Correlation of ultrasonography guided fine needle aspiration cytology of thyroid nodules with histopathology

Background:   This study aims to establish correlation of ultrasonography guided fine needle aspiration cytology (USG-FNAC) of thyroid nodules with histology. USG-FNAC was carried out in fifty cases of thyroid nodules and the result of USG-FNAC was compared with histopathology.Materials and Methods:  The study was performed in the Department of Pathology, National Academy of Medical Sciences, Bir Hospital over a period of one year. Fine needle aspiration of solid area of thyroid nodule was done in each case with USG guidance. FNAC results were classified according to Bethesda system of reporting. Finally, comparison was done between cytological and histological findings.  Results: The age of patients that underwent thyroidectomy ranged from 16 - 70 years. Maximum number of cases fell in age group 31-40 years. Female patients outnumbered male patients by a ratio of 9: 1.On cytological study, 70% cases were diagnosed as benign, 28% as malignant and 2% as inadequate for evaluation. On histopathology, 70% cases of diagnosed cases were benign lesions.  Nodular hyperplasia and colloid goiter were kept under the term ‘follicular nodule’. Follicular nodule was the most commonly diagnosed thyroid lesion. Fifteen cases of nodular hyperplasia and fourteen cases of colloid goiter were detected. Total number of malignant cases diagnosed was 15, out of which papillary carcinoma was the commonest (66.67%). We found two cases of medullary thyroid carcinoma.Conclusion: Sensitivity and specificity of USG-FNAC was 93.33 % and 100 %, respectively. The study showed significant correlation between FNAC (USG-guided in this study) and histopathology.</p

Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal

Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p &lt; 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p &lt; 0.001), quinolone (p = 0.01), and other antibiotics (p &lt; 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p &lt; 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p &lt; 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p &lt; 0.001), de-escalation (p &lt; 0.001), accurate documentation (p &lt; 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p &lt; 0.001) and after diagnoses (p &lt; 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal

Evaluation of an Antimicrobial Stewardship Program for Wound and Burn Care in Three Hospitals in Nepal

Antimicrobial stewardship (AMS) programs can decrease non-optimal use of antibiotics in hospital settings. There are limited data on AMS programs in burn and chronic wound centers in low- and middle-income countries (LMIC). A post-prescription review and feedback (PPRF) program was implemented in three hospitals in Nepal with a focus on wound and burn care. A total of 241 baseline and 236 post-intervention patient chart data were collected from three hospitals. There was a significant decrease in utilizing days of therapy per 1000 patient days (DOT/1000 PD) of penicillin (p = 0.02), aminoglycoside (p \u3c 0.001), and cephalosporin (p = 0.04). Increases in DOT/1000 PD at post-intervention were significant for metronidazole (p \u3c 0.001), quinolone (p = 0.01), and other antibiotics (p \u3c 0.001). Changes in use of antibiotics varied across hospitals, e.g., cephalosporin use decreased significantly at Kirtipur Hospital (p \u3c 0.001) and Pokhara Academy of Health Sciences (p = 0.02), but not at Kathmandu Model Hospital (p = 0.59). An independent review conducted by infectious disease specialists at the Henry Ford Health System revealed significant changes in antibiotic prescribing practices both overall and by hospital. There was a decrease in mean number of intravenous antibiotic days between baseline (10.1 (SD 8.8)) and post-intervention (8.8 (SD 6.5)) (t = 3.56; p \u3c 0.001), but no difference for oral antibiotics. Compared to baseline, over the 6-month post-intervention period, we found an increase in justified use of antibiotics (p \u3c 0.001), de-escalation (p \u3c 0.001), accurate documentation (p \u3c 0.001), and adherence to the study antibiotic prescribing guidelines at 72 h (p \u3c 0.001) and after diagnoses (p \u3c 0.001). The evaluation data presented provide evidence that PPRF training and program implementation can contribute to hospital-based antibiotic stewardship for wound and burn care in Nepal