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1.
Ann Lab Med ; 42(1): 89-95, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34374353

RESUMO

Background: Total laboratory automation (TLA) is an innovation in laboratory technology; however, the high up-front costs restrict its widespread adoption. To examine whether the capital investment for TLA is worthwhile, we analyzed its clinical- and cost-effectiveness for the expected payback period. Methods: Clinical chemistry tests and immunoassays performed in the clinical laboratory of a tertiary care hospital were divided into a post-TLA group, including 1,182,419 tests performed during December 2019, and a pre-TLA group, including 1,151,501 tests performed during December 2018. Laboratory information system data were used to measure clinical effectiveness, and depreciation data were used to calculate TLA costs. Results: Laboratory performance improved after TLA adoption in all four key performance indicators: mean turn-around time (TAT), representing the timeliness of result reporting, decreased by 6.1%; the 99th percentile of TAT, representing the outlier rate, decreased by 13.3%; the TAT CV, representing predictability, decreased by 70.0%; and weighted tube touch moment (wTTM), representing staff safety, improved by 77.6%. Based on these effectiveness results, economic evaluation was performed using two approaches. First, the incremental cost-effectiveness ratio and wTTM were used as the most cost-effective performance indicators. Second, the expected payback period was calculated. Considering only staff cost reduction, it was anticipated that 4.75 yrs would be needed to payback the initial investment. Conclusions: TLA can significantly enhance laboratory performance, has a relatively quick payback period, and can reduce total hospital expenses in the long term. Therefore, the capital investment for TLA adoption is considered to be worthwhile.


Assuntos
Automação Laboratorial , Serviços de Laboratório Clínico , Análise Custo-Benefício , Humanos , Laboratórios , Centros de Atenção Terciária
2.
Rev Chilena Infectol ; 38(3): 423-431, 2021 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-34479301

RESUMO

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a severe syndrome, potentially lethal, with a pathological activation of the immune system and an extreme hyperinflammatory response. The etiology is classified in primary HLH (familiar or genetic) and secondary (infectious, oncological, and rheumatological diseases). AIM: To analyze clinical and laboratory characteristics, treatment, and follow-up rates in pediatric patients with HLH. METHODS: A pediatric cohort of patients with HLH diagnosis attending in a tertiary hospital between January 2000 to February 2019 was analysed. RESULTS: 23 hospitalized patients were recruited with a median of 36 months of age. The most frequent clinical and laboratory findings were fever, cytopenias, and hyperferritinemia. The most frequent aetiologies were infectious (Epstein Barr virus and citomegalovirus) and rheumatological diseases. The global mortality was 35%, there was no significant difference between etiologies. DISCUSSION: Considering the high mortality of HLH it is very important to have a high grade of suspicion that allows treating at an early stage. It would be important to determine clinical and laboratory predictors in multicentric studies.


Assuntos
Infecções por Vírus Epstein-Barr , Linfo-Histiocitose Hemofagocítica , Criança , Seguimentos , Herpesvirus Humano 4 , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/etiologia , Centros de Atenção Terciária
3.
Ultrasound Q ; 37(3): 254-260, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478424

RESUMO

ABSTRACT: This retrospective study shares our departmental experience of screening of ultrasound (US) requests, triaging of studies, and abbreviated US protocols implemented during the COVID-19 pandemic. For US studies requested in April and May 2020, the following data were collected: type of study, indication, COVID-19 status (positive or patient under investigation [PUI]), decision to perform study, US findings, and location of patient. A total of 196 US studies in 150 patients were included. The median age of patients was 60 years (female: 46.7% [70/150]). At the time of study request, 83 patients (55.3%) were COVID-19-positive and 67 (44.7%) were PUI, of which 8 (11.9%) tested positive after waiting for test result. The most frequently requested study was venous extremity Doppler (51%), followed by right upper quadrant (20.4%), renal (11.7%), and liver duplex (6.6%). After radiologist screening and triage of US requests, 156 studies were performed (79.6%), 15 were postponed until COVID test result (7.6%), and 40 were not performed after discussion with ordering provider (20.4%). Notably, 40.1% of studies performed on COVID-19-positive patients yielded pathological findings, most frequently deep venous thrombosis (18.1%), medical renal disease (7.6%), and gall bladder sludge (5.7%). Abbreviated US protocols were used in 29.4% of studies. In conclusion, US study screening and triage played an important role to optimize care of COVID-19 patients and PUIs.


