Study of Patients with First unprovoked Seizure in the Eastern Part of Nepal

Background: About 5-10% of the population get at least one seizure in their lifetime. Treatment is started in patients with first unprovoked seizure if the risk of seizure recurrence is predicted to be high. If patients with first seizure are not treated 40-50% of patients develop recurrence within 2 years of the initial seizure. Starting treatment may cause reduction in the risk of recurrence by almost one half. The aim of the study was to identify the factors causing recurrence in patients with first unprovoked seizure. Materials and Methods: It is a prospective cross-sectional study conducted at Nobel Medical College from March 2015 to March 2019. Patients who presented to Nobel Medical College with first unprovoked seizure were enrolled in the study with follow up during the hospital visit. Results: Eighty six patients participated in our study. Recurrence of seizure occurred in 21(24.4%) patients within the study period of 4 years. Abnormal Electroencephalography was significantly associated with recurrence of seizure in patients with first seizure. (P value<0.001) Neuro imaging abnormality was also associated with increased risk of seizure recurrence (Pvalue<0.001) .Starting an antiepileptic after first seizure reduced the risk of further seizure. Conclusion: Recurrence of seizure was observed in almost a quarter of patients within the study period of four years. Recurrence risk was higher in those patients with abnormal Electro encephalography and in those patients with identified cause than those patients whose seizure was assumed to be idiopathic.

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Phototherapy Induced Hypocalcaemia in Neonates with Jaundice

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v18i2.38829 ◽

2021 ◽

Vol 18 (2) ◽

pp. 1-3

Author(s):

Rajesh KC ◽

Piush Kanodia

Keyword(s):

Serum Calcium ◽

Neonatal Intensive Care ◽

Calcium Supplementation ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Medical College ◽

Increased Risk ◽

Before And After ◽

Clinically Significant

Introduction: Neonatal hyperbilirubinemia is seen mainly in the first week of life and in many of the cases it is only in physiological range which requires no intervention. Approximately 5-10% of them have clinically significant jaundice that requires phototherapy and even exchange transfusion. Phototherapy can produce various adverse effects; hypocalcaemia is one of the lesser known effects. So, estimation of calcium levels before and after phototherapy should be done in neonates with jaundice. Aims: The aim of this study is to determine hypocalcaemia, in neonates receiving phototherapy, by measuring serum calcium levels. Methods: This cross sectional study was conducted, from February 2020 to August 2020, on 50 neonates admitted in Neonatal Intensive Care Unit of Nepalgunj Medical College, Kohalpur with unconjugated hyperbilirubinemia requiring phototherapy. Serum calcium levels were evaluated before and after phototherapy. Neonates were assessed for clinical features of hypocalcaemia i.e. jitteriness, irritability/ excitability and convulsions. Data were analyzed using SPSS version 25.P value <0.05 was taken as significant. Results: Frequency of hypocalcaemia after phototherapy was 26%. There was significant change in serum calcium levels before and after phototherapy (p<0.01). Among hypocalcaemic neonates, 56% were symptomatic; 38% developed jitteriness, 18% developed irritability / excitability and none of them developed convulsions. Conclusion: Neonates undergoing phototherapy are at increased risk for hypocalcaemia. Monitoring for hypocalcaemia and its complications should be considered. However, universal recommendation of calcium supplementation is yet to be established but seems reasonable.

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Depression among Adult HIV/AIDS Patients Attending ART Clinics at Aksum Town, Aksum, Ethiopia: A Cross-Sectional Study

Depression Research and Treatment ◽

10.1155/2019/3250431 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Berhe Beyene Gebrezgiabher ◽

Teklehaymanot Huluf Abraha ◽

Etsay Hailu ◽

Hailay Siyum ◽

Getachew Mebrahtu ◽

...

Keyword(s):

