Background: Blood transfusion is an integral part of patient management. Good transfusion practice guided by standard protocols is considered ideal for optimal use of resources and manpower. Cross-match requests disproportionate to the actual requirement causes overestimation of blood usage and potential wastage. This study aims to determine the crossmatch, transfusion, and utilization rates for blood using transfusion index, and cross-match to transfusion ratio in the various departments of the hospital for the evaluation of transfusion practices.
Materials and Methods: A retrospective study was conducted using the records from the hospital blood bank for 12 months to obtain transfusion and cross-match records from various clinical units. Transfusion requests, units cross-matched, and completed transfusions were used to calculate the cross-match to transfusion ratio, and transfusion index for each department.
Results: A total of 5156 units of blood were cross-matched for 3437 transfusion requests, out of which 3752 were transfused, giving a mean cross-match to transfusion ratio of 1.37. The non-usage of blood was 27.2% and the transfusion index stood at 1.09. The cross-match to transfusion ratio for the individual clinical units ranged from 1.75 (Surgery) to 1.14 (Medicine).
Conclusions: The cross-match to transfusion ratio and transfusion index were within recommended ranges, showing good utilization and low blood wastage. The establishment of a blood ordering protocol via a multidisciplinary approach should be considered to further optimize blood transfusion practices.
Introduction: Abnormal uterine bleeding is the most common presentation in endometrial pathology and endometrial biopsy is the investigation of choice. This study aimed to describe the histological findings of patients who underwent endometrial biopsy to estimate the most common endometrial diseases in Nepali women. Materials and methods: This retrospective cross-sectional study was conducted using hospital records, and included females who underwent endometrial biopsy at a tertiary level hospital from 1 April 2018 to 31 March 2020. Histopathological findings were categorized into eight groups, and patients were divided into three age groups to obtain the relative occurrence of each type of disease at different ages Results:342 female patients were included in the study, among which 97 were pregnancy-related and 245 were non-pregnancy-related. The mean age of the patients was 41.63 years (± 11.45 years). In 28 cases (8.2%) of the 342 total cases, the endometrial biopsy sample was deemed inadequate. Among the non-pregnancy-related cases, normal physiological changes were the most common reported finding (n=93, 38.0%), followed by abnormal physiologic changes (n=68, 27.8%). Premalignant conditions (n=15, 6.1%) and malignancy (n=5, 2.0%) were less common. Conclusions: Normal physiological changes and disordered proliferative endometrium are the most common findings in an endometrial biopsy. Endometrial hyperplasia and malignancy are less common, and usually found in women more than 40 years in age.
Introduction: Idiopathic frozen shoulder (IFS) is a common chronic and disabling condition of shoulder pain characterized by progressive loss of active and passive range of motion (ROM) with unclear pathogenesis. The ideal treatment protocol is still controversial but commonly used treatment includes single agent or combination of oral non-steroid anti- inflammatory drugs (NSAIDS), oral steroids, intra-articular steroid injection and physiotherapy.
Objective: The objective of this study was to evaluate the effectiveness of intra-articular methylprednisolone injection for pain and ROM in patients suffering from idiopathic frozen shoulder who did not respond to oral NSAIDS with or without oral steroid.
Methodology: A total of 70 patients suffering from IFS were enrolled in this cross sectional study from May 2017–October 2018 from outpatient department of orthopaedic and physiotherapy of Koshi Zonal Hospital. All the patients underwent treatment protocol that comprised of Intra-articular steroid injection followed by five days of oral NSAIDS along with five days regime of physical therapy at the physiotherapy centre, followed by home exercise program. Each patient was followed up at every two weeks interval from intra-articular injection till 6th week. Each patient was evaluated for range of motion (ROM), Numerical Pain Rating Scale (NPRS) and Shoulder Pain and Disability Index (SPADI) before the treatment protocol and at every follow up visit. Data was analyzed using Microsoft Excel Program.
Results: All patients enrolled for the study had satisfactory response. The mean age of the patient was 51.8 years (range 40-65 years). The mean age of the 26 male patients was 54 years (range 45-65), whereas the mean age of 44 female patients was 50.5 years (range 45-60). Mean duration of illness was 26.5 weeks (range 18-32 weeks), SPADI before medication was 83.14, at 2nd week was 50.92, at 4th week was 38.63 and at 6th week was 27.22.
