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Initial Experience with Simple Oncoplastic Breast Conserving Surgery in Nepal: A Case Report
(Institute of Medicine, 2020) Singh, Yogendra P; Khanal, Suman
ABSTRACT Oncoplastic breast conserving surgery is increasingly used in the management of early breast cancer. Though its use in Nepal is increasing, it is still under-utilized. We present a case of upper outer quadrant early breast cancer located away from nipple-areola complex managed with radial ellipse segmentectomy 10 years back and under regular follow up. We recommend its usage in upper outer quadrant lesions because of its simplicity, access for sentinel lymph node biopsy and good cosmetic outcome. Keywords: Early breast cancer, lumpectomy, simple oncoplastic surgery
Giant Ocular Surface Squamous Neoplasia Wrapping Almost the Whole Cornea: A Case Report
(Institute of Medicine, 2020) Shrestha, Poonam; Pandey, Mukesh
ABSTRACT Ocular surface squamous neoplasia (OSSN) includes the dysplastic lesions involving the epithelium of conjunctiva and cornea with various clinical pictures. Histopathological examination of the excised tissue is the benchmark for diagnosis. Surgery, chemotherapy, immunotherapy are the various treatment modalities which in combination shows promising result. We present here a case of 83 years old female patient with history of fleshy mass covering the cornea and the patient was diagnosed clinically as ocular surface squamous neoplasia. Patient underwent surgical excision of the mass followed by cryotherapy. Histopathological examination revealed conjunctival intraepithelial neoplasia of grade 3. Six months after treatment the patient is completely tumor free with no recurrence. Keywords: Conjunctival intraepithelial neoplasia, ocular surface squamous neoplasia
Leigh Syndrome in an Adolescent Girl: A Case Report
(Institute of Medicine, 2020) Shrestha, Merina; Bajracharya, Luna; Basnet, Sudha
ABSTRACT Leigh syndrome (LS) is a disorder of infancy and rarely late childhood. It presents with regression of mental and motor skills. Here, we present LS in an adolescent girl who presented with generalized dystonia and cognitive decline. Her infective, metabolic, endocrinal and autoimmune work up was normal. The neuroimaging showed progressive symmetric involvement of basal ganglia with focal intensity over bilateral lentiform nucleus and thalamic region. The cerebrospinal fluid (CSF) lactate level was elevated. Genetic test could not be performed; however the history of neuro-regression with extrapyramidal involvement with CSF and neuroimaging finding led to the diagnosis of Leigh’s syndrome. Keywords: neuro-metabolic, regression, MRI
Multilevel Spinal Injury: Incidence, Distribution and Neurological Patterns
(Institute of Medicine, 2020) Khadka, Yagya; Lakhey, Rajesh B; Kafle, Dinesh
ABSTRACT Introduction: Fractures and dislocation of spine are serious injuries that most commonly occur in young people. Spinal injury at more than one level is not uncommon. Awareness of multilevel injury of the spine and associated neurological patterns is important for the proper initial management of the patient. Methods: This was a prospective observational study carried out in Department of Orthopedics, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal from February 2012 to September 2013. Sixty cases of age group between 18 to 63 years of traumatic spinal injury were enrolled. Patients were examined clinically and radiographically. Results: Out of 60 patients, multilevel spinal injury occurred in 26 (43.3%) patients; 10 (16.67%) had contiguous spinal injury and 16 (26.67%) had non-contiguous spinal injury. There were 5 type A pattern spinal injury. Contiguous spinal injury most commonly occurred at level L1/L2 (n=4, 40%) and most had Frankel grade E neurology (n=6, 60%) followed by Frankel grade D (n=2, 20%). Non-contiguous lesions most commonly occurred at thoracic spine and had Frankel grade E neurology in most cases (n=10, 16.67%) followed by grade B and C (n= 2, 2.33% each). Conclusion: Multiple spinal injury was a common pattern of injury, which occurred in 26 (43.3%) patients out of 60 patients enrolled in our study. Multilevel spinal injury is common. We should be aware about its occurrence. We should evaluate for multilevel spinal injuries, so as not to miss them, especialy non-contiguous injuries, in the patients presenting with spinal injury. Keywords: Contiguous lesion, Frankel grade, multilevel spinal injury, non-contiguous lesion
