bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges of Sustaining Elimination Status of Leprosy in Nepal
Authors: Parajuli Sudip , Pokhrel Dinesh B , Baskota Rabindra , Poudyal Amod , Paudel Upama
Published: July 2024

Introduction: The number of leprosy patients is increasing in Nepal even after declaration of elimination in 2010. The objective of this study was to review the status of leprosy after declaration of elimination in Nepal and to identify challenges to sustain elimination.
Methods: This was retrospective study conducted by reviewing the annual data published by Department of Health Services, Ministry of Health, Government of Nepal from 2010 through 2018. In addition, one year hospital based data (2017/18) was retrieved from records of Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Results: The prevalence of leprosy was found to be 0.77/10,000 population in 2010 and 0.99/10,000 in 2018. The numbers of multibacillary (MB) cases (remained more than 50%) outnumbered paucibacillary (PB) cases throughout eight years.
Conclusion: The prevalence of leprosy is gradually increasing in Nepal with more number of multibacillary cases detected in post-elimination era.
Thyroglossal Duct Fistula with an Unusual Presentation: A Case Report
Authors: Gyawali Bigyan R , Dutta Heempali , Tripathi Prashant
Published: July 2024

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.
Screening of Kidney Disease in Asymptomatic Female College Students by Urine Dipstick Method
Authors: Chhetri Santosh , Shah Dibya S
Published: July 2024

Introduction: Urine examination by urine dipstick method is a useful tool to identify asymptomatic individual for kidney disease. A urine dipstick analysis was conducted on world kidney day to determine the urine abnormalities among asymptomatic female college students.
Methods: A cross-sectional study was carried out in a government female college in Kathmandu Nepal. Three hundred asymptomatic female students participated in this study. Fresh midstream urine samples were obtained and tested by urine dipstick method. Random Blood glucose was monitored with glucometer. Blood pressure was measured by manual sphynomanometer.
Results: The mean age of the female students was 22.62±2.686 years. Fifteen participants (5%) were found positive for proteinuria and only 1% of participants had glycosuria. The systolic blood pressure of >120 mm Hg was present in 14% of participants while 5% of participants had diastolic blood pressure of >90mm Hg. Participants who were found to have urinary proteinuria detected had both systolic and diastolic blood pressure increased. Only 8% of the participants had random blood sugar of >140 mg/dl.
Conclusion: Urinary abnormalities like proteinuria and glycosuria in asymptomatic female students has significant prevalence. Systemic prehypertension and hypertension has alarming rates among adolescents. Hence, screening for blood pressure and early detection of renal disorders will lead to effective interventions and possibly reduce the burden of renal diseases.
Awareness Regarding Hypertension among Adults in a Community of Bhaktapur, Nepal
Authors: Pokhrel Sanju , KC Tulza
Published: July 2024

Introduction: Hypertension is a common global health problem with significant morbidity and mortality. Various preventive life style practices play significant role in controlling it. The objective of this study was to identify awareness regarding hypertension among the adult people in a community of Bhaktapur, Nepal.
Methods: A descriptive cross-sectional study was conducted among 138 adults aged 20-59 residing in Bhaktapur, selected through nonprobability purposive sampling technique. The data was collected by face-to-face interview method through semi structured questionnaire. Data was analyzed by using descriptive and inferential statistics.
Results: The study showed that 58.7% of adults had adequate awareness regarding hypertension. About 35.5% knew the range of value of high blood pressure and nearly half (47.8%) answered heart as the organ primarily related to hypertension. Stress was identified as a risk for hypertension by 96.4%, 92% specified headache as main symptom and only 31.9% knew about the asymptomatic nature of hypertension. Nearly 90% were aware that management of hypertension includes all: medicine, diet and exercise. Almost 99% of the respondents mentioned about restricting alcohol for BP control and 93.2% mentioned heart attack as the complication of hypertension.
Conclusion: The study concluded that only half of adults have adequate awareness regarding hypertension. It also showed that there is statistically significant association of awareness level with age, religion, educational status, occupation, economic status, family history and diagnosis of hypertension. Thus, it could be recommended that health personnel should provide education and information covering all aspects of hypertension to adults residing in community.
Correlation between Iron Parameters and Platelet Parameters in Iron Deficiency Anemia
Authors: Chalise Sanat , Acharya Nishant , Pradhan Sailesh B
Published: July 2024

