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Fulminant Hepatic Failure Due to Dengue
(Kathmandu University, 2011) Sedhain, A; Adhikari, S; Regmi, S; Chaudhari, SK; Shah, M; Shrestha, B
ABSTRACT: Dengue Fever (DF) is only rarely considered as a cause of acute liver failure even globally and only a few case reports of acute hepatic failure and encephalopathy occurring in DF in adults are available. We report a case of Acute Liver Failure due to Dengue during a major outbreak in 2010 in Chitwan. A 20 year old previously healthy female presented to the emergency department of Chitwan Medical College with fever, jaundice and altered sensorium. She was tested positive for Dengue IgM. Her biochemical and clinical parameters were suggestive of acute liver failure with total billirubin of 10.1 mg/dL, direct billirubin of 5.2 mg/ dL, ALT 5760 IU, AST 14100 IU, alkaline phosphatase of 1250 IU, PT INR of 1.76 and platelet count of 30,000 /mm3. Other causes for acute hepatic failure like acute viral hepatitis, leptospirosis, malaria, Reye’s syndrome were ruled out. The patient was admitted and managed in the ICU with supportive care and platelet transfusion. With treatment she made a significant clinical and biochemical improvement with AST of 105 IU, ALT of 120 IU and platelet count of 150,000/mm3. She was discharged after 11 days of hospital stay. KEY WORDS Dengue, Dengue Hemorrhagic Fever, Fuminant Hepatic failure
Triiodothyronin, Thyroxine and Thyrotropin in Vitiligo
(Kathmandu University, 2011) Subba, K; Karn, D; Khatri, R
ABSTRACT Background Vitiligo is a common pigmentary disorder of the skin, affecting individuals globally. Not only is this ailment psychologically incapacitating, it also has a high incidence of autoimmunity, signifying that its manifestations may be the portrayal of dysfunction of immune system. Objective The aim of this study is to find out the situations of abnormal thyroid function test (TFT) in vitiligo patients. Methods A prospective cross sectional study was conducted at the Dhulikhel Hospital, KUTH, Dhulikhel during November 2008 to January 2011 with the objective to assess the thyroid function tests in vitiligo patients. Results Total 66 vitiligo patients with male 30 (45%) and female 36 (55%). Total 26 (39.39%) vitiligo patients have been found to have abnormal thyroid function test. Among them 10 had abnormal T3, seven had abnormal T4 and 12 had abnormal TSH level. Thyroid function test were normal in other vitiligo patients. Total seven vitiligo had high level of T3 than normal value, four male and three female. Two had higher level of T4 above 2.0 ng/dl and all were male, while five had abnormally low level of T4 with three male and two female. There were seven vitiligo patient with increased T3 level and three with decreased T3 level, among them six were males and four were females, the age group was ranged from seven to 68 years old. The T4 level were found abnormal in seven vitiligo patients among which five were males and two were females with the age group ranging from 7 to 51 years. Conclusions There has been significant association of thyroid disorder in the patient with vitiligo. Therefore, patient with vitiligo need to undergo thyroid function test to rule out the thyroid disorder and prevent from long-term complications. KEYWORDS thyroid, thyroxin, thyroid function test, vitiligo
Bacterial Conjunctivitis and Use of Antibiotics in Dhulikhel Hospital - Kathmandu University Hospital
(Kathmandu University, 2011) Sthapit, PR; Tuladhar, NR; Marasini, S; Khoju, U; Thapa, G
ABSTRACT Background Acute Infective Conjunctivitis may be due to viral or bacterial infection; though it is usually self limiting, topical antibiotics are often prescribed for rapid recovery. Objectives This study aims to find out prevalence of bacterial infection among cases of acute infective conjunctivitis and to determine their in-vitro antibacterial susceptibilities to commonly used antibacterial agents and to find out whether the rampant use of topical antibiotics are at all necessary or justified. Methods A prospective analytical study conducted over a period of two years on clinically diagnosed cases of Acute Infective Conjunctivitis. Isolation and identification of microorganisms by culture and antimicrobial susceptibility test were done on conjunctival swabs from 65 patients. Results A total of 65 patients were included where children (one month to 10 years old) accounted for the commonest age group (35.4%).On Gram’s Stain, 90.8% were negative for pus cells or micro organisms. Gram positive cocci were found in 6.2% of cases. On culture, bacterial growth was seen in 11 cases (18.9%) among which Streptococcus pneumonia was seen in seven cases (10.8%).The analysis on in-vitro susceptibility testing showed that Chloramphenicol and Gentamicin were the most sensitive (78.6% of samples) drugs for conjunctivitis. Conclusion Ophthalmic antibiotics should be prescribed judiciously in acute infective conjunctivitis even for suspected bacterial cases; since it is found to resolve spontaneously without any serious complications. Chloramphenicol and Gentamicin are drugs of choice if at all required. Key Words acute infective conjunctivitis, bacterial conjunctivitis, chloramphenicol, gentamicin
Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Diametaphyseal Tibia Fracture
(Kathmandu University, 2011) Shrestha, D; Acharya, BM; Shrestha, PM
ABSTRACT Background Distal diametaphyseal tibia fracture though requires operative treatment is difficult to manage. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed reduction and minimally invasive plate osteosynthesis (MIPO) with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia and fracture hematoma and also provides biomechanicaly stable construct. Objectives To find out suitability of MIPO with LCP for distal diametaphyseal tibia fracture including union time and complicatios and compare wih other available management options in literature. Methods Twenty patients with closed distal diametaphyseal tibia fracture with or without intra articular extension (AO classification: 12 type 43A1, 4 type 43A2, 2 type 43A3 and 2 type 43B1) treated with MIPO with LCP were prospectively followed for average duration of 18.45 months (range 5-30 months). Results Average duration of injury-hospital and injury-surgery interval was 12.8 hrs (range 2-44 hrs) and 4.45 days (range 1-10 days) respectively. All fractures got united with an average duration of 18.5 weeks (range14-28weeks) except one case of delayed union which was managed with percutaneous bone marrow injection. Two patients had union with valgus angulation < 5 degees but no nonunion was found. There were two superficial and one deep post operative wound infection. All infections healed with extended period of intravenous antibiotics besides repeated debridemet for deep infection. Implants were removed in eight patients among whom six (30%) had malleolar skin irritation and pain due to prominent hardware. Conclusion The present case series shows that MIPO with LCP is an effective treatment method in terms of union time and complications rate for distal diametaphyseal tibia fracture. Malleolar skin irritation is common problem because of prominent hardware. Key Words Distal diametaphyseal tibia fracture; LCP, MIPO
Antenatal Care Practices in Tamang Community of Hilly Area in Central Nepal
(Kathmandu University, 2011) Sanjel, S; Ghimire, RH; Pun, K
ABSTRACT Background Antenatal care is provided during pregnancy to save lives of mother and foetus. World Health Organization recommends four focused visits as sufficient for normal pregnancy. Objective The objective of the study was to find out antenatal care practices in Tamang community of hilly areas of central Nepal. Methods Descriptive cross-sectional study was conducted in Tamang community of Lalitpur district. Systematic random sampling method was used to collect data from April to May 2011. Data of 194 women having ≥3 years of children was collected and analyzed in descriptive and inferential ways. Results Antenatal visits were made by 78.9% (153) of women but only 46.4% (71) completed four antenatal visits. Mean visit was of 3.5 ± 1.13 times. Ninety four (61.4%) of first antenatal visits attainders completed the fourth visit. Age of women and antenatal visits, taking tetanus toxoid injection and knowledge on work of iron tablets exhibited significant association at 95% level of confidence (p <0.05). There was also significant association between numbers of childbirth and antenatal visits at 95% level of confidence (p <0.05). Conclusions There was a high rate of early marriage and early pregnancy in the Tamang communities. Women did not place high importance on antenatal visits. A large percentage did not complete all four recommended antenatal visits. Use of necessary medicine like iron, albendazole tablets and tetanus toxoid injection was often incomplete. KEY WORDS antenatal visits, central Nepal, hilly areas, Tamang
Correlation of Calcium, Phosphorus, Uric Acid and Magnesium Level in Serum and 24 hours Urine of Patients with Urolithiasis
(Kathmandu University, 2011) Gyawali, PR; Joshi, BR; Gurung, CK