Pediatric Percutaneous Nephrolithotomy in a Peripheral Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Gupta, Dipesh K; Jaiswal, Deepak
ABSTRACT Introduction: Pediatric nephrolithiasis though uncommon, poses clinical management dilemma due to anatomical and physiological factors. Percutaneous Nephrolithotomy (PCNL) is well established in adults and miniaturization of the instruments has helped to expand its indication for uses in pediatric population with equivalent results. The aim of our study is to evaluate the application of the procedure in our settings. Methods: This was a retrospective study done at Nepalgunj Medical College teaching hospital from June 2017 to April 2020. Total of 75 patients with 76 renal units under 18 year of age were evaluated. PCNL was done in prone position in all patients using fluoroscopy for initial puncture and subsequently for clearance. The size of the tract varying from 15 Fr to 24 Fr was decided based on the degree of hydronephrosis. Results: Mean stone volume was 372 mm2. With mean operative time of 58 min, 96% of stone clearance rate was achieved. Mini PCNL was done in most of the cases. Single tract was used in 84% cases mostly with subcostal puncture. Major complications were pelvic perforation in 4% cases and two patients required restaging. Conclusion: PCNL in pediatric population is safe with good stone free rate with minimal complications. Application of miniaturized instruments has further improved the outcome with comparable morbidity. Keywords: Mini PCNL, pediatric nephrolithiasis, percutaneous nephrolithotomy, urolithiasis
Correlation of Hypoechoic Lesions in Trans-rectal Ultrasound of Prostate with Histopathology in Prostate Cancer
(Institute of Medicine, 2020) Chataut, Dinesh; Basnet, Babin; Lohani, Benu; Suwal, Sundar; Paudel, Sharma; Kayastha, Prakash
ABSTRACT Introduction: Prostate cancer is one of the most common cancer in elderly male. Suspicion of prostate cancer is based on increased Prostate Specific Antigen (PSA) level and abnormal digital rectal examination (DRE) findings. Transrectal ultrasonography (TRUS) can detect and localize hypoechoic lesions in prostate which are considered as suspicious for malignancy. TRUS can also guide for prostate biopsy, which is the gold standard for diagnosis of prostate cancer. The study was aimed to find out TRUS findings in suspected prostate cancer patients and correlate these findings with histopathological findings. Methods: Prospective study was done in 66 males of age >40 years, sent for prostate biopsy in suspicion for prostate cancer (PSA >4 ng/ml, and/or abnormal DRE findings). Prostate was evaluated with TRUS and subsequently underwent TRUS guided six core biopsy of prostate. Total 396 cores of biopsy were taken. Histopathology reports were collected and correlated with the TRUS findings. Results: Twenty three patients were positive for prostate cancer and 14 of them showed hypoechoic lesions in TRUS. Total 81 suspicious hypoechoic lesions were seen in prostate of all the patients and among them 42 lesions matched with histopathology report for cancer. Cancerous focus detection rate of TRUS was 51.85%. Conclusion: TRUS is a supplementary tool in diagnosis of prostate cancer, however when used alone it has less sensitivity for detection of prostate cancer. Keywords: Biopsy, prostate cancer, transrectal ultrasonography
Predictors of Multiple Micronutrient Powder Intake Adherence among Children Aged 6-23 Months in Rasuwa District, Nepal: A Cross-sectional Study
(Institute of Medicine, 2020) Timalsina, Ashish; Paudel, Rajan; Upadhyaya, Dipak P; Bhattacharya, Sujay; Kuikel, Bihari S; Joshi, Naresh P; Adhikari, Sunil; Aung, Aye A
