Journal of the Institute of Medicine最新文献_第6页

Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study 持续出院耳朵的微生物特征和药物敏感性模式：一项基于三级医院的回顾性研究

Journal of the Institute of Medicine Pub Date : 2020-08-31 DOI: 10.3126/JIOM.V42I2.37541

B. Gyawali, Rabindra B Pradhanaga, Pabina Rayamjhi, K. Dongol, Mudit Gupta, L. Shrestha, K. Acharya

{"title":"Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study","authors":"B. Gyawali, Rabindra B Pradhanaga, Pabina Rayamjhi, K. Dongol, Mudit Gupta, L. Shrestha, K. Acharya","doi":"10.3126/JIOM.V42I2.37541","DOIUrl":"https://doi.org/10.3126/JIOM.V42I2.37541","url":null,"abstract":"Introduction Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population. Methods This was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics. Results COM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin. Conclusion COM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"64-68"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43001364","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}

引用次数: 0

Pediatric Percutaneous Nephrolithotomy in a Peripheral Tertiary Care Center in Nepal 尼泊尔一家外周三级医疗中心的儿科经皮肾穿刺取石术

Journal of the Institute of Medicine Pub Date : 2020-08-31 DOI: 10.3126/JIOM.V42I2.37545

D. K. Gupta, D. Jaiswal

{"title":"Pediatric Percutaneous Nephrolithotomy in a Peripheral Tertiary Care Center in Nepal","authors":"D. K. Gupta, D. Jaiswal","doi":"10.3126/JIOM.V42I2.37545","DOIUrl":"https://doi.org/10.3126/JIOM.V42I2.37545","url":null,"abstract":"Introduction Pediatric nephrolithiasis though uncommon, poses clinical management dilemma due to anatomical and physiological factors. Percutaneous Nephrolithotomy (PCNL) is well established in adults and miniaturization of the instruments has helped to expand its indication for uses in pediatric population with equivalent results. The aim of our study is to evaluate the application of the procedure in our settings. Methods This was a retrospective study done at Nepalgunj Medical College teaching hospital from June 2017 to April 2020. Total of 75 patients with 76 renal units under 18 year of age were evaluated. PCNL was done in prone position in all patients using fluoroscopy for initial puncture and subsequently for clearance. The size of the tract varying from 15 Fr to 24 Fr was decided based on the degree of hydronephrosis. Results Mean stone volume was 372 mm2. With mean operative time of 58 min, 96% of stone clearance rate was achieved. Mini PCNL was done in most of the cases. Single tract was used in 84% cases mostly with subcostal puncture. Major complications were pelvic perforation in 4% cases and two patients required restaging. Conclusion PCNL in pediatric population is safe with good stone free rate with minimal complications. Application of miniaturized instruments has further improved the outcome with comparable morbidity.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"80-84"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45883586","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}

引用次数: 0

Correlation of Hypoechoic Lesions in Trans-rectal Ultrasound of Prostate with Histopathology in Prostate Cancer 前列腺低回声病变经直肠超声与前列腺癌症组织病理学的相关性

Journal of the Institute of Medicine Pub Date : 2020-08-31 DOI: 10.3126/JIOM.V42I2.37544

D. Chataut, Babin Basnet, B. Lohani, S. Suwal, S. Paudel, P. Kayastha

{"title":"Correlation of Hypoechoic Lesions in Trans-rectal Ultrasound of Prostate with Histopathology in Prostate Cancer","authors":"D. Chataut, Babin Basnet, B. Lohani, S. Suwal, S. Paudel, P. Kayastha","doi":"10.3126/JIOM.V42I2.37544","DOIUrl":"https://doi.org/10.3126/JIOM.V42I2.37544","url":null,"abstract":"Introduction Prostate cancer is one of the most common cancer in elderly male. Suspicion of prostate cancer is based on increased Prostate Specific Antigen (PSA) level and abnormal digital rectal examination (DRE) findings. Transrectal ultrasonography (TRUS) can detect and localize hypoechoic lesions in prostate which are considered as suspicious for malignancy. TRUS can also guide for prostate biopsy, which is the gold standard for diagnosis of prostate cancer. The study was aimed to find out TRUS findings in suspected prostate cancer patients and correlate these findings with histopathological findings. Methods Prospective study was done in 66 males of age >40 years, sent for prostate biopsy in suspicion for prostate cancer (PSA >4 ng/ml, and/or abnormal DRE findings). Prostate was evaluated with TRUS and subsequently underwent TRUS guided six core biopsy of prostate. Total 396 cores of biopsy were taken. Histopathology reports were collected and correlated with the TRUS findings. Results Twenty three patients were positive for prostate cancer and 14 of them showed hypoechoic lesions in TRUS. Total 81 suspicious hypoechoic lesions were seen in prostate of all the patients and among them 42 lesions matched with histopathology report for cancer. Cancerous focus detection rate of TRUS was 51.85%. Conclusion TRUS is a supplementary tool in diagnosis of prostate cancer, however when used alone it has less sensitivity for detection of prostate cancer.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"76-79"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42692276","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}