ABSTRACT Bakcground Urinary stones disease is common pathology encountered in urological practice in Nepal. Supersaturated urine and its stagnation are well known facts for the development of urolithiasis. Metabolic disorders like hypercalciuria, hyperuricaemia, hypocitraturia are also responsible for formation of urolithiasis. Objective The aim of this study was to identify the level of calcium, phosphorus, uric acid, and magnesium in the blood and urine of Nepalese patients with urinary stones. Methods This study was conducted over a period of six months (From May to November 2010). It is a descriptive cross sectional study and quantitative method was used for analysis. Primary data were collected and utilized from 79 cases. Results: The prevalence of urolithiasis in male patients was 65.8% and 34.2% in female patients (p<0.05). Serum calcium in stone former and non-stone former was 8.3±1.2 and 7.5±1.5 (p<0.01) respectively. Serum phosphorus and uric acid in both groups were statistically not significant (p value 0.269 and 0.597 respectively) though in 24 hours urine of stone formers value of phosphorus was 447.9±182.4 but in non-stone formers it was 186.5±118.7 (p<0.001). Magnesium level in urine was 48.1±69.7 and 131.4±86.9 (p<0.001) respectively. Conclusion Higher level of calcium in serum was found in patients with urolithiasis in our population. Though phosphate level in blood serum was not different in the both groups but in urine phosphate and magnesium levels were significantly different. KEY WORDS hypercalciuria, hyperphosphaturia, hyperuricosuria, hypocitraturia, urolithiasis
Sonographic Measurement of Fetal Pinna Length in Normal Pregnancies
(Kathmandu University, 2011) Joshi, KS; Chawla, CD; Karki, S; Shrestha, NC
ABSTRACT Background Many studies have emphasized on fetal pinna measurements and morphologic features to use this structure as an additional marker for fetal chromosomal anomaly. Objectives To assess relationship between fetal pinna length and gestation age and develop a nomogram. To assess relationship between fetal pinna length and head circumference and biparietal diameter. Methods Fetal pinna measurements from the tip of helix to the end of lobe were obtained prospectively in 850 singleton pregnant women between 15 and 40 weeks’ gestation Normal case was defined as normal sonographic findings during examination and normal infant examination at birth or both. Final study population was 787. The relationship between gestational age in weeks to pinna length in millimeters was analyzed by simple linear regression. Correlation of fetal ear length measurements with gestational age, biparietal diameter and head circumference were also obtained. Results Linear relationships were found between fetal pinna length and gestational age [Pinna Length (mm)=1.044xGestational age (weeks) -3.857]. A nomogram of normal pinna length was obtained. High correlation was found between pinna length and gestational age (r=0.942; p< 0.001), pinna length and head circumference (r=0.931; p< 0.001). Significant correlation was found between pinna length and biparietal diameter (r=0.934; p=0.004) Conclusions The results of this study provide a nomogram for fetal pinna. The study also provides relationship and good correlation between pinna length and other biometric measurements. KEY WORDS gestational age, pinna length, sonography
Prevalence of Sexually Transmitted Infections in a Tertiary Care Centre
(Kathmandu University, 2011) Karn, D; Amatya, A; Aryal, ER; KC, S; Timalsina, M
ABSTRACT Background The burden of sexually transmitted infections is huge and is disproportionately affecting developing nations. In Nepal, recent available data on sexually transmitted infections are mostly targeted to high risk population. A prevalence study was thus done to explore the pattern of sexually transmitted infection syndromes among general population of Nepal. Objectives To highlight the prevalence and changing pattern of sexually transmitted infections among general population. Methods A retrospective study. The study was conducted among 145 patients attending Department of Dermatology and Venerology, Dhulikhel Hospital Kathmandu University Hospital, for voluntary counseling and testing from April 2010 to April 2011. Syndromic case management approach was used for the classification and treatment of the patients. Results 106 patients were suffering from Sexually Transmitted Infections and 2 patients were positive for Human Immunodeficiency Virus. The most common diagnosis was genital viral infections (41.7%). Prevalence was highest among drivers/conductors (26.9%) and migrating workers (23.1%). Age group 20 to 24 years was the maximum sufferers (37%). Unsafe sexual activity (66.7%) was the most potential exposure and majority of the patients were not consistent in using condom. Conclusions Genital viral infections constitute the major bulk of sexually transmitted infections. Majority of the patients suffering from sexually transmitted infections were in the age group 20 to 24 years and were mostly drivers, conductors or migrating workers by occupation. In the background of few available baseline data, the results are expected to assist successful target interventions in the near future. KEY WORDS prevalance, sexually transmitted infection
