Estimated Fetal Weight: Comparison of Clinical Versus Ultrasound Estimate.

BACKGROUND: Accurate estimation of fetal weight is of paramount importance in the management of labour and delivery. METHODS: This was a cross sectional study conducted over a period of 6 months in a tertiary care teaching hospital. All singleton term mothers with cephalic presentation and intact membranes with ultrasound examination done within a week were included in the study. IUFD, multiple gestation, malpresentation, diagnosed oligohydramnios or polyhydramnios, pelvic and or abdominal masses, and current weight more than 80 Kgs were excluded from the study. Expected fetal weight was estimated by clinical method (Johnson's formula), which was compared with Ultrasound weight estimation (Hadlock method) and actual birth weight. RESULTS: The estimated mean birth weight by clinical method was 3492.75±393.16g, by Ultrasound was 3230.02±407.22g and actual mean birth weight was 3236.32±472.87g. The estimated birth weight by ultrasonographic method showed slightly stronger positive correlation (r=0.54; p<0.001) with actual birth weight as compared to the clinical method (r=0.44; p<0.001). The error of estimation of weight by clinical method showed significant negative correlation (r=-0.24; p=0.01) with gestational age, however ultrasonographic method did not show significant correlation (r= +0.045; p=0.64). The sensitivity and specificity of clinical method and ultrasonographic method for identifying fetal birth weight above 3500 gm was 69.23; 65.67% and 46.15; 80.60%, respectively. CONCLUSIONS: Ultrasound was more reliable method to establish fetal weight at term and more consistent in various period of gestations. Clinical method can be reliably used to screen large babies in centers where ultrasound has limited availability.

Chondrodysplasia Punctata: A Case Report of Fetal Warfarin Syndrome.

Chondrodysplasia punctata is abnormal calcification in the cartilage of developing bones and has been seen in association with deranged vitamin K metabolism. Warfarin, an oral anticoagulant acting on vitamin K dependent clotting factors is known to cause chondrodysplasia punctata. Despite the knowledge of the condition the management of patients with prosthetic heart valves might require use of the drug for anticoagulation. Here, we present a case of a fetal warfarin syndrome in a second born child of a 27 year lady under warfarin for prosthetic heart valve. The pregnancy was complicated by polyhydramnios in third trimester and terminated at term by normal vaginal delivery. The baby was well, except for facial dysmorphism in the form of depressed nasal bridge, narrow nares and suspected left choanal atresia. Radiograph revealed stippled ephiphysis of vertebra, femora and humera supporting diagnosis of fetal warfarin syndrome. The baby did not develop any perinatal complication and was discharged home.

Assessment of Knee Joint Injuries with Low Field Strength Magnetic Resonance Imaging.

BACKGROUND: Magnetic Resonance Imaging is an appropriate screening tool before therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients. This study aims to evaluate the MRI findings in knee injuries and diagnostic value of low Strength MRI for assessing Meniscal and cruciate ligament tear. METHODS: A cross sectional study was conducted on patients undergoing "Magnetic Resonance Imaging of the Knee" for injuries of the knee and excluded patients undergoing MRI for other causes, poor diagnostic quality MRI and post operative MRI. All patients were interviewed for mechanism of injury and followed up for arthroscopic findings. Statistical analysis was doe using IBM SPSS 20.0. RESULTS: A total of 81 MRIs was included in the study. Arthroscopic finding of only 32 patients could be followed up. Anterior cruciate ligament (ACL) tear was the most common internal ligament tear accounting for 34(42%) of cases followed by medial meniscus tear in 33(40.7%). Twisting 14( 42.4%)was the most common mechanism involved in medial meniscus tear while combined mechanism of injury was most common mechanism for ACL tear 16( 47.05%). The sensitivity of MRI for diagnosis of ACL tear and medial meniscus tear was 96.3% and 94.7% respectively. Specificity for ACL tear was however only 80% and that for medial meniscus tear was 100%. CONCLUSIONS: The diagnostic value of MRI for diagnosing internal derangement of knee was high even with a low Tesla (0.3 T) MRI thus emphasizing the role of MRI as a non-invasive alternative to diagnostic arthroscopy.

Morphological Changes in Degenerative Disc Disease on Magnetic Resonance Imaging: Comparison Between Young and Elderly.

BACKGROUND: Morphological changes implicated in low back are complicated by additional age related degenerative changes in spine, which increases with aging. This study aims to compare the morphological MRI findings in young and elderly patients with low back pain and also correlate them with the clinical symptoms. METHODS: The study was a retrospective hospital record based comparative study carried out in a Teaching Hospital. MRI performed for patients with low back pain during May 2012 to October 2012 were reviewed. The MRI findings were compared between below 60 years and at and above 60 years and were also correlated with symptoms. RESULTS: A total of 301 MRI met the inclusion criteria out of which 228(75.74%) were young adults and 73(24.25%) were elderly adults. Degenerative changes and disc bulge was more common in elderly. Disc herniations including disc prolapse was more common in young adults. Disc protrusion involving L4-L5 was most common in the elderly while L5-S1 was most common in young adults. Nerve root compression was noted more commonly in the young adults. Radiculopathy was associated with grade III nerve root compression and paramedian disc protrusion in young adults while no such association was noted in elderly. No association of radiculopathy with presence of degenerative changes, spinal stenosis was noted in both groups. CONCLUSIONS: Degenerative changes are more common in elderly while disc herniations are more common in young adults. Morphologic changes do correlate with symptoms in young adults to some extent while they do not correlate in elderly.

