Nevin Manimala

J Nepal Health Res Counc. 2023 Sep 8;21(1):86-91. doi: 10.33314/jnhrc.v21i1.4361.

ABSTRACT

BACKGROUND: Prolapse is among the most common indication for gynaecological surgery. It is difficult to estimate prevalence of pelvic organ prolapse even in developed countries due to lack of epidemiological studies. This study was done to find the prevalence, risk factors and common presenting complaints of women with pelvic organ prolapse.

METHODS: Women with pelvic organ prolapse visiting Paropakar Maternity and Women’s Hospital during 4 months duration in 2021 were approached and after obtaining an informed consent, all the patient information on various risk factors and clinical profile(age,parity,body mass index,smoking etc.) for pelvic organ prolpase were collected in a pre-developed proforma. Pelvic Organ Prolapse was classified by Pelvic Organ Prolapse Quantification system. Data analysis was done using statistical package for the social sciences-25. Ethical approval was taken from Institutional Review Committee- National Academy of Medical Sciences.

RESULTS: Out of 58 cases enrolled in the study, prevalence of pelvic organ prolapse was found to be 1.28%. Women belonging to age group ≥ 49 years was 91.4%. Bulge symptom was the most common presenting complain among the women, 98.3%. 50% of women (n=29) were grand multipara. 53.4% (n=31) of women had delivered their first baby before 20 years of age. Multiparity,vaginal birth and menopausal age were the common risk factors.

CONCLUSIONS: Menopausal age, multi-parity, vaginal births, age at first vaginal delivery of less than 20 years were significant risk factors for development of prolapse. Bulge symptom was the most common presenting complaint. However,Smoking habit, overweight were not related to pelvic organ prolapse.

PMID:37742155 | DOI:10.33314/jnhrc.v21i1.4361

J Nepal Health Res Counc. 2023 Sep 8;21(1):81-85. doi: 10.33314/jnhrc.v21i1.4558.

ABSTRACT

BACKGROUND: Pneumonia is the commonest lung disease which is a major cause of mortality and morbidity in young children and is a common acute respiratory infection. The presentation varies among the cases. The study was done to know the risk factors, clinical profile, radiological findings, and short-term outcome of the admitted patients with pneumonia between six months to sixteen years at Dhulikhel Hospital.

METHODS: A hospital based observational prospective cross-sectional study done in 65 cases over the period of 17 months in children admitted with pneumonia at Pediatrics department of Dhulikhel Hospital. Socio-demographic variables, clinical profile, radiological profile, diagnosis, and short-term outcome were collected and analyzed using descriptive statistics.

RESULTS: Out of 65 patients, 76.9% cases were children between six months to five years. The most common clinical presentation was fever (98.5%) followed by cough (86.2%). Crepitation (78.5%) and subcostal retraction (29.2%) were common clinical findings. Disseminated intravascular coagulation, thrombocytopenia, sepsis, and right heart failure were associated with mortality. The requirement of mechanical ventilation, oxygenation, and inotrope support was more likely to have fatal outcome.

CONCLUSIONS: Fever and cough were the most common clinical presentation and right middle zone consolidation was the most common finding in children admitted with pneumonia.

PMID:37742154 | DOI:10.33314/jnhrc.v21i1.4558

J Nepal Health Res Counc. 2023 Sep 8;21(1):34-39. doi: 10.33314/jnhrc.v21i1.4339.

ABSTRACT

BACKGROUND: The purpose of this study is to determine whether preoperative magnetic resonance image measurements can predict the hamstring tendon autograft diameter during anterior cruciate ligament reconstruction.

METHODS: We prospectively evaluated Forty-two patients with anterior cruciate ligament injury who underwent reconstruction using hamstring tendon autograft. Preoperative diameters and cross-sectional areas of the hamstring tendons were estimated using magnetic resonance imaging of the knee. Intraoperative diameters of the hamstring tendon graft were measured using a cylindrical graft sizer. We used Pearson’s correlation test to compare the Preoperative and intraoperative graft size measurements. A possible cutoff value for the hamstring graft size was determined using Receiver operating characteristic analysis.

RESULTS: The mean age of the patient in the study was 27.5 ± 8.5 years. There were statistically significant correlations between preoperative and intraoperative hamstring tendon graft measurements (P < 0.001). Our study found 13.3 mm² cross-sectional area as the cutoff for predicting 7mm of quadrupled hamstring graft size with both sensitivity and specificity of 85.7 %, respectively.

CONCLUSIONS: We can conclude that preoperative magnetic resonance imaging measurements can predict the intraoperative graft size. This study can help in preoperatively planning for the graft choice.

PMID:37742146 | DOI:10.33314/jnhrc.v21i1.4339

J Nepal Health Res Counc. 2023 Sep 8;21(1):8-14. doi: 10.33314/jnhrc.v21i1.4019.

ABSTRACT

BACKGROUND: Patients with acute coronary syndrome may lead to various metabolic and electrophysiological changes that induce both asymptomatic and symptomatic life-threatening arrhythmias, which increases morbidity and mortality.

