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A Handbook of Emergencies in ENT- Head and Neck Surgery
(Kathmandu University, 2023) Thapa, Nar Maya Tripathi, Prashant
NA
Globozoospermia
(Kathmandu University, 2023) Bhattarai, L; Gautam, B; Raut, BB; Chettri, S
ABSTRACT Male infertility may be due to low sperm concentration, poor sperm motility, or abnormal morphology. Among the factors involved in male infertility, there is a rare morphology disorder called “Globozoospermia”. This condition is primarily characterized by the presence of round-headed spermatozoa, absence of acrosomal cap and cytoskeleton defects around the nucleus. The morphological characteristics of globozoospermia are formed during spermiogenesis. We report here a case of male infertility due to morphological disorder Globozoospermia. Assessment of semen by observing macroscopic and microscopic parameters are not sufficient for sperm analysis. In present case, macroscopic and microscopic assessment was within normal range. Morphological assessment showed 80% of spermatozoa with round head and absence of acrosomal cap. The absence of acrosome makes fertilization impossible since these sperm are unable to bind to the zona pellucida. By using Intracytoplasmic Sperm Injection (ICSI), conception is possible; however, the fertilization rate remains very low. KEY WORDS Globozoospermia, Male infertility, Morphology
Capillary Haemangioma of Gingiva - A Rare Lesion
(Kathmandu University, 2023) Manohar, B; Meena, V; Metgud, R; Bhuvaneshwari, S; Humagain, M
ABSTRACT Capillary Haemangioma is a benign vascular tumour characterized by proliferation of blood vessels with a very striking similarity to pyogenic granuloma with a predilection to occur on the gingiva. Though the head and neck are the most common region of occurrence, but is considered to be rare occurring on the gingiva, intra-orally. The lesion clinically mimicked pyogenic granuloma but was histopathologically diagnosed as capillary haemangioma. It was surgically excised and followed up for 6 months without any recurrence. KEY WORDS Capillary haemangioma, Hamartoma, Haemangioma, Pyogenic granuloma, Telangiectasis
Papillary Carcinoma of Thyroglossal Duct Cyst- A Diagnostic and Therapeutic Conundrum
(Kathmandu University, 2023) Agrawal, V; Colbert, KR; Kumar, S; Dharanya; Bhat, RV
ABSTRACT Thyroglossal duct cysts (TGDC) are the most common congenital midline neck mass. It accounts for 70% of congenital neck masses in children and 7% in the general population. Untreated, Thyroglossal duct cyst may transform into a thyroid carcinoma in less than 1% of cases. A 47 year old female patient presented with complaints of swelling on the anterior aspect of neck for 1 year which was progressively increasing in size. Smears from needle aspiration revealed features suspicious of Papillary carcinoma of thyroid which was confirmed as on histopathology. Thyroid gland and the adjacent lymph nodes were free of the tumour on Computed Tomography (CT). Thyroglossal duct cysts undergoing neoplastic change is more common among women. Though sistrunk’s procedure is widely accepted as a primary management, the role of total thyroidectomy with radioiodine therapy still remains a controversy due to contrasting opinions available in the literature. KEY WORDS Papillary carcinoma, Thyroglossal duct cyst, Thyroid
Huge Lipoma of Left Parotid Region with Intra-Parotid Extension
(Kathmandu University, 2023) Amatya, N; KC, AK; Shrestha, BL; Shrestha, KS
ABSTRACT Lipoma is a benign mesenchymal tumor originating from adipose tissue. The occurrence of this tumor in head and neck is less frequent and it rarely involves parotid gland. These are asymptomatic and occur both in the deep and the superficial lobe of the parotid. The most favored age group is from the fifth to sixth decade of life and is 10 times more common in the males. A 66-year-old male patient, with left parotid region lipoma is reported in this article. A fine-needle aspiration biopsy and ultrasonography were performed to establish the preoperative diagnosis and to plan the correct surgical approach. It was managed by surgical excision of lipoma with removal of cuff of superficial parotid tissue on superior aspect with preserving facial nerve. Follow-up examinations were planned to assess any facial nerve injury complications. KEY WORDS Adipose tissue, Lipoma, Parotid gland, Superficial lobe
