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Comparison of Subjective Global Assessment and Nutritional Risk Index on Outcome after Abdominal Surgery
(Institute of Medicine, 2014) Gupta, DK; Sharma, MR; Ghimire, B; Vaidya, P
Abstract Introduction: Preexisting malnutrition in surgical patients has been conclusively correlated with complications such as wound infection and myriad of other adverse outcomes during and after hospitalization. So, it is imperative to recognize and manage this status preoperatively in an effort to improve outcome. The aim of the study was to compare the Subjective Global Assessment (SGA) and Nutritional Risk Index (NRI) with outcome after abdominal surgery. Methods: This is a prospective study conducted at the Department of Surgery, Tribhuvan University Teaching Hospital, Nepal, for the period of one year. The study included a total of fifty patients undergoing abdominal surgery. Patients were assessed with two types of nutritional assessment techniques, namely, SGA and NRI. The outcome parameters included were wound infection, and chest infection, and length of hospital stay. Results: No complications occurred in 24 of the 50 patients; 13 patients had more than one complication. The frequency of malnutrition was found to be 74% and 80% as assessed by SGA and NRI respectively. Morbidity rate was significantly higher and length of hospital stay was also longer in malnourished patients assessed by SGA group. Wound infection rate was significantly higher and length of hospital stay was also longer in malnourished patients when assessed by SGA. The area under the receiver operating characteristics curve for SGA and NRI revealed that SGA was better for predicting overall morbidity as well as specific complications than the NRI. Three patients died during treatment period. Conclusions: Malnutrition is a marker of poor postoperative outcome. Subjective Global Assessment is better than Nutritional Risk Index to predict postoperative complications in patients undergoing abdominal surgery. Keywords: malnutrition, nutritional assessment techniques, nutritional risk index, subjective global assessment
Outcome of in-hospital resuscitation in a tertiary level teaching hospital in Nepal
(Institute of Medicine, 2014) Pradhan, B
Abstract Introduction: Cardiopulmonary resuscitation (CPR) is being used extensively in the hospital settings for life saving purposes. Resuscitation guidelines are reviewed and published frequently for better outcome of the patient. The objective of this study was to identify predictors of outcome of CPR and compare the outcome of PR with other centers. Method: This is a retrospective analytical study of one year duration carried out in tertiary level teaching hospital. Data were collected and then entered in Microsoft excel software with all the variables. Statistical analysis was done using Statistical Package for Social Sciences 17 software. Results: There was no influence of gender, age, time of call and site of call on outcome of CPR. Strong correlation was observed with primary rhythm of the patient at the time of CPR, with better outcome for ventricular fibrillation (VF) & pulseless ventricular tachycardia(VT) (survival 65%), and worse for asystole (survival 25%) and pulseless electrical activity (survival 54%). Conclusion: In this study it was found that primary rhythm at the time of CPR is strong predictor of survival. Outcome of CPR in this centre is comparable to other centres following standard protocols for CPR. Keywords: asystole, pulseless, resuscitation, ventricular fibrillation
Antibiogram and Plasmid profiling of clinical multidrug resistant Escherichis coli
(Institute of Medicine, 2014) Shrestha, S; Mali, NM; Tiwari, KB; Adhikari, N; Shrestha, UT; Basnyat, SR
