Grande Medical Journal最新文献

{"title":"ABO blood group discrepancies: Study of prevalence and related factors","authors":"B. Nepal, B. Shrestha, Sabindra Maharjan, Sunil Bhasima, S. K. Shrestha","doi":"10.3126/gmj.v1i2.27059","DOIUrl":"https://doi.org/10.3126/gmj.v1i2.27059","url":null,"abstract":"Background: ABO discrepancy is any deviation from the expected pattern of red cell antigen grouping with serum-grouping or when the forward-grouping results do not correlate with reverse-grouping results. This study was done to determine the incidence and causes of ABO discrepancies and to identify the correct blood group for safe blood transfusions. \u0000Methods: This is a retrospective descriptive study. It was done on 9970 samples collected between June 2017and May 2018. All ABO typing records kept at the Grande International Hospital (GIH) blood bank laboratory were reviewed. \u0000Results: During the study period, 9970 blood grouping tests were performed. ABO discrepancies occurred in 26 of them. Discrepancies were more prevalent in the age of 20-30 and 30-40 years. Majority were seen in patients with history of pregnancy/miscarriage (30%) and with any Carcinoma (23%). The most common blood group involved was B with 34% frequency. 96% were reverse discrepancy type, 84% with extra antibody which was resolved by incubating the sample at 37°C for 30 minutes signifying most probably A and B subgroups and auto/allo antibodies. \u0000Conclusion: This study emphasizes the need of considering ABO discrepancies in blood banks for donors and recipients for safe blood transfusion to avoid any fatal complications. This discrepancy ratio of 1/384 is more than in other studied population of other countries and also higher than ABO mismatched transfusion in standard centers in Nepal. Repeat testing and investigating for ABO subgroups and auto/allo antibodies is important.","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125581211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescribing pattern and utilization of selected antimicrobials in a tertiary hospital of Nepal","authors":"Upasana Acharya, Ravi Mahat, S. Acharya, B. Pahari, P. Tripathi","doi":"10.3126/gmj.v1i2.27089","DOIUrl":"https://doi.org/10.3126/gmj.v1i2.27089","url":null,"abstract":" Introduction: This study was done to understand the purpose of using higher grade antimicrobials in a one year period and to compare the consumption of commonly prescribed parenteral antimicrobial agents in four consecutive years in a tertiary care hospital of Nepal. \u0000Materials & Methods: A retrospective observational study was carried out to collect the information on prescription of selected six classes of antimicrobial for all admitted patients aged 2 years or above for a one-year period. Further, the antimicrobial consumption tool 2016 was used to calculate defined daily dose (DDD) per 100 bed days of commonly dispensed parenteral antimicrobials for four consecutive years. \u0000Results: A total of 2568 antimicrobial supply forms prescribing higher grades antimicrobials were analyzed. The indications for use of antimicrobials were mainly for empiric treatment. Among the infections being treated, lower respiratory tract infection (LRTI) was the most frequent cause. Piperacillin-tazobactam was most frequently prescribed followed by Meropenem. Also, DDD for commonly used parenteral antimicrobials showed increasing trends over four consecutive years. \u0000Conclusion: The prescription of higher grades of antimicrobial for empiric treatment and surgical prophylaxis need to be monitored. The rate of consumption of such antimicrobials could not be assessed due to lack of similar studies but the increase in DDD/100 bed days each year suggested the rise in consumption of antimicrobial in the same institution.","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128255552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of tuberculosis of spine: Nepalese experience","authors":"B. Bijukachhe, C. Sutterlin","doi":"10.3126/GMJ.V1I1.22400","DOIUrl":"https://doi.org/10.3126/GMJ.V1I1.22400","url":null,"abstract":"Introduction : Spinal tuberculosis treatment goal is eradication of the disease, neurological protection, and deformity prevention. Accepted indications for conservative or surgical management of the disease are still lacking. The purpose of this study was to classify disease based on pre- and post-treatment clinical and radiological criteria to help management. \u0000Material and methods : Out of 101 patients, retrospectively reviewed between 2007 and 2015, seventy adult patients (44 males, mean age 29 years, range 16-76) were included in the study. Patients were evaluated clinically for pain, deformity and neurological status while radiological evaluation included sagittal deformity, vertebra destruction and number of vertebrae involvement. 60 patients underwent surgery (abscess drainage, 2; anterior radical debridement and fusion, 12; anterior debridement + posterior instrumentation, 26; posterior instrumentation, 20) All patients were given anti-tuberculous treatment for 12 months. Mean follow up period was 44.9 months (range: 6-108 months). \u0000Result: Pre-treatment pain (Visual analogue score, VAS 0-10, mean 7.52) improved by 0.99 at last follow up. Number of vertebrae involved ranged from 1 to 15 (mean 4.2). 