Massive Subcutaneous Emphysema and Pneumothorax in a Case of Attacked by a Domesticated Bull – An Autopsy Based Diagnosis
(Kathmandu University, 2023) Singh, PK; Shah, DK
ABSTRACT Subcutaneous emphysema is a condition when air or gas gets trapped within the subcutaneous layer. It is characterised by crackling feeling on palpation of the skin known as subcutaneous crepitation which is described as touching rice krispies. A 70 years male from hilly region of Nepal with agricultural background suffered multiple injuries sustained due to an attack by domesticated bull in his house. Upon the incident the injured male was taken to hospital, where he was declared “Brought Dead” by the Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital. His body was brought for autopsy in Department of Forensic Medicine and Toxicology of Kathmandu University School of Medical Sciences. On complete autopsy, massive subcutaneous emphysema and pneumothorax was demonstrated. The details of finding are discussed in detail as follows. KEY WORDS Autopsy, Pneumothorax, Subcutaneous emphysema
Monkeypox Virus: A comprehensive narrative review
(Kathmandu University, 2023) Hassan, S; Paudyal, N; Emaan, A; Ibrahim, S
ABSTRACT Monkeypox virus, now known as Mpox virus is a large, enveloped, double stranded deoxyribonucleic acid (DNA) virus belonging to the Orthopox viridae genus of the Poxviridae family. Though, Mpox, have earlier been endemic to only African countries, the 2022 outbreak has shown its rapid spread throughout the world. The May 2022 outbreak have shown primarily human to human transmission in contrast to animal to human transmission that had been seen previously. Recent data also suggest a possibility of a pre symptomatic spread. After an incubation period of 9 days, patients with Mpox can present with a prodrome of symptoms followed by a rash. If untreated, severe complications develop in the high-risk groups especially children and pregnant woman. Such groups of people will benefit from antiviral treatments. The current approach to prevent against it is pre-exposure and post exposure prophylaxis with vaccines. The vaccines that have been approved by Food and Drug Administration to date is ACAM2000 and JYNNEOS. Several diagnostic methods exist, among which polymerase chain reaction has proven to be the most specific and sensitive. In this review, we will discuss its epidemiology, the clinical manifestations, diagnostic modalities, complications, treatment approaches and preventive measures. KEY WORDS Monkeypox, Outbreak, Pandemic, Prophylaxis, Transmission
Frequency of Low Cardiac Output Syndrome Following on Pump Coronary Artery Bypass Grafting Surgery and it’s Association with Degree of Pre-operative Left Ventricular Dysfunction
(Kathmandu University, 2023) Rana, KB; Ansari, A; Sharma, P; Yadav, L; Shahbaz, A
ABSTRACT Background Low cardiac output syndrome (LCOS) is a serious complication after coronary artery bypass grafting (CABG) surgery. It is associated with 10 times to 17 times increase in mortality and markedly increase morbidity. Objective To find out the frequency of Low cardiac output syndrome following on pump coronary artery bypass grafting surgery, to determine the association of Low cardiac output syndrome with degree of pre-operative left ventricular dysfunction and to compare in hospital outcomes of coronary bypass surgery with and without low cardiac output syndrome. Method This prospective, descriptive study enrolled 200 patients who underwent on pump coronary artery bypass grafting surgery using antegrade St Thomas blood cardioplegia. Pre-operatively grouped into two groups consisting Group A of 100 patients with pre-operative left ventricular ejection fraction (LVEF) ≥ 40% and group B of 100 patients with pre-operative left ventricular ejection fraction (LVEF) < 40%. Post-operatively frequency of low cardiac output syndrome was compared between the groups and in-hospital outcomes were studied. Result The mean age of the patients in the study was 53.50±7.57 years. Male to female ratio was 1.8:1. Results showed overall frequency of low cardiac output syndrome was 21.5%. The frequency of LCOS was 15 vs 28% (p - 0.038) in patients with pre- operative LV EF ≥ 40% and < 40% respectively. The outcomes of coronary artery bypass grafting surgery were stroke (3.82 vs. 30.23%, p - 0.001), acute kidney