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Awake Throughout Craniotomy: Initial Experience and the Anaesthetic Challenges
(Institute of Medicine, 2019) Shakya, Bigen M; Acharya, Binita; Shrestha, Gentle S; Shrestha, Anil; Sedain, Gopal; Shrestha, Ninadini
ABSTRACT Awake throughout technique for craniotomy demands very careful titration of drugs for sedation. It does not utilize any airway devices. The success depends on experience of anesthesiologist, good team work and meticulous planning. This is the first case of awake throughout craniotomy in our institute. Keywords: Awake throughout, craniotomy, outcome
Lumbar Diastomatomyelia with Syringomyelia: A Case Report
(Institute of Medicine, 2019) Gyawali, Deepika; Lama, Dharana; Pradhananga, Amit B; Sharma, Mohan R.
ABSTRACT Diastomatomyelia with syringomyelia is a rare clinical condition where there is a duplication of spinal cord. We recently came across a child who had this anomaly. The case was successfully managed with an uneventful recovery. We describe this patient in detail in addition to reviewing the pertinent literature. Keywords: Diastomatomyelia, syringomyelia
Perception of Nursing Students toward Academic Learning Environment in a College of Kathmandu
(Institute of Medicine, 2019) Koirala, Manisa; Koirala, Surya; Neupane, Sharmila
ABSTRACT Introduction A supportive and systematic design of academic learning environment has been important for transfer of learning in clinical context, can lead to positive outcomes for graduates and best prepares for professional life. The objective of this study was to find out the perception of nursing students toward academic learning environment. Methods The descriptive, cross sectional study design was used among 172 proficiency certificate level (PCL) nursing students at Maharajgunj Nursing Campus, Kathmandu Nepal. The data were collected by using Dundee Ready Education Environment Measure (DREEM) Inventories with complete enumeration technique which was developed by Roff et al (1997). Data were analyzed using descriptive and inferential statistics. Results Overall mean score of academic learning environment was found 142.78 out of 200 for 50 items which was in the ranged for ‘positive’ learning environments. The total mean score for perception of learning was 34.4 out of 48; for perception of teacher 30.7 out of 44; for academic self-perception 25 out of 32; for perception of atmosphere 33.3 out of 48; for social self-perceptions 19.3 out of 28. Mean scores indicated that students’ rated all five dimensions of the educational environment in this institution as an average. The significant differences were found between overall mean score; mean score of teachers, academic self-perception & social self perception of students and different academic year. Conclusion The overall mean DREEM scores indicate a more positive academic learning environment. Although the overall learning environments score of this institution observe as an average, none of the items represents ‘excellent’ score or real positive academic learning environment. Keywords: Academic learning environment, nursing students, perceptions
Analysis of Outcomes of Critically ill Surgical Patients using SAPS II Score
(Institute of Medicine, 2019) Paudel, Prakash; Rai, Subash; Shrestha, Sunil; Pradhan, Giridhar BN; Bhattachan, Chitra L
ABSTRACT Introduction Several prognostic models have been implemented for risk assessment and mortality prediction in critically ill patients admitted in ICU. The availability of such sophisticated methods has facilitated in clinical decision making and comparison of outcomes. However, none are universally accepted as standard method to predict mortality. We have decided to use SAPS II score because of the simplicity and easy availability of its variables to analyse the outcomes of critically ill surgical patients admitted to ICU at our centre. Methods The study was conducted between September 2016 and August 2018 at Nepal Medical College and Teaching Hospital, Kathmandu, Nepal. We prospectively collected data on surgical patients consecutively admitted to the ICU during the study period. The variables of SAPS II score were collected from the physiological, laboratory, and patient characteristics mentioned in the ICU scoring data sheet at 24 hours. The SAPS II score and predicted mortality was calculated using computer software programme. The predictive mortality based on the score was compared with the actual outcome to derive the standardized mortality ratio (SMR). Results During the period of study, 64 patients met the inclusion criteria. The mean age of the patients was 54±17.9 (20-84) years and length of ICU stay was 5.3 ±3.5 (3-22) days. GI malignancy was most common pathology comprising 43.8% (n=28). The mean SAPS II score was 24.9±16.4 (3-68). There was no statistical difference in mean SAPS II score between patients with different gender, nature of disease and type of surgical intervention