Conclusion: Combination of intra-articular methylprednisolone injection, physiotherapy and home exercise program is effective in IFS for rapid improvement in pain and ROM.
AbstractBackground: Acute cholecystitis is typically managed with cholecystectomy. However, in patients with underlying co-morbidities who are not suitable for surgery, drainage procedures are recommended. Traditionally, these procedures have been performed percutaneously, but endoscopic techniques have gained popularity in recent years due to their physiological approach and lower complication rates. Aims: This study aims to compare endoscopic modalities of drainage (nasobiliary and internal drainage with stenting) in patients with acute cholecystitis and acute cholangitis. We also compared percutaneous drainage with endoscopic retrograde drainage procedures. Methods: We analyzed the National Inpatient Sample (NIS) database (2016-2020) to compare outcomes of acute cholecystitis and cholangitis patients undergoing endoscopic nasobiliary drainage and stent placement. Differences in outcomes between percutaneous and various endoscopic drainages were highlighted. Statistical significance was assessed using χ² and t-tests for categorical and continuous data respectively, with P<0.05 considered significant. Multivariate analyses were performed to assess study outcomes and adverse events for each procedure. Results: Patients subjected to nasobiliary drainage exhibited a higher mean age compared to those undergoing internal drainage (68.56 +/- 1.84 years vs 64.62 +/- 0.39 years, p-value < 0.05). Both groups shared similar demographic parameters and comorbidities. Internal drainage with stenting correlated with elevated incidences of acute pancreatitis (14.68% vs 13.04%, p-value <0.05) and intestinal perforation (4.24% vs 2.17%, p-value <0.05) compared to nasobiliary drainage. Conversely, nasobiliary drainage was associated with increased occurrences of bleeding (2.17% vs 0.98%, p-value < 0.05) and ileus (10.87% vs 5.22%, p-value < 0.05). Additionally, internal drainage with stenting exhibited a higher rate of subsequent cholecystectomy compared to nasobiliary drainage (3.20% vs 2.17%, p-value < 0.05). Percutaneous drainage predominated among older individuals (70.36 +/- 0.16 years vs 64.15 +/-0.35, p-value < 0.05). The adjusted odds ratio for mortality for percutaneous drainage versus endoscopic drainage was (5.15 +/- 0.88 vs 0.2 +/- 0.03, p-value < 0.05). Those undergoing endoscopic drainage demonstrated a substantially higher rate of subsequent cholecystectomy (26.50% vs 0.24%, p-value < 0.05). Conclusion: Patients undergoing nasobiliary or internal drainage with stent shared similar demographic characteristics and comorbidities. Internal drainage with stenting correlated with a heightened risk of acute pancreatitis and intestinal perforation, whereas bleeding and ileus were more prevalent with nasobiliary drainage. Moreover, internal drainage with stent was associated with a higher incidence of subsequent cholecystectomy.
With the advancement in basic and clinical sciences, medical education is also constantly evolving. The Accreditation Council for Graduate Medical Education (ACGME) has endorsed six core competencies to improve teaching and learning. This narrative review was conducted after searching the article databases (PubMed, PubMed Central, Embase, and Scopus) about the core competencies such as medical knowledge (problem-based learning), interpersonal communication, patient care, professionalism, practice-based learning and improvement, and system-based care endorsed by ACGME. We included randomized and quasi-experimental trials, cohorts, and case-control studies in this narrative review. In a problem-based learning modality, a real-life scenario is allocated to a group of students. Studies have shown that it is more effectively demonstrated by a better post-test score, improved concentration, and application of knowledge. Interpersonal communication skills promote collaboration with interdisciplinary teams, work quality, and patient adherence to treatment. Professionalism is a human attribute that creates a pleasant work environment and is an essential trait that improves patients' adherence to treatment. In system-based care, patients are benefitted through a well-structured plan of care. Finally, in practice-based learning, medical trainees learn to systematically evaluate the pattern of care and practice the best modality to improve the overall patient care and physician satisfaction. These core competencies need to be incorporated into all levels of medical training.
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