引用次数: 0

Prevalence of Diabetes and Dyslipidemia in Hypertensive Young Adults in a Tertiary Care Centre in Nepal, a Cross Sectional Study 尼泊尔一家三级医疗中心高血压年轻人糖尿病和血脂异常的患病率：一项横断面研究

Journal of the Institute of Medicine Pub Date : 2020-08-31 DOI: 10.3126/JIOM.V42I2.37530

K. Lamsal, K. Neupane, N. Acharya, D. Lamsal, N. Karmacharya, D. Paudel, R. Paudel, R. Sharma

引用次数: 0

Comparison of EuroSCORE II with EuroSCORE in Cardiac Surgical Patients in a Tertiary Level Teaching Hospital in Nepal EuroSCORE II与EuroSCORE在尼泊尔某三级教学医院心脏外科患者中的比较

Journal of the Institute of Medicine Pub Date : 2020-08-31 DOI: 10.3126/JIOM.V42I2.37525

B. Pradhan, P. Bastola, M. Basnet, Bibhush Shrestha, S. Sigdel, Arjun Gurung

引用次数: 0

Granular Cell Tumor of Breast: Rare Tumor Masquerading as Malignancy 乳腺颗粒细胞瘤:伪装成恶性肿瘤的罕见肿瘤

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37443

S. Hirachan, Y. Singh, A. Jha, U. Manandhar

引用次数: 0

Clinical Overview of Cancer Patients in Province Two of Nepal: A Single Center Experience 尼泊尔第二省癌症患者临床概况：单中心经验

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37457

Anshul Thakur, Anishee Shah, B. Ray

{"title":"Clinical Overview of Cancer Patients in Province Two of Nepal: A Single Center Experience","authors":"Anshul Thakur, Anishee Shah, B. Ray","doi":"10.3126/JIOM.V42I1.37457","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37457","url":null,"abstract":"Introduction The incidence of cancer is rising in Nepal. It is estimated to reach 38.5 per 100,000 for males and 41.5 per 100,000 for females by 2020. The studies to determine the cancer burden in Nepal at provincial level have been insufficient and those that have been done are more inclined to Province 3. With establishment of a dedicated cancer facility in this area, we present an overview of clinical scenario of cancer patients in Province 2.MethodsWe performed a single centered, retrospective review of 118 patients who were registered in Oncology Clinics between May 2019 and February 2020. Demographics, diagnoses and the treatment strategies were obtained from the medical records.ResultsMedian age of presentation for cancer was 55 years (range, 6 to 83 years) with maximum number of patients falling within range of 50-60 years (31.4%). 71 patients (60.2%) were female and 47 patients (39.8%) were male. The common presenting cancers were gastrointestinal (27.1%), breast (16.9%), head and neck (15.3), gynecological (13.6%), hematological (11.9%) and others (15.2%). Among the gastrointestinal cancers, carcinoma of gallbladder with 15 cases (46.9%) was the most frequently occurring, followed by colorectal cancer with 6 cases (18.8%) and esophageal cancer with 4 cases (12.5%). Among all, 78 patients (66.1%) received palliative care only, 25 patients (21.2%) received chemotherapy only, 8 patients (6.8%) underwent surgery only, 3 patients (2.5%) underwent surgery and received chemotherapy as well, 2 patients (1.7%) received both chemotherapy and palliative care and 2 patients (1.7%) were reassured and observed. ConclusionThe most common age of presentation for cancer of any type was 50-60 years, with most common cancer being gastrointestinal in origin. Most of the patients received palliative care owing to their advanced stage at presentation.","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"78-78"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44648087","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}

引用次数: 0

Low Grade Appendiceal Mucinous Neoplasm: A Report of Three Cases 低级别阑尾黏液性肿瘤3例报告

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37444

N. Sharma, Alina Karna, A. Jha

引用次数: 0

Comparison of Outcomes of Open versus Laparoscopic Living Donor Nephrectomy in Nepal 尼泊尔开放式与腹腔镜活体供肾切除术的疗效比较

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37422

P. Sigdel, D. Gnyawali, B. Rai, P. Dhital, Purushottam Parajuli, Sampanna Chudal, N. Dhakal, M. Pradhan, S. Poudyal, S. Chapagain, B. Luitel, Chalise Pr, S. Uk, Gyawali Pr

