Care Center In Nepal Research Articles

Pancreatic Configuration Index in Predicting Postoperative Pancreatic Fistula in a Tertiary Care Center in Nepal.

Post-operative pancreatic fistula is the single most common and most significant cause of post-operative morbidity and perioperative mortality. Identification of at risk patient preoperatively help to take policy of extra vigilance to act on time. This study evaluated the predictive role and cut-off value of pancreatic configuration index to predict post-operative pancreatic fistula. This was a prospective observational study in patients who had undergone pancreaticoduodenectomy from March 2017 to June 2018 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The patients with age <16 years, those who underwent re-exploration or mortality before 3rd postoperative day, additional surgery besides pancreaticoduodenectomy were excluded from the study. Pancreatic configuration index was calculated as a ratio of pancreatic parenchymal thickness and pancreatic duct diameter. Predictive value of pancreatic configuration index in predicting post-operative pancreatic fistula was evaluated. Among 58 patients, 9 were excluded from study and 49 patients were included in the study. The mean age of the patients was 56.6 ± 13.9 years (21 to 79 years) and male to female ratio was 1.1:1 (26 vs 23). Post-operative pancreatic fistula developed in 13/49 (26.5%) patients. On both univariate and multivariate analysis, pancreatic texture (p = 0.022), main pancreatic duct diameter at neck (p = 0.002) and pancreatic configuration index (p = 0.001) were significantly associated with development of post-operative pancreatic fistula. The sensitivity and specificity of pancreatic configuration index to predict post-operative pancreatic fistula are 92.3% and 91.7% with positive predictive value of 80% and negative predictive value of 97.1%. Pancreatic configuration index is a useful preoperative predictor of post-operative pancreatic fistula after pancreaticoduodenectomy.

Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal

Introduction: Temporary transvenous pacemaker insertion is an emergency lifesaving procedure for patients with hemodynamically unstable and life-threatening bradyarrythmias. The aim of this study was to analyze demographics, indications, route of insertion and complications in patients undergoing temporary transvenous pacemaker implantation. Methods: This was a retrospective observational study conducted at a tertiary-care center in Nepal. The hospital records of patients who had undergone temporary transvenous pacemaker implantation between July 2015 and June 2019 were reviewed. Results: A total of 343 patients with mean age of 65.52±16.09 years received temporary transvenous pacing. Out of these 205 (59.8%) were males. Greater proportion of patients were between the age group of 70-80 years (n=76, 22.2%). Hypertension (n=97, 28.3%) was the most common comorbidity noted. The most common indication for temporary pacing was symptomatic complete heart block 165 (59.6%). Total of 288 (84%) patients received permanent pacemakers while 55(16%) had reversible cause so TPI was removed. Right Femoral vein was the most common (99%) venous access site. Among the 343 patients, complications were observed in 29 (8.4%) of cases during and after the temporary transvenous pacemaker insertion. The overall mortality stood low at 2% (n=7). Conclusion: Temporary transvenous pacemaker insertion is required in elderly population presenting with bradyarrythmias and occasionally in acute myocardial infarction presenting with bradyarrythmias as complication. Temporary pacemaker insertion was overall a safe procedure with infrequent serious complications; however, strategies to avoid and alleviate such complications (RV perforation) should be sought and implemented.

Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal

Introduction Hepatolithiasis is more prevalent in Far-East than in Middle-East countries. There are various treatment modalities available for hepatolithiasis like surgical and non-surgical procedures. Non-surgical procedures have higher recurrence rate.&#x0D; MethodsThis is a descriptive retrospective study of the clinical data of hepatolithiasis patients treated at Tribhuvan University Teaching Hospital (TUTH), Maharajgunj from April 2016 to October 2019.&#x0D; ResultsThere were 14 patients and mean age was 45.8±14.8 years. It was more common in female (F: M = 4:3). Left sided hepatolithiasis was the most common type (50%). One (7.1%) patient had bilateral hepatolithiasis associated with unresectable cholangiocarcinoma. Eight (57.1%) patients were treated with surgical procedures; four (28.6%) patients underwent interventional radiological procedures and remaining two (14.3%) patients had combined surgical and intervetional radiological procedures. Complete stone clearance was achieved in 11 patients (78.57%). In surgical therapy group, seven out of eight (87.5%) patients achieved the complete stone clearance; two out of four (50%) patients in interventional radiology group and all patients in combined therapy group achieved the clearance. There was no recurrence among those patients who had complete stone clearance and there was no mortality.&#x0D; ConclusionThe management of hepatolithiasis should involve multi-modality (surgical and non-surgical) therapeutic techniques available, in order to achieve complete stone clearance and prevent the complications.

