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Life Satisfaction and Insomnia among Elderly Community Dwellers of Lalitpur, Nepal
(Institute of Medicine, 2019) Khagi, Bina R; Timalsina, Rekha; Chhantyal, Anita; Shiwakoti, Shrijana; Maharjan, Manju
ABSTRACT Introduction Life satisfaction during elderly is essential in ageing process. Globally, insomnia is a problem that degrades the health of elderly people, which also interferes with the quality of life. Methods A descriptive cross-sectional study was conducted to identify life satisfaction and insomnia among 501 community dwellers elderly of Lalitpur by using structured interview schedule on socio-demographic information, Satisfaction with Life Scale (SWLS) to measure a life satisfaction and Pittsburgh Insomnia Rating Scale (PIRS) to identify the prevalence of insomnia. Results Data was edited, classified, and coded manually. Then, data entry and data cleaning were done using Epi data software and data analysis was done using SPSS software version 16. Descriptive and inferential statistics were used to analyze data. The study showed that 31.9% and 35.7% of respondents were highly satisfied and satisfied with their life respectively. However, 6% and 0.6% of respondents were dissatisfied and extremely dissatisfied with their life respectively. Study reveals that 50.5% of respondents had insomnia. Ethnicity, current job status, and health problems during night sleep were significantly associated with life satisfaction. Similarly, age, marital status, educational status, current job status, current physical health problems, presence of disease, taking medication at present and health problems during night sleep were significantly associated with insomnia. Conclusion Most elderly people were satisfied with their life, but majority of them suffered from insomnia. Therefore, it is necessary to plan awareness program regarding life satisfaction and insomnia by concerned authority to help elderly to stay healthy and improve their quality of life. Keywords: Elderly, insomnia, life satisfaction
Brachiobasilic Fistula at Manmohan Center: A Retrospective Review
(Institute of Medicine, 2019) Shrestha, Kajan R; Gurung, Dinesh; Shrestha, Uttam K
ABSTRACT Introduction Brachiobasilic fistula (BBF) with transposition is one of methods for creating native arteriovenous fistula (AVF) for hemodialysis. This study aims to highlight the result of a BBF in a tertiary referral center and aims to improve its result. Methods This is a retrospective descriptive study conducted on the basis of data collected of patients undergoing BBF with transposition from January 2014 to December 2018 (5 years) at Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Data regarding demographics, results and complications has been analyzed. Results Total 59 patients underwent brachiobasilic fistula performed by 3 surgeons with male to female ratio of approximately 3:2 with mean age of patient 68.78±13.77 years. Hypertension was the most common comorbidity present in 91.53% (54) of patients. Fifty six (94.92%)patient had previous undergone some sort of arteriovenous fistula creation and in 10 (16.95%) patients it was done in two stages. There were 2 immediate failures (within 1 week) and 9 early failures (before 1st dialysis) however 2 patients presented later with blocked BBF after starting dialysis. Only 31 patients could be followed up with patent BBF after 1 year of creation. About 71.19% of fistulas were able to mature and undergo dialysis by 6 week period and most common complication was bleeding from incision site in 20 patients (33.90%). Conclusion Brachiobasilic fistula is the good option for native arteriovenous fistula access for hemodialysis but it need proper selection of cases to decrease complication rates. Keywords: Brachiobasilic fistula, hemodialysis access, native arteriovenous fistula
Clinical and Etiological Profile of Patients with Optic Disc Edema in Tertiary Care Centre of Nepal
(Institute of Medicine, 2019) Shah, Ritesh K
ABSTRACT Introduction sible in most cases using tests like visual acuity, color vision, visual field and suitable radiological imaging. Study in Nepalese population with regard to optic disc edema is scarce. Hence this study aims to act as a guideline for evaluation of such cases and help in further studies in this regard. Methods A descriptive, cross-sectional study was conducted in all cases of optic disc edema presenting to neuro-ophthalmology clinic of B.P. Koirala Lions Centre for Ophthalmic Studies from January 2011 to June 2012. A detailed history was obtained and proper ocular and nervous examination was done by ophthalmologist and neuro-physician. Assessment of visual acuity, color vision, contrast