Effect of Cholecystectomy on Serum Lipids and Blood Glucose (Hospital Based Observational Prospective Study)

Introduction: Association between cholelithiasis and dyslipidemia has been shown in many studies. Recent studies have shown improvement in lipid profile following cholecystectomy. This study aimed to determine the changes in lipid profile and blood glucose level after cholecystectomy.Methods: Seventy-three patients of cholelithiasis were studied prospectively. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), atherogenic index (AI) and fasting blood sugar (FBS) levels were estimated pre-operatively. Further, the same parameters were studied after cholecystectomy after one week and one-month intervals. None of the patients received any lipid-lowering drug or dietary restriction. Results were analysed and compared.Results: Of the 73 patients with cholelithiasis, 66% were female and 34% male. The mean age of patients was 40.53± 13.16 years. 56% of patients with cholelithiasis had a deranged lipid profile. TC was significantly decreased at one week (p=0.002) and one month (p=0.00) interval after cholecystectomy while TG levels also decreased significantly at one month postoperative (p=0.001). There were no significant differences in LDL-c however improvement was seen on HDL-c. Blood glucose level also increased significantly (p=0.028) after one month of cholecystectomy.Conclusion: Cholelithiasis is associated with an abnormal lipid profile. Cholecystectomy leads to a significant decrease in some of the parameters of lipid profile and the atherogenic index. The presence of gall stones thus should be perceived in the context of metabolic syndrome, which may be investigated and treated.

Online Healthcare Service Delivery in Nepal during COVID Era: A challenge

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Retrospective Evaluation of Patients Leaving Against Medical Advice from Intensive Care Unit (ICU) in Tertiary Care Teaching Hospital

Introduction: Leaving Against Medical Advice (LAMA) can cause a state of dilemma among the treating physician whether to continue the treatment or to de-escalate from the treatment. It can deteriorate the primary disease of the patient, leading to an increase rate of re-admission to the hospital, increased morbidity and mortality. This is a worldwide phenomenon and the prevalence of LAMA varies between various countries and between different region, religion, and the socioeconomic status of the patient in the same country.Methods: The hospital records from 1st December 2018 to 30th November 2019 of a tertiary care teaching hospital were studied. Patient demography, disease characteristics and length of ICU stay and the factors leading to LAMA were noted and statistically analysed.Results: During the study period, 14.5% of patients asked for LAMA. The mean age was 51.22 ± 22.39 years (range 8 months to 97 years) with Male predominance (n= 288, 62.60%) over Female (n= 172, 37.39%). Patients residing in rural areas were 56.08% (n=258) and 63.91% were financially dependent on others for their living. The mean length of stay in hospital was 3.02 ± 3.50 days while 30.86% of patients required mechanical ventilation. About 51.73% of patients taking LAMA were admitted from the Internal medicine department. Around 79.56% were Hindus, with 54.34% opting for LAMA due to financial restrain followed by poor prognosis (22.60 %).Conclusion: The large number of patients admitted in ICU opts out for LAMA. This necessitates formulation and implementation of strategies to reduce the prevalence of LAMA discharge so that patient gets the optimum level of care and the burden in the health care system is reduced

Comparative Study of Efficacy and Safety of Diacerein versus Acelofenac in Patient with Knee Osteoarthritis

Introduction: There are different pharmacological modalities currently in practice for the treatment of osteoarthritis knee. Broadly these are divided into anti-inflammatory drugs such as NSAIDs and symptomatic slow-acting drugs in osteoarthritis (SYSADOA). Diacerein, an anthraquinone derivative inhibits IL-1b and has been shown to significantly decrease the symptoms.Methods: This is open label, prospective comparative study. Total 40 patients were divided into two groups: group A (diacerein) and group B (aceclofenac) by alternate method. In group A diacerein was given 50mg orally for 1 week followed by 50 mg orally twice a day for 3 weeks. In group B aceclofenac 200 mg sustained release tablet was given orally once a day for 4 weeks. Outcomes were measured at the end of the treatment period i.e. at four weeks and after two weeks of discontinuation of treatment i.e. at 6 weeks.Results: Improvement is observed in both treatment groups in their baseline value in terms of efficacy parameters. Results of VAS and WOMAC scores were better in group B (aceclofenac). However intra-group analysis showed VAS scores and WOMAC scores significantly decreased in patients receiving diacerein as well. (p<0.05).Conclusion: Though not superior to the control drug, diacerein showed efficacy in terms of measurement by patient self-reported WOMAC and VAS scores for the treatment of Osteoarthritis knee.

ATE Scale to Assess Attitudes towards Euthanasia among Health Professionals in Pokhara, Nepal

Introduction: Most people want to live up to old age with no pain and sufferings. This study is meant to know the opinion of doctors and nursing professionals regarding euthanasia which is an important component for practising euthanasia in Nepal, which is a debated topic in the whole world and Nepal is no exception.Methods: A descriptive study design was used to conduct this study. ATE scale was used which includes ten questionnaires.Results: The ATE scale used in this study showed to have internal consistency, with Cronbach alpha at 0.736. Men were found to be more supportive of Euthanasia.Conclusion: Overall, this study suggests that health professionals from Pokhara have a positive attitude towards Euthanasia with patients request taken as more important.

