Browsing by Author "Adhikari, P"
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Publication Aetiology and management of epistaxis at TU Teaching Hospital(Institute of Medicine, 2006) Adhikari, P; Pradhananga, RB; Thapa, NM; Sinha, BKAbstract Background: Epistaxis is a common condition, as well as a frequent otolaryngologic emergency. Up to 60% of people experiencing one episode in their lifetime and 6% seeking medical attention. Methods: A retrospective study of records of 93 patients admitted in the department of ENT-Head and Neck Surgery of TU Teaching Hospital for the management of epistaxis in between March 2005 and February 2006. Results: The incidence of epistaxis was found to be in 6.0% of all the ENT patients admitted in the department in this time period. The most common cause / risk factors were hypertension followed by deviated nasal septum. In 24.7% of cases no cause could be found and was labeled as idiopathic. Regarding treatment, 9.7% treated with Chemical cautery, 34.4% anterior nasal packing, 25.8% posterior nasal packing and 2.2% required arterial ligation to control their epistaxis. Conclusion: Our study shows that epistaxis is also a common emergency. Etiology could be found nearly 75% of cases only which could be preventable. Anterior Nasal Packing was the most common treatment. We should manage a case of epistaxis in an orderly manner.Publication Analysis of tracheobronchial foreign bodies(Institute of Medicine, 2007) Adhikari, P; Shrestha, BL; Sinha, BK; Baskota, DK; Sharma, NRAbstract Background: To analyze the type and site of tracheo-bronchial foreign bodies in patients admitted in the department of ENT-Head and Neck surgery (ENT-HNS) of TU Teaching Hospital. Methods: Medical records of 41 cases admitted in the department of ENT-HNS, TU Teaching Hospital, Kathmandu between April 2004 to October 2006 for the management of suspected foreign bodies in tracheobronchial tree were analysed retrospectively. It was found that rigid bronchoscopy was performed in all 41 cases and foreign bodies were removed from 36 cases. In the five cases where foreign body was not found, were excluded from the study. Results: There were 83.3% children and 16.6% adults. Most common type of foreign body found in children were vegetative (63.3%) where as in adults beetle nut (50.0%) and metallic foreign bodies (50.0%) were found. Majority of foreign body was found to be lodged in the right main bronchus (56.7%) in children. Whereas, in adults foreign bodies (66.7%) were found in the left main bronchus. Radiological confirmation of the foreign body could be made only in 8 cases (22.2%). All patients had an uneventful postoperative period except two (5.5%) who died during postoperative period after removal of foreign bodies from trachea. Conclusion: In children, foreign body is more common in right bronchus where as in adults it is more common in left bronchus. Only 22.2% foreign bodies could be seen in plain X-ray. In unresolved pneumonia high index of suspicion of foreign body in tracheobronchial tree must be made and diagnostic bronchoscopy should be performed. Keywords: Vegetative foreign body, metallic foreign body, rigid bronchoscopyPublication COVID 19 Vaccine Breakthrough Infection among Health Care Workers(Kathmandu University, 2023) Tamrakar, D; Katuwal, N; Adhikari, P; Banjara, M; Shrestha, N; Poudel, P; Shrestha, RABSTRACT Background Mass vaccination is considered the primary strategy for reducing the impact of COVID-19, and it has been implemented globally. Objective To study the extent of SARS-CoV-2 infection and breakthrough infection among the HCWs who were fully vaccinated for at least 14 days and investigated the relation between neutralizing antibody response and breakthrough infection. Method This study was a retrospective cohort study among health care workers at Dhulikhel Hospital Kathmandu University Hospital from December 2021 to October 2022. The interviews with semi structured questionnaire were conducted in person or over phone. Out of 1450 participants 137 fully vaccinated HCWs without breakthrough infection were randomly selected for the prospective serological cohort. Result Out of 1079 participants’ majority (51.8%) were of age 25-34 years. Two thirds (66.7%) were females. More than half of participant (54.7%) had infection with SARS-CoV-2 at least once whereas more than one third people (35%) had reported SARS-CoV-2 infection 14 days after receiving full vaccination. Infection after vaccination had less moderate and sever/critical illness and less need for hospitalization as compared to infection before vaccination. Staffs who were directly involved in patient care had higher chance of breakthrough infection compared to those not involved directly in patient care. Those who had prior infection or booster dose had relatively higher antibody level and participants with low level of antibody had higher chance for breakthrough infection (35.3%) than participants with moderate to high level of antibody (11.9%). Conclusion