Nevin Manimala

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1209-1214. doi: 10.31729/jnma.6392.

ABSTRACT

INTRODUCTION: Pregnancy Induced Hypertension is a major health issue with limited studies conducted so far in Chitwan, Nepal regarding adverse perinatal outcomes in obstetric population. This study aimed to find prevalence of pregnancy induced hypertension among pregnant women delivering in a tertiary care hospital.

METHODS: A descriptive cross-sectional study was conducted in a teaching hospital of Chitwan, Nepal during the study period of six months from 15th Jan 2019- 16th July 2019 after getting ethical approval from Chitwan Medical College-Institutional Review Committee (Reference number-2075/076042). Women were selected via convenience sampling technique. Face to face interview was conducted to collect socio-demographic and obstetric data whereas, data related to the fetomaternal outcomes were obtained from patient charts and delivery record books. Statistical Package for Social Sciences version 20 was used for data analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

RESULTS: The prevalence of pregnancy induced hypertension was found to be 91 (6.43%) (3.83-9.03 at 95% Confidence Interval) representing 71 (78.1%), 12 (13.2%), and 8 (8.7%) as gestational hypertension, preeclampsia and eclampsia respectively.

CONCLUSIONS: The burden of pregnancy induced hypertension was found quite higher as compared to other similar studies done in Nepal. Gestational hypertension was most common type.

PMID:35199794 | DOI:10.31729/jnma.6392

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1297-1301. doi: 10.31729/jnma.6627.

ABSTRACT

INTRODUCTION: Acute Pancreatitis is a common disease, diagnosed in about 3% of cases presenting with abdominal pain. Severe disease with multiple systemic complications develops in 10-20% of the cases which require intensive care in specialized centres. Harmless acute pancreatitis score is a simple and economical score predicting the non-severe course of disease within 30 minutes of admission. The aim of our study was to find the prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis in a tertiary care centre.

METHODS: A descriptive cross-sectional study was conducted after obtaining the ethical approval (Reference no. 344/2076/77). The study was carried out from September 2019 to February 2020 taking 50 patients with the first attack of acute pancreatitis. Convenient sampling was done. Harmless acute pancreatitis score prediction of severe disease and final outcome as severe or non-severe was noted with predefined severity criteria. Data were entered in Microsoft Excel and Statistical Package for the Social Sciences and results represented in tables and charts. Point estimate at 95% was done and frequency and percentage were calculated.

RESULTS: Out of 50 patients with first attack of acute pancreatitis, using the harmless acute pancreatitis score, the prevalence of harmless acute pancreatitis was 22 (56%) (44.45-67.5 at 90% Confidence Interval).

CONCLUSIONS: The harmless acute pancreatitis score is an easy, less expensive, quick and promising early scoring system for prediction of non-severe courses of acute pancreatitis. The prevalence of harmless (harmless acute pancreatitis) among cases of acute pancreatitis was found to be similar to other studies.

PMID:35199790 | DOI:10.31729/jnma.6627

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1234-1238. doi: 10.31729/jnma.6652.

ABSTRACT

INTRODUCTION: Performing the total knee arthroplasty in moderate to severe fixed flexion deformity, appropriate resection of bone from distal femur along with proper ligament balancing is mandatory in order to get the reasonable intraoperative correction. The aim of our study is to find out the prevalence of total knee arthroplasty among knees with moderate to severe fixed flexion deformity in a tertiary care center.

METHODS: This is a descriptive cross-sectional study conducted from hospital records of 2013 to 2019 in elderly patients with moderate to severe fixed flexion deformity in a Tertiary Care Hospital. Ethical clearance (14/2020) was taken from Institutional Review Board. Convenience sampling was used and statistical analyses were performed using the Statistical Package for the Social Sciences software (version 16.0). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data.

RESULTS: Out of 400 knees with moderate to severe fixed flexion deformity, the prevalence of total knee arthroplasty was found to be 80 knees (20%) (16.08-23.92 at 95% Confidence Interval).

CONCLUSIONS: The prevalence of total knee arthroplasty is comparable to other study. In our study total knee arthroplasty can be performed successfully with excellent functional outcomes in patients with moderate to severe fixed flexion deformity of knee joint provided the joint stability is maintained by appropriate ligamentous balancing.

PMID:35199789 | DOI:10.31729/jnma.6652

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1252-1255. doi: 10.31729/jnma.6879.

