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Outcome Analysis of Lipomeningomyelocele Repair in Children in a Tertiary Care Center in Nepal
(Institute of Medicine, 2019) Koirala, Puspa R; Pradhanang, Amit B; Sedain, Gopal; Sharma, Mohan R
ABSTRACT Introduction Lipomeningomyelocele (LMM) is a common neural tube defect especially prevalent in low income countries. When they get appropriate care, long term result is generally good provided the patient receives good neurosurgical, paediatric and rehabilitation care. Surgery is the mainstay of treatment. Our aim was to analyze immediate and long-term results of lipomeningomyelocele repair in symptomatic patients presenting to TU Teaching Hospital, Kathmandu, Nepal. Methods Thirteen patients admitted to Department of Neurosurgery from January 2017 to December 2018 were evaluated. All patients underwent MRI of whole spine before surgery. Surgical procedures involved total excision of lipoma and repair in 10 patients and subtotal excision and repair in 3 patients. Division of filum terminale could be done in 8 patients. Follow up varied from 6 months to 2 years. Results This study included 8(61.5 %) patients of lumbosacral LMM, 3(23%) patients of sacral LMM and 2( 15.38%) patients of thoracolumbar LMM . About 2 (15.38%) were operated before 3 months of age, 2 (15.38%) were operated between 3-6 months of age, 5 (38.46%) were operated between 6-12 months of age and 4 (30.7%) were operated after 1 year. All children except one presented with lump on back since birth and four presented with urinary incontinence, one presented with bilateral club foot. Four (30.7%) patients had weakness of one or both lower limbs. Two (15.38%) patients had improvement in urinary incontinence, two unchanged and one had developed urinary incontinence postoperatively. Four children with had weakness of lower limbs; one patient improved whereas three patients did not improve postoperatively. There was no development of postoperative hydrocephalus after LMM repair. Three (23%) patients developed wound infection who responded well with regular dressings and antibiotics. Conclusion Lipomeningomyelocele repair can be done with satisfactory outcome with total excision of lipoma and division of filum terminale. Patients with residual lipoma and undivided filum terminale should be observed closely for the development of progressive neurological deterioration. Keywords: Lipoma, lipomeningomyelocele, neurosurgery, outcome
Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient
(Institute of Medicine, 2019) Parajuli, Pawan; Bhandari, Ramesh S; Pathak, Rahul; Sharma, Shashi; Khadga, Prem K; Jha, Anurag; Hamal, Rabin; Kafle, Brindeswari
ABSTRACT Introduction Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology. Methods Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis. Results Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy. Conclusion Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain etiology. Keywords: Ascites, peritoneal carcinomatosis, peritoneoscopy
Ventilator-Associated Pneumonia in Neurosurgical Patients: A Tertiary Care Center Study
(Institute of Medicine, 2019) Shrestha, Dipendra K; Rajbhandari, Binod; Pradhanang, Amit; Sedain, Gopal; Shilpakar, Sushil K; Pradhan, Saurav
ABSTRACT Introduction Ventilator-associated pneumonia (VAP) is a well recognized complication in patients who are admitted to the Intensive Care Unit (ICU). A number of factors have been suspected or identified to increase the risk of VAP in Neurosurgical patients. Early and rapid diagnosis and initiation of the appropriate antibiotic treatment reduce mortality and decrease the development of MDR organisms. The aim of our study is to determine the incidence of VAP in the neurosurgical patients and also to assess the probable contributing neurosurgical risk factors and find out the causative bacterial pathogens and the resistant pattern of these bacteria in neurosurgical patient in ICU of our institute Methods A retrospective observational study of 106 neurosurgical patients who were on mechanical ventilation for more than 48 hours was done. Results Out of 106 patients, 35 patients fulfilled the clinical and microbiological criteria for the diagnosis of VAP. The commonest age group involved was between 15-25 years of age with male preponderance. Head injury was the commonest etiology. There was a linear correlation between the number of days in ICU and the development of VAP. The majority of the pathogen isolated were gram-negative bacteria and all were sensitive to Colistin. Conclusion Head injury is a significant risk factor for VAP. Prolonged mechanical ventilation is an important risk factor for VAP. Keywords: Intensive care unit, neurosurgical patient, ventilator-associated pneumonia
