemic inflammatory syndrome in children or pediatric multi systemic inflammatory syndrome is unique in children. Therefore, awareness of the recent consensus, structural uniform reporting and multi-organ involving patterns in COVID-19 can guide radiologists for a better understanding of this complex novel disease leading to early diagnosis and timely treatment of affected children.

Evaluation of Breast Mass by Mammography and Ultrasonography with Histopathological Correlation.

BACKGROUND: Mammography, ultrasound and Magnetic Resonance Imaging are the available modalities for the evaluation of breast masses. Advances and ongoing improvements in imaging technologies have improved the sensitivity of breast cancer detection and diagnosis, but each modality is most beneficial when utilized according to individual traits such as age, risk factors, and breast density. However, pathological diagnosis is most crucial for the treatment of breast masses. METHODS: A cross-sectional study were conducted from January 2017 to April 2018. There were total of 50 patients with clinically diagnosed palpable breast lumps who attended Gynaecological OPD/surgical OPD/medicine OPD in the study period. The patients above 30 years were evaluated by mammography and ultrasound in Department of Radiology, National Academy of Medical Sciences, Bir Hospital. The patients were then send for FNAC/biopsy and histopathology examination. Data were collected and analyzed using SPSS version 16. Specificity and sensitivity of MG and USG individually and in combination to determine the nature of breast lump in relation to histopathological findings were calculated. RESULTS: Ultrasound had 88.90% sensitivity and 68.80% specificity whereas mammogram had 94.40% and 87.50% sensitivity and specificity respectively. When combined, both sensitivity of diagnosing malignant lesions increases up to 94.4% and specificity decreases up to 31.2%. Most of the variables of ultrasound and mammography (except density of the lesion) had significance in predicting nature of the lesion (p< 0.05). CONCLUSIONS: Combined Mammography and Ultrasound had higher sensitivity than sensitivity rate observed for either single modality. A combined Mammography and Ultrasound approach to detect breast diseases was significantly more helpful in accurate evaluation of breast pathologies.

Normal Anatomy and Variants of Renal Vasculature with Multidetector Computed Tomography in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Preoperative multisection computed tomography evaluation can provide necessary anatomic information in minimally invasive surgeries. This study was done to estimate the preva-lence and pattern of variations of renal vasculature through contrast-enhanced computed tomogra-phy in patients referred to the radiology department of a tertiary care hospital. METHODS: A descriptive cross-sectional study was conducted from 6th April 2016 to 6th April 2017. Ethical approval was taken. The triple-phase contrast-enhanced computed tomography was per-formed on 188 patients enrolled through convenient sampling. The images were evaluated in un-enhanced, arterial, and venous phases for the vascular variants. Data were analyzed based on the anatomical types of variations and descriptive statistics such as frequency and percentage using the Statistical Package for the Social Sciences. RESULTS: Out of the 188 patients, 60 (31.9%) had accessory renal arteries. The most common variant was hilar arteries which comprised 38 cases (20.2%) whereas polar arteries were present in 21 (11.1%)cases and the capsular artery was present in one (0.5%) case. Early bifurcation of the renal artery was noted in 15 (8%) cases with 10 (5.3%) on the right and 5 (2.7%) on the left side. Twelve (6.3%) cases of the double right renal vein were noted whereas retroaortic left renal vein was noted in only 4(2.1%) cases. CONCLUSIONS: Based on our study, almost one in three patients had accessory renal arteries and eighty-five out of a thousand patients had variants of renal veins.