sensitivity and visual field along with radiological tests were done in all possible cases. Results Out of all the cases evaluated, 38 cases where causes of optic disc edema could be established were included in the study. The commonly affected age group was 31 to 40 years (26.3%) and most of them were males. The commonest cause observed was optic neuritis (36.8%). Others were papilledema, idiopathic intracranial hypertension, toxic optic neuropathy, non-arteritic anterior ischemic optic neuropathy (NA-AION), compressive and traumatic optic neuropathy. Conclusion Optic neuritis and papilledema should be considered as common differential diagnosis in patients with optic disc edema. NA-AION is a relatively uncommon disease among Nepalese population. Keywords : NA-AION, optic disc edema, optic neuritis, papilledema
Measurement of Subcarinal Angle: A Cadaveric study
(Institute of Medicine, 2019) Shrestha, Anusuya; Ranjit, Nirju; Bhandari, Rosha; Adhikari, Bidur; Gautam, Jyoti
ABSTRACT Introduction The bifurcation of trachea into two primary bronchi at the level of fourth thoracic vertebra creates an angle at the bifurcation. This angle can be seen clearly in routine chest X-rays where the measurement can throw light on many medical conditions within the mediastinum. This study aimed at finding the subcarinal angle, which is the angle formed by inferior borders of two primary bronchi. Methods The measurements were taken from photographs of tracheal specimen of 92 cadavers, 63 male and 29 female. Angle was measured by photographic software and analysis of subcarinal angle was done in the study population. Results The mean subcarinal angle was found to be 41.090 with standard deviation of 17.140. This measurement was found to be significantly more in males (68.02± 15.720) than in females (60.14 ± 17.710). Conclusion The subcarinal angles in the study population were seen to be different among sexes. Also, the mean subcarinal angles from other studies, radiological or on specimen were close to the observations made in this study. Keywords: Bronchus, subcarinal angle, trachea
Prevalence of Chronic Cor Pulmonale in Chronic Obstructive Pulmonary Disease Patients in a Teaching Hospital in Nepal
(Institute of Medicine, 2019) Sayami, Matina; Baral, Suman; Shrestha, Rakshya; Karki, Dambar B
ABSTRACT Introduction Chronic obstructive pulmonary disease (COPD) is the most common cause of cor pulmonale. Cor pulmonale in COPD is associated with decreased survival, increased hospitalization and mortality. In this study we aim to find out the prevalence of chronic cor pulmonale in COPD patients which would help in prevention of right sided heart failure and improve patients’ quality of life. Methods This was a cross sectional observational study done in Kathmandu Medical College Teaching Hospital, Nepal. 50 COPD patients above the age of 30 years attending the outpatient department or admitted in wards were included. All COPD patients diagnosed by pulmonary function test (PFT) were assessed for cor pulmonale by echocardiography (ECHO). The demographic data, chest X-ray, PFT, electrocardiography (ECG) and ECHO findings were recorded, entered and analyzed using SPSS software, version 17. Results Most of the patients enrolled in the study were between age group of 51-60 with female preponderance. 68% of the COPD patients had chronic cor pulmonale. Out of 21 male, 76.2% and out of 29 female COPD patients, 62.06% had cor pulmonale. Cor pulmonale was present in 53.12% and 94.4% of patients who had COPD for < 10 years and ≥10 years duration respectively. Cor pulmonale was present in 76% patients with severe COPD, 75% of patients with moderate COPD, 64.2% patients with very severe COPD and none of the patients with mild COPD. Pulmonary hypertension (PH) was present in 67.64% of cor pulmonale patients. Conclusion The prevalence of chronic cor pulmonale in COPD patients was 68%. It was more in male patients, highest in patients with severe COPD, and the prevalence increased with duration of COPD. PH was present in 67.64% of cor pulmonale patients. Keywords: Chronic obstructive pulmonary disease, chronic cor pulmonale
Early Laparotomy: A Necessity for Postoperative Intraperitoneal Hemorrhage
(Institute of Medicine, 2019) Rawal, Suniti; Paudyal, Pooja
