Knowledge about obstetric danger signs is very crucial for preventing obsterric complication. Globally there was 211 maternal deaths per 1,00,000 live birth in 2017. The maternal mortality ratio for Nepal is 239 deaths per 1,00,000 live births in 2016. A descriptive cross sectional study was conducted to assess the knowledge regarding obstetric danger signs among pregnant mother attending ANC at Scheer Memorial Adventist Hospital, Banepa, Kavre, Nepal. Total 100 respondents were selected using non probability purposive sampling technique through a semi-structured interview questionnaire. Data were analyzed in SPSS-16 using descriptive statistics (mean, frequency, standard deviation and percentage) and inferential statistic Chi Square. The study shows that mean age of the respondents was 25.56±4.307. More than half of the respondents (53%) were from 15-25 age group. Majority of respondent (97%) were literate. Fifty six percent of respondents had adequate knowledge on obstetric danger signs, while 27% of respondents had moderate knowledge and few respondents (17%) had inadequate knowledge. There is no any significant relationship with knowledge with selected variable age, educational status, gravida, week of gestation and -number of ANC visit. Thus it is concluded about that the entire pregnant mother requires some interventions for the awareness regarding obstetric danger signs from the beginning of ANC visit. ANC visit should be focused more than eight times as recommended by WHO.
Acute Pancreatitis (AP) is a very common cause of acute abdomen in emergency department. The disease may vary from mild self-limiting symptoms to multi organ failure and has high mortality rate. Although most of the cases are treated by mild symptomatic treatment but severe cases require intensive monitoring, so early diagnosis and goal directed treatment is very essential to reduce mortality and morbidity of disease. The present study aims to know the efficacy of urinary trypsinogen-2 dipstick test in early diagnosis of acute pancreatitis. The prospective study sample included 98 patients who were presented to emergency department of Maharaja Krishna Chandra Gajapati Medical College & Hospital (MKCGMCH), Berhampur between August 2018 and July 2020 with acute severe pain abdomen suggestive of acute pancreatitis. Urine sample were obtained and results were recorded. Blood sample of all the patients were sent for serum amylase, lipase. Urinary Trypsinogen (UT)-2 dipstick test, based on principle of immunochromatographic, was done at the time of admission and serum amylase and lipase were sent for all patients. Serum Lipase was done through Calorimetric Method and Serum Amylase was done through Coupled Enzymatic Assay Method. Ultrasonography (USG) and Contrast-Enhanced Computed tomography (CECT) abdomen were sent after 4-5 days of admission and final diagnosis was made on the basis of CECT report. Of 98 patients, 47 cases were final diagnosed to have acute pancreatitis. Sensitivity and specificity of Urinary Trypsinogen (UT)-2 was found to be 91.48% and 94.11% respectively and Positive Predictive Value (PPV) and Negative Predictive Value (NPV) was found to be 93.47% and 92.30% respectively. Sensitivity, specificity, PPV and NPV of Serum Amylase was found to be 76.5%, 74.5%, 74.5% and 74.5% respectively and similarly, sensitivity, specificity, PPV and NPV was found to be 80.85%, 72.5%, 73.1% and 80.4% respectively. Urinary Trypsinogen (UT)-2 Dipstick test has high sensitivity, specificity, PPV and NPV and therefore can be used reliably in emergency setting for diagnosis and thereby start a goal directed treatment and thus, reduce the mortality and morbidity of the disease.
BACKGROUND Acute cholecystitis is a pathology of inflammatory origin, usually associated with cholelithiasis, with a high incidence in the world. Its treatment involves an important socioeconomic impact. There are two surgical therapeutic options: early laparoscopic cholecystectomy (ELC) done within 72 hours of onset of pain or delayed laparoscopic cholecystectomy (DLC) done after 6 weeks of conservative treatment. The present study intends to compare between the effectiveness of ELC vs DLC in the management of acute cholecystitis in a tertiary care setup. METHODS The study sample included 65 patients who were clearly documented and radiologically proven cases of acute calculous cholecystitis, met the inclusion criteria, admitted to the surgery department of MKCG MCH, Berhampur, between August 2018 and July 2020. Out of 65 patients, 33 and 32 patients were selected randomly for ELC and DLC respectively. In ELC group surgery was done within 72 hours of the onset of pain while in DLC group surgery was done after 6 weeks of initial conservative treatment. The study was conducted using a case record proforma, prepared in their local language. The questionnaire included timing of cholecystectomy, duration of antibiotic coverage, mean duration of hospital stay, number of intraoperative and postoperative complications, conversion to open cholecystectomy, and follow-up. The data was compiled and tabulated in MS ® Excel and statistically analysed using IBM ® SPSS 22.0. RESULTS The overall morbidity and mortality were less in ELC compared to DLC. The mean duration of surgery was less in ELC (47.36 minutes) compared to DLC (65.75 minutes). The mean duration of antibiotic coverage was lesser in ELC (3.58 days) compared to DLC (5.50 days).The mean hospital stay was less in ELC (4.67 days) to DLC (6.50 days). The overall morbidity and mortality were less in ELC. CONCLUSIONS ELC is considered to be a safe modality of treatment in patients with acute cholecystitis and leads to an economical treatment. KEYWORDS Acute Calculus Cholecystitis, Early Laparoscopic Cholecystectomy, Delayed Laparoscopic Cholecystectomy
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