Tertiary Care Center In Nepal Research Articles

Prevalence and Factors Associated with Occupational Musculoskeletal Disorders among the Nurses of a Tertiary Care Center of Nepal

Introduction: Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system which could lead to temporary or permanent impairments. The nature of nursing jobs makes nurses vulnerable to MSDs. This study aimed to assess the prevalence and potential risk factors associated with MSDs among nurses. Methods: In between March to June 2021, a cross-sectional study was conducted among 165 nurses using self-administered questionnaires. A standardized Nordic Questionnaire was used to measure MSDs. Pearson’s chi-square test and binary logistic regression at a 5% level of significance were performed to identify factors associated with upper extremities and spinal musculoskeletal disorders (UMSD) and lower extremities musculoskeletal disorders (LMSD). Variables associated with UMSD and LMSD in bivariate analysis were subjected to multiple logistic regression. Results: The prevalence of UMSD and LMSD experienced by nurses was 86.1% (95% CI: 79.4%-90.9%) and 66.1% (95% CI: 58.9%-74.3%), respectively. Among several factors, working in same position for long periods (AOR: 4.16, 95% CI: 1.2-13.4), not receiving training in injury prevention programs (AOR: 3.15, 95% CI: 1.0-9.2), not enough rest breaks during the day (AOR: 4.65, 95% CI: 1.3-15.9) and moderate to higher job stress (AOR: 3.62, 95% CI: 1.2-10.8) were found to be significantly associated with UMSD. Not having enough rest breaks during the day (AOR: 2.19, 95% CI: 1.0-4.7) was significantly associated with LMSD. Conclusion: Higher prevalence of MSDs among nurses is a serious concern that threatens individual health as well as the overall healthcare system. Sensitization and capacity enhancement programs on the issue could prevent MSDs among nurses.

Correlation of Body Mass Index and Oxygen Saturation in Chronic Obstructive Pulmonary Disease Patients at a Tertiary Care Center in Nepal: A Cross-Sectional Study.

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity worldwide. COPD is associated with clinically relevant pulmonary and extrapulmonary manifestations, including hypoxemia and weight loss. The correlation of body mass index (BMI) and oxygen saturation (SpO2) with COPD grades may provide a useful additional marker for understanding and managing the disease. The aim of the study was to study the correlation of BMI and oxygen saturation with COPD in patients presenting to a tertiary care center in Nepal. A descriptive cross-sectional study was conducted among 145 COPD patients visiting the Department of Medicine in Shree Birendra Hospital between 1 March 2019 and 28 February 2020. A non-probability purposive sampling method was used and data were analyzed using SPSS version 21. A p-value of <0.05 was considered significant. Out of 145 COPD patients, 58 (40%) were underweight, 53 (36.55%) were of normal weight, 20 (13.79%) were overweight, and 14 (9.6%) were obese. The number of underweight patients was highest in COPD grade 4 and lowest in COPD grade 1. The proportion of subjects with underweight BMI and hypoxia increased with COPD severity, and both were statistically significant (p-values <0.01). Our study shows that BMI and oxygen saturation have an inverse association with COPD severity. The correlation of BMI and oxygen saturation with COPD grade could provide a supplementary marker of disease severity, which could be useful in the understanding of the disease process and subsequent management of COPD.

Epidemiology of Traumatic Peripheral Vascular Injury in Patients Presenting at Tertiary Care Center of Nepal

