Background: Subfertility refers to describe women or couple who are not sterile but exhibit decreased reproductive efficiency even after 12 months of regular unprotected intercourse. Objectives: To find probable aetiological factors in subfertile couples attending Dhulikhel Hospital. Methods: This descriptive cross-sectional study was conducted among 140 subfertile couples in Dhulikhel Hospital from March 2016 to December 2017 after ethical clearance. The participants were recruited by convenience sampling, data were entered in Microsoft Excel Sheet and analysed using SPSS v.23. Descriptive statistics like frequency, percent, mean, and standard deviation have been presented. Results: Among 140 subfertile couples, mean duration of subfertility was 5.55 ± 3.96 years. About two-thirds (95, 67.9%) of them were of primary subfertility. Most subfertile clients (both) were of 26-30 years age group and about three-fifths (83, 59.3%) were of Janajati caste. The most common cause of subfertility was female factor (72, 51.4%) only. Ovulatory dysfunction (49, 35%) followed by tubal abnormalities (24, 17.1%) were major female contributory factors. Thyroid disorder was noted in 19 (13.6%) clients and hyperprolactinaemia was observed in 14 (10%) subfertile female clients. Two (1.4%) female clients had diabetes mellitus and 24 (17.1%) had evidence of different forms of genital infection. Only male factor contributed was seen in 16 (11.4%) clients and asthenozoopermia was the commonest abnormal semen parameters. Six (4.3%) males with abnormal semen parameter were working abroad. Conclusion: Ovulatory causes was found to be the commonest cause of subfertility in Dhulikhel Hospital. Asthenooospermia was the most common male factor.
Introduction: Cirrhosis in young adults is an important health problem worldwide and is a common disease. Patients usually present late in a decompensated state with varied complications. However, national data on the exact burden of the disease is lacking. The aim of this study was to find out the prevalence of liver cirrhosis among young adults admitted to the Department of Gastroenterology in a tertiary care centre. Methods: A descriptive cross-sectional study was done among patients admitted to the Department of Gastroenterology in a tertiary care centre between 25 November 2021 to 30 November 2022 after receiving ethical approval from the Institutional Review Committee [Reference number: 227(6-11)E2-078/079]. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 989 patients, liver cirrhosis in young adults was seen in 200 (20.22%) (18.12-22.32, 95% Confidence Interval). Chronic alcohol use was the primary cause of cirrhosis seen in 164 (82%) cases. The most typical presenting symptom was abdominal distension seen in 187 (93.50%) patients. The most frequent complication was ascites seen in 184 (92%) patients. The most frequent endoscopic finding was gastro-oesophagal varices seen in 180 (90%) patients. There were 145 (72.50%) men and 55 (27.50%) women. Conclusions: The prevalence of liver cirrhosis in young adults was found to be lower than the other studies done in similar settings.
INTRODUCTION Anemia is common nutritional deficiency disorder in pregnant women. It is important cause of morbidity and mortality among pregnant women. We evaluated pregnant women presenting to UCMS-TH with hemoglobin level less than 9 gm/dl with reference to maternal and fetal outcome. MATERIAL AND METHODS Total of 255 women presenting with moderate to severe anemia at our hospital were evaluated. Demographic profile of patients, maternal outcomes and fetal outcomes were evaluated. RESULTS Most of patients were from rural area (78%) of which majority (69.8%) were unbooked. Severe anemia was present in 16.5% cases. Maternal complications included preterm labor (23.1%), post partum hemorrhage (19.2%), wound infection (8.6%), ante partum hemorrhage (5.5%), intensive care unit admission (4.3%) and mortality (0.4%). Fetal outcomes included neonatal intensive care unit admission (29.8%), intrauterine growth restriction (9%) and neonatal death (7.5%). CONCLUSION Severity of anemia associated with significant increase in PPH, preterm delivery, ICU admission and heart failure.