The mean predicted mortality was 13.4% and the observed ICU mortality was 15.6% (n=10). The calculated mean SAPS II score and predicted mortality was higher in nonsurvivors compared to survivors (p<0.0001). The calculated SMR for our study population was 0.85 ranging from 0.01 to 5.2. The number of patients with SMR greater than 1 was only 17 % (11/64). There was significant correlation of mortality with SMR greater than 1 (p=<0.0001). Conclusion The variables in SAPS II score are readily available. Neither special samples nor cumbersome procedures are required. SAPS II can be used as simple and rapid tool to predict mortality in critically ill surgical patients in our set up. Keywords: Critically ill, intensive care unit, mortality, outcome, SAPS II
Clinico-etiological Profile of Seizure Disorder among Adults Admitted to Tertiary Care Hospital of Nepal
(Institute of Medicine, 2019) Rayamahji, Parash; Karn, Ragesh; Gajurel, Bikram P; Rajbhandari, Reema; Ojha, Rajeev; Agrawal, Jagadish P
ABSTRACT Introduction Seizures beginning in the adult life require special attention as regards to their etiology because these are likely to be due to an identifiable cause. Understanding the trend in prevalence of various etiology of seizure will help in formulation of diagnostic protocol and might help to reduce the cost of investigations. In this retrospective study, we, therefore, aimed to assess etiology and clinical profile of adult onset seizures. Methods This was a retrospective study done at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. We included patients of both sexes and age > 18 years old admitted to neurology ward with seizure disorder and excluded the patients who suffered from unprovoked seizure and epilepsy. Our study variables included demographic profile of patients, co-morbidities, clinical features, laboratory investigation, neuro-imaging, EEG and drugs. Results Among 26 patients, 3 (11.5%) had hyponatremia, 2(7.7%) had intra-cranial space occupying lesion, 12(46.2%) had neurocysticercosis (NCC), 1 (3.8%) had opioid withdrawal, 1 (3.8%) had alcohol withdrawal, 1 (3.8%) had stroke, 1 (3.8%) tuberculoma and in 5 (19.2%) patients no underlying cause was found. Conclusion NCC was the most common cause of seizure disorders among adults. Even after huge development in laboratory, neuroimaging and neurophysiology testing, in as much as 19.2% patients, no etiology could be found. Keywords: Adults, outcome, seizure, tertiary care hospital
Effectiveness of Audit and Feedback in Improving the Quality of Operative Notes - A Retrospective Observational Study
(Institute of Medicine, 2019) Maharjan, Leison; Singhal, Aditya; Guragain, Rajendra PS
ABSTRACT Introduction Surgeons must maintain detailed and accurate operative notes as it is important not only for safe patient care but also for research, audit and medicolegal purposes. But literature has shown that many operative notes are incomplete and illegible. Audit and feedback is a useful strategy to improve such practices which our department has been following. Our aim is to study its effectiveness by comparing the quality of operative notes of 2016 with that of 2014. Methods Total 96 operative notes, 48 each of the year 2014 and 2016 were studied under 22 parameters including 18 suggested by “Good Surgical Practice” guideline. Each operative notes was analyzed by a single observer for completeness. Parameters of the operative notes of two different years were compared and given the status of either improved, deteriorated or unchanged. Results Only parameters related to patient identification, date, surgeon’s fullname, postoperative plan were complete in both the years. In comparison to earlier year, in 2016 improvement was seen in parameters such as postoperative diagnosis, details of tissue removed, authors details, closure details, operation time and operative difficulties/complications and deterioration was seen in hospital number, preoperative diagnosis, procedure, fullname of anesthetist, fullname of scrub nurse, operative findings and signature of the surgeon. Conclusion Improvement in the quality of the operative notes was not adequate with audit and feedback strategy alone. Hence to increase the effectiveness, other methods such as computerized operative notes and aide-memoire should also be introduced. Keywords: Audit, feedback, operative notes, surgical notes
Early Experience of Cardiac Surgery in the Maldives
(Institute of Medicine, 2019) Sapkota, Ranjan; Shafiu, Mohamed; Razzag, Dusooma A; Patil, Priyanka B; Sadoon, Haytham M Y; Abouhabiba, Karim M; Vivehananthan, Sivaranjani P; Shinde, Dipti S; Moosa, Mohamed F; Sattar, Fathmath A A; Gautam, Mani P; Bhadauria, Prateek S
