Tertiary Care Center In Nepal Research Articles

Cesarean Section Rate at Lumbini Zonal Hospital, Nepal: An Analysis Using the Robson Ten Group Classification System

Background Caesarean section (CS) rates have increased globally. The World Health Organization (WHO) recommends the use of the TenGroup Robson classification as the global standard for assessing appropriateness of CS. Nepal has higher-than-global average rates of CS requiring further investigation into appropriateness. Aim This study aims to investigate the caesarean section rates at tertiary care center in Nepal and make analysis based on the group-10 classification. Methods A retrospective cross-sectional study was carried out from 2016 April -2017 March in Lumbini Zonal Hospital, Butwal, Rupendehi, Nepal. 3,817 women who birth over a 12-month period were analyzed using this classification. The caesarean rate, its indications were calculated and categorized into groups according to Robson’s 10-group classification. Results Women with previous CS (Group 5) comprise the largest proportion (9.4%) of the overall 26.41% CS rate. The second largest contributor was a singleton nulliparous woman with cephalic presentation at term (6.6% of total 26.41%). Caesarean section rates in single breech pregnancies were very high (>65%). Robson’s Group 5 was the highest contributors to overall CS rate contributing 35% of all C-sections, followed by Group 2 (24%), and Group 1 (13%). Conclusion The ten-group classification helped to identify the main groups of the subjects who contribute the most to the overall caesarean section rate. This study results suggest that women with previous CS are at risk for having another CS delivery in subsequent pregnancies and therefore there is an urgent need for a dedicated vaginal birth after caesarean section (VBAC) clinic to support this such women to ensure CS are only done when indicated. Furthermore, reducing the CS rate for nulliparous i.e. Group 1 and 2 would, in the long-term, also reduce the size of Group 5 in the future.

Management of Postpancreatectomy Hemorrhage Following Pancreaticoduodenectomy at a Tertiary Care Center in Nepal

Introduction Postpancreatectomy hemorrhage (PPH) is an important complication which significantly increases morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to find the incidence, classification, management, and mortality associated with PPH following PD. This study also describes the changes in management and outcomes between the period of 2004-2014 and 2015-2019 in our institute as in the later time period there was use of CT angiography and interventional radiology (IR) to identify and control the bleeding site.
 MethodsThis is a retrospective study in which medical records of patients having PPH following PD between 2004-2019 were analyzed. The grading and classification were done according to the International Study Group of Pancreatic Surgery (ISGPS). Management and outcomes were analyzed using standard descriptive statistics.
 ResultsA total of 43 patients developed PPH out of 336 PDs. Out of 43 patients, 4 (9.3%) had Grade A, 16 (37.2%) had Grade B and 23 (53.5%) had Grade C PPH. Fifteen (35%) patients were managed conservatively, seven (16.2%) with IR procedure and 21 (48.8%) were reexplored. There were 16 (37.2%) mortalities, out of different factors- intraoperative blood loss >500 ml showed the predictability for mortality (p= 0.01). On comparing two time periods it was seen that the PPH rate was almost similar but the mortality decreased from 58.8% to 23.07%.
 ConclusionPPH following PD is associated with high mortality. Increased use of IR procedure and CT angiography can decrease the relaparotomy rates and eventually decrease mortality.

Management of Postpancreatectomy Hemorrhage Following Pancreaticoduodenectomy at a Tertiary Care Center in Nepal

Introduction: Postpancreatectomy hemorrhage (PPH) is an important complication which significantly increases morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to find the incidence, classification, management, and mortality associated with PPH following PD. This study also describes the changes in management and outcomes between the period of 2004-2014 and 2015-2019 in our institute as in the later time period there was use of CT angiography and interventional radiology (IR) to identify and control the bleeding site. Methods: This is a retrospective study in which medical records of patients having PPH following PD between 2004-2019 were analyzed. The grading and classification were done according to the International Study Group of Pancreatic Surgery (ISGPS). Management and outcomes were analyzed using standard descriptive statistics. Results: A total of 43 patients developed PPH out of 336 PDs. Out of 43 patients, 4 (9.3%) had Grade A, 16 (37.2%) had Grade B and 23 (53.5%) had Grade C PPH. Fifteen (35%) patients were managed conservatively, seven (16.2%) with IR procedure and 21 (48.8%) were reexplored. There were 16 (37.2%) mortalities, out of different factors- intraoperative blood loss >500 ml showed the predictability for mortality (p= 0.01). On comparing two time periods it was seen that the PPH rate was almost similar but the mortality decreased from 58.8% to 23.07%. Conclusion: PPH following PD is associated with high mortality. Increased use of IR procedure and CT angiography can decrease the relaparotomy rates and eventually decrease mortality.

