Kathmandu University Hospital Research Articles

Clinical and epidemiological profile of bacterial pathogens isolated from infected lesions in Kathmandu University Hospital.

Clinical and epidemiological profile of bacterial pathogens isolated from infected lesions in Kathmandu University Hospital.

Prevalence of Burnout among Healthcare Workers in a Tertiary Care Hospital, its Contributing Factor, and Strategies to Overcome Challenges during the Covid-19 Pandemic

Introduction: Globally, burnout on healthcare workers leads to negative impact on the individual and organizational levels, which ultimately affects patient care. This study aims to identify the prevalence, contributing factors, and mitigation of burnout among healthcare workers during the Covid-19 pandemic. Method: This is a web-based cross-sectional study conducted among 177 healthcare workers during Covid-19 pandemic in Dhulikhel Hospital, Kathmandu University Hospital, Nepal, from June to December 2021. The participants were selected using a convenience sampling technique. The Copenhagen Burnout Inventory scale (>50) was used to assess the level of burnout among healthcare workers during this crisis, along with contributing factors and mitigation strategies to overcome the Covid-19 pandemic. The descriptive statistics, bivariate analysis and post-hoc test were utilized Result: The prevalence of burnout for healthcare workers was 125 (70.6%). Nurses and healthcare workers, who have previously worked in covid-19 management were having significantly higher level of personal burnout (H= 13.34, p= 0.004) and work related burnout (H=9.78, p=0.02) score. The main concerns were fear of infecting the family members (80.79%), followed by a lack of resources such as oxygen, personal protective equipment (64.97%). The major mitigation strategies were the provision of incentives (77.97%), good hospital management (74.01%), and training for healthcare professionals (67.8%). Conclusion: Healthcare workers have higher burnout scores in covid -19 pandemic. The study indicated the necessity of employing effective strategies at the individual and institutional level to overcome Covid-19 crises.

Quality of life in individuals with spinal cord injury treated in tertiary care centers in Nepal

Introduction: Traumatic spinal cord injury (SCI) constitutes a significant challenge to the quality of life (QoL). People with SCI perceive the overall QoL at a lower level in comparison to normal individuals.
 Objective: This study aims to access the QoL among individuals with SCI and identify factors affecting the QoL.
 Methodology: This prospective cross-sectional study was done in Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), and Spinal Injury Rehabilitation Center (SIRC), Sanga, Nepal. All the individuals above 18 years with SCI of at least 3 months from trauma seeking treatment in DH, KUH, or SIRC from June 2019 to May 2021 were included. We utilized the WHO quality of life questionnaires (WHOQOL–BREF) for assessing the QoL.
 Result: The mean age was 32.95 ± 11.7 years with the majority being males (74.5%). The majority had ASIA Impairment Scale grade A. The social health domain had the highest mean raw and transformed score (13.87 ± 3.13 and 61.7 ± 19.59 respectively). The transformed total QoL score was 50.76±29.76. Only 22 individuals (15.6%) had a transformed total score of > 60 signifying good/ satisfactory QoL.
 Conclusion: There is a high rate of poor/ unsatisfactory QoL in individuals with SCI in Nepal. Female gender, married status, loss of relative during trauma, ASIA injury severity (AIS) A or B during admission, and no improvement in AIS grade after treatment are significant predictors of poor/ unsatisfactory QoL. Physical health, compared to psychological, social, and environmental health, correlates highest with the transformed total score.

A cross-sectional analysis of the histopathologic structure of thyroid patients undergoing thyroid surgery

Major health issues in the contemporary world, thyroid illnesses are distinguished by changes in hormone output, thyroid gland hypertrophy, or both. The purpose of this study was to identify thyroid histological patterns in people who had thyroid surgery. At Kathmandu University Hospital, a retrospective study was conducted over a two-year period, from January 10, 2021, to December 30, 2022. This study includes all 300 patients who underwent thyroid surgery. gender, age, residency, the outcome of a fine needle aspiration biopsy (FNAB), and post-operative histological patterns were all taken into account. Patients who underwent FNA exclusively were ineligible.Participants' average ages ranged from 35.06 ± 15.19 years. Thyroid disorders were more frequently found in females (90%) than in males ( 10%). Nodular colloid goitre (65.1%), adenoma (5.8%), papillary thyroid neoplasms (25.4%), follicular thyroid carcinoma (6.8%), medullary thyroid carcinoma (8.5%), thyroiditis (9.3%), and anaplastic thyroid cancer (3.9%) were the histopathologic patterns. With a prevalence of 64 (23.1%), papillary thyroid cancer was the most prevalent type. The combined accuracy of the final histology and FNAB was 90.04%. However, 50% of follicular cancer preoperative diagnoses made by FNAB were insufficiently accurate. While FNAB specificity varied from 95.1% to 98.9%, FNAB sensitivity ranged from 75.8% to 90.8%. The most common thyroid condition is nodular colloid goitre, while papillary thyroid carcinoma is the most common cancer seen in this study. We suggest more research with a bigger sample size to confirm our findings.