ABSTRACT Introduction From stitching a heart wound to the current level of sophistication, cardiac surgery has come a long way as a discipline. Heart surgery in South Asia has advanced tremendously; both, quantitatively and qualitatively. This is a report of the first fifteen surgeries done in the Maldives where cardiac surgery has started as an organized program. Methods Data on the first fifteen consecutive cardiac surgeries done in our hospital, over a period of 7 months, was analyzed. We briefly describe our usual perioperative management, and the pretext of the beginning of the cardiac surgery program. Results Fifteen patients, 13 males, aged 59.9±13.8 years, with a EuroScore of 0.9±0.4%, were operated. Eleven underwent CABG; and four had a valve replacement. Nine out of 11 had TVD, including 6 who had an LMCA disease. The first surgery was an off-pump CABG. The CABG group had a total of 2-5 grafts. Pump and cross-clamp times were 239.6 (± 56.1) min and 154.2 (± 45) min respectively. Five (33.3%) had at least one non-fatal complication. Two (13.2%) required re-exploration for mediastinal bleeding. The length of hospital stay was 16.5 days (±6.9 days). The chest tubes stayed for an average of 4.8 (±0.7) days. There was no in-hospital, 30-day and 90-day mortality recorded. Conclusion Cardiac surgery has begun in the Maldives. It is safe and feasible to sustain cardiac surgery program in the country, provided continued national support and international collaboration is ensured. Keywords: Cardiac surgery; coronary artery bypass; Maldives; valve replacement
Life Satisfaction and Insomnia among Elderly Community Dwellers of Lalitpur, Nepal
(Institute of Medicine, 2019) Khagi, Bina R; Timalsina, Rekha; Chhantyal, Anita; Shiwakoti, Shrijana; Maharjan, Manju
ABSTRACT Introduction Life satisfaction during elderly is essential in ageing process. Globally, insomnia is a problem that degrades the health of elderly people, which also interferes with the quality of life. Methods A descriptive cross-sectional study was conducted to identify life satisfaction and insomnia among 501 community dwellers elderly of Lalitpur by using structured interview schedule on socio-demographic information, Satisfaction with Life Scale (SWLS) to measure a life satisfaction and Pittsburgh Insomnia Rating Scale (PIRS) to identify the prevalence of insomnia. Results Data was edited, classified, and coded manually. Then, data entry and data cleaning were done using Epi data software and data analysis was done using SPSS software version 16. Descriptive and inferential statistics were used to analyze data. The study showed that 31.9% and 35.7% of respondents were highly satisfied and satisfied with their life respectively. However, 6% and 0.6% of respondents were dissatisfied and extremely dissatisfied with their life respectively. Study reveals that 50.5% of respondents had insomnia. Ethnicity, current job status, and health problems during night sleep were significantly associated with life satisfaction. Similarly, age, marital status, educational status, current job status, current physical health problems, presence of disease, taking medication at present and health problems during night sleep were significantly associated with insomnia. Conclusion Most elderly people were satisfied with their life, but majority of them suffered from insomnia. Therefore, it is necessary to plan awareness program regarding life satisfaction and insomnia by concerned authority to help elderly to stay healthy and improve their quality of life. Keywords: Elderly, insomnia, life satisfaction
Brachiobasilic Fistula at Manmohan Center: A Retrospective Review
(Institute of Medicine, 2019) Shrestha, Kajan R; Gurung, Dinesh; Shrestha, Uttam K
ABSTRACT Introduction Brachiobasilic fistula (BBF) with transposition is one of methods for creating native arteriovenous fistula (AVF) for hemodialysis. This study aims to highlight the result of a BBF in a tertiary referral center and aims to improve its result. Methods This is a retrospective descriptive study conducted on the basis of data collected of patients undergoing BBF with transposition from January 2014 to December 2018 (5 years) at Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Data regarding demographics, results and complications has been analyzed. Results Total 59 patients underwent brachiobasilic fistula performed by 3 surgeons with male to female ratio of approximately 3:2 with mean age of patient 68.78±13.77 years. Hypertension was the most common comorbidity present in 91.53% (54) of patients. Fifty six (94.92%)patient had previous undergone some sort of arteriovenous fistula creation and in 10 (16.95%) patients it was done in two stages. There were 2 immediate failures (within 1 week) and 9 early failures (before 1st dialysis) however 2 patients presented later with blocked BBF after starting dialysis. Only 31 patients could be followed up with patent BBF after 1 year of creation. About 71.19% of fistulas were able to mature and undergo dialysis by 6 week period and most common complication was bleeding from incision site in 20 patients (33.90%). Conclusion Brachiobasilic fistula is the good option for native arteriovenous fistula access for hemodialysis but it need proper selection of cases to decrease complication rates. Keywords: Brachiobasilic fistula, hemodialysis access, native arteriovenous fistula