Abstract Introduction: Multiple antibiotic resistances among common bacterial pathogens have been established as an alarming public health problem elsewhere. This study was aimed to explore prevalence of Extended-spectrum beta-lactamase (ESBL) producers among multi drug resistant (MDR) and plasmid profiling patterns of Escherichia coli isolated in Kathmandu Model hospital, Nepal over three months period. Methods: Altogether 49 isolates were randomly selected among the reported MDR E. coli and retested for the susceptibility pattern and ESBL production by Kirby- Bauer disc diffusion test. Minimum Inhibitory Concentration of the isolates towards (fluro) quinolones was determined by agar dilution method. Plasmids from isolates were extracted by alkaline lysis method. Results: All isolates were completely resistant to Amoxycillin but sensitive to Imipenem. A very high prevalence (44, 89.8%) of ESBL was detected. Most of the isolates were resistant to commonly uses antibiotics such as Quinolones, Tetracyclines and Cotrimoxazole. Among Quinolones, the Minimum Inhibitory Concentration (MIC) range for Nalidixic acid, Ciprofloxacin and Ofloxacin were 512->4093, 8-4096 and 1-256 µg/ml respectively. All 31 (63.3%) plasmid- harboring isolates contained a>33.5 kb sized plasmid. Among them, seven isolates possessed multiple (2 – 7) plasmids. Overall, twelve different resistance patterns were observed among the bacteria. Based on the patterns, the high molecular weight plasmid seemed to contain most of the resistance genes. Conclusion: It is suspected that multi drug resistance and ESBL production in E. coli with resistance to Quinolones may be due to their high molecular weight plasmids. So, continuous antibiotic susceptibility test and surveillance of the plasmid and chromosome of E. coli is essential as plasmid analysis has been applied to determine the evolution and spread of antibiotic resistance among isolates. Keywords: escherichia coli, antibiotic resistance pattern, multidrug resistant (MDR), extended spectrum beta- lactamases (ESBL), plasmid profiling
Skin Diseases and Impact on Quality of Life in the Central Development Region Of Nepal: A Major Public Health Problem
(Institute of Medicine, 2014) Shrestha, DP; Gurung, D; Shrestha, R; Rosdahl, I
Abstract Introduction: Skin diseases are one of the most common health problems in Nepal. The objectives of this study are to determine the prevalence of skin diseases and impact on quality of life in the rural areas of central development region of Nepal. Methods: The study was conducted in the 10 VDCs of 4 districts – Dolakha, Kavre, Makawanpur and Chitwan – of the central development region. A house-to-house survey was carried out to obtain socio-demographic data and identify individuals with skin diseases. Then a dermatologic health camp was conducted in each VDC. During the health camp, the skin diseases diagnosed were recorded and villagers with skin diseases more than 1 month duration were interviewed with skin disease disability index, to assess the impact on the quality of life. Results: A total of 7348 inhabitants (male – 3651, female – 3787) were surveyed. Of 2586 individuals with skin disease attending the health camps, 1862 (male – 721 and female – 1141, mean age 31.4yrs, range 6 months – 90years) were included in the study. The overall prevalence of skin diseases was 25%. The most common SD categories were eczemas, pigment disorders, fungal infections, nevi and urticarial. The mean skin disease disability index score in the central development region was 13.7, indicating very large impact on the quality of life. Conclusion: The prevalence of skin diseases and impact on quality of life is very high in the rural areas of the central development region of Nepal. It is a major public health problem. Targeted intervention at the primary health care level should help to reduce the burden. Keywords: skin disease, prevalence, impact, qyality of life
Does Stone Culture Predict Systemic Inflammatory Response after Percutaneous Nephrolithotomy?