Assuntos
COVID-19/epidemiologia , Pandemias , SARS-CoV-2 , Centros de Atenção Terciária/estatística & dados numéricos , Ultrassonografia Doppler Dupla/métodos , Trombose Venosa/diagnóstico , Adulto , COVID-19/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose Venosa/etiologia
4.
Adv Rheumatol ; 61(1): 55, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479631

RESUMO

BACKGROUND: Anti-rheumatic drugs can increase the predisposition to infection, and patients may be unaware of continuing their treatment during the COVID-19 pandemic. OBJECTIVE: This study aimed to assess whether patients maintain their treatment for rheumatic conditions during the pandemic period and determine the factors responsible for discontinuation. METHODS: Patients were randomly selected from the prospectively collected database of our tertiary referral center. The patients were interviewed by telephone through a standardized closed-ended questionnaire, which is targeting the continuity of the treatment plan and the considerations related to the individual choice. The patients were asked whether they hesitated to visit the hospital for follow-up or intravenous drug administration. RESULTS: A total of 278 patients completed the questionnaire. While 62 of the patients (22.3%) had reduced or interrupted the treatment, only 11 patients (3.9%) stopped the treatment completely. A significant difference was observed between the duration of illness and the discontinuation of treatment. (p = 0.023) There was a significant difference in disease activity between the group that stopped treatment and continued treatment. (p = 0.001) There was no statistically significant difference in other demographic characteristics. One hundred thirty-five patients (48.6%) made the treatment decision by themselves, and 80% continued the treatment. Reasons for stopping the treatment were anxiety (48.4%), not being able to go to the hospital for intravenous treatment (45.1%), and not being able to find the drug (6.5%). CONCLUSION: Since patients with long-term illnesses were found to be significantly more likely to stop their treatment, this group of patients should be monitored.


Assuntos
Antirreumáticos/uso terapêutico , Atitude Frente a Saúde , COVID-19/epidemiologia , Pandemias , Doenças Reumáticas/tratamento farmacológico , Suspensão de Tratamento/estatística & dados numéricos , Adulto , Idoso , Antirreumáticos/provisão & distribuição , Ansiedade , Continuidade da Assistência ao Paciente , Bases de Dados Factuais , Tomada de Decisões , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Reumáticas/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Centros de Atenção Terciária , Adulto Jovem
5.
BMJ Open ; 11(9): e047444, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493512

RESUMO

OBJECTIVE: Official guidelines recommend tuberculosis (TB) screening programmes for all healthcare workers (HCWs), along with offering treatment when latent TB infection (LTBI) is diagnosed. However, adherence to treatment among HCWs is lower compared with non-HCWs. The aim of the present study was to examine the rate of LTBI treatment acceptance among HCWs and to characterise the factors associated with non-acceptance. DESIGN AND SETTING: This was a retrospective cohort study. All HCWs diagnosed with LTBI, who had tuberculin skin test (TST) conversion during their work, between 2000 and 2015, in a single tertiary academic medical centre, and who consented to answer a questionnaire, were enrolled. RESULTS: Overall, 147 of 219 (67%) with TST conversion agreed to participate. Acceptance rate for LTBI treatment was only 16%. The overall completion rate among those who accepted treatment was 87%. HCWs' recall of discussing the importance of LTBI treatment with their caregiver had the strongest association with LTBI treatment acceptance: 23 of 52 HCWs (44%) who recalled this discussion accepted treatment (adjusted OR=10.2, 95% CI: 2.2 to 47.6, p=0.003). Knowing the risk of developing TB was associated with 3.7 increased odds to accept treatment (95% CI: 1.2 to 11.8, p=0.02). CONCLUSIONS: LTBI acceptance rate was very low among our HCWs. Focusing on educating HCWs is potentially the key step towards an increased rate of LTBI treatment acceptance.


