College Of Medical Sciences Teaching Hospital Research Articles

Role of Laparoscopy in Reproductive Age Group Women with Gynecological Problems in a Tertiary Medical College

Background Laparoscopy has been a revolution in gynecological surgery as it is safe and minimally invasive. It can be used as a diagnostic as well as treatment modality for different gynecological problems like Chronic pelvic pain, adnexal cyst, ectopic pregnancy, Pelvic inflammatory disease and infertility.MethodsThis study was carried out at College of Medical Sciences-Teaching Hospital from April 2022 to March 2023 in 105 women. All the women undergoing laparoscopic surgeries were analyzed for indications, intraoperative findings and interventions.ResultsThe mean±SD of age of women was 30.34±7.73 years, most were in age group 26-35 years. The most common indications for Laparoscopy were for Adnexal cyst (74.28%), Chronic Pelvic Pain (14.28%) and Infertility (11.42%). The most common findings according to site were Ovarian pathology (48.60 %) followed by peritoneal pathology (22.9 %), Tubal pathology (17.14%) and normal findings (10.50%). In ovarian - Dermoid cyst (31.37 %), in tubal - ectopic pregnancy (55.56%), in peritoneal-Adhesions (45.83%) were the most common finding. In laparoscopic interventions, 26.70% had cystectomy, 14.3 % had salpingectomy and 13.3 % had Sterilization. Conclusions Laparoscopy as a modality for diagnosis and treatment of gynecological problems has been well established in recent times. It’s been a choice of surgery because of its reduce postoperative pain, shorter hospital stay, faster recovery and minimal scar. However, adequate advanced training and equipment are needed to perform skillful laparoscopic surgeries.

Bacteriological Study of Post-Operative Wound Infection and its Antibiograms

INTRODUCTIONPostoperative wound infections are a significant complication of surgical procedures, which increases morbidity, mortality, prolonged hospital stay, and increased healthcare costs. The study was undertaken with an aim to investigate the etiological agents of postoperative wounds and their sensitivity to commonly used antibiotics. MATERIAL AND METHODSThis study was a descriptive cross-sectional prospective study, carried out at Universal College Of Medical Sciences-Teaching Hospital, Bhairahawa, Nepal, on 100 postoperatively wounded infected cases, during April 2023 – August 2023, Non Probability sampling method (Purposive sampling) was used, and specimens were collected by sterile cotton swabs and pus was aspirated with a sterile needle and syringe and processed using standard bacteriological techniques. Antibiotic sensitivity test was conducted by disc diffusion (Kirby-Bauer) method. RESULTSPostoperative wound infections caused by Gram negative bacilli were more frequent and predominant pathogens involved were Pseudomonas aeruginosa, followed by Klebsiella spp and Enterobacter aerogenes. Among Gram positive bacteria Staphylococcus aureus was predominant. Gram positive cocci were highly sensitive to Ampicillin, and Gram negative bacilli were highly sensitive to Ceftazidime, Gentamicin, and Amikacin. Coagulase negative staphylococci were resistant to all drugs tested. CONCLUSIONPseudomonas aeruginosa was the commonest etiological agent for postoperative wound infections. Gram positive cocci and E.coli were highly sensitive to Ampicillin and Gram negative bacilli were highly sensitive to Ceftazidime, Gentamicin, Amikacin. Staphylococcus aureus was resistant to vancomycin and Teicoplanin and coagulase staphylococci were resistant to all drugs tested. Gram negative bacilli were resistant to Polymyxin B and Tigecycline. Increasing resistance to commonly used antibiotics warrants the judicious use of antibiotics and establishment of antibiotic policy in the hospital.

