Journal Issue: Volume: 16, No 2, Issue 62, APRIL-JUNE, 2018
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Volume
Number
Issue Date
2018
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
À La Carte Learning Catered on a Technology Platter !
(Kathmandu University, 2018) Eachempati, Prashanti
NA
Crural Bypass Surgery in Case of Critical Ischemia: Technical Aspects and Results
(Kathmandu University, 2018) Thermann, F; Karmacharya, RM
ABSTRACT
Background
Crural bypass surgery is one of the last options to salvage the leg. Compared to
arterial reconstructions of more proximal localization patency rates are generally less
good. The aim of this retrospective study was to answer the question if crural bypass
surgery is justified. For that we focused on different technicalities, bypass material,
recipient vessel and anticoagulation regimes.
Objective
To know outcome of crural bypass in terms of patency rates, survival rates,
amputation. The difference in outcome is compared in different stages of peripheral
arterial disease and various bypass materials and sites.
Method
Between 07/2013 and 06/2018 we performed 102 crural bypasses (27 female, 75
male; age 44-90 (70) years). Reasons for the bypasses were a critical peripheral
arterial diseases (PAD) (stage III [pain at rest] and IV [necrosis/gangrene] according
to Fontaine). End point of the study was major amputation or death. All patients
were operated on in the same department by two experienced vascular surgeons.
Result
Amputation-free time was 78% after sixmonths and 70% after 24 and 60 months.
Six, 12 and 40 months survival was 83%, 78% and 59%, respectively. Patency rates
were affected by the severity of the disease (stage III vs. stage IV) and so was major
amputation. Autologous bypasses were not associated with a better patency rate.
Minor amputation or the anticoagulation scheme did not influence the long term
results.
Conclusion
The long term survival after crural bypass is good and amputation rates are low,
independent of the vessel of the lower leg used as recipient outflow. Accordingly,
if a bypass is technically feasible, there is no limitation regarding the choice of the
recipient vessel. If possible, autologous vein should be used, but a graft prosthesis
can lead to equally good results. As patients with stage III PAD have better outcomes,
early intervention is recommended in order to avoid deterioration to stage IV.
KEY WORDS
Anticoagulation, Crural bypass, Limb salvage, Recipient vessel
Pattern and Prevalence of Refractive Error and Secondary Visual Impairment in Patients Attending a Tertiary Hospital in Dhulikhel, Nepal
(Kathmandu University, 2018) Kaiti, R; Pradhan, A; Dahal, HN; Shrestha, P
ABSTRACT
Background
Uncorrected refractive error is one of the most important causes of visual impairment
worldwide.
Objective
To ascertain the pattern and prevalence of refractive error and secondary visual
impairment in subjects attending Ophthalmology department.
Method
A prospective hospital-based study was designed where presenting visual acuity, age
of presentation, refractive status, best corrected visual acuity and status of visual
impairment were assessed in participants, ages ranging from 3-39 years presenting
to the Ophthalmology department of Dhulikhel Hospital, Kathmandu University
Hospital. History of use of spectacle was noted and participants were categorized
into different visual impairment categories as per their presenting visual acuity.
Result
Out of a total of 4500 total clients examined during the study period, 388 (8.62%)
had refractive error where 219 (56.44%) were females and 169 (43.56%) were males.
Mean age at presentation was 22.70±7.69 years (range, 3-39 years). Astigmatism
was the most common subtype seen in 373 eyes (48.06%), followed by myopia
(366 eyes, 47.16%) and hypermetropia (31 eyes, 4.0%). Only 40.50% subjects who
required refractive correction were using spectacle. 62.37% (242 clients) had some
of visual impairment during their presentation. There was statistically significant
improvement in visual acuity after refractive correction (p=0.00).
Conclusion
Uncorrected refractive error is one of the most important causes of visual impairment.
Lack of awareness, infrequent ocular examination and lack of community or preschool
vision screening were the main causes for the late presentation and significant visual
impairment associated with the condition. Social stigma, economical limitation and
negative counseling and attitudes about spectacle wear were primary factors behind
the unsatisfactory spectacle use.
