Journal Issue: Volume: 42, No. 2 (2020) August
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Volume
Number
Issue Date
2020
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Learning to Live with COVID-19 in Nepal: A Unique Experience
(Institute of Medicine, 2020) Singh, Yogendra P
NA.
Relationship Between Ossicular Chain Erosion and Facial Canal Dehiscence in Chronic Otitis Media Squamous
(Institute of Medicine, 2020) Kharel, Bijaya; Shreepaili, Ashok; Tripathi,Prashant; Neupane, Yogesh; Gurung, Urmila; Pradhananga, Rabindra B; Rayamajhi, Pabina; Bhattarai, Hari
ABSTRACT
Introduction: Chronic otitis media squamous is a gradually expanding destructive lesion and leads to complications by eroding the adjacent structures. Facial canal and ossicles are in close proximity in the middle ear space and they share the same pathogenesis of the bony erosion. Ossicular chain erosion found intraoperatively due to cholesteatoma, may suggest the likelihood of facial canal dehiscence. This study was conducted to assess the relationship between ossicular chain erosion and facial canal dehiscence in chronic otitis media squamous.
Methods: It is a retrospective chart review of patients who had mastoidectomy done for chronic otitis media squamous in Tribhuvan University Teaching Hospital from January 2014 to December 2018. The operative findings of facial canal dehiscence were correlated with ossicular chain status.
Results: Among 158 cases, facial canal dehiscence was seen in 20 (12.7%), of which, 19/20 (95%) had ossicular erosion. Majority (90%) of dehiscence was in the horizontal segment. Incus was the most common ossicle to be eroded. Among the ossicles, stapes erosion was related to the facial canal dehiscence with odds ratio of 3.216 (1.235-8.374) and p-value 0.03.
Conclusion: Among the ossicles, there is a relationship between the stapes erosion and the facial canal dehiscence in chronic otitis squamous. Erosion of ossicular chain especially stapes should alert surgeons towards the possibility of facial canal dehiscence.
Keywords: Chronic otitis media squamous, facial canal, ossicular erosion
Comparison of EuroSCORE II with EuroSCORE in Cardiac Surgical Patients in a Tertiary Level Teaching Hospital in Nepal
(Institute of Medicine, 2020) Pradhan, Bishwas; Bastola, Priska; Basnet, Madindra B; Shrestha, Bibhush; Sigdel, Shailendra; Gurung, Arjun
ABSTRACT
Introduction: European System for Cardiac Operative Risk Evaluation (EuroSCORE) is the standard tool for risk stratification of patients undergoing cardiac surgery. Its relevance has been validated in European, Asian countries and also in Nepal. Its limitations led to development of EuroSCORE II. This study was carried out to compare EuroSCORE II with EuroSCORE in Nepalese cardiac surgical patients.
Methods: A retrospective analytical cohort study of 3 years duration in 972 adult cardiac surgeries was conducted. Scores obtained from EuroSCORE (Logistic and Additive) and EuroSCORE II was compared with the observed mortality. Calibration was calculated by Hosmer- Lemeshow (H-L) test (Chi Square test) and discrimination by calculating the area under the curve (AUC) of receiver operating characteristics (ROC) curve.
Results: Observed mortality was 4.11%. EuroSCORE additive, logistic and EuroSCORE II predicted mortality were 4.32%, 4.55% and 2.13% respectively. H-L chi square calculation for EuroSCORE additive model could not hold as all observed and expected frequencies match exactly. Hence it can be considered as a good fit. EuroSCORE logistic model (H-L, Chi-square 7.743, p<0.001) and EuroSCORE II (H-L, Chi-square 11.631, p = 0.168) also showed good fit i.e. both can predict mortality satisfactorily. AUC of ROC curve of EuroSCORE additive, logistic and EuroSCORE II were 0.632, 0.636 and 0.616 respectively, which showed fair discrimination power.
Conclusion: Mortality prediction of adult cardiac surgical patients by EuroSCORE (additive and logistic) and EuroSCORE II was satisfactory.
Keywords: Additive, cardiac surgical, EuroSCORE, logistic
Knowledge and Self-Care Practice on Hypertension among Hypertensive Patients in a Tertiary Level Hospital of Kathmandu
(Institute of Medicine, 2020) Satyal, Geeta K; Rai, Lalita; Gautam, Roshani; Dangol, Bhuvan K; Shakya, Rajina
ABSTRACT
Introduction: Hypertension is a public health challenge and major risk factor for cardiovascular disease in the developing as well as developed countries. The successful management of hypertension depends upon patient’s knowledge on hypertension and self-care practices.
Methods: A descriptive cross-sectional study was conducted to identify the knowledge and self-care practice on hypertension among 212 hypertensive patients attending in outpatient department of Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC). Non-probability purposive sampling technique was used. Data was collected through face-to-face interview by using structured questionnaire. Data was analyzed using SPSS version 16.0.
Results: This study showed that 57.5% of the respondents had adequate level of knowledge on hypertension and 57.1% of the respondents had good overall self-care practice. Regarding self-care practice, we found 100% medicine adherence, 85.8% respondents avoided alcohol and 84.9% avoided smoking, 50.9% followed weight management practice, 48.6% followed dietary management and 44.8% performed physical activity. Level of knowledge was significantly associated with age, gender, educational status and occupation. Self-care practice was only significantly associated with educational status. Level of knowledge and self-care practice were significantly positively correlated.
Conclusion: More than half of the respondents had adequate level of knowledge. Regarding self-care practice, nearly sixty percent of the respondents had good self-care practice. To bring those rates to higher level, awareness programs should be launched about diseases and self-care practice on hypertension.
Keywords: Hypertension, knowledge, self-care practice
Early Outcome of Surgery in Pediatric Head Injury: Experience From a Tertiary Care Center in Eastern Nepal
(Institute of Medicine, 2020) Khanal, Babita; Kafle, Prakash; Singh, Sandip K; Yadav, Sunil K; Neupane, Bishomber; Shakya, Ipsa; Yadav, Dipak K
ABSTRACT
Introduction: Head injuries among the pediatric age group remain an unwelcomed source of morbidity and mortality resulting from falls, motor vehicle accidents, assaults, and child abuse. Early identification and management of traumatic brain injury (TBI) are crucial in halting the progress of the primary insult and preventing or reducing secondary brain injury. The present study aims to investigate the major cause of pediatric TBI and analyze the early outcome and serve as a reference study from a tertiary care center in eastern Nepal.
Methods: This is a prospective cohort study conducted in the Department of Pediatric Medicine and Neurosurgery from February 2018 to January 2020. All the pediatric head injury cases that were managed surgically in the center were included in the study. Presenting Glasgow coma scale (GCS) was correlated with the Glasgow outcome scale (GOS).
Results: The study population comprised of 65 patients fulfilling the study inclusion criteria. The mean age of the study population was 10.86±4.72 years, fall was the commonest mode of injury (52.3%), 50.8% had mild TBI, 43.1% had moderate TBI and 6.2% had severe TBI. Depressed skull fracture with underlying extradural hematoma (EDH) or contusion was the commonest pathological diagnosis seen in 30.8 % (20) cases. The mean duration of hospital stay was 2.6 days. The presenting GCS correlated well with the outcome.
Conclusion: This study concluded that the timely management of pediatric TBI can prevent grave prognosis and the patients presenting GCS and the pupillary reaction has strong correlation with the outcome.
Keywords: Head injury, Glasgow outcome score, pediatric, surgery