Functional Outcomes of Open Reduction and Internal Fixation in Proximal Humerus Fractures by Philos Plate

INTRODUCTION Proximal humerus fractures are one very common and usually occur in elderly people. These fractures are usually associated with some degree of comminution and deformity. Therefore, good anatomical reduction of fracture fragments and early mobilization are the main component for optimal outcomes of involved limb. This study was intended to evaluate the functional outcome of proximal humerus fracture in adults managed by open reduction and internal fixation (ORIF) by proximal humerus interlocking osteosynthesis (PHILOS) plate. MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department of Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from October 2021 to September 2023. All patients with proximal humerus fractures who fulfilled the inclusion criteria and who underwent open reduction and internal fixation by PHILOS plate were enrolled in the study. Functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS In this study of 60 cases, the mean age group was 55.38±11.40 years and male patients outnumbered female patients (39 males and 21 females). 36 cases (60%) were of right side and 24 (40%) were of left side. Majority of the fractures were due to fall injury (57%) followed by road traffic accident (35%). The mean Constant Murley Score was 78.15±5.620 and VAS (visual analogue score) was 1.88±0.865. CONCLUSION Open reduction and internal fixation by PHILOS plate is an effective procedure providing good anatomical restoration and early mobilization in proximal humerus fracture thus providing good functional outcome.

Functional Outcomes of Close Reduction and Percutaneous Pinning in Proximal Humerus Fractures

INTRODUCTION Proximal humerus fractures are usually sustained from trivial fall in elderly. These fractures are usually associated with severe degree of comminution and deformity. Therefore, anatomical reduction of fracture fragments, and early mobilization are key factors for optimal outcomes of involved limb. This study was intended to evaluate the functional outcomes of proximal humer- us fractures in adults managed by closed reduction and percutaneous pinning (CRPP). MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from July 2021 to June 2023. All patients with proximal humerus fractures who fulfilled the inclusion criteria and who underwent closed reduction and percutaneous pinning were enrolled in the study and functional outcome was assessed according to Constant murley scoring system and Visual analogue score. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS In this study of 60 cases, the mean age group was 53.08±13.10 years and male patients outnumbered female patients (37 males and 23 females). Forty one cases (68.3%) were of right side and 19 (31.7%) were of the left side. Majority of the fractures were due to fall injury (53.3%), followed by road traffic accident (40%). The mean Constant Murley Score was 76.95 ± 5.53 and VAS (visual analogue score) was 1.97 ± 0.97. CONCLUSION Closed reduction and percutaneous pinning is simple, less invasive and effective procedure for proximal humerus fracture providing good functional outcome.

TREATMENT ADHERENCE AMONG PATIENTS UNDERGOING HEMODIALYSIS IN HOSPITALS PROVIDING DIALYSIS SERVICE OF BHARATPUR NEPAL

Background: Chronic kidney disease is a worldwide public health problem. In Nepal, chronic kidney disease patients are increasing and the management of this disease is very expensive compared to other chronic diseases. The objective of this research was to assess the treatment adherence among the patient’s undergoing hemodialysis. Methods: A descriptive cross-sectional study was conducted among the hemodialysis patients in Hemodialysis unit of College of Medical Sciences-Teaching hospital, Bharatpur. Semi-structured interview schedule was used. Data was entered and analyzed using in statistical package for social science (SPSS) version 20 using descriptive statistical tools. Results: The Mean ± SD of age was 48.4 ± 13.5 years, 50% of the respondents were adherent with hemodialysis schedule, 69.69% were adherent in diet restriction, 72.73% were adherent with fluid restriction, 43.94% adherent to medication and 63.6% of the respondents were Hemodialysis adherence. Conclusions: Based on the finding of this research the hemodialysis adherence among the patients was good in others except diet and medication. Hemodialysis adherence is influenced by type of family, level of education, Time taken for hemodialysis, no. of days to receive hemodialysis treatment in a week.

A Study of Functional Outcome of Retrograde Intramedullary Interlocking Nailing in Treatment of Supracondylar Femoral Fracture

INTRODUCTIONFractures of the distal femur are usually sustained from high velocity trauma in adults and trivial fall in elderly. These fractures are usually associated with severe degree of comminution and intra-articular involvement. Therefore, anatomical reduction of fracture fragments, restoration of limb length, and early mobilization are key factors for optimal outcomes of involved limb. This longitudinal study was intended to evaluate the functional outcome of distal femoral fracture in adults managed surgically by Retrograde Nail. MATERIAL AND METHODSThis prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from July 2020 to June 2021. All patients with traumatic distal femoral fractures (AO/OTA type A) who fulfilled the inclusion criteria were enrolled in the study and were treated surgically by Retrograde Nail. Fracture was classified according to AO/OTA classification and functional outcome was assessed according to Neer’s scoring system. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTSIn this study of 30 cases, male to female ratio was 3:2 with mean age of 39.47 years. Road Traffic Accident (RTA) was most common mode of injury. The functional outcome evaluated according to Neer’s scoring system was found good result in 43.3%, excellent in 36.7%, fair in 16.7% and poor in 3.3%. The mean Neer’s score was 78.9. CONCLUSIONDistal femoral fractures (AO/OTA type A) when treated with retrograde nailing has good to excellent functional outcome in majority of cases with minimal manageable complication.

