Journal of Lumbini Medical College

Childhood Tuberculosis and its Relation with Nutrition

Uma Chhetri — 2018-07-11

Introduction: Tuberculosis is the sixth leading cause of mortality in Nepal. Childhood tuberculosis consisted 5.54% of newly registered 32,056 cases in 2016-17. Malnutrition is a predictor of tuberculosis and is associated with poorer outcomes. This study evaluates the clinico-epidemiologic profile of childhood tuberculosis and its relation to nutritional status.

Methods: This was a retrospective review of 60 cases of tuberculosis admitted over a period of five years. Details regarding demographics, anthropometry, symptomatology and examination findings were retrieved. Diagnosis was categorized as pulmonary, extra-pulmonary and disseminated tuberculosis. Findings of various investigations were noted. Nutritional status of the patients was assessed using the WHO standard charts. Association of malnutrition and anemia with types and severity of tuberculosis was assessed.

Results: A total of 60 patients were included in the study. Mean age was 7.9 years (SD = 4.6). The commonest presenting symptom was fever (83.3%) followed by decreased appetite (33.3%) and weight loss (26.7%). Cough was the predominant symptom in pulmonary tuberculosis (45%). Only eight cases were bacteriologically confirmed. Underweight, wasting and stunting were observed in 68.4%, 63.3% and 53.3% of cases respectively. Wasting was significantly associated with severe forms of tuberculosis (p = 0.03). Anemia was present in 89.5% of under five children (p = 0.02).

Conclusion: Malnutrition often co-exists in a significant proportion of children with tuberculosis. Diagnosis in resource limited settings heavily relies on clinical suspicion and supporting investigations. Anemia is significantly associated with childhood TB, especially under five children.

Echocardiographic profile of patients with cardiomyopathy

Jeevan Khanal — 2018-07-12

Introduction: Cardiomyopathies represent a heterogeneous group of diseases that often lead to progressive heart failure with significant morbidity and mortality. Exact epidemiological data on cardiomyopathy in Nepal are lacking. This study was done to observe the demographic and echocardiographic profile of patients with cardiomyopathy attending a medical college teaching hospital.

Methods: Trans-thoracic two-dimensional echocardiographic study was performed by first author on all patients with cardiomyopathy over a period of six months. Patients’ demographic and echocardiographic data were collected and analyzed using SPSS version 20 software. Student t-test and Chi-square test were applied where appropriate.

Results: A total of 60 patients were studied from October 2017 to March 2018. Mean age of all participants was 56.38 years (SD = 13.86). Mean age of males was significantly higher than that of females (60.96 yrs, SD = 13.61 versus 51.62 yrs, SD = 13.47) in dilated cardiomyopathy subgroup (p < 0.05). Of all patients, 32 (53.33%) had dilated cardiomyopathy (idiopathic) and 13 (21.66%) had ischemic cardiomyopathy.

Conclusion: Our study highlighted significant burden of dilated cardiomyopathy. Dilated cardiomyopathy appeared in females at earlier age compared to males. Potentially reversible cardiomyopathies like alcoholic and peripartum cardiomyopathies were also present which have a probability of cure if treated properly.

Metabolic Syndrome and Benign Prostatic Hyperplasia

Raj Kumar Chhetri — 2018-07-18

Introduction: Metabolic syndrome is defined as the presence of at least 3 of the following parameters: (1) waist circumference ≥ 90 cm, (2) triglycerides > 150 mg/dl or treatment for hypertriglyceridemia, (3) HDL-cholesterol < 40 mg/dl or treatment for reduced HDL-cholesterol, (4) blood pressure ≥ 130/85 mmHg or current use of antihypertensive medications, (5) fasting blood glucose ≥ 110 mg/dl or previous diagnosis of type-2 diabetes mellitus. It is closely associated with many diseases and recent studies have also shown its association with benign prostatic hyperplasia and lower urinary tract symptoms. Our study aimed to investigate association between metabolic syndrome and its components with benign prostatic hyperplasia among patients managed surgically in a tertiary centre in Western Nepal.

Methods: One hundred and four patients above 50 years with benign prostatic hyperplasia managed in the department of Surgery over one year were included in the study.

Results: Twenty-seven patients had metabolic syndrome (25.96%). There was association between metabolic syndrome and mean prostate size and among components of metabolic syndrome, high serum triglyceride and low HDL Cholesterol were found to be associated. There was increase in mean prostate size with increase in number of metabolic syndrome components which was statistically significant.

Conclusion: Metabolic syndrome along with its two components, serum triglyceride and HDL Cholesterol were associated with increase in mean prostate size.

Outcome of Percutaneous Nephrolithotomy in Horseshoe Kidneys

Udaya Man Singh Dongol — 2018-08-16

Introduction: The horseshoe kidney is extremely rare, the incidence being one in every 400 - 800 patients. In a recent review of more than 15000 radiographic imaging studies, the incidence was one in every 666 patients. The renal stone formation in horseshoe kidney is around 20-80%. Percutaneous nephrolithotomy is the most accepted modality of treatment . This study was carried out to find the outcome of percutaneous nephrolithotomy in horseshoe kidneys.

Methods: Between May 2013 and November 2017, 11 adult patients (12 renal units) with stones in horseshoe kidneys underwent percutaneous nephrolithotomy in the department of urosurgery, Kathmandu Medical College and Teaching Hospital and were evaluated for the operating time, stone free rate , complications and hospital stay. Data analysis was done using Statistical Package for the Social sciences (SPSS) Version 20. Categorical data were analysed by using Fisher exact test.

Results: The mean age of the patients was 30.9 years (SD = 10.3) and the mean stone burden was 385.83 mm2 (SD = 331.3). The overall stone free rate was 83.33%. The two patients with residual stones when counselled for Extracorporeal shock wave lithotripsy, refused for it and decided to be on follow up. No auxiliary procedure was done. The complications noted were of Clavien-Dindo grade I and II. No pleural or bowel injury was seen. One patient needed blood transfusion.

Conclusions: Percutaneous nephrolithotomy is safe and effective in the management of stones in horseshoe kidneys. It does not carry increased risk than reported in normal kidneys.