Pediatric Percutaneous Nephrolithotomy in a Peripheral Tertiary Care Center in Nepal

Introduction: Pediatric nephrolithiasis though uncommon, poses clinical management dilemma due to anatomical and physiological factors. Percutaneous Nephrolithotomy (PCNL) is well established in adults and miniaturization of the instruments has helped to expand its indication for uses in pediatric population with equivalent results. The aim of our study is to evaluate the application of the procedure in our settings. Methods: This was a retrospective study done at Nepalgunj Medical College teaching hospital from June 2017 to April 2020. Total of 75 patients with 76 renal units under 18 year of age were evaluated. PCNL was done in prone position in all patients using fluoroscopy for initial puncture and subsequently for clearance. The size of the tract varying from 15 Fr to 24 Fr was decided based on the degree of hydronephrosis. Results: Mean stone volume was 372 mm2. With mean operative time of 58 min, 96% of stone clearance rate was achieved. Mini PCNL was done in most of the cases. Single tract was used in 84% cases mostly with subcostal puncture. Major complications were pelvic perforation in 4% cases and two patients required restaging. Conclusion: PCNL in pediatric population is safe with good stone free rate with minimal complications. Application of miniaturized instruments has further improved the outcome with comparable morbidity.

Pediatric Percutaneous Nephrolithotomy in a Peripheral Tertiary Care Center in Nepal

Introduction Pediatric nephrolithiasis though uncommon, poses clinical management dilemma due to anatomical and physiological factors. Percutaneous Nephrolithotomy (PCNL) is well established in adults and miniaturization of the instruments has helped to expand its indication for uses in pediatric population with equivalent results. The aim of our study is to evaluate the application of the procedure in our settings.&#x0D; MethodsThis was a retrospective study done at Nepalgunj Medical College teaching hospital from June 2017 to April 2020. Total of 75 patients with 76 renal units under 18 year of age were evaluated. PCNL was done in prone position in all patients using fluoroscopy for initial puncture and subsequently for clearance. The size of the tract varying from 15 Fr to 24 Fr was decided based on the degree of hydronephrosis.&#x0D; ResultsMean stone volume was 372 mm2. With mean operative time of 58 min, 96% of stone clearance rate was achieved. Mini PCNL was done in most of the cases. Single tract was used in 84% cases mostly with subcostal puncture. Major complications were pelvic perforation in 4% cases and two patients required restaging.&#x0D; ConclusionPCNL in pediatric population is safe with good stone free rate with minimal complications. Application of miniaturized instruments has further improved the outcome with comparable morbidity.

Clinical Profile of Patients Undergoing Temporary Transvenous Pacing in a Tertiary Cardiac Care Centre in Nepal