Introduction: Iron deficiency anemia is the most common type of anemia and is diagnosed by iron studies. Reactive thrombocytosis is usually seen in iron deficiency anemia. The objectives of the study is to correlate between iron parameters and platelet parameters in patient with iron deficiency anemia.
Methods: This was a cross-sectional study done in Department of Pathology at Kathmandu Medical College, Sinamangal between December 2018 to May 2019. Blood samples of 81 iron deficiency anemia patients were analysed to determine iron parameters and platelet parameters. SPSS version 20 was used to analyse the data.
Results: Thrombocytosis was seen in 62 (76.5%) patient with iron deficiency anemia. Platelet count was negatively correlated with serum iron, percentage saturation and platelet distribution width (p˂0.001, for all) while positive correlation was obtained between platelet count and plateletcrit (p<0.05). Plateletcrit showed negative correlation with serum iron (p˂0.001) and platelet distribution width (p<0.05) while positive correlation was obtained with mean platelet volume, total iron binding capacity and platelet (p<0.05, for all). There was negative correlation between mean platelet volume and platelet count (p<0.001). Positive correlation was obtained between mean platelet volume and plateletcrit (p<0.05). Correlation was not found between mean platelet volume and iron parameters (p>0.05). Platelet distribution width showed negative correlation with total iron binding capacity, platelet (p˂0.001, for both), plateletcrit (p<0.05).
Conclusion: Thrombocytosis is more commonly observed as compared to thrombocytopenia in patient with iron deficiency anemia. Serum iron and percentage saturation are the most important parameters affecting the platelet count.
Awareness Regarding Child Abuse among Mothers Attending a Paediatric Clinic of a Tertiary Level Hospital, Kathmandu
Authors: Mishra Tulashi Adhikari , Bhattarai Tilarupa
Published: July 2024

Introduction: Child abuse constitutes all forms of physical as well as emotional maltreatment resulting in harm to the child’s health and overall development. Parental awareness plays a significant role in the prevention of child abuse. The objective of this study was to find out the awareness of mothers regarding child abuse.
Methods: This descriptive cross-sectional study was carried out among mothers attending a Pediatric Outpatient Department of Tribhuvan University Teaching Hospital Kathmandu, Nepal. A total of 162 mothers having their children aged one to 16 years were selected as a sample using non-probability convenient sampling technique. Data was collected by face to face interview using semi-structured interview schedule.
Results: Findings of the study revealed that majority of mothers could state different types of abuse as physical abuse (72.8%), psychological abuse (78.4%), sexual abuse (71.6%), but 53.1% of mothers were aware about neglect, 48.8% of mothers considered that relatives could abuse their child. In total, 49.1% of mothers had moderately adequate, 26.4% had inadequate and 23.9% had adequate level of awareness regarding child abuse. No significant association was noted between the level of awareness and mothers’ age, ethnicity, religion and occupation. The level of awareness of mothers was significantly associated with nuclear family type (p=0.03).
Conclusion: The mothers are aware of child abuse at moderate level. Conducting awareness programmes in community, regarding child abuse focusing on child neglect is recommended.
Profile and Outcome of Adult Spine Pathologies Managed in a Neurosurgical Tertiary Care Center in Nepal
Authors: Sah Hemant K , Shrestha Dipendra K , Rajbhandari Binod , Sedain Gopal , Pradhanang Amit B , Shilpakar Sushil K , Sharma Mohan R
Published: July 2024

Introduction: Spine pathology involves a wide spectrum of diseases and needs a multidisciplinary approach including surgery, rehabilitation and psychological support. It increases the burden to the family and society. This study describes diseases related to spine and spinal cord from a neurosurgical department of a tertiary hospital in Nepal.
Methods: This is a retrospective study of all spinal cases admitted between April 2019 to February 2019, in the Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. All adult patients of ≥16 years, diagnosed with various spinal diseases were included. Based on the spectrum of causative pathologies, the study population was broadly categorized into trauma, degenerative, tumor, vascular and infection. Demographics, other variables, and outcome at 1 month were assessed.
Results: A total of 71 patients were included in this study. Male preponderance was observed in all categories. Twenty three patients (32.4%) had traumatic spine injury and fall from height was the most common mode of injury, accounting for two-third of the total spinal trauma patients. Cervical segment was involved in two-third patients. More than one-third of the spinal patients (36.6%) had a degenerative disorder involving lumbar (57.7%) and cervical regions (42.3%). Spinal infection was diagnosed in 11.2% of the patients with 62.5% diagnosed as Pott’s spine. Overall complications were seen in 20%. Pain improved in all patients while overall good outcome was noted in 63.2% of the patients.
Conclusion: Our study demonstrated a large patient burden and a clinical profile dominated by preventable causes such as RTA and fall injury. With early treatment and rehabilitation, significant improvement can be achieved. Further large scale multicenter studies are required to generalize the findings of this study to the whole population of Nepal.
Anesthetic Management of a Case of Hemophagocytic Lymphohistiocytosis
Authors: Shrestha Gentle S , Gulati Harmeet , Acharya Binita , Poudyal Bishesh S
Published: July 2024

