Browsing by Author "Thapa, P"
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Publication A Comparative Study of Enhanced Recovery after Surgery Versus Non-Enhanced Recovery after Surgery in Emergency Surgery for Duodenal Ulcer Perforation(Kathmandu University, 2021) Thapa, P; Sharma, A; Mahato, NABSTRACT Background Enhanced recovery after surgery is a multimodal strategy, used to attenuate the loss and improve the restoration of functional capacity after surgery. Now widely used in elective surgery, the implementation of all of its components is not feasible in emergency surgery. Therefore, its tailored protocol is likely to give better outcome. Objective To investigate the feasibility and effectiveness of enhanced recovery after surgery in emergency surgery for Duodenal Ulcer Perforation. Method Hospital based study conducted at Nepalgunj Medical College, Kohalpur from September 2018 to 2020. Hundred patients underwent emergency laparotomy with Classical Graham’s Patch Repair. Fifty patients in the enhanced recovery after surgery group were managed as per the protocol and the rest were managed conventionally. Both the groups were compared in terms of length of hospital stay, functional recovery parameters and complications. Result There were 48 (96%) males and 2 (4%) females in enhanced recovery after surgery group and 45 (90%) males and 5 (10%) females in non-enhanced recovery after surgery group. The mean length of hospital stay in enhanced recovery after surgery group was 4.9 ± 0.76 days together with early functional recovery compared to 9.06 ± 2.44 days in non-enhanced recovery after surgery group (p < 0.05). Complications as per Clavien-Dindo grading were more in the non- enhanced recovery after surgery group (p=0.03). Conclusion Enhanced recovery after surgery is feasible and effective strategy resulting in early recovery, reduced hospital stay and complications in patients undergoing emergency surgery for duodenal ulcer perforation. KEY WORDS Duodenal ulcer, Enhanced recovery after surgery, Length of hospital stayPublication Ancient cystic pelvic schwannoma presenting as a right iliac fossa mass(Kathmandu University, 2005) Rai, BR; Chaudhary, D; Thapa, P; Joshi, MR; Dongol, UMS; Singh, DR; Sharma, SKSchwannoma is rare in pelvis. Ancient schwannoma is rarer histological subtype of schwannoma. We report a very rare case of pelvic schwannoma presenting with right sciatica and right iliac fossa pain. Clinical and imaging findings were suggestive of Peritoneal Hydatid cyst. The tumour was resected completely with marked clinical improvement. Histopathological examination showed Ancient cystic schwannoma. Key words: Benign pelvic Schwannoma, Benign retroperitoneal tumour, Giant ancient Schwannoma, Presacral Cystic SchwannomaPublication Comparison of Initial Response of Nebulized Salbutamol and Adrenaline in Infants and young Children Admitted with Acute Bronchiolitis(Kathmandu University, 2016) Adhikari, S; Thapa, P; Rao, KS; BK, GABSTRACT Background Acute bronchiolitis is common cause of hospitalization in infants and young children. There are widespread variations in the diagnosis and management. Despite the use of bronchodilators for decades, there is lack of consensus for the benefit of one above another. Objective To compare initial response of nebulized adrenaline and salbutamol. Method Children aged two months to two years admitted with acute bronchiolitis in the department of Paediatrics of Manipal teaching hospital, Pokhara, Nepal, from 1st March 2014 to 28th February 2015 were enrolled. Patients fulfilling inclusion criteria received either adrenaline or salbutamol nebulization. Data were collected in a predesigned proforma. Respiratory distress assessment instrument (RDAI) scores were considered primary outcome measure and respiratory rate at 48 hours, duration of hospital stay, requirement of supplemental oxygen and intravenous fluid were considered secondary outcome measure. Result A total of 40 patients were enrolled in each study group. Mean RDAI scores at admission was in 9.75 with (CI- 9.01, 10.49) in adrenaline and 9.77 (CI- 9.05, 10.50) in salbutamol group. There was gradual decline in mean RDAI scores in both the groups over 48 hours to 4.15 (CI- 3.57,4.73) and 4.13 (CI- 3.69,4.56) in adrenaline and salbutamol group respectively. Hospital stay was 5.32 days in adrenaline and 5.68 days in salbutamol group. Patients nebulized with adrenaline required oxygen for 33.30 hours compared with 36.45 hours in salbutamol. Intravenous fluid duration was also less in adrenaline group