ABSTRACT Introduction Haemorrhage is considered the dreaded complications following any surgery. “Relaparotomy” is a better described terminology for a repeat case postoperative haemorrhage in gynecological surgeries. With increased awareness and early detection and subsequent rise in gynaecological operations have led additional incidence of relaparotomies and further in morbidity and mortality. Methods The study was conducted from April 2006 - March 2017 including cases of re/laparotomy for intraperitoneal bleeding at TUTH, Nepal. Results There were 27 cases of intraperitoneal hemorrhage majorly from 20 abdominal surgeries comprising 12(44.4%) abdominal hysterectomies, 6 (22.2%) laparotomy, 1(3.7%) each of diagnostic laparoscopy and abdomino perineal approach and 7(26%) vaginal hysterectomies. Features of hypovolaemic shock in 14(51.8%), marked abdominal distention in 9(33.3%) and blood loss of 400 to 3000 ml was observed.Five (18.5%) cases of active bleeding from pedicales were secured. Oozing from various sites (10, 37%) cured with haemostatic sutures. Generalised oozing post diagonistic laproroscopy, subtotal hysterectomy was done (1, 3.7%). In 2 (7.4%) cases bleeding from fallopian tube and mesosapinx were sutured. Six (22.2%) hematomas were evacuated and bleeders secured. Dissection of left uterosacrial ligament and tearing of infundibulopelvic ligaments (1, 3.7%) were reinforced and sutured. Sputter in the vault (1, 3.7%) were ligated and isolated rise in PT (1, 3.7%) with FFP transfusion.Two succumbed to death, one following diagnostic laparoscopy from adult respiratory distress syndrome and next from VH with PFR anesthetic complications. Conclusion Proper closure of surgical incision with the right technique, appropriate ligature, careful tying of the blood vessel, monitoring pulse rate and blood pressure in postoperative cases can minimize the morbidity and mortality. Keywords: Hemoperitoneum, intraperitoneal bleeding, relaparotomy
Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit
(Institute of Medicine, 2019) Shrestha, Pramesh S; Marhatta, Moda N; Acharya, Subhash P; Shrestha, Ninadini
ABSTRACT Introduction Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU. Methods A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost. Results There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001). Conclusion Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room. Keywords: Complications, intensive care unit, percutaneous tracheostomy, surgical tracheostomy
Batwing Technique in Large Volume Excision of Breast Lesions: Case Report
(Institute of Medicine, 2019) Khanal, Suman; Singh, Yogendra P; Sharma, Rashmi
ABSTRACT Oncoplastic surgical techniques are seeing widespread use for excision of large volume breast lesions. Batwing technique is one of the volume displacement techniques that can be used to manage lesions in central quadrant of the breast. Such techniques are still underused in Nepal. Here we present three cases with large volume benign breast lesions managed with simple, easy-to-learn technique of Batwing oncoplasty. Keywords: Batwing, fibroadenoma, oncoplasty, phyllodes
Elderly Great Grand Multipara with Gestational Hypertension and Anemia Managed in a Rural Tertiary Hospital: A Case Report
(Institute of Medicine, 2019) Shrestha, Uma
ABSTRACT Introduction Parity more than five is grand multiparity and more than 10 is great grand multiparity. Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is even higher for great grand multiparous women than grand multiparous women. Grand and Great grand multiparity predispose for adverse maternal and perinatal outcomes such as malpresentation, labor dystocia, caesarean delivery, postpartum hemorrhage, maternal anemia, congenital malformations and perinatal mortality. Grand and Great grand multiparty is also independent risk factor for labor dystocia and perinatal mortality. However, most of the adverse outcomes that have been associated with grand multiparity may actually be confounded by advanced age, less antenatal care and low socioeconomic level. Although pregnancy hypertension is more commonly seen among young primigravidas, hypertension is equally common in elderly women. This is a unique case of elderly great grand multiparous women with moderate anemia who developed gestational hypertension and underwent emergency cesarean section resulting into normal maternal and fetal outcome. Keywords: Elderly, gestational hypertension, great grand multiparity, pregnancy outcome
Thyroglossal Duct Fistula with an Unusual Presentation: A Case Report
(Institute of Medicine, 2019) Gyawali, Bigyan R; Dutta, Heempali; Tripathi, Prashant
ABSTRACT Thyroglossal duct anomaly is one of the commonest congenital anomalies with midline neck manifestation. Though commonest location mentioned in the literature is thyrohyoid, several rare presentations have also been described. Here, we present a very rare case of thyroglossal fistula manifesting in submental region. Keywords:Fistula, submental, thyroglossal duct
Anorectal Autoeroticism: A Case Report
(Institute of Medicine, 2019) Tulachan, Pratikchya; Shrestha, Kenison; Chapagai, Manisha; Dhungana, Saraswati; Pant, Sagun B; Lama, Pratik; Bhandari, Ramesh S