ABSTRACT Introduction: Breastfeeding would not be sufficient to meet the micronutrient requirement of children after six months and more prone to iron deficiency anemia. Micronutrient powder (MNP) can be mixed with semi-solid food to feed the children aged 6-23 months, contains 12 different micronutrients, one of the appropriate strategies. The study’s objective was to assess adherence to MNP and its predictors among children aged 6-23 months in Rasuwa district of Nepal. Methods: A cross-sectional study was conducted in the Uttargaya rural and the Kalika rural municipality of Rasuwa district among 200 mothers of children aged 6-23 months who were fed MNP. Proportionate random sampling was used to select eligible mothers for interviews, and a semi-structured questionnaire was employed for data collection. Multivariate logistic regression was used to obtain adjusted odds ratio with 95% C.I. Results: Sample mean was calculated among 155 mothers who received 60 sachets of MNPs;41.3% had adhered to 60 sachets intake of MNP. The mean age of the mother was 25. 29±5.3 years and the mean age of children was 14. 66±5.2 months. In bivariate analysis, the mother having one child less than five years (COR=0.5, 95% CI: 0.24-1.0) and MNP received from the health facility (COR=1.96, 95% CI: 1.02-3.76) were statically significant. Further, multivariate analysis, a mother who accepted the properties of MNP (AOR=2.52, 95% CI: 1.27-5.00), was associated with high adherence. Conclusion: Acceptability of MNP by the mother is the key to increase adherence to MNP. The distribution of MNP from a health facility, tailored with nutrition education is essential to improve adherence to MNP. Keywords: Adherence, children, multiple micronutrient powder, Nepal
Microbiological Profile and Drug Sensitivity Pattern in Persistently Discharging Ears: A Tertiary Level Hospital Based Retrospective Study
(Institute of Medicine, 2020) Gyawali, Bigyan R; Pradhanaga, Rabindra B; Rayamjhi, Pabina; Dongol, Kripa; Gupta, Mudit; Shrestha, Lava; Acharya, Kunjan
ABSTRACT Introduction: Antimicrobial resistance is an emerging issue resulting from the misuse of antibiotics in today’s world. As an effect of it, cases with persistent ear discharge not responding to the conventional oral antibiotics prescribed in ear pathologies are seen increasing in our day to-day practice. This study aims to review the microbiological growth and the pattern of their antibiotic sensitivity in this group of population. Methods: This was a retrospective study which was conducted at the Department of ENT-HNS of Tribhuvan University Teaching Hospital. Record files of all cases who presented with persistently discharging ear for more than 2 weeks and not responding to oral antibiotics, between January 2017 to March 2020 were assessed. Cases of chronic otitis media (COM) squamous with persistent discharge were excluded as most of the times it is the disease process rather than type of organism which causes the persistence of ear discharge despite the use of antibiotics. Results: COM mucosal and cavity infection following modified radical mastoidectomy (MRM) were the commonest pathologies. Pseudomonas aeruginosa (PA) and Coagulase negative Staphylococcus (CoNS) were the commonest bacterial isolates. Pseudomonas aeruginosa showed a good sensitivity to antibiotics like Tazobactam and Piperacillin and resistance to conventionally used antibiotics like Ciprofloxacin and Levofloxacin. Similarly, CoNS had good sensitivity to antibiotics like Oxacillin and Levofloxacin and resistance to conventionally used antibiotics like Amoxicillin. Conclusion: COM mucosal and post MRM cavity infection are the commonest pathologies presenting with persistent ear discharge with PA and CoNS as the predominant isolates. Pseudomonas aeruginosa holds a good sensitivity to drugs like Tazobactam and Piperacillin; and CoNS to drugs like Oxacillin and Levofloxacin. Keywords: Drug sensitivity, ear discharge, microbiological, persistent
Incidence of Contrast Induced Acute Kidney Injury, Its Risk Factors and In-Hospital Outcomes in Patients Undergoing Coronary Angiography and Angioplasty
(Institute of Medicine, 2020) Upadhaya, Prashun; Thapa, Pradeep; Gajurel, Ratna M; Sigdel, Mahesh R
ABSTRACT Introduction: Contrast-induced acute kidney injury (CI-AKI) is a serious complication of angiographic procedures with significant morbidity and mortality. We aimed to find the incidence, risk factors and outcomes of CI-AKI in patients who have undergone coronary angiography/angioplasty in a referral hospital in Nepal. Methods: It was a descriptive observational study of consenting consecutive patients above 18 years undergoing coronary angiography/angioplasty at Manmohan Cardiothoracic Vascular and Transplant Centre, Nepal from July 2015 to September 2017. CI AKI was defined as an elevation of serum creatinine of >25% or ≥0.5 mg/dl (44 μmol/L) from baseline within 