compared to salbutamol group (33.15 vs 37.80 hours). Conclusion Patients of acute bronchiolitis nebulized with either salbutamol or adrenaline experienced similar decline in RDAI scores in the first 48 hours. Duration of supplementary oxygen and intravenous fluid was less in adrenaline group compared with salbutamol group. KEY WORDS Acute bronchiolitis, adrenaline nebulization, salbutamol nebulizationPublication Complex Regional Pain Syndrome(Kathmandu University, 2024) Shakya, S; Amatya, S; Thapa, S; Thapa, P; Pokharel, SABSTRACT Complex regional pain syndrome is chronic pain condition involving hyperalgesia and allodynia of extremities. The pathophysiology of CRPS is thought to be combination of different factors that take place at the time of initial injury. Sixty two years female presented to us with severe leg pain after intravenous cannulation during her spine surgery and associated with hyperalgesia and allodynia. On examination, there was shinny skin and nail changes on right leg and significant surface temperature difference between two legs. Patients were managed conservatively with patient education, physical therapy, pharmacological management, and psychological therapy with diagnosis of complex regional pain syndrome. Diagnosis is a clinical finding based on the Budapest diagnostic criteria. Early treatment with multidisciplinary approach to pain management is necessary to achieve complete recovery and prevent damage. Complex regional pain syndrome is life altering condition but understanding the etiological factors helps us to an early diagnosis and a better implementation of treatment. KEY WORDS Allodynia, Budapest criteria, Complex reginal pain syndrome, HyperalgesiaPublication Compliance and its Determinants Regarding Iron and Folic Acid Supplementation during Pregnancy in Kathmandu, Nepal(Kathmandu University, 2016) Rai, SS; Ratanasiri, T; Arkaravichien, T; Thapa, P; Koju, RABSTRACT Background Iron deficiency anemia is one of the major public health problems mostly affecting pregnant women of developing countries like Nepal. Kathmandu, the capital city of Nepal, has considerably high prevalence of anemia, which is attributed to inadequate dietary iron and problems of compliance to iron and folic acid supplementation. Objective This descriptive study aimed to identify the levels of and determinants associated with compliance regarding Iron and folic acid supplementation among pregnant women in Kathmandu, Nepal. Method The study was conducted in Paropakar Maternity and Women’s Hospital in Kathmandu. Systematic random sampling was done to select a total of 406 samples that were either handed questionnaire for self-administration or interviewed. The χ2 test and multiple linear regressions were used for statistical analysis. Result The findings showed 73.2% of the respondents had high compliance, 12.8% moderate compliance, and 14% low compliance to iron and folic acid supplementation. More than half of the respondents had insufficient knowledge regarding anemia, iron deficiency and iron and folic acid supplementation. Multiple linear regression revealed that perceived severity, perceived barriers and social support were determinants of compliance to iron and folic acid supplementation (p<0.05). Conclusion This study infers that there is a lack of knowledge and awareness regarding anemia, iron deficiency, and iron and folic acid supplementation among pregnant women, and improvement in social support and perception of severity of the disease, and minimization of associated barriers may lead to better outcome in terms of compliance to iron and folic acid supplementation among pregnant women. KEY WORDS Anemia, compliance, iron, pregnant women, supplementationPublication Delirium in Critically ill Patients in a Tertiary Care Centre in Western Region of Nepal(Kathmandu University, 2014) Thapa, P; Chakraborty, PK; Khattri, JB; Ramesh, K; Sharma, PABSTRACT Background Delirium affects a significant proportion of critically ill patients admitted in hospital. It is associated with various adverse outcomes. Despite its enormous prognostic significance it tends to be underdiagnosed. There is a dearth of studies on risk factors of delirium in our setting. Objectives The main objectives of this study was to find out the prevalence, rate of non recognition and risk factors associated with delirium in hospitalized critically ill patients. Methods A hospital based cross-sectional study was carried out. Data was collected using a predesigned semi-structured proforma and Intensive care delirium screening