Outcome of diagnosed cases of appendicitis and diagnostic accuracy of ultrasound of the appendix

Background: Acute appendicitis is the most common condition requiring an emergency ultrasound scan as well as surgery. Several scoring systems for acute appendicitis has been suggested to improve diagnostic accuracy and decrease the negative appendectomy rate. In this study, we have evaluated the diagnostic performance of ultrasound on the diagnosis of acute appendicitis, other appendicular pathology, and correlate with surgical outcome. Material and methods: This retrospective study included 776 cases of ultrasound scan reports in which the appendix was visualized and not visualized or equivocal. Data were collected from October 2014 to April 2019 from different department and wards of Gandaki Medical College Teaching Hospital and Research Center (GMCTHRC). All the cases with diagnosed acute appendicitis, appendicular lump, and appendicular abscess were included and were followed for its surgical outcome. The surgical note or post-operative findings served as the reference standard for determining whether perforation was present or not. Result: There were 776 ultrasound scans for suspected appendicitis out of which 423 (54.5%) were diagnosed as appendicular pathology. Out of 423 diagnosed cases, 192 (45.4%) were males and 231 (54.6%) were females, with age ranging from 24 months to 87 years. Sonographic findings, in these positive subjects, suggested acute appendicitis, appendicular lump, abscess, and amount of free fluid in right iliac fossa (RIF) and pelvic cavity. Frank acute appendicitis was present in 378 (89.3%) cases, eight (1.9%) cases had an appendicular abscess, 23 (5.4%) had an appendicular lump and 14 (3.3%) had perforated appendicitis. Conclusion: We conclude that ultrasound is a good modality for visualization of appendicitis with other appendicular pathology. We could follow a structured report and identify pathology more specifically. Ultrasound is an easy and non-invasive test to investigate

Prenatal and Perinatal Risk Factors for Autism at National Children’s Hospital

Background: Autism, or autism spectrum disorder, refers to a broad conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. Objectives: To determine the demographic profile of patients diagnosed with ASD, determine the significant prenatal and perinatal risk factors associated with ASD. Results: A total of 116 subjects were included in the study with 58 cases and 58 controls. They belong to the age ranging from 4 to 16 years old. Every case had a confirmed diagnosis of autism at NCH. There was a significant association noted between neonatal jaundice, nulliparity (OR=2.38; 95% CI, 0.85-6.8) and family history of autism (OR=5.30; 95% CI, 1.29-25.1) with ASD. Exposure to x-ray, medical problems, medicine intake and maternal complications during pregnancy were not significantly associated with ASD with OR 0.74; 95% CI, (0.12-4.15), OR 1.00; 95% CI (0.38-2.61), OR1.49; 95% CI, (0.63-3.53), and OR 1.27; 95% CI, (0.28-6.05), respectively. Conclusion: The current study indicates that the only significant predictor of ASD is a family history of autism. However, neonatal jaundice, maternal age of >40 years old, smoking during pregnancy and nulliparity showed a trend towards being risk factors for ASD. None of the other prenatal and perinatal characteristics significantly predicts ASD

Estimation of ventricles size of human brain by Magnetic Resonance Imaging in Nepalese Population: A retrospective study

Background and Objective: Magnetic resonance imaging (MRI) provides image acquisition of three-dimensional data and measurement in any chosen imaging plane. Objective of this study is to assess the size of ventricles of the brain of normal Nepalese people and establish the range of size of the ventricular system and compute the ventricular dimensions among different age and gender. Materials and methods: This is a cross-sectional retrospective study done at Gandaki Medical College, Pokhara. A total of 106 MRI scan data of healthy individuals were collected over a period of seven months between March to September 2019. Patients ranged between eight and eighty years of age with 58 males and 48 females. Measurements of the mean of bifrontal diameter (BFD), bihemispheric diameter (BHD), third ventricle transverse dimension (TVTD), fourth ventricle antero-posterior dimension (FVAP), fourth ventricle width (FVW), and frontal horn ratio (FHR) were done. Result: The mean of BFD, BHD, TVTD, FVAP, FVW, and FHR were found to be 3.05 ± 0.10 cm, 10.11 ± 0.40 cm, 0.43 ± 0.11 cm, 0.90 ± 0.11 cm, 1.22 ± 0.12 cm, and 0.30 ± 0.01 cm, respectively. The mean width of fourth ventricle in males and females was observed to be 1.23 ± 0.12 cm and 1.19 ± 0.11 cm respectively. There was a significant correlation of TVTD, FVAP, FHR and BFD with age with Pearson correlation coefficient 0.393 (P value <0.01), 0.259 (P value <0.01), 0.34 (P value <0.01), and 0.219 (P value <0.05) respectively. However, BHD and FVW have no correlation with age. Conclusion: Third Ventricle Traverse Dimension, FVP, FVW and FHR show almost similar or slight difference in measurement according to gender. However, BFD shows larger difference in measurement according to gender. Similarly there is no such significant difference according to age in measurement of BFD, BHD, FVAP, FVW and FHR, while TVTD measurement shows slight increased measurement according to age

