Grande Medical Journal

Artificial Intelligence in medical field: Challenges and consequences

Bibhuti Nath Mishra — Thu, 02 Jan 2025 00:00:00 +0000

The emergence of artificial intelligence (AI) has opened up a new realm of possibilities across various industries, with healthcare being no exception. AI has shown immense potential to revolutionize medical practices, from early disease detection and personalized treatment plans to accelerating drug discovery. However, these advancements also bring substantial challenges and implications that require careful consideration to ensure AI integration serves the best interests of both patients and healthcare providers.

Myocysticercosis of hand - A case report on a rare presentation

kshiteez Puri, Bibhuti Nath Mishra — Thu, 02 Jan 2025 00:00:00 +0000

Isolated Thenar muscle involvement of Taenia solium larva causing myocysticercosis is rarely reported in literature. A high degree of suspicion has to be kept in the people of endemic regions in developing county with an ethical background of pork consumption in regular diet. Ultrasound is the first investigation to look for, however, MRI can further aid to the diagnosis. Different treatment options including observation, surgical excision, anti-helminthic and anti-inflammatory medication.

Laparoscopic hysterectomy in a 14 years old girl with sarcoma botryoidesm: A rare case report

Nilam Subedi, Asmita Ghimire, Padam Raj Pant, Samriddha Raj Pant — Thu, 02 Jan 2025 00:00:00 +0000

Sarcoma botyroides (Rhabdomyosarcoma) of the uterus is not a common disease. Here we describe a case of 14 yr old young girl, she came to the emergency (ER) department of our hospital with acute retention of urine and per vaginal bleeding on and off. Her MRI and biopsy confirmed sarcoma botryoides. She was planned for surgery. We performed a Total laparoscopic Hysterectomy with Bilateral Salpingoophorectomy with removal of upper vagina.

Role of bone marrow aspiration in hematological disorders

Thu, 02 Jan 2025 00:00:00 +0000

Background

Bone marrow aspiration is a safe procedure with a high degree of accuracy in the diagnosis of hematological disorders. This study was done to analyze the causes, spectrum of hematological disorders and interpret the bone marrow findings.

Method

This was a retrospective study of bone marrow aspiration (BMA) and biopsies done on 94 patients who were referred for bone marrow examination to the Department of Pathology of Grande International Hospital in the last 5 years. Cases were analyzed in detail regarding the clinical examination and other investigations.

Result

BMA from 94 patients were analyzed. 63 cases were male. The age of the patient ranged from 8 months to 85 years. The highest number of cases (44 cases, 46.08%) were in the age group of >45 years. PUO (42 cases, 44.68%) followed by pancytopenia (13 cases,13.82%) was the most common indication for BMA. Megaloblastic anemia (3 cases, 23.07%) and aplastic anemia (3 cases, 23.07%) was the most common cause of pancytopenia. Erythroid hyperplasia (23 cases, 24.46%) was the most common finding in BMA. Multiple myeloma (6 cases, 6.38%) followed by Acute Leukemia (5 cases, 5.31%) was the most common malignancy with AML (3 cases, 60%) more than ALL (2 cases, 40%).

Conclusion

Although bone marrow examination is an invasive procedure this is well tolerated by patients. The examination helps in many cases to arrive at a final diagnosis within a short period.

Comparison of nexus low risk criteria and Canadian cervical spine rule in blunt neck trauma

Ram Krishna Dahal, Sushil Paudel, Dinesh Kafle — Thu, 02 Jan 2025 00:00:00 +0000

Background

The Canadian C-Spine (cervical-spine) Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) Low-Risk Criteria (NLC) are guidelines for the use of cervical-spine radiography in patients with blunt neck trauma and polytrauma. It is unclear how the two decision rules compare in terms of clinical performance in our setting.

Method

We conducted a prospective observational study in 150 patients in emergency department of IOM TUTH comparing the CCR and NLC as applied to patients with blunt neck trauma and polytrauma. The sensitivity, specificity, and reduction in radiographs were analysed and compared.