Myringoplasty graft uptake: Short and long term outcome

INTRODUCTIONMyringoplasty is surgical procedure to restore tympanic membrane perforation. The objective of the study is to compare overall success rate of myringoplasty after 6 weeks and 6 months post-operatively. MATERIAL AND METHODSThis is a retrospective, comparative study carried out in the Department of ENT (Ear, Nose and Throat) and Head and Neck Surgery (ENT-HNS), Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Rupandehi, Nepal. All the data was collected from the operative notes and operative record book of our hospital which were done from October 2018 to September 2020 over a period of 24 months by single surgeon. A total of 77 patients with age range of 12-70 years including all gender with chronic otitis media (COM) mucosal type, inactive who underwent myringoplasty were studied. Graft uptake results were assessed after 6 weeks and 6 months following surgery. RESULTSThe age of the patients ranged from 12-70 years. The mean ± standard deviation (S.D) of age was 27.84 ± 13.16 years. There were 47 (61%) female patients and 30 (39%) male patients involved in the study. Graft uptake success rates were 84.4% (65) and 83.1% (64) after 6 weeks and 6 months respectively. CONCLUSIONNo statistical significance was noted in graft success and failure rates between 6 weeks and 6 months (p = 0.320).

Albuminuria in Patients with Type 2 Diabetes Mellitus: a Single Center Cross-Sectional Study

Introduction: Diabetes mellitus is one of the commonest non-communicable diseases in Nepal and is associated with long term microvascular and macro vascular complications. Detection of albumin in urine is the earliest recognizable feature in the development of proteinuric diabetic nephropathy. This study aims to study the prevalence as well the determinants of albuminuria in patient with Type 2 diabetes mellitus visiting the medical OPD of College of Medical Sciences-Teaching hospital. Methods: This was a cross-sectional study done from January to June 2022 among Type 2 diabetes patients presenting to medical OPD for the comprehensive diabetes management. Relevant epidemiological, clinical and laboratory data were obtained. Urine dipstick test was done to screen for albuminuria. The prevalence and determinants of albuminuria were studied. Results: Study among 360 patients with mean age of 58.5 + 10.9 years and the mean duration since the diagnosis of diabetes of 6.8 + 5.5 years, showed that the prevalence of albuminuria was 33.3%. Albuminuria in these patients was found to have significant association with age (P<0.001), duration since diagnosis of diabetes (<0.001) and HbA1c (P<0.001). No significant association of albuminuria was found with gender (P=0.087), hypertension (P=0.063) and previous use of Angiotensin-converting enzyme inhibitors/ Angiotensin II receptor blockers. (P=0.217) Conclusions: Albuminuria is highly prevalent among our cohort of diabetic patients. Increasing age, longer duration since diagnosis of diabetes and higher HbA1c are the factors significantly associated with it.