Antiretroviral Treatment ◽

Cross Sectional Study ◽

Adult Patients ◽

P Value ◽

Sectional Study ◽

Aids Patients ◽

Cross Sectional ◽

Increased Risk ◽

Hiv Aids

Background. Depression is consistently associated with increased risk of Human Immunodeficiency Virus infection and poor antiretroviral treatment adherence. Though many factors have been reported as determinant factors of depression, site-specific evidence is needed to identify factors associated with depression among adults on antiretroviral treatment. Methods. An institution based cross-sectional study was carried out from March to May 2015 among 411 adults HIV/AIDS patients on ART clinic follow-up. Participants were selected using systematic random sampling techniques. Data were collected using chart review and interviewer- administered techniques. Both bivariable and multivariable logistic regressions were used to compute the statistical test associations by SPSS version-20. Variables with p value < 0.05 were considered as statistically significant. Results. Four hundred eleven patients with a mean age ± Standard Deviation of 36.1±9.2 years and with a total response rate of 97.6% were enrolled in the study. The prevalence of depression was 14.6% (95% CI, 10.90-18.2). Factors independently associated with depression were nonadherence to ART, eating two meals per day or less, having side effect of ART medication, being in the WHO Stage II or above of HIV/AIDS, and living alone with AOR (95% CI) of 3.3 (1.436, 7.759), 2.8 (1.382, 5.794), 4.7 (1.317, 16.514), 2.8 (0.142, 0.786), and 2.4 (1.097, 5.429), respectively. Conclusion. Though the magnitude of depression was found relatively low, it was commonly observed as a mental health problem among adult patients with HIV/AIDS on ART. Programs on counseling and close follow-up of adherence to ART, drug side effects, and nutrition should be strengthened. Health facilities should link adult patients with HIV/AIDS who live alone to governmental and nongovernmental social supporter organizations.

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Frequency of Metabolic Abnormalities of Vesical Calculus in Children Younger than 10 Yrs of Age

10.53350/pjmhs211561243 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1243-1245

Author(s):

H.U Rahman ◽

S. F. Shah ◽

A. J. Sheikh ◽

I. U. Memon ◽

W. S. Bhatti ◽

...

Keyword(s):

Cross Sectional Study ◽

P Value ◽

Metabolic Abnormalities ◽

Urine Ph ◽

College Hospital ◽

Cross Sectional ◽

Vesical Calculus ◽

Medical College ◽

Presenting Symptoms ◽

Calcium Magnesium

Aim: To assess the metabolic abnormalities in children younger than 10 years of age with vesical calculus. Study design: Retrospective cross-sectional study Place and duration of study: Department of Urology, Khairpur Medical College Hospital, Khairpur from 1st October 2014 to 30th September 2016. Methodology: Two hundred and six children age <10 years of age and either gender presented with vesical calculus were enrolled. Demographic information like age, gender, residence, serum electrolytes, calcium, magnesium, phosphate, uric acid, blood, and urine pH were recorded for the purpose of metabolic workup. Results: The mean age was 4.76±1.22 years and 157 (76.2%) were males and 49 (23.8%) were females. The frequency of metabolic abnormalities was observed in 153 (74.3%) of the patients. A significantly higher prevalence of metabolic abnormalities was observed with male gender (p-value 0.006), dark colored urine as presenting symptoms (p-value 0.022), frequent urination (p-value 0.045), and hematuria (p-value 0.016). Of 153 patients with metabolic abnormalities, hypercalciuria was observed in 45 (29.4%), hypocitraturia in 73 (47.7%), hyperoxaluria in 21 (13.7%), and hyperuricosuria in 14 (9.2%) patients. Conclusion: The frequency of metabolic abnormalities was high among children with vesical calculus. Moreover, hypocitraturia in these children was observed in majority followed by hypercalciuria, hyperoxaluria, and hyperuricosuria. Keywords: Metabolic abnormalities, Children, Vesical calculus

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ROLE OF ABSOLUTE EOSINOPHIL COUNT AS A MODALITY OF INVESTIGATION IN SUSPECTED CASES OF HELMINTHIC INFESTATION IN CHILDREN AGED BETWEEN 5 TO 15 YEARS WITH COMPARISON TO STOOL ROUTINE AND MICROSCOPY

10.36106/gjra/6111669 ◽

2021 ◽

pp. 112-113

Author(s):

Meghashree N ◽

Rohini D ◽

Mahendar Reddy M ◽

A.M Koppad

Keyword(s):