Advanced Maternal Age and Pregnancy Outcome at Manipal Teaching Hospital: Cross-sectional Analytical study

Introduction: Advanced and very advanced maternal age are associated with several adverse maternal and fetal outcome. The objective of this study was to find out the possible association between advance maternal age and adverse pregnancy outcomes at Manipal Teaching Hospital.Methods: A cross sectional analytical study conducted at department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara, Nepal. A total of 198 patient who were ≥30 years and >24 weeks pregnant admitted in obstetric ward were selected. These patient were divided into three groups according to their age (30-34, 35-39 and ≥ 40years). We compared the incidence of adverse maternal and perinatal outcome among these groups. We also calculated odds ratio of maternal and perinatal outcomes in 35-39 years and ≥ 40years women, compared with women aged 30-34 years.Results: Comparison of the three age groups revealed that advanced maternal age constitute a predisposing factor for malpresentation, gestational diabetes mellitus, placenta previa, fetal distress and caesarean section. Whereas, risk of non progress of labour, preterm birth, postpartum hemorrhage, perinatal death and congenital anomalies were increased in very advanced maternal age group. From these, statistical significance was reached in case of greater risk of malpresentation (p=0.01,OR=6.66), fetal distress (p=0.04, OR=2.6) and caesarean section(p=0.02,OR=2.06) in advanced age group when compared to the patients aged 30-34. Furthermore, very advanced age group were higher risk of postpartum hemorrhage (p=0.03, OR=2.47) and congenital anomalies, which were statistically significant (p=0.04, OR=29.57) when compared to the 30-34 years.Conclusion: Advanced and very advanced maternal age is associated with several adverse maternal and perinatal outcome. The risk of perinatal complication begin to increase after the age of 35 but significantly increased after 40 years.

Lactate Clearance as a Predictive Marker of Mortality in Adult Intensive Care Unit

Introduction: Lactate clearance has been widely investigated. Serial lactate concentrations can be used to examine disease severity and predict mortality in the intensive care unit. We investigated the diagnostic accuracy of lactate concentration and lactate clearance in predicting mortality in critically ill patients during the first 24 hours in Intensive Care Unit (ICU).Methods: It was a Prospective, observational study conducted in ICU. Sixty eight consecutive patients having blood lactate level >2 mmol/L were included irrespective of disease and postoperative status. We measured blood lactate concentration at ICU admission(H0), at six hours(H6), 12 hours(H12), and 24 hours(H24). Lactate clearance was measured for H0-H6, H0-H12 and H0-H24 time period.Results: ICU mortality was 33.8%. Lactate clearance was 15.80 ± 17.21% in survivors and 1.73±11% in non survivors for the H0-H6 (p = 0.001) and remained higher in survivors than in non survivors over the study period of 24 hours; 17.97±15 vs. -2.04±19.84% for H0-H12 and 27.40 ± 11.41% vs. -14.83 ± 26.84% for the H0-H24 period (p < 0.001 for each studied period). There was significant difference in lactate concentration (static) between survivors and non survivors during the course of initial 24 hours. The best predictor of ICU mortality was lactate clearance for the H0-H24 period (AUC =0.89; 95% CI 0.78-1.01). Logistic regression found that H0-H24 lactate clearance was independently correlated to a survival status (p = 0.005, OR = 0.922 and 95% CI 0.871-0.976).Conclusion: Blood lactate concentration and lactate clearance are both predictive for mortality during initial 24 hours of ICU admission.

Online Medical Education during COVID-19 Pandemic

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A Unique Case of Hoarseness of Voice following Left Sided Supraclavicular Block: A Case Report

Supraclavicular brachial plexus block is popular for surgeries distal to the level of mid-arm. Though rare, recurrent laryngeal nerve palsy can occur in 1.3% of cases. It has been reported mostly in cases of right-sided block and only one case has been reported on the left side. We present a case of 50-year-old-female patient, who developed hoarseness of voice following a left-sided classical supraclavicular block.

Endoscopic Sphenopalatine Artery Ligation in Posterior Epistaxis

Introduction: Posterior epistaxis brings us with a more challenging condition that can even threaten the life of a patient. Approaching the posterior nasal cavity is not an easy task because of its anatomical complexity and impending vision by turbinate. Increase endoscopic anatomic details of lateral nasal wall and endoscopic expertise with high definition camera leads to a higher success rate of endoscopic sphenopalatine artery ligation.Methods: This prospective study was conducted in patients with refractory posterior epistaxis between January 2017 to December 2019. All patient who had undergone Endoscopic Sphenopalatine artery ligation were included in this study. The site of bleeding was confirmed with the help of a rigid endoscope. Bipolar cauterization or clipping was performed to stop bleeding. Data analysis was done by using SPSS 26.0 version.Results: Twenty nine patients who had undergone Endoscopic sphenopalatine artery for posterior epistaxis were included during this study period. The mean age of the patient was 53.31 ± 18.65years. The site of bleeding was mostly from the left in 20 (75.9%) cases and 10 (34.4%) cases had severe bleeding that needed a blood transfusion. No recurrence of bleeding was found during follow up period. The severity of bleeding was significantly correlated with the age of patients (p<0.003). Out of 29 patient, 27 patients had undergone bipolar diathermy and 2 patients clipping was done.Conclusion: Sphenopalatine artery ligation is an effective management strategy for surgical control of refractory epistaxis. The early timing of sphenopalatine artery ligation may lead to reductions in length of stay.