Suchergebnisse

Background: Thyromental Height Test is a relatively new, easy method considered as a more accurate predictor of difficult laryngoscopy than existing methods. The aim of this study was to evaluate its accuracy in predicting difficult laryngoscopy as compared to commonly used methods.Methods: This hospital based, cross-sectional, observational study was conducted on 246 patients scheduled for surgery under general anesthesia with endotracheal intubation. Airway assessment was done during pre-anesthetic assessment by Thyromental Height Test, Modified Mallampati Test, Thyromental Distance and Sternomental Distance measurements and predicted as 'difficult' or 'easy' laryngoscopy based on accepted cut-off values. Direct laryngoscopic view was assessed after administration of general anesthesia by a laryngoscopist unaware of the pre-anesthetic assessments and recorded as 'actual' difficult or easy laryngoscopy based on Cormack-Lehane grades. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each clinical test were determined. Results: Thyromental Height Test had the highest sensitivity (71.42%) and negative predictive value (98.9% respectively) but lowest accuracy (77.2%). Maximum specificity was observed with Thyromental Distance and Sternomental Distance (97.49% each). Thyromental Distance had the highest positive predictive value (25%) and accuracy (95.52%). Conclusions: Thyromental Height Test, with its high sensitivity, is a useful predictor of difficult laryngoscopy. However, due a high number of false positives and relatively low accuracy, it cannot be considered as a sole, reliable and accurate predictor of difficult laryngoscopy. Keywords: Accuracy; difficult laryngoscopy; predictor; thyromental height

Though springs are the primary source of water for communities in the mid-hills of Nepal, an in-depth scientific understanding of spring systems is missing, preventing the design of effective climate-resilient interventions for long-term sustainability of springs. This study marks the first attempt to combine environmental isotopes analysis with hydrometric and hydrogeological measurements to identify dominant recharge zones for springs in two mountainous catchments—Banlek and Shikarpur—in Far-Western Nepal. In total, 422 water samples collected from rainfall, springs and streams between March 2016 and March 2017 were analyzed for their isotopic composition (δ18O and δD). Isotopic composition of rainwater shows seasonality, suggesting that different sources of water vapor cause rains in monsoon and in dry season. Rainfall responses of individual springs were used to identify connections to unconfined and deeper groundwater strata. The isotopic composition of springs in the two catchments ranges from −9.55 to −8.06‰ for δ18O and −67.58 to −53.51‰ for δD. The isotopic signature of the spring sources falls close to the local meteoric water line for the corresponding season, indicating strong rainfall contribution to springs. Altitudinal isotopic gradients suggest mean recharge elevation of 2,600–2,700 m asl for springs in Shikarpur, which lies beyond the surface-water catchment, and a recharge elevation of 1,000–1,100 m asl for Banlek, which partially extends beyond the surface-water catchment. The demarcated recharge zones will be used by government agencies to implement recharge interventions to increase the resiliency and reliability of springs in Far-Western Nepal. ; Peer reviewed

Background: There is a high risk of occupational exposure to tuberculosis among healthcare workers in endemic countries. Regular screening for tuberculosis among healthcare workers is not carried out in Nepal. Infection control measures are also not routinely implemented. The aim of this study was to determine the prevalence of active tuberculosis among staff/students at Patan Hospital.Methods: Participants were given a self-administered questionnaire and invited to undergo chest radiography. Cases were scored and reviewed based on predetermined criteria, and presumptive tuberculosis cases were invited to undergo sputum smear and culture. Participants were categorized according to the extent of patient contact and asked about history of tuberculosis medication. Results: Among 560 participants, 76.8% had direct contact with patients. Fifty-eight (10.4%) gave history of cough >2 weeks. Based on symptom history and chest radiography, 20.0% (n=112) cases were reviewed, and 12.5% (n=14) of those reviewed had sputum tested for acid-fast bacilli. One participant had culture-positive tuberculosis. Fifty participants (8.9%) reported tuberculosis in the past, among which 42.0% (n=21) occurred after employment at Patan Hospital and 42.0% before joining Patan Hospital. Security staff, radiology technicians and ward cleaning staff had the highest proportion of cases with a history of tuberculosis.History of tuberculosis medication had no relation with age, sex, education, body mass index and smoking.The incidence rate of tuberculosis at Patan Hospital was 3.6 per 1000 person-years.Conclusions: Overall incidence of tuberculosis among healthcare workers is noteworthy. However, this study suggests when symptomatic tuberculosis occurs in healthcare worker at Patan Hospital, it is diagnosed and there is not a large pool of undiagnosed tuberculosis.