Eosinophil Count ◽

Stool Specimen ◽

Cross Sectional Study ◽

Research Centre ◽

P Value ◽

College Hospital ◽

Cross Sectional ◽

Mean Values ◽

Medical College ◽

Absolute Eosinophil Count

Introduction: Eosinophilia is a well-known host immune response in helminthic infestation. This study was carried out to investigate whether a correlation exists between absolute eosinophil count in children with stool specimen positive for helminthic infestation. Aim And Objective: To determine average raised absolute eosinophil count in children who were having various helminthic infestation with stool specimen positive. Materials And Methods: A hospital based cross sectional study done at Navodaya medical college hospital and research centre during 2019 October to 2020 September for a period of 12 months. Both blood and stool samples were obtained from a total of 69 suspected children after examined, categorised into 2 groups. Among them 24 cases were positive of helminthic infestation and 45 cases were negative. T-test and descriptive statistics were used to analyse the data. Results: The study revealed that children infested with helminths found to have higher absolute eosinophil count (mean 4644/µl (95%CI; 3474-4212) than not infested (mean 801/µl (95%CI; 616-945) with p value <0.001. In this helminth's family; nematodes, trematodes, cestodes showed mean values of absolute eosinophil count were 5206/µl (4806-7151/µl), 4930/µl (4500-5382/µl) and 2179/µl (2500-1669/µl) respectively. Conclusions: Raised absolute eosinophil count has been observed in stool specimen positive cases of helminths, especially more in nematodes. Therefore, should be considered for a single dose of albendazole.

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Peak expiratory flow rate among smokers and non-smokers working in Kathmandu Medical College

Journal of Chitwan Medical College ◽

10.3126/jcmc.v10i2.29667 ◽

2020 ◽

Vol 10 (2) ◽

pp. 33-35

Author(s):

Preetu Gurung

Keyword(s):

Cigarette Smoking ◽

Peak Expiratory Flow ◽

Flow Rate ◽

Peak Expiratory Flow Rate ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Medical College ◽

Significant Difference ◽

Expiratory Flow

Background: Cigarette smoking has remained a popular habit since ages. Most people are well aware of the deleterious effects of cigarette smoking yet continue to give a blind eye which deteriorates overall public health. The purpose of the present study was to assess Peak Expiratory Flow Rate among smoking and nonsmoking staffs who work in Kathmandu Medical College. Methods: In this comparative cross-sectional study Peak Expiratory Flow Rate was obtained using Mini Wright’s Peak Flow Meter of 108 smokers and 108 nonsmokers in the age group ranging from 25-45 years. Those who never smoked or who have quit smoking for the past 2 years were grouped as nonsmokers and the smokers with history of smoking at least five or more cigarettes per day for at least two years were included in the study for measuring their Peak Expiratory Flow Rate. Data was collected, compiled and analyzed by using Statistical Package of Social Science (SPSS) software version16. Student ‘t’ test was used for group comparison. Results: The Peak Expiratory Flow Rate value was significantly reduced in the smokers (p value< 0.05). Mean Peak Expiratory Flow Rate was reduced with increasing age of the smokers. However, no significant difference was observed in Peak Expiratory Flow Rate with increase in the number of cigarettes smoked (p value> 0.05). Conclusions: In the study Peak Expiratory Flow Rate among smokers (367.13 ± 74.182) was lower than nonsmokers (471.39±60.842), which was statistically significant proving that cigarette smoking reduced peak expiratory flow rate.

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Factors Associated with Depression among Heart Failure Patients at Cardiac Follow-Up Clinics in Northwest Ethiopia, 2017: A Cross-Sectional Study

Psychiatry Journal ◽

10.1155/2019/6892623 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Kassahun Gebeyehu Yazew ◽

Debrework Tesgera Beshah ◽

Mohammed Hassen Salih ◽

Tadele Amare Zeleke

Keyword(s):

Heart Failure ◽

Depressive Symptoms ◽

Cross Sectional Study ◽

Northwest Ethiopia ◽

P Value ◽

Cross Sectional ◽

Heart Failure Patients ◽

Referral Hospitals ◽

Poor Social Support

Background. Depression is a comorbid disorder in patients with heart failure and it is a major public health problem worldwide. Little is known about the depression among heart failure patients in low-income countries, while, in Ethiopia, none was studied. Objective. This study is to assess the prevalence of depression and associated factors among heart failure patients at cardiac follow-up clinics at Amhara Region Referral Hospitals, Northwest Ethiopia, 2017. Methods. A hospital based cross-sectional study was conducted between March 30, 2017, and May 15, 2017, G.C., by using a systematic random sampling technique to select 422 of 1395 HF patients. Structured interviewer-administered questionnaires and patient card review with a checklist that incorporates the PHQ-9 tool for depression measurement were used. The collected data were checked, coded, and entered into Epi-info version 7 and exported to SPSS version 20. Bivariate logistic regression at p-value <0.2 was exported to multivariate logistic regressions and p-value <0.05 was considered statistically significant. Results. A total of 403 were included with a response rate of 95.5%. Among the participants, 51.1% had depressive symptoms. Factors associated with depressive symptoms were poor self-care behavior 1.60 [AOR (95% CI=1.01, 2.55)], poor social support 1.90 [AOR (95% CI=1.16, 3.12)], being female 2.70 [AOR (95% CI=1.44, 5.07)], current smoking history 4.96 [AOR (95% CI=1.54, 15.98)], and duration of heart failure (>1 year) 1.64 [AOR (95% CI=1.04, 2.59)]. Conclusions. Around half of the patients were depressive. The patients who had poor self-care behavior, were females, had poor social support, had a current history of smoking, and had duration of chronic heart failure >1 year need special attention. Therefore, all referral hospitals need efforts to focus on those problems and target improvements of depressive symptoms.