Vaccinations significantly decreased severe diseases and the need for hospitalizations. Breakthrough infection was higher among the health care workers involved in direct patient care and with low level of antibody. KEY WORDS Antibody level, Breakthrough infection, COVID 19, COVID 19 vaccinationPublication Development of a Model One Stop Approach to Post-COVID-19 and other Rehabilitation Conditions(Kathmandu University, 2024) Adhikari, P; Tamrakar, D; Thakur, C; Shakya, R; Vaidya, N; Acharya, R; Shrestha, J; Byanju Shrestha, IABSTRACT Background Post-COVID-19 cases can cause severe disabling symptoms and functional disabilities. WHO recognizes the severity of the condition and publishes a standardised Case Report Form to inform clinical management and public health response. Objective To determine the post-COVID-19 case load. A multidisciplinary team including a diverse team were composed and priority intervention areas were identified through a transdisciplinary approach eventually developing a Model One Stop Approach to post-COVID-19 and other Rehabilitation Conditions. Method The COVID-19 cases recorded at Dhulikhel Hospital were monitored through phone calls to post-COVID-19 complications. Patients were then invited for additional clinical assessments. A diverse team conducted these assessments to identify the needs for expanding a post-COVID-19 clinic and devised rehabilitation services based on predefined criteria. Result A total of 550 respondents were included in the study. The proportion of males (51.7%) was slightly higher than females (48.3%) with the majority of them being Brahmin/Chettri. The primary comorbidities identified were diabetes (10.55%) and hypertension (11.4%). Of the participants, about 50.73% experienced persistent symptoms. About 17.8% reported lasting muscle-related problems, 12.1% had persistent joint pain, and 33% faced temporary cardiac issues. Less than 10% experienced enduring health problems related to vision, hearing, and sleep patterns. Conclusion After COVID-19, patients experienced cardiac and muscle-related issues, increasing morbidity, financial burdens, and pressure on healthcare systems. With the need of sustainable rehabilitation training package, Dhulikhel Hospital serves as a model for a One-Stop Approach to post-COVID-19 and other rehabilitation conditions. KEY WORDS Model, Persistent, Post-COVID-19, Rehabilitation, SymptomsPublication First Reported Death of a Postpartum Woman Due to Coronavirus Disease 2019 in Nepal: A Lesson Learnt(Kathmandu University, 2020) Shrestha, AP; Bhushal, N; Shrestha, A; Tamrakar, D; Adhikari, P; Shrestha, P; Shrestha, A; Karmacharya, B; Basnet, S; Tamrakar, SR; Shrestha, R; Shrestha, RABSTRACT The first case of coronavirus disease 2019 was reported on December 31, 2019 in Wuhan, China where the average case fatality rate was 6.1 ± 2.9%. There are 453 deaths as of September 24, 2020 in Nepal. We report the first death of a 29-years-old postpartum woman due to COVID-19 in Nepal who was referred from a rural health center to Dhulikhel Hospital. On arrival, she was taken to the acute respiratory zone of the emergency department to provide immediate lifesaving procedures. Despite the repeated resuscitative measures, return of spontaneous circulation could not be achieved. The real time polymerase chain reaction test was positive. Our case report highlights the importance of early clinical suspicion, importance of “safety first” in healthcare settings, and the chain of management in such patients. We consider the fact that a postpartum woman registered as the first case of COVID-19 related death in Nepal to be an area of further study. KEY WORDS Coronavirus, Emergency department, Personal protective equipment, Postpartum death, Real time polymerase chain reaction, ResuscitationPublication Incidence of dysmenorrhoea associated with high stress scores among the undergraduate Nepalese medical students(Institute of Medicine, 2010) Pramanik, T; Shrestha, R; Sherpa, MT; Adhikari, PAbstract Introduction: Primary dysmenorrhoea is one of the major problems associated with menstruation among the young undergraduate medical students which affect the daily routine. Among various causes, mental stress is one of the major causes of primary dysmenorrhoea. This study aims to assess the relationship between the degree of stress and incidence of dysmenorrhoea amongst the young Nepalese medical students. Methods: Young, unmarried, non-smoker female medical undergraduate students (age: 18-20years, n = 104) having no pelvic pathology participated in this study. A baseline questionnaire was used to note the medical history on menstruation, use of contraceptive pills, active or passive smoking exposure and alcohol use. The independent and individual perception of stress was evaluated by using a stress questionnaire. Results: Result indicated that the stress score is significantly higher (31.30 vs. 18.81) in dysmenorrhoeic women (n=50) compared to eumenorrhoeic participants (n=54). Conclusions: The present study indicated a positive relationship between psychological stress (supported by stress scores) and dysmenorrhoea. The path of solution of this painful problem might be paved out by de-stressing the person through relaxation exercise, yoga and pranayama (the breathing exercises.) Keywords: Primary dysmenorrhoea, psychological stress, yogaPublication Is coagulation profile routinely indicated in Epistaxis?