Computed Tomography in the Evaluation of Pathological Lesions of Paranasal Sinuses.

BACKGROUND: Computed tomography is now the modality of choice for imaging paranasal sinuses and along with Functional Endoscopic Sinus Surgery has empowered the modern rhinologist to treat patients more effectively. This study aims to evaluate anatomical variation in paranasal sinuses; compare computed tomography with histopathological and surgical findings and establish its diagnostic value. METHODS: A hospital based observational study including all patients referred from the department of Ear, Nose and Throat for computed tomography scan of paranasal sinus to the department of radiology and imaging of Trubhuvan University Teaching Hospital from August 2011 to July 2012. Both axial and coronal sections were evaluated and findings were correlated with surgical findings and histopathology. RESULTS: A total of 44 patients were included in the study. The most common clinical diagnosis was sinonasal polyposis and chronic rhinosinusitis. Most common anatomical variation was deviated nasal septum (68.2%) followed by choncha bullosa(27%). In most cases more than one sinus was involved. Maxillary sinus was involved in 90.9% followed by ethmoid sinus in 81.8%. Inflammatory pathology was seen in 35 (79.5%) patients with sinonasal polyposis pattern being the most common pattern of involvement. Findings of computed tomography were similar to surgical findings in 84.6% cases. The sensitivity and specificity of computed tomography was fairly good except for fungal rhinosinusitis. CONCLUSIONS: CT scan should be performed preoperatively in order to guide the surgeon for Functional Endoscopic Sinus Surgery or other surgical procedures.

Crossed Testicular Ectopia.

Crossed testicular ectopia also known as transverse testicular ectopia is a rare anomaly of the testis which is ectopically located in contralateral hemiscrotum with absent testis in the ipsilateral hemiscrotum. Most case are incidentally discovered intraopeartively during operation of inguinal hernia and few case reports are available which have reported preoperative diagnosis of crossed testicular ectopia. We report a case of crossed testicular ectopia in 12 year old boy who presented with right undescended testis diagnosed preoperative on Ultrasound and Magnetic Resonance Imaging as crossed testicular ectopia.

Knowledge attitude and practice on contraception in village women in Khotang.

BACKGROUND: Contraceptive prevalence in remote districts of Nepal like Khotang is still low despite a high unmet need in the population. The study aims to estimate the contraceptive prevalence, knowledge, attitude and practice on contraception among women in Khotang. METHODS: A cross sectional study designed to find the contraceptive prevalence, knowledge, attitude and practice of contraceptive use, conducted at four health facilities at Khotang district during reproductive health camp in January 2011 by interviewing using a predesigned questionnaire. RESULTS: The mean age of 112 women who participated in the study was 25.3±6.1 and most were predominantly Mongolians and multipara. The knowledge of family planning was wide spread with clients listing 5±1 methods on average. Depo povera was the most commonly listed. Total 87 (77.7%) women had positive attitude towards family planning were positive in using contraceptives if needed. Other 22 (19.6%) were indecisive and wanted to consult husband and a very few did not want any contraception. Implant was preferred by most followed by Depo Provera. Seventy eight (69.6%) had ever used modern temporary method contraceptive devices and 41 (31.6%) were currently using them. Depo povera was the most common method ever used or currently in use. Commonest cause of discontinuation for past users was husband working abroad, followed by side effects. CONCLUSIONS: Knowledge of contraceptive is high in Nepal even in remote area, however use of contraception is low; male participation in family planning may reduce the unmet need.

Morbidity profile and prescribing patterns among outpatients in a teaching hospital in Western Nepal.

BACKGROUND: Recent studies on prescribing among outpatients in hospitals in Western Nepal are lacking. The main objectives of the study were to obtain information on the morbidity pattern among outpatients and to analyze prescribing using drug use indicators. METHODS: A retrospective hospital record based study from 01.01.2004 to 31.12.2004 was carried out among individuals attending the outpatient department (OPD) of the Manipal Teaching hospital, Pokhara, Western Nepal. A total of 32,017 new patients attended the OPD during the study period. Systematic random sampling (1 in every 20 patients) was done and 1600 patients selected. After excluding patients visiting the emergency department, those who got admitted and whose records were not available, 1261 cases were analyzed. The demographic details, morbidity pattern, average number of drugs prescribed, percentage of drugs prescribed by generic names and from the Essential drug list of Nepal (Essential drugs are those which satisfy the priority healthcare needs of the population), percentage of encounters with an antibiotic and an injection prescribed were noted. RESULTS: 1261 patients made 1772 visits. Upper respiratory tract infection and acid peptic disease were the most common diagnoses. The mean number of drugs was 1.99. Only 19.5% and 39.6% of drugs were prescribed by generic name and from the Essential drug list. Antibiotics and injections were prescribed in 26.4% and 0.96% of encounters. Cetrizine, vitamins, amoxicillin, the combination of paracetamol and ibuprofen and ranitidine were most commonly prescribed. CONCLUSIONS: Upper respiratory tract infections and acid peptic disease were the common illnesses. Generic prescribing and use of essential drugs were low. Some of the drug combinations being used were irrational. Prescriber education may be helpful in encouraging rational prescribing.