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Tablet and web-based audiometry to screen for hearing loss in adults with cystic fibrosis

Thorax ◽

10.1136/thoraxjnl-2019-214177 ◽

2020 ◽

Vol 75 (8) ◽

pp. 632-639 ◽

Cited By ~ 2

Author(s):

Anitha Vijayasingam ◽

Emily Frost ◽

Julie Wilkins ◽

Lise Gillen ◽

Presanna Premachandra ◽

...

Keyword(s):

Cystic Fibrosis ◽

Hearing Loss ◽

Intraclass Correlation ◽

Cross Sectional Study ◽

Outpatient Setting ◽

P Value ◽

Cross Sectional ◽

Web Based ◽

High Frequency Audiometry ◽

Increased Risk

IntroductionIndividuals with chronic lung disease (eg, cystic fibrosis (CF)) often receive antimicrobial therapy including aminoglycosides resulting in ototoxicity. Extended high-frequency audiometry has increased sensitivity for ototoxicity detection, but diagnostic audiometry in a sound-booth is costly, time-consuming and requires a trained audiologist. This cross-sectional study analysed tablet-based audiometry (Shoebox MD) performed by non-audiologists in an outpatient setting, alongside home web-based audiometry (3D Tune-In) to screen for hearing loss in adults with CF.MethodsHearing was analysed in 126 CF adults using validated questionnaires, a web self-hearing test (0.5 to 4 kHz), tablet (0.25 to 12 kHz) and sound-booth audiometry (0.25 to 12 kHz). A threshold of ≥25 dB hearing loss at ≥1 audiometric frequency was considered abnormal. Demographics and mitochondrial DNA sequencing were used to analyse risk factors, and accuracy and usability of hearing tests determined.ResultsPrevalence of hearing loss within any frequency band tested was 48%. Multivariate analysis showed age (OR 1.127; (95% CI: 1.07 to 1.18; p value<0.0001) per year older) and total intravenous antibiotic days over 10 years (OR 1.006; (95% CI: 1.002 to 1.010; p value=0.004) per further intravenous day) were significantly associated with increased risk of hearing loss. Tablet audiometry had good usability, was 93% sensitive, 88% specific with 94% negative predictive value to screen for hearing loss compared with web self-test audiometry and questionnaires which had poor sensitivity (17% and 13%, respectively). Intraclass correlation (ICC) of tablet versus sound-booth audiometry showed high correlation (ICC >0.9) at all frequencies ≥4 kHz.ConclusionsAdults with CF have a high prevalence of drug-related hearing loss and tablet-based audiometry can be a practical, accurate screening tool within integrated ototoxicity monitoring programmes for early detection.

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Prevalence of microalbuminuria and associated factors among HIV − infected ART naïve patients at Mulago hospital: a cross-sectional study in Uganda

BMC Nephrology ◽

10.1186/s12882-020-02091-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Thomas Kiggundu ◽

Robert Kalyesubula ◽

Irene Andia-Biraro ◽

Gyaviira Makanga ◽

Pauline Byakika-Kibwika

Keyword(s):