Traumatic Cervical spine injury epidemiology: a tertiary care center perspective in Nepal

Background: The epidemiology of traumatic cervical spine injury is not well documented in developing/ underdeveloped countries. There are a few single-centered studies on the epidemiology of cervical spine injury in Nepal. Objectives: This study aimed to explore the epidemiology of traumatic cervical spine injuries presented at Dhulikhel Hospital, Kathmandu University Hospital, Nepal. Methods: This was a retrospective study of individuals with traumatic cervical spine injuries admitted to the Department of Orthopedics from 2015 January to 2021 December. Data collection was done by using the International Spinal Cord Injury core data set (version 2) and International Spinal Cord Injury Spinal Column Injury Basic Data Set (version 1.0). Results: One hundred and forty-four patients were included of which the majority (68.8%) were males. The mean age of the patients was 47.89 ± 17 years. Fall injury was the most common etiology (79.2%). C2 was the most common level injured (28.5%). Patients with ASIA A neurology was 18% and surgical treatment was given to nearly 60%. The patients had a median hospital stay of 9 days (4- 16) and a mortality of 4.2%. Conclusion: There was a male predominance with a recent increase in the female proportion for traumatic cervical spine injury. Fall was the most common etiology with the majority of patients in their 30s and 40s. Surgical treatment is more preferred recently. The mortality rate was relatively low which needs further investigation.

Post-traumatic stress disorder among individuals with traumatic spinal cord injury in Nepal: a cross-sectional study.

Cross-sectional study OBJECTIVES: To identify the prevalence of posttraumatic stress disorder (PTSD) among the individuals with traumatic spinal cord injury (TSCI) and to examine the relationships between demographic and clinical characteristics, and PTSD. Spinal Injury Rehabilitation Center (SIRC) and Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Kavrepalanchowk, Nepal. Individuals above 18 years of age with TSCI of at least one month from trauma and admitted to SIRC and DH, KUH from June 2019 to May 2021 were included. The specific stress version of the PostTraumatic Stress Disorder Checklist (PCL), was utilized. To classify the neurological status of TSCI individuals, International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) was used. Hierarchical multiple regression analysis between independent variables and normalized PCL score was done to evaluate the predictors of PTSD. Among 163 patients, the overall prevalence of PTSD was 27%, and the mean PCL score was 36 ± 13.9. Factors predictive of PTSD included gender, family type, ethnicity, and literacy rate. No significant association was found between the clinical characteristics and PTSD. PTSD appears to be considerably prevalent among individuals with TSCI in Nepal. Females, individuals from nuclear families, individuals with lower literacy, and individuals from lower caste are significantly vulnerable to developing PTSD. However, clinical characteristics do not appear to be influential in the development of PTSD.

Fetal outcome of adolescent pregnancy in a tertiary care center in western Nepal: A case control study

Background: The incidence of adolescent pregnancy is decreasing in developed countries, whereas developing countries like Nepal still report a high incidence.
 Aims: To compare the fetal outcomes of adolescent pregnancies with those of the optimal reproductive age group in a country that accounts for 95% of teenage pregnancies, in contrast to 11% worldwide. 
 Method: A hospital-based case-control study was conducted with 150 pregnant women with singleton gestation admitted to Kathmandu University Hospital. An adolescent pregnancy (<19 yrs.) was considered a case, and pregnant women of the optimal age group (20-35 yrs.) were considered the control. The data were collected from Jan 5, 2018, to Jan 5, 2019. The control group was selected by matching the parity of the cases in the study groups during the same study period. Respondents were interviewed and examined with a pre-structured tool. Odds Ratio (OR) and 95% Confidence Interval (CI) were calculated using conditional logistic regression (P<0.05 considered significant).
 Results: The mean age of adolescent mothers was 17 years, the majority being primigravida. This study identified that fetal complications were higher in adolescent pregnancies (61% vs. 40%). The fetal complications like low birth weight (OR 2.42, 95%CI :1.044-5.43, P=0.03), NICU admission (OR 3.27, 95%CI:1.48-7.25, P=0.003), low APGAR score (OR 2.32, 95%CI:1.05-5.11, P=0.034) and Neonatal Death (OR 3.72, 95%CI:1.15-12.01, P=0.04) were associated with the adolescent pregnancies respectively.
 Conclusion: Adolescent pregnancies are at increased risk of fetal complications compared to pregnancies in the optimal reproductive group. Adolescent pregnancies were at increased risk of low birth weight, neonatal death, low APGAR score, and higher admission in NICU. Therefore, an adequate antenatal visiting program for early detection and timely management likely will reduce the fetal complications during adolescent pregnancy.