Introduction:Traumaticperipheralvascularinjuryremainsasignificantcauseofmorbidityandmortalityamongthegeneralpopula- tion. Majority of peripheral arterial injury are caused by a blunt trauma with a concomitant soft tissue injury and fractures requiring multidisciplinaryapproach.Despitemajoreffortsinestablishingprotocolsandguidelines,optimalstrategiesoftraumaticperipheral vascular injury are still under investigation and may vary depending upon the local setup and expertise available. The aim of this study was to identify the epidemiological profile of traumatic peripheral vascular injury presenting at tertiary care center of Nepal. Method: This is a retrospective study of patients who underwent vascular surgery in College of Medical Sciences Bharat- pur, from December 2018 and July 2021. Ethical approval was taken from the Institutional Review Committee of College of Medical Sciences (Registration Number 2020-081). Data for the study was retrieved from Emergency records, oper- ation records and medical record department of the hospital. A total of 63 cases of all age and sex were included in the study. Only patients having traumatic peripheral arterial injury and undergoing surgical intervention were included in the study. Patient data was initially tabulated using Microsoft Excel and analysis was done in SPSS software version 22.0. Result:Traumatic peripheral arterial injury was most commonly seen in 21-30 years (36.5%) age group with male preponderance (88.9%).Sharpinjurymechanismaccountedfor(42.9%),followedbyroadtrafficaccidents(41.3%).Upperlimbarterialinjurywasseenin 61.9% of patients and radial artery was the most common to be injured (34.9%). Associated tendon injury was seen in 63.5%, whereas nerveinjurywasseenin20.6%.Complicationswereseenin47.6%patientsandwoundinfectionwasthemostcommonailment(12.7%). Conclusion:Traumatic peripheral vascular injury has a male preponderance with road traffic incidents being the major mechanism of injury in Nepal. These injuries have a high rate of complications.

Pattern of Liver Function Test in Scrub Typhus Cases: A Hospital Based Observational Study in a Tertiary Care Center in Nepal

Background and Aim: Scrub typhus, a potentially severe but treatable infection is a major cause of acute non-malarial febrile illness in children in the rural tropics. The present study aims to explore the association between the liver function tests in the cases of scrub typhus and correlate the levels of these parameters with the severity of the scrub typhus infections, their clinical risk characteristics that may be used to forecast disease severity under routine clinical practice.&#x0D; Methodology: This prospective observational study, conducted at National Medical College Teaching Hospital, a tertiary care referral teaching hospital situated in province two of Nepal over a period of 7 months (November, 2021- May 2022) enrolled 75 scrub typhus cases and their liver function tests were done following standard guidelines.&#x0D; Results:There were deranged liver function tests in the participants. The mean Aspartate Transaminase, Alanine Transaminase, Total Bilirubin and Albumin were425.48 ± 505.56 U/L, 368.54 ± 402.22 U/L, 3.8 ± 3.1 mg/dL and 3.10 ± 0.8 g/dL, respectively. Most of the cases presented with hypoalbuminemia (66.7%), cardiac dysfunction (64%), acute kidney injury (61%) and hepatitis (60%). About 9 % of the subjects presented as multiorgan dysfunction syndrome (MODS).&#x0D; Conclusion: Scrub typhus cases presents with deranged liver function tests results and the values can be helpful in assessment of the disease severity and outcome.

The pattern of sarcoid uveitis at a tertiary care center in Nepal.

A retrospective quantitative cross-sectional study was conducted at the uveitis clinic of the Institute of Medicine by obtaining medical data from the medical record section on sarcoid uveitis cases visiting from March 2018 to March 2021. Demographic profile, ocular findings, laboratory findings and treatment details were documented and statistical analysis was done via Statistical Program for Social Science (SPSS) version 23. Out of 50 eyes of 30 patients included in the study; 66.6% patients (n=20) had bilateral and 33.3% (n=10) had unilateral ocular involvement. Anterior with intermediate uveitis (26.7%) was the most common type of uveitis among the cases. Serum angiotensin converting enzyme was raised in 66.7%, Chest X-ray showed hilar changes in 63.33%, and high-resolution computed tomography showed mediastinal, hilar lymphadenopathy with or without the involvement of the lung in 63.33% of patients. Sarcoid uveitis may have varied ocular presentations, the commonest being anterior and intermediate uveitis. The commonest complications are cataract and cystoid macular oedema, which are associated with vision loss. Steroids and immunomodulators are the mainstays of treatment.

