College Of Medical Sciences Teaching Hospital Research Articles

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BACKGROUND AND NEED FOR STUDY: Manual hemorrhoidopexy is a new technique proposed by Tagariello Carlo1 (2011) for the treatment of hemorrhoids especially grade III. In contrast to the conventional excisional hemorrhoidectomy (Milligan-Morgan/ Ferguson) this novel technique, does not involve excision but plication with fixation of the prolapsing hemorrhoid. In the original study the new technique was not compared with any other techniques of treatment for hemorrhoids. This study compares the new method and the traditional Milligan-Morgan hemorrhoidectomy. MATERIAL AND METHODS: A prospective study of patients who have undergone surgery for hemorrhoids over 2 years (from March 2011 to March 2013) was done in College of Medical Sciences Teaching Hospital (COMS-TH), Bharatpur, Chitwan, Department of Surgery. The patients who presented with third degree internal hemorrhoids on a random basis, underwent either conventional MilliganMorgan hemorrhoidectomy (Group A) or Manual hemorrhoidopexy (Group B). The patients who had external hemorrhoids in addition to internal were excluded. Preoperative, intraoperative, and postoperative characteristics were evaluated. RESULTS: Group A included 37 patients (25 males) with mean age group 42 years underwent conventional Milligan-Morgan hemorrhoidectomy. Group B included 33 patients (20 males) with mean age group 40 years underwent manual hemorrhoidopexy. The patients in Group A had longer duration of surgery (42.2 min vs 25.2 min, p=.001), more postoperative pain as compared to Group B (8.18 vs 2.14, as assessed by the visual analogue scale, p=.014) and this was statistically significant. Most of the Group A patients had minimal post-operative bleeding. None of the Group B patient had postoperative bleeding. There was no significant difference among the other post-operative complications (eg. Urinary retention). Mean hospital stay in Group A was 4.06 days as compared to 2.69 days in Group B (p =.002). Median follow up was 3 (1-4) months. None of the patients in either group had recurrence at follow up. CONCLUSION: Manual hemorrhoidopexy scores better then Milligan-Morgan method of hemorrhoidectomy with respect to duration of surgery, post-operative pain and hospital stay. KEYWORD: Manual haemorrhoidopexy, haemorrhoid, Milligan –Morgan, haemorrhoidectomy.

Growth of Infants on Exclusive Breastfeeding up to 6 Months and then along with Complementary Feeding in a Hospital Based Survey

OBJECTIVE: To study growth of infants on exculsive breastfeeding for 6 months and further along with complementary feeding upto 12 months of age. METHODS: This Cross-sectional, Prospective, Hospital Based, Observational study was conducted in Department of Pediatrics, in collaboration with the Department of Gynaecology and Obstetrics, Universal College of Medical Sciences-Teaching Hospital, Bhairahawa, Lumbini, NEPAL on 292 infants born at the hospital and their growth monitored over a period of 12 months. Evaluation of nutritional trends practiced by the people and its effects on growth of infants was done and compared to the growth of infants according to the NCHS-WHO (CDC-2000) standards. RESULTS: The average weight at birth and average weight- for- age for both male and female infants were lower th than the 50 perentile of National Center for Health Statistic (NCHS) standards. The average length of the th infants was found lower than 50 percentile curve of NCHS. The difference of length between boys and girls was th insignificant at 6 months (Z<1.88). The average head circumference in our study was below 50 percentile of NCHS standard. The difference between weight, length, mid arm and head circumference of boys and girls was insignificant at 6, 9, 12 months (Z<1.88). CONCLUSIONS: Most of the values represent normal growth but the gain in weight and length of infants was th far below the 50 percentile of NCHS-WHO standards.DOI: http://dx.doi.org/10.3126/jucms.v1i2.8404 Journal of Universal College of Medical Sciences Vol.1(2) 2013: 13-19

Clinical profile of patients hospitalized with heart failure in Bharatpur, Nepal.