Comparison of Sevoflurane and Isoflurane for Myocardial Protection During Coronary Artery Bypass Surgery in a Tertiary Care Center in Nepal
(Institute of Medicine, 2019) Bastola, Priska; Bishwas Pradhan,; Basnet, Madindra
ABSTRACT Introduction Myocardial protection during Coronary Artery Bypass Graft (CABG) has always been an area of concern so we aimed to evaluate the level of release of Creatine Phosphokinase (CPK-MB) and Troponin I (cTnI) at various time intervals in the first 24 hours after on pump CABG in patients receiving either Sevoflurane or Isoflurane. Furthermore clinically relevant patient outcomes were also evaluated in patients undergoing on pump coronary artery bypass grafting. Methods This was a prospective randomized trial in patients undergoing on pump coronary artery bypass graft surgery, which was conducted from January 2016 till June 2017. A total of 105 patients were enrolled out of which there were 53 in Isoflurane and 52 in Sevoflurane group who received the respective volatile anesthetic agents throughout the surgery except during bypass at 1-1.5 MAC. The primary outcome was comparison of the CPK MB and cTnI levels at 0 hr, 6 hr, 12 hr and 24 hr after surgery from baseline, whereas the secondary outcomes were duration of intensive care unit stay, usage of vasopressors and inotropes, renal dysfunction, stroke. Results No significant difference in CPK MB and cTnI levels at all time intervals in both the groups, the other secondary outcome parameters were comparable. Conclusion The study found no difference in the cardiac markers between the two anesthetics. Based on the data, Sevoflurane and Isoflurane might be used equivalently in patients undergoing coronary artery bypass graft surgery with extracorporeal circulation without any difference in their myocardial protection function. Keywords: Coronary artery bypass graft, isoflurane, myocardial injury, myocardial protection, sevoflurane
Knowledge and Practice on Prevention of Complications of Diabetes Mellitus among Patients with Diabetes in a Tertiary Hospital
(Institute of Medicine, 2019) Acharya, Om K; KC, Takma; Shrestha, Krishna D
ABSTRACT Introduction Diabetes is a major contributing factor for overall health status, morbidity, mortality and quality of life. Adequate knowledge and sufficient practice can prevent many possible diabetic complications. Hence, the objective of this study was to find out the knowledge and practice regarding prevention of complications of diabetes among diabetic patients. Methods A descriptive, cross sectional design was carried out in Tribhuvan University Teaching Hospital Kathmandu (TUTH). A total 124 diabetic patients who came for follow-up in endocrine Out Patient Department were selected through purposive sampling technique by using pre-tested structured interview schedule during four weeks. Data was analyzed by using the descriptive and inferential statistics with the help of Statistical Package of Social Science (SPSS) version 16. Results The study findings showed that 24.2% respondents had adequate knowledge about complications . More than half of the respondents had sufficient practice (52.4%) regarding prevention of diabetic complications. Association between knowledge and selected variables showed that sex and education level tends to be significantly associated and regarding practice, area of residence and duration of illness were significantly associated (p<0.05). There was a statistically significant (p<0.001) and average positive relationship (r=0.605) was found between knowledge and practice. Conclusion The study concluded that though only few respondents had adequate knowledge, more than half of the respondents had sufficient practice regarding preventing complications. This finding suggests awareness program regarding prevention of compilcations of diabetes mellitus should be launched periodically to increase knowledge and sufficient practice on prevention of diabetic complications. Keywords:Diabetic complications, diabetes mellitus, knowledge, practice
Serum Vitamin D Level in Chronic Obstructive Pulmonary Disease and its Relation with Severity: A Single Centre Study
(Institute of Medicine, 2019) Pant, Pankaj; Thapa, Shovit; Das, Santa K; Bam, Niraj
