Evaluation of Alcazar Scoring System to Differentiate Between Benign and Malignant Ovarian Masses- A Nepalese Perspective

Introduction: Ovarian cancer is the fifth most common cancer in Nepalese females and the tenth overall, accounting for 5% of the total new cases of cancer in females in 2020. Ultrasonography (USG) remains the primary tool for the diagnosis and characterization of ovarian masses in which many grey-scale and Doppler characteristics are evaluated. Various scoring systems have been described incorporating different USG parameters to differentiate the benign and malignant nature of ovarian masses. Alcazar scoring system includes both grey-scale as well as Doppler characteristics of the ovarian masses and is one of the more widely used systems worldwide. Methods: This was an observational cross-sectional study based on 52 consecutive patients who were clinically suspected to have ovarian mass and referred for USG evaluation and who subsequently underwent surgery.Results:As confirmed by histopathology, 37 cases were benign and 15 were malignant masses. Alcazar system of scoring identified 34 out of 37 benign cases and 15 out of 15 malignant cases with sensitivity and specificity for diagnosing malignant cases of 83.3% and 91.1% respectively. Conclusion: Alcazar system of scoring is a highly effective tool to differentiate between benign and malignant ovarian masses and can be of great help in diagnosis, characterization and effective preoperative planning

Morphological Variation of Circle of Willis in Nepali Population: A 3D Time-of-Flight Magnetic Resonance Angiography Based Study

Introduction: The Circle of Willis (COW) is an anatomic ring of vessels located at the base of the brain connecting the anterior and posterior circulation by uniting the internal carotid and vertebrobasilar systems to maintain adequate cerebral perfusion. The importance of detailed information of the COW morphology and integrity in any patient cannot be overemphasized, especially for neurophysicians, neurosurgeons, and interventional neuroradiologists who are considering intervention to the intracranial arteries. This study was conducted to study the variation of COW among the Nepalese population and compare the results with those of other nationalities. Methods: It was a prospective cross-sectional study performed using a 1.5 Tesla MRI machine. Complete anatomical assessment of the COW was done. The anterior and posterior components of COW were defined as per the standard literature and evaluated in detail. Results: A total of 118 patients were studied during the period out of which 75 (63.6%) were males and 43 (36.4%) were females. A morphologically normal COW configuration was found only in 55 (46.6%) cases whereas a variant configuration was present in 63 (53.4%) cases. The most common variation was noted in the posterior communicating artery (PCOM) which was present in 42 (67%) cases. The most common single variation in abnormal COW configuration was absent right PCOM. Conclusion: The morphologic variation of the COW is more common than the normal textbook configuration in the Nepalese population, PCOM being the most commonly involved vessel

Antidiabetic Activity of Methanol Extract of Canthium parviflorum Lam. Leaves

The present investigation was carried out to study the antidiabetic activity of the methanol extract from the leaves of Canthium parviflorum Lam. (Family- Rubiaceae) in adult Wistar rats at 100, 200 and 400 mg/kg p.o. respectively using normoglycemic, glucose loaded and alloxan induced hyperglycaemic models. Metformin (250 mg/kg, p.o.) was used as reference standard for the activity comparison. Results of the study revealed significant antidiabetic activity of the methanol extract in a dose dependent manner. The antidiabetic activity showed by the extract may be due to by promoting the insulin release from the undestroyed β-cells or its action may be similar to insulin. Our study supports the folklore claims to its utilization as an antidiabetic medicinal plant and and suggests that leaves possess promising therapeutic activity for the maintenance of diabetes mellitus

Role of Ultrasound Scan in Non-Traumatic Acute Abdomen Presenting in Surgery Department of a Tertiary Care Center

Introduction: An acute abdomen is defined as a clinical condition characterized by severe abdominal pain developing suddenly over several hours or less. Ultrasonography (USG) helps the managing surgeons arrive at early diagnosis and rule out alternative diseases, thus reducing negative laparotomy rate. This study analyzed the diagnostic yield of USG in patients with non-traumatic acute abdomen presenting to Surgery department via Emergency department/outpatient department of a tertiary hospital. Methods: This cross-sectional observational study included 110 patients with non-traumatic acute abdominal pain who were sent for USG examination. The percentage concordance of USG diagnosis with the final diagnosis at discharge was determined in terms of sensitivity, specificity, positive and negative predictive values for acute abdomen. Results: Of 110 patients, correct clinical diagnosis was made in 83 patients (75%) while USG made a correct diagnosis in 101 patients (91%). Hence, with the help of USG, accuracy of diagnosing cause of acute abdomen increased by 16 %. The sensitivity and specificity of USG in diagnosis of acute appendicitis were 87.7% and 98.3% respectively. Conclusion: USG is easily available and non-invasive modality without radiation exposure and requiring minimal patient preparation. USG should, therefore, be an important routine diagnostic investigation in patients presenting with acute abdomen

Anemia as a risk factor for lower respiratory tract infection in children of 6 months to 5 years of age