(Institute of Medicine, 2007) Adhikari, P; Guragain, RPS; Pradhananga, RBAbstract Background: Epistaxis is the most common ENT emergency worldwide.It is also common ENT problem in Nepal. Most cases of epistaxis don’t have an easily identifiable cause. Both local and systemic processes can play a role in it.Treatment of severe epistaxis can encompass different modalities. Objective: To observe the significance of coagulation studies to find out a cause for epistaxis. Materials and Methods: A retrospective chart review of coagulation studies of 124 cases(male=85, female=39) of epistaxis patients admitted in ENT-Head and Neck Surgery ward of T.U.Teaching Hospital from January 2005 to June 2006 was performed to find out the coagulation disorder in such patients. Results: There were 124 patients with epistaxis admitted during the study period of 1 1/2 year duration with M: F ratio 2.2:1. Prothrombin Time ranged between 11-16 seconds, Bleeding Time between 2-8 minutes, Activated Partial Thrombin Time between 25-35 seconds, and International Normalized Ratio between 0.8-1.2. All those values being normal, we did not further investigate for factor assays.None of the patients with epistaxis had coagulation profile derangement. Conclusion: From our study it seems that routine coagulation profile is not necessary in patients with epistaxis. The indications for coagulation profile testing in patients with epistaxis should be identified by a more scientific larger study. At present, the tests should be done when there is high suspicion of such disorders. Keywords: Coagulation disorder, EpistaxisPublication Knowledge and Attitude Regarding Human Milk Banking among Antenatal Mothers Attending Antenatal Clinic(Kathmandu University, 2024) Dhakal, RD; Upreti, R; Nepal, S; Dahal, BD; Adhikari, PABSTRACT Background Breast milk is the ideal food that has essential nutrients for the normal growth and development of infants. It contains antibodies that help to protect against many common childhood illnesses. For infants who cannot receive breast milk from their own mothers, due to maternal illness, death, medication, disability, insufficient milk production, allergies, or prematurity, donated breastmilk can become the ideal option. Objective To assess the knowledge and attitude regarding human milk banking among antenatal mothers. Method A cross-sectional analytical research was conducted among 422 antenatal mothers attending the antenatal outpatient department of Bharatpur hospital from date 04 November to 04 December 2022. Systematic random sampling was used to select the study unit. A semi-structured interview schedule was adopted to collect the data. Collected data were analyzed by using Descriptive statistics as well as inferential statistics. Result Out of 422 mothers, the majority 58.8 % had poor knowledge and 55.9% had a negative attitude toward human milk banking. There was a significant association between poor knowledge and negative attitude with some socio-demographic variables such as age (AOR=2.16; 95%CI= 1.372-3.401; p=0.001), history of adverse pregnancy outcome (AOR =6.202 95% CI=1.786-21.54;p=0.004), occupation (AOR= 1.906; 95% CI = 1.246-2.915; p=0.003). Conclusion It is concluded that the majority of the respondents had poor knowledge and a negative attitude regarding human milk banking.Knowledge and awareness of human milk banking, play a major role to remove misperceptions about human milk donation and banking. Therefore, proper dissemination of information about human milk bank services, is necessary. KEY WORDS Antenatal Clinic, Antenatal mother, Human milk bank, Knowledge and attitudePublication Knowledge and practice regarding menstrual hygiene in rural adolescent girls of Nepal(Kathmandu university, 2007) Adhikari, P; Kadel, B; Dhungel, Sl; Mandal, AObjective: This study was done in the adolescent girls to evaluate the knowledge and practice on different aspects of menstrual hygiene. Methods: One hundred and fifty adolescent girls of age 13-15 years from 3 schools of Shivanagar and Patihani village development committees of Chitwan district were involved in this study. Altogether 27 questions were asked to each of them. Results: During our study, we found that they were not properly maintaining the menstrual hygiene. Only 6.0% of girls knew that menstruation is a physiologic process, 36.7% knew that it is caused by hormones. Ninety-four percentages of them use the pads during the period but only 11.3% dispose it. Overall knowledge and practice were 40.6% and 12.9% respectively. Conclusion: Although knowledge was better than practice, both were not