SHORT SEGMENT FIXATION WITH TRANSPEDICULAR SCREWS IN TRAUMATIC THORACOLUMBAR SPINE FRACTURES

ABSTRACT Aim: The gold surgical treatment for an unstable thoracolumbar fracture is transpedicular screw fixation. Although traditional treatment supports long-segment posterior fixation (LSPF), more recent studies suggest short-segment posterior fixation (SSPF) with transpedicular screws, but incur higher failure rates. Thus, this study aimed to evaluate the effectiveness of SSPF in the management of traumatic unstable thoracolumbar injuries in terms of stability, deformation correction, neurological recovery, and pain relief. Methods: This prospective and observational hospital-based study was carried out in the Orthopedics Department of Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from August 2020 to July 2021. After Ethical clearance (UCMS/IRC/047/20) from the Institutional Review Committee (IRC) and informed written consent, all patients with a traumatic thoracolumbar fracture who fulfilled the inclusion criteria were enrolled in this study and were treated with SSPF. The fracture was classified according to Thoracolumbar injury classification and severity score (TLICS) and AO classification. Functional outcome was assessed according to neurological status, patient satisfaction, and pain assessment which was assessed by Frankel grading, Macnab grading, and Denis pain scale respectively. Post-operatively patients were regularly followed at 6 weeks, 3 months, and 6 months. The data was analyzed in SPSS 20 and descriptive statistics like frequency, percentage, mean and standard deviation were used to analyze the data. Chi-Square test, Independent sample t-test, and ANOVA tests were used as inferential statistics. Results: Thirty-one patients (16 females and 15 males) with traumatic thoracolumbar fracture were surgically managed with SSPF with a mean age of 38.61 ± 11.54 years. Twenty-seven patients (87.1 %) had fall injuries. The majority of cases (14 patients: 45.2%) had L1 vertebral fracture with a majority of the cases being wedge compression type (24 patients: 77.4%) and A1 type (24 patients: 77.4%). Posterior ligamental complex (PLC) was injured in 23 patients (74.2%) and 7 cases (22.6%) had neurological involvement. The majority of cases had a TLICS score of 4 (12 patients). The mean interval between trauma and surgery was 2.13 ± 0.71 days. The average duration of hospital stay was 13.10 ± 2.95 days and intraoperative average blood loss was 460±58.2 ml. In 16 cases, an additional screw was fixed through the intact pedicle of the fractured vertebra. Screw failure was the only complication seen in 2 cases (6.5%). Preoperatively, 20 cases (64.5%) had Frankel type E injury, mean Denis pain scale was 4.16±0.93, and mean preoperative kyphotic angle was 16.77±6.82 degree which improved to 26 cases (83.9%), 1.42±0.62, and 1.35±0.48 degrees at 6 months respectively. The mean loss of kyphotic correction angle was 0.58±0.88 (range 1-4) degrees. The majority of compression fracture cases had excellent to good patient satisfaction scores where 12(50%) and 10(41.7%) cases had excellent and good scores respectively (P 0.02). Concerning patient satisfaction score, a statistically significant difference was observed in mean TLICS score (P 0.101) and AO fracture type (P 0.034) while no difference was observed in PLC status (P 0.101) and additional screws (P 0.909). There was a statistically significant difference between the fracture type and improvement of Frankel grading at the end of six months follow up (P <0.001) where compression fracture managed with SSPF showed remarkable neurological recovery than burst fracture in terms of improvement of Frankel grading. Conclusions: Short segment transpedicular screw fixation is an effective treatment procedure for achieving better neurological recovery and good pain control in traumatic unstable thoracolumbar fractures. Keywords: Short segment, thoracolumbar spine fracture, transpedicular screw

Lipid Profile and Ultrasonographic Grading in Alcoholic and Non Alcoholic Fatty Liver Patients

Background Fatty liver disease (FLD) is a common and major chronic liver disease. It has been implicated that patients have disorders of lipid metabolism and are involved in the pathogenesis of fatty liver. Hence, it was designed to observe the association between lipid profile and fatty liver disease.&#x0D; Objective This study was undertaken to evaluate the association of lipid profile status, hemoglobin and albumin levels with fatty liver disease patients diagnosed based on ultrasonography (USG).&#x0D; Method This Cross-sectional study was undertaken in the Department of Internal Medicine with the collaboration of the Department of Radiology and Department of Biochemistry, Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal from March 2019 to February 2020 in a total of 100 patients diagnosed with fatty liver disease by ultrasonography. The fasting blood was collected for lipid profile and carried out in the automated analyzer following standard protocol.&#x0D; Result In 100 cases, the male to female ratio was 1.8:1. Fifty six percent of the total cases presented with alcoholic fatty liver disease (AFLD) while the remaining 44% with non-alcoholic fatty liver disease (NAFLD). The spectrum of lipid abnormality was observed with increased total cholesterol (TC), Low Density Lipoprotein (LDL), increased triglycerides (TG), Very Low Density Lipoprotein (VLDL) in alcoholic fatty liver disease cases as compared to non-alcoholic fatty liver disease cases. However, it has been observed that TG/HDL and Non-HDL/HDL were higher in non-alcoholic fatty liver disease as compared to alcoholic fatty liver disease. Moreover, a statistically significant difference was observed in HDL between AFLG2 and NAFLG2 (p-value: 0.012).&#x0D; Conclusion Dyslipidemia and decreased HDL have been implicated in fatty liver diseases. USG in conjunction with Non-HDL/HDL, TG/HDL, hemoglobin, and albumin can be useful in early screening and monitoring of dyslipidemia in fatty liver patients.