Clinical and Etiological Profile of Patients with Optic Disc Edema in Tertiary Care Centre of Nepal
(Institute of Medicine, 2019) Shah, Ritesh K
ABSTRACT Introduction sible in most cases using tests like visual acuity, color vision, visual field and suitable radiological imaging. Study in Nepalese population with regard to optic disc edema is scarce. Hence this study aims to act as a guideline for evaluation of such cases and help in further studies in this regard. Methods A descriptive, cross-sectional study was conducted in all cases of optic disc edema presenting to neuro-ophthalmology clinic of B.P. Koirala Lions Centre for Ophthalmic Studies from January 2011 to June 2012. A detailed history was obtained and proper ocular and nervous examination was done by ophthalmologist and neuro-physician. Assessment of visual acuity, color vision, contrast sensitivity and visual field along with radiological tests were done in all possible cases. Results Out of all the cases evaluated, 38 cases where causes of optic disc edema could be established were included in the study. The commonly affected age group was 31 to 40 years (26.3%) and most of them were males. The commonest cause observed was optic neuritis (36.8%). Others were papilledema, idiopathic intracranial hypertension, toxic optic neuropathy, non-arteritic anterior ischemic optic neuropathy (NA-AION), compressive and traumatic optic neuropathy. Conclusion Optic neuritis and papilledema should be considered as common differential diagnosis in patients with optic disc edema. NA-AION is a relatively uncommon disease among Nepalese population. Keywords : NA-AION, optic disc edema, optic neuritis, papilledema
Measurement of Subcarinal Angle: A Cadaveric study
(Institute of Medicine, 2019) Shrestha, Anusuya; Ranjit, Nirju; Bhandari, Rosha; Adhikari, Bidur; Gautam, Jyoti
ABSTRACT Introduction The bifurcation of trachea into two primary bronchi at the level of fourth thoracic vertebra creates an angle at the bifurcation. This angle can be seen clearly in routine chest X-rays where the measurement can throw light on many medical conditions within the mediastinum. This study aimed at finding the subcarinal angle, which is the angle formed by inferior borders of two primary bronchi. Methods The measurements were taken from photographs of tracheal specimen of 92 cadavers, 63 male and 29 female. Angle was measured by photographic software and analysis of subcarinal angle was done in the study population. Results The mean subcarinal angle was found to be 41.090 with standard deviation of 17.140. This measurement was found to be significantly more in males (68.02± 15.720) than in females (60.14 ± 17.710). Conclusion The subcarinal angles in the study population were seen to be different among sexes. Also, the mean subcarinal angles from other studies, radiological or on specimen were close to the observations made in this study. Keywords: Bronchus, subcarinal angle, trachea
Prevalence of Chronic Cor Pulmonale in Chronic Obstructive Pulmonary Disease Patients in a Teaching Hospital in Nepal
(Institute of Medicine, 2019) Sayami, Matina; Baral, Suman; Shrestha, Rakshya; Karki, Dambar B
ABSTRACT Introduction Chronic obstructive pulmonary disease (COPD) is the most common cause of cor pulmonale. Cor pulmonale in COPD is associated with decreased survival, increased hospitalization and mortality. In this study we aim to find out the prevalence of chronic cor pulmonale in COPD patients which would help in prevention of right sided heart failure and improve patients’ quality of life. Methods This was a cross sectional observational study done in Kathmandu Medical College Teaching Hospital, Nepal. 50 COPD patients above the age of 30 years attending the outpatient department or admitted in wards were included. All COPD patients diagnosed by pulmonary function test (PFT) were assessed for cor pulmonale by echocardiography (ECHO). The demographic data, chest X-ray, PFT, electrocardiography (ECG) and ECHO findings were recorded, entered and analyzed using SPSS software, version 17. Results Most of the patients enrolled in the study were between age group of 51-60 with female preponderance. 68% of the COPD patients had chronic cor pulmonale. Out of 21 male, 76.2% and out of 29 female COPD patients, 62.06% had cor pulmonale. Cor pulmonale was present in 53.12% and 94.4% of patients who had COPD for < 10 years and ≥10 years duration respectively. Cor pulmonale was present in 76% patients with severe COPD, 75% of patients with moderate COPD, 64.2% patients with very severe COPD and none of the patients with mild COPD. Pulmonary hypertension (PH) was present in 67.64% of cor pulmonale patients. Conclusion The prevalence of chronic cor pulmonale in COPD patients was 68%. It was more in male patients, highest in patients with severe COPD, and the prevalence increased with duration of COPD. PH was present in 67.64% of cor pulmonale patients. Keywords: Chronic obstructive pulmonary disease, chronic cor pulmonale