Traumatic spinal spondyloptosis presenting in a tertiary care unit in central Nepal

Introduction: Traumatic spinal spondyloptosis, though rare, harbingers a high risk of mortality as well as permanent and disabling neurological deficits. They invariably become socially aloof and marginalized in most parts of our subcontinent owing to the lack of dedicated rehabilitation units amid their poor economic status. There is a paucity of studies pertaining to such rare epiphenomenon within our region. Materials and Methods: A study of 16 patients presenting with spinal spondyloptosis from January 2017 to January 2023 in a tertiary care center in Nepal was undertaken. The clinical records of the patients were retrieved from the hospital record section to study the demographic variables, modes of injury, American Spinal Injury Association (ASIA) grades, salient radiological characteristics, management strategies, and the resultant clinical outcomes. Result: The mean age of the cohorts in our study was 40 years with an age range of 25-80 years. Most of the patients presented in ASIA ‘A’ neurological grade (75%). The cervical spine was involved in the majority (68.75%) of cases. 8 (50%) patients left against medical advice, 2 (12.5%) were managed conservatively, and 6 (37.5%) were operated. The posterior-only approach was undertaken in 4(66.67%) cases. Tracheo-oesophageal fistula occurred in 2 (33.33%) patients. And cerebrospinal fluid (CSF) leak occurred in 2 (33.33%) patients. The overall hospital mortality was 3(37.5%). All the surviving patients were of the ASIA ‘E’ grades. Conclusion: There is a continuum of physical, economic, psychological, and social burdens to both the patients and their care providers. Rehabilitation is the ‘bottleneck’ variable governing poor outcomes in our subcontinents. The poor economic status of the people has a ripple effect upon the same. This should also aid in the patient counseling as well as fostering the notion of the paramount need for dedicated neuro-rehabilitation units in our regions.

Surgical Management of Pediatric Urolithiasis: Descriptive Study from a Tertiary Care Center in Nepal

Introduction: Urolithiasis is common in the pediatric population in low-resource countries but appropriate management is not available in all parts of the country. This study aimed to identify demographic parameters, clinical characteristics, and surgical management of pediatric urolithiasis in a tertiary care center in Nepal. Methods: This was a retrospective and descriptive study of pediatric patients (≤18 years) who underwent surgical management of urolithiasis in the Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital from January 2021 to December 2022. Results: Total 64 patients with Male: Female ratio 1.78:1 and mean age of 8.63±5.56 years presented mostly with pain abdomen (93.8%) followed by lower urinary tract symptoms (26.6%), hematuria (20.3%), and fever (14.1%). The mean number of calculi was 2.2±1.47 and the mean size was 13.97±8.30 mm. Most of the calculi (39.1%) were in the right system and 90.62% were in the upper tract. Only 15.62% of patients had calculi in the lower tract. Open surgeries were performed in only 10.93% and the rest were managed by minimally invasive procedures. Percutaneous nephrostomy tube insertion was done in 6 (9.37%) of patients and 1 (1.56%) underwent nephrectomy for nonfunctioning kidney. Conclusion: Pediatric urolithiasis patients presented with pain abdomen, lower urinary tract symptoms, or hematuria. Surgical management has shifted from open surgeries in the past to minimally invasive surgeries at present.

Ultrasonographic Assessment of Submandibular Salivary Gland at a Tertiary Care Centre of Nepal

Background: There various disease condition which can leads to increased size of the submandibular gland. Normal dimensions of salivary gland is useful for identification and diagnosis of various associated pathology. The study objective was to assess the normal dimension of submandibular gland using ultrasonograph at a tertiary care centre of Nepal. Methods: The descriptive cross-sectional study was conducted in Department of Radiology and Imaging College of Medical Sciences, Bharatpur, Nepal among 126 patients. Ultrasound of submandibular gland was done of all patients with Toshiba Aplio 500 superficial probe. The data was collected and entered into Statistical Package for the Social Sciences version 16 and analyzed using descriptive statistics. Later the data was presented in form of tables. Results: There were in total 126 patients who participated in the study. Among them 78 (61.9%) were females and rest were males. The mediolateral width of right submandibular salivary gland (2.70±0.40 cms) was slightly greater than the left side. The volume of left salivary gland (6.91±2.32 cm3) was slightly larger than the right side in male. However, there was no statistically significant difference between male and female Conclusion: This study concluded that the volume of left salivary gland was slightly larger than the right side. The volume of salivary gland of females was more than male. Keywords: Submandibular gland, Salivary gland, Ultrasonography.