Result

Among the 150 patients, the CCR was more sensitive than the NLC (100 % vs. 83.33%) and more specific (47.9 % vs. 42.3%) for injury, and its use would have resulted in lower radiography rates by (46 % vs. 42.33%). Using CCR no potential clinically important cervical spine injuries was missed but using NLC one clinically important cervical spine injury was missed.

Conclusion

For blunt neck trauma and polytrauma patients who are in stable condition, the CCR is superior to the NLC with respect to sensitivity and specificity for cervical-spine injury, and its use would result in reduced rates of radiography. Further studies in larger sample size need to follow rigorous methodologic procedures to ensure that the findings are as free of bias as possible.

Seroprevalence of transfusion transmissible infections among blood donors at a tertiary care hospital in urban area of Nepal

Thu, 02 Jan 2025 00:00:00 +0000

Background

Infection with hepatitis B virus (HBV), hepatitis C virus (HCV), human Immunodeficiency Virus (HIV) and syphilis are serious complications of blood transfusion. These infections are always screened by blood banks. Such tests are mandatory for transfusion safety in Nepal and the entire world. This study was aimed at determining the seroprevalence of HBV, HCV, syphilis and HIV.

Method

A retrospective analysis of blood donor data from June 2017 to May 2020 was conducted at Blood Bank of Grande International Hospital, Kathmandu, Nepal. Sera samples were screened for hepatitis B surface antigen (HBsAg), antibodies to hepatitis C virus (HCV), human immunodeficiency virus (HIV) 1 & 2 by Enhanced Chemiluminance Assay method, using diagnostic kit from Johnson & Johnson at Vitros 5600 machine and by Immunochromatography method for Treponema pallidum antibody, commercially available immunochromatography based kits from SD biosensor.

Result

Out of 8811 candidate blood donors, 133 (1.5%) donors were serologically reactive with either one of Transfusion Transmitted Infection. Seroprevalence of HIV, HBV, HCV and syphilis infection was 0.17%, 0.39%, 0.28% and 0.65% respectively. The prevalence of TTIs was 1.55% for male and 1.31 % for female in the donation population.

Conclusion

The prevalence of HIV, HBV, and HCV was higher in male donor whereas syphilis show high prevalence among the female donors. According to age group HIV prevalence was highest among blood donors of the age group 21 to 30 years of age.

The outcome of the use of custom made antibiotic cemented nail in management of chronic diaphyseal osteomyelitis

Sushil Sharma, Krishna Wahegaonkar, Prakash Dware — Thu, 02 Jan 2025 00:00:00 +0000

Background

Chronic osteomyelitis of long bone is a difficult condition to treat. Local delivery of antibiotics via custom-made antibiotic cemented nail(ACN) enables delivery of antibiotics at high concentration, which helps in eradication of infection and provides mechanical stability in infected nonunion. The study aims to find out the role of ACN in the control of infection and union of long bones.

Method

30 patients presenting with the feature of chronic osteomyelitis of long bones & infected nonunion between 2014 and 2017 at Manipal Teaching Hospital were included. Cases were treated with debridement, sequestrectomy, and the use of ACN. Follow-up of patients was done till control of infection and union. Patients were assessed clinically and on laboratory parameters for control of infection & union.

Result

Among 30 patients, 13 (43%) were infected nonunion, 6 (20%) were of osteomyelitis following open fracture, 5 (17%) were of osteomyelitis following soft tissue procedure and 6 (20%) were of open fracture where ACN was used prophylactically. Infection control was achieved in 28 (93%) cases. The average time of radiological union was 12 months. The average duration of removal of ACN was 7.4 weeks. Complications included the failure of removal of antibiotic cement in one (3%) case & failure of union in one (3%) case.

Conclusion

ACN is an economical method that can be used safely in the management of chronic osteomyelitis of long bones. The technique is simple, cost-effective with excellent results, minimal complications, and can be used in a minimal resources setting.