Assuntos
Tuberculose Latente , Pessoal de Saúde , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/tratamento farmacológico , Tuberculose Latente/epidemiologia , Programas de Rastreamento , Estudos Retrospectivos , Centros de Atenção Terciária
6.
JNMA J Nepal Med Assoc ; 59(235): 252-255, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506434

RESUMO

INTRODUCTION: Acute appendicitis is the most common reason for abdominal surgery in children. Though appendectomy considered the gold standard there are a lot of complications related to it. Conservative management of acute appendicitis is not new to medical science. In pandemic like COVID-19 when all the health systems were about to shut-down because of lack of manpower and resources, we started a trial of non-operative management. The main aim of this study is to find out the management of acute appendicitis during COVID-19. METHODS: This was a descriptive cross-sectional study conducted in a tertiary care centre. Data collection was done from the record section which included the patients diagnosed with acute appendicitis from February 2020 to July 2020 after obtaining ethical clearance from Institutional Review Committee. Cases of appendicular lump, appendicular abscess, appendicular perforations have been excluded. Data was collected and entry was done in Statistical Package for the Social Science software version 20, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The conservative management of acute appendicitis was done in 44 cases (55.7%) while 35 cases (44.3%) had to undergo appendectomy. CONCLUSIONS: COVID-19 can complicate the perioperative course as a result of direct lung injury and multiple organ dysfunctions and can also bring serious threats to the safety of medical staffs involved in managing the acute appendicitis case operatively, so conservative management can be considered as an alternative way of management of acute appendicitis in the pandemic outbreak.


Assuntos
Apendicite , COVID-19 , Apendicectomia , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Estudos Transversais , Humanos , Pandemias , SARS-CoV-2 , Centros de Atenção Terciária
7.
JNMA J Nepal Med Assoc ; 59(235): 243-247, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506437

RESUMO

INTRODUCTION: D-dimer is currently the best available marker for COVID-19 associated hemostatic abnormalities. This study aims to find out the prevelance of elevated D-dimer levels in confirmed COVID-19 cases in intensive care unit of a tertiary care hospital of western Nepal. METHODS: This descriptive cross-sectional study was conducted among 95 patients admitted to COVID Intensive Care Unit of a teriary care centre from August 2020 to January 2021 after taking ethical clearence from Institutional Review Committee in order to determine the D-dimer levels in confirmed COVID-19 cases. D-dimer value was measured at the admission and the highest D-dimer value was recorded during the course of hospital stay with the risk of mortality in confirmed COVID-19 cases. The normal range of D-dimer was taken as <0.35 mg/dl as per our hospital laboratory standards. Convenience sampling method was used. Data entry and descriptive analysis were done in Statistical Package for the Social Sciences version 25.0, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of total 95 cases of COVID-19 included in this study, 25 (89.3%) patients with age ≥ 65 years and 42 (62.69%) patients aged <65 years had elevated D-dimer on admission. Data showed that 29 (67.4%) patients having elevated D-dimer at admission had mortality. CONCLUSIONS: Elevated D-dimer levels was frequently seen in patients admitted in Intensive Care Unit with COVID-19. Our study suggested that measurement of D-dimer may guide in clinical decision making.


Assuntos
COVID-19 , Idoso , Estudos Transversais , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , Unidades de Terapia Intensiva , Nepal/epidemiologia , Prevalência , SARS-CoV-2 , Centros de Atenção Terciária
8.
JNMA J Nepal Med Assoc ; 59(235): 267-270, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506441

RESUMO

INTRODUCTION: Varicosity is the common problem of various etiology having simple limb aching to worst complications like oedema, ulcer, and skin changes. Minimal invasive endovenous laser therapy is a noble procedure. The aim of the study is to find out the recurrence of the varicose vein after laser therapy in a tertiary care center. METHODS: This descriptive cross-sectional study was done in 38 patients with varicosity of the lower limb in a tertiary care hospital, from January 2019 to June 2019 after taking ethical clearance from Institutional Review Committee. Convenience sampling was done. Data was collected and entry was done in Statistical Package for the Social Science software version 22, point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: We recorded 38 patients with ablated limb out of which none of the ablated veins showed recanalization in six months follow up. Twenty two (58%) patients were male and 16 (42%) patients were female with a mean age of 40.26 years. Major bulk, 23 (60.5%) resumed activity in second postoperative day and only 1 (2.6%) patient waited for 5 days for normal activity with mean of 2.58 days postoperatively. Sixteen (42.1%) patients developed erythema or ecchymosis, 12 (31.6%) patients had induration along the long saphenous vein course, 7 (18.4%) patients had paresthesia, 2 (5.3%) patients had limb swelling and 1 (2.6%) patient had skin burn. CONCLUSIONS: Endovenous laser ablation has very low rate of recurrence of varicosity and has minor complications.