38 patients had obvious clinical deformity with Cobb angle mean 36.6° (range 10°-130°). Deformity was corrected at mean of 17.5° (range: -60° to 90°) at last follow up. \u0000There were two ASIA A, eight ASIA B, five ASIA C, four ASIA D and 51 patients with ASIA E neurology at the time of presentation. One patient with ASIA A neurology remained same even after decompression while other patient died on the day of surgery. Out of 8 patients with ASIA B neurology six patients improved to ASIA E, one patient remained same and one patient deteriorated to ASIA A. In ASIA C group, three patients improved to ASIA E. One patient deteriorated to ASIA A. All four patients with ASIA D neurological status improved to ASIA E. And all 51 patients with pre-operative ASIA E status remained same but one deteriorated to ASIA C. \u0000Eight patients had deformity progression, two patients had deep vein thrombosis, two patients had superficial wound infection and one patients had recurrent cold abscess. Two patients died due to associated co-morbidities. \u0000Based upon the clinical and radiological pre- and post-operative findings; Uncomplicated spines were managed conservatively or with abscess drainage (USG or CT – guided). Complicated spines were managed with posterior instrumentation and complex spines were managed with anterior / posterior procedure (posterior only approach) \u0000Conclusion: Based upon the outcome of treatment of spinal tuberculosis, conservative treatment results in healing of the disease process with residual deformity while surgical treatment in selected cases results in early pain alleviation, spinal balance, neurologic protection and eventually early return to work.","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131691210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrence of spinal epidural abscess after inadequate antibiotic dosage regimen","authors":"R. Dahal, J. Khan, B. Bijukachhe","doi":"10.3126/GMJ.V1I1.22419","DOIUrl":"https://doi.org/10.3126/GMJ.V1I1.22419","url":null,"abstract":"Introduction: Spinal epidural abscess (SEA) is a potentially life threatening condition which can present with a clinical triad of fever, back pain and neurological deficit. It is more common in elderly population with risk factors like immunocompromised status, diabetes mellitus and alcoholism. High index of clinical suspicion of SEA warrants prompt investigated and treatment. Immediate surgical decompression along with antibiotic is recommended for better outcome. \u0000Case Presentation : A 16 years old boy presented with complaints of fever, upper back pain which had developed gradually over a period of 10 days. He had history of furuncle in perineal region 3 weeks prior to his symptoms, which was drained. With high clinical suspicion of SEA, Contrast enhanced Magnetic Resonance Imaging (CEMRI) was done along with blood parameters and was diagnosed as SEA D3-D6 level. He underwent immediate surgical decompression and was given 3 weeks of antibiotics. Post-operative period was uneventful with clinical improvement of the symptoms. He again presented to us with relapse of the infection on 28th post-operative day with similar fever and back pain. He was reinvestigated with MRI and blood investigations which revealed relapse of the infection. He was then managed with intravenous (IV) Vancomycin for 2 weeks and oral Erythromycin for another 6 weeks. He did not require any surgical intervention in his later presentation. \u0000Conclusion: Spinal epidural abscess is a surgical emergency and prompt diagnosis with surgical drainage is recommended for better outcome even when there is no neurological deficit. Abscess drainage should be adjunct with longer duration of antibiotics for at least 6 weeks for optimum results.","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129450265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute appendicitis in children: How is it different than in adults?","authors":"G. Dahal","doi":"10.3126/GMJ.V1I1.22404","DOIUrl":"https://doi.org/10.3126/GMJ.V1I1.22404","url":null,"abstract":"Acute appendicitis is common in both children and adults. As children are different than adults in many aspects, the disease process, presentation, and outcome are different. Children have more complicated appendicitis. This article discusses the differences of acute appendicitis in children.","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128150457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial for the Inaugural Issue: Grande Medical Journal (GMJ)","authors":"P. Kafle","doi":"10.3126/GMJ.V1I1.22398","DOIUrl":"https://doi.org/10.3126/GMJ.V1I1.22398","url":null,"abstract":"We are proud and honored to launch the inaugural issue of our new academic endeavor – Grande Medical Journal (GMJ), published by Academic & Research Department, Grande International Hospital (GIH). \u0000GMJ is an annual, open, peer-reviewed interdisciplinary journal that encompasses all fields of medicine and clinical practice. GMJ will be published both in print and online. It will be freely accessible via the internet through GIH’s website with open access to the full text of articles. \u0000There will be no subscription fees to the readers or processing fees for the authors. Publisher and authors who publish in the journal will jointly retain the copyright to their article. \u0000The editorial policy of GMJ will be guided by the high standards of scientific quality and integrity, professional responsibility, and ethical legacy. GMJ follows double-blind peer-review process. This minimizes the possibility of a biased opinion ensuring a responsible and ethical environment. \u0000GMJ will be initially published as one issue per year, and with contributions from national and international physicians and scientists, we aim to increase the frequency to two issues per year. GMJ will publish original research, clinical review, invited reviews, case report, clinical problem solving, clinical images, short communications, and editorials. \u0000This inaugural issue features fifteen scientific papers - 1 invited review, 3 original researches, 2 clinical reviews, 1 clinical images article, 8 case reports. \u0000The editorial board is committed to get the journal indexed in major search engines, indices, and databases to increase their visibility/ searchability and recognition in wider scientific community. For us to achieve these goals, in the forthcoming issues we seek to publish original, high-quality, peerreviewed papers including original clinical and editorials, clinical reviews, and correspondence on matters that will provide comprehensive