KEY WORDS
Astigmatism, Refractive correction, Refractive error, Visual impairment
Post-Operative Pain and Associated Factors in Patients Undergoing Single Visit Root Canal Treatment on Teeth with Vital Pulp
(Kathmandu University, 2018) Shresha, R; Shrestha, D; Kayastha, R
ABSTRACT
Background
Pain after root canal therapy is unwanted yet common experience for the patient and
unpleasant for the dentist so it is always desirable to predict such pain.
Objective
To evaluate the frequency, intensity and associated factors of post-operative pain
after single visit endodontic therapy on teeth with vital pulps.
Method
A total of 418 single visit root canal treatments were performed on patients of
age 18 years and above by two endodontists. Canals were shaped with rotary Pro-
Taper files. After the canal preparation, the canals were obturated, using lateral
compaction technique, with ProTaper universal gutta-percha and AH-Plus sealer.
Independent factors were recorded during the treatment and characteristics of post-
operative pain were later surveyed through questionnaires. The severity of pain
was recorded on a visual analogue scale (VAS) of 0-5. The data were analyzed using
logistic regression models.
Result
The prevalence of post-operative pain within first six hours after treatment was high
(79.2%) which decreased to 22% at the end of 72 hours however majority (70%)
of the patients had mild to moderate pain (VAS 1-2). The factors that significantly
influenced post-obturation pain experience were: gender (OR=0.55, 95%CI=0.32-
0.93; p=0.03), tooth type (OR-0.67; 95% CI=10.56-0.81, p=0.00), history of pre-
operative pain (OR=1.26; 95% CI= 1.04-1.51; p=0.02) and number of canals (OR=2.03;
95% CI=1.40-2.95; p=0.00).
Conclusion
The prevalence of some level of post -operative pain after single visit root canal
therapy was high and was significantly influenced by female gender, increased
number of canals, posterior tooth type and positive history of pre-operative pain.
KEY WORDS
Pain, Post-operative pain, Root canal treatment, Single visit
Radiographic Anatomy of the Neck-Shaft Angle of Femur in Nepalese People: Correlation with its Clinical Implication
(Kathmandu University, 2018) Shrestha, R; Gupta, HK; Hamal, RR; Pandit, R
ABSTRACT
Background
Neck-shaft angle (NSA) is one of the prominent features in the proximal femur which
is an important determinant of fracture of femoral neck. Present study evaluating
the value of neck-shaft angle has relied heavily on radiographs. As knowledge of
neck-shaft angle is important to orthopaedic surgeons, there is need to elucidate
whether there is significant variation of this angle among the two different genders
and various age groups of both right and left femora of Nepalese population.
Objective
To ascertain the value of neck-shaft angle in the Nepalese population by means of a
radiographic study and to correlate the values with regard to right neck-shaft angle/
left neck-shaft angle side (RNSA/LNSA), gender and three different age group.
Method
Normal pelvic radiographs of 148 patients seen at department of orthopedic and
radiology, College of Medical Sciences- Teaching Hospital (COMS-TH), Bharatpur,
Chitwan from the month of February 2017 to June 2017 were divided into two
different gender and three different age groups (21-40 years, 41-60 years and Above
60 years) and their neck-shaft angle of both right and left sides were recorded.
Result
The average of RNSA and LNSA were found to be 132.96±6.05° and 131.54±13.66°
respectively for male and 134±6.57° and 132.98±6.23° respectively for female. In
total the average RNSA and LNSA were 133.51±6.32° and 132.26±10.61° respectively.
Similarly, the average RNSA and LNSA for three different age groups (21-40 years,
41-60 years and Above 60 years) were found to be 133.76±6.44°, 133.69±6.36° and
132.50±6.06° and the 133.35±6.29°, 132.47±5.85° and 128.84±21.98° respectively.
Conclusion
The average neck-shaft angle recorded here shows no significant difference in both
RNSA and LNSA in males except for a small and significant difference in LNSA in
female of three different age groups.
KEY WORDS
Left neck-shaft angle, Neck-shaft angle, Pelvic radiographs, Proximal femur, Right
neck-shaft angle