Hemophagocytic Lymphohistiocytosis (HLH) is characterized by an overwhelming activation of histiocytes and T lymphocytes leading to fulminant hemophagocytosis and organ damage. Anesthetic management of patients with HLH is associated with challenges such as pancytopenia, hemodynamic instability and infections. In addition to sepsis, metabolic acidosis, disseminated intravascular coagulation, multi-organ involvement with an exacerbation of symptoms with the use of anesthetic agents poses significant risk perioperatively. We present a case planned for excision of pilonidal sinus. The surgery was performed after thorough workup and with the patient in remission. Elective procedures should ideally be performed with patients in remission. Cases receiving concurrent therapy with immunomodulators and steroids require special attention due to possible interaction with anesthetic agents and the need for perioperative steroid supplementation.
Low Grade Appendiceal Mucinous Neoplasm: A Report of Three Cases
Authors: Sharma Nisha , Karna Alina , Jha Abhimanyu
Published: July 2024

Low-grade appendiceal mucinous neoplasm (LAMN) is an uncommon malignancy with varied clinical features. The most alarming complication of this neoplasm is seeding of mucin into the adjacent peritoneum leading to pseudomyxoma peritonei (PMP). We report three cases of LAMN. Two cases were seen post appendicectomy in 23-year old and 36-year old females. The third case was seen in 53-year-old male post Whipple procedure and hemicolectomy. LAMNs are often diagnosed incidentally, as clinical presentation is barely specific and resembles acute appendicitis. Hence it is imperative to examine all appendicectomy specimens not to miss cases of appendiceal mucinous neoplasm which can have implications on the further management of the patient.
Adnexal Torsion in Ovarian Hyperstimulation Syndrome in Early Pregnancy: A Diagnostic Challenge
Authors: Regmi Pradeep R , Amatya Isha , Poudel Atit
Published: July 2024

Adnexal torsion in ovarian hyperstimulation syndrome (OHSS) is rare but serious complication in pregnancy. It is more common in assisted reproductive techniques. Delay in diagnosis and treatment results in functional loss of ovary as well as termination of pregnancy. In this report, we are presenting a case of 27 years female with subfertility who conceived after ovulation induction presented at 7 weeks 6 days period of gestation with ovarian hyperstimulation associated with adnexal torsion. Later, she was treated with laparoscopic salpingo-oophorectomy.
Breast Cancer Surgery at a Cancer Center in Janakpurdham: An Initial Experience
Authors: Jha Pamesh , Thakur Anshu K , Gupta Sanjay , Mishra Richa , Singh Yogendra P
Published: July 2024

Introduction: Breast cancer is the second commonest cancer in Nepalese women. In most of the low-income countries including Nepal, breast cancer is commonly diagnosed at late stage. The Binaytara Foundation Cancer Center (BTFCC), a 25 bed cancer hospital was established in Province 2, the most densely populated province, of Nepal in December 2018. We describe our experience of breast cancer surgery at the cancer hospital.
Methods: Surgical service was started from April 2019 after establishing an equipped operating room and post-operative and ICU wards. Total 51 surgeries were performed for both benign and malignant diseases by the end of 2019. The commonest surgery was breast surgery in 18 patients. Retrospective analysis of all six patients who were operated for breast cancer at the cancer center was done.
Results: Six female patients of this province were operated for breast cancer during this period. Age ranged from 40 to 56 years. Four patients were presented with locally advanced disease. Two patients received neo-adjuvant chemotherapy and two were subjected for upfront surgery. Modified radical mastectomy was done in four patients. For one patient with suspected hereditary localized breast cancer and one with Paget’s disease of the breast with non-invasive ductal carcinoma, simple mastectomy was performed. Postoperative period was uneventful except one case with seroma formation. Other than one Paget’s disease of the breast, all were triple nipple breast cancer.
Conclusion: Breast cancer surgery is one of the important modality of treatment even for locally advanced disease in resource limited settings.
Prevalence of Molecular Subtypes of Breast Cancer in a University Hospital of Nepal
Authors: Hirachan Suzita , Singh Yogendra P
Published: July 2024