checklist was used to screen for delirium in patients admitted in various wards of Manipal teaching hospital, Pokhara, Nepal. Results Ninety five cases were included in the analysis. The mean age of study group was 58.9 ± 19.1 years. Delirium was present in 15/95 cases and it was not recognized by treating physician in about one third of cases. Odds ratio (OR) was statistically significantly increased in patients with history of stroke (OR=4.484 95% CI=1.0896;18.459), alcohol use (OR=10.792 95% CI=2.906;40.072), smoking (OR= 4.836 95% CI= 1.411;16.576), use of restraint (OR=17.143 95% CI=4.401;66.766), nasogastric tube placement (OR= 7.731 95% CI=2.348;25.452) and use of Foley’s catheter (OR=12.000 95% CI= 3.072;46.877). Conclusion About 16% of critically ill patients were found to be delirious. In about one third of the cases delirium was not recognized. Both patient related and iatrogenic factors may increase the risk of delirium in hospitalized critically ill patients. KEY WORDS Critical care, delirium, non-recognitionPublication Empyema thoracis(Kathmandu University, 2007) Singh, DR; Joshi, MR; Thapa, P; Nath, SAbstract Objective: To review the management of Empyema Thoracis in the surgical department of Kathmandu Medical College Teaching Hospital. Methods: Thirteen cases with Empyema thoraces treated in the surgical department of the hospital with different modalities of treatment was taken for study and analyzed for morbidity, mortality, and hospital stay. Results: there was a single mortality in the thoracotomy group. Video assisted thoracic surgery or VATS debridement or deloculation was successful in the eight of the patients with shorter stay in the hospital. One patient who refused surgery was treated with streptokinase with good result. Conclusion: Streptokinase may be effective in the treatment of empyemas. Video assisted thoracic surgery or VATS has definite advantage over traditional surgery in terms decreased morbidity, mortality, earlier hospital discharge and cosmesis in the treatment of empyema. Keywords: Empyema thoracis, VATS, Decortications, StreptokinasePublication Intra-abdominal abscess presenting as a thigh abscess(Kathmandu University, 2004) Chaudhary, D; Magar, A; Thapa, P; Singh, DR; Sharma, SKSecondary thigh abscesses are rare, and their cause is often obscure. We report a case of an elderly diabetic who presented with thigh abscess secondary to tuberculous sacroilitis. Key words: Secondary thigh abscess, retroperitoneal abscess, tuberculous sacroilitisPublication Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization(Kathmandu University, 2022) Vaidya, N; Karmacharya, RM; Vaidya, S; Bade, S; Bade, S; Paudel, K; Kandel, G; Thapa, P; Maharjan, R; Duwal, S; Karki, YABSTRACT Hemoptysis is a crucial entity taking into account its morbidity and mortality. Pulmonary tuberculosis is the leading cause for massive hemoptysis in our part of the world, which if left untreated may be life threatening. We present a case of a 37-year-old male patient with pulmonary tuberculosis with concurrent pulmonary thromboembolism presenting with massive hemoptysis, which was successfully managed with Bronchial Artery Embolization. This case represents that this measure can be a viable therapeutic choice for a patient with a severe life- threatening hemoptysis, particularly when other treatment options are unavailable or ineffective. KEY WORDS Bronchial arteries, Embolization, Hemoptysis, TherapeuticPublication Medication Adherence to Oral Hypoglycemic Agents Among Type II Diabetic Patients and Their Clinical Outcomes with Special Reference to Fasting Blood Glucose and Glycosylated Hemoglobin Levels(Kathmandu University, 2013) Shrestha, SS; Shakya, R; Karmacharya, BM; Thapa, PABSTRACT Background Oral hypoglycemic agents (OHAs) are the major treatment for people with type 2 diabetes mellitus (DM2). However, non-adherence to OHAs remains as one of the main reasons for poor glycemic control. Objectives To assess the adherence pattern to OHAs and clinical outcomes with special reference to fasting blood glucose (FBG) level and glycosylated hemoglobin (HbA1c) levels. Methods Informed consent was obtained from patients fulfilling the criteria and from the patient party in case of incapacitated patients. Information was obtained by interviewing them and filled in the appropriate questionnaire. All the medical information of the patients was obtained from the medical case records and laboratory reports. Results OHAs had been discontinued by 25% of patients. Overall 38% had ever discontinued