Heart failure (HF) is a common cardiovascular condition whose incidence and prevalence are increasing. Being a common reason for urgent hospital admission, it is a major cause of morbidity and mortality for the patients. In the developed countries coronary artery disease remains the leading cause of HF, whereas, in the underdeveloped countries, rheumatic heart disease leading to valvular lesion still remains the commonest causes of HF admission.The current study was designed to evaluate the clinical profile and medications prescribed reflecting the extent to which evidence based medicine is being practiced at our community. Clinical profile and prescribed medications of patients with diagnosis of HF who were admitted in the cardiology department of College of Medical Sciences & Teaching Hospital (CMS-TH), Bharatpur, Nepal, April 2010 to May 2012, were analyzed. A total of 255 patients presented with HF during the studied period were included. Coronary artery disease, rheumatic heart disease, dilated cardiomyopathy, hypertensive heart failure, cor-pulmonale, and congenital heart disease leading to HF were found in 93 (36.5%), 65 (25.5%), 37 (14.5%), 22 (8.6%), 31 (12.2%),and 7 (2.7%) patients respectively. The commonest presenting symptom was shortness of breath (81%) and the commonest sign was bilateral basal crepitations (68%). From all patients, 89%, 64%, 51%, 16%, 48%, and 32% received loop diuretics, angiotensin-converting enzyme inhibitor, digoxin, angiotensin receptor blocker, spironolactone, and beta-blocking agents respectively. Coronary artery disease leading to HF was the commonest cause of HF admission in our centre. Despite current guidelines suggesting the use of beta-blocking agent in patients with HF, only 32% of our patients received this class of medications. Thus, many patients were not being managed fully in accordance with the evidence-based guidelines.

Role of pleural fluid analysis in establishing the diagnosis of pleural effusion Experience in College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal

Aspiration of serous cavities is a simple and relatively non-invasive technique to achieve a diagnosis. The information provided by body fluid analysis serves several functions; it is a complete diagnostic modality which aims at pointing out the etiology of effusion as well as in certain cases, a means of prognostication of the disease process. The diagnostic performance of the cytological study of the fluid may be attributable to the fact that the cell population present in sediment. Thus, this study was aimed to assess the role of pleural fluid analysis in establishing the cause of pleural effusion. A retrospective study was carried out in the Department of Pathology, College of Medical Sciences Teaching Hospital, Bharatpur from July 2008 to July 2010. Two hundred samples of pleural fluid were examined for total cell count, cell type and cellular features along with biochemical study to find out the level of protein, glucose and chloride. In two hundred samples, 80% were exudative and 20% were transudative. Cirrhosis and congestive cardiac failure were commonest causative factors in transudatives. The cases of Tuberculosis were predominant in exudatives followed by malignancies. In the samples from all the tuberculosis patients, lymphocytes were the predominant cell type. Most of malignant effusions were exudatives. The primary site could be assessed by cytological examination in more than fifty percent of cases. The present study demonstrates that the most useful test in establishing the diagnosis of pleural effusion is pleural fluid analysis which includes mainly its cytology and cell count. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 36-45 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6724

Laparoscopic cholecystectomy: An experience at College of Medical Sciences, Teaching Hospital, Bharatpur Nepal

Laparoscopic cholecystectomy is the "gold standard" for benign gallbladder diseases. Laparoscopic cholecystectomy has rapidly gained popularity and it is one of the commonly performed operations in Nepal. Laparoscopic Cholecystectomy first performed by Muhe in 1985. The current descriptive study is carried out in Department of General Surgery, College of Medical Sciences – Teaching Hospital (CMS-TH), Bharatpur to evaluate the result of Laparoscopic Cholecystectomy in symptomatic gallstones disease in our set up with special emphasis on complication rate, morbidity and mortality. The data of all patients who underwent laparoscopic cholecystectomy form March 2008 to March 2009 was entered in standardized proforma and analysed on SPSS 10. Out of 110 patients, 85 (77.27%) were female and 25 (22.73%) were males; the age range from 17 to 70 years mean age being 41.30 years, majority were in age 25–40 years group. Eight (7.2%) patients had bile leak, 2 (1.8%) patients developed port site wound infection. There was no bile duct or colonic injuries. The conversion rate was 7.2% (in 8 patients). There was no mortality. Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 6-10DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6701

Evaluation of acute head injury by computed tomography scan in College of Medical Sciences-Teaching Hospital, Chitwan