Endoscopic Management of Foreign Body Impaction in the Upper Gastrointestinal Tract in a Tertiary Care Centre of Nepal

Background Ingested foreign body impaction on upper gastrointestinal tract is common incidence among children, older age group, mentally challenged individuals, and people the influence of alcohol. In most cases, the foreign bodies pass spontaneously and uneventfully but when this does not occur; endoscopic management to ensure removal under direct visualization is required. Relief upon removal of foreign body and prevention of complications is essential. Objective To assess the endoscopic management and outcome of foreign body impacted in the upper gastrointestinal tract. Method This is a hospital based observational retrospective cross sectional study involving 165 patients at Endoscopy Department of Dhulikhel Hospital in Nepal between November 2015 and October 2019. The data regarding the demographic profile, clinical characteristics and endoscopic findings were retrieved and analyzed to determine endoscopic interventions performed, complications and outcomes. Result One hundred and sixty five patients presenting with history of ingestion of foreign body were included in the study. The mean age of the patients was 46.8 ± 19.1 years with male predominance (60%). The most common site of foreign body impaction was oesophagus (70%). The most common foreign body encountered was bone (62.2%) among which chicken bones (91.1%) were most frequent. For the retrieval of sharp-pointed foreign bodies, rat forceps and graspers (45.7%) were most commonly used. Total 14 cases required rigid oesophagoscopy as the foreign body could not be retrieved by flexible endoscopy. Conclusion Foreign body ingestion and its impaction in the upper gastrointestinal tract has been found to be common in endoscopic practise. Early detection and timely removal of foreign bodies is of utmost importance to avoid discomfort to the patient as well as to ensure successful removal without complications.

Maternal and Perinatal Outcomes of Singleton Term Breech Vaginal Delivery at a Tertiary Care Center in Nepal: A Retrospective Analysis.

Background Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P=0.043). Conclusion The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.

Congenital genital tract obstruction as a challenge for functioning reproductive health: a study from a tertiary care center in Nepal

Aims: To find out the uterovaginal anomalies associated with congenital genital tract obstruction and successes achieved in its management.&#x0D; Methods: This was a descriptive study done at department of Obs/Gyn at Tribhuvan University Teaching Hospital from April 2014 to April 2018. Types of genital tract obstruction, surgical treatment, success of management and surgical complications were studied.&#x0D; Results: Of 35 cases 16 (46%) consisted of adolescents aged 11-15 yrs. Majority cases of GTO was due to vaginal septum 12(34%): longitudinal 4(33%), mostly transverse vaginal septum (TVS) 8(67%): upper TVS 4 and lower TVS 4,one among each associated with concurrent Imperforate hymen (IH). Other GTO consisted of only IH cases 9 (26%), vaginal agenesis 7 (21%), non- communicating rudimentary horn 4 , non-communicating right cornua 1and cervical stenosis 1(3%). Resection of septum performed in 12 cases of vaginal septum. hymenectomy in 8 and rudimentary horn excision in 4 cases. Restenosis was common complication in six cases.&#x0D; Conclusions: Adolescent age of 11-15 years is the common age of presentation of genital tract anomaly with vaginal septum the most common. Pre-surgical assessment is the key to successful surgical outcome.&#x0D; Keywords: adolescent, congenital, genital tract obstruction, resection

Angiographic profile of young patients (≤ 40 years) in a tertiary care center of Nepal

