000			03098nam a22002417a 4500
005			20251007134010.0
008			251007b |||||||| |||| 00| 0 eng d
040			_eNLM
060			_aWI 141.5.F4 _b00768
100			_aJoshi, Bishal Raj Dr.
245			_aDiagnostic accuracy of fibrosis-4 index in assessment of hepatic fibrosis in metabolic dysfunction associated steatotic liver disease
260			_aKathmandu, Nepal ; _bKathmandu University & Nepal Health Research Council (NHRC) ; _c2025.
300			_a60p.
500			_aIn partial fulfilment of the requirements for the degree of Master in Medical Research.
520			_aBackground: Tuberculosis (TB) remains a leading cause of morbidity in developing nations, with cervical lymphadenopathy being the most common extrapulmonary manifestation. In resource-limited settings like Nepal, rapid and accurate diagnosis is critical for effective treatment. This study evaluates the diagnostic performance of two key modalities - ultrasound-guided fine-needle aspiration cytology (FNAC) and GeneXpert MTB/RIF assay - in patients with suspected tuberculous lymphadenitis. Methods We conducted a hospital-based comparative cross-sectional study at Bir Hospital, Nepal from February to June 2025. Sixty-two consecutive patients presenting with cervical lymphadenopathy underwent simultaneous ultrasound-guided FNAC and GeneXpert testing. FNAC smears were evaluated for cytomorphological features of TB, while GeneXpert detected Mycobacterium tuberculosis DNA and rifampicin resistance. A composite reference standard combining both tests was used for analysis. Diagnostic accuracy parameters including sensitivity, specificity, positive and negative predictive values were calculated. Agreement between tests was assessed using Cohen's kappa statistic. Results: FNAC demonstrated superior sensitivity (93.1% vs 89.6%) while both tests showed perfect specificity (100%). The combined approach increased diagnostic yield by 7.4%, identifying additional cases that would have been missed by either test alone. Excellent agreement was observed between methods (?=0.902, p<0.001). Among 27 GeneXpert- positive cases, no confirmed rifampicin resistance was detected, though 14.8% showed indeterminate results. The majority of patients (58.1%) were aged 25-50 years, with a female predominance (59.7%). Conclusions Both ultrasound-guided FNAC and GeneXpert are highly accurate for diagnosing tuberculous lymphadenitis. Their complementary use enhances detection rates and should be adopted in high-burden settings. These findings support the integration of these diagnostic tools in the Nepalese TB control program to improve case detection and treatment outcomes. Keywords: extrapulmonary tuberculosis, lymphadenitis, Nepal, sensitivity and specificity, tuberculosis.
650			_aExtrapulmonary tuberculosis.
650			_aLymphadenitis.
650			_aSensitivity and specificity.
650			_aTuberculosis.
650			_aNepal.
856			_yhttps://nhrc.gov.np/contact _zVisit NHRC Library
942			_2NLM _cTR _kTHS00768-JOS-2025. _n1
999			_c3480 _d3480