Incidence of Hypertension in Patients Undergoing Surgery at Dhulikhel Hospital - Kathmandu University Hospital
(Kathmandu University, 2011) Sapkota, S; Sherpa, M; Bhattarai, B
ABSTRACT Background Hypertension is an important public health challenge worldwide and is most important modifiable risk factor for cardiovascular, cerebrovascular and renal disease. Blood pressure determination forms an integral part of anaesthesiologist’s evaluation of hispatient’s condition prior to and during surgery. Data are not available which indicate changes in blood pressure occurring preanaesthetically in hospitalized patients. There are several risks from untreated preoperative hypertension in perioperative and postoperative phase. Objective To know the incidence of hypertension in preoperative patients undergoing major surgery Methods This retrospective observational study was based on the data collected from preanaesthetic checkup record book from January 2010 to December 2010. Results A total of 955 patients were studied and analyzed in terms of hypertension and demographic characteristics. The total incidence of hypertension in preoperative phase was 10.16%. Among them 64.9% being male and 35.1% female. Maximum incidence was found in age group 50-59 years i.e. 26.6%. Among the case detected maximum patients i.e. 52% were patients with newly diagnosed hypertension and among those under medications 61.1% were using calcium channel blockers. Conclusion Knowing the incidence will help in proper preoperative optimization of the hypertensive patients and also help in decreasing the incidence of postoperative complications.. KEY WORDS anaesthesia, calcium channel blockers, diuretics, hypertension,
Haemolytic Effects of Hypo-osmotic Salt Solutions on Human Erythrocytes
(Kathmandu University, 2011) Nepal, O; Rao, JP
ABSTRACT Background While it is well known that hypotonic solutions of sodium chloride induce hemolysis, the effects of other salt solutions on human erythrocytes have not been well documented. Objective The study is to compare the effects of other salt solutions on human red cells. Methods Iso-osmotic and hypo-osmotic solutions of various salts were prepared after taking into account their molecular weight and osmotic pressure. Five healthy volunteers between the age of 22-30 years were randomly selected and ten blood samples were collected from them. The study was conducted from January 2009 to February 2009. Blood was collected from subjects by venepuncture into heparinised tubes. 20 μl of blood was pipetted into 1 ml of each solution and incubated for one hour at 37ºC in a water bath. The solutions were centrifuged and the colour of the supernatant was read in a spectrophotometer. Supernatant from blood added to distilled water was considered 100% hemolysed. Results Iso-osmotic salt solutions were free of hemolysis. Among chloride salts, sodium chloride showed the least hemolysis and potassium chloride and nickel chloride resulted into greater hemolysis. Among potassium salts, potassium bromate caused highest amount of hemolysis whereas potassium sulphate showed the least. Conclusion The significant differences in hemolytic pattern in hypo-osmotic salts solutions suggest that the hypo-osmotic stress causes morphological changes in red cells that alter their permeability to various ions leading to hemolysis. This probably occurs through opening of volume sensitive channels. KEY WORDS hemolysis, morphological changes, red cells, salt solutions
Pattern of Organophosphorous Poisoning: A Retrospective Community Based Study
(Kathmandu University, 2011) Chataut, J; Adhikari, RK; Sinha, NP; Marahatta, SB