Background: With rise in prevalence of conventional risk factors like diabetes, hypertension, smoking, dyslipidemia and obesity the incidence of coronary artery disease in young patients have increased in the recent decades even in developing world. There have been multiple studies done in Nepal studying the angiographic profile of coronary disease in general population. However, only few studies has been done till date on the angiographic profile in the young population in our country.&#x0D; Aims and Objectives: In this study, we aim to determine the angiographic profile of young patient ≤ 40 years in a tertiary care centre of Nepal.&#x0D; Materials and Methods: A retrospective analytic study was done in Shahid Gangalal National Heart Centre from January 2019 to December 2019. Individuals of both genders with age ≤ 40 years who underwent coronary angiography were included.&#x0D; Results: Total 109 patients were included. Out of 109, 89 were male and 20 were female. The mean age for male was 35.55 ± 4.31 and for female was 38.55 ± 1.90 (P = 0.003). Among 61 (55.96%) patients who had significant coronary artery disease, 33 patients (30.27%) with single vessel disease, 15 patients (13.76%) had double vessel disease, and 13 patients (11.92%) had triple vessel disease. Left anterior descending (LAD) artery was found to be most frequently involved in all patterns of Coronary artery disease (CAD). Smoking was the most common coronary risk factor present in 29.3% of patients followed by hypertension, family history of premature CAD and diabetes in 14.6%, 7.5% and 5.5% of patients respectively. Overall, the prevalence of smoking was more in males (31.4%) than in females (20%).&#x0D; Conclusion: Single vessel disease (SVD) was most prevalent in young patients with significant CAD. LAD is the most commonly involved coronary artery followed by Right coronary artery (RCA) and Left Circumflex (LCX).

Microbiological profile and their antibiotic sensitivity pattern in patients of chronic suppurative otitis media at eastern tertiary care center of Nepal

Chronic suppurative otitis media (CSOM) is one of the most common and an important global public health problem leading to hearing impairment and is particularly prevalent in developing countries. Even in this era of powerful antibiotics, due to increased irrational use of wide spectrum antibiotics, the resistance in the bacterial isolates is common. The objective of the study was to determine the aerobic bacterial etiology of patients with CSOM and the antimicrobial susceptibility of the bacteria isolated.A descriptive cross sectional study was carried out in 112 patients suffering from chronic discharging ear. Pus samples were cultured aerobically. Antibiotic sensitivity testing was performed with standard antibiotic discs using modified Kirby-Bauer disk diffusion method.Out of 112 patients, 70 (62.5%) were females. Among 112 swab cultures, 98 (87.5%) were positive for the growth of organism and 14 (12.5%) were sterile cultures. Among them Staphylococcus aureus (42.24%), Pseudomonas aeruginosa (28.44%), Klebsiella pneumoniae (10.34%), Acinetobacter anitratus (6.9%), Proteus mirabilis (5.17%) and E. coli (4.31%) were the common microbial isolates. Among the antibiotics commonly available as topical eardrops, Ofloxacin (91.83%)) had the highest susceptibility rate, followed by Ciprofloxacin (81.63%), Tobramycin (73.46%) and Gentamicin (63.26%).Staphylococcus aureus was the most common organism isolated followed by Pseudomonas aeruginosa. Ofloxacin had the highest susceptibility rate against the isolated organisms.

Penetrating Keratoplasty - Indications in a tertiary care center in Nepal.