and/ or often missed OHAs. Intentional discontinuation of OHAs attributed for 72% of the patients, followed by forgetfulness (42.9%), carelessness (30.6%), and hypoglycemia, (24%). There were 50.50% patients who had uncontrolled FBG (>130 mg/dl) level and 39% had uncontrolled HbA1c (≥ 7%) level. Taking reference age group 51-60 years, control of FBG level was found to be statistically associated with the decreasing age group (p = 0.006, OR = 4.8) as well as increasing age group (p = 0.008, OR = 4.034). There was significant association between controlled HbA1c level and patients’ knowledge about the precautions to be taken while using OHAs (p = 0.044, OR = 4). However, there was no significant association between glycemic control and OHAs adherence. Conclusion Majority of the patients who had missed OHAs attributed it to forgetfulness. Hypoglycemia may also be one of the contributing factors for poor adherence to OHAs. However no association was found between adherence and various other factors like age groups, treatment complexity, health literacy and social or family support. KEY WORDS Adherence, diabetes, HbA1c, hypoglycemia, non-adherencePublication Omental torsion: a case report(Kathmandu University, 2005) Chaudhary, D; Rajkarnikar, R; Joshi, MR; Thapa, P; Singh, DR; Sharma, SKOmental torsion is a rare cause of acute abdomen. Most often it presents with sign and symptoms of acute appendicitis. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during surgery. We present a case of omental torsion in a middle aged male patient who presented with findings suggestive of appendicular perforation and underwent emergency laparotomy. Key words: acute abdomen, omentum, torsion, appendicitisPublication Postoperative Analgesic Effect of Morphine Added to Bupivacaine for Transversus Abdominis Plane (TAP) Block in Appendectomy(Kathmandu University, 2017) Ghimire, A; Bhattarai, B; Prasad, JN; Subedi, A; Thapa, P; Limbu, PM; Adhikari, SABSTRACT Background Transversus abdominis plane (TAP) block with local anaesthetics produces effective pain relief following lower abdominal surgeries. Although opioids have been found to have effects through peripheral receptors also, reports on their effect when used as additive to local anaesthetics for TAP block are lacking. Objective To assess the analgesic effect of peripherally administered morphine with bupivacaine for ipsilateral TAP block in patients undergoing emergency appendectomy under general anaesthesia. Method Sixty patients undergoing appendectomy were randomized to undergo ipsilateral TAP with 20 ml of 0.5% bupivacaine plus 2 ml of NS (total 22 ml) and 2 ml of intravenous (IV) saline (Group TB) or with 20ml of 0.5% bupivacaine plus 2 mg (2 ml) of morphine (total 22 ml) and 2 ml of NS IV (Group TBM) or with 20 ml of 0.5% bupivacaine plus 2 ml of NS (total 22 ml) and 2 mg (2 ml) IV morphine (Group TB-IVM). Pain severity was measured using Visual Analogue Scale (VAS) preoperatively (Baseline) and at 30 min, 6h, 12 h and 24 h postoperatively. Inj. tramadol 50 mg IV was used as rescue analgesic when postoperative VAS was 4 or more. The duration of analgesia (time to first analgesic) and the postoperative 24 h tramadol requirement was recorded. Result The mean duration of analgesia in Group TBM was significantly longer (801.50 ± 74.92 min, p=0.002) than in Group TB (720.00 ± 42.17 min) and Group TB-IVM (712.70 ± 40.94 min). The mean postoperative 24 h tramadol requirement was also less in Group TBM (69.23 ± 25.31mg) than in Groups TB (100.00 ± 38.34 mg) and TB-IVM (95.00 ± 39.40 mg) but did not reach the level of statistical significance (p=0.057). Significantly less ondansetron was required in Group TBM (3.80 ± 2.04 mg) than in Group TB (6.80 ± 2.93 mg) and TB-IVM (6.00 ± 2.75 mg) (p=0.002). Conclusion Morphine added to bupivacaine effectively prolongs the analgesic duration of TAP block in appendectomy. KEY WORDS Morphine, postoperative analgesia, transversus abdominis plane block, USG guidedPublication Prevalence and Associated Factors of Cesarean Section in Dhulikhel Hospital, Kathmandu University Hospital(Kathmandu University, 2022) Acharya, R; Singh, B; Nepal, J; Thapa, P; Pandey, C; Pandey, J; Shrestha, S; Khan, A; Pun, KDABSTRACT Background The Cesarean Section (CS) is a major obstetric life-saving procedure used to avoid pregnancy and childbirth complications. Cesarean sections are becoming more popular across the world, as well as in Nepal. Objective To assess the prevalence of cesarean section and its associated factors among women in Dhulikhel, Nepal. Method