(Institute of Medicine, 2014) Luitel, BR; Chalise, PR; Gyawali, PR; Sharma, UK; Shrestha, GK; Joshi, BR
Abstract Introduction: Systemic inflammatory response syndrome (SIRS) is a common and important complication after percutaneous nephrolithotomy (PNL). This study was carried out with the objective of finding out the association between stone culture and PostPNL- SIRS. Methods: A prospective study was done in the urology unit, Tribhuvan University Teaching Hospital from July 2009 to June 2011. Preoperative midstream urine, intraoperative pelvic urine and stone fragments were sent for culture in all patients undergoing PNL. The primary outcome was SIRS on second postoperative day. Data analysis was done using Statistical Package for Social Sciences (SPSS) 17.0 version. Results: Out of 47 patients 22 (46.8%) patients developed SIRS on second postoperative day. Stone and pelvic urine culture positivity rate was 8(17%) and 6(12.8%) respectively with P. aeruginosa E. coli and Proteus spp being the common organisms isolated, most of which were sensitive to amikacin. Positive stone culture was the significant risk factor for SIRS (P=0.018). Conclusion: Positive stone culture is an important risk factor for SIRS after PNL. Routine stone culture is beneficial in patients undergoing PNL for the subsequent postoperative management. Keywords: Percutaneous nephrolithotomy, Stone culture, Systemic Inflammatory Response Syndrome (SIRS)
Use of five different tests for Helicobacter pylori infection in Nepal
(Institute of Medicine, 2014) Sharma, RP; Yamaoka, Y; Shrestha, PK; Khadga, P; Sharma, S; Shrestha, KB
Abstract Introduction: The prevalence of Helicobacter pylori (H.pylori) has declined rapidly in Asia. This has been shown in both sero-prevalence-based and endoscopy-based studies. The present study was conducted to determine the current prevalence of H.pylori infection in Nepali population referred for upper gastrointestinal endoscopy and its relation with gastro-duodenal diseases. Method: Total of 146 patients (71 males and 75 females with the mean age of 42, 43 yrs, range 16-90yrs) underwent endoscopy at endoscopy services in Tribhuvan University Teaching Hospital (TUTH), Nepal. The diagnosis of H.pylori infection was determined non-invasively by serology and invasively by rapid urease test, culture, histology and immunohistochemistry. Results: The overall prevalence of H.pylori infection was 48.6%. The sero-prevalence was 43.8%. Gastritis was the predominant finding (76.7%), followed by duodenal ucler (4.1%), gastric ulcer (4.8%), gastric adenocarcinoma (3.4%) and normal mucosa (10.9%). Conclusion: The present study revealed the prevalence of H. pylori infection measured by serology was higher than that with other studies conducted in Nepal, the present study of the first study to use several tests at the same time to determine H. pylori prevalence. Keywords: Helicobacter pylori, infection, test, Nepal
Re-emergence of the deadly Ebola virus disease: A Global Health Threat
(Institute of Medicine, 2014) Sherpa, K
NA.
Pregnancy Induced Hypertension and its Management
(Institute of Medicine, 2014) Subedi, D
Abstract Pregnancy induced hypertension which occurs after 20 weeks gestation, in labour or within 48 hours of delivery. The mortality is closely associated with the severity of hypertension, being more evident in patients with eclampsia. Neonatal and infant mortality rates are consistently higher in preterm infants than in term infants. Preeclampsia and eclampsia can lead to higher frequency of induced labor, fetal growth restriction, neonatal respiratory difficulties, and increased frequency admission to neonatal intensive care unit. Early detection and prevention of maternal hypertensive disorder is important in order to avoid morbidity and mortality. Education about the warning symptoms is also important because early recognition may help women receive treatment and prevent worsening of the disease.
Systemic Lupus Erythematosus with antiphospholipid Syndrome Presenting as Seizure Disorder and Retinopathy
(Institute of Medicine, 2014) Sharma, AK; Sitaula, S; Thapa, M; Gautam, P; Shrestha, GS; Gajurel, BP; Sigdel, MR
NA.