Assuntos
Terapia a Laser , Varizes , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Recidiva , Veia Safena , Centros de Atenção Terciária , Resultado do Tratamento , Varizes/epidemiologia , Varizes/cirurgia
9.
JNMA J Nepal Med Assoc ; 59(235): 239-242, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506442

RESUMO

INTRODUCTION: Health personnel working in the frontline to deal with COVID 19 outbreak are at increased risk of developing psychological problems. This study aims to find out the prevalence of depression, anxiety and stress among Nepalese health care workers. METHODS: This is a hospital based descriptive cross-sectional study conducted from July 10 2020 to September 10, 2020. All health care workers (total 280) were included in the study. HADS-14 item was used to measure anxiety and depression. Perceived stress scale was used to measure stress. Data was analyzed with Statistical Package for the Social Sciences software version 24.0. Statistical data was analyzed by percentage, mean and standard deviation. RESULTS: Out of total 270 respondents the prevalence of anxiety, depression and stress was found to be 112 (41.4%), 65 (24.1%) and 203 (74%) respectively. Females accounted for 148 (54.8%) and males 122 (45.2%). More than one third 96 (35.6%) of the health workers were working in front line. CONCLUSIONS: Prevalence of anxiety, depression and stress is higher among health workers when compared to similar studies. Effective strategies toward improving the mental health like adequate rest, supply of protective equipments, frequent breaks, ensuring safety issues of their family members, training on management of stress might be helpful in reducing stress.


Assuntos
COVID-19 , Pandemias , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Pessoal de Saúde , Humanos , Masculino , Nepal/epidemiologia , SARS-CoV-2 , Centros de Atenção Terciária
10.
JNMA J Nepal Med Assoc ; 59(235): 256-262, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506445

RESUMO

INTRODUCTION: Typhoid fever and paratyphoid fever commonly called as enteric fever is a life-threatening illness caused by Salmonella serotype Typhi and Salmonella serotype Paratyphi, respectively. It is a major public health issue in underdeveloped and developing countries. The aim of the study is to find out the prevalence of enteric fever pathogens in blood culture of patients attending a tertiary care centre. METHODS: A descriptive cross-sectional study was conducted in 3483 blood samples of patients attending a tertiary care centre, with the history and symptoms suspicious of enteric fever during one year period from mid-September 2019 to mid-September 2020 after ethical approval from the institutional review committee. Isolates were identified by standard microbiological methods and tested for in vitro antibiotic susceptibility by modified kirby-bauer disc diffusion method. The obtained data was entered and analyzed in WHONET 5.6 program, point estimate at 95% was calculated along with frequency and proportion for binary data. RESULTS: In our study, enteric fever pathogens were isolated from 18 (0.51%) blood samples. Out of which, Salmonella Paratyphi A was isolated from 10 (8.19%) and Salmonella Typhi was isolated from 8 (6.55%) blood samples. Other serotypes were not isolated. Antimicrobial susceptibility test showed that salmonella species that was isolated were sensitive to most of the drugs. CONCLUSIONS: Prevalence of enteric fever pathogens was lesser compared to other studies. Varying degrees of antibiotic resistance among isolated enteric fever pathogens necessitates continuous surveillance of the susceptibility patterns. Prudent use of antimicrobials, active infection control practices and stringent antibiotic policy should be implemented to prevent emergence of antibiotic resistance and future outbreaks.