Objective: To determine whether anemia is a risk factor for acute lower respiratory tract infections (ALRTI) in children aging6 months–5 years. Materials and Methods: Observational case–control study was performed in 540 children in the age group of6 months–5 years who attended the outpatient and inpatient unit of the department of pediatrics of a tertiary care hospital of Jaipur,during the period from January 2017 to June 2018. 270 cases hospitalized for LRTI who fulfilled the inclusion criteria and 270 healthyage and sex matched controls without any respiratory problems attending outpatient department of the department of pediatrics. Childrenwith congenital anomalies, protein energy malnutrition, tuberculosis, congenital heart defects, HIV, and malignancies were excludedfrom the study. After a detailed history and anthropometric measurements, complete blood count, C-reactive protein, peripheral bloodfilm examination, reticulocyte count, chest skiagram, Mantoux test were done. Iron profile and detailed anemic investigations are doneif hemoglobin level was below 11 g/dl as per the WHO criteria. The sentence in abstract can be framed like this. The norms consideredfor ALRTI were also considered as per defined by the WHO criteria. Results: Male preponderance was observed (55.2%) in the studygroup. Most of the children were <2 years of age (59.6%). On auscultation, crepitations were a major finding (64.8%). Out of 270;240 (88.9%) patients were diagnosed as pneumonia and rest 30 (11.1%) cases as bronchiolitis. Anemic patients were found to be3.7 times more susceptible to ALRTI in this study (p=0.01). Iron deficiency anemia (IDA) was found in 63.7% of total anemic cases inthe study group. In the study group, the mean serum iron level 26.3±7.9 mcg/dl in the anemic cases and 29.11±8.95 mcg/dl in the nonanemiccases. It was observed that with an increase in the severity of anemia among the cases, a concomitant increase in the severityof pneumonia was also observed (p=0.04). Conclusion: Early detection, preventive measures, and aggressive treatment with propernutrition and medication of anemia; especially, IDA in all children are helpful for prevention of ALRTI

Sexual Dimorphism of Maxillary Sinus: A Morphometric Analysis using Computed Tomography

 Introduction: Gender determination is the important aspect of forensic science. Most of the bones used for sex determination are badly disfigured and found in incomplete state, thus bones recovered intact are used. Maxillary sinus being recovered intact can be used for gender determination by measuring maxillary sinus dimension through computed tomography (CT). The aim of this study was to assess sexual dimorphism using morphometric maxillary sinus measurements through CT scan. Methods: This analytical cross-sectional study included CT scan images of 80 patients (40 males and 40 females). Maxillary sinus mediolateral (ML), superoinferior (SI), anteroposterior (AP) linear dimensions and volume were measured. All the measured parameters were then subjected to Student’s t-test to determine mean difference between males and females and discriminative statistical analysis to determine gender. Results: The mean value of maxillary sinus length, width, height and volume in males on both right and left sides were (3.80±0.175, 3.74±0.209) cm, (2.57±0.317, 2.51±0.295) cm, (3.55±0.338, 3.5±0.286) cm and (17.49±3.909, 16.54±3.274) cm3 respectively and in females (3.67±0.250, 3.64±0.256) cm, (2.37±0.297, 2.34±0.3222) cm, (3.29±0.280, 3.23±0.254) cm and (14.42±2.935, 13.81±2.779) cm3 respectively. The discriminative analysis showed that the accuracy of maxillary sinus measurements was 72.5% in females and 75% ofmales (overall accuracy = 73.8%). Conclusion: The maxillary sinus measurements are valuable guide for sex determination with relatively good accuracy rate

Revised Glycemic Index for Diagnosing and Monitoring of Diabetes Mellitus in South Indian Population

AIM: To find the optimal threshold of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) for diagnosis of diabetes mellitus (DM) and to evaluate the association with diabetic retinopathy (DR) in the South Indian population. SETTINGS AND DESIGN: A retrospective population-based study. METHODS AND MATERIALS: A total of 909 newly detected type 2 DM patients were selected from our two previously conducted studies, which include an urban and a rural population of South India. All underwent estimation of fasting, postprandial plasma glucose (PPG), and other biochemical tests. A comprehensive and detailed ophthalmic examination was carried out. The fundi of patients were photographed using 45°, four-field stereoscopic photography. Based on receiver operating characteristic (ROC) curves, sensitivity and specificity were derived. RESULTS:  The optimal cut-off values determined by maximizing the sensitivity and specificity of FPG and HbA1c using the Youden index were ≥ 6.17 mmol/L and ≥ 6.3%, respectively. By distributing the cut-off points into deciles and comparing them to the WHO criteria, we found that our HbA1c level of 6.60% was more than the WHO threshold (6.5%), with higher sensitivity (81.6%) and lower specificity (48.3%). The FPG level of 6.80 mmol/L was lower to the WHO criteria (7 mmol/L) with increased sensitivity (77.0%) and lower specificity (45.7%). Prevalence of DR by HbA1c levels between 6.5% and 6.9% was 15.3%. The prevalence of DR was more in the FPG category between 6.4 and 6.9 mmol/L and ≥ 7.5 mmol/L. CONCLUSION: Our population-based data indicate that for the South Indian population HbA1c value of ≥63 % and FPG value of ≥6.17 mmol/L may be optimal for diagnosing DM with a high level of accuracy and will be useful for the identification of mild and moderate DR