Surgical Management of Tibial Plateau Fractures with Locking Compression Plate

&#x0D; INTRODUCTION&#x0D; Tibial plateau fracture is a common fracture that accounts for 1-2% of all fracture. Various treatment options including proximal tibial plating with locking compression plates are available for the treatment of tibial plateau fracture. This study was done to determine the clinical profile and functional outcome of tibial plateau fracture following locking compression plating.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; This prospective and observational study was carried out in Orthopedics Department of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH) from December 2018 to July 2020. After Ethical clearance (UCMS/IRC/224/18) from Institutional Review Board (IRB) of UCMS-TH and informed written consent, all patients with tibial plateau fracture (Schatzker II-VI) who fulfilled the inclusion criteria were enrolled in the study and treated with locking compression plate. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months for clinical, radiological and functional assessment. Descriptive statistics like frequency, percentage, mean and standard deviation were used to analyze the data.&#x0D; &#x0D; RESULTS&#x0D; In our study of 30 cases, the mean age was 37.77 ±15.65 years. Most of the cases were Schatzker type VI (13 patients) and type II (9 patients). The average duration for fractures union was 23.4 ±2.1 weeks. Superficial wound infection was the common complication seen in five cases. At six months, the mean knee society score (KSS) was 78 ±7.22 and majority of patients (19 patients) had good results.&#x0D; &#x0D; CONCLUSION&#x0D; Locking compression plate has an excellent functional and radiological outcome. It is an effective implant that can be adopted for the treatment of tibial plateau fractures in adults.&#x0D;

A Study of Clinical Profile and Complications In Patients with ST-Elevation Myocardial Infarction Attending In College of Medical Sciences Teaching Hospital, Bharatpur (Chitwan), Nepal.

Background and Aims: ST-Elevation Myocardial Infarction (STEMI) is a leading cause of morbidity and mortality. This study aims to summarize the clinical profile and complications of patients with STEMI in a teaching hospital.&#x0D; Methods: This was a prospective hospital based descriptive and observational study conducted at College of Medical Sciences Teaching Hospital (CoMSTH), Bharatpur from January 2017 to July 2018 in 110 patients with a diagnosis of acute STEMI.&#x0D; Results: Out of 110 patients the mean age of presentation was 59.31 years and 64.5% were male. Typical chest pain (90%) was the most common presenting symptom and 45.5% patients presented within six hours of chest pain. Most common traditional risk factors were hypertension and smoking which were present in 44 (40%) cases, followed by diabetes in 33 (30%), dyslipidemia in 22 (20%). Majority of patients (49.1%) were in killips class I, and only 9 (8.2%) patients were in cardiogenic shock (killips class IV). Inferior wall was the most common in 30% patients followed by anteroseptal wall MI (23.6%), anterior wall MI (11.8%) and combined (anterior and inferior) in 10%. Revascularization with primary Percutaneous Coronary Intervention (PCI) was done in 46 (41.8%) patients, thrombolysis was done in 41 (37.3%) patients. Arrhythmias (39.1%) followed by heart failure (24.5%) were the common complications. The overall in-hospital mortality was 16 (14.5%).&#x0D; Conclusions: Patients with acute STEMI at College of Medical Sciences Teaching Hospital (CoMSTH) were predominantly male with hypertension and smoking as the commonest risk factors. Arrhythmias were the most common complications and in-hospital mortality rate was 14.5%.