48 hour of exposure to contrast. Statistical analysis was performed using SPSS 18 software. Statistical analysis was completed using Student’s t-test, chi-square test and multivariable logistic regression analysis. Results: Out of 240 patients, 156 (65%) were male, mean age was 60.36±11.29 years. Eighteen patients (7.5%) developed CI-AKI. Incidence of CI-AKI was 20% in patients with chronic kidney disease (CKD), 5.4% in diabetics, 13.6% in patients >70 years, 12.79 % in patients with anaemia and 12.3% in patients with prior contrast exposure. Multivariate logistic regression analysis found smoking and history of prior contrast exposure to be independent predictors for development of CI-AKI. Among patients with CI-AKI, one (5.88%) required dialysis and one (5.88%) died. Conclusion: Incidence of CI-AKI after coronary angiography/angioplasty was 7.5%. Patients with prior contrast exposure and smoking were at significantly increased risk of CI-AKI; higher trend of CI-AKI was seen in patients with CKD, diabetes, elderly and anaemia. Keywords: Angiography, angioplasty, contrast induce acute kidney injury, contrast media,, contrast nephropathy
Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Maharjan, Narendra; Lakhey, Paleswan Joshi; Ghimire, Bikal; Kansakar, Prasan BS; Bhandari, Ramesh S
ABSTRACT Introduction; Hepatolithiasis is more prevalent in Far-East than in Middle-East countries. There are various treatment modalities available for hepatolithiasis like surgical and non-surgical procedures. Non-surgical procedures have higher recurrence rate. Methods: This is a descriptive retrospective study of the clinical data of hepatolithiasis patients treated at Tribhuvan University Teaching Hospital (TUTH), Maharajgunj from April 2016 to October 2019. Results: There were 14 patients and mean age was 45.8±14.8 years. It was more common in female (F: M = 4:3). Left sided hepatolithiasis was the most common type (50%). One (7.1%) patient had bilateral hepatolithiasis associated with unresectable cholangiocarcinoma. Eight (57.1%) patients were treated with surgical procedures; four (28.6%) patients underwent interventional radiological procedures and remaining two (14.3%) patients had combined surgical and intervetional radiological procedures. Complete stone clearance was achieved in 11 patients (78.57%). In surgical therapy group, seven out of eight (87.5%) patients achieved the complete stone clearance; two out of four (50%) patients in interventional radiology group and all patients in combined therapy group achieved the clearance. There was no recurrence among those patients who had complete stone clearance and there was no mortality. Conclusion: The management of hepatolithiasis should involve multi-modality (surgical and non-surgical) therapeutic techniques available, in order to achieve complete stone clearance and prevent the complications. Keywords: Hepatolithiasis, left lateral sectionectomy, percutaneous transhepatic biliary drainage
Adherence to Therapeutic Regimen in Diabetic Patients Attending a Tertiary Level Hospital
(Institute of Medicine, 2020) Shrestha, Krishna D; KC, Takma; Ghimire, Rachana
ABSTRACT Introduction: Adherence to treatment regimen among diabetes patients is very crucial for good glycemic control. Poor adherence is a widely recognized problem causing great impact on poor health outcomes and healthcare costs. Hence, this study was conducted to identify the adherence to prescribed therapeutic regimen among diabetic patients. Methods: A descriptive cross sectional research design was adopted. Data was collected purposively among 422 respondents attending at medical OPD in Tribhuvan University Teaching Hospital through interview using structured questionnaire. Analysis was done by descriptive and inferential statistics. Results: The study findings revealed good follow up adherence (57.8%). Adherence to medicine, diet and exercise were (28.5%), (16.1%) and (8.8%) respectively. Dietary adherence was associated with sex (p=0.03), educational level (p<0.001), occupation (p=0.04), attending diabetic counseling (p<0.001) and knowledge level (p<0.001). Exercise adherence was associated with sex, educational level, attending diabetic counseling, history of hospitalization and knowledge level (p<0.05). Medication adherence was associated with attending diabetic counseling (p=0.03). Follow up adherence