ABSTRACT Introduction Chronic obstructive pulmonary disease (COPD) is a public health problem of epidemic proportion. Several studies have shown low serum vitamin D levels in patients with COPD. The aim of this study was to compare serum vitamin D level in patients with Global Initiative for Chronic Obstructive Lung Diseases (GOLD) COPD stage II, III and IV with controls and correlate serum vitamin D level with severity of COPD. Methods A cross sectional study was conducted from June 2014 to November 2015 at Tribhuvan University Teaching Hospital (TUTH). A total of 154 subjects were enrolled for study that consisted of 77 cases of COPD and 77 controls for comparison. Participants were taken from medical wards and outpatient department. COPD staging was done as per GOLD guidelines and stage II, III and IV were labeled as advanced COPD cases. Both descriptive and inferential statistics were performed in SPSS version 20. ResultsStage II, III and IV COPD were 30%, 36% and 34% respectively. Mean serum vitamin D level was 15.16±7.19 ng/ml in COPD cases and 33.99±12.37 ng/ml in healthy controls showing statistically significant relation of low serum vitamin D in patients with advanced COPD (p <0.0001). Serum vitamin D was found to be in decreasing trend with increasing severity of COPD. Conclusion Patients with advanced COPD (GOLD stage II, III and IV) had low serum vitamin D levels compared to normal population and serum vitamin D level correlated with GOLD severity in Nepalese patients with COPD. Keywords: Chronic obstructive pulmonary disease; global initiative for chronic obstructive lung diseases; vitamin D
Challenges of Sustaining Elimination Status of Leprosy in Nepal
(Institute of Medicine, 2019) Parajuli, Sudip; Pokhrel, Dinesh B; Baskota, Rabindra; Poudyal, Amod; Paudel, Upama
ABSTRACT Introduction The number of leprosy patients is increasing in Nepal even after declaration of elimination in 2010. The objective of this study was to review the status of leprosy after declaration of elimination in Nepal and to identify challenges to sustain elimination. Methods This was retrospective study conducted by reviewing the annual data published by Department of Health Services, Ministry of Health, Government of Nepal from 2010 through 2018. In addition, one year hospital based data (2017/18) was retrieved from records of Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results The prevalence of leprosy was found to be 0.77/10,000 population in 2010 and 0.99/10,000 in 2018. The numbers of multibacillary (MB) cases (remained more than 50%) outnumbered paucibacillary (PB) cases throughout eight years. Conclusion The prevalence of leprosy is gradually increasing in Nepal with more number of multibacillary cases detected in post-elimination era. Keywords: Leprosy, multibacillary, paucibacillary
Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient
(Institute of Medicine, 2019) Parajuli, Pawan; Bhandari, Ramesh S; Pathak, Rahul; Sharma, Shashi; Khadga, Prem K; Jha, Anurag; Hamal, Rabin; Kafle, Brindeswari
ABSTRACT Introduction Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology. Methods Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis. Results Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy. Conclusion Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain etiology. Keywords: Ascites, peritoneal carcinomatosis, peritoneoscopy
Biomedical Editing in Nepal: A Challenging Task
(Institute of Medicine, 2019) Singh, Yogendra P
NA.
Case Report on Pseudoaneurysm of Brachial Artery: A Rare Complication of Paediatric Supracondylar Humerus Fracture Pinning
(Institute of Medicine, 2019) Bhandari, Prawesh S; Bastola, Priska; Gurung, Dinesh
ABSTRACT Pseudoaneurysm (PA) of the brachial artery in pediatric supracondylar humerus fracture who have undergone closed reduction and percutaneous pinning is a rare complication. A few cases have been reported in medical literature. This case report sheds some insight into early identification and management outcome of such complication. Rapidly progressive swelling in antecubital fossa in cases of supracondylar fracture who have undergone pinning should arouse suspicion of vascular lesion. It should be timely intervened. Surgical intervention of pseudoaneurysm with reversed saphenous venous graft has shown to have no early vascular complication. Keywords: Case report, supracondylar fracture, pseudoaneurysm, supracondylar fracture
A Case Report of Recurrent Pyogenic Granuloma with Satellitosis
(Institute of Medicine, 2019) Parajuli, Sudip; Das, Anil K; Paudel, Upama
ABSTRACT Recurrent pyogenic granuloma with satellitosis is an uncommon condition with majority of cases resolving within one year after treatment. We report a case of recurrent pyogenic granuloma in a middle aged man who kept on relapsing at different point of time despite treatment with electrocoagulation, cryosurgery and oral methotrexate. The case highlights the unusual presentation of relatively common condition of pyogenic granuloma. Keywords: Electrocoagulation, pyogenic granuloma, satellitosis
Case of HER2-Enriched Multifocal Breast Cancer Associated with Pregnancy
(Institute of Medicine, 2019) Khanal, Suman; Singh, Yogendra P; Shrivastav, Shreya