Treatment Adherence Among Patients Undergoing Hemodialysis of Selected Hospitals of Rupandehi

INTRODUCTION&#x0D; Chronic kidney disease (CKD) is a major public health problem in Nepal. Adherence is the crucial factor in determining the morbidity and mortality of hemodialysis patients.&#x0D; MATERIAL AND METHODS&#x0D; A cross-sectional study was conducted to find out the hemodialysis adherence among 125 hemodialysis patients of Universal College of Medical Sciences-Teaching Hospital and Crimson Hospital, Rupandehi. The data was collected by enumerative sampling using semi-structured interview schedule. The duration of the study was from June 16, 2019 to August 2, 2019. The data was analyzed by using descriptive and inferential statistics with SPSS software version 16.0.&#x0D; RESULTS&#x0D; The study revealed 56.8% were adherent to haemodialysis in general. Likewise 62.7%, 77.1%, 74.6% and 48.3% were adherent to haemodialysis schedule, diet restriction, fluid restriction and medication respectively. There was statistically significant association between level of adherence to haemodialysis and education level (p=0.020), adequacy of family monthly income for haemodialysis (p=0.007), presence of care taker to haemodialysis centre (p=0.057) and haemodialysis hours in a session (p=0.002).&#x0D; CONCLUSION&#x0D; It is concluded that the haemodialysis adherence among patients is good in general but poor adherence to medicine. The adherence is influenced by education, family monthly income, presence of care taker and haemodialysis hours in a session. Hence it emphasizes on need for educating patients to enhance adherence to haemodialysis.&#x0D;

Study On Skin Fold Thickness in Newborns as an Index of Foetal Nutritional Assessment

Introduction: Skin fold thickness is a measure of adiposity and is a validated method of assessing malnutrition in older children. The present study was undertaken to see the role of skin fold thickness measurement in neonates as an index of foetal nutritional assessment and to compare between CAN (Clinical Assessment of Nutrition) score and other anthropometric indicators in foetal malnutrition (FM).&#x0D; Methods: A prospective observational study was conducted in postnatal ward of Universal College of Medical Sciences-Teaching Hospital for a duration of six months. Three hundred seventy term newborns were assessed by CAN score and anthropometry recorded. The CAN score was determined and those with scores &lt; 25 was classified as having foetal malnutrition. Skin fold thickness using the Slim Guide skin fold caliper was taken at the triceps, biceps, sub scapular, supra iliac and quadriceps locations for each neonate. Two readings were taken at every site and the mean was recorded. All the skin fold thickness measurements were correlated with the CAN score and statistical comparisons were made.&#x0D; Results: Incidence of FM was 18.38%. The mean (SD) for sum of all skin-fold thickness at all sites for males and females were 4.3 ± 1.61 and 4.18 ± 0.72 mm respectively. All the skin-fold thickness measurements correlated significantly with the CAN score, but the sum of the five had the best correlation. The mean (SD) of anthropometric data of babies and sum of all comparing foetal malnutrition versus without foetal malnutrition using nutritional status CAN score was statistically significant (p-value &lt; 0.001). &#x0D; Conclusions: The sum of all five skin-fold measurements might be a useful screening tool for FM in view of its objectivity, convenience and simplicity, but it is not sufficiently sensitive or specific to replace the CAN score in the identification of FM in neonates.

CT Angiography in Patients with Peripheral Arterial Disease

Background: Peripheral arterial disease is one of the most important causes of morbidity. Non-invasive characterization of peripheral arterial disease is possible by using CT angiography. The aim of this research is to evaluate CT angiographic findings in patients with peripheral arterial disease, to characterize lesion, risk factors and site of lesion.&#x0D; Methods: This hospital based prospective study was conducted in 40 consecutive patients with lower limb peripheral arterial disease who underwent CT angiography in the Department of Radiodiagnosis College of Medical Sciences-Teaching Hospital from January 2018 to Jan 2019.&#x0D; Results: Atherosclerotic peripheral disease was most common in elderly male patient with history of smoking, hypertension, diabetes or dyslipidemia and usually presents in the late stages with single or multiple arterial segmental involvement including the abdominal aorta. However, non- atherosclerosis peripheral arterial disease was seen in younger patients and presents with vascular thrombosis.&#x0D; Conclusions: CT angiography is a reliable non-invasive imaging modality for evaluating patients with peripheral arterial disease and lesion characterization.&#x0D; Keywords: CTA; Peripheral arterial disease.&#x0D;

Patterns of Pediatric Ear, Nose and Throat Disorders in a Tertiary Care Hospital of Western Nepal: A Cross-Sectional Study