ABSTRACT

INTRODUCTION: Ureteric calculi are lying at any point of ureter from the pelvic ureteric junction to the vesicoureteral junction. If left untreated, ureteropelvic junction obstruction can lead to hydronephrosis. With the improved availability of computed tomography and ultrasound scanning, hydronephrosis is being diagnosed more frequently. The main aim of this study is to find out the prevalence of moderate Hydronephrosis among ureteral calculus on ultrasonography imaging in a tertiary care center of Nepal.

METHODS: A descriptive cross-sectional study was conducted among 110 acute ureteral calculus cases at Radiodiagnosis and Imaging Department of Chitwan Medical College and Teaching Hospital, Bharatpur from 15th August 2020 to 15th May 2021. The ethical approval was taken from the Institutional Review Committee of same institution. Convenient sampling technique was used to select the participant. The collected data was entered in excel 16 and analysed in Statistical Package for Social Sciences. Point estimate at 95% Confidence Interval was done and frequency and percentage were calculated.

RESULTS: Out of the 110 cases of acute ureteral calculus, 31 (28.2%) (19.79-36.60 at 95% Confidence Interval) has moderate hydronephrosis in the ultrasonographic imaging. The mean age of participants was 31.61±8.51 years and male to female ratio was 1.97:1. Vesicoureteric junction was the most common site for ureteric calculus 39 (35.5%).

CONCLUSIONS: The ultrasound is an easy method to be applied, and a fast one to help and diagnose obstructive hydronephrosis. The main causes of hydronephrosis are kidney stones, followed by ureteral stones, with a moderate degree of hydronephrosis.

PMID:35199787 | DOI:10.31729/jnma.6879

JNMA J Nepal Med Assoc. 2021 Dec 11;59(244):1256-1261. doi: 10.31729/jnma.7045.

ABSTRACT

INTRODUCTION: The Surgical safety checklist by World Health Organization has been used for the last two decades. There is every chance of unwanted expected disasters in Operating-Room in Pediatricsurgical cases. Our study is to observe the utilization of the safety checklist and evaluate occurrence of never-events in Tertiary Level Pediatric Surgery Unit in Nepal.

METHODS: A descriptive cross-sectional study was done at Nepal Medical College Teaching Hospital from January 2021-June 2021 with record-based data of children from 0-15 years operated in Pediatric Surgery unit from March 2017-July 2018. Ethical approval (Reference number: 049-077-078) was taken from the Institution review committee of the institute. Convenience sampling was done. Self-designed Pro-forma with demographic data along with World Health Organization-Surgical-safety-checklist used was collected and entered in Microsoft-Excel. Data were analyzed using Statistical-Package-for-the-Social-Sciences-version-25.Point estimate at 95% Confidence Interval was done along with frequency and proportion for binary data.

RESULTS: Out of 267 cases enrolled, 103 (38.6%) (35.6-41.6 at 95% Confidence Interval) were fully compliant with the checklist, 69 (25.8%) partially compliant. Among compliant cases, 148 (55.4%) Sign-in part, 128 (47.9%) cases -Time-out part and 152 (56.9%) cases Sign-out part were complete.

CONCLUSIONS: Compliance with World Health Organization-Surgical-safety-checklist has a major role in preventing morbidity and mortality in Pediatric surgical cases. With proper use of the checklist, the unwanted never-events can be prevented with better surgical outcomes.

PMID:35199784 | DOI:10.31729/jnma.7045

J Biomed Opt. 2022 Feb;27(8). doi: 10.1117/1.JBO.27.8.083009.

ABSTRACT

SIGNIFICANCE: Diffuse correlation spectroscopy (DCS) is an optical technique that measures blood flow non-invasively and continuously. The time-domain (TD) variant of DCS, namely, TD-DCS has demonstrated a potential to improve brain depth sensitivity and to distinguish superficial from deeper blood flow by utilizing pulsed laser sources and a gating strategy to select photons with different pathlengths within the scattering tissue using a single source-detector separation. A quantitative tool to predict the performance of TD-DCS that can be compared with traditional continuous wave DCS (CW-DCS) currently does not exist but is crucial to provide guidance for the continued development and application of these DCS systems.

AIMS: We aim to establish a model to simulate TD-DCS measurements from first principles, which enables analysis of the impact of measurement noise that can be utilized to quantify the performance for any particular TD-DCS system and measurement geometry.