{"title":"Comparison of Outcomes of Open versus Laparoscopic Living Donor Nephrectomy in Nepal","authors":"P. Sigdel, D. Gnyawali, B. Rai, P. Dhital, Purushottam Parajuli, Sampanna Chudal, N. Dhakal, M. Pradhan, S. Poudyal, S. Chapagain, B. Luitel, Chalise Pr, S. Uk, Gyawali Pr","doi":"10.3126/JIOM.V42I1.37422","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37422","url":null,"abstract":"IntroductionLaparoscopic donor nephrectomy is the gold standard for kidney retrieval in live donors. Until recently,donor nephrectomies were performed only by open technique in Nepal. There is no information on theexperience and outcomes of laparoscopic donor nephrectomy in Nepal. The study was done to comparethe outcomes among donors undergoing open and laparoscopic nephrectomies, and to compare the graft related outcomes between the two groups receiving these kidneys.MethodsIn this retrospective study, 44 kidney donors from March 2019 to October 2019 were analyzed. Donors were divided into 2 groups: open donor nephrectomy (ODN) and laparoscopic donor nephrectomy (LDN).Parameters for analysis included demographic data, warm ischemia time, surgery time and length ofhospital stay. Data on early graft function and complications in recipients till 30th post-operative day were compared.ResultsThere were 22 donors each in the ODN and LDN groups. Baseline characteristics of the donors were comparable between two groups. Mean surgery duration (183.55±43.31 minutes vs 117.73±18.75 minutes) and first warm ischemia time (11.22±4.34 minutes vs 2.3±0.8 minutes) was significantly high in LDN. Hemoglobin drop, post-operative complications in donors, creatinine of donors at discharge, mean hospital stay, graft function at one month and complications in recipients were comparable among ODN and LDN. Pain score in 1st post-operative day was comparable between two groups, however, pain was significantly less in second post-operative day in LDN.ConclusionLaparoscopic donor nephrectomy is feasible in Nepal and associated with acceptable morbidity and graft function when compared to ODN.Keywords: Laparoscopic donor nephrectomy, open donor nephrectomy, renal transplantation","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"31-35"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43301549","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}

引用次数: 0

Pediatric Ventriculoperitoneal Shunt: Outcome Analysis in a Tertiary Care Center in Nepal 尼泊尔一家三级医疗中心的儿童脑室腹膜分流术结果分析

Journal of the Institute of Medicine Pub Date : 2020-04-30 DOI: 10.3126/JIOM.V42I1.37424

Suman Phuyal, B. Rajbhandari, A. Pradhanang, G. Sedain, S. Shilpakar, M. Sharma

{"title":"Pediatric Ventriculoperitoneal Shunt: Outcome Analysis in a Tertiary Care Center in Nepal","authors":"Suman Phuyal, B. Rajbhandari, A. Pradhanang, G. Sedain, S. Shilpakar, M. Sharma","doi":"10.3126/JIOM.V42I1.37424","DOIUrl":"https://doi.org/10.3126/JIOM.V42I1.37424","url":null,"abstract":"IntroductionVentriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. It results in a dramatic improvement in patient survival and neurological function but is associated with several complications requiring multiple shunt revisions throughout a patient’s lifetime. The main aimof the study was to evaluate the outcome especially complications of shunt surgery at our center.MethodsA single-institutional, retrospective observational study was conducted in 60 operated cases of congenital hydrocephalus with a minimum follow-up for up to 6 months. Parameters for analysis included demographic data, etiology of hydrocephalus, surgery time, and type of complications.ResultsOut of 86 patients, 60 patients who fulfilled the inclusion criteria were enrolled in the study. The mean age of the patients at the time of VP shunt placement was 3 months, range from 8 days to 15 years with male preponderance. The majority of the patients belonged to the 0-1-year age group (76.8%). Thecommonest etiology of hydrocephalus was congenital aqueduct stenosis. Fifteen patients (25%) developed complications within six months follow-up period. Eight patients (13.3%) developed clinical shunt infection with four cases having culture positive. Four (6.67%) had mechanical complications in the form of shuntobstruction. Three patients had ascites, subdural collection, and shunt extrusion from the anus. The shunt related mortality was 1.67%.ConclusionThe shunt infection and obstruction still remain the most important complications. Despite inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available.Keywords: Complications congenital hydrocephalus, ventriculoperitoneal shunt","PeriodicalId":85033,"journal":{"name":"Journal of the Institute of Medicine","volume":"42 1","pages":"40-43"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47749672","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}

引用次数: 0