Introduction: Breast cancer is the second most common malignancy in Nepalese women. It represents a group of heterogenous disease with diverse biologic, clinical and molecular characteristics requiring personalized treatment. Based on Immunohistochemical markers, breast cancer is classified into distinct molecular subtypes. The aim of the study was to analyze the incidence of molecular subtypes of all breast cancer patients treated at University Hospital of Nepal in the period over 3 years.
Methods: A retrospective observational study was carried out in Breast Unit of Tribhuvan University Teaching Hospital, Kathmandu. Electronic medical records of all breast cancer patients treated between January 2017 to December 2019 were retrieved from the hospital database. Patient’s characteristic, histological features and molecular subtypes were collected and analyzed.
Results: A total of 156 surgically treated breast carcinoma patients were studied. The median age of study population was 55 years (range 28–82years). Among these, 69 (44%) were of ≤45 years and 87 (56%) were over 45 years. The mean tumor size was 29 mm (range 50-140 mm). The most common histology was invasive ductal carcinoma (93.5%). Luminal type A was positive in 68 (43%) patients while luminal type B was present in 12 (7.6%) patients. Triple negative subtype was observed in 50 (32%) patients while HER2 rich subtype was seen in 25(16%). Incidence of Triple negative subtype was highest in patients less than 45 years (42%). Luminal A subtype was correlated with low tumor grade and less positive lymph nodes metastasis.
Conclusion: The most common molecular subtype of breast cancer in Nepal is Luminal A having favorable features. The incidence of triple negative breast cancer is higher in Nepal, having an aggressive and clinically distinct subtype and is important for personalized treatment plan.
Clinical Overview of Cancer Patients in Province Two of Nepal: A Single Center Experience
Authors: Thakur Anshu K , Shah Anish , Ray Barun K
Published: July 2024

Introduction: The incidence of cancer is rising in Nepal. It is estimated to reach 38.5 per 100,000 for males and 41.5 per 100,000 for females by 2020. The studies to determine the cancer burden in Nepal at provincial level have been insufficient and those that have been done are more inclined to Province 3. With establishment of a dedicated cancer facility in this area, we present an overview of clinical scenario of cancer patients in Province 2.
Methods: We performed a single centered, retrospective review of 118 patients who were registered in Oncology Clinics between May 2019 and February 2020. Demographics, diagnoses and the treatment strategies were obtained from the medical records.
Results: Median age of presentation for cancer was 55 years (range, 6 to 83 years) with maximum number of patients falling within range of 50-60 years (31.4%). 71 patients (60.2%) were female and 47 patients (39.8%) were male. The common presenting cancers were gastrointestinal (27.1%), breast (16.9%), head and neck (15.3), gynecological (13.6%), hematological (11.9%) and others (15.2%). Among the gastrointestinal cancers, carcinoma of gallbladder with 15 cases (46.9%) was the most frequently occurring, followed by colorectal cancer with 6 cases (18.8%) and esophageal cancer with 4 cases (12.5%). Among all, 78 patients (66.1%) received palliative care only, 25 patients (21.2%) received chemotherapy only, 8 patients (6.8%) underwent surgery only, 3 patients (2.5%) underwent surgery and received chemotherapy as well, 2 patients (1.7%) received both chemotherapy and palliative care and 2 patients (1.7%) were reassured and observed.
Conclusion: The most common age of presentation for cancer of any type was 50-60 years, with most common cancer being gastrointestinal in origin. Most of the patients received palliative care owing to their advanced stage at presentation.
Research and Publication from Developing Countries
Authors: Sharma Mohan R
Published: July 2024

N/A
Head Injuries at the Emergency Department of a University Hospital in Kathmandu
Authors: Henriksson Thérèse , Kjellberg Jacob , Shakya Yogendra , Kurlberg Göran
Published: July 2024

Introduction: Traumatic head injuries constitute a major cause of morbidity and mortality worldwide. The developing world is particularly affected due to a high prevalence of risk factors and difficulties in enforcing preventive efforts. This study was carried out at the Emergency Department (ED), Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal – where head injuries account for five per cent of all emergency visits. The aim was to describe demographics, cause of trauma, type of injury, and severity according to the Glasgow Coma Scale (GCS), as well as the outcome of emergency attendance in patients seeking medical care for traumatic head injuries. Auxiliary aims were to study correlations between age, cause of trauma and injury severity.
Methods: Data from 577 cases of head injuries from June to October 2019 were collected retrospectively.
Results: Traumatic head injuries accounted for 5.2 % of all emergency visits. The median age was 23 years. Patients were predominantly male. Superficial injuries and concussions were the most common. Most injuries were mild (94.4 %, GCS 13–15) and caused by falls (51.3 %) or road traffic accidents (19.1 %). Fall accidents and mild injuries had the lowest median age. Patients from outside Kathmandu Valley constituted 44.9 % of the cases. Only 12.1 % of the patients were admitted to the hospital.
Conclusion: Commonest head injuries are mild and superficial; and are caused by falls and road traffic accidents. Most head injury patients are children.
Assessment Of Third Ventricular Parameters in Computed Tomography of Head: A Pilot Study in Tertiary Level Hospital
Authors: Khanal Umesh P , Sah Keshav , Chand Ram B
Published: July 2024