ABSTRACT Pregnancy-associated breast cancer is less common and often presents in advanced stage. Management is similar to non-pregnant cases with trimester-specific considerations. In this case report, we present a case of worrisome mother with locally advanced multifocal pregnancy-associated breast cancer who was so much concerned about effects of neoadjuvant chemotherapy on fetus leading to its delayed initiation, and show why targeted therapy is still not within reach in a developing economy like Nepal. Short term data of chemotherapy though reveal relative safety, long term data are lacking. This may be a hindrance in counselling, when patients are more anxious and worrisome. Keywords: Breast cancer, chemotherapy, HER2-neu, pregnancy
Vein of Galen Aneurysmal Malformation Presenting with Obstructive Hydrocephalus: A Case Report
(Institute of Medicine, 2019) Khanal, Nischal; Rajbhandari, Binod; Sedain, Gopal; Shilpakar, Sushil K
ABSTRACT The prognosis for children harboring vein of Galen aneurysmal malformation (VGAM) has significantly improved over the last three decades due to refinements in the interventional endovascular techniques. It is now possible to obliterate the malformation with better results. Endovascular approaches evolved as the gold standard treatment option for this disorder. A few reports were published warning about the high rate of complications associated with ventriculoperitoneal shunting (VPS) in this setting. We present a pediatric case with VGAM where an emergency ventriculoperitoneal shunt procedure was required for symptomatic obstructive hydrocephalus (HCP) and management of the subsequent complications that followed it. Keywords: Complications, obstructive hydrocephalus, vein of Galen aneurysmal malformation, ventriculoperitoneal shunt
Drug Induced Sleep Endoscopy for Obstructive Sleep Apnea Syndrome: An Initial Experience in a Tertiary Level Centre
(Institute of Medicine, 2019) Parajuli, Bashu D; Mandal, Lokendra; Koirala, Megha; Bhattarai, Amit S; Neupane, Yogesh; Shrestha, Anil
ABSTRACT Drug induced sleep endoscopy (DISE) is a technique of performing endoscopy of the upper airway after inducing sleep by the use of anaesthetic agents in patients suffering from obstructive sleep apnea syndrome (OSAS). The main purpose of DISE is to detect the obstruction or collapse at one or more location in the upper airway, both for the successful diagnosis and management of OSAS. Here we discuss a case of OSAS who underwent DISE under novel anaesthetic agents midazolam and dexmedetomidine. Keywords: Dexmedetomidine, drug induced sleep endoscopy, obstructive sleep apnea syndrome, propofol
Knowledge Regarding Antibiotic Use, its Resistance and Consequences among Higher Secondary Students in Private Schools of Kathmandu Valley
(Institute of Medicine, 2019) Deo, Satish K; Gautam, Naveen; Gyawali, Siddinath; Shrestha, Deepti; Yadav, Shikha
ABSTRACT Introduction The lack of awareness on the appropriate use of antibiotics, its dose and duration is one of the leading causes of global antimicrobial resistance (AMR). AMR poses a growing threat to public health, as infections from resistant strains of microbes become increasingly difficult to treat, resulting in prolonged illness and greater risk of death. Hence, this study would be an important reference for determining the scope of the problem which will be essential for formulating and monitoring an effective response to antibiotic use and its problem of resistance. Methods A descriptive cross-sectional study was done among higher secondary level students from selected schools in Kathmandu valley. Baseline data was collected after a tutorial session through semi-structured questionnaires which was based on past researches and verified using expert consultation. Ethical consideration was maintained throughout the study. Descriptive statistics was used to find out the KAP level including knowledge score and attitude-practice score of the selected population. Results Among 465 participants conducted in our research, the overall average knowledge score of the participants was found to be 73.3% while the attitude-practice score was 60.53%. It was found that 80.86% of the participants had heard the term “antibiotic resistance”. The knowledge score percentage among the students of grade 10 and 11 had no significant difference (p value= 0.592). Conclusion Our study concludes that if topics like antibiotics and their judicial use is well covered in school curriculum, it can produce measurable change in knowledge, attitude and practice level of the students. Keywords: Attitude, antibiotics, antimicrobial resistance, knowledge, practice
Blood Groups and their Association with Academic Performance among Medical Students in a Nepalese Medical College
(Institute of Medicine, 2019) Mahat, Barun; Shrestha, Lava; Adhikari, Shailesh; Thapa, Bikalp; Limbu, Prakesh; Banstola, Dinesh; Dhungel, Sunil