injury (5.09 vs. 23.25%, p - 0.001), respiratory failure (6.36 vs. 34.88%, p - 0.001), ICU stay days (4.75 ± 1.28 vs. 7.44 ± 4.66, p - 0.018), hospital stay days (9.56 ± 2.40 vs. 15.22 ± 3.89, p - 0.001) and mortality (4.45 vs. 32.55%, p - 0.001) in patients without and with low cardiac output syndrome respectively. Conclusion The frequency of low cardiac output syndrome following coronary artery bypass surgery is 21.5%. Left ventricular dysfunction pre-operatively is associated with high frequency of low cardiac output syndrome following surgery. There is significantly poor outcome of coronary artery bypass surgery with low cardiac output syndrome in terms of stroke, respiratory failure, acute kidney injury, mortality and significant ICU stay, hospital stay in compare to patients without low cardiac output syndrome. KEY WORDS Coronary artery bypass, Low cardiac output, Ventricular dysfunction, Coronary artery disease
Bedside Index of Severity in Acute Pancreatitis (BISAP) Score on Outcome of Patients Presenting with Acute Pancreatitis in a Tertiary Care Hospital
(Kathmandu University, 2023) Gurung, RB; Jaisy, D; Sapkota, P; Bhandari, S
ABSTRACT Background Acute pancreatitis is a life-threatening condition characterized by inflammation of the pancreas causing intense abdominal pain and potential harm to multiple organs. The mortality rate is 1-5% and thus requires specialized and interdisciplinary care to inhibit it. Objective To describe the bedside index of severity in acute pancreatitis score on the outcome of acute pancreatitis patients in a tertiary care hospital. Method This is a hospital based observational cross-sectional study conducted in the internal medicine inpatient department of Dhulikhel Hospital from April 2018 and March 2019. This study reviewed the medical records of the department. Result The study included 70 participants with 44 (±14) years of average age and stating common cause as gallstone (45.7%). The study showed that those with bedside index of severity in acute pancreatitis score ≥ 3 during hospital admission had significantly higher rate of organ failure (p-value < 0.05), as well as had a prolonged hospital stay (mean: 20 [±7.9] days). The mean hospital stay was 12.9 days. Conclusion Patients with bedside index of severity in acute pancreatitis score greater than three at admission were found to have an increased risk of organ failure, significantly higher chances of requiring mechanical ventilation, and a longer duration of hospital stay. KEY WORDS Acute pancreatitis, Bedside index of severity in acute pancreatitis score, Organ failure, Outcome
Pyrexia in Pregnancy and its Maternal and Fetal Outcome
(Kathmandu University, 2023) Shrestha, A; Bhattarai, S; Madhup, SK
ABSTRACT Background Contemporary obstetrics has witnessed improved maternal and fetal outcomes, owing to several advances. Any source of maternal hyperthermia that results in significant core temperature increase (> 38°C), could potentially affect the fetus. Fetus being an integral part of the feto-maternal unit and pregnancy involving numerous physiological changes and adaptations, pyrexia during the pregnancy affects both the mother and her fetus adversely. Objective To find the etiology and prevalence of fever in pregnancy and to know the effect of fever on maternal and fetal outcome. Method Pregnant ladies with fever > 38°C, presenting to Obstetrics and Gynecology, Department of Dhulikhel Hospital were enrolled in the study. A detailed clinical history, thorough general and physical examinations were done. All risk factors were asked and recorded including all baseline investigations and cases were followed up till delivery. Maternal and fetal outcomes were recorded. Data were recorded in Excel and calculated using SPSS 26. Result Eighty patients presented with complaints of fever were included in this study. The mean age of the patient was 25.49± 4.50 years. Out of 80 patients, 46 (57.50%) presented with fever in the third trimester. The most common etiology of fever being urinary tract infection in 21 (26%) cases followed by respiratory tract infection in 20 (25.1%) cases. Twenty two newborns had low birth weight among which 12 (15%) neonates had IUGR. About 14 (17.5%) neonates were admitted in NICU due to various complications and perinatal mortality was in 9 (11.25%) cases. The most common antepartum complication was preterm labor in 16 (20%) cases. Conclusion Fever in pregnancy is still a challenge to obstetrician and the society at large due its problems related to its prevention, diagnosis, management and its feto-maternal outcome. Hence, an evaluation of the effect and outcomes of fever in pregnancy, provides definite knowledge of clinical epidemiology, and facilitates optimum prioritization of efforts and resources. KEY WORDS Fever, Feto-maternal outcome, Pregnancy, Preterm labour
