Browsing by Author "Parajuli, B"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
Publication Assessing Spectrum of Fractures in Elderly; Perspective on Tertiary Care Hospital of Nepal(Kathmandu University, 2023) Parajuli, B; Sharma, R; Kayastha, SR; Thapa, J; Shrestha, R; Shrestha, DABSTRACT Background There is an increasing life expectancy and a surging elderly population in the last few decades, leading to a higher incidence of fractures in the elderly. The health care of the elderly in Nepal is below par and there are no studies done to evaluate the spectrum of fractures in the elderly. Objective To evaluate the demographical and epidemiological aspects of fractures in the elderly (≥ 65 years) presenting to a tertiary care hospital in Nepal in a 15 years’ timeline. Method This study was a retrospective epidemiological study conducted in the Department of Orthopedics, Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Nepal. The patients of age ≥ 65 years having traumatic injuries, admitted in the orthopedics ward from 2006 January to 2020 December were included. Patient demographics, site of injury, fracture incidence, mechanism of injury, hospital stay duration, and mode of treatment (surgical/ conservative) were evaluated. Result Of the 787 patients with an average age of 73.65 ± 7.5 years, 54% were females. Peritrochanteric fracture was the most common fracture (29.4%) followed by spine (18.3%). The most common mechanism of injury was fall on the labeled ground (38.6%). The incidence of fragility fractures (peri-trochanteric, proximal humerus, spine, and distal radius) was increasing with age. Conclusion Females, peritrochantric fractures, and trivial trauma are the most common occurrences for fractures in elderly. The incidence of fragility fractures is increasing with age but the overall incidence of fractures compared to other studies is low. Higher incidences of road traffic accidents (RTA) and compound fractures among the elderly are serious public health concerns that highlight the importance of primary preventive measures. KEY WORDS Elderly, Fracture, Incidence, NepalPublication Epidemiological Characteristics of the Spine Tumors in a Single Tertiary Centre of Nepal(Kathmandu University, 2025) Kayastha, SR; Pandey, A; Lamichhane, S; Thapa, J; Parajuli, B; Shrestha, DABSTRACT Background Spine tumors can be primary or secondary, depending on their origin. Metastasis compromises the majority of spine tumors. Primary tumors of the spine are rare and mostly asymptomatic; consequently, their real incidence cannot be investigated. Primary malignancies of the spine are even rarer. Most epidemiological data for spine tumors comes from registries in developed countries. Objective To provide epidemiological data on spine tumors in a single tertiary hospital in Nepal. Method This is a descriptive cross-sectional study done at the department of orthopaedics at Dhulikhel Hospital. The study was done using retrospective hospital records from January 2010 to December 2024. The data related to all the spine tumors admitted under the department of orthopedics during the study’s duration were included. Records without complete, relevant information were excluded. We took data from 135 patients admitted for spine tumors. The information related to the demography, site of tumors, types of tumors, and histological diagnosis was entered in Google Sheets and exported for descriptive analysis in Statistical Package for Social Sciences (SPSS) version 20. Result Among the 135 patients, the most common site of spine tumor was thoracic (42.22%). Primary benign neoplasms were the most common (n=68), and among the 61 malignancies, 36 were secondary and 25 were primary malignancies. Schwannomas were the most common benign tumors in the spine (n=23). The most common site for secondaries in the spine was the lungs (n=11). Conclusion This study’s results represent data on the epidemiology of spinal tumors from a single institute. Although this data is far too small to represent the whole country, in the absence of registries or other large multicentric databases, it can shed some light on the less studied spine tumors in Nepal. KEY WORDS Epidemiology, Metastasis, Spine tumorsPublication Functional Outcome of Pediatric Monteggia Fracture Dislocation Treated Surgically in a Tertiary Care Centre of Nepal(Kathmandu University, 2021) Dhoju, D; Parajuli, BABSTRACT Background Monteggia fracture dislocation may need operative management. The fracture of ulna is reduced by closed or open reduction followed by stabilization of ulna with Rush pin, K-wires or Dynamic compression plate. Objective To evaluate the Mayo Elbow Performance Score of patients with Monteggia fracture dislocation treated operatively. Method It is a retrospective study conducted at Dhulikhel Hospital, Kathmandu University Hospital. All the pediatric patients with Monteggia fracture dislocation managed operatively from January 2011- December 2019 were included in the study. The functional outcome scoring of the effected elbow using Mayo Elbow Performance Score was done in the last follow up. Result Forty eight surgically managed Monteggia patients had a mean age of 7.23 ± 2.9 years with male predominance. Left side was the dominant side of involvement with 29 patients. Bado type 1 was the most common type (81.3%). Most of the patient underwent closed reduction and fixation with Rush pin (n=40). All of the patient has excellent (89.6%) to good (10.4%) functional outcome. Conclusion Operative management of Monteggia fracture dislocation with complete ulna fracture has excellent to good outcome. KEY WORDS Functional outcome, Monteggia fracture dislocation, Operative management, Rush pinPublication Myocardial Infarction in Non-obstructive Coronary Arteries (MINOCA) in the Perioperative Period can Epinephrine be Responsible?(Kathmandu University, 2022) Koirala, M; Shakya, BM; Parajuli, B; Ghimire, BABSTRACT Ephedrine, metaraminol, epinephrine and maneuvers like carotid sinus stimulation used during intraoperative period have been postulated to cause temporary spasm of the coronary vessels leading to decrease supply to the myocardium and precipitating myocardial infraction in non-obstructive coronary arteries (MINOCA). As an anaesthesiologists, we should be aware that even a dose as small as 25 mcg epinephrine infiltrated along with local anaesthetic in the subcutaneous plane may be responsible for coronary vessel spasm and thus myocardial infraction in non- obstructive coronary arteries. We report a case of 45 years old female with papillary carcinoma of thyroid who developed features of non-ST elevation myocardial infarction 5 minutes after the subcutaneous infiltration of 5 ml of 2% Xylocaine with 1:200000 Epinephrine. Patient was managed for acute Myocardial Infarction. Coronary angiogram done the next day revealed normal coronary arteries, hence the diagnosis Myocardial infraction in non-obstructive coronary arteries was made. KEY WORDS Acute myocardial infraction, Epinephrine, Local anaestheticsPublication Orthopaedic Services during Nationwide COVID-19 Lockdown: Dhulikhel Hospital, Kathmandu University Hospital Experience and Review of Literature(Kathmandu University, 2020) Kayastha, SR; Parajuli, B; Basi, A; Shrestha, DABSTRACT Background The Nepal government issued a nationwide lockdown due to COVID-19 from 24 March to 21 July 2020. This halted elective medical services in our hospital. A number of modifications in the orthopaedic practices at our department were made. Objective This article discusses the impact on orthopaedic load at the Department of Orthopaedics and Trauma, Dhulikhel Hospital, Kathmandu University Hospital during the lockdown. Method This is a longitudinal observational study done during the nation-wide lockdown including all the patients who presented to the hospital requiring orthopaedic consultation. For comparison purposes, the patient numbers from the same date in previous year (2019) were retrieved. Result We received no COVID-19 cases requiring orthopaedics consultation. A total of 1828 patients were seen in the Orthopaedic Outpatient Department, 1077 trauma patients in the Emergency Department, 216 patients were admitted and 210 orthopaedics procedures were performed at the operation theatre. There was 82.21% decrease in OPD patients and 56% less surgeries in OT compared to the same duration of last year. Conclusion There was a great reduction in the patient numbers visiting the hospital, which reflected in decreased number of admission and surgery. A greater part of our work during the lockdown was trauma. KEY WORDS COVID-19, Orthopaedics, Trauma