Assuntos
Febre Paratifoide , Febre Tifoide , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Hemocultura , Estudos Transversais , Farmacorresistência Bacteriana , Humanos , Testes de Sensibilidade Microbiana , Febre Paratifoide/diagnóstico , Febre Paratifoide/tratamento farmacológico , Febre Paratifoide/epidemiologia , Prevalência , Salmonella typhi , Centros de Atenção Terciária , Febre Tifoide/diagnóstico , Febre Tifoide/tratamento farmacológico , Febre Tifoide/epidemiologia
11.
JNMA J Nepal Med Assoc ; 59(235): 248-251, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506444

RESUMO

INTRODUCTION: The virus that causes COVID-19 is known as severe acute respiratory syndrome Coronavirus-2. This new variant of Corona Virus introduced in China has urged the massive health system resources to focus on its screening and management of sick patients worldwide. We aimed to find the prevalence of COVID-19 positive cases diagnosed by Real-time polymerase chain reaction in a tertiary care hospital of Nepal. METHODS: This is a descriptive cross-sectional study that was conducted from 11th of November to 15th December 2020. Nasopharyngeal and Oropharyngeal swabs were collected, and confirmation of cases of COVID-19 was done based on the detection of viral ribonucleic acid by nucleic acid amplification tests such as real-time reverse transcriptase-polymerase chain reactions. The viral genes targeted include the E, N, and ORF. RESULTS: A total of 15247 samples have been processed, of which s (14.81%) positive cases were included in this study. There were 1427 (63.19%) male and 831 (36.68%) females. The majority of the cases were asymptomatic 1386 (61.38%). The most common age group infected was between 15 to 40 years, 841 (58.93%) male and 542 (65.22%) females. The most common presenting symptoms were cough 315 (13.95%) and fever 306 (13.55%). CONCLUSIONS: Most of the individuals reported for real-time polymerase chain reaction were asymptomatic patients who might be contagious and have the potential to transmit infection. Among symptomatic cases, common symptoms were cough and fever.


Assuntos
COVID-19 , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Nepal/epidemiologia , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , SARS-CoV-2 , Centros de Atenção Terciária , Adulto Jovem
12.
JNMA J Nepal Med Assoc ; 59(235): 225-230, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506449

RESUMO

INTRODUCTION: Vitamin D deficiency is an emerging risk factor for cardiovascular diseases. Very few studies have been done to find out vitamin D deficiency status among cardiovascular patients in Nepalese setup. This research aims to find out the prevalence of vitamin D deficiency among patients of acute coronary syndrome admitted in a tertiary care center of eastern Nepal. METHODS: This was a descriptive cross-sectional study conducted among patients of acute coronary syndrome admitted in a tertiary care hospital from 1st February 2018 to 31st July 2018. Ethical clearence was taken from Institutional Review Committee of B.P. Koirala Institute of Health Sciences (Reference number: 259/074/075-IRC). Convenience sampling method was used. Data was entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 25. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: A total of 33 (64.7%) at 95% Confidence Interval (51.58-77.82) patients of acute coronary syndrome had vitamin D deficiency in our study with 19 (37.3%) having mild deficiency and 14 (27.4%) having moderate deficiency. None of the patients had severe vitamin D deficiency in our study. The mean vitamin D levels were lower in diabetics (23.57±9.28ng/ml) as compared to non-diabetics (31.91±12.50ng/ml), in hypertensive patients (24.36±7.67ng/ml) as compared to non-hypertensive patients (30.97±13.72ng/ml), and in patients with dyslipidemia (22.86±6.44ng/ml) as compared to those without dyslipidemia (37.68±13.15ng/ml). CONCLUSIONS: Prevalence of vitamin D deficiency among patients of acute coronary syndrome in our study was comparable to various other homologous international studies.


Assuntos
Síndrome Coronariana Aguda , Deficiência de Vitamina D , Síndrome Coronariana Aguda/epidemiologia , Estudos Transversais , Humanos , Nepal/epidemiologia , Prevalência , Centros de Atenção Terciária , Deficiência de Vitamina D/epidemiologia
13.
JNMA J Nepal Med Assoc ; 59(234): 116-119, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506453