ABSTRACT Introduction Knowing a person’s blood type is not only important in transfusion medicine and forensic medicine but is also useful for predicting a person’s characteristics including intelligence, knowledge, skill and behavior. It is recognized that intelligence, knowledge and skill are assessed by performance in examination. The objective of this study was to determine distribution of blood groups among students and its association with their academic performance. Methods This was an analytical study that was conducted among the medical students of Nepalese Army Institutes of Health Sciences (NAIHS) in Department of Clinical Physiology from June 2014 to April 2019. This study was conducted among 738 students by using convenient sampling method. Blood group was determined on the basis of agglutination reaction. Academic performance of students was assessed by the marks obtained by them in annual final examination. Results Blood group O was the most prevalent at 33.5%, followed by B at 29.5%, A at 29% and AB at 8%. Distribution of Rh positive and Rh negative were 96.6% and 3.4% respectively. The mean scores obtained in final university examination were highest in blood group A (62.9%) and lowest in blood group AB (60.3%) but the difference between different blood groups was not statistically significant. Conclusion Blood group O was the most common blood group. Rh positive was present in 96.6%. Though mean score was highest in blood group A, significant association between blood groups and academic performance was not seen in our study. Keywords: ABO, academic performance, blood groups, medical college, Nepal, Rh
Role of Preoperative CEA, CA 19-9, NLR and PLR as Predictors of Adverse Prognostic Pathological Features of Gastric Carcinoma Patients in a Tertiary Centre of Nepal
(Institute of Medicine, 2019) Mandal, Rajesh K; Bhandari, Ramesh S; Lakhey, Paleswan J; Singh, Yogendra P; Vaidya, Pradeep; Kansakar, Prasan BS; Ghimire, Bikal; Kandel, Bishnu P
ABSTRACT Introduction According to GLOBOCAN 2018, gastric carcinoma is the fifth most common cancer (5.7%) and third most common cause of cancer related death (8.2%) worldwide. Delayed presentation and advanced disease at diagnosis, owing to the overlapping symptoms, can be attributed to its high mortality. Gastrectomy is one of the most commonly performed surgery at our centre. This study aims to study the role of pre-operative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as predictors of adverse prognostic pathological features of gastric carcinoma patients who were considered for surgery at our centre. Methods This is a retrospective analysis of prospectively maintained database of all operated gastric carcinoma patients since June 2016 to January 2019. Various pre-operative variables including serum CEA level, serum CA 19-9 level, NLR and PLR were collected. Intra-operative surgical procedures performed and post-operative pathologic variables like tumor size, stage, grade, lymph node ratio (LNR), lymphovascular invasion (LVI) and perineural invasion (PNI) were collected. Results A total 60 patients were planned for surgical intervention over this duration. Mean age of the population was 56.8±12.5 years with slight male predominance (i.e. 55%). Mean CEA level was 6.17 ng/ml and CA 19-9 level was 72.1 U/ml. The mean NLR and PLR of the study population was 3.4 and 200 respectively. Fifty four patients had distal tumors and six had proximal tumors. Curative surgery was performed in 40 patients out of which 37 underwent subtotal gastrectomy and three underwent total gastrectomy. D2 gastrectomy was performed in 55% patients treated with curative intention. Advanced disease (T2 and above) was seen in 86.7% of patients. Preoperative CEA, CA 19-9, NLR, PLR were evaluated for association with pathologic features like tumor size, T stage, grade of tumor, LNR, LVI, and PNI but statistical analysis failed to show any significant association. Conclusion Advanced disease at presentation is common in gastric carcinoma. Preoperative clinical parameters including tumor markers CEA, CA 19-9, NLR and PLR may not be useful to diagnose the advanced disease in gastric carcinoma patients. Keywords: Gastric carcinoma, gastrectomy, CEA, CA 19-9, NLR, PLR
Outcome of Endoscopic Sphenopalatine Artery Cauterization for Posterior Epistaxis
(Institute of Medicine, 2019) Kharel, Bijaya; Gurung, Urmila; Tripathi, Prashant; Rayamajhi, Pabina; Silwal, Priyansha