Early Laparotomy: A Necessity for Postoperative Intraperitoneal Hemorrhage
(Institute of Medicine, 2019) Rawal, Suniti; Paudyal, Pooja
ABSTRACT Introduction Haemorrhage is considered the dreaded complications following any surgery. “Relaparotomy” is a better described terminology for a repeat case postoperative haemorrhage in gynecological surgeries. With increased awareness and early detection and subsequent rise in gynaecological operations have led additional incidence of relaparotomies and further in morbidity and mortality. Methods The study was conducted from April 2006 - March 2017 including cases of re/laparotomy for intraperitoneal bleeding at TUTH, Nepal. Results There were 27 cases of intraperitoneal hemorrhage majorly from 20 abdominal surgeries comprising 12(44.4%) abdominal hysterectomies, 6 (22.2%) laparotomy, 1(3.7%) each of diagnostic laparoscopy and abdomino perineal approach and 7(26%) vaginal hysterectomies. Features of hypovolaemic shock in 14(51.8%), marked abdominal distention in 9(33.3%) and blood loss of 400 to 3000 ml was observed.Five (18.5%) cases of active bleeding from pedicales were secured. Oozing from various sites (10, 37%) cured with haemostatic sutures. Generalised oozing post diagonistic laproroscopy, subtotal hysterectomy was done (1, 3.7%). In 2 (7.4%) cases bleeding from fallopian tube and mesosapinx were sutured. Six (22.2%) hematomas were evacuated and bleeders secured. Dissection of left uterosacrial ligament and tearing of infundibulopelvic ligaments (1, 3.7%) were reinforced and sutured. Sputter in the vault (1, 3.7%) were ligated and isolated rise in PT (1, 3.7%) with FFP transfusion.Two succumbed to death, one following diagnostic laparoscopy from adult respiratory distress syndrome and next from VH with PFR anesthetic complications. Conclusion Proper closure of surgical incision with the right technique, appropriate ligature, careful tying of the blood vessel, monitoring pulse rate and blood pressure in postoperative cases can minimize the morbidity and mortality. Keywords: Hemoperitoneum, intraperitoneal bleeding, relaparotomy
Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit
(Institute of Medicine, 2019) Shrestha, Pramesh S; Marhatta, Moda N; Acharya, Subhash P; Shrestha, Ninadini
ABSTRACT Introduction Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU. Methods A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost. Results There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001). Conclusion Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room. Keywords: Complications, intensive care unit, percutaneous tracheostomy, surgical tracheostomy
Batwing Technique in Large Volume Excision of Breast Lesions: Case Report
(Institute of Medicine, 2019) Khanal, Suman; Singh, Yogendra P; Sharma, Rashmi
ABSTRACT Oncoplastic surgical techniques are seeing widespread use for excision of large volume breast lesions. Batwing technique is one of the volume displacement techniques that can be used to manage lesions in central quadrant of the breast. Such techniques are still underused in Nepal. Here we present three cases with large volume benign breast lesions managed with simple, easy-to-learn technique of Batwing oncoplasty. Keywords: Batwing, fibroadenoma, oncoplasty, phyllodes
Elderly Great Grand Multipara with Gestational Hypertension and Anemia Managed in a Rural Tertiary Hospital: A Case Report
(Institute of Medicine, 2019) Shrestha, Uma
ABSTRACT Introduction Parity more than five is grand multiparity and more than 10 is great grand multiparity. Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is even higher for great grand multiparous women than grand multiparous women. Grand and Great grand multiparity predispose for adverse maternal and perinatal outcomes such as malpresentation, labor dystocia, caesarean delivery, postpartum hemorrhage, maternal anemia, congenital malformations and perinatal mortality. Grand and Great grand multiparty is also independent risk factor for labor dystocia and perinatal mortality. However, most of the adverse outcomes that have been associated with grand multiparity may actually be confounded by advanced age, less antenatal care and low socioeconomic level. Although pregnancy hypertension is more commonly seen among young primigravidas, hypertension is equally common in elderly women. This is a unique case of elderly great grand multiparous women with moderate anemia who developed gestational hypertension and underwent emergency cesarean section resulting into normal maternal and fetal outcome. Keywords: Elderly, gestational hypertension, great grand multiparity, pregnancy outcome
Thyroglossal Duct Fistula with an Unusual Presentation: A Case Report
(Institute of Medicine, 2019) Gyawali, Bigyan R; Dutta, Heempali; Tripathi, Prashant