Caesarean myomectomy: How safe it is? A retrospective analysis

Nilam Subedi, Asmita Ghimire, Asmita Shrestha, Padam Raj Pant — Thu, 02 Jan 2025 00:00:00 +0000

Background

Leiomyoma uterus not only causes menorrhagia, pain abdomen but also complicates pregnancy in various ways. The objectives of present analysis were to investigate the outcome in cases of pregnancy complicated by fibroids undergoing lower segment cesarean section (LSCS) in Grande International Hospital, Kathmandu Nepal.

Method

Fourteen cases of leiomyoma with pregnancy underwent LSCS with myomectomy following the delivery of the baby. The suturing of the uterus was done using vicryl no 1 and vicryl no 1 ‘0’ for closing the dead space after myomectomy. Continuous oxytocin infusion was given for next 12 hrs. The cases were analyzed for age of patient, parity, gestational age, an indication of LSCS, type of fibroid, size of fibroid, blood loss, duration of operation, and blood transfusions.

Result

Thirty-eight fibroids of various sizes (3-15cm) were removed from 18 women. The fibroid was on both anterior uterine walls with most being subserous and intramural. Mean blood loss (excluding cesarean section) was 76.1 ml and mean operative time (only myomectomy ) was 26.1 mins. Three patients had a whole blood transfusion in post-operative period. No hysterectomy was required in any case.

Conclusion

Myomectomy during cesarean section is possible and safe in selected cases with proper indications and also with expert hands. It avoids a second surgery and its associated morbidity.

Analysis of cervical cytology in tertiary care hospital

Samira Shafi Khan — Thu, 02 Jan 2025 00:00:00 +0000

Background

Cancer of the cervix is the third most common cancer in women. In Nepal and other developing countries cervical cancer is the leading cause of morbidity and mortality. Cancer of cervix is readily preventable, and can be diagnosed at the pre-invasive stage with cytological screening with Papanicolaou (Pap) smears.

Method

This is a retrospective study aimed to evaluate all previously conducted cervical smears examined at Grande International hospital during a one-year period. Pap smear cytology reports were obtained and data noted in a structured Performa. All the smears were reported as per the 2001 Bethesda system.

Result

A total of 3202 Pap smears were examined. Maximum number of patients was in the age group of 36 to 50 years. A total of 3161 smears were reported as Negative for Intraepithelial Lesion or Malignancy (NILM), of which 2944 showed normal cytological findings and 217 were inflammatory. The abnormal cases comprised of two cases with ASC-US, 33 cases of LSIL, 4 cases of HSIL, and 2 cases of invasive Squamous cell carcinoma.

Conclusion

Premalignant and malignant lesions of cervix can be diagnosed easily by Pap smears.

The outcome of displaced intraarticular fracture of calcaneum: Open reduction and internal fixation with locking plates versus closed reduction and percutaneous K wires fixation

Sunit Dahal, Sagar Dhakal — Thu, 02 Jan 2025 00:00:00 +0000

Background

The treatment of displaced intraarticular fracture of the calcaneum is challenging because of complicated bony structure, complex fracture anatomy, fragile soft tissue, and difficulty in achieving anatomic reduction and rigid fixation. In this study, we aimed to compare the outcome treatment by percutaneous K wires fixation and locking plate osteosynthesis.

Method

The prospective study was conducted among patients who were admitted and operated on for calcaneum fractures in the Department of Orthopedics, Shaikh Zayed Postgraduate medical institute Lahore Pakistan from October 2014 to October 2015. Of the 30 cases, half received treatment with K-wire and the other half of the patients underwent plating. Pre- and post-operative Bohler’s and Gissane’s angles, the width of calcaneums, the height of posterior facet, and complications were noted for all patients. Functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS).

Result

Bohler’s angle and posterior facet height increased significantly postoperatively (p<0.05) and Gissane’s angle decreased significantly postoperatively (p<0.05) for both groups of patients. In both groups, 80 % of the patients had excellent and good functional rate according to the AOFAS scoring system. The average duration of surgical procedure in plating and of hospital stay was less in the K wires group compared with the plating group.