Evan’s Index in adult Nepalese population: A Computerized Tomographic Study

Introduction: Evan's Index is a linear measurement of the ventricular size which is used as an indirect marker of ventricular volume. It is used widely as a screening tool to rule out ventricular enlargement. As the ventricular enlargement indicates the neuropathological state of the brain, Evan's Index serves as the quick and reliable method to assess ventricular size. Objectives: The study aims to generate a baseline value of Evan's Index among the Nepalese population and also investigates the effect of age and gender on EI. Methodology: A quantitative study was conducted in the Department of Anatomy, Kathmandu University School of Medical Sciences and data was collected from the Department of Radiodiagnosis, Dhulikhel Hospital, Kathmandu University Hospital. The study was done on 385 head CT Scans of the individuals of mean age of 45.44years. The ratio of inter anterior horns distance of the lateral ventricles and maximal internal diameter of the skull at the same level was taken to calculate Evan’s Index. Results: The mean value of Evan’s index in the present study was 0.250.03. The study did not report gender-wise variation in Evan's Index (p>0.05). Evan’s index was minimum at the age group of 20-29 and maximum at the age group of 80-89. The value of Evan’s Index showed a significant increase with the age (p<0.05). Conclusions: The study provides the mean value of Evan’s Index among the Nepalese population. Even though Evan’s Index is not influenced by gender, the value increases with normal aging.

Traumatic Thoracic and Lumbar Spine Injury in Adult Population Presenting to a Tertiary Care Hospital.

Epidemiology of traumatic thoracolumbar spine injury is a less explored subject in developing/ underdeveloped countries. The number of available studies in Nepal is even smaller. This study aims to establish the epidemiological characteristics of patients with thoracic and lumbar spine injuries presenting to Dhulikhel Hospital, Kathmandu University Hospital in Nepal. This is a single-center retrospective observational study. Patients with traumatic thoracolumbar spine injuries admitted to to Dhulikhel Hospital, Kathmandu University Hospital from 2015 January to 2019 December were included. International Spinal Cord Injury core data set (version 2) and International Spinal Cord Injury Spinal Column Injury Basic Data Set (version 1.0) were used for data collection. Three hundred and seventeen patients were included, of which, 50.2% were male and the mean age was 45.5± 17years. Fall was the most common etiology of injury (69.1%). The most common level of injury was L1 (32.5%). Thirty-seven patients (11.7%) had ASIA A neurology. One hundred and seventy-three (54.6%) patients underwent surgical intervention. The median hospital stay of the patients was 7 days(IQR: 3-11) with no recorded in-hospital mortality. Males and females are equally vulnerable to thoracic and lumbar spinal injuries, with the majority of patients in 46-60 age groups. More than 1/3rd neurologically impaired patients are with ASIA A neurology. The findings of this study can contribute to traumatic thoracic and lumbar spine injury prevention and rehabilitation.

Domestic Violence during Pregnancy among Postnatal Women in Tertiary Hospital, Nepal

Domestic violence is the most prevalent pregnancy-related health issue in developing county. The health of both mother and child is seriously jeopardized. This research was to assess the incidence of psychological, physical, economical and sexual violence during pregnancy among postnatal mothers at Dhulikhel Hospital - Kathmandu University's Hospital. A descriptive cross-sectional study was conducted on 804 postnatal women. The respondents were chosen using a systematic random sampling strategy. Findings of the study revealed that the majority of respondents stated that they had little experienced psychological violence such as meeting restrictions, work obstruction, unjustified blaming, or threats during pregnant. The minority of responders indicate they have sometimes been slapped, pushed, yanked hair, burnt, attacked, or strangled by a family member while pregnant. Very few Respondents state that they have experienced sexual violence, such as being pushed or coerced to have sex when they are physically and mentally exhausted or have no interest. In that 36. % respondents experience tension during pregnancy due to domestic fights, 54.7% have faced such issue. Study show that domestic violence to pregnant women was seems .