satisfactory. So, the girls should be educated about the process and significance of menstruation, use of proper pads or absorbents and its proper disposal. This can be achieved by giving them proper training and health education (by teachers, family members, health educators, and media) so that there won't be any misconception to the adolescent girls regarding menstrual hygiene. Key words: Menstrual Hygiene, adolescent Girls and NepalPublication Knowledge, Attitude and Practice towards COVID-19 among Private School Teachers of Chitwan, Nepal(Kathmandu University, 2021) Dhakal, RD; Paudel, D; Shrestha, P; Adhikari, PABSTRACT Background The coronavirus disease (COVID-19) pandemic has brought life to a standstill across the world, with nearly 178 countries reporting school closures. As the schools have started reopening slowly, precautions are utmost necessary to prevent the potential spread of COVID-19 in school and community settings. Objective To assess knowledge, attitude and practice towards COVID-19 among private school teachers. Method A web based cross-sectional analytical study design was undertaken. Currently working private school teachers of Chitwan District were included as a unit of analysis. The snowball sampling technique was employed to identify the eligible participant. Collected data was entered in SPSS version 20 and analyzed using the Chi-square test, Pearson correlation, and binary logistic regression. Result Of 344 participants, the majority were male (52.9%), most of the participants were from age group 26-30 years (38.4%). Regarding knowledge, attitude and practice, 57% had good knowledge, 53.2% had favorable attitude and 51.7% had good practice towards COVID-19. Logistic regression analysis demonstrated gender (OR 0.475, 95% CI: 0.256-0.818) and COVID-19 training (OR 25.687, 95% CI 5.354-123.226) were significant with good knowledge. Conclusion Knowledge about COVID-19 among private schools teacher was good, attitudes have been mostly favorable, and the practices were mostly adequate. However, good knowledge is not the only factor for better attitude and good practices. It is necessary to implement massive education campaigns, trainings and information via school authorities and health authorities by developing and adopting appropriate guidelines on COVID-19. KEY WORDS Attitude-practice, COVID-19, Knowledge, School teacherPublication Overview of Nasal masses(Institute of Medicine, 2008) Pradhananga, RB; Adhikari, P; Thapa, NM; Shrestha, A; Pradhan, BAbstract Background: This study was performed to determine distribution of various nasal masses and correlate between clinical and histopathological diagnosis. Methods: A prospective study of 143 cases of nasal masses were done in patients of > 13 years undergoing surgery over 2 years period (Apr.2004 to Apr.2006). All the patients with suggestive symptoms were examined and diagnosed clinically. All the patients were posted for surgical treatment and the specimens were sent for histopathological examination postoperatively, and reports were noted. The age and sex distribution with patients of various nasal masses and correlation between clinical and histological diagnosis also were analyzed. Results: There were 78 male and 65 female operated for nasal masses. Among the nasal masses operated, the commonest was the ethmoidal polyps (53 patients, 37.06%). The ethmoidal polyps, polyps, bleeding polypus of septum and fungal polyps were common in age group of <40 years whereas inverted papilloma and malignancy were common in >40 years. The ethmoidal polyps and AC polyps were common in male whereas bleeding polypus of septum were in female. A case of venous haemangioma (histopathology) was clinically diagnosed as angiofibroma. In one clinically suspected case of ethmoidal polyps was reported as inverted papilloma. Similarly clinically diagnosed five cases of inverted papilloma were histopathologically reported as inflammatory polyps in two, angiofibroma in one and Squamous cell carcinoma in two cases. Conclusion: The commonest nasal masses operated was ethmoidal polyps. A discrepancy between the pre-operative clinical diagnosis and final histopathological diagnosis was found in 6.3% of the patients. Keywords: nasal masses, ethmoidal polyps, AC polypsPublication Patients’ perspective on informed consent in ear surgery(Institute of Medicine, 2007) Adhikari, P; Guragain, RPSAbstract Background: Informed consent is required before any surgical procedure. This study was done to assess patient’s expectations before to signing consent forms for ear surgery. Methods: This study was done in Department of ENT and Head and Neck Surgery, T U Teaching Hospital from August to December 2006. All patients attending to OPD for appointment of surgery were randomly selected and were explained verbally about the possible complications of surgery, by the first author. There were 100 patients and they were interviewed with a standard questionnaire just one day before surgery. Answers were written by the first