ABSTRACT Background Pesticide poisoning is very common in Nepal. Hospital based studies from various parts of Nepal have shown that poisoning with organophosphorus compounds is the most common type of poisoning. Current study is undertaken to see the pattern of organophosphorus poisoning and to identify the common risk factors among the cases. If the risk factors are modifiable, attempts in addressing the risk factors and decreasing the likelihood of poisoning will certainly be fruitful in reducing the morbidity and mortality associated with organophosphorus poisoning. Objectives To assess the risk factors of organophosphorus poisoning which is major public health problem in Nepal. Methods A community based retrospective study of 75 cases of organophosphate poisoning who were brought to the emergency department of Dhulikhel hospital over the period of 3 years. Basic information was collected from hospital records and home visits were made to study the risk factors. Data were collected through interviews of the study population and their family members using a pre-designed questionnaire. Results In this study 75 cases and their families were interviewed of which there were 59% males and 42% females (M/F ratio of 1:1.4). The majority (40%) of the poisoning cases were in the age group 25-34 years. Lower literacy level showed positive association with the incidence of poisoning. Occupation wise vast majority (80%) of the cases were engaged in agricultural work. Suicidal attempts by ingesting organophosphate compounds were high in farmers and females. Conclusion In this study, majority of the poisoning were attempts of intentional self harm. Agriculture workers and females are high risk groups and may be associated with the fact that they have easy access to the poison. Interventions directed towards health education, counseling, and enforcement of laws restricting the availability and use of harmful pesticides may help in reducing such events in future. KEY WORDS Organophosphorus, Pesticides.
Incidence of incidental carcinoma gall bladder in cases of routine cholecystectomy
(Kathmandu University, 2011) Ghimire, P; Yogi, N; Shrestha, BB
ABSTRACT Background Carcinoma of gall bladder is the most common malignancy of the billiary tract. Most of the cases are diagnosed as an incidental case among patients undergoing cholecystectomy. Objectives To establish the rate of incidental carcinoma of gall bladder in patients undergoing routine cholecystectomy to study the demographic profile and prognosis of these patients. Methods A retrospective study was carried out in Fishtail Hospital and Research Center, Pokhara during 1998-2009. The surgical notes, hospital records and histopathology reports of 783 patients undergoing routine cholecystectomy were studied. Results Out of 783 cases, gall bladder cancer was detected in 10(1.28%) of cases and was more common in females (M:F ratio 1:2.3) and the mean age of occurrence was 63.8 years. Most of the cases diagnosed were at their early stages and none of them were in T3 and T4 stages. Six of these patients have survived till a mean follow up duration of 23.7 months. Conclusion The rate of incidental carcinoma of gall bladder is 1.28%. KEY WORDS carcinoma gallbladder, cholecystectomy, incidental
The Burden of Injury in terms of Economic Loss and Disability Days: A Community Based Study from Eastern Nepal
(Kathmandu University, 2011) Ghimire, A; Nagesh, S; Jha, N; Niraula, SR; Devkota, S
ABSTRACT Background Injuries are already a substantial public Health problem all over the world and are expected to increase in the 211st Century. They are major causes of deaths and disability in the population and also involve high societal costs. Objectives This study was designed to assess the economic loss due to the injury and the disability days due to different types of injuries. Methods A systematic random sampling technique was used to select 1388 households from 19 wards. A detailed questionnaire was used to collect information related to injuries to the persons suffered from injuries including treatment obtained, cost of treatment (direct/indirect cost) and length of disability. Results Among the minor injured persons, majority (93.2%) did not spend any indirect cost. 36.7% of the major inured persons spent Nepalese rupees 10,001 to NRs 100,000 as direct treatment costs. But 50% spent less than 5000 NRs as indirect cost for major injury treatment. Maximum number (67.4%) of major injured persons had disability days of 31 to 90 days. Conclusion The high incidence of injuries, especially road traffic injuries, adds a huge economic burden to nation. KEY WORDS injury, disability days, economic burden
Ultrasound Assessment of Gestational Age Using Fetal Binocular Distance in Uncomplicated Pregnancies, Correlating with Standard Fetal Biometry Parameters at a Tertiary Care Hospital in Nepal