RESUMO

INTRODUCTION: Implant removal surgery is one of the common surgical procedures done in orthopedics. Studies report that a major portion of orthopedic surgeries carried out in different institutions comprises implant removal procedures. This can be challenging in limited manpower and infrastructure availability scenarios, like in developing countries like Nepal. This study aims to study the prevalence of orthopedic implant removal procedures carried out among overall surgical procedures in the orthopedic department of a tertiary care center in Nepal. METHODS: A descriptive cross-sectional study was performed on the medical records of the department of orthopedics of a tertiary care center after approval from the institutional review committee. The data included records from the starting of 2018 to the end of 2019. Data related to the number of implant removal procedures, types of implants, indications, fracture sites, anesthesia use, gender and age distribution were studied. Statistical Package for Social Sciences version 20 was used to study descriptive data. RESULTS: Out of 2557 orthopedic operations carried out in the study duration, 458 (17.91%) of implant removal procedures were done in the department. The most common age group was the young adult age group, 255 (55.68%). Medium-sized implants were the commonly removed ones, 337 (73.58%). Elective procedures were the most common indication, 369 (80.57%). CONCLUSIONS: Implant removal procedures cover a major fraction of overall orthopedic operations carried out by the department, most of which are elective procedures. In limited-resource settings, this can be challenging, and a proper evaluation with counseling could be done before implant removal surgery.


Assuntos
Procedimentos Ortopédicos , Ortopedia , Estudos Transversais , Humanos , Nepal , Centros de Atenção Terciária , Adulto Jovem
14.
JNMA J Nepal Med Assoc ; 59(234): 220-224, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506454

RESUMO

Pregnancy with uterine myoma increases the risk of abortion, fetal malpresentation, placenta previa, postpartum hemorrhage, hysterectomy and risk to neonate and mother. Caesarian myomectomy is a safe and cost-effective procedure especially when performed by an experienced surgeon only in selected cases. Here, we present our experiences of cesarean myomectomy on ten patients presenting to our center in a period of one year. The most common indications were breech presentation and previous cesarean section. The most common site was anterior, except one which was posterior and the common type is intramural. Despite prophylactic measures, two cases had a postpartum hemorrhage of 2000ml and 700ml, respectively and one even received a blood transfusion. No cases of hysterectomy, neonatal morbidity and mortality were noted in these cases. In our experience, cesarean myomectomy in uterine fibroids has been a safe procedure with limited intraoperative and postoperative complications.


Assuntos
Apresentação Pélvica , Miomectomia Uterina , Neoplasias Uterinas , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , Centros de Atenção Terciária , Neoplasias Uterinas/cirurgia
15.
JNMA J Nepal Med Assoc ; 59(234): 184-187, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506452

RESUMO

INTRODUCTION: Personality disorders is comprised of deeply ingrained and enduring behavioral patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations." Personality Disorders are frequently occurring among patients with substance use disorders. Co-occurrence of substance use disorders and personality disorder is associated with a greater functional impairment affecting treatment adherence. This study's objective was to find out the prevalence of personality disorders among substance use disorders from the Department of Psychiatry and Mental Health, of a tertiary care center of Nepal. METHODS: A descriptive cross-sectional study was done at the Department of Psychiatry and Mental Health of Shree Birendra Hospital, Chhauni, Kathmandu, Nepal. The ethical approval was approved by the Institutional Review Committee prior to the study. The International Personality Disorder Examination ICD-10 module interview schedule was used to determine personality disorders. There were 100 patients, 86 males and 14 females of age ranging between 18-59 years, from different education levels, socioeconomic statuses, and ethnicities. RESULTS: Of the total 100 patients, 63% of the patients with substance use disorders were found to have either single 24 (24%) or multiple 39 (39%) personality disorders. The most frequently identified disorders were Emotionally Unstable Borderline Type 34 (34%), Anxious Personality Disorder 27 (27%), Emotionally Unstable Impulsive Type 27 (27%). CONCLUSIONS: Present study indicates that personality disorders were highly comorbid with patients of substance use disorders with either single or multiple personality disorders. Personality disorders mostly found in substance use disorders are Emotional Unstable Borderline Type, Anxious Personality Disorder, and Emotional Unstable impulsive Type.


