Outcome of Non-Invasive Ventilation in Patients of Acute Respiratory Failure.

Introduction: Non-invasive ventilation (NIV) is a method of ventilator support or delivery of positive pressure into the lungs usually through a face mask, mostly initiated before severe acidosis occurs. NIV failure requiring invasive mechanical ventilation in decompensated chronic obstructive pulmonary disease (COPD) patients is low, but, in critical patients, it is as high as 60%. Acute respiratory failure (ARF) is the common reason for admission to the intensive care unit. This study assesses the outcome of NIV among patients with acute respiratory failure, the duration of use, stay in ICU, and failure rate of NIV. Such type of study result is scarce in our country. Methods: Arterial blood gases were assessed prior, after, and at discontinuation of NIV. NIV was delivered by ventilator via face mask. All patients above age 15 years who presented to the hospital, diagnosed to have ARF by ABG were included and admitted to Medical Intensive Care Unit (MICU). . Appropriate statistical tests (Chi-square) were performed and the statistical significance of the results was assessed. Results: 35 patients with the median age of 73 years (range: 39- 89 years), of 60.0 % females among which 74.3 % were current smokers. Arterial blood pH prior to admission ranged from 7.11-7.39 and 7.06-7.41 among NIV success and failure, respectively. Similarly, PCo2 ranged from 54.0-127.5 and 29.5-105.9 among them, respectively. Two hours after ventilation pH ranged from 7.12-7.43 and 7.05-7.30 respectively in the success and failure group. The most common disease condition requiring NIV was 77.1% COPD. Out of NIV failure group (n=19) ,57.8 % were intubated and 42.1% patients left the intervention. Conclusions: Usage of NIV among ARF patients was associated with lower intubation and ICU mortality rate. COPD patients showed the most benefit with NIV, whereas patients suffering from interstitial lung disease, lung cancer had less benefit.

Most Common MRI finding in Lumbosacral Degenerative changes in Nepal Police

Introduction: Low back pain (LBP) is a common problem that affects about two-thirds of adults sometimes in their life. Magnetic Resonance Imaging (MRI) with excellent tissue contrast is a better modality for assessing it. We aimed to assess the common findings overall, gender-wise and age-wise in lumbosacral degenerative changes in Nepal police personnel. Methods: The 54 Nepalese police with disc degeneration changes in the MRI report were included . The following MRI findings were evaluated: decrease disc height, disc desiccation change, diffuse disc bulge, asymmetrical disc bulge, disc protrusion, disc extrusion, annular tear, central spinal canal stenosis, foraminal stenosis, spinal nerve compromise, lumbar lordosis preserved or not, osteophyte and modic changes. Results: Mostly involved lumbosacral discs were L4-L5 and L5-S1 and the least involved lumbosacral disc was L1-L2. Disc desiccation changes were the most common finding observed. Disc desiccation changes, decreased disc height, lateral recess stenosis, foraminal stenosis was common in L5-S1. Diffuse disc bulge, asymmetric disc bulge, disc protrusion, annular tear, central spinal canal stenosis were common in L4-L5. Modic type II change was the commonest endplate change observed.. Lateral recess stenosis and foraminal stenosis showed an increasing trend with increment in age group. The most common finding in both gender was disc desiccation changes and diffuse disc bulge. However, disc protrusion, disc extrusion, and annular tear were more common in males and asymmetrical disc bulge in females. Conclusion: This study shows L4-L5 and L5-S1 is the most common intervertebral disc involved in degeneration in Nepal police. Disc desiccation change and diffuse disc bulge are the most frequent finding irrespective of age and gender. Degenerative changes have an increasing trend with increasing age. Disc herniation is more common in male police individuals than female police individuals of Nepal.

Second Trimester Abortion practices in Eastern Hilly District of Nepal: A Cross-Sectional Study

Introduction: Second-trimester abortion comprises 10-15% of total cases worldwide because of maternal disease, fetal anomalies, and delay in obtaining first trimester services during unintended pregnancies. The availability of legal safe abortion services with skilled hands is limited in rural hilly areas of Nepal. Unsafe and delays in seeking abortion services in resources poor countries like Nepal are contributing to maternal mortality and morbidity. This study aims to describe the demographic profile of patients, indications, and methods of second-trimester abortion with possible complications and family planning acceptance in the rural hilly areas of Nepal. Methods: A retrospective cross-sectional study was conducted at Ilam District Hospital in Province 1 of Nepal. The study sample comprises 75 patients who were admitted for abortion services in 1 fiscal year period from 16th July 2017 to 15th July 2018. Data for all the patients who received second-trimester abortion services were retrieved from Health Management Information System (HMIS) logbook maintained by the Hospital. Descriptive analysis was performed. Ethical approval for this study was obtained from the Nepal Health Research Council (Ref. No- 1921). Results: Most common age group seeking second-trimester abortion were 20-24 years(26.66%) and the majority of women who participated in this study were literate up to secondary level education(58.66%). Most participants belonged to janajati/adibasi caste(73.33%) and were from Ilam districts(72%).Most of the cases were in the early second trimester (62.66%) and were multiparous (60%). Common indications for termination of pregnancy were mental/maternal cause(82.66%) and medical induction was most (69.33%) common method. No major complications were found following abortion. The majority of participants chose short-term contraception (36%) following the termination of pregnancy. Conclusions: Awareness and availability of legal safe abortion services at local health facilities can reduce delays in seeking abortion services, prevent unsafe abortion practices, and reduce maternal morbidity and mortality.

