Efficacy of morning-only dose compared with split-dose polyethylene glycol electrolyte solution in bowel cleansing for afternoon colonoscopy

Introduction: The efficacy of colonoscopy in detecting abnormalities within the colon is highly dependent on the adequacy of the bowel preparation. The objective of this study was to compare the efficacy and tolerability of morning only vs split-dose administration of polyethylene glycol (PEG) solution for colon cleansing in patients undergoing afternoon colonoscopy. Methods: This was a comparative study conducted in Department of Medicine, Patan Academy of Health Sciences (PAHS), Patan Hospital, Nepal from November 2021 to June 2022. The ethical clearance was obtained from the Institutional Review Committee. Informed consent was taken from the patients. Patients aged >18 years undergoing elective colonoscopy were randomly assigned to one of the two bowel preparation regimens- morning only or split-dose of PEG. The adequacy of bowel preparation was assessed by the endoscopist using Boston Bowel Preparation scale. Preparation to colonoscopy interval, adverse events and risk factors for poor bowel preparations were noted. Results: In this study, 110 patients were included in the final analysis- 55 received morning only regimen and 55 received split-dose. Mean Boston bowel preparation scales of Morning only and Split-dose regimen were 7.60 and 7.09 respectively (p= 0.019). Split-dose group had significant sleep disturbances compared to Morning only regimen (p< 0.001), whereas nausea occurred significantly more often in Morning only regimen (p=0.012). Preparation to colonoscopy interval between 4-6 hours resulted in better bowel cleansing compared to PC interval of greater than 6 hours. Conclusion: Morning-only bowel preparation is more effective than Split-dose for achieving adequate colon cleansing for afternoon colonoscopy

Factors predicting early re-bleeding and in-hospital mortality after acute variceal hemorrhage in patients with cirrhosis

Introduction: Risk factors for early re-bleeding and in-hospital mortality following acute variceal hemorrhage (AVH) are incompletely understood. The aim of this study was to find out the risk factors for early re-bleeding within 5 days and in-hospital mortality after AVH in patients with cirrhosis. Methods: This was an analytical cross-sectional study conducted in Department of Medicine, Patan Academy of Health Sciences (PAHS), Patan Hospital, Nepal from July 2021 to June 2022. The ethical clearance was obtained from the Institutional Review Committee. Informed consent was taken from the patients. Patients aged > 18 years with diagnosed case of liver cirrhosis and endoscopy confirmed variceal bleeding were enrolled. All cases of early re-bleeding within 5 days and in-hospital outcome were recorded. Results: In this study total 72 patients were enrolled. The mean age of our patients was 51.68 years. More than 91% of the patients improved, 4.16% had early re-bleeding and 6.9% died during the same hospital admission. Univariate analysis showed that early re-bleeding was significantly associated with the high PT/INR (p=<0.001) and high high Child-Turcotte Pugh (CTP) score (p=0.032), whereas in-hospital mortality of patients was significantly associated with low Protein (p=0.044), CTP score (p=0.041), high Model for End stage Liver Disease (MELD) score (p=0.002) and presence of gastric varices (p=0.008). Conclusion: High PT/INR and high CTP score were the predictors of early re-bleeding after AVH in cirrhotic patients. Low Protein, high CTP and MELD scores, and presence of gastric varices were the predictors of in-hospital mortality in these patients

Upper gastrointestinal endoscopy findings in patient presenting with dyspepsia

ntroductions: The objective of this study was to evaluate the upper gastrointestinal endoscopy findings in patients presenting with dyspepsia. Methods: This retrospective observational study was conducted in Department of internal medicine, Patan Hospital from April 2013 to March 2014. Adult patients who underwent upper gastrointestinal endoscopy for dyspepsia were included in the study. Results: There were 2141 endoscopies (out of total 3195) performed for dyspepsia, male 996 (46.52 %), female 1145 (53.48%), mean age 39.37 years (SD ±18.16). A single endoscopic diagnosis was made in 1991 (93%) and in rest combinations of lesions were seen. Gastritis 892 (41.66%), Oesophagitis 215 (10.04%), Duodenal Ulcer 100 (4.67%), Gastro-duodenitis 85 (3.97%), Hiatus hernia 82 (3.82%), Gastric Ulcer 46 (2.14%) and no lesions in 594 (27.74%) were seen. Conclusion: Gastritis followed by oesophagitis was seen half of the dyspeptic, while a quarter had functional dyspepsia with normal findings. Keywords: duodenal ulcer, gastritis, gastric ulcer, hiatus hernia, oesophagitis, upper gastrointestinal (UGI) endoscopyÂ