ABSTRACT Thyroglossal duct anomaly is one of the commonest congenital anomalies with midline neck manifestation. Though commonest location mentioned in the literature is thyrohyoid, several rare presentations have also been described. Here, we present a very rare case of thyroglossal fistula manifesting in submental region. Keywords:Fistula, submental, thyroglossal duct
Anorectal Autoeroticism: A Case Report
(Institute of Medicine, 2019) Tulachan, Pratikchya; Shrestha, Kenison; Chapagai, Manisha; Dhungana, Saraswati; Pant, Sagun B; Lama, Pratik; Bhandari, Ramesh S
ABSTRACT Introduction Anorectal autoeroticism is one kind of paraphilia where individual attains sexual pleasure through self inserting objects into ones rectum. We present here a case of 40 years old man presented in Surgery department with retention of steel glass into his rectum which he had inserted himself to achieve sexual satisfaction. Keywords: Anorectal autoeroticism, biopsychosocial factors, paraphilia
Nephron Sparing Surgery for Small Renal Mass at a University Teaching Hospital: A Six Years Retrospective Review
(Institute of Medicine, 2019) Rai, Bipendra DK; Poudyal, Sujeet; Dhital, Pawan; Pradhan, Manish; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction Nephron-sparing surgery (NSS) is the standard of care for clinical T1 (cT1), renal mass less than 7 cm, whenever intervention is indicated. It has oncological outcome equivalent to radical nephrectomy in small renal masses and it also minimizes the progression to chronic kidney disease. However, there is paucity of data on outcomes of NSS in Nepalese population. Methods A six years retrospective review of medical records of patients undergoing partial nephrectomy from Jan 2012 to Dec 2017 in Department of Urology and Kidney Transplant Surgery at Tribhuvan University Teaching Hospital was done to determine its demographics and outcomes. Results Twenty eight patients underwent nephron sparing surgery for clinical T1 renal masses in the past six years. Complications occurred in three cases. Five of the lesions were benign and 23 malignant on final histology. Clear cell carcinoma was the commonest variant of renal cell cancer. Margin was positive in two cases and both were kept in close surveillance. There was no local recurrence and renal impairment during five to 60 months follow-up. Conclusion Nephron sparing surgery is a safe procedure with good oncological outcome for clinical T1 renal mass. It prevents unnecessary nephrectomy in benign lesions as well as chronic renal impairment at the same time. Keywords: Nephron sparing surgery, small renal mass
Donor Factors Affecting Short Term Graft Outcome in Live Donor Kidney Transplantation
(Institute of Medicine, 2019) Nepali, Rabin; Shah, Dibya S; Gyawali, Prem R; Sharma, Uttam; Chalise, Pawan R
ABSTRACT Introduction Since the beginning of renal transplant, the objective has been to increase the patient and graft survival, both short term and long term. Data relating to donor factors affecting short term survival at 6 months in live donor kidney transplantation has been scarce. This single center study tries to examine the predictors of short term graft outcome at six months in recipients of live donor kidney transplants and explore which donor characteristics are the most useful in predicting the post-transplant graft function in Nepalese population. Methods All patients who underwent kidney transplantation between May 2015 to July 2016 were included in the study. The patients who expired during follow were excluded. The clinical and laboratory parameters of the donors were recorded. The recipients were followed up for six months post transplantation. The eGFR of the recipients and the occurrence of rejection were recorded at the end of six months post transplantation. Results A total of 82 donor-recipient pairs underwent living donor renal transplantation at our hospital during the study period. One recipient who expired during follow up was excluded. The mean age of donor was 45.20 ± 11.226 years of which 55 (67.9%) were female and 26 (32.1 %) were male. The mean eGFR of the donor calculated from Cockcroft Gault equation was 81.98 ± 18.11. The eGFR of the recipient at the end of six months post transplantation calculated form the MDRD equation was 67.76 ± 20.94. A total of 7 patients (8.6%) had rejection that were biopsy proven. Only donor eGFR was found to be significantly associated with eGFR of the recipient at six months post transplantation (p=0.034). Body mass index of the donor was significantly associated with rejection in the recipient at six months post transplantation (p=0.011). Conclusion Our study demonstrates that the donor eGFR and body mass index are independent and important factors affecting the short term graft outcome at six months post transplantation. Keywords: Body mass index, donor eGFR, graft outcome, renal transplantation

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