coverage on all aspects and subspecialties of medicine. \u0000We would like to thank everyone who has worked diligently behind the scenes to bring this inaugural issue to fruition. This launch of the GMJ would not have been possible without the contributions from authors, and experienced and devoted reviewers who willingly signed up for timeconsuming workloads and enthusiastically agreed to provide their critical input to the review process. \u0000Thank you all for your trust and support. Indeed, it is a real honor to serve as the founding editors. \u0000Sincerely Yours,Prakash Kafle, MSEditor-in-Chief","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133242092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gossypiboma can remain asym ptomatic for a long time","authors":"P. Pant, A. Ghimire, Nilam Subedi, S. R. Pant, A. Shrestha","doi":"10.3126/GMJ.V1I1.22418","DOIUrl":"https://doi.org/10.3126/GMJ.V1I1.22418","url":null,"abstract":"Gossypiboma, a retained foreign body after surgery, is a rare complication. It appears years after surgery, has nonspecific symptoms, and is usually identified on imaging sequences. We present here an asymptomatic case of a 32 years old lady with a history of laparotomy done two years earlier. She was initially misdiagnosed clinically and radiologically as hydatid cyst of pelvis. During re-surgery, foreign body was detected. Postoperative period was uneventful. To prevent these types of complications, we have to follow the main principle of surgery in all procedures i.e. ensuring a proper count of surgical materials before and after surgery.","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121696487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucocele of the appendix: Incidental finding of a rare occurrence","authors":"A. Malla, Rakesh Sah","doi":"10.3126/GMJ.V1I1.22416","DOIUrl":"https://doi.org/10.3126/GMJ.V1I1.22416","url":null,"abstract":"Mucocele of the appendix is a rare disease. Clinically, appendeceal mucocele (AM) is an incidental finding or it may mimic appendicitis. In AM, distension of the appendix is caused by mucus, the source of which can be benign or malignant. For the benign disease, appendectomy alone is sufficient but for malignant conditions adjunct treatments are needed. Proper pre-operative evaluation is imperative to distinguish between benign and malignant causes in order to guide the management and reduce complications. For the definitive diagnosis, histology and immunohistochemistry are required. We report an incidental finding of an appendeceal mucocele in a kidney donor during pre-transplant evaluation.","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121815470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-communicable disease pattern in adults seeking preventive general health checkup","authors":"B. Shrestha, B. Nepal, Ravi Mahat, Abish Adhikari","doi":"10.3126/GMJ.V1I1.22401","DOIUrl":"https://doi.org/10.3126/GMJ.V1I1.22401","url":null,"abstract":"Non Communicable diseases (NCDs) are now endemic in low and middle income countries. Nepal had a high burden of communicable diseases (CDs) which has now been overtaken by NCDs. Although prevention and control of NCDs is prioritized in national policies and strategies, there is no proper monitoring system. This study aims to review the morbidity pattern among the adults seeking preventive general health checkup in a major tertiary care hospital in Kathmandu. 3000 cases were evaluated. 53.6% were males and 46.4% were females. The mean age of cases was 44.9 yrs. Most of the cases ranged from 40 to 60 years of age. Almost half of them were from Kathmandu district. Nearly 78% participants live a sedentary life. Abdominal obesity was seen in 27.5% of females and 21.7% of males. Nearly 49% of cases were overweight and 24% were obese. Almost 21 % of the cases were smokers and about 36% of them consumed alcohol. Only 9% are vegetarians. 10% have diabetes and 20% have hypertension. 69% of females and 43% of males have less than normal bone mineral density. \u0000The government and private sectors must focus on strengthening preventive and curative services for early detection of risk factors and management of NCDs.","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132358773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updates on 2016 CNS tumor classification - Where do we stand?","authors":"Manish Kolakshyapati, T. Shrestha, Anish M Singh, R. Adhikari, P. Shrestha","doi":"10.3126/GMJ.V1I1.22403","DOIUrl":"https://doi.org/10.3126/GMJ.V1I1.22403","url":null,"abstract":"The updated 2016 World Health Organization (WHO) classification of central nervous system (CNS) tumors has incorporated the molecular markers together with histological parameters in defining and diagnosing various tumor entities. This has led to major changes and revision of the classification. A number of new entities are classified based on clinical, diagnostic, and prognostic relevance and those without such relevance have been removed. Major changes are incorporated in diffuse glioma, medulloblastoma, pediatric gliomas, and other embryonal tumors. These new requisites make molecular testing a basic requirement for CNS tumor diagnosis and treatment. New treatment protocols are designed and targeted based on the genetic alteration involved in the tumor entity. The update aims to achieve accurate diagnosis, determine precise prognosis and ensure better patient treatment all through facilitating better categorization of clinical and experimental trials. The multidisciplinary team of clinicians treating such tumor patients in a developing country like Nepal should try to adopt this updated version of the classification so as to improve and upgrade the neuro-oncological services to meet the international standards.","PeriodicalId":314361,"journal":{"name":"Grande Medical Journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133981497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}