Introduction: Measurement of ventricles of the brain is important for evaluating changes due to growth, ageing, intrinsic and extrinsic pathologies. The aim of this study was to determine the various parameters of the third ventricle and to assess their association with gender and age using computed tomography (CT) scans of head.
Methods: This retrospective, quantitative, cross sectional study was performed in the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital from July to October 2019 (4 months) on images of 100 patients (50 males and 50 females) whose age group were 18-87 years, who underwent non-contrast and contrast enhanced CT scan of head.
Results: The total mean of width of third ventricle was found to be 0.33±0.09 cm, 0.35±0.10 cm in male and 0.31±0.06 cm in female. Third ventricle width (TVW) showed statistically significant correlation with male and also with Age. Mean of third ventricle sylvian fissure distance index was 0.41±0.67 cm, 0.42±0.65 cm in male and 0.39±0.06 cm in female respectively. Mean of third ventricle ratio was 0.03±0.09 cm, 0.03±0.09 cm in male and 0.02±0.09 in female respectively. The value were slightly higher in male.
Conclusion: The third ventricle width in CT in this study was 0.33±0.09 cm. CT was very useful to determine the upper limits of normal value and its variation with age.
Risk Score for Prediction of Severe Postoperative Complications After Pancreaticoduodenectomy
Authors: Shah Surendra , Bhandari Ramesh S , Vaidya Pradeep , Singh Yogendra  P , Joshi Paleswan
Published: July 2024

Introduction: Morbidity after pancreaticoduodenectomy (PD) still remains high. Postoperative pancreatic fistula (POPF) is the most common cause of increased morbidity after PD. Assessment of predictability of risk score for severe postoperative complications was the objective of this study.
Methods: This was a retrospective observational study. Patients undergoing pancreaticoduodenectomy at Tribhuvan University Teaching Hospital (TUTH) between January 2017 to December 2017 were included in the study. Variables were recorded from case sheets of the patients. The “Risk Score” was calculated using the pancreatic duct diameter and body mass index (BMI). Association of risk score and severe postoperative complications were analyzed.
Results: A total number of patients were 43, including 23 (53.5%) males and 20 (46.5%) females. The mean age was 57.09 ± 11.85 years ranges from 29 years to 76 years. The POPF and delayed gastric emptying (DGE) was 23.3% (10/43); and post-pancreaticoduodenectomy hemorrhage (PPH) was 11.6% (5/43). Severe postoperative complications were present in 13.9% (6/43) patients. In univariate analysis, pancreatic duct diameter (p=0.045) and Risk Score (p=0.02) were significantly associated with severe postoperative complications after PD. However none of them were significant in multivariate analysis
Conclusion: Risk score failed to predict severe postoperative complication after pancreaticoduodenectomy.
Prevalence of Metabolic Syndrome among Subjects attending General Health Checkup of a Tertiary Center of Kathmandu, Nepal
Authors: Shakya Yagya L , Raut Shankar , Shrestha Tirtha M , Neupane Ram P
Published: July 2024

Introduction: Metabolic syndrome is one of the major concerns of modern health causing morbidity and mortality. The metabolic syndrome is the constellation of metabolic disorders - insulin resistance; obesity, dyslipidemia and hypertension that are interrelated which lead to higher risk of cardiovascular disease, diabetes, stroke, atherosclerosis and serious health condition. The study focused on the prevalence of all the metabolic syndrome cases that came to general health checkup (GHC) of Tribhuvan University Teaching Hospital.
Methods: The study was a cross-sectional retrospective study of all cases that came to GHC from July 2019 to October 2019. GHC records files of all patients that came for their general health check-up were used to obtain data that included demographic details and the criteria for metabolic syndrome. Waist circumference, weight, height and blood investigations were sent as a routine examination of the general health checkup. Data analysis was done in Microsoft Excel 2019 and SPSS 20.
Results: Among 311 cases enrolled in our study, 99 (31.8%) met the revised National Cholesterol Education Program, Adult Treatment Panel III (NCEP ATP III) criteria for metabolic syndrome. Among those with metabolic syndrome, males were 52 (52.53%) and females were 47 (47.47%). Also, 81 (81.81%) out of 99 cases had decreased HDL (<1.03 mmol/L for males and <1.30 mmol/L for females), which was the most common component of metabolic syndrome in the study.
Conclusion: Metabolic syndrome is present in almost one third of the studied apparently healthy patients coming for general health checkup and it emphasizes on awareness regarding screening for metabolic syndrome.
Right Sided Aortic Arch with Aberrant Left Subclavian Artery from Kommerell’s Diverticulum, a Cause of Persistent Dysphagia in an Adult: A Case Report
Authors: Regmi Pradeep R , Amatya Isha , Kafle Bipula , Kayastha Prakash , Paudel Sharma
Published: July 2024