Assuntos
Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Nepal/epidemiologia , Transtornos da Personalidade/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
16.
JNMA J Nepal Med Assoc ; 59(234): 180-183, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506455

RESUMO

INTRODUCTION: Pregnancy is one of the predisposing factors for carpal tunnel syndrome, which may manifest as swelling of the median nerve. The purpose of this study was to obtain the mean cross-sectional area of median nerve using ultrasound in pregnant females at carpal tunnel inlet and its variations with different trimesters. METHODS: A total of 102 pregnant females at first, second and third trimesters were evaluated for median nerve with ultrasonography. Mean cross sectional area of median nerve was calculated in both hands by using two methods- direct and indirect. The study was conducted after obtaining ethical clearance from Institutional Review Board of Institute of Medicine, and after obtaining the written informed consent from the subjects. Convenience sampling technique was used. Data obtained were compiled and analyzed using Statistical Package for the Social Sciences version 20. RESULTS: The overall mean cross-sectional area was 6.84±1.09 mm2 using direct method and 7.09±1.19 mm2 using indirect method. The values obtained with indirect method were greater than that obtained with direct method. Mean cross-sectional area of the median nerve were higher at third trimester in both hands and by both direct and indirect methods. CONCLUSIONS: From the study conducted, the normal value of mean cross-sectional area of median nerve in pregnant females was established.


Assuntos
Nervo Mediano , Gestantes , Estudos Transversais , Feminino , Humanos , Nervo Mediano/diagnóstico por imagem , Nepal , Gravidez , Centros de Atenção Terciária , Estados Unidos
17.
JNMA J Nepal Med Assoc ; 59(234): 188-191, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506458

RESUMO

INTRODUCTION: Zuckerkandl tubercle is a prominent anatomical structure of the thyroid lobe. Identification and preservation of recurrent laryngeal nerve and parathyroid glands during thyroid surgery can be made easier through assessment of their relationship with the Zuckerkandl tubercle. This study aims to determine the anatomical relationship between Zuckerkandl tubercle and superior parathyroid in patients who underwent thyroidectomy in a tertiary care center. METHODS: This descriptive cross-sectional study was conducted at a tertiary care hospital of Nepal following ethical clearance from the Institutional Review Committee (Reference no: 0106201804) among patients who underwent thyroid surgery between July 2018 to February 2020. Convenience sampling was used for collecting data and was entered in Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency andproportion for binary data. RESULTS: Out of 59 cases, 27 (96.4%) of superior parathyroid on the left were at the 1-2 o'clock position, and 28 (90.3%) of superior parathyroid on the right were at 10-11 o'clock position. On the left side, the superior parathyroid was adhered to Zuckerkandl tubercle in 10 (35.7%), was within 5 mm in 16 (57.1%), and was >5 mm away from Zuckerkandl tubercle in 2 (7.14%). On the right side, the superior parathyroid was adhered to Zuckerkandl tubercle in 12 (38.7%), was within 5 mm in 13 (41.93%), and was >5 mm away from Zuckerkandl tubercle in 6 (19.3%). CONCLUSIONS: Zuckerkandl tubercle has a consistent relationship with the superior parathyroid and can be used as an important landmark for identifying superior parathyroid during thyroid surgery.


Assuntos
Glândulas Paratireoides , Tireoidectomia , Estudos Transversais , Humanos , Glândulas Paratireoides/cirurgia , Nervo Laríngeo Recorrente , Centros de Atenção Terciária
18.
JNMA J Nepal Med Assoc ; 59(234): 120-123, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506460

RESUMO

INTRODUCTION: Endoscopic examination is one of the commonest procedures done in day-to-day practice in evaluating gastrointestinal problems. Esophagogastroduodenoscopy provides an excellent view of mucosal surfaces of the esophagus, stomach, and proximal duodenum. Upper gastrointestinal endoscopy is utilized for various diagnostic and therapeutic reasons. This study aimed to study the prevalence of gastritis in a tertiary health care center in Pokhara. METHODS:  A descriptive cross-sectional study was conducted at Gandaki Medical College Teaching Hospital, Pokhara. After ethical approval from the institutional review board with Ref No: 070/2077/2078, endoscopic records of 889 patients undergoing upper gastrointestinal endoscopy from May 2018 to April 2019 were retrospectively reviewed. The convenience sampling method was used. Data entry and descriptive analysis were done in SPSS version 21.0. Descriptive statistics were performed. RESULTS: A total of 889 patients undergoing upper gastrointestinal endoscopy during a period of 12 months period were studied. Among them, females were 472 (53.1%) and males were 417 (46.9%). The mean age of the study population was 45.6 years (SD, 16.86). The majority of the patients belonged to the age group 30 to 50 years. Gastritis was the most common finding in 452 (50.8%) cases. CONCLUSIONS: Gastritis was the most common finding in the patients undergoing upper gastrointestinal endoscopy. A significant proportion of people had normal endoscopy findings. Optimal selection of cases is needed to avoid overuse in younger and encourage use in older populations.