Introduction Temporary transvenous pacemaker insertion is an emergency lifesaving procedure for patients with hemodynamically unstable and life-threatening bradyarrythmias. The aim of this study was to analyze demographics, indications, route of insertion and complications in patients undergoing temporary transvenous pacemaker implantation.&#x0D; MethodsThis was a retrospective observational study conducted at a tertiary-care center in Nepal. The hospital records of patients who had undergone temporary transvenous pacemaker implantation between July 2015 and June 2019 were reviewed.&#x0D; ResultsA total of 343 patients with mean age of 65.52±16.09 years received temporary transvenous pacing. Out of these 205 (59.8%) were males. Greater proportion of patients were between the age group of 70-80 years (n=76, 22.2%). Hypertension (n=97, 28.3%) was the most common comorbidity noted. The most common indication for temporary pacing was symptomatic complete heart block 165 (59.6%). Total of 288 (84%) patients received permanent pacemakers while 55(16%) had reversible cause so TPI was removed. Right Femoral vein was the most common (99%) venous access site. Among the 343 patients, complications were observed in 29 (8.4%) of cases during and after the temporary transvenous pacemaker insertion. The overall mortality stood low at 2% (n=7).&#x0D; ConclusionTemporary transvenous pacemaker insertion is required in elderly population presenting with bradyarrythmias and occasionally in acute myocardial infarction presenting with bradyarrythmias as complication. Temporary pacemaker insertion was overall a safe procedure with infrequent serious complications; however, strategies to avoid and alleviate such complications (RV perforation) should be sought and implemented.

Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal

Introduction: Hepatolithiasis is more prevalent in Far-East than in Middle-East countries. There are various treatment modalities available for hepatolithiasis like surgical and non-surgical procedures. Non-surgical procedures have higher recurrence rate. Methods: This is a descriptive retrospective study of the clinical data of hepatolithiasis patients treated at Tribhuvan University Teaching Hospital (TUTH), Maharajgunj from April 2016 to October 2019. Results: There were 14 patients and mean age was 45.8±14.8 years. It was more common in female (F: M = 4:3). Left sided hepatolithiasis was the most common type (50%). One (7.1%) patient had bilateral hepatolithiasis associated with unresectable cholangiocarcinoma. Eight (57.1%) patients were treated with surgical procedures; four (28.6%) patients underwent interventional radiological procedures and remaining two (14.3%) patients had combined surgical and intervetional radiological procedures. Complete stone clearance was achieved in 11 patients (78.57%). In surgical therapy group, seven out of eight (87.5%) patients achieved the complete stone clearance; two out of four (50%) patients in interventional radiology group and all patients in combined therapy group achieved the clearance. There was no recurrence among those patients who had complete stone clearance and there was no mortality. Conclusion: The management of hepatolithiasis should involve multi-modality (surgical and non-surgical) therapeutic techniques available, in order to achieve complete stone clearance and prevent the complications.

Prevalence of Diabetes and Dyslipidemia in Hypertensive Young Adults in a Tertiary Care Centre in Nepal, a Cross Sectional Study

Introduction Diabetes mellitus (DM) and lipid disorders (LD) in hypertensive patients are associated with increased risk of cardiovascular complications requiring close follow-up and more aggressive treatment. Hence, the present study was done to study the prevalence of diabetes and dyslipidemia in young hypertensive patients i.e. &lt;40 years in a tertiary care hospital, Nepal.&#x0D; MethodsThis is a hospital based cross-sectional study carried out in Civil Service Hospital, Kathmandu. Study included 165 patients of &lt;40 years who had hypertension, either newly diagnosed or undergoing antihypertensive treatment from September 2018 to September 2019. Blood pressure was measured two times on right upper arm in sitting position at interval of 30 minutes and the aver­age was taken. Fasting Lipid Profile and Fasting Blood Glucose was measured after 12 hours of fasting and the prevalence of dyslipidemia and diabetes were analyzed from the data collected. All calculations and statistical analyses are processed by the SPSS 25.0.&#x0D; ResultsAmong 165 patients included, majority of patients, 107 (64.8%) were among 31-39 years, followed by 53 (32.1%) patients among 21-30 years. In total, 98 (59.4%) were male and 67 (40.6%) female. The prevalence of diabetes was 24 (14.5%) and pre-diabetes was 49 (29.7%). The prevalence of dyslipidemia was 125 (75.6%), high triglyceride being the most common disorder followed by low HDL in 87 (52.1%). Elevated total cholesterol was found in 53 (32.1%) patients and 48 (29%) had high LDL cholesterol level.&#x0D; ConclusionA high prevalence of diabetes, pre-diabetes and dyslipidemia was observed in the hypertensive patients &lt;40 years of age.