Disseminated cysticercosis in a child: A Rare Presentation
(Institute of Medicine, 2014) Poudel, DR; Lhaden, T; Shrestha, M
Abstract We here present a rare case of disseminated cysticercosis presented with clouding of cornea with gradual loss of vision in the right eye and multiple nodules all over the body. Opthalmologic evaluation revealed none perception of light on right eye with calcified cyst in entire intraocular lens. MRI of the brain showed starry sky pattern in brain parenchyma and multiple calcified cysts in the orbit. Serological test (ELISA) for cysticercal IgG antibodies was positive. Histopathology report on an excised biopsy from subcutaneous nodule also showed calcified cyst. She was treated initially with steroid for 3 days followed by albendazole for 2 weeks. MRI was repeated after 3 months which showed no resolution of the lesion. Later she presented with generalized seizure managed with anticonvulsant. Keywords: cysticercosis, calcified cyst
Topiramate-Induced Psychosis in an Individual with alcohol Dependence: a case Report
(Institute of Medicine, 2014) Chapagai, M; Tulachan, P; Dhungana, S
Abstract Introduction: Topiramate, an antiepileptic drug, has been shown to reduce alcohol craving and heavy drinking and to improve abstinence among alcohol-dependent individuals 1. We report here a case of psychosis which occurred following use of topitramate in an alcohol dependence case .Thus, this case highlights need for clinicians to become aware of this association and its subsequent severe morbidity. Keywords: Topiramate, Alcohol dependent, psychosis
clinical Manifestation of Ocular Motor Nerve Palsies in a Tertiary Eye Hospital of Kathmandu, Nepal
(Institute of Medicine, 2014) Sitaula, S; Sharma, AK; Shrestha, GB; Gajurel, BP; Shrestha, GS
Abstract Introduction: Ocular motor nerve palsies are one of the leading causes of ocular morbidity in the neuro-ophthalmology clinic. Objective: This study was aimed to determine the aetiology of ocular motor nerve palsies in a tertiary referral eye center of Nepal. Methods: This hospital based cross-sectional descriptive study was carried out over a period of one and a half years. All cases of ocular motor nerve palsies were evaluated and relevant laboratory investigations and imaging studies were done. Results: Ninety–one patients with ocular motor nerve palsies were examined, of which 53 (58%) were males and 38(42%) were females. The mean age was 39.4 years ±18.29 years. Majority of the cases (n=78, 86%) had unilateral involvement and the most common chief complaint was double vision (n=58, 63.7%). The sixth cranial nerve palsy was most commonly seen (n=49, 53.85%) followed by third nerve palsy (n=22, 24.18%). Fourth cranial nerve palsy and combined cranial nerve palsies accounted for 10.99% each (n=10). Aetiology of ocular motor nerve palsies could not be determined in 31.8% of the cases. Among the identifiable etiologies were vascular diseases (n=24, 26.3%), infections (n=14, 15.3%), trauma (n=14, 15.3%) and neoplasms (n=9, 9.8%). Imaging studies were done in 92 %(n=84) of cases. In cases of combined cranial nerve palsies, positive diagnostic findings were noted in 50% (n=5) of the cases with imaging studies. Conclusion: The sixth cranial nerve palsy was the most common ocular motor nerve palsy in our study. The most common identifiable aetiology was vascular diseases followed by trauma. Besides ophthalmic examination, neurological evaluation and imaging plays an important role in diagnosis. Keywords: aetiology, imaging, ocular motor nerve palsy
Radiation Hazards and Protection: are Nepalese Radiologists Up to Date?
