Browsing by Author "Pradhan, A"
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Publication Abdominal Cocoon in an Adolescent Male(Kathmandu University, 2012) Shakya, VC; Agrawal, CS; Rajbanshi, SK; Pradhan, A; Khaniya, S; Adhikary, SABSTRACT Abdominal cocoon is an uncommon peritoneal condition characterized by partial or complete encasement of small bowel by a thick rind of fibrous tissue and adhesions. Only few cases of this disease have been reported in world literature. The etiology of this condition is unknown, and most often it is found in adolescent girls from tropical or subtropical countries, and usually diagnosed incidentally on exploration. Surgery (membrane dissection and extensive adhesiolysis) is the treatment of choice. Here, we report a case of abdominal cocoon in a 20-year-old male patient, with a brief review of the literature. KEYWORDS Abdominal cocoon; adhesiolysis; intestinal obstructionPublication Acquaintance with the actuality: Community diagnosis programme of Kathmandu Medical College at Gundu village, Bhaktapur, Nepal(Kathmandu University, 2008) Vaidya, A; Pradhan, A; Joshi, SK; Gopalakrishnan, S; Dudani, IAbstract Introduction: In Nepal, various field programs such as community diagnosis programmes (CDP) have been initiated to make the education of doctors, nurses and dentists more community oriented and relevant and suited to the health care scenario. Community diagnosis refers to the identification and quantification of the health problems in a community and identification of their correlates for the purpose of defining those individuals or groups at risk or those in need of health care. The article presents the main activities of community diagnosis as a core component of community-based education for the medical students at Kathmandu Medical College, Kathmandu, Nepal. Methodology: A 4 weeks’ Community Diagnosis Programme was conducted by MBBS II students (9 th Batch) of the Kathmandu Medical College under the supervision of the Department of Community Medicine in November 2006 in the rural community of Gundu VDC (village development committee). The tools used included pre-tested questionnaires, weighing machines, measuring tapes, stethoscopes and sphygmomanometers. After the data collection and compilation, the students presented their findings in oral presentations, accompanied by a written report, including essential recommendations for improving the health status of these communities. Results: The students benefited from the necessary process of integrating clinical skills and a public health approach, so as to enhance their epidemiological thinking and be of greater use to the communities where they will practice. The community also benefited by achievement of behavioral changes leading to healthier lifestyles and increased awareness of health-related matters and their role in quality of life. Conclusions: CDP is a way to practically demonstrate that the link between a medical college and society is possible. That is, a medical college can serve the community and thus society, with specific activities to improve health and the skills of students who will serve as future health professionals.Publication Audiological Outcome of Endoscopic Stapedotomy in Nepalese population(Kathmandu University, 2024) Subba Rai, S; Shrestha, BL; Pradhan, AABSTRACT Background Otosclerosis is a complex disease of otic capsule that mainly affects the stapes footplate causing conductive hearing loss, sometimes mixed hearing loss. Microscope stapes surgery was used traditionally but endoscopic stapedectomy has ushered a new revelation. Objective To report the audiological outcome of solely endoscopic trans canal stapedotomy surgery for otosclerosis in Nepalese population. Method This retrospective case series study analysed pre and post operative pure tone average of air conduction (AC) and bone conduction (BC) threshold and air bone gap (ABG) at 0.5, 1, 2 and 4 kHz. Postoperative ABG ≤ 10 dBHL (decibels hearing level) and ABG ≤ 20 dBHL was used to consider surgical success and improvement respectively. Paired t-test was used to test the significance of the audiological outcome of the study group pre and post operatively. Result The study included 9 patients, 10 operated ears with male to female ratio of 1:2. Mean age was 37.60 ± 9.28 years and mean postoperative air bone gap was 19.00 (± 5.89) and gain in air bone gap 18.75 (± 8.70) which was found to be statistically significant (p < 0.000). Audiological outcome in each of the four frequencies, 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz was also found to be statistically significant. Conclusion This limited series study concludes that because of its favourable audiological gain and closure of the air bone gap postoperatively and better intraoperative view, it can uplift other surgeons to choose this as preferred technique. KEY WORDS Audiological outcome, Endoscopic stapedotomy, Otosclerosis, Stapes surgeryPublication Backache prevalence among groups with long and normal working day(Kathmandu University, 2004) Pradhan, AObjectives: to describe the prevalence of backache among groups with long and normal working day. Design: A cross sectional study of prevalence of backache among groups with long and normal working day. Materials and Method: Among the 19 wards of Kirtipur municipality, ward no. 11 was selected as a random cluster. 