Assessment of Functional Outcome of Bicolumnar Dual Plating for Bicondylar Fractures of Tibial Plateau

Introduction: Operative treatment of bicondylar fractures of tibial plateau is challenging and controversial. Aims: The aim of this study is to reveal the functional outcome of it by using bicolumnar dual plates and screws. Methods: This is a prospective hospital based interventional study carried out in the department of Orthopaedics of Nepalgunj Medical College Teaching Hospital. Thirty two Schatzker type V or AO (Association of Osteosynthesis) type 41 C1 & C2 fractures were treated between January 2016 and December 2019 with bicolumnar dual plating. The functional clinical outcomes were analyzed and evaluated using modified Rasmussen score. Results: Thirty two patients were included in the study. Out of which twenty four were male and eight were female. Average age was 32.21 years, eighteen were right sided and fourteen were left sided. Duration of surgery was 106 mins (range 90-120 mins) and the average duration of hospitalization was 7.81 days (range 4-14 days). Five patients of impending compartment syndrome and three patients with common peroneal nerve palsy were managed conservatively and also were included in the study. Two patients with superficial wound infection needed minimal debridement. One patient had varus angulation of 100 at third follow up after he fell from bed but surgical intervention were not needed. All fractures united. The average time for fracture healing was 21.5 weeks (range 16-32 weeks). At the Eighteen months follow up, the average knee range of motion was 1310(range 1100-1400). The functional outcome were evaluated using modified Rasmussen scoring system, which was 27.34 (range 22-30). Conclusion: Bicolumnar dual plating for bicondylar fractures of tibial plateau can provide excellent and stable fixation allowing early range of motion and gives excellent to good functional outcome.

Making Monsters

Instructors have critically sought ways to embody the theories and ideals espoused in radical texts and work to better force changes in the type of students we produce. What is presented here is an honest reflective dialogue, based on a reflexive critique of 17 years as a professor and the students I have encountered. But more importantly, this is also based on an equal set of years studying the aftereffects of White supremacy, the “candy wrapper” left on the ground at a campsite that informs someone was present, insinuates what may have been done, and eludes a sense of disregard while foreclosing any understanding of what it will go on to do next. Those candy wrappers are the “mild” subjects of the legacy of lynching, colonialism, and state-sanctioned violence. So, in the context of being a faculty member engaged with students, I pose a question to you, for us, from me: What if instead of “transgressing” White supremacy, we are in fact maintaining it? Many of us in higher education have come to an understanding that diversity, equity, and inclusion (DEI) is insufficient for college teaching and student learning to positively move forward through the 21st century. If we are to understand White supremacy not as a societal add-on that has corrupted the world around us but instead as the actual world around us, how do we properly contextualize this in a course or class? How do we foster experiences that deepen an understanding of a systemic reality? This essay challenges reductionist understandings of White supremacy as a matter of privilege that are reflected in DEI, culturally responsive teaching, dismantling, antiracist, invisible-knapsack-based approaches. Could it be that through this reduction we are instead producing “monsters”?

Knowledge, attitude and practice of over-the-counter drug among undergraduate medical students-a cross sectional study

Background: Self-medication of the over-the-counter (OTC) drug is practice all over the world. Although appropriate self-medication practice can address minor illness and is time and cost-effective, it can promote irrational use of medicine; prolong the illness, drug dependency and abuse. Medical students are the future medical practitioners and play the crucial role in counseling the patients. Therefore, the present study was conducted to assess the knowledge, attitude and practice of self- medication among undergraduate students. Methods: An institution based descriptive, cross sectional study was conducted after ethical approval was taken from the Institutional ethical committee of Gandaki medical college teaching hospital and research center (GMCTHRC) and data was collected from May to July 2018. Descriptive and correlation analysis were done with the data. The results were expressed in percentages. Results: Among 115 respondents, 60.9 % (70) were female and 39.1% (45) were male students. Majority of respondents (94.8%) believed that instruction on the label of the drugs should be followed and 78.3% respondents agreed that OTC drugs could interact with other prescribed drugs. However, only 53.9% respondents knew that OTC drugs were Group Ga drugs in Nepal. Despite good knowledge and attitude only 37.4% students had good practice in the rational use of the OTC drugs. Moreover, Antipyretic and analgesic drugs were the most commonly used drugs. However, only 36.84% respondents (p<0.05) knew about the correct dose and duration to take the drugs. Conclusions: We concluded that first year medical and dental should be motivated to use their knowledge into practice.

Prevalence of Anemia and Morphological Variation in RBC among COPD Patients admitted at a Tertiary Health Care Center, Kathmandu, Nepal

Many studies have depicted that anemia is one of the most common co-morbidity among Chronic Obstructive Pulmonary Disease (COPD) patients. Therefore, its correction in those patients is an important aspect of the treatment protocol. Our study was designed to explore the prevalence of anemia and morphological alteration, if any, in RBC among COPD patients. The study was conducted from November 2020 to June 2021 among the COPD patients admitted in the Medical ward of Nepal Medical College Teaching Hospital. If hemoglobin level was <13gm/dl in males and <12gm/dl in females and/or hematocrit level was <39%, the patient was considered anemic. Anemia was morphologically classified following standardized procedure with RBC indices as a reference. Among the COPD patients (n=101), 40 (39.6%) were anemic, out of which 21(52.5%) was normocytic normochromic, 10 (25%) were microcytic hypochromic, 5 (12.5%) were normocytic hypochromic, 3 (7.5%) were microcytic normochromic and (2.5%) was macrocytic hyperchromic. Anisocytosis was commonly noted (25.7%) among the COPD patients with microcytosis (20.8%) and macrocytosis (4.9%) among them. Among the patients, 23.8% showed hypochromia while only 0.9% showed hyperchromia. Polycythemia was present in 24 (23.8%) of them. Inflammatory mediators and cytokines in COPD causes a compromised response of marrow cells to erythropoietin and shortens the survival of red blood cells.