Comparison of the Mean Cross-sectional Area of the Median Nerve between Pregnant and Non-Pregnant Women Using Ultrasonography in a Tertiary Level Hospital, Nepal
(Kathmandu University, 2023) Adhikari, G; Regmi, PR; Paudel, S; Lamichhane, B; Kayastha, P; Maharjan, S; Amatya, I
ABSTRACT Background The median nerve is subjected to compression in the carpal tunnel giving rise to a constellation of symptoms known as carpal tunnel syndrome. It is the most frequent form of peripheral entrapment neuropathies and is most prevalent in the middle age females. The most common cause of this syndrome is idiopathic. One of the known secondary causes is pregnancy. Objective To compare the mean cross sectional area of median nerve using ultrasound in pregnant and non-pregnant females at carpal tunnel inlet and its variations with different trimesters. Method The study was conducted during a period of one year (October 2014 to September 2015). A total of 204 participants were evaluated among which 102 were nonpregnant and 102 were pregnant. Among the 102 pregnant participants, 34 females each were in the first, second, and third trimesters. A convenience sampling technique was used for the selection of the participants. The mean cross-sectional area of the median nerve was calculated in both of these groups in both hands by using the direct method. The mean cross-sectional area of non-pregnant female was used as the reference value to which that of pregnant female were compared. Data obtained were compiled and analyzed using Statistical Package for Social Sciences Version 16. Result The overall mean cross-sectional area of the median nerve in non-pregnant females was 6.76 ± 1.05 mm2 and in pregnant females was 6.84 ± 1.09 mm. No statistically significant difference was noted in the mean cross-sectional area of the median nerve in either hand in both pregnant and non-pregnant females. No statistically significant difference was noted in the overall mean cross-sectional area between the non-pregnant and pregnant females. There was no significant difference in the mean cross-sectional area within the different trimesters in both hands on intergroup comparisons. Conclusion Ultrasound examination of the median nerve and measurement of its cross- sectional area is a useful diagnostic tool in the evaluation of carpal tunnel syndrome. Ultrasound has the advantage of easy availability, low cost, quick scan time, able to scan a long segment of nerve and examine the structures in both static and dynamic states. Besides, it also helps in the identification of various anatomic variants and pathologies within or adjacent to carpal tunnel. KEY WORDS Carpal tunnel, Mean cross sectional area, Median nerve, Ultrasonography
Assessing Spectrum of Fractures in Elderly; Perspective on Tertiary Care Hospital of Nepal
(Kathmandu University, 2023) Parajuli, B; Sharma, R; Kayastha, SR; Thapa, J; Shrestha, R; Shrestha, D
ABSTRACT Background There is an increasing life expectancy and a surging elderly population in the last few decades, leading to a higher incidence of fractures in the elderly. The health care of the elderly in Nepal is below par and there are no studies done to evaluate the spectrum of fractures in the elderly. Objective To evaluate the demographical and epidemiological aspects of fractures in the elderly (≥ 65 years) presenting to a tertiary care hospital in Nepal in a 15 years’ timeline. Method This study was a retrospective epidemiological study conducted in the Department of Orthopedics, Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Nepal. The patients of age ≥ 65 years having traumatic injuries, admitted in the orthopedics ward from 2006 January to 2020 December were included. Patient demographics, site of injury, fracture incidence, mechanism of injury, hospital stay duration, and mode of treatment (surgical/ conservative) were evaluated. Result Of the 787 patients with an