64 households of different socioeconomic status were selected at random. Total of 64 individuals from these households were selected in the study. Conclusion: The backache was found to be 62.5% prevalent. 75.8% of individuals in long working day category were found to be suffering from backache whereas 48.4% in normal working day group were suffering from it. Key words: backache, working dayPublication Publication Comparison of Hearing Result and Graft Uptake Rate between Temporalis Fascia and Tragal Cartilage in Endoscopic Myringoplasty(Kathmandu University, 2022) Shrestha, BL; Shakya, S; Pradhan, A; Dhakal, A; KC, AK; Shrestha, KS; Pokharel, MABSTRACT Background There are different methods to repair the perforation of the tympanic membrane. Recently cartilage has been used for the repair and results are comparable to temporalis fascia. For surgical procedure endoscope had added good assistance in middle ear surgery. Though the one hand technique the image quality and results are on par with the use of a microscope. Objective To compare the graft uptake rate and hearing results between temporalis fascia and tragal cartilage in endoscopic myringoplasty. Method This is a prospective, longitudinal study conducted among 50 patients who underwent endoscopic myringoplasty using temporalis fascia and tragal cartilage with 25 patients in each group. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1 KHz, 2 KHz, 4 KHz). The status of graft and hearing results was evaluated on 6 months of follow up in both the groups. Result Out of total 25 patients enrolled for study in both (temporalis fascia and cartilage) groups, 23 (92%) patients in each group had graft uptaken. The audiological gain in the temporalis fascia group was 11.37±0.32 dB whereas in the tragal cartilage group it was 14.56±1.22dB. The audiological gain between the two groups did not show any statistically significant (p = 0.765). However, the pre and post-operative hearing difference was statistically significant in both temporalis fascia and tragal cartilage group. Conclusion Tragal cartilage has similar graft uptake rate and hearing gain when compared with temporalis fascia in endoscopic myringoplasty. Hence, tragal cartilage can be used for myringoplasty whenever required without any fear of deterioration in hearing. KEY WORDS Air bone gap, Endoscopic myringoplasty, Temporalis fascia, Tragal cartilagePublication Dental Biofilm Accumulation and Gingival Health of Teeth with Fixed Single Prosthesis Fabricated by Various Prosthetic Materials(Kathmandu University, 2024) Pradhan, A; Shrestha, K; Aryal, S; Shrestha, SABSTRACT Background Periodontal health plays an important role in maintaining the health of natural teeth as well as in the success of all dental procedures. Fixed single prosthesis (dental crown) can be fabricated with different types of prosthetic restorative materials like Metal, Ceramic, Ceramic fused to metal. These different materials have different affinity for plaque accumulation leading to the development of gingival inflammation and periodontal disease. Objective To determine the amount of Plaque accumulation and gingival health of teeth with a fixed single prosthesis fabricated by various Prosthetic materials. Method This quantitative cross-sectional study was carried out from July 2021 to March 2022. The patients who visited the hospital after six months of use of the prosthesis enrolled and were categorized into three groups according to the material used for the prosthesis metal, ceramic, and metal-ceramic. The periodontal condition was assessed using the plaque index and gingival index. Result A total of 136 patients (78 female and 58 male) were enrolled in the study, with a mean age of 39.44 ± 16.23 years (Range 19 – 70 years). There were 47 patients with ceramic crowns, 39 patients with metallic, and 50 patients with metal ceramic crowns. The mean plaque index of metal, ceramic, and metal-ceramic crowns was found 1.15 ± 0.546, 0.86 ± 0.479, and 0.93 ± 0.498 respectively. Similarly, the mean gingival index of metal, ceramic, and metal-ceramic crown were 1.22 ± 0.56, 0.91 ± 0.48, and 1.09 ± 0.55 respectively. Conclusion The dental biofilm (plaque) accumulation and hence gingival inflammation is less in ceramic crowns than in metal and metal-ceramic crowns. KEY WORDS Dental crown, Dental plaque index, Gingival indexPublication Factors Affecting Recanalisation after Optimal Management of Deep Vein Thrombosis; A single institution based study(Kathmandu University, 2019) Karmacharya, RM; Shrestha, B; Devbhandari, M; Tuladhar, SM; Pradhan, AABSTRACT Background Presence of recanalisation will favour