Prevalence of Diabetes and Dyslipidemia in Hypertensive Young Adults in a Tertiary Care Centre in Nepal, a Cross Sectional Study

Introduction: Diabetes mellitus (DM) and lipid disorders (LD) in hypertensive patients are associated with increased risk of cardiovascular complications requiring close follow-up and more aggressive treatment. Hence, the present study was done to study the prevalence of diabetes and dyslipidemia in young hypertensive patients i.e. &lt;40 years in a tertiary care hospital, Nepal. Methods: This is a hospital based cross-sectional study carried out in Civil Service Hospital, Kathmandu. Study included 165 patients of &lt;40 years who had hypertension, either newly diagnosed or undergoing antihypertensive treatment from September 2018 to September 2019. Blood pressure was measured two times on right upper arm in sitting position at interval of 30 minutes and the average was taken. Fasting Lipid Profile and Fasting Blood Glucose was measured after 12 hours of fasting and the prevalence of dyslipidemia and diabetes were analyzed from the data collected. All calculations and statistical analyses are processed by the SPSS 25.0. Results: Among 165 patients included, majority of patients, 107 (64.8%) were among 31-39 years, followed by 53 (32.1%) patients among 21-30 years. In total, 98 (59.4%) were male and 67 (40.6%) female. The prevalence of diabetes was 24 (14.5%) and pre-diabetes was 49 (29.7%). The prevalence of dyslipidemia was 125 (75.6%), high triglyceride being the most common disorder followed by low HDL in 87 (52.1%). Elevated total cholesterol was found in 53 (32.1%) patients and 48 (29%) had high LDL cholesterol level. Conclusion: A high prevalence of diabetes, pre-diabetes and dyslipidemia was observed in the hypertensive patients &lt;40 years of age.

Complications and Mortality in Hospitalised Patients With Decompensated Cirrhosis of Liver in a Tertiary Care Centre in Nepal.

BackgroundPatients with decompensated cirrhosis present with various complications and are associated with increased inpatients mortality. This study aimed to evaluate the complications and mortality in hospitalised patients with decompensated cirrhosis of liver.MethodsThis descriptive, cross-sectional, hospital-based study included 754 decompensated cirrhotic patients. The primary endpoints were mortality and hospital stay. The data analysis was done using Statistical Product and Service Solutions (SPSS) version 20 (IBM Corp., Armonk, NY). The chi-square test was used to compare the differences between different predictors of mortality with p<0.05 considered significant.ResultsA total of 754 patients (mean age 54±11.51 years; male/female ratio of 3.6:1) were studied. Ascites was the most common complication (99.2%) followed by upper gastrointestinal (UGI) bleed (42.3%), hepatic encephalopathy (32.5%), rebleeding (33.2%), spontaneous bacterial peritonitis (26%), and hepatorenal syndrome (19.1%). Inpatient mortality was 19.8%. The most common causes of mortality were rebleeding (21.5%) followed by hepatic encephalopathy (HE) (18.7%), hepatorenal syndrome (HRS) (14.7%), and spontaneous bacterial peritonitis (SBP) (12.1%). The presence of Grades IV HE, the presentation with shock, Child Turcotte Pugh (CTP) C, rebleeding, variceal bleed, HRS, hyponatremia (<130 mEq/L), the requirement of ≥3 units of blood and blood products, co-existence of hepatocellular carcinoma (HCC), and multiple comorbidities and complications in a single patient were strong predictors of mortality (p≤0.05).ConclusionsAscites followed by UGI bleed, hepatic encephalopathy, rebleeding, spontaneous bacterial peritonitis, and hepatorenal syndrome were common complications among the admitted decompensated cirrhotic patients. Inpatient mortality was high. The most common cause of mortality was rebleeding followed by hepatic encephalopathy, HRS, and SBP.

