Stump Appendicitis with Diagnostic Dilemma: A Case Report

Stump appendicitis is a rare delayed complication of incomplete appendectomy. The clinical symptoms and signs are like acute appendicitis. The possibility of stump appendicitis is not clear to all clinicians. It represents a diagnostic dilemma with incidence of one in 50,000 cases. We report how we encountered diagnostic dilemma during the management of a 30 years old male patient of acute abdomen with history of appendectomy done for acute appendicitis even years back.

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.

Histopathology of Polyps and Cancer of Colorectum: A ten years study from a tertiary care center

Introduction and objectives: Polyps and colorectal cancer have overlapping clinical presentation and may be difficult to diagnose on clinical grounds alone and close clinicopathological correlation is required for correct diagnosis and management. This study was aimed to see the spectrum of polyps and cancer in colorectum, see the percentage of colorectal cancer in younger individuals, see association between histologic grade and pathologic stage at presentation and compare site of tumor and pathologic stage at presentation in younger and older age group. Methods: This study was carried out on 138 consecutive cases of polyps and malignant lesions of colorectum during a time period of 10 years from January 2011 to December 2020. Results: Age of the patients ranged from 2 – 90 years with mean 45.1 years and a male female ratio 2:1. There were 58 (42.0%) cases of polyps and 80 (58.0%) cases of malignancies. 37 (46.3%) malignancy cases were seen in individuals ≤ 50 years of age. Most common site of involvement was rectum in 80 (58.0%) cases. Most common non-neoplastic polyp was retention polyp comprising 25 (67.6%) and most common neoplastic polyp was adenoma comprising of 18 (85.7%) cases. Most common malignancy was adenocarcinoma comprising 75 (93.8%) cases. Conclusion: Significant number of malignancies is seen in younger individuals stressing the need for suspicion and surveillance in this age group. Histologic grade is an important prognostic parameter and there is no difference in site of tumor and stage at presentation between younger and older age group.

A study of efficacy and feasibility of laparoscopic surgery in a tertiary care center, Pokhara, Nepal

Introduction: Laparoscopic surgery is the gold standard technique for most of the gastrointestinal surgeries in developed countries. However, challenges in developing countries, apart from cost of instrumentation, include lack of awareness. Therefore, the aim of this study is to determine the efficacy and feasibility of laparoscopic surgeries in our part of the world. Methods: Retrospective, cross-sectional study was carried out from January 1, 2018 to June 30, 2019. Patient’s information on demographic details, type of laparoscopic surgery, operation time, length of hospital stay, reasons for conversion to open surgery, and intra-operative and post-operative complication details were retrieved from the operation log book and patient’s chart. Results: A total of 380 patients that underwent laparoscopic surgeries were included in the study. Out of 193 patients that underwent laparoscopic cholecystectomy, there were 144 (74.61%) females and 49 (25.38%) males with conversion rate of 4.66% and post-operative complication rate of 8.80%. Similarly, among 136 patients that underwent laparoscopic appendectomy, there were 68 (50%) females and 68 (50%) males with conversion rate of 4.41% and post-operative complication rate of 14.70%. Finally, amid 51 patients who underwent trans-abdominal pre-peritoneal approach, post-operative seroma collection was seen in three cases and port site hematoma formation was seen in two cases only. Conclusions: Our results were comparable with various literature demonstrating that laparoscopic surgeries are safe and effective. However, evolution of laparoscopic surgery in developing countries is still slow. Therefore, effective training and availability of required instruments is needed.

Role of Nasal parameters in gender determination among medical students

Introduction: Anthropometric measurement of the nose has a great importance to differentiate gender, race, and ethnicity. Nasal index is an important parameter in forensic sciences and rhinoplasty surgery. Our aim is to compare the nasal index of both males and females and its role to identify gender differences among medical students. Methods: First and second year medical students were chosen and height, breadth and nasal index were calculated. The height and width of the nose was measured using a vernier caliper. The nasal index of both males and females were calculated and compared and based on this, the nasal shape was also determined. Results: Among 184 total participants, 114 (61.9%) were Nepalese and 70 (38.1%) were Indian. In the Nepalese cohort, mean nasal height for male students was 4.58 ± 0.37 cm which was higher than females (4.39 ± 0.34 cm). The mean nasal index was higher among males in students of both the countries. The mesorrhine was most common type of morphology found among all students. Conclusions: Nasal index of male medical students was significantly higher than females. Mesorrhine nose was the commonest type of nose in our study. This information may be used to estimate gender differences.