Penetrating keratoplasty has become one of the most commonly performed transplant procedures where full thickness diseased host corneal tissue is replaced with healthy donor corneal tissue. Aims of penetrating keratoplasty include improvement in visual acuity, removal of infectious load, alleviate pain or even to simply save the anatomy of the eye. Visual improvement and removal of infection is the prime objective of majority of corneal grafts. The objective of the study was to evaluate various current indications of penetrating keratoplasty in central Nepal and its difference from the developed world. A hospital based study of 36 patients who underwent penetrating keratoplasty between January 2014 and June 2015 was carried out at B.P. Koirala Centre for ophthalmic studies. Following clinical examination and investigations, surgical intervention was done when required. The patient data were recorded and followed up. Indication for surgery, investigations and demographic profile were assessed. Mean recipient age was 46.56 years (+/- 16.02 years). The male: female ratio was 1.57:1. The most common indication for penetrating keratoplasty was infectious keratitis (44.44%), followed by corneal opacity or scarring (30.56 %), re-grafts (13.89%),bullous keratopathy (2.78%), keratoconus (2.78%) and others (2.78%) Introduction: Penetrating keratoplasty has become one of the most commonly performed transplant procedures where full thickness diseased host corneal tissue is replaced with healthy donor corneal tissue. Aims of penetrating keratoplasty include improvement in visual acuity, removal of infectious load, alleviate pain or even to simply save the anatomy of the eye. Visual improvement and removal of infection is the prime objective of majority of corneal grafts. The objective of the study was to evaluate various current indications of penetrating keratoplasty in central Nepal and its difference from the developed world. A hospital based study of 36 patients who underwent penetrating keratoplasty between January 2014 and June 2015 was carried out at B.P. Koirala Centre for ophthalmic studies. Following clinical examination and investigations, surgical intervention was done when required. The patient data were recorded and followed up. Indication for surgery, investigations and demographic profile were assessed. Mean recipient age was 46.56 years (+/- 16.02 years). The male: female ratio was 1.57:1. The most common indication for penetrating keratoplasty was infectious keratitis (44.44%), followed by corneal opacity or scarring (30.56 %), re-grafts (13.89%),bullous keratopathy (2.78%), keratoconus (2.78%) and others (2.78%) Conclusion: Though corneal diseases and indications for transplant surgery in developing countries are different from those in the western world, penetrating keratoplasty has emerged as one of the most successful way to reduce corneal blindness and to restore vision. Though corneal diseases and indications for transplant surgery in developing countries are different from those in the western world, penetrating keratoplasty has emerged as one of the most successful way to reduce corneal blindness and to restore vision.

Patterns of Rheumatic Heart Disease and Treatment Practices at Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study.

Rheumatic heart disease is a sequel of rheumatic fever which causes heart valve damage. This study was conducted to look at the pattern of valve lesions and treatment practices in patients with rheumatic heart disease. A cross-sectional study conducted at the tertiary care center with a diagnosis of rheumatic heart disease from July 2018 to January 2020 by convenient sampling. Ethical clearance was obtained from the Institutional Review Committee (ref no. 55/2018). Data were analyzed by using Statistical package for social sciences version 20. Out of 600 patients, 428 (71.3%) were female. The mean age was 44.24±14.24 years. The isolated mitral valve was affected in 280 (46.6%). Dual involvement of mitral and aortic valve was present in 294 (49%). Only 14 (2.3%) had involvement of isolated aortic valve involvement. Overall, mitral stenosis was the most common abnormality 508 (84.6%) followed by mitral regurgitation 418 (69.6%), aortic regurgitation 320 (53.3%), and aortic stenosis 63 (10.5%). Assessment of the severity of lesions showed that 247 (41.2%) patients had severe mitral stenosis, 119 (19.8%) severe mitral regurgitation, 14 (2.3%) severe aortic stenosis, and 11 (1.8%) severe aortic regurgitation. Majority 493 (82.2%) were treated with medical therapies. Surgical procedures were performed in 51 (8.5%). The use of anticoagulation was in 212 (35.3%) of eligible patients. Mitral valve was affected commonly both in isolation and combination. The majority of patients who were eligible for cardiac interventions were treated medically with suboptimal use of anticoagulation and secondary prophylaxis.

Computer Vision Syndrome among Patients Attending the Outpatient Department of Ophthalmology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Computers and digital electronic devices have become an integral part of life. These devices have adverse effects and nowadays are considered leading occupational hazards. Computer vision syndrome comprises of all the ocular, visual and musculoskeletal symptoms secondary to long term computer use. The objective of this study is to determine the prevalence of computer vision syndrome among people attending the outpatient department of ophthalmology in the tertiary care center in Nepal. A descriptive cross-sectional study was done among 70 patients in a tertiary care hospital from January 2017 to June 2017 after obtaining ethical approval from the institutional review committee (Ref: 12042017). Convenient sampling method was applied and the point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Patients using computers for more than one hour were included in the study. All data were entered in Microsoft Excel and analyzed using statistical package for social sciences version 20. Among 70 patients, 67 (95.7%) (87.9-99.1 at 95% confidence interval) had one or more symptoms on computer use. The mean duration of computer use was 7.5±5.4 years and average hours of computer use among computer users were 6.9±3 hours. The most common symptom among computer users was headache seen in 46 (62.2%) patients. Our study showed that a significant number of people using a computer develop one or more symptoms on the long-term use of the computer. Therefore, it is very important to create awareness regarding computer vision syndrome and methods to prevent it among computer users.