average age of 73.65 ± 7.5 years, 54% were females. Peritrochanteric fracture was the most common fracture (29.4%) followed by spine (18.3%). The most common mechanism of injury was fall on the labeled ground (38.6%). The incidence of fragility fractures (peri-trochanteric, proximal humerus, spine, and distal radius) was increasing with age. Conclusion Females, peritrochantric fractures, and trivial trauma are the most common occurrences for fractures in elderly. The incidence of fragility fractures is increasing with age but the overall incidence of fractures compared to other studies is low. Higher incidences of road traffic accidents (RTA) and compound fractures among the elderly are serious public health concerns that highlight the importance of primary preventive measures. KEY WORDS Elderly, Fracture, Incidence, Nepal
Association of Different Biochemical and Hemodynamic Characteristic with Type 2 Diabetes Mellitus and Hypertension in Nephrolithiasis Patients
(Kathmandu University, 2023) Katwal, BM; Gautam, N; Shrestha, S; Adhikari, R; Baral, H; Jha, SK; Jha, G
ABSTRACT Background Although Nephrolithiasis is a common condition caused by a wide variety of metabolic or environmental disturbances, its being one of the major factor of morbidity. Incidence of kidney stone disease (KSD) is highly affected by metabolic disorders and change in blood pressure and glucose. Objective To find out association of different biochemical and hemodynamic parameters with various glycemic status and hypertension in kidney stone disease. Method A cross sectional study was conducted in patients diagnosed as nephrolithiasis by using re¬nal ultrasonography and underwent nephrectomy between January 2019 to January 2021 in Shahid Dharmabhakta National Transplant Centre (SDNTC). A total of 100 subjects with 60 male and 40 females were enrolled. Glycemic status was categorized based on criteria of American Diabetes Association (ADA) and hypertension was defined as BP ≥ 140/90 mm Hg in right arm supine position. All biochemical and hemodynamic profile was carried out following standard protocol. Result Out of 100 patients enrolled, pre-diabetes accounted for 31% followed by diabetes (4%). However, hypertension comprised of 66% in total subjects. Serum urea, cholesterol and triglyceride level were found to be increased by 84.6%, 67.7% and 64.7% respectively in diabetes followed by increase of 3.9%, 19.5% and 3.1% respectively in prediabetes when compared to normal glycemic condition in nephrolithiasis subjects. Serum fasting blood glucose, creatinine and uric acid level was observed significantly higher (p=0.003, p=0.004, p < 0.001 respectively) in hypertensive patients. Duration of hospital stay was also seen positively correlated with hypertension. Conclusion Not only diabetes, prediabetes also manifests the increased risk of kidney stone disease along with hypertension. There is significant impairment in renal function and lipid profile based on diabetes mellitus and hypertension. Early identifying these systemic diseases, different biochemical and hemodynamic parameters and proper treatment accordingly may minimize risk and prevent serious complication in these patients. KEY WORDS Diabetes mellitus, Hypertension, Nephrolithiasis
Outcome of Three Dimensional Printed Functional Prostheses for Children with Upper Limb Deficiency in Nepal
(Kathmandu University, 2023) Shrestha, S; Gautam, S
ABSTRACT Background Children with congenital and traumatic upper limb amputation are undervalued in a low and middle-income country (LMIC) like Nepal. The use of a prosthetic hand can give them a feeling of self-reliance to perform their daily activities. However, prosthesis require periodic maintenance and replacement which could be a financial burden to some families. The e-Nable community has designed and developed three dimension printed prosthetic hands for children under 19 years old, and distributed them free of cost. Objective To explore the functionality of the three dimension printed prosthetic hands using semi-structured questionnaires and assess a series of daily tasks after three months prosthetic use. Method This descriptive cross-sectional study was conducted from July 2019 to June 2020, after receiving an ethical clearance from the Nepal Health Research Council (Registration number: 582/2019). Seventy six children (5-18 years old) who met the