was associated with education, occupation, attending diabetic counseling, duration of diabetes mellitus, frequency of follow up visit, and knowledge level (p<0.05). Moreover, respondents with good adherence to exercise (75.7%), medicine (63.3%) and follow up adherence (66%) had controlled fasting blood sugar level (p=0.01, p=0.03 and p=0.01 respectively). Conclusion: Adherence on diet and exercise was very low than other components among diabetes patients. So, it is recommended to focus on education especially on diet and exercise adherence which would be of great benefit in glycemic control. Keywords: Adherence, compliance, diabetic patient, treatment regimen
Cesarean Section or Instrumental Delivery: The Best Choice for Mode of Delivery during Second Stage of Labor
(Institute of Medicine, 2020) Rawal, Suniti; Katuwal, Neeta; Shrestha, Sajana
ABSTRACT Introduction: Managing second stage of labour is very crucial. Emergency Cesarean Section (CS) or Instrumental Delivery (ID) is the only choices although complications might occur in both modes of deliveries. The rate of CS is at rise and the fear of failed ID followed by emergency CS with added complications makes the choice more difficult amongst the obstetricians. Methods: A retrospective study done to assess the maternal and fetal outcome in second stage of labour following ID and emergency CS from April 2018 to March 2019 among the pregnant women having completed 34 weeks of gestations and beyond. Results: Of 4761 deliveries, 2537 (53.2%) were vaginal and 2224 (46.7%) CS, and amongst all, 133 (2.7%) were second stage interventions. Out of 133, 78 had ID, 76 were successful and 2 failed. Fifty seven (2.6%) were second stage CS. Nulliparas (65.8%) needed more ID, teenage pregnancy (6.5%) (p=0.04) and heart disease (18.4%) (p=0.002) were high risk for ID. Complications were more in CS, uterine extensions, (29.8%) (p<0.001), urinary complications, (43.9%) (p<0.001) and blood loss (p<0.001). Neonatal admission too was higher in CS (n=29) and more so due to respiratory distress (16/29). Conclusion: Despite of few failed attempted ID, it still proved to be better choice for delivery during second stage, as both maternal and neonatal complications were higher following the second stage CS. Hence, the correct and timely decision for ID addressing the associated risk factors could lead to favorable outcome. Keywords: Cesarean Section, instrumental delivery, second stage of labour
Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal
(Institute of Medicine, 2020) Sharma, Manju; Jha, Sunil C; Sayami, Arun; Gajurel, Ratna M; Poudel, Chandra M; Khanal, Rajaram; Pathak, Surya R; Thapa, Shovit; Adhikari, Suman; Yadav, Vijay
ABSTRACT Introduction: Temporary transvenous pacemaker insertion is an emergency lifesaving procedure for patients with hemodynamically unstable and life-threatening bradyarrythmias. The aim of this study was to analyze demographics, indications, route of insertion and complications in patients undergoing temporary transvenous pacemaker implantation. Methods: This was a retrospective observational study conducted at a tertiary-care center in Nepal. The hospital records of patients who had undergone temporary transvenous pacemaker implantation between July 2015 and June 2019 were reviewed. Results: A total of 343 patients with mean age of 65.52±16.09 years received temporary transvenous pacing. Out of these 205 (59.8%) were males. Greater proportion of patients were between the age group of 70-80 years (n=76, 22.2%). Hypertension (n=97, 28.3%) was the most common comorbidity noted. The most common indication for temporary pacing was symptomatic complete heart block 165 (59.6%). Total of 288 (84%) patients received permanent pacemakers while 55(16%) had reversible cause so TPI was removed. Right Femoral vein was the most common (99%) venous access site. Among the 343 patients, complications were observed in 29 (8.4%) of cases during and after the temporary transvenous pacemaker insertion. The overall mortality stood low at 2% (n=7). Conclusion: Temporary transvenous pacemaker insertion is required in elderly population presenting with bradyarrythmias and occasionally in acute myocardial infarction presenting with bradyarrythmias as complication. Temporary pacemaker insertion was overall a safe procedure with infrequent serious complications; however, strategies to avoid and alleviate such complications (RV perforation) should be sought and implemented. Keywords: Complete heart block, myocardial infarction, temporary transvenous pacemaker