Scenario of General Anesthesia for Cesarean Section in Rural Tertiary Care Center in High Altitude Karnali Academy of Health Sciences

Background: General anesthesia for cesarean section is being less popular for cesarean section in present days but sometime general anesthesia is inevitable. The aim of the study is to assess the trends of general anesthesia, indications, clinical outcome in mother and fetus in high altitude setting of tertiary care center of Nepal.&#x0D; Methods: We conducted descriptive cross-sectional study all cases of cesarean section in Karnali Academy of health Sciences (KAHS) located at high altitude over three years period in our institute. Data were retrieved from the hospital records during three fiscal year (Jan 1st 2017 to Jan Dec 31st 2019). The record of all the patients who underwent cesarean section under general anesthesia was reviewed for demographic details, indication of general anesthesia, trends for general and spinal anesthesia and maternal and neonatal outcome.&#x0D; Results: Out of total deliveries 2175, 309 (14.2%) cases account for cesarean section. Among them, 52 (17%) required general anesthesia . Eclampsia 19(36%) remain the major indication for General Anesthesia in cesarean section followed by failure of spinal anesthesia number 14 (26%) , cord prolapse six (12%), antepartam haemorrhage five (10%), spinal site infection four (8%), Khiphoscoliosis two(4%), Patients request two (4%). Use for general anesthesia technique was consistent for three years with slow rise in use of spinal anesthesia . There was no any anesthesia related maternal mortality and nine intraoperative neonatal &#x0D; Conclusions: General anesthesia practices are consistently required in rural high-altitude setup. Eclampsia is the commonest indication followed by failure of spinal anesthesia and cord prolapse. Neonatal outcome is still not good.

Epidemiology of Gall Stone Diseases among Patients attending Surgical Department of a Tertiary Care Hospital in Nepal

Background and Objectives: Gallstone disease (GSD) is a chronic disease that consumes a lot of economic and medical resources. It not only affects patients’ life quality, but also is associated with the potential risks of the development of consequences of gallstone diseases. Therefore, the study is aimed to investigate the epidemiology and risk factors of gall stone diseases among patients attending tertiary care centre in Nepal.&#x0D; Material and Methods: A cross sectional study was conducted among patients attending surgical department of Janaki Medical College Teaching Hospital (JMCTH) over a period of one year from January 2019 to December 2019. Chi-square test was applied to show the association between the two groups. P-value &lt; 0.05 was considered statistically significant.&#x0D; Results: In a total of 148 patients, 69.59% had mixed gallstone, 17.57% had cholesterol stone and 12.84% had pigment gallstone. Types of gallstone was found significant for age group (p=0.006), gender (p=0.027) and presence of diabetes (p=0.003) but insignificant with presence of hypertension (p=0.992).&#x0D; Conclusion: Age of the patients, gender and presence of diabetes were found significant for the all types of gall stone. Further large scale research need to be conducted.

Clinical Characteristics and Management of the Hydatid Cyst of the Liver: A Study from a Tertiary Care Center in Nepal.