UNITED STATES’ DOMESTIC TRADE AND DOMESTIC MIGRATION DURING 1993 - 2017 : THE ROLE OF POLITICS, FOREIGN IMPORT, AND SIZE

In the present dissertation, we study the United States’ domestic trade and domesticmigration with special focus on Politics, Foreign Import and Size. This study sheds light on the literature of International Economics, Regional Economics, and Development Economics. In Chapter 1, using a Gravity model for trade between the U.S. states and employing CFS data of the year 1993 - 2017, we find that politically and economically similar states trade more among themselves. We use three different definitions of political similarity based on election outcomes, and they all give similar results. For economic similarities, we follow the literature on Linder’s hypothesis. In Chapter 2, by using the same CFS data and Gravity model which we have used in Chapter 1, we analyze the impact of foreign imports by the States on their domestic exports. We find fairly strong support for our hypothesis that foreign imports promote domestic exports. We carry out a series of robustness checks, and the qualitative results remain the same. Chapter 3 investigates the impact of size on the U.S. inter-state migration over the period of 1998-2017 employing structural gravity model of migration. We use population, GDP and Land area as a proxy to measure the size of the states. We find that people are moving from big states to small states. We find that the American’s are moving from big states to small states. We also find that increase in income tax as a proportion of population in U.S. states, positively affect the interstate migration in the origin state but negatively affect the destination state

Psychosocial and mental health problems of older people in postearthquake Nepal

Objective: To identify community perceptions on psychosocial and mental health problems of older people in postearthquake situation in Nepal. Method: A qualitative methodology was adopted to explore the experience and opinions of older people, social workers, school teachers, health workers, and nongovernmental organization workers on the psychosocial and mental health problems of older people in Nepal, using key informant interviews. Results: Major local vocabulary for older peoples’ psychosocial and mental health problems were “bichalan” (variation in mood and feeling), “ekohoro” (becoming single minded), “athmabiswasko kami” (low self-esteem), and “bina karan rune” (crying without any reason). The major causes attributed to older people’s problems were physical injury, disability, family conflict, and economic problems. Forgetfulness, tiredness, loss of concentration, restlessness, and isolation were observed in older people since the 2015 earthquake. Discussion: The findings suggest that earthquake had negative impact on older people’s psychosocial well-being; however, little support or treatment options have been made available to these individuals. The tailor-made community-based psychosocial and mental health programs for older people are needed

Burden and consequence of birth defects in Nepal-evidence from prospective cohort study

Background: Every year an estimated 7.9 million babies are born with birth defect. Of these babies, more than 3 million die and 3.2 million have disability. Improving nationwide information on prevalence of birth defect, risk factor and consequence is required for better resource allocation for prevention, management and rehabilitation. In this study, we assess the prevalence of birth defect, associated risk factors and consequences in Nepal. Method: This is a prospective cohort study conducted in 12 hospitals of Nepal for 18months. All the women who delivered in the hospitals during the study period was enrolled. Independent researchers collected data on the social and demographic information using semi-structured questionnaire at the time of discharge and clinical events and birth outcome information from the clinical case note. Data were analyzed on the prevalence and type of birth defect. Logistic regression was done to assess the risk factor and consequences for birth defect. Results: Among the total 87,242 livebirths, the prevalence of birth defects was found to be 5.8 per 1000 live births. The commonly occurring birth defects were anencephaly (3.95%), cleft lip (2.77%), cleft lip and palate (6.13%), clubfeet (3.95%), eye abnormalities (3.95%) and meningomyelocele (3.36%). The odds of birth defect was higher among mothers with age &lt;20years (adjusted Odds ratio (aOR) 1.64; 95% CI, 1.18-2.28) and disadvantaged ethnicity (aOR 1.78; 95% CI, 1.46-2.18). The odds of birth asphyxia was twice fold higher among babies with birth defect (aOR 1.88; 95% CI, 1.41-2.51) in reference with babies without birth defect. The odds of neonatal infection was twice fold higher among babies with birth defect (aOR 1.82; 95% CI, 1.12-2.96) in reference with babies without birth defect. Babies with birth defect had three-fold risk of pre-discharge mortality (aOR 3.00; 95% CI, 1.93-4.69). Conclusion: Maternal age younger than 20years and advantaged ethnicity were risk factors of birth defects. Babies with birth defect have high risk for birth asphyxia, neonatal infection and pre-discharge mortality at birth. Further evaluation on the care provided to babies who have birth defect is warranted