Correlation between Serum-Ascites Albumin Gradient and Esophageal Varices in Portal Hypertension due to Cirrhosis of Liver

Introduction: Cirrhosis of the liver is a major health problem in our country. Patients with cirrhosis are at risk of developing esophageal varices and variceal bleeding with high mortality. They must undergo routine upper gastrointestinal endoscopy to screen for the presence of varices. This poses an economic, social, and medical burden. Thus, this warrants a non-invasive predictor of esophageal varices in a cirrhotic patient. The aim of this study was to find the correlation between SAAG and esophageal varices in portal hypertension due to cirrhosis of liver. Methods: Patients (45 males and 35 females) above 18 years of age and with cirrhosis of the liver underwent cross sectional observational study at Nepal Medical College Teaching hospital between October 2015 and December 2017 AD. Serum albumin and ascitic fluid albumin were analyzed on the same day and serum-ascites albumin gradient (SAAG) was calculated. Upper GI endoscopy was done to evaluate for the presence of esophageal and gastric varices. Pearson's chi-square test was applied to see the relation between SAAG and esophageal varices. Results: Among the 80 patients studied, 56.2% were male and 93.75% had varices. Majority of the patients who had esophageal varices had SAAG of more than 1.1 g/dL. A positive correlation was found between serum-ascites-albumin gradient and esophageal varices but was statistically not significant. A cut-off of >1.6 for SAAG to discriminate between presence and absence of varices yielded a sensitivity of 78.66% and a positive predictive value of 92.18%. Conclusion: This study highlighted that SAAG has a positive correlation with esophageal varices with high sensitivity and positive predictive value in estimating the presence of varices but without statistical significance. It has a low specificity. Due to statistically insignificant correlation and low specificity, SAAG cannot be used in place of upper GI endoscopy in diagnosing gastroesophageal varices

Association of Acrochordons with Diabetes Mellitus - A Hospital based Case Control Study

Introduction Acrochordons or skin tags are common benign cutaneous tumors that occur especially over the neck and major flexures. A possible association between diabetes mellitus and dyslipidemia is observed in numerous past studies with varying results. We aim to find out the association of diabetes mellitus with acrochordons Methods: One hundred patients were enrolled in our study. Among them, 50 (27 males and 23 females) with skin tags were selected as cases and 50 with other dermatologic diseases after matching age and gender were taken as controls. Blood glucose levels including both fasting and postprandial glucose levels were determined for both cases and controls and compared. Results: There was a higher frequency of Diabetes Mellitus and impaired glucose tolerance in patients with skin tags in comparison to controls (p<0.001). Moreover, there were higher odds of acquiring skin tags in patient with abnormal blood glucose levels. Conclusions: There is an increased risk of developing DM in patients with skin tags. It is highly recommended that suspicion for Diabetes Mellitus is to be done in patients with skin tags for early screening and diagnosis of Diabetes.

Effectiveness of Visual Inspection with Acetic Acid and Pap Smear for Early Detection of Cervical Cancer among Women attending Gynecology O.P.D of Tertiary Level Hospital Gwalior (M.P) India

Introduction: Cervical cancer is the fourth most common cause of cancer in women in the world and the second most common cancer among Indian women. About 23% of the global cervical cancer burden is beard by India alone. The screening of cervical cancer is commonly done by a pap smear, visual inspection of acetic acid, human papillomavirus DNA testing etc. These identify precancerous changes which when treated can prevent the development of cancer. The objectives of the study were to screen the patient at Gynecology OPD by visual Inspection with acetic acid (VIA) and Pap smear for early detection of cervical cancer and to evaluate the efficacy of visual inspection with acetic acid and Pap smear in the early detection of cervical cancer. Methods: A descriptive cross-sectional study was conducted among 60 women attending Gynecology O.P.D of a Tertiary Level Hospital, Gwalior (India) by non-probability purposive sampling technique between 1st August to 30th August 2017. Pap smear was taken from each woman followed by VIA. Women with positive VIA and/or positive Pap smear were referred for colposcopy-directed cervical biopsy. Results: After the application of 3% VIA among 60 women, 16 (26.67%) developed acetowhite while 44 (73.33%) didn’t. While the result of Pap smear shows, 22 (36.66%) had an inflammatory smear, 6(10%) shows benign smear, 9(15%) bacterial vaginosis, 1(1.66%) squamous metaplastic cells, 12 (20%) shows adenocarcinoma and 10(16.66%) normal pap smear. Conclusion: The study concludes that VIA and pap smear were effective methods for the early detection of cervical cancer. Visual inspection of the cervix after acetic acid application (VIA) is widely recommended as the method of choice in cervical cancer screening programs in resource-limited settings and developing countries because of its simplicity, cost-effectiveness and ability to link with immediate treatment.

