Journal Issue: Volume: 43, No. 2 (2021)
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Issue Date
2021
Journal Title
Journal ISSN
ISSN (Print) : 1993-2979 | ISSN (Online) : 1993-2987
Journal Volume
Articles
Health Research During COVID-19 Pandemic: Nepalese Perspectives
(Institute of Medicine, 2021) Singh, Yogendra P
NA.
Split Thickness Skin Grafting With and Without Surgical Removal of Granulation Tissue in Granulating Wounds: A Single Blinded, Randomized Controlled Trial
(Institute of Medicine, 2021) Sharma, Samit; Pokhrel, Biraj; Rayamajhi, Sangam; Shrestha, Jayan M; Lohani, Ishwar
ABSTRACT
Introduction: Split thickness skin graft (STSG) is a commonly carried out procedure in granulating wounds. The graft may be applied directly on the granulation tissue (without scrapping) or it may be applied after complete removal of the granulation tissue (after scrapping). Surgeons are divided on this issue.
Methods: A single blinded, randomized, controlled trial was carried out between November 2017 and December 2018 in the Department of Plastic Surgery and Burns, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The study consisted of 62 patients who were divided into two groups. Group A consisted of patients undergoing removal of granulation tissue and Group B included patients on whom the skin graft was directly applied on the granulation tissue. On the 10th post-operative day, assessment of the graft take was done.
Results: There was no statistically significant difference in graft take between group A and group B (p=0.59). The average drop in hemoglobin levels after the surgery was 1.6 gm% in group A and 0.4 gm% in group B and this difference was statistically significant. Also, the drop of serum protein after surgery was 8.6% gm/dl in group A and 1.0 gm/dl in group B and this difference was significant.
Conclusion: There was no significant difference in the take of skin graft with or without removal of granulation tissue in our study. However, with lesser blood loss, lesser protein loss and lesser operative time, this study favours skin grafting without the removal of granulation tissue.
Keywords: Graft take, granulation tissue, split thickness skin graft
Six-Sigma Methodology for Quality Monitoring in a Teaching Hospital Biochemistry Laboratory in Nepal
(Institute of Medcine, 2021) Mishra, Akash; Pokhrel, Rakesh; Budhathoki, Uttam; Yadav, Binod K; Sharma, Vijay K; Tuladhar, Eans T; Bhattarai, Aseem; Raut, Mithileshwor
ABSTRACT
Introduction: Six-sigma is emerging method of choice for performance testing of clinical laboratory. This study was designed to evaluate the performance of 12 routine biochemical analytes on sigma-scale and calculate the quality goal index (QGI).
Methods: A cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH), Biochemistry Laboratory for 3 months. BT1500 and BT3500 automated biochemistry analyzers were used. Internal quality control (IQC) performed routinely for 12 clinical analytes for both control levels were recorded from both analyzers and used for calculation of coefficient of variation (CV%). Bias was estimated based on the average difference obtained for each analyte from the target values provided. Values for total allowable errors (TEa) were taken from Clinical Laboratories Improvement Act guidelines. Variables used for calculation of sigma values and QGI were CV%, percentage bias and TEa.
Results: Both levels of control for alanine-aminotransferase (ALT) in BT1500 and only control level L2 for aspartate-aminotransferase (AST) in both analyzers showed the sigma value greater than six. Sigma-values between three and six were found for uric acid for both levels of control in both analyzers. Less than three sigma values were obtained for parameters urea, creatinine, albumin, triglyceride, total-cholesterol, alkaline phosphatase (ALP) and magnesium for both levels of control in both analyzers indicating the need towards improvement in these methods.
Conclusion:The quality of test for urea, creatinine, albumin, triglyceride, total-cholesterol, ALP and magnesium were unacceptable. Hence, appropriate actions should be taken towards measurement method in these parameters to improve accuray and report quality.
Keywords: Bias, IQC, quality goal index, six-sigma, total allowable error
Management of Choledochal Cyst: Experience from A Tertiary Care Center of Nepal
(Institute of Medicine, 2021) Shrestha, Sujan; Ghimire,Bikal; Kansakar, Prasan; Bhandari, Ramesh S; Lakhey, Paleshwan Joshi
ABSTRACT
Introduction: Choledochal cysts are infrequent congenital cystic dilation of the biliary tract. The aim of this study is to analyze the clinicopathological profile and short-term operative outcomes of patients with choledochal cysts.
Methods: This is a retrospective study of 32 consecutive patients of choledochal cyst who underwent multidisciplinary management in last two and half years at Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Results: A total of 32 patients, 9 males and 23 females were operated. The average age at diagnosis was 24.67±16.4 years (range from 2 to 56 years). The most common presenting symptoms were pain 31(96.88%), jaundice 10(31.25%) and mass 5(15.63%). Triad of pain, jaundice and mass was present in 4(12.5%). Transabdominal Ultrasonography (100%) was the initial diagnostic modality followed by Magnetic resonance cholangiopancreatography (MRCP) (68.75%), and contrast enhanced computed tomography (CECT) (31.25%). Endoscopic retrograde cholangiopancreatography (ERCP) was done for stent placement in 3 (9.38%) patients with severe cholangitis. Type IVA (37.5%) was the most common type of CC followed by type IC (31.23%), type IB (15.65%), type IA (12.5%) and type IVB (3.12%). Abnormal pancreaticobiliary duct junction was observed in 3 (9.38%) patients. All patients underwent open cyst excision with Roux-en-Y hepaticojejunostomy (HJ). The overall morbidity was seen in 6 patients (18.75%). There was no mortality. None of our patient had cholangiocarcinoma on pathological examination.
Conclusion: Choledochal cyst was common in young females. Type IC and IVA choledochal cyst were the most common types and majority of them were symptomatic. Cyst excision with Roux-en-Y hepaticojejunostomy was the commonest surgical treatment modality and had excellent perioperative outcome
Keywords: Choledochal cyst, cyst excision, Roux-en-Y hepaticojejunostomy
Clinical Profile of Low Vision in Children
(Institute of Medicine, 2021) Gupta, Jewel D; Bhattarai, Sanjeev; Sharma, Anand K; Joshi, Niraj D; Gautam, Pragati; Chhetri, Suraj
ABSTRACT
Introduction: Visual impairment in children is more common in developing countries like Nepal. A low vision service has been found to be effective in significantly improving their overall development and quality of life. The main aim of this study was to determine the causes of low vision in pediatric population along with their refractive error distribution and visual functions.
Methods: A descriptive cross sectional study was carried out in Tribhuvan University, BP Koirala Lions Center for Ophthalmic Studies. A total of 50 low vision children were under went detail low vision examination. They were selected through purposive sampling. Data was analyzed by using the descriptive and inferential statistics with SPSS version 19.0.
Results: The study findings showed, most common cause of visual impairment in low vision children was refractive error (20%), followed by congenital cataract (18%) and macular dystrophy (16%). The most commonly prescribed low vision device for distance was telescope and for near was spectacle magnifier. There was average acuity improvement of five lines in distance visual acuity with low vision devices.
Conclusion: The study concluded that refractive error and congenital cataract being the commonest cause of low vision in children, which reflect poor accessibility of care service among Nepalese children. Refractive error, the major cause of visual impairment could have been managed even in primary eye care center in Nepal. Children with impairment have potential visual acuity that can be improved with low vision services.
Keywords: Congenital cataract, low vision, low vision devices, refractive error