ABSTRACT Introduction Anorectal autoeroticism is one kind of paraphilia where individual attains sexual pleasure through self inserting objects into ones rectum. We present here a case of 40 years old man presented in Surgery department with retention of steel glass into his rectum which he had inserted himself to achieve sexual satisfaction. Keywords: Anorectal autoeroticism, biopsychosocial factors, paraphilia
Nephron Sparing Surgery for Small Renal Mass at a University Teaching Hospital: A Six Years Retrospective Review
(Institute of Medicine, 2019) Rai, Bipendra DK; Poudyal, Sujeet; Dhital, Pawan; Pradhan, Manish; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction Nephron-sparing surgery (NSS) is the standard of care for clinical T1 (cT1), renal mass less than 7 cm, whenever intervention is indicated. It has oncological outcome equivalent to radical nephrectomy in small renal masses and it also minimizes the progression to chronic kidney disease. However, there is paucity of data on outcomes of NSS in Nepalese population. Methods A six years retrospective review of medical records of patients undergoing partial nephrectomy from Jan 2012 to Dec 2017 in Department of Urology and Kidney Transplant Surgery at Tribhuvan University Teaching Hospital was done to determine its demographics and outcomes. Results Twenty eight patients underwent nephron sparing surgery for clinical T1 renal masses in the past six years. Complications occurred in three cases. Five of the lesions were benign and 23 malignant on final histology. Clear cell carcinoma was the commonest variant of renal cell cancer. Margin was positive in two cases and both were kept in close surveillance. There was no local recurrence and renal impairment during five to 60 months follow-up. Conclusion Nephron sparing surgery is a safe procedure with good oncological outcome for clinical T1 renal mass. It prevents unnecessary nephrectomy in benign lesions as well as chronic renal impairment at the same time. Keywords: Nephron sparing surgery, small renal mass
Donor Factors Affecting Short Term Graft Outcome in Live Donor Kidney Transplantation
(Institute of Medicine, 2019) Nepali, Rabin; Shah, Dibya S; Gyawali, Prem R; Sharma, Uttam; Chalise, Pawan R
ABSTRACT Introduction Since the beginning of renal transplant, the objective has been to increase the patient and graft survival, both short term and long term. Data relating to donor factors affecting short term survival at 6 months in live donor kidney transplantation has been scarce. This single center study tries to examine the predictors of short term graft outcome at six months in recipients of live donor kidney transplants and explore which donor characteristics are the most useful in predicting the post-transplant graft function in Nepalese population. Methods All patients who underwent kidney transplantation between May 2015 to July 2016 were included in the study. The patients who expired during follow were excluded. The clinical and laboratory parameters of the donors were recorded. The recipients were followed up for six months post transplantation. The eGFR of the recipients and the occurrence of rejection were recorded at the end of six months post transplantation. Results A total of 82 donor-recipient pairs underwent living donor renal transplantation at our hospital during the study period. One recipient who expired during follow up was excluded. The mean age of donor was 45.20 ± 11.226 years of which 55 (67.9%) were female and 26 (32.1 %) were male. The mean eGFR of the donor calculated from Cockcroft Gault equation was 81.98 ± 18.11. The eGFR of the recipient at the end of six months post transplantation calculated form the MDRD equation was 67.76 ± 20.94. A total of 7 patients (8.6%) had rejection that were biopsy proven. Only donor eGFR was found to be significantly associated with eGFR of the recipient at six months post transplantation (p=0.034). Body mass index of the donor was significantly associated with rejection in the recipient at six months post transplantation (p=0.011). Conclusion Our study demonstrates that the donor eGFR and body mass index are independent and important factors affecting the short term graft outcome at six months post transplantation. Keywords: Body mass index, donor eGFR, graft outcome, renal transplantation
Retrospective Review of Adrenalectomy in a Tertiary Center in Nepal
(Institute of Medicine, 2019) Dhital, Pawan; Rai, Bipendra DK; Pradhan, Manish; Poudyal, Sujeet; Chapagain, Suman; Luitel, Bhoj R; Chalise, Pawan R; Sharma, Uttam K; Gyawali, Prem R