Outcome of Acute Burn Injuries in a Tertiary Care Centre of Kathmandu Nepal
(Institute of Medicine, 2020) Devkota, Manish; Sharma, Samit; Rayamajhi, Sangam; Shrestha, Jayan M; Lohani, Ishwar
ABSTRACT Introduction: Burn injuries are associated with higher morbidity and mortality especially in middle and low-income countries. The objective of the study is to assess the outcome of acute burn injuries in a tertiary care center of Kathmandu, Nepal. Methods: This is a descriptive cross-sectional study of the clinical data of acute burn patients admitted from January 2016-December 2018. Results: Out of 124 patients with burn injuries, there were more females (n=65, 52.4 %) than males (n=59, 47.6%). Flame burn was the most common mode of injury (n=71,57.3 %) followed by scald (n=22,17.7 %). Thirty-eight (30.6%) patients arrived to hospital on the same day of injury. The average time required to reach our hospital was 24 hours. The most frequently involved site was lower extremities (n=40, 32.26%) followed by upper extremities (n=33, 26.62%). Total body surface area (TBSA) involved in the burn injury ranges from 10% to 50% with a median of 15%. Hospital stay was 14 to 58 days with a median of 17 days. Partial thickness burn was seen in 114 (91.94%) patients whereas 10 (8.06%) patients had full thickness burn. Surgical intervention was needed in 71 (57.26%) patients. Among 71 patients, 12 patients underwent surgery twice. Fifty-two (41.94%) patients were managed conservatively. The mortality rate was 4.03%. Conclusion: Adult female population is at high risk for burn injuries mostly due to flame burn. Delay in reaching care has also contributed for poor outcome of burn injuries. Majority of burn injury patients needed surgical intervention and hence improvement in surgical aspects can lead to better outcome of burn injuries. Keywords: Acute burn, burn injury, burn outcome, epidemiology
Profile and Antibiotic Susceptibility Pattern of Bacterial Isolates from Mobile Phones of Healthcare Workers in a Tertiary Care Centre of Nepal
(Institute of Medicine, 2020) Sapkota, Jyotshna; Jha, Beena; Mishra, Bhavesh; Shrestha, Deepti; Barakoti, Achut; Sharma, Manisha
ABSTRACT Introduction: Nosocomial infection is a serious problem worldwide. Healthcare workers mobile phones may act as vehicle for nosocomial infections. Mobile phones are rarely cleaned and healthcare workers frequently use them thorough out their time in hospitals. The objective of this study is to determine the rate of contamination of mobile phones, prevalent microorganisms and their antibiotic sensitivity pattern. Methods: The descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from July 2019 to September 2019 after ethical approval. Samples were collected aseptically by rolling sterile swabs over the exposed surfaces of the mobile phones and inoculated on the agar plates and incubated aerobically. After incubation, plates were examined for growth. Bacteria were identified by standard microbiological procedure and antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method. Statistical analysis was done by Excel 2018. Results: Of the 198 mobile phones sample cultures, 112 (56.6%) samples showed 7 different types of bacteria. Mixed growth was observed in 3 mobile phones and total of 115 bacterial isolates were identified. Staphylococcusspecies (74.7%) were predominant organism followed by Acinetobacter spp, Klebsiella pneumoniae, E. coli, Citrobacter and Pseudomonas aeruginosa. Total 37.5% of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus (MRSA). Conclusion: Mobile phones may have potential pathogenic microorganisms on their surface and can act as vector in spread of infectious agents in hospital settings. It is recommended to disinfect mobile phones regularly and to implement hand washing practices and regulations around the use of mobile phones in hospital settings. Keywords: Acinetobacter species, mobile phones, MRSA, nosocomial infections, Staphylococcus species
Outcome of Elastic Stable Intramedullary Nail in Length Unstable Diaphyseal Femur Fractures in Children: A Case Series
(Institute of Medicine, 2020) Bhandari, Prawesh S; Uprety, Suresh