APPROACH: We have integrated the Monte Carlo simulation describing photon scattering in biological tissue with the wave model that calculates the speckle intensity fluctuations due to tissue dynamics to simulate TD-DCS measurements from first principles.

RESULTS: Our model is capable of simulating photon counts received at the detector as a function of time for both CW-DCS and TD-DCS measurements. The effects of the laser coherence, instrument response function, detector gate delay, gate width, intrinsic noise arising from speckle statistics, and shot noise are incorporated in the model. We have demonstrated the ability of our model to simulate TD-DCS measurements under different conditions, and the use of our model to compare the performance of TD-DCS and CW-DCS under a few typical measurement conditions.

CONCLUSION: We have established a Monte Carlo-Wave model that is capable of simulating CW-DCS and TD-DCS measurements from first principles. In our exploration of the parameter space, we could not find realistic measurement conditions under which TD-DCS outperformed CW-DCS. However, the parameter space for the optimization of the contrast to noise ratio of TD-DCS is large and complex, so our results do not imply that TD-DCS cannot indeed outperform CW-DCS under different conditions. We made our code available publicly for others in the field to find use cases favorable to TD-DCS. TD-DCS also provides a promising way to measure deep brain tissue dynamics using a short source-detector separation, which will benefit the development of technologies including high density DCS systems and image reconstruction using a limited number of source-detector pairs.

PMID:35199501 | DOI:10.1117/1.JBO.27.8.083009

J Breast Cancer. 2022 Feb;25(1):37-48. doi: 10.4048/jbc.2022.25.e7.

ABSTRACT

PURPOSE: This study identified factors predicting malignant upgrade for atypical ductal hyperplasia (ADH) diagnosed on core-needle biopsy (CNB) and developed a nomogram to facilitate evidence-based decision making.

METHODS: This retrospective analysis included women diagnosed with ADH at the National Cancer Centre Singapore (NCCS) in 2010-2015. Cox proportional hazards regression was used to identify clinical, radiological, and histological factors associated with malignant upgrade. A nomogram was constructed using variables with the strongest associations in multivariate analysis. Multivariable logistic regression coefficients were used to estimate the predicted probability of upgrade for each factor combination.

RESULTS: Between 2010 and 2015, 238,122 women underwent mammographic screening under the National Breast Cancer Screening Program. Among 29,564 women recalled, 5,971 CNBs were performed. Of these, 2,876 underwent CNBs at NCCS, with 88 patients (90 lesions) diagnosed with ADH and 26 lesions upgraded to breast malignancy on excision biopsy. In univariate analysis, factors associated with malignant upgrade were the presence of a mass on ultrasound (p = 0.018) or mammography (p = 0.026), microcalcifications (p = 0.047), diffuse microcalcification distribution (p = 0.034), mammographic parenchymal density (p = 0.008). and ≥ 3 separate ADH foci found on biopsy (p = 0.024). Mammographic parenchymal density (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.005-0.35; p = 0.014), presence of a mass on ultrasound (HR, 10.50; 95% CI, 9.21-25.2; p = 0.010), and number of ADH foci (HR, 1.877; 95% CI, 1.831-1.920; p = 0.002) remained significant in multivariate analysis and were included in the nomogram.

CONCLUSION: Our model provided good discrimination of breast cancer risk prediction (C-statistic of 0.81; 95% CI, 0.74-0.88) and selected for a subset of women at low risk (2.1%) of malignant upgrade, who may avoid surgical excision following a CNB diagnosis of ADH.

PMID:35199500 | DOI:10.4048/jbc.2022.25.e7

United European Gastroenterol J. 2022 Feb 24. doi: 10.1002/ueg2.12207. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) at lowest risk of progression may allow for a reduced intensity of surveillance.

OBJECTIVE: We aimed to externally validate the previously developed Dutch-American Risk stratification Tool (DART-1; https://rtools.mayo.edu/DART/), which identifies cysts at low risk of developing worrisome features (WFs) or high-risk stigmata (HRS).

METHODS: Three prospective cohorts of individuals under surveillance for BD-IPMNs were combined, independent from the original development cohort. We assessed the performance (discrimination and calibration) of DART-1, a multivariable Cox-proportional logistic regression model with five predictors for the development of WFs or HRS.