A hydatid cyst of the liver is a significant yet neglected public health problem in Nepal. The present study was carried out to evaluate the demographic characteristics, clinical presentations, and management of the patients of the hydatid cyst of the liver in the setting of a developing country. It was a retrospective, descriptive analysis of 53 patients admitted in the department of surgery with the diagnosis of hydatid cyst of the liver based on clinical manifestations, imaging studies, or serology between 2016 and 2019. The median age of the patients was 36 years, with the age group of 25-45 years being the most commonly affected (23, 43.4%). 58.5% of the patients were female. Abdominal pain (49, 92.5%) and a palpable liver (17, 32.1%) were the most common complaint and physical finding in our study population, respectively. Abdominal ultrasonography and computed tomography scan were the major imaging studies used to establish a diagnosis. A unilocular and anechoic cystic lesion was the most frequent imaging finding. The right lobe of the liver harbored the cysts in the maximum number of patients. Surgery was the preferred modality of treatment (23, 43.4%), with pericystectomy being the most common form of surgical intervention. The hydatid cyst of the liver is a common cause of morbidity in Nepal. Clinical evaluation supplemented by imaging studies is required for diagnosis, and surgery remains the treatment of choice in most cases. To explain the epidemiological pattern of the disease, multicentric studies involving a larger sample of patients should be conducted.

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

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

Profile and Antibiotic Susceptibility Pattern of Bacterial Isolates from Mobile Phones of Healthcare Workers in a Tertiary Care Centre of Nepal

Introduction: Nosocomial infection is a serious problem worldwide. Healthcare workers mobile phones may act as vehicle for nosocomial infections. Mobile phones are rarely cleaned and healthcare workers frequently use them thorough out their time in hospitals. The objective of this study is to determine the rate of contamination of mobile phones, prevalent microorganisms and their antibiotic sensitivity pattern. Methods: The descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from July 2019 to September 2019 after ethical approval. Samples were collected aseptically by rolling sterile swabs over the exposed surfaces of the mobile phones and inoculated on the agar plates and incubated aerobically. After incubation, plates were examined for growth. Bacteria were identified by standard microbiological procedure and antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method. Statistical analysis was done by Excel 2018. Results: Of the 198 mobile phones sample cultures, 112 (56.6%) samples showed 7 different types of bacteria. Mixed growth was observed in 3 mobile phones and total of 115 bacterial isolates were identified. Staphylococcus species (74.7%) were predominant organism followed by Acinetobacter spp, Klebsiella pneumoniae, E. coli, Citrobacter and Pseudomonas aeruginosa. Total 37.5% of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus (MRSA). Conclusion: Mobile phones may have potential pathogenic microorganisms on their surface and can act as vector in spread of infectious agents in hospital settings. It is recommended to disinfect mobile phones regularly and to implement hand washing practices and regulations around the use of mobile phones in hospital settings.

Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal

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

Pediatric Percutaneous Nephrolithotomy in a Peripheral Tertiary Care Center in Nepal

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

Pediatric Percutaneous Nephrolithotomy in a Peripheral Tertiary Care Center in Nepal

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

Profile and Antibiotic Susceptibility Pattern of Bacterial Isolates from Mobile Phones of Healthcare Workers in a Tertiary Care Centre of Nepal

Introduction Nosocomial infection is a serious problem worldwide. Healthcare workers mobile phones may act as vehicle for nosocomial infections. Mobile phones are rarely cleaned and healthcare workers frequently use them thorough out their time in hospitals. The objective of this study is to determine the rate of contamination of mobile phones, prevalent microorganisms and their antibiotic sensitivity pattern.&#x0D; MethodsThe descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from July 2019 to September 2019 after ethical approval. Samples were collected aseptically by rolling sterile swabs over the exposed surfaces of the mobile phones and inoculated on the agar plates and incubated aerobically. After incubation, plates were examined for growth. Bacteria were identified by standard microbiological procedure and antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by Kirby-Bauer method. Statistical analysis was done by Excel 2018.&#x0D; ResultsOf the 198 mobile phones sample cultures, 112 (56.6%) samples showed 7 different types of bacteria. Mixed growth was observed in 3 mobile phones and total of 115 bacterial isolates were identified. Staphylococcus species (74.7%) were predominant organism followed by Acinetobacter spp, Klebsiella pneumoniae, E. coli, Citrobacter and Pseudomonas aeruginosa. Total 37.5% of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus (MRSA).&#x0D; ConclusionMobile phones may have potential pathogenic microorganisms on their surface and can act as vector in spread of infectious agents in hospital settings. It is recommended to disinfect mobile phones regularly and to implement hand washing practices and regulations around the use of mobile phones in hospital settings.