METHODS: This observational retrospective study was conducted at Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Maharajgunj, Kathmandu, Nepal. Three hundred ninety-five patients with a diagnosis of acute coronary syndrome were enrolled in the study.

RESULTS: A total of 395 patients were included in the study with a mean age of patients 61.29± 13.5 years and with male predominance. A total number of 115 cases of arrhythmia were recorded among which the most common were atrioventricular block (10%), reperfusion arrhythmia (9.6%) followed by ventricular premature complex (8%), atrial fibrillation/flutter (6%), and ventricular tachycardia/fibrillation (5%). There was a significant difference in the incidence of arrhythmia in acute coronary syndrome group. STEMI (39.7%), NSTEMI 26(20.8%) and unstable angina11(14.8%) respectively (p=<0.001). Reperfusion arrhythmia was present in 89.47% of STEMI and 10.4 % of NSTEMI/ unstable angina and was statistically significant (p-value <0.001). A total of three patients (0.7%) needed permanent pacemaker insertion in the acute coronary syndrome group. All of these patients were STEMI which was 1.5% of total STEMI, two in inferior wall STEMI (2.6%) and 1 in anterior wall STEMI (0.8%). The total in-hospital mortality was 20 (5.06%), 17(8.6%) among STEMI and 3(2.4%) among NSTEMI, and none in unstable angina (P =<0.001). Pulmonary edema (12.9%) was the most common in-hospital outcome followed by cardiac arrest (7.6%).

CONCLUSIONS: Arrhythmia in acute coronary syndrome is a common problem and may lead to structural and functional impairment of myocardial function.

PMID:37742141 | DOI:10.33314/jnhrc.v21i1.4019

J Nepal Health Res Counc. 2023 Sep 8;21(1):1-7. doi: 10.33314/jnhrc.v21i1.3732.

ABSTRACT

BACKGROUND: The overall purpose of this study was to determine the incidence and perioperative factors that predispose to cause delirium in postoperative cardiac surgery patients in our Intensive Care Unit.

METHODS: We performed a prospective, observational study. Following institutional review board approval, this study included 234 patients above the age of 18 years meeting the inclusion criteria for cardiac surgery in Shahid Gangalal National Heart Center from July 2018 to December 2018. Preoperative, intraoperative and postoperative data for possible risk factors were obtained. Daily assessment of delirium was done during Intensive Care Unit stay of the patient. Collected data were analysed by means of statistical software SPSS-21.

RESULTS: The incidence of delirium was 15.6% (35/224) in our study. Delirium was seen in 14 out of 58 (24.1%) patients with age >60 years which was found to be statistically significant. Preoperative risk factor for developing delirium were carotid artery disease and Hemoglobin level <10gm/dl. Intraoperative risk factor for developing delirium were blood transfusion, longer cardiopulmonary bypass time. Post-operative factors for developing delirium included longer Intensive Care Unit stay, mechanical ventilation time ,duration on inotropes , blood transfusion, use of non-invasive ventilation, sleep deprivation, use of intra-aortic balloon pump, Pao2<70.

CONCLUSIONS: As shown in our study, delirium is a frequent occurrence in the cardiac surgical population. The incidence of delirium after cardiac surgery was 15.6%. Several risk factors pre-operatively like age>60 years, carotid artery disease, Hb<10gm/dl, intra-operative factors like longer cardiopulmonary bypass time, blood transfusion and post-operatively longer duration of Mechanical ventilation, Intensive Care Unit stay, blood transfusion, use of intra-aortic balloon pump and Non-invasive ventilation were found to be predictors of delirium.

PMID:37742140 | DOI:10.33314/jnhrc.v21i1.3732

Adv Wound Care (New Rochelle). 2023 Sep 24. doi: 10.1089/wound.2023.0037. Online ahead of print.

ABSTRACT

Objective This is the first clinical trial to evaluate the analgesic effect of 10 and 20 mg of morphine used in a postoperative dressing with patients after surgical debridement of burn wounds. Approach In this randomized controlled trial, 20 adult patients with third-degree flame burns who had undergone surgical debridement under general anesthesia were randomly assigned to either group A, whose members were treated with a burn dressing that contained 10 mg of morphine, or group B, whose members were treated with a burn dressing that contained 20 mg of morphine; the dressing was also soaked with octenidine and phenoxyethanol in the case of both groups. The plasma morphine concen-trations were measured 1, 2, 3, and 6 hours after surgery, while the level of pain intensity was deter-mined on the Numeric Pain Rating Scale (NRS), and the occurrence of side-effects was observed. Results The serum morphine concentration levels were very low but statistically different between the two groups at all time points. The NRS value was similar in both groups at all time points (p>0.05). De-spite this, in group B the NRS value was 0 in all patients in postoperative hours 1, 2, and 3. No ad-verse effects of morphine sulfate were observed in any patient. Innovation This project is the first clinical study to have demonstrated that morphine administered in dressings in concentrations of 0.02-0.08 mg/ml significantly reduces the occurrence of pain. Conclusion The use of morphine in dressings after surgical treatment of burn wounds is very effective when it comes to pain management, and is safe for the patient.