BACKGROUND Cirrhosis is the end result of varieties of chronic liver disease. A large proportion of patients with cirrhosis develop cardiopulmonary complication. The aim of this study was to evaluate the cardiopulmonary functions of patient with cirrhosis of liver and to correlate these abnormalities with CTP and MELD score. METHODS The study involved 81 cirrhotic patients admitted in Department of Gastroenterology of TUTH over a period of one year. The diagnosis of cirrhosis was established and clinical evaluation and investigation done. RESULTS The mean age of cirrhotic patients included in the study was 52 years. Alcohol was most common cause of cirrhosis (75.31%). The mean CTP score and MELD score was 10.02±1.77 and 23.59±7.53 respectively. Thirty patients (37.03%) had prolonged QTc interval, which had statistically significant association with alcohol as etiology of cirrhosis (p = 0.04). More than half (50.62%) of patients had diastolic dysfunction but it was not statistically significantly associated with CTP and MELD-Na score. Seven patients had evidence of intrapulmonary shunting, which had statistically significant association with MELD-Na score (p =0.01). Similarly, total 5 patients (6.17%) had PPHTN but there was no statistically significant association with CTP and MELD-Na score. Seventeen patients had dilated left atrium with no statistically significant association with CTP score and MELD-Na score. CONCLUSION There was significant incidence of cardiopulmonary abnormalities in cirrhotic patients. Every patient with decompensated cirrhosis irrespective of severity of disease should be evaluated for cardiopulmonary complication with a noninvasive, real-time, rapid imaging transthoracic contrast echocardiography.
DESCRIPTIONA man aged 64 years presented to emergency department with chest pain and shortness of breath. On cardiac auscultation, he had loud P2 and parasternal heave; however, lung auscultation was normal. Bilateral lower limb pitting oedema was present. CBC, CMP and cardiac biomarkers were normal. D-dimer and CT chest were performed and it excluded pulmonary embolism. His EKG was suggestive of right ventricular strain. He was being treated for systemic and pulmonary hypertension, taking carvedilol 3.125 mg two times per day, furosemide 40 mg once daily, sildenafil 20 mg three times a day, treprostinil 0.5 mg two times per day, amlodipine 2.5 mg two times per day, atorvastatin 40 mg once daily, aspirin 81 mg once daily and clopidogrel 75 mg once daily. Trans-thoracic echocardiography showed his systolic function was normal, his estimated ejection fraction was 60-65% with markedly dilated right ventricle (RV), no valve defect was detected and peak pulmonary artery pressure (Ppa) was 80 mm Hg. On coronary angiography, there was 60%, 50% and 60% stenosis detected in the left main artery, left anterior descending and right coronary artery, respectively. On cardiac catheterisation, RV was massively dilated and hypokinetic, the left ventricle (LV) was normal in size and function with preserved ejection fraction (figure 1, videos 1 and 2), his pulmonary artery pressure was 76 mm Hg. On cardiac catheter haemodynamics, his mean right atrial pressure was 64 mm Hg, RV pressure was 66/20 mm Hg and pulmonary artery wedge pressure was 17/14 mm Hg. On echocardiography, tricuspid annular plane systolic excursion was <0.9 cm, and TR jet velocity was 3.08 m/s. An apical four-chamber view shows dilation of RV (video 3). NT-proBNP value was 578 pg/mL. Symptomatic management with oxygen, intravenous fluid and home medications were continued. Owing to severe pulmonary hypertension and enlarged RV, atrial septostomy was offered. He refused to undergo surgery or consultation and went to another institution for further evaluation.Normal RV have a thinner wall, are crescent shape and have greater compliance than the LV. RV enlargement is defined as the RV being greater than the two-thirds the size of the LV on the apical fourchamber view of echocardiography.1 Pulmonary arterial hypertension (PAH) is associated with changes in the pulmonary vasculature and subsequently RV. The severity of symptoms and prognosis of PAH are strongly associated with RV function. 2In milder forms of PAH, the reduction in pulmonary vascular resistance (PVR) has beneficial effect on the RV, but these effects may not occur in severe PAH.2 Although current pharmacological treatments of PAH reduce RV load, they do not reduce its pressure or output and RV failure may continue to progress, especially in those with severe PAH. Various haemodynamic factors such as mean Ppa, right atrial pressure, cardiac output and cardiac index are directly related to RV function and it has been identified as significant predictors of mortality.3 Despite its significant clinical im...
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