Antiretroviral Therapy ◽

Cross Sectional Study ◽

Cd4 Count ◽

P Value ◽

Mulago Hospital ◽

Sectional Study ◽

Chi Square ◽

Cross Sectional ◽

Exact Test ◽

Increased Risk

Abstract Background HIV infection affects multiple organs and the kidney is a common target making renal disease, one of the recognized complications. Microalbuminuria represents an early, important marker of kidney damage in several populations including HIV-infected antiretroviral therapy (ART) naïve patients. Early detection of microalbuminuria is critical to slowing down progression to chronic kidney disease (CKD) in HIV-infected patients, however, the burden of microalbuminuria in HIV-infected antiretroviral therapy (ART) naïve patients in Uganda is unclear. Methods A cross-sectional study was conducted in the Mulago Immune suppression syndrome (ISS) clinic among adult HIV − infected ART naïve outpatients. Data on patient demographics, medical history was collected. Physical examination was performed to assess body mass index (BMI) and hypertension. A single spot morning urine sample from each participant was analysed for microalbuminuria using spectrophotometry and colorimetry. Microalbuminuria was defined by a urine albumin creatinine ratio (UACR) 30-299 mg/g and macroalbuminuria by a UACR > 300 mg/g. To assess the factors associated with microalbuminuria, chi-square, Fisher’s exact test, quantile regression and logistic regression were used. Results A total of 185 adult participants were consecutively enrolled with median age and CD4+ counts of 33(IQR = 28–40) years and 428 (IQR = 145–689) cells/μL respectively. The prevalence of microalbuminuria was 18.9% (95% CI, 14–25%). None of the participants had macroalbuminuria. CD4+ count <350cells/μL was associated with increased risk of microalbuminuria (OR: 0.27, 95% CI: 0.12–0.59), P value = 0.001). Diabetes mellitus, hypertension, smoking, alcohol intake were not found to be significantly associated with microalbuminuria. Conclusion Microalbuminuria was highly prevalent in adult HIV − infected ART naive patients especially those with low CD4+ count. There is need to study the effect of ART on microalbuminuria in adult HIV − infected patients.

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Association between Acne and Body Mass Index: A Hospital Based Cross Sectional Study

Nepal Journal of Dermatology Venereology & Leprology ◽

10.3126/njdvl.v16i1.19408 ◽

2018 ◽

Vol 16 (1) ◽

pp. 53-56

Author(s):

Saraswoti Neupane ◽

Binamra Basnet ◽

Tara Devi Sharma

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Acne Vulgaris ◽

Cross Sectional Study ◽

Normal Weight ◽

P Value ◽

Cross Sectional ◽

Middle Income ◽

Medical College ◽

Middle Income Countries

Introduction: Acne vulgaris is a common and chronic inflammatory skin disease of pilosebaceous unit. Obesity is one of the biggest problems in western life style but nowadays, the problem is increasing even in low and middle-income countries. Body Mass Index (BMI) is used to accurately measure obesity.Objective: To find out the association between different categories of BMI and severity of acne.Materials and methods: This was a cross sectional prospective study conducted in the outpatient department of Gandaki Medical College from January to July, 2017. All the newly diagnosed patients with acne were included in the study. Height and weight of the patients was recorded and BMI was calculated. BMI was categorized as underweight, normal weight, overweight and obese. Type of lesions were noted and severity of acne was graded from 1 to 4.Statistical analysis was performed using SPSS version 17.0 for windows. One-way Analysis of Variance between groups (ANOVA) test was applied. P value of less than 0.05 was considered significant.Results: There were altogether 249 patients with acne. Age of the patients ranged from 10 to 44 years with mean age of 20.82 ±5.9 years. Most of the patients were in the age group of 11-20 years. Female: male ratio was 1:1.4. Majority of patients (65.5%) had normal BMI. Most of the patients had Grade 2 acne (52.6%). There was no significant association between the BMI and severity of acne (p=0.129).Conclusion: There was no significant association between BMI and severity of acne.

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Interleukin 21 as a diagnostic marker of rheumatoid arthritis.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.1897 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1229-1232

Author(s):

Khadija Kiran ◽

Amtul Huda ◽

Zuhair Bhatti

Keyword(s):

Rheumatoid Arthritis ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Diagnostic Marker ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Medical College ◽

Sensitivity Specificity

To investigate the role of IL-21 as diagnostic marker in diagnosis of rheumatoid arthritis. Study Design: Cross sectional study. Setting: Department of Physiology and Orthopedic Gujranwala Medical College, Gujranwala. Period: October 2017 to October 2018 in one year duration. Materials and Methods: A total of 150 patients were included in the study, main variables assessed in this study were positive predictive value negative predictive value, sensitivity, specificity and accuracy of IL-21 in diagnosis of rheumatoid arthritis. SPSS version 23 was used to analyze the data. P value less than or equal to 0.05 was taken as significant. Study was started after permission from hospital ethical committee and patients were informed in detail about disease and procedure to be done. Non probability consecutive sampling was used. Results: The estimated sensitivity was 93.6%. The estimated specificity was 50%. Positive predictive value was 96.3% and negative predictive value was 35.7%. The overall accuracy was 90.6% for diagnosing rheumatoid arthritis. Conclusion: IL-21 induces MMP3 in rheumatoid arthritis patients, identification of IL-21 from synovium of patients indicates the presence of rheumatoid arthritis. We observed 90.6% diagnostic accuracy of IL-21 for rheumatoid patients taking RA factor as gold standard of diagnostic tool.

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