Outcome of Extracorporeal Shockwave Lithotripsy as Monotherapy in Upper Urinary Tract Lithiasis

Introduction: Due to its non-invasive nature, extracorporeal shockwave lithotripsy (ESWL) is the preferred treatment modality for uncomplicated renal and ureteral stone < 20 mm in diameter. The success rate of it ranges from 46% to 91% depending on various factors. Objective: To assess the outcome of ESWL as monotherapy in uncomplicated solitary renal and upper ureteric calculus ranging from 10mm to 20mm. Methods: In this retrospective study, the records of 34 patients who underwent Extracorporeal shockwave lithotripsy ESWL inBirat Medical College – Teaching Hospital over a period of one and a half years were reviewed to assess the outcome in terms of stone free rate and complication rate. Results: Mean age of the patients was 30.57±8.44 years and mean calculus size was 14.47±2.68 mm (range 10-20mm). The male and female ratio was 2:1. The success rate was higher for pelvic (83.33%) and upper calyceal (75%) and upper ureteric calculi (75%) compared to other calyces. Clinically significant residual fragment (CSRF) was the most common problem after ESWL (23.33%) at three months after the procedure. Conclusions: The outcome of ESWL as monotherapy for upper urinary tract calculi is acceptable in selected cases three months after the procedure. Keywords: Extracorporeal shockwave lithotripsy; outcome; upper urinary tract calculi.

Vectorial analysis of the electrocardiogram from conventional limb leads in healthy adult Nepalese females

Introduction: ECG interpretation plays a vital role in the initial evaluation of patients presenting with cardiac complaints. Assessment of degree of cardiac vector is one of the important parameters to be studied in ECG. Methods: A prospective cross-sectional study was carried out among 84 female subjects, aged 18- 40 years of age, including students and staff of Gandaki Medical College Teaching hospital and Research Center, Pokhara, Nepal over a period of one month from 1st Oct to 1st Nov 2021. A Standard ECG machine was used and the ECG was recorded using the conventional limb leads. The individual mean electrical axis of the heart was plotted using the net voltage of QRS complex of Lead-I and Lead-III. The possible correlation between cardiac vector and physical measurements like height weight BSA and BMI were analyzed. The data were analyzed in SPSS version 27. Results: The normal mean electrical axis of the healthy female subjects was observed as 61.7±23.51°. There was a significant positive correlation of cardiac vector with height (p< 0.05), whereas a negative correlation was observed with weight and BMI (p< 0.01). However, there was no significant correlation with BSA. In our study, we observed the maximum left axis cardiac vector as -2° and right axis as 98° among 84 female subjects. Conclusion: Documentation of cardiac vector was made using standard bipolar limb leads in normal healthy female subjects. BMI is involved in the deviation of cardiac vector with a negative correlation. This observation could make it quite attractive for use in clinical practice.

Assessment of Safety of Vaginal Repair of Pelvic Organ Prolapse in Elderly at Birat Medical College Teaching Hospital, Nepal

Background: Pelvic organ prolapse in elder women causes sufficient morbidity and decreased quality of life. Despite age related comorbidities and decreased physiological capabilities, elder women with pelvic organ prolapse may be benefitted by surgical repair via vaginal route.The purpose of this study is to evaluate the safety of vaginal repair of pelvic organ prolapse in women of age 60 years or older. Materials and Methods: This hospital based analytical study was carried out in Birat Medical College Teaching Hospital from September 2020 to September 2021. Fifty-four patients aged 60 years or older with third and fourth degree pelvic organ prolapse were recruited for the study. Necessary information was obtained by self-structured questionnaire and entered into Microsoft Excel. Data was analyzed by SPSS version 22. Results: Fifty-four women with third or fourth degree prolapse with cystocele and rectocele underwent vaginal hysterectomy with anterior colporrhaphy with posterior colpoperineorrhaphy. No organ injury occurred during operation. There was no mortality or severe intraoperative or postoperative complications. Conclusion: Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in women of 60 years or older is safe.

Status of Vitamin D among People Visiting a Tertiary Care Center of Eastern Nepal: A Hospital-Based Study

Background: Vitamin D deficiency is a serious health-problem worldwide and the estimation of its plasma concentration is crucial. The study aims to determine the circulating levels of vitamin D in patients visiting Birat Medical College Teaching Hospital, one of the tertiary care centers of Eastern Nepal. Materials and Methods: It was descriptive cross-sectional study conducted in the Department of Biochemistry at Birat Medical College Teaching Hospital, Nepal. From the hospital registry, clinical data of 250 patients including their age, gender and serum 25-hydroxy vitamin D was retrieved for the four months of May – August, 2021. The vitamin D status was classified as deficiency (<10 ng/mL), insufficiency (10–30ng/mL), sufficiency ≥ 30ng/mL) and toxicity (≥ 100 ng/mL). Results: Out of total subjects (n=250), none of them showed toxic serum concentrations of vitamin D, 38% had sufficient, 57% had insufficient and 5% had deficient levels of this vitamin. Among affected individuals, vitamin D insufficiency had predominated in 41% population who were 41-60 years old. Gender-wise comparison of vitamin D status in the insufficiency group showed around 33% males and 67% females having insufficient levels of this vitamin. Conclusion: With the vitmain D inssufficieny present in more than half of the study population, it becomes paramount to further scrutinize the associated factors apart from the age and gender. To this end, further studies are needed.