Congenital variations and anomalies of the aortic arch are important entity in vascular imaging. Most of them are asymptomatic. About 30-40% presents with tracheo-oesophageal symptoms like dyspnea and dysphagia. A 27 year-old female presented with persistent dysphagia for 6 months duration and cause of persistent dysphagia was the right sided aortic arch with aberrant left subcalvian artery from Kommerell’s diverticulum. The diagnosis was made through combination of chest X-Ray, echocardiography, non-ionic contrast swallow and Computed Tomography angiography. Non-invasive modalities (CT and MR Angiography) play an important role in diagnosis and pre-operative surgical planning providing relationship with the surrounding structures especially trachea and esophagus.
Anesthetic Management of Apert Syndrome: A Case Report
Authors: Koirala Megha , Shrestha Gentle S , Joshi Pankaj , Parajuli Bashu D
Published: July 2024

Apert syndrome is a rare autosomal dominant disease associated with abnormalities of skull, face and limbs. These patients present for different types of surgeries. To the anesthesiologists,they pose special challenge during airway management, manifesting as difficulty in bag-mask ventilation and increased incidence of airway obstruction. Here, we report a case of a child with Apert syndrome undergoing syndactyly release under general anesthesia, in whom severe bronchospasm and a failed bag-mask ventilation occurred during the emergence of anesthesia requiring re-insertion of laryngeal mask airway.
Health Research During COVID-19 Pandemic: Nepalese Perspectives
Authors: Singh Yogendra P
Published: July 2024

N/A
Split Thickness Skin Grafting With and Without Surgical Removal of Granulation Tissue in Granulating Wounds: A Single Blinded, Randomized Controlled Trial
Authors: Sharma Samit , Pokhrel Biraj , Rayamajhi Sangam , Shrestha Jayan M , Lohani Ishwor
Published: July 2024

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.
Six-Sigma Methodology for Quality Monitoring in a Teaching Hospital Biochemistry Laboratory in Nepal
Authors: Mishra Akash , Pokhrel Rakesh , Budhathoki Uttam , Yadav Binod K , Sharma Vijay K , Tuladhar Eans T , Bhattarai Aseem , Raut Mithileshwor
Published: July 2024

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 accuracy and report quality.
Clinical Profile of Low Vision in Children
Authors: Gupta Jewwl D , Bhattarai Sanjeev , Sharma Anand K , Joshi Niraj D , Gautam Pragati , Chhetri Suraj
Published: July 2024

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.
Cuscuta reflexa Roxb. Poisoning: A Case Report
Authors: Prasad Pravin , Bajracharya Sangha R , Lamichhane Samir , Ghimire Rakesh , Gupta Sanjay K , Prasad Archana
Published: July 2024

Cuscuta reflexa (C. reflexa Roxb.), is an endogenous parasitic plant found in Nepal and has been used by various ethnic communities of Nepal. However, there has been cases of toxicity in humans which needs attention. Here we discuss a case of C. reflexa Roxb. Accidental self-poisoning while being used for liver ailments that presented with gastrointestinal symptoms initially and local health facility and visited two health facilities before presenting to Tribhuvan University Teaching Hospital with multiple complaints. Appropriate risk assessment was done and the patient was managed conservatively at our center for three days following which he was discharged.
Patients’ Operative Care Knowledge and Desire for Information About Surgery and Anesthesia
Authors: Gurung Renu , Acharya Binita , Shakya Bigen M
Published: July 2024

Introduction: Good communication between patients and health professionals and sharing of information on operative procedures form the basis of informed consent. The objective of the study was to assess our patients’ information on the operative procedures and their desire for information about surgery and anesthesia.
Methods: This was a descriptive cross-sectional study done in one of the academic institutes of Nepal. The sample size calculated was 422. A simple random sampling by proportionate method was used. Patients between 18 to 80 yrs. scheduled for elective surgeries were included in the study. The questionnaires were read by anesthesiologist to the participants after preanesthetic check-up just before scheduled operation in the preparation room. Patients were requested to complete a 100 mm visual analogue scale by marking a cross to indicate level of anxiety on a spectrum of 'not anxious ' to 'extremely anxious'.
Results: The final number of participants were 404. About 21.53 % of the patients did not know about the type of operation that they were about to undergo and 19.8 % of the patients were unaware whether they would be put into unconscious state or not. More than half did not know about duration of surgical procedure (61.88%), time of resuming daily activities after surgery (60.64%), duration of stay in hospital (48.76%), pain after surgery (47.77%). There was positive correlation between the information and level of education (p<0.001) and patients with past history of surgeries (p=0.001).
Conclusion: The patients lacked information on operative care especially regarding duration of surgical procedure, duration of stay in hospital and time required for resuming daily activities.
Experience in Flap Reconstruction of Lower Limb Defects in a Tertiary Care Center of Nepal
Authors: Niraula Himalaya , Rajbhandari Bikesh , Devkota Manish , Sharma Samit , Rayamajhi Sangam , Shrestha Jayan M , Lohani Ishwar
Published: July 2024