for better physiological recovery after medical management of Deep Vein Thrombosis (DVT) along with lesser chances of post thrombotic syndrome. Rate of recanalisation is varied and can range from 43-57% and the factors that affect recanalisation are still a dilemma. Objective To know the factors for recanalisation following Deep Vein Thrombosis. Method This is a single institution based retrospective-prospective analytical study encompassing all ultrasonologically diagnosed cases of Deep Vein Thrombosis in adults from January 2015 to November 2017. All the cases were admitted with oral warfarin bridged by Heparin/ Enoxaparin and were discharged once International Normalization Ratio was in therapeutic range. The patients were followed up for three months with minimal of three outpatient followup. Best finding in the doppler ultrasonography (done by Acuson P500, Seimens) in relation to recanalisation was taken for the study. Result There were 67 cases of Deep Vein Thrombosis. Of these cases male to female ratio was 0.91. The mean age was 48.07. Most common extent was up to common femoral vein (47.8%) followed by upto popliteal vein (40.3%). Remaining 11.9% had extension upto iliac veins. There was no recanalisation in 2 cases (3%). Partial recanalisation was seen in 23 cases (34.3%) while complete recanalisation was seen in 42 cases (62.7%). Recanalisation is more in DVT involving popliteal vein while it decreases as the extension goes up. In contrast to 79.4% complete recanalisation in popliteal vein, that in common femoral vein is 62.5% while in iliac vein is only 37.5%. Mean age in no recanalisation group is much younger than partial or complete recanalisation groups. Conclusion Recanalisation following Deep Vein Thrombosis distal to popliteal vein is more than that in proximal Deep Vein Thrombosis. The information on recanalization can be considered to use to decide upon the duration of medical management of Deep Vein Thrombosis. KEY WORDS Deep vein thrombosis, Doppler ultrasonography, RecanalisationPublication Faculty opinion survey following attendance to teacher training workshops in Kathmandu Medical College(Kathmandu University, 2004) Joshi, S; Pradhan, A; Dixit, HIntroduction: With the growing awareness of the importance of teaching and learning in Universities, the need to improve professional qualities in teachers has been identified. Aim and Objectives: This paper describes the outcome of the impact of teacher training workshops on faculty- teaching performance. Methodology: A total of 30 faculties who had undergone teacher training in the one-year period were included in the study. Survey questionnaire were distributed and all the forms were returned. Results: All (100%) respondents found the teacher training to be very useful/useful for improvement of teaching skills. A total of 76.66% said that the skills learnt in the workshop were very applicable, 80% perceived changes in students’ classroom behaviour and found their lecture to be more participatory and interactive. As for their own change in behaviour, 66.66% respondents experienced better interaction with the students in classroom. Discussion: The overall impression of the training was very positive. Future studies should include student feed back and classroom teaching observation for faculty teaching evaluation. We also need to utilise the feed back information obtained in this article, to further improve the strength of the future teacher training workshops. The future workshops should include sessions in problem-based learning and follow up refresher courses. Key Words: Teacher- training, Survey, KMCPublication Health profile of school children in Bhaktapur(Kathmandu University, 2005) Pandey, S; Dudani, I; Pradhan, AObjectives: To find out the existing common health problems among school children and to arouse health consciousness among the children. Material and methods: All the students studying in Mandev Amrit Smriti School, Jhaukhel VDC of Bhaktapur District were included in the sample. The methods used were the interview, clinical history and check-up for provisional diagnosis. A semi-structured questionnaire was used to record information regarding name, age, sex, standard in which s/he was studying, physical examination/ personal hygiene, anthropometric measurements, clinical findings, provisional diagnosis etc. The medical instruments used in the survey were: weighing machine, measuring tape, and thermometer. Common medicines like Jeevanjal packets, Albendazole tablets for deworming, Metron, amoxicyllin, paracetamol, Tagyl etc were also distributed to the needy students. Results and Conclusion: The physical examination of all 118 students in age group ranging from 3 to 13 years of Mandev Amrit Smriti School situated at Jhaukhel VDc of Bhaktapur district was carried out. Thirteen health related problems were detected in this study. The most important three problems were ear problems (22.03%), worm infestation (16.10%) and dental caries (13.56%). Thus school health