Conclusion

There is no significant difference in treating the displaced intraarticular calcaneum fracture with locking plates or percutaneous k wires. Percutaneous k wires treatment method is economical, less invasive, decreases surgical time with a shorter hospital stay.

Coronal alignment in total knee arthroplasty and its effect on functional outcome A retrospective study

Promish Maharjan, Wang Chen, Guo Yu Dong, Wang Shang Zheng — Thu, 02 Jan 2025 00:00:00 +0000

Background

This retrospective study was conducted to compare the coronal alignment of the lower extremity before and after surgery in patients undergoing total knee replacement by assessing the mechanical axis in the full-length weight-bearing radiograph taken preoperatively and post-operatively, and to assess the clinical outcome after TKA with reference to the mechanical axis.

Method

Fifty eight patients who underwent primary TKA from date October 2013 to March 2017 were included in the study. The patient’s demographics such as age, gender primary TKA were noted. All patients underwent clinical and radiological evaluation including standardized radiographs (Anteroposterior long length leg X-Ray) was evaluated. For clinical outcome scoring the Hospital for Special Surgery score (HSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used. One-way ANOVA was used to compare the outcome of the surgery and the alignment (p <0.05).

Result

Out of the 58 patients included in the study, 16 (27.58%) were male and 42 (72.41%) were female with age ranged between 34 to 88 years (mean 65.44 years). The male patient’s age ranged from 53 to 85 (median 63 years) and that of female patients ranged from 52 to 83 (median 65.5 years). The overall mean HSS score improved from 59.86 ± 10.91 preoperatively to 82.52 ± 11.04 in one year postoperatively (<0.0001) and WOMAC score improved from 33.98 ± 11.25 to 10.4 ± 6.06

(P<0.0001) after 1 year from the TKA respectively. Both showed a significant difference in the results. There were 50 patients with pre-operative Varus alignment and 8 with pre-operative valgus alignment. Pre-operative Varus groups have a post-operative HSS score of83.98±9.962153 and that of pre-operative valgus groups has HSS score of 77.625±14.20199. Similarly, pre-operative Varus group had a postoperative WOMAC score of 9.38±5.27949 and that of the valgus group had 12±9.273618. In these two groups, there was no significant difference between their post-operative HSS score (P=0.2571) and WOMAC score (P=0.4590). After the surgery, 25 patients (43.10%) had varus alignment, 22 patients (37.9%) had neutral alignment and 11 patients (18.97%) had valgus alignment. The post-operative mechanical axis group was divided into the post-op varus group, postop neutral group, and post-op valgus group. After comparing within the groups, the neutral group had the highest HSS score (91.3636±4.1946, lowest WOMAC score (5.2272±1.37945), P<0.005, which showed the best result and the HSS score of post-operative varus group was (82.12±7.5), the WOMAC score was (9.64±4.344) showing the moderate result. The postoperative valgus group has HSS score (68.82 + 9.39), WOMAC score (16.3636 + 8.205), showing worst result.

Conclusion

Total Knee Arthroplasty is a good treatment modality for primary osteoarthritis. The coronal alignment before surgery has no significant effect on the function after total knee arthroplasty. However, the post-operative coronal alignment of the lower limbs was related to the clinical function of the patients. The outcome of the patient with the mechanical axis was the best with neutral groups followed by the Varus group and was the worst in the valgus group.

Intussusception in adult due to appendicular invagination causing sub-acute intestinal obstruction

Akanand Singh, Rakesh Kumar Sah — Thu, 02 Jan 2025 00:00:00 +0000

We are presenting a case of 48 year old female presented to us with the compliant of mild pain over right lower abdomen for one week. On evaluation, Plain CT scan showed features of ileocolic intussusceptions (Figures 1, 2, and 3). Preoperative evaluation was done and patient was taken for surgery. We performed laparoscopic assisted ileo-caeccal resection and anastomosis which was uneventful. There was appendix invagination into the caecum extending to ascending colon. Patient was discharged from hospital on post-operative day five. Histopathology result showed margin free low grade appendiceal mucinous neoplasm.