Complete Recovery of Renal Function among Obstetric Patients with Acute Kidney Injury at a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Acute kidney injury is a rare complication of pregnancy and is associated with high maternal morbidity and mortality. Obstetric factors associated with it are preeclampsia/eclampsia, sepsis, hemorrhage and dehydration. Here, we aim to find out the prevalence of complete recovery of renal function among obstetric patients with acute kidney injury. Methods: This is a descriptive cross-sectional study conducted in a tertiary care hospital from 1st July 2020 to 30th June 2021 where obstetric patients who had developed acute kidney injury were included and followed till 6 weeks of diagnosis. Ethical approvalwas obtained from Institutional Review Committee of Nobel Medical College and Teaching Hospital (IRC- NMCTH 437/2020). The convenience sampling method was used. Data entry and analysis were done using Statistical Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of total 66 obstetric patients with acute kidney injury, 45 (68.2%) (57-79.3 at 95% Confidence Interval) had complete recovery of renal function. Rate of renal function recovery in Stage 1, Stage 2 and Stage 3 acute kidney injury were 19 (90%), 19 (86%) and 7 (58%) respectively. The most common causes of acute kidney injury were Preeclampsia/eclampsia 18 (40%), sepsis 23 (28.8%) and hemorrhage 10 (22.2%). Conclusions: The prevalence of complete recovery in obstetric patients with acute kidney injury was similar to findings from other studies done in similar settings.

Injury amongst Medicolegal Cases in Department of Forensic Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Victim of injuries presenting to a hospital is a medico-legal issue. So, with medical management, proper documentation of injuries should be done as a legal duty by all physicians attending such cases. The study aims to find the prevalence of injury amongst medicolegal cases inthe Department of Forensic Medicine in a tertiary care centre. Methods: A descriptive cross-sectional study was done amongst 328 medicolegal cases presenting at a tertiary center, from January 2019 to February 2021. Ethical approval was obtained from the Institutional Review Committee (Reference number: 2603202101). Convenience sampling was used to select study samples. After detailed history regarding the incidence, injuries were examined and documented in a performa. The data were entered in Statistical Package for Social Sciences version 18. Point estimate at 95% Confidence Interval was calculated along with frequency and percentagefor binary data. Results: Among 328 cases presenting to hospital for medicolegal issues, 237 (72.25%) (67.40-77.09 at 95% Confidence Interval) had injuries, out of which 170 (71.73%) cases were due to physical assault, 64 (27%) cases due to accident; 2 (1.26%) were undetermined. Majority of victims of injury were adult males, with mean age of 32.41±13.96 years. In most accidental injuries internal organs were also injuries and life-threatening. Conclusions: The prevalence of injuries amongst medicolegal cases was found to be higher in our study in comparison to other studies done in similar settings. Most of the injuries were due to physical assault; however, the majority of road traffic injuries were life-threatening. These road traffic injuries could have been prevented by following a safe system approach to road safety.

Pesticide Poisoning among All Poisoning Cases Presenting to the Emergency Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Acute pesticide poisoning is a significant global public health issue that contributes to one of the leading causes of emergency department visits. There is no national data on the incidence of acute pesticide poisoning or the pesticides that cause deaths. The purpose of this study is to find the prevalence of pesticide poisoning among patients who presented to the emergency department with acute poisoning. Methods: This was a descriptive cross-sectional study undertaken in a tertiary care hospital from April to September 2021 among patients who presented to the emergency department with acute poisoning. Ethical clearance was obtained from (reference number: 123/2077-78). Convenient sampling was done. Sociodemographic factors, types of poison consumed, route of consumption, reason, motive, and place of poison intake, time elapse in the presentation to the hospital were studied along with psychological factors associated with poisoning. Statistical analysis was done using Statistical Package for the Social Sciences version 23. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 85 cases studied, the prevalence of pesticide poisoning was 60 (70.58%) (61.28-79.88 at 90% Confidence Interval). Insecticides 41 (68.33%) was mainly responsible for poisoning with organophosphate compounds 33 (42.30%), being the commonest chemical constituent. Fifty-three (88.33 %) incidents occurred at home. Domestic disputes 26 (43.33%) were the main reason behind poison consumption and suicide 43 (71.66%) was the main motive. Conclusions: The prevalence of pesticide poisoning among all cases of poisoning presenting to the emergency department was slightly higher than studies done earlier in similar settings.