Low Dose Oxybutin in Primary Hyperhydrosis: A Prospective Study from a Tertiary Care Center in Nepal

Introduction: Hyperhydrosis is a clinical condition where there is excessive sweating beyond the physiological need of the patient’s body. This can directly or indirectly affect the quality of patients life. Oxybutin is widely used in urology as anticholinergic medication for bladder urge incontinence. It can be used safely at a high doses (over 15 mg/day) to treat urological disorder. It also acts against excessive sweating and can be used in cases of hyperhidrosis. Objectives: To evaluate effectiveness of oxybutin at low dose and to assess the Hyperhidrosis Disease Severity Scale (HDSS) . Materials and Methods: This is a hospital based cross-sectional study in primary hyperhydrosis. Oxybutin was prescribed to all patients of primary hyperhydrosis with gradual increment of dosage of 2.5 mg orally once a day to 5 mg twice a day. Patients were evaluated at zero wk (baseline), 4 wk, 8 wk, 12 wk and follow-up in 16 wks with Hyperhidrosis Disease Severity Scale (HDSS) along with adverse effects were noted. Results: There was a significant difference in HDSS at zero wk (baseline) and 4th wk (p=0.001) at a dose of 2.5 mg once a day of oxybutynin. Also, a significant difference was noted (p=0.022) in HDSS between zero wk (baseline) and 12 wk. Similarly, a significant difference between HDSS at zero wk (baseline) versus the 16th wk was also noted. Conclusion: Oxybutin is an anticholinergic drug with an emerging role in hyperhydrosis. Low doses have shown significant results with minimal side effects. The dose requirement varies among authors. Studies with long-term follow-ups with ideal protocol need to be established in the future.

FUNCTIONAL EVALUATION OF VOLAR BARTON FRACTURES MANAGED WITH ANATOMICAL PLATING AT A TERTIARY CARE CENTER IN NEPAL: A RETROSPECTIVE REVIEW OF RECORDS.

Introduction Distal end radius fractures have been extensively studied in literature and yet many aspects of management remain controversial. Volar Barton fractures have been treated surgically with volar locking plates. Very few dedicated studies have been conducted in Nepal. The aim of this study was to describe the functional outcomes of Volar Barton fractures managed with open reduction and internal xation (ORIF) and Volar plating at a high volume tertiary care centre in Nepal. This retrospective Methodology review of patients was conducted after approval of the institutional ethics committee. A review of records of patients operate in the last 24 months was be performed. Patients aged 18 to 65 years who had been operated for Volar Barton fractures (AO type B3) within 3 weeks of injury with ORIF and Volar plating with a minimum of 12 months follow up were included in the study. Data regarding demographics, side of injury, functional outcomes using the Patient rated wrist evaluation (PRWE), Modied Mayo Wrist score and Radiological parameters. Statistical analysis of the data was done. Proportion, percentage, mean, standard deviation was calculated. A total of 180 records of patients who underwent ORIF Results and plating between 1st April 2021 to 31st March 2021 were identied. Of these 50 patients met the inclusion criteria and were included in the analysis. The mean age of the patients was 36.4 ± 1.4 years (18- 62 years). All fractures united with a mean union time of 5.7 ± 3.2 weeks. On radiographic assessment at 12 months the Volar tilt was 5.23 ± 2.41®, mean radial height was 9.23 ± 2.2®. Radial inclination was 22.9 ± 5.0®. The mean articular step was 0.3 ± 0.5 mm. Functional outcomes using the PRWE at 12 months was 3.5 ± 1.3. The Modied Mayo score was 82.12 ± 7.3. Conclusion Volar plating provides good functional and radiological outcomes in our study population. It has good union rates and a relatively low complication rate.