education should mainly aim at these problems and the care and cleanliness of ears and teeth by proper and regular brushing should be stressed. Applying Water low classification, 33% males were found normal as per their weight for age. 61.9% males were stunted and 4.8 % males were wasted. Likewise, 54.6% females were found normal as per their weight for age. 43.6% females were stunted and 1.8 % females were wasted. Key Word: School health, Health problemsPublication HIV/AIDS and STI related knowledge, attitude and practice among high school students in Kathmandu valley(Kathmandu University, 2005) Jaiswal, S; Magar, BS; Thakali, K; Pradhan, A; Gurubacharya, DLObjective: To assess the knowledge, attitude and practice of high school students regarding HIV/ AIDS and STI and to determine if a school education programme would bring about statistically significant positive change in the knowledge, attitude and practice regarding HIV/AIDS and STI. Methods: The study was conducted among 1012 students of various schools in Kathmandu Valley (Kathmandu, Bhaktapur and Lalitpur). The tool for assessment was confidentially administered closed questionnaire both before and after the education programme of 45 minutes single class, standardized education package. Results: Knowledge on some aspect of the disease was quite low in the study group. 45.8% had prior knowledge of HIV, 65.2% knew that HIV/AIDS could be transmitted by sharing same needle, 46.2% knew that vaccine is not yet available for HIV/AIDS. Knowledge about STI was also quite low, 41.5% knew that pus in the urine is a symptom of STI and 41.7% knew that STI is curable. 4.2% of the study group had previous sexual intercourse, 64.2% had sexual intercourse with friend and 35.17% had sexual intercourse with commercial sex workers. 1.8% would commit suicide if they contracted HIV/AIDS. According to sex wise distribution of the sample, female’s knowledge about HIV was low 43.2% as compared to male 48%, male’s knowledge about transmission of HIV/AIDS from pregnant mother to child was low; 89.7% as compared to female’s knowledge 94.2%. Female’s knowledge about commercial sex worker as high risk group was low (87.8%) as compared to male’s knowledge 90.6%. Key words: HIV, AIDS, STI, high school children.Publication Incidence of Accidental Awareness with Recall during General Anaesthesia: A Prospective Observational Study in a Tertiary Care Hospital(Kathmandu University, 2024) Moktan, SL; Pradhan, R; Pradhan, AABSTRACT Background Accidental awareness during general anaesthesia, though rare, is a serious issue. It could lead to potential harmful psychological consequences. It has been reported that general surgical population has an incidence of awareness ranging from 0.1 to 0.2%. Objective To determine the incidence of awareness with recall under general anaesthesia by using modified Brice questionnaire in post-operative care unit. Method This was an observational study conducted on adult patients in a tertiary care hospital. A modified Brice questionnaire was used for the post-operative interview in 1,120 patients following the written informed consent. They were of American society of anaesthesiologists’ physical status I to III and had surgeries under general anaesthesia. The incidence of intraoperative awareness with recall was the primary outcome of the study. Result Among the total 1,120 patients, 678 patients were female and 442 were males. Most patients, 785 were of American society of anaesthesiologists’ physical status I, while 316 were II and 19 were III. While 1071 (95.6%) patients underwent elective surgery, 49 (4.3%) patients had emergency surgeries. The mean age of the study population was 40.31years with standard deviation of 12.12. Of the 1120 patients, two of them had definitive awareness. Conclusion The incidence of intraoperative awareness with recall after general anaesthesia in patients from a tertiary care hospital was 0.13%. KEY WORDS General anaesthesia, Intraoperative awareness, Modified brice questionnairePublication Knowledge and Attitude on Eye Donation among Undergraduate Medical Students of Kathmandu University School of Medical Sciences, Nepal(Kathmandu University, 2021) Kaiti, R; Dhungel, P; Pradhan, A; Chaudhry, MABSTRACT Background Corneal blindness accounts for a significant proportion of avoidable visual impairment in developing countries. Eye donation is voluntary and awareness in undergraduate medical students being a future practitioner in any field are expected to be linked to patients during death in hospitals. Objective To assess the awareness of medical students on eye donation at Kathmandu University School of Medical Sciences (KUSMS). Method This was a cross-sectional study conducted among undergraduate medical students of KUSMS. Students’ responses were recorded using a predesigned, pretested, semi- structured questionnaire inquiring knowledge and attitude of eye donation, sources of information, their willingness to donate eyes as well as the reasons for donating/ not donating eyes. Result Less than half of the medical students (45.6%) were aware of eye donation only after death. Newspapers (72.2%) were the major source of information. The final year medical students were more aware (Average knowledge score = 11.56 ± 2.05) than their juniors. 