A cross-sectional study was conducted where 1246 pregnant women of age 15-45 years, admitted and delivered in hospital, were selected through purposive sampling technique and interviewed using structured questionnaires in Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal. Result The prevalence of cesarean section among women was 39.7% where the most common indication was previous cesarean section with scar tenderness, 27.9%. Half of the participants, i.e. 50.6%, were primigravida. Majority of women, 97.5% had done their antenatal checkup and among them 74.8% had their checkup in Dhulikhel Hospital, Kathmandu University Hospital. Most of them, i.e.76.2% had emergency cesarean section and 69.5% had primary cesarean section. Women of the age group 30-45 years (AOR=2.23) and women with higher secondary education level (AOR=2.03) were two times more likely to perform cesarean section. Women involved in service (AOR=1.37) and business (AOR=1.23) had greater odds of performing cesarean section than homemakers. Women giving birth to infants weighing 3.51- 5.00 kg were more likely to perform cesarean section (AOR=1.33). Conclusion The prevalence of cesarean section is noticeably high where the educated, employed and higher aged women are more inclined to cesarean section. More obstetric factors could be explored to determine the rise in cesarean section in Nepal which can help in decision making for clinicians. KEY WORDS Cesarean section, Dhulikhel hospital, PrevalencePublication Relation of Sociodemographics and Personal Hygiene on Different Childhood Dermatoses(Kathmandu University, 2015) Gauchan, E; Kumar, A; BK, G; Thapa, P; Pun, JABSTRACT Background Skin diseases in children contribute to significant morbidity and psychological distress. Infective dermatoses are one of the major dermatoses in children. Low socioeconomic status, overcrowding and poor personal hygiene has been linked to skin diseases. Objective To find out the prevalence of infectious skin disease in children, rate of transmissible skin disease and association of sociodemographic factors and personal hygiene on infective childhood dermatoses. Method This was a cross-sectional study conducted in the Pediatric and Dermatology Department, Manipal Teaching Hospital, Pokhara, Nepal. A total of 226 patients were examined over a period of one year. Relation of sociodemographics, crowding and personal hygiene on skin disease were assessed. Result The most common category was Infections and Infestations (51.3%) followed by Dermatitis (27.9%) . Transmissible skin disease was seen in 49.6%. Low socioeconomic status and overcrowding were associated with increased risk for infective dermatoses. Conclusion Skin disease in children constitutes a public health problem. Improving the socioeconomic status and personal hygiene can help to reduce the incidence of skin disease in children. KEY WORDS Infections and infestations, personal hygiene, sociodemographicsPublication Role of Staging Laparoscopy in Gallbladder Cancer(Kathmandu University, 2020) Sharma, A; Thapa, PABSTRACT Background Preoperative accurate staging of gallbladder cancer is still difficult. A number of patients with gallbladder cancer who undergo laparotomy for curative resection are ultimately found to have unresectable disease. The benifit of staging laparoscopy is its ability to find out the radilogical occult intraperitoneal metastasis and to spare from nontheraputic laparotomy. The role of staging laparoscopy has been extensively studied in hepatobiliary and pancreatic malignancies and found to be useful. But in recent time its utility in biliary cancers is sceptical probably because of the advent of positron emission tomography. However in gallbladder cancer it is still recommended. Objective To identify the utility of staging laparoscopy in gall bladder cancers. Method Hospital based study conducted at Nepalgunj Medical College, Nepal from October 2014 to June 2020. The patients with resectable gallbladder cancers on computed tomography were included. All patients underwent single stage staging laparoscopy. Staging laparoscopy was considered positive if the surface lesions (liver and/or peritoneal deposits) were detected. The surgery was terminated if positive. Patients with negative staging laparoscopy were proceeded with laparotomy. Result Staging laparoscopy was done in 47. The yield of staging laparoscopy was 14 (29.78%) and its accuracy was 58.33% (14/24). Out of 33 (70.21%) with negative staging laparoscopy, 10 (30.3%) had unresectable disease in laparotomy. The