Prevalence of Preoperative Anxiety in Preoperative Patients in Nepal Police Hospital: A Cross-sectional Descriptive Study

Introduction: The possibility of undergoing anesthesia-assisted surgery can cause a great deal of anxiety in individuals. Excessive anxiety can have a number of negative consequences, including perioperative cardiac events, greater anesthetic needs, higher postoperative pain ratings, and a longer stay in the hospital. Anxiety levels during surgery might be influenced by a variety of reasons. The objective of the study was to estimate the prevalence of anxiety in adult patients scheduled for Surgery. Methods: This is Cross-sectional Descriptive Study conducted in Nepal police hospital with calculated sample size of 92 with round figure of 100, convenient sampling technique was used. Descriptive analysis was used for Analysis. Results: Prevalence of anxiety in preoperative patient was 31%. The prevalence in male patients and female patients were 21.2% and 39.5% respectively. Conclusions: When compared to many other research, the general prevalence of anxiety at Nepal Police Hospital was lower; nevertheless, the incidence was higher among female patients.

Guide Flange Prosthesis with Acrylic Guidance Ramp for Management of Deviation following Segmental Mandibulectomy and Partial Maxillectomy for Gingivobuccal Mucosal Cancer: A Case Report.

Surgical resection of maxilla and /or mandible due to the presence of benign or malignant tumor is most common. Segmental resection frequently causes deviation of mandible towards the defective side and disturbances in maxillomandibular relationship. Variety of materials and techniques have been used for the construction of prosthetic replacement of acquired surgical defects. This case report describes prosthodontic management of a patient who has undergone partial maxillectomy and segmental mandibulectomy using the mandibular guide flange prosthesis with acrylic guidance ramp. This not only helps to correct the deviation but also guides the mandible for achieving occlusal contact with opposing teeth.

Sphingosine Kinase 1(SphK1) – A Novel Marker for Cancer Risk Assessment in Oral Premalignancy

Introduction Head and neck cancer is the sixth most common cancer worldwide, resulting in approximately 550,000 diagnoses of new cases and 300,000 deaths per year globally. Overexpression of Sphingosine kinase - 1 (SphK1) is found in head and neck squamous cell carcinoma (HNSCC) from early to advanced stages and is associated with tumor progression, invasion, metastasis and poor prognosis. This study assesses the expression of sphingosine kinase - 1 (SphK1) in oral leukoplakia and oral squamous cell carcinoma (OSCC) and suggests its role as a potential biomarker tool for cancer risk assessment in oral leukoplakia. Methods In this retrospective study, eighty-two (n = 82) archival formalin-fixed paraffin blocks consisting of 10 normal tongue mucosa (Group A), 42 cases of oral leukoplakia (Group B) and 30 cases of OSCCs (Group C) were selected and subjected to immunohistochemical staining for anti-rabbit SphK1 antibody. The three different groups were compared for the presence of Sphk1 expression. The clinicopathological parameters such as age, gender, habits, histopathology, and Sphk1 expression were analyzed and compared between the malignantly transformed leukoplakia with untransformed leukoplakia. Results Positive SphK1 expression was found in 18 out of 42 (42.9 %) cases of oral leukoplakia and 17 out of 30 (56.7 %) cases of OSCCs while there was no SphK1 expression in normal tongue mucosa. The expression of SphK1 among three different groups of tissue samples was statistically significant (P = 0.007). The correlation between the malignant transformed and untransformed leukoplakia lesion with respect to SphK1 expression was also found to be statistically significant (P= 0.007) Conclusions Positive SphK1 expression in oral leukoplakia is suggestive of an increased risk for malignant transformation which can be used as a biomarker tool. Higher SPHK1 expression in the OSCC may suggest an important role in the early stages of tumorigenesis.

Pyemotes Species Isolated from Sputum Sample of COVID-19 patient- A Case Report

COVID-19, which emerged as a new and unknown disease in December of 2019, has transformed into a full-blown pandemic. It has affected all spheres of life, however, has claimed more lives of immune-compromised. Many opportunistic infections are being reported. We present a case of pyemotes species in sputum sample of a COVID-19 patient