C-reactive Protein to Albumin Ratio among Patients Admitted to Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Crosssectional Study

Introduction: Sepsis is the most common cause of mortality among patients admitted to intensive care unit. There is emerging evidence on the role of C-reactive protein to albumin ratio (C-reactive protein/Albumin) in predicting outcomes in patients with critical illness and sepsis, admitted to intensive care unit. We aimed to find out the median value of C-reactive protein/Albumin ratio among patients admitted to intensive care unit of a tertiary care hospital. Methods: We conducted a descriptive cross-sectional study of 110 critically ill patients (>18 years old) admitted to intensive care unit of Dhulikhel Hospital from April, 2014 to June, 2016. The ethical approval (Reference number.51/16) was obtained from Institutional Review Committee at Kathmandu University School of Medical Sciences. C-reactive protein/albumin ratio was calculated from records of patients admitted to the intensive care unit. Convenience sampling was done. Data were entered into Microsoft Excel and analysed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequencies and percentages for binary data. Results: Among 110 patients admitted to the intensive care unit, the median value of C-reactive protein/Albumin ratio was found to be 3.4 (Interquartile range: 3.1-4.5). Conclusions: Our study showed higher median C-reactive protein /Albumin similar to toher studies. Sepsis is a common finding among patients admitted to intensive care unit. Monitoring of C-reactive protein/albumin level in a patient admitted to intensive care unit could be useful for stratifying patients with a high risk of developing sepsis.

Ways to Make Medical Students Competent Professionally: View of Medical Students

Medical students in Nepal learn passively by gaining encyclopedic knowledge, with little focus on the application of that knowledge to clinical scenarios and other soft skills like communication. This raises the question that whether medical students will be competent enough to serve their society in the future or not. The article highlights the domains where medical students should focus apart from medical knowledge to be competent enough to meet the health needs of society.

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

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

Endoscopic Septoturbinoplasty among Patients Undergoing Surgery in the Department of Otolaryngology-Head and Neck of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Septoplasty without turbinoplasty is one of the main reasons for failure of procedure in case of deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty is the procedure of choice for complete treatment. The main objective is to find out the prevalence of endoscopic septoturbinoplasty among patients undergoing surgery in Department of Otolaryngology-Head and Neck of a tertiary care hospital. Methods: This was a descriptive cross-sectional study in Department of Otolaryngology-Head and Neck Surgery done over a period of 1 year duration from 1st August 2020 to 31st July 2021 among 1248 patients who underwent surgery in the department. Ethical Approval was taken from Institutional Review Committee of Kathmandu Medical College and Teaching Hospital (Reference number: 2207202004). A convenience sampling technique was used. Two different techniques, Microdebrider Assisted Turbinoplasty and Outfracture with Submucosal Diathermy were used in surgery. Nasal Obstruction and Symptom Evaluation Scale questionnaire was used pre and postoperatively for data collection. Data were analyzed in Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated, with frequency, percentage, mean and standard deviations. Results: Out of 1248 patients, about 92 (7.37%) patients (4.95-10.14 at 95% Confidence Interval) underwent septoturbinoplasty. The mean Nasal Obstruction and Symptom Evaluation Scale before surgery was 75.21±6.19. Conclusions: The prevalence of septoturbinoplasty in our study is similar to other studies done in similar settings. We found almost complete resolution of breathing problems following endoscopic septoturbinoplasty, hence improving quality of life.