Profile of Custom Ocular Prosthesis Users in a Tertiary Eye Care Centre in Nepal

Objective: To analyze the profile of custom ocular prosthesis users in Nepal. Methodology: This was a retrospective study done at Drishti Eye Care System, Nepal from January 2019 to June 2019. One eyed subject who used custom prosthesis for minimum of 6 months or above of any age group were recruited in the study. Information regarding laterality, cause of loss of eye, reason for opting ocular prosthesis and source of information regarding ocular prostheses were collected from the participants. A set of questions were asked to the participants through telephonic interview after the duration of 3 to 6 months wear of ocular prosthesis to collect information on any symptoms after the wear. Results: Mean age of subjects in the study was 31.35±16.59 years (range 1.5 years – 78 years), 46.7% (n=14) were male and 53.3% (n=16) were female. Trauma was the most common cause of loss of the eye in 43.3% (n=13), followed by congenital loss and eye infections in 16.7% (n=5). 43.3% (n=13) of the subjects had lost their right eye and 56.7% (n=17) subjects had lost their left eye. 33.3% (n=10) of the subjects didn’t have any symptoms with the use of prosthesis. Milder form of symptoms like small appearance, mild discharge and pain were major complaints after the wear. Conclusion: There is a need of best prosthetic rehabilitation for the anophthalmic patients.

Clinical profile and management of vitreous hemorrhage in tertiary eye care centre in Nepal.

Vitreous hemorrhage is one of the most common diseases presenting to emergency department and leading cause of painless vision loss. To determine the profile of vitreous hemorrhage in patients presented to Outpatient Department (OPD) and emergency Department of Tilganga Institute of Ophthalmology (TIO). This is a hospital based observational non interventional descriptive study. Total 198 patients were enrolled who visited OPD and Emergency department of TIO from August 1st 2012 to July 30th 2013. Total 198 patients (201 eyes) were enrolled for the study, out of which 144 were male and 54 females. 195 were unilateral and 3 bilateral cases. Most common age group of presentation of vitreous hemorrhage was 51-60 years (24.75%). Most common presenting complaint was sudden onset of decreased vision (95%). Most common etiology of vitreous hemorrhage was branch retinal vein occlusion (22.38%). Among the total subjects, 57.7% of the patient were managed with medical therapy, 35.8% surgically and 6.47 % with combined medical and surgical treatment. Branch retinal vein occlusion (BRVO) is the most common cause of vitreous hemorrhage. Diabetes and hypertension are the most commonly associated systemic illnesses.

Study of Trichomonas Vaginalis and Bacterial Vaginosis in Pap smear at a Tertiary Health Care Centre of Nepal

Cervical-vaginal infections are common problems in women of reproductive age presented with clinical features like white vaginal discharge, foul smelling odor and pruritis. Trichomonas vaginalis, Candidia and Gardnerella vaginalis are responsible for infectious vaginitis in creating anaerobic environment favoring Bacterial vaginosis caused by organisms like Gardnerella vaginalis, Chlamydia Trachomatis. Papanicolaou (Pap) smear examination is the simple, quick, painless routine screening test used for identification and detection of precancerous changes of uterine cervix as well as the cervico-vaginal infections resulting from bacterial, fungal and candida infections. The prime objective of the study was to identify the age wise distribution of cervical-vaginal infections and determine the frequency of Trichomonas vaginalis (TV) and Bacterial vaginosis (BV). A descriptive cross-sectional study was carried out in the Department of Pathology, Nepal Medical College and Teaching Hospital, Kathmandu. A total of 163 cases of TV and BV diagnosed on Pap smear were taken for the study. However, 564 Pap smears were received in the Department of Pathology for cytological evaluation during the study period. Once the smears were stained, the presence of clue cells, cannon balls and Trichomonas were observed. Out of 564 Pap smears received during the study period, 163 cases were of BV, TV and combined BV and TV. These 163 cases were included in our study. The age ranged from 20 to 65 years with majority (19.1%) of the women belonging to 35-39 years and the mean age was 38.18 ± 10.18 years. There were 97 cases (17.2%) of BV, 50 cases (8.9%) of TV and 16 cases (2.8%) of TV and BV co-infection. Bacterial vaginosis was the most predominant type of cervicovaginal infection followed by TV infection and TV and BV co-infections. Trichomonas vaginalis may create an environment favoring the development of BV. Pap screening could be the beneficial tool in early disease diagnosis and helps in preventing further complications by starting appropriate treatment.