Accuracy of bedside index for severity in acute pancreatitis ‘BISAP’ score in predicting outcome of acute pancreatitis

Introduction: Early identification of severe acute pancreatitis is of paramount importance in the management and for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP) is a simple and accurate score for stratification in acute pancreatitis. This study was conducted to find out the accuracy of BISAP score in predicting outcomes of acute pancreatitis in local population. Method: We prospectively analyzed 96 patients with acute pancreatitis from February 2019 to December 2019. Revised Atlanta classification was used to stratify mild, moderately severe and severe pancreatitis. BISAP score was calculated within 24 hours of admission. Accuracy was measured by area under receiver operating curve (AUC). Result: Out of 96 patients, alcohol related acute pancreatitis accounted for 74.7%. There were 63.2% of mild AP, 37.3% of moderately severe AP, 9.4% of severe AP and 15.8 % of pancreatic necrosis. The AUC for moderately severe AP, severe AP and pancreatic necrosis were 0.77 (CI 0.68-0.87), 0.95 (CI 0.90-0.99) and 0.87 (CI 0.79-0.96) respectively. The statistically significant BISAP cut off for diagnosing sever AP was≥3, and ≥2 for moderately sever AP and pancreatic necrosis. There was positive correlation between revised Atlanta severity of acute pancreatitis and length of hospital stay (r=0.41). Mortality was 3.3 % which was seen in BISAP score 3 or above. Conclusion: BISAP is a simple predictive model in identifying patient at a risk of developing different severity of pancreatitis and its outcome in our population

Intravenous paracetamol vs tramadol for pain management in patients with acute pancreatitis

Introduction: Acute Pancreatitis causes severe and persistent pain, and thus, necessitates effective treatment. Opioids are widely used to relieve pain in acute pancreatitis due to their efficacy and effectiveness. Intravenous paracetamol has been documented to have comparable effectiveness as that of opioids, with lesser side effects. In this study, the analgesic efficacy of tramadol, an opioid was compared with paracetamol in acute pancreatitis.  Method: This was an open label comparative study conducted in a tertiary referral hospital of Nepal. Patients with Acute Pancreatitis were randomly assigned to receive 1 g of paracetamol or 50 mg of tramadol with 100 mL normal saline within 4-5 minute. Pain measurements of the patients were conducted at baseline and 24 hours after the treatment intervention. Changes in pain scores were calculated by subtracting the mean scores at baseline and 24 hours as pairs.  Result: In this study, 80 patients were enrolled and included in the final analysis. The study subjects had a mean age of 39.33 +/- 13.3 years and 62(77.5%) of them were male. Alcohol was the etiology for pancreatitis in 67.5% (n=54) of patients. Mean pain scores at baseline and 24 hours were similar in the two groups. Similarly, change of scores from baseline to 24 hours did not differ between the groups. Comparison of pain improvements failed to reveal any differences between groups.  Conclusion: Intravenous paracetamol is an effective alternative to tramadol in pain management of acute pancreatitis

Prevalence of long covid-19 syndrome among health care workers of Patan Academy of Health Sciences