Surgical management of neonatal Sacrococcygeal teratoma in a tertiary care center of Eastern Nepal: An observational cross-sectional study in a resource-limited setting

BackgroundDespite being an uncommon tumor, sacrococcygeal teratoma (SCT) is the most prevalent among newborns. SCT comprises tissue generated from many germ layers. It develops from Hensen's node's totipotent cells. The objective of our study was to determine the epidemiology and management of neonatal sacrococcygeal teratoma in the tertiary care center of Nepal in a resource-limited setting. MethodsIt is a retrospective cross-sectional study that includes all cases of neonatal SCT admitted and treated in the department of Pediatrics and Neurosurgery, B. P. Koirala Institute of Health Sciences, over the period from July 2017 to December 2021. The primary endpoint was to determine the epidemiological profile of neonates with SCT, their surgical management, and their complications. ResultsOur investigation included a total of 15 patients. Nine of the fifteen cases were female (60%) and six were male (40%). Six newborns (40%) were diagnosed with SCT antenatally and were referred to our tertiary care institution for delivery. The size of the SCT varied ranging from less than 8 cm to greater than 11 cm. Surgical excision was performed. Only 1 case (6.6 %) expired due to complications. ConclusionsIn our context, SCT is the most prevalent tumor in babies. Even with limited resources, great surgical results with a high level of satisfaction in patients and caregivers may be accomplished with sound clinical judgment and competency of the surgeons and clinicians. Prenatal diagnosis should be encouraged.

Surgical treatment and outcome of the hydatid cyst: A study from a tertiary care center in Nepal

Introduction: Hydatid cyst is commonly encountered in Nepal with different clinical presentation. Surgery is the treatment of choice. For H. cyst of lung, beside standard thoracotomy Video assisted Thoracoscopy Surery (VATS) has equally good outcome.Method: This was a retrospective, descriptive study of duration of 5 years from 2017 to 2021, conducted in Department of General Surgery of Bir Hospital, National Academy of Medical Sciences, Nepal. Result: Out of 43 patients (age 14 – 63years), most common presenting symptom was cough (48.84%), 16.28% were asymptomatic. Patients were treated with standard thoracotomy (72.09%) and VATS (11.63%) with commonest complication of pneumothorax (6.98%), recurrence in (2.33%) having mortality of (2.33%).Conclusion: H. cyst is commonly encounter in Nepal. Surgery is the treatment of choice. For the treatment of the pulmonary H.cyst VATS is safe having good result.

Impact of Right Ventricular Dysfunction in Morbidity and Mortality in Patients with Inferior Wall Myocardial Infarction Presenting to a Tertiary Care Center of Nepal

Impact of Right Ventricular Dysfunction in Morbidity and Mortality in Patients with Inferior Wall Myocardial Infarction Presenting to a Tertiary Care Center of Nepal

Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia; however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia, mild, moderate and severe anemia. An overall incidence of mortality in anemic patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia was high in the Nepalese patients with Rheumatic valvular heart disease planned for elective surgery. There was an increased incidence of blood transfusion, longer hospital stay, and increased mortality in anemic patients compared to their non anemic counterparts.

Assessment of Inter-Incisal Distance among the Bachelor Level Students of a Tertiary Care Centre of Nepal

INTRODUCTION: The inter-incisal distance at maximum mouth opening has been referred to as normal mouth opening. Variations in the inter-incisal distance exists among different age groups, sex, gender, race and ethnicity. The mean inter-incisal distance is required during the treatment of maxillofacial fractures, temporomandibular joint disorders, oral malignancies, reconstructed mouth anomalies, and craniofacial syndromes. The aim of this study was to determine the maximal inter-incisal distance among bachelor level students of tertiary care center of Nepal. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among the 320 bachelor level students of Chitwan Medical College. Convenience sampling method was used. Sex and ethnicity of the patient were recorded. Inter-incisal distance was measured in all the participants with the help of tongue depressor. The data were entered in Microsoft Excel 2019 and later transported to Statistical Package for Social Science (SPSS) version 16 for the statistical analysis. Descriptive statistical analysis was done. RESULTS: In this study among the 320 participants 131 (40.9 %) were male and 189 (59.1 %) were female. The mean age was 22.34 ± 2.02 years. The mean inter-incisal distance of male and female was 48.69 ± 6.92 mm and 46.51 ± 6.24 mm respectively. The mean inter-incisal distance was maximum in Muslims who had inter-incisal length ie.51.24± 3.54 mm, followed by Buddhists 48.86± 5.89 mm. CONCLUSIONS: This study concluded that the mean inter-incisal distance of male was more than that of female. On the basis of religion, Muslim students had maximum inter-incisal length followed by Buddhists, Hindus and Christians. On basis of ethnicity this study documented the maximum inter incisal distance in Chhetris and minimum in Newars.