Traumatic Fractures Involving Major Dural Venous Sinuses: A Reappraisal Study from the Tertiary Trauma Care Center in Nepal

Objective: The surgical management of compound depressed fractures overlying dural venous sinuses confers major challenges for the neurosurgeons. On one hand, the depressed fracture and associated compound wound herald the risk of venous occlusion and fatal brain swelling, on the other hand, the surgical attempt in managing them foresees major risks of bleeding and air embolism. Materials and Results: A retrospective analytical study was conducted from the hospital records pertaining to the cohorts of patients admitted with traumatic fractures overlying major dural venous sinuses. Among 45 patients included on our study, six patients were managed conservatively, and the rest 39 patients required surgical intervention due to compound depressed fractures heralding high risk of venous flow obstruction. The age of our patients ranged from 6 to 60 years with a high male predominance (77% vs. 22.22%).The most common mode of injuries was road traffic accidents in 66.67% (30/45) of cases. The most common location of depressed fracture was in the anterior third of SSS, seen in 57.77% of cases. The surgical complications were seen is 2.23% of cases, with the single instances of air embolism, profuse bleeding and cortical venous thrombosis seen respectively. The overall mortality seen in our study was 6.67%, whereas the operative mortality was only 4.45%. Conclusion: The refinement in the surgical nuances has now enabled us in managing depressed fractures overlying major dural venous sinuses with minimal risks of complications, thereby preventing the high risks of venous hypertension they otherwise invariably harbinger.

Clinical and Laboratory Profile and Therapeutic Response of Scrub Typhus in Children in a Tertiary Care Centre in Nepal

Introduction Scrub typhus is the most common ricketisial infection from the Indian subcontinent. It is caused by the organism Orienta tsutsugamushi inhabiting in trombiculid mites and transmitied to humans by the bite of these mites. The disease has a variety of clinical manifestations in children. As this is a common disease in our country so a retrospective study was conducted to study the clinical and laboratory profile and therapeutic outcomes of scrub typhus in children.&#x0D; Methodology A retrospective study was conducted at Sukraraj Tropical and Infectious disease Hospital, Teku, Kathmandu, Nepal after obtaining ethical clearance from Institutional Review Committee, and reviewing the medical records of serologically confirmed scrub typhus in children aged less than 14 years admitted to the hospital between March 2017 and February 2018. Relevant data were entered in excel spreadsheet and analyzed using SPSS 20.&#x0D; Result A total of 20 children were enrolled in the study. Of them 70% were female, with the mean age being 11.45 ± 3.1 years (range 3-14 years) and majority were from Dhading district (40%). All the children had fever; while there was cough, loss of appetite, rashes, headache, myalgia, arthralgia and hepatosplenomegaly in 45%, 90%, 20%, 55%, 35%, 35% and 30% of children respectively. There was thrombocytopenia in 50% of children; while hyponatremia, elevation of SGOT and SGPT was present in 30%, 70% and 55% of patients respectively. Azithromycin was used for treatment in 95% of children and all had defervescence of fever.&#x0D; Conclusion Scrub typhus should be suspected in children having prolonged fever with organomegaly, thrombocytopenia and elevated transaminases. Azithromycin can be used effectively in children diagnosed as scrub typhus.