ABSTRACT Introduction Epistaxis is a common otorhinolaryngology emergency condition. Majority of it is anterior epistaxis which usually improves with conservative management. However, for posterior epistaxis, apart from posterior nasal packing, endoscopic sphenopalatine artery cauterization (ESPAC) is considered an effective measure for its control. Hence, this study was conducted to evaluate the outcome of endoscopic sphenopalatine artery cauterization for posterior epistaxis. Methods Retrospective medical chart review of patients who underwent endoscopic sphenopalatine artery cauterization for posterior epistaxis from January to December 2018 at Ganesh Man Singh Memorial Academy of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results A total of 31 patients (21 males and 10 females) underwent ESPAC during the one-year period. Twenty-seven of them were unilateral whilst four were bilateral. Four of them rebled, of which two bled within 48 hours and the remaining two after two months. The overall success rate of ESPAC was 87.1% (27/31). Conclusion Endoscopic sphenopalatine artery cauterization is an effective measure to control posterior epistaxis. Keywords: Endoscopy, epistaxis, nasal packing, sphenopalatine artery cauterization
Antimicrobial Susceptibility Pattern of Acinetobacter calcoaceticus-Acinetobacter baumannii Complex Isolated from Sputum in a Tertiary Care Hospital
(Institute of Medicine, 2019) Sapkota, Jyotshna; Sharma, Manisha; Shrestha, Deepti; Jha, Beena
ABSTRACT Introduction Acinetobacter calcoaceticus-Acinetobacter baumanni (ACB) complex is one of the commonest cause of hospital acquired and ventilator associated pneumonia. Multidrug resistant Acinetobacter species have become a matter of huge concern. This study was done to find out the antibiotic susceptibility pattern of Acinetobacter calcoaceticus-Acinetobacter baumanii complex from sputum samples. Methods This descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from July 2018 to Jan 2019 after ethical approval. Acinetobacter calcoaceticus-Acinetobacter baumannii complex was identified on the basis of its microscopy and morphological characteristics followed by biochemical tests. Antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method. Results Of the 384 culture positive sputum specimen, 76 (19.80%) were Acinetobacter calcoaceticus-Acinetobacter baumannii complex. Most of the isolates were resistant to commonly used antibiotics, 72.36% of the isolates were multidrug resistance and 3.95% isolates were resistant to tigecycline. Conclusion This study provides valuable information regarding prevalence of Acinetobacter calcoaceticus-Acinetobacter baumannii complex from sputum specimen. The alarming number of Multidrug resistance isolates is worrisome finding. Antibiotics like Tigecycline and Colistin which is still sensitive to isolates should be cautiously used only in MDR cases. Keywords: Acinetobacter, ACB complex, antibiotic resistance, MDR, Nepal
Association of ABO Blood Groups with Craniofacial Morphology among Orthodontic Patients in Selected Private Clinics of Kathmandu
(Institute of Medicine, 2019) Gupta, Sanjay P
ABSTRACT Introduction The craniofacial morphology and blood groups both are related to genetic components, hence it can be hypothesized that blood groups have an association with craniofacial morphology. Some studies showed the relationship whereas others could not find any relationship in different population. The aim of this study was to find out the relationship between ABO blood groups and craniofacial morphology among orthodontic patients of Kathmandu district. Methods In this cross sectional analytical study, 385 participants (age range from 13-45 years) were selected among the orthodontic patients who came for orthodontic treatment in private orthodontic clinics. After obtaining written consent, all the patient’s demographic information were recorded and lateral cephalograms were obtained from the patient’s record. Blood group of all the participants was recorded. Results Among 385 participants, 162 (42.07%) were male while 223 (57.93%) were female and the mean age was 16.31±4.38 years. Twenty cephalometric parameters depicting craniofacial morphology were digitally analyzed using lateral cephalograms. The prevalence of blood group O patients was highest (32.20%) followed by blood group B (30.64%), blood group A (29.88%) and blood group AB (7.28%). Statistical analysis with ANOVA revealed nine out of twenty cephalometric parameters were statistically significant among different blood groups (p<0.05). Tukey post hoc test was done to find out the difference among the groups. Conclusion The evaluation of relationship between blood group and craniofacial morphology revealed that blood groups have association with some craniofacial parameters. This suggests, there may be some genetic influence of ABO blood group on craniofacial morphology. Keywords: ABO blood groups, association, craniofacial morphology, orthodontic patients

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