(Perinatal Society of Nepal (PESON), 2023) Khanal, Umesh; Katwal, Shailendra; Suhail, Afla; Lohani, Benu
ABSTRACT Background: Fetal biometry, typically using parameters like biparietal diameter (BPD), Head circumference (HC), abdominal circumference (AC), and Femur length (FL), estimate gestational age. Recent literature highlights the utility of orbital dimensions, particularly fetal binocular distance (FBD) for precise fetal gestational age estimation (FGAE). Due to a lack of published data on FBD in Nepal, this study aimed to fill this gap by assessing GA using FBD from 18th week in healthy women with uncomplicated pregnancies. Methods: Obstetric USG was performed in 288 women with uncomplicated pregnancy to evaluate the efficacy of FBD as a measure to calculate the predicted GA. GA ranged from 18 weeks to term. Only patients with known clinical GA, previous history of normal menstrual cycle, and who fit the inclusion criteria were included in the study. Results: The correlation between FBD in mm and gestational age (GA)in weeks was analyzed. The correlation was highly significant (r=0.987, p<0.001), assisting in compiling a nomogram of FBD and GA for Nepalese women. A highly significant correlation was also found between the FBD and other parameters as well. Conclusion: Fetal binocular distance correlates linearly with clinical gestational age and positively with other standard fetal biometry parameters such as biparietal diameter, head circumference, abdominal circumference, and femur length. Thus, fetal binocular distance proves to be a reliable parameter for determining gestational age. Keywords: Gestational age, Fetal Binocular distance (FBD), Ultrasonography (USG)
The Glucose Challenge Test for Screening of Gestational Diabetes
(Kathmandu University, 2011) Shrestha, A; Chawla, CD
ABSTRACT Background The frequency of gestational diabetes mellitus (GDM) is 0.6% -15% of pregnant woman. The modern trend towards the delay starting family is the main factor responsible for increase prevalence of GDM. This condition is associated with the adverse effect on mother and fetus, so it is important to find out the GDM by screening of all the pregnant women. Objective To observe the feasibility of using the 50g GCT for all pregnant women attending Dhulikhel Hospital, Obstetric OPD. To determine the incidence of gestational diabetes in the population and to observe the maternal and fetal outcome among those having an elevated GCT level and gestational diabetes. Methods A prospective and analytical study of 1598 pregnant women booked and delivered between June 2009and August 2010. Glucose challenge test (GCT) performed by using 50gm glucose and diagnosis of gestational diabetes performed by using the Carpenter Coustan Criteria. Pregnancy outcomes were assessed by the gestation and mode of delivery. Similarly, neonatal outcomes assessed in terms of birth weights, APGAR scores, congenital abnormalities, hyperbilirubinaemia, hypoglycaemia or respiratory distress syndrome. Results The detected incidence of gestational diabetes was 0.75%. With the threshold plasma glucose level at140 mg/ dl, 198 women needed to undergo the 100g oral glucose tolerance test and 12 women had gestational diabetes. The diagnostic yield was 6.06%. Perinatal outcome was similar to the rest of the women with normal glucose challenge test. Conclusions The 50g GCT is feasible and also helps to find out GDM. It is easy, user friendly, cheap and convenient for screening purpose. KEY WORDS Glucose challenge test, gestational diabetes, oral glucose tolerance test
Variability of Presentations and CT-Scan Findings in Children with Neurocysticercosis
(Kathmandu University, 2011) Gauchan, E; Malla, T; Basnet, S; Rao, KS
ABSTRACT Background Neurocysticercosis is one of the common neurological morbidities in childhood. Objectives To find the commonest mode of presentation of this disorder in children. The study also aims to find out the age at which it commonly occurs, commonest site affected in the brain and the ethnic group and region most commonly affected in Western Nepal. Methods Retrospective hospital based study carried out in the Department of Pediatrics, Manipal Teaching Hospital, Pokhara from June 2004 to June 2009. Results Over the period of five years, 678 patients were admitted for seizures; out of which 109 patients were diagnosed as having neurocysticercosis (16%). Out of them, 66 (60.5%) were males and 43 (39.4%) were females. The age of presentation varied from 18 months to 16 years, with mean age 9.77 years. The most common age of presentation was between 6-10 years (n=47; 