Knowledge and Attitude of health Professionals on pain management using KASRP tool in a tertiary cancer care center of Nepal

Knowledge and Attitude of health Professionals on pain management using KASRP tool in a tertiary cancer care center of Nepal

Precipitating factors leading to decompensation of heart failure in patients attending a tertiary care centre of Nepal

Background and Aims: Heart failure is one of the debilitating conditions in patients with various forms of heart disease. It can have impacts on various aspects of the life of a patient. There have been few studies on the etiological aspects and precipitants of heart failure in the Nepalese population. The aim of our study is to find out the major factors that lead to decompensation of heart failure in patients who already have established heart failure.&#x0D; Methods: This study was a single-centre, prospective, observational study conducted in the emergency department of Manmohan Cardiothoracic Vascular and Transplant Centre (MCVTC) from 1st June 2019 to 30th November 2019. Hundred and one patients with established heart failure in the past, who presented again with decompensated heart failure were enrolled.&#x0D; Results: The mean age of the patients was 62.81 years (SD=15.92). Factors responsible for acute decompensation of heart failure were identified in 95.0 % of patients included in the study. The most common factor identified was poor compliance with medications and diet and fluid intake (38.6%). Next to it was arrhythmia identified in about 35.6% of cases.Other important factors responsible for decompensation in our study were infection (12.8%), anemia (4.9%) and ischemia (2.9%).&#x0D; Conclusion: Preventable and identifiable factors are responsible for the decompensation of heart failure. Most of these factors can be modified with the use of proper patient counseling/patient education, thereby reducing recurrent hospital admissions and economic burden to the patient and the government as well.

Fracture Nasal Bone: Causes, Presentation and Management in a Tertiary Care Center in Nepal

Introduction: Fracture of nasal bone, the commonest facial fracture is frequently encountered in ENT practice. This study was conducted to assess the causes, presentation and management of fracture nasal bone in a tertiary care center. Methods: A retrospective chart review was done of patients admitted from August 2017 to July 2019 for management of isolated nasal bone fracture in the department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital. Results: Thirty-five patients (31 males and 4 females) of 13 to 86 years (mean age 26 years) underwent closed reduction of fracture nasal bone. The injury was sustained following physical assault in 13/35 (37%), fall from height in 10/35 (29%), road traffic accident in 8/35 (23%) and sports injury in 4/35 (11%). Pain, epistaxis, swelling over nasal dorsum, nasal deformity and wound were the presenting symptoms which most often occurred in combination. Close reduction was done under local anesthesia in 28/35 (80 %) and under general anesthesia in 7/35 (20%). The time between trauma and closed reduction ranged from 1 to 16 days with a mean of 6.2 days. Conclusion: Nasal bone fracture needing reduction was common following physical assault in males predominantly of 21 to 30 years. A combination of pain, epistaxis and nasal deformity was the commonest presentation. Closed reduction of fracture under local anesthesia within 16 days of trauma was the usual practice.

Fracture Nasal Bone: Causes, Presentation and Management in a Tertiary Care Center in Nepal

Introduction Fracture of nasal bone, the commonest facial fracture is frequently encountered in ENT practice. This study was conducted to assess the causes, presentation and management of fracture nasal bone in a tertiary care center.&#x0D; MethodsA retrospective chart review was done of patients admitted from August 2017 to July 2019 for management of isolated nasal bone fracture in the department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital.&#x0D; ResultsThirty-five patients (31 males and 4 females) of 13 to 86 years (mean age 26 years) underwent closed reduction of fracture nasal bone. The injury was sustained following physical assault in 13/35 (37%), fall from height in 10/35 (29%), road traffic accident in 8/35 (23%) and sports injury in 4/35 (11%). Pain, epistaxis, swelling over nasal dorsum, nasal deformity and wound were the presenting symptoms which most often occurred in combination. Close reduction was done under local anesthesia in 28/35 (80 %) and under general anesthesia in 7/35 (20%). The time between trauma and closed reduction ranged from 1 to 16 days with a mean of 6.2 days.&#x0D; ConclusionNasal bone fracture needing reduction was common following physical assault in males predominently of 21 to 30 years. A combination of pain, epistaxis and nasal deformity was the commonest presentation. Closed reduction of fracture under local anesthesia within 16 days of trauma was the usual practice.

Profile and Outcome of Adult Spine Pathologies Managed in a Neurosurgical Tertiary Care Center in Nepal

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.