ABSTRACT Introduction: Elastic stable intramedullary nailing (ESIN) has been a common method of treatment of diaphyseal femur fracture in children. Though they are used in length stable fracture with favourable results, their use is debated in case of length unstable variants. The objective of the study was to evaluate outcome of these nails in length unstable diaphyseal femur fracture in children. Methods: We retrospectively reviewed seven fractures in seven children treated with ESIN for functional outcome. Results: Total of seven patients with seven unstable femur fractures were studied. There was male predominance with 71.4%. The fracture united at a mean duration of 12 wks. The overall Flynn scoring showed 71.4 % excellent and 28.6 % satisfactory result. Conclusion: Elastic stable intramedullary nailing can be safely used in length unstable variant of femur fracture in children. Keywords: Elastic stable nailing, length unstable, pediatric femur fracture
Prevalence of Diabetes and Dyslipidemia in Hypertensive Young Adults in a Tertiary Care Centre in Nepal, a Cross Sectional Study
(Institute of Medicine, 2020) Lamsal, Kamal Sharma; Neupane, Keshab R; Acharya, Niranjan; Lamsal, Dinesh K; Karmacharya, Niraj; Paudel, Deepak; Paudel, Rajan; Sharma, Rabi P
ABSTRACT Introduction: Diabetes mellitus (DM) and lipid disorders (LD) in hypertensive patients are associated with increased risk of cardiovascular complications requiring close follow-up and more aggressive treatment. Hence, the present study was done to study the prevalence of diabetes and dyslipidemia in young hypertensive patients i.e. <40 years in a tertiary care hospital, Nepal. Methods: This is a hospital based cross-sectional study carried out in Civil Service Hospital, Kathmandu. Study included 165 patients of <40 years who had hypertension, either newly diagnosed or undergoing antihypertensive treatment from September 2018 to September 2019. Blood pressure was measured two times on right upper arm in sitting position at interval of 30 minutes and the aver age was taken. Fasting Lipid Profile and Fasting Blood Glucose was measured after 12 hours of fasting and the prevalence of dyslipidemia and diabetes were analyzed from the data collected. All calculations and statistical analyses are processed by the SPSS 25.0. Results: Among 165 patients included, majority of patients, 107 (64.8%) were among 31-39 years, followed by 53 (32.1%) patients among 21-30 years. In total, 98 (59.4%) were male and 67 (40.6%) female. The prevalence of diabetes was 24 (14.5%) and pre-diabetes was 49 (29.7%). The prevalence of dyslipidemia was 125 (75.6%), high triglyceride being the most common disorder followed by low HDL in 87 (52.1%). Elevated total cholesterol was found in 53 (32.1%) patients and 48 (29%) had high LDL cholesterol level. Conclusion: A high prevalence of diabetes, pre-diabetes and dyslipidemia was observed in the hypertensive patients <40 years of age. Keywords: Diabetes, dyslipidemia, hypertension, prediabetes
Early Outcome of Surgery in Pediatric Head Injury: Experience From a Tertiary Care Center in Eastern Nepal
(Institute of Medicine, 2020) Khanal, Babita; Kafle, Prakash; Singh, Sandip K; Yadav, Sunil K; Neupane, Bishomber; Shakya, Ipsa; Yadav, Dipak K
ABSTRACT Introduction: Head injuries among the pediatric age group remain an unwelcomed source of morbidity and mortality resulting from falls, motor vehicle accidents, assaults, and child abuse. Early identification and management of traumatic brain injury (TBI) are crucial in halting the progress of the primary insult and preventing or reducing secondary brain injury. The present study aims to investigate the major cause of pediatric TBI and analyze the early outcome and serve as a reference study from a tertiary care center in eastern Nepal. Methods: This is a prospective cohort study conducted in the Department of Pediatric Medicine and Neurosurgery from February 2018 to January 2020. All the pediatric head injury cases that were managed surgically in the center were included in the study. Presenting Glasgow coma scale (GCS) was correlated with the Glasgow outcome scale (GOS). Results: The study population comprised of 65 patients fulfilling the study inclusion criteria. The mean age of the study population was 10.86±4.72 years, fall was the commonest mode of injury (52.3%), 50.8% had mild TBI, 43.1% had moderate TBI and 6.2% had severe TBI. Depressed skull fracture with underlying extradural hematoma (EDH) or contusion was the commonest pathological diagnosis seen in 30.8 % (20) cases. The mean duration of hospital stay was 2.6 days. The presenting GCS correlated well with the outcome. Conclusion: This study concluded that the timely management of pediatric TBI can prevent grave prognosis and the patients presenting GCS and the pupillary reaction has strong correlation with the outcome. Keywords: Head injury, Glasgow outcome score, pediatric, surgery