RESULTS: Of 832 individuals (mean age 77 years, SD 11.5) under surveillance for a median of 40 months (IQR 44), 163 (20%) developed WFs or HRS. DART-1’s discriminative ability (C-statistic 0.68) was similar to that in the development cohort (0.64-0.72) and showed moderate calibration. DART-1 adequately estimated the risk for patients in the middle risk quintile, and slightly underestimated it in the lowest quintiles. Their range of predicted versus observed 3-year risk was 0%-0% versus 0%-3.7% for Q1; 0.3%-0.4% versus 3%-11% for Q2; and 2.6%-3% versus 2.4%-9.8% for Q3. The development of WFs or HRS was associated with pancreatic cancer (p < 0.001). Vice versa, in absence of WFs or HRS, the risk of malignancy was low (0.3%).

CONCLUSIONS: The performance of DART-1 to predict the development of WFs or HRS in BD-IPMN was validated in an external international cohort, with a discriminative ability equal as in the development cohort. Risk estimations were most accurate for patients with BD-IPMNs in the middle risk quintile and slightly underestimated in the lowest quintiles.

PMID:35199484 | DOI:10.1002/ueg2.12207

Int J Rheum Dis. 2022 Feb 23. doi: 10.1111/1756-185X.14307. Online ahead of print.

ABSTRACT

AIM: S-flurbiprofen plaster (SFPP) is a novel topical nonsteroidal anti-inflammatory drug (NSAID) patch. This study aimed to assess the efficacy and safety of SFPP in knee osteoarthritis (OA) patients compared to diclofenac gel.

METHODS: This study was a multicenter, randomized, active-controlled, open-label, non-inferiority phase III trial. There were 311 enrolled patients treated by SFPP or diclofenac gel for 2 weeks. The primary efficacy outcome was the knee pain when rising from the specially arranged chair assessed by visual analog scale (rVAS). The other efficacy outcomes were clinical symptoms, pain on walking, global assessment by both investigator and patient, and use/non-use of the rescue drugs during the treatment period. Adverse events (AEs) were evaluated as the safety outcome.

RESULTS: The least-squares mean (95% CI) of ΔrVAS at the end of the study was 41.52 (39.16-43.88) mm in the SFPP group and 36.01 (33.69-38.33) mm in the diclofenac gel group, with a between-group difference of 5.51 (2.20-8.82), indicating non-inferiority. There were statistically significant differences between the groups in rVAS, clinical symptoms, pain on walking, and the global assessment by both investigator and patient. The incidence rate of AEs in the SFPP group was 5.8%, and there was no statistically significant difference from that in the diclofenac gel group (5.2%). Most of the AEs were mild, and no AE led to discontinuation.

CONCLUSION: Non-inferiority of SFPP to diclofenac gel was demonstrated in the efficacy for pain on rising from a chair. SFPP was also well-tolerated in knee OA patients.

PMID:35199483 | DOI:10.1111/1756-185X.14307

Clin Exp Dent Res. 2022 Feb 24. doi: 10.1002/cre2.503. Online ahead of print.

ABSTRACT

OBJECTIVE: Wiskott-Aldrich syndrome (WAS) is a rare X-linked primary immunodeficiency, characterized by micro-thrombocytopenia, recurrent infections, and eczema. This study aims to describe common oral manifestations and evaluate oral microbioma of WAS patients.

MATERIAL AND METHODS: In this cohort study, 11 male WAS patients and 16 male healthy controls were evaluated in our Center between 2010 and 2018. Data about clinical history, oral examination, Gingival Index (GI) and Plaque Index (PI) were collected from both groups. Periodontal microbiological flora was evaluated on samples of the gingival sulcus.

RESULTS: WAS subjects presented with premature loss of deciduous and permanent teeth, inclusions, eruption disturbance, and significantly worse GI and PI. They also showed a trend toward a higher total bacterial load. Fusobacterium nucleatum, reported to contribute to periodontitis onset, was the most prevalent bacteria, together with Porphyromonas gingivalis and Tannerella forsythia.

CONCLUSIONS: Our data suggest that WAS patients are at greater risk of alterations in the oral cavity. The statistically higher incidence of periodontitis and the trend to higher prevalence of potentially pathological bacterial species in our small cohort, that should be confirmed in future in a larger population, underline the importance of dentistry monitoring as part of the multidisciplinary management of WAS patients.

PMID:35199474 | DOI:10.1002/cre2.503