Bilateral Neuroendocrine Carcinoma of Breast: A Case Report

Primary neuroendocrine carcinomas of the breast are rare of all breast carcinomas. They may be welldifferentiated, poorly differentiated, or invasive breast cancers with neuroendocrine differentiation. They are staged and treated similarly to conventional breast cancer. Herein, we report a case of invasive ductal carcinoma with neuroendocrine differentiation of the breast in a 73 years female with a history of breast lump initially in the lower inner quadrant of left breast and a month later, similar lump at the same site in right breast. Patient underwent Modified Radical Mastectomy bilaterally followed by adjuvant chemotherapy based on Carboplatin and Etoposide regimen.

Manual Anesthesia Record Keeping at a Tertiary Care Center: A Descriptive Cross-sectional Study

Introduction: Intraoperative record form is one of the cardinal parts of anesthesia practices. Ideally, it should contain complete information about patients under anesthesia and intraoperative events. It serves as valuable information for subsequent patient management, research, or during medicolegal conditions. The objective of this study was to assess the practice and completeness of manual intraoperative anesthesia record keeping. Methods: A descriptive cross-sectional study was conducted from May 1 to July 31, 2021, in the postoperative ward of Kathmandu Medical College, which is a multispecialty tertiary care center. Approval from the ethical committee of Kathmandu Medical College Teaching Hospital was obtained (Reference: 2603202105) before conducting the study. Convenience sampling was used. The data were entered in Microsoft Excel and statistical analysis was done using Statistical Package for the Social Sciences version 20. Point estimate was done at 95% Confidence Interval and data present in numbers and percentages. We devised forty-two variables, which included demographics, personal identifiers, intraoperative events, anesthesia and airway management, intraoperative parameters, monitoring and medication. Results: The overall completion rate was 202 (52.59%) (47.6-57.57 at 95% Confidence Interval). Out of 42 variables, the completion rate of 14 variables was less than 50%. Among those were important parameters such as known allergies 94 (24.4%), Body mass index 50 (13%), intraoperative saturation of oxygen 104 (27%), intraoperative electrocardiogram recording 107 (27.8%), total fluid volume administered 45 (11.7%), patient status on transfer 84 (21.8%) had poor completion rate. Conclusions: Our intraoperative record form shows poor completion rate, which was similar to other studies. many important variables were missing and had incomplete data.

Compliance of WHO Surgical Safety Checklist at a Pediatric Surgical Unit in a Tertiary Level Hospital: A Descriptive Cross-sectional Study

Introduction: The Surgical safety checklist by World Health Organization has been used for the last two decades. There is every chance of unwanted expected disasters in Operating-Room in Pediatricsurgical cases. Our study is to observe the utilization of the safety checklist and evaluate occurrence of never-events in Tertiary Level Pediatric Surgery Unit in Nepal. Methods: A descriptive cross-sectional study was done at Nepal Medical College Teaching Hospital from January 2021-June 2021 with record-based data of children from 0-15 years operated in Pediatric Surgery unit from March 2017-July 2018. Ethical approval (Reference number: 049-077-078) was taken from the Institution review committee of the institute. Convenience sampling was done. Self-designed Pro-forma with demographic data along with World Health Organization-Surgical-safety-checklist used was collected and entered in Microsoft-Excel. Data were analyzed using Statistical-Package-for-the-Social-Sciences-version-25. Results: Out of 267 cases enrolled, 103 (38.6%) (35.6-41.6 at 95% Confidence Interval) were fully compliant with the checklist, 69 (25.8%) partially compliant. Among compliant cases, 148 (55.4%) Sign-in part, 128 (47.9%) cases -Time-out part and 152 (56.9%) cases Sign-out part were complete. Conclusions: Compliance with World Health Organization-Surgical-safety-checklist has a major role in preventing morbidity and mortality in Pediatric surgical cases. With proper use of the checklist, the unwanted never-events can be prevented with better surgical outcomes.