ABSTRACT Introduction Adrenal gland surgery is a challenging art as it encompasses diverse physiological derangements which are even life-threatening. Also, it remains a medical finesse to rightly identify the correct patient who will benefit from surgery which include strong biochemical and radiological resource. Soundly performed surgery will lead to oncologic and homeostatic correction leading to near normal course. Methods This is a retrospective analysis of adrenalectomy cohort over three years in a tertiary center in Nepal identifying diagnosis, perioperative management and postoperative course. The objective of this study is to review the presentation, histopathology and clinical outcomes of patients operated for adrenal mass in our center. Results There were 42 surgeries performed via open approach. The number of adenoma, phaeochromocytoma, carcinoma and non-functioning tumor were 13, 16, 12 and one respectively. In most of the hypertensive patients, control was achieved with minimal drug and recurrences were observed in 25% of carcinoma in postoperative follow up. Conclusion A large proportion of operative adrenal mass are observed clinically in our setup. The surgical outcome is satisfactory but judicious perioperative management is essential. Keywords: Adrenalectomy, adrenocortical carcinoma, phaeochromocytoma
Hemodialysis Catheter-Related Infection in a Teaching Hospital of Central Nepal
(Institute of Medicine, 2019) Sedhain, Arun; Sapkota, Abja; Mahotra, Narayan B
ABSTRACT Introduction Infection of the central venous catheter (CVC) is a major complication seen among patients undergoing hemodialysis. Identifying CVC related infection (CRI) and its risk factors and causative organisms is important for better implementation of preventive strategies. Methods A prospective study was conducted at Chitwan Medical College for a duration of 2 years from January 2017 to December 2018 among the patients undergoing hemodialysis via CVC. The data collected were related to patients’ demographics, site of catheter insertion, and duration, microbiological data including cultures from catheter sites, blood, and catheters’ tips and antibiotic sensitivity. Catheter related infection was divided into catheter related local infection (CRLI) and catheter related blood stream infection (CRBSI). Data was analyzed using IBM SPSS Statistics version 21.0. Results A total of 41 cases of CVC related infection (CRI) were documented with an incidence rate of 6.94 episodes per 1000 catheter days at risk. Out of the total CRI, 39.02% were CRLI and 60.98% were CRBSI. Fever with chills and rigor were the most common clinical presentation. Risk factors for the development of CRI were duration of catheter in situ, repeated change of CVC and the use of CVC for indications other than hemodialysis (HD). Staphylococci and Klebsiella were the most common organisms isolated in culture. Conclusion The rate of CRI among Nepalese patients undergoing hemodialysis is high. Prolonged duration of CVC usage, recent change of catheter and the use of the HD catheter for the purpose of institution of intravenous medication have been found as the risk factors for CRI. Keywords: Catheter related infection, central venous catheter, hemodialysis
Mortality in Emergency Services in a University Teaching Hospital: A Retrospective Study
(Institute of Medicine, 2019) Shrestha, Tirtha M; Aacharya, Ramesh P; Neupane, Ram P; Prajapati, Bigyan
ABSTRACT Introduction Emergency services are the gateway between the community and hospital that provides 24-hour access for most needy patients in critical and emergency conditions. Mortality rate varies in emergency department across the world and even in different emergency units of the same hospital. This retrospective study was done in adult emergency services of a tertiary hospital to determine mortality rate and analyze causes of death. Methods A retrospective observational study of mortality cases to analyze mortality rate and causes of death of patients for a period of 6 months between October 2017 to March 2018 was carried out in the adult emergency services of Tribhuvan University Teaching Hospital, Kathmandu. Data required were collected from copies of death certificates. Results During the study period, a total of 128 patients died in emergency, accounting 0.5% of total patient. Male deaths (52.3%) were slightly higher compared to female deaths (47.7%). Age group 66-75 years had the highest (24.2%) of total mortalities in the emergency. The most common immediate cause of death was sepsis/septic shock (21.9%) followed by cardiopulmonary arrest, aspiration, respiratory failure, other causes of shock and poisoning. The commonest antecedent cause of death was attributed to respiratory causes. Similarly, the most common contributory cause of death was chronic obstructive pulmonary disease. Conclusion Older age group are prone to the mortality risk. Sepsis/septic shock was the most common immediate cause of death. Pneumonia was the most common antecedent causes of death. Chronic obstructive pulmonary disease was the commonest contributory cause. Keywords: Emergency Department, mortality, Nepal, sepsis