inclusion criteria were enrolled in this study. Data were collected using semi- structured questionnaires, and observational methods to identify the benefits and drawbacks of the three dimensional prosthetic hands. Mean, standard deviation, and percentage were used to interpret the data. Result All participants could only lift light objects such as tray, tennis ball or a bottle of water. They had difficulty with those task that required complex movement and with lifting heavy objects. Moreover, only 47(61.8%) participants were completely satisfied with the prosthetic hand and the major reasons for dissatisfaction were tear of the rubber band or cord, and broken parts. Conclusion Participant were able to complete certain tasks using the e-Nable community three dimensional printed prosthetic hands. KEY WORDS Children in low and middle-income country, Upper limb deficiency, Three dimensional functional prostheses
Pre-menstrual Syndrome and Pre-menstrual Dysphoric Disorder in Female Medical Students of Nepal
(Kathmandu University, 2023) Mahat, A; Dhungana, R; Amatya, A
ABSTRACT Background Pre-menstrual Syndrome and Pre-menstrual Dysphoric Disorder can have negative impact on medical students and remains mostly underdiagnosed. Different treatment modalities like medications (doctor-prescribed or self-medicated), and alternative therapies are used by students to cope with pre-menstrual symptoms. Objective To estimate the prevalence and severity of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among medical students in Nepal along with its impact in their quality of life, their health seeking behavior and treatment modalities used to cope with these disorders. Method A cross-sectional study was conducted among female medical students studying MBBS in various medical colleges in Nepal using a self-administered questionnaire from September 2020 to March 2021. Result The prevalence of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among female medical students in Nepal was 64% and 36.3% respectively as per this study. Among the areas impacted by premenstrual symptoms, concentration in class was the most affected (68.1%), followed by distress (64.6%). Only 7.3% of the responding participants sought medical consultation for their symptoms. Among those who suffered from at least one symptom for any length of time, 34.8% of participants reported of using at least one medication (either prescribed or self- medication). Similarly, alternative remedies were used by 44.4% of the participants. Conclusion Premenstrual syndrome and premenstrual dysphoric disorder were found to be common in female medical students of Nepal. However, very few students sought medical consultation despite a significant impact in their academic and other activities. Self-medication and traditional therapies were common modalities used for treatment of premenstrual symptoms. KEY WORDS Complementary therapies, Premenstrual syndrome, Premenstrual dysphoric disorder, Self medication
Inter-individual Variation in Pain Sensitivity among Healthy Young Indian Adults- a pilot study
(Kathmandu University, 2023) Aparna Rao, C; Savitha, D
ABSTRACT Background Pain perception, with inter-individual variability, is a challenge for both patients and clinicians. Distribution of pain sensitivity parameters being less explored in Indian population can vary with reports from outside India. Objective To describe distribution of pain sensitivity parameters using cold pressor test in healthy adults and to explore relationship of pain sensitivity with gender, vascular reactivity and parental history of hypertension. Method Pain was induced with non-dominant hand immersed in cold water (30C to 50C) in 150 subjects (75 males and 75 females) selected as per inclusion and exclusion criteria. Pain sensitivity (pain threshold, tolerance and unpleasantness), vascular reactivity (Δ change in blood pressure and pulse rate) were measured. Result Subjects demonstrated pain threshold [17.6 s (10.7, 26.6)], tolerance [40.2 s (30.0, 59.2)] and unpleasantness [7.0 (6.1,8.0)]. Pain unpleasantness showed a weak negative correlation with pain threshold and tolerance (p < 0.001). Pain threshold had moderate positive correlation with tolerance (p < 0.001). Males had significantly higher pain threshold and tolerance than females (p=0.004). Significant rise in post- test systolic and diastolic