Morphometric Analysis of Posterior Fossa and Foramen Magnum among Pediatric Age Group 6 to 16 Years

Background Configuration and size of the foramen magnum and posterior cranial fossa plays an important role in the pathophysiology of various disorders like Chiari malformations, basilar invagination etc. Thus, a fundamental knowledge of normal anatomy of this region is important to the clinician for diagnosis and treatment. However, we couldn’t find any anatomical study related to the concerned topic among the pediatric population aged 6 to 16 years in Nepal to the best of our knowledge.
 Objective To attain the baseline results (volume of bony part of posterior cranial fossa and the surface area of foramen magnum) that will help in the better diagnosis, classification, and treatment of diseases related to posterior fossa and craniovertebral junction and serve as a future reference defining an anatomic range in our region.
 Method This is a retrospective prospective observational study conducted from 1st February 2021 to 31st January 2022 at Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchowk, Nepal. We used convenient sampling technique to fulfil our sample size. We considered 68 patients, who got recruited either from our emergency and OPD departments and were fulfilling our criteria of inclusion. Upon the recruitment, 68 consecutive head CT scan of pediatric patients with normal reports (without any bony or soft-tissue abnormality) were studied. Volume of the posterior fossa was calculated with the help of inbuilt “advanced work station - 3D volume calculator” program in 128 slices - SOMATOM PERSPECTIVE CT Scanner from Siemens, Germany. The area of the foramen magnum was calculated using formula πr2, where r is average radius calculated from obtained antero-posterior and transverse diameter.
 Result The age of the patients ranged between 6 and 16 years with the mean age of 10.56 ± 3.38 years with male to female distribution of 1: 1.125. The mean volume of the posterior fossa was 165.61 ± 8.52 mm3. The mean AP diameter, transverse diameter, and the surface area of foramen magnum were 3.31 ± 0.12 mm, 2.72 ± 0.12 mm, and 28.60 ± 0.09 mm2 respectively.
 Conclusion Normal ranges of volume of posterior cranial fossa and various dimensions and surface area of foramen magnum of pediatric population were determined using CT scans, which could serve as future reference in Nepal.

SELF-CARE MANAGEMENT AND ITS ASSOCIATED FACTORS AMONG PATIENT WITH HYPERTENSION IN NEPAL

Background: Hypertension is currently a common and serious health issue that leads to cardiovascular disease and premature death around the world. Self-care practice is essential for blood pressure control and reduction of hypertension complications of cardiovascular and renal diseases. The objective of this study is to assess the level of self-care management and its associated factors among patients with hypertension. Methods: The cross-sectional study was conducted at the Internal medicine and Cardiac outpatient department of Kathmandu University Hospital, Dhulikhel on 386 participants diagnosed with hypertension with six months of diagnosis and age of 30-80 years. The participants were recruited conveniently in the study. Face to face interviews with participants using Hypertension Self-Care Profile (HTN-SCP) and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess self-care management and perceived social support. Descriptive and inferential statistics were performed using SPSS version 23. Results: The mean age of the participants was 57.39 years. Half of the participants (52.3 %) had poor self-care practice. There is significant association between level of self-care practice with religion (p= <0.001), educational level (p= <0.001), area of residence (p= 0.001), income (p=<0.001) and perceived social support (p= 0.001). Conclusions: The present study revealed that half of the participants had poor self-care practice. Based on the results, the study concluded that good self-care practices and social support influence better self-care practice among hypertensive patients which may eventually help to prevent complications in the coming future.

