Browsing by Author "Guragain, RPS"
Now showing 1 - 8 of 8
Results Per Page
Sort Options
Publication Accuracy of otoscopy, tympanic membrance mobility and tympanometry in the diagnosis of otitis media with effusion(Institute of Medicine, 2007) KC, S; Guragain, RPS; Sinha, BKAbstract Background: To determine the accuracy of otoscopy, pneumatic otoscopy and tympanometry in the diagnosis of otitis media with effusion. Materials and Methods: A total of 71 patients (121 ears) suffering from Otitis Media with Effusion (OME) diagnosed clinically were subjected to myringotomy and ventilation tube insertion (VTI). The finding of presence of fluid in middle ear after myringotomy was correlated with Tympanic Membrane (TM) color, fluid level, air bubble, TM mobility and tympanometric curve recorded preoperatively. Results: Otoscopic findings revealed pink TM in 78.5%, prominent landmarks in 98.3%, generalized retraction 73.6%, fluid level in 14% and air bubble in 2.5% of cases. On pneumatic otoscopy, decreased or absent mobility was found in 85.1%. Tympanometry with ‘B’ curve was the most sensitive finding (98.9%), whereas pneumatic otoscopy was found to be the most specific amongst all the three tools. Combination of tympanometry with either otoscopy or pneumatic otoscopy or combination of all three modalities was found to be highly significant . Conclusion: Tympanometry is the most sensitive tool for the diagnosis of OME and combination of tympanometry with either otoscopy or pneumatic otoscopy is highly significant. Keywords: otitis media with effusion (OME), pneumatic otoscopy, tympanometryPublication Audit on the quality of discharge summary in TU Teaching Hospital(Institute of Medicine, 2006) Pradhananga, RB; Guragain, RPSAbstract Background: To find out whether all the criteria of discharge summary outlined in modified VanWalraven et al. 1999, were met in the discharge summary. To determine the completeness of the discharge summary form printed by the hospital Methods: Review of the records of 20 discharge summary form from each seven departments of Tribhuvan University Teaching Hospital (TUTH) betweenApril 2005 and September 2005. The notes were looked for completeness and inclusion of all criteria outlined in modified van Walraven et al 1999. Results: According to van Walraven et al Modified Criteria Department of Gynaecology showed the best summaries in which most of the necessary informations were included where as Department of Orthopedics had the least inclusion of criteria. Department of ENT & Head and Neck Surgery tops the list for completeness of the hospital printed discharge form. Department of Orthopedics, again, was found to be at the bottom of the least. Conclusion: Discharge summary should be filled up completely, clearly and without missing necessary informations. Regular audit should be performed to ensure that the quality of discharge summary is maintained. Keywords: Discharge summary, van Walraven criteriaPublication Branchio-Oto-Renal (BOR) Syndrome-an uncommon form of congenital deafness(Institute of Medicine, 2007) Koirala, K; Guragain, RPS; Bhusal, CLAbstract Case report: Children with congenital deafness are common referrals to the Pediatric Otolaryngology unit of the Teaching Hospital. Branchio-Oto-Renal (BOR) Syndrome, an autosomal dominant syndromic form of deafness presents variably with the presence of auricular or preauricular pits in association with hearing loss, branchial sinuses and renal abnormalities ranging from renal hypoplasia to agenesis. Renal manifestations are least common and mostly missed. The present case report highlights a case of Branchio-Oto-Renal syndrome detected at the age of 5 years with unilateral renal agenesis and normal renal function. Keywords: Branchio-Oto-Renal syndrome, hearing loss, renal agenesisPublication Correlation of hearing impairment with site of tympanic membrane perforation(Institute of Medicine, 2005) Bhusal, CL; Guragain, RPS; Shrivastav, RPAbstract Objective: This prospective study was done to assess the level of preoperative hearing impairment in different sites of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. Materials and Methods: A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology and Head and Neck Surgery from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, with conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. Just prior to operation, examination under microscope was performed. Exact site of perforation was noted. During operation, those found to have ossicular discontinuity or fixation were excluded from this study. Results: It was observed that the greatest hearing loss was found in big central (45dB) and posterior central (43dB); whereas least in those of anterior central (31dB) and central malleolar (34dB) perforations. The average hearing loss at 500Hz, 1000Hz and 2000Hz was 46.40 dB, 30.90 dB and 31.9 dB respectively. This showed that the hearing loss is maximum at the lowest frequencies and minimum as the frequencies increase. Conclusion: This study shows that the posterior-central perforations cause more hearing loss than anterior-central ones. The hearing loss is maximum at the lowest frequencies and minimum as the frequencies increase.Publication Defensible record keeping(Institute of Medicine, 2007) Rayamajhi, P; Guragain, RPSAbstract Background: This retrospective study was conducted by the department of ENT and Head & Neck Surgery, TU Teaching Hospital to evaluate the maintainance of records of the inpatients in TU Teaching Hospital. The rolling audit was performed to evaluate the implementation of the recommendations made. Material and Methods: Total of twenty files from each of the eight departments with the inpatient wards was reviewed retrospectively on January 2004. Similarly, other twenty files from each department were studied for the rolling audit on October 2006. The notes were reviewed for completeness and inclusion of the criteria as laid down in the protocol by the Royal College of Surgeon. Results: The admission notes were adequately filled in the department of Psychiatry. The progress notes were adequately filled in the department of Psychiatry and ENT-HNS. The investigation form filling was comparable in all the departments. The discharge summaries were complete and understandable in the department of Psychiatry followed by ENT-HNS. Significant improvement was seen in the department of Obstetrics and Gynecology during the rolling audit. Conclusion: The rolling audit can be done every 6 month to assess the maintainance of the records and the implementation of the recommendations. Keywords: Audit, Defensible record keeping, Royal College of SurgeonsPublication 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 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 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.