Knowledge and Self-Care Practice on Hypertension among Hypertensive Patients in a Tertiary Level Hospital of Kathmandu
(Institute of Medicine, 2020) Satyal, Geeta K; Rai, Lalita; Gautam, Roshani; Dangol, Bhuvan K; Shakya, Rajina
ABSTRACT Introduction: Hypertension is a public health challenge and major risk factor for cardiovascular disease in the developing as well as developed countries. The successful management of hypertension depends upon patient’s knowledge on hypertension and self-care practices. Methods: A descriptive cross-sectional study was conducted to identify the knowledge and self-care practice on hypertension among 212 hypertensive patients attending in outpatient department of Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Non-probability purposive sampling technique was used. Data was collected through face-to-face interview by using structured questionnaire. Data was analyzed using SPSS version 16.0. Results: This study showed that 57.5% of the respondents had adequate level of knowledge on hypertension and 57.1% of the respondents had good overall self-care practice. Regarding self-care practice, we found 100% medicine adherence, 85.8% respondents avoided alcohol and 84.9% avoided smoking, 50.9% followed weight management practice, 48.6% followed dietary management and 44.8% performed physical activity. Level of knowledge was significantly associated with age, gender, educational status and occupation. Self-care practice was only significantly associated with educational status. Level of knowledge and self-care practice were significantly positively correlated. Conclusion: More than half of the respondents had adequate level of knowledge. Regarding self-care practice, nearly sixty percent of the respondents had good self-care practice. To bring those rates to higher level, awareness programs should be launched about diseases and self-care practice on hypertension. Keywords: Hypertension, knowledge, self-care practice
Comparison of EuroSCORE II with EuroSCORE in Cardiac Surgical Patients in a Tertiary Level Teaching Hospital in Nepal
(Institute of Medicine, 2020) Pradhan, Bishwas; Bastola, Priska; Basnet, Madindra B; Shrestha, Bibhush; Sigdel, Shailendra; Gurung, Arjun
ABSTRACT Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Its relevance has been validated in European, Asian countries and also in Nepal. Its limitations led to development of EuroSCORE II. This study was carried out to compare EuroSCORE II with EuroSCORE in Nepalese cardiac surgical patients. Methods: A retrospective analytical cohort study of 3 years duration in 972 adult cardiac surgeries was conducted. Scores obtained from EuroSCORE (Logistic and Additive) and EuroSCORE II was compared with the observed mortality. Calibration was calculated by Hosmer- Lemeshow (H-L) test (Chi Square test) and discrimination by calculating the area under the curve (AUC) of receiver operating characteristics (ROC) curve. Results: Observed mortality was 4.11%. EuroSCORE additive, logistic and EuroSCORE II predicted mortality were 4.32%, 4.55% and 2.13% respectively. H-L chi square calculation for EuroSCORE additive model could not hold as all observed and expected frequencies match exactly. Hence it can be considered as a good fit. EuroSCORE logistic model (H-L, Chi-square 7.743, p<0.001) and EuroSCORE II (H-L, Chi-square 11.631, p = 0.168) also showed good fit i.e. both can predict mortality satisfactorily. AUC of ROC curve of EuroSCORE additive, logistic and EuroSCORE II were 0.632, 0.636 and 0.616 respectively, which showed fair discrimination power. Conclusion: Mortality prediction of adult cardiac surgical patients by EuroSCORE (additive and logistic) and EuroSCORE II was satisfactory. Keywords: Additive, cardiac surgical, EuroSCORE, logistic

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