80.7% of the students were willing to donate their eyes. The adjudged reasons for willingness to donate were that eye donation is a noble work and pleasure in helping a blind person while the reasons for unwillingness to donate were lack of awareness followed by family objection to eye donation. Conclusion Future medical practitioners possessed satisfactory knowledge about eye donation. Educating this cadre of human resources to sensitize them towards the need for eye donation would be a crucial step towards reducing the global burden of corneal blindness. KEY WORDS Attitude, Eye donation, Knowledge, Medical students, TransplantationPublication Pattern and Prevalence of Refractive Error and Secondary Visual Impairment in Patients Attending a Tertiary Hospital in Dhulikhel, Nepal(Kathmandu University, 2018) Kaiti, R; Pradhan, A; Dahal, HN; Shrestha, PABSTRACT Background Uncorrected refractive error is one of the most important causes of visual impairment worldwide. Objective To ascertain the pattern and prevalence of refractive error and secondary visual impairment in subjects attending Ophthalmology department. Method A prospective hospital-based study was designed where presenting visual acuity, age of presentation, refractive status, best corrected visual acuity and status of visual impairment were assessed in participants, ages ranging from 3-39 years presenting to the Ophthalmology department of Dhulikhel Hospital, Kathmandu University Hospital. History of use of spectacle was noted and participants were categorized into different visual impairment categories as per their presenting visual acuity. Result Out of a total of 4500 total clients examined during the study period, 388 (8.62%) had refractive error where 219 (56.44%) were females and 169 (43.56%) were males. Mean age at presentation was 22.70±7.69 years (range, 3-39 years). Astigmatism was the most common subtype seen in 373 eyes (48.06%), followed by myopia (366 eyes, 47.16%) and hypermetropia (31 eyes, 4.0%). Only 40.50% subjects who required refractive correction were using spectacle. 62.37% (242 clients) had some of visual impairment during their presentation. There was statistically significant improvement in visual acuity after refractive correction (p=0.00). Conclusion Uncorrected refractive error is one of the most important causes of visual impairment. Lack of awareness, infrequent ocular examination and lack of community or preschool vision screening were the main causes for the late presentation and significant visual impairment associated with the condition. Social stigma, economical limitation and negative counseling and attitudes about spectacle wear were primary factors behind the unsatisfactory spectacle use. KEY WORDS Astigmatism, Refractive correction, Refractive error, Visual impairmentPublication Quality of Life in Individuals with Tinnitus(Kathmandu University, 2025) Dhakal, A; Shrestha, BL; Pokharel, M; Pradhan, A; Shrestha, SABSTRACT Background Tinnitus, the perception of sound without an external acoustic stimulus, significantly impacts quality of life (QoL) and is often associated with hearing loss. Despite its prevalence, the psychosocial burden of tinnitus remains understudied in many populations. Objective This study evaluates tinnitus-related handicap and its association with emotional and social well-being in order to enhance treatment approaches. Method A descriptive cross-sectional study was conducted among 114 patients presenting with tinnitus at Dhulikhel Hospital, Nepal. The Tinnitus Handicap Inventory (THI) was used to assess severity, categorized as slight, mild, moderate, severe, or catastrophic. Audiometric evaluations classified hearing loss as conductive or sensorineural. Pearson’s chi-square test was performed using SPSS version 21, with significance set at p < 0.05. Result The median age of participants was 40 years (IQR: 20.25), with a female predominance (60.5%). Hearing loss was present in 50% of participants, predominantly sensorineural (82.8%) and bilateral (62.1%). Tinnitus Handicap Inventory scores indicated moderate handicap in 37.5%, severe in 15.8%, and catastrophic in 5.0%. No significant association was found between Tinnitus Handicap Inventory severity and age, sex, or hearing loss type. However, participants with hearing loss had nearly three times higher likelihood of being severe-to-catastrophic handicap [COR: 2.74, 95% CI: 1.25 – 5.99] (p-value = 0.011). Conclusion Tinnitus imposes a substantial psychosocial burden, particularly in individuals with concurrent hearing loss. The findings highlight the need for early psychological intervention and multidisciplinary management to mitigate tinnitus-related distress and improve quality of life. KEY