A study of height, weight and body mass index in Nepalese

Introduction: The height measurement is an important anthropometric measurement which can be directly correlated with health status of an individual. Body weight of an individual refers to total body mass and is also important indicator of health status of people. Body mass index (BMI) is a key index for relating weight to height. It is defined as the body mass divided by the square of the body height, The BMI is an attempt to quantify the amount of body tissue mass in an individual, and then categorize that the person as underweight, normal weight, overweight or obese. Objectives: To find out the average height and weight, to calculate BMI and find out its average value and to correlate height and weight in Nepalese population. Methodology: A cross sectional study was conducted in subjects from different parts of Nepal. Three hundred twenty one healthy subjects of 25-40 years of age group were studied. Height and weight of subjects were recorded and BMI was calculated. Data were analyzed using SPSS. Result: In overall Nepalese population, Mean height was found to be 156.6 ± 6.3 cm; mean weight 56.6 ± 11.4 kg and BMI 20.9 ± 1.8 kg/m2. Pearson’s correlation co-efficient(r) for height and weight was 0.88. Conclusion: There was partial positive correlation between height and weight. There was statistically significant difference in height, weight and BMI between Nepalese male and female(p<0.05).

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.

Functional outcome among patients treated by percutaneous cannulated screw with tension band for transverse patella fracture

Introduction: Tension band wiring is the most commonly used treatment method for transverse patella fracture. Tension band construct can be achieved by various modifications. Percutaneous cannulated screw with tension band is a minimally invasive technique with stiffer fixation that follows tension band principle. This study aims to assess the clinical and radiological outcome using percutaneous cannulated screw with tension band for the management of transverse patella fracture. Methods: This was a prospective study among 30 adult patients who had closed displaced transverse patella fracture. Patients with polytrauma, comminuted fracture, neurovascular injury and prior injury to the limb were excluded from the study. Each patient was followed up at 2 weeks, 4 weeks, 3 months and 6 months postoperatively. Results: Among all surgically treated patients using this technique, Pain gradually decreased over time and was less than VAS score of 1 in all patients at 6 months follow-up with an average score of 0.3. The final range of motion at 6 months was: flexion ranging from 122 to 145 degrees and extension lag from of 0 to 8 degrees. There was significant improvement in range of motion of knee in each follow up. The mean duration for fracture union was 11.4±2.3 weeks. There were no cases of nonunion and hardware failure. The mean Lyshom score was 82.5 at final follow up. Conclusions: The percutaneous fixation of transverse patella fracture with cannulated screw and SS wire is safe and effective method which gives good functional outcome.

Cernea's classification of the External Branch of the Superior Laryngeal Nerve during Microscopic Thyroidectomy at Gandaki Medical College, Pokhara

Background: Preservation of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy is important because its injury may lead to frequent occurrence of vocal fatigue and the inability to perform phonation. The objective of the study was to identify and classify the nerve as per Cernea's classification using operating microscope during thyroidectomy Method: Between January 2017 to December 2019, we evaluated 50 patients for the position of external branch of superior laryngeal nerve, who underwent microscopic thyroid surgeries in the department of ENT- head and neck surgery at Gandaki Medical College. Results: In our study, we dissected a total 59 superior poles of thyroid from 50 patients and identified the nerve in all the cases. Of the total superior poles, 36 (61.01%) had type IIa EBSLN among which 24 was on the right side and 12 on the left followed by 19 (32.20%) patients with type IIb EBSLN among which 8 on right and 11 on left side. There were only 4 poles (6.77%) of type I with 3 on the right and 1 on the left side. Conclusion: The EBSLN can be very efficaciously identified during a microscope assisted thyroidectomy. Cernea type 2a and 2b EBSLNs are in position to be at high risk of injury during ligation of the superior vascular pedicle, which can be avoided by prompt identification through a microscope and a meticulous extra capsular dissection technique.

Knowledge, Attitude and Practice among endodontists of Nepal in patient management during COVID-19 arena

Background: Coronavirus disease, 2019 (COVID-19) is an infectious disease caused by the severe acute respiratorysyndrome coronavirus 2 (SARS-CoV-2).COVID-19 is a global pandemic affecting all aspects of life in all countries. Endodontist are at inherent risk because of aerosol generating procedures. The objective of the study was to assess the knowledge, attitude and practice (KAP) among Endodontists of Nepal to combat the COVID 19 pandemic. Method:A web-based cross-sectional study was conducted among Endodontist of Nepal from March to June 2021.Convenient sampling method was adopted. The data were analysed using SPSS version 20.Descriptive statistics was performed, percentage and frequency distribution were assessed. Chi-square tests wereused to see the association between the categorical variables. A p-value of <0.05 was considered statistically significant. Results: Out of the total 81 Endodontists who responded to our study, 55.6% of them were females and 44.4% males. Around 65%were from Bagmati province.Majority (87.7%) of responders reported that they categorize the cases on the basis risk assessment, 56.8% do not perform routine procedures during the pandemic. Maximum (97.5%) of the responders discuss about COVID-19 with the patients.About 55% of the responders use rubber dam during the endodontic procedures, while 17.3% of the responders do not use them at all. Conclusion:Endodontists of Nepal werefound to have good knowledge, attitude and practice score, which is important to overcome the present pandemic scenario of COVID19.Certain pitfalls in attitude and practice level can be decreased by efficient training programs, precise guidelines, and treatment protocols.