author on a standard questionnaire form. All those 100 patients who were informed previously about the possible complications were included in the study. Informed consent was obtained from all patients for the study. Data analysis was done statistically using frequency and percentage. Results: Ninety five percentages of patients were satisfied with the information given by doctors before ear surgery. There were very few patients (7.0%) who looked for further information. Only 27.0% patients could tell complication of ear surgery. Among them, 5.0% patients could list more than one complication. The common complications listed by our patients before ear surgery werebleeding (10.0%), infection (9.0%). Around 96.0% want to be informed all known complications even if the incidence was less than one percent. Conclusion: The information given by the doctors might not meet the expectation of the patients of twenty first century as they have a high expectation. However, the doctors should give a sufficient time to explain about the surgical procedure and they should not miss a common and important complication of surgery. Keywords: Informed consent, Patients expectation, Ear surgeryPublication Prevalence of chronic suppurative otitis media in school children of Kathmandu district(Institute of Medicine, 2007) Adhikari, P; Sinha, BK; Pokharel, NR; Kharel, B; Aryal, R; Ma, JAbstract Background: Chronic suppurative otitis media is a major health problem throughout the world in developing countries including Nepal. This study was carried out to find the prevalence of chronic suppurative otitis media (CSOM) among school going children of Kathmandu district. Methods: This is a prospective cross sectional study among 1070 school children aged between 5 - 12 years. Students were randomly selected from four different schools of Kathmandu district. All these students were interviewed and examined otoscopically from November 2006 to January 2007. Data were analyzed statistically. Results: Results showed that 5.4% of the children had CSOM. Unilateral disease was seen in 79.3% and 96.5% had a tubotympanic disease. Around 24.1% had active disease, 65.4% used unhygienicand risky materials to clean their ears. There were 10.3% students having CSOM who did not receive any treatment. More than half were treated by paramedics. Conclusion:The prevalence of CSOM among school children in Kathmandu district is lower as compared to rural areas of Nepal. This might be due to the improvement of health care facilities or due to increase in the use of antimicrobials in Kathmandu. Awareness for school children as well as parents through health education is in need to reduce the prevalence of CSOM. Keywords: Chronic suppurative otitis media (CSOM), tubotympanic disease, health educationPublication Pseudomembranous colitis in a pregnant woman(Kathmandu University, 2010) Mridula, T; Pai, RR; Mathai, AM; Tantry, BV; Adhikari, PABSTRACT Pseudomembranous colitis in association with pregnancy has not been well described in English literature. Recent studies show a drastic increase in the incidence and severity of Pseudomembranous colitis in pregnant women, who were once thought to be at low risk. We report here a case of Pseudomembranous colitis in a young healthy immunocompetent pregnant lady. An early suspicion of this entity with the characteristic appearance of pseudomembranes on colonoscopy and histology confirmed the diagnosis enabling prompt treatment and complete recovery without any serious consequences. Key Words immunocompetent, pregnancy, pseudomembranous colitisPublication Rolling audit on the quality of discharge summary in TU Teaching Hospital(Institute of Medicine, 2009) Guragain, RPS; Adhikari, PAbstract Background: Audit 2007 (December) was significant in that it was the third rolling audit on the discharge performance started in TU Teaching Hospital. The audit was started in 2005 and it intends to transfer important clinicalinformation from inpatient to outpatient settings and between hospital admissions. Materials and Methods: There were 20 discharge summary forms picked up from each of seven departments of TU Teaching Hospital between November 2007 and December 2007. All summaries were looked for the inclusion of modified Van Walraven criteria. Apart from Van Walraven eight points, admission and discharge date and follow up instructions were also checked by the second author. These summaries were compared with previous discharge summary performed 2 ½ years ago. Results: Department of ENT and HNS showed the best discharge summary as per modified Van Walraven criteria whereas Department of Orthopaedics had the least inclusion of criteria. Previous study showed best summaries in Department of Gynaecology while poor in Department of Orthopaedics. Regarding completeness of hospital discharge summary form, Department of ENT and HNS had the highest number of almost completely filled discharge summaries (>90%) while Department of Medicine had the least number of properly filled discharge