Surgical Outcome of Limberg’s Flap Reconstruction in the Treatment of Pilonidal Sinus Disease in a Community Hospital

Background Pilonidal sinus disease is an acquired condition that commonly arises in the hair follicles of the gluteal cleft with male predominance. Different treatment modalities have been described in the literature ranging from simple incision and drainage, wide local excision to complex plastic flaps.
 Objective To evaluate the efficacy and outcome of Limberg’s flap reconstruction in a community hospital.
 Method This is a prospective study conducted over two-year duration in forty-two patients in the department of Surgery at Dhulikhel Hospital Kathmandu University Hospital from January 2017 till December 2018.
 Result Total of 42 patients were operated ranging from 16-31 years with mean of 22.86 years, male to female ratio was 7.5:1, 52% were students and 19% were drivers. Mean operative duration was 61.86±25.3 minutes, length of hospital stay was 2.83±1.68 days, mean duration of drain in situ was 4±1.34 days, mean days for return to work was 14.5±5.7. We had a complication rate of 9.52% out of which 4.76% had seroma, 2.38% hematoma, 2.38% wound infection, and there was no flap necrosis or recurrence.
 Conclusion It is a simple, easy to learn and safe procedure with good cosmetic results and low recurrence rate. It can be considered as an alternative to other flap and plasty procedures

Comparison of Blood Pressure Readings on a Bare Arm, over a Sleeve Arm and over a Rolled-Up Sleeve Arm in Outpatient Department of Medicine in Dhulikhel Hospital, Kathmandu University Hospital

Background: It is universally recommended that blood pressure should be measured on bare arm for accurate reading. However, this is seldom done in busy clinical schedules. This study aims to see if clothing adjustments should be a concern while measuring blood pressure under suboptimal conditions.
 Materials and Methods: This was a cross sectional study conducted at medicine department of Kathmandu University Hospital, Dhulikhel Hospital among conveniently selected 100 patients. After getting informed consent, consecutive blood pressure measurements were done over rolled-up sleeve arm, sleeve arm and bare arm in seated position. Socio-demographic information were obtained through an interview using a semi-structured questionnaire. Data were entered in Microsoft Excel and analyzed using descriptive and inferential statistics in Statistical Software for Social Sciences version 20.
 Results: The median of differences between sleeved arm and bare arm was 0 for both systolic and diastolic blood pressure and the median value for differences between rolled up arm and bare arm was 2 units for both systolic and diastolic blood pressure. Although the differences looked statistically significant, the size of the differences was not clinically significant.
 Conclusion: Meticulous clothing adjustment has clinically insignificant differences in measurement of blood pressure if patient is wearing thin sleeves. Therefore, in suboptimal conditions, blood pressure can be measured on rolled-up sleeve arm and sleeve arm if patient is wearing thin sleeve clothes.

Drug Utilization Study in Outpatient Department of Ophthalmology in Tertiary Care Hospital

Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use.
 Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH).
 Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation.
 Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%).
 Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs.

Maternal and Perinatal Outcome of Urinary Tract Infection in Pregnancy at Dhulikhel Hospital, Kathmandu University Hospital

Background Urinary tract infection (UTI) is common in pregnancy and poses a great challenge because it has several adverse outcomes in both the mother and her unborn foetus.
 Objective This study aims to determine the incidence of culture positive urinary tract infection, culture and sensitivity of the common causative organisms and find out the maternal and perinatal outcomes in culture positive urinary tract infection.
 Method This prospective study was carried out in the Department of Obstetrics and Gynaecology at Dhulikhel Hospital over a period of one year. Urine routine and microscopy was done as a preliminary screening test for urinary tract infection and those with abnormal results were subjected to urine culture and sensitivity and ultrasonological evaluation.
 Result A total of 162 pregnant women were included in the study. Incidence of culture positive urinary tract infection was 25.9%, highest in age group 15-20 years (47.8%), more in primigravida (30.1%) and common at second trimester (40.4%). Escherichia coli (90.4%) was the commonest organism isolated and ceftriaxone was the most sensitive antibiotic. Patients with culture positive urinary tract infection had higher incidence of anaemia, preterm labour, need of surgical intervention. Such patients also had increased chances of preterm delivery, low birth weight babies and newborn intensive care unit (NICU) admission.
 Conclusion We conclude that urinary tract infection in pregnancy leads to adverse maternal and fetal outcomes. And we recommend urine culture and sensitivity at each trimester so that urinary tract infection can be diagnosed and treated on time.