Nutritional Assessment of Patients with Liver Cirrhosis by Nutrition Screening Tool and Anthropometry at a Tertiary Care Center
(Institute of Medicine, 2019) Sherpa, Tshering W; Pathak, Rahul; Khadga, Prem K; Sharma, Sashi; Hamal, Rabin; Jha, Anurag
ABSTRACT Introduction Malnutrition is one of the most common complications of liver cirrhosis. Yet, little attention is paid in evaluating nutrition in this group of patients. This study aims to assess malnutrition among cirrhotic patients using a nutrition screening tool and anthropometry. Methods This was a prospective, observational study of admitted patients with liver cirrhosis. In the study duration of 3 months, 50 patients met the inclusion criteria and were included. Nutritional assessment was performed using the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), BMI and standard anthropometry including TSF, MUAC and MAMC. Results The mean age was 51.56 ± 11.50 with a Male to Female ratio of 3:2. Chronic alcohol consumption (72%) was the most common etiology while management of tense ascites (40%) was the most common reason for hospital admission. 58% had Child Pugh Class C cirrhosis while the remaining 42% were Class B. The average MELD Na score was 19.64 ± 6. Significant differences in anthropometric measurements including BMI, MUAC, TSF and MAMC were found between Child B and C cirrhosis. Similarly, those patients who had low, moderate and high risk of malnutrition by the RFH-NPT had significant differences in anthropometric measurements between them. Conclusion A significant number of patients had moderate to severe risk of malnutrition that correlated well with anthropometric measurements. The degree of malnutrition is parallel with the severity of liver disease among these patients. Both the RFH-NPT and anthropometry are relatively easy to perform and effective. Hence, they can be used as a practical means for identifying malnutrition among cirrhotic patients in routine clinical practice. Keywords: Anthropometry, liver cirrhosis, malnutrition
Risk Factors for Gall Stone Diseases in Patients Presenting to General Practice Out Patient Department in a Tertiary Care Center in Nepal
(Institute of Medicine, 2019) Neupane, Ram P; Shrestha, Tirtha M; Raut, Shankar; Aacharya, Ramesh P
ABSTRACT Introduction Gallstone disease (GSD) is a major public health problem that is associated with a number of risk factors. This study aims to analyze the risk factors of GSD in patients visiting General Practice Outpatient Department of Tribhuvan Universtiy Teaching Hospital. Methods A case-control study of 174 participants comprising 85 cases with GSD and 89 controls without GSD, as confirmed by ultrasonography of abdomen was conducted as hospital based in outpatient department of General practice, Tribhuvan University Teaching Hospital, Kathmandu from 1st February 2018 to 31st January, 2019. The participants were asked questions regarding putative risk factors for development of GSD and underwent physical and ultrasonographic examination. Risk factors included were age, sex, BMI, occupation, co-morbidities e.g. diabetes mellitus, hemolytic diseases, family history of GSD, smoking status, alcohol consumption, parity if applicable and dietary history. Data analysis was done by univariate method. Results The mean age of the case group was 47.82 years whereas mean age for the control was 46.51 years (p=0.355). 22% of cases were male and 78% were female where as in control group 29% were male (p=0.3030). Majority of the participants in both group were housewife by occupation and Hindu by religion.Mean BMI of the cases and control were 24.05 kg/m2 and 21.13kg/m2 respectively. BMI was found significant for the gall stone diseases ( p=<0.001). Similarly, Diabetes mellitus was found significant for GSD (p=0.001). 98% cases and 61% in control group were Non-vegetarians with significant p value of 0.021. Smoking (p=0.005), Non-vegetarian diet (p=0.021), family history of gall stone disease (p<0.001) and parity (p<0.001) were also found significant for the gall stone disease. Conclusion High BMI, non-vegetarian diet, family history of gall stone disease, diabetes mellitus, smoking and increased parity were associated with gall stone diseases. Keywords: Gall stone diseases, parity, risk factors, smoking, tertiary centet
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

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