INTRODUCTION: In outpatient department (OPD) of hospital in low and middle income countries (LMICs), pediatric ear, nose and throat (ENT) disorders are common and huge variation in number is being reported in different seasons. This study aimed to study the prevalence and seasonal effect of ENT disorder in children.&#x0D; MATERIAL AND METHODS: One year (Jan-Dec, 2015) retrospective data of children (0 months-17 years) visiting ENT outpatient (ENT-OPD) department at Universal College of Medical Sciences-Teaching Hospital, Nepal was analysed. Descriptive statistics were calculated to report the prevalence of ENT disorders for various sub-groups including season. In addition to quantifying the prevalence of ENT disorders in children, the seasonal influence of each disorder was analysed.&#x0D; RESULTS: Out of 14,126 patients visiting the ENT-OPD, 3,423 (24.23%) were children. The mean age of children having ENT- disorders were 8.4±5.1, 10.6±4.6 and 10.7±4.7 years respectively with male-female ratio of 1.3:1.&#x0D; During all seasons 2,645 (77.3%) had ear problems, 328 (9.6%) nose disorders and 450 (13.14%) throat disorders. The percentage of children with ear disorders declined significantly with increase in age unlike those with nose and throat disorders (P &lt; 0.001). Seasonal trend analysis showed that children had significantly higher number of ear disorders during summer and autumn seasons (P &lt;0.001) whereas nose disorders were more common in spring and winter seasons (P&lt;0.001) with chronic otitis media and wax being the main types of ear disorders and deviated nasal septum (DNS) for nose disorders. Among the throat disorders, tonsillitis was most prevalent in all seasons followed by pharyngitis.&#x0D; CONCLUSION:- The study suggests a clear seasonal trend in the prevalence of ENT disorders that can be used for advanced planning and management of the conditions in hospitals.

Analgesic Efficacy and Tolerability of Tramadol Versus Low Dose Tramadol-Paracetamol in Patients with Gastro Intestinal Surgery

INTRODUCTION: Analgesic regimens with an improved efficacy and tolerability balance have potential to improve acute pain management, and thus reduce the progression into chronic pain. Hence, an opportunity was gained to compare analgesic efficacy and tolerability of Tramadol (T) 1.5 mg/kg versus low dose Tramadol 1mg/kg-Paracetamol 1000mg (T-P) in patient with Gastro Intestinal (GI) surgery.&#x0D; MATERIAL AND METHODS: The study was a hospital based prospective, observational study conducted in sixty post-operative GI surgery patient at Universal College of Medical Sciences-Teaching Hospital, Ranigaon, Bhairahawa, Nepal. One group received Tramadol 1.5mg/kg (n=30) while the other group received Tramadol 1mg/kg with Paracetamol 1000 mg (n=30). The primary efficacy outcome measures were pain intensity difference (PID) and sum of pain intensity difference (SPID) whereas secondary efficacy measures included number of patient who require rescue medication, haemodynamic parameter, their quality of sleep in the night and satisfaction with their medication. For tolerability, adverse effect was noted that occurred during study time intervals.&#x0D; RESULTS: Mean pain intensity differences assessed on Numerical Rating Scores (NRS) were significantly better for Group T-P compared to Group T at all the points except 0.5, 1 and 6 hrs. The sum of pain intensity difference over 8, 16, 24, 48 hrs for Group T-P was significantly superior to Group T. Two patients in Tramadol group required rescue medication. Satisfaction to the pain medication was comparatively higher for Tramadol-Paracetamol group.&#x0D; CONCLUSION :- Tramadol-Paracetamol had more pronounced analgesic effect with lower incidence of side effect than Tramadol alone. Thus, low dose Tramadol-Paracetamol is better option for management of post-operative pain in patient with GI surgery.