PMID:37742106 | DOI:10.1089/wound.2023.0037

Int Forum Allergy Rhinol. 2023 Sep 23. doi: 10.1002/alr.23271. Online ahead of print.

NO ABSTRACT

PMID:37742086 | DOI:10.1002/alr.23271

Vet Med Sci. 2023 Sep 23. doi: 10.1002/vms3.1282. Online ahead of print.

ABSTRACT

BACKGROUND: Rabies is a zoonotic disease transmitted mainly by animals, especially dogs.

OBJECTIVE: The aim of the article was to examine reported cases of animal rabies in Ghana for trends to provide information that could be helpful to control the disease.

METHOD: Retrospective analyses of reported cases of rabies in Ghana from 2010 to 2017.

RESULTS: In all, 328 rabies cases were recorded in animals in the period under review. The predominant species involved were dogs (299; 91.2%) and cats (12; 3.7%). Other species included pigs (4; 1.2%), goats (4; 1.2%), monkeys (4; 1.2%), sheep (2; 0.6%), bats (2; 0.6%) and cattle (1; 0.3%). The numbers of reported cases in animals were markedly higher than those in humans except in 2013 and 2017. There was a positive but weak correlation between cases in animals and humans which could be due to lack of reporting collaboration between institutions responsible for these. Greater Accra and Ashanti Regions were identified as hotspots in the period under review, while January and August were the months with the highest peaks for cases reported. Cases reported in rainy season were significantly higher than those in dry season. Poisson regression for spatio-temporal analyses showed no statistical significance in predicting number of rabies cases (response variable) from year, month, season, region and affected species (predictor variables).

CONCLUSION: Rabies remained endemic in Ghana during 2010-2017 with cases reported in nearly every month of the year during this period. There was a significant seasonal pattern with higher proportion of cases reported in the rainy/wet season compared to the dry season.

PMID:37742084 | DOI:10.1002/vms3.1282

Q J Exp Psychol (Hove). 2023 Sep 23:17470218231203951. doi: 10.1177/17470218231203951. Online ahead of print.

ABSTRACT

Representing events in episodic memory in a coherent manner requires that their constituent elements are bound together. So far, only few moderators of these binding processes have been identified. Here we investigate whether the presence of an agentic element in an event facilitates binding. The results from six experiments provided no evidence for a facilitating effect of agency on the binding of event elements. In addition, binding effects were only found when event elements were presented simultaneously, but not when they were presented sequentially pairwise, contrary to previous findings. The results suggest that the presence of an agentic element in an event does not or only to a very limited extent contribute to the formation of coherent memory representations and that additional processes may be required when binding event elements across temporarily divided encoding episodes. These findings add to a growing body of research regarding moderators and processes relevant for the binding of event elements in episodic memory. Explanations of these findings and directions for future research are discussed.

PMID:37742043 | DOI:10.1177/17470218231203951

J Environ Qual. 2023 Sep 23. doi: 10.1002/jeq2.20519. Online ahead of print.

ABSTRACT

Crop rotation is a management practice with high greenhouse gas (GHG) mitigating potential that is often neglected due to economic influences. Three long-term rotation studies in Wisconsin were selected to assess potential opportunities for mitigating GHG emissions by comparing temporal and spatial variability of N₂ O, CO_2, and CH₄ emissions in continuous corn (Zea mays L.) (CC), corn-soybean [Glycine max (L.) Merr.] (CS), and corn-soybean-wheat (Triticum aestivum L.) (CSW) using a static chamber method. Greenhouse gas emissions were influenced by weather conditions and following nitrogen (N) application during a 3-year measurement period. In high N input environments at Arlington and Lancaster, N₂ O emissions in CC were 5.80 and 4.40 kg N ha^-1 , respectively, which was much higher than the emissions in CS and CSW rotations that ranged from 1.52 to 3.33 kg N ha^-1 . In the low N input environment at Marshfield, N₂ O emissions were not statistically different among CC, CS, and CSW rotations (1.20 to 1.66 kg N ha^-1 ). Yield-scaled N₂ O emissions were not different among crop rotations. When pooled over locations, CO₂ emissions were highest in CC (4.16 Mg C ha^-1 ) and were similar in CS and CSW (3.71 and 3.50 Mg C ha^-1 , respectively). Soils either emitted or absorbed small and inconsistent amounts of CH₄ . These results provide important insights as to how weather conditions and differences among management practices affect GHG emissions and show that application of either 2-yr CS or 3-yr CSW rotation can be equally effective in reducing N₂ O emissions compared to CC, especially with high N applications. This article is protected by copyright. All rights reserved.

PMID:37742040 | DOI:10.1002/jeq2.20519