(Institute of Medicine, 2014) Subedi, K; Suwal, S; Pant, OB
Abstract Introduction: Radiation safety is a major concern in this modern era of diagnostic and therapeutic radiology. Institutions in Nepal still lack the adequate standards to maintain radiation safety. This study was conducted to assess the status of update on radiation hazards and methods of protection among radiologists in Kathmandu. Methods: A questionnaire survey was performed during continuing medical education program at Tribhuvan University Teaching Hospital, Kathmandu before and after a lecture session on radiation hazards and protection. Results: A total of 28 participants volunteered to answer the questionnaire. The mean pretest score was 57.8±29.7, which increased to 83.5± 16.8 after the lecture session. Twelve (42.86%) participants scored less than 50%, which increased significantly comparable to the rest (scoring more than 50%) in posttest score. Mean score was least in ionizing radiation questions. Conclusion: The update on radiation hazards and methods of protection is inadequate among radiologists in Kathmandu. Continuing medical education programs pertinent to the topic must be regularly conducted to keep the radiologists up to date. Keywords: knowledge, radiation hazards, radiation protection, radiologists
Ameloglyphics: a Novel appraisal of the Enamel Structure in Identification of an individual
(Institute of Medicine, 2014) Dahal, S; Boaz, K; Srikant, N; Agrawal, NK
Abstract Introduction: Ameloglyphics is a newly emerging field that studies the patterns of enamel rods. Amelo means enamel and glyphics means carving. It is said by some investigators that the patterns of enamel rods are unique to each individual. Methods: The aim of the study was to estimate and categorise tooth print patterns among 30 teeth of known age and gender and to analyze the variation among carious and non-carious teeth. The tooth surface was etched and imprint was transferred to a slide using an adhesive tape. Further evaluation was done under light microscopy by using verifinger SDK software. Results: The various patterns observed were straight, wavy, branched, looped, intersecting and radiating. The carious teeth and deciduous dentition showed predominance of wavy and straight pattern which is in accordance with their softer nature and increased susceptibility to bacterial invasion. Keywords: enamel, tooth prints, biometrics, ameloglyphics
Evaluation of Ejection Fraction in Patients with cardiac Resynchronization Therapy by Two and Three Dimensional Echocardiography
(Institute of Medicine, 2014) Anil OM
Abstract Introduction: Since assessment of left ventricular ejection fraction (LVEF) is crucial for evaluation of patients with cardiac resynchronization therapy (CRT) device both for selection of potential candidates for CRT as well as assessing outcome of therapy, we compared LVEF in patients with CRT device by two dimensional and three dimensional echocardiography. Methods: Two dimensional echocardiography (2DE) was performed first with CRT device on. LVEF obtained by modified biplane Simpson’s Rule. Then real time three dimensional echocardiography (3DE) was performed by (iE 33, PHILIPS Machine). Procedure was repeated with CRT device off. Results: A total of 19 patients aged 54.6 ±11.2 years (Range: 32 years to 75 years) were studied. LVEF measured by 2DE and 3DE, with CRT device off, was 22±4% (17-27%) and 24 ±3% (15-27%) respectively. With CRT device on, LVEF measured by 2DE and 3DE was 26.6±4.1% (22-32%) and 31.3±5.8% (25-41%) respectively. Conclusion: Two dimensional echocardiography underestimates LVEF as compared to three dimensional echocardiography. Cardiac resynchronization therapy (CRT) improves LVEF measured either by two or three dimensional echocardiography. Keywords: Dilated cardiomyopathy, Echocardiography, Cardiac Resynchronization Therapy
A Retrospective Review of Elderly Patients admitted in Psychiatry Department of a Tertiary care center Over 3 Years
(Institute of Medicine, 2014) Dhungana, S; Chapagai, M; Tulachan, P; Ojha, SP