Hepatorenal Syndrome in Cirrhosis of Liver at Tertiary Care Centre of Nepal

Introduction: Hepatorenal syndrome (HRS) is the development of renal failure in patients with severe liver disease. Acute renal dysfunction including HRS is commonly occurs in hospitalized patients with cirrhosis. It is observed that morbidity and mortality remain high once the syndrome is established. This syndrome is usually managed with different vasoconstrictors and albumin with variable outcome but ultimate treatment is the liver transplantation. Methodology: This was a hospital based descriptive study carried out in Liver unit of Bir hospital. The cases were collected from (April, 2015 to March, 2016), admitted in Liver unit, Bir Hospital, Kathmandu, Nepal. One hundred and thirty eight cases were randomly selected from 450 patients admitted in the hospital.Patients of HRS were selected and treated with one of the treatment regime from 1. Albumin and Nor adrenaline group 2. Albumin and Dopamine group 3. Dopamine only 4.Terlipressin and Albumin groups. Patients with No HRS group were treated according to standard protocol of the institute.

A Comparative Study between Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis in a Tertiary Care Center of Nepal

Background: Laparoscopic Cholecystectomy is considered as a gold standard treatment for symptomatic cholelithiasis. The timing of surgery for acute Cholecystitis is still controversial, weather to go early surgery or wait for six to eight weeks after conservative management. Therefore, the aim of this study is to compare the clinical outcomes of early versus delayed laparoscopic cholecystectomy for acute Cholecystitis.&#x0D; Materials and Methods: A prospective study was conducted in Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Total of 80 patients with the diagnosis of acute Cholecystitis were enrolled in the study. The patients were equally divided in two groups: 40 underwent early laparoscopic cholecystectomy within 72 hours of admission (Group A) and next 40 underwent delayed laparoscopic cholecystectomy after 6-8 weeks of conservative management (Group B).&#x0D; Results: Out of 80 patients of acute Cholecystitis, mean age of the patients in Group A was 43.40±13.45 years and that in Group B was 44.80±14.36 years. The mean operative time in Group A was 90.22±2.81 minutes whereas in Group B it was 80.97±4.47 minutes. Mean duration of Hospital stay in Group A was 2.02±0.15 days whereas in Group B it was 2.15±0.36 days. Two patients in Group A and one patient in Group B converted to open cholecystectomy. Three patients of Group A and one patient of Group B landed in outpatient department with superficial surgical site infection. Group B patients underwent second hospital admission compared to Group A patients.&#x0D; Conclusion: Early Laparoscopic cholecystectomy for acute cholecystitis is almost comparable with delayedLaparoscopic cholecystectomy. However, early laparoscopic cholecystectomy reduces the morbidity of patients as well as it is cost-effectiveness.

Intraoperative Neuromonitoring in Predicting Neurological Deficits in Patients with Intramedullary Lesions in a Tertiary Care Center in Nepal