This study was conducted to evaluate the computed tomography findings in patient with acute head injury and to emphasize the importance of computed tomography scan in head injury. One hundred consecutive patients presenting to the emergency department with head injury were evaluated by computed tomography scan of the head. Seventy five patients (75%) were male and twenty five (25%) were females. The age of the patients ranged from three to seventy years and the most affected age group was between thirty and forty (40%). The common causes of head injury were motor vehicle accident (70%), fall injury (25% ) and physical assault (5%). The most common computed tomographic findings were: cerebral contusions (52%), skull fractures (41%), intracerebral hematomas (24%), diffuse cerebral edema (23%), midline shift (18%), subdural hematomas (15%), subarachnoid hemorrhage (13%), diffuse axonal injury (8%), intraventricular hemorrhage (6%), extradural hemotomas (4%), pnemocephalus (2%) and normal scans were found in (5%). In conclusion, computed tomography is the mainstay in the imaging of head injury and helps in the patient management. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5971 JCMSN 2011; 7(1): 36-39

Evidence for HIV-2 infection in Nepal

Assessment of the presence and prevalence of HIV-2 antibodies in patients attending the Universal Collegeof Medical Sciences Teaching Hospital, Bhairahawa, western Nepal was done. A total of 1534 patients serawere screened for the presence of HIV-1 and HIV-2 antibodies from March 2000 to May 2003. A total of 3(0.195%) patients were found to be sero-positive for HIV-2 antibodies. Out of the above three patients, 1(0.065%) was infected with HIV-2 only and the remaining 2 (0.13%) were infected with HIV-1 and HIV -2 both. This evidence of HIV-2 presence implicates serious outcomes as HIV-2 has not been reported fromhospital patients in Nepal.Key Words: HIV-2, sero-prevalence, hospital patients, AIDS.

Study of acute encephalitis syndrome in children

Objective: To determine the profile and outcome of children admitted with Acute Encephalitis Syndrome (AES) and to find out the prevalence of Japanese Encephalitis (JE) IgM antibodies positive cases among these patients with their case fatality rate (CFR). Materials and methods: Study consist of retrospective analysis of hospital records of children up to 15 years of age admitted with diagnosis of AES in pediatric wards of College of Medical Sciences-Teaching Hospital, Bharatpur from January 2007 to December 2008. Results: During two years, 61 patients of AES were admitted. Male and female patients were 33 and 28 respectively. Meningitis accounted for 29 and encephalitis for 32 patients. JE IgM seropositive cases contributed for 18% of all AES cases. Case fatality for JE was 16.6%. Conclusions: Japanese Encephalitis is endemic in catchment area of the hospital. JE has significant morbidity and mortality which can be prevented by immunization and mortality can be reduced if supportive interventions are provided in time. Key words: AES; JE; CFR. DOI: 10.3126/jcmsn.v6i1.3596 Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1, 7-13

Profile of Neonatal sepsis

Objective: To study the clinical presentation, investigational profile and outcome of neonatal sepsis in general and with special reference to inborn (intramural) or out born (extramural), sex and weight of the neonate. Materials and method: Retrospective descriptive study of neonates admitted during 2 years from July 2007 to June 2009 in special care neonatal unit of the department of Pediatrics, College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal. Results: Majority of neonates were out born and referred (72.2%) to this institution. Significant number of babies was having sepsis in out born group (59%) as compared to inborn (35%). Male sex was found to have more sepsis as compared to female. Sepsis was observed to be inversely related to birth weight, 65% in low birth weight (LBW, <2.5Kg) as compared to 42.6% in normal birth weight group (> 2.5kg). Conclusions: High index of suspicion for diagnosis of neonatal sepsis is required especially in the presence of risk factors. Prevalence of sepsis is inversely related to birth weight. More number of out born delivered babies developed sepsis. Neonatal sepsis related morbidity and mortality can be significantly reduced by comprehensive obstetric and neonatal care at multiple levels right from community to health institutions. Key words: Neonatal sepsis; Inborn; Out born; Low birth weight (LBW). DOI: 10.3126/jcmsn.v6i2.3609 Journal of college of Medical Sciences-Nepal, 2010, Vol.6, No-2, 1-6