Abstract Introduction: Psychiatric morbidity is high in the elderly population. Despite this, literature regarding inpatient study in elderly is lacking in context to world, including Nepal. This study aimed to study the socio-demographic variables and patterns of psychiatric illnesses in elderly patients admitted in a psychiatry ward of a tertiary hospital. Methods: This was a retrospective study of all elderly patients aged 60 years and above admitted in psychiatry ward over three years period between 2067 Baisakh to 2069 Chiatra (2010 April to 2013 April). Data were collected by reviewing in-patient admission charts from medical records. Descriptive analysis was done by using SPSS version 20; Chicago, IL; and results were expressed as percentages. Results: There were a total of 881 patients admitted in the psychiatry ward during the study period, among which 34 were elderly aged above 60 years. Females slightly predominated in our study. Most of the geriatric sample consisted of Brahmins and all were Hindus. More than 50% of the patients were from central developmental region. The most common diagnosis made was depression followed by schizophrenia Persistent Delusional Disorder (PDD) and organic conditions. Majority of the patients had hospital stay between 2-3 weeks; and all patients were discharged home without mortality. Conclusion: We were able to show the socio-demographic characteristics of elderly patients admitted in a psychiatry ward of a tertiary care center, which will help add insight of psychiatry issues in elderly in Nepalese context. Keywords: elderly, psychiatric illness, inpatient study
Hysterectomy in the Present Day for Dysfunctional Uterine Bleeding: a finding from Tertiary Care Hospital Nepal
(Institute of Medicine, 2014) Baral, J; Gurung, G; Kaudel, S; Paudyal, P; Chudal, D; Shrestha, P; Rana, A
Abstract Introduction: Hysterectomy is a an operative procedure in gynecology, performed for benign or malignant indication, accomplished via abdominal or vaginal routes, technically as open or endoscopic surgery by various approaches; laparoscopic, laparoscopic assisted vagina hysterectomy or robotic surgery. This study was undertaken to analyze the indications of hysterectomies for benign condition with main focus on dysfunctional uterine bleeding (DUB). Method: This study was conducted between 2009 April and 2014 March in the Department of Obstetrics and Gynaecology Tribhuvan University Teaching Hospital. Data were obtained from Operation Theater. Results were precisely reevaluated to find out the indication of hysterectomy done for benign etiology, routes of surgery. Results: Fibroid, utrovaginal prolapsed (UVP), adenomyosis, endometriosis, dysfunctional uterine bleeding (DUB) and adnexal mass were the main indication in total hysterectomy (n1644) performed for benign aetiopathologies, most surgery being performed abdominally (n1126). DUB which were principally treated by hysterectomy and occupied the fifth position as an indication had the postoperative diagnosis other than DUB on histopathological examination in more than 50%. The endometrial pathologies in the operated cases showed endometrial hyperplasia in three cases and adenocarcinoma in one. Conclusion: Presently, abdominal hysterectomy is seen as the only available surgical option for DUB, indicating a need for a change in practices favoring organ preservation. Keywords: endometrial hyperplasia, hysterectomy, dysfunctional uterine bleeding(DUB)
Nosocomial Bacterial Infection and antimicrobial Resistant Pattern in a Tertiary care Hospital in Nepal
(Institute of Medicine, 2014) Sah, MK; Mishra, SK; Ohora, H; Kirikae, T; Sherchan, JB; Rijal, BP; Pokhrel, BM
Abstract Introduction: Nosocomial infection is a global problem with multi facet outcomes. At present, the emergence of resistance to antimicrobial agents is a global public health problem which is well pronounced in developing countries. Methods: The aim of this study was to determine the prevalence of bacteria causing nosocomial infections and their antibiotics resistant pattern among the patients admitted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal. The study was conducted during a period of March 2011 to February 2012. Nine hundred clinical specimens which included urine, sputum, endotracheal aspirates, pus & blood were subjected for bacterial culture and their antibiotics sensitivity test at the Department of Microbiology with the use of standard method as described by American Society for Microbiology (ASM). Results: Prevalence of bacteria causing nosocomial infection was 34.4% (n=310). Out of 310 specimens, urine 122 (39.30%), sputum 78(25.2%), pus 78(25.2%), endotracheal secreation 24 (7.7%) and blood 8(2.6%). Three hundred thirty three bacteria were isolated from three hundred ten specimens. The most common isolates were Escherichia coli followed by Acinetobacter species, Klebsiella pneumonia and Staphylococcus aureus. In-vitro antibiotic susceptibility tests revealed that the Gram-negatives bacilli were only sensitive to fluroquinolones, ceftrixone, cefepime carbapenem, polymyxin B and colistin sulphate while the Gram-positive cocci were sensitive to fluroquinolones, Ceftroxone, cefepime and vancomycin. Conclusion: The findings suggested the need for constant monitoring of susceptibility of specific pathogens in different populations to commonly used anti-microbial agents to cope up this alarming situation in the hospital for the management of such patients and prevent the dissemination of such strains. Keywords: noscomical infections, bacteria and antibiotics