Introduction: Lower limb defects are caused by trauma, chronic ulcers or oncological resection. Being a large and varied area of the body, lower limb reconstruction is challenging. This study analyzed clinical presentation of such defects, surgical management and outcomes in Nepalese context.
Methods: Single-center retrospective study of flap reconstruction of lower limb defects conducted in Tribhuvan University Teaching Hospital, Kathmandu over a two years period (April 2019-March 2021). Demographics, clinical presentation, comorbidities, treatment and complications were recorded and analyzed.
Results: A total of 53 flaps were performed on 47 patients with 50 defects (35 males and 12 females). Road traffic accidents (38.3%) and pressure ulcers (17.02%) were common causes. Ankle-foot was the most affected site (48%), followed by leg and thigh (18% each). Defect size ranged from 3 cm2 to 396 cm2. Surgery consisted of 46 pedicled and seven free flaps. Reverse sural artery flap was the commonest flap performed (30.2%). All free flaps were performed on defects larger than 100cm2. Overall complication rate was 30.2%, partial flap loss being the commonest (15.1%). Total flap loss occurred in one pedicled and one free flap. Eleven pressure ulcers were operated on, with 36.4% complication rate. Average hospital stay was 33.5±26.88 days.
Conclusion: Multiple surgeries, comorbidities and high complication rates with hospital stay of more than a month reflect the difficulties encountered in lower limb reconstruction. Despite these challenges, majority of our patients were discharged with stable wound coverage.
Pattern of Colour Vision Anomalies Among Patients Presenting to a Tertiary Eye Center of Nepal
Authors: Dahal Manisha , Adhikari Pragati Gautam , Bhattarai Sanjeev , Mishra Sanjeeb
Published: July 2024

Introduction: Colour vision deficiency (CVD) is the inability to clearly differentiate colour differences under normal lighting condition. People are unaware of colour vision defect due to which they suffer in various aspects of their career. The purpose of this study was to explore the colour vision defect pattern among patients attending tertiary eye centre, Kathmandu, Nepal.
Methods: A hospital based, retrospective study was conducted to evaluate the defective colour vision pattern in patients attending B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Nepal where total of 692 subjects medical case sheetswere reviewed and included in the study from September 2018 to April 2019.
Results: Among 692 patients enrolled in the study, 272 (39.30%) patients were found to have CVD . Among 272 CVD,227(83.45%) were males and 45(16.54%) were females. Congenital colour vision defect was found in 139 (26.73%) males and 21 (13.81%) females. Acquired color vision defect was found in 88 (16.92%) males and 24 (15.78%) females . When congenital CVD was observed, deutan (28.3%) CVD was more prevalent than protan (22.79%) and tritan defect (7.72%). For acquired CVD, non-specific type of CVD (8.92%) was more prevalent followed by tritan CVD (5.35%).
Conclusion: Significant proportion of patient presenting for eye care at tertiary eye hospital have color vision defects. Congenital CVD was found more in males than females whereas acquired color vision defect was found almost in same proportion in both males and females.
Airway Management Skills in Emergency Services
Authors: Shrestha Jukel , Shakya Yogendra M , Maharjan Ramesh K , Neupane Ram P , Shakya Yagya L , Prasad Pratap N
Published: July 2024

Introduction: Endotracheal intubation in critically ill and injured patients is a high- risk procedure in an Emergency Room (ER). The risk of complications increases with repeated or prolonged attempts, making first attempt success primary goal for airway management in these patients. The primary objectives were to compare first pass success during intubation among various specialties with different level of airway management training and education.
Methods: This was a quantitative, observational, cross-sectional study conducted at Tribhuvan University Teaching Hospital for one year. The intubators completed an intubation data collecting form post intubation. After a failed first attempt, alternative methods such as using experienced intubators for subsequent intubation attempts were performed.
Results: In the emergency room, 265 attempts of endotracheal intubation were made on total 224 patients. Most common causes for intubation were stroke (49 [21.8 %]), sepsis (39 [17.20 %]), COPD (28 [12.20 %]), and head traumas (24 [10.90 %]). During endotracheal intubation, 185 (82.58%) patients had a successful first-attempt success, and 39 (17.41 %) patients required ≥2 attempts. First pass success was least among medical officers (13/20 (65%)), compared to other senior specialties (p=0.01).
Conclusion: With more training and education on the airway, first-pass success during endotracheal intubation increased. All front-line workers should consider it an ethical commitment to stay updated through lifelong learning, an obligation that should be made easier by governing bodies enforcing a thorough airway management training programs.
Anatomic Variation of Posterior Slope of Tibial Plateau in Adults
Authors: Humagain Vaskar , Maharjan Rajram , Paudel Krishna P , Sigdel Arun , Sah Krishna J , Regmi Rabindra
Published: July 2024