WORDS Hearing loss, Psychosocial impact, Quality of life, Tinnitus, Tinnitus handicap inventoryPublication Refractive and Binocular Vision Status and Associated Asthenopia among Clinical Microscopists(Kathmandu University, 2022) Kaiti, R; Shrestha, JB; Dev, MK; Pradhan, AABSTRACT Background Clinical microscopists are at a greater risk of developing binocular vision anomalies and asthenopia. Objective To assess the refractive and binocular vision status and to explore the association between the presence of asthenopic symptoms and microscopy work among clinical microscopists working at medical laboratory department. Method This cross-sectional study involved 37 clinical microscopists working at medical laboratory department of Dhulikhel Hospital, Nepal. The study was conducted from January to December 2013. Only those participants who had been using microscope for at least a year were enrolled in this study. Each participant underwent distance visual acuity (VA) assessment, refractions, and orthoptic evaluation, including measurement of distance and near phoria, near point of convergence (NPC), near point of accommodation (NPA), positive fusional vergence (PFV), adduction, and calculation of accommodation convergence/accommodation (AC/A) ratio. The tear test was also carried out in each subject. Information about use of glasses, microscopy work (duration, and time spent per day in microscope), and visual symptoms associated with the use of microscope such as eye strain, headache, double vision, and near vision were collected. Result The mean age of the clinical microscopists was 29 ± 5.7 years. The prevalence of refractive error was 56.76% and the mean spherical equivalent (SE) refractive error was -0.77 ± 0.86 D. Refractive error had neither correlation with microscopy work and asthenopic symptoms associated with it, and nor with binocular vision parameters- NPC, AA and AC/A ratio. However, there was a positive association between asthenopic symptoms and microscopy work. There was statistically significant difference between symptomatic and asymptomatic subjects for binocular vision parameters, including NPC, AA and positive fusional vergence (PFV) for near. Conclusion Microscopy work has an impact on near binocular vision. Asthenopic symptoms bear a positive association with microscopy work. Refractive error has no significant correlation with either microscopy works or associated asthenopic symptoms. KEY WORDS Asthenopia, Binocular vision, Microscopists, Orthoptic, Refractive errorPublication Reversing AV Block and Cardiogenic Shock in STEMI Care: A Case Report on Use of Fibrinolysis and Inotrope without PCI in Rural Nepal(Kathmandu University, 2025) Pradhan, A; Tamrakar, P; Bhandari, J; Mahat, PABSTRACT Atrioventricular block and cardiogenic shock are critical complications of inferior wall myocardial infarction with high mortality, especially in resource-limited settings lacking percutaneous coronary intervention. We report a 53-year-old male smoker presenting to a rural hospital with acute chest pain, dyspnea, and profound hemodynamic instability with electrocardiogram showing inferior wall ST-segment elevation myocardial infarction with Mobitz type I atrioventricular block. This case highlights reversal of atrioventricular block with return of hemodynamic stablility using Streptokinase and ionotropes in a rural setting. Therefore, timely fibrinolysis and inotropes in managing inferior wall myocardial infarction with atrioventricular block and cardiogenic shock in percutaneous coronary intervention -inaccessible regions and strengthening rural ST segment elevation myocardial infarction care networks is crucial. KEY WORDS Atrioventricular block, Fibrinolysis, Percutaneous coronary intervention, Rural health, Shock cardiogenic, ST elevation myocardial infarctionPublication Role of Endoscopic Modified Inlay Butterfly Cartilage Perichondrium Myringoplasty in Hearing Outcome and Graft Uptake(Kathmandu University, 2017) Shrestha, BL; Dhakal, A; Pradhan, A; Rajbhandari, PABSTRACT Background The endoscopes have better optics and magnification with wide angle of view due to angled lenses. It provides the excellent resolution of image in surgeries having many difficult anatomic nooks and corners like; antero-inferior recess of external auditory canal, middle ear cavity and difficult areas to visualize under microspore like sinus tympani. Likewise, the use of cartilage has very low metabolic rate, provide support to prevent retraction and reacts minimally to inflammatory reaction, so it has advantageous role in closure of tympanic membrane perforations. Objective The main objective of our study is to see the graft uptake rate and hearing results after endoscopic cartilage myringoplasty with our own modification. Method This is a prospective, cohort study conducted among 37 patients who underwent endoscopic modified inlay butterfly cartilage perichondrium myringoplasty using tragal cartilage. The hearing was assessed by comparing pre with post-operative ABG (Air bone gap) and ABG closure in speech frequencies (500Hz, 1KHz, 2KHz, 4KHz). Result Among 42 patients, 37 (88.09%) had graft uptaken. Other five patients had residual perforation because of infection. The post-operative ABG was smaller than pre- operative ABG.