Assuntos
Endoscopia Gastrointestinal , Gastrite , Adulto , Idoso , Estudos Transversais , Feminino , Gastrite/diagnóstico , Gastrite/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Centros de Atenção Terciária
19.
JNMA J Nepal Med Assoc ; 59(234): 176-179, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506461

RESUMO

INTRODUCTION: The number of neurosurgical cases, especially traumatic injuries, are increasing in remote settings. This study aims to determine neurosurgical cases in a tertiary care center teaching hospital situated in a remote area of Nepal. METHODS: It was a descriptive cross-sectional study among 138 neurosurgical patients at Karnali Academy of Health Sciences from 2019 August to 2020 July. A convenient sampling technique was used. The demographic data, the diagnosis, and management offered were recorded, reviewed, and analyzed using Statistical Package for Social Sciences version 16 and Microsoft Excel. RESULTS: Out of 138 cases, trauma was the main finding in 102 (73.91%) cases, and fall injury was the most frequent mechanism of injury in 64 (46.38%) cases. Traumatic brain injury was the most common disease in 85 (61.6%) cases followed by prolapsed intervertebral disc in 11 (8%), Spine fracture/dislocation in 11 (8%), stroke in 7 (5.1%), spondylosis in 6 (4.3%) and so on. Among the Traumatic Brain Injuries, normal findings were noted in 28 (20.3%) cases, extra dural hemorrhage in 12 (8.7%), contusion 11 (8%), and skull base fracture in 7 (5.1%). With a mean age of 29.8 years, a maximum number of the cases were 30 (21.74%) from the age group 31-40. CONCLUSIONS: Trauma was seen in a majority of neurosurgical cases. Hematoma, depressed skull fracture, and spinal fractures were the main findings of neurosurgical cases. The burden of neurosurgical cases in this part of the world is quite high, so necessary step should be taken to increase such services.


Assuntos
Fraturas Ósseas , Acidentes por Quedas , Adulto , Estudos Transversais , Humanos , Nepal/epidemiologia , Centros de Atenção Terciária
20.
JNMA J Nepal Med Assoc ; 59(234): 165-169, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-34506463

RESUMO

INTRODUCTION: Tonsillectomy is one of the common ENT surgical procedures. Post-tonsillectomy haemorrhage remains a frequent complication which can be potentially life-threatening. The objective of the present study was to calculate the prevalence of haemorrhage following a tonsillectomy at a tertiary care centre. METHODS: It was a descriptive cross-sectional study performed by medical chart review of the patients who underwent tonsillectomy from January 2018 to December 2019 at the department of ENT- Head and Neck Surgery of Tribhuvan University Teaching Hospital. Ethical approval was obtained from the institutional review committee (Ref:-282(6-11) E2 076/077). Convenient sampling method was used. All patients of any age who had tonsillectomy for recurrent tonsillitis or tonsillar hypertrophy with or without obstructive sleep apnoea and no missing information on chart review were included in the study. Data were entered in MS-Excel 2007 and analyzed in rate and percentage. RESULTS: Ten (5.18%) out of a total of 193 patients who underwent tonsillectomy had a post tonsillectomy haemorrhage. All 10 (100%) were adults patients, operated for recurrent tonsillitis, and used electrocautery. It was common in male patients 7 (70%). All of the haemorrhages was between a third and sixth postoperative day and were mild in severity. CONCLUSIONS: The prevalence of post-tonsillectomy haemorrhage was high at our centre during the study period of two years. It was common in adults, males and surgery done for recurrent tonsillitis using electrocauterization.


Assuntos
Tonsilectomia , Adulto , Estudos Transversais , Humanos , Masculino , Nepal/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Prevalência , Centros de Atenção Terciária , Tonsilectomia/efeitos adversos
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