Introduction: Posterior tibial slope (PTS) is the tilt bore by the tibial plateau posteriorly and inferiorly relative to the long axis of the shaft of tibia. Mean PTS in each population is imperative to keep within the normal range as possible for good outcome of different surgeries around the knee. Measurement of the PTS using plain radiograph is a cost effective, facile approach and can be done without the use of advanced imaging modalities.
Methods: A prospective observational study was done from January to December 2020. Patients presenting to Outpatient Department at National Trauma Center, NAMS with minor knee problems like soft tissue injury, pain, and stiffness were included in the study. PTS was measured via software on a true lateral radiograph of affected knee and its mean value was correlated with parameters, namely, age, sex, BMI, laterality, and race.
Results: Mean PTS was 10.350 ±2.030 (range 3-140) in the study size of 185. The mean age of study population was 41.25 ± 15 years (range: 19-73 years). There were 96 males and 89 females in the study. Mean PTS in males was 10.650±2.040 while that in females was 10.030±1.970. The mean BMI of individuals in this study was 25.3 ± 2.61 kg/m2. There was no statistically significant correlation of PTS with age, sex, BMI, laterality, and ethnicity.
Conclusion: Posterior tibial slope in adults is not influenced by sex, BMI, side, ethnicity or advancing age.
Variations in Pancreatic Duct Course, Configuration and Pancreaticobiliary Junction on MRCP in 3-T MRI: A Descriptive Cross Sectional Study
Authors: Jha Anamika , Tuladhar Sasmita , Jha Sujit K , Gurung Ghanshyam , Karki Dan B
Published: July 2024

Introduction: Anomalies and anatomic variations of the pancreatic duct must be identified because they can predispose to conditions like pancreatitis, choledochal cysts, and cholangiocarcinoma, as well as increase surgical complications. In this study, we describe the course and configuration of pancreatic ducts and pancreaticobiliary confluence in cholangiopancreaticography on 3-Tesla magnetic resonance (3-T MR) scanner.
Methods: This cross-sectional descriptive study was done after obtaining ethical clearance, and included 128 magnetic resonance cholangiopancreatography (MRCP). The MRCP image records from December 2015 to 2018 were retrospectively analyzed for pancreatic duct course, configuration, angle of pancreaticobiliary confluence and common channel. Obtained data was entered in previously prepared proforma. Statistical analysis was performed using SPSS v 16.
Results: There were 56 (43.8%) males and 72 (56.2 %) females with mean age 48.72±18.05 years, ranging from 3 - 84 years. The most common pancreatic duct course was descending in 45 (36.3%) followed by sigmoid in 42 (33.9%) and vertical in remaining 37 (29.8%) patients. The most common ductal configuration was rudimentary non- dominant duct of Santorini in 88 (71%) patients followed by bifid configuration with dominant duct of Wirsung in 27 patients (21.8%). Pancreatico-biliary junction was more often acute angled than right or obtuse. The common indications for undergoing MRCP were pain abdomen (102, 82.8%), vomiting (53, 43%) and jaundice (36, 28.9%).
Conclusion: In symptomatic patients undergoing MRCP, the common anomalies of the pancreatic duct observed were descending course, rudimentary non-dominant duct of Santorini configuration and acute pancreatico-biliary angle.
Menopausal Symptoms in Overweight and Obese Middle Aged Women: A Community Based Study
Authors: Ojha Neebha , Koirala Poonam , Shrestha Srijana
Published: July 2024

Introduction: Overweight and obesity is on the rise globally and women with higher body mass index at midlife have been found to suffer more from menopausal symptoms. This study aims to assess the menopausal symptoms in overweight and obese middle aged women using menopause rating scale (MRS) in the community setting.
Methods: This descriptive cross-sectional study was conducted at Gokarneswore Municipality in Kathmandu district, from June to December, 2021. Women in the age group of 40-60 years were interviewed regarding the frequency and severity of menopausal symptoms using MRS. The collected data were entered and analyzed in SPSS 25.
Results: Among the 378 women, 156 (41.3%) were premenopausal, 104 (27.5%) perimenopausal and 118 (31.2%) were postmenopausal women; and 176 (46.6%) were overweight and 87(23.0%) were obese. Overall, 38-68% suffered from different menopausal symptoms. Most of the menopausal symptoms were not significantly different among normal, overweight and obese middle-aged women. Urinary symptom was more frequent in obese premenopausal, however the urogenital symptoms were significantly more in normal weight postmenopausal women (p <0.05). The mean MRS score was similar among normal, overweight and obese women, however according to the menopausal status the mean score was significantly higher among perimenopausal and post menopausal women (p <0.001).
Conclusion: This study showed that among the middle aged women almost half were overweight and one-fourth was obese. Menopausal symptoms were similarly distributed in perimenopausal and postmenopausal women in overweight and obese middle aged women. It is important to assess the obesity and menopausal symptoms, which can be specifically targeted for treatment.