summaries. Previous audit showed Department of ENT and HNS to be the best while Department of orthopaedics to be the worst. On analyzing the previous recommendations, they were not properly followed. Conclusion: Discharge summary should be filled up completely without missing necessary information. Although ENT and HNS has best discharge summary according to Van Walraven discharge criteria as well as completeness of our hospital discharge summary, it needs to follow previous recommendations. The recommendations previously given should be strictly followed and informed to the heads of all Departments concerned.Publication Small Cell Carcinoma of Ethmoid Sinus(Institute of Medicine, 2009) Adhikari, P; Bhatta, R; Pradhan, B; Thapa, N; Bhandari, R; Karki, R; Shrestha, A; Sayami, GAbstract Extrapulmonary small cell carcinoma is a rare entity. Here, we report a case of small cell carcinoma of left ethmoid sinus, in a 32 years old female. She underwent left medial maxillectomy and excision of the mass via lateral rhinotomy approach with post operative chemoradiation.Publication Theraputic application if Poly-2-hydroxy ethyl mathacrylate contact lens in various ocular surface disorders among Nepalese population(Institute of Medicine, 2015) Joshi, SN; Chaudhary, M; Bhattarai, D; Gnyawali, S; Shrestha, G S; Adhikari, PAbstract Introduction: Therapeutic contact lens (TCL) is indicated to relieve pain, promote corneal wound healing, provide mechanical protection and support, maintain corneal hydration, improve vision and seal or splint cornea in various ocular surface disorders. Till date no study has been reported about use of contact lenses for these purposes in Nepalese population. is study thus aims to evaluate the outcome of TCL in ocular surface disorders in Nepalese population. Methods: A prospective analysis of patients fitted with TCL for various ocular surface disorders was done at B.P. Koirala Lions centre for Ophthalmic Studies. All the subjects were fitted with Poly-2-hydroxy ethyl methacrylate (70% water content); information on clinical conditions were evaluated and recorded at initial and final treatment visit. Results: Of 57 eyes fitted with TCL, corneal laceration caused by mechanical injury (22.8%) and vernal keratoconjunctivitis (21.1%) were the most common ocular surface disorders. The common indications for applying TCLs were to alleviate pain and discomfort (31.5%) and corneal thinning impending to perforation (26.3%). Subjects’ clinical conditions and symptoms were resolved partially to completely in 89.4%. Dry eye was a common cause of contact lens associated therapeutic failure. Conclusion: Poly-2-hydroxy ethyl methacrylate contact lenses are safe and effective in alleviating symptoms and healing of various ocular surface disorders in Nepalese population. Keywords: Cornea, Therapeutic contact lens, Ocular Surface DisordersPublication Visual outcome in Keratoconus with spherical rigid gas permeable contact lens(Institute of Medicine, 2017) Chaudhary, M; Kandel, H; Adhikari, PAbstract Introduction: Keratoconus is a bileteral asymetric progressive ecteria of cornea commonly associated with vernal keratoconjunctivitis and Atopic dermatitis. Rigid gas permeable (RGP) contact lens is the first choice for refractive correction in keratoconic eyes. The visual outcome in Keratoconus with spherical RGP contact lens along with the mean age of presentation, gender predominance, ethnicity, associated conditions, refractive error and corneal astigmatism was evaluated. Methods: The records of the Keratoconus patients attending cornea and contact lens clinic for last 6 years were reviewed and analyzed using SPSS-14 software. Data on laterality, race, age, gender, refractive error, visual acuity (VA), associated conditions and contact lens parameters were obtained. A total of 22 patients with 38 keratoconic eyes were included in the study. Results: The mean age of Keratoconus presentation was 18.11 ± 4.45 years. Sixteen cases (72.73 %) were bilateral; 6 (27.27 %) were unilateral. Mean uncorrected visual acuity (UCVA) was 0.86 ± 0.40 Log MAR. Mean spectacle visual acuity was 0.54 ± 0.38 Log MAR. Mean visual acuity with spherical RGP contact lenses was 0.08 ± 0.14 Log MAR. The difference between mean spectacle visual acuity and mean VA with spherical RGP contact lens was statistically significant (p < 0.001). Conclusion: In all stages of Keratoconus, improvement in visual acuity with spherical RGP contact lens was highly significant. Key words: Contact Lenses, Keratoconus, Visual AcuityPublication Warthin’s tumor of Submandibular gland(Institute of Medicine, 2009) Adhikari, P; Singh, BK; Baskota, DKAbstract Warthin’s tumour is a benign tumour which is exceedingly rare in submandibular gland. Here, we report a case of warthin’s tumour of submandibular gland in a 64 years old female which is treated with excision of tumour along with the gland. A brief review of literature is also included. Keywords: Submandibular gland, warthin’s tumour, cyst-adenolymphoma