Study of Characteristic Retinal Findings among Hypertensive Population Attending a Tertiary Care Hospital in Nepal

Background Systemic hypertension is one of the most common chronic, debilitating diseases prevalent in the modern era, with many complications in terms of stroke, chronic kidney disease, coronary artery disease and retinopathy. When it comes to the eye, as a target organ damage, it leads to one of the many vision threatening conditions, hence degrading the quality of life. Early detection and subsequent management of patients at risk of hypertensive retinopathy serves to be a crucial panacea in the treatment course.
 Objective To investigate the characteristics retinal findings among hypertensive population and analyze the associated risk factors.
 Method A hospital based prospective study was conducted, among 250 patients presenting to ophthalmology outpatient department in Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH), over a time span of 6 months, to analyze hypertensive retinopathy and its implications. Fundus examination under mydriasis was done on all subjects and hypertensive retinopathy was graded according to the modified Scheie classification.
 Result Most patients belonged to age group of 56-65 years (30%). Nearly half (48%, N=120) of the hypertensive population had some forms of retinopathy. Grade II hypertensive retinopathy (24.8%) was the most common hypertensive change observed. Majority (55%) of the patients with retinopathy were smokers. About two-third of the subjects (67.5%) had been diagnosed to have hypertension and under treatment for over 5 years.
 Conclusion The occurrence of retinopathy among hypertensive patients attending ophthalmology department is higher. Awareness regarding systemic hypertension and its effect on ocular health is very important to be disseminated among public. Timely referral among medical specialities could diagnose and prevent curable blindness among hypertensive patients.

Nasopharyngolaryngoscopy in the Diagnosis of Various Pathologies of the Larynx in a Tertiary Care Hospital.

Introduction: Laryngeal disorders are frequently encountered in ENT practice. Nasopharyngolaryngoscopy is an outpatient department procedure that is used for the diagnosis and management of laryngeal disorders. The objective so the study was to study the prevalence of different laryngeal disorders by the use of Nasopharyngolaryngoscopy as an outpatient department procedure in ENT. Materials and Methods: A hospital-based prospective and analytical study was conducted in the department of ENT at Dhulikhel hospital, Kathmandu University Hospital during the period of 2 years. A total of 132 patients, who had various laryngeal symptoms and underwent NPL were included in this study. A careful and detailed history and clinical examination of the patients was done. Data were recorded and analyzed. Results A total of 132 patients with various laryngeal symptoms underwent Nasopharyngolaryngoscopy. Among them, 54.5% (72) were male and 45.5% (60) were female. The age range was from 18-84 years. The most common laryngeal disorder observed was Laryngopharyngeal reflux disease, followed by chronic laryngitis, true vocal cord nodule, and true vocal cord polyp. Conclusion Nasopharyngolaryngoscopy is a safe outpatient department procedure that is helpful for the diagnosis and management of various laryngeal disorders.

Successful Outcome of Anterior Cruciate Ligament (ACL) Reconstruction by Hamstring Tendon for Anterior Cruciate Ligament Deficit Knee at a University Hospital: A Descriptive Cross-sectional Study.

Anterior cruciate ligament is a commonly injured and reconstructed ligament in the knee. Unlike in urban areas where sports activities and road accidents are common mechanisms of injuries, the semi-urban and rural population has a different mode of injuries, needs, and expectations. This study explores the prevalence of successful outcome of anterior cruciate ligament reconstruction in by hamstring tendon for anterior cruciate ligament deficit knee at a university hospital. A descriptive cross-sectional study was conducted at Dhulikhel Hospital, Kathmandu University Hospital from 2018 February to 2020 January among patients having anterior cruciate ligament injuries after ethical approval. Whole sampling technique was used. Functional outcome was assessed with Lysholm scale at the end of at least one year. Data was analysed using Statistical Package for Social Sciences version 11. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. Out of 66 anterior cruciate ligament reconstruction, 35 (59%) cases had successful outcomes. Excellent outcomes were seen in 9 (15%) cases and 26 (44%) had good outcomes. The mean Lysholm score was 84. Anterior cruciate ligament injuries were seen in heterogeneous populations during their activities of daily living or recreational sports activities. Anatomic anterior cruciate ligamentreconstruction with hamstring grafts provided good functional outcomes, especially among the young population. Our findings are similar to current studies on anterior cruciate ligament-reconstruction.

Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal.

SETTING:Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal.OBJECTIVES:1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures.DESIGN:This was a cohort study using secondary data (December 2017 to April 2018).RESULTS:Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9–6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, P = 0.02). The most common HAI bacteria (n = 70) were Escherichia coli (44.3%), Enterococcus spp. (22.9%) and Klebsiella spp. (11.4%). Of 98 CAIs with 41 isolates, E. coli (36.6%), Staphylococcus aureus (22.0%) and methicillin-resistant S. aureus (14.6%) were common.CONCLUSION:We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.