43.1%) and 11-15 years (n=47; 43.1%). Maximum number of patients were from Kaski district (n=41; 37.6%) followed by Syangja (n=34; 31.1%).The commonest presentation was with seizures (n=85; 77.9 %); generalised seizures was present in 45 patients (52%). Psychiatric manifestations were present in 3 patients (2.7%). The lesions were found mostly in the parietal region (n=65; 59.6 %). Most of the lesions were single (n=89; 81.6%). Out of 109 patients, 74 patients (67.8%) improved without any recurrence of symptoms on two years follow-up. Conclusion Neurocysticercosis is a preventable zoonotic disease which results in significant morbidity in children where sanitary measures are inadequate. Any child presenting with a first episode, afebrile seizure should be screened for neurocysticercosis provided other common causes are ruled out. KEY WORDS neurocysticercosis, seizures
Kangaroo Mother Care (KMC) Therapy: A Bonding Between Mother and Baby
(Perinatal Society of Nepal (PESON), 2023) Manandhar, Sunil Raja
NA
Ipsilateral Supracondylar Fracture and Forearm Bone Injury in Children: A Retrospective Review of Thirty one Cases
(Kathmandu University, 2011) Dhoju, D; Shrestha, D; Parajuli, N; Dhakal, G; Shrestha, R
ABSTRACT Background Supracondylar fracture and forearm bone fracture in isolation is common musculoskeletal injury in pediatric age group But combined supracondylar fracture with ipsilateral forearm bone fracture, also known as floating elbow is not common injury. The incidence of this association varies between 3% and 13%. Since the injury is rare and only limited literatures are available, choosing best management options for floating elbow is challenging. Method In retrospective review of 759 consecutive supracondylar fracture managed in between July 2005 to June 2011, children with combined supracondylar fracture with forearm bone injuries were identified and their demographic profiles, mode of injury, fracture types, treatment procedures, outcome and complications were analyzed. Result Thirty one patients (mean age 8.91 yrs, range 2-14 yrs; male 26; left side 18) had combined supracondylar fracture and ipsilateral forearm bone injury including four open fractures. There were 20 (64.51%) Gartland type III (13 type IIIA and 7 type III B), seven (22.58 %) type II, three (9.67 %) type I and one (3.22 %) flexion type supracondylar fracture. Nine patients had distal radius fracture, six had distal third both bone fracture, three had distal ulna fracture, two had mid shaft both bone injury and one with segmental ulna with distal radius fracture. There were Monteggia fracture dislocation, proximal ulna fracture, olecranon process fracture, undisplaced radial head fracture of one each and two undisplaced coronoid process fracture. Type I supracondylar fracture with undisplaced forearm were treated with closed reduction and long arm back slab or long arm cast. Displaced forearm fracture required closed reduction and fixation with Kirschner wires or intramedullary nailing. Nineteen patients with Gartland type III fracture underwent operative intervention. Among them nine had closed reduction and K wire fixation for both supracondylar fracture and forearm bone injury. One patient with closed reduction and long arm cast application for both type III supracondylar fracture and distal third radius fracture developed impending compartment syndrome and required splitting of cast, remanipulation and Kirschner wire fixation. There were three radial nerve, one ulnar nerve and one median nerve injury and two postoperative ulnar nerve palsy. Three patients had pin tract related complications. Among type III, 16 (80%) patients had good to excellent, two had fair and one gad poor result in terms of Flynn’s criteria in three months follow up Conclusion Displaced supracondylar fracture with ipsilateral displaced forearm bone injuries need early operative management in the form of closed reduction and percutaneous pinning which provides not only stable fixation but also allows close observation for early sign and symptom of development of any compartment syndrome. KEYWORDS Floating elbow; Forearm bone injury; Ipsilateral fracture; Supracondylar fracture
Neurocysticercosis in Nepal and It’s Global Perspective
(Kathmandu University, 2011) Agrawal, JP
NA
Integration and mobilization of female community health volunteer: A better response and prevention of community transmission of COVID-19 in Nepal: A lesson learned strategies from Thailand
(Madhesh Institute of Health Sciences (MIHS), 2025) Yadav, Satya Narayan
NA

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