Empirical use of antibiotics in Emergency Department of Tribhuvan University Teaching Hospital and Treatment Success Rate in Discharged Patients
(Institute of Medicine, 2014) Joshi, D; Bhandari, S; Upreti, AR; Banjara, MR; Regmi, BM; Prasad, PN
Abstract Introduction: Infectious diseases are the common presentation in emergency department, which require treatment within minutes. As a result, the empirical antibiotics are started prompt in emergency department before the bacteriological results are available. Therefore, the aim of this study was to explore the use of antibiotics at emergency room and to determine the success rate in discharged patients. Methods: A descriptive, exploratory, non-interventional study was conducted during 8 weeks among the discharged patients from emergency department who received the antibiotic therapy and culture/ sensitivity test was asked. Patients were followed from emergency room and adequate information was taken from emergency records and also at the time of outpatient department visit. Results: Out of 297 patients, only 179 patients were studied. We found that 75.1% of empirically prescribed antibiotics were oral. The most commonly administered intravenous and oral antibiotics were ceftriaxone (20.4%) and cefixime (17.0%). The most common isolate leading to emergency department visit was Escherichia coli (29 patients, 16.2%). In vitro sensitive test for gram positive and gram negative isolates, amoxicillin-clavulanate combination and ciprofloxacin were most effective and cefixime was the least effective antibiotic. The treatment success rate was found to be 147(82.1%) of the patients, as the medication prescribed at emergency room was continued by outpatient department physician. Conclusion: Quinolones and cephalosporins groups of antibiotics are rising as the determinant antibiotics at emergency room. The rate of appropriate use of antibiotics and treatment success rate were found to be higher. Keywords: antibiotics, emergency department, emperical theory
Comparison Between Hydroplasty and Intra-articular Steroid Injection in Treatment of Idiopathic Frozen Shoulder
(Institute of Medicine, 2014) Dhungana, DP; Lamichhane, AP; Mahara, DP
Abstract Introduction: Idiopathic frozen shoulder is one of the common problems in orthopedic outpatient department. It is characterized by gradually progressive pain and stiffness of the shoulder followed by spontaneous recovery over the period of time.Many different modalities are available for the treatment of Idiopathic frozen shoulder, but no one is universally accepted. The purpose of this study was to compare the outcome of hydroplasty with intra-articular steroid injection. Methods: This was a comparative hospital based study conducted between March2011 to September2012, which included 50 patients with Idiopathic Frozen shoulder. There were 25 patients in each group. The mean age of respondent was 57.36 years. Simple Random method of sampling was adopted for selecting patients for each group. Hydroplasty group was given 30ml chilled(cold) sterile normal saline with 2 ml Methylprednisolone (80 mg), 4 ml 2% Lidocain(plain) and 4 ml 0.5% Bupivacain (total volume:40ml) and steroid group was given 2ml Methylprednisolone, 4ml 2% Lidocain(pain), 4ml 0.5% Bupivacain with total volume: 10 ml. Both groups were attached for therapeutic exercises. Comparison of outcomes between two treatment groups was done using Visual Analogue Scale (VAS) for pain, Shoulder Pain and Disability Index for Shoulder function and degree of range of motion. Statistical analysis was done using SPSS 17.0 Results: There was significant improvement in level of pain, Shoulder function (Shoulder Pain and Disability Index) and range of motion in forward flexion, abduction, external rotation, and internal rotation in three month period in Hydroplasty group compared to Steroid group. Conclusion: There was improvement in pain, range of movement and Shoulder Pain and Disability Index (SPADI) score in all patients of both group but the difference in improvement was found to be statistically significant in hydroplasty group as compared to steroid injection group. So Shoulder hydroplasty technique was found to be more effective treatment modality than intra-articular steroid injection in idiopathic frozen shoulder. Keywords: frozen shoulder, hydroplasty, intracular steriod injection, shoulder pain anddisability index

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