Computed Tomography Findings in Patients with Seizure Disorder

Introduction: Seizure occurs in up to 10% of the population, whereas epilepsy is a chronic disease characterized by recurrent seizures that may affect up to 2% of the population. Modern neuroimaging is useful in diagnosis of  abnormalities underlying the epilepsies, but the information provided by imaging techniques can also contribute to proper classification of certain epileptic disorders and can delineate the genetics of some underlying syndromes. Neuroimaging is even more important for those patients who have medically intractable seizures. This study was carried out to establish different etiologies of seizures, to correlate the clinical data and radiological findings in cases of seizure, and to identify the common etiologies in different types of seizures. Methods: This was a retrospective hospital-based study conducted in the Department of Radiodiagnosis of Lumbini Medical College Teaching Hospital. Records of patients of past two years, admitted in any department of the hospital with history of seizure disorder and underwent a Computed Tomography  (CT) of brain were included. The CT patterns were assessed and the data were tabulated and statistically analyzed. Results: There were a total of 480 cases out of which 263 (55%) were male and 217 (45%) were female with M:F ratio of 1.2:1. Generalized seizure was more frequent than partial seizure in both gender. In 274 cases of generalized seizures, CT scan findings were abnormal in 151 cases and normal finding observed in 123 cases. In 206 cases of partial seizures, 125 cases were abnormal and 81 having normal CT scan findings. Age wise distribution showed highest number (n=218) of cases in young group (<20 yr) and least number (n=45) in eldest group (>60 yr). The most common cause of seizure  was  calcified granuloma (n=79, 16.5%) followed by neurocysticercosis (NCC, n=64, 13%). Diffuse cerebral edema, sub-arachnoid hemorrhage, and hydrocephalus was seen only in lower age group particularly among 1-20 years. Infarct and diffuse cortical atrophy were most common cause of seizure in older age group.  NCC and tuberculoma are the most common cause of partial seizure whereas cerebral infarcts, hemorrhage, malignancy, diffuse cortical atrophy are the most common cause of complex seizure. Few rare diseases like Fahr disease and tuberous sclerosis were also found in CT scan of  seizure patients. Conclusion: NCC and tuberculoma are the most common cause of partial seizure whereas cerebral infarcts, hemorrhage, malignancy, and diffuse cortical atrophy are the most common cause of complex seizure. CT scan plays an important role as a preliminary tool in radiological assessment of patients presenting with seizures

Placental Thickness and Its Correlation with Gestational Age: A Cross-sectional Ultrasonographic Study

Introduction: Placenta grows in size with the advancement of gestational age (GA) and plays an important role for delivery of nutrients from mother to fetus. Ultrasonography (USG) is implicated for the estimation of GA by using fetal growth parameters like Femur Length (FL), Bi-parietal Diameter (BPD), Head Circumference (HC), and Abdominal Circumference (AC). This study intends to observe the correlation between Placental Thickness (PT) and GA. Methods: It was an observational, cross-sectional, and analytical study conducted over a period of six months from November 2017 to April 2018. Fetal growth parameters i.e. FL, BPD, HC, and AC were measured to estimate GA. PT was also measured at the same time. Results: There was a positive correlation between PT and GA (r = 0.89, n=249, p < 0.001). Pearson correlation coefficient between the two variables at second and third trimesters were 0.81 and 0.49 respectively. Fisher r-to-z transformation was used to analyze the difference between those two coefficients and was found to be statistically significant (z = 4.6, p < 0.001). This indicates that there was a significant overall relationship between PT and GA. As GA increases, PT also increases. Conclusion: Our study observed a positive correlation between the PT and GA in second and third trimesters. Thickness of placenta can thus be used as a reliable parameter for the estimation of GA during the second and third trimesters, and can be used as a supplementary USG parameter along with FL, BPD, HC and AC

Pattern of Lumbar MRI Changes in Patients with Chronic Low Back Pain in a Tertiary Care Center

Introduction: Chronic low back pain (LBP) is a common cause of disability worldwide. Magnetic resonance imaging (MRI) is an excellent non-invasive imaging modality for morphologic evaluation of the lumbar spine in patients with chronic low back pain because of its high contrast resolution and lack of ionizing radiation. This study was done to see the patterns of MRI changes in patients with chronic low back pain in a tertiary care center in Western Nepal. Methods: This was a cross-sectional study conducted on patients presenting with chronic low back pain. Eleven MRI parameters were noted and analyzed. Chi square test and Fisher’s Exact test were employed to see the associations between the various MRI findings. Results: A total of 108 patients were evaluated during the study period. MRI changes were noted in over 95% of the cases. Degenerative changes were the most common cause of low back pain, disc bulge being the most common MRI finding. A significant association was found between radiculopathy and decreased lumbar lordosis and vertebral endplate changes. Conclusion: MRI is an invaluable tool in the evaluation of chronic LBP because of its high resolution and lack of ionizing radiation. Significant MRI findings are noted in most of the cases of chronic LBP, degenerative changes being the most common and ranging from congenital to malignant lesions