Introduction: Any symptoms acquired after COVID-19 infection that persists beyond 12 weeks period and not explained by any other disease either already present or acquired after COVID-19 infection is termed as long COVID 19 by World Health Organisation. We tried to find out the prevalence of long COVID 19 in healthcare workers. Method: Questionnaire was made in google form based on COVID-19 Yorkshire Rehabilitation Screening Tool (COVID YRS Tool). Ethical approval was taken from IRC-PAHS. Data collected from all health care workers of PAHS from 2022/05/20 to 2022/07/20. Difference in Precovid and Postcovid status in different domains were compared by statistical tests. Result: The median age of our participants was 29 years. Prevalence of Long COVID 19 was 68.1%. 19 55.3% ha mild, 10.4% had moderate, 2.4% had severe symptoms. The most common symptom was fatigue (44%), anxiety (41%) and shortness of breath (36%). The COVID YRS Tool overall score was statically significant with p value <0.001. Pre COVID 19 and Post COVID 19, patients had statically significant in breathlessness, fatigue, nutrition, anxiety, usual activity, pain, anxiety and depression. Only 6% of our patients had severe COVID 19.   Conclusion: People are still experiencing various symptoms after COVID 19 infection. Long COVID 19 has now been a health care problem.  Long COVID 19 patients have multisystem involvement and multi speciality team is needed for their management and rehabilitation

Histopathological findings of renal biopsy in systemic lupus erythematousus

Introductions: Classifying morphological pattern of renal involvement is important in systemic lupus erythematosus (SLE) for definitive treatment and prognosis. This study aim to analyse the histopathological pattern of glomerular in SLE patients.Methods: This was a retrospective chart review of patients diagnosed with SLE who had renal biopsy during October 2013 to September 2015 at Patan Hospital.Results: There were 38 patients of SLE.  Antinuclear antibody (ANA) was positive in all patients 38 (100 %), Anti-dsDNA seen in 18 (47.4%). Active urinary sediment & proteinuria was seen 25 (65.8%) patients and proteinuria in 13 (34.2%) patients. Histopathological patterns were of glomerular involvement was, ISN Class II in 2 (5.3%), Class III in 2 (5.3%), class IV 20 (52.5%), class V in 6 (15.8%) and mixed IV –V in 8 (21.1%).Conclusions: The diffuse proliferative lupus nephritis (ISN Class IV) was the most com­mon pattern of lupus nephritis encountered in our study followed by mixed pattern (ISN class IV&V) and membranous lupus nephritis (ISN class IV). Keywords: histopathology, lupus nephritis, renal biopsy, systemic lupus erythematosu

Kidney biopsy in glomerular disease: a hospital based study

Introductions: Kidney biopsy is the standard tool to diagnose glomerular disease (GD). There is lack of national registry of kidney biopsy for the type, incidence and prevalence of GD. We aim to review kidney biopsy at Patan Hospital for profile of GD in local scenario. Methods: This was a chart review of patients who underwent kidney biopsy at Patan Hospital, Nepal, from October 2013 to September 2015. We analyzed the data for indication of kidney biopsy, types of GD and complication of biopsy. Results: There were 117 patients who had kidney biopsies. Immunoglobulin A Nephropathy was seen in 42 (35.8%) and Lupus Nephritis in 38 (32.5%). Sub nephrotic range proteinuria with or without active urinary sediments was found in 75 (64%). Blood transfusion was required in 3 (2.5%) patients after biopsy. There was no surgical intervention or mortality related to biopsy. Conclusions: IgA Nephropathy was the commonest glomerular disease. Kidney biopsy was a safe and effective procedure. Keywords: glomerular disease, kidney biopsy, nephropath

Search for gravitational-lensing signatures in the full third observing run of the LIGO-Virgo network

Gravitational lensing by massive objects along the line of sight to the source causes distortions of gravitational wave-signals; such distortions may reveal information about fundamental physics, cosmology and astrophysics. In this work, we have extended the search for lensing signatures to all binary black hole events from the third observing run of the LIGO--Virgo network. We search for repeated signals from strong lensing by 1) performing targeted searches for subthreshold signals, 2) calculating the degree of overlap amongst the intrinsic parameters and sky location of pairs of signals, 3) comparing the similarities of the spectrograms amongst pairs of signals, and 4) performing dual-signal Bayesian analysis that takes into account selection effects and astrophysical knowledge. We also search for distortions to the gravitational waveform caused by 1) frequency-independent phase shifts in strongly lensed images, and 2) frequency-dependent modulation of the amplitude and phase due to point masses. None of these searches yields significant evidence for lensing. Finally, we use the non-detection of gravitational-wave lensing to constrain the lensing rate based on the latest merger-rate estimates and the fraction of dark matter composed of compact objects

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M>70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0<e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level