blood pressure (p < 0.001), decrease in pulse rate (p=0.007) were found compared to resting values. Pain tolerance showed a weak positive correlation with Δ systolic blood pressure (p=0.039). Subjects with positive parental history of hypertension showed higher pain unpleasantness scores (p=0.02). Conclusion The study demonstrated a wide range of pain sensitivity for narrow age and body mass index. Gender difference was observed for pain threshold and tolerance. Vascular reactivity was demonstrated. Subjective pain perception was higher in subjects with parental history of hypertension. KEY WORDS Cold pressor test, Pain threshold, Tolerance, Parental history of hypertension, Vascular reactivity
Cross-cultural Adaptation and Psychometric Properties of Nepali Version of Developmental Coordination Disorder Questionnaire
(Kathmandu University, 2023) Shrestha, N; Thapa, A; Gupta, S; Lepcha, L; Adhikari, SP
ABSTRACT Background Revised developmental coordination disorder questionnaire (DCDQ’07) is the best available population-based screening tool to identify developmental coordination disorder and being a parent reported tool, it needs to be available in Nepali language for its application in Nepali population. Objective The objective of this study was to cross-culturally adapt developmental coordination disorder questionnaire into Nepali (DCDQ-NP). The psychometric properties of Nepali version of Developmental coordination disorder questionnaire were established. Method The adaptation was done following Beaton’s guideline and the psychometric properties was studied in the community sample of 165 parents of school going children of 5-15 years. Fifty parents were asked to refill the questionnaire after the two weeks period. The study determines internal consistency, test retest reliability, floor and ceiling effect and construct validity. Result Significant cultural adaptation was required to obtain relevant Nepali version. The Nepali version of Developmental coordination disorder questionnaire demonstrates high internal consistency (α = 0.912), excellent test-retest reliability (IC = 0.901) and the floor and ceiling effect were acceptable. Principal component analysis showed three factor structure accounting 62% of variance. Conclusion The developmental coordination disorder questionnaire into Nepali were successfully translated and culturally adapted preserving its original concept. It showed good psychometric properties in a Nepali population. The adapted questionnaire shall be of significance in carry out further research in developmental coordination disorder in Nepal. KEY WORDS Cross cultural adaptation, Developmental coordination disorder, Parent reported, School going children, Screening
Post-tonsillectomy Hemorrhage in Patients Receiving Ketorolac Analgesic
(Kathmandu University, 2023) Yadav, D; Dangol, B; Shrestha, N; Pandit, S; Nepal, A
ABSTRACT Background Ketorolac, the non-steroidal anti-inflammatory drug, is thought to have less sedation as well as postoperative nausea and vomiting in comparison to opioids, but with higher risk of post-tonsillectomy hemorrhage as reported in some of the literatures. There is no consensus till date in the use of ketorolac in the management of pain following tonsil and adenoid related surgeries. Objective To find out the incidence of hemorrhage following tonsil and adenoid related surgeries in patients receiving ketorolac in postoperative period. Method This is a retrospective chart review of patients undergoing tonsil and adenoid related surgeries who had received ketorolac during April, 2013 to May, 2019 at department of ENT-HNS, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal. Post-tonsillectomy hemorrhage rate was calculated in pediatric and adult patients. Result During the study period, 103 patients (male – 50 and female – 53) received ketorolac in postoperative period. Tonsillectomy and adenotonsillectomy were performed in 71and 32 patients respectively. Forty-five patients were < 18 years whereas 58 were ≥ 18 years. Most common indication for surgery was recurrent tonsillitis (66/103) followed by adenotonsillar hypertrophy (31/103). Post-tonsillectomy hemorrhage was observed in 15 patients; among them, four out 45 were < 18 years and 11 out of 58 ≥ 18 years. All five patients out of 15, who required surgical intervention for post-tonsillectomy hemorrhage, were ≥ 18 years and were operated for recurrent tonsillitis. Rest of the patients (10/15) were managed conservatively. None of the patients required blood transfusion. Conclusion Ketorolac is not associated with increased risk of post-tonsillectomy hemorrhage in children and can safely be administered. Whereas in adults, recurrent tonsillitis being the most common indication for tonsillectomy, it should be used cautiously. KEY WORDS Adenoidectomy, Adenotonsillectomy, Ketorolac, Tonsillectomy, Non-steroidal anti- inflammatory drugs