(26.41±8.47dB and 36.57±12.13dB respectively). The mean ABG closure was 10.15±10.23dB. The ABG closure was ≤ 10dB in 28(75.6%) patients. Conclusion Endoscopic modified inlay butterfly cartilage perichondrium myringoplasty has advantages in terms of hearing results and graft uptake rate as it is comparable or even better than others. So, it is advisable to perform this technique without any difficulty. KEY WORDS Air bone gap, cartilage, endoscope, myringoplastyPublication Situation of antenatal care and delivery practices(Kathmandu University, 2005) Pradhan, AObjectives: The study aims to assess the situation of antenatal care usage and delivery practices in the study area. (i) To study the coverage rate for ANC and hospital delivery in different age group, parity, educational status and economic status. (ii)To study the relation of ANC visit and hospital delivery. Materials and method: The study design is descriptive cross sectional study. The study was carried out in ward no. 9 of Mahankal VDC, Kathmandu. 50 women of reproductive age group who had delivered live birth five years preceding the survey were selected. A semi- structured questionnaire was administered through informal interview. For the women with more than one child, the information was gathered for the last birth. The data were analyzed through the SPSS software. Results: Antenatal visit was a success story. Seventy eight percent of women were using the services. More notable fact was that the 62% of the respondents made antenatal visits for four or more than four times. Seventy two percent of the respondents y received the tetanus toxoid shots. Sixty six percent of the deliveries were hospital deliveries assisted by the doctors. However, 34% of deliveries occurred at home. The difference in ANC visit in different age groups and parity was not much obvious. The educational effect was clear as nearly double women who attained SLC or above, made four or more ANC visit as compared to illiterates. ANC seen as pathway to the institutional deliveries, once again proved its potential. Around 90% of women who made four or more ANC visits delivered in hospital as compared to 18.18% of women who never made any ANC visit. Conclusion: The rate of antenatal care use and hospital deliveries in the study area is found good in percentage. The rapid urbanization is taking place in nearby VDCs of Kathmandu. The hospitals in the Kathmandu are accessible to these VDCs. This could be the reason behind increased antenatal care usage and hospital delivery in the study area. Key words: antenatal care, deliveryPublication Sonographic Assessment of the Normal Dimensions of Liver, Spleen, and Kidney in Healthy Children at Tertiary Care Hospital(Kathmandu University, 2015) Thapa, NB; Shah, S; Pradhan, A; Rijal, K; Pradhan, A; Basnet, SABSTRACT Background Ultrasonography is one of the most common imaging modality to measure dimensions of visceral organs in children. However, the normal limit of size of visceral organs according to age and body habitus has not been specified in the standard textbooks. This might result in under detection of organomegaly in pediatrics population. Objective The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy children. Method This is prospective cross-sectional, hospital-based study done at Tertiary-care teaching hospital. Participants included 272 pediatric subjects (152 male and 120 female) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The subjects were one month to 15 year (180 months) old. All measured organs were sonographically normal. Relationships of the dimensions of these organs with sex, age, body weight and height were investigated. Limits of normal dimensions of these organs were defined. Result Normal length of liver, kidneys and spleen were obtained sonographically for 272 children (152 male [55.9%] and 120 female [44.1%]) in the age group from 1 months to 15 (180 months) years. The mean age was 45.78 months (SD, 44.73). The measured dimensions of all these organs showed highest correlation with height and age so the descriptive analysis of the organ dimensions (mean, minimum, and maximum values, SD and 5th and 95th percentiles) were expressed in 10 age groups along with height range of the included children. The mean length of right kidney was shorter than the left kidney length, and the difference was statistically significant (p = 0.001). Conclusion This study provides practical and comprehensive guide to the normal visceral organ dimension in pediatric population. The normal range limit of the liver, spleen, and kidney determined in this study could be used as a reference in daily practice in local radiology clinics. KEY WORDS Children, kidneys, liver, spleen, ultrasonography