Introduction: Intramedullary spinal cord lesions (IMSCL) constitute 20%–30% of all spinal cord lesions. There is still uncertainty regarding the usefulness of intraoperative neuromonitoring (IONM) during spinal surgery. The purpose of this study is to determine the effectiveness of IONM in patients undergoing intramedullary spinal surgery. Methods: Twenty-three patients who underwent surgery at the Department of Neurosurgery, Tribhuvan University Teaching Hospital from January 2017 to December 2020 were included. Somatosensory evoked potential, transcranial motor evoked potentials and electromyography were recorded. Patients were divided into three groups based on IONM parameters: 1. one with no drop 2. one with a decrease and a recovery during surgery, and 3. one with a decrease but no recovery. The duration of follow-up was six months. Results: Neurological improvement was noted in 14 patients, stable in 4, and worse in 5. Out of 14 patients with clinical improvement, 9 had no decrease in IONM, while 5 had a temporary decrease. Among 4 patients whose postoperative status remained unchanged, 2 had no decrease in IONM, while one had a temporary decrease and one has a sustained decrease. Among 5 patients who deteriorated postoperatively, 1 had no decrease in IONM, and 4 had a decrease without recovery. During surgery, patients who demonstrated monitoring alterations but reverted to baseline had better neurological outcomes than those who did not (p=0.045). Conclusion: Our findings support that IONM is an effective tool for the safe resection of IMSCL. Further multi-centric larger studies are recommended to gain more insight into IONM.

Incidence and Patterns of Major Complications Following Spinal Instrumentation- A Retrospective Descriptive Study from a Tertiary Care Center in Nepal

Background: With the continuous uprise of spinal instrumentations within the global front, the complications they harbinger may have multispectral effects upon the patients as well as their caretakers. These are of prime significance in the context of low and middle-income nations. There is however drought of studies pertaining to the same in our subcontinent. Materials and methods: A retrospective descriptive study was undertaken to study the incidence and patterns of early and late major complications among 300 patients undergoing spinal instrumentation from the hospital database of the College of Medical Sciences (CMS), in Bharatpur, Chitwan, Nepal. Results: Trauma comprised 63.33% of cases in the study. 40% of the study cohorts were either in the American Spinal Injury Association (ASIA) ‘A’ or ‘B’ neurological status. The incidence of major complications in our study cohort was 20.33%. The posterior-only surgical approach was undertaken in 200 (66.67%). Surgical site infection was the most common type of complication observed (6.67%). Hardware-related complications were observed in 5.67%) of cases. The incidence of re-operation was 2.67%. The mortality rate observed in our study was 2%. Conclusion: Adequate preoperative planning, proper optimization of the patient, and adoption of procedure-specific, risk-adjusted predictive models may be pivotal for nullifying complications adherent to spinal instrumentation.

Virologic Response Following a Switch to Dolutegravir-based Regimen in People Living with HIV/AIDS at a Tertiary Care Center in Nepal

Background The dolutegravir-based antiretroviral regimen is the preferred first-line regimen for the management of people living with human immunodeficiency virus in Nepal recently. It is considered safe to transition to a dolutegravir-based regimen for children and adults on Nevirapine and Efavirenz-based regimens.&#x0D; Objective To determine the virologic response following the transition to a Dolutegravir-based regimen in people living with human immunodeficiency virus previously taking Nevirapine and Efavirenz-based regimen.&#x0D; Method This is a retrospective cohort study including people living with human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) who were transitioned to Tenofovir/Lamivudine/Dolutegravir previously on other antiretroviral therapy regimens for at least 6 months and who had their viral load test done before transition. The medical records of patients were reviewed from records available at the antiretroviral therapy clinic of Dhulikhel Hospital. The viral load done at least 3 months after switching to the Dolutegravir-based regimen was recorded. Descriptive analysis of socio-demographic and clinical characteristics data was done.&#x0D; Result Fifty-seven people living with human immunodeficiency virus/ acquired immunodeficiency syndrome who transitioned to a Dolutegravir-based regimen previously on other antiretroviral therapy regimens for at least 6 months were included in this study. Tenofovir/Lamivudine/Efavirenz (47.4%), Zidovudine/ Lamivudine/Nevirapine (22.8%) and Zidovudine/Lamivudine/Efavirenz (17.5%) were the most common antiretroviral regimens before transition. The majority of the patients (86%) had suppressed viral load of fewer than 40 copies/mL before the switch. Following the transition, 96.5% of the patients had suppressed viral load of fewer than 40 copies/mL.&#x0D; Conclusion Dolutegravir-based antiretroviral regimen led to untransmittable viral load following a switch from Nevirapine and Efavirenz-based regimen.