yield was higher in locally advanced in comparison to early disease (78.57% Vs 21.42%). Conclusion We recommend routine staging laparoscopy in gallbladder cancer, particularly when the disease is locally advanced. KEY WORDS Accuracy, Gallbladder cancer, Locally advanced disease, Staging laparoscopy, YieldPublication Study of Two Different Volumes of 0.75% Ropivacaine for Ultrasound Guided Supraclavicular Brachial Plexus Block on Successful Blockade and Diaphragmatic Motility(Kathmandu University, 2022) Prasad, JN; Adhikari, S; Singh, SN; Subedi, A; Thapa, P; Guddy, KM; Sarraf, DPABSTRACT Background Use of ultrasound guidance during supraclavicular brachial plexus block allows the usage of a lower anesthetics dose and minimizing unwanted effects of the anesthesia. Objective To compare the success of sensory blockade and the incidence of hemidiaphragmatic dysfunction in patients receiving two different volume of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Method A prospective randomized double-blinded comparative study was conducted. Group A patients (n=30) received 20 ml and Group B (n=30) received 25 ml of 0.75% Ropivacaine for ultrasound guided supraclavicular brachial plexus block. Hemodynamic parameters, oxygen saturation, diaphragmatic excursion, onset of sensory blockade and time for completion of blockade were measured. Independent t-test, Chi-square test and Mann-Whitney U test were used to analyze the data at p value of less than 0.05 using Statistical Package for Social sciences (version 11.5). Result At 30 minutes, 29 (96.67%) patients in group B and 27 (90.0%) patients in group A had no sensation in median, radial, ulnar, musculocutaneous and medial cutaneous nerves teritories; however, it was not significant statistically (p value > 0.05). At 30 minutes in Group A, 25 (83.33%) patients had no diaphragmatic hemiparesis and five (16.67%) patients had partial diaphragmatic hemiparesis. However, three (10%) patients had no diaphragmatic hemiparesis in Group B, 25 (83.33%) patients had partial and two (6.67%) patients had complete diaphragmatic hemiparesis and it was statistically significant (p < 0.05). Age and sex had no effect on diaphragmatic hemiparesis in both groups (p value > 0.05). Conclusion The patients receiving lower volume of Ropivacaine had less incidence of hemidiaphragmatic dysfunction with similar sensory blockade as compared to the patients receiving higher volume of Ropivacaine. KEY WORDS Brachial plexus block, Diaphragmatic motility, RopivacainePublication The outcome of Radial Neck Fracture Treated with Closed/ Open Reduction and Retrograde Kirschner Wires Fixation in the Paediatric Age Group(Kathmandu University, 2022) Sapkota, K; Ranjeet, N; Onta, PR; Thapa, PABSTRACT Background Radial neck fractures in children are rare injuries, representing 1 to 5% of all elbow pediatric fractures. Most of them are non-displaced or slightly displaced and treated conservatively. Severely displaced or angulated radial neck fractures (Judet type III and IV fractures or O’Brien type III radial neck fractures) requires surgical treatment. Objective To study the clinical and radiological outcomes of fractures following closed or open reduction and percutaneous intramedullary stabilization of the displaced radial neck fracture in children. Method There were 24 children with displaced radial neck fracture Judet type II, III and IV fractures O’Brien type II, III who underwent closed reduction and retrograde intramedullary stabilization with Kirschner wires. Functional outcomes were evaluated based on of Mayo Elbow Performance Score. Result The mean age of patients was 8.42 ± 1.82 years with boys 15(62.5%) and girls 9(37.5%) in number. An excellent result was seen in 5(20.8%) cases and good results in 15(62.5%) cases according to the Mayo elbow performance score. Analyzing a passive and active range of motion, 5 had excellent results, 15 had good results and 4 had fair results compared to the normal side. Radiological evaluation showed fracture healing in excellent or good alignment according to Ursei radiological evaluation classification. Conclusion Closed reduction and retrograde intramedullary Kirschner wires stabilization for the displaced radial neck fracture provide excellent clinical and radiological results with few complications. KEY WORDS Kirschner wires fixation, Paediatric elbow, Radial neck fracturePublication Toxic epidermal necrolysis masquerading as scald burn(Kathmandu University, 2007) Mahat, B; Pandit, N; Shrestha, R; Rupakheti, S; Thapa, P; Neopane, A; Joshi, KDNA