Prevalence of Iron Deficiency Anemia in Anemic Patients: A Hospital Based Study

Introduction: In developing countries like Nepal, iron deficiency anemia (IDA) is one of the major concern. The high rate incidence has been related to insufficient iron intake, accompanied by chronic intestinal blood loss due to parasitic and malarial infections. Therefore, a study was conducted to evaluate the prevalence of IDA in anemic patients of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), South Western region, Nepal.&#x0D; Material and Method It was a hospital based cross sectional study comprised of 100 anemic patients. Their detailed medical history and lab investigations, focusing on hematological parameters were documented. Peripheral smear examination and serum ferritin estimation were done to observe red cell morphology and iron status respectively.&#x0D; Results: This study revealed that out of 100 anemic patients, 35% were that of IDA. The most affected age group was 21-40 years with frequency 42.55%. IDA was more common in females (42.85%) than in male (21.62%). Out of 100 anemic patients, microcytic hypochromic anemia was predominant in 47% followed by macrocytic anemia (31%) and then normocytic normochromic anemia (22%). Out of 47 microcytic hypochromic anemic patients, 12 had normal serum ferritin. There was a statistical significant difference in Hb (p=0.011), MCV (p=0.0001), MCH (p=0.0001), MCHC (p=0.0001) and serum ferritin (p=0.0001) among all types of anemia. There was a statistical significant positive correlation of ferritin with Hemoglobin (0.257, p= 0.01), MCV (0.772, p= 0.0001), MCH (0.741, p=0.0001) and MCHC (0.494, p=0.0001).&#x0D; Conclusion: The peripheral smear in conjunction with serum ferritin estimation needs to be included for susceptible individuals to screen the IDA and other types of anemia.

A Comparative Study of Endoscopic Versus Otomicroscopic Myringoplasty

Introduction: Myringoplasty is one of the common surgical procedures done for closure of perforated tympanic membrane. Traditionally, it used to be performed with the help of operating microscope, however, the rigid endoscopes are being popular nowadays. So, we are comparing the success of graft uptake between endoscopic versus otomicroscopic myringoplasty.&#x0D; Materials and methods: This is a prospective, comparative and randomized study done in the Department of Otorhinolaryngology and Head and Neck Surgery (ORL-HNS), Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal. The study duration was for 18 months (1st December 2015 to 31st May 2017). There were 60 patients with age range of 12-60 years. All the patients fulfilling the inclusion criteria were included. Patients were randomized into Group A (endoscopic) and Group B (otomicroscopic).&#x0D; Results: Patient's age ranged from 12-60 years. The mean ± standard deviation (S.D) of age (years) between two groups was 27.07 ± 11.96 years and 27.20 ± 9.65 years respectively. There were 33.33% male and 66.67% female patients in group A and 43.33% male and 56.67% female patients in group B. The graft uptake success rate was 93.33% in group A and 90% in group B. Statistically no significant difference was observed in graft success and failure rates between two groups (p =0.640).&#x0D; Conclusion: Comparatively the rate of graft uptake was higher in endoscopic group without statistical significance. Thus, endoscopic myringoplasty can be a good alternative of microscopic myringoplasty.&#x0D;

Clinical profile of patients presenting with acute myocardial infarction

Background: Cardiovascular diseases are the number one cause of death globally. Cardiovascular diseases have emerged as a major health burden in developing countries. Myocardial infarction (MI) is defined by the demonstration of myocardial cell necrosis due to significant and sustained ischaemia. Author attempted to study the risk factors and clinical profile of patients with MI admitted in Cardiology Department of tertiary care center, Chitwan, Nepal.Methods: This descriptive retrospective study was conducted in College of Medical Sciences Teaching Hospital (CMS-TH), Chitwan, Nepal, from January 2016 to November 2017. Demographic features, cardiovascular risk factors, clinical presentation, Electrocardiogram (ECG) findings, regions of infarction and rhythm disturbances were studied and documented.Results: A total of 132 patients diagnosed with MI were studied. Most of the patients (90.15%) had ST-elevation MI (STEMI). The patients were predominantly male (87%). The majority of patients lied in the age group of 61-70 yrs (29.54%). The most common presenting symptom was chest pain (86.36%) followed by shortness of breath (42.42%) and vomiting (12.87%). Tobacco smoking/chewing (62.87%) was the major risk factor followed by hypertension (43.18%) and diabetes (34.09%). Majority of infarction occurred on anterior wall (52.94%). Most of the patients (90.90%) had normal sinus rhythm on ECG. On arrival to emergency department eight (6.06%) patients had cardiogenic shock and only one had congestive cardiac failure.Conclusions: STEMI was most common type of MI presenting to CMS-TH. Most of the patients were male and the most common risk factor contributing to MI was cigarette smoking. Most of the patients arrived more than 24 hours after onset of symptom.