Alarm Fatigue among Nurses Working in Critical Care Setting in a Tertiary Hospital, Nepal
(Kathmandu University, 2023) Regmi, B; Shrestha, B; Khanal, S; Moktan, S; Byanju, R
ABSTRACT Background Alarm fatigue is a well-recognized patient safety concern in critical care settings. It occurs when nurses become overwhelmed by the total number of alarm signals which can result in alarm desensitization and eventually contributes to missing of serious and important changes in a patient’s condition, thus failing to respond properly. Objective To find out alarm fatigue and its associated factors among nurses working in critical care setting. Method A cross-sectional study design with convenient sampling technique was used to select 56 nurses working at different critical care settings in Dhulikhel Hospital. A self- constructed semi structured questionnaire and nurses alarm fatigue questionnaire was used for the survey. Frequency, percentage, mean and standard deviation were used for descriptive statistics whereas Independent t-test and One-way ANOVA were used for inferential statistics. Result The result shows that more than half of the nurses were less than 25 years, single and more than two-third of the participants worked in Adult Intensive Care Unit. Out of total obtainable score 44, the overall mean score of the Alarm Fatigue was 28.03±12.813. The result showed that there was no significant difference between alarm fatigue and selected socio-demographic and work related characteristics. Conclusion The alarm fatigue among nurses working in critical care settings was found to be higher in this study. Since alarm fatigue is directly related to patients’ safety, the effective management of medical device alarms can reduce alarm fatigue and prevent potentially dangerous outcomes. KEY WORDS Alarm fatigue, Critical care settings, Nurses
Study of Serum Magnesium Levels in Patients Admitted with Sepsis in Intensive Care Unit
(Kathmandu University, 2023) Patil, PSG; Aslam, SS
ABSTRACT Background Magnesium plays an important role in sepsis, and this could be attributed to its effects on the immune system, which are important in the pathogenesis of sepsis. Magnesium deficiency, one of the underrated electrolyte abnormalities, is observed in critically ill patients admitted to intensive care unit (ICU). Objective To find the association of serum magnesium with the outcome, duration, and need for ventilation. Method The hospital-based prospective observational study included patients > 18 years (N=150) with sepsis admitted to intensive care unit. Patients were divided into normomagnesemia (n=75) and hypomagnesemia (n=75) groups. Sequential Organ Failure Assessment Score (SOFA) score, length of intensive care unit stay, need and duration of mechanical ventilatory requirement, and outcomes were compared between the two groups. Result The mean Sequential Organ Failure Assessment score (5.87 ± 2.31 vs. 3.85 ± 1.75), mean duration of intensive care unit stay (in days) (7.21 ± 1.74 vs. 5.24 ± 1.38), the mean duration of mechanical ventilatory requirement (in days) (4.05 ± 3.47 vs. 1.13 ± 1.98), and mortality rate were (33% vs. 4%) were higher in the hypomagnesemia group when compared to the normomagnesemia group (p < 0.001 for all). Conclusion The study concludes that hypomagnesaemia is a significant electrolyte abnormality in critically ill sepsis patients. Hypomagnesaemia, Sequential Organ Failure Assessment Score, and mechanical ventilation are the factors that independently predicted mortality in intensive care unit patients. Hence, clinicians should regularly monitor the occurrence of hypomagnesemia in intensive care unit patients to reduce its poor clinical outcomes. KEY WORDS Artificial, Critical care, Magnesium, Mortality, Organ dysfunction scores, Respiration, Sepsis

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